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In treating borderline personality disorders, Dr. Marsha M. Linehan identified the need for a program that went beyond Cognitive Behavioral Therapy. She developed a subset of CBT known as Dialectical Behavior Therapy and DBT techniques to address many mental health conditions.
What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy can be defined as a type of therapy that uses DBT techniques to help individuals focus on acceptance and change to manage unhealthy emotions, improve interpersonal relationships, and better cope with stress.
The Cambridge Dictionary defines “dialectical” as discovering what is true by considering opposite theories.
In other words, it is a “logical discussion of ideas and opinions, concerned with or acting through opposing forces.”
In the mental health and addiction treatment setting, Dialectical Behavior Therapy attempts to make positive changes through the revelations exposed through questions and conflict.
Dialectical Behavior Therapy has shown to be effective for treating:
- Borderline Personality Disorder (BPD)
- Suicidal behavior
- Depression
- Anxiety
- Substance Use Disorder and Addiction
- Post-Traumatic Stress Disorder (PTSD)
- Eating Disorders
DBT techniques tend to be more “present-focused” by examining what is happening right now that is causing distress, rather than discussing ruminating thoughts about the past or future.
DBT is an educational therapy for the client to learn coping skills that are necessary for successful, long-term recovery.
DBT Techniques Teach 4 Core Skills:
- Mindfulness
- Distress Tolerance
- Emotional Regulation
- Interpersonal Effectiveness
Dialectical Behavior Therapy Techniques
Dialectical Behavior Therapy techniques are flexible and customizable, unlike other therapies that can be rigid or difficult to learn.
A certified therapist uses a combination of DBT techniques and environments that include:
- Individual therapy
- Group therapy
- Stress management
- Mindfulness and meditation
The skills and techniques are learned during individual and group sessions between a therapist and a client. They focus on the core skills of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Once the skills have been mastered, the client patient will be able to continue using them outside of therapy sessions to manage negative emotions and unhealthy behaviors in daily life.
DBT techniques are effective for mental health conditions like depression, different types of anxiety, borderline personality disorder, PTSD, addiction, and suicidal thoughts and ideations.
Examples of DBT Therapy Techniques
1. Mindfulness DBT Techniques
Mindfulness teaches individuals to stay present in the current moment and be aware of the “here and now,” as opposed to worrying about the past or future.
These are similar to grounding techniques for anxiety and PTSD.
One technique is Observing, Describing, and Participating.
This includes observing current thoughts and feelings without judgment, describing the feelings or environment in words, and participating by engaging in the moment or activity.
Mindfulness techniques also include breathing and relaxation exercises while focusing on the present moment.
2. Distress Tolerance Skills
Distress tolerance skills are designed to manage difficult situations or painful emotions to reduce their impact and avoid turning to unhealthy behaviors as a coping mechanism.
A common example is the STOP technique. It is an acronym for:
- Stop
- Take a step back
- Observe
- Proceed mindfully
When you find yourself in a stressful situation, Stop what you are doing, Take a step back, Observe what you are thinking or feeling, and Proceed mindfully by focusing on the present moment.
Understanding the difference between reacting vs responding to stress is beneficial for staying calm. The STOP technique focuses on responding in a sensible manner rather than carelessly reacting.
Another example is the TIP technique. It is an acronym for:
- Temperature change
- Intense exercise
- Paced breathing
The Temperature change involves splashing cold water on your face or hands, engaging in an Intense exercise, and incorporating Paced breathing to break free of distress and distract the mind from negative thoughts and emotions.
3. Emotional Regulation
As the name implies, these DBT techniques aim to manage and regulate emotions in a positive way to avoid negative behaviors.
Check the Facts
Checking the facts involves analyzing a stressful situation to decide if our feelings and emotions are in line with the problem at hand, or if we are overacting to something that is not as serious as we perceive.
By examining the evidence, we can challenge our emotions and act accordingly.
Opposite Action
Instead of acting on a negative emotion, like wanting to stay in bed because you’re feeling depressed, choosing to take an opposite action, such as going for a walk outside, offers a healthier approach to overcome the depressive thoughts and feelings.
Cognitive Triangle
The cognitive triangle is similar to cognitive therapy techniques that help a person to positively change negative thoughts and behaviors.
Write down a negative thought, then write down the feelings that arose from the thought, and finally, write down the behavior or action that occurred following these thoughts and feelings.
Understanding and seeing how these negative thoughts, feelings, and behaviors work together will make it easier to replace them with positive ones.
4. Interpersonal Effectiveness
Interpersonal effectiveness skills are DBT therapy techniques intended to improve relationships and communication with others.
DEAR MAN is one example. It is an acronym for:
- Describe the situation
- Express feelings
- Assert needs
- Reinforce
- Mindful
- Appear confident
- Negotiate
Describe the situation, Express your feelings, Assert what you want, Reinforce or reward the other person by their actions, be Mindful of staying on track about the situation, Appear confident and make good eye contact with the other person, and be willing to Negotiate or compromise to find the best solution.
GIVE Skill is an acronym for:
- Gentle
- Interested
- Validate
- Easy Manner
GIVE helps build communication skills to improve social and interpersonal relationships.
When interacting with others, be Gentle and respectful, act Interested, listen, and pay attention, Validate the other person’s thoughts and feelings, and communicate in a relaxed and Easy Manner.
FAST Skill is an acronym for:
- Fair
- No Apologies
- Stick to Your Values
- Truthful
FAST is a DBT technique for communicating within a relationship to maintain self-respect and avoid conflict.
Always be Fair to the other person when communicating, there’s no reason to Apologize for disagreeing with the other person, Stick to Your Values and explain why you feel that way, and always Be Truthful to build trust with the other person.
FAQs
When was dialectical behavior therapy developed?
Dialectical Behavior Therapy (DBT) was developed in the late 1970s by psychologist Marsha M. Linehan, at the University of Washington.
What are DBT techniques used for?
DBT techniques are used to treat a variety of mental health conditions and substance use addiction.
- Borderline Personality Disorder (BPD)
- Depression
- Post Traumatic Stress Disorder (PTSD)
- Substance Use Disorders
- Eating Disorders
- Bipolar Disorder
- Anxiety
What are the main goals of DBT techniques?
The main goals of DBT techniques are to focus on acceptance and change to improve interpersonal relationships and overcome unhealthy emotions and behaviors.
- Manage negative thoughts and behaviors
- Decrease self-harm
- Reduce suicidal tendencies
- Regulate emotions
- Improve relationships
- Learn mindfulness techniques
- Strengthen communication
- Develop problem-solving skills
How does DBT differ from other forms of therapy?
DBT differs from other therapies in several ways:
1. Emotional Regulation is intended to balance and accept thoughts and emotions, whereas CBT focuses on challenging and changing negative thought patterns.
2. DBT techniques focus on 4 core areas of mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
3. DBT therapy techniques are flexible, customizable, and easy to learn.
4. Dialectical Behavior Therapy helps build social and interpersonal relationship skills.
Are DBT techniques evidence based?
Yes, Dialectical Behavior Therapy and DBT techniques are evidence-based and backed by over three decades of use and research.
DBT is supported and recommended by American Psychological Association and American Psychiatric Association.
Can you do DBT techniques on your own?
Yes, anyone can use DBT techniques on their own at home or anywhere they might be beneficial.
Working with a trained DBT therapist will provide the best experience for learning the techniques, although there are many workbooks and online materials that offer self-guided instruction.
