I have recently come across Dr Marsha Linehan’s work on DBT, Dialectical Behavioral Therapy. I’ve found it really encouraging and I’m creating a few blog posts around it for a couple of reasons. Firstly it fits in with a journaling practice really well. Secondly it fits in with the health and wellness subject matters which we also cover in the Wardrobe Journaling website.
I have written a blog post on a DBT diary card which also covers, briefly, the difference between DBT and Cognitive Behavioral Therapy.
I hope you find everything in this blog and the other two really interesting and that it inspires you to use it in someone to help you in your life.
Dialectical Behaviour therapy is a type of therapy that combines elements of cognitive-behavioral therapy (CBT) with concepts from dialectics, which refers to the examination of opposing viewpoints and finding a synthesis or balance between them.
DBT was developed by psychologist Marsha Linehan in the late 1980s, primarily as a treatment for borderline personality disorder (BPD). However, it has since been adapted and used to treat various other mental health conditions.
DBT focuses on helping individuals develop skills in four main areas:
- Mindfulness: The practice of being fully present and aware of the current moment, without judgment.
- Distress Tolerance: Developing strategies to cope with and tolerate distressing situations without resorting to self-destructive or impulsive behaviors.
- Emotion Regulation: Learning to identify, understand, and manage emotions effectively to avoid extreme emotional reactions.
- Interpersonal Effectiveness: Acquiring skills to navigate and improve relationships, including setting boundaries, effective communication, and problem-solving.
DBT typically involves both individual therapy and group skills training. Individual therapy sessions focus on exploring and addressing specific issues and behaviors, while group sessions provide education, support, and opportunities for skill-building.
DBT has been found to be effective not only for borderline personality disorder but also for other conditions such as substance abuse, eating disorders, depression, anxiety disorders, and post-traumatic stress disorder (PTSD). It is known for its emphasis on validation, acceptance, and balancing change with self-acceptance.
DBT and Distress Tolerance Skills
One of the first things that I found brilliant about Dr Linehan’s work is the idea of distress tolerance skills. While I appreciate that Dr Linehan’s work is primarily with people with Borderline Personality Disorder (BPD) as I read these skills I realised how useful they can be in my own life to help me get through my daily life.
I particularly appreciate her work on radical acceptance which is explained in the section below. I realise that radical acceptance is taught in the major world religions around the world, including my own, Christianity. But hearing it spoken about in a different context gave me a completely different idea for how radical acceptance feels in my body and how I can engage with it better.
If you are new to DBT then you might find a very quick introduction to Distress tolerance skills very useful.
Distress tolerance skills
Distress tolerance skills are strategies and techniques used in Dialectical Behavior Therapy (DBT) to help individuals effectively cope with and tolerate distressing or overwhelming emotions. These skills are particularly useful in situations where it may not be possible or appropriate to immediately change or solve the source of distress. The goal of distress tolerance skills is to help individuals survive and get through difficult moments without making impulsive or self-destructive choices. I am finding these skills really useful for situations in my current life which are challenging and which have led me to feeling depressed, emotional eating, feeling trapped in my situation and wanting to withdraw from the situation and the world.
Here are some common distress tolerance skills used in DBT which you can use and adapt for yourself:
- Self-Soothing: Engaging in activities or behaviours that provide comfort and bring a sense of calmness. This can include things like taking a warm bath, listening to soothing music, practicing deep breathing exercises, or using aromatherapy.
- Mindfulness: Focusing attention on the present moment without judgment. Mindfulness exercises, such as mindful breathing or body scans, can help individuals observe their thoughts and emotions without getting caught up in them.
- Radical Acceptance: Acknowledging and accepting reality as it is, even if it’s difficult or painful. It involves letting go of resistance and finding ways to tolerate the distressing situation without trying to change or fight against it.
- Distraction: Engaging in activities that redirect attention away from distressing emotions or situations. This can include activities like watching a movie, reading a book, playing a game, or going for a walk.
- Improving the moment: Finding ways to make the present moment more tolerable or positive. This can involve engaging in pleasurable or meaningful activities, using imagery or visualization techniques, or using humour.
- Comparisons: Comparing the current situation to a more difficult or distressing experience in order to gain perspective and remind oneself that the current distress is manageable.
- Pros and Cons: Weighing the potential positive and negative consequences of engaging in impulsive or destructive behaviors versus tolerating the distress. This helps individuals make more informed decisions about their actions.
- Radical Self-Care: Engaging in self-care activities that promote physical and emotional well-being. This can include getting enough sleep, eating balanced meals, exercising, and seeking support from others.
These skills aim to provide individuals with alternative ways to manage distressing emotions and situations, reducing the likelihood of engaging in harmful or self-destructive behaviours. It’s important to note that distress tolerance skills are not meant to be long-term solutions but rather tools to help individuals get through challenging moments until they are able to address the underlying issues more effectively.
The Stop skill
I don’t have massively destruction or impulsive behaviours. Or so I thought! But when I analysed my attitude to risk for example I can see that part of what I regard as being risk tolerating is also impulsive and partly destructive. So what I used to regard as risk tolerant is sometimes an emotional reaction in difficult situations.
Learning emotion regulation skills for stopping myself saying “I’ll take the risk” when the underlying motivating thought is, “I’m frustrated in this moment/experiencing negative emotions and am just going to press the button/any button”, is really really useful. I think for anyone who is trying to be patient and struggles, the stop skill is so invaluable to help with emotional regulation in stressful situations.
Here is a brief outline of the stop skill
In Dialectical Behavior Therapy (DBT), the STOP skill is a technique used to help individuals pause and gain control over impulsive or destructive behaviours. STOP is an acronym that stands for:
S – Stop:
The first step is to physically or mentally stop what you are doing. This pause allows you to create a moment of awareness and interrupts the automatic response.
T – Take a step back:
Once you have stopped, take a step back from the situation, both physically and mentally. This step helps you gain some distance from the immediate triggers and emotions, allowing for clearer thinking.
O – Observe:
After taking a step back, observe and pay attention to what is happening within yourself and in the environment. Notice your thoughts, emotions, bodily sensations, and any external factors that might be influencing your behaviour.
P – Proceed mindfully:
Once you have observed and gained some clarity, you can decide how to proceed in a more mindful and intentional way. Consider the consequences of different actions and choose a response that aligns with your values and long-term goals.
The STOP skill is often used in situations where impulsive or self-destructive behavior is likely to occur. By utilizing this technique, individuals can break the cycle of automatic reactions and engage in more thoughtful and effective responses. It provides a moment of mindfulness and self-reflection, enabling individuals to make healthier choices and avoid impulsive or harmful behaviours.
DBT stop skill worksheet
Here are a number of stop skill worksheets produced by others, more qualified than me, to do so.
Eden Counselling Stop Skill worksheet
Therapist Aid (variety of worksheets)
It is highly recommended that you seek the guidance of mental health professionals, such as a DBT therapist, to effectively navigate DBT practice. For individuals experiencing mild symptoms of BPD or those interested in learning self-regulation techniques, utilizing the therapist aid worksheets independently could be a viable short-term option.
However, it’s important to note that I am not a medical practitioner or therapist, and my role is to emphasize the tremendous value I’ve personally found in DBT skills training handouts.
I strongly recommend that you consider working with a DBT therapist for personalized guidance in advancing your practice. They can provide valuable support in crisis survival skills, reality acceptance, interpersonal relationships, and addressing strong urges.
Complementary/supporting strategies to DBT
Alongside Dialectical Behavior Therapy (DBT), several complementary strategies can enhance the therapeutic process and support individuals in managing their emotions and improving their overall well-being. Here are some commonly used complementary strategies:
- Mindfulness Practices: Mindfulness is a key component of DBT, and incorporating formal and informal mindfulness practices can deepen its effectiveness. Mindfulness meditation, body scans, and mindful breathing exercises can help individuals cultivate present-moment awareness, reduce reactivity, and enhance emotional regulation.
- Self-Care: Engaging in regular self-care activities is essential for promoting overall well-being. This can include practices such as getting enough sleep, maintaining a balanced diet, participating in enjoyable hobbies or activities, practicing good hygiene, and nurturing social connections.
- Relaxation Techniques: Various relaxation techniques, such as progressive muscle relaxation, guided imagery, deep breathing exercises, or listening to calming music, can help individuals reduce stress, lower anxiety levels, and promote a sense of calmness.
- Supportive Relationships: Building and maintaining positive, supportive relationships can provide a strong foundation for emotional well-being. Seeking the support of friends, family, or support groups can provide a sense of validation, understanding, and encouragement throughout the therapeutic journey.
- Physical Exercise: Engaging in regular physical exercise, such as aerobic activities, strength training, or yoga, can have numerous benefits for mental health. Exercise promotes the release of endorphins, reduces stress hormones, and improves overall mood and well-being. Intense exercise can also have a positive effect on the mind.
- Cognitive Restructuring: Cognitive restructuring techniques help individuals identify and challenge negative or distorted thinking patterns. By replacing irrational or unhelpful thoughts with more realistic and balanced ones, individuals can experience a shift in their emotions and behaviors.
- Artistic Expression: Creative outlets such as art therapy, writing, music, or dance can provide a means of self-expression and emotional release. Engaging in artistic activities can promote self-reflection, reduce stress, and enhance emotional well-being.
- Journaling: Keeping a journal or diary can serve as a therapeutic tool for self-reflection, tracking emotions, and identifying patterns or triggers. Writing thoughts and feelings down can provide a sense of clarity and facilitate the exploration of one’s experiences.
- Spirituality or Mind-Body Practices: For individuals with a spiritual or religious inclination, incorporating practices like prayer, meditation, or attending religious services can provide solace and support in their healing journey. Mind-body practices such as Tai Chi or Qigong can also help cultivate a sense of balance and harmony.
It’s important to note that these complementary strategies are not meant to replace DBT but rather to enhance its effectiveness. Working with a trained therapist or mental health professional can provide guidance on integrating these strategies into one’s treatment plan and tailoring them to individual needs and goals.
DBT and a journaling practice,
Does Marsha Linehan say anything about journaling?
Marsha Linehan recognises the value of journaling as a complementary practice to DBT.
In her book “Skills Training Manual for Treating Borderline Personality Disorder,” Linehan discusses the importance of keeping a diary card, which is a specific form of journaling used in DBT.
The diary card is a tool designed to help individuals track and monitor their emotions, behaviours, and skills usage on a daily basis. It provides a structured format for individuals to record their experiences, such as their level of distress, urges to engage in impulsive behaviours, skill utilization, and other relevant information. The diary card helps individuals gain insight into their patterns, triggers, and progress over time, thus facilitating self-awareness and enhancing the effectiveness of therapy.
Linehan emphasizes the importance of consistent and honest tracking in the diary card. By regularly noting experiences and reflecting on them, individuals can better identify patterns, monitor progress, and discuss relevant information with their therapists during sessions. The diary card serves as a valuable tool for both individuals and therapists to collaboratively evaluate and modify treatment strategies.
While Linehan specifically focuses on the use of the diary card, the principles of journaling extend beyond this specific tool. Engaging in reflective journaling outside of therapy sessions can be an additional practice that supports self-reflection, emotional processing, and the integration of DBT skills into daily life. By writing down thoughts, feelings, experiences, and reflections, individuals can deepen their understanding of themselves, identify triggers, explore alternative perspectives, and track progress in applying DBT skills.
It’s worth noting that the use of journaling or reflective writing in DBT may vary based on individual therapist preferences and treatment plans. It is advisable to discuss and incorporate journaling practices with a trained DBT therapist who can provide guidance on how to effectively integrate it into the therapeutic process.
Practical uses of the Stop Skill
The DBT Stop skill is a great way to effectively manage intense emotions and impulsive behaviours. When faced with difficult moments or strong urges, individuals can incorporate this skill into their lives by pausing their actions, creating distance from the current situation, observing their thoughts and emotions without judgment, and then choosing a mindful response.
The Stop skill is a great tool for reality acceptance, stress reduction, and making positive changes in daily life.
To learn more or take this practice forward, individuals can explore DBT skills training handouts, consider group therapy or cognitive behavioral therapy, and find mental health treatment at therapy clinics. Additionally, resources like the Dear Man technique, urge surfing, the DBT Bingo card, and diary cards can support the development of specific skills.
Incorporating the Stop skill into one’s life can lead to significant improvements in mental well-being and the ability to navigate painful situations without resorting to harmful behaviors. It is an excellent resource for those with borderline personality disorder or anyone seeking effective communication and interpersonal effectiveness.
By utilising the Stop skill, individuals can make their lives more worth living and manage extreme emotions with greater resilience.
There are some great short videos of Marsha Lineham on YouTube including:
Strategies for emotional regulation
The necessity of distress skills
I hope you have found this really interesting and really useful for learning to regulate your own emotions.
To recap, the other two blog posts which I have created on DBT are: