h"ps://[Link].

com

Dialectical Behaviour Therapy: An Overview of the Treatment

Dialectical behaviour therapy, developed by Marsha Linehan is extraordinarily effective

at helping people manage their overwhelming emotions. Research shows that dialectical
behaviour therapy strengthens a person’s ability to handle distress without losing control or
acting destructively. A lot of people struggle with overwhelming emotions. It’s as if the knob is
turned to maximum volume on much of what they feel. When they get angry or sad or scared, it
shows up as a big, powerful wave that can sweep them off their feet.

If you’ve faced overwhelming emotions in your life, you know what we’re talking about.
There are days when your feelings hit you with the force of a tidal wave. And when that happens,
it makes you—understandably—afraid to feel things because you don’t want to get swept away
by your emotions. The trouble is, the more you try to suppress or put a lid on your emotions, the
more overwhelming they can get. We’ll talk about that in chapters 7 and 8 on emotion regulation.
What’s important to know right now is that trying to stop your feelings doesn’t work.

Dialectical behavior therapy teaches four critically important skills that can both reduce the size
of emotional waves and help you keep your balance when those emotions overwhelm you.

1. Distress tolerance will help you cope better with painful events by building up your
resiliency and giving you new ways to soften the effects of upsetting circumstances.
2. Mindfulness will help you experience more fully the present moment while focusing less
on painful experiences from the past or frightening possibilities in the future.
Mindfulness will also give you tools to overcome habitual, negative judgments about
yourself and others.
3. Emotion regulation skills help you to recognize more clearly what you feel and then to
observe each emotion without getting overwhelmed by it. The goal is to modulate your
feelings without behaving in reactive, destructive ways.
4. Interpersonal effectiveness gives you new tools to express your beliefs and needs, set
limits, and negotiate solutions to problems—all while protecting your relationships and
treating others with respect.

Created on 04 Feb, 2024 copyrights, Sagheer Afzal & The Psycholar

h"ps://[Link]

Basic Distress Tolerance Skills: WHAT ARE THEY?

At some point in our lives, we all have to cope with distress and pain. Either it can be
physical, like a bee sting or a broken arm, or it can be emotional, like sadness or anger. In both
cases, the pain is often unavoidable and unpredictable. You can’t always anticipate when the bee
will sting you or when something will make you sad. Often, the best you can do is to use the
coping skills that you have and hope that they work. But for some people, emotional and
physical pain feels more intense and occurs more frequently than it does for other people.

Their distress comes on more quickly and feels like an overwhelming tidal wave. Often,
these situations feel like they’ll never end, and the people experiencing them don’t know how to
cope with the severity of their pain. For the purposes of this book, we’ll call this problem
overwhelming emotions. (But remember, emotional and physical pain often occur together.)
People struggling with overwhelming emotions often deal with their pain in very unhealthy, very
unsuccessful ways because they don’t know what else to do. This is understandable. When a
person is in emotional pain, it’s hard to be rational and to think of a good solution. Nevertheless,
many of the coping strategies used by people with overwhelming emotions only serve to make
their problems worse. Here’s a list of some common coping strategies used by people dealing
with this problem.

• You spend a great deal of time thinking about past pains, mistakes, and problems.
• You get anxious worrying about possible future pains, mistakes, and problems.
• You isolate yourself from other people to avoid distressing situations.
• You make yourself feel numb with alcohol or drugs.
• You take your feelings out on other people by getting excessively angry at them or trying
to control them.
• You engage in potentially dangerous behaviors, such as cutting, hitting, scratching,
picking at, or burning yourself or pulling out your own hair.
• You engage in unsafe sexual activities, such as having sex with strangers or having
frequent unprotected sex. You avoid dealing with the causes of your problems, such as an
abusive or dysfunctional relationship.
• You use food to punish or control yourself by eating too much, not eating at all, or by
throwing up what you do eat.

Created on 04 Feb, 2024 copyrights, Sagheer Afzal & The Psycholar

h"ps://[Link]

• You attempt suicide or engage in high-risk activities, like reckless driving or taking
dangerous amounts of alcohol and drugs. You avoid pleasant activities, such as social
events and exercise, maybe because you don’t think that you deserve to feel better.
• You surrender to your pain and resign yourself to living a miserable and unfulfilling life.
The Cost of Self-Destructive Coping Strategy

1. You spend a great deal of time thinking about past pain, mistakes, and problems. (Miss
good things that might be happening now and then regret missing those things too;
depression about the past).
2. You get anxious worrying (Miss good things that might be happening now; about
possible future pain, mistakes, and problems. anxiety about the future)
3. You isolate yourself to avoid possible pain. (Spend more time alone and, as a result, feel
even more depressed)
4. You use alcohol and drugs to numb yourself. (Addiction; loss of money; work problems;
legal problems; relationship problems; health consequences)
5. You take your painful feelings out on others. (Loss of friendships, romantic relationships,
and family members; other people avoid you; loneliness; feel bad about hurting other
people; legal consequences of your actions)
6. You engage in dangerous behaviors, like cutting, burning, scratching, pulling out hair,
and self-mutilation. Possible death; infection; scarring; disfigurement; shame; physical
pain Other:
7. You engage in unsafe sexual activity, like unprotected sex or frequent sex with strangers.
Sexually transmitted diseases, some life threatening; pregnancy; shame; embarrassment
Other:
8. You avoid dealing with the causes of your problems. Put up with destructive
relationships; get burned out doing things for other people; don’t get any of your own
needs met; depression Other:
9. You eat too much, restrict Weight gain; anorexia; bulimia; health what you eat, or throw
up what you eat. consequences; medical treatment; embarrassment; shame; depression
Other:

Created on 04 Feb, 2024 copyrights, Sagheer Afzal & The Psycholar

h"ps://[Link]

10. You have attempted suicide or engaged in other nearly fatal activities. Possible death;
hospitalization; embarrassment; shame; depression; long-term medical complications
Other:
11. You avoid pleasant activities, like social events and exercise. (Lack of enjoyment; lack of
exercise; depression; shame; isolation)
12. You surrender to your pain and live an unfulfilling life. (Lots of pain and distress; regrets
about your life; depression)
Distress Tolerance Srategy

TAKE A “REST”

Now that you’ve identified some of your own self-destructive and problematic behaviors—as
well as their costs—the first distress tolerance strategy you need to learn is REST.

REST is an acronym that reminds you to:

• Relax
• Evaluate
• Set an intention
• Take action
Changing any behavioural habit is difficult. It requires you to know what actions you want to
change, when you want to change them, and what alternative actions you want to do instead. But
equally important, it also requires that you remember that you want to do something differently
in the first place. Often this is the hardest step—remembering that you want to change—
especially when you’re feeling overwhelmed by your emotions. When you get overwhelmed by
painful emotions, often your first instinct is to act impulsively and to engage in some type of
habitual self-destructive or problematic behavior (like the ones you previously identified). This
happens because, unless you’re prepared in those moments of heightened emotion, you might not
even remember that you had planned to do something differently. So, how do you prepare to
make healthier decisions when you’re feeling overwhelmed? The first step to changing any
problematic or selfdestructive behaviour—and to not act impulsively—is to use the REST
strategy: Relax, Evaluate, set an intention, and Take action

Questionnaire

Created on 04 Feb, 2024 copyrights, Sagheer Afzal & The Psycholar

h"ps://[Link]

´ What happened in this distressing situation?

´ How did you feel?
´ What did you do?
´ Did you engage in any self-destructive behaviors?
´ If yes, what were they?

Now use the REST strategy and imagine what could have happened differently.

´ How could you have relaxed (R) in this situation?

´ If you had done an evaluation (E), what would you have discovered?
´ If you had set an intention (S), what would it have been?
´ If you would have taken action (T) in this situation, what might have happened?
´ What would the overall advantages have been if you had used the REST strategy

Created on 04 Feb, 2024 copyrights, Sagheer Afzal & The Psycholar