Dialectical Behavior Therapy for Emotional Regulation and Distress Tolerance
Dialectical Behavior Therapy (DBT) is a unique form of talk therapy that can teach you how to regulate your emotions, embrace the present moment, and develop healthy coping habits when you encounter stress, anxiety, or painful experiences. There are many forms of therapy, and DBT is one option that can work independently or in conjunction with other therapeutic approaches. Learning more about dialectical behavioral therapy can help you determine a good fit for your specific needs and what you should look for in a therapist.
What is Dialectical Behavior Therapy?
The word "dialectical" refers to bringing together two ideas that might be opposites or contradictory. Dialectical behavior therapy offers a very innovative approach in psychology where it allows clients to embrace both acceptance and change. Therapists will work with clients to identify the negative behaviors and accept negative changes that they cannot control. Dialectical behavior therapy helps clients understand that their emotions (whether negative or positive) are a natural part of life, and balancing acceptance and change leads to better results than just focusing on one concept alone.
Dialectical Behavior Therapy Versus Cognitive Behavioral Therapy
Cognitive behavioral therapy is an umbrella term for any kind of talk therapy. CBT is rooted in exploring how thoughts and behaviors influence feelings, and from there, finding ways to change the way we think about situations. This process helps us to guide our reactions and cope with challenging experiences.
Dialectical behavior therapy is a type of cognitive behavioral therapy. The main difference between CBT and DBT is that while CBT focuses on using talk therapy to help people work through their feelings, DBT goes a step further and empowers clients to change their behavior patterns.
Dr. Marsha Linehan introduced dialectical behavior therapy in the late 1980s. The treatment was created because standard methods of cognitive behavior therapy were not successfully working to alleviate the symptoms of individuals diagnosed with borderline personality disorder (BPD). However, DBT has proven to be effective for a variety of patients struggling with varying levels of depression, anxiety, substance use disorder, and eating disorders.
Dialectical Behavior Therapy Strategies
Dialectical behavior therapy includes multiple strategies that teach clients how to regulate their emotions and change their behavior for the better. These strategies include:
Mindfulness is a core strategy used in DBT that helps clients learn to focus on what is happening at that present moment. The mind has a tendency to wander away from the present moment or what is currently happening around us; we can find ourselves dwelling on either the past or worried about the future. Mindfulness teaches you to be completely present and aware of what you are doing at that present moment.
One way to embrace the present moment is by using your senses to pay attention to what you are smelling, touching, looking at, or listening to at that exact moment. Practicing different breathing techniques is another common method of practicing mindfulness. In mindfulness, the client learns to bring their awareness back to the present moment whenever they feel that their mind is drifting off to other thoughts.
Practicing mindfulness regularly has tremendous benefits, including teaching the client how to avoid overwhelm from external stressors around them. The client will learn healthy ways to cope when they are going through emotional pain. Mindfulness also helps them resist impulsive behavior and obsessing over automatic negative thoughts.
Improving Interpersonal Relationships
This method teaches the client to improve their communication skills by becoming more assertive while keeping their relationships healthy and positive. They are taught ways to say "no" when they want, express their needs, and deal with difficult people.
Distress tolerance teaches the client how to accept themselves and their present situation no matter how negative it may be. Distress tolerance methods help clients cope with extreme emotions as they are going through them. Clients become more confident navigating negative emotions if they come up in the future.
Common methods of distress tolerance in a crisis include distracting yourself, listing the pros and cons of not accepting your distress, or self-soothing talk. For example, if you are feeling intense anger or sadness, it might be a good idea to go outside and go for a walk. This allows your emotions to flow through your body and also serves as a distraction.
The therapist works with the client to help them develop skills where they will be able to recognize and actively change their emotions. These skills will eventually enable the client to experience more positive emotions. Clients who are suicidal tend to benefit significantly from learning emotion regulation strategies because they frequently experience intense emotions.
Listed below are various strategies that teach clients how to regulate their emotions in DBT:
- Recognizing when emotions come up and accurately labeling them
- Practicing mindfulness while focusing on your current emotion
- Engaging more in activities that you associate with positive emotions
- Opposite action: when you do the opposite of what you feel like doing. For example, if you are feeling down and don't want to be around your loved ones, opposite action would encourage you to do the exact opposite and make plans to spend time with your loved ones.
Dialectical Behavior Therapy Services
While the approach to dialectical behavior therapy will vary from client to client, DBT usually involves one or more of the following settings:
In individual therapy setting, the therapist and client work together to identify the client's learned behavior skills and adapt these skills to their personal life challenges. This part of the process aims to increase the patient's motivation to keep practicing their learned strategies. In a typical DBT program, the therapist and client meet about once a week at the same time the client is engaging in skills group training. Individual therapy is offered in a face-to-face setting or via telehealth.
Clients learn behavioral skills by engaging in a group setting that mimics a classroom where the group leader discusses different skills and assigns homework assignments for the clients to practice these skills on their own. There are also role-playing scenarios that often take place in group settings so the clients can practice their social skills. Standard programs last about one year, but there are also other programs available that are created for certain populations that take less than one year to complete.
Phone coaching is a very useful part of therapy that allows clients to call their therapist on the phone if they need guidance at that exact moment. If the client suddenly comes across a stressful situation and does not know how to deal with it, then they can call their therapist right then so the therapist can walk them through how they feel and what they can do to cope with the situation.
DBT Therapist Consultation Groups
While this isn't a client-facing service, DBT therapists often gather to discuss providing high-quality patient care. This component of DBT was created to help therapists motivate one another to better serve clients who have complex or difficult to treat disorders. The group leaders and individual therapists typically met about once a week to discuss how to provide the best care for their clients.
Applications for Dialectical Behavior Therapy
Even though dialectical behavior therapy was initially created to treat borderline personality disorder, it has been modified since then so that it can effectively treat other mental health conditions¹, such as:
- Post-Traumatic Stress Disorder (PTSD)
- Major depression
- Binge eating disorder
- Bulimia nervosa
- Substance use disorders
- Attention deficit hyperactivity disorder (ADHD)
- Bipolar disorder
DBT for Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) is a mental health condition where the person experiences one or more events that count as trauma and cause them great emotional harm. They find themselves unable to recover from their trauma and experience symptoms such as flashbacks and nightmares. Furthermore, PTSD and BPD share many similar problems. In both situations, the person will have difficulty regulating emotions, managing interpersonal relationships, and resisting impulsive behavior. Dialectical behavior therapy was created to help clients deal with these very same problems, and it can be effective for both BPD and PTSD.
DBT for High-Risk Suicidal Patients
Dialectical behavior therapy has saved many lives due to its high success rate in treating suicidal patients. In fact, DBT is the most researched treatment available for clients with suicidal thoughts/intentions. The U.S. National Strategy for Suicide Prevention identified DBT as an evidence-based approach that delivers suicide-related treatment to clients in one of the least restrictive settings.²
Suicidal patients often struggle because something is going on in their life (a problem or an experience) that they don't think they can solve or tolerate anymore. Dialectical behavior therapy specifically targets that logic and helps the patient analyze what factors are leading to the "unsolvable problem" that the person is experiencing. Then, the client learns ways to solve the problem. Equally important, the patient learns emotional regulation and acceptance strategies that decrease their urges to harm themselves.
Is Dialectical Behavioral Therapy Right for You?
Intense negative emotions and impulsive behaviors can be tough to navigate on your own. If you or a loved one is suffering from a mental health condition, then your mental state and your life could be at risk. Dialectical behavior therapy may help you improve the quality of your life, and, in extreme cases, could help save a life.
All Points North Lodge offers Dialectical Behavioral Therapy in Edwards, CO. The treatment experts at All Points North can offer personalized guidance about what is best for your unique situation. We are standing by and ready to support you: call us at 855.235.9792 or contact us online via LiveChat to talk with a recovery specialist now.
- "How DBT Helps." Behavioral Tech, A Linehan Institute Training Company, 2019, behavioraltech.org/research/how-dbt-helps/.
- "DBT Helps Individuals at High Risk for Suicide." Behavioral Tech, A Linehan Institute Training Company, Sept. 2019, behavioraltech.org/wp-content/uploads/2018/09/How-DBT-Helps-High-Risk-for-Suicide.pdf.
- Buffum Taylor, Rebecca. "Dialectical Behavioral Therapy." Edited by Smitha Bhandari, WebMD, WebMD, 18 Feb. 2020, www.webmd.com/mental-health/dialectical-behavioral-therapy.
- Webb, Christian A et al. "Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement." Behaviour research and therapy vol. 81 (2016): 12-20. doi:10.1016/j.brat.2016.03.006