Telehealth Counseling, Coaching, and Psychotherapy

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Wellness Solutions Provides Effective Telehealth Dialectical Behavior Therapy (DBT) in Texas

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.

For additional information please visit our "Mindfulness" page.

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).

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DBT Explained

Dialectical Behavior Therapy (DBT) is a type of counseling and psychotherapy designed to help you manage intense emotions, build healthier relationships, and develop effective coping strategies. DBT combines cognitive-behavioral techniques with mindfulness practices to help you understand and change unhelpful behaviors and thoughts.

DBT was developed by Dr. Marsha Linehan in the late 1980s. Dr. Linehan created DBT to treat individuals with borderline personality disorder (BPD), a condition characterized by severe emotional instability and self-destructive behaviors. Since then, DBT has been shown to be effective for a wide range of mental health issues, including depression, anxiety, and eating disorders.

DBT is backed by extensive scientific research demonstrating its effectiveness. Studies have found that DBT helps reduce self-harm, suicidal thoughts, and emotional distress while improving overall functioning and quality of life.

Neurologically, DBT helps change the way the brain processes emotions and stress. Practicing DBT skills can strengthen parts of the brain responsible for emotion regulation and impulse control, making it easier to manage difficult feelings and behaviors.

DBT is organized into four main components:

1. Mindfulness: 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.

- Observe: Just notice what's happening around you and inside you without trying to change it. For instance, pay attention to how you feel without reacting immediately.

- Describe: Put words to your experiences, like saying, "I feel angry" or "I notice my heart is beating fast." This helps you understand your feelings better.

- Participate: Fully engage in what you're doing, whether it's talking with a friend, doing homework, or playing a sport. Being present can improve your focus and enjoyment.

2. Interpersonal Effectiveness: 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.

- DEAR MAN: Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, and Negotiate to ask for what you need or want. This structure helps you communicate clearly and effectively.

- GIVE: Be Gentle, act Interested, Validate, and use an Easy manner to maintain good relationships. This approach can improve your interactions with others.

- FAST: Be Fair, no Apologies, Stick to your values, and be Truthful to maintain your self-respect. This helps you stand up for yourself without being aggressive.

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

- TIP: Temperature (change your body temperature), Intense exercise, Paced breathing, and Progressive relaxation to quickly calm down. These techniques can help you manage overwhelming emotions.

- Self-Soothing: Use your senses to comfort yourself, like listening to music, taking a warm bath, or looking at beautiful pictures. This can provide immediate relief from stress.

- Distraction: Distract yourself with activities, contributing to others, or doing something you enjoy to take your mind off the distress. This can help reduce the intensity of negative emotions.

4. Emotion Regulation: 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.

- Identifying Emotions: Recognize and name your emotions, like knowing when you feel sad, angry, or scared. This awareness is the first step in managing your emotions.

- Opposite Action: Do the opposite of what your emotion is telling you to do, like approaching something you're afraid of instead of avoiding it. This can help you change your emotional state.

- Check the Facts: Look at the facts of a situation to see if your emotional response fits the actual situation. This helps you respond more appropriately to your feelings.

A key concept in DBT is Radical Acceptance, which means fully accepting your reality as it is, without fighting against it. This doesn’t mean you have to like or approve of what's happening, but it helps you stop suffering from resisting reality.

For example, if you're facing a difficult situation that you can't change, like your parents' divorce, practicing radical acceptance can help you cope better by acknowledging your feelings and focusing on what you can control. By accepting things as they are, you can reduce emotional pain and find more peace.

DBT is particularly effective for individuals who experience intense emotional responses, self-destructive behaviors, and difficulties in relationships. It provides practical tools and strategies to help you navigate life's challenges and improve your overall quality of life. By learning and practicing these skills, you can gain better control over your emotions, enhance your relationships, and build a more fulfilling life.

Wellness Solutions provides telehealth counseling, coaching, & psychotherapy to adult clients in Texas.

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.

Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based approach to mental health care. It emphasizes building coping skills in four key areas: Distress Tolerance, Emotional Regulation, Interpersonal Effectiveness, and Mindfulness. Each of these categories plays a vital role in supporting mental well-being. Below, we’ll explore these essential skills with practical strategies and examples for each.

1. Distress Tolerance Skills

Distress tolerance skills are designed to help individuals navigate moments of crisis without making the situation worse. These skills empower you to tolerate intense emotions, avoid impulsive actions, and regain a sense of control. A crucial part of distress tolerance is self-soothing using sensory-based coping skills, which engage the five senses.

Self-Soothing Skills by Sense:

Sight: Look at calming images, such as nature scenes, art, or family photos.
Sound: Listen to soothing music, nature sounds, or guided meditations.
Touch: Hold a soft blanket, pet a dog or cat, or take a warm bath.
Smell: Light a scented candle, use essential oils, or smell fresh flowers.
Taste: Savor a piece of chocolate, sip herbal tea, or enjoy a flavorful fruit.

Additional distress tolerance techniques include deep breathing, grounding exercises, and "TIP" skills (Temperature change, Intense exercise, Paced breathing, and Progressive relaxation) to help regulate overwhelming feelings.

2. Emotional Regulation Skills

Emotional regulation involves understanding and managing emotions effectively. By increasing emotional awareness and implementing healthy coping strategies, individuals reduce vulnerability to emotional extremes.

Here are 10 emotional regulation skills:

Identifying and labeling emotions.
Opposite action (engaging in actions opposite to emotional urges).
Practicing self-compassion and self-kindness.
Building mastery through goal-setting and accomplishment.
Creating a "pleasant events" list and scheduling enjoyable activities.
Using positive self-affirmations.
Journaling to process and reflect on emotional experiences.
Reducing emotional vulnerability by prioritizing sleep, nutrition, and exercise.
Checking the facts of a situation to reframe negative thoughts.
Building a "crisis survival kit" with comforting items for moments of distress.

By using these tools, individuals can feel more in control of their emotions and reduce emotional reactivity over time.

3. Interpersonal Effectiveness Skills

Interpersonal effectiveness skills are essential for maintaining healthy relationships and navigating social interactions.

These skills enable individuals to assert their needs, set boundaries, and improve communication.

10 Interpersonal Effectiveness Skills include:

DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate) to make effective requests.
GIVE (Gentle, Interested, Validate, Easy manner) to maintain relationships with kindness.
FAST (Fair, Apologies are limited, Stick to values, Truthful) to maintain self-respect in relationships.
Clarifying personal values and communicating them clearly.
Practicing active listening to understand others’ perspectives.
Setting and maintaining boundaries with clarity and confidence.
Role-playing difficult conversations to build confidence.
Identifying "red flags" in relationships to protect personal well-being.
Responding to criticism without defensiveness.
Practicing saying “no” respectfully but firmly to protect your time and energy.

Interpersonal effectiveness supports healthier connections with others and fosters a sense of self-respect and confidence in social situations.

4. Mindfulness Skills

Mindfulness is the foundation of DBT, encouraging individuals to stay present and fully aware of the moment. This awareness reduces emotional suffering, increases focus, and helps individuals accept reality as it is.

10 Mindfulness Skills include:

Radical Acceptance (accepting reality even when it’s difficult to do so).
Practicing non-judgmental observation of thoughts, feelings, and sensations.
Focusing on "one-mindfully" doing one task at a time.
Using the "what" skills of mindfulness: Observe, Describe, and Participate.
Using the "how" skills of mindfulness: Non-judgmentally, One-mindfully, and Effectively.
Practicing body scans to increase awareness of physical sensations.
Engaging in mindful breathing exercises.
Practicing gratitude by noticing and appreciating positive moments.
Using mindful walking or movement meditation.
Repeating mindfulness statements such as “I am exactly where I need to be right now” or “This moment is difficult, but it’s only temporary.”

Mindfulness supports individuals in embracing life’s challenges with acceptance and self-compassion. By grounding themselves in the present moment, people can reduce stress and improve their overall sense of well-being.

Closing Thoughts

DBT coping skills offer a powerful toolkit for managing life’s challenges. Whether you’re learning to tolerate distress, regulate emotions, communicate effectively, or stay present in the moment, these skills provide tangible ways to feel more in control. At Wellness Solutions, we’re committed to helping you develop and master these essential skills with empathy, compassion, and support. You deserve a life of balance, well-being, and emotional clarity — and we’re here to walk that journey with you.

DBT Coping Skills

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

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.

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

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.

Telehealth Counseling, Coaching, and Psychotherapy

Wellness Solutions

Mailing Address: 8000 Research Forest Dr.
Ste. 115 PMB 1168
The Woodlands, TX 77382

Call or Text: 713-893-3989

Email: Admin@WellnessSolutionsLLC.com