Dialectical Behavioral Therapy (DBT)

Mindful. Present. Calm.

Often, when personality, behavioral, or mental health disorder symptoms come forward, we lose sight of the present. We probably even do this when we’re just feeling extra emotional. However, bringing yourself back to the present moment can remedy many strong feelings that feel overwhelming. 

Dialectical behavioral therapy is a relatively new form of talk therapy that focuses on training patients to regulate their emotions when they arise. Similar to cognitive behavioral therapy, patients learn to tie their feelings and thoughts together. 

Emotions can often feel overwhelming and out of control. Dialectical behavioral therapy aims to guide patients to peacefully coexist with these intense reactions.  

What is DBT?‍

Dialectical behavioral therapy (DBT) is a type of talk therapy based on cognitive behavioral therapy. It was created by Marsha Linehan in the 1970s. DBT integrates a combination of elements from cognitive behavioral therapy (CBT) and Zen mindfulness to help individuals experiencing very intense emotions make sense of those emotions and deal with them in a healthy manner.

DBT teaches people to identify their emotions, understand them, and accept them, however difficult and uncomfortable those feelings may be. It was originally developed to treat those who had Borderline Personality Disorder, but has been shown to be an effective treatment for many different mental disorders, including anxiety, bipolar disorder, eating disorders, substance use disorders, and depression.

How Can DBT Help Me? ‍

DBT skills have been proven to help increase well-being, attention to the present moment, positive emotional experiences, and interpersonal relationships while decreasing negative emotions and distress. Many people who feel overwhelmed by their emotions and as though they cannot cope with life—or wish they could cope better—can benefit from learning DBT skills.

Emotions can be contradictory and ever changing. The mind can be a naturally complex and messy place. DBT is organized around understanding and accepting this while acknowledging the need for change. 

Regardless of the difficulties an individual is dealing with, DBT essentially takes what starts as an empty tool box and fills it with the necessary tools to utilize when negative and maladaptive thoughts and behaviors intrude into someone’s life.  

The DBT Process

DBT is not a quick fix for symptoms of different mental health and behavioral disorders. Like all forms of talk therapy, it takes time and commitment, but can resolve an array of issues. 

Individualized Therapy

There is no set timeline for DBT, and the time needed for complete treatment will vary by individual, but it typically requires at least six months to a year of consistent therapy and practicing the newly learned skills.

DBT usually consists of weekly individual meetings with a therapist, and weekly group skills training meetings with other DBT patients. When necessary, the therapist will recommend inter-session meetings where a patient can text or call their therapist when they have immediate concerns. 

Again, DBT is similar to other forms of therapy where the patient will have “homework” in between sessions; usually they practice skills or ruminate on what was covered in the last session.    

The Four Stages of DBT

Before any DBT sessions begin, the patient and therapist generally go through a short pre-treatment phase where they decide whether DBT is right for the patient, and if the therapist is the right person to take them through the process. 

The stages of DBT are not chronological, but rather circular. Most clients start in stage one, but it is not uncommon for them to move through different stages throughout the experience. 

The amount of time a person will spend in each stage depends on the targets and goals of the patient.

Stage 1

The goal of stage one is for the client to stabilize and control their behavior. The therapist teaches them to address current problem behaviors and those that are life threatening or interfering with therapy. Getting control of their behavior such as self-harm, substance use, or other self-destructive behaviors will allow the client to progress forward to the next stage.

This is a skills-based practice stage as the client implements the newly learned skills for managing emotions and impulses when negative thoughts, emotions, and experiences arise.

Stage 2

This stage works to move the patient from suffering from emotions to experiencing them. After stage one, the client is still suffering internally, the change is that they are able to control their behavior and responses. 

Invalidation and past trauma prevents people from processing and accepting a lot of emotions. They might feel like they’re completely prevented from a “real” emotional experience 

Phase two of DBT allows the client to move from emotional paralysis to fully experiencing them.

This stage can be difficult. It consists of the patient and therapist discussing the patient’s childhood history and traumatic experiences again and again until the symptoms of the trauma are reduced or gone.

Stage 3

Once the client can control their behavior and indulge in the full emotional experience, the next stage is to learn to truly live life with the “normal” full range and balance of emotions that comes with it. The client should learn to find love, respect, and happiness with themselves along with defining goals and ambitions for the future. 

Stage 4

Stage four is only for some clients who make it through the first three stages and remain unfulfilled and disconnected with ordinary life. This stage assists the client in experiencing their spiritual side and finding deeper meaning. 

Stages three and four are less defined and structured than the first two stages. What they look like will truly vary greatly among different individuals.

Elements of DBT

While working through the stages and group skills practice of DBT, there are four main elements the therapy method focuses on. Each element circles back to being introspective, and to reach inwardly in order to act outwardly.

Mindfulness

Every DBT stage or group of skills has mindfulness as its foundation. In its simplest form, “mindfulness” is bringing oneself back to the present. It is the act of taking inventory of yourself—physically, emotionally, and mentally. If you notice you’re not present, focus on coming back to the “now”’ It is a deceptively simple skill, that is an ever-moving target. 

Mindfulness is at the root of DBT because, without being aware of the now and what you are doing or feeling, you cannot change your response. Mindfulness helps us to become self-aware, which gives us the ability to implement new skills.

Interpersonal effectiveness

The second element of DBT is interpersonal effectiveness, or “how I get along with others.” This skill encompasses how one verbalizes:

  • Their needs 
  • How they get their needs met 
  • How they build healthy relationships 
  • How they end unhealthy relationships
  • How one balances their relationships and their needs.

Interpersonal effectiveness skills help us all to navigate relationships, both personal and professional. It can also be effective in helping us have a healthier relationship with ourselves. ‍

Emotion Regulation

Emotion regulation is feeling our emotions, yet being able to control them. It is an essential skill to help us feel confident in ourselves and have happy, healthy relationships with others too. ‍

Once you’ve reached this element in the DBT process, you will learn how to name your emotions, know what your emotions feel like, decrease negative emotions, decrease emotional vulnerability, and ultimately decrease emotional suffering. This element of DBT helps people to cope with their emotions and the world around them. ‍

Many times, we are not in control of how we feel, but we can be in control of how we react and express our feelings. This stage does not focus on how to suppress emotions, but rather, how to manage those feelings. 

Distress tolerance

The fourth element to DBT, distress tolerance, is how we help ourselves when we are upset. With distress tolerance, we learn skills on how to cope in a crisis, continue to live in acceptance (even when we do not like reality), and how to take care of our own needs. The distress tolerance module teaches adults how to calm and soothe themselves in difficult situations.

The foundations of DBT are distress tolerance, emotional regulation, and interpersonal effectiveness. These all create mindfulness.

Get Started

DBT teaches people how to feel, validate, and manage their emotions. Skills are taught and mastered that aid individuals in experiencing the good and the bad that inevitably come with life and allows people to truly live.

Inner Balance Counseling has a team of compassionate and experienced therapists trained in DBT, along with a variety of other therapy methods. Reach out today at 602-497-2912 to work with trained professionals ready and able to help you learn to not only survive everyday life, but thrive in it.

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© Inner Balance. All right reserved.