Article by Tara Anton
DBT was created by Marsha Lindham in the 1990s from the foundational concepts of Cognitive Behavioural Therapy. CBT’s theoretical framework stems from Behaviourism and Social Learning Theory. At its roots, DBT is a trauma-informed therapy with influences from Zen Buddhism. This modality was created to help manage the intense emotions associated with Borderline Personality Disorder (BPD), including suicidality, but is now often used for a variety of issues, including mood disorders and intense impulsivity. Many negative thought patterns stem from very black-and-white thinking – “dialectics” emphasizes the grey area, and helps identify that two differing ideas can be true.
DBT is a long-term form of counselling, generally at least a year, and entails a detailed curriculum and weekly homework in the form of Diary Cards that you work through with a DBT-trained counsellor. Diary cards track your mood, urges, and behaviours, as well as the learned skills that were used to cope with them. Generally, the client attends a DBT group therapy, where a variety of skills are introduced and taught, and then has one-on-one therapy as well, to discuss the specific use and integration of these skills in their lives
The 4 DBT concepts that are taught throughout the curriculum include Mindfulness, Distress Tolerance, Emotional Regulation & Interpersonal Effectiveness Skills. There are several different skills within each category to help develop long-term coping mechanisms in these areas.
1. Mindfulness: “Many folks who come to DBT find themselves ruminating on the past or fretting about the future. Practicing Mindfulness skills can help achieve a balance” (DBT self-help). Mindfulness can help you to focus on the present, instead of catastrophizing the future or being frozen and overwhelmed with the past. It helps you to see your thoughts in a non-judgmental way, and then let them go. This is often done with a variety of exercises that are similar to meditations, but are often a bit directed, such as body scans, breathing exercises, observational exercises, and learning to focus on one thing at a time. Here’s a link to a mindfulness exercise as an example:
2. Distress Tolerance: This concept helps you build up a skill set for when times of crisis do happen. Distress happens to everyone, but learning positive and effective coping skills instead of utilizing old, detrimental habits will improve your overall quality of life. This includes distraction techniques, skills to reframe a situation, radical acceptance, and learning to self-soothe. An example is the STOP acronym skill, to use when you’re in a crisis:
- Stop: do not react. Freeze yourself in the moment before you react.
- Take a step back: take a break, let go, take a breath.
- Observe: What’s happening in and around you? What are you thinking and feeling? What are others doing?
- Proceed mindfully: moving forward, act with awareness. Remember your goals- what will help you get closer to them? What actions might move you farther away from them?
3. Emotional Regulation skills: This focuses on being able to identify your emotions – they are valid, real, and meaningful, but we must also learn how to manage them instead of being managed by them. To intervene on the ineffective behaviours that often follow dysregulated emotions you have to get to the root of the problem and identify the entangled emotions. These skills include problem-solving skills, checking the facts, opposite action, and others which build on each other throughout learning this DBT concept.
4. Interpersonal Effectiveness Skills: These “are designed to help you get what you need from your relationships while being respectful to yourself and others.” (DBT Self Help). The skills practiced in this category are used to teach how to communicate effectively with others to support and create healthy relationships. This includes learning how to set and abide by boundaries while respecting yourself and others, how to develop friendships, and how to navigate when social situations are not going well.
DBT was created to support those individuals with strong emotional reactions due to trauma and help them learn to manage and cope more effectively than the behaviours which usually stem from ineffective, emotional, thought patterns. Marsha Linehan’s (1993) goals are “accepting patients just as they are within a context of trying to teach them to change” (p. 19). This is a very task-focused and skill-development-driven modality of therapy which requires a long-term commitment from both client and therapist. However, components can be used selectively for certain skill development and concept teaching.
Linehan M. M. (1993) Cognitive Behavioural Treatment of Borderline Personality Disorder. The Guilford Press, New York
Lineman M. M. (2015) DBT Skills Training Manual (2nd ed.). The Guilford Press, New York.
Oliver, M., Horvath, A., & Mae, R. (n.d.). Home. DBT Self Help. https://dbtselfhelp.com/
Wu, J. (2022, November 7). leaves on a stream meditation . YouTube. https://www.youtube.com/watch?v=Ml-yuYraZkA