What is DBT (And Why We Love It)
What is Dialectical Behavior Therapy (DBT)?
DBT is an evidence-based therapy that helps folks manage strong emotions, handle unhelpful behaviors, and develop more meaningful relationships.
DBT is used to treat challenges related to depression, ADHD, anxiety, and other issues. Initially designed to help adults with significant needs, DBT has been adapted for youth and families. This therapy may include skills training and practice, parent coaching or family therapy, and/or individual therapy - among other elements.
DBT was designed to be a multi-modal therapy with four components: individual therapy, skills training, phone coaching, and consultation for the therapist. This is often called comprehensive or standard DBT. A comprehensive DBT program with all four components is helpful for young folks with significant emotional dysregulation, self-harm, or chronic suicidality. Research also supports adapted, evidence-based DBT to support folks with different needs and in different settings. For instance, research shows that skills-only DBT groups and individual DBT can be helpful for folks with depression, anxiety, and other issues so long as the amount of therapy is sufficient enough to meet the client’s needs (Linehan et al., 2015).
What does the “D” in DBT mean?
Snowing in spring?
Raining when it’s sunny?
Just as the weather can seem paradoxical, so can our thoughts, feelings, and behaviors. These paradoxical circumstances seem like they can’t go together, yet, they actually can – both can be simultaneously true. We call these coinciding and opposing truths, dialectics.
Feeling scared and doing that scary thing… knowing you are capable and seeking support… loving someone and feeling upset with them — are all examples of dialectics. DBT works by helping us deal with two seemingly opposite things at once: acceptance of feelings and using skills to change behaviors and thoughts. Rather than getting stuck in acceptance OR change, DBT helps us to see the truth on each side, and thus, walk the middle path.
Rooted in the belief that folks are doing the best they can and (you see where this is going) want to improve, DBT is fueled by dialectics. DBT therapists help youth and families develop contextually, culturally relevant skills to cope with stress and improve relationships. All the while, providing validation and supporting acceptance.
Let’s learn more about the skills!
Mindfulness: The practice of paying attention helps individuals maintain awareness of the present moment, free from judgment while connecting what our brains and bodies are experiencing. This helps us to better hold attention and experience pleasure while reducing suffering (Rathus & Miller, 2015). Mindfulness lays the groundwork to engage in all other DBT skills.
Distress Tolerance: Skills such as crisis survival skills and reality acceptance skills can be used when we aren’t able to solve a problem immediately and, instead, must tolerate a challenging situation. Crisis survival skills help us employ short-term solutions that do not necessarily make us feel better but may buffer us from engaging in behaviors that make things worse. Some of these skills include learning to self-soothe, DISTRACT, IMPROVE the moment, and more. On the other hand, reality acceptance skills help us increase our willingness to accept (rather than avoid or fight) challenges that we may not be able to change.
Walking the middle path: These strategies can be especially helpful for adolescents and families where polarized or extreme thinking and behavior occur. Here we practice validation, as well as receive psychoeducation about developmentally appropriate behaviors and expectations.
Emotion regulation: These skills specifically target individual factors including emotional vulnerability and reactivity. DBT helps folks recognize, label, and understand emotions, create more positive emotions, and reduce the intensity of some emotions.
Interpersonal effectiveness: These skills help us build and maintain positive relationships. For instance, we learn how to reduce conflict, effectively express our wants and needs, and uphold respect for ourselves (Rathus & Miller, 2015).
We know that skills don’t help if you don’t practice and use them. So, therapists are there to help you enact them in daily life! Daily practice helps you identify limitations and barriers to skills use, so you can refine your approach over time. It also beefs up your wellness toolkit so you can react and respond in challenging situations in a way that aligns with your values.
And what’s more!? DBT can be even more beneficial when parents join in on it!
DBT offers ample opportunities for parents to take part in the therapeutic process, ranging from as-needed short phone coaching sessions to full parenting sessions (Rathus & Miller, 2015). Parent work can be especially beneficial for parents that feel like they want to improve their parenting and learn helpful ways to respond to their young people. When parents learn the skills they are more informed about the therapy content which helps them support their child better. DBT encourages parents to use the skills, themselves, to interact with their children more effectively. Doing this work together can strengthen the parent-child relationship and encourage everyone to walk the middle path together.
Ready to join a DBT group or a Parent Workshop? Contact us at hello@mindchicago.com.
Written by therapist, Lee Wells, AM, LCSW, and Advanced Clinical Intern, Naomi Kaplan.
