DBT: Is it right for me?
Dialectical Behavioral Therapy: Is it right for me?
There are hundreds of treatment techniques and modalities in the world of psychology, and it can be overwhelming when trying to find a new therapist. Their bio’s are full of acronyms, and words that look like a foreign language. Next thing you know, you’ve spent 3 hours googling three letter words, and still have no idea what direction you should go in. When I first started graduate school, I completely had no idea what any of those acronyms meant. Even after graduation, I am still having to do my research on what they are, and how I can implement techniques & treatment modalities that my clients will benefit from.
One modality that I am finding useful for a multitude of my clients is Dialectical Behavioral Therapy (DBT, ah ha! acronym). Now, there is no one size fits all in any treatment approach, but what I like about DBT is that it is effective for many mental health issues such as ADHD, Bipolar Disorder, Eating Disorders, Major Depressive Disorder, Generalized Anxiety Disorder, PTSD, Substance-Abuse, Borderline Personalty Disorder, those struggling with suicidal behavior, and many more.
There are four skill based modules in DBT, which I will break down and expand on.
1. Mindfulness: Incorporating the wise mind! Patients will learn to identify their emotional reasoning and their rational reasoning, and how to incorporate both in order to mindfully move forward with their goal. Mindfulness also teaches patients awareness of their internal emotional world, how to be in the moment, and how to respond appropriately in behavior.
2. Distress tolerance: Learning how to manage crises without making it worse, and being able to tolerate painful emotions without engaging in destructive behavior. Patients will also learn how to implement action rather than reaction, and learn how to distract in healthy ways rather than avoiding negative emotions. Skills that are used in assisting with building distress tolerance are:
ACCEPTS
Activities: Do an activity that requires thought & concentration like journaling, playing a sport, or reading.
Contributing: Do something that allows you to focus on another person like asking a friend about their day., or making a gift for a loved one.
Comparisons: Put your situation in perspective by comparing it to something more painful or distressing. Or, thinking back on a time in which you were in a much more distressing situation and being able to handle it.
Emotions: Do something to create a new emotion that will compete with your distressing emotion. If you’re sad, watch a happy movie, or anxious, practice deep breathing.
Pushing away: Avoid a painful situation or block it from your mind using a technique such as imagery, or utilizing containment imagery (putting a problem in a box and putting it away for a while).
Thoughts: Use a mental strategy or an activity to shift your thoughts to something neutral, like finding things around you that start with the letter A, or count a specific object around you (e.g. bricks, trees…)
Sensations: Find safe physical sensations to distract you from distressing emotions like holding an ice cube in your hand, eating something sour or spicy, or taking a cold shower.
IMPROVE
Improve: Imagine yourself dealing successfully with the problem, being in wise mind, and feeling accomplished when the situation is over. By doing so, you may actually be able to change the outcome of the problem in your favor.
Meaning: Try to find meaning in painful situations. What can you learn from this experience? Maybe you’ll be more empathetic. Maybe you’ll build new relationships. Maybe this will launch you on a healing journey. Find a reason, or a possible reason, to assign your present suffering.
Prayer: Prayer can come in any form that works for you. The prayer can be to any higher power, including God or the universe. Surrender your problems and ask to tolerate the situation a little longer.
Relaxation: We tense up during stressful situations thanks to our fight or flight instinct. Engage in relaxing activities to calm the psychological distress you’re experiencing such as deep breathing, yoga, a hot bath, or a relaxing walk.
One thing in the moment: Stay in the moment by letting go of the past and future. Adding old issues to the situation, or future tripping about potential consequences of the situation, will not be helpful in solving the problem.
Vacation: Unfortunately, most of us aren’t able to take a real vacation during a moment of crisis. Instead, you can take a vacation in your mind. Imagine yourself somewhere else, like taking an evening stroll around the lake or driving on the Pacific Coast Highway. Stay on your “vacation” as long as necessary, and revisit as often as needed. Hopefully, you’ll “return” better able to tolerate your circumstances.
Encouragement: Encouragement doesn’t have to come from an external source to be effective. Give yourself encouragement by repeating phrases that are meaningful to you, such as “I got this”, “I can improve this moment.” Say it loud, say it proud! You’ll be amazed at your ability to motivate yourself to make it through a challenging time.
Pro’s and Con’s list: Weighing the consequences and outcomes.
3.Emotional regulation: Learning how to reduce emotional vulnerability, creating positive emotions, stepping out of ineffective incongruent moods, and how to develop and maintain emotional balance, are the key focal points here. Patients will learn how to build mastery by engaging in positive experiences, and tackling daily activities as a way to stabilize emotional reactivity. This fosters a sense of control, builds confidence, and competence for the patient to believe in themselves in order to accomplish what they need to successfully.
4. Interpersonal effectiveness: patients will learn how to build self-respect, make and maintain relationships, how to meet their wants and needs, as well as be able to set boundaries effectively and say no. This assists patients in being able to show up authentically, and conduct themselves in alignment with their true values and selves.
Dialectical Behavioral Therapy, is one of the more structured modalities out there, which is why it is so effective for those who struggle to regularly check in with themselves. In a way it can seem like you are in a classroom, having to stay on top of all the homework assignments your therapist will give you, but the homework is on yourself! Becoming aware of the why helps in the change of behavior. DBT connects the dots between why we feel the way we feel, and why we act the way we act. It calls attention to problematic patterns that are getting in the way of achieving the life you’ve always wanted, and emotional peace you’ve always craved.
This is merely a glimpse into what Dialectical Behavioral Therapy is, and does of course. DBT has several other skills and applications such as the ‘Diary card,’ which is the ultimate way to keep track of felt emotions, positive experiences, and identifying growth for yourself. I am always open to discussing DBT in its totality for those who may need a bit more information as to how it may help them. So please, if you are considering therapy for the first time, and want to know if Dialectical Behavioral Therapy is right for you, give me a call.