WHAT IS DBT TRAINING?

Dialectical Behavioral Therapy (DBT) was designed to help us regulate our emotions so that we can maintain our equilibrium.  We were “designed” to remain in a state of homeostasis. When something upsets this natural state the body compensates in some way, i.e. an infection causes a fever and overheating causes sweating.  

In much the same way, becoming very emotional drives us to compensate. Unfortunately, we often end up over-compensating. For example, we may overeat, restrict, binge and/or purge, over-drink, or shut down emotionally in order to avoid emotional pain. This doesn’t work and as a result, we end up suffering more than necessary and often creating new problems. 

DBT training was designed to enable us to reduce the level of arousal that we experience and therefore return us to homeostasis without the overcompensations that end up becoming the problem.  We accomplish this by learning how to lean into the feeling instead of trying to avoid it or numb ourselves to it.  

The term ‘dialectical’ is derived from classical philosophy. It refers to a form of argument in which an assertion is first made about a particular issue (the ‘thesis’), the opposing position is then formulated (the ‘antithesis’) and finally, a ‘synthesis’ is sought between the two extremes, embodying the valuable features of each position and resolving any contradictions between the two. 

“Truth” is seen as a pattern that develops over time in transactions between people, i.e. DBT is transactional in nature, or the result of human interactions. From this perspective, there can be no statement representing absolute truth, as patterns are always changing and new truths are always emerging.  In a disagreement, from a dialectical perspective, truth is viewed as the middle way between two opposing points of view. 

The dialectical approach to understanding and treating human problems is therefore non-dogmatic, i.e. it is not restricted to a particular theory of pathology such as psychodynamic, gestalt, or behavioral. Instead, the source of a problem, as well as its solution, is always open-ended and emerges over time as a result of a pattern, or patterns, of behavior. 

Another important assumption in systems theory is that problems are not necessarily linear in terms of what causes them. In other words, you may miss a lot if you believe that A causes B, i.e. molestation causes Anorexia.  Sometimes it is A plus B in the context of C&D that actually causes a problem, i.e. 

A. An unusually sensitive child; 

B. Overhears a negative comment about body fat; 

C. At a time when his/her body is changing because; 

D. She/He is going through puberty and reacts by restricting food which gets reinforced with weight loss and approval or concern from family and friends

In DBT Training there is always a balance between ‘acceptance’ on the one hand and ‘change’ on the other. DBT includes specific techniques of self-acceptance and self-validation that are designed to counteract the self-invalidation that many individuals with emotional problems experience. 

There are also problem-solving skills that act as a counterbalance to the acceptance skills. Finally, the therapy is mindful and behavioral in that, instead of regretting the past or dreading the future, it focuses is on the present moment. We cannot change the past and we do not control the future, only our reactions in the moment.

HOW IS DBT TRAINING DONE?

Skills training is usually carried out in a group context and is divided into four modules or four groups of skills:

1. Core Mindfulness Skills.

2. Interpersonal Effectiveness Skills.

3. Emotion Modulation Skills.

4. Distress Tolerance Skills.

1. The ‘core mindfulness skills‘ are derived from certain techniques of Buddhist meditation, although they are essentially psychological techniques and no religious allegiance is involved in their application. Mindfulness is the capacity to pay attention, non-judgmentally, to the present moment. Mindfulness is all about living in the moment, experiencing one’s emotions and senses fully, yet with perspective. It is the foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel during DBT training or when voluntarily exposing themselves to upsetting situations as a result of DBT training, that they would usually avoid.

2. The ‘interpersonal effectiveness skills‘ which are taught, focus on effective ways of achieving one’s objectives with other people: to ask for what one wants effectively, to say no and have it taken seriously, to maintain relationships and to maintain self-esteem in interactions with other people. They are very similar to those taught in many assertiveness and interpersonal problem-solving courses.

   Many of us possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. The interpersonal effectiveness module is intended to maximize the chances that your goals in a specific situation are met, without damaging the relationship or either person’s self-respect

3. ‘Emotion modulation skills‘ are ways of changing distressing emotional states. Individuals suffering from eating disorders, drug and alcohol abuse, PTSD, and anxiety disorders frequently experience intense emotions. Because you can be angry, intensely frustrated, depressed, or anxious the assumption is that you will benefit from help in learning to regulate your emotions.

   Dialectical behavior therapy skills for emotion regulation include:

   • Identifying and labeling emotions

   • Identifying obstacles to changing emotions

   • Reducing vulnerability to emotional mind

   • Increasing positive emotional events

   • Increasing mindfulness to current emotions

   • Taking opposite action

   • Applying distress tolerance techniques

4. ‘Distress tolerance skills’ include techniques for dealing with these emotional states if they cannot be changed for the time being. Many treatment approaches focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. Dialectical behavior therapy emphasizes learning to bear pain skillfully.

   Distress tolerance skills have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although this is a nonjudgmental stance, it is not one of approval or resignation.

   The goal is to calmly recognize negative situations and their impact, rather than becoming overwhelmed by them or trying to avoid them with numbing techniques such as overeating, overspending, excessive drinking, obsessive cleaning, abusing drugs, etc. This will allow you to make wise decisions about whether and how to take action, rather than falling into the intense, desperate, and often destructive behaviors you may be using currently in response to emotional distress.

   You will learn three skills for acceptance which include:

   • Radical acceptance

   • Turning the mind toward acceptance

   • Distinguishing between “willingness” (acting skillfully, from a realistic understanding of the present situation) and “willfulness” (trying to impose one’s will regardless of reality).

   You will also learn four crisis survival skills, to help deal with immediate emotional responses that may seem overwhelming:

   • Distracting oneself

   • Self-soothing

   • Improving the moment

   • Thinking of pros and cons