Find Us On
  • Facebook - White Circle
  • YouTube - White Circle
  • Instagram - White Circle

Follow Us on Instagram:

@sophrosynementalhealth

©2019 by Sophrosyne Mental Health

DBT Skills
What is DBT?
"Currently, DBT is used to treat people with chronic or severe mental health issues. Issues DBT treats include self-harmeating and food issuesaddiction, and posttraumatic stress, as well as borderline personality. DBT was originally designed to treat people who had chronic suicidal thoughts as a symptom of borderline personality."

How did I learn about DBT?

I learned about DBT therapy after I was accepted into a therapy program at McLean Hospital 3East Outpatient DBT. We had a series of modules which focused on Middle Path, ​Interpersonal Effectiveness, MindfulnessDistress Tolerance, and Emotion Regulation. The program typically has people stay for 20 weeks, but my parents wanted to stay for 40 weeks. It was an intensive therapy program and in order to be in it, I had to make a lot of sacrifices with my time and some days, I resented going, but I am so glad that I went because I never would have been so articulate and never would have become an activist without going through this therapy program. I learned to look from many different perspectives and have definitely become a braver, kinder, and smarter person.

Middle Path

Validation

Validation:

  • It communicates to another person that their feelings, thoughts, or actions make sense and are okay to feel, and are understandable

  • Validation is not an agreement

Why is validation important?

  • Validation helps improve relationships

  • It can help de-escalate a situation or disagreement

What can validation demonstrate?

  • We are listening

  • We are trying our best to understand

  • We are being nonjudgemental

  • We care about the relationship with the other person

  • We can disagree without having a serious and angry argument

What should we validate in ourselves and others?

  • Feelings

  • Thoughts

  • Behaviors

  • Validate the valid, not the invalid

  • You can validate the feeling, but perhaps not the action that the person took and caused the way they feel

Acceptance
Change
Middle Path

How can you validate?

  1. Are you listening mindfully?

    • Listening with empathy

    • Put aside distractions and put the focus on the other person

  2. Accurately reflecting and acknowledging what the other person is feeling

    • Try to summarize what they expressed to you and make sure to ask them if you are getting it right and trying to understand their emotions might be as well as what they said

    • Try not to interpret the situation, so that you can understand it without judgment​

  3. Ask questions to understand more clearly

    • Ask about what they are feeling, thinking, and wanting

  4. Validation of causes of behavior or experiences

    • Validate part of a behavior in terms of the causes

    • Current biological conditions

    • Validate basic feelings, that you sincerely can understand 

    • Describe how you understand the context of this problem

  5. If you believe a person's actions are reasonable and justified

    • Communicate that the person's behavior is reasonable, meaningful, and effective

    • Validating feelings like saying "this makes sense to me considering..."

  6. Radical genuineness: expressing equality and respect

    • Expressing to the person that you do not see them as a weak, fragile, or incapable person

    • Allow that person to experience; without attempting or forcing the person to change how they

Dialectical thinking

Dialectics:

  • They help teach us that there is more than one way to view a situation and more than one way to solve the problem at hand

  • They show how important it is to look at the world with an open mind

  • They point out that the only constant is change

  1.  Try to move away from "either-or" thinking and try to think in the "both-and" thinking. Try to not use words such as "always or never" Describe in a mindful way, trying your best not to make judgments.

  2. Try looking at other perspectives. There are always multiple sides to a story. Find a kernel of truth in each perspective.

  3. Remember that no one has the absolute truth.

  4. Use "I feel _______" statements.

  5. Accept that opinions aside from your own can be legitimate, even though you don't have to agree. 

  6. Don't assume you can tell exactly what another person is thinking. Check to see if you are making assumptions.

  7. Don't expect that other people can read your mind.

Ways To Think or Act Dialectically:

behaviorism

Increases likelihood of behavior

Decreases likelihood of behavior

Something added

Something removed

POSITIVE REINFORCEMENT:

Increasing behavior by providing a rewarding consequence

NEGATIVE REINFORCEMENT:

Actions used to decrease a behavior that doesn't have a natural consequence

NEGATIVE REINFORCEMENT:

EXTINCTION:

Increasing behavior by removing a consequence

Reduction in a behavior because the reinforcement is removed

Interpersonal Effectiveness

Effectiveness

RELATIONSHIP EFFECTIVENESS

SELF-RESPECT EFFECTIVENESS

Keeping and improving the relationship

Keeping or improving self-respect

  • Acting in a way that the other person  keeps liking and respecting you

  • Investing and maintaining wise mind relationships

  • Respecting your own wise mind values and beliefs

  • Acting in a way that makes you feel capable and effective

Dearman

Use to reach your objectiveness goal

Describe the situation

Express your feelings about the situation

Assert yourself by asking what you

Reward the person ahead of time by describing the positive effects of getting what you want

Mindful, keep the focus on what you want
Appear confident, use a confident tone of voice

Negotiate, be willing to GIVE to GET

GIVE

HOW TO KEEP A GOOD RELATIONSHIP

Gentle (be), be courteous and respectful

Interested (act), listen to the other person

Validate feelings, show that you understand the other person's about the situation

Easy manner (use an), ease the person along

FAST

HOW TO KEEP YOUR SELF-RESPECT

Fair (be), to YOURSELF and to the OTHER person

Apologies (no), no overly apologetic behavior

Stick to values, stick to YOUR OWN WISE MIND VALUES

Truthful (be), DON'T LIE

screw

Choices for responding to any problem situations

Solve it, use your interpersonal skills to solve the problem

Change it, change my reaction, challenge my interpretation of the problem

Radically accept it, cope better with my reaction, use Distress Tolerance skills to cope, non-judgementally accept my reaction

Entertain misery. keep complaining, keep being dissatisfied by the outcome

Worsen the problem, act non-skillfully, engage in ineffective behaviors

Mindfulness

Mindfulness Basics

What is Mindfulness?

  • Intentionally living with awareness in the present moment

  • Without judging or rejecting the moment

 

What are Mindfulness Skills?

  • Mindfulness skills are specific behaviors that make up mindfulness

 

What is Mindfulness Practice?

  • Mindfulness and Mindfulness skills that can be practiced anytime, anywhere, while doing anything

What does mindfulness do for you?

Be Mindful can:

  1. Give you more choices and more control over your behavior

  2. Reduce your emotional suffering and increase your pleasure and sense of well-being

  3. Help you make important decisions using both your emotions and logic in a balanced way

  4. Help focus your attention and therefore make you effective and productive

  5. Increase compassion for self and others

  6. Lessen your pain, tension, and stress, and in turn can even improve your health

Three states of mind

Reasonable Mind

Wise

Mind

Emotion Mind

Reasonable/Rational Mind:

Cool

Rational

Task-Focused

 

When you're in reasonable mind, you are controlled by facts, logic, and values and feelings aren't what you're focused on.

Wise Mind:

Seeing the value of both reason and emotion, aligned with self-respect, values, and long term goals.

Emotion Mind:

Hot

Mood-dependent

Emotion-focused

 

When you're in emotion mind, you're controlled by moods, feelings, and urges to do or say something. Facts, reason, and logic aren't important.

what skills

Observe:

  • Just notice the experience in the present moment

  • Use your five senses to understand your surroundings

Describe:

  • Put words on the experience 

  • Describe "who, what, where, and when"

Participate:

  • Get in the zone

  • Fully experience whatever you're doing

  • Experience even negative emotions

  • Try to get yourself in wise mind

How skills

Don't Judge:

  • Don't evaluate as good or bad 

  • Acknowledge your values, your wishes, your emotional reactions, but don't judge them

Stay Focused:

  • Focus your attention on only one thing at a time

  • Let go of distractions and notice where your attention shifts

Do What Works:

  • Be effective, focus on what works

  • Don't let emotions control your behavior

  • Play by the rules

  • Act skillfully as you can to achieve your goals

  • Let go of negative feelings

Distress Tolerance

Coping with urges and feelings

THE IMPORTANCE OF COPING WITH PAIN 

  1. Pain is part of life and cannot be avoided 

  2. If you can't deal with your pain and act impulsively

  3. When you act impulsively, you may end up hurting yourself or others or not getting what you want

WHEN TO USE CRISIS SURVIVAL SKILLS

A crisis is when the situation

  • Highly stressful

  • Short-term

  • Creates intense pressure to resolve the crisis

Use crisis survival skills when

  1. You have intense pain that cannot be helped quickly

  2. You want to act on your emotions, but it will only make things worse

  3. Emotion mind threatens to overwhelm you and you need to stay skillful

  4. You are overwhelmed but demands need to be met

  5. You are feeling very emotional, but your problem can't be solved in the moment

accepts

Choices for responding to any problem situations

Activities, do something

Contributing, do something nice for someone else

Comparisons, compare yourself to back when you were less effective

Emotions, create different emotions

Pushing away, push painful situations out of your mind temporarily

Thoughts, replace your thoughts

Sensations, intensify other sensations

radical acceptance 

PAIN = EMOTIONAL OR PHYSICAL DISTRESS THAT CANNOT ALWAYS BE AVOIDED

SUFFERING = PAIN + NONACCEPTANCE

ACCEPTANCE ISN'T APPROVAL

  • RADICAL ACCEPTANCE The skill of accepting things that you can't change 

  • RADICAL = complete and total accepting in mind, heart, and body

  • ACCEPTANCE = seeing reality for what it is, even if you don't like it

  • ACCEPTANCE can mean to acknowledge, recognize, endure, not give up or give in

  • Life is worth living, even with painful events in it

  • Stop bitterness towards a situation

willfulness

WILLFULNESS:

  • Willfulness is refusing to tolerate a situation or giving up

  • Willfulness is trying to change a situation that cannot be changed, or refusing to change something that must be changed

Willingness

WILLINGNESS:

  • Willingness is doing what is needed in each situation & focuses on effectiveness

  • Listening very carefully to your WISE MIND

  • Willingness is being open to the moment as it is

  • Being open to new thoughts, feelings, experiences

Self soothe with five senses

VISION:

Look at posters you like, take a walk and look at the nature around you. People watch, watch your favorite movie.

SMELL:

Put on your favorite perfume, light a scented candle, bake, make some cookies or hot chocolate and focus on the smell.

TOUCH:

Pet a dog or cat, take a bubble bath, have a massage, brush your hair, hug someone, change into some comfy clothes.

HEARING:

Listen to beautiful or soothing music, pay attention to sounds of nature, listen to your favorite song or a sound machine.

TASTE:

Have a comfort meal, have a soothing drink, sample ice cream flavors, have a piece of candy.

Emotional Regulation

Why are emotions important

  • Emotions motivate (and organize) us for action

  • Emotions communicate to (and influence) others

  • Emotions communicate to ourselves

Why is it important to take charge of your emotions

  • People often have intense emotions, such as sadness, fear, and shame. Difficulties controlling these emotions can lead to dangerous or ineffective behaviors

  • Impulsive or ineffective actions that often lead to very painful emotions that might even have long-term negative consequences

Factors that make it hard to regulate your emotions

Biology:

  • Hunger

  • Lack of sleep

  • Forgetting to take medications

  • Having a mental illness or mental health problem

Lack of Skill:

  • Don't know how to regulate or manage emotions in a healthy way

  • Not having emotional regulation skills for crisis situations

Reinforcement of Emotional Behavior:

  • The environment around you

  • What people are saying or doing to you

  • What is going on at that time

Moodiness:

  • Your current mood, instead of your wise mind

  • You're likely in emotion mind

  • You're not willing to put in the time and effort to regulate your emotions 

Emotional Overload:

  • High emotional arousal causes to reach a skills breakdown point

Emotion Myths:

  • Myths about emotions get in the way​

  • These myths often lead to emotional avoidance​

Reduce vulnerability: abc please

Accumulate Positive Emotions

  • Short Term: Do pleasant things that are possible now.

  • Long Term: Make changes in your life so that more positive events will happen more often in the future.

Build Mastery

  • Do things that make you feel competent and effective to combat feelings of helplessness and hopelessness

Cope Ahead of Time with Emotional Situations

  • Rehearse a plan ahead of time so that you are prepared to cope skillfully in case of emotional situations.

Physical ilLness, BalanceEating, Avoid mood Altering substances, Balance Sleep, Get Exercise

  • Take Care of Your Mind by Taking Care of Your Body

 

pleasant activities list

self care 2.jpg

Accumulative positive emotions in the long-term

Step 1. Avoid Avoiding 

  • Start now to do what is needed to build a life you want.

Step 2. Identify Wise Mind Values That Are Important to You

  • What values are important to you right now in your life.

Step 3. Identify One Value to Work on Now

  • What is important to me right now to work on?

Step 4. Identify a Few Goals Related to This Value

  • What specific goals can I work on that will make this value part of my life?

Step 5. Choose One Goal to Work on Now

  • Start to join some activities and work on

Step 6. Identify Small Action Steps Towards Your Goal

  • What small steps can I take to get to my goal?

Step 7. Take One Action Step Now

  • Do something RIGHT NOW

How to check the facts

1. Ask: What is the emotion I want to change and what is the event prompting my emotion?

  • Describe the facts you observed while using mindfulness.

2. Ask: What are my interpretations, thoughts, and assumptions about the event?

  • Think of other possible interpretations. Test to see if your interpretations fit the facts.

3. Ask: Am I assuming a threat?

  • Label the threat. Asses the probability of the threating event. Think of as many possible outcomes as you can.

4. Ask: What's the catastrophe?

  • Imagine the catastrophe occurring. Imagine how you would cope effectively in the situation.

5. Ask: Does my emotion and/or its intensity fit the actual facts?

  • Check the facts that fit each emotion. Use your Wise Mind.

opposite action

ACTION URGE EXAMPLE:

EMOTIONS:

OPPOSITE ACTION:

Anxiety/Fear

Sadness

Avoid

Approach

Withdraw

Get Active

Anger

Envy

Shame

Attack

Sabotaging, criticizing 

Accusing, spying

Jealousy

Hide

Gently Avoid, be decent

Let go of controlling others, share

Count your blessings

Be open, approach

Guilt

Hide

Be open

Love

Be close

Avoid the person, distract yourself from thoughts of them; Remind yourself why love is not justified

steps for problem solving

Step 1. Get yourself in Wise Mind

 

 

Step 2. Ask: Can the problem be solved?

 

Step 3. OBSERVE and DESCRIBE the problem.

 

 

Step 4. BRAINSTORM lots of solutions.

 

 

Step 5. CHOOSE the potential solutions that you think will work.

 

 

Step 6. Put the potential solution into ACTION. Try the solution.

 

Step 7. It WORKED? Give yourself a reward.

OR

Step 8. It didn't WORK? Give yourself a reward for trying.

Credits to: 3East Outpatient DBT Manual