Dialectical Behavior

TherapyBy Gina Vanderham, MA,ICADC, CEAP,

SAP, LMFT, RCC

What is DBT?

ACCEPTANCE

Distress

Tolerance

Interpersonal

Effectiveness

MindfulnessEmotional

Regulation

CHANGE

Dialectics involves the synthesis of

opposites.

Dialectic Behaviour Therapy synthesizes

strategies for ACCEPTANCE and

CHANGE to promote well-being.

Clients study four skills modules pictured

on the right.

Who benefits from DBT training?

Effective recovery from…

Substance abuse and addiction

Emotional eating

Anxiety

Emotional reactivity

Mood swings

Low Self-esteem

Mindfulness

A “way of paying attention” (Kabat-Zinn, 1990)

Bringing full awareness to one thing (one mind fully) in the

moment with detached awareness

Letting go of distractions and judgments

Focusing with acceptance of what is

Mindfulness

Seeing what is, in this moment, for the first time (open mind)

Like a lampshade directing the light of your attention on just one

thing in the moment (Thich Nhat Hanh, 1987)

Not religious, though it has grown from multiple spiritual traditions

Mindfulness As A Tool For Change:

Attention to food for those who binge eat / eat emotionally

Fullness and of effect of eating on body

Hunger as cue to eat rather than as something to be

proud/fearful of

Mindfulness As A Tool For Change:

Aware of effect of substances/problematic eating on

body/family/work/school

Want client to step back and observe all aspects of eating

experience

Nonjudgmentally, trustingly and with acceptance

Mindfulness: A Breath of Fresh Air

Clears the mind

Reduces obsession

Brings attention to what matters

Increases awareness in the acceptance of self

Helps clients to find their own path

Mindfulness Practice

Can be done in any moment/place

Provides freedom to choose a course of action

Enhances mental flexibility and agility -- ability to move

attention from one thing to another

STATES OF MIND

wise mindreasonable mind emotional mind

“What”: MINDFULNESS: TAKING HOLD OF YOUR MIND

“How”: Taking Hold of Your Mind

Non-judgmentally

One-mindfully

Effectively

Dialectic Behavior Therapy:

Taking Hold of Your Mind

Observe:

Just notice the experience

Teflon mind

Control only your attention

Watch your thoughts

Senses

Emotional Regulation Training

Understand emotions you experience

Identify your emotions

Understand what emotions do for you

Reduce vulnerability to emotional mind

Decrease negative vulnerability

Increase positive emotions via positive events and

focusing on the positive

Emotion Regulation cont’

Decrease emotional suffering

Let go of painful emotions through mindfulness

Change painful emotions through opposite action

Distress Tolerance Skills

Increase: Management of Distress and Urges

1. Distract: activities, contributing, comparisons, pushing

away, pleasant thoughts, sensations

2. Self soothe: vision, hearing, smell, taste, touch

3. Improve the moment: imagery, meaning, prayer, relaxation,

one thing at a time, vacation, encouragement, pros and cons

of tolerance

More Distress Tolerance Skills

Guidelines for accepting reality:

1. Observing the breath

2. Half – Smiling exercise

3. Radical Acceptance

4. Awareness Exercises: positions of the body, connection to

the universe, while washing the dishes, having a slow motion

bath etc.

Increase: Experience & Regulation of

Emotions

Reduce vulnerability to negative emotions-stay out of

emotional mind

Treat physical illness, balance eating, balance sleep, get

exercise, build mastery

Increase positive experiences

Do pleasant things now

Build a life “worth living”

Be mindful of positive experiences- focus and re-focus

Be unmindful of worries-distract

Increase Interpersonal Effectiveness

Objective: describe, express, assert, reinforce, be mindful,

appear confident, negotiate

Relationship: gentle/not too, interested, validate, easy-going

Fair, stick to values, true to self

Cheerleading