Dialectical Behavior Therapy
With all the different kinds of therapies and modalities out there, it can be hard to decide which one may be right for you. There are some that focus on our behaviours, some that look into our past and our childhood, and some that expose us to the things we are truly afraid of. The main focus of Dialectical Behavior Therapy, or DBT for short, is to provide clients with a set of skills to help them manage painful and distressing emotions, in turn helping them to decrease conflict in their relationships and live a life they feel is worth living.
What is the Difference Between Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT)?
A key difference between CBT and DBT lies in the concept of validation and relationships. DBT teaches that our experiences are real/valid and to accept them as such. It also informs us that we must make positive changes if we wish to have a healthy relationship with the ever-changing, and often-challenging world around us. This can be tough given these are two opposing constructs however, they are vital in the DBT process. Although both CBT and DBT incorporate cognitive-behavioural techniques, DBT is a modified version that places more emphasis on the emotional and social aspects of a person’s life. Originally developed to help individuals cope with extreme emotions that would often result in harmful behaviours, DBT works towards reducing one’s emotional distress that negatively impacts their wellbeing and the way they interact with their surroundings. More specifically, DBT focuses on skills training and includes mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance. These four components are the key to successfully implementing this modality in one’s day to day life.
Because they are such important therapeutic skills, let’s break them down a little further:
Mindfulness
As with mindfulness-based therapy itself, this skill helps one to live in the present moment and accept what is happening in the here-and-now. With anxiety, we have a tendency to live in the future and try to predict what will happen in every possible scenario. The problem with this is no one can predict the future and therefore it will always remain an unknown to some degree. Conversely, with depression, we have a tendency to become stuck in the past and reflect on what could have been or should have been. The problem here lies in the inability to change the past or travel in time. With mindfulness, we can eliminate these two attempts that are ultimately beyond our ability and accept that what is happening in the present moment is all that we have control over. This can be quite challenging at first, but with practice, it can be liberating and a means of letting go of the extra weight that we perceive life to pile on. This skill may incorporate practices like mindful meditation, body scans, or simply taking a moment to focus on our breath. We feel the stress of the day leave with each breath that exits our body, and we breathe in the experiences that the present moment has to offer. By letting go of the need to control, we let go of the distressing emotions and the rigid expectations we hold of ourselves and others.
Emotion Regulation
This is the ability to regulate our emotions so that they do not get to the point of controlling/impacting our thoughts and behaviours. By learning strategies to manage and change the intense emotions that are causing problems in our lives, we can, in turn, live more peacefully with the world and the people around us. This skills often encapsulates three goals: to understand the emotion, to reduce emotional vulnerability, and to decrease emotional suffering. This seems like a lot to pack into one skill, but the Coles Notes version is to understand that negative emotions are not inherently bad or need to be avoided, but are a regular part of life that can be acknowledged, processed, and then let go of. We can better regulate something, in this case, an emotion, when we understand what it is we are trying to regulate. This leads us to “labelling” (i.e. angry, sad, scared, confused, etc.) From there, we can say to ourselves “Ok, I know what I am feeling, now why am I feeling that way?” This then leads us to tease apart primary and secondary emotions. The primary emotion is the initial reaction, whereas the secondary emotion is a reaction to the subsequent thought (i.e. I got really 1.angry with the cashier at the grocery store and now I am feeling 2.depressed because I am a terrible person for feeling this way). When we process our anger as a normal emotion, we can reduce the vulnerability associated with the secondary emotion (i.e. depressed) and decrease our overall suffering. It takes time, practice and guidance but is an incredible skill to reference when the world seems a bit unfair or chaotic.
Interpersonal Effectiveness
This is the ability to ask another person for what they need and to say no to them when necessary, all the while still maintaining self-respect and healthy relationships with others. In other words, this is assertive communication and boundary setting. Being able to ask other people what they need and to assert one’s self in a conversation is so important because we are not mind-readers and therefore if we do not ask someone what they need (either from us, from the interaction or from their situation) we are left guessing and assuming. And we all know what happens when we assume… Doing this can also lead to increased tension, frustration and overall hopelessness. From there, we must also keep in mind our boundaries and be able to recognize if what they need is beyond our realistic abilities. If it is not, then we offer our assistance and do what we can to help. If it is, then we learn the art of saying No. By understanding our boundaries and sticking to them, it prevents us from taking on an unrealistic task, from feeling burnout, and/or from feeling guilty or useless that we could not provide what they needed. If we do not know our boundaries, and if we do not say no, then we are setting ourselves up to feel negative because it was out of our scope, to begin with. It is asserting ourselves in the conversation while maintaining our boundaries to foster healthy relationships with ourselves and others.
Distress Tolerance
This is the ability to cope during a crisis, particularly when it is impossible to change, and accepting the situation as it is, rather than how it should be. Let’s discuss that word for a moment, “should”. The number of times we use this word in a day can be astonishing. But, what it does is make us feel as though we have the power to change the past, other people, the world, the future, and everything in between! It makes us feel guilty for not doing something and allows us to dwell on a hypothetical situation that has not, nor potentially will, ever happen. As one can imagine, this is distressing and because we do not like feeling distressed, our natural inclination is to avoid. This works when we move our hand away from a hot object or when we eat something because our stomach is growling, but when it comes to our emotions, it actually makes matters worse. Fear and avoidance are like a magnifying glass for distress and can amplify it to the point that it feels more distressing later on. Instead, we learn that negative emotions, although uncomfortable, are normal and will pass. Emotions happen in moments and moments can change! Distress tolerance helps us broaden our capacity to withstand negative emotions or physical discomfort. Have you ever wondered how some people can ‘keep their cool’ so easily? Well, it could be that they are very good actors OR, that they have learned the skill of distress tolerance. The saying “it is what it is” can sum this skill up nicely and reminds us that we are not avoiding or washing away the distress, we are simply preventing ourselves from doing something that will make it worse in the future.
When working hand-in-hand, these fours skills allow us to go out into the world and live a healthy, realistic and meaningful life that we feel is worth living! Each skill strengthens one another and arms us for the best possible chance of success as we move forward in life.
When is Dialectical Behavior Therapy Used?
Initially developed to treat individuals diagnosed with Borderline Personality Disorder, dialectical behaviour therapy has expanded its repertoire to successfully treat individuals suffering from depression, bipolar disorder, posttraumatic stress disorder, substance abuse and a variety of eating disorders, including bulimia and binge-eating. It is typically used during one-one therapy with a trained professional who can ensure that each of the four pillars we talked about earlier are being addressed. The therapist will also help the individual remained motivated and properly apply the learned skills in their day to day life. Regular sessions on a weekly basis are most effective with this type of therapy. The therapeutic relationship is also very important and the therapist holds an active role with the client both between and during sessions. DBT also consists of skills groups wherein participants can have the opportunity to practice their skills with one another in a group setting. This environment provides mutual support, an opportunity to share lived experiences and is a great way to directly practice creating and maintaining healthy relationships.
For more information about counselling in general, see our Guide to Counselling.