Dialectical Behavior Therapy: Accepting Reality & Embracing Change

*Content Note: This post will mention sensitive topics such as suicidal ideation, self-harm, and invasive thoughts.

Do you ever feel like managing emotional dysregulation is a full-time job? Like your emotions are running the show, and it’s hard to function or focus on anything else? When tricky situations happen and the emotions feel overwhelming, do you resort to behaviors you know are harmful, such as cutting, binge-eating, or drinking? If you’ve suffered a serious loss or trauma, or you’re experiencing acute depression or anxiety, Dialectical Behavior Therapy is a method that might help you tolerate stress with healthy habits and access emotional equilibrium.

What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) is a type of talk therapy based on Cognitive Behavioral Therapy (CBT) that has been adapted for those who need help managing and regulating intense emotions. Unlike CBT which focuses on changing an individual’s thought patterns, DBT is focused on giving clients skills to manage their emotional dysregulation. DBT is especially effective for people of all ages who suffer from mood disorders such as depression and anxiety, severe PTSD, suicidal ideation, self-harm, substance abuse, disordered eating, or other issues.

Maladaptive coping skills like substance abuse and self-harm are forged from traumatic experiences when healthy coping skills (like talking to a safe adult) aren’t accessible. These maladaptive strategies may offer immediate relief by easing or numbing the emotional pain, but they also pose risks to a person’s emotional, mental, and physical health that further increase dysregulation. Oftentimes, clients want to end these maladaptive behaviors but need help replacing them with healthier coping mechanisms. Dialectical Behavioral Therapy is all about redirecting behavior to better manage emotional dysregulation through:

• Acceptance of reality

• Awareness of emotions

• Healthier coping mechanisms, like mindfulness techniques

Two Things Can Be True

“Dialectical” refers to the act of accepting contradictory ideas. For example, someone who has a severe mood disorder can accept that their brain chemistry makes it difficult for them to feel safe and happy, while at the same time choosing to stop engaging in self-harm behaviors with help from a DBT therapist.

DBT is about “walking the middle path” between two things, i.e., building awareness of the emotions without acting on the impulses. Clients in DBT are coached on how to tolerate intense emotions and accept painful realities without engaging in maladaptive behaviors such as cutting or disordered eating.

Managing Dysregulation with Mindfulness

Of course, ending maladaptive behaviors isn’t as simple as stopping. We have to replace the maladaptive impulse with healthier skills that decrease emotional dysregulation. In Dialectical Behavior Therapy, therapists work with clients on mindfulness activities to help them ride the wave of discomfort without action or judgment. Many of these activities employ acronyms that are easy to recall in the middle of dysregulation, such as the STOP and RAIN methods.

The STOP mindfulness technique stands for:

• Stop

• Take a breath

• Observe your thoughts and feelings

• Proceed, i.e., return to what you were doing before you stopped, but with more awareness

The RAIN mindfulness technique stands for:

• Recognize what’s happening in the moment

• Allow the experience to exist just as it is

• Investigate with interest and care

• Nurture with self-compassion

The Benefits of DBT

Dialectical Behavior Therapy offers many benefits, whether its for individuals, couples, or families:

• Greater self-awareness: individuals learn how to notice their emotions and identify cycles of self-harm.

• Emotional resilience: clients can also learn to tolerate stress through mindfulness techniques, so that when difficult situations or emotions occur, they can stay present and emotionally regulate themselves.

• Interpersonal effectiveness: in couples or group therapy settings, DBT gives clients the chance to practice communicating their emotions, slow down the conversation, and identify what’s important to say and how to say it, so that their needs are met.

Is DBT Right for Me?

As mentioned above, Dialectical Behavior Therapy can be applied in a variety of contexts, from individuals (including children) to couples and families. Here are a few signs that DBT might be right for you:

• You find it hard to stay present when difficult emotions arise

• You struggle with impulsive or compulsive behaviors when feeling overwhelmed

• You have severe anxiety and depression

• You have an eating disorder

• You’re struggling with substance abuse

• You’re struggling with suicidal ideation or intrusive thoughts

DBT Therapy in Chicago:

Suffering happens when we get stuck in a cycle trying to change something we can’t, but acceptance is a skill we can learn. Some things about our lives may always be painful or difficult, but through practicing acceptance and mindfulness, we can end cycles of self-harm and find emotional equilibrium. DBT can be a profound and transformative therapeutic experience that sets people on a path toward peace. If you’re curious about whether DBT is right for you, your child, or your family, reach out today. We’ll connect you with the therapist and therapeutic approach to help you thrive.

For more information about Dialectical Behavior Therapy, watch this video of ECC Founder Danielle Zawadski discussing it on PHTV4’s Living Well segment!

About ECC:

Empowered Connections Counseling is a practice of licensed therapists providing quality, multidisciplinary counseling for adults, children & teens, relationships, and families in Chicago and across Illinois. Whether by in-person session or via telehealth, we work with clients to find the therapist and treatment methods that best suit their needs. Connect meaningfully with your life by booking an appointment today.

GIVE to Yourself

Dialectical Behavior Therapy’s (DBT) GIVE is a powerful therapeutic tool I find myself returning to over and over again in my work with clients, particularly in strengthening interpersonal communication skills. Recently, when preparing for a session, I was thinking of new ways to treat negative self-talk; realizing there is great potential in applying GIVE not only to communication with others, but also toward one’s self!  Today I would like to introduce you to Marsha Linehan’s GIVE and how it can be used for positive self-talk.

What GIVEs?

GIVE stand for Gentle, Interested, Validate, Easy Manner. Gentle can mean many things, I often tend towards tender or non-judging in my approach. Interested means to be listening, if you are listening you can summarize what the speaker said and they would agree with it. Validate means to acknowledge what is being said, this does not mean agreeance. Easy Manner means light-hearted, at ease or humorous.

How can I GIVE to myself?

When I talk with strangers or friends I use GIVE as a guideline to monitor if it is a healthy conversation. The same holds true with my self-talk. If I cannot be gentle with myself, I must be hurt. It’s important that I talk to myself gently if I wish to feel heard, much like I require of myself and those I associate with. If my internal dialogue is abrasive and rapid (cutting myself off) - it is time to implement a coping skill to center myself so that I can fully listen to myself. If conflicting parts of me cannot acknowledge that I have differing roles   that can conflict (being a therapist is different than that of a brother, son or partner) then it is no wonder that I am hurting. Even in ambivalence I have to create space to acknowledge  inner conflicting ideas, thoughts, and emotions. I admit that Easy Manner is an odd and deeply personal approach when it comes to self-talk. I am not particularly humorous, but I can be at ease. My role as a therapist should be at ease with my role as a son, even though they conflict from time to time. GIVE is a great way to support healthy internal communication, which can lead to improvements in other aspects of life including emotional well-being, interpersonal communication, and self-esteem.

What do I do when GIVE doesn’t work?

This is where coping skills come in. What can you do that will ground  yourself so that you can practice GIVE? Use your creativity! You know yourself best. For some inspiration here are a few ways I have seen clients successfully ground themselves in this situation: (1) Just breathe. Find an easy rhythm that keeps your attention on your breathing. (2) Music. Let the tone or lyrics speak to you in a positive way to balance the negativity. (3) Reach out to a close friend, or family member, and talk about mutual interests that you enjoy. Once you feel relaxed, centered, and grounded try to focus on one of the principles of GIVE and see how you feel on the second try. 

Self-talk is one of the hardest parts about communication. If you are trying to communicate with others and it is difficult, you can take a break. When it comes to yourself, you can never quite leave yourself. This is where using GIVE can help, because it is about respecting you, and all your parts, when you use it for self-talk.

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Linehan, M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. The Guilford Press.

Using Dialectical Behavior Therapy as part of Holistic Wellness

Owner Danielle Zawadzki, LMFT talks about using DBT in therapy and its role in holistic wellness with Dr. Serena Wadhwa. Episode recorded on July 23, 2017.