Dialectical behaviour therapy or DBT is a talking treatment that was originally developed for people with borderline personality disorder, but is now used to treat a range of mental health problems. It aims to teach patients skills for coping with their lives better, and these are divided into four areas: mindfulness, getting through a crisis, managing mood and relationship skills.

I have never had formal DBT therapy, but a few years ago I took part in an online class which teaches the skills. Here I’m going to share a summary of the main DBT skills with links to further help and information.

I know not everyone is a fan of DBT. Some of the skills can seem a bit patronising, and it can feel like the emphasis is on coping better on the surface without addressing the reasons why you’re struggling in the first place. My personal experience is that DBT and similar skills (together with meds) have helped stabilise me enough that I’m able to work on the underlying stuff without self-destructing. I also view the DBT skills as a toolbox with a wide range of options: you don’t have to use every single skill, just figure out what works for you and under what circumstances. Finally, there’s more to DBT than just self-help techniques, and I have found its philosophy on emotions and suffering (which is drawn from Buddhism) makes a lot of sense.

If you’re interested in learning DBT skills, I highly recommend two websites which explain them far better than I ever could. The first is the free online DBT Class run by BPD from the Inside Out which takes you through one skill each week with a short homework assignment. The other is DBT Self-Help which provides lots of information on all the skills.

Mindfulness

Mindfulness is the art of paying attention to your thoughts, actions and experiences in the present moment without judging. I’ve found that mindfulness is grounding, reduces my stress levels and makes it easier to cope with any problems in life, so that I’m less likely to self-destruct.

What to do (summary)

• Observe
• Describe
• Participate

How to do it (summary)

• Non-judgementally
• One-mindfully (one thing at a time)
• Effectively (focus on what works)

DBT also teaches that there are three states of mind: reasonable mind, which is rational and logical; emotional mind, when emotions control or influence our thoughts and behaviour; and wise mind, which is a healthy balance of the two.

Getting Through a Crisis

Distress tolerance skills are skills for coping with distressing emotions, events and crises. Once learned, these skills can be used in the heat of the moment as an alternative to self-harm, bingeing, getting drunk or whatever your personal flavour of self-destruction is.

Distraction techniques can be remembered with the acronym ACCEPTS:

• Activities
• Contributing (helping others)
• Comparisons (with other people) (everyone I’ve spoken to hates this one. I don’t use it)
• opposite Emotions (e.g. watching a film or listening to music that will trigger a different emotion)
• Pushing away (mentally blocking the situation)
• Thoughts
• Sensations

Self-soothing techniques focus on the five senses and have to do with nurturing, comforting and being kind to yourself. These are some of my favourite skills.

IMPROVE the moment is an acronym for a set of skills:

• Imagery (e.g. create an imaginary “safe place”)
• find Meaning in the crisis
• Prayer (feel free to ignore this one if you’re not religious)
• Relaxation
• One thing at a time
• Vacation (take some time out)
• Encouragement (talk to yourself in an encouraging way)

Pros & cons involves weighing up the advantages and disadvantages of different courses of action.

Radical acceptance involves accepting reality as it truly is. That doesn’t mean you have to like or approve of the situation, but it means you stop fighting reality. Radical acceptance can be a way to avoid unnecessary suffering.

Managing Your Mood

Emotion regulation skills help you to understand the way you feel and manage your emotions. DBT teaches that emotions are not right or wrong – they just are. It places a lot of importance on validating the way you feel, while also teaching ways of reducing negative emotions and increasing positive ones.

Describing Emotions and The Function of Emotions explain the DBT perspective and can help you understand and validate your feelings. I recommend reading these before you try any of the other skills.

PLEASE Master is an acronym for a set of skills that can make you less vulnerable to negative emotions:

• treat Physical iLlness
• Eat healthily
• Avoid mood-altering drugs
• Sleep well (suggestions here)
• Exercise
• Mastery – do something every day that gives you a sense of competence or achievement

Increasing positive emotions does what it says on the tin! This involves doing more enjoyable activities and also making changes in our lives that will lead to more positive experiences.

Being mindful of your current emotion is a way to reduce unnecessary suffering when you are feeling bad.

Acting opposite is a way of changing unpleasant emotions by doing the opposite of the way you feel – for example, doing something that scares you, or finding compassion for someone you are angry with.

Relationship Skills

In DBT, relationship skills are known as “interpersonal effectiveness” skills. This basically means being able to meet your goals in your relationships with other people. DBT teaches that there are three types of goals in relationships:

• objectives (getting what you want or saying no to what you don’t want)
• relationship goals (keeping or improving the relationship)
• self-respect goals (feeling good about your behaviour and respecting your own values and beliefs)

DEAR MAN is an acronym of the skills needed for objectives:

• Describe the facts
• Express your feelings or opinions
• Assert your wishes
• Reinforce the positives (how the other person will benefit if they do what you need/want)
• stay Mindful
• Appear confident
• Negotiate

GIVE is for keeping or improving the relationship:

• be Gentle
• act Interested
• Validate
• use an Easy manner

FAST is for self-respect:

• be Fair
• no Apologies
• Stick to values
• be Truthful

Obviously, you can use more than one set of skills at a time if you have more than one type of goal. However, it can be helpful to prioritise what is most important to you in a given situation – getting what you want, the relationship, or your self-respect.

The following links may also be useful:

• When to use interpersonal effectiveness
• Factors reducing interpersonal effectiveness
• Myths about interpersonal effectiveness
• Cheerleading statements
• Intensity options (how firm do you want you be?)
• Suggestions for practice

Other Stuff

Behaviour chain analysis
You can do this exercise after you’ve self-destructed to help you understand all the factors that led up to it, and to look at what you could have done differently or can do differently in future. It can be used for any problem behaviour – self-harm, abusing drugs or alcohol, binge-eating, fighting with your partner, and so on.

Flash cards
Handy reminders of all the main DBT skills.

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