Practical Skills for Managing Emotions, Distress, and Relationships
There are times when understanding why you react a certain way is important, but understanding alone may not tell you what to do when emotions become intense.
You may know that you are overwhelmed but have difficulty settling yourself. You may recognize that a conversation is becoming unproductive but struggle to respond differently in the moment. Or you may understand the importance of setting boundaries while finding it difficult to actually set them.
Dialectical Behavior Therapy (DBT) offers practical skills for situations like these.
In my practice, I incorporate DBT skills into individual trauma-informed psychotherapy when concrete tools may be useful alongside the broader work we are doing together.
What Is Dialectical Behavior Therapy?
Dialectical Behavior Therapy was developed by psychologist Dr. Marsha Linehan at the University of Washington. DBT was originally developed for people experiencing severe emotional and behavioral difficulties and has since been adapted and studied for a range of clinical concerns.
At the heart of DBT is a balance between two ideas that can sometimes seem contradictory: acceptance and change.
We can acknowledge and understand what we are experiencing while also recognizing that something may need to change.
DBT teaches practical skills in four main areas:
- Mindfulness
- Emotion Regulation
- Distress Tolerance
- Interpersonal Effectiveness
The Four DBT Skill Areas
Mindfulness
Mindfulness involves developing greater awareness of what is happening in the present moment.
This may include noticing thoughts, emotions, physical sensations, and urges without immediately having to react to them.
The goal is not to stop thinking or eliminate difficult emotions. It is to create enough awareness to recognize what is happening and respond more intentionally.
Emotion Regulation
Emotions provide important information, but they can sometimes become so intense that it is difficult to think clearly or choose how we want to respond.
Emotion regulation skills involve learning to identify emotions, understand what may be contributing to them, and consider how to respond rather than being carried entirely by their intensity.
Distress Tolerance
Some situations cannot be changed immediately.
Distress tolerance skills provide ways of getting through difficult moments without responding in ways that create additional problems.
The emphasis is not necessarily on making distress disappear, but on increasing your ability to tolerate what is happening until you are in a better position to decide what to do next.
Interpersonal Effectiveness
Relationships often require us to balance several things at once: what we want, what another person may need, the importance of the relationship, and our own self-respect.
Interpersonal effectiveness skills can help with communicating needs, setting boundaries, saying no, asking for what you want, and navigating conflict more intentionally.
How I Use DBT Skills
I use DBT skills selectively rather than assuming that every person needs the same set of tools.
For example, we might use emotion regulation skills to better understand an intense reaction, distress tolerance skills when circumstances cannot immediately be changed, or interpersonal effectiveness skills when you are trying to set a boundary or communicate something difficult.
Mindfulness skills can also help create a little more space between noticing an emotion or urge and acting on it.
The skills are most useful when they are connected to what is actually happening in your life rather than learned simply as abstract techniques.
DBT Skills and Trauma Therapy
DBT skills can be particularly useful when intense emotions or difficulty tolerating distress make other therapeutic work harder.
Sometimes developing a greater ability to remain present with difficult emotions needs to come before working more directly with painful experiences.
At other times, a DBT skill may simply provide something practical to use between sessions when a familiar situation arises.
Depending on what we are working on, I may integrate DBT skills with EMDR, Somatic Experiencing®, Parts Work (Ego State Therapy), mindfulness-based approaches, or relational psychotherapy.
Is This a Comprehensive DBT Program?
No.
Comprehensive DBT is a structured treatment program that typically includes individual DBT therapy, group skills training, between-session skills coaching, and a DBT therapist consultation team.
My practice does not provide a comprehensive DBT program.
Instead, I incorporate DBT skills and principles into individual psychotherapy when they are relevant to a client’s needs.
This distinction is important. Someone who needs comprehensive DBT—particularly a person requiring the full structure and support of the standard treatment model—may be better served by a dedicated DBT program.
Who Might Find DBT Skills Useful?
DBT skills may be useful if you:
- Become overwhelmed by intense emotions
- Have difficulty calming down once activated
- Shut down or withdraw during conflict
- Have difficulty tolerating uncertainty or distress
- Struggle to communicate your needs
- Have difficulty setting or maintaining boundaries
- React impulsively when emotions are intense
- Understand what you would like to do differently but have difficulty doing it in the moment
You do not need to identify with all of these experiences for particular DBT skills to be useful.
Frequently Asked Questions
Do I need to have borderline personality disorder to use DBT skills?
No. Although DBT was originally developed for people with significant emotional and behavioral difficulties and became particularly associated with the treatment of borderline personality disorder, DBT skills are now used more broadly.
The question is less about having a particular diagnosis and more about whether specific skills might be useful for what you are experiencing.
Will I have homework?
Sometimes.
DBT skills become more useful when they can be practiced outside the therapy room. Depending on what we are working on, I may suggest practicing a particular skill or paying attention to how a familiar pattern unfolds between sessions.
This is collaborative rather than a rigid requirement.
Do you offer a DBT skills group?
No. I incorporate DBT skills into individual psychotherapy rather than providing a comprehensive DBT program or DBT skills group.
If comprehensive DBT appears to be more appropriate for your needs, we can discuss that distinction and what type of program to look for.
Getting Started
You do not need to know DBT or have experience using DBT skills before beginning therapy.
If intense emotions, difficulty tolerating distress, conflict, or relationship patterns are part of what brings you to therapy, we can consider whether particular DBT skills might be useful as part of our work together.
