How Does Dialectical Behavior Therapy Work?

Saturday, July 7, 2018 | By Chris Clancy

therapy session

Dialectical behavior therapy, which was first developed back in the 1970’s, is a form of cognitive behavioral therapy that was designed to help treat the needs of those who are diagnosed with borderline personality disorder (BPD).

Individuals with borderline personality disorder struggle with symptoms such as a distorted sense of self, impulsive behavior, cutting off relationships with others, self-harming behavior, and suicidal thoughts/tendencies. Therefore, to help manage these symptoms, dialectical behavior therapy works to encourage effective ways to handle negative experiences and emotions by utilizing strong skills such as mindfulness, emotion regulation, and interpersonal effectiveness.

As dialectical behavior therapy began working for several individuals with borderline personality disorder, therapists began using it to treat several other mental health conditions, such as addiction, posttraumatic stress disorder, bipolar disorder, and depression. Today, it remains one of the most popular behavioral therapies in existence.

What Exactly is Dialectical Behavior Therapy?

Dialectical behavior therapy is a multi-layered form of therapy that involves a multitude of different steps. And while this type of therapy might seem overwhelming on paper, when it is implemented into one’s treatment, it is much simpler to understand and apply.

This therapeutic approach is broken down into four different parts:


Mindfulness is something that is often discussed and practiced by those who are recovering from substance use disorders and other mental health conditions. In short, mindfulness is the practice of being in the present moment. It refers to placing your focus on what is occurring around you in a comfortable manner, as opposed to overthinking or being non-accepting of what it is that is occurring. For many, mindfulness comes easily, however, others can struggle with this process. The goal of mindfulness is to help develop self-control, mental clarity, and compassion for both yourself and others.

Distress Tolerance

Distress tolerance is highly beneficial for those who often become easily stressed or overwhelmed by even the smallest of things. Through distress tolerance, four specific skills are taught:

  1. Distracting
  2. Self-soothing
  3. Improving the moment
  4. Focusing on pros and cons

When something distressing occurs, you can start off by distracting yourself from disturbing events or thoughts by thinking of something happy or calming. Next, using the five senses (sight, sound, smell, touch, and taste), you can utilize self-soothing techniques, such as listening to a song you like, patting your dog, or looking at something pretty in nature. After that, you can improve the moment by using positive mental imagery to change the upsetting situation, meaning that you can breathe deeply, watch a television show, talk to yourself in a supportive manner, etc. Once you have done that, focus on the pros and cons of having to manage distress and not having to manage distress. This can help promote a stronger understanding of managing distress.

Emotion Regulation

Similar to distress tolerance, emotion regulation follows three steps:

  1. Understand one’s emotions
  2. Reduce emotional vulnerability
  3. Decrease emotional suffering

First, individuals work to identify their emotions and put names to them. Rather than just saying, “I feel off” or “something just isn’t right”, individuals are taught to say things such as, “I am feeling angry” or “I am feeling disappointed”. This helps foster a stronger understanding of what the specific emotion is. From there, individuals work to decrease their emotional vulnerability by utilizing the acronym PLEASE MASTER:

PL – taking care of one’s physical health

E – eating well

A – avoiding alcohol and drugs

S – getting good sleep

E – regularly exercising

MASTER – participating in everyday activities that promote confidence

To complete emotion regulation, individuals are encouraged to decrease their emotional suffering through:

  1. Letting go
  2. Taking opposite action

When an upsetting emotion develops, individuals can become aware of it, put a name to it, and then learn to let it go, rather than remain focused on it. At this time, one’s mindfulness skills can come in very handy.

group therapy

Interpersonal Effectiveness

Through DBT, individuals are introduced to different methods of communicating and existing amongst others in a way where they do not overreact to upsetting feelings. To do this, individuals must work to better establish the following:

  1. Objective effectiveness
  2. Relationship effectiveness
  3. Self-respect effectiveness

For objective effectiveness, individuals are asked to utilize the acronym DEAR MAN to help better mitigate what he or she needs from an interaction with another:

D – Describe the situation truthfully and directly

E – Express feelings regarding the situation

A – Assert what it is that you want

R — Reinforce your outcome and why you want it

M – Mindfulness should be included in objective effectiveness so you can be present in the moment

A – Appear confident

N – Negotiate in order to give and get what you want

Relationship effectiveness is addressed through the acronym GIVE:

G – Utilize a gentle approach

I – Show your interest in someone else by listening

V – Validate how the other person feels

E – Adopt an easy manner

Through the use of this acronym, individuals can begin working on how to foster healthy relationships by implementing their own positive actions.

Self-respect effectiveness uses the acronym FAST:

F – Be fair to yourself and those around you
A – Replace constant apologizing with taking action and being responsible

S – Stick to your morals and do not give up who you are in order to achieve a certain outcome

T – Stay truthful to prevent manipulation, storytelling, and exaggeration

Getting Help

It can be extremely challenging to live with the symptoms of a mental health condition or a substance use disorder. Your everyday life can feel overwhelming, and sometimes you may wonder if you will ever be able to break the cycle. And while you may feel that there is nothing left for you to do, there is.

By getting professional help, such as that offered at a treatment center, you can begin to unravel the various aspects of your condition so that you can not only understand them better but also learn how to manage them in an effective, healthy manner. And, as you work through this process, you may participate in dialectical behavior therapy amongst other forms of therapies.

If you do not reach out for treatment, you may never get the opportunity to benefit from an evidence-based therapy like dialectical behavior therapy that could otherwise change your life for the better. However, taking that first step can introduce to treatment that can not only help you improve upon yourself but also potentially save your life.

If you are ready to get help, do not wait to reach out. We are here to help you face your challenges and show you how you can get over them. Call us right now at 270-282-7192.

Get the best treatment for yourself or a loved one.

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