DBT Skills: Distress Tolerance & Crisis Survival

Crisis Survival Skills are distress tolerance skills that help us survive a crisis without making things worse. There are six crisis survival skills in DBT, each of which is described in the video below:

  • The STOP Skill
  • Pros and Cons
  • TIP Your Body Chemistry
  • Distract with Wise Mind ACCEPTS
  • Self-Soothe with the Five Senses
  • Improve the Moment

DBT Skills: Distress Tolerance & Crisis Survival

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Distress tolerance involves learning to tolerate and survive crises without making things worse. The two elements of distress tolerance are crisis survival skills and reality acceptance skills. And i have a couple of videos about acceptance that explain reality acceptance in a lot more detail, and you’ll find links to these in the pinned comment and description. But basically reality acceptance involves a willingness to accept reality as it is and by doing so we relieve any excess distress we cause ourselves when we try to fight against reality and struggle against things that are outside of our control.

Crisis survival skills are skills for tolerating painful events urges and emotions when we can’t make things better right away. A crisis often but not always starts with an external trigger like some interpersonal conflict, which could be an argument with your partner or falling out with a friend. Or some conflict at work. Or maybe you’re overwhelmed by stress at work, with your family, or a combination of things. Or there’s some distressing event like finding out you’ve lost your job a relationship ending, the death of a loved one, and so on.

And then this external situation triggers a number of distressing inner experiences like difficult and painful feelings and emotions, negative thoughts, and uncomfortable physical symptoms and sensations. And this inner distress can also arise without anything external to trigger it. And then when our emotions reach a boiling point and it all becomes too much we find ourselves in crisis

There are six basic crisis survival skills we’re going to look at, starting with techniques to help stop the crisis and allow you to take a step back from it. And then once you’ve been able to get some distance from the crisis, the skills focus on helping you recover from the aftermath and calm whatever after effects remain.

The first skill is called stop which is an acronym for stop, take a step back, observe and proceed mindfully. So when you stop you don’t react. You freeze. Don’t move a muscle. Your emotions may try to make you act without thinking, but stay in control.

And then take a step back from the situation. Take a break. Take a deep breath .and don’t let your feelings make you act impulsively.

And then observe. Notice what’s going on inside and outside you. What is the situation? What are your thoughts and feelings? And what are others saying or doing?

And then proceed mindfully. Act with awareness. In deciding what to do consider your thoughts and feelings, the situation, and other people’s thoughts and feelings/ think about your goals, and ask wise mind which actions will make it better or worse. And if you’re not sure what wise mind refers to check out the list of videos in the pinned comment and description.

So stop is basically an advanced form of time out. Sometimes stop alone is enough to calm the crisis. But it can also be a great first step before proceeding to another distress tolerance skill, like the next distress tolerance skill we’ll look at, pros and cons.

Now a pros and cons list is nothing new, but for distress tolerance we use a specific type. When we’re in a crisis we’re driven by our emotions, which creates urges for us to act impulsively often in ways we’ll later regret. So first we consider the pros and cons of acting on these impulsive urges and giving into them, giving up, or avoiding what needs to be done. So the pros might look something like this. It’s what we want to do right now based on what our emotions are telling us to do. It might release our pent-up energy and frustration, and it might make us feel better at least for a few moments. And it’s hard and takes a lot of effort to resist such a strong urge.

And then the cons of acting on these urges, such as it’s not strategic, it doesn’t help the situation, and there’s no regard for the consequences. It’s often self-destructive and leads us to do things we later regret. And it can damage our relationships and friendships.

And then we look at the pros of resisting our impulsive urges, of doing what needs to be done and not giving in or giving up. These can be things like, it allows us to make better choices and act strategically in ways that benefit us and have positive consequences. In the long run we’ll feel better about ourselves if we stay in control and don’t act impulsively. And it’ll improve our relationships with people we care about.

And finally the cons to this might be things like in the short term we continue to feel bad. We have to keep tolerating some distress and discomfort. And it can take all of our self-control to try to resist doing what our emotions are telling us to do.

And once you have all these pros and cons in front of you it can allow you to see that acting on your impulsive urges isn’t in your best interest, and help you resist regardless of how strong the urge is. And then instead of relying on your ability to come up with this list in the midst of a crisis when you’re probably not thinking very clearly, plan ahead and create a pros and cons list in advance. And then keep it with you perhaps in your phone. Because when we’re in a crisis and our emotions are driving our thoughts it can be hard to access the rational reasonable part of our minds that we need in order to be able to create something like a pros and cons list.

The next skill is tip which stands for: tip the temperature of your face with cold water, which is pretty self-explanatory. Splash some cold water on your face. Dunk your head in a sink of cold water, or hold some ice up to your face. You can even take a cold shower. These can all help shock you out of your emotional state of mind and help snap you out of a reactionary crisis mode long enough to be able to start acting a little more strategically.

And then intense exercise. A lot of times doing some intense exercise can give an outlet to the physical energy and adrenaline that’s been building up during a crisis and get it out of our system enough to calm some of our distress. Many people find that when their mind is racing and they’re feeling distressed exercise is the only thing that can clear their minds enough to allow them to start to calm down.

And then paced breathing so slowing down your breathing and a good way to do this is to breathe in through your nostrils and then breathe out through pursed lips because the pressure of your lips forces your exhalation to be slower and once you slow your breathing down for a couple of minutes your level of physiological arousal will naturally start to decrease.

Paired or progressive muscle relaxation, which is a relaxation exercise in which you move through your body tensing and relaxing each muscle group along the way. And for instructions on progressive muscle relaxation check out the link in the description.

Next we have distraction. Distraction is just temporary: you’re not completely ignoring problems or emotions. You’re just setting them aside for a while until they’re cool enough that you can handle them, just like they were a hot pan on the stove, and then once they’ve cooled down you can return to them if you need to and resolve any outstanding conflicts or issues. Or engage in some emotion regulation.

The complete list of distraction skills in dbt form the acronym accepts and some of these skills along with the ones in the next couple of sections will resonate with you and make sense and others probably won’t and that’s fine. The comfort level that people have with these techniques varies from person to person so just focus on the ones that feel right for you.

Distracting yourself with activities: this can be any sort of activity from chores around the house to watching TV or reading a book, to playing a video game to doing something with your friends. Just any activity to take your mind off what’s distressing you long enough for the most intense distress to start to calm down and become cool enough to touch.

Contributing: doing some volunteer work or helping a friend or family member or just doing something thoughtful for someone, which not only provides some distraction, but can help you feel better about yourself by doing something nice for someone else.

Comparisons: compare how you feel now to a time when you felt different think about people who are coping the same or less well than you. Compare yourself to those less fortunate.

Distracting yourself with different emotions: read an emotional book or story or watch an emotional film or TV show or listen to some emotional music. And be sure that what you’re doing creates a different emotion than the one that’s causing you distress.

With pushing away, push the situation away by leaving it for a while. Or leave the situation mentally or put your pain on a shelf box it up and put it away for a while.

With other thoughts: count to 10, repeat words to a song in your head, or work on a puzzle. Watch some TV or read.

And finally with other sensations: squeeze the rubber ball very hard. Listen to some really loud music or hold an ice cube in your hand or mouth. Go out in the rain or snow. Or take a hot or cold shower.

And starting from here the skills shift from focusing on getting some distance between yourself and the worst of the crisis to calming and soothing yourself in the aftermath. And the next skill is self-soothing with your senses. So looking at listening to or smelling something that gives you pleasure or that you find calming or relaxing. Or for taste eating some comfort food or having a soothing drink like a cup of tea or coffee or a smoother or treating yourself to something that you wouldn’t usually eat. And make sure to eat mindfully savoring the taste rather than just binging. And for touch doing something like taking a shower or long bath or soaking your feet getting a massage or feeling the warmth of the sun on your skin or a cool breeze on your face.

And finally improving the moment with the acronym improve. So improving the moment with imagery: imagining a relaxing scene. Remembering a happier time and imagining yourself in it indulging in some pleasant daydreams

With meaning: find purpose or meaning in a painful situation. Focus on any positive aspects of the situation that you can find any silver linings.

With prayer or spirituality: opening your heart to a supreme being or wherever you find meaning in the universe. Practicing some meditation opening yourself up to wise mind. Listen to or read about spiritual values.

With relaxing activities: taking a hot bath massaging your neck or scalp or practicing some yoga or other stretching. Or just doing some deep breathing.

Improving the moment with one thing in the moment. Focus all of your attention on just what you’re doing be mindful and keep yourself in the present moment.

Improving the moment with a brief vacation. Just give yourself a brief vacation get into bed and pull the covers over your head. Go to the beach or the woods for the day. Or turn off your phone go to the park and have a picnic.

And finally improving the moment with encouragement and rethinking the situation. Using some positive self-talk to encourage yourself. I’ll make it out of this. I’m doing the best that i can. Repeat to yourself that whatever this is i can stand it. This too shall pass. Everything’s going to be okay. It’s not going to last forever.

So when you find yourself in distress or in the midst of a crisis you can use these crisis survival skills to help calm things down enough to pull yourself out of emotion mind, step back from what’s distressing you, and get a little distance between yourself and the crisis.

And then once things have calmed down you can return to the situation and resolve things if necessary. Or attend to any emotions you’re still feeling in the aftermath by using some emotion regulation skills. Or just do whatever you need in terms of self-care to help yourself continue to recover from this crisis and the distress that you found yourself in.

So once you’ve become familiar with the skills and had a chance to try them and find out what works for you, come up with a crisis survival plan that lists the steps you want to take and the skills you want to remember to use when you find yourself in a crisis. And then keep this plan with you in your phone so it’s always there when you need. It for more on distress tolerance and how we can stave off a crisis by the way we react to things that have the potential to set one off check out my video on distress tolerance and how pain doesn’t have to lead to suffering.

If you have any questions or comments, please leave them on the YouTube video page.

Behavioral Activation: Opposite Action for Depression

Behavioral Activation is a type of opposite action that helps relieve depression. In CBT, Behavioral Activation is one of the main techniques we use to treat depression.

Behavioral Activation: Opposite Action For Depression

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

When we’re feeling sad and depressed and just don’t feel like doing anything, acting based on how we feel and cutting back on our level of activity, and spending too much time in bed, or wasting time on the Internet, or not wanting to socialize or make plans with friends, just feeds back into how we’re feeling making those feelings even stronger. But when we’re sad or depressed one of the best things we can do for ourselves is to increase our level of activity. We call this behavioral activation and it’s often the first step in lifting our mood or pulling ourselves out of a period of depression.

Behavioral activation involves starting small and gradually increasing our level of activity. And we focus on three types of activities: activities that give a sense of pleasure or enjoyment; activities to give a sense of accomplishment or achievement; activities that involve some social interaction, which is going to be a lot harder now with everyone practicing social distancing.

As difficult as it can be to imagine something being pleasurable when you’re depressed, just doing anything is usually more enjoyable than isolating yourself, or sitting around just doing nothing. And you might find that activities aren’t as enjoyable as they used to be, or as you’d like them to be, but even things as small as getting out of bed having a shower, eating breakfast, or going for a walk can all make a difference in how you’re feeling. And so it’s important to do at least some small things like this every day to give yourself a chance to feel a little better, or at least help prevent yourself from sinking even deeper.

And when you’re depressed it’s hard to imagine you could do anything that could give you a sense of achievement or accomplishment. But there’s no need to be ambitious. These can be simple things—answering an email, doing the dishes, paying some bills—no matter how small these things may seem they can still give you some sense of accomplishment, which in turn usually helps improve your mood even if just a little bit.

And when you’re depressed sometimes you just want to isolate yourself from people. Socializing can seem impossible, and you can feel like nobody would want to be around you the way you are and you’d just be a burden. But a sense of isolation can be a big contributing factor to feeling depressed, so it is important to find some way to have contact with other people.

Things like going to a party or being with a big group of people can seem overwhelming, so focus on things that are more manageable, whether it’s talking to someone on the phone, or texting with them, going for a coffee, or even just going out by yourself and being around other people. Though obviously these last couple are not good ideas right now which makes staying connected to others during the coronavirus crisis that much more difficult as we need to find ways to socialize that don’t involve physically being around other people. But the more you isolate yourself the more depressed you’re likely to feel, and just having any sort of social interaction can help lift your mood and make you feel a little better.

Now if your mood is really low and you go for a little walk everything’s not going to be sunshine and rainbows all of the sudden, but you’ll probably feel at least a little bit better. And being aware of even small shifts in your mood is important, because when you’re feeling this way it can be so difficult to notice anything positive or have any hope. And so even the smallest improvement in how you’re feeling is worth recognizing because it is a big step compared to not being able to get out of bed or up off the couch and just feeling worse and worse as the day goes on.

And another reason why being more active is so important is because when we’re feeling sad or depressed we tend to ruminate a lot. And research has found that the amount of rumination associated with an emotion is the determining factor in how long that emotion lasts. And because we ruminate so much when we’re feeling sad, sadness is by far our longest lasting emotion, and so anything we can do to cut down on how much we’re ruminating when we’re feeling sad or depressed helps limit how long those feelings last. And even something as simple as going for a walk can help us get out of our heads start ruminating less and as a result our mood starts to improve.

Behavioral activation can often be hard to put into practice because when we’re feeling depressed we tend to be very pessimistic and have lots of negative thoughts, and these thoughts can sometimes get in the way of increasing our level of activity. To help counteract this type of negative thinking and these negative expectations one thing that we encourage with these activities is that you use a behavioral activation diary, which you’ll find a link to below in the description, to help you predict beforehand how much pleasure or enjoyment, sense of achievement or accomplishment, or sense of social connection you’ll get from doing the activity.

And then after you’ve done it record the actual amount of pleasure you got, the actual sense of accomplishment that you felt, and the actual sense of social connection you experienced, as often these will be higher than predicted. And this can help counteract that negative thinking you have that tells you there’s no point in doing anything, why bother, it’s not gonna help, or it’s gonna make you feel worse.

And then this is a way of giving yourself some evidence that even though you don’t want to do anything, can’t see the point in doing anything, when you actually do do something you tend to get more out of it than you think you will. And then this can help motivate you to do more in the future even if your depression and negative thoughts are telling you not to bother.

If you’d like to try a Behavioral Activation Diary, you can download the worksheet in Word or PDF format. If you have any questions or comments, please leave them on the YouTube video page.

Cooling Down Your Emotions: Emotion Regulation or Distress Tolerance

Sometimes it can be confusing whether a situation calls for emotion regulation skills, or distress tolerance skills. This video helps us decide when to use emotion regulation and when to use distress tolerance to cool down our emotions.

Cooling Down Our Emotions

If you have any questions or comments, please leave them on the YouTube video page.

Mindfulness of Thoughts

This videos expands on the DBT mindfulness skills from the last post, focusing on how we can practice being mindful of our thoughts. Mindfulness of Current Thoughts is a DBT Distress Tolerance skill, but it makes sense to me to group it here with the rest of the DBT mindfulness skills.

Mindfulness of Thoughts

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

My first video on mindfulness and dbt was an overview of the goals of mindfulness and six of the core mindfulness skills. In this video we’re going to go into more detail about how we can practice mindfulness, and especially how we can be mindful of our thoughts.

One way to practice mindfulness is through meditation. In a mindfulness meditation we’re noticing, paying attention to, and observing whatever we’re experiencing in the present moment, focusing on our inner experiences: our breath, our thoughts, our feelings and emotions, and the physical sensations in our bodies. And then whenever we get distracted and our minds start to wander, we simply acknowledge whatever’s distracted us, and then as best we can we let it go and redirect our attention back to what we’re trying to pay attention to, which is usually our breath. And if you’d like to learn how to practice mindfulness meditation check out the videos that i link to in the pinned comment and description.

But the fact is most people aren’t going to practice mindfulness meditation on a regular basis. But all of the things we do in a mindfulness meditation, we can also do as we go about our daily lives. We just need to focus our attention on whatever we’re doing in the present moment. If we’re working, we’re focused on our work: what we’re doing, and thoughts related to what we’re working on. And we’re aware of other thoughts and feelings and emotions and body sensations that arise while we’re focused on our work, but we just observe these thoughts, feelings and sensations. We don’t allow them to carry our minds away. We acknowledge them, and then as best we can we let them go and redirect our attention back to whatever it is we’re trying to pay attention to.

Now the two main ways that we practice mindfulness in dbt are by observing, and describing and labeling. So as we go about our daily lives, we’re being mindful when we’re able to take a step back from what we’re doing, stay in the present moment, and observe what’s going on with our thoughts, feelings and emotions, and body sensations.

But often instead of just observing what we’re experiencing, we start getting pulled into our experiences. Rather than simply observing our thoughts, we get stuck in our heads, our minds racing, and we can get completely caught up in our thoughts. Or our emotions and body sensations can become so strong that they begin to overwhelm and subsume us. One way to stay mindful in the face of strong uncomfortable feelings emotions and body sensations is to practice radical acceptance, and we can also use various emotion regulation skills and i have videos that go into more details about these topics that i link to in the description and pinned comment. And in the remainder of this video we’re going to look at how to stay mindful of our thoughts by observing and describing or labeling them.

There are always lots of thoughts passing into and out of our minds. And while we can’t control what thoughts come into our minds at any given time, we do have the ability to choose which thoughts we want to pay attention to. When we’re being mindful we’re aware of and observing the thoughts that come into our minds. And then when we notice ourselves having a thought that’s not related to what we want to be paying attention to at the time, we’re mindful of this thought, we notice we’re having it, but that’s all we do with. It we don’t engage with it. We don’t think about it. We just acknowledge that we’re having that thought. And then as best we can let it go and redirect our attention back to what we’re trying to pay attention, to without allowing that thought to distract us and carry our minds away.

And the best way to explain how we practice being mindful of our thoughts is to use some metaphors. One way we can be mindful of our extraneous thoughts that aren’t related to what we’re doing at the time is to treat them as if they were just sounds going on in the background. We generally don’t pay attention to these sounds or think about them very much, and we just allow them to pass in one ear and write out the other. And we can do the same sort of thing with our thoughts: not give them any undue attention and think about them or try to figure out what they mean, and just treat them like mental noise in the background, allow them to pass into our mind and then right out again.

Another metaphor for this way of relating to our thoughts is to simply treat our thoughts as if they were clouds passing through the sky: noticing as a cloud or a thought passes into our field of awareness, sticks around for a while, and then continues to float through the sky or through our minds until it passes away.

Or sitting back and observing our thoughts as if we were at the movies and watching our thoughts being projected on the screen in front of us. Not actively participating or getting caught up in the action on the screen that is our thoughts, and just sitting back and watching them as they unfold. And remember that the thoughts that we’re trying to simply watch and observe and allow to pass from our minds without interacting with them aren’t the thoughts related to what we’re doing at the time, but extraneous thoughts that act as distractions that can pull us away from what we’re trying to focus on. And if you’d like to try an exercise that leads you through these metaphors with a guided audio file, please check out the link in the description and pinned comment.

But often it’s not that easy to just sit back and watch our thoughts. And so if we find ourselves getting caught up in our thoughts rather than just observing them, describing or labeling our thoughts is a great way to take a step back. When we’re describing our thoughts we’re observing our thoughts and simply describing to ourselves what’s going on in our minds.

So instead of just observing the thought, i hate my life, describing what’s going on in your mind: first that you’re having a thought, and then noting what you’re thinking about. I’m having the thought, i hate my life. Instead of just observing the thought ,what if i can’t get this done on time, describing what’s going on in your mind. I’m worrying, what if i can’t get this done on time? Or I’m wondering, why haven’t they emailed me back yet? Or I’m having the thought, how could he do that to me?

Now instead of describing the content of our thoughts we can simply label our thoughts with a couple of words or a short phrase that labels what’s going on in our minds so merely noting that we’re thinking thinking; or worrying about work; or I’m obsessing; or I’m dwelling on an argument. When we label our thoughts, we’re shifting our focus away from the content of what we’re thinking about, and merely observe that we’re engaged in the act of thinking or worrying, or obsessing, or dwelling, and the content of our thoughts loses its power.

If we’re observing ourselves having the thought, i hate my life, or why haven’t they emailed me back yet, those thoughts generate an emotional reaction that makes them more difficult to let go. But if instead we describe our thoughts with a simple label like thinking or worrying, there’s really no emotional pull to that label. So labeling helps us become aware of and acknowledge our extraneous thoughts, while making it less likely that these thoughts end up carrying our minds away from what we’re trying to pay attention to.

So even if you don’t practice mindfulness meditation there are lots of ways that you can learn to be more mindful of your thoughts. And remember that being mindful takes practice, so try to use these strategies on a regular basis to build up your mindfulness skills, so if you’re feeling overwhelmed or a crisis arises they’ll be ingrained enough that you can rely on them to help you through it. And if you missed my first video on dbt and mindfulness please check out the link in the description and pinned comment, where you’ll also find a link to my guided mindfulness of thoughts exercise.

The next post contains the Mindfulness of Sounds and Thoughts exercise mentioned in this video. If you have any questions or comments, please leave them on the YouTube video page.

Emotion Regulation, Problem Solving and Action Plans

When we’re experiencing a difficult or unpleasant emotion, sometimes we can change how we feel by changing our thoughts or behavior. But if our emotion fit the facts, our thoughts are accurate, and our behaviours are reasonable for this situation, there may not be much we can change about how we’re thinking or acting.

So instead, if we want to change our emotion, we need to figure out a way to resolve the situation or event that’s leading us to feel this way. And we do this by problem solving, and then coming up with an action plan to implement our solution.

Problem Solving and Action Plans in DBT

You can download the Problem Solving and Action Plan Worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

DBT Distress Tolerance Skills

DBT Distress Tolerance Skills

In her book, Cognitive Behavioral Treatment of Borderline Personality Disorder, Marsha Linehan explains the importance of Distress Tolerance skills:

DBT emphasizes learning to bear pain skillfully. The ability to tolerate and accept distress is an essential mental health goal for at least two reasons. First, pain and distress are part of life; they cannot be entirely avoided or removed. The inability to accept this immutable fact leads itself to increased pain and suffering. Second, distress tolerance, at least over the short run, is part and parcel of any attempt to change oneself; otherwise, impulsive actions will interfere with efforts to establish desired changes.

There are three goals of distress tolerance skills in DBT:

  • To survive crisis situations without making them worse
  • To accept reality, and replace suffering and feeling stuck with ordinary pain and the possibility of moving forward
  • To become free of needing to act on our desires, urges, and intense emotions

In DBT, there are two types of distress tolerance skills:

  • Crisis Survival Skills help us survive a crisis without making things worse

  • Reality Acceptance Skills help us reduce suffering by accepting the reality of things that are outside of our control

In this section you’ll find posts about:

DBT Interpersonal Effectiveness Skills

Interpersonal Effectiveness Skills help us manage interpersonal conflicts, build new relationships, and strengthen current ones.

DBT Interpersonal Effectiveness Skills

In DBT, there are three sets of interpersonal effectiveness skills:

  • Obtaining Objectives involves getting what we want from other people without damaging relationships, while maintaining our self-respect.

  • Building Relationships and Ending Destructive Ones involves finding friends and getting them to like us, maintaining relationships, and how to end destructive relationships

  • Walking the Middle Path involves balancing acceptance and change in relationships.

Although not technically DBT interpersonal skills, I’ll also be including my videos about relationships in this section:

DBT Skills Training Self-Help Video Course

Learn the four DBT skills in this self-help course: mindfulness, emotion regulation, distress tolerance & interpersonal effectiveness.

Dialectical behavior therapy (DBT) consists of two components, individual psychotherapy in conjunction with DBT skills training. While self-help videos can’t replace individual sessions with a therapist, they can be a good way to learn DBT skills. And if you’ve taken a DBT skills group or are in one now, these videos can help clarify and reinforce concepts, and serve as reminders about things you’ve learned.

Dialectical Behavior Therapy and DBT Skills

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Dialectical behavior therapy is a type of cognitive behavioral therapy originally developed by Marsha Linehan to treat borderline personality disorder. And there’s a growing body of research that’s found dbt effective in treating a number of other issues. And dbt is also very helpful in teaching people how to manage and regulate emotions and tolerate distress better.

So like traditional cbt, dialectical behavior therapy looks at how our thoughts and our behaviors contribute to various mental health and psychological issues; and how if we change how we think and change how we act, we can change our emotions and how we feel and help treat these issues and the symptoms associated with them. So in this sense dbt is a type of change-based therapy.

But dbt is also an acceptance-based therapy. So what does that mean? Well since the 1990s mindfulness has played an important role in a number of approaches to therapy including dbt. And so dbt is a type of cognitive behavioral therapy that integrates elements of mindfulness.

Now acceptance is a big part of mindfulness. And what does mindfulness mean? In simple terms mindfulness is a non-judgmental awareness of how things are in the present moment.

So when we’re being mindful we’re accepting our experiences, and not judging them as good or bad, pleasant or unpleasant, desirable or undesirable, and so on. We’re simply accepting them however they are in this moment.

If we’re sad in this moment, we accept that we’re sad in this moment. If we’re anxious or angry in this moment, we accept that we’re anxious or angry in this moment. If we’re having a distressing thought, we accept that we’re having that thought. And if we find ourselves in an unpleasant or distressing situation, we accept that this is our experience right now in this moment. We also practice self-acceptance.

And so something that’s often hard to wrap our minds around is, if we accept something aren’t we resigning ourselves to that and giving up? Isn’t acceptance the opposite of change?

And this discrepancy between acceptance and change is at the heart of dbt. Dbt is about finding a balance between these two opposing ideas of change and acceptance. And this is one of the dialectical elements of dbt. And dialectics involves reconciling the tension between two opposing ideas, a thesis and an antithesis, into a synthesis that integrates what is true of both ideas. And so dbt is the synthesis of the change aspect of cbt, and the acceptance aspect of mindfulness. And a lot of people have trouble grasping both the concept of acceptance in general and also how acceptance can be compatible with change, and I talk about this more in a couple of videos about acceptance that I’ll link to in the description.

So those are some of the basics of the theory behind dbt now let’s look at the practical side,

So there are two main components to dbt: individual therapy, plus dbt skills training. Now we’re not going to talk about what goes on in a dbt therapy session because this is a self-help video. But you can learn dbt skills on your own. And dbt skills alone have been found effective in treating a number of issues and disorders, and are a great way to learn how to tolerate distress and manage and regulate emotions better. So now we’re going to go through an overview of these skills. And I have a number of videos to go into more details about each of these skills that I’ll link to in the description.

So there are four dbt skills: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. Mindfulness and distress tolerance are acceptance-based skills and emotion regulation and interpersonal effectiveness are change-based skills.

So first core mindfulness skills. We refer to mindfulness skills as core skills because they’re fundamental to dbt: each of the other skills rely on our abilities to be mindful. And so mindfulness skills are the first skills we learn, and then a comprehensive dbt skills program, mindfulness skills are repeated between each new skill. The order in which we learn the skills doesn’t matter, as long as we start with mindfulness and repeat mindfulness skills before each new skill.

There are seven core mindfulness skills. The first is called wise mind which is a synthesis of reasonable mind and emotion mind. Reasonable mind refers to approaching things intellectually and thinking and acting rationally and based on logic. Whereas emotion mind involves thinking and acting based on our emotions and how we’re feeling. And I have a whole video that explains wise mind reasonable mind and emotion mind.

Next there are the what skills: what do we do when we’re being mindful? We’re observing, both what’s going on outside ourselves—external things that we’re taking in through our senses, and what’s going on inside ourselves with our thoughts feelings and emotions and bodies.

And we’re also describing we’re taking a step back and watching and observing what we’re doing we’re observing ourselves observing and acting describing or putting words to what we’re experiencing, I’m watching the sun rise. I’m thinking about work. I’m arguing with my partner. I’m feeling some tightness in my chest.

And we’re participating, turning ourselves completely towards the present moment. Participating is the opposite of automatic pilot and we engage directly with what we’re experiencing in the present moment and don’t allow ourselves to be distracted by anything else.

Then there are three how skills, how do we practice mindfulness? Non-judgmentally, and we’ve looked at what this means already and it’s related to acceptance; one mindfully, focusing on just one thing at a time; and effectively, doing what needs to be done in any given situation and I also have a whole video about these what and how skills.

So next let’s look at emotion regulation skills. So this is a change based skill: we’re learning ways to change our emotions and how we feel now. We can’t control our emotions we can’t make ourselves feel or not feel a certain way. Instead, emotion regulation increases our abilities to influence our emotions and how we feel. So with emotion regulation we can sometimes modify our emotions so that we’re no longer experiencing a particular emotion. Or simply calm our existing emotions and make them less intense.

And the first step in being able to regulate our emotions is to be mindful of our emotions and how we feel. And so even though this is a change-based skill, we’re starting from a place of mindfulness, which involves accepting our current emotions before deciding whether we then want to try to change these emotions.

And if we would like to change how we’re feeling, we learn to influence our emotions by changing our thoughts, changing our behavior, or through problem solving. And I have a whole section about emotion regulation where we look at various strategies to help us do this on my selfhelptoons.com website that I’ll link to in the description.

Next distress tolerance skills, which are acceptance-based skills. In dbt distress tolerance helps us accept, in non-judgmental fashion, both ourselves and our current situations. Distress tolerance skills build upon the non-judgmental awareness we learn practicing mindfulness. Distress tolerance helps us cope with distressing situations and feelings of distress such as strong negative emotions as best we can. We learn to accept what’s going on around us without demanding it to be different. And to experience our current emotions without needing to change them. And to observe our thoughts without attempting to change or control them.

Sometimes we find ourselves in situations where we can’t avoid being in a certain amount of distress. So when that’s the case we need to accept that that’s what we’re experiencing right now, which doesn’t mean we still can’t try to change things to make them better. But while we’re actually experiencing the distress in the moment, by accepting it we help prevent things from getting worse, while we work on trying to make them better. And this is a theme that keeps coming up in dialectical behavior therapy finding this balance between acceptance and change.

So in dbt there are two types of distress tolerance skills. Crisis survival skills involve getting through crises without making things worse. Reality acceptance skills help reduce suffering and increase the sense of freedom by helping us find ways to accept the facts of our lives and things we can’t change. And you’ll find a whole section with videos that teach these distress tolerance skills on selfhelptoons.com.

And then there are dbt interpersonal effectiveness skills. Interpersonal effectiveness skills help us navigate interpersonal interactions more effectively, and as a result avoid the negative emotions and damage to relationships that can accompany interpersonal conflicts.

There are three components to interpersonal effectiveness skills. The first is objectives effectiveness, which refers to learning to communicate assertively in order to get our objectives met, and have our rights and wishes respected, and get what we want or need from other people. Next are skills to build close healthy relationships, and end destructive ones. And finally there’s walking the middle path, which involves finding a balance in relationships between acceptance and change.

There are four categories of DBT skills. Click the on the headings below to go to the start of a category, or use the links in the sidebar.

DBT Core Mindfulness Skills

Mindfulness Skills

Mindfulness Skills are central to DBT. Mindfulness skills are considered “Core” skills because each of the other skills incorporate elements of mindfulness. There are three goals of mindfulness practice in DBT: reducing suffering and increasing happiness; increasing control of our minds rather than allowing our minds to control us; and experiencing reality as it is.

In DBT, there are seven core mindfulness skills. The first is called Wise Mind. Next there are three “What” skills: observing, describing, and participating. Then there are three “How” skills: nonjudgmentally, one-mindfully, and effectively.

Mindfulness skills are the first skills we learn in DBT, and they are foundation for many of the other skills. Emotion regulation and distress tolerance rely on our ability to observe and describe our experiences nonjudgmentally. And if we allow our minds to control us, emotion regulation, distress tolerance, and interpersonal effectiveness all become extremely difficult, if not impossible.

DBT Emotion Regulation Skills

Emotion Regulation

We can’t control our emotions. We can’t make ourselves feel or not feel a certain way. Instead, Emotion Regulation Skills increase our ability to influence our emotions and how we feel.

In DBT, emotional regulation skills teach us to:

  • Understand, name and accept our current emotions
  • Change emotional responses
  • Reduce emotional vulnerability
  • Increase resiliency
  • Increase positive emotions
  • Manage strong or difficult emotions

Emotion regulation requires us to be able to observe and describe our current emotions nonjudgmentally. Observing and describing nonjudgmentally are core mindfulness skills, which illustrates how important mindfulness skills are in DBT, and why we learn them first.

DBT Distress Tolerance Skills

Distress Tolerance

In DBT, Distress Tolerance Skills help us accept, in a nonjudgmental fashion, both ourselves and our current situations. Distress tolerance skills build upon the non-judgmental acceptance we learn practicing mindfulness.

With distress tolerance we learn to:

  • Perceive our environment without demanding it to be different
  • Experience our current emotional state without needing to change it
  • Observe our thoughts without attempting to change or control them

In DBT, there are two types of distress tolerance skills. Crisis Survival Skills involve getting through crises without making things worse. Reality Acceptance Skills help reduce suffering and increase a sense of freedom by helping us find ways to accept the facts of our lives.

DBT Interpersonal Effectiveness Skills

Interpersonal Effectiveness

In DBT, Interpersonal Effectiveness Skills help us navigate interpersonal interactions more effectively, and as a result, avoid the negative emotions and damage to relationships that can accompany interpersonal conflict.

Interpersonal effectiveness skills in DBT include:

  • Communicating assertively get what we want or need from other people
  • Making friends and maintaining these relationships
  • Ending destructive relationships
  • Finding a balancing in relationships between acceptance and change

If you have any questions or comments, please leave them on the YouTube video page.

DBT Core Mindfulness Skills

DBT mindfulness skills

Mindfulness is the act of paying attention to whatever we’re experiencing in the present moment. We’re aware of what’s going on around us in our environment. And we’re aware of our thoughts, our feelings and emotions, sensations in our bodies, and our actions and behavior. And we simply observe these elements nonjudgmentally and with acceptance, without reacting to, or fighting against them.

In Dialectical Behavior Therapy (DBT), there are three goals of mindfulness skills:

  • To reduce suffering, such as emotional pain, tension and stress; and to increase happiness
  • To increase control of our minds instead of allowing our minds control us
  • To experience reality as it is and live life with our eyes wide open

There are seven core mindfulness skills in DBT:

Wise Mind

The “What” DBT mindfulness skills:

  • observing
  • describing
  • participating

The “How” DBT mindfulness skills:

  • nonjudgmentally
  • one-mindfully
  • effectively

We call these “Core” mindfulness skills because mindfulness lies at the core of DBT. And we learn core mindfulness skills first because they provide the foundation we need in order to practice the other DBT skills.

In this section you’ll find posts about:

The Difference Between Pain and Suffering: The Two Arrows

Mindfulness-based cognitive therapy (MBCT) uses the parable of the two arrows to explain the difference between pain and suffering. This video takes another look at the interrelationships between thoughts, feelings and emotions, behaviors, and body sensations from that perspective. And it teaches us how to respond to unpleasant and painful experiences in ways that don’t lead to suffering.

The Difference Between Pain and Suffering

To learn more about MBCT, please check out my Online MBCT Course. If you have any questions or comments, please leave them on the YouTube video page.