DBT Skills Part 1: Introduction and Mindfulness
Dialectical Behavior Therapy (DBT) is a powerful system with an amazing set of skills that can help you create and live the life you want. These next few pages will describe these skills, but frist let me give you a bit of history and introduction to what DBT is, though before I jump head first into the skills.
DBT was developed by a psychologist at the University of Washington, Marsha Linehan. Dr. Linehan worked with suicidal clients and clients diagnosed with something called "Borderline Personality Disorder." Her methods, which have been applied to many, many other situations since, aimed to reduce feeling overwhelmed, helpless, and in pain that many of clients experienced as precursors to feeling suicidal or self-harming. Additionally, she recently admitted that she herself had engaged in self-harming, experienced hospitalization and realized that the treatment available simply wasn't enough. Out of this realization, DBT was born.
I've engaged in training specifically for DBT, some from Dr. Linehan herself, over the course of many years, and during my clinical internship I also had the opportunity to use DBT in individual therapy, in leading skills training groups, and in homework/practice group sessions. From both my training and my experience working with people, I believe strongly that these sets of skills are useful not just for people experiencing suicidal or self-harming behaviors, but for people dealing with depression, anxiety, "the blues," or a multitude of other situations. I've used them myself as well - they are well-grounded in both research and experience and work well and when you get down to it, are simply good, solid life skills. So...on to the skills.
The first thing you need to know is that DBT skills are divided into an orientation session designed to introduce you to the behavioral goals ("behaviors to decrease" and "behaviors to increase") and general guidelines of working in DBT. One of the most important aspects covered in this introduction is making a commitment to working on the skills, no matter what. The reasoning behind this requirement is that if you're not committed to learning and practicing the skills, they don't work. I tell people it's a lot like learning to ride a bicycle - you can say you want to ride the bike, and envision yourself doing it, but if you never get on the seat and learn to balance and work the pedals, guess what? You don't learn how to ride the bike. The same is true with DBT - you have to practice these skills and commit to learning them.
Linehan has a form she uses with her clients and that we use in group skills training classes called a "diary card." This diary card has rows for each skill along with each day of the week. To use the diary card, you simply circle the days of each week that you used or even tried to use the skills. For example, if you used "Wise Mind" on Wednesday, you'd circle "Wednesday" in the "Wise Mind" row. If you tried "Wise Mind" on Tuesday, but found that it didn't help much, you still circle for Tuesday because you tried. There is a little more, but that's the basic idea.
DBT Skills are divided into four groups: Mindfulness skills (awareness), Interpersonal Effectiveness skills (how to work with others, get your needs met and keep your self-respect), Emotional Regulation (how to feel less overwhelmed and less helpless), and Distress Tolerance (how to deal with stressful situations and feeling overwhelmed/out of control). The way a DBT group works is that you meet for an orientation session and, depending on the group, signing a contract agreeing to practice the skills and attending the group and/or any related therapy sessions. From there, you work through the skills with your group leader, and practice in your everyday life the skill you learned each week along with the skills you have learned in previous weeks.
So, the first set of skills are related to Mindfulness. Linehan teaches that we all have two basic states of mind, "reasonable mind" and "emotional mind." The goal of the mindfulness skills is to find middle ground - the intersection between the two minds, which she calls "wise mind." In "wise mind," you use your logic AND your emotions (as opposed to numbing out and using logic only, or losing control and acting completely on emotion).
The skills involved in developing "wise mind" are the "WHAT" and "HOW" skills. The WHAT skills involve 1) observing the situation somewhat as if you were watching a movie. Linehan talks about having a "teflon mind" where your experiences, feelings, and thoughts are noticed, but allowed to "slip right out." Next, you 2) describe what is happening, using words, and finally 3) participate in the experience using "wise mind" - both reasonable and emotional minds. Basically, the WHAT skills teach you to see the situation without becoming swallowed up by it. The "What" skills have to be done one at a time - if you're observing, you can't be describing, and if you're participating, you're focused on just that - participating!
The HOW skills teach you, not surprisingly, how to do these observations. Being 1) nonjudgmental is absolutely, completely, utterly crucial. This is, as the show "Dragnet" said so well, looking at "Just the facts, ma'am". You want to separate out your opinion, your judgment, and your attitudes from what you are observing. And, if you catch yourself judging, well..."don't judge your judging" or as Albert Ellis famously said, "Don't 'should' on yourself." The next skill is to be 2) one-mindfully oriented. Focus on one thing at a time - it's that simple. If you're distracted, accept it and then come back to what you're doing. Finally, do these 3) effectively. Here is where you basically do what it takes to help you get what you want. You may have to play by the rules, put up with "the politics" of a situation - don't end up not reaching your goals because you're ticked off at the way things are done! Keep your goal in mind, let go of your negative emotions around the situation, and focus on what atually works, not what "should" work, what's "right"and "wrong," or "fair" and "unfair." Unlike the "What" skills, the "How" skills can be done in combination. They also tend to go with the "What" skills: we encourage describing nonjudgmentally, observing and participating one-mindfully, participating and describing effectively, etc.
There are some other things that can help you get to "Wise Mind": dialectical thinking and being aware of and challenging negative thinking patterns ("cognitive distortions".) Many people come into DBT with the question, "What ARE dialectics?" A dialectic is simply a situation where two things seem to be opposites and are both true. Here's an example: I can be angry - furious - with someone AND still care about them. Thinking dialectically is working to find the "AND" - the intersection between "either" and "or." Dialectical thinking helps you recognize and challenge negative thinking patterns - what we call "cognitive distortions," "thinking traps," or "core negative beliefs." These thinking traps are things like all-or-nothing thinking, mind-reading, or emotional reasoning ("because I feel this way, it must BE this way.") Working with these aspects helps you get to Wise Mind, as do the "what" and "how" skills.
These skills are the basis of everything else that follows. "Wise Mind" and mindfulness are the foundation upon which the other skills are built - if you don't practice and learn these, the rest will help some but you won't reap the full benefit. These skills are also returned to and practiced through out the program - I know of groups that revisit and re-teach mindfulness at the end of every other grouping of skills training - it's that important.
The next posts will briefly recap the rest of the skills. These are incredibly useful and powerful when practiced and used well. I can tell you, again from experience and from training, that there are many, many professionals who use these or similar skills for their own coping. It's important enough that Linehan, in her own workshops, begins each session with a mindfulness exercise.
Next up: Interpersonal Effectiveness! If you have any comments or questions, please feel free to contact me: [email protected]
Please Note: The content in these articles is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.
If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help.
DBT was developed by a psychologist at the University of Washington, Marsha Linehan. Dr. Linehan worked with suicidal clients and clients diagnosed with something called "Borderline Personality Disorder." Her methods, which have been applied to many, many other situations since, aimed to reduce feeling overwhelmed, helpless, and in pain that many of clients experienced as precursors to feeling suicidal or self-harming. Additionally, she recently admitted that she herself had engaged in self-harming, experienced hospitalization and realized that the treatment available simply wasn't enough. Out of this realization, DBT was born.
I've engaged in training specifically for DBT, some from Dr. Linehan herself, over the course of many years, and during my clinical internship I also had the opportunity to use DBT in individual therapy, in leading skills training groups, and in homework/practice group sessions. From both my training and my experience working with people, I believe strongly that these sets of skills are useful not just for people experiencing suicidal or self-harming behaviors, but for people dealing with depression, anxiety, "the blues," or a multitude of other situations. I've used them myself as well - they are well-grounded in both research and experience and work well and when you get down to it, are simply good, solid life skills. So...on to the skills.
The first thing you need to know is that DBT skills are divided into an orientation session designed to introduce you to the behavioral goals ("behaviors to decrease" and "behaviors to increase") and general guidelines of working in DBT. One of the most important aspects covered in this introduction is making a commitment to working on the skills, no matter what. The reasoning behind this requirement is that if you're not committed to learning and practicing the skills, they don't work. I tell people it's a lot like learning to ride a bicycle - you can say you want to ride the bike, and envision yourself doing it, but if you never get on the seat and learn to balance and work the pedals, guess what? You don't learn how to ride the bike. The same is true with DBT - you have to practice these skills and commit to learning them.
Linehan has a form she uses with her clients and that we use in group skills training classes called a "diary card." This diary card has rows for each skill along with each day of the week. To use the diary card, you simply circle the days of each week that you used or even tried to use the skills. For example, if you used "Wise Mind" on Wednesday, you'd circle "Wednesday" in the "Wise Mind" row. If you tried "Wise Mind" on Tuesday, but found that it didn't help much, you still circle for Tuesday because you tried. There is a little more, but that's the basic idea.
DBT Skills are divided into four groups: Mindfulness skills (awareness), Interpersonal Effectiveness skills (how to work with others, get your needs met and keep your self-respect), Emotional Regulation (how to feel less overwhelmed and less helpless), and Distress Tolerance (how to deal with stressful situations and feeling overwhelmed/out of control). The way a DBT group works is that you meet for an orientation session and, depending on the group, signing a contract agreeing to practice the skills and attending the group and/or any related therapy sessions. From there, you work through the skills with your group leader, and practice in your everyday life the skill you learned each week along with the skills you have learned in previous weeks.
So, the first set of skills are related to Mindfulness. Linehan teaches that we all have two basic states of mind, "reasonable mind" and "emotional mind." The goal of the mindfulness skills is to find middle ground - the intersection between the two minds, which she calls "wise mind." In "wise mind," you use your logic AND your emotions (as opposed to numbing out and using logic only, or losing control and acting completely on emotion).
The skills involved in developing "wise mind" are the "WHAT" and "HOW" skills. The WHAT skills involve 1) observing the situation somewhat as if you were watching a movie. Linehan talks about having a "teflon mind" where your experiences, feelings, and thoughts are noticed, but allowed to "slip right out." Next, you 2) describe what is happening, using words, and finally 3) participate in the experience using "wise mind" - both reasonable and emotional minds. Basically, the WHAT skills teach you to see the situation without becoming swallowed up by it. The "What" skills have to be done one at a time - if you're observing, you can't be describing, and if you're participating, you're focused on just that - participating!
The HOW skills teach you, not surprisingly, how to do these observations. Being 1) nonjudgmental is absolutely, completely, utterly crucial. This is, as the show "Dragnet" said so well, looking at "Just the facts, ma'am". You want to separate out your opinion, your judgment, and your attitudes from what you are observing. And, if you catch yourself judging, well..."don't judge your judging" or as Albert Ellis famously said, "Don't 'should' on yourself." The next skill is to be 2) one-mindfully oriented. Focus on one thing at a time - it's that simple. If you're distracted, accept it and then come back to what you're doing. Finally, do these 3) effectively. Here is where you basically do what it takes to help you get what you want. You may have to play by the rules, put up with "the politics" of a situation - don't end up not reaching your goals because you're ticked off at the way things are done! Keep your goal in mind, let go of your negative emotions around the situation, and focus on what atually works, not what "should" work, what's "right"and "wrong," or "fair" and "unfair." Unlike the "What" skills, the "How" skills can be done in combination. They also tend to go with the "What" skills: we encourage describing nonjudgmentally, observing and participating one-mindfully, participating and describing effectively, etc.
There are some other things that can help you get to "Wise Mind": dialectical thinking and being aware of and challenging negative thinking patterns ("cognitive distortions".) Many people come into DBT with the question, "What ARE dialectics?" A dialectic is simply a situation where two things seem to be opposites and are both true. Here's an example: I can be angry - furious - with someone AND still care about them. Thinking dialectically is working to find the "AND" - the intersection between "either" and "or." Dialectical thinking helps you recognize and challenge negative thinking patterns - what we call "cognitive distortions," "thinking traps," or "core negative beliefs." These thinking traps are things like all-or-nothing thinking, mind-reading, or emotional reasoning ("because I feel this way, it must BE this way.") Working with these aspects helps you get to Wise Mind, as do the "what" and "how" skills.
These skills are the basis of everything else that follows. "Wise Mind" and mindfulness are the foundation upon which the other skills are built - if you don't practice and learn these, the rest will help some but you won't reap the full benefit. These skills are also returned to and practiced through out the program - I know of groups that revisit and re-teach mindfulness at the end of every other grouping of skills training - it's that important.
The next posts will briefly recap the rest of the skills. These are incredibly useful and powerful when practiced and used well. I can tell you, again from experience and from training, that there are many, many professionals who use these or similar skills for their own coping. It's important enough that Linehan, in her own workshops, begins each session with a mindfulness exercise.
Next up: Interpersonal Effectiveness! If you have any comments or questions, please feel free to contact me: [email protected]
Please Note: The content in these articles is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.
If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help.