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4 DBT Skills ANYONE Can Use!

Though DBT (dialectical behavior therapy) is known predominantly as a treatment for borderline personality disorder (BPD), its foundation is pretty simple. The concept of dialectics is used to simultaneously foster change and acceptance.  This allows sufferers to accept the present while acknowledging that their future must involve change.  

DBT is an empirically based treatment, meaning it is backed by evidence. It is broken down into two major components: skills training and individual therapy.

Skills offer specific solutions to pretty common problems. Though created specifically for those with BPD, it addresses common issues. This means it can actually be used by anyone. DBT teaches clients emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness-skills we can all benefit from. Here are four DBT skills that can help individuals cope with anxiety or stress.

One-mindfully

One-mindfully is a skill that suggests that fully engaging in the moment can be a deceptively therapeutic exercise. Often people are living their present lives ruminating about the past or future. This can easily provoke anxiety as we get stuck mulling over what we’ve already done wrong, or what we’re certain to do wrong.

I always try to help clients develop the ability to anchor themselves in the present because that is key to maintaining good mental health. It is all too easy to allow your mind to be hijacked by the past and the future. With this skill, we become aware of our thoughts, feelings, and reactions. We learn to pause and check in before responding. This helps to limit people from reacting which tends to be driven by raw emotion as opposed to responding which is when we are calm and with a set intention.

The idea of cultivating this skill is that this better prepares us to handle future problems. This way we are taking charge of our emotions instead of allowing them to rule us.

The truth is that fully engaging in the present allows us to be better capable of dealing with future challenges as they arise. This can be a foreign concept in cultures, industries, and countries that operate under a “work till you keel over” attitude. Self-care and maintenance are an oft-overlooked, extremely important facet of productivity.

It also helps keep anxiety at bay, by fostering less rumination about the past while allowing us to effectively deal with future problems from a more mentally grounded perspective. It helps avoid burnout and its predecessor: over-extension.

Self-Soothe

In DBT, the concept of self-soothing refers to our ability to calm emotional turmoil by grounding ourselves by focusing on physical stimuli. This is done by using any number of the five senses: taste, smell, sight, hearing, and touch.

This means there are seemingly endless ways to utilize this skill, dependent upon whatever is the most effective for the individual. It can help anxiety sufferers “get out of” their mind, in order to become grounded in the physical world again.

For example, one could suck on hard candy and analyze the feel and taste. They can also escape through a favorite song or the soft, soothing feel of an animal’s fur.

Because the exercise momentarily replaces rumination and worry, it can be particularly useful for sufferers of anxiety. Taking a break from the rumination can then be utilized to think in a more detached and calm manner. This would hopefully allow the individual to think of more effective ways of addressing whatever is provoking their anxiety, or at give them a momentary vacation from it.  

Luckily this skill both helps heed off anticipatory anxiety and deal with the aftermath of an emotionally triggering event.

Radical Acceptance

Radical acceptance can require more effort and is one of the more difficult DBT skills to master. It involves accepting the world exactly as it is, at that moment. Sounds pretty easy right? But what if you’re accepting the death of a loved one, end of a relationship, financial mistake, embarrassing gaffe or catastrophic mistake?

The idea of radical acceptance is not to turn away from these painful experiences but to accept that they’re in fact real and true. Mental effort should, therefore, go into either coming to peace with the experience or changing it. It is embodied in one of my favorite coping mantras, it is what it is.

This can be life-altering for anxiety sufferers who tend to focus on the why and how of the experience, mulling over the disbelief of the circumstances as opposed to how they are going to either accept or extricate themselves from the situation. Often clients come to counseling intently focused on figuring out the WHY. I often state gently it doesn’t matter–not to be dismissive but because the fact is a lot of things in life are inherently meaningless. People act without thinking, life events unfold due to happenstance. Too often clients try to prescribe intent to actions where there is none. A lot of anxiety is grounded in the idea that a better understanding of the situation will somehow make the situation different. This is often only subtly false.

This is because rumination can be seen as a pre-emptive deterrent to being caught unaware of a problem or issue. It can be practiced to pathologically damaging levels, however.  This can leave individuals expending truly immense amounts of effort, noticing their situations never seem to actually change.

Non-judgmental Stance

This skill is about cultivating a non-judgmental perspective where things are neither good or bad. Everything and everyone are simply is as it is. The truth is judging is often a short hand way of stating our preference. It is in our nature to label and judge. And maintaining a non-judgmental stance in the face of stress and anxiety is very difficult, but in doing so will help us to regulate our emotions. Common judgmental words include: right, wrong, good, bad, should, must, unfair, stupid, crazy, awesome, great, terrible, etc.

The fact remains judgments do more harm than good. Passing judgments about people, things, or ourselves shuts those things out of our world and closes the doors to opportunities, growth, and relationships. Staying in a non-judgmental state of mind keeps us open to possibilities and options.

These are four DBT skills that can be life changing for those that commit to them. However, like all therapies, DBT shouldn’t be considered a one-size fix for any problem or individual. Counseling can help you cultivate these skills to be more at peace with yourself and the world around you.

Your Past is Only Relevant to How It Impacts Your Present Life

All too often some counselors and their clients fall into a trap many people fall into in the wider sphere of life is that they tend to focus on the past at the expense of the here and now. Thinking about the past can be useful but only as it relates to present functioning. Otherwise, it’s like walking through the ruins of an ancient civilization or digging up archeological relics; sure, it’s interesting but there’s no life, no vitality, no vibrancy.

Most of us know that having had a hard childhood can affect our adult lives. Depending on the severity of childhood hardship, and the amount of counseling, who you are as an adult can be based on what you knew as a child. In fact, an Adverse Childhood Experiences scale is a popular tool clinicians use to assess childhood adversity. Such experiences can interfere with a person’s health, opportunities and stability throughout his or her lifetime—and can even affect future generations.

We all know people who act a certain way because of the unhappiness of their formative years. The child who had to deal with an alcoholic parent, one who suffered abuse at the hands of family members, witnessed their parents’ hostile divorce, children who were exposed to the horrifying aspects of poverty — anyone who has had what is commonly referred to as “dysfunctional family dynamics.”

There are a few psychological reasons that people focus all their attention on the past. The biggest one is that for many, their past is their present. What I mean is that they haven’t been able to find a resolution, a sense of closure about what happened to them, and as such these past events are still very much alive. The problem of course is that they can no longer do anything to influence this past, they can’t channel their psychic energy where it needs to go, so it sticks around regardless of how many times they play out what happened in their heads.

For others talking about the past is a good way to escape the present. The past feels safer, precisely because it’s set in stone and carries no uncertainty with it, no risk. By focusing on the past they can keep things at the theoretical level instead of the more dangerous visceral level that fully committing to the here and now entails.

As you get older and you gain more life experience, the way you perceive your past changes. As you mature, you begin to recognize the life lessons that you’ve learned through your past experiences, and this can influence the way you look back at your past.

I think there is something to be gain from exploring the past with a client. It is helpful to understand a client’s life history to conceptualize their present functioning. Part of an intake session is going over a client’s life story as well as their presenting problem ie what is bringing them to counseling. I don’t think it’s automatically a waste of time to work on your past in therapy. I’m not saying counseling should exclusively be about your present circumstances, and anything focused on the past is misguided. It’s not that black or white. I just want to push back against the idea that counseling is about focusing on the past or blaming one’s parents for their current life problems, a common generalization I hear from critics of talk therapy.

As a clinician myself, I always utilize Gestalt therapy with my clients as part of my tool bag of techniques. Gestalt therapy is a client-centered approach to counseling which helps clients focus on the present and understand what is really happening in their lives right now, rather than what they may perceive to be happening based on past experience.

Thinking about the past is only really useful when it gives you vital clues about present functioning, about the way you relate to yourself, others, and the world. The only thing that is real is the present moment; it’s the place where you spend the entirety of your life, even when you’re projecting yourself backwards or forwards in time. The key is to better understanding how your current patterns of behavior are connected to what happened to you so that you can take the next vital step of changing these behaviors.

Radical Acceptance

A key component of radical acceptance is not fighting reality. It is the cornerstone of DBT (Dialectic Behavior Therapy). Radical acceptance can be defined as the ability to accept situations that are outside of your control without judging them, which in turn reduces the suffering that causes them.

Radical acceptance is a distress tolerance skill that is designed to keep pain from turning into suffering.

It’s easy to confuse the idea of radical acceptance with unhealthy states of being like giving up, complacency, or settling for less. The typical argument runs something like, “Acceptance is for losers. I refuse to accept my lot. I’m going to keep striving until I get to a better place.”

But radical acceptance places no restraints on wanting a different future, no restraints on motivated behavior meant to change the present set of circumstances. In fact we could make the existential argument that acceptance is the necessary prerequisite for any future change. As Carl Rogers once put it, “When I accept myself as I am, then I can change.”

In our view the heart of radical acceptance has two fundamental parts. The first is seeing the present clearly for what it is and the second is realizing that despite the various unwanted elements of this present situation there also exist all the necessary elements for happiness and fulfillment right now.

Radical acceptance is accepting the facts of a situation without responding by throwing a tantrum or putting our head in the sand. It embodies my favorite mantra, it is what it is.

Mind you, radical acceptance is not approval or agreeing with what happen, but rather completely and totally accepting the current facts, EVEN IF WE DO NOT LIKE THEM. By choosing to accept things out of our control, we prevent ourselves from becoming stuck in unhappiness, bitterness, sadness, and in a perpetual state of suffering. Completely totally and accepting this fact is challenging, but liberating. It frees up all the the energy we are using to fight reality to effectively cope with the situation and take care of ourselves.

Radical acceptance takes lots of practice and counseling can help you develop the skills to cope with distress. It is a difficult skill but a skill that can transform your life.

Don’t PUNISH the Wrong People

Most of us do our best to behave. We try to do the right thing, be polite, follow social/moral norms, and not harm others.

Yet punishment exists across society in as far back as history goes, albeit our ancestors doled out different forms of “punishment” then current society may permit (public stoning–not going to fly these days)! Evolution has instilled in humans the desire to identify and discipline wrongdoers. It is a part of our collective human nature. The reasons for direct punishment are clear. If someone wrongs you, retaliation reduces the likelihood that they will do it again. Additionally, if others see you retaliate, they will also be less likely to wrong you in the future.

When our goals are thwarted or we feel diminished in some way, many of us find ourselves in the uncomfortable position of having a lot of negative energy to unload but not feeling able to direct it towards the correct person due an imbalance of power. Thus, we punish the wrong people, usually those closest to us, making them suffer to relieve our own suffering.

Of course, this process is not conscious. We wait for some way to rationalize our behavior by citing the wrong behavior of the person we are punishing, but if we look deeply we can usually trace our hostility not to what this person has done, but to an unfulfilled desire to retaliate against the person who has hurt us.

If this setup is familiar to you, try a different route next time. Instead of attacking the wrong person, openly admit to your hurt feelings and ask for comfort and support instead. You’ll feel a lot better, which is why you’re trying to punish your loved one in the first place, and you’ll be strengthening your relationship instead of decaying it.

It can be pretty tough to admit to feeling diminished, you’re exposing your soft underbelly not just to someone else but also to yourself by admitting you have one. But it’s preferable to blaming and punishing a person who doesn’t deserve it, in effect making someone else feel just as bad as you have been made to feel yourself.

How CBT is Utilized for Anxiety

You might have heard a lot of talk about cognitive-behavioral therapy (CBT) and its benefits but still not be entirely sure what it is. Often CBT is a popular treatment for people who struggle with anxiety. It is the most widely used treatment approach to managing anxiety.  If you have ever heard that if you can change your thoughts, you can change your life, or that if you act on your dreams, you’ll be more confident, you’ve heard of cognitive and behavioral ideas.  CBT aims to change our thoughts and behaviors to help us feel better and achieve our goals. CBT looks at how negative thoughts, or cognitions, contribute to anxiety.

Cognitive-behavioral therapy combines techniques from two schools of psychotherapy: cognitive therapy and behavioral therapy.  Cognitive therapy aims to change our thinking while behavioral therapy aims to change our actions. Combined, these evidence-based techniques are extremely effective for treating various mental health concerns, including anxiety, depression, substance abuse, trauma, and more.

The following are cognitive-behavioral techniques commonly used for anxiety. The way they are applied varies from person to person and depends on the individual experience and context.  A therapist uses these techniques tailored to their individual client.

Anxiety Psychoeducation

Psychoeducation is an important part of treating anxiety. The understanding and normalization of anxiety will allow you to better recognize your symptoms, and understand the rationale behind common treatments.

Reframing Thoughts

Reframing our thoughts is a cognitive technique.  This technique invites us to take inventory of our thoughts and the things we are telling ourselves.  We know that what we tell ourselves shapes our beliefs about ourselves and life, our emotions, and our behaviors.  When we are anxious, we often don’t see things accurately.  We might not accurately view situations, judging them to be more dangerous than they are.  We can worry about the future and start to think everything will turn out badly.  We revert to black-and-white thinking about situations, stressing ourselves out even more.  When we analyze our thoughts, we can more objectively evaluate if they are accurate.  We can also change our thoughts to ones that are more empowering. Reframing our thoughts can have a drastic positive effect on our mood and behavior.

Mindfulness Exercises

Mindfulness exercises are behavioral interventions. They can include deep breathing, progressive muscle relaxation, and other coping skills.  Deep breathing helps calm our nervous system response to anxiety and is a fast and easy way to calm down. Progressive muscle relaxation helps us relax our muscles and become more in tune to whether we are tense or relaxed. Other coping skills include ways to improve the present moment: listening to music, exercising, stretching, meditating, socializing, etc.

Recognizing Triggers

We can retrigger our anxiety in various ways.  We might be too vigilant, too avoidant, or too compulsive.  If we are too vigilant, we will notice every change in our bodies or environments and then ascribe some meaning to it.  This can trigger a cascade of anxiety.  We need to learn to calm our vigilant minds.  If we are too avoidant, we can go to great lengths to avoid the things we are afraid of.  Avoidance increases our anxiety so we have to learn to lean into situations. If we are compulsive, we might constantly expose ourselves to anxiety-provoking things, like reading about diseases when we are worried about getting sick or checking on an ex when we are trying to move on.  In this case, we need to learn to reduce those behaviors.

Anxiety can feel like a debilitating experience but it is something  that can be treated and controlled.  Cognitive-behavioral techniques, like the ones outlined above have been shown to be effective for anxiety and panic.  Many clients also find they can manage these symptoms without medication, since medication is often not an effective long-term solution.

If you need therapy for anxiety or a cognitive-behavioral treatment, please reach out to me and I am happy to work with you to overcome this common mental health problem.

Erin Doyle Theodorou, M.Ed., LPC, NCC

590 Franklin Ave.

Suite 2

Nutley, NJ


973-963-7485

etheodorou@theodoroutherapy.com