Dialectical Behavior Therapy, more popularly known by its abbreviation, “DBT”, is a psychotherapy for emotion dysregulation. However, what is “emotion dysregulation”? And what does “dialectical” mean? I had the same questions when I began learning DBT in early 2007! And once I started learning and using DBT with my clients and in my own life, I realized these terms weren’t so intimidating after all. Don’t let these big words scare you away from a highly effective therapy.
The term “dysregulation” was coined by DBT founder, Marsha Linehan, PhD, to explain a process of an individual’s response to a distressing event. In a “dysregulated” reaction, let’s say, to losing the car keys, a person would have intense physiological arousal and emotion, often followed by thoughts and actions that keep the emotion rising. To continue with the lost keys example, someone might think “There I’ve done it again, now I’m not going to make it to my presentation on time, what a screwup I am! I know I’m going to lose my job over this. What am I going to do?”. This person may take actions to try decreasing the anxiety and fear, like going back to bed, that do not do anything to solve the problem of finding the car keys. Mind you, they are not jumping in bed because they think the keys will be there and the problem will be resolved, but because the impact of their emotions is so painful that they want to avoid it at all costs. DBT helps someone with this type of response pattern to notice their reaction, engage in behaviors to decrease the heightened physiological distress, and get them back on track for problem solving. The skills taught in DBT skills training focus on changing the cycle: Mindfulness, Distress Tolerance, Emotion Regulation & Interpersonal Effectiveness (after all, doesn’t much of our problem solving involve other people?).
Now, for that obscure term “Dialectical”. What it means at its essence is the balancing of opposites and the integration of different thoughts or viewpoints into a cohesive whole. We may face a lot of dialectics–or opposites–in our lives without even knowing it. Such as: balancing work and pleasure, time with others and time to ourselves, or thoughts like “I’m happy with myself” and “I wish I were a better listener, more patient, etc.”. In therapy, we move people through stuck points and back on track with their life’s goals.
Interested in more DBT? See the Skills Training Manual: DBT Skills Training Handouts and Worksheets, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.
