Dialectical Behaviour Therapy (DBT) for Psychiatry Residents
Dialectical Behaviour Therapy (DBT) is a type of therapy developed to help people regulate their emotions. It was first developed for those with a diagnosis of borderline personality disorder, but it turns out that DBT is helpful for a wide range of conditions.
In DBT, people how to handle intense emotions through various skills such as:
- Interpersonal effectiveness;
- Distress tolerance;
- Emotional regulation.
People can become “stuck” in their intense and distressing emotions, “I feel terrible; I’m such a bad person for feeling this way.”
Mindfulness meditation can help a person get “unstuck”. It can help them cope with these feelings, and give more options on how to cope, “I’m feeling terrible. Anyone would feel terrible in this situation. This is what I’m going to do about it…”
Mindfulness is one of the core strategies in DBT.
To be mindful:.
- Practice being in the present moment, instead of thinking or worrying about the past or future. Focusing on the body (sights, sounds, body sensations, breathing) while letting other thoughts go, can help a lot with worries.
- Learn to look at themselves and the world in a way that helps you to accept yourself, without being critical or judgmental.
On one hand, human beings are social creatures, and we want to feel connected to other human beings. On the other hand, it is not always easy dealing with other people, especially when other people may have their own issues which lead them to be hard to deal with.
Interpersonal effectiveness teaches you skills on how to deal and interact in a healthy way with others, while helping you get what you want (in a healthy way).
The mnemonic DEAR MAN summarizes key assertiveness strategies:
- D)escribe the current situation
- E)xpress your feelings and opinions
- A)ssert yourself by asking for what you want, or by saying no
- R)eward the person - let them know what they will get out of it
- M)indful of objectives without distraction (broken record technique, ignoring attacks)
- A)ppear effective and competent (role play, use your acting skills)
- N)egotiate alternative solutions
Everyone feels distressed from time to time. It is our body’s signal that something isn’t right. Feeling distress is actually a good thing, because it lets us know that then we can do something about it.
On the other hand, distress can become excessive, and when it is, we may feel overwhelmed.
When overwhelmed, people often react in ways to quickly reduce our distress in the short run, but which may actually be not so healthy in the long run. Examples of not so healthy behaviours include:
- Addictions (e.g. eating junk food, excessive screen time),
Unfortunately, these reactions don’t usually help to solve these problems in the long run, and can end up causing other problems.
Distress tolerance teaches you how to tolerate intense emotional responses using healthy ways that help you stay calm, without making things worse in the long run.
Our ability to experience emotions is important for our survival, and is what makes us human. On the other hand, emotions can sometimes become overwhelming. The good news is that there are ways to regulate our emotions so that they do not become overwhelming.
Prevention -- Building up a positive bank account of positives
- A)ccumulate positive experiences:
- Keeping busy with positive experiences, e.g. going for a run or a walk with someone; thanking someone for something positive; writing a story; helping out someone, reading a book, etc.
- B)uild mastery:
- We all feel better when we improve our skills over time and get good at something. This could be skills such as music, drawing, or athletic skills, or even just learning about something.
- C)ope ahead:
- We all have stresses in our lives, and it is best when we plan ahead on how to cope with our stresses, e.g. upcoming tests; upcoming job interview; upcoming visit with relatives, etc.
Dealing with Stressful Situations
Despite our best efforts, we will encounter challenging situations. The following strategies may help:
- R)ecognize your feelings
- E.g. “I’m feeling upset and ignored. I can’t believe that my friend didn’t say hi to me in front of the others.”
- A)ccept your emotions
- E.g. "It is natural to feel upset in a situation like this."
- C)alm down if you're too upset
- E.g. "I'm too upset to deal with this right now. I'm going to go to the bathroom, and take a few deep breaths before I do anything rash."
- Choose how to respond in a healthy way
- E.g. “Maybe she’s upset with me? Or maybe she was just distracted? Or perhaps too shy? Either way, the safest thing to do is to be nice. When things are quieter, we can talk alone and see what’s up. Even if she’s upset, if I’m kind and helpful, she’ll apologize later. It won't help to get angry and upset at her."
The following videos were created by Dana Tran, uOttawa Psychiatry Resident, in order to help psychiatry residents learn DBT skills.
Portable Survival Kit
Improving the Moment
Soothing the Senses
Weighing Pros & Cons
TIPP Crisis Survival Skills
For Adults with Intense Emotions
The Dialectical Behaviour Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effective, Emotional Regulation and Distress Tolerance, by Matthew McKay, Jeffrey Wood and Jeffrey Brantley.
Do you have trouble managing your emotions? The Dialectical Behavior Therapy Skills Workbook, offers evidence-based, step-by-step exercises for key skills that will help you manage your emotions and make real and lasting change. Start by working on the introductory exercises and, after making progress, move on to the advanced-skills chapters. Whether you’re a mental health professional or a general reader, you'll benefit from this clear and practical guide to better managing your emotions.
For Parents of Teens with Intense Emotions
Parenting a Teen Who Has Intense Emotions: DBT Skills to Help Your Teen Navigate Emotional and Behavioral Challenges by Pat Harvey (Author), Britt H. Rathbone (Author)
Parenting a teen with intense emotions can be extremely difficult. This much-needed book will give you the tools needed to help your teen regulate his or her emotions. In addition, you’ll learn the skills for managing your own reactions so you can survive these difficult years and help your teen thrive.
For Adolescents with Intense Emotions
Surviving the Emotional Roller Coaster: DBT Skills to Help Teens Manage Emotions Paperback, by Sheri Van Dijk MSW (Author)
The teen years are an emotional roller coaster. So, how can you make it through? In this important guide, leading dialectical behavior therapy (DBT) and teen expert Sheri Van Dijk offers core skills to help you manage your emotional ups and downs, build great relationships, and thrive!
Basic DBT skills such a s core mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. You'll discover how to apply these skills to help deal with a number of negative emotions, such as low self-esteem, anger, anxiety, depression, and more. By changing the way you react to your emotions and to others, you'll be able to build better relationships and feel more confident as a result.
If you're ready to understand and better manage your feelings, stop acting on impulses, and calm yourself in moments of emotional stress, this book will show you how.
Written by Dr's Michael Cheng, Marjorie Robb, Michel Poirier, Dana Tran and the health care professionals at CHEO (Children’s Hospital of Eastern Ontario).
Information in this fact sheet may or may not apply to your specific situation. Your health care provider is the best source of information about your health.
Under a Creative Commons License. You are free to share, copy and distribute this work as in its entirety, with no alterations. This work may not be used for commercial purposes. View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/
Date of Last Revision: Oct 29, 2022