Managing Your Emotions Through Dialectical Behavior Therapy

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Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

  • Core mindfulness: The first of the four primary modules of DBT, this concept involves learning to observe one’s emotions, describe those emotions, and fully participate in present experiences. This skill forms the foundation for the other three modules, and is derived largely from eastern practices of living in the moment.
  • Interpersonal effectiveness: The second core component of DBT teaches clients assertiveness skills and strategies to ask for what they need, set boundaries and say no when appropriate, and deal more effectively with interpersonal conflict.
  • Distress tolerance: The third module entails clients developing nonjudgmental acceptance of themselves as well as their current situation. The focus is on learning to accept the present reality and to tolerate crises, and making use of strategies such as distraction, self-soothing, and improving the moment. Practicing these skills will increase the client’s ability to tolerate challenging events and environments.
  • Emotion regulation: The final module of DBT consists of three main goals: to understand one’s emotions, reduce emotional vulnerability, and decrease emotional suffering. With this in mind, some of the specific skills taught in DBT include identifying and labeling emotions as well as evaluating: events that prompt the emotion, interpretations that trigger the emotion, how the emotion is experienced, how the emotion is expressed behaviorally, and the aftereffects of the emotion.

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

  • Enhance behavioral capabilities: DBT helps clients develop important life skills that help them regulate emotions, experience the present moment, improve interpersonal interactions, and better tolerate distressing situations.
  • Improve motivation to changes: DBT supports clients’ motivation to change by tracking and reducing detrimental behaviors, thereby increasing quality of life.
  • Generalize capabilities to other environments: In order for the client to make progress, the skills learned in therapy must transfer to a wide variety of situations. This is accomplished through homework assignments and practicing skills. Telephone consultations also can be valuable in helping clients utilize these skills in their daily lives.
  • Support client and therapist capabilities: DBT aims to maintain and build the capabilities of therapists through continued training and consultation-team meetings.
  • Enhance therapist motivation: The DBT model encourages the use of support, validation, feedback, and encouragement between therapists to avoid burnout and improve their effectiveness.

Stages of treatment:

The course of DBT generally flows through three stages:

  • Stage 1: This stage is primarily focused on eliminating or reducing serious behaviors, including self-injury, suicidal thinking, and aggression. Behaviors that interfere with therapy also are addressed, such as missing appointments and not returning phone calls.
  • Stage 2: The client strives to increase quality of life and experience emotions in a less intense manner. The client continues to eliminate or decrease destructive behaviors, and address other issues or situations that are interfering with daily life, such as past trauma.
  • Stage 3: The client is experiencing increased feelings of completeness, self-respect, and love.

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

  • Difficulty with emotional regulation
  • A high level of reactivity, with a slow return to baseline
  • Impulsiveness with a tendency toward self-destructive behaviors
  • An inclination toward extreme thinking, unable to perceive a middle ground
  • A lack of sense of self, tending to feel incomplete or empty
  • A history of instability in relationships, and difficulty with interpersonal interactions
  • Extreme sensitivity, accompanied by rapid mood swings, anxiety, and depression
  • Fears of abandonment and trouble with intimate relationships

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

© Copyright 2012 GoodTherapy.org. All rights reserved. Permission to publish granted by Suzette Bray, MFT, therapist in Burbank, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • gordon

    gordon

    September 24th, 2012 at 11:48 PM

    I’ve read much about mindfulness and even tried practicing the same a few months ago.But I was not very successful with that and felt like I needed a coach to teach me the same.The idea kept getting delayed until now when I read about mindfulness again.Is it really worth it? And should I seek out a coach?

  • freedom

    freedom

    September 25th, 2012 at 3:42 AM

    Could anyone point me to some resource which would more esaily outline the difference between DBT and cognitive behaviioral therapy?

  • grammyat53

    grammyat53

    September 25th, 2012 at 6:27 PM

    I believe the book I mentioned in Kegan’s post does that.

  • Kallie

    Kallie

    September 25th, 2012 at 8:49 AM

    It sounds as if BBT certainly does address a lot of issues going on within an individual, leaving no stone unturned. For many of us while it would be frightening to go through sessions so intensive, I think that it really would force you to look beyond the surface and really get to the meat of the matter, to find out what it is in life that is causing so much angst and providing you with real world solutions for helping to resolve it. I hope that the reasons for undergoing this sort of treatment do not always have to be to the extreme though because just based on my reading here it sounds as if there are many different ways that DBT could be of benefit to patients with all sorts and ranges and needs in the mental health realm.

  • Kegan

    Kegan

    September 25th, 2012 at 9:07 AM

    I often find myself depressed for no particular reason. There is gloom and darkness in my head and this can be triggered just like that, without anything in particular. I do not remember when this started but I am really sick and tired of this. I find myself unable to remain productive when this happens and I do not even feel like making an effort to get out of it once an episode has begun.

    I wish something like this therapy can come to the aid for my problem. Anyone have any insights on whether this would be right for my issue?

  • grammyat53

    grammyat53

    September 25th, 2012 at 6:23 PM

    Kegan,
    DBT is intensive. You have to be willing to work hard. What helped get me started was a self-help book from amazon.com called: The Dialectical Behavior Therapy Skills Workbook byMcKay, Wood, and Brantley. It is a great start. I found my therapist on a search on the Internet. I got very lucky. Please keep in touch!!

  • grammyat53

    grammyat53

    September 25th, 2012 at 5:53 PM

    I found an excellent therapist who specializes in BPD and Mindfulness. He has been a GREAT help to me thus far!! I feel so blessed to have found him!!

  • regan

    regan

    September 26th, 2012 at 5:28 AM

    Although it appears that dbt is kind of a new kid in town when it comes to treatment options, I really do like, from what I have read here, that it offers patients a way to heal in a manner that addresses many different venues. Some days we will all do better in individual sessions while there will be other times when group meetings could be important for breaking through. I like how DBT stresses that there is more than one way to get to the heart of the matter and that a therapist trained in this kind of therapy will allow you to explore and find out the methods which will be the most comfortable for you.
    I have always been more of a think outside of the box kind of person and while I have always felt that therapy is important at certain times in our lives for pretty much all of us, there have been times when certain methods have felt too constricting and restrictive. DBT treatment looks as if will offer patients a way to better personalize their own treatment and will offer you mahy different methods for discovering who you are and for getting at the truth. Great job!

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