Incorporating Dialectical Behavior Therapy Skills
Written by Fiona Stone, LMFT
By Fiona Stone, LMFT
In my work with couples and individuals, I frequently turn to psychoeducation, focusing on four key areas: emotion regulation, distress tolerance, effective communication, and mindfulness. These foundational components stem from Dialectical Behavior Therapy (DBT), a therapeutic modality originally developed by Marsha Linehan for treating clients with borderline personality disorder (BPD), especially those struggling with suicidal ideation. Although DBT is rooted in psychoeducation rather than psychoanalysis or process-based therapy, it has proven to be one of the most effective treatments for BPD when its protocols are strictly adhered to. Over time, DBT’s scope has expanded to address various other emotional and behavioral challenges, making it an invaluable tool for a wide range of clients.
DBT is a structured program where clients acquire and practice skills each week. The process begins with mindfulness, followed by distress tolerance, emotion regulation, and interpersonal effectiveness. These skills build on one another, with weekly handouts and diary card homework guiding the practice. Though I do not identify as a strictly DBT therapist, I recognize the value of integrating DBT skills into my sessions. My therapeutic orientation leans toward existential humanism and emotion-focused approaches, complemented by attachment theory. This blend encourages clients to explore their family-of-origin experiences and interpersonal relationships, helping them identify, communicate, and address their feelings and needs.
Despite this, I still appreciate DBT’s foundational biosocial theory, which posits that individuals often experience emotional difficulties due to a combination of biological predispositions and invalidating environments. This dual influence can amplify emotional sensitivities and maladaptive behaviors. By framing emotional responses through this lens, I help clients understand why they may be struggling and work collaboratively to address these challenges. In DBT, the therapeutic relationship is non-hierarchical, emphasizing that the client is the expert on their own experience—an approach I fully endorse.
The Role of Escape Behaviors
One of the common manifestations of emotional dysregulation is the use of “escape behaviors”—maladaptive coping mechanisms such as substance abuse, disordered eating, self-harm, or risky sexual behavior. These behaviors, while providing short-term relief, often exacerbate long-term distress. DBT offers practical tools, such as self-soothing and coping strategies, that help clients manage emotional dysregulation without resorting to harmful behaviors. By learning to tolerate distress and survive crisis moments, clients are more likely to avoid these problem behaviors in the future. Each time a client successfully navigates a moment of distress without resorting to their usual coping mechanisms, they reinforce the possibility of abstinence from those behaviors, creating a positive feedback loop.
Behavioral Analysis: A Tool for Understanding and Change
One of DBT’s most valuable tools is behavioral analysis, often referred to as chain analysis. This method encourages clients to dissect the events leading up to problematic behavior, allowing them to identify patterns and triggers. By breaking down the sequence of thoughts, emotions, and actions, clients gain insight into how and why they respond to certain situations in maladaptive ways. With this understanding, they can implement new strategies to interrupt the cycle and prevent negative consequences. Engaging clients in this analytical process fosters a sense of self-efficacy as they learn they can influence their emotional responses and behavior.
I’ve found that behavioral analysis is particularly effective with adolescents. These children often struggle to manage overwhelming emotions and maintain healthy relationships with their caregivers and peers. I help them develop emotional resilience and improve their interpersonal effectiveness by guiding them through this process.
Radical Acceptance: A Path Toward Change
A core DBT concept is radical acceptance, which encourages clients to acknowledge painful emotions or situations without judgment. This can be incredibly transformative for clients who struggle with low self-esteem or feel stuck in negative behavioral cycles. The dialectical nature of DBT allows clients to hold two seemingly opposing truths at once: they can accept themselves as they are while simultaneously working toward change. This realization can be empowering for clients—accepting their current circumstances doesn’t mean resigning themselves to a life of suffering. Instead, it paves the way for meaningful change by reducing the shame and self-criticism that often block progress.
Radical acceptance is essential for clients who feel overwhelmed by their emotions or behaviors. Encouraging them to sit with their feelings without rushing to change them fosters self-compassion and patience, which are essential for long-term healing.
The Importance of Validation
One of the most critical yet often overlooked components of DBT is validation. Clients frequently come from environments where their emotions or experiences were invalidated, which may have contributed to their emotional dysregulation. In therapy, validation plays a dual role: clients learn to validate their own feelings and how to validate others. This skill improves interpersonal relationships, fosters understanding, and reduces conflict.
Teaching clients to model validation in their interactions with family members and other close relationships can significantly enhance their communication skills and help them feel more understood. Clients are more likely to reciprocate when others validate their emotions, leading to healthier, more empathetic relationships.
Integrating DBT Skills into Therapy
Although I do not practice DBT exclusively, I often incorporate its principles into my sessions as one of several approaches to helping clients explore their concerns, conflicts, and internal contradictions. The skills DBT offers—particularly in emotion regulation, distress tolerance, and mindfulness—are invaluable tools for tackling negative thought patterns, fostering insight, and building emotional resilience. For clients with deeply ingrained emotional challenges, these skills can be a practical guide for navigating life’s difficulties and improving their relationships with others.
At the heart of DBT is the belief that people can change. By incorporating these skills into a supportive, nonjudgmental therapeutic environment, I aim to help my clients modify their thoughts and behaviors meaningfully, ultimately empowering them to lead more fulfilling lives.