DBT 101

I’ve stated that my daughter and I started a 25-week Dialectical Behavior Therapy (DBT) skills group.  There are five other teens in the group with their parents so it’s not a big group.  Most of the kids seem to struggle with “target” behaviors on a regular basis.  Target behaviors are cutting and high-risk behaviors.  My daughter has cut twice, and she doesn’t engage in high-risk behaviors.  I requested DBT because she has problems emotionally regulating.  I wanted to give her the skills now before it was a bigger problem–before she needed to engage in high-risk behaviors to regulate or organize her emotional experiences.

So, the major premises behind DBT are:

• DBT is an effective treatment for people who have difficulty controlling their emotions and behaviors.
• DBT aims to reduce problem behavior and increase skillful behavior.
• DBT helps people learn to better understand and value themselves and others.
• DBT helps people create a live worth living.

Dialectical means:

• Two opposite ideas can be true at the same time.
• There is always more than one way to see a situation, and more than one opinion, idea, or dream.
• All people have something unique and different to offer.
• Considers a life worth living to have both positive and negative aspects including happiness, sadness, anger, and peace, and all these aspects are necessary and valuable.

Problems (Behaviors to Decrease)                        Skills (Behaviors to Increase)

• Confusion About Yourself  (Do not know what you          1. Mindfulness                              feel or why you get upset)
• Impulsivity (Acting without thinking it through)              2. Distress Tolerance
• Emotional Instability (fast, intense mood changes,         3.  Emotional Regulation          or steady, negative emotional state)
• Interpersonal Problems (pattern of difficulty                   4. Interpersonal Effectiveness  keeping relationships steady, and getting                                                                          what you want)
• Family Dilemmas (Extreme thinking, feeling,                  5. Walking The Middle Path acting, e.g. all or nothing “black/white” thinking)

The bio-social theory behind DBT states that there can be a biological vulnerability to emotions which can cause people to be sensitive, reactive, and slow to return to baseline.  In addition to this, some people have an inability to regulate their emotions effectively.  This is the biological part of the bio-social theory.  The social part of the theory states that when we are in an invalidating environment (IE) that communicates to us that what we are feeling, thinking, and doing are inaccurate, inappropriate or wrong, the result is that rejection and punishment are communicated through the IE causing us to feel ‘less than’ which often leads us to invalidate ourselves with thoughts like “I’m so stupid!” or “I don’t understand why I’m getting so upset,” or “There must be something wrong with me.”  Sometimes there is a poor fit between the individual and the environment.  Over time this leads to multiple problems like confusions about the self, impulsivity, emotional instability, and interpersonal problems.

The DBT approach then is to teach validation and self-validation skills so that the IE can be changed or so that the individual can learn to self-validate regardless of environment as well as learn resiliency so that skills are increased in the areas of impulsivity, emotional regulation, and interpersonal effectiveness.

This is the bird’s-eye view of DBT.  Frankly, no matter who you are, you can benefit from it because we all engage in invalidating behavior, and we all have experienced an invalidating environment.  Learning to self-validate is an excellent skill, and learning what true validation means is key to maturing and learning kind, effective communication.  Emotional regulation is the other key piece of DBT that I really like.  I don’t know anyone who doesn’t struggle from time to time.  Lastly, interpersonal effectiveness is something we will all need until the day we die.  Ideally, we will want to grow in our interpersonal effectiveness over time rather than stall out and stagnate, but that’s what I see many people do.  As we get older we stop challenging ourselves and feel entitled to our way of doing things rather than find humility and desire wisdom.

**information cited above has been adapted from Linehan’s skills training manual.

Resources:

Dialectical Behavior Therapy: Multi-Family Skills Training Group Manual, Miller, Rathus, and Landman (1999)

Skills Training Manual for Treating Borderline Personality Disorder, Linehan, Marsha (1993)