Dialectical behavioral therapy, or DBT, was developed by Marsha Linehan as a way to help those suffering with borderline personality disorder find recovery. It brings together aspects of cognitive behavioral therapy (CBT), Zen teachings, and the dialectic of Greek philosophy. Because so many of the problems encountered by those with borderline personality disorder are of an interpersonal nature, focus is placed on psychosocial therapy and skills training as well as medication and traditional psychotherapeutic interventions.
Dialectical behavioral therapy works well for those with BPD, but it can also help with a wide range of what the counseling community calls “stinkin’ thinkin’.” It is our thoughts that shape our feelings and behaviors, and how we think has a lot to do with what happens in our lives. This is a theory used in DBT. It was originally developed as the basis of cognitive behavioral therapy. The difference is that dialectical behavioral therapy places an emphasis on the Zen philosophy of mindfulness and skills training to change the thoughts and behaviors.
An Invalidating Environment
While it is believed that there is a definite biological component to borderline personality disorder, it is also believed that those with the disorder lack the ability to think about and control their emotional reactions because they were raised in invalidating environments.
When a parent or another authority figure responds to a child’s expression of his or her internal experiences with punishment or trivialization, the child’s experiences are invalidated. Over time, this can cause the individual to believe he or she is always wrong, even when naming his or her own emotions. Some invalidating responses include:
- “I know you really did do that, even though you say you didn’t. Tell the truth!”
- “You’re just lazy.”
- “You’re just making a big deal out of nothing.”
- “You’re so sensitive! I was only kidding.”
- “You just need to try harder.”
- “I’m not going to let you manipulate me by lying.”
The two basic messages here are, “You’re lying,” and, “You’re wrong.” No one’s internal experience is wrong, and, if they’re describing it the way they feel it, it isn’t a lie. Parents who communicate this way with their children mean well most of the time; they’re simply uncomfortable with talking about negative emotional experiences or allowing their children to express them.
The Four Skill Sets of DBT
Because of past invalidating experiences, people with borderline personality disorder have no vocabulary to express their emotions, and they have no coping skills for times when extreme negative emotions arise. Instead, they express themselves through extremely emotional and inappropriate outbursts. Because they’ve also been repeatedly told that they’re “wrong” or “dishonest,” they punish themselves for thoughts, feelings and behaviors seen as socially unacceptable. The four skill sets that dialectical behavioral therapy teaches are meant to provide the tools to get beyond self-harm, self-hatred, and inappropriate acting out behaviors so that the person can handle his or her emotions more effectively.
- Core Mindfulness Skills: Zen philosophy focuses on accepting what is rather than struggling against reality. Mindfulness is how we become aware of reality. Mindfulness involves observing, describing, and participating in life with a spirit of non-judgment. Becoming mindful means being able to say, “This is what’s going on, and it’s neither good nor bad—it simply is what it is.” Core mindfulness skills are the foundation of all other skills taught through dialectical behavioral therapy.
- Interpersonal Effectiveness Skills: Interpersonal effectiveness skills include learning to ask for what one needs, learning to say no, and learning to handle conflict in relationships. Often the focus here is on situations where the objective is to change oneself into something or to resist the changes someone else is trying to make.
- Distress Tolerance: The therapeutic community has paid little attention to learning to accept and tolerate distressing situations. Instead, CBT and other therapeutic interventions focus on changing the circumstances that cause distress. The spiritual, Zen aspect of DBT emphasizes learning skills to help the individual learn to tolerate pain. By accepting stressful events with a spirit of non-judgment, the individual can avoid blaming either themselves or the situation for being “bad” or “wrong.” At the same time, acceptance doesn’t mean approval. People can tolerate distress through learning to self-soothe, distraction, thinking about the pros and cons of a situation, or improving what they can in the moment, even if they can’t change the situation itself.
- Emotion Regulation: Many times, emotions cause problems because we don’t have the vocabulary to name them, don’t understand the thoughts that keep us stuck, and don’t know how to express our emotions in a healthy way. Emotion regulation involves learning the following skills: identifying and labeling emotions, identifying the obstacles to changing emotions, reducing vulnerability to the emotional mind, increasing positive emotional events, increasing mindfulness toward current emotions, taking opposite action, and applying distress tolerance skills. By doing this, a person can watch themselves have an emotion, ask themselves what the emotion is about, and think about other ways they might react to the current situation before acting out inappropriately or destructively.
Dialectical behavioral therapy helps change rigid thought patterns that paint the whole world in black and white and make it difficult for someone to handle the ambiguous and changing nature of life. Everyone at times has difficulty with change and ambiguity, especially in relationships, so using these skills is one of the simplest and most effective ways of building healthy coping mechanisms.