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What Is Dialectical Behaviour Therapy

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Dialectical behaviour therapy (DBT) is a cognitive behavioural therapy (CBT)-based therapy that was originally developed by Dr Marsha Linehan to treat borderline personality disorder and chronic suicidality. Borderline personality disorder is a traditionally intractable personality disorder that Dr Linehan has herself.  In borderline, people have extreme and very fast mood swings, much faster than is typical in bipolar. A pervasive feeling of emptiness is common, as is black and white thinking. Something is the best ever, or the worst ever, nothing is ever in-between. Self-harm and risk-taking are also common in borderline. DBT  is Dr Linehan’s (successful) attempt to help others with this disorder. Before DBT, many therapists were reluctant to take on borderline, it was too distressing for the therapist, and often not useful for the client, but DBT just changed all of that.

DBT has since been found to be successful when used with other mental illnesses, such as bipolar, PTSD, eating disorders, and others. DBT teaches “skills” that can be used for emotional regulation, distress tolerance, and interpersonal effectiveness, as well as the core skills used as a basis for the other skills. It has been said that even people without a diagnosable mental illness can benefit from the skills taught.

DBT consists of three components. First, learning in a classroom, usually once a week for about four to five months, it’s commonly recommended that students take this twice. Second, individual therapy, usually once a week. Third, phone coaching between sessions, as needed. Not all centres do phone coaching. Classroom time and individual sessions are a must-have.

Talking about every skill would be too much for a quick post that’s intended to give the flavour of DBT, so I’ll write about a favourite skill from each of the four categories: core skills, distress tolerance, interpersonal effectiveness, and emotional regulation.

Core skills, wise mind

If you think of it, there are two facets to your mind, The emotional part, and the logical part. For the emotional part, think of the stereotypical drama-loving teenager. Everything is huge and highly important in a very dramatic way. For the logical part of your mind, think of Mr Spock from the original Star Trek series. The one from the 1960s with William Shatner as Captain Kirk and Leonard Nimoy as Mr Spock. You wouldn’t want to always be at one extreme or the other, would you? Even less, you would not want to make all your decisions at one extreme or the other, affecting everything you do and how you react to stimuli, would you? You don’t always have to think and live at one extreme or the other, although you might have grown up in such a way that you often do. There is an in-between, or rather, an overlapping area of your consciousness, where you use your “wise mind” and use both types of thinking together, living in the overlap. This alone can make you happier and more competent intellectually and emotionally. As with all DBT skills, it takes practice to achieve the desired result.

Distress tolerance, distract

Distraction is just what it sounds like—you distract your mind from what is troubling you. It seems pretty obvious, doesn’t it? However, some people grow up never realising that they can deliberately distract their mind from troubling situations. It just happens sometimes and not others. Once the technique is learned, it can bring much relief. It can be overdone though, if you have a serious problem that has to be addressed immediately, or in the very near future, of course, it would be best to put some thought and effort into it. Distract is most appropriate when there is nothing practical to do about the situation in the immediate future.

DEAR MAN: Interpersonal effectiveness

DEAR MAN stands for Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, Negotiate. It is a skill that can be used to get what you want when dealing with another person. You might want a favour, or you might want to decline something they would like you to do. This can be hard if you like pleasing people. In DEAR MAN you start out by describing the situation as you see it to the other person. Be polite and honest, express what you really feel. Explain what you want the outcome to be, in a polite way, but be assertive. Tell them what you want and don’t water it down to make it more comfortable. This skill is to get what you want in a respectful, polite way, it’s not about making the other people happy. Other people are often not happy when, instead of bending to their will, you assert your needs. That’s OK, it’s just how it is. Reinforce this assertion as many times as needed. Think of a broken record (for those who are old enough to remember a record player repeating a section of a scratched record over and over). While doing this, stay mindful of your goals and appear confident. It doesn’t matter if you don’t feel confident, you know how people look and act when they’re confident. Do that. In the end, if you don’t have 100% success, feel free to negotiate something else that will help you. Something that gets you both something of what you need. This is an important skill, as many people don’t know how to go into a discussion in a way that maximises the chances of being satisfied with the outcome.

Emotional regulation,  opposite to action emotion.

This one is hard, but rewarding, even when it’s only partially successful. Suppose you feel bad emotionally. Perhaps you are depressed. What do you do? Sit around dwelling on everything that is wrong, how you are unhappy, have no energy, and how everything seems hopeless? That’s the natural thing to do and by far the easiest. But if you are fed up with feeling that way, there is a solution. Think of something that you do when you’re feeling better and then do it. That’s really hard when depressed. Depression lies to you and tells you that doing something like that is impossible. But it’s not! You can force yourself into action, perhaps gardening, going for a bicycle ride, visiting a friend or relative, and so on. You’ll find yourself feeling better. Maybe you won’t go from a 7 on your depression scale down to 0, but you might very well find yourself at a 4. A big improvement and worth the effort.  This skill can be used for any unpleasant emotion, just think of something you do when you don’t have this particular problem, and take action.

Of course, there are many other DBT skills, all useful in their own situation. If you think that learning these skills and using them might help you in your life, I encourage you to see if DBT is taught in your area. It can be a lifesaver—perhaps literally in a case of extreme depression.

Jim Buchanan is a mental health advocate and a volunteer with the National Alliance on Mental Illness (NAMI). You can follow him on Twitter @jbuchana. To read more of his articles, visit his blog




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