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.
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.
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.
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.
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
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