Dialectical Behavior Therapy (DBT): What is it, Who is it Good for, and How Does it Work? 

 

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment that was initially designed to help people who were chronically suicidal, self-injuring and also for treatment for Borderline Personality Disorder.  Since it’s existence, it has also shown to be proven effective for treating other issues such as: substance use/abuse, victims of domestic violence and trauma, PTSD and Complex PTSD, as well as mood disorders such as Anxiety and Depression and Bipolar Disorder.  DBT has also been proven effective through clinical studies for those individuals who experience heightened emotional reactivity (emotional dysregulation), or intense emotional responses to triggers.   

Emotional dysregulation has been linked to a wide range of mental health conditions stemming from patterns of instability in regulating emotions, impulse control, interpersonal relationships and self-image.  DBT skills are directly aimed at these dysfunctional patterns.  The overall goal of DBT is to help individuals change behavioral, emotional, thinking, and interpersonal patterns associated with problems in living. 

In DBT, people begin to see and accept “dialectics” in thinking and feeling.  A dialectic is when two opposing thoughts or feelings can be true at the same time.  For example, you can love your parents but also be very angry at their treatment toward you.  A lot of times when someone is emotionally dysregulated, it is very easy to lose sight of the dialectic.  DBT skills help people learn focus their thoughts and feelings on these polarities and learn practical daily living skills to identify these dialectics and ways to get out of them. 

Although there are formal DBT style programs, you can still benefit from DBT skills by practicing with an individual therapist who is DBT informed or trained.  DBT can be broken down into two main skill groups:  Acceptance Skills and Change Skills.  The first area of focus is on Mindfulness.  Mindfulness is the act of consciously focusing the mind on the present moment without judgment or getting too attached to the moment itself.  This forces us out of our automatic thinking and behavior patterns.  Mindfulness teaches you to be present in the moment no matter how uncomfortable the feelings are you are experiencing.  Feelings pass, albeit not as quickly as we may like, but they do pass.  Mindfulness teaches you how to accept and understand these feelings, teaching one to “ride the wave out”.  One of the most important Mindfulness skills is to teach people to use their WISE Mind.  WISE Mind helps to regain perspective between our rational thoughts and our over or under-emotional reactions.  WISE Mind begs us to ask the question, “Do my emotions fit the facts of the situation I am currently experiencing?” 

The other areas that are focused on in DBT consist of: Emotional Regulation Skills, Distress Tolerance Skills and Interpersonal Effectiveness.  Emotional Regulation Skills help to identify emotions and give practical ways to learn to have a more balanced way of responding versus reacting over or under-emotionally.  Unfortunately, for a lot of people, uncomfortable emotions such as: sadness, anger, rejection, embarrassment, and disappointment, are hard to sit with.  Most people will try to avoid negative feelings as much as possible, which is when masochistic and self-destructive patterns emerge.  Emotional Regulation Skills also allow the person to reduce these unwanted emotions. 

Distress Tolerance is the ability to tolerate and survive crisis situations without making things worse.  The skills teach us how to accept and fully enter into a life that may not be the life we hoped for or want.  When we experience heightened emotions, they can often feel like the world is caving in on you.  These skills help to tolerate painful events, urges and emotions when we cannot make things better for ourselves right away.  They permit us to reduce suffering by accepting and living a life that is not the life we want.  They also enable us to back down from addiction and self-destructive behaviors and live a life of abstinence.   

Interpersonal Effectiveness Skills help us to maintain and improve our relationships both with people who are close to us and also with strangers.  Core interpersonal effectiveness skills teach us how to deal with conflict situations and to express our wants and needs in a healthy and productive way.  They also help us learn to say no to unwanted requests and demands all while maintaining our self-respect and others’ respect for us.  These skills enable us to find potential friends and maintain positive relationships with others.  They show how to build closeness with others and to end any destructive relationships that are not good for you.  They help us to walk a “middle path” in our relationships by balancing acceptance of what is, and working to change within ourselves and our relationships.    

One of the reasons why DBT has been proven effective in treating many mental health conditions is that each of these conditions are associated with issues that are the result of unhealthy and problematic efforts to control negative, intense emotions.  Rather than focusing on efforts that cause the problems for the person, it rather helps people learn healthier ways to cope.  DBT skills are really at their core, coping skills.  When most people come to therapy, it is with the goal of learning how to cope with whatever is going on in their lives.   

These skills when practiced, result in overall improved well-being and lead the person to leading a more balanced and less destructive lifestyle.  There are many resources available online devoted to teaching DBT skills and learning ways to practice them daily.  Through individual therapy, a therapist can help hone in on what skills would be useful and beneficial to practice given the person’s unique symptoms and emotions toward their triggers.  Marsha Linehan, who developed DBT summarized DBT best when she said: “It is hard to be happy without a life worth living.  This is a fundamental tenet of DBT.  Of course, all lives are worth living in reality.  No life is not worth living.  But what is important is that you experience your life as worth living- one that is satisfying and one that brings happiness.” 

Harmony Bay offers a number of mental health services and therapies, including DBT therapy. Contact us today by calling 855.956.1493 to learn more. Click trauma to book an appointment today. 

Published on 11/3/2022 | Written by Harmony Bay Therapist, Nicole Drake, LPC, LCASC, ACS