Dialectical Behavior Therapy (DBT)

What I'll Cover in this DBT Blog Post:

What is DBT?

Dialectical Behavior Therapy (DBT) is a type of therapy that teaches practical skills to address a wide range of difficulties. DBT is an evidence-based therapy, meaning it has been thoroughly tested and scientifically proven to be effective.

DBT was developed by Marsha M. Linehan, who until recently was a Professor of Psychology at the University of Washington. Dr. Linehan developed DBT for individuals with Borderline Personality Disorder (also known as emotionally unstable personality disorder of the borderline type). This personality disorder is characterised, among other things, by intense emotional outbursts.

What makes Marsha Linehan's approach particularly unique is that she herself has a diagnosis of Borderline Personality Disorder. DBT was therefore created by a woman who truly understands what she's talking about. She personally experienced severe self-harm and was hospitalised many times in her youth.

While this therapy was initially developed for individuals with Borderline Personality Disorder, it can help most people, whether or not they have a psychiatric diagnosis. As part of a DBT therapist's training, we learn and practise the skills ourselves. This means I can personally vouch for the effectiveness and broad applicability of these skills.

In DBT, the focus is on simultaneously accepting yourself and life as it is, while also working towards change. You can watch a short video here featuring Marsha Linehan, where she describes how she began developing DBT.

DBT Skills

The therapy involves learning concrete skills or tools to better understand yourself and your emotional life. The skills are divided into four categories, also known as modules:

Mindfulness Skills

Interpersonal Effectiveness Skills
Emotion Regulation Skills
Distress Tolerance Skills

Most often, these skills are learned through group instruction. The DBT therapist explains each skill and how it can be applied in daily life. Sessions often include exercises or role-playing, or the therapist will use examples from their own life or invite clients to share their experiences. After each session, you'll receive a homework assignment to practise the skill at home. Individual instruction is also available.

Below, I provide a brief introduction to the four modules.

Mindfulness Skills

Mindfulness skills teach us to be more aware of the present moment without being judgmental or evaluative.

Many people find themselves caught up in thoughts about the past or future. Often, we aren't even aware of it, but simply notice that we are in a bad mood or feeling anxious. With mindfulness skills, we learn to take control of where we direct our attention, thereby training ourselves to be more present in the moment.

Another important aspect we practise in this module is identifying judgmental thoughts. When we are judgmental, we are preoccupied with what we think about something. For example, is it good or bad, ugly or beautiful, right or wrong? This tends to intensify and strengthen our emotions, especially when we are judgmental towards ourselves. Self-judgment often leads to self-criticism and self-blame, which can leave us feeling disheartened, ashamed, and without hope.

Therefore, recognising these judgmental thoughts is a crucial part of DBT. Often, this is something we do automatically. This is one of the reasons why we train our attention, as we can only work with what we are aware of.

Siluet i solen symbolisere Mindfulness og Opmærksomhedsfærdigheder

Interpersonal Effectiveness Skills

Siluet af gruppe i naturen symbolisere Relationsfærdigheder

In this module, we focus on managing our relationships with others. Relationships, especially close and personal ones, can often intensify our emotions. Many people experience difficulties in their relationships, finding it complex to balance their own needs with those of others.

Many people are conflict-avoidant and find it difficult to say no or set clear boundaries with others. This can lead to a range of consequences, such as misunderstandings, tension, stress, sudden anger outbursts, and lowered self-esteem.

With DBT's interpersonal effectiveness skills, we practise different ways to decline requests or ask for the help we need. We focus on being clear and respecting both ourselves and the other person. The emphasis is on saying no without damaging the relationship or our self-respect. By learning these skills, we increase the likelihood of listening to ourselves and navigating our relationships in a healthy way. (You may also want to read my blog post about the specific skill 'DEAR MAN/BUKOOST' for building and maintaining self-respect).

Emotion Regulation Skills

In this module, we work on getting to know our emotions better. Many people struggle to identify and differentiate their feelings. Some may even wish to eliminate their emotions, which is understandable when feelings are intensely painful.

With the skills in this module, we focus on befriending our emotions. When we no longer fear our emotions or see them as enemies, we can listen to them and use them to navigate life. We also learn when to act opposite to our emotions, including the use of exposure techniques.

Billede af bølger - symbolisere følelsesregulering færdigheden fra Dat

Furthermore, we discuss myths associated with emotions. Many of us hold myths or rules about our emotional lives, such as believing it's wrong to be angry or that being sad is a sign of weakness. These myths typically originate from our upbringing. While they may once have been important for coping with life as it was, they often become problematic over time. They don't update even as our lives change, and we are no longer dependent on, for example, our parents.

With emotion regulation skills, we work on updating our approach to our emotional life so that we no longer struggle against our feelings.

Distress Tolerance Skills

Person kigger ud over Vandet symbolisere Krisefærdigheder i DAT

These skills are well-suited for managing crisis situations involving very strong emotions.

When we experience highly intense emotions, it often leads to impulses to do something to make the feeling disappear or become less intense. Frequently, the strategies we use to make these feelings vanish are not particularly helpful.

If you tend to experience impulses towards problematic behaviour, it's highly beneficial to learn distress tolerance skills. Problematic behaviour can include self-harm, excessive alcohol consumption, social isolation, or anger outbursts.

Distress tolerance skills offer alternatives for managing intense feelings without making the situation worse. After using these skills, you will typically be better able to think clearly and apply other skills to work through the situation.

In this module, we cover techniques such as distraction, improving the moment, and using intense sensory input to regulate emotions. We also work with the skill of acceptance, where we practise accepting life as it is in the here and now, to find the peace needed to create change.

Homework in DBT

To achieve lasting change in your life, simply receiving instruction in DBT skills is not enough. Change doesn't happen during the time you spend in a group or individual session with a DBT therapist. Change occurs when you integrate this new knowledge into your daily life – in all the other hours of your week. Therefore, one of the most important aspects of DBT is that you implement the skills in your own life, meaning you start using them where you desire change. One way to do this is through homework.

This might sound a bit like school, but it doesn't mean you'll be writing long essays in DBT. Instead, it's a good idea to set aside 10-15 minutes each day to practise the new skill. You'll receive materials to guide you, and together we can discuss how and in which situations you can practise effectively.

Just like learning to ride a bicycle, it's crucial to practise. When learning a new skill, you should practise in a non-challenging situation, much like using stabilisers when first learning to cycle. The more you practise, the easier you'll find it to apply the skills when it truly matters.

Chain Analysis in DBT

Chain analysis is one of the most important working methods in DBT. Let's take a closer look at what a chain analysis involves.

In individual therapy, beyond learning skills, we delve into the specific problems an individual client is facing. Together with your psychologist, we examine what triggered a problematic behaviour. We look at both what happened in your environment and what feelings and thoughts it initiated. This involves identifying primary and secondary emotions. A primary emotion is the first feeling that arises when something happens, and it's the emotion most people would experience in a similar situation. However, many people don't notice the primary emotion, instead experiencing a secondary emotion. This often arises due to judgmental thoughts about oneself, others, or the situation.

Example of a Chain Analysis

In this example, the client experienced a job application rejection and subsequently isolated themselves, drank alcohol, and stopped writing further applications. Together, we would work to uncover what led to this problematic behaviour. In this case, it's the feeling of shame (the secondary emotion) that created the impulse to withdraw and drink alcohol. This shame arose alongside judgmental thoughts. The client wasn't aware of the primary sadness and disappointment about not getting the job, as shame quickly took over their focus.

Once we've completed the chain analysis together, we will discuss which skills would be most helpful to apply in this and similar situations. However, simply gaining an understanding of why you engage in problematic behaviour and understanding your inner life can be profoundly helpful in itself.

What Can DBT Treat?

When our emotions become too intense to manage, this can lead to many different difficulties. DBT is highly effective in treating anger outbursts, self-harming behaviour, overeating problems, substance or alcohol misuse, and relationship difficulties. Furthermore, these skills are valuable when working with self-criticism, depression, conflict avoidance, stress, and anxiety. If you are looking for a psychologist in Aarhus who can help with these challenges, DBT may be a suitable approach for you.

What I Offer in DBT

I am an experienced DBT therapist, having worked with DBT for 8 years within psychiatry in Silkeborg. My experience includes both group programmes and individual therapy.

My experience with DBT is that it resonates deeply with most people. Many of my former clients have asked, "Why isn't this taught in school?" and "Everyone should learn DBT" — and I agree with them.

Although these skills were developed for individuals with personality disorders, they are essentially life skills that can benefit everyone.

I offer both skills training and therapy. I am keen to form a DBT group, so please get in touch if you are interested in participating or if you'd like to learn more about whether DBT can help you. If you prefer individual instruction and therapy, you can book an appointment here. Together, we can create a customised programme if you don't require all the skills.

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