New Members Introduction to DBT

References:
Personal DBT Skills Group notes 11/25/08, 12/2/08
David Burns, M.D., Adapted from Feeling Good: The New Mood Therapy
Skills Training Manual page 107
Alec L. Miller, Jill H, Rathus, Marsha M. Linehan, Dialectical Behavioral Therapy with
Suicidal Adolescents, pages 311 and 312
As many of you know, DBT was originally developed for the treatment of people who
experience emotion dysregulation. This (emotion dysregulation) entails being highly sensitive
(which can be a gift if you know how to channel it!), highly reactive and slow return to baseline.
DBT is based on a Bio-social model. Individuals have a biological predisposition to emotional
dysregulation. Then, socially there is a poor fit between the family environment and the
emotionally dysregulated individual. This poor fit is evidenced by an invalidating
/inconsistent environment. This leads us to having difficulty tolerating stress, poor
communication skills, etc. We dont trust our own judgment, have low self-esteem, identity
crisis and dont know how to self-sooth. Everything is mood driven the moment is what
counts, NOT the overall goal. We never learned that Thoughts are not facts, emotions are not
facts.
a)
b)
c)
d)

Some characteristics of an invalidating environment include:

Not taken as accurate when describing their private experiences
Not taken as valid response to events
Punished, trivialized, dismissed, disregarded
Erratic, inconsistent, inappropriate responses.

The child is told s/he is over- reacting. The child goes from inhibiting to exploding; from stuffing
to being out there and getting angry.
In failing to validate private experiences, the environment does not teach the child to:
a) Label private experiences (including emotions) in a manner normative in large social
communities for the same or similar experiences.
b) Effectively regulate emotions.
c) Trust emotional and cognitive experiences as valid response to events. Instead the child
learns to actively invalidate experiences and search social environments for clues as to
how to feel, think and act, in a given situation.

DISTORTED THINKING
1. All or nothing thinking: You look at things in absolute, black-andwhite
categories.
2. Overgeneralization: You view a negative event as a never-ending pattern of
defeat.
3. Mental Filter: You dwell on the negatives and ignore the positives.
4. Discounting the positives: you insist that your accomplishments or positive
qualities dont count.

5. Jumping to conclusion: You conclude things are bad with out any definitive
evidence.
i. Mind reading: You assume that people are reacting negatively to you.
ii. Fortune telling: You predict that things will turn out badly.
6. Magnification or minimization: You blow things way out of proportion or you
shrink their importance.
7. Emotional reasoning: You reason from how you feel: I feel like an idiot, so I
must be one.
8. Should statements: You criticize your self or other people with shoulds
shouldnts, musts, oughts, and have-tos.
9. Labeling: Instead of saying, I made a mistake, you tell yourself, Im a jerk
or a loser.
10. Blame: You blame yourself for something you werent entirely responsible for,
or you blame other people and overlook ways that you contributed to a problem.

The Goals of Skills Training.

General Goal: To learn and refine skills in changing behavioral, emotional and thinking
patterns associated with problems in living, those causing misery and distress. In summary, to
develop a life worth living.
Specific Goals
Behaviors to decrease
1. Interpersonal chaos
2. Labile emotions, moods
3. Impulsiveness
4. Confusion about self, cognitive dysregulation
Behaviors to Increase
1. Interpersonal Effectiveness skills
2. Emotion regulation skills
3. Distress tolerance skills
4. Core Mindfulness skills

Dialectics: What is it?

Dialectics teach us that:
There is always more than one-way to see a situation, and more than
one way to solve a problem.
All people have unique qualities and different points of view.
It is important not to see the world in blackand-white, all-ornothing ways.
Two things that seem like (or are) opposites can both be true.
Change is the only constant.
Meaning and truth evolve over time.
Change is transactional.

Acceptance --

Acceptance
AND
Change =
--Change
Middle path

Examples:
- You are doing the best you can, and you need to do better, try harder, and be more
motivated to change.
- You are tough and you are gentle.
- Balancing reward with punishment.
This perspective helps pave the way toward the middle path by helping you:
Expand your thoughts and ways or considering life situations
Unstick standoffs and conflicts.
Be more flexible and approachable.
Avoid assumptions and blaming.

Validation: What is it?

Validation communicates to another person that his or her feelings, thoughts and actions make
sense and are understandable to you in a particular situation.
Self-validation involves perceiving your own feelings, thoughts and actions as accurate and
acceptable in a particular situation.
Remember: Validation does not = Agreement
Validation does not necessarily mean that you like or agree with what the other person is doing,
saying, or feeling. It means you understand where the other person is coming from.
WHAT should we validate?
Feelings, thoughts and behaviors in:
ourselves
other people
WHY should we validate?
It improves relationships!
Validation can show that:
We are listening.
We understand.
We are being nonjudgmental.
We care about the relationship.
Conflict is possible with decreased intensity.

Validation
A How To Guide to verbal and Nonverbal Validation
How can we validate others?
1. Actively Listen. Make eye contact and stay focused.
2. Be mindful of both nonverbal and verbal reactions in order to avoid invalidation (e.g.,
rolling eyes; sucking teeth; walking away; saying, Thats stupid, Dont be sad, or I
dont care what you say).
3. Observe what the other person is feeling in the moment. Look for a word that describes
the feeling.
4. Reflect the feeling back without judgment. The goal is to communicate that you understand how the other person feels (e.g., It makes sense that youre angry, I Understand
that you are having a rough time right now) (for self, I have the right to feel sad).
5. Show tolerance! Look for how the feelings, thoughts and actions make sense, given the
other persons (or your) history and current situation, even if you dont approve of the
behaviors, emotions, or actions themselves.
6. Respond in a way that shows you are taking the other person seriously (with or without
words). If someone is crying, give a tissue or a hug. If someone is presenting a problem,
start problem solving immediately (unless the person wishes merely to be heard).

Homework:
Take a few minutes and read/absorb the above.