As therapy modalities are constantly evolving, one thing remains constant: the need for effective therapy for complex mental health problems of emotional and behavioural dysregulation. Dialectical Behavior Therapy (DBT) was originally developed to support people with suicidal and self-harmingbehaviours who were at high risk of suicide – mostly used on those diagnosed with Borderline Personality Disorder (BPD).
Over the years, however, this modality has evolved and has been incorporated to fit multiple presentations of dysregulation and multiple types of dysfunction. Dialectical Behavior Therapy has been proven to be effective even when only certain modules of the treatment are being used.
A comprehensive use of DBT treatment will be very different from a skills based use, or session to session use. The full version of DBT is quite intensive and requires commitment from the client, their caregivers and a team of skilled DBT therapists. Comprehensive Dialectical Behavior Therapy will include group therapy, one-on-one therapy, as well as 24-hour crisis intervention. For the purpose of this article, I am going to focus on the use of Dialectical Behavior Therapy in more of a relaxed setting, such as incorporating DBT framework generally into a one-on-one therapeutic practice.
From my experience as a Registered Clinical Counsellor, having knowledge and training in DBT has been an incredible asset to my practice and to the wellness of my clients.
What is Dialectical Behavior Therapy (DBT)?
Dialectical Behavior Therapy focuses on acceptance and change through the accumulation of behavioural and cognitive skills. DBT aims to guide one to think more dialectically – that is understanding that there is no one truth, and that two seemingly opposite things can exist simultaneously.
For example, “I am capable and I need support”, or “I want to be sober and I want to drink”. Dialectical thinking involves analytical reasoning, pursuing knowledge and truth of one’s thoughts and emotions as long as there are questions and conflicts in one’s life. It pushes us to see our own conflicts and problems from multiple perspectives. The underlying theory in DBT is the Biosocial Theory. This theory is based on the understanding that people with chronic and significant problems regulating emotions have an innate emotional sensitivity, high reactivity, and slow return to baseline which is reinforced due to certain social situations and environments.
DBT is an extension of Cognitive Behavioural Therapy (CBT) in which the basic principles focus on the understanding of the cognitive triangle – thoughts lead to emotions which lead to behaviours. DBT extends this into effective behavioural modification in the way of learning new skills to replace unwanted and ineffective behaviours. These behaviours are often impulsive and destructive.
DBT and its 4 Basic Elements
DBT is derived from 4 basic elements: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. Rather than just addressing the problems that arise from dysregulation and conflict in one’s life, DBT teaches skills to help modify problematic behaviours which often arise as a way of coping with unwanted emotions or thoughts. Addressing the problem and understanding its origin is important, however, that will not solve the problem. This is where skills accumulation in Dialectical Behavior Therapy can help over the long-term. The skills are there to help a client build a life worth living.
Let’s take a further look at DBT’s 4 Elements, which can be referred to as DBT Modules.
Mindfulness is the core component of DBT and understanding of these skills is needed in order to be able to use other skills in later modules effectively. Mindfulness is used to improve one's ability to focus on the present moment. Mindfulness skills are used to increase non judgemental awareness of our present experiences and can help improve attentional control. Research indicates that mindfulness practice increases our capacity for pleasure but reduces suffering in the moment.
Ultimately, being mindful will give us more choices and allow us to be more in control of our behaviours by slowing down and noticing our emotions, thoughts, and urges – without this skill it is more difficult to modify behaviours. Mindfulness has also been shown not only to reduce emotional suffering, but also lessen physical pain, tension, and stress and in turn can improve overall health.
2. Distress Tolerance
These skills are focused on how to manage high levels of distress in a way that does not worsen the situation. Oftentimes when we are feeling overwhelmed with unwanted emotions we lash out and act out in a way that will ultimately worsen the outcome. Distress Tolerance skills are used to help us tolerate emotional and difficult situations when the problems can not be solved right away. This module includes skills for short-term relief by addressing physiological symptoms of distress and long-term relief by focussing on reality acceptance. Some of the short-term distress tolerance skills include distraction and self soothing techniques. THe goal of these skills is to reduce extreme emotional arousal and avoid impulsive behaviours and emotional urges.
3. Emotional Regulation
Emotional regulation skills address the biological vulnerability to emotion dysregulation which in turn help with emotional instability and rapid mood changes. Emotional Regulation skills can be learned through one-on-one therapy, and aim to teach you how to be able to regulate unwanted emotions as they arise, and provide alternative ways to cope with life’s ups and downs.
A key component of this module is the understanding that emotions are neither good nor bad, however, why experiences of different emotions can be painful and difficult.
When we struggle with being able to emotionally self-regulate and have trouble managing our emotions, we tend to turn to negative coping strategies without even realising it.
4. Interpersonal Effectiveness
These skills focus on building and maintaining positive relationships. While the above areas of Dialectical Behavior Therapy will inadvertently improve relationships with others, this module does so by directly teaching specific relationship skills and communication. Within these skills the goal is to learn how to build positive relationships and reduce conflict, effectively ask for what we want and learn how to say no, as well as how to maintain our self respect.
As a therapist who has worked with a multitude of clients with a multitude of experiences and struggles, I can wholeheartedly say that Dialectical Behavior Therapy has been the most effective treatment for my clients with high emotionality and impulsivity. Not only have I seen DBT skills help others, I have also greatly benefited from learning many of these skills. While engaging in comprehensive DBT treatment can be time consuming and costly, there are ways to incorporate aspects of the treatment into your day to day life with or without a therapist. However, it is always recommended to seek out a skillful therapist well-versed in working from a DBT lens if you are someone who struggles with symptoms of emotional dysregulation and impulsive or destructive behaviors while in a highly emotional state.
Therapy can be life-changing if you are able to unlearn some of these types of dysfunction or destructive tendencies. It’s worth looking into, because few things matter more than your mental health.