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Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT)
When I talk to clients about using Dialectical Behavior Therapy or DBT as part of their treatment process, they can be skeptical. Often, they don’t understand what DBT is or how it might help them. So, I wanted to take a moment and explain DBT for readers who might like to know more, particularly as it can be useful outside of a formal DBT program.
What is DBT?
DBT is a fast growing, and widely recognized treatment for a variety of different presenting problems. The “D” is probably the most challenging concept to understand. Dialectical means finding balance. It is the idea that things which appear opposite can both be true at the same time. For instance, I can be angry with someone and also care about them. I don’t have to choose one or the other. Increasing dialectical thinking allows us to move away from extreme, concrete, or black and white ways of thinking that keep us stuck. The basis of all DBT skills is finding this equilibrium in our emotional experience, relationships with others and sense of being. Mastering those skills can lead to more fulfilling relationships, a greater sense of hope, and confidence in our ability to manage our lives.
The Four Modules
DBT has four parts, or modules. The first is mindfulness. Mindfulness means being in the “now.” Increasing our ability to do this can significantly help decrease feelings of depression or anger which are often a result of the past. Additionally it helps relieve stress and anxiety which are caused by focusing too much on the future. Incorporating mindfulness in the therapy process, and in our daily lives, creates a sense of control, reduces impulsive actions, and allows us to appreciate and celebrate all of the wonderful things life has to offer.
The second module is distress tolerance. People often experience mental health symptoms because they’ve become more vulnerable to distress. Things they may have been able to handle more easily before suddenly become challenging, or impossible. When we become saturated with stress we rely on old coping skills that aren’t very effective like binge eating or yelling at our spouse. And ultimately these create even bigger problems than the ones we started with. Learning distress tolerance skills allows us to better cope with the inevitable stress we will experience in life without acting in ways that make our problems worse.
The next module is called emotion regulation. These skills allows us to understand what emotions are, why we have them, and how they can help us. The coping strategies in this section allow us to manage our emotional intensity, or even change our emotional experience altogether. If you notice that you have an extreme emotional response to something that is not working for you, emotion regulation skills allow you to choose alternative ways to handle the situation and ultimately get to a point where you no longer experience that feeling in the same way.
Interpersonal effectiveness is the last skill set, and an important one. Interpersonal effectiveness is a fancy way of saying “communication skills.” This section is all about learning to set boundaries with others, increasing our ability to relate to others effectively, find new relationships, end old ones and enjoy our experiences with people in a more healthy and meaningful way.
The Skills
DBT isn’t as complicated as you may think. In fact, you’ve likely used some of the DBT skills before without realizing it. For example, distraction is a skill from the distress tolerance section. Using it, we’re encouraged to distract ourselves from an intense emotion or situation if we cannot act effectively to address it. This might look like taking a time out, watching TV, or listening to music. The difference here is, we practice the distraction skill with every intention of returning to the  distressing situation when we are calm and can be more effective, instead of simply avoiding the situation altogether.
DBT is often used in a group setting, however it can be effective in outpatient, individual or family therapy, as well. Assessing your needs during the session can help determine which DBT skill might be most appropriate to learn and practice. For instance, a client might come to my office concerned about an upcoming event they have to attend which causes significant anxiety. They don’t want to avoid attending the event because it would create bigger problems in the long run, but they aren’t sure how to tolerate their emotions while there. I might suggest implementing the skill called “Improve the Moment.” This works when a situation is unavoidable and we want to make it as tolerable as possible. We would talk in session about ways to improve the moment that work for the client and then develop a plan of action.
In all my years of teaching these skills to clients, the most common feedback I receive is “Why don’t they teach this in school? Everyone should know this.” And there’s a lot of truth to this. DBT isn’t just useful for addressing mental health issues. It can teach basic life skills which in turn, create a more meaningful and fulfilling life. DBT can help us get along better with others, and even more importantly, ourselves. And aren’t we all looking for that goal?

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