What is DBT?
Don't Google it!
Okay, since we all do the thing we're told not to, welcome back. Or if you found this from that very Google search, welcome!
Depending on what search results popped up for you, DBT may have sounded a lot more intense that it is or has to be. Even as a therapist when I first heard of DBT, my first thought was "oh that sounds a lot, no thanks!" Once I took the time to learn about what it was and see how the skills were helpful to not just my clients, but also myself and my peers, I was all-in with it. Here, we're going to break it down and talk more about what it is, why it's so helpful, and why everyone could benefit from the tools in some way.
What is DBT?
DBT is short for Dialectical Behavior Therapy. It's a type of talk therapy that tends to be more on the structured side (more skill-focused). If you've ever participated in cognitive-behavioral therapy (CBT), it definitely has components of that mixed in with mindfulness and acceptance skills. The idea is that sometimes CBT can leave people feeling like they just need to change the way they think about things in order to "feel better." Sounds great, but then that can leave some people feeling like their feelings in the moment are invalid or "wrong." DBT on the other hand teaches us to acknowledge the feelings, understand where they come from, and regulate them in more effective ways. This sometimes means using those CBT techniques to change our thoughts, but DBT also brings in lots of other strategies and tools.
Dialectical means opposites can co-exist and both be valid. The sun can be out AND it can be raining. You can be in a room full of other humans AND still feel alone. One does not cancel the other out. DBT teaches us to balance acceptance AND change. Acceptance of our reality as it is in the moment AND creating change when and where we need to in order to live a better life. We'll come back to that acceptance piece in a future blog post, or sooner in therapy if you'd like!
What does DBT look like?
DBT is made up for 4 modules, or sections of content: mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. These modules include specific skills to help us be more effective in each of those areas.
The goals of Mindfulness are to increase our presence in the moment, reduce suffering, and experience reality as it is. We learn skills that teach us what to do to be mindful, how to practice mindfulness, different states of mind we can be in, and loving kindness. Mindfulness skills also lay the foundation for everything else in DBT. After all, in order to use the skills and create change, we first need to be aware of the things that may need changing.
The goals of Emotion Regulation are to understand our emotions more, reduce unwanted emotions, and increase positive emotions. We learn skills that help us recognize how we experience emotions, change feelings we don't want to feel, reduce our vulnerability to negative emotions, increase our positive feelings and emotional resiliency, and reduce our emotional suffering in painful situation.
The goals of Interpersonal Effectiveness are to be more effective in getting our needs met, building healthy relationships, and ending destructive relationships. We learn skills that teach us how to clarify our needs for ourselves and better communicate them to others in different situations. We also learn how to balance relationship goals with self-respect so we don't get stuck feeling like we're always sacrificing our needs for everyone else.
The goals of Distress Tolerance are to help us get through overwhelming situations without reacting in a way that makes it worse for us or others, accept reality, and feel more free from intense reactions. We learn skills that help us use our mind and sometimes body to pause, reset, and move forward in an effective way.
The fact is that as humans and regardless of mental health or mental illness, we all experience the range of human emotion and the ebb and flow of life's stress. At some point, we all experience overwhelming stress, or painful heartbreak, or excited anticipation. Sometimes in those moments, it can feel like our emotion gets into the driver's seat and we're holding on in the back with no idea where the destination actually is. In those moments, the skills in these modules can help us remain (or get back in) the driver's seat, and choose our responses rather than having us get caught up in the reactions.
When problem's arise, there are really only 4 options we have in responding. I know what you're thinking, "no way, there were 10 options I had for yesterday's problem!" Yes but, those 10 options probably fall into 1 of 4 categories of options we have. When a problem arise we can choose to…
Solve the problem: you use problem-solving skills to change the problem, resolve it, or remove ourselves from it so it's not really a problem for you anymore
Change how you feel about the problem: the problem continues to exist but you shift your thinking about it to reduce the intensity of distress it causes for you and make it not feel so heavy
Tolerate the problem: the problem continues to exist but you figure out how to get through it. This tends to work better for short-term or time specific problems like having to go to a meeting or make a phone call
Stay miserable: yes this is an actual option and you can choose it. It's easy, it requires no effort or skills on your part. It's also sneaky because if we don't choose one of the other 3, we by default are choosing this one
The modules we talked about above tie into these 4 options. Depending on which option we choose, we'll tap into different sets of skills.
Solve the problem: interpersonal effectiveness skills, problem solving (emotion regulation)
Change how you feel about the problem: emotion regulation
Tolerate the problem: distress tolerance, mindfulness
Stay miserable: no skills needed!
What makes it so helpful?
Because of the variety of concepts and skills in DBT, it can be helpful for everyone! Feeling pulled in different directions with all the things going on in your life? DBT can help! Feeling like other people around you are leading you to question yourself and if you're thinking or feeling the "right" way about something? DBT can help! Feeling like it's easy to get caught up in the heat of the moment and say "yes" more than you'd like? DBT can help!
While DBT was originally created for the treatment of Borderline Personality Disorder, research has shown it to be an effective treatment for all sorts of mental health issues. You do not need to have a formal diagnosis to benefit from the skills that DBT has to offer.
If you have a specific diagnosis of mental illness, you may benefit from participating in a full DBT program that typically includes a combination of individual therapy and skill group training. If you don't have a specific diagnosis or your symptoms are more mild (ask your therapist), you may benefit from learning the DBT skills in individual therapy, focusing on specific skills that can help your specific concerns.
Interested in DBT but not sure what set-up is the best for you?
Great! You can click here to schedule a consult call with Mindfully Balanced Therapy in the next 2 weeks, or contact Kimberleigh by email at khagar@mindfullybalancedtherapy.com.
Information from DBT Skills Training Manual Second Edition (2014) by Marsha M. Linehan.
