Dialectical Behavioral Therapy (DBT)

The skills learned in DBT sessions can be categorized as follows:

• Core Mindfulness: These skills help the person learn to be “in the moment” and accept the present for what it is. Due to the distorted perceptions of those with BPD and other disorders, learning to be present and accepting of life is critical to treating their symptoms. Core mindfulness skills are at the center of all the additional skill-building for those using DBT.

• Interpersonal Effectiveness: Due to the presence of traumatic events in their lives, those with BPD and PTSD may develop insecure attachment styles that impact their adult relationships. They may have been neglected or abused in childhood and struggle to understand how to get meet their needs in relationships. They might fear abandonment and may paradoxically end relationships to protect themselves from their fear that people will eventually leave or let them down. This skill area focuses on things like:

• • Learning how to ask for what is needed
  • Saying “no” to demands that are inappropriate or make a person feel uncomfortable
  • Coping with conflict during interpersonal relationships

• Emotional Regulation: Learning to regulate emotions is crucial to treating many mental health disorders. Those with BPD and PTSD may have intense emotional reactions that can be extreme within the context of the situation. Emotional regulation skills focus on a process of:

• • Identifying and labeling emotions
  • Identifying obstacles to changing their emotions, like maladaptive behaviors, addictions, and suicidal ideation
  • Learning to avoid negative situations that make the person feel vulnerable
  • Learning to increase events and circumstances in life that lead to positive emotions
  • Use mindfulness techniques to deal with painful emotions in a nonjudgmental and less reactive manner

• Distress Tolerance: DBT helps individuals learn how to tolerate painful, distressing, and frustrating emotions. When people cannot handle any discomfort in their lives, they might “fly off the handle” at any event that does not go their way or go as expected. Spilling a glass of water, missing a bus, or experiencing everyday misfortunes can lead to extreme overreactions or validated distorted self-images. By learning how to tolerate discomfort and “sit with” painful or negative emotions—like boredom, disappointment, and loneliness—the person can learn to accept things from a detached perspective.