Dialectical Behavioral Therapy. Those three words left me baffled the first time I heard them used together. Specifically, Dialectical…. What does that even mean? It’s easy to get turned off by that word alone. The truth is, for most of us, we don’t really need to know what a Dialectic is. What we need are DBT Skills! Let me tell you, there are tons of them. Literally, tons. The skills manual is not a lightweight or small book. Luckily, we typically already use many of these skills in our day to day lives. We just don’t label them the same way.
Have you ever found yourself overwhelmed by a strong emotion and chosen to distract yourself with something benign like a crossword puzzle, word search, sudoku puzzle… you get the idea. Maybe you chose to watch a movie or TV show that provoked an opposite emotion for you. Have you ever planned out a conversation ahead of time to make sure you stay on point and get what you want? Well, guess what? You’ve used DBT skills!
DBT encompasses four broad areas: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.
Mindfulness is the practice of participating in something fully and from a balanced place in our mind. In our modern lives, we are constantly being distracted by notifications on our phones, smart watches, computers… distractions are everywhere. When we are mindful, we push away distractions to maintain our focus on what we’re doing. When is the last time you spent time with someone and remained fully present with them the whole time? No responding to text messages, emails, social media notifications…. just being present with that person? If you’re like most people, it’s probably been a while. When our attention is focused, we get so much more out of our experiences. Try eating a food you enjoy while focusing solely on that food. It’s a much more fulfilling experience. Now try playing with your child or talking with a friend with no distractions. It’s also a much more fulfilling experience, right?
Distress Tolerance means managing an emotional crisis effectively. Think back to the last real crisis you faced. Perhaps it was a death of a loved one or the loss of a relationship you thought would last forever. How did you handle it? What did you do to make it through? What do you wish you had done differently? Distress Tolerance skills give us concrete actions we can take to get through a crisis without making it worse. I’ll give you an example of something that worked for me. First, it’s important to know that I have a phobia of snakes. I am absolutely terrified of them. I don’t like pictures. I change the channel when they’re on TV. I didn’t even like typing the word. It’s irrational, but it’s a fear nonetheless. Several years ago, I was at work and out on the playground with my children’s group. What comes slithering onto the playground? A snake. A tiny, baby snake that all the kids thought was the coolest thing ever. Now, I couldn’t very well panic, run inside, and climb on top of a table the way I wanted. I had a group of children under my care and a slithery creature I couldn’t identify as being safe. So, instead, I chose to distract myself and the children by starting a physically active game away from the invading snake and simultaneously notified a snake-wrangling coworker that I needed help. She came running to the rescue, the kids were all safe, and I did not have a heart attack. It was a good outcome, and I had used two different Distress Tolerance skills at once. I distracted from the crisis (snake) and incorporated vigorous exercise to alleviate my body’s adrenaline response to the crisis. I recommend everyone have at least two good Distress Tolerance skills in their back pocket because you never know when a slithery invader might show up on your playground.
Emotion Regulation is the practice of creating a healthy baseline for emotional functioning and also employing skills to manage emotional reactions that don’t serve you well. The foundation for managing our emotions effectively is in both understanding our emotions and taking good care of ourselves physically. Emotions are complex, and we often experience multiple emotions at the same time. It can be difficult to break apart those emotions to determine what, exactly, we are feeling. It can also be quite difficult to prioritize basic self care in our current world. We burn the candle at both ends, rush and stress to manage everything on our plates, and often fail to get appropriate sleep or eat well. If we’re exhausted, stressed out, and hungry, it’s no wonder we struggle with managing our emotional reactions to things. Sometimes, we can have emotional reactions to things that lead us to behave in ways that don’t serve us well in the situation. One day when I hadn’t slept well, had been at work far too long for one day, and hadn’t eaten lunch because I was too busy, I came home ready to eat the dinner I had picked up on the way home. I opened my meal only to discover it was not what I had ordered and was actually something I hated. I burst into tears and found myself paralyzed and unable to make a decision to get myself fed. Now, my rational, well-rested, non-starving self sees that as an utterly ridiculous reaction. But I was hungry, tired, and stressed, and I simply didn’t have the reserves to make a reasonable decision in that moment. That’s where the skills to manage that emotional reaction would have been very helpful - I wanted to cry and give up and go to bed hungry, but Opposite Action would suggest I push through my discomfort and take steps to feed myself in some manner. The beauty of Emotion Regulation skills is that they are both preventative and reactive to a specific situation.
Finally, Interpersonal Effectiveness is one of those skills that most people think they have… and then realize they may not be quite as skilled as they thought they were. It basically breaks down into three main skills to help you ask for what you want/need, maintain relationships, and set limits and boundaries in your relationships. Relationships are complicated, whether it be a romantic, family, or work relationship. Having a guide for handling difficult discussions can be so helpful, especially if you have the opportunity to prepare for them ahead of time. For example, let’s say you’ve got a coworker who is always asking for your help with their projects. You’ve tried to say no, but somehow always end up helping out anyway. Interpersonal Effectiveness gives you a guideline to set a boundary with the coworker. Interpersonal Effectiveness skills are some of the most important and effective skills for so many of the people I see, whether they need help setting limits or in maintaining relationships. Effective communication can make so much difference in the relationships in your life, and that can make a huge difference in anxiety, depression, or whatever other issues you might be facing.
In my experience, DBT is the most effective and useful therapy modality I’ve studied. You may read a lot of things about DBT that seem confusing, and at first, it can definitely seem that way. With time and practice, though, the skills become second nature and are so useful in day to day life. I truly believe that everyone can benefit from DBT at some level. If you're interested in learning more, please don't hesitate to reach out.