How DBT Reshapes Your Thinking Patterns

How DBT Reshapes Your Thinking Patterns

A key component of DBT is the balancing of acceptance and change

Dialectical Behavior Therapy (DBT) is a Cognitive Behavioral Treatment (CBT).  Cognitive Behavioral Therapies help patients identify thought patterns and core beliefs that may be contributing to harmful behaviors. DBT also teaches specific skills that promote emotional stability and improved functioning.

Unlike many other therapies, which tend to address problems in the order in which they appear, DBT proceeds through a pre-planned series of stages. The Linehan Institute notes that these stages follow a logical progression. Each stage has its own goals and component parts, and each builds on the previous work.

Stages of DBT

In Stage I of DBT, the goal is for patients to progress from dyscontrol to control. In this stage the first behaviors to be addressed are those that are potentially fatal, followed by behaviors that could result in early cessation of therapy. The third area of attention is the practice of behaviors that negatively affect patients’ quality of life, and the final stage is the acquisition of new skills that will replace ineffective coping mechanisms.

When patients have control of their behaviors, they move to Stage II, which focuses on emotions. The goal is for patients to experience their emotions in a healthy and complete manner. If patients are experiencing post-traumatic stress disorder (PTSD), it is addressed in Stage II.

The goal of Stage III of DBT is for patients to live stable lives and experience periods of happiness and unhappiness in a normal way. The Linehan Institute notes that some individuals may wish to complete a Stage IV. In this final stage the goal is for patients to find spiritual fulfillment or a sense of being part of a greater whole.

Skills Taught in DBT

A key component of DBT is the balancing of acceptance and change. As a Frequently Asked Questions page on the Lineham Institute website notes, it is important to recognize what about ourselves can be changed and what must be accepted, at least in the short term. Toward that goal DBT teaches skills that address both sides of the equation.

There are four primary skills taught in DBT, each with a number of component parts. Two skill modules emphasize change and two emphasize acceptance. The following skills are taught:

  • Mindfulness – Mindfulness involves observing the external and internal environment. Patients learn to pay attention to their senses and emotions and to accept their feelings without judgment.  Individuals are taught to be fully present in the moment and to let feelings pass through their minds without becoming lodged there.
  • Distress Tolerance – The Distress Tolerance module teaches patients to accept and find meaning in pain and to suffer skillfully. Patients learn to objectively recognize negative situations so that they can make wise decisions about them. Many specific skills are taught. These include distraction techniques such as engaging in enjoyable activities, helping others, making comparisons, finding humor or utilizing a strong sensory experience like a cold shower. Patients are also taught to self-soothe. This involves positive imagery, prayer, muscle relaxation, deep breathing, focus on the present, taking a break and self-encouragement. Other distress tolerance skills include weighing pros and cons and radical acceptance of the situation.
  • Emotion Regulation – The regulation of emotions starts with properly identifying them. This involves recognizing triggering events and interpreting them. It also involves noticing body language and physical sensations. Patients are taught to maintain physical health by focusing on diet, sleep and exercise and by treating illnesses and avoiding mood-altering substances.
  • Opposite Action – Another skill involved in emotion regulation is known as opposite action. This involves recognizing that an emotional reaction to a situation is inappropriate and acting in a way that contradicts the emotion being experienced. Patients are also taught to work on problem-solving skills, to focus daily on building control and competency and to observe and experience emotions then let them go.
  • Interpersonal Effectiveness – Skills taught in the Interpersonal Effectiveness module include learning to say no, ask for help when there is a need and deal with conflict. Patients learn to ignore distractions, appear confident, negotiate and compromise. They are also taught to use courteous, non-attacking language, maintain interest and validate the situations and emotions of others.

DBT for Addiction

DBT has shown promise in treating many conditions including addiction to drugs like Xanax. The National Institute on Drug Abuse lists it as a treatment that may be helpful for patients with self-harming behaviors. A 2011 study reported in The American Journal of Drug and Alcohol Abuse examined improved mood, emotional regulation and lower levels of substance use in patients treated with DBT.  DBT produced gains in all areas and the study found that decreased substance use was explained by the improvements in emotion regulation.

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