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Understanding Dialectical Behavioral Therapy: Key Principles and Skills

ByDavid Goodman

Introduction

Dialectical Behavioral Therapy (DBT) is a type of cognitive-behavioral therapy that was developed in the late 1980s by psychologist Marsha Linehan primarily to treat borderline personality disorder (BPD). Over time, its applications have expanded to include a variety of mental health issues. DBT combines traditional cognitive-behavioral techniques with concepts from Eastern mindfulness practices. Here’s an overview of its foundational principles, skills, and effectiveness.

Core Principles of DBT

DBT is grounded in several key principles:

  1. Dialectics: The term dialectic refers to a method of thinking that recognizes the coexistence of opposites. In DBT, clients learn to find a balance between acceptance and change. The therapist helps patients acknowledge their feelings and experiences while encouraging them to make positive changes.
  2. Validation: A crucial aspect of DBT is validation, where therapists acknowledge and accept the client’s emotional experience. This helps in fostering trust and a therapeutic alliance, enabling clients to feel understood and accepted.
  3. Mindfulness: Mindfulness is at the heart of DBT. It involves being fully present and aware of one’s thoughts, feelings, and surroundings without judgment. Clients learn mindfulness techniques to help them gain control over their emotional responses.

DBT Skills Training

DBT includes a comprehensive skills training part, which is divided into four main modules:

  1. Mindfulness Skills: These skills help individuals become more aware of their thoughts and feelings in the present moment. Techniques include meditation, observing one’s thoughts, and focusing on breathing.
  2. Distress Tolerance Skills: These skills are aimed at increasing a person’s tolerance for emotional distress. Strategies include distraction, self-soothing, and improving the moment.
  3. Emotion Regulation Skills: This module teaches individuals how to understand and manage their emotions more effectively. It includes identifying and labeling emotions, increasing positive emotional experiences, and reducing vulnerability to negative emotions.
  4. Interpersonal Effectiveness Skills: These skills help individuals communicate more effectively and maintain relationships while expressing needs and setting boundaries. They include techniques for assertiveness, negotiation, and conflict resolution.

Examples of DBT Skills

1. Mindfulness Skills
  • Meditation: Practicing daily meditation, which can involve focusing on the breath or observing thoughts as they come and go without judgment.
  • Body Scan: Engaging in a body scan exercise where individuals focus on each part of the body, noticing any tension or sensations without trying to change them.
  • Mindful Walking: Going for a walk while paying attention to the sensations of walking, such as feeling the ground beneath your feet and noticing the movements of your body.
2. Distress Tolerance Skills
  • Distraction Techniques: Engaging in activities that divert attention away from distressing thoughts, such as watching a movie, reading, or doing a puzzle.
  • Self-Soothing Exercises: Using the five senses to comfort oneself, like listening to music, savoring a favorite food, taking a warm bath, or using aromatherapy.
  • Improving the Moment: Practicing “TIP” skills—Temperature (applying ice or a warm towel), Intense Exercise (doing a short burst of physical activity), and Pairing (combining an unpleasant experience with a comforting skill).
3. Emotion Regulation Skills
  • Identifying Emotions: Keeping a journal to track daily emotions, helping recognize patterns and triggers.
  • Increasing Positive Emotions: Scheduling activities that bring joy or relaxation, such as spending time with friends, engaging in hobbies, or practicing gratitude.
  • Cognitive Restructuring: Challenging negative thoughts by identifying cognitive distortions and reframing them into more balanced ones.
4. Interpersonal Effectiveness Skills
  • DEAR MAN Technique: A method for communicating needs effectively that stands for Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate.
  • Giving and Receiving Feedback: Practicing how to give constructive feedback to others and being open to receiving it without becoming defensive.
  • Boundary Setting: Learning to say “no” when necessary and articulating personal limits in relationships without guilt.

These examples illustrate how individuals can apply DBT skills in their daily lives to enhance emotional well-being and interpersonal relationships.

Effectiveness of DBT

Research has shown that DBT is particularly beneficial for individuals with BPD. Studies indicate that it can reduce suicidal behavior, self-harm, and treatment dropout rates. Additionally, DBT is adaptable for various populations, including adolescents, those with substance use disorders, and individuals experiencing mood disorders.

Conclusion

Dialectical Behavioral Therapy presents a structured and comprehensive approach to mental health treatment. By integrating mindfulness with core therapeutic principles, it empowers individuals to accept their experiences and work towards meaningful change. Through skills training, clients can enhance their emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness, leading to improved mental health outcomes. Whether seeking treatment for BPD or other mental health concerns, DBT offers valuable tools for navigating emotional challenges.