D: Dialectical. The word “dialectic” refers to two ideas that are seemingly in conflict with one another. In the case of DBT, the two ideas that are seemingly in conflict are: “Accept yourself as you are,” and “Work toward positive change in yourself.” These ideas are only “seemingly” in conflict because self-acceptance can mean avoiding punishing yourself and berating yourself for your faults and mistakes; not getting down on yourself can help, rather than interfere with, the process of self-improvement.
B: Behavior. DBT is aimed at helping you do the behaviors that make your life best.
T: Therapy. Therapy applies to trying to heal, to make better, to relieve suffering, to promote well-being, whether with someone else or on your own.
Mindfulness
Distress Tolerance
Emotional Regulation
Interpersonal Effectiveness
Logic Mind: A person in Logic Mind is calm, cool, and collected. They approach a situation using the intellect, not the emotions. Decisions carried out by computations of what action is most likely to produce the best outcome.
Emotion Mind: A person is in Emotion Mind when their emotions are in control. Logical or rational thinking is not present. They may seem out of control. If the emotions are very unpleasant, they may report feeling overwhelmed, stuck, hopeless, or confused.
Wise Mind: A person using Wise Mind uses input from both the Emotion Mind and Logic Mind. The person is aware of their emotions as very important signals about the external and internal world. They use rational reasoning to generate options and predict consequences. They take into account how they would feel about those consequences, in making careful decisions.
This means figuring out and accurately appraising “what” is going on in the situation, the choice point, you are responding to.
Observe: You pay attention both to the events in the outside world and to what is going on inside you. Your first priority is taking it in, accurately. You try not to get down on yourself for what is going on in your mind, or to make negative judgments about what is happening versus what should have happened.
Describe: Describe events, label emotions, identify thoughts. Try not to take emotions and thoughts as accurate and exact reflections of events. List "just the facts.”
Participate: Enter into the activity of the moment. Be spontaneous and give attention to the activity.
This refers to making a decision of “how” you are going to respond in the choice point.
Non-Judgmental: Think about the facts regarding the situation and predicted consequences of actions. Try not to be too distracted by thoughts about how bad some situation or someone is.
One Mindful: This means focusing on the current situation and making a good choice in it, rather than distracted by other situations from the past or other issues.
Effective: Do what works; focus on achieving the outcome you desire.
Distress tolerance skills help us get through difficult emotional situations. The acronym/mnemonic is ACCEPTS.
A: Activities. You choose an activity to do that will provide a feeling of accomplishment, some pleasure, or even just distraction from whatever is distressing. You avoid any activity that is self-harming or too risky.
C: Contributions. Sometimes the best thing you can do for yourself is to find a way to make a contribution to someone else.
C: Comparisons. Sometimes comparing your state to people who are in much worse circumstances allows you to reset the meter whereby you measure how awful your current state is.
E: Emotions. Having experiences that activate other emotions can help get you out of negative emotional cycles. For example, reading fiction or watching a movie that stirs up an intense emotion may be helpful.
P: Pushing Away. Push the situation away from your mind for a while – distract yourself onto something else. You can come back to decision making later, when you feel more equipped for it.
T: Thoughts. Do something that stimulates thoughts that are different from the unpleasant ones that may be cycling through your mind repeatedly.
S: Sensations. Do something non-harmful that gives you some strong physical sensations: for example, exercise intensively, hold ice in your hand or mouth, go out in the cold, take a hot or cold shower.
TIP is an acronym for ways of changing your body physiology to reduce extreme emotion.
T: Temperature. For example: Wash your face with ice water.
I: Intense Exercise. Run, jump, do squats, walk fast, do calisthenics, etc., even if for only a short time.
P: Paced Breathing. Slowing down the breathing can avoid hyperventilation and help in calming. Five seconds in and five seconds out gives a breathing rate of 6 breaths per minute. Many people find that using the abdominal muscles and the diaphragm are useful in purposive breathing. Usually the most important thing is not whether your belly or chest seems to do the moving, but that you avoid breathing too fast.
S: Self-Soothing. You do things that feel pleasant, comforting, and relieving of stress or pain. Consider it a success to pass the time without making things worse.
More on self-soothing:
Think of soothing each of your five senses
Vision: Look for a beautiful sunrise or sunset, the stars at night, or pictures of these things. Look for beautiful photos of beaches or mountains or a beautiful flower. Look at nature all around you.
Hearing: Listen to or play music you enjoy. Listen for the breeze, or the trees in the breeze. Listen for birds or waves of the water.
Smell: Find a fragrance you enjoy, and smell fragrances around you. Smell a flower, or a candle, some coffee, freshly cut grass, or the burning of wood in a fireplace.
Taste: Enjoy some of your favorite foods.
Touch: Apply lotion. Take a hot shower, or a long bath. Sit in the sun or shade and feel the warmth or cool of the breeze.
The point of the IMPROVE skill is to improve the moment by replacing the immediate event, that has caused unpleasant emotions, with a more positive act, thereby making the moment more pleasant and easier to tolerate.
I: Imagery: Improve the moment with Imagery. Imagine a beautiful scene on the beach or in the mountains. Image a safe place in your home.
M: Meaning: Improve the moment with Meaning. Find purpose or meaning in your daily activities.
P: Prayer: Improve the moment with Prayer. This can be prayer in the traditional sense of communion with a deity, or in the sense of devoutly wishing for something or giving thanks for something, for example strength and positivity and wisdom, etc.
R: Relaxation: Improve the moment with Relaxation. Use any of several relaxation techniques.
O: One: Improve the moment by focusing your attention on one thing.
V: Vacation: Improve the moment with a mini-vacation. Go to the woods or a park for a walk, or do something else recreational, or go someplace that gives the feeling of being on vacation, if only briefly.
E: Encouragement: Encourage yourself. Review or read aloud positive affirmations. Try to have encouraging self-talk.
Pros and cons are the same as the advantages and disadvantages of an option, or the positive and negative consequences that might occur from enacting it. Trying to predict the pros and cons of the competing options is a central part of making good decisions.
First describe the choice point at hand, and think of several options. Examine the advantages & disadvantages (or pros and cons) for each of the viable options.
The Problem Solving skill can be very useful once we have determined that a problem has arisen, and it’s our problem to solve. Sometimes we experience unpleasant emotions about the actions of others or situations that we cannot change. This skill specifically helps us to collect the facts and take steps to solve a problem for which we can change.
1. Stop long enough to realize that a situation is a problem and you may need time to find a resolution.
2. Define the problem in detail. What is the situation? Who is involved? What is happening or not happening that is a problem? Where did it happen? When did it happen? How did it happen? How often does it occur? Why does it happen? How do you feel? What do you do in response? What do you want to change?
3. Assess how the problem interferes with your goals. If the situation does not interfere with your goals, maybe you don’t have to do anything about it.
4. Generate options. Think of at least 3 ways of responding to the situation.
5. Try to predict the consequences of each option/alternative. Seek additional knowledge if necessary. (Desirable consequences are advantages or pros; undesirable consequences are disadvantages or cons.)
6. Identify the steps needed to resolve/take action. Make a list of when and how the steps will be taken and then take the required action.
7. Evaluate results. If the steps taken were successful to resolve the problem, acknowledge that you successfully solved a problem and give yourself some credit. If the steps taken were not successful to solve the problem, learn more about what would be needed to solve the problem and follow steps 4-7 again until the matter is resolved.
Radical acceptance is the complete and total acceptance of the reality of a situation or state of affairs. Acceptance in this sense doesn’t mean that you have to like the situation or welcome it. It doesn’t mean you have to give up on changing it if it’s possible to do so. But it does mean that you don’t expend your energy trying to deny that the situation exists, or trying to magically make it go away, or act as if you should be able to make it go away by being mad about it and complaining to yourself or others about it. One aspect of reality is that life contains a certain amount of unavoidable suffering or pain. Another is that there a certain events and actions of other people that we can’t control. Another is that we can’t change the past. But none of these mean that we can’t make a good life.
Useful for when emotions seem out of control:
S: Stop. Stop yourself from taking impulsive action. Give yourself time to figure out what to do.
T: Take: Take a step back. Give yourself some space to think.
O: Observe. Observe what is happening around you and within you. Observe your own thoughts. Gather facts with which to make a decision.
P: Proceed. Proceed with the action that you think will bring about the best results.
Most emotions activate us to respond. Sometimes the urges emotions give us are not good actions to take. Opposite Action Skill allows us to choose to respond opposite from our emotion-driven urge. Here are some examples:
Anger gets us ready to attack/ It activates us to attack or defend. To do the opposite: show kindness or concern or walk away.
Shame gets us ready to hide. It activates us isolate. To do the opposite, raise your head up, give eye contact, take on a confident posture.
Fear gets us ready to run or hide. It activates us to escape danger. To do the opposite, go toward the situation, stay in it, build courage.
Depression gets us ready to be inactive and give up on trying to make things better. It tends to make us to avoid putting out effort. To do the opposite, get active in trying to make things better.
Disgust gets us ready to avoid something. To do the opposite, push through the situation and make the best decision about what to do.
Guilt sometimes gets us ready to punish ourselves. To do the opposite, make amends, learn from the experience, or otherwise use energy to make things better.
The ABC PLEASE skill is about taking good care of ourselves so that we can take care of others. Also, an important component of DBT is to reduce our susceptibility to disease and emotional crises, by taking good care of ourselves.
ABC
A: Accumulate. Accumulate positive emotions by doing things that are pleasant.
B: Build. Build mastery by practicing enjoyable or useful skills. Examples are reading, doing math, cooking, cleaning, fixing a car, writing, playing a musical instrument, studying listening skills, practicing muscle relaxation, studying this handout…
C: Cope. Cope Ahead means to rehearse a plan before the situation actually comes up in real life. Practicing in imagination (also known as fantasy rehearsal) can help us cope skillfully.
PLEASE
PL: Physical ILlness – treat physical illness rationally, with help of competent professionals.
E: Eating: Eat a healthy diet in sensible amounts.
A: Avoid. Avoid mind altering recreational drugs, including nicotine, alcohol, marijuana, opiates, cocaine, etc., especially including unidentified stuff of unknown dose, offered by someone else.
S: Sleep: Enough hours, in a regular rhythm.
E: Exercise: Exercise regularly, preferably in ways you enjoy, in rationally chosen amounts.
The DEARMAN skill is relevant to joint decision making or conflict resolution conversations with others.
D: Describe. Describe the current situation (if necessary). Stick to the facts. Tell the person exactly what you are reacting to.
E: Express. Express your feelings and opinions about the situation.
A: Assert. Assert yourself by asking for what you want or saying “No” clearly. Do not assume that others will figure out what you want. Remember that others cannot read your mind.
R: Reinforce. Reinforce (reward) the person ahead of time by explaining positive effects of getting what you want or need. Acknowledge it if the other person acts reasonable or compassionate. If necessary, also clarify the negative consequences of not getting what you want or need.
M: Mindful. Mindful keep your focus on your goals. Don’t get distracted. Don’t get off the topic.
A: Appear. Appear confident, effective, and competent. Use a confident voice tone and physical manner; make good eye contact.
N: Negotiate. Be willing to give some in order to get some. Offer and ask for other solutions to the problem.
This has to do with ways of acting to build good relationships.
G: Gentle. Be nice and respectful.
I: Interested. Get interested in the other person.
V: Validate. Show that you understand the other person’s feelings and thoughts about the situation.
E: Easy manner. Be light-hearted, use humor, smile, act relaxed.
FAST is a mnemonic for ways to act in interpersonal communication about issues that affect both people.
F: Fair. Be fair to yourself and to the other person.
A: Apologies: Don’t over apologize. Don’t invalidate your reasonable wishes.
S: Stick to Your Values. Get clear on what you think is right and wrong, and stick to your principles.
T: Truthful. Don’t lie. Don’t exaggerate or make up excuses.