Uncategorized Mar 29, 2019

DIALECTICAL BEHAVIOR THERAPY techniques to help you transform your emotions in the moment and over time. First, let’s get some misconceptions out of the way and talk about what DBT (Dialectical Behavior therapy) is NOT:

This is not a quick fix. Real change takes time. We all want that magical silver bullet, or the one phrase or technique that’s going to change our lives forever. I’m sorry to say that this doesn’t exist, no matter how many shiny magazine covers try to convince you otherwise.

This is not positivity culture. I’m sure you’ve seen a number of self-help books and blogs written by happy people and marketed with bright colors, proudly stating that if you just “think positive” then all of your problems will go away. Genuine personal growth cannot be reduced to a single phrase, particularly when that phrase dismisses the vast range of human emotions.

This is not victim blaming. The online world of mental and emotional health is riddled with misinformation about how if your life isn’t going your way, it’s because you’re not optimistic enough. Or that if you have the ability to manage your emotions, then it’s your fault for feeling them. These concepts are at best reductive, and at worst gaslighting.

This is not pop psychology. Although you might hear a phrase or two that’s been repurposed into a meme or Instagram post, the real work of DBT is too complex to be reduced to social media marketing.


Dialectical Behavior Therapy (DBT), a form of structured mindfulness therapy developed by Dr. Marsha Linehan as a way to address the shortcomings of Cognitive Behavior Therapy. While both CBT and DBT help people unravel patterns of negative self-talk, DBT provides a structured series of skills and exercises that give the patient more control for change beyond the office setting.

This is real work, real power, real growth. In reality, becoming emotionally aware is an ongoing series of small epiphanies and setbacks, all of which create an upward trajectory. As you develop this series of techniques and apply them on a consistent basis, you’ll be able to find space between the emotions you feel and how you react to them. In time, you will develop the resiliency and flow of mind needed to best suit the way you interact with yourself and others.

Why “Dialectical”? DBT recognizes that there is truth to both rational, objective facts and emotional, subjective experiences. While “Reasonable Mind” and “Emotion Mind” represent the two extremes, “Wise Mind” is the balance that incorporates both truths. In this context, dialectics are how two seemingly contradictory ideas talk to each other. It’s about finding truth in the grey area. A Wise Mind must be able to understand, validate, and utilize both rational thought and emotions. For example, it is possible for you to be mad at someone AND have compassion for them.


DBT was originally developed for PTSD sufferers and is also effective for complex cases like Borderline Personality Disorder. However, DBT provides skills for emotional intelligence that can benefit everyone from children to folks with clinical diagnoses to neurotypical, improvement-minded folks looking to better themselves.

  • Mindfulness
  • Radical Acceptance and Validation
  • Distress Tolerance
  • Emotion Regulation
  • Interpersonal Effectiveness



This is the practice of bringing your attention back to the present when your thoughts wander. The most common example of anchoring is to focus on your breathing during meditation. This can be difficult for a lot of people, especially if you’re working through trauma-centered in your chest or alongside your breathing patterns. Some folks also find it boring and inaccessible.

The beauty of anchoring is that the “anchor” can be whatever you want it to be. For example, when washing dishes, focus on the sensation of the water on your hands. When trying to get a task done, the task itself can be the anchor. When having trouble sleeping, focus on the feeling of the bed supporting your body.

Acknowledge the thoughts you have when your mind wanders, and then refocus on your anchor. The more you practice this technique, the more you will be able to focus your attention wherever is most beneficial. This is an important skill that will help you prepare for later aspects of DBT as well.


Let’s start by talking about Radical Acceptance. Have you ever heard that phrase, “The first step to solving a problem is recognizing that there is one”? While somewhat simplistic, it carries a lot of truth. If you cannot identify the problem, then how can you deconstruct and overcome it?

This is at the core of Radical Acceptance, the next concept in Dialectical Behavioral Therapy.

I admit, I struggled with this one myself. There is a lot of false noise about “smiling through the pain”; while some may find that kind of rhetoric helpful, others can find it dismissive and hurtful. I had a lot of resistance toward accepting the truth of what I was dealing with, and I viewed acceptance as a dead-end.

This is not the case. Rather, Radical Acceptance is the first step to CHANGE. When you accept things in the state that they are, you gain the power to change them for the better.

What are you having trouble accepting in your life? Write it down. Dig deep. Only when you understand your demons can you begin to transform them.

First, consider the consequences of denying current painful circumstances. While in certain situations this can be protective, over time this denial can lead to suffering. Attempting to “think positively” without confronting and accepting the situation as it is has the potential to exacerbate your pain. Again, you cannot solve a problem unless you recognize and accept that the problem exists in the first place.

With that in mind, here is one of my favorite exercises, the 5 Factor Model.

This model appears in some variation in a number of different therapeutic/mind-body medicine protocols. It is a comprehensive way to analyze your personal state during a stressful situation so that you understand your behavior and, with practice, are able to make healthier decisions in the future.

In this diagram, you start with the environment or circumstance that has caused you stress. This is the objective, factual statement of what has happened. Then, you analyze your reaction in terms of physical sensations, emotions, thoughts, and behavior. Take a look at the example below:

How else could your friend’s actions be interpreted? Perhaps they were in their own world and simply didn’t notice you. When you are aware of possibilities that aren’t inherently negative, you are able to review and react to the situation in different ways. Perhaps instead of tensing, you become more alert. Your emotions are curiosity and concern. Your thoughts are, “I wonder if my friend’s dealing with something difficult,” or, “We should catch up soon!” Then your action, rather than to become withdrawn and irritable, would be to text your friend and schedule dinner.

In the beginning, this can be a great journal exercise. Every evening think about your day and if there were any stressful events that would benefit from analysis. Eventually, this will become a skill that you can use to change your reaction in the moment, and you will have more control over your responses to events as they happen.


In order to practice Distress Tolerance (and Emotion Regulation), it also helps to stay out of “Emotion Mind”, the state in which your emotions are dragging you along for the ride. You can reduce your vulnerability to emotions when you PLEASE do the following:

  • Treat PhysicaL Illness
  • Practice Balanced Eating
  • Avoid Mood-Altering Drugs (non-prescription)
  • Get the right amount of Sleep
  • Exercise and move

Emotion Regulation is getting your emotions to work with you rather than against you.

This is where the rubber hits the road. After practicing Mindfulness to expand awareness and taking stock of the situation as it is with Radical Acceptance, you’re ready to start changing your reality. The Emotion Regulation portion of Dialectical Behavior Therapy is designed to help you recognize and move through unpleasant emotions, rather than resisting them or putting them in a box and pretending that they don’t exist – until, of course, the box gets so full that it bursts open and there’s a messy pile of complicated, rotting emotions all of the floor. No one wants that.

This tool is intended to help you identify your personal myths around emotions in general. Emotions are NOT bad – the issue is only when the emotion is having you, rather than you having the emotion. The below are false statements – how can you reword them to dismantle the myth and repair your relationship with the concept of emotion? I’ve done #6 to help you along:

  1. Letting others know that I am feeling bad equates weakness.
  2. Uncomfortable feelings are destructive and should be avoided at all costs.
  3. Being emotional means being out of control.
  4. Other people are the best judge of how I should feel.
  5. If I feel it, it must be true.
  6. If I’m scared, it means I shouldn’t do it. Eleanor Roosevelt would be very disappointed. Fear is a healthy emotion. It’s not there to prevent you from living your life; it’s there to wake you up! Therefore, I’ve replaced the above myth with:

If I’m scared, it means PAY ATTENTION!

This has allowed me to shift ANXIETY into EXCITEMENT, and to confront and dismantle unhelpful restrictions based on fear.

What are your personal myths about emotions, and how do you think you can change them?


The final stage of Dialectical Behavior Therapy is Interpersonal Effectiveness. Once you have applied the skills from the previous segments to strengthen your internal emotional awareness, you can apply those skills in relationships with others so that you can more effectively:

  • Solve interpersonal problems.
  • Increase assertiveness when needed.
  • Strengthen social skills.

In order to interact respectfully with others, you have to maintain respect for yourself.

When interacting with others, remember to be FAST!

FAIR – Be fair to YOURSELF and the OTHER person.

No unnecessary APOLOGIES

  • No apologizing for: Being alive. Making a request. Disagreeing.
  • Over-apologizing can damage your self-respect.
  • It can reinforce self-invalidation and old judgments about yourself, your effectiveness, and your worth as a person.

STICK TO VALUES – Stick to YOUR OWN values.

  • Don’t keep quiet just to avoid being judged or sounding dumb.
  • Let others know where you’re coming from and don’t change your mind on moral or value issues without a very good reason.
  • Be careful not to confuse flexibility with a lack of integrity.
  • You can hold opinions different from others and still respect and be respected. (Provided that said opinions do not cause direct social harm.)

Be TRUTHFUL – Don’t lie or act helpless when you are not.

  • Don’t exaggerate or make up excuses.
  • Tell others what you need or want.
  • Be kind in your truthfulness – being honest is not an excuse to be cruel.


This article is intended to introduce you to DBT. While most people can benefit from trying one or more of the skills mentioned above, there are a number of other skills that can be customized to your unique needs and circumstances. Dialectical Behavior Therapy is a methodical process that is best done with a trained provider. If your curious about how mindfulness practices can help you, schedule an appointment or free introductory call with Dr. Oristano!


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