What is DBT?
DBT is used to treat people with severe or chronic mental health issues, including self-harm, eating and food issues, addiction, PTSD, and borderline personality disorder. It was originally designed to treat people who had chronic suicidal thoughts as a symptom of borderline personality disorder.
DBT has four main modules: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. The first two have their own guides, returning to this site soon; the other two are below.
Interpersonal effectiveness
Validation
Validation communicates to another person that their feelings, thoughts, or actions make sense, are understandable, and are okay to feel. Validation is not agreement.
Why validation matters
- It helps improve relationships
- It can de-escalate a situation or disagreement
- It shows we are listening, trying to understand, and staying nonjudgmental
- It shows we can disagree without a serious, angry argument
What to validate
- Feelings, thoughts, and behaviors — in others and in yourself
- Validate the valid, not the invalid: you can validate a feeling without validating the action it led to
How to validate
- Listen mindfully: with empathy, distractions down, focus on the other person
- Reflect back what they're feeling, and check that you're getting it right
- Ask questions about what they are feeling, thinking, and wanting
- Validate the causes of a behavior — the context and conditions behind it
- When their reaction is reasonable, say so: “this makes sense to me considering…”
- Be radically genuine: express equality and respect, and don't treat the person as fragile or incapable
Dialectical thinking (the middle path)
Dialectics teach that there is more than one way to view a situation and more than one way to solve a problem — and that the only constant is change.
- Move from “either–or” thinking to “both–and” thinking; avoid “always” and “never”
- Look at other perspectives; find the kernel of truth in each
- Remember that no one has the absolute truth
- Use “I feel…” statements
- Accept that opinions other than yours can be legitimate without agreeing
- Don't assume you know what another person is thinking, and don't expect mind-reading of you
Behaviorism
- Positive reinforcement — increasing a behavior by providing a rewarding consequence
- Negative reinforcement — increasing a behavior by removing a consequence
- Extinction — a behavior reduces because its reinforcement is removed
Effectiveness skills
DEARMAN — reaching your objective
- Describe the situation
- Express your feelings about the situation
- Assert yourself by asking for what you want
- Reward the person ahead of time by describing the positive effects of getting what you want
- Mindful — keep the focus on what you want
- Appear confident — use a confident tone of voice
- Negotiate — be willing to give to get
GIVE — keeping a good relationship
- Gentle — be courteous and respectful
- Interested — act interested; listen to the other person
- Validate — show you understand the other person's feelings about the situation
- Easy manner — ease the person along
FAST — keeping your self-respect
- Fair — to yourself and to the other person
- Apologies — no overly apologetic behavior
- Stick to your own wise-mind values
- Truthful — don't lie
SCREW — your choices in any problem situation
- Save it, and use your interpersonal skills to solve the problem
- Change it — change your reaction, challenge your interpretation
- Radically accept it — cope with your reaction using distress tolerance skills
- Entertain misery — keep complaining, stay dissatisfied
- Worsen the problem — act unskillfully, engage in ineffective behaviors
Distress tolerance
Coping with urges and feelings
Pain is part of life and cannot be avoided. If you can't deal with your pain and act impulsively, you may end up hurting yourself or others, or not getting what you want.
When to use crisis survival skills
A crisis is highly stressful, short-term, and creates intense pressure to resolve it. Use crisis survival skills when:
- You have intense pain that cannot be helped quickly
- You want to act on your emotions, but it will only make things worse
- Emotion mind threatens to overwhelm you and you need to stay skillful
- You are overwhelmed, but demands still need to be met
- You are very emotional, but the problem can't be solved right now
ACCEPTS — distracting through a crisis
- Activities — do something
- Contributing — do something nice for someone else
- Comparisons — compare yourself to when you were less effective
- Emotions — create different emotions
- Pushing away — push painful situations out of your mind temporarily
- Thoughts — replace your thoughts
- Sensations — intensify other sensations
Accumulating positive emotions, step by step
- Avoid avoiding — start now to build the life you want
- Identify the wise-mind values that matter to you right now
- Pick one value to work on now
- Identify a few goals that would make that value part of your life
- Choose one goal to work on now
- Identify small action steps toward the goal
- Take one action step now
Checking the facts
- What is the emotion I want to change, and what event prompted it? Describe the facts mindfully.
- What are my interpretations, thoughts, and assumptions about the event? Test whether they fit the facts.
- Am I assuming a threat? Label it, and assess how probable it really is.
- What's the catastrophe? Imagine it occurring — and imagine coping effectively with it.
- Does my emotion, and its intensity, fit the actual facts? Use your wise mind.
Problem-solving with opposite action
- Get yourself into wise mind
- Ask: can the problem be solved?
- Observe and describe the problem
- Brainstorm lots of solutions
- Choose the solutions you think will work
- Put a solution into action — try it
- It worked? Give yourself a reward.
- It didn't? Give yourself a reward for trying.
Opposite action, emotion by emotion
- Anxiety and fear — the urge is to avoid; the opposite action is to approach
- Sadness — the urge is to withdraw; the opposite action is to get active
- Anger — the urge is to attack; the opposite action is to gently avoid, and be decent
- Love that isn't justified — the urge is to be close; the opposite action is to avoid the person, distract yourself from thoughts of them, and remind yourself why the love is not justified
- Envy — the urge is sabotaging and criticizing; the opposite action is to count your blessings
- Jealousy — the urge is accusing and spying; the opposite action is to let go of controlling others, and share
- Shame — the urge is to hide; the opposite action is to be open
- Guilt — the urge is to hide; the opposite action is to be open, and approach
Sources
- McLean 3East Outpatient DBT Manual (print; credited by the original page)
- GoodTherapy — Borderline personality issues overview (linked from the original page's introduction)