In part 1, I introduced the new and promising therapy called dialectical behavior therapy (DBT); as I said, there is growing evidence that it is a very effective treatment for conditions which may arise as a consequence of an individual having suffered childhood trauma (especially those who have developed borderline personality disorder -BPD).
As a quick reminder, five key skills which DBT endeavours to teach those who choose to undergo the therapy are:
1) CORE MINDFULNESS
2) TAKING THE ‘MIDDLE PATH’
3) DISTRESS TOLERANCE
4) EMOTIONAL REGULATION
5) INTERPERSONAL EFFECTIVENESS
In part one I covered 1 and 2 above. It seems quite logical then (!) that I should, in this post, move on to look at number 3 – DISTRESS TOLERANCE:
3) DISTRESS TOLERANCE
Practitioners of DBT try to instil the view in their clients that sometimes it is easier, and psychologically healthier, to stop struggling against reality, and,(they tell us) we need to accept that we, nor anybody else, for that matter, can prevent painful events from occurring in life (sometimes extremely painful ones, if we’re going to be up-front about it), nor can the painful emotions they bring with them. It is hardly a new idea, but practitioners of DBT also remind us that some painful things in life cannot be changed and that the only viable option we really have, therefore, is to accept the fact. This, of course, is difficult and requires considerable inner strength. By accepting the things which cannot be changed, though, it is reasoned, we free up energy which could have been wasted (by, say, being angry and bitter about the existence of these unchangeable facts) to deal with what CAN BE CHANGED.
DBT therapists tell us that there are certain skills we may wish to develop which will INCREASE OUR ABILITY TO TOLERATE DISTRESS; these are:
a) distraction/improving the moment
c) considering pros and cons of the situation
d) radical acceptance
Let’s briefly look at each of these in turn:
a) distraction/improving the moment – eg distracting ourselves with activities we enjoy, keeping our minds busy ; reminding ourselves of the good things in life ; reminding ourselves that it is better to think clearly and in a focused way about our problems ‘after the storm has passed’ (rather than try to make decisions when in the middle of an intense crisis which may be over-determined by our emotions) ; remind ourselves that difficult periods will pass
b) self-soothing – eg we can use postive self-talk (see my posts on cognitive behavior therapy for more on this – to access the posts just type ‘CBT’ into this site’s search facility) ; meditation/relaxation activities/breathing exercises ; using our imaginations to recall a soothing and comforting memory or place (if recalling a place it can be helpful to imagine, for a while, actually being there) ; thinking of things in life which are meaningful to us and give us the motivation to get through the difficult period.
c) considering the pros and cons of the situation : eg we may wish to consider how getting through a very difficult period may benefit us – for example, we may learn from it, it may strengthen us, it may make us more compassionate and sensitive towards others, we may be able to pass on the benefit of our experience to help others, it may even open up completely unexpected avenues in life which may not otherwise have been available to us (bad events do sometimes lead to positive outcomes, however indirectly – it is often worth keeping that in mind).
d) radical acceptance : this might involve trying to view what is happening, however undesirable, from as objective and detached a perspective as possible – a bit like watching the events unfold around somebody else in a movie ; another, perhaps surprising, technique suggested by DBT therapists is to try to, literally, half-smile. This sounds strange and even rather silly, but research shows that just as the mind can affect the body (eg thinking about something embarrassing and going red in the face) so too can the body effect the mind – in this case, the idea is that the half-smile ‘fools’ the brain into ‘believing’ things aren’t as bad as all that. It is obvious, however, that in certain situations this technique would be highly inappropriate (I need hardly list examples).
4) EMOTIONAL REGULATION :
The fourth skill that DBT teaches is how to cope with intense and overwhelming emotions – this skill is referred to by practitioners of DBT as emotional regulation.
This skill is made up of three sub-skills : a) increasing one’s understanding of one’s emotions; b) decreasing one’s emotional vulnerability; c) lessening the degree of distress caused by one’s negative emotions.
5) INTERPERSONAL EFFECTIVENESS
The final skill of interpersonal effectiveness helps the person undertaking DBT to communicate with others effectively when interacting with others in a way that helps to improve his/her relationships.
In order to achieve this, s/he is helped to communicate with others in a more controlled manner and to be less prone to speaking impulsively and without forethought due stress or overwhelming emotions (such as anger).
DBT TRAINING MANUAL :
David Hosier BSc Hons; MSc; PGDE(FAHE).
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