Dialectical Behavior Therapy (or “DBT” as it’s more commonly known) is an emotion regulation system that helps our clients modify and modulate their emotional reactivity. Once we learn to accept our current emotions, we can learn to regulate them with new coping skills while building a life of unprecedented skilled behaviors and choices. We recover from depression, anxiety, and trauma and open ourselves to a world filled with optimism and unlimited possibility.
This amazing system was initially developed by Marsha Linehan Ph.D. in the early 1990’s to treat severe personality disorders. Its popularity has skyrocketed in recent years due to new research driven applications and innovations in decreasing emotional intensity in millions of Americans with mood disorders, trauma conditions, addictions, and much more.
Similar to its predecessor Cognitive Behavioral Therapy (or “CBT”), DBT is primarily skills based and teaches our clients how to actively apply strategies and tools during moments of emotional intensity and to regain control of their emotions, thoughts and actions. Rather than rushing in to change negative thoughts and feelings, we hold those thoughts and emotions in our minds in the moment. We accept them without approval while actively focusing on the calm and serenity of present moment awareness. This approach helps to disarm the thoughts which felt so upsetting moments ago, and neutralizes the cruel edge of negative emotions. DBT gives us a specific methodology and a research proven strategy to remain effective and to not lose our ability to make a positive choice at a critical moment.
Emotions can be so misleading and even torturous. Many of us view our thoughts as facts and take them at face value. Emotional thinking can cause us to distort the situation and think and judge in the extremes. We automatically go to extreme thinking and reacting when we are in the grip of our loud and insistent emotions. Such thoughts and emotions can lead to endless agony and adversity with others.
In the world of DBT, we teach our clients to ascribe to a dialectical point of view. We believe that even opposing points of view can have equal legitimacy. We do not have to agree or even approve of that opposing viewpoint but we do honor the other person’s right to have an opposing conviction. By approaching setbacks and failures, interpersonal conflict or even our own negative self-appraisal dialectically, we avoid becoming mired in the extreme emotions that inevitably arise in life. When we can find the “dialectic” or synthesis of the opposing viewpoints (the middle ground), this empowering perspective allows us to move on constructively. Non-judgment is essential in sustaining a dialectical perspective.
In his magnum opus “Nicomachean Ethics,” Aristotle explores the essential virtue of balance. He describes how extremes of both deprivation and excess – in thought, word, or deed – lead to complications in human behavior and actions.
In the world of emotions, a lack of balance in our reactions can keep us chronically stressed. When we frame the world in binary extremes (such as good and bad or success or failure) we remain vulnerable to an ever-shifting set of daily circumstances, unkind opinions from others, and factors clearly beyond our control. When events shift negatively, we lack the resources to reestablish emotional balance. Instead, our negativity skews our mood and that imbalance often leads to rumination, worry and a sense of inadequacy. Once the worrying and invalidation begin, we can spiral into the major mood disorders including depression and anxiety. To relieve that discomfort and to distract from our pain, we turn to self-sabotaging activities and behaviors. We don’t sleep well, we don’t eat well, and we engage in a thousand moments of self-invalidation. We lash out or withdraw from the very people who could give us support and a more realistic perspective.
One of the most expensive costs of mood disorders is our lack of full productivity. We lose our direction, energy, and motivation to move forward with our lives. Instead, that inability to emotionally up-regulate can keep us vulnerable to spiraling in and out of depression and anxiety and helplessness for years. Our frustration increases as we wonder if this cycling will ever end.
As DBT therapists, we believe that emotional dysregulation—that basic inability, despite our best efforts, to change, regulate, or influence our emotional experience consistently and skillfully, is the primary culprit in most recurrent mood disorders including depression, anxiety and trauma conditions. Once in place, those mood disorders can generate and sustain an extreme version of reality that is hopeless and often leaves us feeling chronically helpless. We only focus on the negatives to reinforce our conviction that life is too difficult and we are somehow to blame. These negative states of mind skew reality to polarized or extreme perspectives that deepen the mood disorder and narrow our world.
DBT can be viewed as an evolution of CBT since it is also a cognitive behavior therapy based system. While CBT focuses primarily on an individual’s thoughts and how they influence their emotions, DBT goes several steps further. DBT honors the immediacy and the enormous power of the emotion. We teach our clients how to lean into emotions with acceptance (without avoidance and certainly without approval) and instead of seeking to change them (as in CBT), we simply mindfully observe and describe them non-judgmentally. The mindfulness skills create a pause or distance between us and the powerful emotion. That distance allows us to effectively navigate the emotional storm instead of becoming captured and swept away. Mindfulness empowers us to avoid the action urges that can be so disastrous when emotions are compelling.
Before DBT was developed, Dr. Linehan found that clients struggled to meaningfully integrate the lessons of CBT because their emotions were far too volatile for the CBT skills to make that critical difference. While they intellectually understood the concepts, they were unable to regulate their minds and emotions long enough to employ CBT’s strategies and tools.
Imagine riding a surfboard in challenging waters. Without skills, practice and courage we cannot possibly ride the waves if the water is too stormy and chaotic. One of DBT’s primary ambitions is to help each of us build better skills to not only ride our “surfboard” in the challenging waves of emotions but to gain confidence that we can handle any waves that we face. We now believe that we can “surf” the waves of turbulent emotions by relying on ourselves and by using our skills.
Dialectical Behavior Therapy’s teachings are widely applicable and effective for any client whose emotions are interfering with daily life. Emotional Dysregulation can manifest in thousands of ways, but many of us have a similar psychological experience. Often, we think we are fine and then we are triggered by something we thought we could handle. Our emotion suddenly surges from zero to sixty in a matter of milliseconds. What was manageable only a few moments ago has now overwhelmed our coping skills. We have lost emotional self-control. This loss of control can lead to endless variations of acting out behavior – emotional shutdown, tirades, substance abuse, self-harm, withdrawal from others, overspending, over or under eating, emotional and behavioral avoidance, and rumination. We lack the ability to return to a baseline of calm without resorting to the support of others (if they are available), avoidant behaviors and if all else fails, destructive behavior.
Over time this pattern can lead to severe mood disorders such as anxiety and depression. With the assistance of our DBT trained and highly experienced licensed mental health clinicians, you will discover your own individual pattern of emotion dysregulation and actively build strategies and skills to disarm the “emotional bomb” that pattern creates in your life. When chronic emotional dysregulation (the inability to control and determine the emotions we experience, their intensity and their expression in our lives) persists, Dialectical Behavioral Therapy is the most effective form of treatment.
Hundreds of research studies have concluded that DBT is a highly effective treatment solution for many issues including mood disorders (anxiety, depression, etc.), eating disorders, trauma, grief and loss, addictions and more. In addition, multiple studies found that DBT was effective with all age groups (children, teenagers, and adults). The American Psychological Association has recognized DBT as an evidence-based treatment with “strong research support.” In one particular study, DBT was found to decrease suicide attempts by 50% and psychiatric hospitalizations for suicidal thoughts by 73% when compared to other treatments (Linehan et al., 2006). More than 30 trials from 20 independent research groups across nine countries have found statistically significant outcomes and effects from DBT treatments. For more information, please visit Dr. Linehan’s webpage regarding DBT research and professional recognitions (https://behavioraltech.org/research/).
Since DBT’s intention is to help you fundamentally reorganize how your mind experiences and processes emotions, this therapy requires a highly disciplined approach. With DBT and your therapy team (one individual therapist and two group therapists), you are essentially breaking down and “unlearning” the dysfunctional emotional regulation systems that you have been using. Instead, we are teaching you how to master a whole new system for interacting with emotions and thoughts that require patience, persistence, and practice.
The minimum treatment frequency for a recognized DBT program requires weekly individual sessions (45 minutes), and weekly DBT skills group sessions (45 minutes to one hour). These group sessions last for up to a year due to the amount of material, discussion and processing those skills groups require. Remember we are assembling and refining your new emotional processing toolkit. In addition there is DBT homework (handouts and worksheets), and the dedicated practice of applying the coping skills between sessions. In more severe cases, additional individual sessions may be recommended to ensure the client is properly supported in learning the skills. The curriculum is organized around fundamental DBT skills and regular practice and application of those skills in a variety of different environments. Through regular repetition and consistent practice, clients are able to integrate these invaluable skills until a tipping point is reached. At that time, less effort is required as the skill now operates on its own when we need it the most.
DBT is revolutionary because it emphasizes the central importance of acceptance with emotion, the benefits of dialectical perspective, and the active utilization of coping skills in decreasing emotion dysregulation. The goals of DBT differ from many of the other popular therapy systems. Many systems focus almost exclusively on the importance of the therapeutic relationship during a session. While we also believe that the therapeutic relationship is essential to a successful therapy outcome, we also believe that having a DBT team of therapists places the emphasis on the skills acquisition rather than just on the individual therapy.
DBT teaches you skills that you take with out to use for many years after therapy has ended. By focusing on the development of mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness skills, we become our own source of self-analysis, direction, and choice. We have many people (an entire team) to consult and learn from. With our team of therapists coaching and assisting us, we begin to use the tools, strategies, and new strengths to navigate our successes and our adversities.
At Gearing Up, you will be ready to enjoy your new perspective on life, to build the relationships you seek and to honor your own special contribution in the world and in the lives of others. Most importantly, as you learn the skills of DBT, your sense of self-effectiveness increases. That hard won resilience allows you to find new adventures and to take carefully considered risks that lead to achievement, growth and development. Most of all, as you develop a new compassion for others, you will also develop a deeper understanding and compassion for yourself.
This article references the work of Dr. Marsha Linehan, Dr. Lane Pederson, Dr. Charles Swenson, Dr. Thomas Marra, Dr. Kelly Koener, and Dr. Cathy Moonshine and more.