Dialectical Behavioral Therapy

Dialectical behavior therapy (DBT) is an adapted version of Cognitive Behavioral Therapy (CBT) initially designed to address the needs of individuals struggling with chronic suicidality and diagnosed with borderline personality disorder. It has since become widely acknowledged as the premier psychological intervention for individuals with borderline personality disorder. The core objectives of DBT include fostering present-moment awareness, cultivating adaptive coping mechanisms for stress, enhancing emotional regulation skills, and fostering healthier interpersonal relationships. Beyond its effectiveness in borderline personality disorder, research indicates DBT’s efficacy in treating various other conditions such as eating disorders, depression, substance dependence, and post-traumatic stress disorder (PTSD).

DBT encompasses four distinct behavioral skill modules. Mindfulness and distress tolerance are categorized as acceptance-oriented skills, while interpersonal effectiveness and emotion regulation are regarded as change-oriented skills.

• Mindfulness: the practice of being fully aware and present in that moment
• Distress Tolerance: how to tolerate pain in difficult situations, not change it
• Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
• Emotion Regulation: how to decrease vulnerability to painful emotions and change emotions that you want to change

DBT therapy incorporates the valuable practice of cultivating mindfulness skills. Mindfulness entails directing attention to the present moment, allowing individuals to “live in the moment” by focusing on the immediate minutes or seconds. This practice facilitates heightened awareness of internal experiences, such as thoughts, sensations, impulses, and emotions, as well as external surroundings, including sights, smells, sounds, tastes, and tactile sensations, all observed in a nonjudgmental manner.

By fostering mindfulness, individuals can effectively manage emotional distress by slowing down time and employing healthy coping strategies. This approach promotes a calm demeanor, reduces reactivity and impulsivity, and mitigates engagement in automatic negative thought patterns and impulsive behaviors, such as self-harm or cutting.

Distress tolerance allows one to tolerate the current situation and find self-acceptance. DBT teaches four techniques for handling a crisis and diffusing the stress including:

• Distraction such as journaling or changing to a new task
• Improving the moment but staying in the moment
• Self-soothing
• Thinking of the stressor and tolerating the good and bad with it

Distress tolerance techniques help prepare one for intense emotions.

Interpersonal effectiveness skills aid individuals in cultivating assertiveness within relationships. This encompasses the capacity to assertively decline requests or set boundaries while maintaining the overall positivity and health of the relationship. Understanding that asserting boundaries and saying “no” can be beneficial and constructive is a fundamental aspect of this skill set.

Interpersonal effectiveness training focuses on enhancing listening skills, improving communication, navigating interactions with difficult individuals, and fostering self-respect through the establishment of healthy boundaries and limits within relationships.

Emotion regulation equips individuals with the ability to manage intense emotions more adeptly. These skills facilitate the identification and moderation of extreme emotional states. The underlying premise is that by effectively recognizing and addressing intense emotions, such as anger, emotional vulnerability diminishes, leading to a shift toward more positive emotional experiences.