What is DBT?
Dialectical behavior therapy (DBT) treatment is a type of psychotherapy — or talk therapy — that utilizes a cognitive-behavioral approach. Developed by Marsha Linehan, DBT emphasizes the psychosocial aspects of treatment.
The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.
Components of DBT
- Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
- Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
- Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.
The 4 Modules of Dialectical Behavior Therapy
The essential part of all skills taught in skills group are the core mindfulness skills.
Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”
Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”
2. Interpersonal Effectiveness
The interpersonal response patterns –how you interact with the people around you and in your personal relationships — that are taught in DBT skills training share similarities to those taught in some assertiveness and interpersonal problem-solving classes. These skills include effective strategies for asking for what one needs, how to assertively say ‘no,’ and learning to cope with inevitable interpersonal conflict.
3. Distress Tolerance
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.
Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.
4. Emotion Regulation
People who may be suicidal or who are having intense mental health symptoms are typically emotionally intense and labile — frequently angry, intensely frustrated, depressed, and anxious. This suggests that people grappling with these concerns might benefit from help in learning to regulate their emotions.
Dialectical behavior therapy skills for emotion regulation include:
- Learning to properly identify and label emotions
- Identifying obstacles to changing emotions
- Reducing vulnerability to “emotion mind”
- Increasing positive emotional events
- Increasing mindfulness to current emotions
- Taking opposite action
- Applying distress tolerance techniques