April 8, 2020

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Amber Petrozziello

Everything You Want To Know About Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy is a behavioral-based talk therapy that focuses on finding balance and getting unstuck from extremes. The D in DBT stands for Dialectics, which means synthesizing or integrating opposite ideals, thoughts, or behaviors. The goal of DBT is finding the truth in opposing forces to cultivate balance and acceptance about the world around us. Cultivating balance and acceptance decreases suffering and increases acceptance for ourselves and others.

Dialectical Behavior Therapy (DBT) is focused on not only creating a life worth living, but also a life worth loving.

What is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy is a behavioral-based talk therapy that focuses on finding balance and getting unstuck from extremes. The D in DBT stands for Dialectics, which means synthesizing or integrating opposite ideals, thoughts, or behaviors.

The goal of DBT is finding the truth in opposing forces to cultivate balance and acceptance about the world around us. Cultivating balance and acceptance decreases suffering and increases acceptance for ourselves and others.

Dialectical Behavior Therapy helps us learn to accept thoughts and feelings without judgment, while letting go of fixating on our past and future so that we can be more present-focused. Focusing on the present gives us better control and regulation of our emotions, which results in better balance and improved relationships.

Marsha Linehan created DBT to provide an effective and empirically based treatment to treat clients who did not respond to other forms of therapy. DBT has been shown to be successful with a wide range of conditions, including borderline personality disorder, anxiety, bulimia, PTSD, substance abuse, bipolar disorder, and other personality disorders and eating disorders.

What is Wise Mind?

To understand DBT, we can’t leave out the 3 states of mind. There are 3 states of mind (according to DBT): Reasonable Mind, Emotional Mind, and Wise Mind.

Reasonable mind is our rational and intellectual mind; the mind that focuses on facts and logic for problem-solving. Reasonable mind is beneficial in many ways. We wouldn’t have structures or the ability to solve complex problems without reasonable mind; however, when we only focus on thinking in reasonable mind, we ignore the importance of our values and emotions.

Emotional mind is the opposite of reasonable mind. In this mind, you are fueled only by your emotions, discounting logic and reason. Without emotional mind, we would be unable to understand our emotions and how they influence our behaviors/thoughts. We would also be unable to feel positive emotions such as happiness or love. On the other hand, when we only focus on emotional mind, we ignore facts and logic; which affects our ability to make effective and adaptive decisions.

Wise Mind is the combination of both these minds, in which both emotion and reason have equal importance. When tapping into wise mind, we are able to make decisions that are based on reason AND take into account our values. Wise Mind also allows us to experience emotions (even strong ones) as they come and go.

The Four Modules of DBT

DBT has four main modules of skills: Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. Let’s discuss each skill:

Mindfulness – Learning to be present-focused and nonjudgmental of ourselves and others.

Mindfulness includes skills such as learning the what and how of mindfulness, mindfulness of current emotions and thoughts, and building loving kindness towards yourself and others.

Some ways to practice mindfulness in our everyday lives are mindfully walking (walking while observing your surroundings and being present in the moment) or mindfully doing a task (one-mindfulness – not multitasking and simply doing one task at one time).

Distress Tolerance – Learning how to tolerate stress and negative emotions when they arise so that they do not become paralyzing

Distress Tolerance (DT) skills help us put space between the event/emotion and ourselves so that we have time to decompress and come back to the situation in wise mind, not emotion mind.

One such skill is STOP (Stop, Take a step back, Observe, and Proceed Mindfully).

STOP tells us to freeze before we react.

Then, we want to physically or mentally take a step back from the situation or emotion.

Next, we want to observe what is going on inside and outside of us. Observing helps us tap into wise mind.

Then, we want to use that information to Proceed Mindfully. In this step, we ask ourselves “How do we want this situation to ideally be resolved?” or “What would be effective in this moment?”

Emotional Regulation – Learning how to better understand and handle our emotions so that we have more control over our thoughts, feelings and behaviors.

Check the facts is an important emotional regulation skill which helps us see that our thoughts and feelings aren’t reality.

This skill helps to remind us to look at the facts of a situation and not our interpretations, which in turn helps us to change our emotional response to situations.

Interpersonal Effectiveness – Learning how to better navigate relationships.

Interpersonal effectiveness includes skills related to communication, building relationships, setting boundaries, better advocating for our own needs and wants, and ending toxic relationships.

Interpersonal effectiveness skills include GIVE and FAST. GIVE reminds us to validate and be respectful of others when we communicate and interact, while FAST reminds us to validate and show self-respect for ourselves without white lies or manipulation.  

How is DBT different from CBT?

We often receive this inquiry in our practice. While Dialectical Behavior Therapy and Cognitive Behavioral Therapy (CBT) both focus on behaviors and they are both empirically supported therapies, they are also quite different.

CBT focuses on restructuring thoughts in order to change self-destructive behaviors. CBT is based in the belief that our thoughts and behaviors influence our feelings. Cognitive Behavioral Therapy relies on cognitive capabilities, logic and reason, to direct responses and change emotions.

In contrast, Dialectical Behavior Therapy is more about finding balance through navigating dialectics,  getting unstuck from extremes, and validating our emotions while also addressing behaviors and changing them.

DBT programs usually last 2-3 years with both individual and group sessions, whereas CBT has a session cap.

What you can expect from Individual DBT.

Individual DBT sessions occur a minimum of 1x weekly; however it can be more if we need more assistance and support.

Some DBT programs mandate both group and individual therapy, some don’t -  it depends! Make sure you research what will be most effective for you financially and commitment-wise.

DBT therapists will be collaborative, challenging, and validating. If you enjoy a more direct and present therapist who is not afraid to gently challenge you while remaining aware of and validating your concerns, distress, and experience, then DBT might be right for you!

You will be assigned homework to complete during your time away from session. Homework takes the form of an assignment or task you will work with your therapist to practice during the week. Individual sessions are generally more structured – both starting and ending with a mindfulness activity.  You and your therapist will work towards SMART goals which will be decided collaboratively.

We want to set you up for success, not failure. Small steps lead to big steps, which lead to leaps!

What you can expect from DBT Group

DBT Group is purely skills based, meaning that we focus on learning and improving new skills each week during group.

Group sessions allow us to gain knowledge, experience peer support and practice, and figure out ways to implement skills in your daily life. Combined with individual therapy, groups allow you to process more in-depth reactions to the skills and your emotions, as well as focus on other important events.

Group is also structured. Sessions begin an ends with mindfulness. Then we check in, speak about the skill from previous group and how it was practiced during the week via the homework, and then we learn a new skill!

DBT is a diverse and flexible therapy

DBT is applicable to many issues, concerns and distress we experience in life. We all navigate dialectical dilemmas more often than we think and find ourselves in places where we are stuck or are having difficulty gaining perspective. DBT gives us concrete, measurable, and validating skills and knowledge to conquer our barriers and cope more effectively in life.

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About the author

Amber Petrozziello is a Mental Health Counselor holding a Limited Permit in New York City. She graduated from Teachers College, Columbia University in 2019 and is passionate about assisting her clients with empowering themselves through self-awareness and skills. Amber utilizes Dialectical Behavior Therapy with an integration of Psychodynamic Therapy for a range of concerns such as life transitions, stress, anxiety, depression, relationship distress and self-esteem.

She works at Empower Your Mind Therapy; which was founded by Alyssa Mairanz. EYMT focuses on assisting client’s with gaining skills for the present, while building self-awareness of the past to decrease unwanted behaviors and better regulate emotions. The practice focuses on individual, couple and group work. Empower Your Mind Therapy also utilizes DBT skills group to provide clients with additional support and psychoeducation.

Amber is also the Social Media, Marketing and Community Outreach Coordinator for EYMT and works on the practice’s ad campaigns, social media, and blog posts.

Sign up for EYMT’s newsletter and receive news, as well as tips and tricks every week on how to regularly practice DBT in your everyday life – plus, you get a free e-book that focuses on how positive affirmations can change your life!

Amber is a proud member of the My Wellbeing therapist network and happy to connect with clients who feel her or her colleagues’ style would be a good fit for their journey to empowerment.

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