Mood swings with feelings of euphoria to deep depression. Intense anger that causes you to lash out immediately followed by extreme guilt. Impulsive and potentially dangerous behavior. Chronic feelings of emptiness and suicidality. These are some common characteristics of Borderline Personality Disorder (BPD). BPD is categorized as a personality disorder. These mental disorders are typically categorized by an unhealthy pattern of thinking, functioning, and behaving. 

Dialectical Behavior Therapy or DBT was created by Marsha Linehan who was diagnosed with BPD herself. Initially diagnosed with schizophrenia and treated with electroconvulsive therapy, Linehan felt that she should have instead been diagnosed with BPD, especially since she dealt with suicidal behavior, a common symptom of BPD. 

Linehan studied psychology in her undergraduate and graduate programs and continued on to teach psychology, psychiatry, and behavior sciences. During her work, Linehan realized two important concepts within mental health:

1. To achieve meaningful and happy lives, people must learn to accept things as they are.
2. Change is necessary for growth and happiness

These two concepts laid the foundation for DBT. Using concepts from Cognitive Behavioral Therapy (CBT) and her own experience with mental health, DBT was born.

For individuals with BPD, it can be incredibly difficult to manage emotions. This lack of control then often leads to impulsivity and can affect how the individual sees themself. DBT sought to give individuals skills to help navigate these emotions and interrupt impulsive thoughts and behaviors. The four key skills of DBT are mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. Below are how each skill can help with BPD.

Mindfulness

Mindfulness skills are broken up into two types, “what” skills and “how” skills. “What” skills teach you how to be fully present in the moment; observe, describe and participate fully in what is currently going on. These skills help resolve impulsive or emotion-driven behaviors as you are present without awareness of impulsive thoughts. “How” skills focus on being effectively present in the moment without having a judgmental mindset and focusing on one thing at a time. Individuals with BPD often ruminate on the past or future and these skills help keep you focused on what is the “here and now.”

Interpersonal Effectiveness

Relationships can be a difficult thing to maintain for someone who struggles with BPD. Often, individuals have a history of abuse, neglect, or invalidation that leads to insecure attachment which affects relationships later in life. Interpersonal effectiveness teaches people how to ask for what they need, how to say “no” to inappropriate demands and cope with interpersonal conflict. The goal is to maintain respect for yourself in addition to holding onto meaningful relationships. 

Emotional Regulation

people who are diagnosed with BPD struggle with intense emotions that often feel uncontrollable. These intense emotions can often lead to dysfunctional behaviors, especially behaviors that work to avoid negative emotions. Emotional regulation helps you to regain control over personal emotions. By working to identify emotions, you can begin to understand the function of the behavior the emotion leads to. Once you’ve identified the emotions, you can begin to change emotions and behaviors. 

Distress Tolerance

Distress is something everyone experiences. But for people with BPD, this distress can feel chronic or debilitating. Distress Tolerance teaches you how to experience your current situation non-judgmentally without trying to change it. It is important to note that accepting your situation does not mean you must approve it. Through crisis survival and acceptance strategies, you can learn how to soothe and adjust your thoughts in the moment. 

While there is no cure for BPD, Dialectal Behavior Therapy can begin to provide hope and the tools to support people struggling with BPD. Schedule a session with a DBT specialist today.

Sources:

Dialectical Behavior Therapy | Behavioral Research & Therapy Clinics. (n.d.). Retrieved March 16, 2023, from https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

Linehan, M. (2015). DBT skills training manual (Second edition). The Guilford Press.

May, J. M., Richardi, T. M., & Barth, K. S. (2016). Dialectical behavior therapy as treatment for borderline personality disorder. The Mental Health Clinician, 6(2), 62–67. https://doi.org/10.9740/mhc.2016.03.62

Moeller, F. G., Barratt, E. S., Dougherty, D. M., Schmitz, J. M., & Swann, A. C. (2001). Psychiatric Aspects of Impulsivity. American Journal of Psychiatry, 158(11), 1783–1793. https://doi.org/10.1176/appi.ajp.158.11.1783

It’s not uncommon nowadays to hear someone say “Yeah I dyed my hair last night because I let the intrusive thoughts win.” Maybe you’ve even thought to yourself “I’m going to let the intrusive thoughts win and cut myself bangs” or something along those lines. But what actually are intrusive thoughts and why are casual phrases like this harmful?

Intrusive thoughts are generally associated with Obsessive-Compulsive Disorder (ODC). These thoughts can usually be identified as something the person does not personally believe; they are intruding on your normal, everyday thought process.

For people with OCD, acting on intrusive thoughts or “letting them win” is the last thing they want to do, and that’s what makes it obsessive. Compulsions are repetitive actions in an attempt to negate obsessive thoughts. For example, an obsessive or intrusive thought would be “I think I hit someone while I was driving but didn’t notice in the moment” and the compulsion would be going back to constantly check and see if someone actually got hit.

A very common misunderstanding of OCD as being a “clean freak” or wanting everything to be organized and perfect can be very harmful because it misconstrues the true definition of this mental illness. Additionally, casual language, especially “letting the thoughts win” can be very harmful and dismissive of the experiences of people with mental illness. The casualness also leads to misrepresentations and a lack of understanding of OCD.

(Wanting to put jewelry on your plants is NOT an intrusive thought.)

 (Having specific and negative thoughts that are not your own about your girlfriend ARE intrusive thoughts.)

This distinction is important as identifying mental disorders can be empowering for those who experience intrusive thoughts. It’s also important that representation of mental illness is correct so people can better understand and support people who may be struggling.

If you or someone you know is struggling with intrusive thoughts or OCD and want help or support, schedule a session with a mental health clinician here. Exposure and Response Prevention (ERP) Therapy is commonly used to treat individuals with OCD.

Impulsivity

Now that we’ve covered intrusive thoughts, what are impulsive behaviors? Impulsive behaviors are a reaction to certain situations that are not planned and the consequences of said actions are not thought through. These behaviors are often risky or inappropriate for the given situation and generally have negative consequences.

Cutting your bangs or dying your hair at 1 am could be defined as impulsive behavior if it is unplanned and the negative consequences are not considered. Repeatedly cutting your hair because you have negative thoughts about your appearance would be considered compulsive behavior.

Impulsive behaviors are often associated with attention-deficit/hyperactivity disorder (ADHD), personality disorders (such as borderline personality disorder), or substance use disorders. DBT, or Dialectical Behavior Therapy, is often used to treat impulsive behaviors. DBT works with the “wise mind” which is the middle ground between your “emotional mind” and your “rational/reasonable mind.” By thinking with your “wise mind” we can picture what is true and begin to unlearn thought processes that cause impulsive behaviors. An activity your therapist might do with you would be the Four Square Pros and Cons as laid out below:

Learn more about DBT and its uses here.

Sources:

• Heather A. Berlin, P., & Eric Hollander, M. D. (2008). Understanding the Differences Between Impulsivity and Compulsivity. 25.
• https://www.psychiatrictimes.com/view/understanding-differences-between-impulsivity-and-compulsivity
• How to Check Your Impulses Using DBT – Pine Rest Newsroom. (2019, May 20). https://www.pinerest.org/newsroom/articles/how-to-check-your-impulses-using-dbt-blog/

CBT, DBT, ACT, MI, ERP, EFT, IFS, EMDR and so many more. What do all these acronyms mean and how can they be used in your therapy sessions?

The following is not an extensive list of the different types of therapy by any means. The therapeutic treatments, styles, or modalities listed below are some of the most commonly practiced. If you’re new to therapy and not sure where to start, this list may be helpful in identifying a clinician or practice that you might like to work with.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) involves looking at concerns or stresses in your life and reframing how you think about those issues. CBT is broken up into three different stages: cognitive challenging, cognitive refocusing, and cognitive reframing. Throughout your sessions, your therapist will have you identify thoughts and patterns. Once you’ve identified thoughts, together you can think about whether or not the thought is helpful. From there you will work to “reframe” or rethink the unhelpful thoughts. For example, a thought could be “I’m not worthy and I don’t deserve my friends.” And a reframe could be “I am a valuable person and my friends love and care about me.”

Dialectical Behavior Therapy (DBT)

The development of Dialectical Behavior Therapy, or DBT, used CBT as a base and then expanded and added acceptance and change skills. Borderline Personality Disorder (BPD) was the original diagnosis DBT sought to treat, but it has also been proven to be successful in treating eating disorders, substance use disorders, post-traumatic stress disorder (PTSD), suicidal ideation, and self-harming behaviors. There are four key interventions that make up DBT: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Your therapist may guide you through different activities during your sessions together. For more information on DBT read our DBT Overview blog post.

Acceptance and Commitment Therapy (ACT)

Contrary to CBT, Acceptance and Commitment Therapy (ACT) teaches us to accept our thoughts as they are and practice mindfulness. The six key principles of ACT are Contact With the Present Moment, Values, Committed Action, Self-As-Context, Defusion, and Acceptance. ACT describes almost every psychological problem as getting “hooked” in difficult thoughts and feelings. And through “diffusion” ACT asks us to be open to the present and “become comfortable with the uncomfortable.” A popular ACT mindfulness activity is Leaves on the Stream.

Motivational Interviewing

Motivational Interviewing involves finding motivation within yourself in order to change yourself. Often used to support substance use, motivational interviewing operates on the belief that you already have the power within yourself to make changes in your life. While you may not be ready to commit to change, throughout your sessions your therapist will help guide you to find the motivation. Your therapist will spend lots of time listening and reflecting back on what they hear you saying.

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Something to keep in mind during therapy is that your therapist may not stick to one approach for the entire time you are together. Different symptoms that present themselves throughout your journey in therapy may require different approaches. Additionally, you may not spend each session engaging in activities or interventions. Therapy is a different experience for everyone and there is no one-size-fits-all approach. Most therapists will walk you through these techniques and activities with the intent that you will continue to practice the skills outside of therapy and incorporate them into your daily life.

Not sure what therapy even looks like? Read more here: What to Expect in Therapy

Sources:
Beck, J. S. (2021). Cognitive behavior therapy: Basics and beyond (Third edition). The Guilford Press.
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy (Second edition). New Harbinger Publications, Inc.
Linehan, M. (2015). DBT skills training manual (Second edition). The Guilford Press.
Understanding Motivational Interviewing | Motivational Interviewing Network of Trainers (MINT). (n.d.). Retrieved April 24, 2023, from https://motivationalinterviewing.org/understanding-motivational-interviewing

Have you ever been caught in an emotional whirlwind that feels like a never-ending spiral? Or like you’ve fallen into a pit of emotions and can’t pull yourself out? Or even that negative thoughts constantly cloud your mind. If you resonate with any of these statements, DBT could help you overcome these thoughts. But what is DBT? And how can it help you in therapy?

Dialectical Behavior Therapy, or DBT, was developed by Dr. Marsha Linehan in 1987. Although Borderline Personality Disorder (BPD) was the original diagnosis DBT sought to treat, it has been proven to be successful in treating eating disorders, substance use disorders, post-traumatic stress disorder (PTSD), suicidal ideation, and self-harming behaviors. DBT is founded on the belief that people struggling with their mental health can learn effective coping strategies.

There are four key interventions that make up DBT: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills are broken into two categories, acceptance skills, and change skills. Mindfulness and distress tolerance teach us how to accept our thoughts as they are, whether positive or negative, and how to navigate the feelings associated with these thoughts. Emotional regulation and interpersonal effectiveness teach us how to identify our needs and change our emotions.

Mindfulness

Mindfulness is the first skill taught in DBT and creates the foundation for the other skills to follow. Marsha Linehan describes mindfulness as “the act of consciously focusing the mind in the present moment without judgment and without attachment to the moment.” Mindfulness is not just a state of calm but rather has to do with the quality of one’s current awareness or presence. In a therapy session, your clinician might walk you through a mindfulness exercise and help you identify thoughts throughout the exercise. The therapist might encourage you to practice the same mindfulness exercise outside of the session and record your thoughts afterward.

Distress Tolerance

Distress is a natural part of life that we cannot avoid. However, at times it can become overwhelming and begin to affect our everyday lives. Regulating one’s levels of distress follows the natural progression of mindfulness. The skills taught in the distress tolerance phase will teach you how to get through a crisis and accept things as they are. At its core, distress tolerance is “the ability to perceive one’s environment without put- ting demands on it to be different; to experience one’s current emotional state without attempting to change it; and to observe one’s own thoughts and action patterns without attempting to stop or control them.”

Emotional Regulation

Being vulnerable and accepting emotions is the core of emotional regulation. By being able to not only name our emotions but also allow ourselves to feel them, we can begin to understand what purpose our emotions are serving us, either positively or negatively. In noticing this change, we can begin to change the way we see our emotions.

Interpersonal Effectiveness

Identifying needs, being able to say “no,” and managing interpersonal conflict are the core strategies and skills that are built when working on Interpersonal Effectiveness. The goal is to be able to get what you need from relationships while being respectful to yourself and others. A common DBT exercise within this module is the DEAR MAN which stands for:
Describe the current situation
Express your feelings
Assert yourself
Reinforce

Stay Mindful
Appear confident
Negotiate

What does this look like in therapy?

DBT can be used in either an individual or a group therapeutic setting. DBT interventions often use worksheets or role-play activities to practice the skills.

Think DBT is right for you? Schedule a session with a Better Life clinician today!

Sources:

DBT Skills List. (n.d.). DBT Self Help. Retrieved March 16, 2023, from https://dbtselfhelp.com/dbt-skills-list/

Dialectical Behavior Therapy | Behavioral Research & Therapy Clinics. (n.d.). Retrieved March 16, 2023, from https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/

Floyd, E. (2019, October 28). Accepting Reality Using DBT Skills. Skyland Trail. https://www.skylandtrail.org/accepting-reality-using-dbt-skills/

Linehan, M. (2015). DBT skills training manual (Second edition). The Guilford Press.