Intro to DBT

Mareah C. Steketee, Ph.D. and Charles Holton, LCSW

What is DBT?

DBT stands for Dialectical Behavioral Therapy. This type of cognitive-behavioral therapy was created by Marsha Linehan to help people learn how to respond effectively to highly stressful and difficult life circumstances without making choices that can cause more trouble in their lives. Having more healthy and informed choices is one of the main goals of DBT. This goal is reached by learning a set of skills that includes the practice of mindfulness and radical acceptance of those things we cannot change while working toward changing those things that we can make better in our lives. Among other skills, mindfulness helps us learn how to accept and tolerate life’s unavoidable distress.

How is it dialectical?

The word “dialectical” refers to the interplay of opposites in our lives. A central pair of apparently opposing values in DBT is acceptance and change. We need both acceptance and change in order to make the best choices and learn to live life as it is, not as we would like it to be. That is known as the dialectic of DBT.

How is acceptance used in DBT?

The idea that behaviors are an effort to reduce and avoid suffering is an important idea in DBT. With training in the four units of skills, including Core Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness, healthy behaviors that help manage difficult times can be learned and mastered. This practice of new skills requires a commitment to change on the part of a DBT skills group participant because it takes time and serious practice to make lasting changes in day-to-day quality of life.

“Non-judgmental” is one of the Core Mindfulness skills that is taught and practiced. This skill is intended to help reduce harmful criticism and the ability to work with reality as it is, without judgment, which is a change and a challenge for most people. Harsh judgments can lead to self-destructive behaviors in stressful situations and DBT skills can reduce harmful judgments. Practicing being ‘non-judgmental” helps reduce suffering while also encouraging you to stick to your values.

“Radical Acceptance” is a skill taught and practiced in the Distress Tolerance module. It consists of realizing the power of strong emotions associated with the frustration of wanting things to be different than they are. When successfully used, this skill allows people to be more effective at changing things than when they are emotionally stressed and not getting the outcome they want.

What are some DBT techniques that people can learn quickly?

The “Wise Mind Exercise” and “Judgmental Thoughts” are two techniques that are taught early in DBT skills training and are then practiced regularly. In addition, there are many practical skills that are taught over the course of six months to a year of weekly skills group that are easy to understand and work well with practice.

DBT Modules

DBT Skills Training is divided into four units or modules. They are Core Mindfulness Skills, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness. In our training, we start every eight-week module with four weeks of Core Mindfulness Skills. We repeat Core Mindfulness each unit because these specific skills are so important to the practice of DBT skills and even experienced group participants can use the review and further practice. It also means people can begin anywhere in the cycle, because they will always get exposure to Core Mindfulness Skills in the first weeks of the group. In the second part of each eight-week module, we focus on one of the remaining three modules. Each unit is described below:

• Core Mindfulness Skills is basically training your mind to be alert and focused. More advanced core mindfulness emphasizes attending to what is happening at the present time without strong intense emotional reactions or harsh judgments. Wise Mind Exercise is a powerful decision-making skill using reason, emotions, and body sensations. This skill involves asking practical problem solving questions to get answers that are real and make sense in the situation. There are six additional core mindfulness skills.
• Emotional Regulation teaches the biology of emotion and provides a set of skills to help people increase their resilience to stress and improve their mood by developing their mindfulness skills and using cognitive-behavioral techniques, especially those skills involving creating more positive experiences for themselves.
• Distress Tolerance skills are used in times of more severe crisis or when an event causing emotional distress can’t be controlled, changed, or improved. The goal of Distress Tolerance skills is to get through crises without making the situation worse.
• Interpersonal Effectiveness is defined as the complicated skill of managing three conflicting goals in our interactions with other people: 1) getting your needs met or saying “no”, 2) keeping the relationship with the other person or persons, and 3) sticking to your values.

More details about DBT Skills Group

Groups meet weekly for 1 hour, 45 minutes. We require that you practice homework outside of the group each week, which is explained in group each week. It is also necessary to be in individual therapy while in DBT skills group because all of DBT research tells us that people learn much faster when they have a DBT coach/therapist as well as attend skills group regularly. Group size varies from 8 to 12 with 2 to 4 new people in each module. Groups include women and men with usually more women than men. There are two group facilitators who attend each group with the exception of occasional absences. A notebook of handouts and work sheets is provided at the beginning of DBT skills training.

Many people find that completing two cycles of all four modules gives them a thorough grounding in the ideas and DBT skills to practice so that they can use the new skills more consistently, even in the most troubling situations. Completing one cycle of all the skills requires attendance in skills group for three modules, which takes six months. Some people prefer to take one module at a time and return for other modules after they have practiced on their own. However, we encourage group participants to commit to learning all the skills or completing all three modules before you practice more independently, but respect decisions about how to learn and practice the skills.

For more information and a required pre-group evaluation appointment, please call Colleen Mitchell at 929.1227 or leave a message with either Mareah Steketee at 442-1127 or Chuck Holton at 685-8499.