Dialectical Behavioral Therapy

Dialectical behavior therapy (DBT) is a modified form of Cognitive Behavioral Therapy (CBT) that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder. DBT is now recognized as the gold standard psychological treatment for those with borderline personality disorder. The primary goals of DBT are to teach people how to live in the moment, develop healthy ways to cope with stress, to regulate their emotions, and improve relationships with others. Besides Borderline personality research has shown that DBT can be effective in treating a wide range of other disorders including eating disorders, depression, substance dependence and even PTSD.

DBT includes four behavioral skill modules. Mindfulness and distress tolerance are considered acceptance oriented skills. Interpersonal effectiveness and Emotion regulation are change-oriented skills.

• Mindfulness: the practice of being fully aware and present in that moment
• Distress Tolerance: how to tolerate pain in difficult situations, not 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 decrease vulnerability to painful emotions and change emotions that you want to change

DBT therapy includes the benefit of developing mindfulness skills. Mindfulness helps you focus on the present minutes or even seconds “live in the moment.” This helps one pay attention or focus on what is happening inside them (their thoughts, sensations, impulses and feelings). Mindfulness also helps one tune into what’s happening around them (what one can see, smell, hear, taste and touch) in nonjudgmental ways.

Mindfulness helps you slow down time and focus on using healthy and appropriate coping skills during emotional discord. This strategy can help one stay calm, non-reactionary or impulsive and avoid engaging in automatic negative thought patterns and impulsive behavior like self harm/cutting.

Distress tolerance allows one to tolerate the current situation and find self-acceptance. DBT teaches four techniques for handling a crisis and diffusing the stress including:

• Distraction such as journaling or changing to a new task
• Improving the moment but staying in the moment
• Self-soothing
• Thinking of the stressor and tolerating the good and bad with it

Distress tolerance techniques help prepare one for intense emotions.

Interpersonal effectiveness helps you to become more assertive in a relationship. This includes the ability to say “no” while allowing the relationship to remain positive and healthy. That saying “no” is okay and sometimes good, appropriate and healthy. Interpersonal effectiveness teaches one to listen and communicate more effectively, deal with challenging people, and respect oneself with proper walls, boundaries and limit setting in relationships.

Emotion regulation lets one navigate extreme feelings more effectively. The emotion regulation skills help one to identify and mitigate those extreme emotions. This is based on a belief that when one can recognize and cope with intense emotions (such as anger), it reduces emotional vulnerability and helps gravitate towards more positive emotional experiences.