Dialectical Behavior Therapy (DBT)

heal background_edited_edited_edited_edited.png

Dialectical Behavior Therapy (DBT)

DBT is a model of therapy developed by Marsha M. Lineham for the treatment of Borderline Personality Disorder. The use of DBT has expanded to include many additional diagnoses and symptoms.

Dialectical refers to dialogue between the client and therapist where opposing viewpoints are discussed and both parties eventually come to an agreement. (This is the opposite of debate where two parties come together and argue until one party is proven incorrect.) Dialectics is also a perspective from which one attempts to understand the true nature of reality.

The nature of the relationship between the client and therapist is collaborative and helping. A client’s feelings are validated. Empathy and respect are integral characteristics to the treatment process. The treatment environment is receptive to dialogue and emotionally safe while setting clear healthy boundaries.

DBT holds that all behavior patterns are interrelated and we are always in a state of change and transition. This can be unsettling to those who do not have a perception of control in their lives and who need skills for resilience and adapting to one’s environment.

As Western culture is developing an understanding and appreciation for Eastern philosophies and practices, such as, yoga; psychology is exploring treatments that expand the traditional knowledge base to include meditation, acceptance, and mindfulness.

DBT is a combination of Cognitive Behavior Therapy (CBT), specific skills training, and Buddhist philosophy. DBT concepts do not require a specific belief system, religion, or spirituality for it to be an effective treatment and will not conflict with a client’s religious beliefs.

DBT skills are separated based on the type of skill, they are as follows: Distress Tolerance Skills, Emotional Regulation Skills, Interpersonal Effectiveness Skills, and Mindfulness Skills. The concepts of Wise Mind, Radical Acceptance, and Building Mastery are popular DBT skills that are positive and helpful for clients seeking long term sustainable behavior change.

The emphasis on acceptance and mindfulness as mechanisms for coping with a highly stressful situation, rather than merely emotionally reacting to stimuli, is a major tenet of DBT and is borrowed from traditional Eastern philosophy, namely, Zen.

In DBT acceptance is acknowledging the situation and your feelings in the situation as they are and taking an “it is what it is,” frame of mind. Another way of framing an acceptance statement is, “I am doing the best I can at this moment in my life right now.”

The concept of acceptance does not mean that one submits to problems and is a helpless victim of their circumstances. Instead, one uses acceptance to understand and gain insight into behaviors (without negative judgments) and from a new perspective an individual can make a clear assessment of what needs to change and how to achieve his or her goal.

There are many ways to describe mindfulness. According to Germer, Siegel, and Fulton (2005), mindfulness is awareness of the current moment with acceptance. Kabat-Zinn (1994) defines mindfulness as purposely paying attention, in the present moment and without judgment.

Mindfulness is paying attention to one’s life with intent and purpose to live fully in the moment, in the present, and without judgment about the situation or one’s feelings in regards to the situation.

Mindfulness is a form of meditation and requires active concentration as we go through our daily activities.

Mindfulness is helpful because we are less likely to be hyper-emotional if we are consciously aware of the moment, analyze the situation, and develop a proportional reaction to our feelings and environment. (To try your first mindfulness exercise see below.)

DBT is helpful to people who feel emotionally overwhelmed easily and may need assistance developing stress tolerance. DBT can assist those with volatile mood swings, hyper-sensitivity to their environment, and self-harm behaviors. It is also for those seeking increased peace of mind through improving coping skills.

Mindfulness Exercise:

Concentrate on an object. Notice all of the qualities of the object. Take a mental inventory of each characteristic of that object paying attention to each detail. Do this for as long as you can. How long does it take for your mind to drift into another subject?

When you showered this morning how often did you take notice of the water on your skin? Or did you ignore it? Were you lost in your thoughts preparing for your day?

While driving how long do you actually concentrate on what you are doing? How many times in the past few days have you arrived at your destination only to realize that you do not recall the previous intersections? Do you recall the car in front of you as you drove?

Try these exercises out and see how long it takes for your mind to drift and you lose yourself to your thoughts. The more we walk through our day as a passive observer the more we are allowing our environment to rule our emotions and behaviors through our “unawareness”.

Resources:

The Dialectical Behavior therapy Skills Workbook for Bipolar Disorder by Sheri Van Dijk, MSW (2009).

The Dialectical Behavior therapy Skills Workbook for Bulimia by Ellen Astrachan-Fletcher, PhD and Michael Maslar, PsyD (2009).

Skills Training Manual for treatment Borderline Personality Disorder by Marsha Lineham (1993).

Mindfulness is the first step in emotional healing—being able to turn toward and acknowledge our difficult thoughts and feelings with a spirit of openness and curiosity.

Marsha Lineham

Explore How DBT Skills Can Improve Your Life & Relationships

Complete the WS New Client Intake Form to get scheduled today!

DBT Skills

Emotional Regulation Skills

Learning to understand and manage your intense emotions in a healthier way. These skills help you identify your feelings and learn how to change them if needed.

Distress Tolerance Skills

Developing techniques to tolerate and survive crises without resorting to harmful behaviors. These skills help you get through tough times without making things worse.

Mindfulness Skills

Learning to be present and fully engaged in the moment helps you gain control over your thoughts and emotions. Mindfulness practices make you more aware of your thoughts and feelings without being overwhelmed by them.

Interpersonal Effectiveness Skills

These skills help you communicate more effectively and build healthier relationships. It's about asking for what you need, saying no, and managing conflicts in a healthy way.

Wisdom and freedom require the ability to allow the natural flow of emotions to come and go, experiencing emotions but not being controlled by emotions.

Marsha Lineham

Radical Acceptance Skills

Turning the Mind
- Acknowledge when you are resisting reality and consciously choose to accept the situation as it is. This skill involves repeatedly turning your mind toward acceptance whenever resistance arises.
Willingness Over Willfulness
- Practice being open and willing to accept reality, even if it’s painful, instead of clinging to willfulness (resisting or refusing to accept).
Observing Without Judgment
- Notice the reality of the situation without labeling it as "good" or "bad." Focus on what "is" instead of how you think it "should" be.
Allowing Yourself to Feel Emotions Fully
- Permit yourself to experience emotions without pushing them away, numbing them, or trying to control them. Acceptance includes sitting with discomfort without judgment.
Acknowledging the Limits of Control
- Recognize what you can and cannot control in your life. Let go of attempting to change the uncontrollable.
Self-Compassion in Painful Situations
- Treat yourself with kindness and understanding when faced with difficulties. Acknowledge that suffering is a natural part of life.
Mindfulness of Thoughts
- Observe thoughts of resistance or denial as they arise, and gently redirect them toward acceptance without self-criticism.
Practicing Acceptance Statements
- Use affirmations or mantras to reinforce acceptance, such as:
  - "It is what it is."
  - "This moment is as it should be."
  - "I can’t change the past, but I can choose my response now."
Imagery for Radical Acceptance
- Visualize a symbol or image that represents letting go, such as releasing a balloon or watching leaves float down a stream.
Body Relaxation to Support Acceptance
- Practice progressive muscle relaxation or deep breathing to release physical tension that might accompany resistance to reality.
Fact-Checking Reality
- Focus on facts instead of emotional interpretations to ground yourself in the truth of the situation.

Mindfulness Skills

Observe
- Notice what is happening in the present moment without trying to change it. Pay attention to your thoughts, feelings, sensations, or surroundings as if you are watching them from the outside.
Describe
- Put words to your experience by describing what you notice. For example: “I feel my heart beating fast,” or “I notice the sound of birds outside.”
Participate
- Fully engage in the moment by immersing yourself in the activity at hand. Let go of self-consciousness and focus completely on what you are doing.
Nonjudgmental Stance
- Observe and describe events, thoughts, and feelings without labeling them as "good" or "bad." Simply notice them as they are.
One-Mindfully
- Focus on one thing at a time. Let go of distractions and bring your attention fully to the present activity or moment.
Effectiveness
- Do what works in the moment, rather than what you feel like doing or what "should" be done. Focus on actions that achieve your goals.
Breathing Awareness
- Pay attention to your breath as it flows in and out. Use your breath as an anchor to bring your mind back to the present.
Body Scan
- Tune in to physical sensations throughout your body by mentally scanning from head to toe. Notice areas of tension, relaxation, or other sensations without trying to change them.
Wise Mind Practice
- Connect with your inner “Wise Mind,” the balance between emotional and rational thinking. Ask yourself: “What is the most effective response in this moment?”
Mindfulness of Emotions
- Observe your emotions as they come and go, like waves in the ocean. Notice their intensity, duration, and changes without trying to push them away or cling to them.
Mindfulness of Thoughts
- Watch your thoughts come and go like clouds in the sky. Acknowledge them without getting attached or believing that they define you.

The Dialectical Behavior Therapy Wise Mind Mindfulness diagram and a quote from Marcha Lineham.

Wise Mind: Finding Balance Between

Emotion and Reason

In Dialectical Behavior Therapy (DBT), "Wise Mind" is the part of you that balances your emotions and logical thinking to make decisions that feel right and true to who you are.

Imagine it as the middle ground between two extremes: the emotional mind, which reacts based on feelings, and the rational mind, which focuses only on facts and logic. Wise Mind combines these perspectives, helping you respond to life's challenges in a way that feels balanced, thoughtful, and grounded.

Everyone has a Wise Mind, even if it doesn’t always feel easy to find. It’s that quiet, knowing voice inside that helps you make decisions when you're calm and centered. Learning to access your Wise Mind can help you respond to overwhelming emotions, reduce stress, and create a life that feels more balanced and fulfilling.

At its core, Wise Mind is about understanding and trusting yourself while respecting both your emotions and logic. In therapy, we can work together to help you strengthen this skill, so you feel more confident and in control, even during difficult times.

We care about you, your safety, and your peace of mind. If you or someone you care about is having a mental health emergency and needs immediate care to ensure the safety and security of themselves or others please call 911 or go to the nearest emergency room. If you are in need of mental health crisis resources please visit the Wellness Solutions "Safety Resources" page for helpful information and supports.