Dialectical Behaviour Therapy

Dialectical Behaviour Therapy.

Dialectical Behaviour Therapy (DBT) is a long term therapy created by Marsha M. Linehan in the late 1980s. It is a therapy that focuses on mindfulness, interpersonal effectiveness, regulating emotions and skills for distress tolerance and was originally created for the treatment of Boderline Personality Disorder (Emotionally Unstable Personality Disorder) but is now used for a variety of mental health disorders, including mood disorders (Other Personality Disorders, Bipolar Disorder, Depression) and other unstable disorders (Eating Disorders, Substance Abuse, Suicide Ideation). DBT usually lasts one year.

A lot of people who receive DBT have intolerable, unstable and irrational emotions which most likely affect their daily living. This is why DBT is derived from the Buddhist meditative practice and hugely promotes mindfulness. It is the core idea behind DBT as it helps patients accept and tolerate powerful emotions by observing such emotions without judgement as well as staying in the present moment by using all the five senses; sight, touch, smell, taste and sound.

Diary Sheets

Each week, each patient has to fill in a diary sheet to bring to the session. The main aim of the diary sheet is to identify emotion intensity from a prompting event and to identify which skills were used in order to lessen the emotion intensity. This can help patients break down what they’re struggling with and help them realise what is effective in helping them in certain situations.

Mindfulness

DBT is usually a group based therapy which takes place for two hours a week. Some patients also receive one to one therapy on top of this, especially if they struggle with self-harm or chronic suicide ideation. Mindfulness aims to achieve being one-mindful, non-judgemental and effective. This can help with understanding emotions and events.

Each session starts with a mindful exercise. Some of the exercises include:

-          Colouring in a picture with the non-dominant hand within a time frame.

-          Observing a stone using the five senses.

-          Meditation/relaxation.

-          Blowing bubbles.

-          Acting out or drawing ones perspective of different emotions.

-          Saying positive things about other people in the group.

-          Saying positive things about oneself.

-          Playing a game using memory.

Each mindful exercise is done while observing any emotions, thoughts or feelings without judgement. Afterwards, each person in the group gives their feedback about how they found the exercise, including what judgements or emotions they noticed. The exercises are used to teach patients to tolerate these.

Mindfulness also includes using what is called Wise Mind. This is the middle ground between Reasonable Mind (cool, rational and task- focused) and Emotion Mind (mood-dependant and emotion-focused). Wise Mind is the wisdom in each person, the middle path and bringing left brain and right brain together.

What skills:

(What you do while practicing mindfulness)
Observing, Describing, Participating.

Observing includes paying attention on purpose, either to the breath or judgements and emotions.
Describing is putting words on the experience and aims to unglue interpretations and opinions from the facts.
Participating includes throwing yourself completely into a task and becoming one with whatever you’re doing.


How skills:

(How you practice when practicing mindfulness)
Non-judgementally, One-Mindfully, Effectively.

Non-judgementally means to acknowledge values and emotional reactions without judging them.
One-Mindfully includes riveting yourself to now and concentrating the mind.
Effectively is to be mindful of your goals in a situation and to let go of wilfulness.

Interpersonal Effectiveness

The definition for interpersonal is:

- relating to relationships or communication between people.

Some of those with mental health issues (and even some without) have problems with their interpersonal skills. This can include not being able to communicate effectively, which can lead to destructive relationships. The interpersonal effectiveness module in DBT teaches how to communicate effectively, including how to say no, how to end destructive relationships and how to keep self-respect.

Goals of Interpersonal Effectiveness are being skilful in getting what you want and need from others. (this does not mean manipulation), building relationships/ending destructive ones and walking the middle path to create balance in relationships.

One of the skills used is FAST:

Fair: Being fair to both oneself and the other person.
Apologies: Not apologising more than once for something that was ineffective.
Stick to one’s values: Stick to what one believes in without being discouraged.
Truthful: Not lying thus not damaging one’s self-respect.

Clarifying Goals in Interpersonal Situations
Objectives Effectiveness:This includes getting what you want from another person by obtaining your legitimate rights, saying no to an unwanted request and resolving a conflict.

Relationship Effectiveness:This includes balancing immediate goals with the good of a long-term relationship as well as maintaining relationships that matter to you.

Self-Respect Effectiveness:This means respecting your own values/beliefs and acting in a way that makes you feel capable and effective.

Emotion Regulation

This module is specifically designed to help people with unstable and intense emotions such as anger, depression and anxiety and helps to identify, accept and regulate such emotions. This happens through increasing mindfulness to current emotions as well as overcoming obstacles in the way of positive emotions. The mindfulness aspect is extremely important because it teaches how to validate emotions (there is no wrong emotion) and to observe all emotions without judgement.

In order to regulate emotions, there are certain skills that are to be used. These include:

PLEASE

PhysicaL illness: Getting treatment when sick or injured-
Eating balanced): Eating a healthy, balanced diet.
Avoiding mood-altering drugs: Not taking non-prescribed medication and avoiding harmful, illegal drugs.
Sleep: Not sleeping too much or too little and practicing sleep hygiene.
Exercise: Getting an effective amount of exercise to release endorphins (they make us feel good).

Building mastery:
Doing one thing a day (small goal) to build competence and control in one’s life.

Letting go of emotional suffering:
Observing and experiencing the emotion, accepting it, then letting it go.

Checking the facts:Making sure that the emotions fit the facts of the situation.

Distress Tolerance

Distress tolerance skills are used when people are feeling distressed and overwhelmed by their emotions. These skills are designed to help bring down the intensity of emotions, thoughts and feelings.

TIP skills. This is changing the temperature of the face with cold water to calm down fast. Holding the breath and putting the face in a bowl or sink of cold water helps give a little shock to the mind as well as the body.

Intense Exercise. This is to calm down the body when it is revved up by emotion.

Paced Breathing. Counting breaths can really help to calm down. Breathing in for four and out for six can really help calm down intense emotions and anxiety.

Distraction and Self Soothing. Distracting from intense emotions can stop them from elevating further. People can distract with activities or self soothe with the five senses (a safe smell, a little stone to feel, listening to soothing music, etc).