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Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that emphasizes the psychosocial aspects of treatment. Psychologist Marsha M. Linehan developed DBT in the late 1980s as a means to more effectively treat chronically suicidal adults diagnosed with borderline personality disorder (BPD). It is founded on the principals of cognitive behavioral therapy (CBT) and blends Eastern mindfulness techniques (e.g., awareness, mindfulness, and attentiveness to current situations and emotional experiences) to encourage acceptance and change. It is comprised of three different therapy settings, including weekly individual psychotherapy sessions, weekly group DBT skills training therapy sessions, and as-needed phone coaching to provide additional support between weekly individual and group sessions. The philosophical perspective of dialectics, balancing opposites, influences the DBT process. As explained by Behavioral Tech, DBT focuses on teaching four sets or modules of behavioral skills, which include:

  • Core mindfulness: the practice of being completely present and aware in any given moment. Examples of exercises related to this module include:
    • Observe your breathing: take a few minutes each day to cast your wandering thoughts aside and focus only on your breathing. 
    • Do one thing at a time: instead of attempting to multitask, try tackling one thing at a time. This can enable you the ability to provide your undivided attention to completing each task accurately and efficiently. 
  • Distress tolerance: increasing an individual’s tolerance of negative emotion as opposed to attempting to avoid or escape them. Examples of exercises associated with this module include:
    • Self-soothing techniques: there are a variety of self-soothing techniques that can be used to ground oneself mentally and emotionally.
    • Radical acceptance: is simply accepting the state of things as they are, without working to change them.
    • Distraction: in moments of intense overwhelm, temporary distractions (e.g., calling a friend, reading a book, watching TV, etc.) can provide brief relief from the distressing situation. 
  • Emotion regulation: decreasing emotional impulsivity, learning to manage and shift intense, problematic emotions. Examples of exercises associated with this module include:
    • Take opposite action: identify how you are feeling and do the opposite (e.g., if you are feeling sad and want to withdraw from loved ones, make plans to spend time with them instead).
    • Cope ahead: come up with a plan that prepares you to skillfully navigate and cope with emotional situations.
  • Interpersonal effectiveness: authentically advocating for one’s own wants and needs in a relationship in a way that is both self-respecting and non-damaging. The components of interpersonal effectiveness are practiced using exercises such as:
    • Remember to THINK, which is an acronym for: 
      • Think about the situation from the other person’s perspective
      • Have empathy for and consider the other person’s feelings
      • Interpretations: try to identify a positive interpretation or an alternative explanation for the persons behavior/ situation
      • Notice if the other person is attempting to improve the situation 
      • Use Kindness and a gentle approach when interacting with the other person
    • Be sure to GIVE, which is an acronym for: 
      • Be Gentle, kind, and respectful in your approach to help the person with whom you are communicating feel loved instead of attacked
      • Act Interested in what the other person is saying through body language and by maintaining eye contact
      • Validate by confirming that you hear what they are saying and echoing their emotions back to them
      • Use an Easy manner and present yourself as being comfortable and relaxed throughout the interaction

A mental health clinician offering DBT services works with an individual to identify ways to hold two seemingly opposite perspectives simultaneously. This, in turn, promotes balance and minimizes the tendencies to think in absolutes (e.g., viewing all in black and white, all-or-nothing style of thinking, etc.). DBT encourages an inclusive worldview and perspective instead of an exclusive outlook on life which is reinforced through DBT exercises. 

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.

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