Dialectical Behavioural Therapy You may have heard about it, it’s been around for a little while, but as far as therapies goes, it’s fairly new. It was first developed in the mid 90’s by Dr. Marsha Linehan. She found that while working with certain clients, especially those diagnosed with Borderline Personality Disorder, that just using Cognitive Behavioral Therapy (CBT) wasn’t quite doing it; she needed to add something more. To complete this therapy model, she has added aspects of Mindfulness, Acceptance, and Dialectics. This is a treatment model that works especially well with clients who have self-harming behaviors, and is most popular with people diagnosed with Borderline Personality Disorder, although it does work great with many disorders. The key assumption in DBT is that self-harming behaviors are learned coping techniques for unbearably intense and negative emotions.

The top treatment goals of DBT” include…

  1. Learning how to be in control of your own behaviour.
  2. Learning how to fully experience emotions, instead of continuing to avoid them.
  3. Learning how to build an ordinary life, and solve/deal with ordinary problems.
  4. Learning ho to feel complete, and connected with others.

This is done using a few different techniques…

How to use mindfulness within this model

It’s common for us to not be aware of what is going on in our surroundings because we get distracted by only one aspect of it. If we are not aware, we may not know what is actually setting us off, what helps us feel better, or what makes us feel worse. By learning how to observe, describe, and participate with the environment in the moment, it can help clients to become aware and in control of their environment. This can be achieved doing things like keeping a journal or log. When someone starts to feel upset, they can write down what they currently observe going on within themselves and in the environment, and what was happening just before they became upset. The same should also be done with positive, happy emotions, otherwise the client will only further focus on the negative.

Distress Tolerance

Some people experience emotions more strongly than others.This happens for many different reasons, but that does not change the intensity for which these people experience the pain. many times the pain feels so severe to the client, they will do anything to avoid feeling those emotions. By practicing distress tolerance, these people are able to slowly learn how to feel and express distress in a way that does not feel so painful. One way this can be done is using an A.C.C.E.P.T.S. distracting skill, which allows the client to distract themselves from the pain, but without dissociating from it. The skill is used as follows…

Activities: Engage in positive activities you enjoy, instead of fully throwing yourself into the ones that increase the pain.

Contribute: Help out someone else, often helping others makes us feel better about ourselves. Volunteer, offer to babysit, or just do something nice and surprising for someone else who may be stressed or less fortunate.

Comparisons: compare yourself to people who are coping either the same as, or less well than you. Are you coping better with a situation than you did a couple months, or a year ago? Allow yourself to see where you have grown, and maybe where you do still need to grow. Use this to set new goals for yourself.

Emotions: engage in something that will elicit an emotion that is the opposite of the negative one you are feeling. If humor is your medicine, go watch a funny movie, or read the comics in the newspaper. Maybe go see a stand up comic, or visit with a friend you think is funny and uplifiting.

Push Away: If you are in a stressful situation, give yourself a break by pushing the situation away. Although mindfulness is about being in the moment, if you know you are in a situation that will make you feel worse, you don’t have to stay there. If what is causing pain is a cognitive distortion, or self-criticism, prepare yourself with statements to argue why those distortions or criticisms are false.

Thoughts: If you keep thinking about a painful old memory, or a painful thought keeps popping into your head, purposefully, and mindfully shift your attention to a thought to counteract this. This can is similar to “Pushing Away” listed above, although focuses more on the cognitive aspect.

Sensations: If you still find yourself stuck engaging in painful thoughts and memories, use bodily sensations in a healthy way to distract yourself. This is where cutting can be replaced with a healthy behavior. It could be hopping a cold shower to send a mild “shock to the system” to get your brain to “snap out of it!” Listen to loud music, and sing along with it! Using a physical sensation to help shift attention is good thing to try if you have not yet mastered doing it using any of these other techniques.

Are you interested in learning more? You can check out this DBT Skills Handbook created by Fulton State Hospital in New York City. You can also check out these articles and handouts created by DBTselfhelp.com.

 Nicole Paulie is a Counselling Psychologist, and co-author of “How to be Happy and Healthy – The seven natural elements of mental health.” She provides therapy in the Dublin city area. Contact us to learn more or to book an appointment.

What is Dialectical Behavioural Therapy?

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