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Dialectical Behavior Therapy

If you’ve done some of your own research, you may have seen how Dialectical Behavior Therapy (or DBT) is often associated with treating Borderline Personality Disorder. While it was developed with that specific set of symptoms in mind, the basic tenets of DBT are immensely helpful for a host of different concerns which may have nothing to do with impulsivity, dramatic moods, self-injury, or other behaviors that are often associated with borderline personality disorder. The skills taught through DBT can be beneficial to anyone working to improve their emotional state. Curious about what DBT is and how it could benefit you? Stick with me for the next 5 minutes and I will help you explore and understand this treatment option.

What Exactly Is DBT?

DBT is an evidence-based psychotherapy that is a type of cognitive behavioral therapy, except that it focuses a lot more on emotions and behaviors than the thought component. Which means it is a researched and proven way of helping you sort through thoughts and behaviors with a heavier emphasis on how feelings influence behaviors than traditional CBT approaches. Honoring and validating emotions in healthy ways is a huge part of this type of therapy, because emotions can certainly feel like tidal waves that come in and drown us at times.

This type of therapy can be immensely helpful if you are looking to improve your interpersonal relationships, because that often starts with taking an honest look at how you’re taking care of yourself and the choices you’re making in terms of regulating and expressing your own emotions.

If you’re wondering: what the heck does “dialectic” mean? You’re not alone. And no, it’s not close in meaning to diabolical 😊. In DBT, a dialectic means being able to hold more than one idea in your mind at a time—even contradictory ones. This really helps when emotions feel so intense that they seem to overtake everything.

 

examples of common dialectics
  • I’m doing the best that I can and I also would like to do better
  • I am struggling right now and I am also strong
  • I know why I made the choice I made and I’m working to accept myself

DBT Basics

There are many useful components to DBT, and it is beyond the scope of just one blog to go over each one in detail, so we will breakdown the two major ingredients of DBT.

  • Mindfulness
  • Emotion Regulation
    • Acting opposite to emotion
    • Building positive experiences
    • Diary card review

These concepts seem simple enough. But how do these things help you when you’re struggling?

Mindfulness

When people think of mindfulness, someone sitting in lotus position in front of a beautiful creek may come to mind. How Zen, no? However, building the skill of mindfulness doesn’t just mean accepting and embracing emotional states that feel good—it means accepting all emotional states without judgement. Even the ones that don’t feel so good. We often want our big overwhelming emotions to just go away, but paradoxically, when we try to “stuff” them, they can seem to gain more power over us! Again, part of DBT is validating and accepting emotions as they are without trying to change them. Though there are certainly coping strategies that can help you to get through a really tough moment and that is where the second part, emotional regulation, comes in.

Emotional regulation

Oftentimes people benefit from DBT when they want to change a specific behavior. This could include self-injury as well as many other potentially not helpful coping strategies, like overeating or relying on others to make you feel better. With DBT, you can build a skill list of things to do to act “opposite to emotion,” meaning, you will choose to act not in accordance to the emotion that you are feeling. For example, if you are depressed and want to stay in bed, being skillful in this way may include getting up, taking a shower, or calling a friend.

Healthy emotional regulation also includes intentionally building positive experiences by finding something you like or find meaningful. This could include painting, writing, dancing, attending to animals/nature etc. and incorporating that into your life.

And finally, a diary card is often used in DBT to track a behavior that you’d like to change. This can be as structured or unstructured as you and your therapist would like, but especially in the beginning more detail is usually better. For example, if you find yourself drinking more than you would like but can’t seem to pinpoint what is leading to it—recording what has happened before, during, and after the behavior as well as your emotions throughout can be particularly illuminating and provide rich material for you and your therapist to process during session.

What Can I Expect from DBT-Focused Sessions?

DBT can be a very structured therapy, having the diary card guide each session, but it doesn’t necessarily have to be this way. Maybe you have a lot of insight into your behaviors and just want to work on skills? That’s fine too. You and your therapist could focus on mindfulness or ways to act opposite to emotion that you can commit to and coming up with a list so that you’ll have it in front of you instead of trying to generate ideas on the spot when emotions may be overwhelming.

DBT based sessions could include
  • Diary card review
  • Mindfulness exercises
  • Emotion exploration
  • Working with dialectics (holding potentially competing views at once and practicing acceptance)
  • Practice self/emotional acceptance
  • Creating safety plans
  • Working on distress tolerance
  • Working on interpersonal effectiveness/communicating and building positive connections

Seeking Support

DBT sessions aren’t all alike and they can be tailored to your specific needs and goals. If you’ve found yourself overwhelmed and consumed by emotions and that has disrupted your life, you may want to consider an in-depth DBT program or focusing on the DBT ingredients in your existing counseling sessions! Locally, the UPMC Partial program uses a primarily DBT basis for an intensive outpatient program that runs 3-5 days a week to give you a full immersion approach to managing emotions. Want to make changes but don’t feel you need or are ready for something that intense? Consider making an appointment with an Angelus therapist today to get started.

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