In talking to a private psychologist (as one needs to do in this day and age of our public healthcare system), he recommended something that I haven’t heard of before—DBT, also known as dialectical behaviour therapy. I’m sure if any of you guys have heard of a type of therapy, it’s probably CBT also known as cognitive behavioural therapy, one of the most common types of therapy. I’ve had multiple experiences with CBT yet I’ve never found therapy helpful as, in my experience, it lacked creating tools or skills to navigate situations outside of the therapy session. There is minimal spotlight on DBT despite it being an adaptation of CBT, only adding extra emphasis on emotional regulation, acceptance, and mindfulness. In this article, I’ll explain a brief history of DBT and its four core focuses—mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills—as well as provide examples of DBT tools to provide a sense of direction when dealing with intense emotions and situations.
DBT was originally developed in the 1980s when psychologists realized CBT’s insufficiency in dealing with chronic-self harm including suicidality. As a new wave of CBT emerged, DBT focused on validating a patient’s feelings and behaviors while still focusing on identifying and changing harmful experiences. This new strategy outlines the “dialectical” aspect of DBT, that is, accepting that two opposing truths may exist at the same time. DBT focuses on tackling four dimensions including mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness skills. Mindfulness is the practice of learning to be fully present in the moment and can be achieved through meditation, short pauses inserted in everyday life as well as integrating meditative practices in other activities, as seen with yoga. It allows us to stop obsessive flight of ideas concerning the past or future, and helps reduce stress, improve self-insight, and foster self-compassion. Emotion regulation involves multiple components including identifying and naming emotions, learning to balance how to accept difficult emotions while also learning to change them, and help make emotions less overwhelming.
Common tips for regulating emotions include taking care of one’s physical needs (ex. healthy sleep, diet and exercise), engage in activities that bring you joy, and focus on changing thoughts rather than changing feelings (e.g., asking yourself “Are these facts or assumptions?” or “What exactly is making me upset?”). Distress tolerance involves learning how to navigate painful situations, accepting that pain cannot be entirely avoided and is a natural part of life. It highlights the art of tolerance rather than impulsivity. We’ll cover distress tolerance skills and tools later in this article. Interpersonal effectiveness skills include learning the necessary strategies to build and maintain healthy relationships and learning how to end toxic ones, all while maintaining self-respect and creating boundaries. Such skills tackle collaboration, conflict resolution, inclusion, and communication.
In a world full of distractions and dopamine, the art of self-regulation is often challenged when presented with difficult emotions, situations and relationships. That is why I believe, aside from its clinical use, DBT can be helpful for everyone navigating life and its situations.
With the following skills and tools, I’ll organize them according to the four focuses of DBT: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills.
For mindfulness, we will go over two skills that focus on what mindfulness looks like and how we can integrate it into our lives efficiently. Firstly, the What skill includes three steps: observing, describing, and participating. To observe includes paying attention to events, emotions, and thoughts and not avoiding them when they are painful. To describe includes describing events, identifying thoughts, and naming emotions while listening to the facts rather than assumptions or judgements. To participate includes entering into the activity completely, focusing on the present, and trying to not be self-conscious. Lastly, the How skill encourages us to follow the What skill while being non-judgemental, being present in the moment, and being effective by focusing on what works for you. Moving on to emotion regulation, there is an acronym I find personally helpful when managing difficult emotions. The STOP skill includes the following components: stop (e.g., freeze and identify the emotion), take a step back (e.g., take some time to calm down), observe (e.g., gather the facts and avoid jumping to conclusions) and proceed mindfully (e.g., ask yourself “What are my goals?” and “What choice might make this situation better or worse?”). With distress tolerance skills, these particularly require extra effort and practise as they are meant to help with heavily overwhelming situations. The TIP skill is useful to reboot our mind by taking advantage of our physiological responses, which include the following components: tip the temperature by putting your face in ice cold water or applying an icepack to your face for 10-30 seconds, engage in intense exercise, and paced breathing by slowing down the pace, breathing into your belly, and focus on breathing out more slowly than breathing in. Lastly, interpersonal effectiveness skills focus on healthy communication which is demonstrated with the FAST skill. The components of the FAST skill include being fair and validating both parties feelings, focus on not over-apologizing, stick to your values and morals as well as being truthful by not exaggerating or making up excuses. These DBT tools are only a select few and if you are interested in learning more, I would recommend visiting the official DBT tools website to reinforce the described skills and learn new ones.
Conclusion: DBT has been shown to be effective for people ranging from adolescents to older adults with a range of mental health conditions, but it’s important to note that the skills training part of DBT has been shown to help anyone navigate difficult emotions and situations with much more ease, success, and satisfaction. Talking about the benefits such skill training and therapy can have for everyone helps to continue to de-stigmatize mental health and build a world of self-compassion and positive change.