What Is Dialectical Behavior Therapy?

Instructor: Jennifer Kinder
Explore dialectical behavior therapy and its general concepts. Learn the four modules of dialectical behavior therapy and why they are helpful skills applied to some real life examples.

Dialectical Behavior Therapy: Concepts

Janet has struggled all her life. Her relationships are mostly turbulent. She's terrified of being alone and when boyfriends break up with her she threatens suicide so they will stay. Her emotions are all over the place and feel so intense that she can't tolerate them. When she can't take them anymore she cuts her arm to manage the pain. She has a hard time saying no to people and asking for what she needs, and often feels like she doesn't even know who she is. She feels empty on the inside and doesn't know how to feel complete or live a normal life. She makes an appointment with a psychologist who refers her for dialectical behavior therapy or DBT.

DBT was developed by psychologist Dr. Marsha Linehan to help treat a mental health diagnosis, borderline personality disorder, or BPD, that is often very resistant to treatment. Borderline personality disorder is a combination of chronic and pervasive difficulties having healthy relationships, managing emotions, and having a stable sense of who you are. The scenario above describes the misery of someone suffering from BPD.

DBT is a four module treatment intervention. Each module was originally developed to address the debilitating symptoms of BPD, but has been used to successfully treat other mental health issues such as substance abuse or depression.

DBT: Treatment Modules

The following are descriptions of each DBT module:

Mindfulness Skills

The mindfulness module is at the core of DBT treatment. Mindfulness is the ability to observe thoughts, feelings, or physical sensations without judging or changing them. This involves describing these inner experiences and labeling them as they come into your awareness. For example, you might notice you are sad and just let yourself feel sad without doing anything to cheer yourself up.

This is an important skill in DBT because it teaches an individual with BPD that it is possible to tolerate strong emotions or self loathing thoughts without resorting to self-harm.

Example: Chelsea can't stand it when she feels depressed. As soon as she starts to feel down, she tells herself that she's a worthless failure. The more she chastises herself, the worse she feels. Dr. Breath takes her through a mental exercise where she labels all her thoughts and feelings by imaging she is writing them on leaves as they float down a stream. Chelsea learns that she can observe her painful emotions and thoughts without cutting her arm.

Distress Tolerance Skills

This module involves learning the skill of distress tolerance. Distress tolerance is simply that, the ability to tolerate emotional distress. This involves learning breathing and awareness exercises to help accept reality, just as it is. Radical acceptance is a DBT distress tolerance skill where you are challenged to accept reality without fighting what it should or shouldn't be.

This is an important skill because individuals with BPD have a difficult time accepting painful emotions and handling crises skillfully.

Example: Jeff can't tolerate break-ups. When a girlfriend breaks up with him, he often takes a handful of anxiety medication and then calls 911 right as he is passing out. Jeff is tired of being hospitalized for a suicide attempt. He meets with Dr. S'os who teaches him the DBT distress tolerance acronym IMPROVE to help him survive the emotional crisis of a break-up. Jeff learns that he can use Imagery, making Meaning, Prayer, Relaxation, considering One thing in the moment, taking a mental Vacation, and Encouraging himself to survive the next emotional crisis without taking pills.

Emotion Regulation

This module involves learning the skill of regulating your emotions through emotion identification and labeling, considering the utility of emotions, and increasing self care.

This is an important skill in DBT because those with BPD lack the basic skills to manage their emotions in healthy ways.

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