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What is DBT and why is it amazing?

When we are younger, we learn coping skills to adapt to life’s stressors. If you’ve ever struggled with intense anger, over-eating, not-eating, using substances, self-harming, losing control, withdrawing (avoidance), and using-up relationships, then DBT is here for you! DBT was originally created for people who were suicidal. DBT is about making life meaningful and worth living. Over time, it’s been shown to be helpful for a variety of challenges, including self-harm, substance use, disordered eating, anger issues, and relationship challenges. DBT works well on depression and anxiety, too. Many of my patients with PTSD find tools from DBT to be extremely helpful. I love DBT. I have seen it transform the lives of my patients and their families.

You know how some people complain that there isn’t a manual on how to live life? Well ladies and gents, the DBT Skills Training Handouts and Worksheets Manual by Marsha M. Linehan is, in my opinion, an excellent (and secular) “How To Guide” for life.

The main goal with Dialectic Behavioral Therapy (DBT) is, “to learn how to change your own behaviors, emotions, and thoughts that are linked to problems in living and causing misery and distress (DBT Skills Training Handouts and Worksheets, p.9).” The term “dialectic” feels a bit intimidating but the concept is really quite simple: “dialectical” thinking means a synthesis or integration of opposites. With DBT we can have two and equal opposite beliefs at the same time. Just as you might have multiple ice cream flavors in a bowl, you can have multiple feelings or thoughts at once. For example, you can love someone and they can drive you crazy. A client might want to be in a therapy session and they might also really want to be playing video games or binging on Netflix instead. They might want to be sober and they’re having thoughts about drinking. Dialectics happen in our environment, too: in Michigan it can rain and be sunny at the exact same time. Now you’re starting to get the idea; DBT is all about the “both and.” Most of us operate through life from black-and-white thinking, also known as “all or nothing.” DBT strives to find a balance; DBT skills provide tools to “walk the middle path” without operating from such extreme perspectives.

The main dialectic within DBT is between the seemingly opposite strategies of acceptance and change. We have to accept that our old learned behaviors – yelling, over-eating, under-eating, avoiding, lying, cutting, drinking/drugging, shopping, stealing, gambling, promiscuity, etc. – were helpful at one point in our lives. Yet just like the clothes we used to wear when we learned those coping methods (yes, those behaviors are all types of coping methods), we’re starting to outgrow them and, if you’re reading this, it’s probably a sign you’re ready for some new tools in your toolbox.

In DBT we learn to decrease:

- Judgmentalness

- Loneliness/interpersonal conflict

- Difficulty with change

- Difficulty regulating emotions

- Impulsivity and addiction

DBT provides four different modules targeting the following behavioral skills:

Mindfulness: the practice of being fully aware and present in this one moment
Emotion Regulation: how to change emotions that you want to change
Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
Distress Tolerance: how to tolerate pain in difficult situations, not change it

All of the skills taught in DBT are balanced in terms of acceptance and change. The acceptance-oriented skills are Mindfulness and Distress Tolerance. The change-oriented skills are Emotion Regulation and Interpersonal Effectiveness.

In DBT, there is a saying “one cup of acceptance to a teaspoon of change.” Why do we say that? Because often times we come into therapy thinking that everyone around us has to change (e.g. I don’t like that my family member or partner or boss or friend does ____). Sometimes we might think that we are so broken, everything has to change – e.g. “I don’t like that I…”, “I hate myself because…”, “There is something wrong with me…” DBT is powerful because we are taking a look at ourselves – our skills and relationships – with compassion. We recognize that we are doing the best we can with what we have AND we can learn to do better and try harder. DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals.

DBT was developed by the bad-ass therapist, Marsha Linehan, PhD. Marsha struggled with her own mental health and found that using Cognitive Behavioral Therapy was helpful, but felt really invaliding for many of her clients. DBT provides validation by explaining why we’ve come to use certain coping methods, why we might have a hard time regulating our feelings, and how we can learn new strategies and tools instead. DBT starts with mindfulness because you have to notice what’s happening before you can try to change it. When you’re driving, you have to notice and accept that it’s raining before you can turn on the windshield wipers. Admitting and accepting that you have a problem is the first step to solving it.

Those that know me are well aware I am a huge advocate for 12-step programs; I have seen 12-step programs transform the lives of my patients as well as my friends. I genuinely believe DBT is an excellent complement for individuals seeking recovery because it provides tangible skills to manage daily stressors and instruction s on key aspects of coping with life – from managing big feelings, to checking the facts, to improving communication and setting boundaries, to identifying values and priorities. It also provides beginner-friendly mindfulness practices to improve serenity.

If you’re thirsty for some new skills, schedule your first session today! I also offer frequent DBT skills-focused workshops to provide support along the path.

If you haven't already, join my free, private Facebook group where I share mindfulness and some DBT skills 2x/month (it’s not a therapy group, but it’s the next-best thing).


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