(DBT) Dialectical Behavior Therapy

Mindfulness skills can help you to center and calm yourself to better understand your emotions. You learn to reflect and train your brain to stay in the present, rather than getting stuck in the past or worrying about the future. You can sit with your anxiety instead of pushing it away, and observe your thoughts, listen to yourself, and acknowledge your fears or apprehensions. In practicing these skills, you can avoid taking things personally and listen more fully to better understand others. Mindfulness is encouraged throughout all 4 stages of DBT therapy and practiced at home during the week.

Depression can present different symptoms, depending on the person. But for most people, depression is feeling sad and not being able to snap out of it and having it last for weeks. People also often report feeling unmotivated, fatigued, irritable and having a lack of interest in things that they used to find enjoyable. Many people experiencing depression report changes in sleep patterns and eating behaviors. For some people, it can include having negative intrusive thoughts about self-worth and even thoughts of suicide.

Distress Tolerance skills are used to help us cope and survive during a crisis and helps us tolerate short-term or long-term physical or emotional pain.

Distress Tolerance skills address the tendency of some individuals to experience negative emotions as overwhelming and unbearable. People with a low tolerance for distress can become overwhelmed at relatively mild levels of stress, and may react with negative behaviors. Many traditional treatment approaches focus on avoiding painful situations, but in the distress tolerance module of DBT, clients learn that there will be times when pain is inevitable or unavoidable and the best course is to learn to accept and tolerate distress.

A main part of distress tolerance is the concept of radical acceptance. This refers to experiencing the situation and accepting the reality of it when it is something the person cannot change. By practicing radical acceptance without being judgmental or trying to fight reality, the client will be less vulnerable to intense and prolonged negative feelings. Within the distress tolerance module, there are four skill categories:

• Distracting
• Self-soothing
• Improving the moment
• Focusing on pros and cons

These skills are aimed at helping individuals cope with crisis and experience distress without avoiding it or making it worse.

Interpersonal Effectiveness skills are extremely important because the way we communicate with others has a significant impact on the quality of our relationships and on the outcome of our interactions. In order to communicate more effectively, clients are taught skills that help them approach conversations in a more thoughtful and deliberate manner rather than acting and reacting impulsively due to stress or intense emotions. Two key components of interpersonal effectiveness are the ability to ask for things and to say no to requests, when appropriate.

There are three types of effectiveness that must be addressed in interpersonal exchanges:

• Objective effectiveness: the goal or purpose of the interaction which often is a tangible outcome.
• Relationship effectiveness: the goal of a conflict-free relationship.
• Self-respect effectiveness: the goal is maintaining personal values and dignity.

For any given situation, these three factors must be considered and prioritized. The individual is likely to be more satisfied with the interaction and outcome if his or her highest priority has been addressed.

Throughout all stages of DBT there is a weekly goal to complete homework assignments to practice and rehearse the new skills in real life situations. This allows the client to build new neural pathways to develop new behaviors and to encourage sustained change. The skills that are assigned to each person are customized based on the treatment plan developed in the office. The therapist helps the person to learn, apply and master the DBT skills in each weekly session.