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Dialectical Behavior Therapy (DBT) 101: What is it and how can it help you?

Dialectical Behavior Therapy (DBT) 101: What is it and how can it help you?

by Shannan Blum, LMFT 

Dialectical Behavior Therapy (DBT) was initially developed by Marcia Linehan in the 1980s. She noticed patients with chronic suicidal thoughts often demonstrated ‘skills deficits’ along with extreme emotional sensitivities. She observed the suicidal thoughts occurred less frequently when patients learned how to manage and redirect thought patterns, along with specific skills acquisition and consistent therapeutic support. If you’re not familiar with DBT, here’s a brief overview. 

Our clinicians are trained in Marcia Linehan’s DBT model of therapy and are ready to work with you and your family in both individual and group settings to help you become more effective in your emotion management, relationships and self-awareness. 

The first word in DBT, “dialectical,” captures the treatment’s foundation. Dialectic philosophy features these core beliefs:

  • All things are interconnected
  • Change is constant and inevitable
  • Opposites can be integrated into harmonious whole statements using ‘both/and’ to get closer to the truth, for instance: 
    • “It’s important to accept where you’re at and strive to improve” or
    • “It is both important to express emotions and sometimes contain them.” 

The second word in DBT, “behavioral” refers to the specific behavior(s) that will be targeted by the therapist and client together, (either increasing or decreasing) to create relief and a life worth living.

The DBT paradigm assumes that people are doing the best they can, that most ‘problems’ are attempts at solutions, and most people lack skills in managing emotions and difficult life circumstances. DBT is built upon four modules of skill-building: 

  • Mindfulness
  • Distress Tolerance 
  • Emotion Regulation
  • Interpersonal Effectiveness

These DBT skills help people who struggle with various issues like severe depression & anxiety, eating disorders, self-harm, addiction, and post-traumatic stress disorder.

An example of a skill you might learn with a DBT Therapist or in a DBT Skills Training Group is the TIPP Skill. The TIPP skill is intended to quickly change the body’s physiological response in order to reduce the effects of overwhelming emotions (when your thinking and behaviors seem to be controlled by your Emotion Mind). Note: because these skills are designed to create fast body changes, their effects aren’t going to last super long – so it’s most effective to pair them with thinking skills afterward to improve problem-solving or decision-making. 

T – “Tip the temperature”

Tip the temperature of your face with ice water (to calm down fast). Hold your breath, put your face in a bowl of

ice water, or hold an ice pack on your eyes and cheeks. Hold for 10 to 30 seconds. 

  • This activates the mammalian diving reflex, a natural reflex that occurs in all mammals and is triggered in humans when our faces are submerged in cold water. The reflex causes changes in our body —heart rate drops down immediately and the parasympathetic nervous system is activated to prompt a relaxation or ‘slow down’ response.

I – “Intense” Exercise

Engage in intense exercise – only for a short while, to calm down your body when it is revved up by emotion. If you’re in a crisis, consider pausing and do 20 jumping jacks, burpees or getting outside and do some short sprints. Even just clenching & unclenching your fists, doing large arm swings, etc. – whatever it may be for you to bring that heart rate up. 

  • The idea is you want to release some of that stored up energy from a fight/flight response and sometimes get trapped from strong emotions. 

P – Paced Breathing 

Pace your breathing by slowing it down. Breathe deeply into your belly. Slow the pace of inhaling and exhaling way down (on average, five to six breaths per minute). I encourage clients to focus first on slowing down their EXHALING before focusing on their inhaling (for example, 5 seconds inhale and with a 4 second pause, then 7 or 8 seconds exhale). 

  • Slowing our breathing cues your parasympathetic nervous system to calm the body’s processes and begin restoring the ‘rest and digest’ state. 

P – Paired Muscle Relaxation

This refers to pairing muscle relaxation along with the Paced Breathing above. (if you know about Progressive Muscle Relaxation (PMR) – this is another version of that!) We know that when we’re in a crisis or when our stress response is high, we tend to carry tension in many parts of our body. So when you breathe in, clench your fists firmly, hold the tension, notice what that tension feels like in the body, and as you breathe out, release the muscle tension. Continue the deep breathing and progress through the major muscle groups of your body. Pay attention to the difference in your body as you tense and let go of each muscle group.

  • Both slowing your breathing and releasing muscle tension cues your parasympathetic nervous system to calm the body’s processes and begin restoring the ‘rest and digest’ state.

Gentle Reminder to Practice

Learning any skill takes time, and these may not work immediately and not every one of these will work for every person. With practice, they become part of many tools to regulate strong emotions, manage difficult situations, and generally feel better. It can take some practice and in many cases, it helps to work with a DBT therapist to ensure that you are engaging in the skills effectively.

Want to learn more about DBT and see if it’s right for you? Click here to schedule a free consultation. 

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