Dialectical Behavioral Therapy, or DBT, was originally developed to treat people with Borderline Personality Disorder. It has now been adapted and generalized to treat a variety of areas. DBT is a therapy designed to assist people in adapting behaviors and thoughts that negatively impact their life to more healthy and appropriate ways of responding to emotional distress. The ultimate goal of DBT is to teach clients the skills necessary to cope with situations that are stressful and cause emotional distress. The core belief that the inability to regulate and control emotions and reactions during times of high stress is what leads to inappropriate or harmful, self-destructive behaviors. Therefore, skills that target this inability can lead to success in improving behavior and quality of life. The four concepts or skill groups that target the missing skills are emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. DBT focuses on teaching skills in these groups, helping the client to learn and generalize them to outside life.

Emotional Regulation:

Emotional regulation teaches skills to help cope with negative emotions, increase awareness of state of mind or emotions, handle vulnerabilities to emotions, and increase positive emotions. The goal is to identify the obstacles that may stand in the way of positive emotions or trigger negative emotions and learn to cope with them and move past them. Some specific skills used in Emotional Regulation are:

• Identify and label emotions
• Identify obstacles to changing emotions
• Reduce vulnerability to emotion mind
• Increase positive emotional events
• Increase mindfulness to current emotions
• Take opposite action
• Apply distress tolerance techniques
• Story of Emotion
• PLEASE
• Build Mastery
• Problem Solving
• Letting go of emotional suffering

Distress Tolerance:

Distress Tolerance skills aim to accept and deal with stressful situations calmly, rationally, and without judgment. This assists in making good decisions and reacting more appropriately to situations, reducing the amount of damaging or inappropriate reactions to distress. Distress tolerance focuses not on changing the events that cause distress but accepting, finding meaning for, and tolerating distress.This allows the goal to be becoming capable of calmly recognizing situations and how they might effect you, rather than shutting down, becoming overwhelmed, or avoiding them. While using distress tolerance skills, people are able to make decisions calmly and rationally when deciding how to act or respond to a stressor or extreme emotion. Some specific skills taught in Distress Tolerance are:

• Distract with ACCEPTS
• Self-Soothe
• IMPROVE the moment
• Weigh Pros and Cons
• Radical Acceptance
• Turning the Mind
• Willingness vs Willfulness

Interpersonal Effectiveness:

Interpersonal Effectiveness teaches how to communicate effectively, with the goal of avoiding interpersonal conflict or appropriately dealing with conflict as it arises through assertiveness. Skills used are:

• DEARMAN – getting something
• GIVE – giving something
• FAST – keeping self-respect

Mindfulness:

Mindfulness is the ability to focus on the present moment without being judgmental or reacting based on past experiences. It emphasizes the importance of the ability to remain in the current moment even when situations trigger emotions or memories from painful experiences in the past. Mindfulness comes strongly into play in the other three core concepts of DBT and is generally used as a starting point in skills training.

Individual vs Group Settings:

DBT, in its truest form, involves both group and individual therapy. Group therapy for DBT focuses heavily on skills training and education, as well as structured and supervised practice of the skills. Individual therapy for DBT is able to be individualized more to the person’s needs, while still holding true to the core concepts of DBT. Sessions will focus more on identifying and discussing the issues that the client has faced since last seen, documenting them on diary cards, and addressing them directly with skills learned in group. Unfortunately, group therapy is not always readily available and that skills training must transfer over to individual therapy.