by Ashley Gregory

As mentioned in part one, Dialectical Behavioral Therapy (DBT) is a widely applicable practice combining a variety of concepts and skills. Marsha Linehan created DBT in the late 1970’s, inspired by her own personal experience to dedicate her life to supporting people in severe distress. Marsha wove together concepts and interventions from Zen Buddhism, behavioral and humanistic approaches to arrive at four essential DBT skills: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Radical acceptance is an essential belief in DBT, grounding the skills practice in embracing one’s present moment experience. 

What does Radical Acceptance mean?

Each of the DBT skills is designed to offer relief during different points throughout an experience of emotional pain. From moment to moment, emotional pain shifts and changes. DBT stresses the importance of understanding choice and control. A key concept and practice of DBT is radical acceptance. Radical acceptance means accepting the past and focusing on the present moment, without inflicting criticism, blame or judgment. It is in the present moment where we have the most power to make change. Only by accepting the present may we create something different in the future. 

Mindfulness is Noticing Without Judgment

DBT is grounded in the practice of mindfulness. Mindfulness is not the same as meditation. In fact, Marsha found that many of the people she worked with in her early work with clients became overwhelmed when directed to focus on their breath. In the experience of many trauma survivors, focusing on the breath can bring up terrifying memories. Instead, mindfulness is directing one’s attention to the present moment without judgment. It is the practice of simply noticing. Simply noticing thoughts, feelings, impulses, sensations or images arising in one’s own experience. Noticing without judgment means letting go of labels such as “good” or “bad,” “healthy” or “unhealthy” and trusting that your experience is your experience. In most DBT groups, mindfulness is repeatedly practiced throughout the course of learning all of the other skills. 

Distraction and Self-Soothing in Order to Cope 

Being in extreme emotional distress may lead to impulsive reactions and coping in ways which lead to more suffering, like hurting yourself or someone else. Distraction and self-soothing skills are distress tolerance tools which increase capacity to deal with overwhelming emotions. Authors of The Dialectical Behavioral Therapy Skills Workbook stress “do not confuse distraction with avoidance. When you avoid a distressing situation, you choose not to deal with it. But when you distract yourself from a distressing situation, you still intend to deal with it in the future, when your emotions have calmed to a tolerable level” (p. 9). Distraction skills may include holding an ice cube, engaging in enjoyable activities like playing with a pet, going outside, learning a new language, playing a card game or writing in a journal. Other skills include picking something in your environment to count or completing chores like cleaning behind the refrigerator. The idea behind distraction skills is to create some space to be able to work through overwhelming emotions. Self-soothing practices are ways to create increased calm and improved focus. Most often, self-soothing skills engage the senses. Examples include listening to music (sense of hearing), lighting a candle of your favorite scent (sense of smell), looking at pictures of nature (sense of sight), slowly drinking tea or chewing gum (sense of taste) and wearing your most comfortable clothes (sense of touch). What may be most supportive for one person will most likely be different from another person. Each distraction and self-soothing plan is a reflection of your unique needs and interests. 

Interlocking Skills

Many of the skills taught in DBT overlap and reinforce each other. Emotion regulation skills, for example, are also mindfulness and distress tolerance skills. One way to slow down to create more space and choice between emotion and action is to speak your feelings out loud. Becoming aware of the relationships between emotions, thoughts and behaviors in your own life can be an empowering process. Identifying coping thoughts, such as “Mistakes happen, nobody’s perfect” may offer relief and allow for radical acceptance and self-compassion to be more accessible. 

Finally, interpersonal effectiveness skills integrate mindful awareness of yourself and others within relationships. The Dialectical Behavioral Therapy Skills Workbook describes six core interpersonal effectiveness skills: knowing what you want, asking for what you want, negotiating conflicting wants, getting information, saying “no” in a way that protects the relationship and acting according to your values (p. 187-188). These skills support you in identifying barriers to creating and maintaining nourishing relationships in your life. 

Your Unique Healing Journey

DBT stresses the importance of cultivating awareness, following intuition, creating effective plans, taking wise action and honestly reflecting. In my practice with clients, I also draw upon a combination of these practices with gentleness, humor and acceptance. Together we can weave an experience of therapy unique to you, meeting you where you are while building your capacity for change. 

The Dialectical Behavioral Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance by Matthew McKay, Ph.D, Jeffrey C. Wood, Psy. D, and Jeffrey Brantley, MD.