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BLOG: Dialectical Behavior Therapy Skills
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By Rachel Silberman, Clinical TraineeJournaling can be an extremely effective mental health outlet and coping mechanism for many individuals. It provides a structured space for individuals to express and explore their thoughts and emotions in a non-judgmental environment. The act of putting thoughts onto paper can provide a cathartic release, helping individuals gain clarity and perspective on their feelings. Moreover, it offers a tangible record of one's emotional journey, allowing for reflection and identification of patterns over time. This self-awareness can be a crucial step in understanding triggers, managing stress, and fostering personal growth. Ultimately, the practice of journaling empowers individuals to cultivate a deeper connection with themselves, promoting emotional well-being and resilience in the face of life's challenges. Studies have found that journaling can reduce mental health distress significantly. A study (2023) conducted by Smyth et al. found that journaling can serve as an effective intervention for mitigating mental distress, increasing well-being, and enhancing positive physical functioning. It is also important to note that while journaling can be an effective tool for many individuals, it is most effective in combination with other modes of mental health assistance such as therapy. If you are struggling to get started, consider writing about some of the following journal prompts from Switch Research (2022)!
Smyth JM, Johnson JA, Auer BJ, Lehman E, Talamo G, Sciamanna CN. Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial. JMIR Ment Health. 2018 Dec 10;5(4):e11290. doi: 10.2196/11290. PMID: 30530460; PMCID: PMC6305886. By Fiona Smith, Clinical TraineeOne major skill within Dialectical Behavior Therapy’s (DBT) Mindfulness Module is the idea of observing. Observing is the act of sensing or experiencing without labeling your experience. This can be challenging. It takes conscious effort to remind ourselves that we are allowed to be in the world and experience life without labeling, judging, or quantifying each moment. Over time, when we practice the art of simply observing, the mind grows quieter and our thoughts slow. It helps bring our awareness to things we may never before have noticed - like the fact that we have a talkative mind or tend to make quick judgments as we see or experience people or events. As Marsha Linehan writes in the DBT manual: “Observing your thoughts can sometimes be very difficult. This is because your thoughts about events may often seem to you like facts instead of thoughts. Many people have never really tried to just sit back and watch their thoughts. When you observe your own mind, you will see that your thoughts (and also your emotions and bodily sensations) never stop following one another. From morning till night, there is an uninterrupted flow of events inside your mind. As you watch, these will come and go like clouds in the sky. This is what thoughts and feelings do inside the mind when just observed—they come and go.” Observing is not dissociating. It is coming back to yourself and grounding through your feet into the earth to nonjudgmentally let experiences unfold. One of the parts that I appreciate most about this DBT skill is that I find it helps me understand my reactions to situations, things, and people more closely. With plain observation, I can hear what my gut reactions really are. This provides insight into how I’m seeing the world and opens up the option to see certain events from a different perspective. This skill goes hand in hand with the “how” skill of non-judgement. Author: Fiona Smith, Taproot Therapy Clinical TraineeDialectical Behavior Therapy (DBT) is a skills based therapy founded by Dr. Marsha Linehan that is oriented around the idea of dialectics: the existence of opposites. We can accept where we are, while also acknowledging that we need to change certain things. The dialectical aspect of DBT addresses the integration or synthesis of two opposing points.
One core component of DBT is its effort to educate the participant. DBT believes that participants show greater levels of improvement when they comprehend the mechanisms behind their actions, thoughts, and feelings. The education aspect of DBT puts the power in the participants’ hands and provides a reason for why we are focusing on certain skills. DBT investigates the underlying reality of a situation through a compassionate lens and an understanding that life is complex and ever evolving. It helps us to recognize negative patterns of thinking and unproductive behaviors. DBT is effective in treating a wide range of life’s stressors. The skills taught within a DBT group or DBT-informed therapy can be applied to various circumstances and help us to deal with overwhelming emotions, unexpected life events, difficult relationships, anxiety, depression, and rocky transitions, and more. Though there is no “one size fits all” method of therapy that works in every scenario, DBT skills are useful to have in our back pockets as we navigate life. Mindfulness Pulling from ancient spiritual traditions, these techniques help to focus us in the present moment and ground through the body. These skills encourage us to slow down and use our “wise mind.” Distress Tolerance These set of skills teach productive and healthy coping mechanisms and self soothing techniques for when we are feeling upset or any intensity of emotion. Crisis survival skills are a key element in this module, as are reality acceptance skills. Emotion Regulation This module offers ideas for reducing the intensity of strong emotions and learning to ride the wave instead of reacting or acting out. It helps us to better understand and navigate our feelings. Interpersonal Effectiveness These skills address relationships and effective ways of ensuring our needs are met. Key elements in this module include self respect and respect of others, effective listening and communication techniques, learning how to deal with challenging individuals, knowing when to say no, and repairing relationships. Author: Luke Fox, Taproot Therapy Clinical Trainee The pressures of being a parent are numerous. It seems that the tasks are endless, sleep can be unpredictable, and efforts often go unappreciated. And these things don’t exist in a vacuum, they are mixed in with various other daily stressors. In times of exhaustion or heightened stress, parents might find they are reacting to their children in a way that is not as attuned, understanding, and supportive as they’d like. This awareness can be followed by feelings of guilt and shame about not being the perfect parent. This is where the concept of rupture and repair can be helpful. Ruptures in relationships are inevitable and there is no such thing as a perfect parent. In a study with infants and their parents, Tronick and Gianino found that the pairs were in sync about one third of the time.1 This results in mismatches that can be stressful for the child and parent. Both child and parent attempt to correct this mismatch and repair the communication. This attuned effort toward repair helps the child develop self-regulation and resilience. It can be helpful to remember that closeness and attunement are the key factors in fostering repair and growth. Shaming oneself for not being the perfect parent can have the opposite effect. Shame often decreases our self-worth and leads to isolation and distance from others. Understanding that parents make mistakes, and that efforts to repair the relationship are key, it might be possible to move away from shame toward self-compassion. And through repetition of this repair process, children learn that they are worth being understood, that conflict can be resolved, and that they can manage uncomfortable feelings. From a place of self-compassion, it is easier to practice mentalization. Mentalization is the “human ability to interpret the meaning of others’ behavior by considering their underlying mental states and intentions, as well as the capacity to understand the impact of one’s own affects and behaviors on others”2. When we are stressed and not grounded, we tend to focus less on the intentions of others and more on their behaviors, especially the frustrating aspects. Being grounded increases our ability to see beyond behaviors and consider the world of thought and emotion that influences these behaviors. While we can never know what someone else is thinking, curious exploration tends to increase patience, attunement, and the child’s sense of being understood. And mentalization also means understanding what is driving our behaviors and how we are experienced by others. Acknowledging and accepting our own experience helps us to better understand ruptures and conflict cycles and move towards repair. 1Tronick, E., & Gianino, A. (1986). Interactive mismatch and repair: Challenges to the coping infant. Zero to Three, 6(3), 1–6. 2Fonagy, P., & Target, M. (1996b). Playing with reality: I. Theory of mind and the normal development of psychic reality. The international journal of Psychoanalysis Interested in working with a DBT therapist? Email annie@taproottherapynyc.com for more information.
Author: Fiona Smith, Taproot Therapy Clinical Trainee A central pillar of Dialectical Behavior Therapy (DBT) is the concept of Radical Acceptance. This DBT skill is featured in the distress tolerance module and encourages the complete and unrestrained being at peace with unwanted events, problems, or emotions. Instead of resisting, we are encouraged to accept that the unwanted situation is occurring. Depending on the scenario, total acceptance can be enormously difficult to achieve.
DBT posits that pain - emotional or physical - is a sign that something is off. It’s your body’s natural way of alerting you to this. Accepting a painful event or emotion does not mean you condone it, like it, or approve of it. Rather, the acceptance of it in your mind, body and soul - that it did happen or is present in your environment - eliminates the mental struggle against it. It frees up your energy to move forward skillfully. Radical Acceptance is built on the idea that changing one’s reality first requires acknowledgement of what that reality truly is. Rejection of reality morphs pain into suffering and thus, prolongs that uncomfortable sensation. An important facet of Radical Acceptance is that practicing of this skill does not mean we tolerate or stand for any unhealthy or abusive behavior. Rather, it is a framework for acknowledging the reality in which we find ourselves. The first step is to simply observe. Ask: am I telling myself “it shouldn’t be this way.” “Am I denying the fact that things turned out differently from how I wanted them to?” Am I ruminating: “If only it had turned out differently.” Practicing Radical Acceptance in daily life can feel like embracing the flow of each day as it comes. Let’s say you missed your train to work and now you’re going to be late because they only stop at your station every thirty minutes. Rather than resisting the reality of this scenario (that you will not be on time), Radical Acceptance instructs us to release any resistance to how things are and seek an alternate solution. In this case, one next step might consist of consulting the train schedule and planning ahead by texting your boss or colleagues that you will arrive later than expected. There is no problem too small or too large for this skill. This skill is not an easy one. It requires persistence in order to fully incorporate it into your reflexive mindset, but once mastered, it is a comforting and freeing perspective through which to view life. Have you practiced dialectics in your daily life? What has or hasn’t worked for you? What have you found challenging? What has come naturally to you? Author: Carly Barocas, Taproot Therapy Clinical Trainee Life is a masterpiece of contradictions and complexities, woven with intricate threads that shape
our experiences. As you embark on your therapeutic journey, it's essential to understand and embrace a powerful concept called dialectics, or both/and thinking. This way of approaching life and its challenges can help you find balance, emotional well-being, and personal growth. Let's explore how you can integrate this way of thinking into your life. What is Dialectics? ● Dialectics is the art of holding opposing ideas and feelings at the same time. It recognizes that life is rarely black or white; instead, it's filled with shades of gray. By accepting that multiple perspectives and emotions can coexist, dialectics opens the door to greater understanding and growth. ● By acknowledging that opposing ideas and feelings can coexist, we open ourselves to greater understanding and compassion. Let's allow the power of dialectics to inspire us to new heights of self-discovery and connection with those around us. Implementing Dialectics 1. Embrace the beauty of uncertainty. a. If you grapple with anxiety and feel overwhelmed when making decisions, dialectics offers a compassionate perspective. It encourages you to acknowledge that uncertainty is a natural aspect of life. Rather than perceiving it as something to be feared, embrace the discomfort of uncertainty and recognize the potential for personal growth when you step outside your comfort zone. By holding space for both the unease and the opportunity, you can approach decision-making with self- compassion and a gentle curiosity about the possibilities. 2. Honor different perspectives. a. In a disagreement with a loved one, dialectics invites you to consider the validity of both your perspective and theirs. Rather than clinging to the idea of being right, try to understand where the other person is coming from. By practicing active listening and empathy, you can create space for both viewpoints, fostering healthier communication and connection. 3. Embrace your complexity. a. As you navigate the therapeutic process, you may experience a mix of emotions, such as sadness and joy. Dialectics reminds you that it's possible to hold both emotions simultaneously. By allowing yourself to embrace the complexity of your experience, you can find moments of joy and hope amidst the challenges and setbacks. 4. Embrace the messiness of emotions. a. If you struggle with depression, there may be times when you experience both sadness and glimpses of happiness. Dialectics encourages you to honor these contradictory emotions. Recognize that feeling some moments of happiness doesn't invalidate your difficulties. By embracing both sides, you can cultivate resilience and find moments of light even within the darkness. As you embark on your therapeutic journey, remember that dialectics can be a guiding light, helping you navigate the complexities of life. By embracing both/and thinking, you cultivate emotional resilience, foster stronger relationships, and unlock the doors to personal growth. Allow the power of dialectics to guide you toward a deeper understanding of yourself and those around you. Embrace the beauty of contradictions! Author: Danielle Alberta, Taproot Therapy Clinical Trainee Summertime is finally here! For many of us, the warm weather may provide a much needed respite from the low-energy moods that we may feel in the colder months. Since we only have the warmth for a few short months, it might be beneficial to take advantage of it while it's here, spending more time outdoors or exploring new parts of the city. Mindfulness is a core skill of Dialectical Behavior Therapy that can be used this summer to allow us to be more present and appreciative of the good energy that the warmth brings with it. Mindfulness can be used to ground us in the present moment, fully engage with our surroundings, or notice any sensations or feelings arising within us.
The great thing about mindfulness is that we often engage in it without knowing that we are doing it. The mindful experience is fully immersing ourselves into one task, without multitasking or judging it. For example, this might happen naturally while washing the dishes, doing the laundry, or cooking a meal. Now, we can name these everyday activities as mindful activities and then employ them when we are feeling stressed, anxious, or are lost in our negative thoughts. A great and simple way to practice mindfulness at any time is to engage our senses (sight, sound, smell, taste, and touch) because they can help to ground us in the here and now or fully experience a moment. Here are some ways that we can engage our five senses this summer in New York City:
Mindfulness can be done in many small ways throughout the day. Recognizing opportunities to practice being mindful is the first step in cultivating self-awareness. If we can draw on our mindfulness skills in times of peace, we can more easily apply mindfulness skills when we are experiencing overwhelming emotional or physical responses. Try connecting with your five senses this summer using these examples. As you get more comfortable with identifying opportunities to be mindful, make your own list of mindfulness activities or ways to engage your senses throughout the day! Author: Rachel Silberman, Taproot Therapy Clinical Trainee Burn-out, according to the World Health Organization, is a syndrome that results from chronic workplace stress. There are three dimensions of burn-out:
In other words, burn-out occurs when an individual is feeling overworked and overwhelmed by their workload. It is important to understand how to avoid burn-out in the workplace, so that you can continue to be productive while also prioritizing your mental health. Here are some tips that can help:
While these tips may appear to be simple, they can be tricky to enforce in your daily life. Remember that we all cope with stress differently, so be kind and patient with yourself when implementing these strategies. Your brain will thank you! Author: Nancy Moyers, Taproot Therapy Clinical Trainee Transitioning to sobriety from addiction can feel so daunting, yet freeing. The waves of emotions without the safety blanket of a substance can leave us feeling raw. Feeling unsure of what to do in your next steps to sobriety is a shared experience many have. Here are a few steps to check in with yourself to see how you can build up your recovery. You are not alone.
Recovery brings connection, personal growth, passion for life, and safety within ourselves. You have made it this far. Now you can pause and take a deep breath, you are safe. You are taking the steps to allow yourself to heal. One day at a time! Taproot offers individual and group therapy for those questioning their use of substances, those wanting to get sober, and those maintaining their recovery. Author: Nancy Moyers, Taproot Therapy Clinical Trainee To the person that had a slip during Dry January:
2023 rolled around and you set your sights on not drinking for the month of January. Congrats! That’s a great intention to set to start off your new year. Perhaps you started off strong, noticing the incredible impact of no alcohol on your system. You wake up earlier, without a hangover, and head to the gym. You notice you don’t have to drink to have fun in social settings. As the days go on, you slowly start to see the stress build up as you go back to work, school, family life, etcetera. The January blues roll in, and the sun sets at 4:45 pm. On certain days, your fitness routine is swapped out for sitting at home to manage your stress. Then, you find alcohol in your fridge that you didn’t intend on thinking about this month, and you drink it. The day is long, you’re stressed and tired, and you go back to an old buddy that you relied on for so long. And the alcohol worked for coping! Until it didn’t, and perhaps you’re feeling guilt, shame, or frustration because you slipped up and drank. Pause. Deep breath. You are okay. Slips happen! Progress is absolutely not linear. Humans go to what is engrained and what “works”. Whether that’s alcohol, drugs, shopping, food, relationships, gambling, overworking, overexercising, the list goes on. So many of our coping skills, which take the pain away, actually detach us from our reality. Humans struggle with accepting and listening to the feelings we have, the feelings are uncomfortable, and they make us face a reality that we so desperately avoid. Instead of sitting in the emotions, riding the waves that come, and allowing them to pass – we avoid them. And of course we avoid, we aren’t given a guidebook on how to cope in a way that feels authentic and healthy. Yet we are still left with those thoughts, feelings, and quite often, behaviors that keep us in an old cycle of dysfunction and dysregulation. So, what do you do if you slip? Well, I’m here to say that you are not a bad person for slipping up and drinking. You continue on, reminding yourself of the initial intention you set when you were curious about Dry January. Perhaps you realign your intention, reminding yourself that your goal is to re-evaluate your relationship with alcohol. Maybe you want to decrease the number of days you drink, or the amount you drink in one sitting. Your goal of wellness is a fantastic goal. You don’t have to be perfect. You are already doing so much by acknowledging and increasing your awareness of the reality you are in. Perhaps you 6 months ago, or 2 years ago, would’ve never thought to evaluate your relationship with substances! Search inward for that compassion and love for trying your best. Enjoy that mocktail. Today is a new day. |
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