Dialectical Behavior Therapy (DBT) is a comprehensive cognitive behavioral therapy that can be effective in treating a variety of problems including suicidal thinking, self-injurious behaviors, depression, impulsive behaviors, and substance use. DBT emphasizes that we need to learn more adaptive skills to replace the behaviors that are not serving us and to address the problems that are causing difficulty in our lives.
DBT is derived from the philosophical process of dialectics: the balancing of opposites. Therapists who practice DBT form a therapeutic alliance and cultivate healing through dialectically balancing acceptance with change strategies. DBT emphasizes an accepting, non-judgmental, and validating approach to clients. Therapists utilizing a DBT approach strive to understand their client’s feelings, thoughts, and behaviors make sense given the context of their unique situation.
DBT can be practiced in individual and group settings and is largely skills-based. Standard DBT contains four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. As with any new skill, these skills often require a lot of practice. Let’s start here!
Mindfulness Skills: Mindfulness skills teach us how to observe and experience reality as it is, to be less judgmental, and to live in the moment with effectiveness.
Walking Down the Spiral Stairs: Imagine that within you is a spiral staircase, winding down to your very center. Starting at the top walk very slowly down the staircase, going deeper and deeper within yourself. Notice the sensations. Rest by sitting on a step, or turn on the lights on the way down if you wish. Do not force yourself to go further than you want to go. Notice the quiet. As you reach the center of your self, settle your attention there—perhaps in your gut or abdomen.
Interpersonal Effectiveness Skills: Interpersonal Effectiveness skills help us to manage interpersonal conflicts effectively and maintain and improve relationships with other people.
(Be) Fair- Be fair to yourself and to the other person. Remember to validate your own values and wishes as well as the other persons.
(No) Apologies- Don’t over apologize. No apologizing for making a request, having an opinion, or disagreeing.
Stick to Values- Don’t sell out your values and/or integrity.
(Be) Truthful- Don’t lie. Don’t act helpless when you’re not. Don’t exaggerate and make up excuses.
Emotional Regulation: Emotion Regulation Skills help us to manage emotions.
PL: Treat Physical Illness- Tale care of your body. See a doctor when necessary. Take Prescribed Medication
E: Balance Eating
A: Avoid Mood-Altering Substances
S: Balance Sleep- 7-9 hours of sleep each night
E: Get Exercise- Try to build up to 20 minutes of daily exercise
Distress Tolerance: Distress Tolerance skills help us to learn to tolerate and survive crisis without making things worse.
T: Tip the Temperature- use cold water to change emotions
I: Intense Exercise
P: Paced Breathing and Paired Muscle Relaxation
(Linehan, 2015).
Written by Kimberly Bonsiero, LCSW-C
Read more about Kim HERE.