A Brief Introduction to Dialectical Behaviour Therapy (DBT) 

Written by Daniela. D | Provisional Psychologist

Dialectical Behaviour Therapy (DBT) is an alternative form of Cognitive Behaviour Therapy (CBT) and a commonly practised intervention (Bass et al., 2014). There are four key components of DBT: Mindfulness, Emotional Regulation, Distress Tolerance, and Interpersonal Effectiveness.

These components can be divided into two categories: Emotional Regulation and Interpersonal Effectiveness as the “changing skills”, and Mindfulness and Distress Tolerance as the “acceptance skills” (Linehan & Wilks, 2015). 

The primary goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others (Linehan & Wilks, 2015).

Mindfulness

This focuses on being able to remain in the present moment and accept what is occurring. 

For instance, when an unwanted task is asked of somebody (such as, cleaning toys after play), they may experience challenges with accepting the current circumstances and proceeding in a mindful manner. Alternatively, they might become heightened and react accordingly. 

Square Breathing 

Square breathing (or box breathing) is a common type of breathing strategy that is regularly used. It focuses on maintaining a consistent pace and timing your breathing, and you can repeat as many times as needed: 

1. Breathe in for 4 seconds
2. Hold your breath for 4 seconds
3. Breathe out for 4 seconds 
4. Hold your breath for 4 seconds

Emotional Regulation 

This focuses on being able to understand and handle experiences, heightened emotions, changes in emotions, and challenging situations. 

For instance, having control over your emotions and being able to communicate how you feel when you become angry when something unpreferred occurs (such as, getting into a fight with a friend). 

Checking the Facts 

When our emotions become heightened, it can be difficult to separate the facts of a situation from your own thoughts and feelings. Thinking about the following can help you better understand and process your situation: 

1. What event triggered my emotions? 
2. What are my thoughts saying about the event? 
3. Does how I am feeling match the event that happened or do they match my thoughts/ my interpretation of the event? 

Distress Tolerance 

This focuses on being able to tolerate challenging emotions and situations more effectively, as opposed to engaging in unhealthy behaviours as a method of coping with them.

For instance, being able to engage in an uncomfortable situation more effectively; such as being able to deliver a speech in class despite disliking public speaking. 

5 Senses Grounding Technique 

This grounding exercise focuses on bringing your attention to the space around you and to the present moment. 

1. FIVE things you can see in the space around you
2. FOUR things you can touch in the space around you 
3. THREE things you can hear in the space around you
4. TWO things you can smell in the space around you
5. ONE thing you can taste in the space around you 

Interpersonal Effectiveness 

This focuses on the capacity to appropriately communicate with others and maintain healthy relationships. For instance, being able to create and understand boundaries with others. 

DEAR MAN

This focuses on increasing effective communication with others and developing the capacity to express wants and needs in a clear and respectful manner. 

Describe – Describe the situation; stick to the facts

Express – Express your feelings about the situation (“I” Statements”) 

Assert – Assert what you want and need (or say no) clearly   

Reinforce – Reinforce the other person if they respond well by smiling or saying thank you 

Mindful – Focus on what you want and don’t get sidetracked by other topics or situations 

Appear confident – Use a self-assured voice and feel confident in what you are saying 

Negotiate – Be open to negotiating and ask for the other person’s opinion

References

Bass, C., van Nevel, J., & Swart, J. (2014). A comparison between dialectical behavior therapy, mode deactivation therapy, cognitive behavioral therapy, and acceptance and commitment therapy in the treatment of adolescents. International Journal of Behavioral Consultation and Therapy, 9(2), 4–8. https://doi.org/10.1037/h0100991 

Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. American Journal of Psychotherapy, 69(2), 97–110. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.97