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Dialectical Behavioral Therapy

Dialectical Behavioral Therapy

Dialectical Behavior Therapy aka DBT is a form of therapy that focus on the dialectic of change and acceptance. Many times, when we are wanting to change an aspect of our lives or work on a traumatized or triggered part of ourselves, we become stuck. Noting this, DBT acknowledges how difficult it is to begin working on and making these changes. DBT points out how important it is to work on ourselves in terms of growth and change, but we must be able to also accept our situation or past to move forward. DBT has also been known as “developing balance therapy” as balance, compromise, and neutrality are important aspects of the work done in this kind of therapy.

DBT was developed by Marsha Linehan in the late 1970s. Marsha Linehan is both a psychologist and author who also has had her own fair share of mental health difficulties. From her learned experience in hospitals, treatment centers, and therapeutic spaces, she came to learn from this and further research, what clients could benefit from and what seemed to help her and others. Marsha Linehan therefore created Dialectical Behavioral Therapy and continues to make revisions, update skills and tools, and discuss publicly the benefits of DBT.

4 Modules of DBT

The four modules of DBT are as follows: Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.

Below you will find a small description of each:


Mindfulness consists of becoming aware of our bodies and minds in the present moment and working towards being non-judgmental to ourselves. There are a multitude of skills within the Mindfulness module, such as: Wise Mind, What and How Skills, Thought Defusion, Breathing Techniques, Progressive Muscle Relaxation, and Mindful Walks.

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Emotion Regulation

Emotion Regulation focuses on learning how to identify and name your emotions in the moment and afterwards as you reflect on your experience. By learning to identify our emotions, we are inherently learning how to better cope and decreasing emotional pain or confusion moving forward. Some examples of Emotion Regulation skills are as follows: PLEASE, Opposite Action, SMART Goals, Building Mastery, Coping Ahead of Time, and Check The Facts.

Distress Tolerance

Distress Tolerance consists of skills that will help one maintain regulation and/or handle distressing situations in a more helpful/neutral way. With Distress Tolerance skills, we can avoid completely shutting down when overwhelmed or potentially saying things we don’t mean in the moment. Distress Tolerance skills consist of: HALT, STOP, TIPP, ACCEPTS, Creating a Distraction Plan, IMPROVE, Visualizations and Imagery, Affirmations, Radical Acceptance, Behavior Chain Identification, and Soothing ourselves with our 5 senses.

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Interpersonal Effectiveness

Interpersonal Effectiveness is focused on helping the person understand their current relationships while also considering deepening connections or finding new ones. Interpersonal Effectiveness skills help us do a deep dive into our own behaviors in relationships as well as how our close relationships impact our lives. Interpersonal Effectiveness skills consist of the following: Identifying Values, Values Assessment, noting your Needs, understanding your Legitimate Rights, DEAR MAN, GIVE, FAST, Understanding Self Validation and Levels of Validation, Intensity Factors, how to say “No,” Boundaries, and Boundary Setting.

Who Should Consider DBT?

Because of the wide variety of skills DBT offers, it can benefit basically anyone! If you are someone dealing with anxiety, depression, trauma and/or PTSD, a personality disorder, or mental health difficulties in general, DBT can be something of benefit to you. There are elements of DBT that can be applicable to the average person’s daily life, encounters with others, and time with self. As mentioned above, the four DBT modules are Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness. While you may find that one of these modules may be more relative to your life, it is important to note all the modules and skills within the modules are interconnected.

An example of this interconnectedness could be as follows: A person may come to therapy due to distress in their interpersonal relationships, this person may struggle to set boundaries or could be a chronic people-pleaser, consistently meeting others needs while consistently letting themselves down. This person may believe they need to work solely on the interpersonal module. While the interpersonal module would be of great help and importance in this situation, they would also benefit from learning about mindfulness and skills within mindfulness to help them know what they want, what their intentions may be, and how to stay present when in difficult interpersonal situations. We could also see benefit from this person learning emotion regulation skills, this is because emotion regulation skills would help the person develop a language and awareness of what they are feeling in a particular moment. This language of emotion goes hand and hand with interpersonal effectiveness, so the person would be able to communicate what they are feeling to others. And lastly, the person would benefit from distress tolerance skills. Distress tolerance skills would be coping skills or strategies for the person to use to regulate their mind and body in a vast majority of situations. It is easy for a person to get triggered or become anxious in an interpersonal encounter if they struggle in this area regarding asking for their needs to be met, being a people pleaser, a lack of assertiveness skills, etc. So, we see an interconnectedness in each of these four modules, and how each can at times build off one another or be needed in a situation that may cause distress.

What Happens During DBT Sessions?

What happens in DBT sessions in highly dependent on the client and the DBT therapist! DBT sessions can be highly structured if this would benefit the client, but they can also be less structured if needed. At times, some clients may benefit from starting at the beginning of the four modules and consistently working their way through each module and skill. While other times, clients may request or want to learn these skills as they become relative to what they bring into the therapy session or space. All of this and the structure is highly dependent on the clients’ needs and wishes, as anything can be adjusted and made unique to meet the needs of each individual client.

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How Do I Get Started?

If you are in immediate crisis, you can call or text 988 to be connected with a crisis clinician. If you are in ready to begin therapy sessions and feel safe enough to do so, you can reach out to Therapeutic Counseling and Consulting. You can call our number 804-322-9955, email us at, or fill out an online inquiry form. We look forward to assisting you on your healing journey.

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