by EK Wills
This week was one to test anyone’s patience.
And so I was glad to learn about a specific type of therapy that includes skills training on aspects such as distress tolerance and emotion regulation. These are part of a type of therapy called dialectical behavioural therapy or DBT.
It was initially developed by Marsha Linehan for people suffering what is labeled borderline personality disorder and, interestingly, she was a sufferer herself. But DBT has now been advocated for children as young as in preschool because it teaches life skills we can all use.
It starts with elements many of us have heard about such as mindfulness. This week, I practiced the technique of eating a lolly and it was the most intense sweet experience I have ever tasted. In the group program, mindfulness is practiced for a couple of weeks using exercises to develop the skill.
Then DBT looks at interpersonal effectiveness and is broken down into objectives in relationships, which include self respect, assertive communication and problem solving. For example, when you have a difference of opinion with your partner, there are several objectives that you could perceive to be of most importance. Is it that you need to maintain the relationship or is your moral code at stake? Or is it that you have an objective in this interaction?
You can decide which action to take based on the importance of these elements at the time and DBT provides steps to actualize these.
For example, if the objective is key, there is a pneumonic to help you remember the steps: DEAR MAN.
D – Describe the situation
E – Express clearly
A – Assert wishes
R – Reinforce
M – (stay) Mindful
A - Appear confident
N - Negotiate
This helps you to remember the steps when faced with a situation you find challenging. You can then take the time to respond using the prompts.
After learning techniques for each objective, the therapy addresses emotion regulation.
One of the hardest things to do is to step back from an emotion and allow time to process what it is. Part of this process involves understanding the function of emotions, identifying and labeling your emotions as they occur and identifying obstacles to changing them.
In order to change them, steps involve:
1. check the facts
2. problem solving
3. opposite action
Opposite action is a fun aspect that involves being able to take an action that does not inflame the situation but gives you a sense of ownership and control. The one I most recently heard, and made me laugh, was someone peeing in the shower because she knew it would annoy her boyfriend and she was really ticked off at him at the time. This way she could modify her reaction to her boyfriend before it escalated.
And of course, mindfulness assists with managing extreme emotions by observing the emotion, not judging it, allowing it and riding the wave then watching it dissipate. This reduces secondary emotions like guilt, which can cause more emotional distress.
Relationships require balance between acceptance and change, which require skills to develop and maintain them.
Based on the recognition that life is tough and involves painful times, attempts to avoid any pain can cause more suffering. By tolerating distressing emotions, you build the capacity to perceive your environment without putting demands on it to be different. It should be noted, however, that tolerance or acceptance of reality does not mean approving it but learning to change your response to it.
The DBT framework involves looking at your emotions as part of your ‘emotion mind’ and the facts as your ‘rational mind’. Your task is to develop your ‘wise mind’ as the balance between the two, in order to find the middle ground or the considered response to a situation.
All this takes place in the context of your daily life and can be modified by reducing your vulnerability to your emotion mind. This is referred to as PLEASE skills:
(treat) Physical (illness)
Accumulate positives
Eating well
Avoid drugs that effect your mood (yes alcohol and cigarettes, too)
Sleep
Exercise
which are all good aspects to our selves that we need to focus on to lead balanced lives.
Luckily, the course is much less condensed than this short bog but it gives you an idea of what is involved, should you decide to find out more about it.
Wishing you a balanced week!
References:
Jo Hew Clinical Psychologist Hew, J. & Chu, D. (2016). Introduction to Dialectical Behaviour Therapy lecture. Psychotherapy Program, Brain & Mind Centre, University of Sydney,
Marsha Linehan, Ph.D. at www.linehaninstitute.org
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