Chronic Pain, Depression, Dialectical Behavioral Therapy, Fibromyalgia, Health

What is Dialectical Behavioral Therapy (DBT) & How Can it Help You : A Beginner’s Guide, Part 1

Dialectical Behavioral Therapy (DBT) Part 1

When I was in the clinic to deal with my depression, I learnt a very important therapy which helped me to accept my Fibromyalgia, change my way of thinking and improve my depression. I’ll cover the different parts of DBT over the next couple of posts. The first part to understand is the theory of Dialectical Behavioral Therapy.

It’s not about the nail … please watch

Dialectical Behavioural Therapy (DBT) was devised by Marsha Linehan at the University of Washington, Seattle. It was developed especially for borderline patients because they are difficult to keep in therapy, often fail to respond to therapy and place high demands on the emotional resources of the therapist.

“Dialectical” comes from the classical philosophy and it refers to a form of argument where an assertion is first made about an issue (the thesis), the opposing position is then formulated (the antithesis) and finally a “synthesis” is found between the two extremes.

It embodies the valuable feature of each position and resolves any contradictions between the two. In simple words, it means that two opposite ideas can be true at the same time, and when considered together, can create a new truth and a new way of viewing the situation. There’s always more than one way to think about a situation.

DBT includes techniques of:

  • Acceptance and validation designed to counter the self-invalidation of the person
  • Problem Solving to help learn more adaptive ways of dealing with difficulties
  • Skills to deal with difficulties

Dialectical approach is non dogmatic, open, systemic and transactional orientation, i.e. acceptance and change.

Behavioral in the way that it doesn’t ignore the past, but focuses on present behavior and current factors controlling the behavior.

There are 4 sections in DBT:

  • Core mindfulness skills
  • Distress tolerance skills
  • Emotion regulation skills
  • Interpersonal effectiveness skills

“Dialectical” Open-Mind Thinking

Dialectical means that two ideas can both be true at the same time.

  • There’s always more than one TRUE way to see a situation, and more than one TRUE opinion, idea, thought, or dream.
  • Two things that seem like (or are) opposites can both be true.
  • All people have something unique, different, and worthy to teach us.
  • A life worth living has both comfortable and uncomfortable aspects (happiness AND sadness; anger AND peace; hope AND discouragement; fear AND ease; etc).
  • All points of view have both TRUE and FALSE within them.

Examples of Opposite Sides That Can Both Be True

  • You’re right AND the other person is right.
  • You’re doing the best that you can AND you need to try harder, do better, and be more motivated to change.
  • You can take care of yourself AND you need help and support from others.
  • You are tough AND you are gentle.
  • You can share some things with others AND also keep some things private.
  • At times you need to both control AND tolerate your emotions.
  • Someone may have valid reasons for wanting something from you, AND you may have valid reasons for saying no.
  • The day can be sunny AND it can rain.
  • You can be mad at someone AND also love and respect that person.

Being dialectical means:

  • Letting go of self-righteous indignation.
  • Letting go of “black and white”, “all or nothing” ways of seeing a situation.
  • Looking for what’s “left out” of your understanding of a situation.
  • Finding a way to validate the other person’s point of view.
  • Expanding your way of seeing things.
  • Getting “unstuck” from standoffs and conflicts.
  • Being more flexible and approachable.
  • Avoiding assumptions and blaming.
Change & Acceptance

DBT accepts your thoughts and your feelings, but wants to encourage you to change your behavior to become more functional, to limit unwanted long term consequences and to maintain self-respect.

Guidelines for Dialectical Thinking

Do:

  • Move away from “either-or” thinking to “BOTH-AND” thinking.
  • Avoid extreme words like, always never, you make me.

Example:

Instead of saying: “Everyone always treats me unfairly”, say “Sometimes I’m treated fairly AND at other times I’m treated unfairly.”

Practice looking at ALL sides of a situation/points of view.

Find the “kernel of truth” in every side.

Remember: NO ONE owns the truth. Be open and willing.

If you feel indignant or outraged, you’re NOT being dialectical.

Use “I feel …” statements, instead of “You are …” statements.

Accept that different options can be legitimate, even if you don’t agree with them: “I can see your point of view even though I don’t agree with it.”

Don’t:

  • Assume that you know what others are thinking, check it out: “What did you mean when you said …?”
  • Expect others to know what you’re thinking, be clear: “What I’m trying to say is …”

Reference: Akeso Crescent Clinic

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