Dialectical Behavior Therapy, DBT therapy

Dialectical Behavior Therapy

DBT skills therapy

Most clients I work with get to learn more about DBT or Dialectical Behavior through our conversations. DBT has been around for at least two decades, first developed by psychologist Marsha Linehan. It is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) but has since been adapted for depression, substance abuse, and eating disorders. It tends to be active in its approach by providing skills or a  road map in terms of dealing with life’s challenges.

The term “dialectical” means a synthesis or integration of opposites. In lay man’s term: we tend to sometimes see things as black or white, good or bad, empty or full. DBT helps us balance out these two perspectives to incorporate an emerging point of view that holds both simultaneously. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For some of us this can translate to- accepting ourselves for who we are as well as noting that there are things about us we need to change.

DBT includes four sets of behavioral skills.

  • Mindfulness: the practice of being fully aware and present in the moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not jump to change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change and work through emotions that we want to change

Over a decade of learning and teaching DBT, here are five skills that I have found to be most helpful and frequently use and recommend to clients:

  1. Checking the facts: Very applicable to those of us who are extremely sensitive to others or at time over-sensitive to others. The central premise being that our perception of reality is not reality itself but our view of reality as we know it (personal and subjective). When our emotions don’t fit the facts (reality) or the intensity of our emotions don’t fit the facts, DBT recommends being aware of the emotions we are experiencing that we want to change, considering the event prompting the emotion (aiming to be as factual as possible), considering the threat we are assuming and assessing whether that threat is real, contemplating the worst case scenario, and finally- whether the emotion or its intensity fits the facts. For example, someone walks past me and doesn’t say hello or look in my direction. I can assume they don’t like me,  or they’re weird. Checking the facts may include gathering some information surrounding this situation. Does this person always interact this way? Have there been other signs of antagonism towards us? What are the other person’s personal circumstances. It also means getting out of our zone and trying to see things from a different perspective.
  2. Coping ahead: Coping ahead is an emotion regulation skill that reminds us to plan ahead and force issues and difficulties before they overwhelm us and strategize to reduce their severity or impact. Coping ahead of a stressful family interaction may mean limiting our time with family member, bringing a neutral person to the interaction, scheduling a therapy session in the vicinity of the interaction, and planning a positive activity/event for the following day.
  3. Willing hands: A part of radical acceptance that teaches us to accept things that we don’t have control over and cannot change. Willing hands means turning our mind towards the stance of surrendering and allowing our body to show its willingness towards that process. Sitting with your hands on your knees, palms facing upwards conveys to the body to accept what the mind has difficulty accepting. This posture is a channel to allowing your body to speak to your mind.
  4. Opposite Action: Our thoughts lead to our emotions which in turn lead to action urges and finally behavior. Put another way: Thoughts–> Emotions –> Action Urges–> Behavior. The thought that I am a failure can lead to the emotion of embarrassment or shame, can lead us to wanting to isolate or shy away from others, can lead us to avoiding social contact with others or hastily ending interactions. Opposite action means asking ourselves if the action urge is skillful or effective for us to engage in both the long term and the short term. If not, then to practice the opposite of that emotion urge. In this situation, if avoiding contact with others hurts my personal or professional life then I must engage in the opposite of the urge–make and maintain contact with others despite the seeming difficulty.
  5.  DEAR MAN: It may sound strange but Dearman is an acronym to an interpersonal effectiveness skill used when we are aiming to achieve a goal whilst communicating the importance of this goal to others. D stands for describe the problem: “Joe, you come home late at night and at times use the kitchen/phone/bathroom in a manner that wakes me up. This disturbs my sleep”. E = expressing emotions: “I also get frustrated as it sometimes takes me several minutes to an hour to go back to sleep and nervous about whether I will get a good night’s rest”. A= assert: “I would really appreciate it if you would be more mindful of our shared space and the noise levels when you get back home”. R= reinforce: “I really value being your roommate and know that you are mostly quite considerate of my needs”. M= being Mindful of staying on track and not getting tangential: “Sleep is important to me as it really interferes with my ability to function the next day”. A=appearing confident in our tone of voice and body language, N= negotiate: “Not sure if you have encountered this, but pls feel free to let me know if I inadvertently disturbed you”.

If any of this sounds interesting to you, try reading and learning more or talk to your therapist about it. DBT provides skills that we can use regardless of our age, life circumstance and problem behavior.

For those of you in NYC, I lead a DBT skills group each week that provides a unique opportunity to learn and be challenged by others. Contact me for more information or if you would like to join.



Behavior Tech website: http://behavioraltech.org/resources/whatisDBT.cfm



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