Dialectical behavioral therapy (DBT) is one of the best therapeutic approaches for people with complex mental health symptoms. A recent study found that 69.7% of a therapist sample population use DBT predominantly or exclusively.

DBT is a powerful tool for teaching individuals healthy coping skills. Methods like the DBT STOP skill enable problem-solving during crises. Others are better for preventing or accepting these distressing situations.

Simcoe Rehab and The Insight Clinic have teamed up to write this article about DBT and how it can help individuals improve their well-being in this guide.

What Is DBT?

DBT is a cognitive behavioral therapy in which individuals learn modules (also known as skills) to better regulate their emotions and reduce self-destructive behaviors that negatively affect their lives.

Mental health professionals originally developed DBT to treat people with suicidal tendencies, especially individuals with borderline personality disorder (BPD). The therapy has since evolved to help with:

● Depressive disorders
● Anxiety disorders
● Post-traumatic stress disorder (PTSD)
● Substance use disorder (SUD)
● Eating disorders

Importantly, DBT is not a cure for these mental health conditions. Instead, it can help individuals develop healthier coping mechanisms and, ideally, reduce distressing symptoms of their disorders.

Skills Clients Learn in DBT

We mentioned that DBT teaches individuals coping mechanisms to use in place of self-harm. These coping mechanisms are also known as DBT skills. They include mindfulness and distress tolerance skills (acceptance), interpersonal effectiveness and DBT emotion regulation skills (change).

Change and acceptance skills help people with the above mental health conditions. They are also effective for undiagnosed individuals struggling with negative thought patterns and behavioural regulation in stressful situations.

This guide aims to help both groups understand how to use acceptance and change skills in everyday life. We will begin with a summary of the four core DBT skills.

Mindfulness

DBT mindfulness means focusing on the current moment instead of reflecting on the past or looking to the future. It also helps people experience their reality without attaching emotions or applying judgment.

Experts have distinguished three helpful skills for learning mindfulness:

1. Wise Mind: A skill that teaches people to use their emotions and logic to make decisions
2. What: A skill utilizing observation, description, and participation to focus on the present moment
3. How: A skill encouraging a non-judgmental mindset to achieve a desired outcome

A goal of these skills is to foster more self-awareness. Self-awareness is crucial for decision-making, self-confidence, and creativity. It also enables a growth mindset wherein people can improve their abilities through hard work.

Distress Tolerance

Distress tolerance depends on the fact that life is full of painful and distressing moments. With that in mind, these skills enable people to accept these moments without resorting to impulsive, often destructive behaviors.

There are eight skills individuals can learn to improve their distress tolerance:

1. ACCEPTS: A skill for distracting oneself from distressing events that stands for Activities, Contributions, Comparisons, Emotions, Pushing Away, Thoughts, and Sensations
2. TIP: A skill encouraging physical changes to promote mental clarity that stands for Temperature, Intense Exercise, and Paced Breathing
3. Self-Soothe: A skill teaching people to comfort themselves via beautiful sights, enjoyable sounds, scents, and flavors, and pleasant tactile sensations
4. IMPROVE: A skill enabling individuals to improve their current state through pleasant Imagery, Meaning, Prayer, Relaxation, One thing, Vacation, or Encouragement
5. Pros/Cons: A decision-making skill promoting accepting and tolerating distress instead of rejecting for growth
6. Problem-Solving: A skill for solving problems that are within one’s ability to control
7. Radical Acceptance: A skill encouraging acceptance of reality to prevent temporary pain from becoming long-term suffering
8. STOP: A skill for preventing emotional impulsivity

Without these skills, many people unknowingly make distressing situations worse due to their impulsive emotional reactions. Regarding people with self-harming coping mechanisms, distress tolerance saves lives.

Emotional Regulation

DBT emotional regulation skills are needed to name, understand, and manage feelings. The ultimate goal is to reduce suffering and the frequency or intensity of negative emotions.

Skills needed to effectively manage one’s emotions include the following four:

1. Opposite Action: A skill requiring one to take an action opposite to how they are feeling, such as showing kindness when feeling angry
2. Build Mastery: A skill focusing on one’s passions and building expertise in these areas
3. Cope Ahead: A proactive skill helping people learn to prepare for stressful situations before they occur
4. Positive Self-Talk: A skill encouraging people to think positive thoughts about themselves to promote growth and resilience

As with the radical acceptance skill, learning to better regulate one’s emotions can prevent acute pain from becoming chronic emotional suffering. Emotions lead to actions, meaning these skills can also enable behavioral change.

Interpersonal Effectiveness

Interpersonal effectiveness focuses on interpersonal relationships, or relationships with loved ones, peers, and acquaintances. These skills can help strengthen current relationships, build new ones, and end toxic ones.

Three skills people can use to improve their interpersonal effectiveness are:

1. DEAR MAN: A skill for communicating an issue by Describing the situation, Expressing feelings, Asserting oneself, Reinforcing the other person’s view, being Mindful, Appearing confident, and Negotiating
2. GIVE: A communication skill that fosters connection between two people during and after a conflict
3. FAST: A communication skill allowing individuals to maintain self-respect by being Fair, not Apologizing, Sticking to one’s values, and being Truthful

With the help of these skills, individuals can feel more prepared to communicate during a crisis.

What Is a Crisis?

A crisis is a distressing situation that is not within one’s ability to change. Therapies like DBT aim to help people overcome crises without worsening the situation.

How to Not Make a Crisis Worse

People make crises worse when they act based on emotional impulsivity rather than using the Wise Mind. Acting based on strong emotions during a crisis can worsen the situation.

For one, the person may do something that provides acute relief but ultimately causes problems in the long term (e.g., they feel immense regret). Another way of making crises worse is not acting, which causes more problems in the short or long term.

All four DBT tools we listed above are essential to preventing crises from worsening. Distress tolerance and interpersonal effectiveness, in particular, can help people better manage distressing situations.

DBT Distress Tolerance Skills

Distress tolerance skills include ACCEPTS, TIP, Self-Soothe, Improve, Pros/Cons, Problem Solving, Radical Acceptance, and STOP. Today, we want to delve into the STOP skill, which can help people act amid a crisis.

DBT STOP Skill

STOP stands for Stop, Take a step back, Observe what’s going on, and proceed mindfully. The STOP skill in DBT is best used when someone is triggered by a situation or person and feels their emotional impulsivity rear up.

Stop

When someone experiences an external or internal crisis, the first step is to stop. Stopping means not taking an action, not reacting, and not allowing impulsive emotions to take control.

Take a Step Back

The next step is to mentally or physically take a step back from the trigger. Take this time to practice mindfulness, take a few deep breaths, and gather the facts. Remind the brain and body that a reaction is not urgently required.

Observe What’s Going On

Now, it is time to observe what’s happening in one’s surroundings and inside them. Note what other people are doing or saying to see the bigger picture. At the same time, the person should note their own feelings and thoughts.

Process Mindfully

Before taking action again, consult the Wise Mind. As mentioned, the Wise Mind combines one’s logical and emotional thinking. Ask it, ‘What is the best course of action to achieve the desired result from this situation?

Example of the STOP Skill in Action

John is having a heated argument with his significant other. His partner becomes overwhelmed and informs John that they must step away from the conflict until a later date or time.

Due to his fear of abandonment, John feels angry and afraid that his significant other will leave him while they take space. Before doing something he will later regret, John remembers to STOP:

● Stop: John bites his tongue to prevent himself from yelling at his partner
● Take a step back: John practices deep breathing
● Observe: John observes his partner’s angry expression and reflects on his feelings
● Proceed mindfully: John consults his Wise Mind

At the end of this process, John realizes his partner is right. Taking space will allow them to return to the disagreement less heated and without the risk of one or both of them saying something they will later regret.

Another Example of Using the STOP Skill

Jane over-committed herself to too many work projects. Now, deadlines are approaching, and she feels overwhelmed, so overwhelmed that she can’t make progress on any of the projects.

If Jane doesn’t start working on the projects now, she knows her job could be on the line. To avoid the potential consequences of not completing her projects, Jane uses the STOP skill:

● Stop: Jane asks her manager for a quick break
● Take a step back: Jane walks away from her workstation and takes a walk outside
● Observe: Jane observes her surroundings and her feelings, identifying that she is afraid of failure, angry at herself for over-committing, and too embarrassed to ask for help
● Proceed Mindfully: Jane consults her Wise Mind

Ultimately, Jane decides to start working and ask a colleague for help. She also makes a plan to stop over-committing herself to projects in the future.

STOP Skill DBT Worksheet

Putting the STOP skill into action is another great way to learn this technique. Use this STOP worksheet to practice this DBT skill independently.

DBT Interpersonal Effectiveness Skills

Interpersonal effectiveness skills include DEAR MAN, GIVE, and FAST. Next, we investigate the GIVE skill more in-depth, as it can help people learn effective communication skills for fostering positive interpersonal relationships.

DBT GIVE Skill

GIVE is an acronym for be Gentle, act Interested, Validate the other person, and use an Easy Manner. The GIVE skill is helpful during verbal conflicts between two or more people in a professional or personal setting.

Be Gentle

Always approach conversations of any kind with a kind and respectful attitude. Avoid making verbal attacks or threatening, judgmental, or blaming statements. Use ‘I’ instead of ‘you’ statements.

Act Interested

Listen to the other person’s viewpoint without interrupting. Maintain eye contact and appear interested in what the other person says. Try to act with empathy and sensitivity.

Validate the Other Person

Show understanding of the other person’s view and feelings. Use empathy to imagine how it would feel to be in their shoes and act in a way that makes the conflict easier on that person.

Use an Easy Manner

Approach the conflict light-heartedly by using humor to deflect tension. Throw a compliment into the conversation where it makes sense, and try to use politically correct language.

Examples of the GIVE Skill

Sarah wants to talk with her mother-in-law about respecting her family’s boundaries. Her ultimate goal is to keep her mother-in-law from dropping by the family home unexpectedly.

In the past, Sarah has ended conversations abruptly and angrily when her mother-in-law has refused to comply with her wishes. In the hopes of communicating her goals more effectively, Sarah GIVEs:

● Is gentle: Sarah is considerate and polite while sharing her concerns with her mother-in-law
● Act interested: Sarah listens patiently as her mother-in-law shares her perspective on why she drops by unannounced
● Validate: Sarah validates her mother-in-law’s perspective as a lonely retiree who loves her grandchildren
● Easy manner: Sarah keeps her tone light and her facial expression pleasant, complimenting her mother-in-law on how much the grandchildren love her

The conversation ends with Sarah’s mother-in-law agreeing to give her or her partner at least an hour’s notice before she drops by the family home.

DBT GIVE Skill Worksheet

People can also practice the GIVE skill independently. Here is a GIVE worksheet to get started.

The Insight Clinic in Ontario Is Here for You

DBT is an approach to therapy that teaches coping mechanisms to use during or before stressful situations. Mechanisms such as the DBT STOP skill allow for better tolerance and acceptance of crises. Meanwhile, DBT skills like GIVE encourage individuals to change how they approach interpersonal conflict.

Are you searching for ‘DBT therapy near me’? The Insight Clinic offers expert psychotherapy services, including DBT, to the greater Toronto area. Contact The Insight Clinic to book a consultation and learn more about DBT.