DBT was developed to help people whose distress overwhelms their ability to cope with intense emotions. The treatment is designed to help clients create a ‘life worth living.’ To put it simply, the purpose of treatment is to become skillful at confronting life’s challenges. Of course, this is easier said that done which is why the individual and the therapist work together to use specifically designed DBT skills to address problems, starting with the most serious:
- Problems that interfere with staying alive (life-threatening behaviors or suicide thinking)
- Self-injurious behaviors
- Behaviors that interfere with treatment
- Other problems that interfere with quality of life (depression, anxiety, etc.)
- Problems with creating meaning and joy in life
DBT is more intensive than traditional outpatient therapy. Clients are expected to attend a weekly DBT Skills group while meeting weekly with a DBT trained therapist. In the individual sessions, the client and therapist collaborate to apply the skills to life challenges the client is experiencing. In addition, the therapist is available for “coaching”. Coaching calls are not ‘therapy over the phone’, but do provide clients with assistance in applying the skills they are learning to ‘real life’ problems. The skills training group takes approximately six months to cover skills for emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness. Hence, a six month commitment is expected.
DBT Skill Modules
To address emotion dysregulation, one must learn new skills. Every week, individuals will learn skills from the four modules of DBT which are: Mindfulness, Interpersonal Effectiveness, Distress Tolerance, and Emotion Regulation.
Mindfulness skills are core skills in DBT that teach being in the present moment. Mindfulness is the practice of bringing a conscious awareness to thoughts, feelings, behaviors, bodily sensations, and events through observation, description, and participation, rather than through judgement.
Interpersonal Effectiveness teaches skills that help individuals more effectively and skillfully assert themselves in order to get their needs met while maintaining self-respect and relationships. Core skills taught include how to assert oneself to make a request, how to refuse a request, and how to cope with conflict. Individuals are encouraged to practice these skills in order to initiate new relationships and maintain relationships. Effective use of these skills can help increase socialization and enjoyment from relationships with others. Identifying destructive relationships and skills on how to end them are also covered in this section.
Distress Tolerance teaches accepting and coping with painful or distressing emotions or events. These skills help survive a “crisis” situation by accepting the current situation and finding ways to get through it without making things worse.
Emotion Regulation skills help modulate painful emotions that are sometimes linked to impulsive or risky behavior. These skills help one understand current emotions, identify obstacles to changing unwanted emotions, check the facts around emotions, change emotions, and increase positive emotions, as well as problem solving skills.