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Dialectical Behavior Therapy (DBT): An Overview

So, it’s yes or no, right? Sure, either it is, or it isn’t. Not so, according to one of the main tenets of Dialectical Behavior Therapy, or DBT, for short. DBT therapy and skills training help us see and appreciate the gray areas in our lives. It helps us see that rigidity in our thinking affects our emotions and behaviors in negative ways, causing emotional dysregulation, anxiety, as well as depressive thoughts and feelings. Emotional dysregulation impacts not only our individual behavior, but our behaviors and relationships within our families and with our spouse. Situations we deal with that could be worked out amicably quickly turn into shouting matches where no one is truly being heard or understood. Sound familiar? Let’s take a closer look at how DBT can help you out.

DBT: Not “either-or,” but “both-and”

Look up the word “dialectic” in your favorite dictionary. Oxford Dictionary defines dialect as a way of discovering what is true by considering opposite theories. Here’s another one: Livelaptoptech says a dialectic is when two seemingly conflicting things are true at the same time. The dialectical philosophy of DBT is that opposition creates tension. To dispel that tension, DBT skills seek to help us find a way to honor truth from both sides of an argument. Or to put it another way, we many times see situations involving ourselves or others as “either-or” propositions, when it is more helpful to see things in terms of “both-and”. Some examples: “Either I pass the exam tomorrow or I’m a failure”. DBT skills help us reframe that thought into “I can both fail the exam tomorrow and still be ultimately successful at school.” “If I strike out at bat, then I’m a lousy ball player”. DBT says, “I can strike out at bat and still be a great ball player”. Or in relationships, it’s easy for a couple to decide if an argument comes down to “I’m right and he/she is wrong.” DBT guides us to explore our arguments and reframe that into “Both of us may be right about this, in some form or another.”

DBT Skills

It's the DBT skills that can help with this transformation into a “both-and” thinking style. There are four principal areas to DBT skills training:

  1. Mindfulness – considered to be the core focus of DBT therapy and skills training, mindfulness techniques help us live intentionally and with awareness into the present moment. What’s more, we don’t judge or reject the moment. It is what it is. When being mindful, we focus our minds on body sensations, our breath, and thoughts and emotions. What are we feeling in a certain moment? Are we just mad, or is there some other emotion or thought at play? (Hint: there probably is, and that’s what mindfulness helps you figure out). Mindfulness techniques presented in DBT skills training help you reduce suffering, increase happiness, experience reality as it is, and most importantly, help you increase control of your mind, rather than letting your mind be in control of you.

  2. Interpersonal Effectiveness – this DBT skills set helps us get others to take our opinions seriously, say “no” to unwanted requests effectively, and get others to do what we would like them to do. Interpersonal effectiveness skills promote strong relationships, where problems or hurt feelings aren’t allowed to fester without being resolved. They can assist with creating balance and harmony in relationships, through use of mindfulness practices and looking for “both-and” in our relational problems.

  3. Emotional Regulation - the goal of this DBT skill is to help us understand and identify (through observation and description) what we are feeling at any one time. This knowledge, in turn, helps us decrease the amount of unwanted or unhelpful emotions we feel, either by changing the unwanted emotions when they start---or stopping them from starting in the first place. With this ability, we can also decrease our vulnerability to our negative emotions, increase our resilience when difficult things happen and thereby reduce the amount of emotional suffering we experience.

  4. Distress Tolerance – as the name suggests, this DBT skill helps us survive and successfully navigate situations where we feel a sense of crisis. We can learn tips to calm ourselves in stressful, emotionally charged situations, by using mindfulness skills or actual physiological activities (think exercise or paced breathing). A key component of this skill is learning the art of radical acceptance, being able to accept the reality of a situation without judgment or excessive pain, and even see the possibility of moving forward despite the crisis situation.

DBT therapy and skills training takes time---and practice! A DBT trained therapist will assist in learning how to use these skills, exploring situations in daily life when the skills are used successfully, and learning from incidents when they weren’t. I do this work in my therapy practice with Egan Counseling and Consulting, where I incorporate DBT principles with my child/adolescent/teen clients and in my work with couples in marital therapy. Watch this space for a closer look at DBT therapy and skills!

By Jerry Dye, Jr., LCMHCA, NCC

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