Dialectical Behavior Therapy
DBT Therapists Chicago
Dialectical Behavior Therapy (DBT) is a highly effective treatment for Eating Disorders, depression, self-injury, suicidality, anxiety, addictions, anger issues and Borderline Personality Disorder.
Developed in the late 1980s by psychologist Dr. Marsha Lineahan, there has been a host of research conducted over the past few decades to support its effectiveness in providing symptom reduction.
DBT is a skills-based therapy, meaning that the treatment aims at helping individuals learn effective coping skills to better tolerate distress, regulate emotions, interact effectively in relationships and learn to be more present (mindfulness).
DBT THERAPY IN CHICAGO
At Cityscape Counseling, we tailor treatment to meet your specific needs. Dialectical behavior therapy in Chicago can either be incorporated into regular therapy sessions where applicable, or you can opt to work through the DBT skills curriculum with your DBT trained therapist in Chicago so that you can walk away with a toolbox packed with brilliant coping tools to help you manage panic attacks, depressive episodes, disordered eating, self-harming and addictive behaviors.
How to be more present
When was the last time that you paused for a minute and took note of your breath, your surroundings, and perhaps how you were feeling in your body?
From the moment we wake up until our head hits the pillow, most of us have our eyes glued to our phones, our hands tied to work tasks and our minds caught up in a flurry of past or future oriented thoughts.
We are socialized to be “permanently productive” and “always on the go”. One often wonders where exactly we are all racing towards and what we will do when we get there. With our attention constantly bombarded by task lists, deadlines and disturbing media stories, it’s no wonder that our mental health has suffered.
Thinking about the past is often associated with feelings of regret, despair and depression.
Thinking about the future is often associated with anxiety, panic and worry.
This is because we have little to no control over the past and future.
We only truly have control over the present moment.
The skill of mindfulness can teach us to gain more control of our attention and help us be more truly present in our lives.
Whenever we are feeling overwhelmed, we can remember that mindfulness teaches us that life is just a bunch of moments strung together and we only need to get through one moment at a time.
Benefits of mindfulness
- Reduction in stress and anxiety
- Reduction in depression and increased reported happiness
- Strengthened immune system
- Increased flexibility in thinking and attitude
- Improved quality of relationships
MINDFULNESS AND THE BRAIN
A number of recent scientific studies have revealed that practicing mindfulness can actually reshape the brain (neuroplasticity).
When we practice mindfulness, we engage certain parts of the brain more than other parts, and because neurons that fire together, wire together, mindfulness practice leads to:
- A decrease in size of the Amygdala (the brain’s emotion center responsible for the anxiety & depression response)
- An increase in size of the prefrontal cortex (the brain’s rational/thinking center)
Paying attention, with intention, to the present moment, without judgement.BASIC MINDFULNESS SKILLS
Do one thing at a time. This is the opposite of multi-tasking. When you become distracted by distressing thoughts or a wandering mind, continue coming back to the task at hand. Fully savor the moment.
Example: When you are eating, only eat – focus on the taste of the food, the movement of your hands, the presentation of the food etc. When you are showering, focus on how the soap smells, how the warm water feels on your body, and what the water sounds like.
Stick to the facts. Don’t evaluate as good or bad. Notice when your mind does judge and don’t judge your judging, just notice it. Judgments are “spontaneous and often inaccurate interpretations” that usually lead to an increase in emotional distress. It’s not the trigger itself that leads to our distress, but rather the manner in which we INTERPRET the trigger.
Example: (non-judgmental) My coworker did not greet me today and I noticed I became anxious vs (judgmental) my peer did not greet me today, she must hate me and my anxiety is bad.
Using your 5 senses is one way in which to anchor yourself in the present moment. What can you see, smell, hear, touch and taste in this present moment? Observing with one’s senses also signals to the brain that you are safe, and naturally calms the nervous system.
Example: Trace the outline of the clouds with your eyes, notice the sensation of the breeze on your arms.
Using words, non-judgmentally describe a situation, your emotions, thoughts or an experience.
Example: I’m noticing my heart rate increasing and my hands are sweating vs “I feel anxious and it’s terrible”
Make a choice to actively engage in whatever you are doing in the present moment. Become one with what you are doing, throw yourself completely into the activity of the current moment.
Example: While at a social gathering, be present in the conversation and games instead of checking your phone or day-dreaming.
A quick & easy acronym to help with your MINDFULNESS practice
The PEACE skill below will help you to respond to difficult thoughts, feelings and situations in a MINDFUL manner. When you become aware of your thoughts and feelings, you can pause and thoughtfully choose effective behavior which is how you will create a more meaningful life for yourself.
P: PAUSE – when you notice an intense emotion or unpleasant thoughts, it is time to take a pause. It is a signal to practice being mindful.
E: EXHALE – Take a slow, long, exhale and as you exhale let out a sigh or even some tears. Remember to inhale after exhaling and continue breathing normally, knowing your breath can always be an anchor for you to return to.
A: ACKNOWLEDGE, ACCEPT, ALLOW
- Acknowledge the thought, emotion or situation by saying, “here’s sadness,” “sadness has just arrived,” or “I’m noticing sadness.”
Accept the thought, emotion or situation by saying, “it is what it is” or “I might not like it, but I can accept it.” We do this because fighting against reality only drains you further and heightens unpleasant emotions.
- Allow room for your current experience by inviting the experience to stay as long as it needs to. You can say, “sadness, you can stay here as long as you need as I know you will rise, fall, and then move on like a wave when you are ready”.
C: COMPASSION & CHOOSE
- Express understanding and compassion to yourself that something feels painful and that the human experience can be tough at times.
- Make a decision of how best to respond in the current moment. What choice will move you forward in this moment? Is it in line with the kind of person you want to be and how you want to live your life?
Now that you have paused and been mindful, it’s time to re-engage in the remainder of your day.
Check out this blog post by our very own therapist Nicole Bentley on incorporating mindfulness into your daily activities.
Learning to surf urges
Our DBT therapists here at Cityscape Counseling are waiting to equip you with distress tolerance skills to help you manage any intense urges, cravings, impulses or emotions you may be struggling with such as: urges to self-injure, urges for bingeing and purging, cravings for drugs and alcohol, impulses for compulsive activities, and intense anger, panic and sadness.
Marsha Linehan, founder of DBT, says that the 2 main goals of DBT Distress Tolerance are to help you:
1. “SURVIVE CRISIS SITUATIONS without making them worse”
Examples of how acting on intense emotions can make crisis situations worse:
- You find out you’ve just lost your job, you decide to go out for a night of drinking and then you drive home while intoxicated and receive a DUI.
- Your partner breaks up with you and in order to numb the pain, you impulsively have unprotected sex with a stranger you just met.
- You receive a rejection letter from the Grad school of your dreams and to punish yourself, you engage in self-injury or disordered eating which only leads to more guilt and shame.
2.“ACCEPT REALITY in order to reduce overall emotional suffering”
Emotional pain in life is inevitable, but we oftentimes unintentionally turn our pain into suffering by the way we choose to respond to it. Your DBT therapist can teach you the skill of radical acceptance to help free you from the exhausting struggle that results from a continuous rejection of reality. The goal of radical acceptance is not eliminating your pain— if there was a magic formula for that, we’d certainly share it. Rather, the goal is to provide you with skills to interact with your pain in such a way that your time and energy increase to focus on building a more enriching life in spite of your pain, which ultimately will reduce your suffering.
Our DBT therapists can teach you Distress Tolerance skills to be used in the following situations:
- When you are experiencing urges for harmful behaviors or intense emotional pain
- When acting on intense emotions/urges will only increase your suffering
- You are feeling extremely overwhelmed but you still have tasks to complete
Here’s a Quick Example of a skill our DBT Therapists love to teach, adopted from the DBT Skills Training Manual
Riding the Waves of your emotions
Emotions are like the waves in an ocean. Just as ocean waves can be calm/tranquil one moment and stormy/turbulent the next, so can your emotions. Emotions often transition from waves of peace to waves of distress suddenly and without warning, so of course it feels jarring! One moment you’re coasting the waves of contentment and the next moment you might find yourself being swept away by waves of panic.
Like waves in the ocean, your emotions will not remain at the exact same intensity forever. You can be assured that your emotions will approach, rise to a peak, and then naturally fall and move on, just like a wave does. While you can’t stop the waves from coming, you can learn to surf the waves of your emotions to decrease your suffering!
Next time you notice an intense emotion wave approaching, try the steps below:
- Observe your Feeling
- Rate the intensity on a scale of 1-10
- Notice it, Step back, Get unstuck
- Experience your feeling as a wave coming and going
- Try not to block the feeling
- Don’t try to get rid of it
- Don’t try to push it away
- Don’t try to hold on to it
- Don’t try to make the feeling bigger
- Remember, you are not the feeling
- You don’t need to act on it
- Rate the intensity of your emotion again – has it increased, stayed the same, or decreased?
- Remember times when you have felt differently
- Become more familiar with your feeling
- Don’t judge it
- Radically accept it as a part of you
- Name your feeling
- Invite it to hang out with you and sit alongside you
- Re-rate the intensity of your emotion
- Repeat the steps until you notice a change
If you can ride the wave long enough, eventually your emotion will subside.
Remember, intense emotions/urges/cravings rarely remain at a level 10 longer than a few minutes (unless you retrigger the emotion by struggling against it)
Managing difficult emotions
If you’ve ever wondered why you experience certain emotions, what functions they serve, and how to “get more or less” of a certain emotion, this is the module for you.
Our DBT Therapists will teach you emotion regulation skills that will help you:
- Better identify the emotion you’re experiencing
- Understand why you behave the way you do when you experience certain emotions
- Modulate certain emotions if they are causing problems for you
One popular Emotion Regulation skill our DBT therapists love to teach is known as “Opposite To Emotion Action”.
There are good reasons for feeling whatever it is you feel. Even when they are painful, your emotions are legitimate and valid. The larger problem is emotion-driven behavior, because acting on emotions often creates destructive outcomes. Letting anger drive you to attack with words can disrupt your relationships just like letting fear drive you to avoid critical tasks can paralyze you at work.
A second problem with acting on emotion-driven impulses is that they intensify your original feeling. Instead of feeling relief, you may get even more consumed with the emotion at hand. This is where opposite action comes in. Rather than fueling your emotion, opposite action helps to regulate and change it. Here are some examples of opposite action.
Opposite action isn’t about denying or pretending an emotion isn’t happening. Rather, it is about regulation. You acknowledge the emotion but use the opposite behavior to reduce it or encourage a new emotion.
Opposite Action DBT Skill
1. Start by acknowledging what you feel. Describe the emotion in words.
2. Ask yourself if there’s a good reason to regulate or reduce the intensity of this emotion. Is it overpowering you? Does it drive you to do dangerous or destructive things?
3. Notice the specific body language and behavior that accompanies the emotion. What’s your facial expression, your posture? What are you saying and how are you saying it? What, specifically, do you do in response to the emotion?
4. Identify opposite action. How can you relax your face and body so it doesn’t scream “I’m angry” or “I’m scared”? How can you change your posture to convey confidence and vitality rather than depression? How can you move toward, not away from, what scares you? When you are angry, how can you acknowledge or ignore rather than attack? Make a plan for opposite action that includes a specific description of your new behavior.
5. Fully commit to opposite action and set a time frame to work at it. How long will you maintain the opposite behavior? As you think about making a commitment, keep in mind why you want to regulate your emotions. What’s happened in the past when you gave in to emotion-driven behavior? Were there serious costs to you, to others?
6. Monitor your emotions. As you do opposite action, notice how the original emotion may change or evolve. Opposite action literally sends a message to the brain that the old emotion is no longer appropriate—and it helps you shift to a less painful emotion.
improving relationship skills
Feeling misunderstood? Arguing in circles with your partner?
This DBT Module is for you!
- With the exception of twins, we are all genetically unique
- We are also all subject to different environmental experiences (generational, religious, educational, social, family of origin and political influences, as well as potential exposure to trauma)
Therefore, it’s unlikely that two people will agree on everything and it’s completely expected that at times you will have a perspective that differs to that of a loved one. It’s important to remember that there can be multiple perspectives that can be “true”, and having a different perspective to your loved one does not make either person’s perspective more or less true. They are just different.
If you do VALUE a particular relationship, the skills that follow can help you navigate your differences with your loved one to help you preserve the relationship.
Take a moment to think about why you value this particular relationship?
It will be important to remind yourself of this value when you are dealing with difficult conflict and especially when your emotions are “running high”.
DBT Communication Skills
“What to Do & What Not to Do”
What to Do
– Emotions: If at all possible, save difficult conversations for when you are at your calmest. If you are experiencing anxiety, anger, sadness, shame… you are more likely to use emotionally charged words and say something unhelpful to the relationship.
·Validate, Validate, Validate: When you notice the urge to accuse a loved one of something or point out their faults, say something encouraging instead. Thank them for something or point out their strengths. You might be thinking why on earth would I validate someone I am angry with? Two reasons: Firstly, validation makes them more likely to be receptive when you do make a request because validation will take them out of defensive mode. Secondly, it will help you gain some perspective, and lower your emotional intensity towards the situation because you will be reminded of why you care about the person and why the relationship is important to you.
·Body Language and Voice Tone: Non-verbals communicate more powerfully than verbals do. If your body language and tone don’t match your words, you will appear insincere. Use a quiet, gentle tone, and relaxed posture (sitting back, solid eye-contact, relaxed face and unfolded arms). Relaxing your posture can also signal to your brain to calm your emotions.
·I – Statements: Become familiar with saying “I feel….” instead of “you make me feel…” in heated or difficult conversations. The reality is that nobody can make you feel a particular way. We are responsible for our own feelings and our reactions to things said to us, no matter how influenced we feel in the moment. By saying “I feel…” rather than “you make me feel…” you are disarming the other person’s defense because your feelings are your feelings and they are utterly indisputable.
What Not to Do
· Raise your voice
· Use extremes such as “you always” and “you never”
· Bring up past wrongs
· Stray from the current topic
· Assume you know what the other person is thinking
Effective Communication Interaction
Person A) I feel…. when you…. because….
(For example: I feel disrespected when you leave your breadcrumbs on the counter because I have just cleaned the counter)
Hint: Be specific as possible. Instead of saying “when you are messy” – describe factually how the person is making a mess so they know exactly what you’re referring to. Remember to stick to the facts.
Person B) I’m hearing that… (summarize what you have heard to show you understand). Is that correct?
Person A) Yes that’s correct or No…. it’s….
Person B) Continues to reflect back until person A confirms that person B understands what they are communicating
Person A) Therefore I would like it if…
(For example: Therefore I would like it if you scoop up your breadcrumbs and throw them away in future)
Person B) I’m hearing you would like it if…? (summarize what you believe the request is). Is that correct?
Person A) Yes that’s correct or No…. it’s….
Person B) Continues to reflect until person A confirms that person B understands what they are asking
Person B) Either agree to person A’s request or use the same process to explain how you feel and why you are not able to meet their request
If person A and B still hold different perspectives at the end of the exchange, decide if a compromise is possible. If not, return to why you both value the relationship and decide what you can each radically accept about the situation in order to preserve the relationship.
If it feels comfortable, let the other person know how much you care about them and move onto a new topic to get some space from the challenging conversation.
Note: During the conversation with your loved one, it’s important to TRULY LISTEN and practice “putting yourself in their shoes for a moment”. This will help you better understand their perspective, empathize with them, and be more willing to compromise.
DO NOT plan your defense or “work on your case” while your loved one is speaking. Their feelings are their feelings so there is nothing to dispute. You’ll also be more likely to miss what they are trying to communicate with you.
The above communication skills are helpful because even if agreement on an issue is not achieved, each person still has the opportunity to be heard, validated and respected, and it’s likely that after the exchange, both parties are left a little less polarized on the issue. It also prevents the negative consequences that often result after exchanges where hurtful remarks are made.
Practice frequently and be patient with yourself. If you have been communicating one way your whole life, it will feel strange in the beginning, and may take a while for it to feel authentic.
DBT provides some helpful acronyms to help us remember some key elements for ensuring we communicate as effectively as possible.
When the primary goal of your interaction is to get an OBJECTIVE MET, then use the acronym: DEAR MAN
dEAR MAN DBT Skill
D Describe (only the facts)
E Express (emotions using I-statements)
A Assert (I’d like)
R Reinforce (explain how getting your need met will benefit the other person)
M Mindful (do not deviate from the topic at hand)
A Appear Confident (even if you don’t feel confident)
N Negotiate (if you are willing)
When the primary goal of your interaction is to maintain the RELATIONSHIP, then use the acronym: GIVE
DBT Give Skill
E Easy Manner
When the primary goal of your interaction is to maintain SELF RESPECT, then use the acronym: FAST
DBT Fast Skill
S Stick to own values
Our Chicago based DBT Therapists are ready to coach you to more effectively communicate in all your different relationships!