Dialectical Behavior Therapy

Earlier, I discussed emotional control through the practice of Stoicism. This article about Dialectical Behavior Therapy (DBT) goes deeper into the 'reflective' stage of that process. DBT is a type of psychotherapy that can help you to manage your psychosocial pain points like situations over which you have no control,  common trauma response of reliving serious trauma or other post-trauma maladaptive responses, etc.

Interrelated Core Principles of DBT (dialectics, validation, radical acceptance) for resetting your perspective and coping:

  • Dialectics: DBT recognizes that two seemingly opposing ideas can be true at the same time. The following examples illustrate how dialectics can be applied to complex and challenging situations, allowing individuals to hold multiple perspectives and work toward integrating other perspectives to have an overall more balanced approach. This is key because focusing on the negative extreme is a human default. In fact, it is a defense mechanism to prepare oneself for potential danger. Unfortunately, it is easy to become polarized in difficult circumstances by being hyperfixated on negativity. However, dialectics is a form of de-polarization and balance (and reminiscent of the purpose of the hermetic principle of polarity; ie to become depolarized). Dialectics demands your cognitive agility. On that basis, I remember the 2 of Pentacles tarot card ... and even 5 of cups tarot card that encourages you to recognize that; while 3 cups have indeed spilt, if you turn around, you will see that 2 other cups remain un-spilt behind you and a bridge is also there to the other shore. In short, rather than see circumstances as 'either negative or positive', DBT encourages one to see challenges from the 'negative AND positive' angles. So rather than feel stuck in feeling vulnerable, you may find ways to pivot situations to say “While I am vulnerable in this situation (negativity), I am also strong (positive)” or “while I am capable of taking care of myself (masculine energy), I also need support (feminine energy).” While discussing emotional control through stoicism, I mentioned that, during a painful stoic 'pause', exploit your brain's neuroplasticity. In other words, train your mind to use dialectical reasoning to form new neuropathways. Here are some more examples.
    • Accepting a traumatic past while preparing for change in the future
      • A person with complex PTSD may need to acknowledge their traumatic experiences are a part of their history, while also working towards creating safer circumstances for a more hopeful future.
    • Embracing vulnerability while maintaining self-protection
      • Someone who has experienced trauma learns to be vulnerable and open with others (the right people), while also maintaining healthy boundaries and self-protection strategies to ensure their safety and well-being.
    • Acknowledging powerlessness while taking control
      • A person in an abusive situation acknowledges their powerlessness, while also taking control of their own actions and making decisions to prioritize their safety and well-being. This includes the empowerment that learning DBT and creating new neuropathways provides.
    • Practicing self-compassion while holding oneself accountable
      • Someone with a traumatic past is self-compassionate by acknowledging that maladaptive responses (like PTSD, anxiety disorders, dissociative disorders, cognitive distortions, social anxiety & awkwardness etc) are natural responses to their circumstances, while also learning better ways of responding to stressors.
      • A woman may feel overwhelmed and helpless due to a chronic illness. Erotical acceptance involves acknowledging the reality of her condition, accepting the limitations and challenges it brings, and focusing on her response and coping strategies, such as self-care and seeking support, rather than resisting or fighting against the illness.
    • Accepting the need for support while striving for independence
      • Someone accepts that they require meaningful support (like therapy or support groups), while also striving for independence and self-sufficiency (researching and shadow working on their own).
    • Recognizing the complexity of emotions while simplifying self-care
  • Validation: DBT emphasizes the importance of acknowledging and validating painful emotions and experiences. I must stress that if you are among those without support systems, like family, mental health professionals, police and or legal remedial services, prepare to do this for yourself.
    • A lady who has suffered trauma validates her emotions, such as anger or sadness, while also learning to counteract the distressing cognitive distortions that occur as a consequence.
  • Radical Acceptance
    : Accepting reality as it is, not as you want it to be. You can neither change nor avoid the painful reality. This is a painful, hard pill type of skill that involves pulling the plug on hope of some resolution of undesirable situation. Example(s) of applications.
    • Toxic relationships. You now accept that your best efforts through overexplaining and overcompensating will NOT make a difference. These attempts never have in the past and never will. This is because the other party, abusers (whether narcissistic individuals or groups, their flying monkeys, and so on) will never stop the abuse. This is a no-holds-barred turning point of knowing that there is absolutely nothing more you can do or will try to resolve the situation. For instance, you will no longer live in hope that 'maybe after X happens, or if I just do X more, or accomplish X.' as it relates to relatives, professional colleagues, distinct social groups, and so on. Radical acceptance therefore means 1) grieving loss, often significant loss; such as hope of having a secure childhood, secure parent-child bond, meaningful friendship, marriage, acceptance in a community, working relationship, and fulfillment of dreams. Radical acceptance also means 2) you no longer hide in denial and are therefore consciously facing heavy emotions due to your loss.            Dr Ramani 'A painful look at narcissistic relationships. Radical acceptance' (above video)
    • Self-relationship. You now accept yourself fully, regardless of shortcomings, imaginary, real or set by society. This is a matter of unconditional self-love. Self-lovers see their 'imperfections' as elements of cherished uniqueness. In social circumstances, this involves not trading one's authenticity (which may simply be a difference from the social norms) to get approval from others. In other words, you are unapologietically yourself. Dr Femke Bakker used a fitting analogy of how loving parents would respond by encouraging their child who falters while learning to walk. Rather than be critical, shout at or condescend their child, they accept their child as she is in the present moment. They are patient, recognizing that their wish for a walking child will not happen overnight. This heart posture means they handle their child's daily struggle with empathy and compassion. Listen to her Ted Talk about 'self-gentleness (aka radical self-acceptance)', especially if you are driven to perfectionism in situations but are not performing perfectly. Since perfectionism is often a trauma response, the concept of self-gentleness is particularly important as you 'learn to walk' (thorny situations). Be patient with yourself. Example(s): being overwhelmed by simple tasks is not laziness but executive dysfunction; anxiety disorders is a symptom and not a reflection of your stupidity; open admittance of trauma response disorders that you had previously tried to hide through shame (by others); binging on your guilty pleasure is self-soothing / a search for a dopamine fix; neurodivergence is a symptom and not a reflection of your intelligence; etc. To be clear, this is not about being complacent with poor habits. Instead, it is a first step that can lead to positive change because openly acknowledging an issue is a way of bringing it to the forefront of your consciousness so that it can be resolved. Example(s): AA attendees usually openly introduce themselves as 'alcoholics' in group meetings in which they attempt a 12-step healing program.
    •   YouTube TEDx Talks video 'The power of self-gentleness | Femke Bakker | TEDxLeidenUniversity'
      YouTube short-form video by DoctorRue 'Radical self acceptance'
      YouTube short-form video 'Why you should practice radicatl self-acceptance'

How to apply DBT in your daily life 
Here are the 4 key components of any DBT practice. Since each component is customizable, own the design of your process so you can enjoy and remain committed.
  • Mindfulness: mindfulness practices emphasize the importance of being present and fully engaged in the present moment without judgment or distraction. Examples 
    • deep breathing, meditation (seated, guided, ecstatic dancing), progressive muscle relaxation, adult coloring books
    • Individuals with PTSD often experience flashbacks, which are intrusive memories that can feel as though they are reliving the traumatic event. Mindfulness skills can help you to stay grounded in the present moment. Examples. You can practice the “5-4-3-2-1 technique”. This requires you to focus on your 5 senses by identifying: 
      • 5 things they can see around them,
      • 4 things they can touch,
      • 3 things they can hear,
      • 2 things they can smell, and
      • 1 thing they can taste.
By focusing on these sensory experiences, you redirect your attention away from the flashback and back to their current moment, reducing the intensity of the trauma-related symptoms.

  • Distress tolerance skills. To describe this practice in short form; it is about accepting pain without unnecessary and additional suffering. This is achieved by using healthy distractions. These healthy destructions help you to select thought patterns that are better than ruminating and causing intense emotional suffering and to be clear healthy distractions are not the same as avoidance. Examples.
    • Self-talk in your head or allowed when triggered as by the news or when hearing about or from someone who caused you pain. 
      • I cannot change what has already happened. [Do not relive the painful moments trying to figure what you should have or could have said or done instead Develop some type of releasing, aka 'defusion', like imagining the memory as a black balloon that you release into the wind as you redirect your focus to something else, perhaps a white or colorful balloon with something specific .... Or you can focus intensely on the present moment.]
      • This moment is the outcome of multiple turns in the past do not agonize over 'what-if' scenarios like if you had just returned the call the night before, given x detail and so on.
      • Read about Mel Gibbon's What if it all works out mantra that frees her brain from focusing on only the worst, most catastrophic of multiple probabilities 
    • To cope with nightmares through Distress Tolerance Skills. self-soothing is a form of distress tolerance to cope with overwhelming emotions and situations without resorting to avoidance or harmful behaviors. This involves engaging in calming bedtime routine activities like:
      • taking a warm bath,
      • Listening to soothing music,
      • Practicing deep breathing exercises
      • Using aromatherapy
      • Declaring sleep time intentions 
    • In acute distress situations that might trigger dissociation, use these distress tolerance steps.
      • Step 1: Identify a distressing situation or feeling (e.g., feeling overwhelmed by memories).
      • Step 2: Use the “TIP” technique (Temperature, Intense Exercise, Paced Breathing) to manage acute distress:
        • Temperature: Splash cold water on your face or hold ice cubes; this can help anchor you to reality.
        • Intense Exercise: Engage in physical activity like jumping jacks or running in place for a few minutes.
        • Paced Breathing: Practice slow, deep breathing like 'box breathing' to calm the nervous system.

  • Emotion Regulation Skills: Strategies such as identifying and labeling emotions, understanding emotional triggers, and using coping skills to manage emotions.
  • Interpersonal Effectiveness Skills: Techniques such as active listening, assertiveness, and boundary-setting to improve communication and relationships.
    • Assertiveness in interpersonal relationships might help you if you fear rejection or misunderstanding (that might arise from expressing your needs or feelings). Use “I” statements to express your needs and feelings (ie versus'you' statements). Example; Instead of saying, “You never listen to me,” say, "I really need to be allowed to complete each idea without interruptions/ for someone to take action on XYZ / the direct communication I" or “I feel ignored when I share my thoughts but [describe the person's triggering behavior] like do not get any kind of response.” If the counter party is worthy, this approach is likely to be received as not blaming them.
    • Unapologetically set boundaries to prioritize your mental health while remaining being polite and respectful towards others. Example; say, “I appreciate the invitation, but I need some time for myself right now or I need time to think about that before committing or I needed the scores from your professional observations so I can keep track and really engage in my progress.” 
    • Assuming that the other person is worthy and has good intentions but does not yet understand how to meet your needs, say "If someone does x (like grab me suddenly), that makes me feel  unsafe because it triggers my anxiety.


Who Can Benefit from DBT:

  • People with post-traumatic stress disorder (PTSD): DBT can help individuals manage symptoms of PTSD, such as flashbacks, nightmares, and avoidance behaviors.
  • Anyone seeking to improve emotional regulation and relationships: DBT can be beneficial for individuals looking to enhance their emotional intelligence, communication skills, and overall well-being.
  • Those struggling with emotional dysregulation: DBT can help individuals manage intense emotions, reduce self-destructive behaviors, and improve relationships.


CONTENT RELATED TO DIALECTICAL BEHAVIOR THERAPY