Updated: Feb 25
What is DBT?
Dialectical behavior therapy (DBT) is a form of psychotherapy, also referred to as “talk therapy”. It was developed by Marsha Linehan in the late 1970’s. “A lot of people struggle with overwhelming emotions.” (Mathew McKay, Jeffrey C. Wood & Jeffrey Brantley, 2007) Reasons related to these intense emotions often reflect from abuse, trauma, or neglect as a child, it [may also have been] “hardwired from birth.” (Mathew McKay, Jeffery C. Wood & Jeffrey Brantley, 2007) A combination of both environmental and genetic factors is likely the cause of why individuals struggle with intense emotions. DBT is a skills based therapy that has been proven effective in helping individuals regulate their emotions, manage unbearably painful experiences, develop more successful and meaningful interpersonal relationships, as well as improve self-awareness, acceptance and mindfulness skills.
DBT Treatment for Depression
DBT Treatment teaches people effective distress tolerance skills in order to help them manage the stressful and overwhelming challenges they are faced with during our everyday existence. Many symptoms of depression can be treated through DBT. These symptoms may include:
Trouble concentrating or having short term memory problems
Being easily irritated, persistently sad or feeling extreme highs and lows
Thoughts of death, self-harm or suicidal ideation
Physical problems, headaches, IBS, or trouble sleeping
Lack of pleasure in once-pleasurable activities or hobbies
There are Two Levels of Distress Tolerance Skills: Basic and Advanced
Basic Distress Tolerance Skills: help you cope better during a crisis and build up resiliency to stressful situations. You can expect to learn new ways to alleviate the effects of distress without avoiding it or making it much worse than it is perceived.
1. Distraction: helps the individual distract themselves from situations that are causing them emotional pain, by allowing them to temporarily step away from the pain. This gives them a chance to breathe and then settle themselves so that they can find an appropriate response to the situation. Counting, completing chores, exercising, leaving the situation, distracting your thoughts, and going to visit a friend or family member are just some of the distraction tools one can use to change their focal-point when faced with a stressors.
2. Self-soothing: can help the individual learn to treat themselves with compassion and nurture themselves in a variety of ways. It can bring one peace and relief from their pain so that they can figure out how to best respond to the situation. When someone is experiencing emotional distress using your five senses is extremely helpful, it can help you reach a state of relaxation and inner peace. Going out into nature, going to the movies, talking to a friend, listening to music, playing a musical instrument, following along on a meditation app, lighting a scented candle, burning essential oils, having an enjoyable meal, having a cup of coffee or tea, taking a bath, holding your pet or getting a massage are many examples of self-soothing measures you can take during distress in order to help yourself.
Advanced Distress Tolerance Skills
Improving the moment: allows the individual to get through emotionally trying situations when their usual self-soothing efforts aren’t doing the job. This set of strategies are intended to be used as a list of options you can use to get through emotionally difficult situations. The acronym IMPROVE the moment, stands for the following.
You may feel the need to imagine that you are in a completely different place, or a different situation than the one you are currently in. Imagery can be a very powerful tool that can be used right after receiving bad news, or after experiencing a triggering interaction with another person. This tool can also be very effective during times of abuse or when having thoughts or triggers from past abuse. Maybe you want to imagine you are next to your mom, best friend or a family member in a safe place. You may feel the need to imagine that you are in a completely different situation for a short period of time and then come back when you are able to cope better with the current one.
Finding meaning in the situation; sometimes life has a way of dealing you a bad hand of cards. These painful and difficult situations often have a higher meaning for each of us. Try to look for the silver lining in the bad. Regardless of what you may be faced with, it is important to do your best to keep your behaviors and actions aligned with your values, beliefs and morals.
This can mean many different things to different people. You may be religious, spiritual, you may believe in god, or in prayer, it may be more of an individual practice, you may believe in many gods, a divine universe, or you may have faith in a “higher power”. This is what people may be referring to when they talk about something bigger or feeling empowered. Irregardless of which practice one believes or participates in prayer/practice can have a profound positive response to ones overall ability to cope and manage during stressful times.
It can be extremely hard to relax during highly stressful situations or during emotionally challenging times. You must remember to take care of yourself in order to settle your central nervous system back down. By changing how your body is currently feeling you are able to change your mood and your aroused emotional state. Guided breathing, mediation, stretching, listening to music, and tapping are just some of the ways one can encourage relaxation.
One Thing in the Moment
Just focus on one thing at a time; this provides your brain with the chance to calm down, focusing on the now. During distressing times we may be focusing on the future or past, we must learn to live in the present. It is important to participate in the moment, breathing and mindfulness meditation are great exercises to help you stay focused. If we really focus on our breathing while trying to remain in the present moment we can settle our mind. This may sound simple, give it a try. These exercises are harder than one would think, as an unpracticed mind wanders all over the place.
A challenging situation that may be causing you too much distress, will make you take a step back to assess what you need to do. You may need to take a short mental break when feeling overwhelmed. You may just need to go for a drive out of town or turn your ringer off for a few hours. This break away may help you gain the perspective you need to better respond to the situation more effectively. Because most of us can’t just hop on a plane during a moment of crisis, we need to imagine ourselves somewhere else. You can imagine yourself walking along a beautiful beach, hiking in the mountains or racing a sports car down the Audubon.
Start giving yourself encouragement, this can be done by talking to oneself in a positive way, done with self-encouraging statements during stressful situations. We all need to hear encouraging words, that’s what drives us to keep going when times get tough. Encouraging statements may include; “You got this”, “this too shall pass”(Mathew McKay, Jeffrey C. Wood & Jeffrey Brantley, 2007), “I promise you, nothing is as bad as it seems”, “you are stronger than these feelings”, “You can get through anything”, “I am a fighter”, or “Never give in, never give up”.
2. Radical Acceptance is a key part of DBT treatment. The suffering you and others are experiencing due to your behaviors needs to be addressed. Acceptance is required, it is important to take a step back and see the situation as it really is and not as we would necessarily like it to be. We must take responsibility for our part in the distressful situation. [Successful treatment will depend on] “acceptance and change, not acceptance or change”. (Mathew McKay, Jeffery C. Wood & Jeffery Brantley, 2007) This skill is one of the hardest skills and may take some time to master, [it requires the individual to view themselves and “the world in a different” light](Mathew McKay, Jeffrey C. Wood & Jeffrey Brantley, 2007). This skill however will change the way you feel when you are in distressing situations for the rest of your life. You will gain control over your emotions and make choices instead of reactions during heightened and stressful times.
3. Pro’s and Con’s list: The individual needs to think about both the pros and cons of giving into self-destructive behaviors. By not thinking through the potential outcomes of how you respond to stressful situations, you will likely regret your actions made in that moment. When an individual has heightened emotions they are often not able to think clearly and are seeing in tunnel vision. During this time they are likely to act using those self-destructive behaviors; it’s truly become a pattern. The unhelpful coping mechanisms you have been turning to during distress are habitual self-serving patterns that require change. Through awareness, acceptance, and practice one is fully capable of making these changes. The individual now has understanding and can create new coping mechanisms, ones that work for them not against them.