Dialectical Behavioral Therapy:
​A Comprehensive Approach to
​Managing Overwhelming Emotions

Francesca Viera, ASW

Dialectical Behavior Therapy (DBT) is a well-established branch of cognitive-behavioral therapy (CBT) that is designed to help individuals manage overwhelming emotions and improve their quality of life. Developed by Dr. Marsha Linehan in the 1980’s, DBT aims to strengthen one’s ability to handle distress without losing control. Feelings can be very intense, and we sometimes unintentionally react negatively, because of them. For those of us who have ever struggled to manage our powerful, tsunami-like waves of emotion, DBT can help you develop skills to regain control, find balance, and reduce the size of those emotional waves. 

What is Dialectical Behavior Therapy?
Dialectical means “the existence of opposites.” So, Dialectical Behavioral Therapy operates on the principle of balancing acceptance and change, aiming to help clients accept their experiences, while also working towards meaningful change in their behaviors and emotions. DBT combines cognitive-behavioral techniques with foundational principles of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. 

Techniques for Managing Anxiety and Depression in DBT

• Mindfulness: Mindfulness is a cornerstone of DBT and involves paying attention to the present moment without judgment. It helps individuals become more aware of their thoughts, feelings, and physical sensations, which can be particularly beneficial for managing anxiety and depression.
  • Mindful Breathing: This technique involves focusing on the breath, noting each inhalation and exhalation. It helps ground individuals in the present moment and can reduce anxiety by shifting focus away from overwhelming thoughts. Some people like to use techniques such as box breathing or 4-7-8 breathing.
  • Body Scan: This practice involves systematically focusing on different parts of the body to develop a greater awareness of physical sensations. It can help individuals pause, connect with their bodies, and recognize areas of tension or stress.
• Distress Tolerance: Distress tolerance skills are designed to help individuals cope with crises and tolerate painful emotions without resorting to maladaptive behaviors. When our emotions are intense it can be difficult for our brain to process information and calm ourselves down.
  • TIPP Skills: This acronym stands for Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation. We use these techniques to quickly reduce emotional intensity by resetting our body’s nervous system. TIPP skills utilize your body’s natural calming systems to slow your heart rate and regulate your breathing.
• Emotion Regulation: Emotion regulation skills help individuals understand and manage their emotions more effectively, which is crucial for those experiencing anxiety and depression.
  • Identifying and Labeling Emotions: Recognizing and naming emotions can reduce their intensity and provide clarity. This process helps clients take a step back to understand their emotional reactions and responses, while taking proactive steps to address them.
  • Opposite Action: This involves taking actions that are contrary to one's current emotional state. For instance, if feeling depressed and wanting to isolate, the opposite action would be to engage in social activities. 
• Interpersonal Effectiveness: These skills focus on improving communication and relationships, which can alleviate feelings of isolation and frustration associated with anxiety and depression.
  • DEAR MAN: This acronym stands for Describe, Express, Assert, Reinforce, Mindful, Appear Confident, and Negotiate. DEAR MAN is a structured approach to expressing needs and desires in a clear, respectful manner to enhance positive communication. It can be really hard to communicate our emotions and feel heard, DEAR MAN can help people express their needs objectively and increase the likelihood of getting needs met in different relationships.​

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Effectiveness of Dialectical Behavior Therapy
DBT has demonstrated effectiveness in treating a variety of mental health conditions. Research shows that DBT can significantly reduce symptoms of anxiety and depression, diminish self-injurious behaviors, enhance emotional regulation, decrease anger and impulsivity, and improve overall functioning.

• Anxiety and Depression: A meta-analysis by Kliem et al. (2010) found that DBT is effective in reducing symptoms of anxiety and depression. The mindfulness and emotion regulation components of DBT help clients manage overwhelming emotions and thoughts, which are central to both conditions.
• Behavioral Outcomes: A study by Dimeff and Linehan (2008) highlighted that DBT’s focus on acceptance and change equips clients with practical skills for managing stress and emotional upheaval, leading to improved behavioral outcomes and reduced symptom severity.
• Long-Term Benefits: Research by Linehan et al. (2006) indicates that DBT not only helps reduce immediate symptoms but also promotes long-term emotional stability and resilience. The skills learned in DBT provide individuals with tools to handle future challenges more effectively.

Does DBT Sound Right for You?
Dialectical Behavior Therapy offers a comprehensive approach to managing anxiety and depression through a blend of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. By incorporating DBT techniques, individuals can develop a greater understanding of their emotions, learn effective coping strategies, and improve their overall quality of life. Talk to your therapist to determine if DBT strategies can be helpful for you.

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References

• Dimeff, L., & Linehan, M. M. (2008). Dialectical Behavior Therapy: A Comprehensive Guide. Guilford Press.
  
• Kliem, S., Kroger, C., & Kosfelder, J. (2010). Dialectical Behavior Therapy for Borderline Personality Disorder: A Meta-Analysis using Mixed-Effects Models. Journal of Consulting and Clinical Psychology, 78(6), 936-951.
  
• Linehan, M. M., Heard, H. L., & Armstrong, H. E. (2006). Naturalistic Follow-Up of a Behavioral Treatment for Chronically Suicidal Borderline Patients. Behavior Therapy, 37(1), 11-24.
  
• McKay, M., Wood, J. C., & Brantley, J. (2021). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, Interpersonal Effectiveness, emotion regulation. New Harbinger Publications, Inc. 

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