Dialectical Behavioral Therapy (DBT) is a skill based therapy that was developed by a woman named Marsha Linehan and is split into four major components: Mindfulness, Distress Tolerance (DT), Emotion Regulation (ER) and Interpersonal Effectiveness (IE). Mindfulness comes first as it offers core components that are woven into the other skill sets. I offer insight into DBT, knowing I am biased as I am DBT certified through PESI, in the hopes that it may spark interest and exploration for folks looking to improve the way they cope and manage emotions. Below I break down the four modules:
Mindfulness: This module is rooted in the wise mind concept, which I will elaborate on in a few weeks. The basics are that if you imagine a venn diagram, one circle represents your reasonable mind, the other circle, your emotional mind. The center overlap is the sweet spot, it is a wise mind, a way to balance both mindsets. The additional mindfulness skills are broken down into the WHAT skills (a.k.a., the practice of observing, describing and participating in the present moment) and the HOW skills (a.k.a., practicing non-judgmentally, one-mindfully and effectively).
Distress Tolerance (DT): This module is rooted into two ways to manage distress: recognizing times for crisis survival skills and additional times for reality acceptance skills. The crisis survival skills include many acronyms (Marsha loves her acronyms) which include the S.T.O.P skill, the pros and cons (extended edition, not just two columns), the T.I.P.P skill valuing importance on the nervous system, Distracting with A.C.C.E.P.T.S, Self Soothing using the 5 senses and ways to I.M.P.R.O.V.E the moment. The reality acceptance skills are a subset that work to reframe the perspective we may be having with radical acceptance.
Emotion Regulation (ER): These skills, you guessed it, are to work on regulating emotions both in the short term and long term. The first component of ER is working on understanding and naming emotions. Then we move to changing emotional responses which include skills like checking the facts, practicing opposite action and problem solving. The last piece of ER is reducing vulnerability to the emotional mind (remember that wise mind?) Marsha lays them out as the ABC’s of ER and P.L.E.A.S.E.
Lastly, Interpersonal Effectiveness (IE): which boils down to relationship skills. These are split into three major categories which we need to clarify prior to picking a skill. In clarifying the objective of communication, we consider prioritizing communicating what we want using the DEAR MAN acronym, focusing on maintaining the relationship with the GIVE skill, or prioritizing building self respect through the FAST skill.
Over all, DBT has a lot to offer and this is a short crash course on what some of the main skills may include. I offer this as food for thought as you may continue your therapeutic journey, is there room for some DBT skill building?
Vera Bednar, LMHC is a licensed mental health counselor (LMHC), a registered yoga teacher (RYT-200) and certified in dialectical behavioral therapy (C-DBT). A Lesley University graduate, Vera earned a bachelor's in counseling and art therapy and a master's in clinical mental health counseling with a specialization in trauma.
Prior to joining Looking Glass Counseling, Vera worked in a wide variety of clinical settings including inpatient, residential, intensive outpatient and an assisted living center with an art therapy focus. She also worked in partial hospitalization programs specializing in trauma, LGBTQIA+ individuals and young adult transitions as well as substance use.