Dialectical Behavior Therapy

1. Dialectical Behavior
Therapy
By Gina Vanderham, MA,ICADC, CEAP,
SAP, LMFT, RCC

2. What is DBT?
ACCEPTANCE
Distress
Tolerance
Interpersonal
Effectiveness
Mindfulness
Emotional
Regulation
CHANGE
 Dialectics involves the synthesis of
opposites.
 Dialectic Behaviour Therapy synthesizes
strategies for ACCEPTANCE and
CHANGE to promote well-being.
 Clients study four skills modules pictured
on the right.

3. Who benefits from DBT training?
 Effective recovery from…
 Substance abuse and addiction
 Emotional eating
 Anxiety
 Emotional reactivity
 Mood swings
 Low Self-esteem

4. Mindfulness
 A “way of paying attention” (Kabat-Zinn, 1990)
 Bringing full awareness to one thing (one mind fully) in the
moment with detached awareness
 Letting go of distractions and judgments
 Focusing with acceptance of what is

5. Mindfulness
 Seeing what is, in this moment, for the first time (open mind)
 Like a lampshade directing the light of your attention on just one
thing in the moment (Thich Nhat Hanh, 1987)
 Not religious, though it has grown from multiple spiritual traditions

6. Mindfulness As A Tool For Change:
 Attention to food for those who binge eat / eat emotionally
 Fullness and of effect of eating on body
 Hunger as cue to eat rather than as something to be
proud/fearful of

7. Mindfulness As A Tool For Change:
 Aware of effect of substances/problematic eating on
body/family/work/school
 Want client to step back and observe all aspects of eating
experience
 Nonjudgmentally, trustingly and with acceptance

8. Mindfulness: A Breath of Fresh Air
 Clears the mind
 Reduces obsession
 Brings attention to what matters
 Increases awareness in the acceptance of self
 Helps clients to find their own path

9. Mindfulness Practice
Can be done in any moment/place
 Provides freedom to choose a course of action
 Enhances mental flexibility and agility -- ability to move
attention from one thing to another

10. STATES OF MIND
wise mindreasonable mind emotional mind
“What”: MINDFULNESS: TAKING HOLD OF YOUR MIND

11. “How”: Taking Hold of Your Mind
 Non-judgmentally
 One-mindfully
 Effectively

12. Dialectic Behavior Therapy:
Taking Hold of Your Mind
Observe:
 Just notice the experience
 Teflon mind
 Control only your attention
 Watch your thoughts
 Senses

13. Emotional Regulation Training
Understand emotions you experience
 Identify your emotions
 Understand what emotions do for you
Reduce vulnerability to emotional mind
 Decrease negative vulnerability
 Increase positive emotions via positive events and
focusing on the positive

14. Emotion Regulation cont’
Decrease emotional suffering
 Let go of painful emotions through mindfulness
 Change painful emotions through opposite action

15. Distress Tolerance Skills
Increase: Management of Distress and Urges
 1. Distract: activities, contributing, comparisons, pushing
away, pleasant thoughts, sensations
 2. Self soothe: vision, hearing, smell, taste, touch
 3. Improve the moment: imagery, meaning, prayer, relaxation,
one thing at a time, vacation, encouragement, pros and cons
of tolerance

16. More Distress Tolerance Skills
Guidelines for accepting reality:
 1. Observing the breath
 2. Half – Smiling exercise
 3. Radical Acceptance
 4. Awareness Exercises: positions of the body, connection to
the universe, while washing the dishes, having a slow motion
bath etc.

17. Increase: Experience & Regulation of
Emotions
Reduce vulnerability to negative emotions-stay out of
emotional mind
 Treat physical illness, balance eating, balance sleep, get
exercise, build mastery
Increase positive experiences
 Do pleasant things now
 Build a life “worth living”
Be mindful of positive experiences- focus and re-focus
Be unmindful of worries-distract

18. Increase Interpersonal Effectiveness
 Objective: describe, express, assert, reinforce, be mindful,
appear confident, negotiate
 Relationship: gentle/not too, interested, validate, easy-going
 Fair, stick to values, true to self
 Cheerleading