Sometimes, people look at the word “dialectical” and their eyes go unfocused. “That sounds complicated,” they might say, “or technical”. The more adventurous might look up the word on the internet, but then get even more intimidated, because notions of philosophical debate are usually mentioned. That all might seem complicated and intimidating, but the concept is actually much simpler than you might think.
Before I come back around to “dialectical”, allow me to spend a minute giving you an overview of my relationship to Dialectical Behavior Therapy (DBT). In my psychotherapy practice, I facilitate DBT Skills Groups, and I recommend the groups to many of my clients. I believe in the power of DBT to help a wide range of mental health challenges from anxiety and depression, to the symptoms of Post-Traumatic Stress Disorder (PTSD), and even personality disorders such as Borderline Personality Disorder (BPD) for which DBT was originally developed.
I believe in this both because I’ve seen it in action over and over in the lives of actual clients, but also because numerous scientific studies have validated the techniques to treat an increasing range of disorders. When new clients ask me why I teach the class, I tell them it is because I not only appreciate what it can do for my clients, but because I am glad to be re-exposed to the skills myself. I have a hard time imagining a person who could not benefit from DBT.
Why is DBT Effective?
In short, I regard DBT as the world’s best collection of coping skills all in one place.
Details on the Modules
The modules of DBT Skills groups are broken up into Core Mindfulness (repeated at the beginning of each module), Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. Just the names of the modules sound good, right?
To understand how the modules teach coping skills, we will take a brief look at one sample technique from each module (though there are several within each module)
1. Core Mindfulness
This module is foundational to the work of each of the other modules. Volumes of books have been written about both the concept and the practice of mindfulness. However it’s actually not at all complicated. The main practical point about mindfulness is developing the skill of knowing what is going on in any given moment.
“Wait a minute,” you might say, “I already know what’s going on.”
So, this is where it might seem to get tricky. Do you really know what is going on? How are you looking at any given situation? Are you seeing it through a distorted lens or a clear one?
On the one hand, are your biases from your past (especially past traumas) influencing your interpretation? On the other hand, might an icy-cold calculation which fails to consider all the appropriate feelings involved miss the mark? The DBT mindfulness component seeks to help you find the underlying reality, using very practical, step-by-step techniques.
It’s All About Balance
This is where we can get back to the “dialectical” idea. DBT uses a very simple model of how your mind works, dividing it into Emotion Mind, Reasonable Mind, and Wise Mind. The idea is that if you blend and balance the messages coming from Emotion Mind with the messages coming from Reasonable Mind, you will be more likely to obtain a Wise Mind result.
If you will forgive the geeky metaphor, neither Spock-like calculation nor McCoy-like reactivity will produce ideal results. However, resolving the two into Kirk-like decisions yields wiser outcomes. Well, maybe. At least for Kirk-ish values of “Wise”.
Sci-fi comparisons aside, if “dialectical” means blending and balancing two things that might seem to be opposites, and resolving them into an integrated whole, well that is not so complicated after all.
2. Distress Tolerance
What happens if you run into situations that you just cannot change but have to endure? Are you going to blow up, melt down, act out? While any one of those might temporarily relieve your misery, most come with negative consequences that a person later regrets. How about finding ways to cope that are easily accessible, repeatable, and will not hurt you?
When in Distress, Change Your Biology
A quick and easy way to do this is to take advantage of a neat hack already built into your body, called the dive reflex. Apparently, evolution endowed us with the power to chill out a little bit when water splashes on our face. Why? Theorists hypothesize that this exists to save our breath when diving into the water. All those mammals who gasped or sputtered when diving into the water, and who choked or drowned as a result, are no longer around to tell the tale of what went wrong. As the ancestors of those who chilled out instead, all of us get a reliable trick we can use to quickly change our mood: simply splash cool water on your face.
3. Emotional Regulation
How about situations in which people constantly point out that you “over-react”? Do you have a temper that is hard to contain? Do you get easily frightened by things that never actually harm you? There are ways to manage these responses that are less likely to cause regret.
Opposite Action Technique
The following is a technique to do the opposite of what you habitually do in a stressful situation. For example if you are avoiding someone because they remind you of someone else who hurt you in the past, it might make sense to counteract that avoidance with a wiser course. You can make up your mind to move towards them on purpose, despite your resistance.
On the other hand if someone in your life really is threatening your safety for example, then your emotional response is absolutely correct. Your action urge to say, move away from them and avoid them, is spot on. So part of the process is knowing what’s actually the case. This goes back to the mindfulness component, which helps you be more in touch with the reality of situations.
Examine your interpretations and question them. Use mindfulness skills to tune into the body’s senses and find out what can be adjusted to improve any distress you feel. Take a few deep breaths to influence your biological response. Then after thwarting the unhelpful action potential by doing the opposite, you can feel a sense of power and mastery over yourself and your own emotions. Even starting small and building up is tremendously rewarding, because it starts to change the power dynamic between yourself and your emotions. You start to feel in charge again.
4. Interpersonal Effectiveness
Do you find that you have a weak or absent “no”, which causes people to take advantage of you, or do you get you overwhelmed with obligations you do not really want? How about the other side: do people call you a bully? Do you never seem to get your way no matter how loud you get? If so, you might benefit from interpersonal effectiveness skills.
The DEAR MAN Technique
DBT is rich with mnemonic acronyms, designed to make it easier to remember the techniques. This is an example of one, which may be expanded into: Describe, Express, Assert, Reinforce. Those actions are to be done a certain way, described with: Mindfulness, Appearing confident, and Negotiating. Yeah, the acronyms can be a stretch and get kind of cute, but they are memorable.
The gist of this one is to get clear about what you want at the outset, let it be known clearly and firmly, then repeat it until a satisfactory outcome is met. Use Mindfulness to get clear about goals and check in on the state of those with whom you are conversing. Keep your back straight and your gaze steady (but not too intense) so that you Appear confident. Study up on Negotiation skills to learn how trade offs and compromises work, so you can be effective when someone is trying to be manipulative or take advantage of you or the situation.
I hope this very brief overview of DBT has been useful for you, and gives you a general idea of this excellent, skills-based means of addressing anxiety, among other symptoms. I encourage you to do a deeper dive if you are interested, and even check to see if there is DBT skills group near you that you can join.