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Dialectical behavior therapy (DBT) was developed by psychologist Marsha M. Linehan in the late 1980s as a means to better treat individuals diagnosed with borderline personality disorder (BPD), suffering from chronic suicidal ideation. It is a rigidly structured, evidence-based psychotherapy that combines standard cognitive behavioral therapy (CBT) techniques for emotional regulation and reality testing with concepts derived from Eastern meditative practice (e.g., awareness, mindfulness and attentiveness to current situations and emotional experiences) to emphasize the psychosocial aspects of treatment. DBT is a multifaceted approach that is carried out in three therapeutic settings, which include: weekly individual therapy sessions, weekly DBT skills training group therapy sessions, and as-needed phone coaching. This format allows participants to engage in individualized and collective treatment to focus on the four modules of DBT. Each module highlights distinct and specific skills that build upon each other:

  • Core mindfulness: this module focuses on improving an individual’s ability to accept and be present in any given moment. The skills in this module help individuals learn the importance and value of slowing down and taking pause instead of succumbing to intense emotions and acting in destructive ways, examples include:
    • The observe skill: collect emotional data by simply observing or attending to thoughts, feelings, events, and behaviors without trying to change them.
    • The describe skill: use words to describe your internal experience, and when a thought or feeling arises, acknowledge it.
  • Distress tolerance: this module focuses on increasing an individual’s tolerance of negative emotions rather than trying to avoid or escape them. The skills in this module help individuals learn various techniques for handling crisis, examples include:
    • Weigh the pros and cons: noting the pros and cons can help an individual pause and take a moment to think logically about a situation and the subsequent steps.
    • TIPP skills: TIPP is an acronym for Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. TIPP skills quickly calm the limbic system and lower the state of emotional arousal. 
  • Emotion regulation: this module focuses on helping an individual identify, name, understand the function of, and regulate their emotions. The skills taught in this module are intended to help an individual learn to decrease the intensity of their emotions, sit with, and experience strong unwanted emotions, without impulsively acting on them, examples include:
    • STOP skills: STOP is an acronym for Stop, Take a step back, Observe, and Proceed mindfully, which can help an individual avoid engaging in impulsive behavior.
    • PLEASE skills: are guidelines to remind people to prioritize physical health, because physical health is closely tied to mental health.
  • Interpersonal effectiveness: this module focuses on increasing an individual’s communication strategies. The skills taught in this module help an individual learn to identify their own needs in a relationship and develop assertive and effective communication methods to ensure those needs are met in a healthy, nondestructive way, examples include:
    • DEAR MAN skills: DEAR MAN is an acronym for Describe the current situation, Express your opinions and feelings, Assert yourself by asking for what you want or saying no, Reinforce and reward the person by explaining the positive effects of getting what you want or need, be Mindful and keep your focus on your goals, Appear confident, effective, and competent, Negotiate and be willing to give to get.
    • FAST skills: FAST is an acronym for be Fair to yourself and the other person, no Apologies when you have not done anything wrong, Stick to your values and stand up for what you believe in, be Truthful and honest with yourself and others.

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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