Dialectical Behavior Therapy (DBT) is a therapeutic program created by Dr. Marsha Linehan. The first edition of her skills training manual and client handouts was published in 1993, with a revised edition published in 2014. DBT is based on a blend of Cognitive Behavioral Therapy (CBT) and Buddhist principles. The program was originally designed to treat Borderline Personality Disorder (BPD), but has since been expanded for a number of mental health issues. As one of my former therapists said, “Everyone needs these skills. Some people just didn’t learn them from their parents.”
In addition to Dr. Linehan’s manuals, there are many other materials available about DBT, including workbooks, skills for children, and decks of skills cards. The one I have used most is from Moonshine Consulting. It has simplified versions of some skills, as well as a few new skills not discussed by Dr. Linehan.
DBT is made up of four modules: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. This is not the order they are presented in the material, but I placed them in this order because it seems like the most logical progression for building upon earlier skills. I will be elaborating on specific skills in future posts, so here I present a brief description of each module.
Mindfulness is the act of staying focused on one task in the present moment. Not multitasking, not living in the past or future. Mindfulness primarily consists of the three “what” skills and the three “how” skills.
The purpose of Distress Tolerance is “to tolerate distress”, as I sarcastically say each time my therapist asks. Of course, I follow up with the serious answer. Distress Tolerance is a set of skills to be used to cope in difficult, painful, intense situations without making the situation worse. This module is not about fixing. It’s about damage control.
Emotion Regulation picks up after distress has been tolerated. This module is for understanding the source and function of our emotions and learning not to let them control our actions.
Interpersonal Effectiveness does what it says on the tin. It teaches us how to interact with others in ways that meet our needs. How to ask for help and set boundaries. How to do these things in ways that show respect for both ourselves and the other party.
That, in a tiny nutshell, is DBT. There are two main components to a DBT program: group and individual therapy. In group therapy, we learn the skills. In individual, we can have focused guidance on applying the skills and working through our trouble spots.
A feature of DBT that can bring some frustration and resistance is diary cards. Both group and individual diary cards ask the client to note which DBT skills are used throughout the week. An individual diary card also asks for information on emotions and impulses that were experienced and/or acted upon. Ideally the client would fill this in daily, but in my experience most (including me!) are going to wait until right before the appointment and frantically scribble it in to the best of their memory.