DBT part 1 - overview and Mindfulness
Dialectical Behavior Therapy, or DBT, was founded by Dr. Marsha Linehan in the 1980′s. She is a researcher at the University of Washington and has her own psychiatric past, including being diagnosed with BPD. Part of the reason why she developed DBT is because she felt very hopeless with the treatment that was available to her when she was younger - which was essentially to lock her up in seclusion in a long-term psych unit (she spent over two years at the Institute of Living in CT).
DBT was originally founded specifically to treat BPD and chronically suicidal individuals but it has been used for other diagnoses as well (including PTSD, substance abuse, and eating disorders, among others).
DBT treatment is generally offered on an outpatient basis: it consists of weekly individual therapy sessions with a DBT-trained therapist addressing a hierarchy of behaviors, weekly group therapy in which group members learn specific “skills” and offer support to each other (and homework is usually assigned), phone skills coaching which provides the client with access to the therapist outside of session hours in predetermined agreements (i.e. only during daytime hours, 24/7, texting, paging, calling, or emailing), and a consultation team for the therapist which helps prevent “burnout” and is a place where the therapist can get support from other clinicians about how to best approach the client’s treatment.
The general principle of DBT is to discourage “black and white thinking” (i.e. thinking only in extremes) by helping the client understand that two seemingly opposing ideas can exist at the same time (i.e. dialectics). The main dialectic of DBT is a balance between Acceptance and Change - that the client is doing the best they can in that moment AND that they can do better. Pre-DBT when Dr. Linehan focused mostly on change with her clients, she found that the clients felt invalidated and pushed too hard - many clients would drop out of the treatment. When she shifted to focusing primarily on acceptance, the clients felt validated, but they weren’t getting better. So Dr. Linehan fused the two ideas.
Acceptance and Change each have two modules associated with them - Acceptance encompasses Mindfulness (which is, in some ways, the very foundation of DBT) and Distress Tolerance, while Change involves Emotion Regulation and Interpersonal Effectiveness.
Mindfulness involves the What and the How skills for how to stay present in the current moment. The aim of Mindfulness is for the client to stay in Wise Mind which is the synthesis of two “mind states” - Emotion Mind (when your thinking is influenced by your emotions, often leading to impulsive decisions/behaviors) and Rational Mind (when your thinking is influenced by logic and reasoning with very little attention to emotions). Mindfulness is the core of DBT because all the other skills modules work best if the client is in Wise Mind.
What you do:
Observe - observe your environment non-judgmentally, using “teflon” mind, i.e. allowing thoughts, feelings, and reactions to come into your mind and letting them go. An example would be to imagine watching clouds pass by with a thought/feeling on each cloud, letting them drift out of view without holding onto any part of it.
Describe - describe what you have seen in the environment without judgment or criticism. Stick to the facts, either to yourself or to someone else. For example, “my friend has raised her voice and is making gestures with her hands” instead of “my friend is angry”.
Participate - participate fully in the experience. Throw yourself into the activity or experience and keep bringing your mind back to what is happening when it drifts away. When we learn anything new, we fully participate in the experience of it. When we have done something over and over, like brushing our teeth, we tend not to participate in it. How many times does your mind wander when brushing your teeth? Instead, try brushing your teeth with your non-dominant hand and pay attention to all the sensations in your mouth. Keep bringing your mind back to that sensation when it wanders.
How you do it:
Non-judgmentally - when you describe the facts or any aspect of the situation, try not to think in terms of things being “good” or “bad”, “right” or “wrong”. This will take practice because we are conditioned to make judgments about everything, so don’t be hard on yourself. Similar to a meditation, it will take practice to not have your brain go straight to judgment to make sense of a situation.
One-mindfully - when your mind wanders to other things (which it will!), bring it back to the thing you are focusing on in the moment, again and again and again. And don’t judge your brain for wandering; this will also require practice! You can say something like “oh there my brain goes again to what I’m having for dinner. What is happening right in front of me? What do I hear right now?” etc. For example, when you are talking to a friend, notice when your mind wanders and keep bringing it back to the sound of your friend talking, the expression on her face, etc.
Effectively - do what is most effective in the situation rather than what seems “right” or “fair”. Is there a situation in which you are holding onto anger and it is not helpful to the relationship? Practice letting go of what doesn’t work.
Sources: (x, x)
(You can find Part 2 here, Part 3 here, and Part 4 here)