DBT (dialectical behavioral therapy) is a form of treatment that can help individuals learn to deal with overwhelming or difficult emotions. This is a subtype of CBT, or cognitive behavioral therapy. The main difference is that DBT focuses on validating emotional issues before rectifying them, thus destigmatizing unwanted emotional states as “wrong.”
DBT has proven most effective for BPD and self-harming behaviors, such as suicidal ideation and eating disorders. However, there is a lot of overlap between DBT and CBT. As a result, many people find that they can adapt DBT skills to anxiety disorders and behaviors.
What is DBT?
The first documented use of DBT was by Marsha Linehan, a psychologist specializing in BPD (borderline personality disorder) and suicidal ideation in women. Linehan noticed that CBT – cognitive behavioral therapy – was not doing enough for some of her patients. As it focused on changing their thoughts, emotions, and behaviors, it also felt to some like it invalidated where they were right now.
Linehan soon found that DBT, which incorporated mindfulness and dialectal thinking into CBT practices, removed her patients’ biases that what they were thinking – and feeling – was somehow wrong. (Dialectal refers to the idea that two juxtaposing ideas can exist at the same time). Rather than focusing on fixing problems, DBT allowed her patients to accept their experience as authentic and valid before moving onto treating the underlying causes.
When DBT proved to be an effective treatment, others developed it to use for a variety of disorders, such as:
- Self-harming behaviors
- Eating disorders
- Substance abuse
DBT Skills for Anxiety
DBT works by helping people construct the mental scaffolding to practice four skills, or modules. With this framework in place, individuals can use their newfound abilities to cope with instances of distress and produce more positive outcomes. If you’re looking to use DBT skills for anxiety, these four tenets will be an excellent place to start.
Mindfulness is the practice of being present and “in the moment.” When used in a mental health context, it can help you recognize, acknowledge, and accept your thoughts. By removing judgment of your own thoughts, it’s easier to approach coping with them – and the feelings they bring – more productively.
In DBT, mindfulness is broken down into two categories: “How” and “What.”
“How” skills help you learn how to be more mindful with strategies such as:
- Practicing mindfulness regularly
- Balancing your thoughts against your emotions
- Taking action to deal with thoughts and emotions
- Mitigating issues that may make mindfulness harder to attain, such as anxiety
“What” skills teach you to recognize what that you’re focusing on, such as:
- Current surroundings and actions
- Your emotions and thoughts
- Separating your emotions from your thoughts
Emotional regulation is essential in all parts of our lives. But when you’re learning how to use DBT skills for anxiety, it may be prudent to focus on emotional regulation to keep your anxious moods in check. These skills are designed to help you handle emotions before they spiral out of control.
With emotional regulation skills, you can learn to:
- Recognize and describe your emotions
- Identify where your emotions come from
- Become more mindful and less judgmental of your emotions
- Solve your problems in a positive, effective manner
Emotional regulation is one of the big components of DBT that separates it from CBT. It’s also one of the most helpful for anxiety disorders, as it allows you to describe your emotions without judging them. Only once you’ve understood and accepted your emotions do you force yourself to move on. This can help prevent a reoccurrence of unwanted emotional states or allow you to identify them before they begin.
Distress tolerance is your ability to make it through emotionally tough moments. In particular, distress tolerance is used when your emotions are at their highest, such as moments of crisis. (Hence, the name.) This pillar of DBT skills is designed to keep you from spiraling into destructive or harmful coping mechanisms. Actions such as isolating oneself, self-harm, and angry outbursts can be mitigated or avoided altogether with a robust repertoire of distress tolerance skills.
Furthermore, using these in high-intensity moments can help you:
- Relax and focuses on senses that bring you peace
- Distract your mind from your emotions until you can deal with the issue constructively
- Use coping strategies to improve your situation or outlook, despite setbacks
- Using a pros and cons list to talk yourself into (or out of) various coping strategies
No matter your diagnosis, from BPD to anxiety disorders, building meaningful connections is essential in life. Knowing how to identify your emotions is an essential step in this process – especially when your mood changes quickly. Interpersonal effectiveness skills are designed to help you gain clarity about your moods and emotions.
Interpersonal effectiveness skills combine several mental health practices to improve your skills and outlook. A focus on social skills, assertiveness, and active listening can lead to marked improvements in interpersonal connections. Additionally, those who use this DBT skill for anxiety can count on learning:
- Self-respect effectiveness: building up your self-respect
- Interpersonal effectiveness: working through relationship challenges to maintain social connections
- Objective effectiveness: asking for or taking steps to get what you want or need
How Do You Learn DBT Skills for Anxiety?
As we mentioned above, DBT skills are typically used for BPD, depression, and behaviors related to self-harm and suicide. But if you or your therapist believes that you may benefit from using DBT skills for anxiety, it’s possible to start therapy as soon as you’re ready.
DBT skills use at least two of three methods to help overcome persistent thoughts and emotions.
The first of these is one-on-one therapy. These sessions run just like a normal therapy session, wherein you discuss problems, solutions, and your day-to-day life. But they will also serve as a time when you can work on capitalizing on the second method: skills training. (Note that many resources also list a fourth method: going to a therapist as part of a team of experts. However, individuals with anxiety may not need to worry about a team effort if one therapist appears effective.)
Skills training takes place in a group setting and functions similarly to group therapy. These sessions usually last a few hours per week for up to a full year. Skills training is a time to learn, build on, and practice DBT skills.
In addition to regular therapy and skills training, some therapists offer phone coaching. These serve as extra help or a buffer between one-on-one appointments during times of emotional crisis.
If you’re looking to use DBT skills for anxiety, you don’t have to wait on your therapist to initiate the conversation. You can start practicing the four tenets of DBT – especially mindfulness – on your own. If nothing else, this will give you a head start figuring out if DBT might be effective for you.