What is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy or DBT is a type of psychotherapy that was originally developed to treat people with Borderline Personality Disorder (also known as Emotionally Unstable Personality Disorder), by Marsha M. Linehan, a psychology researcher at the University of Washington.
DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice.
DBT usually involves two components, individual and group.
The patient and the therapist discuss current issues and follow a treatment plan based on priorities:
- 1st priority: Self harming and suicidal behaviours are included in this category and are targeted first.
- 2nd priority: Behaviours which will interfere with the treatment.
- 3rd priority: This group includes behaviours which affect the patient's quality of life in general.
Group therapies usually meet up once a week for at least an hour and most group therapies are broken down into four skill modules:
- Core Mindfulness
- Interpersonal Effectiveness
- Emotional Regulation
- Distress Tolerance
Neither component is used by itself. The individual component is considered necessary to keep suicidal urges or uncontrolled emotional issues from disrupting group sessions, while the group sessions teach the skills unique to DBT, and also provide practice with regulating emotions and behavior in a social context.
The Four Modules
- Observe: This is used to observe one’s environment within or outside oneself, without judgment. It helps to aid understanding what is going on in any given situation.
- Describe: This is used to express what one has observed with the observe skill. It is to be used without judgmental statements. This helps with letting others know what you have observed.
- Participate: This is used to help you fully focus on what you are doing.
- Non-judgment: This is the action of describing the facts, and not thinking about what is good, bad, fair, or unfair, for example. These examples are not part of a factual description, but are a judgment based in how you feel about the situation. Being non-judgmental helps to get your point across in an effective manner without adding a judgment that someone else might disagree with.
- One-mindfully: This is used to focus on one thing. One-mindfully is helpful in keeping your mind from straying into emotional judgments because of a lack of focus.
- Effectively: This is simply doing what works. It is a very broad-ranged skill and can be applied to any other skill to aid in being successful when using that skill.
Mindfulness is one of the core concepts behind all elements of DBT. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations.
Although the concept of mindfulness and the meditative exercises used to teach it are derived from traditional Buddhist practice, it does not involve any religious or metaphysical concepts.
Within DBT it is the capacity to pay attention, non-judgmentally, to the present moment and experiencing one's emotions and senses fully, yet with perspective.
- What skills
- How skills
- Distress tolerance
- Activities: Use positive activities that you enjoy.
- Contribute: Help out others or your community.
- Comparisons: Compare yourself either to people that are less fortunate or to how you used to be when you were in a worse state.
- Emotions: Feel something different by provoking your sense of humor or happiness with corresponding activities.
- Push away: Put your situation aside for a while and concentrate on something else.
- Thoughts: Force your mind to think about something else.
- Sensations: Do something that has an intense feeling other than what you are feeling. For example, taking a cold shower or eatin spicy food.
- Imagery: Imagine relaxing scenes, things going well, or other things that give you pleasure.
- Meaning: Find some purpose or meaning in what you are feeling.
- Prayer: Either pray to whomever you worship, or, if not religious, chant a personal mantra.
- Relaxation: Relax your muscles, breathe deeply. Used with self-soothing.
- One thing in the moment - Focus your entire attention on what you are doing right now. Keep yourself in the present.
- Vacation: Take a break from it all for a short period of time.
- Encouragement: Talk to yourself in an encouraging way. Tell yourself you can make it through this.
- Distract with ACCEPTS
This is a skill used to distract oneself temporarily from unpleasant emotions.
This is a skill in which you behave in a comforting, nurturing, kind, and gentle way to yourself. You use it by doing something that is soothing for you. It is used in moments of distress or agitation.
- IMPROVE the moment
This skill is used in moments of distress to help you relax.
- Pros and cons
- Think about the positive and negative things about not tolerating distress.
- Let go of fighting reality. Accept your situation for what it is.
Turning the mind
- Turn your mind toward an acceptance stance. It should be used with radical acceptance.
Willingness vs. willfulness
- Be willing and open to do what is effective. Let go of a willful stance which goes against acceptance. Keep focused on the goal in front of you.
- Emotion regulation
- Identify and label emotions
- Identify obstacles to changing emotions
- Reduce vulnerability to emotion mind
- Increase positive emotional events
- Increase mindfulness to current emotions
- Take opposite action
- Apply distress tolerance techniques
- Prompting event
- Interpretation of the event
- Body sensations
- Body language
- Action urge
- Emotion name (based on the previous items on this list)
- PhysicaL illness: If you are sick or injured, get proper treatment for it.
- Eating: Make sure you eat a healthy diet, and eat in moderation.
- Avoid mood-altering drugs: Do not take non-prescribed medication or illegal drugs. They are very harmful to your body, and can make your mood unpredictable.
- Sleep: Do not sleep too much or too little. Eight hours of sleep is recommended per night for the average adult.
- Exercise: Make sure you get an effective amount of exercise, as this will both improve body image and release endorphins, making you happier.
- MASTERy: Try to do one thing a day to help build competence and control.
Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense. They can be angry, intensely frustrated, depressed, or anxious.
This suggests that these people might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include:
- Story of Emotion
This skill is used to understand what kind of emotion you are feeling.
- Please Master
This skill concerns ineffective health habits can make one more vulnerable to emotional mind. This skill is used to maintain a healthy body, so you are more likely to have healthy emotions.
- Opposite action
- This skill is used when you have an unjustified emotion, one that doesn’t belong in the situation at hand. You use it by doing the opposite of your urges in the moment. It is a tool to bring you out of an unwanted or unjustified emotion by replacing it with an opposite emotion.
- This is used to solve a problem when your emotion is justified. It is used in combination with other skills.
Letting go of emotional suffering
- Observe and experience your emotion, accept it, then let it go.
- Interpersonal effectiveness
- Describe your situation.
- Express why this is an issue and how you feel about it.
- Assert yourself by asking clearly for what you want.
- Reinforce your position by offering a positive consequence if you were to get what you want.
- Mindful of the situation by focusing on what you want and ignore distractions.
- Appear Confident even if you don’t feel confident.
- Negotiate with a hesitant person and come to a comfortable compromise.
- Gentle: Use appropriate language, no verbal or physical attacks and no put downs. Avoid sarcasm unless you are sure the person is alright with it, and be courteous and non-judgmental.
- Interested: When the person you are speaking to is talking about something, act interested in what they are saying. Maintain eye contact, ask questions, etc.
- Validate: Show that you understand a person’s situation and sympathize with them. Validation can be shown through words, body language and/or facial expressions.
- Easy Manner: Be calm and comfortable during conversation, use humor, smile.
- Fair: Be fair to both yourself and the other person.
- Apologies: Do not apologise more than once for what you have done. Do not apologise for what you haven't done.
- Stick to Your Values: Stay true to what you believe in and stand by it. Don’t allow others to get you to do things that go against your values.
- Truthful: Do not lie. Lying can only damage relationships and your self-respect.
Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for your needs, saying no, and coping with interpersonal conflict.
Individuals with borderline personality disorder generally possess good interpersonal skills. The problems arise in the application of these skills to specific situations.
An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing his or her own situation.
The interpersonal effectiveness module focuses on situations where the objective is to change something, for example requesting that someone do something or to resist changes someone else is trying to make, for example saying no.
The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.
- DEARMAN - getting something
This acronym is used to aid you in getting what you want when asking.
- GIVE - giving something
This skill set aids you with maintaining your relationships, whether they are with friends, coworkers, family, romantic partners, etc. It is to be used in conversations.
- FAST - keeping self-respect
This is a skill to aid you in maintaining your self-respect. It is to be used in combination with the other interpersonal effectiveness skills.