For people trapped in harmful patterns of behavior and thought, Dialectical Behavioral Therapy (DBT) can change their lives for the better. DBT teaches the importance of creating a life worth living and exposes patients to uncomfortable emotions to teach the brain that, by practicing healthy coping mechanisms, we can survive unthinkable situations and the hardest emotions.
What’s in a name?
The word “dialectical” means dealing with polarizing ideas, or opposing thoughts. Someone who has experienced trauma may fall into the habit of seeing the world in black and white: Everything he or she experiences is sorted into categories of good and bad, with no room in the middle for nuance. This distorted worldview leads to emotional suffering.
Psychologist Marsha Linehan created this therapeutic technique to help people experiencing persistent suicidal thoughts, but the psychiatric community soon realized the method showed great promise not just for those patients, but for anyone whose worldview and behavior have been changed by stress or trauma.
How DBT Works
DBT has expanded in popularity in recent years for its ability to help people change their behavior and process their emotions rather than avoiding them. DBT involves creating a safe space for patients to process their emotions. It has four main components: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Mindfulness is the ability to stay mentally in the present moment. This is a skill that involves allowing one’s thoughts and emotions to exist, accepting them rather than reacting to them, judging them, or repressing them. A mindfulness practice can include intentional breathing and guided meditation all aimed at helping a person acknowledge their emotions without being controlled by them.
Distress tolerance means being able to handle difficult situations and negative emotions without acting out in harmful ways. Someone with high distress tolerance is resilient and can return to their emotional baseline rather than existing in emotional extremes.
Emotion regulation is very similar to distress tolerance. It is the toolkit that an individual can draw from to handle stressors and maintain in control of their responses, rather than being at the mercy of their own emotions.
Interpersonal effectiveness coaches the patient on how to interact with others. In this module, participants learn appropriate ways to create and maintain social bonds and set healthy boundaries.
Inappropriate emotional reactions might be unexpected and unwelcome, but they don’t appear out of thin air. Often, dysregulated moods are a response to trauma. People can easily get stuck in a hostile dependence on their own families and fall prey to irrational stubbornness that frustrates themselves and those around them.
The whole family needs help when mental illness crisis strikes. Consider the goldfish as a metaphor: A goldfish (the person struggling with his or her mental health) has been swimming around in dirty water (an unhealthy environment that keeps them in poor communication patterns). Taking the goldfish out of the tank lets them develop new and health skills, but putting them back in a dirty tank would ultimately drag them back into the same harmful patterns they worked so hard to overcome. The whole environment must change.
Someone accustomed to a chaotic environment may depend on chaos and may create chaos when none exists simply to help them maintain a sense of normalcy. Individuals who suffer from severe emotional dysregulation are likely to turn to substance abuse, controlling behavior, and an unhealthy dependence on social media jus to regain some sense of ownership over their own thoughts. People who have fallen into these unhelpful coping mechanisms are likely to be able to benefit from DBT.
Biosocial Theory holds that some people are biologically prone to emotional sensitivity. This means they react strongly to their feelings and have a harder time than most when it comes to returning to a healthy emotional baseline. You might think of these individuals as lion cubs living in families of house cats: They have huge responses to events and emotions that barely bother those around them.
A parent’s gut reaction may be to tell this child that his or her emotions are too extreme and therefore not valid. DBT does the opposite: It holds that these emotions are real, valid, and worth exploring. By holding space for these emotions, DBT allows patients to process volatile feelings without being governed by them.