What is Dialectical Behavior Therapy (DBT)?

At Discovery Ranch for girls, we use dialectical behavior therapy (DBT), which treats a wide variety of disorders, including substance dependence, depression, PTSD, borderline personality disorder, and eating disorders. The goal of DBT is to help patients build a life that they feel is worth living. In DBT, patients receive help through individual therapy, a therapist consultation team, and group therapy.

Individual Therapy

The first key component of DBT is individual therapy. Therapists will often have their patients use diary cards, which are specially-formatted cards used to track when their target symptoms occurred and the skill they used to cope with it. During individual therapy, the therapist and patient discuss the problems that came up.

When discussing the patient’s issues, the therapists will follow a treatment target hierarchy. Life-threatening behaviors take first priority. Behaviors which, while not directly harmful to self or others, interfere with the course of treatment, take second priority. Quality of life issues takes third priority. As the patient and therapist discuss these problems, the therapist teaches the patient problem-solving behaviors to help them deal with these problems in the future.

Therapist Consultation Team

The DBT consultation team includes the individual therapists, group therapy leaders, case managers, and others who help with the patient. The purpose of the consultation team is to help therapists stay motivated and competent so they can provide the best treatment possible.

Group Therapy

In a group setting, patients learn about behavioral skills. These skills are broken down into four skill modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness–they are foundational to DBT.

What are some DBT Skills?

Discovery Ranch for Girls teaches some of the foundational skills of DBT to help build mindfulness, emotional regulation, and distress tolerance.

DBT Skill #1: Mindfulness

The first foundational skill taught in DBT is mindfulness. Mindfulness is the process of bringing one’s attention to the current moment. It is about paying attention to what is happening in the moment without judgment, overthinking, or invalidating the experience. Mindfulness is a major tool in DBT because it helps people accept and cope with the powerful emotions felt when challenging their habits or exposing themselves to upsetting situations.

Mindfulness and the meditative exercises used to teach it came from traditional Buddhist practice, though the version taught in DBT does not involve any religious or metaphysical concepts. DBT is about living in the moment and experiencing one’s emotions and senses fully, and with perspective. Mindfulness makes people more aware of their environments through their five senses of touch, smell, sight, taste, and sound.

To understand mindfulness, it is important to understand “What” and “How” skills.

“What” Skills

“What” skills of DBT are what you do to be mindful. The main “What” skills are: observe, describe, and participate. People nonjudgmentally observe their environment within or outside themselves. They then describe, without judgmental statements, to express what they have observed. The third “What” skill is: participate, which people use to become fully focused and involved in the activity that they are doing.

“How” Skills

“How” skills are how you do the “What” skills. These skills are done nonjudgmentally, one-mindfully, and effectively. To be nonjudgmental, you describe the facts without considering the facts in terms of good, bad, fair, or unfair, because these terms are judgments and not factual descriptions. Being nonjudgmental helps you get your point across. You are mindful by focusing on one thing. This helps you appreciate the moment. You are then effective by doing simply what works. It is a very broad-ranged skill and can be applied to any other skill.

DBT Skill #2: Emotional Regulation

The second foundational skill taught in Dialectical Behavior Therapy (DBT) is emotion regulation. Emotion regulation helps patients manage negative and overwhelming emotions while increasing their positive experiences. Patients learn that negative emotions are not bad and do not need to be avoided. Instead, they learn that negative emotions are a normal part of life. Patients learn to acknowledge and then let go of negative emotion so that their feelings do not control their behaviors. 

PLEASE

“PLEASE” is an acronym that sets guidelines on how patients should take care of their physical health since our physical health is closely tied to our mental health. When we are sick, exhausted, or otherwise unhealthy, we are more likely to experience negative emotions. When we take care of our bodies, we are more likely to have positive emotions.

• PhysicaL illness: If you are sick or injured, get proper treatment.
• Eating: Eat a healthy, balanced diet.
• Avoid mood-altering drugs: Do not take non-prescribed medication or drugs. They can be harmful to your body and can make your mood unpredictable.
• Sleep: Do not sleep too much or too little. Teenagers should get 8-10 hours of sleep each night.
• Exercise: Regular exercise will make you healthier and happier. Exercise will improve your body image, release endorphins, and help you be more active overall.

Building Mastery

Patients build mastery. This means that patients engage in activities that make them feel competent and effective so that they don’t feed into feelings of helplessness and hopelessness. Building mastery is about committing to something and seeing it through. Building mastery often means returning to a hobby or interest that they previously abandoned.

Opposite Action and Problem Solving

Opposite action is used when patients have an unjustified emotion, which is an emotion that doesn’t belong in the current situation. Patients use opposite action by doing the opposite of what their urges tell them to do at the moment. It is a tool that brings them out of an unwanted or unjustified emotion by replacing it with the emotion that is opposite and justified. When their negative emotion is justified, patients learn to use problem-solving.

DBT Skill #3: Distress Tolerance

The third foundational skill taught in Dialectical Behavior Therapy (DBT) is distress tolerance. Distress tolerance increases a patient’s tolerance of negative emotions. The goal is to be able to calmly recognize negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows patients to make wise decisions about how to take action, rather than falling into intense and often destructive emotional reactions. There are two acronyms used to help patients use distress tolerance:

Distract with ACCEPTS

Patients use the acronym “ACCEPTS” to distract themselves temporarily from unpleasant emotions.

• Activities: Do an activity or hobby that you enjoy.
• Contribute: Serve the people around you or contribute to service in your community.
• Comparisons: Compare yourself either to people that are less fortunate or to how you used to be when you were in a worse state.
• Emotions: Cause yourself to feel something different by provoking your sense of humor or happiness with corresponding activities.
• Push away: Put your situation on the back-burner for a while. Put something else temporarily first in your mind.
• Thoughts: Force your mind to think about something else.
• Sensations: Do something that has an intense feeling other than what you are feeling, like taking a cold shower or eating spicy food.

IMPROVE the Moment

Patients use the acronym “IMPROVE” to help them relax in stressful situations.

• Imagery: Imagine relaxing scenes, things going well, or other things that please you.
• Meaning: Find some purpose or meaning in what you are feeling.
• Prayer: Either pray to whomever you worship or, if not religious, chant a personal mantra.
• Relaxation: Relax your muscles and breathe deeply.
• One thing in the moment: Focus your entire attention on what you are doing right now. Keep yourself in the present.
• Vacation: Take a break from it all for a short period of time.
• Encouragement: Cheer yourself on. Tell yourself that you can make it through this.

DBT Skill #4: Interpersonal Effectiveness

The fourth foundational skill taught in Dialectical Behavior Therapy (DBT) is interpersonal effectiveness. Interpersonal effectiveness teaches patients how to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships. There are three acronyms that patients use to understand and apply interpersonal effectiveness:

DEAR MAN

Patients use the acronym “DEAR MAN” to convey their needs to another person.

• Describe your situation using specific factual statements.
• Express your emotions experienced when the situation occurred, why this is an issue, and how you feel about it.
• Assert yourself by asking clearly and specifically what you want.
• Reinforce your position by offering a positive consequence if you were to get what you want.
• Mindful of the situation by keeping your focus on your objective, maintaining your position, and not getting distracted.
• Appear confident and assertive, even if you don’t feel confident.
• Negotiate and come to a comfortable compromise.

GIVE

The acronym “GIVE” helps patients maintain relationships in conversations, whether they are with friends, coworkers, family, romantic partners, etc. 

• Gentle: Use appropriate language, no verbal or physical attacks, no put-downs, avoid sarcasm unless you are sure the person is alright with it, and be courteous and non-judgmental.
• Interested: When the person you are speaking with is talking about something, act interested in what they are saying. Maintain eye contact, ask questions, etc. Avoid using your cell phone during an in-person conversation.
• Validate: Show understanding and sympathy of a person’s situation. Validation can be shown through words, body language, and facial expressions.
• Easy Manner: Be calm and comfortable during the conversation. Use humor and smile.

FAST

The acronym “FAST” helps patients maintain self-respect.

Fair: Be fair to both yourself and the other person.

Apologies (few): Don’t apologize more than once for what you have done ineffectively.

Stick to Your Values: Stay true to what you believe in and stand by it. Don’t allow others to encourage you to act against your own values.

Truthful: Don’t lie. Lying can only pile up and damage relationships and your self-respect

Discovery Ranch for Girls is an excellent program to help your child find the help she needs and grow into someone with strong emotional skills. Contact us today!