What Is Dialectical Behavioral Therapy (DBT)? – By Dr. Rebecca Wang-Harris

        Dialectical behavioral therapy (DBT) is a form of cognitive behavioral therapy (CBT) which was originally developed to treat clients with chronic suicidal ideation and with Borderline Personality Disorder (BPD), due to its emphasis upon increasing awareness of and changing thought and emotional patterns.  More recently, research has shown that DBT is effective in treating a wide range of other disorders, such as substance dependence, depression, Post-Traumatic Stress Disorder (PTSD), and eating disorders.  The term “dialectical” means a synthesis or integration of opposites. The primary “dialectical” focus of DBT is between the seemingly opposite techniques of acceptance and change. In this blog post we will discuss mindfulness training, DBT interpersonal effectiveness, and distress tolerance skills to determine if DBT is right for you. 

 Dialectal Behavioral therapy psychotherapists accept clients as they are while also assisting them in making the necessary changes for reaching their goals.

         DBT includes four skill modules: mindfulness training and DBT distress tolerance, which are acceptance-oriented and emotional regulation and interpersonal effectiveness, which are change-oriented. These skills are what set DBT apart from other therapies and make it very appealing as a therapeutic technique. 

        If you choose to engage in Dialectical Behavioral Therapy, you will learn how to live in the moment, how to cope better with stress and emotional triggers, how to regulate your emotions, and how to improve your interpersonal relationships.  I will summarize the four skill modules as they relate to acceptance and change.  I will also include some of my professional observations within each module, because I implement DBT with most of my clients. Read on to learn about mindfulness training.

Dialectical behavior therapy or DBT distress tolerance skills mindfulness training dbt interpersonal effectiveness


         The first of the two acceptance-oriented skills is mindfulness training, which is the practice of being fully  present and aware of ALL of your emotions at any given moment.  Mindfulness training is considered a foundation for the other skills taught in DBT, because it moves you from unawareness of your emotions toward accepting and tolerating any of the powerful emotions which you may feel when triggered by an upsetting situation or memory.  Mindfulness training is not simply appreciating a moment.  Rather, it is developing the capacity to pay attention, nonjudgmentally, to the present moment, with its positive or negative emotions.  It is about not running from or hiding these negative emotions.  On the contrary, it is about embracing these emotions as they are and not how you or society think that they “should” be.  It can also be used to become more aware of your sensory reactions to different environments. 

         Keep in mind that you must be willing to move out of your comfort zone and to try hard to start viewing situations with no self-judgment and no impulsive pushing down of any emotional responses to these situations.  You will find that you gradually begin to confront all emotions as part of your life story and associated challenges as a human being.  This skill will reduce distress, discomfort, and symptomology.  This skill is the first step toward moving from being out of control to achieving emotional, cognitive, and behavioral control.  More specifically, I help my clients to clarify self-talk and ruminating thoughts.  By doing so, I can guide them in determining the rational versus the irrational thoughts.  Mindful awareness can create a continuous sense of empowerment, patience, and self-compassion in all situations.  Most importantly, you can develop an excellent and valuable introspective ability to carry within you throughout the remainder of your life.   

Dialectical behavior therapy or DBT distress tolerance skills mindfulness training dbt interpersonal effectiveness

Distress Tolerance Skills

        The second of the two acceptance-oriented toolbox is distress tolerance skills, which is the ability to tolerate painful emotions during difficult situations, not to change them.  Distress tolerance skills develop from your mindfulness skills. They have to do with the ability to accept, in a non-evaluative and non-judgmental manner, both your emotions and the current situation.  The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them.  This allows you to make wise decisions about how to take action, rather than falling into intense and often destructive emotional reactions. 

        Distress tolerance skills develop largely through radical acceptance, which is the process of learning how to accept unpleasant or disturbing situations.  The goal is to better equip yourself to accept the things that you cannot change.  I have observed that this acceptance skill reduces my client’s unpleasant emotional reactions and improves their sense of self-control.  Radical acceptance skills include identifying and embrace the upsetting situation, identifying how others may have contributed or are contributing to this situation, and observing how you reacted or are reacting to this situation.  The final crucial radical acceptance skill is visualizing yourself reacting more effectively in the situations which trigger your disturbing emotions. 

Dialectical behavior therapy or DBT distress tolerance skills mindfulness training dbt interpersonal effectiveness

Emotional Regulation

        The first of the two change-oriented skills in Dialectial Behavoral Therapy is emotional regulation, which is the process of decreasing vulnerability to painful emotions by reframing, not reacting to, these emotions.  Emotional regulation skills are based on the theory that intense emotions are conditioned responses to troublesome experiences.  Emotional regulation skills include naming emotions, allowing yourself to fully experience these emotions, and redirecting unwanted emotions during situations when you need to just take action, such as at work or with your children.  Emotional regulation skills are  helpful when you need to take care of your feelings in the midst of circumstances which are out of your control, such as the loss of a loved one or experiencing emotional or physical abuse.  I assist my clients in creating an emotional regulation plan, which often includes the use of personally selected mantras or positive self-talk, specific actions (taking a walk, doing deep breathing, talking to a supportive person), journaling, and reading or listening to self-help information.  Emotional regulation can create a very strong and pure sense of compassion for yourself and others.  This skill can also create a valuable sense of self-discipline and empowerment. Read on to learn about DBT interpersonal effectiveness.

Dialectical behavior therapy or DBT distress tolerance skills mindfulness training dbt interpersonal effectiveness

Interpersonal Effectiveness

        The second of the two change-oriented skills is DBT interpersonal effectiveness, which is the ability to ask for what you want and to create and maintain boundaries with others.  This skill is not easy when these “others” are your family members, romantic partners, and coworkers. DBT Interpersonal effectiveness skills are practiced during therapy sessions and then enacted in your daily life.  Remember that you cannot control others or certain situations, so your interpersonal skills will waver in their effectiveness.  The point is to keep working on these skills, just like you would start with easy and move on to more difficult physical exercises.  As with an exercise regimen, you must practice these skills and persevere even when you have bad days in executing these skills.  Your “emotional muscles” may become strained from time to time, but they do regenerate their strength and ability.  Furthermore, interpersonal effectiveness skills can definitely be used in the workplace, with one’s family members, and with one’s romantic partners, in the form of assertive communication skills and mindful actions.

         In my DBT therapeutic sessions, I support my clients in creating a specific behavioral plan which includes avoiding negative energy in certain people, developing and utilizing problem-solving skills, setting and keeping healthy boundaries, and focusing on self-preservation and self-compassion activities.  I teach my clients how to compartmentalize painful or disturbing emotions when triggered by certain people or situations.  I encourage my clients in each session to identify recent triggers and to discuss how they managed these triggers and can possibly manage them more effectively.  I also teach my clients how to distance themselves, emotionally, cognitively, and, perhaps, physically, from stressful situations.  As with any skill, you will experience obstacles and setbacks.  In Dialectical Behavioral Therapy, you are continually assisted, guided, and supported in maintaining your awareness of all emotions, all setbacks, and all successes in changing your reactions to circumstances.  Courage, strength, and perseverance are the bonus outcomes which you create along the path of DBT!

Want to learn more? Keep reading here learn about Accepting Uncertainty of Challenging Life Circumstances

DBT Training By Dr. Rebecca Wang-Harris

New Age Psychiatry Difference

         New Age Psychiatry offers licensed and certified psychiatric services through virtual telehealth appointments within the state of Florida. We understand the complexities of mental health, and we will work hard to help you manage your condition with services such as mindfullnes training, DBT interpersonal realtionship building, and developing distress tolerance skills in Dialectical Behavioral Therapy and other available modalities.

         New Age Psychiatry is a modern mental health service in Florida that approaches addiction and other mental health issues with compassion and forward-thinking techniques. New Age Psychiatry offers certified psychiatric services through telehealth appointments in Florida. Some of the highlights of the New Age Psychiatry approach include:

  • Online Screening – We will begin with certified online screening to provide an overview of psychiatric care. We also offer a personalized, specific diagnosis through our psychiatric Telehealth services.
  • Diagnosis, Recovery, & Treatment – Our full range of comprehensive psychiatric telehealth services can aid in treating a multitude of psychiatric illnesses and assist in the recovery process.
  • Telehealth Services – Our psychiatric telehealth services are available throughout the state of Florida and can assist you in psychiatric care through counseling and medication management

Contact us on the web for a virtual appointment. If you prefer to use email, you can reach us at info@newagepsychiatry.com or call us today at (877) 769-5206 for more information.