Dialectical Behavioral Therapy
Welcome, come in, take your coat off and stay awhile. I'm kidding, I know this is a blog. But welcome new folks and returning folks. Thank you for choosing to spend some time and energy with me. I want to dedicate this post to a model of therapy called Dialectical Behavioral Therapy (DBT). DBT was designed to be used with people who are experiencing symptoms of borderline personality disorder, and especially those people who engage in non-suicidal self-harm (such as cutting). Over time, research has supported it as an effective intervention not only for borderline personality disorder, but also for PTSD, substance use disorders, bipolar disorder, eating disorders, and others. It's okay if you aren't familiar with these diagnoses. Suffice it to say, DBT is effective for people who feel overwhelmed by their emotions and do destructive stuff because of that.
The Concept:
Let me just start by saying, DBT holds a very special place in my heart. The more I learn about it, the more I love it. I started off as a die hard CBT therapist - 'CBT is the greatest', 'it's helpful for everyone', 'look how awesome it is!'. You may - or may not - recall that CBT is cognitive behavioral therapy which focuses primarily on...well...thoughts and behaviors. (for more info on CBT check out: https://theyogitherapist.blogspot.com/2020/07/cognitive-behavioral-therapy-cbt.html). Don't get me wrong, CBT is a wonderful and helpful tool. CBT is also the foundation for DBT - DBT is almost like a CBT+ if you will. However, I'm hoping you'll see, like I did, that DBT offers a wonderful joining of the analytical and feeling sides of ourselves. Almost like DBT is the emotional right brain to the CBT analytical left brain.There are 4 focus areas for DBT: distress tolerance, interpersonal skills, emotion regulation, and mindfulness. I'm just going to do a very brief discussion of each of these 4 areas, but have no fear! I will do a more in-depth look at each one in turn with future posts - I don't want to overwhelm you right now with too much information.
Distress tolerance is basically the idea of being able to be uncomfortable even to the point of "a mental breakdown" and being able to not do anything that's going to make the situation worse. Remember, I said DBT was designed for people who self-harm. So imagine being in an emotional crisis situation and all you want to do is cut. You need to escape the mental pain, the chaos. You just can't handle it anymore. Distress tolerance is learning to accept reality for what it is and to be able to choose behaviors that have little to no negative consequences. You can think of it as the opposite of being impulsive.
Interpersonal skills is all about learning to have healthy relationships. DBT typically uses group therapy to help teach and practice good communication, boundary setting and reinforcement, and healthy conflict resolution. Every person has social needs, so the goal here is to help people be able to have relationships in a safe, healthy way. An important part of interpersonal skills is maintaining/increasing self respect in relationships.
Emotion regulation is therapist-speak for learning how to not let your emotions control you, and not let other people control your emotions. It's about understanding and recognizing your emotions, so that you are less vulnerable to becoming emotionally overwhelmed. Emotion regulation also teaches skills for changing unwanted emotions which is typically where the CBT stuff comes in.
Mindfulness is kind of a buzz word right now, honestly. Recently, I was asked by a very dear elementary/middle school teacher of mine how I define mindfulness. This is what I told her, "mindfulness is the conscious direction of full awareness to a single target much like a mental flashlight". There are a couple of key aspects to mindfulness though. First, the target is a present moment experience - not past or future. Second, the target can be an activity, emotion, thought, body sensation, sound, sight, taste, etc. There's a lot more to say here, but again, we'll go into more depth later.
There are some assumptions in DBT about both the client and the clinician. My favorite assumption about the client goes, 'we may not have caused our problems, but we are the one responsible for fixing them'. I just find these words so profound. It's so easy to get stuck in the "victim mentality" saying my life is so unfair or I never should have had to go through this or I'm like this because... my parents got divorced or my doctor over-prescribed the medication. This brings up the age old discussion of explanation versus excuse. Yes, maybe it is true that the doctor prescribed too high a dose of oxycodone and didn't taper you off correctly. No, that doesn't excuse you stealing from your grandmother to buy heroin off the street. Not only that, but you are still going to be the one who suffers the consequences of not changing your behavior - jail, loss of relationships, health issues, mental health issues, poor quality of life, etc.
I use to tell my clients when I worked at an inpatient substance use disorder treatment program, 'Someone may have hurt you and treated you unfairly. But who's sitting in the chair right now? Them or you?' There are so many things that happen that are wrong, hurtful, and unfair. It would be great if the person who wronged us could fix it, but that's not how it works. If you want to stop suffering the consequences, then you have to be the one to make the change.
Why it matters:
Okay, I'm gonna be real with you guys. DBT is basically the serenity prayer as therapy. You know how it goes:
DBT is all about developing practical ways of living out the serenity prayer in your daily life.
Action Item:
Self-soothing with your senses is one way to incorporate mindfulness, distress tolerance, and emotional regulation with one activity. Everyone gets upset even if it's not a "crisis situation". Prepare yourself to handle tough situations. Get yourself an orange and put it in the freezer. Next time you're feeling upset whether it's angry, anxious, triggered, depressed, etc., take out the orange and hold it in your hands. Notice the temperature, the texture of the peel, and the color. As it warms in your hands, notice it begin to soften, the temperature changes, the texture changes, you can begin to squeeze it gently. As it warms, it will begin to release the orange scent. In aromatherapy, orange is a happiness booster. Focus all your awareness on the orange. When your mind wanders bring it back to the orange, feel it in your hands. Just be sure not to throw it at anyone or you'll be going against the fourth principle - interpersonal effectiveness!
Questions to Consider:
- Of the four areas discussed, which is the hardest for you and why?
- Which area would you most like to learn and practice? (feel free to post this answer in the comments section)
- What are some ways you can incorporate aspects of all four areas into your daily life?
- What is one (or more) problem in your life that you didn't cause, but that you have to accept responsibility for solving? How will you do it?
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