You are probably here because you and I probably had a conversation around dialectical behavior therapy (DBT)
Last modified date: June 13, 2024
This page provides some background and resources on dialectical behavior therapy (DBT). If you are ready to dive right in and to sign up for DBT program, check out the Clinics section below. Unsure yet if it’s for you? Then start with checking out the Skills module below and learn what problems DBT aims to solve and skills that you will develop throughout the 6 month (or 1 year) program.
How I discovered DBT
Long story short: a psychotherapist who stated that I exhibit some traits XYZ and suggested that I explore dialectical behavior therapy (DBT) since it is quite effective treatment for XYZ. Moreover, DBT is time bound, unlike talk therapy that can go on for years and years. In fact, prior to discovering DBT, I spent 5+ years in weekly talk therapy sessions. While they were helpful and to some degree necessary during those years, I will say that DBT has moved the needle for me in tangible ways.
First Impressions of DBT
“You are doing the best you can … AND you can do better”
Two opposing statements that can be both true — AT THE SAME TIME 🤯
Prior to learning DBT, I struggled with the above statement: aren’t the two mutually exclusive?!? How can you tell me that I’m doing the best I can … and that I can do better?! I felt frustrated … please … just choose one ! Turns out, both of those seemingly contradictory statements can be true at the same time and the inability to hold both truths at the same time, also known as all-or-nothing thinking, one of the many cognitive distortions.
Skills Modules
In DBT, you learn CONCRETE skills. Unlike talk therapy, where you go in and pour your emotions out and often the therapist silently sits there and/or maybe just nods their head (which I discovered, can actually increase anxiety), DBT provides your skills that you practice and the main purpose of the skills is to help you BUILD A LIFE WORTH LIVING (more on this later).
Emotion Regulation
First, to understand emotion regulation, you want to be able to identify your subjective units of distress (SUDs). It is a scale from 0-100, allowing you to subjectively measure how distressed you are. The reason for identifying your level of distress first and foremost is because emotion regulation skill applies to distress up to 70/100. That is, emotion regulation is effective for dealing with emotions that have not breached your tipping point, your threshold. Beyond 70/100, emotion regulation is not the right tool for the right job and instead, you’ll want to turn to distress tolerance (below — it’s aim is to “not make things worst”).
- No mislabeling of emotions – every emotion (e.g. envy, jealously, anger, sadness) serves an evolutionary purpose. Really — there are no “BAD” emotions. Sometimes people will say: “you SHOULDN’T be feeling X”. For example, envy has a certain negative connotation. But in fact, envy is a merely a feeling we experience when we see someone do/possess something that we want. That’s it. Envy can be justified (more on this below) and propel us to take action, ignite a change in our life. To encourage us to go after what we desire. For example, see someone with a high paying job that you want? That might be envy! And it can propel you to work towards that goal!
- Identifying emotions somatically – if you were like me, when someone (usually friends or family or your favorite therapist) would ask, “how are you feeling” I wouldn’t know how to respond. Really, I wouldn’t. Not because I wanted to poker face. But because I couldn’t find the right words to describe the sensations running through me. Therefore, I would spit out some generic, masculine answer like “I’m okay. Everything’s fine.” But I’ve learned that I can sense somatic changes in my body, which provide clues … hints. For instance, so much of what I’ve felt and carried for years was anxiety: my heart palpating rapidly, shortness of breath.
- How to check the facts – okay, so you are feeling some feeling. When you become aware of that feeling, you want to do what they call “check the facts”. In cognitive behavior therapy (CBT), I believe they have a similar phrase. Anyways, we check the facts because what we are feeling can fall into one of two categories: 1) justified 2) unjustified. If the facts line up with how we are feeling, then our emotion is justified. In this scenario, we can (if we want to change the emotion) do what they call problem solving. If however, our emotion is unjustified (or perhaps not helpful in the scenario, anger being a prime example) then we can do what is called opposite action, which changes our behavior. For instance, if we are sad and don’t feel like doing anything and are lethargic and our feelings don’t match our scenario, we behave in opposition and then go surround ourselves with people (or friends or family).
Learning outcomes: Checking the facts (instead of jumping to conclusions — a cognitive distortion), opposite action (when your emotion does not fit the facts OR the emotion is not useful or appropriate for the situation), problem solving (when your emotions DO fit the facts).
Distress Tolerance
Learning outcomes: concrete skills on how to NOT make the situation worst. With this particular skill, we are NOT trying to improve the situation; we are trying to NOT exacberate the situation. We’ve all been there, right? You are in an argument with a loved one and holding back words that can harm or damage the relationship and still, we utter those words. This module will teach concrete skills (e.g. STOP, TIPP, radical acceptance) that can be used when your subjectives units of distress (SUDS) breaches a threshold that makes emotion regulation skills (see above) ineffective.
Mindfulness
Learning outcomes: I rolled my eyes when I first heard about this module. Really — a WHOLE module dedicated for “mindfulness.” Come on now: I’ve been practicing meditation (on and off) for years! Well, this module and the skills developed here are ones that I use EVERY DAY and serve as the FOUNDATION for all the other modules. In order to regulate emotionally, or apply distress tolerance to not make the situation worst, or decide whether you want to prioritize self-respect during an interpersonal interaction, you need to be MINDFUL.
[!info]
For mindfulness, skills are divided into two category. The first three are what skills and what you do to cultivate mindfulness. While practicing each of those what skills, how you do it is just as important; we aim to practice them one-mindfully, non-judgementally, effectively.
What skills
With mindfulness module, you are taught the WHAT to do cultivate mindfulness as well as HOW. What do you do? You can practice 1) Observing – using your senses 2) Describe – concrete words, not abstract 3) Participate – fully immerse yourself in whatever it is. And as you are practicing (the WHAT) skill, you aim to do so with the following qualities:
How skills
- nonjudgemental – no interpretations or judgements. just as they are
- one-mindfully – single threaded attention fully focused on task at hand
- effectively – checking in with yourself that whatever it is that you are doing is aligned with both your long term values as well as life goals
Understanding validation in families
Interpersonal effectiveness
One of my favorite modules. This was the last module I took and where I really dove deep in the six levels of validation. The main takeaway for me was that how I behave during an interpersonal interaction DEPENDS … that is, although I value consistency, I can factor in the three components that make up an interpersonal interaction:
Figuring out interpersonal goals
In any interpersonal interaction, it’s useful to have a framework as to how you want to interact with the person. Remember, check in with your “wise mind” when prioritizing the following:
- Self-respect – how do I want to feel after this interaction
- Relationship – after this interaction, do I want the relationship to stay the same, get worst, improve
- Objective – what do I want to get out of this interaction specifically
Skills
After you identifying which of the three factors (above) you want to prioritize, you can then use one of the interpersonal effectiveness skills
| Goal | Skill | Description |
|---|---|---|
| Objective | DEARMAN | A useful framework for phrasing your question. Basically, sales technique |
| Relationship | GIVE | Do this when you want to IMPROVE the relationship |
| Self-Respect | FAIR | Making sure you walk away from conversation and behaved in a way that aligns with your values |
Resources
If you decide to join a skills group (see [[#Clinics]] below), they’ll require you to purchase the DBT manual. However, the book is free and made available online (here). That being said, I personally prefer having the physical copy next to me.
Clinics
Seattle
Greenlake Therapy Group
Website: https://www.greenlaketherapygroup.com/dbt-skills-group
Columbia City DBT
Website: http://www.columbiacitydbt.com/
Change log
2023.10.24
- Added a reference to the DBT manual/textbook (which if free online)
- Update mindfully and included a note that introduces the two categories of mindfulness exercise, describing what versus how
[^1]: Understanding Validation in Families – Alan E. Fruzzetti, PhD, 2012. https://www.youtube.com/watch?v=EDSIYTQX_dk.
[^2]: Cognitive Behavioral Therapy Los Angeles. “Cognitive Distortions: All-Or-Nothing Thinking,” October 4, 2023. https://cogbtherapy.com/cbt-blog/cognitive-distortions-all-or-nothing-thinking.