Dialectical Behavior Therapy (DBT) Techniques & Examples

DBT is fundamentally concerned with balancing two seemingly conflicting concepts: acceptance and transformations. Dialectical foundation means we can accept the Status quo while at the same time trying to make things get better. Think of it like standing in a doorway: We get to look at things from where we’re at and enjoy what we have while waiting for what we want.

Tools and Techniques in DBT

1. The DBT House

The DBT house serves as a visual representation of emotional stability. Following are the components of a DBT House.

• Foundation: Core values and beliefs
• Walls: Support systems
• Roof: Protection strategies
• Door: Private aspects
• Chimney: Ways to release stress
• Billboard: Achievements and proud moments

2. Chain Analysis

Chain analysis helps understand the sequence of events leading to problematic behaviors.It helps individuals become aware of and understand why certain events occur. It examines.

• Triggering events
• Thoughts and feelings
• Actions and reactions
• Consequences
• Alternative responses

Four Key Modules of DBT

1. Mindfulness Skills

Mindfulness is the core of all DBT skills. It is a process of ‘active, open, non-judgmental paying attention’. Let's take the case of Aisha, a university student with a diagnosed anxiety disorder. By practicing DBT mindfulness she was able to grasp the concept of watching her anxiety arise without having to become involved in it. When feeling overwhelmed before exams, she would practice the "WHAT" skills:

• Watch and observe her thoughts without engaging with them
• Halt automatic reactions
• Act mindfully in the moment
• Take time to observe

2. Distress Tolerance

Distress tolerance skills are skills that enable people to handle crisis situations in such a way that they do not aggravate. These skills are like emotional first aid, applying naphtha on a sore area. For example, Raj, dealing with intense work pressure, learned to use the ACCEPTS strategy:

• Activities (taking a brief walk)
• Contributing (helping a colleague)
• Comparisons (remembering past successes)
• Emotions (generating different emotions through music)
• Pushing away (briefly setting aside the stress)
• Thoughts (engaging in mental puzzles)
• Sensations (holding an ice cube)

3. Emotion Regulation

Emotion regulation helps people become aware of, recognize, and manage their emotions effectively. This module teaches that all emotions serve a purpose and provides tools to manage them. The idea is not to label emotions as healthy and unhealthy but learning to channelise emotions and to have the ability to come back to the state of homeostasis when faced with overwhelming emotions. A practical example is the PLEASE skills:

• Treat Physical illness
• Balanced Eating
• Avoid mood-altering substances
• Balanced Sleep
• Exercise

4. Interpersonal Effectiveness

This component of DBT focuses on maintaining relationships while maintaining self-respect. The DEAR MAN technique helps in making requests or saying no:

• Describe the situation
• Express feelings
• Assert wishes
• Reinforce positive outcomes
• Stay Mindful
• Appear confident
• Negotiate

DBT in Practice: A Transformative Journey

Let's look at Maya, a 28-year-old graphic designer who experienced chronic low self-esteem, emotional dysregulation, and trouble sustaining healthy relationships, to see how DBT works. Her experience with DBT demonstrates how these therapy approaches function in real life.

The Beginning of Change

When Maya first went to therapy, she characterized herself as "a chronic people-pleaser with no sense of self." She was continually looking for validation from people, taking on too many professional initiatives, and struggling to say no. This resulted in regular emotional overwhelm, followed by times of utter shutdown. Her relationships failed as she alternated between too accommodating and absolutely withdrawing.

Early DBT Sessions: Building Awareness

Maya’s first year in DBT was on the practice of mindfulness and understanding of feelings. She learned the signs of her emotional reactions, which were criticisms at the workplace and relational conflict. Through mindfulness exercises, she began noticing how her body responded to stress: tension in her shoulders are tense, breathing is quick, and chest is constricted. These physical signals became her initial signal of action.

Basic forms of ‘mindfulness’ were incorporated into it. For one minute in the morning, she would turn her attention to her breath while for the rest of morning she would focus on describing the objects in the environment without having negative thoughts about them. These basic exercises set the stage for the bigger exercises of change.

Learning Distress Tolerance

Maya's turning point in therapy came with the learning of the distress tolerance skills. Earlier, when there was too much pressure from work, or in case of a clash in relationships, she would either say yes to everything or withdraw completely. By learning TIPP skills in DBT, she found better ways of coping:

• Holding an ice cube (temperature - will cool her down)
• Taking a walk around her office building (movement helps in grounding)
• Practising 4-4-4 square breathing (mindful breathing can help regulate her emotions)
• Doing progressive muscle relaxation during her break time

The Role of Validation in Healing

Embracing self-validation turned out to be an integral part of Maya’s therapy sessions. In her sessions, Maya uncovered that dismissing her own feelings could have come from an upbringing in which her own feelings did not really count because of her parents. Dialectical behaviour therapy taught her that there was a reason why her feelings were relevant in light of her upbringing. This comprehension did not imply that she was to react to every single feeling, but it did mean that she could acknowledge those feelings without feeling any sense of shame.

Crisis Management and Growth

As Maya progressed in therapy, she developed a crisis plan for managing overwhelming emotions. When she would have project deadlines or relationship conflicts, instead of falling into old unhealthy patterns, she could possible make use of these techniques:

1. Making use of grounding techniques (feeling her feet on the floor, naming five objects she could see, folding an ice cube)

2. Checking for the facts of a situation to cross check the validity of her thoughts and emotions (Maya’s thoughts versus facts)

3. Maya can use self soothing techniques for grounding herself (hugging a pillow)

4. Having a social support system that she can reach out to in times of need (friends, family - making a list of the same)

Building Relationships and Self-Worth

The skills of DBT, in particular interpersonal effectiveness skills, played a significant role in facilitating Maya’s transformation when it came to relationships with other individuals. She learned to communicate her needs in an effective way, which is assertiveness, without undermining values of self and others. In professional settings, she began employing the DEAR MAN technique with respect to the colleagues and clients in order to stop them from overstepping her boundaries. Such relationships became more balanced as she mastered these skills over time.

A Life Worth Living

In accordance with the principles of DBT, a life that is worth living refers to the ability to shape a life you do not have to run away from. It is a life where both happiness and sadness can be felt without any of these emotions being stifled, where relationships are nurtured and goals, which belong to one’s value system, are pursued. Instead of trying to achieve an unreasonable ideal, it is finding a midpoint between ‘I am okay the way I am’ and ‘I must change myself and my life in a better way’.

This strategy has the stipulation that there will be hardships as well as emotional discomforts, but strives to assist in the acquisition of methods that will address these concerns without engaging in self-destructive practices. The essence is the ability to go about one’s day, to develop and sustain healthy bonds, and to accept most of the experiences in one’s life, even in hardship. It is the ability to determine that there is a sense of higher value in one’s life, a purpose worth all the hardships, however many there may be within that lifetime.

After consistent DBT sessions, Maya could become aware of her self esteem being dependent on others’. She learnt to not derive her worth from others' approval. She could recognize and name her emotions without becoming emotionally dysregulated. Most importantly, she developed what she called her "emotional toolkit" – which consisted of practical skills for managing life's challenges. Of course, Maya’s progress was not linear. There were setbacks and difficult days, but she now had the skills to handle them.

The Ongoing Journey of Maya’s Healing

The case of Maya is an excellent example of how comprehensive DBT is because it covers both short-term coping skills and more long term patterns. By constant practice Maya was able to build a healthy coping mechanisms and practices. DBT offers a path toward better understanding ourselves and building lives worth living.

Conclusion

DBT provides a holistic approach to mental health therapy, which involves cognitive-behavioural approaches and mindfulness practices. Its emphasis on acceptance and transformation, which then creates a healthy foundation for emotional regulation. Individuals can improve their ability to manage emotions, establish relationships, and live meaningful lives by consistently practising and applying DBT concepts.

Understanding and following DBT concepts can result in equipping oneself with emotional regulation skills, healthy interpersonal connections, and overall well-being. Whether struggling with specific mental health disorders or looking for healthier methods to manage life's obstacles, DBT provides significant skills and techniques for achieving good change while also accepting oneself the way they are.