By Kelsey Harper, PsyD, Clinical Psychologist and Program Director at Promises Malibu Some people can sail through a crisis or upsetting event while others are overwhelmed by mild stress. What’s your coping style? One way we find out is through dialectical behavior therapy (DBT), which we use to assess distress tolerance skills, identify the ways a client typically reacts to stress, and teach tools for accepting and dealing effectively with the realities of any given situation. Originally developed by Marsha Linehan, DBT began as a therapy for people with chronic suicidality, self-harm and personality disorders. Over time it has also proven effective with complex and chronic PTSD and other disorders that involve mood or behavioral dysregulation. At the core of this therapy are mindfulness and meditation skills and training. Clients progress through a series of modules that build upon each other, complete with manuals, exercises and solution-oriented techniques. DBT is a form of cognitive behavioral therapy (CBT) but unlike most talk therapies, it’s very structured. The aim of DBT is to help clients develop skills that can be applied to daily life as they learn techniques to help gain control over their behaviors, thoughts and emotions. Some of the key components include:
- Interpersonal effectiveness. Learning to get needs met effectively is an important part of DBT. We look at ways clients can ask for what they want, assert themselves as appropriate, say no when required, and create boundaries that allow them to build relationships and also have self-respect. For example, if someone is afraid to go on a job interview or ask for a raise, we literally create a transcript with bullet points and tips on how to respond, based on different variables, so the client is prepared. Same goes for difficult conversations with loved ones. We look for ways to challenge people without damaging the relationship or shutting them down. If the client tells somebody, “I don’t want to talk about this, this is a triggering topic for me,” and they keep pushing, we look at ways the client can shape the interaction and set healthy boundaries.
- Mindfulness skills. Research shows that meditation practices are effective at relieving stress and anxiety. In DBT, meditation serves a number of purposes: It’s a stress reliever, it helps clients feel more centered and grounded, and it brings them into the present moment. By being in the present moment, clients can avoid reacting to something they imagine will happen in the future or to a trauma of the past, and can respond effectively to what’s happening right now.
- Building a wise mind. Mindfulness practice strengthens the communication pathway to the higher self and helps create a strong connection to inner knowing, intuition, sense of self and gut feelings, which all lie in what we call the “wise mind.” It helps clients access the aspect of self that is calm and can intuit the best way to proceed in a stressful situation. Clients with chronic dysregulation of emotions often feel a loss of self and lack of self-trust. Mindfulness helps rebuild the relationship clients have with themselves.
- Emotional Regulation. It is normal to experience a myriad of feelings but people can at times become overcome by strong, negative emotions. When this occurs, it can lead back to old patterns and unhealthy coping strategies. The first key is to learn to identify different emotions and the thoughts, reactions and behaviors they may evoke. For example, what is anger and how is it different from anxiety or depression? DBT suggests an overall approach to health that helps regulate day-to-day emotions and also offers specific coping techniques to help in moments of upset and overwhelm. The goal is to reduce overall suffering and increase experiences of joy and meaningfulness in life.
- Distress tolerance. If someone has low tolerance for distress they may become overwhelmed easily. In DBT we teach that it’s impossible to avoid painful situations — they are part of life — but there are ways to cope that allow clients to respond rather than react. Part of effective coping is developing a tolerance for not just the crisis, but for finding ways to manage it, since that can also be overwhelming. These skills are especially helpful for clients who have issues regulating emotions, but everyone can benefit from having tools to navigate an emotional or psychological crisis.
- Radical acceptance. One of the most transformative parts of DBT therapy is consciously learning how to accept reality rather than push against it. When things don’t go as hoped or planned, it is easy to feel upset or wounded. In practicing radical acceptance we learn to navigate stormy experiences by acknowledging the reality of the moment. Radical acceptance does not mean giving up. It is a process of allowing whatever pain the person is feeling. Rather than judging what is happening and reacting to it, they can learn to bring their attention back into the moment and look at ways to proceed effectively.
The more clients practice these key aspects of DBT, the more natural it becomes to live in the moment and, by doing so, build a brighter future.