Dialectical Behavior Therapy

Life with all it’s wondrous joys also brings sorrow. Our wellness is dependent on healthy processing of dialectic experiences. Life pulls in many direction, lifting with joys while challenging with disappointments and fears. We exist in a dialectical tension caused by opposing forces. Our managing of the complexity determines our experience of wellness. Dialectical behavior therapy operates with these factors in mind.

​”The ability to appreciate paradox and to think dialectically” is a helpful skill to manage the diversity of life experiences and a necessary ingredient to healing from trauma (Tedeschi, et al. 2018).

Dialectical behavior therapy (DBT) is designed to improve emotional regulation and enhance resilience to help clients better tolerate stress. DBT achieves these objectives through teaching emotional regulation and interpersonal skills that navigate the opposing forces encountered in living. The underlying belief is that is people can manage their emotions they can effectively direct their own lives.

​Dialectical behavior therapy has strong empirical support on its effectiveness for treating many conditions. Therapists have used DBT to treat clients suffering with depression, drug and alcohol abuse problems, post-traumatic stress disorder (PTSD), traumatic brain injuries (TBI), binge-eating disorder, and mood disorders. Research also suggests that DBT might help patients with symptoms and behaviors associated with spectrum mood disorders, including self-injury.

How Does Dialectical Behavior Therapy differ from Cognitive Behavioral Therapy?

Sheri van Dijk explains: DBT relies on much of the same foundational concepts as cognitive behavioral therapy. However, DBT has built in mindfulness, emotional regulation, distress tolerance, and interpersonal skills as key elements to develop in therapy.

History of Dialectical Behavior Therapy

Marsha Linehan developed DBT as a modified form of cognitive behavioral therapy (CBT) in the late 1980s to treat people with borderline personality disorder (BPD) and chronically suicidal individuals. After Linehan’s techniques proved affective in treatment for BPD and self-harming clients others began using DBT to treat a variety of other illnesses. 

Four Key Elements of Dialectical Behavior Therapy

A dialectical behavior therapists focuses on facilitating growth in four key areas: mindfulness, distress tolerance, emotional regulation and Interpersonal Effectiveness.

Mindfulness

​Mindfulness in DBT is paying attention in the present moment. In practice, mindfulness is that act of intentionally focusing attention on the present moment, allowing felt experience to exist in consciousness without a running commentary of words and judgements.

Mindfulness improves:

• Self-awareness
• Distress toleration
• Integration of multiple sources of data
• Inner peace

Mindfulness halts automatic reaction to emotional arousal, creating a space where healthier choices can be made. Automatic learned responses often include destructive behaviors that push us off course, moving away from instead of toward life goals.

​Dijk warns that “when you’re unaware of your inner experience—specifically, your thoughts, feelings, and urges—you’re much more likely to act on unhealthy urges and to automatically engage in behaviors that you will likely regret later” (2012). As we increase our self awareness and accept what we discover, we increase opportunities to heal the elements interfering with growth.

Distress Tolerance

Dialectical experience of oppositional forces creates stress. Navigating the complexity requires managing arousal without crumbling into self destructive patterns.

Distress tolerance skills enhance our ability to cope with stressful situations, allowing constructive responses to intervene rather than defensive learned reactions. Defensive learned reactions such as intoxication, overspending, unhealthy indulgence, or lashing out have long-term negative consequences.

Our ability to tolerate and mitigate heighten arousal is correlated with many life successes and failures. Skills such as mindfulness, distraction, and relaxed breathing assist in bringing stress back to manageable levels. “The major emphasis of DBT is to learn to bear emotional pain skillfully” (2012, page 6).

​Emotional Regulation

​Dijk explains, “people who have difficulty regulating or managing their emotions usually find it difficult to tolerate their emotions and often have trouble identifying, understanding, and expressing how they feel” (2012, p. 2).

Research supports this concept. Our skills of identifying and differentiating emotion strongly supports regulation. Differentiating emotion is a labelling process rather than a judgment process. We regulate with granular descriptions of felt experience.

DBT teaches that we can act from three different minds:

• emotional mind
• reasonable mind
• wise mind

Passion and logic has historically been pitted against each other in philosophy. Marsha Linehan wrote that “acting from your wise self is about finding a balance between your emotional and reasoning self and following your intuition about what’s in your best interest in the long run” (Dijk, 2012, p. 34).

The wise mind is accessible only when we employ mindful self-awareness and tolerate distressing emotion states. The wise mind is akin to Daniel Goleman’s emotional intelligence.

Interpersonal Effectiveness

We need others. We are biologically driven to belong. While we may want connection, we aren’t always skilled at connecting. When our need to belong is frustrated, we suffer. The dialectic involved in relationships is the oppositional demands for respect of self while honoring the individuality of others.

See Autonomy in Romantic Relationships for more on this topic

This dialectical factor of relationships weighs on every interaction. When too much weight is put on either side (self or other), relationships struggle. We either divorce our self respect in efforts to  please others or selfishly ignore others in personal pursuits of pleasure. A dialectic involvement in healthy relationships requires balancing the needs of others with the needs of the self, while maintaining one’s self-respect.

DBT focuses on developing balanced interpersonal effectiveness to honor balance in three ways: acting with self respect, treating others well, and communicating with assertiveness.

Self-Respect:

An essential requirement for healthy relationships is retaining a healthy autonomy. We must continue to engage in personal activities that brings joy and fulfillment outside of the relationship. 

​”If you are lonely when you’re alone, you are in bad company.”   ~Jean-Paul Sartre

​We encourage self respect by living a self respecting life. We compassionately and kindly honor our values and live with integrity.

Treating Others Well:

Kindness does, in fact, matter. Kindness connects us with reality. Science has sadly found that as we become more self sufficient, connection to others begins to erode. We must work to remain connected and kind. 

We remain connected to others by: 

• Caring
• Remaining interested
• Validating others emotions and experiences
• Respecting differences

Assertiveness:

DBT teaches that communication usually takes one of four possible styles. These styles are passive, aggressive, passive-aggressive, and assertive.

• Passive. A passive communicator stuffs personal emotions and desires rather than communicate them. They communicate protectively rather than openly to avoid risk of negative or confrontational reactions.
• Aggressive. An aggressive communicator uses domination and control. They utilize techniques of shame, fear, and confusion. They use these techniques to avoid open dialogue and compromise.
• Passive-Aggressive. Passive-aggressive communicators don’t openly communicate emotions but express emotions in more subtle ways. They may use sarcasm, silent treatments, or indirect comments to convey their message. They say “I’m not angry,” but then slam a door and sulk.
• Assertive. Assertive communicators express thoughts feelings and opinions in a clear, honest, and respectful way. The assertive communicator meets the dialectic aspect of relationships head on, concerned with meeting autonomous needs while meeting the needs of others as much as possible. Assertive communicators utilize skills of emotional attunement, listening, and negotiating.

​Assertive communication is not about always getting one’s way. Forcing others to comply is not assertive communication. Listening with non-judgmental intent to understand is the most powerful way to connect. The other feels respected and their sense of worth is validated during these interactions.

Assertive communication on the part of the speaker doesn’t always work because the other may respond with attempts to manipulate, or passive acceptance never openly expressing of their own feelings. Unfortunately, not all relationships are salvageable. 

A Few Words on Dialectical Behavior Therapy by Psychology Fanatic

Recognizing and managing life’s conflicts is a primary skill for flourishing. Life, as far as I can predict, will always struggle against opposing forces. DBT recognizes this primary function of life and attends to fundamental skills to assist clients with this task.

David Richo wrote in his wonderful book Five Things We Cannot Change that a spiritual practice is to hold both our hands out, cupped, palms upward, and imagine them holding the opposites. He explains, “we feel the light and equal weight of both, since our hands are empty. We then say for example, ‘I can serenely hold both my need for a relationship and not having one right now'” (2006). Perhaps, DBT teaches exactly how to do just that, hold our hands out, examining opposites, and managing to integrate them into a healthy, flourishing life.

References:

Bruner, Sonya (2021). What Is Dialectical Behavior Therapy And What Can We Learn From This? Betterhelp.com. Published 2-18-2021. Accessed 10-15-2021. 

Richard G. Tedeschi, Jane Shakespeare-Finch, Kanako Taku, Lawrence G. Calhoun (2018). Posttraumatic Growth: Theory, Research, and Applications 1st Edition.

Richo, David (2006). Five Things We Cannot Change: And the Happiness We Find by Embracing Them. ‎Shambhala; Reprint edition.

​Schimelpfening, Nancy (2021). What Is Dialectical Behavior Therapy (DBT)? ​Verywellmind.com. Published 7-9-2021, accessed 10-15-2021.

Van Dijk, S. (2012). Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions and Balance Your Life.

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