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

Whether you have been diagnosed with an anxiety disorder or go through seasons of anxiety, DBT can be a tool that can help. If you are not familiar with Dialectical Behavioral Therapy (DBT), please see our previous blog post that covers DBT in depth.

Everyone at one point in their life experiences anxiety in some capacity. In fact, an estimated 31.1% of adults in the U.S. are diagnosed with an anxiety disorder at some point in their lives (US Department of Health and Human Services). You know the feeling; nervousness, racing heart, tight chest, sweaty palms, stomachaches, muscle tension, consistent worrying or feeling like the walls are caving in. Here are a few skills that can provide immediate relief when anxiety strikes.

How DBT Skills Can Curve Anxiety

• Mindfulness – one of DBT’s skills is learning how to separate from your emotions through mindfulness. Practicing mindfulness can be as simple as reminding yourself that you are not your thoughts.  
• Emotional Regulation and Distress Tolerance –  These are fancy DBT terms that mean “gaining control of your emotions” and “getting comfortable being uncomfortable”. Applying these skills when anxiety hits has proven to signifcantly decrease symptoms.  

What’s the Evidence?

Although DBT was originally created to treat Borderline Personality Disorder, it has been proven to be an effective treatment for eating disorders, suicidal ideation, substance abuse PTSD, anxiety and more. The strong focus on mindfulness and emotional regulation make DBT a reliable option to consider for anxiety. 

Therapy isn’t an Option at this Time?

Not a problem. There are steps you can take right now to start implementing DBT skills and feel more in control of your anxiety. Start by finding small ways to seperate from your anxiety and see it as a seperate part of you. 

Here are a few ideas to try:

• Move your body in some way
• Journal 
• Connect with nature (bonus points if you can get some sunshine while doing it!)
• Cook a new recipe 
• Interact with a pet or a friends’ pet
• Light a candle and focus on the flame for 60 seconds
• Draw, paint, or color
• play your favorite song LOUDLY

Want to give DBT a try for your anxiety? Reach out to Better Life Therapy to be connected with one of our trained therapists. 

Sources:

Canadian Agency for Drugs and Technologies in Health. (2017). Dialectical behavioral therapy for adults with mental illness: A review of Clinical Effectiveness and guidelines.

Falabella, G. S., Johnides, B. D., Hershkovich, A., Arett, J., & Rosmarin, D. H. (2022). CBT/DBT-informed intensive outpatient treatment for anxiety and depression: A naturalistic treatment outcomes study. Cognitive and Behavioral Practice, 29(3), 614-624. https://doi.org/10.1016/j.cbpra.2021.05.001

Malivoire, B. L. (2020). Exploring DBT skills training as a treatment avenue for generalized anxiety disorder. Clinical Psychology (New York, N.Y.), 27(4), n/a. https://doi.org/10.1111/cpsp.12339

U.S. Department of Health and Human Services. (n.d.). Anxiety disorders. National Institute of Mental Health. Retrieved April 5, 2023, from https://www.nimh.nih.gov/health/topics/anxiety-disorders 

It’s 2023, and although we are making strides toward destigmatizing mental health challenges, the topic of self-harm can still be taboo for some. Self-harm is often a secretive form of coping with intense emotions such as saddness, anger, frustration, loneliness and more. The goal of this blog is to bring awareness and normalize self-harm as well as provide immediate strategies to help yourself if you currently are struggling with it.

What is Considered Self-Harm?

The National Alliance on Mental Illness (NAMI) describes self-harm as the act of hurting yourself intentionally. Self-harming behaviors are a coping mechanism many teenagers, young people, and adults develop to manage intense emotions. Many people who self-harm learned to repress their emotions and self-harming acts as a way to release them. Although self-harm creates a short-lived sense of calm, w  it also comes shame and guilt, which can lead to more self-harm, creating a vicious cycle. Examples of ways people may self-harm are cutting, burning, picking wounds or scabs, head banging and pulling out hair.

How DBT Can Help

Dialectical Behavior Therapy (DBT) is commonly used in psychotherapy to support in managing intense emotions and minimizing self-harm. The goal of DBT is to provide positive coping mechanisms for when intense emotions surface and create healthy emotional regulation. Although DBT is most effective when conducted with a trained professional, there are a few skills you can apply immediately to help bring down intense emotions that lead to self-harm.

Support Yourself Now

If you find yourself in a situation where you are feeling the urge to self-harm and are unable to seek professional help at this time, trying one of these options might help:

1. Crisis hotline 9-8-8 – self-harm is almost always accompanied by intense emotions. The crisis hotline can be a place to talk about your feelings and get immediate support.
2. Change your body temperature – splash cold water on your face or take a warm bath.
3. Distract yourself- watch your favorite comedy, engage in intense exercise for 20 min or hold an ice cub in your hand and feel it melt
4. Practice mindfulness- observe your emotions and try not to change them. Remind yourself that you are in control and that they will pass.

How Therapy Can Help

Although the techniques above can provide new ways of coping with intense feelings that lead to self-harm, talking with a therapist allows space to address the underlying issues and paves the way toward healing. Many therapists at Better Life Therpay are trained in DBT and ready to help.

References

Linehan, M. M.(2015) DBT skills training manual (2nd ed.). New York, NY, US: Guilford Press.

https://www.crisistextline.org/topics/self-harm/#what-is-self-harm-1

https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Self-harm

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.