Dialectical Behaviour Therapy (DBT) is designed to help individuals gain a range of skills in four key areas, to help them better deal with emotions and everyday life.
1 – Mindfulness
The essential component of all skills taught in DBT are the core mindfulness skills:
Q: “What do I do to practice core mindfulness skills?”
A: Observe, Describe, and Participate are the core mindfulness “what” skills.
Q: “How do I practice core mindfulness skills?”
A: Non-judgmentally, One-mindfully, and Effectively are the “how” skills.
2 – Interpersonal Effectiveness
The interpersonal response patterns (ie how we interact with the people around us and in our 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.
While people with a diagnosis of Borderline Personality Disorder (BPD) frequently possess good interpersonal skills, they often experience problems in the application of these skills in specific contexts, especially emotionally vulnerable or volatile situations. An individual may be able to describe effective behavioural sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar set of behaviours when analysing their own personal situation.
This module focuses on situations where the objective is to change something (eg requesting someone to do something) or to resist changes someone else is trying to make (eg, saying no). The skills taught are intended to maximise 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.
3 – Distress Tolerance
Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. DBT therapy emphasises learning to bear pain skillfully.
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and non-judgemental fashion, both oneself and the current situation. Although the stance advocated here is a non-judgemental one, this does not mean that it is one of approval – acceptance of reality is not necessarily approval of reality.
Distress tolerance behaviours 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 in DBT: 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 with a diagnosis of BPD or who may be chronically suicidal are typically emotionally intense and prone to continual or quick change in their mood and affect, eg 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.
The list of DBT skills for emotion regulation includes things like:
- Learning to properly identify and label emotions;
- Identifying obstacles to changing emotions;
- Reducing vulnerability to “emotion mind” (ie when a person’s thinking and behaviour are controlled mostly by their emotions);
- Increasing positive emotional events;
- Increasing mindfulness to current emotions;
- Taking opposite action;
- Applying distress tolerance techniques.
In Dialectical Behavioural Therapy, you will learn about three states of mind:
- Emotion mind;
- Rational mind; and
- Wise mind.
Living your life in either emotion mind or rational mind is not effective. In emotion mind, your emotions are in control. They overwhelm you. To make good decisions, you need the information you get from your emotions, such as what you enjoy and what makes you happy, but being overwhelmed is not helpful.
You also need facts such as how much something costs or how it is healthy. You may love chocolate ice cream, but it’s not reasonable or healthy to eat it for all three meals.
Wise mind integrates the information from emotion mind and rational mind, plus adds what you know from your intuition. Using information from your emotions as well as facts, and paying attention to your intuition, helps you make the best decisions you can. When you are making decisions and interacting with others, you want to be in wise mind.
Have you ever hurt someone you love by saying things in anger or because you were hurt or scared? This happens to everyone. You’re in emotion mind when that happens and you can’t think about the effect of your words and actions on others.
If you are an emotionally sensitive person who has difficulty regulating your emotions, then you’ve probably acted impulsively because of the emotions you were experiencing. You may have quit a job, left someone you love, or called someone names. Maybe you yelled at your children when you were frustrated. Maybe you’ve done destructive behaviours like ended a relationship, hurt yourself, or thrown things. People with a diagnosis of BPD often do these things.
If you are a family member or loved one of someone who struggles to manage their emotions effectively, then you’ve probably been angry and upset to the point you’ve said things you don’t mean, or said the words in a way that you wouldn’t have if you hadn’t been so upset. When that happens, you’re in emotion mind.
Awareness of being in emotion mind is important. How do you know when you are in emotion mind? Do you feel hot, do your muscles tense, do you have extreme thoughts (usually evident by strong words such as hate, always, never and the like) or do you have strong urges to run or fight? Do you feel a strong need to tell someone off? These are some of the signs that you’re in emotion mind.
When you’re in emotion mind, it’s not productive to try to solve problems or resolve an issue. The priority is to lower your emotions so you can think more clearly. Take a break. Do vigorous exercise, spend time breathing, take a mindful walk, or talk with a trusted friend who tells you the truth.
When you’re back in wise mind, then talk with the person you are upset with or make the decision that you need to make. You’ll be more likely to make decisions work for you in the long run.
Author: Merryl Gee, BSocWk, AMHSW, MAASW, MACSW, MANZMHA, MPACFA.
Merryl Gee is a psychotherapist working from a strengths-based, person-centred framework. With over 30 years’ experience, she finds strategies like DBT, CBT and NLP (Neuro-Linguistic Programming) useful in counselling.
To make an appointment with Brisbane Psychotherapist Merryl Gee try Online Booking. Alternatively, you can call M1 Psychology Loganholme on (07) 3067 9129 or Vision Psychology Wishart on (07) 3088 5422 .