You may have heard talk of DBT but have absolutely no idea what it stands for after all psychology loves its acronyms. DBT stands for Dialectical Behaviour Therapy, a newer therapeutic orientation that shares some similarities to CBT, or Cognitive Behavioural Therapy, but with many substantial differences. Originally developed by Marsha Linehan, DBT was first and foremost meant as an effective method of treatment for individuals with Borderline Personality Disorder (BPD) 1, 3. The scope of usefulness of DBT has expanded, incorporating primarily eating disorders, anxiety disorders, and mood disorders 1.
I have been lucky enough to be able to learn about and experience DBT through Share Forde and Kelly Williams at Alongside You 4. One thing that has become apparent to me throughout this learning is that everyone could benefit from the skills taught in DBT. Heck, I’m sitting there thinking, “Wow, I don’t even know how to handle these situations…” Dialectical Behaviour Therapy isn’t just for people with BPD, but rather for anyone and everyone looking to improve their coping and interpersonal skills.
The basic premise of Dialectical Behaviour Therapy is dialectics, which pays tribute to the philosophical principle of opposite truths 2. This idea posits that an individual can hold opposing viewpoints simultaneously while looking for truth in both positions; opposite views can exist in one person at the same time 3. This concept can often ring true in individuals struggling with suicidal ideation. It is entirely possible that an individual can both want to die and want to live while finding truth in both of those contradicting statements 3. These opposing viewpoints lead to tension and conflict, which may be necessary to bring about change 3. Dialectics identify multiple truths inherent in any situation and promote flexible thinking, a nonjudgmental stance, and active application of mindfulness 2.
DBT therapy is comprised of four main modules: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation 1.
Mindfulness
Mindfulness is the first core skill taught and one might say the most instrumental; without mindfulness, the other modules may prove ineffective. One of the main concepts of mindfulness first taught is “wise mind”. This is a construct that is returned to time and time again throughout skills training. Wise mind is the idea that every individual has a “rational mind” and an “emotional mind”, with the wise mind being a healthy balance of the two. If an individual is too far into rational mind then they are not experiencing any intuition, if an individual is too far into emotional mind they may not be able to make sound decisions. Returning back to the idea of dialectics there are truths inherent in both rational and emotional mind and it is important to learn to balance the two. The function of mindfulness is to train an individual to bring nonjudgmental awareness to the present moment 1. This is achieved by activating wise mind, where an individual can effectively observe, describe, and participate without judgment 1.
Distress Tolerance
Distress tolerance can also be viewed as “crisis skills”. With distress tolerance skills training participants are given tools to aid in tolerating strong dysregulated emotions when a solution to a problem is not immediately presented 1. Some skills taught in this module are distracting or self-soothing activities, with a later emphasis on willingness and radical acceptance 1. Willingness and radical acceptance can be viewed as more difficult skills to learn, but tend to lead to more enduring life changes 1. Let me tell you, after learning about radical acceptance I can say without a doubt that it is one of the toughest skills and I will be hugely proud the day I can effectively utilize this skill. Radical acceptance is not saying something is right, fair, or permissible, but rather saying that what is, is and that it is outside our power to change in the moment.
Interpersonal Effectiveness
Relationship skills are divided into three sections: reaching goals, making and maintaining relationships, and maintaining self-respect 1. A common challenge to this module is the complaint that the skills taught are less effective when the other party is unwilling to engage in these techniques. If an individual is learning these skills so that they might better interact with family, friends, or partners, it stands to reason that the other party being privy to these skills would prove beneficial.
Emotion Regulation
Like all skills modules, it is imperative that mindfulness skills are constantly applied throughout training 1. Learning self-validation, naming, identifying, and triggering of emotions allows individuals an opportunity to become aware of the link between accompanying body sensations, thoughts, and actions 1. My favourite part of Dialectical Behaviour Therapy thus far is the idea of self-validation around emotions; no emotion an individual feels is “wrong”, but perhaps the way they are expressing it can be attended to. In other words, there is nothing wrong with feeling angry, anger is a natural emotional reaction to certain situations, but the purpose of DBT skills training is to ensure that the resulting behaviour of an emotion is effective. Whether or not an action is effective can be measured by whether it brings us closer to, or further away from, what we want (K. Williams, personal communication, January 18, 2018).
All in all, the more I learn about Dialectical Behaviour Therapy the more I find myself thinking, “it all makes so much sense!” The validation inherent in DBT provides a sense of not being broken, but rather just needed to make a few adjustments. As a student I balance dialectics every day thinking, “I can do this” and “there is no way I can do this”; this is all part of the learning process that I intend to keep following, because at the end of the day if we stop learning, we stop living.
Please call us at (604) 283-7827 if you have questions about what our DBT Group is about and if it’s the right fit for you.
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References
[1] Lenz, A. S., Del Conte, G., Hollenbaugh, K. M., & Callendar, K. (2016). Emotional regulation and interpersonal effectiveness as mechanisms of change for treatment outcomes within a DBT program for adolescents. Counseling Outcome Research and Evaluation, 7(2), 73-85. doi:10.1177/2150137816642439
[2] Long, B., & Witterholt, S. (2013). An overview of dialectical behavior therapy. Psychiatric Annals, 43(4), 152-157. doi:10.3928/00485713-20130403-04
[3] Rizvi, S. L., Steffel, L. M., & Carson-Wong, A. (2013). An overview of Dialectical Behavior Therapy for professional psychologists. Professional Psychology: Research and Practice, 44(2), 73-80. doi:10.1037/a0029808
[4] Linehan, M. M. (2015). DBT skills training handouts and worksheets (2nd ed.). New York, NY: The Guilford Press.