Dialectical Behavior Therapy: What is it? 

Dialectical Behavior Therapy, or DBT, is a style of therapy that has been effective for people who struggle with intense emotions, relationship issues, black-and-white thoughts and/or impulsivity. Dialectical means “the existence of opposite” and holds that change is constant and that two opposite things can exist at the same time. An example of a dialectical thought would be “I’m mad that it’s raining but I’m happy that we are getting moisture to help prevent fires in the summer.” The goal of DBT is to find the middle path between extreme thoughts and emotions, change and acceptance, and to increase sense of self and connection in relationships. Dialectical thinking involves shifting the thought process from “but” and “or” to “both-and.” 

 

There are four main areas where DBT focuses on teaching new skills: 

  • Mindfulness 
  • Distress tolerance 
  • Emotional Regulation 
  • Interpersonal Effectiveness 

The next four weeks will provide different skills within these areas that you and your children can practice taking steps towards a more balanced life.  

 

 

Mindfulness in DBT 

What comes to mind when you think of the term mindfulness? While mindfulness can include activities like meditations, mindfulness in Dialectical Behavior Therapy asks people to slow down and be in the present. This includes noticing feelings without judgement and making important choices from a place where emotions and thoughts are balanced. This is called using the “Wise Mind.” The diagram shows the three states of mind: emotional, reasonable and wise.  Optimally we would make decisions using our wise mind.  The reasonable mind is ruled by logic and disregards feelings.  The emotional mind is ruled by feelings and our mood, logic is unimportant.  As stated above the wise mind incorporates both: I feel this, and I know this so I will do this.   

 

https://mindfulcoaching4u.com/mind-control-a-mindfulness-primer/ 

Here are some ideas for how you and/or your children can practice mindfulness: 

A great example, that many of you participated in, was the experience of eating a piece of chocolate candy.  You can unwrap the chocolate, eat it and move on with your day or you can experience eating the chocolate.  What does the wrapper feel like, what is the shape, texture and smell of the chocolate?  How does the chocolate feel in your mouth?  The results are the same, the chocolate ends up in my tummy and I will probably eat less and enjoy more if I am mindful about the chocolate.  The same is true about many of our daily experiences: driving to work, watching the snow fall, watching members create art, etc. 

In addition to the above skills, there are other mindfulness skills like breathing techniques or other activities that can help ground you in the moment. 

  • 5-4-3-2-1 
  • Find five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. This can help you ground yourself in the moment when you are feeling anxious or overwhelmed 
  • Breathing Exercises 
  • Box breathing 
  • Breath in for 4 seconds 
  • Hold for 4 seconds 
  • Breath out for 4 seconds 
  • Hold for 4 seconds 
  • Alternate Nostril Breathing 
  • Exhale completely and then use your thumb to close your right nostril. 
  • Inhale through left nostril and then close nostril with your fingers. 
  • Open first nostril and exhale through this side. 
  • Inhale through right nostril and then close this nostril. 
  • Open left nostril and exhale through left side. 

 

Distress Tolerance in DBT 

The truth is that everyone experiences pain and distress.  Sometimes those experiences show up in our lives during a crisis: a family member in a car accident, a break-up, etc. The goal is to tolerate the distress/pain in the short term and reduce our desire to act impulsively.  We also experience long-term distressing situations: extended illness, a member’s GPA falls below the acceptable number and cannot play in the next basketball game, etc.  Learning to accept that we cannot change our reality and fighting our reality actually adds to our suffering).    

Steps to using Radical Acceptance: 

  1. Observe that you are fighting against reality. (Ex: “It shouldn’t be like this.”) 
  1. Remind yourself that the unpleasant reality cannot be changed. (Ex: “It happened.”) 
  1. Acknowledge that something led to this moment. (Ex: “This is how it happened.”) 
  1. Practice acceptance with not only your mind, but your body and spirit. Be mindful of your breath, posture, and use skills like half-smiling and willing hands. 
  1. List what your behavior would look like if you did accept the facts then act accordingly. 
  1. Plan ahead with events that seem unacceptable and think about how you should appropriately cope. 
  1. Remain mindful of physical sensations throughout your body such as tension or stress. 
  1. Embrace feelings such as disappointment, sadness, or grief. 
  1. Acknowledge that life is worth living even when there might be temporary pain. 
  1. If you find yourself resisting, complete a pros and cons exercise to better understand the full impact of your choice 

Radical Acceptance is a skill to help assist with long-term distressing situations.  It does not mean that we approve or are passive about our situation, instead we accept it fully.   

 

 

Emotional Regulation in DBT 

So, you are better at noticing and coping with your emotions. Now what? Emotional regulation in DBT calls for you to both recognize what your emotions are doing for you in the moment and build resiliency so that painful emotions have less power over your behaviors and thoughts over time. By working on these skills, you will be able to decrease the frequency of unwanted or painful emotions. 

Taking inventory of your emotions: 

You are going to learn how to evaluate whether your emotional responses are effective. That means you will need to ask yourself whether your emotions are working for you or against you in this moment. 

If the emotion is working for you, then let yourself experience it. For example, you have a big test coming up. Use that emotion to be extra studious in order to reduce emotions surrounding the outcome. Another example: You feel ashamed after being disrespectful toward a teacher whom you normally like. Use this emotion to apologize for your action and assure your teacher that you will not repeat that behavior. Then let it go and move on. 

Accumulating Positives: 

In the Short Term: Build a dam between you and negative emotions! 

  • Increase pleasant activities that lead to positive emotions. 
  • Do one pleasant activity each day. This can be a shared activity between you and your child! 
  • Be mindful of positive experiences. 
  • Focus your attention on positive events while they are happening. 
  • Refocus your attention when your mind wanders to the negative. 
  • Participate fully in the experience. 
  • Don’t destroy positive experiences by thinking about when they will end. 
  • Don’t think about whether you deserve this positive experience. 
  • Don’t think about how much more might be expected of you now. 

In the Long Term: Build a live worth living 

  • Work toward goals based on your values: 
  • Identify one goal (e.g., complete the school year). 
  • List small steps toward goals (e.g., get out of bed, go to first class). 
  • Take first step (e.g., buy an alarm clock or set cell phone alarm). 
  • Pay attention to relationships: 
  • Repair old, create new, work on current relationships, and end destructive relationships. 
  • What can I do this week to repair an old relationship. 
  • Avoid avoiding: 
  • Avoiding makes problems build up and increases vulnerability to Emotion Mind. Return that call, schedule that doctor’s appointment, face that work, discuss that problem. 
  • Avoid giving up. 

 

Interpersonal Effectiveness in DBT 

Now that we’ve practiced tolerating our distress and regulating our emotions, we can use these skills to build and maintain positive relationships with others. It is important to remain mindful of what your emotions are telling you when you are interacting with others. Intense emotions can lead to ineffective interactions with people you are close to which may cause damage to your relationships. If you notice that your emotions are dysregulated, it’s ok to take a step back! The first step in interpersonal effectiveness is learning and implementing GIVE skills in your interactions with others: 

(be) Gentle – Be nice and respectful, don’t attack, use threats or judgments, be aware of your tone of voice 

(act) Interested – LISTEN and act interested in what the other person is saying, don’t interrupt or talk over him or her, don’t make faces, maintain good eye contact. 

Validate – Show that you understand the other person’s feelings or opinions. Be nonjudgmental out loud. 

“I can understand how you feel and . . .” 

“I realize this is hard . . .” 

“I see you are busy, and . . .” 

“That must have felt . . .” 

Easy manner – SMILE, use humor, use non-threatening body language, leave your attitude at the door. 

Give yourself grace! These skills can be difficult to implement, so practice is key. If you struggle with using GIVE in your interactions with others, practice your radical acceptance and keep working on improving your relationships.