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Introduction to DBT

What is DBT?

DBT stands for Dialectical Behavioral Therapy.  This approach combines the discipline of radical acceptance through mindfulness (its creator, Marsha Linehan, studied with Zen master and Benedictine monk, Willigis Jager) with the technologies for change developed in cognitive-behavioral therapy.  Cognitive-behavioral therapy challenges dysfunctional beliefs and self-destructive behavior patterns that worsen our suffering.  Mindfulness trains us to accept and tolerate unavoidable distress.

How is it dialectical?

Dialectical refers to the dynamic interplay of opposites.  A central pair of apparently opposing values in DBT is acceptance and change.   Only using invitations to change results in people feeling pressured, misunderstood, defensive and resistant to help.  Only using acceptance leads to a short-term warm feeling, but no relief from dysfunctional patterns in the long run.  Using the dynamic between the two, accepting the client exactly as he or she is, and simultaneously offering skills that can reduce suffering, is the dialectic of DBT.

How is acceptance used in DBT?

Perjorative descriptors of dysfunctional behaviors, including suicidal and para-suicidal behaviors (for example, “manipulative”) are discarded in favor of the idea that behaviors are all intended to reduce and avoid suffering, and that with training in emotion regulation, distress tolerance and interpersonal effectiveness, distress-reducing behaviors that are healthy can be learned and mastered, and will be preferred.

“Non-judgmental” is one of the core mindfulness skills taught and practiced.  This is training in attending to reality as it is, without the filter of intense emotion clouding judgment, verifying dysfunctional beliefs, and leading to self-destructive behaviors.

“Radical Acceptance” is one of the skills taught and practiced in the distress tolerance module.  It consists of releasing intense emotions associated with the frustration of wanting things to be different than they are.  When successfully used, it allows people to be paradoxically more effective at changing things than when they are emotionally reactive to not having the outcome they want.

What are some DBT techniques that people can use quickly?

The “Wise Mind Exercise” and “Judgmental Thoughts” are two techniques that can be taught quickly, in a single session.  Use the handouts provided.

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

13 April 2005