Dialectical Behavior Therapy: everybody got time for that!

I know what you may be thinking. You either love, hate, or have no clue what dialectical behavior therapy (DBT) is all about, right? Many of you probably fall into that third category...but I have recently learned some very useful things from a self-help book on DBT that I purchased over the summer. With that said, I'm not going to try and make you a believer in DBT skills, but I am going to point out why everyone should at least consider the impact that these skills can have if you choose to incorporate them into your life. And if you are aware of what DBT skills are and you think you don't need or use them...think again. DBT skills are extremely powerful for anyone to utilize, and no one handles situations perfectly every minute of every day. So, let us start with a brief overview of the history of DBT and what it is all about, as well as specific skills that are taught.

For starters, let's give a brief overview of how DBT was first developed. Marsha Linehan (who has since become a well-known psychologist) created DBT as a treatment for individuals suffering with chronic suicidality. It has since been shown to be effective in treating sufferers of borderline personality disorder (BPD), which is a mental illness in which individuals suffer with controlling intense emotions, have interpersonal difficulties, have a low sense of self, are impulsive, describe themselves as feeling "empty" and take part in self-destructive behaviors. In 2012, Marsha Linehan contributed to the fight to end the stigma of mental illness by having an article published in the New York Times about her own struggles with BPD. In the article, she tells readers how her illness ended up helping her create the foundation of what has since become known as BPD. For anyone interested in reading this article (which I highly recommend), here is the link: http://www.nytimes.com/2011/06/23/health/23lives.html.

Alright, so now you have a little more insight as to how DBT came to be. Now, let's get down to business. What exactly is DBT? It is a skills-based treatment approach that has two guiding principles: acceptance and change. In essence, individuals learning DBT skills have to learn to accept the situations they are in or how they are feeling at the moment, while simultaneously seeking to change or improve their behaviors and abilities to control intense emotions. This sounds simple enough, but if you take a second to think of a specific example, you'll quickly realize that it can be a lot harder to do than you might think. But it is doable, and with the right amount of support and tenacity, anyone can achieve this way of thinking. Once this is accomplished, you can begin to learn about and practice the four main skills taught in DBT: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

I could go on for another two pages about each one of the four skills taught in DBT, but in the interest of space, I'll have to cut my explanations short as to how they are useful to everyone. First, mindfulness is all about being aware of-well everything, including your thoughts, emotions, physical sensations, and actions. But the key to being truly mindful is to be aware without being judgmental. Some mindfulness exercises that many people find useful include mindful breathing and progressive muscle relaxation. Once you learn to master the basics of mindfulness, you can move on to more advanced mindfulness skills such as the concept of wise-mind (my personal favorite). Wise-mind is all about being able to be aware of both your emotional thinking and reasonable difference, and then making decisions that are most appropriate and effective (which usually involve meeting someplace in between your emotion and reasonable mind).  The second skill that is essential to DBT is distress tolerance. The point of this skill is to essentially find ways to cope with current stressors or emotions through the use of distraction. For instance, some people find it helpful to go on a walk when they are feeling upset. Others find it helpful to distract themselves by cooking, cleaning, taking a shower, getting work done, or even just talking to a friend on the phone. There is no end to this list, as there are endless ways you can distract yourself from your present situation. Though this doesn't necessarily solve your problems, it can help you calm down so that you can more rationally solve the issue later. The third DBT skill is emotion regulation. Emotion regulation involves several steps, including being able to recognize your emotions, being mindful of your emotions and recognizing when your emotions are negative and how to change them into positive ones. This skill is a bit more difficult to explain but I do know that a good way to start regulating your emotions is really to just stop every once in awhile and ask yourself "How am I feeling at this moment?" The final skill taught in DBT is interpersonal effectiveness. This skill revolves around improving your relationship with others. One of the key ways of doing this is to learn what it is that you want from the relationship. You also need to learn to ask for what you want, solve conflicts in a nonviolent way (both verbally and physically), and to treat others according to your personal values.

What you may have realized by now, is that all four of these skills revolve around one another. You really can't be good at one, without being good at the others. Thus, DBT is a process, but one that is worth sticking to. And for those who feel that you don't need DBT because your life is already what you want it to be, keep in mind that you are likely implementing various aspects of DBT skills without even realizing it. Conversely if you do realize it, keep in mind that you then have the knowledge and ability to pass these valuable skills on to others who may not have them down. Just some food for thought...Oh and by the way here is the source for the self-help book that helped to teach me some of these skills: McKay M, Jeffrey C. Wood J. C. Brantley J (2007). The dialectical behavior therapy skills workbook. Oakland, CA: New Harbinger Publications, Inc.

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