What is Dialectical Behavior Therapy?

November 19, 2021

Sheri Tiziani, LCMHCS, Primary Therapist 

Dialectical Behavioral Therapy (DBT) is one of the therapeutic modalities used at HopeWay. Clients engage in DBT in both group therapy and individual therapy. DBT is a type of Cognitive Behavioral Therapy that was developed to help clients cope with, and change, unhealthy behaviors while focusing on four areas – mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness. One of the many benefits of this form of therapy is that it is comprehensive and skill based.

Using DBT Strategies to Enhance Life Skills

It is natural for all humans to experience a range of emotions. Some may experience more intense emotions more often than others and everyone has ways, either healthy or unhealthy, to deal with their emotions. Many of the DBT skills are helpful to know and understand because it simply helps people enhance their life skills. Below you will find an overview of the four focus areas with applicable strategies.

Understanding DBT Skills: The 4 Components

Mindfulness

Mindfulness is intentionally and non-judgmentally living with awareness in the present moment.

5,4,3,2,1 Grounding Technique

Mindfulness with the 5 Senses, also referred to as “5,4,3,2,1”

Notice:

• 5 things you see
• 4 things you hear
• 3 things you feel
• 2 things you smell
• 1 thing you taste.

These can be done in any order you’d like. Take the opportunity to intentionally notice things you might not otherwise (if you are outside in nature, think warm sunshine, soft rain, birds singing, water flowing, flowers budding, fresh cut grass). Notice sensations as they rise and as they fall. Let your mind focus on each sensation as it arises. Notice each sensation with curiosity, allowing it to be. Examine the uniqueness of each sensation.

Distress Tolerance

Distress tolerance is the ability to survive crisis situations without making them worse. It helps with acceptance of reality and replaces suffering & being stuck with the possibility of moving forward. Finally, it can free an individual of having to satisfy the demands of their own desires, urges and intense emotions.

When an intense emotion arises, no matter if it is anger, sadness, anxiety, or any other emotion, distress tolerance can help bring the intensity down quickly so that the emotion doesn’t overwhelm your ability to reason and problem-solve.

First, rate your emotional intensity on a scale of 1-10, and if it’s at 6 or higher, it’s probably time for some distress tolerance to bring it down to 5 or below.

TIPP Skill

T - Temperature

Grab some ice or something cold like a cold soda can, and hold it in your hand or put it on your face or neck. Splashing cold water on your face may work as well.

I - Intense exercise

Engage in one minute of intense physical activity such as jumping jacks or pushups.   

P - Paced breathing

Breathe deeply into your belly and slow your pace of inhaling and exhaling way down (on average 5-6 breaths per minute).

P - Paired muscle relaxation

It is best to pair this with paced breathing. While breathing into your belly deeply tense your body muscles (not so much as to cause a cramp). Notice the tension in the body. While breathing out, say the word “relax” in your mind. Let go of the tension. Notice the difference in your body. This can be done with body muscles as a whole or one muscle group at a time.

Emotion Regulation

Emotion Regulation helps to understand and acknowledge emotions, decrease the frequency of unwanted emotions, manage extreme emotions, reduce suffering when experiencing painful emotions and ultimately start to feel how you want to feel more often.

Opposite Action

Every emotion has an action urge. Change the emotion by acting opposite to its action urge. For example, if you are feeling unmotivated or have low energy you may have a difficult time getting out of bed or completing a task. The action urge in this situation may be to remain in bed or inactive, and the opposite action is to get out of bed or engage in the task you are avoiding. The key is to engage into the opposite action as soon as you realize your action urge behavior (in this case inactivity/avoidance). While this is often easier in theory than in practice, if you can clear the initial hurdle of getting the ball rolling you will likely notice that you gain momentum and feel more motivated over time.

Another example includes applying the opposite action strategy to managing urges related to anger. When experiencing anger you may have an action urge to lash out or become aggressive toward someone. The opposite action is to gently avoid or, even more effective (albeit challenging), is to pay them a compliment. The idea is the opposite action will then induce an emotion, in the case dissipated anger. 

Interpersonal Effectiveness

Interpersonal Effectiveness is the ability to use assertiveness to meet personal objectives, navigate conflict, improve healthy relationships and build self-respect.

DEARMAN

(This skill can be especially helpful to navigate difficult conversations and practice assertiveness when communicating your wants & needs.)

D – Describe

Describe the current situation if necessary. Stick to the facts. “You told me you’d be home by dinner but you didn’t get here until 11.”

E – Express

Express your feelings and opinions about the situation. “When you come home so late, I start worrying about you”.

A – Assert

Assert yourself by asking for what you want or saying no clearly. “I would really appreciate if you would call me when you are going to be late.”

R – Reinforce

Reinforce (reward) the person ahead of time by explaining the positive effects of getting what you want or need“I would be so relieved, and a lot easier to live with, if you do that.”

M – (Stay) Mindful

Keep your focus on your goals. Don’t be distracted or get off topic even if the other person attempts to divert you. Just keep making your point, broken-record style if needed. “I would still like a call”

A – Appear

Appear effective and confident in your body language and voice tone.   

N – Negotiate

Offer and ask for other solutions to the problem and focus on what will work. “How about if you text me when you think you will be late?”