Dialectical Behavior Therapy – How to be more flexible with your outlook

Hello, I’m Mia Elwood, a licensed clinical social worker and Director here at Healthy Futures. I’m here with co-pilot, Gus.

Our purpose today is to learn a bit about DBT, which stands for Dialectical Behavioral Therapy. If you were to take a DBT skills training class, what might that entail?

The first thing to know is a bit about DBT.

DBT is a research-based treatment helping individuals and their families become more effective, flexible, and fluid in their thoughts, behavior, emotions, and relationships.

It was developed more than 20 years ago by Dr. Marsha Linehan, originally to help those suffering with borderline personality disorder and can also be used to help with other maladaptive coping.

Since then, much research has proven this treatment effective with many populations, including those struggling with eating disorders, substance abuse, depression, anxiety, and trauma.

A second thing to know is what the word “dialectical” means. It’s a way to understand and appreciate opposites, thus allowing you to look at things differently in your own life. The easiest way I know to explain is just say it means both/and versus either/or. Also, and versus but.

If you look at these words, it helps us manage apparent opposites without going extreme, therefore leaving out flexibility. You can both want to change and actively resist changing at the same time. You can both love something and hate it at the same time, like a parent or a job, for example. You will understand this more throughout your time in DBT.

One part of a standard DBT treatment is the skills training class we offer here at Healthy Futures. We have skills training classes for teens, adults, and their family members. I am one of the DBT instructors here, along with several other awesome teachers, like Sheri, Jessica, and Dr. Kim.

What might your skills training experience be like? I’m here to answer that question for you in the hopes of you arriving at your first class with a basic knowledge of how this all works. This is what you need to know.

Skills training is taught in four to five modules or chapters. They are core mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, middle path skills.

We have an open entry to group, meaning you will jump in wherever the class is at the time.  Expect to be a bit disoriented your first one to two groups as you catch on and catch up to where the group is at. It takes roughly 20 weeks to complete all the modules. No matter where you start, you will end after having had all the modules, as it is in active rotation during this 20 weeks. Each module takes about a month, give or take.

Let’s take a look at each module and get a general idea of what it can help you with.

Core mindfulness skills helps to keep you in the present moment and avoid judgment of reality. This helps reduce anxiety, improve relationships, improves focus, awareness, and decreases confusion about self, and helps your identity. This is a foundational skill of DBT, and it will help you with all the other modules.

Emotion regulation skills are a wonderful skillset for learning how to feel emotions more effectively. It will help you reduce mood dependent behavior and feel more in charge of your emotions.

Distress tolerance skills helps you tolerate the pain you will experience in life, rather than trying to change things or avoid the pain. These skills will help you change your current impulsive or avoiding coping skills, which can have negative consequences.

Lastly, interpersonal effectiveness skills and walking the middle path skills help to improve relationships by improving extreme thinking, feeling, and behaving in ways that can push people away. It arms family members with more effective ways to interact with one another. It helps with setting boundaries and asking for the things you need.

Another thing to understand is DBT’s biosocial theory of emotion dysregulation. Emotional sensitivity or vulnerability is biological. It is simply how people are born. They are more sensitive to emotional stimuli. They experience emotions much more often than others. They experience emotions much more intensely, and it takes them longer to return to baseline.

Impulsivity also can have a biological basis. Regulating behavior is harder for some than others. Then, we look at how this emotional vulnerability interacts with the environment. An invalidating social environment can make it very hard to regulate emotions.

What’s an invalidating environment? An invalidating environment doesn’t seem to understand your emotions. Instead, this type of environment tells you your emotions are inappropriate or wrong.

This tends to lead to self-invalidation as if you seem to bet the odd one out. Then people tend to try to adapt to their environment. You just might be the tulip in the rose garden, and you might try to do your best to be a rose and make being a tulip wrong.

Another important point is to understand that people who invalidate are often doing the best they can. They haven’t learned anything different. It was the way they grew up. Most people don’t have a working, functional understanding of emotions or how they work.

It’s these transactions between person and environment over time that tends to lead to the symptoms you might be struggling with and the conflict in your environment.

Now, we’re going to learn the DBT assumptions. These are ways of believing, here called assumptions as they cannot be proved, but we agree to abide by them anyway.

Number one, people are doing the best they can. Number two, people want to improve. Number three, people need to do better, try harder, and be more motivated to change.

Number four, people may not have caused all their own problems, but they have to solve them anyway. Number five, new behavior has to be learned in all relevant contexts. You need to practice these skills in the context they are needed, not just in the classroom.

Number six, all behaviors, actions, thoughts, and emotions are caused. We often don’t know the causes but, number seven, figure it out. Changing the causes of behavior work much better than judging and blaming.

Finally, practically speaking, you show up for a DBT skills class. What might you expect? Here’s how it usually goes. First, some type of warm up exercise or mindfulness activity invites us to engage in the here and now and gets us ready for learning.

Second, homework review of last week’s lesson will occur. You will be expected to share how you practiced the skills taught the previous week. You’ll be supported in acquiring these new skills by other peers and by your instructor.

Any questions about struggling with applying these skills are welcomed, as this is how you learn.