cognitive behavioural therapy; psychology; relationship counselling

What is Dialectical Behavioural Therapy?

What is Dialectical Behavioural Therapy?

Dialectical Behavioural Therapy (DBT) was designed primarly for people with Emotionally Unstable Personality Disorderand focuses on helping someone tolerate the uncomfortable feeling of distress. It also helps a person to learn ways to balance their emotions and not feel so overwhelmed by strong emotions.

Dialectical Behavioural Therapy is a form of Cognitive Behavioural Therapy and also focuses on helping someone to live more in the moment than focusing too much on the past or future. It also helps people learn how to manage relationships.

  • Mindfulness—focusing on the present and living in the moment can have a huge impact on mental wellbeing.
  • Distress Tolerance—this has a lot to do with ACCEPTANCE: learning to accept oneself and the current situation. More specifically, people learn how to tolerate or survive problems in lilfe by using these four techniques: distraction, self-soothing, improving the movement, and thinking of pros and cons. Tolerating distress includes a mindfulness of breath and mindful awareness of situations and ourselves.
  • Interpersonal Effectiveness—DBT teaches you how to be assertive in a relationship (for example, expressing needs and saying “no”) but still keeping that relationship positive and healthy.
  • Emotion Regulation—recognizing and coping with negative emotions (for example, anger) and reducing one’s emotional vulnerability by increasing positive emotional experiences.

Dialectics is the theory that opposites can co-exist. In therapy, different points of view are discussed, and clients are then helped to select appropriate skills to either change or accept situations.

Dialectical behavioural therapy

WISE MIND
DBT uses the theory of Wise Mind (Linehan 1993) – the part of our mind where Emotional Mind (thoughts based on our feelings) and Reasonable Mind (rational thinking part) merge together.

Emotion Mind

Thinking and behaviour controlled by emotional state
Thoughts are unhelpful and distressing
Difficult to think logically and rationally
Facts are distorted to fit with current distress
Opinions
Strong emotions drive strong behaviour
What I want to do

Reasonable Mind

Intellectual, scientific
Logical and rational thinking
Factual thinking, based on evidence
Able to plan how to respond
Focuses attention
Cool in approaching problems
What I should do

Wise Mind

Integrates Emotion Mind and Reasonable Mind
Adds intuitive knowing to emotional distress and logical analysis
The calm that follows a storm
Sees or knows something directly and clearly
Grasps the bigger picture, rather than just parts
Ensures needs of both Emotion Mind and Reasonable Mind are met: Reasonable Mind is right, but Emotion Mind needs to be soothed
What’s the most appropriate and effective skills that I could use for this situation?

When we feel upset or distressed, we normally react automatically, without thinking about the consequences. And we can often get into the habit of using unhelpful and often self-destructive behaviours to help us cope. These may include:

  • Self-harm including cutting or taking overdoses
  • Under or over-eating
  • Using or relying on drugs and alcohol
  • Depending on physical exercise
  • Sleeping too much, or opting to sleep rather than address problems
  • Focusing on illness and physical pain rather than the real issues

When we use these self-destructive coping behaviours, we often then get caught up in thinking were bad for doing them, which makes us feel even worse, and may make us more likely to keep on doing them. A vicious cycle.

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In order to break that cycle, we can learn to do doings differently, including learning new healthy coping skills which will help us feel better about ourselves and others, and learning to understand and see our thoughts differently.

 

Distress Tolerance

Acceptance means being willing to experience a situation as it is, rather than how we want it to be.

To be repeatedly ‘turning the mind’.

To be in the actual situation you are in, rather than the situation you think you’re in, or think you should be in.

Your mind is always going to give you other ideas, interpretations, reminding you of old strategies – whether helpful or unhelpful.

Each time your mind wanders and you notice these other thoughts and images, simply bring your attention back to this moment.

Don’t judge the situation to be good, or bad, or in any way. Simply bringing your attention back to this moment, right nowthis situation, and being effective in this situation.

You may need to ‘turn your mind’ many many times in a short space of time.

Emotional regulation

Emotional regulation involves being more self aware – of situations that distress you and being able to identify when you have been ‘triggered’. Being able to pinpoint thoughts and emotions is a mental skill that can help a person manage themselves better.

It involves being abke to withstand discomfort for a greater gain or a long term goal and not allowing emotions to overwhelm us. Assertiveness can help a person regulate their emotions. By learning to ask for what you want you can reduce inner turmoil and anxiety. Life can be tough and extremely challenging and knowing how to manage your emotions will allow you to achieve far more in life than if you tend to give up at the first hurdle.

Another good example of emotional regulation is the ability to cope when someone is pressuring you.

Emotional regulation allows people to be more disciplined and patient in pursuit of goals.

People who are struggling with emotional dysregulation react to relatively mild negative events in an emotionally exaggerated manner; they may cry, scream, accuse, or blame those around them, or engage in passive-aggressive behaviors or other behaviors that can disrupt relationships and escalate conflict (PCH Treatment Center, n.d.).

One of the most important aspects of treatment is recognizing that negative or painful emotions are not inherently bad. Clients are encouraged to accept that they will undoubtedly experience negative emotions in their life, no matter how happy or well-balanced they may be.

Mandy X