DBT: The Skills

This post is written in conjunction with DBT: Dialectical Behavioral Therapy.

There are four sets of behavioral skills taught in DBT; Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Acceptance is emphasized through mindfulness and distress tolerance, while change is emphasized through interpersonal effectiveness and emotion regulation.

Mindfulness is one of the primary coping skills that is taught in my outpatient program. According to DBT, there are 3 primary ways to refer to our states of mind; emotion, reasonable, and wise mind. Emotion mind is when our thoughts are being controlled only by our emotions and therefore our reasoning and thought-process can appear illogical. Emotion minded people are also known for being ‘hot’. Reasonable mind is when our thoughts are logical and rational. In reasonable mind, our thoughts are fact based with no emotion involved and these people can be known for being ‘cold’. Wise mind is the combination of emotion and reasonable mind. Wise mind is part emotion, part reason and is often considered a sense of intuition.

The three ways to achieve wise mind are to observe ourselves, our environment and our situations, describe the things we observe and participate in the moment, in a way that makes us forget about everything else. We should also consider a non-judgemental stance not only towards others, but also towards ourselves because it can affect the way we view ourselves, our environments, our situations and other people.

Interpersonal effectiveness is the ability to increase the changes that you will reach the outcome you are looking for in a specific situation, while not hurting the relationship you have with others or losing self-respect. This includes using objectiveness, self-respect and relationship effectiveness. Objectiveness effectiveness in known as DEAR MAN, and will be covered more in depth in another post. Relationship effectiveness is known as GIVE. Give stands for be Gentle, act Interested, Validate and have an Easy manner. Self-respect effectiveness is known as FAST. Fast stands for be Fair, no Apologies, Stick to your values and be Truthful. The point of interpersonal effectiveness is to be able to effectively communicate your needs in a healthy manner.

Emotion Regulation is being able to identify what you are feeling in the current moment. It is also being able to recognize when you because angry, frustrated, depressed, distressed or anxious and focuses on the tools that can be used to deal with these intense emotions. Emotions come from our reactions to things and people in our environment and our reactions to the things going on inside ourselves. There are also primary and secondary emotions and while neither of these types of emotions are good or bad, to get to the original problem and work on solving it, it is necessary to deal with the primary emotions. To deal with emotions, we also need to reduce vulnerability, using PLEASE. Please stands for treating PhysicaL illness, balancing Eating, avoiding mood-Altering drugs, balancing Sleep, and getting Exercise. It is also necessary to build positive experiences, be mindful of current emotions, letting go of painful emotions, and practicing opposite to emotion.

The final behavioral skill is distress tolerance. This can also be known as Crisis Survival Strategies. There are 4 sets of skills for dealing with the distressing activities and events in our lives. These 4 skills are distracting, self-soothing, improving the moment and thinking of pros and cons. Distract uses the acronym ACCEPT to find different things to engage your mind and move on from the issue. These are distract by Activities, Contributing, Comparisons, Emotions (opposite to emotion), Pushing away, Thoughts and Sensations. By Improving the moment, you can use Imagery, Meaning, Prayer, Relaxation, One thing at a time, Vacation, and Encouragement (IMPROVE). Other distress tolerance coping skills include using pros & cons, accepting reality and radical acceptance.

Many of these coping skills will be discussed more in depth in a future post.

DBT Selp Help -A website written by people who have been treated with DBT

National Alliance on Mental Health – Fact Sheet

Mayo Clinic– Facts

The Linehan Institute: Behavioral Tech – DBT Overview

National Institute for Mental Health

Dialectical Behavioral Therapy Skills Handbook

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