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What Is DBT or Dialectical Behavior Therapy?

Updated: Jun 23, 2023

Dialectical Behavior Therapy is a therapy that is often used to treat trauma by teaching four core competencies: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These foundational skills can lessen the symptoms of past trauma or stress and help you find healing.
Do You Need Trauma Therapy?

DBT is a broad-based cognitive behavior treatment intervention, which means it can be used for many different applications and issues, and works by helping you connect your thoughts and behaviors.

It is an excellent method for harm reduction and is effective for treatment for many different concerns that you may be experiencing, from poor communication to suicidal thoughts. It can help you learn skills to improve communication with your partner, friends, boss, as well as help to minimize strong urges to engage in harmful behaviors.

DBT asserts that all of us have the capacity to manage both accepting difficult situations and emotions, while also working to change our thoughts and behaviors related to those difficult situations and emotions. From a philosophical view, a dialectic has to do with finding the truth in opinions and acceptance of contradictions -- accepting that two things which don’t seem to be able to happen at the same time, in fact, can and do exist at the same time.

In my work with survivors of sexual violence, clients, especially in the immediate aftermath of a sexual assault, often find it difficult to accept what has just happened. In fact the sheer thought of the event at all would be incredibly difficult and very triggering. It has never been a part of my work to encourage my clients, especially those who have experienced complex trauma, to “accept” their trauma as something that was okay or excusable. Survivors of trauma should never be held responsible or blamed for violence perpetrated against them.

Acceptance through the lens of DBT, however, simply means to accept reality as it is, versus to work towards changing history. For example, accepting that a person has survived a horrible event does not mean that they are now only a survivor and only defined by their experience. They are still a person with a diversity of experiences and identities, all to be determined by the person themselves - not the events which they have endured.

Acceptance in this case does not mean pretending you are okay. You do not have to be okay. Instead, you accept that your trauma is something that has happened to you. You cannot change the past, but you can accept that it has happened and work toward healing and growth now.

When we work against reality, or try to change reality, we work against our own healing. This is, in essence, the concept of “radical acceptance” from DBT. We can work our tails off to fight against the truth of our realities, or we can find the bravery and courage to accept it and accept the indisputable fact that we deserve healing.

In DBT treatment in a counseling context, either in group or individual settings, you will learn the skills to tolerate distress while accepting it. This approach works by being broad, inclusive, and sensitive to the hierarchical needs of an individual. For example, your counselor providing DBT may help you to identify a goal of increasing your ability to cope with a complicated interpersonal interaction, but you may also need some assistance with food security. Contemplating difficult emotions on an empty stomach is no easy feat! Your counselor may work with you and a case manager to find resources to increase food security.

DBT rests on the foundational framework of four skills and their development:

1. Mindfulness -- working to increase your ability to focus on the present.

Mindfulness has gained some ground as a trendy topic in recent years and can often be associated with meditation and yoga. These are both great options for developing mindfulness skills, but mindfulness as a skill is much broader.

Taking a deep breath can be a great start to building a mindfulness practice. Sitting down to enjoy a meal, acknowledging each bite as nourishment to help you get through the day is a form of mindfulness. Staying present while having a conversation with a friend (versus worrying about something that happened when you were six) is a lovely form of mindfulness.

2. Emotion regulation -- this focuses on improving your skills to de-escalate, or manage your emotions in a way that is proportional to the situation or triggering event.

Often, especially when we are in a perpetually stressed out state, it’s really hard to keep ourselves grounded (see mindfulness skills above!) and the smallest thing can completely throw us off whereas a huge stressor doesn’t even cause us to bat an eye. Emotion regulation skills help us to both accept a stressful situation and manage our response.

After a trauma, it can be difficult to process and accept the emotions and distress that linger after the fact. Mindfulness can help you stay present in the moment and not experience those negative, traumatic emotions.

3. Distress tolerance -- focus on crisis survival.

Distress tolerance teaches us skills to get through the toughest of times and thrive. An example of a distress tolerance skill (in conjunction with mindfulness and emotion regulation) may be being able to acknowledge that you are angry, furious in fact, while also being able to keep yourself calm. You may know you’re angry by the sweat on your face and the tingling in your fingers. These sensations in your face and hands cue you to use one of your mindfulness and grounding skills. You can keep yourself calm while still feeling angry.

4. Interpersonal effectiveness -- these are people skills.

Let’s face it: sometimes our interactions with people suck, especially on those days when we have already had enough. It feels like your partner has not listened to you again, and you’re left to pick up the mess. But instead of losing control of your emotions, you pull out a skill where you can use “I” statements to communicate how you are feeling, and effectively make a plan with your partner to get the necessary things done while feeling heard and appreciated. Awesome!

If you are interested in learning more about DBT and developing some of these skills for yourself, contact Mindsight to get set up with a counselor today.

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