Wholeness Healing Center

New Solutions to Old Problems

Dialectical Behavior Therapy:  Providing Acceptance, Validation and Support

By Jacqui Schlund, Assistant Director & Training Coordinator

Dialectical Behavior Therapy (DBT) is a highly effective treatment and a source of hope for many individuals. (Linehan, 2006) It is a nonjudgmental, acceptance-based treatment. This means how you feel, are responding or have responded in the past makes perfect sense to your journey. There is not judgment but understanding and validation in this treatment. There are, however, more effective ways of dealing with troubling emotions. Effective simply means this way works for what you want to achieve, aligning with your values and goals. In DBT, we align with your individual goals and build skills to support new ways of coping. Although this therapy was originally designed to treat individuals with borderline personality disorder, it has since been proven effective in treating a variety of symptoms such as depression, anxiety, impulse control, eating disorders, substance abuse, anger management, and self-destructive behavior (Koerner, 2012). DBT teaches life skills and can be useful for everyone. It guides you to intentionally live now and create a life that works more effectively for you.

Let’s explore Dialectical Behavior Therapy, what is a dialectic? Dialectics are two ideas that are opposite, have opposing tensions. It is a way of thinking in extremes. Here are some examples:

All good                                                                   All bad

All About me                                                          All About Others

I love you                                                                I hate you

Passive                                                                    Aggressive

Dr. Lane Pederson, DBTC describes, “When we get stuck in extremes, we add needless suffering to our emotional pain.” (Pederson, 2012) The solution is to work the dialectic and find middle ground. There is truth to both sides. It is the process of learning that extremes rarely work, identifying when you are in this thinking and instead of reacting in the emotion, finding more options in the middle ground.

Dialectical Behavior Therapy was created by Marsha Linehan and takes clients through learning a series of life skills. Working dialectics and finding balance or middle ground are interwoven throughout these skills. There are four main modules of skills: Mindfulness, Distress Tolerance, Emotional Regulation and Interpersonal Relationships. (Linehan, 1993)

Mindfulness is a skill that helps slow everything down. It teaches individuals to be in the here and now. It is essentially grounding. We all participate in the opposite, mindlessness, at times. This is when we are on auto-pilot and have automatic behavior without thought. Everyone does this and it is okay sometimes to be in mindlessness mode but it is not an effective way to live all of the time.

Mindfulness is observant behavior. It is deliberately deciding where you are going to put your attention and focusing only on that task. It helps quiet the mind as you learn to be mindful without judgment. This skill teaches how to immerse yourself and be one with your experience. It also teaches the difference between emotional mind and reasonable mind and how to find balance in thinking from our wise mind (some heart and some mind).

Emotional Mind                              Reasonable Mind

Wise Mind

When you can find middle ground in thinking (wise mind), it allows for deliberate response versus impulsive reaction. With enough practice and the addition of Distress Tolerance, Mindfulness creates a safe place in your mind.

Distress Tolerance is building skills that help individuals tolerate painful emotion. It is distracting without avoiding; is action instead of reaction. This is where individuals learn to manage a crisis without making it worse. What is a crisis? Linehan defines a crisis as “ . . . a stressful event, or traumatic moment that is short-term but has urgency to solve it now.” (Linehan, 2006). When you aren’t able to solve the crisis now or you are not able to think from your wise mind to be solving a problem, how do you deal with this? You must survive it. Your old survival skills, those fancy ways of escaping, are the behaviors that can that make life more difficult. Distress Tolerance skills are what you choose to use instead of using your old ineffective skills. This skills module builds your toolbox with new ways to deal with life by learning ways to solve problems, make more effective choices and react less impulsively.

The next skills module is called Emotional Regulation. This is where individuals learn how emotions work, ways to balance emotions and decrease emotional vulnerability. Decreasing emotional vulnerability simply means learning ways to not be triggered as easily. Emotional vulnerability leads to escape and avoidance behaviors (Pederson, 2012). This skill module focuses on smoothing out and balancing emotions. It teaches proactive skills to increase events that create positive emotions. It is where you learn to start caring for yourself. It can start the process of challenging some of the old crippling core messages and replacing them with self-validating thoughts.

The last module is Interpersonal Skills. Interpersonal Skills lead to healthy relationships. This module includes skills that help individuals make and maintain relationships, effectively resolve conflict as it occurs and balance out the needs of themselves and others. (Pederson, 2012) This is no small feat for anyone! It involves defining values, goals and embracing self-respect. It teaches respect toward others, validation, appropriate boundaries, how to say no and ways to negotiate needs. It is part of creating a functional support system and learning how to genuinely connect with others.

This is DBT in a nutshell. Wholeness Healing Center embraces DBT’s nonjudgmental, acceptance-based philosophy. Our entire staff has recently undergone extensive DBT training. We are now offering DBT Individual Skills Treatment, several DBT Skills Groups as well as a consultation team for DBT providers. If you are seeing another provider in the community, talk with them about attending a DBT Skills Group along with your regular therapy. If you think you could benefit from having more options and learning these life skills we encourage you to call. DBT is profoundly effective with life-changing skills if you are willing to try new ways to solve old problems.

Works Cited

Koerner, K. (2012). Doing dialectical behavior therapy: a practical guided (guides to individualized evidence-based treatment. New York: The Guilford Press.

Linehan, M. (1993). Skills training manual for treating borderline personality disorder. New York: The Guilford Press.

Linehan, M. (1997-2013). Crisis Survival Skills, Part I. New York, NY: Guilford Press.

Linehan, M. C. (2006). Dialectical behavior therapy vs. therapy by experts for suicidal behavior & borderline personality disorder, a randomized controlled trial. American Medical Associates.

Pederson, L. (2012). The expanded dialectical behavior therapy skills training manual. Eau Claire: Premier Publishing and Media.

Tags: DBT, Distress Tolerance, Effective treatment for anxiety and depression, Effective ways to live, emotiona regulation, interpersonal effectiveness, Mindfulness, PTSD treatment