Assignment

Submitted by:

Hifza 24101830002

Farah Shahzadi 24101830003

Laiba Shafqat 24101830008

Khadija Raheel 24101830011

Esha 24101830019

Instructor:

Dr. Talha Khalid

Course Name:

Therapeutic Approaches-II

Section: A

Last date:

2025

Department of MS Clinical Psychology

GIFT University, Gujranwala
Dialectical Behavior Therapy (DBT)
 About Dialectical Behavior Therapy (DBT)

Marsha M. Linehan
Marsha M. Linehan, PhD, ABPP, the developer of
Dialectical Behavior Therapy (DBT), is Professor Emeritus
of Psychology and Director Emeritus of the Behavioral
Research and Therapy Clinics at the University of
Washington. Before retiring in 2019, she devoted her career
to developing and evaluating evidence-based treatments for
populations with high suicide risk and multiple, severe
mental disorders. Dr. Linehan is the 2025 recipient of the
Lifetime Achievement Award from the American
Foundation for Suicide Prevention. Her contributions to
suicide research and clinical psychology research have also
been recognized with the University of Louisville Grawemeyer Award for
Psychology, the Career/Lifetime Achievement Award from the Association for
Behavioral and Cognitive Therapies, the Gold Medal Award for Life Achievement in
the Application of Psychology from the American Psychological Foundation, and the
James McKeen Cattell Award from the Association for Psychological Science. In her
honor, the American Association of Suicidology created the Marsha Linehan Award
for Outstanding Research in the Treatment of Suicidal Behavior. Dr. Linehan was
featured in TIME Great Scientists: The Geniuses and Visionaries Who Transformed
Our World. She is founder of the Linehan Institute and is a Zen master.
First developed:
Marsha Linehan developed Dialectical Behavior Therapy (DBT) in the late
1980s as a treatment for individuals with borderline personality disorder (BPD) who
were chronically suicidal. DBT was developed as a modification of cognitive-
behavioral therapy (CBT) to better address the needs of this population. Linehan
recognized that traditional CBT wasn’t enough for these individuals, who often
struggled with intense emotions and self-destructive behaviors.
Introduction:
Dialectical Behavior Therapy (DBT) was developed in the 1980s by
psychologist Marsha Linehan in the United States. Originally, it was designed to
address the challenges of treating individuals with borderline personality disorder
(BPD)—a condition marked by significant emotional dysregulation and impulsivity,
often leading to self-harming behaviors and suicide attempts. Traditional Cognitive
Behavioral Therapy (CBT) seemed insufficient for this population, prompting
Linehan and her team to create a more tailored and effective approach: DBT (Van
Dijk, 2012, p. 1).
While DBT was initially intended for BPD, it has since proven highly
effective for a wide range of emotional regulation difficulties, regardless of diagnosis.
Today, it is commonly used for conditions like depression, anxiety, bipolar disorder,
eating disorders, chronic pain, low self-esteem, and interpersonal difficulties. It’s even
suitable for people experiencing emotional instability without a formal psychiatric
diagnosis (Van Dijk, 2012, pp. 2–3).
Unlike CBT, which tends to label clients’ thinking as "distorted" or
"irrational," DBT uses a nonjudgmental and accepting stance. It acknowledges that
while clients’ ways of thinking may be problematic, they are understandable within
the context of their emotional sensitivity and life experiences. DBT aims first to foster
acceptance and then guide clients toward more balanced thinking and healthier
behaviors (Van Dijk, 2012, p. 7).
One of the core ideas in DBT is that it’s a principle-driven therapy, offering
flexibility to the therapist rather than following a rigid set of protocols. This flexibility
is essential when treating clients with complex emotional and behavioral issues who
may present multiple challenges simultaneously (Van Dijk, 2012, pp. 7–8).
The full DBT model includes four treatment components:
1. Individual Therapy
2. Skills Training Groups
3. Telephone Consultation
4. Therapist Consultation Teams
Each of these modes plays a vital role in supporting the client and the therapist
throughout the therapeutic journey (Van Dijk, 2012, pp. 15–17).
Underlying DBT is the biosocial theory, which explains emotional
dysregulation as a result of both biological vulnerability and an invalidating
environment an environment that dismisses or punishes emotional expression. This
theory highlights the interaction between a person’s inherent sensitivity and their
surroundings, which, over time, can result in dysfunctional emotional and behavioral
patterns (Van Dijk, 2012, pp. 9–13).
 Finally, the "dialectical" aspect of DBT reflects its philosophical foundation in
dialectics: the idea that two seemingly opposite things can be true at the same time.
For example, a client can be doing their best and also need to try harder. DBT teaches
clients (and therapists) to hold these opposing truths and synthesize them to promote
change while practicing acceptance (Van Dijk, 2012, pp. 14–15).
Purpose:
Van Dijk also clearly defines why DBT is needed and what the therapy aims
to achieve. The central purpose of DBT is to help individuals with emotional
dysregulation achieve a better quality of life by balancing acceptance with the need
for change. DBT teaches clients how to tolerate distress, regulate intense emotions,
improve interpersonal effectiveness, and become more mindful of their internal
experiences. Through these skills, clients learn to replace destructive coping behaviors
such as self-harm, substance use, or emotional avoidance—with more constructive
alternatives. Therapy focuses not just on symptom reduction, but on helping clients
develop the skills needed to navigate life more effectively, even in the face of
emotional pain. In DBT, the therapist is not seen as the one who “fixes” the client.
Instead, the therapist becomes a coach teaching, guiding, and reinforcing the client’s
efforts to solve their own problems and build a meaningful life (Van Dijk, 2012, pp.
2–3, 23–24).
Philosophy:
Dialectical philosophy comes from the ancient Greek philosophers Plato and
Socrates, who utilized dialectical argument to settle disagreements. It is true that
dialectics can Dialectical philosophy in DBT uses logic, but it also accepts personal
truths that may not hold up to a purely logical analysis but may be grasped in the
context of one's own frame of reference. The purpose of dialectics is to create a
synthesis that is responsive to needs and works (Dialectical Philosophy, 2015). DBT's
main purpose is to help the client learn new skills and change their behavior so that
they can have a life worth living. DBT's biosocial theory of BPD says that people
with BPD are biologically prone to emotional dysregulation and that their social
context encourages bad conduct. Linehan employs dialectical philosophy to bring
together the two opposing ideas of acceptance and change. Dialectical philosophy
includes a way of looking at the world and a way of thinking about how things change
(Linehan, 1993a; Linehan & Schmidt, 1995). Both of these things are important in
DBT. The dialectical world view says that reality is complicated, interconnected, and
made up of competing forces. Dialectics takes a systematic view of reality because it
understands how the pieces of a system relate to the whole. DBT looks at how
different systems in a person affect each other (for example, how emotional
dysregulation affects systems of behavioral and cognitive control, interpersonal
functioning, and sense of self) and how the person and their Social and cultural
settings affect each other in many ways. Change happens when competing forces are
connected and at odds with each other. Dialectics as a way of changing things sees the
truth in conflicting or contradictory points of view and combines them into a new
point of view. It then creates more tension that needs to be resolved. The dialectical
approach to treatment affects how treatment tactics are balanced and how people are
always looking for ways to bring together different points of view (Swales, 2009).
DBT is based on Zen Buddhism and puts a lot of emphasis on mindfulness, which is
being aware of the current moment without judging it. This helps to grow acceptance
of the way things are now, less emotional reaction, more clear and purposeful actions,
mindfulness is also the basis for the radical acceptance part of DBT, which means
accepting things as they are, not how we want them to be. DBT uses the ideas of
behavioral psychology, which says that behavior can be learnt and changed through
rewards and punishments. The therapy is systematic, goal-oriented, and skills-based,
and it focuses on finding and stopping bad behaviors, reinforcing behaviors that are
skillful, keeping track of progress with data (like diary cards). This shows a practical
and empirical philosophy that values what works over what is just a theory. Validation
is a key part of DBT, both as a way of doing things and as a way of thinking. It
includes recognizing that the client's feelings and experiences are normal, showing
empathy and respect through words, making the therapeutic partnership secure and
trustworthy. The philosophical view here is radical genuineness the therapist is not in
charge but rather a partner who often shares their own humanity in a helpful and
skillful way.
Goal:
Dialectical Behavior Therapy (DBT) helps people learn skills in four main
areas that help them be more emotionally strong and have better relationships.
Mindfulness skills help people accept the present moment by adopting tactics
including watching, describing, and participating in experiences without judging,
distracting, or avoiding them. Distress tolerance skills educate people how to deal
with emotional pain in healthy ways. They learn that suffering is a part of life and
how to get through tough times without making things worse. Interpersonal
effectiveness abilities let people stand up for their demands, set limits, and deal with
relationships in a courteous and confident way. They also help people keep their self-
respect and make meaningful social connections. Finally, emotion regulation skills
help people understand, define, and deal with their feelings better by finding patterns,
making them less emotionally vulnerable, and making more good emotional
experiences. Together, these skills help people deal with life's problems with more
balance, self-awareness, and control.
Techniques:
Dialectical Behavior Therapy (DBT) uses a number of basic methods to help
people deal with strong feelings, get along better with others, and learn how to deal
with stress in a healthy way. There are four basic modules that these techniques are
grouped into: Mindfulness, Distress Tolerance, Emotion Regulation, and
Interpersonal Effectiveness
Mindfulness:
The steps of mindfulness involve cultivating present moment awareness with
acceptance and without judgment. These steps can be practiced informally throughout
the day or formally through meditation.
1. Set your intention: Before beginning, decide why you are practicing
mindfulness.
2. Find a quiet and comfortable space: Choose a calm environment where you
can sit or lie down without distraction.
3. Focus on your Breath: Gently bring your attention to your breathing.
 Notice the sensation of air entering and leaving your nostrils.
 Feel your chest or belly rising and falling.
 Don’t try to control the breath, just observe it.
4. Notice when your mind wanders: Your mind will drift, that’s normal. When
it does:
 Gently acknowledge the thought without judgment.
 Then return your attention to the breath or current moment.
5. Observe thoughts and emotions without judgment: instead of reacting to
thoughts, just notice them:
  label them: thinking, worrying or planning
 let them pass like clouds in the sky, pushing them away.
6. Use your senses to anchor yourself: Engage tour sense to ground yourself in
the moment:
 What do you see, hear, smell, taste, or feel?
 Mindfully drink tea, or walk. Notice each detail.
7. Practice acceptance and self-compassion: Be kind to yourself if you feel
distracted, bored, or emotional.
8. Gently return to the present: If you get caught in the thoughts or emotions,
gently redirect your attention over and over.
9. Close with gratitude: End your practice with a short reflection: what did I
notice? Or what am I grateful for right now?
Key Mindfulness Techniques:
Observe: Just notice your experience
 Simply notice what’s happening inside and around you.
 Don’t try to change anything, just pay attention.
 Watch your thoughts, feelings, and body sensations.
 You’re not acting or reacting, just observing.
Describe: Put words to your experience objectively.
 After observing, label what you’re experiencing with clear language.
 Don’t add judgment or assumptions, just state the facts.
 Helps separate you from the emotion, so you’re less whelmed.
Participate: Be fully present and involved in the moment.
 Let go of self-consciousness and immerse yourself in what you’re doing.
 Act with awareness
 Give your full attention to here and now, not the past or future.
One-Mindfully: Do one thing at a time.
 Focus on one task or experience with your full attention.
 Avoid multitasking or letting you mind drift elsewhere.
 Help reduce stress and increase clarity
Non-Judgmentally: observe without labeling and criticizing
 Accept your thoughts and feelings without judging them as good, bad, right, or
wrong.
 Let go of harsh self-talk and just acknowledge what is.
  This doesn’t mean approval, it just means acceptance without added suffering.
Effectively: Do what works, even if its not what you want.
 Focus on practical results, not ideals or what feels fair.
 Ask: what will help me feel better or move forward in this moment?
 Helps you stay skillful, especially during emotional moments.
Distress Tolerance:
This guide is especially useful when emotions feel intense, painful, or
overwhelming and you need to manage the moment without making it worse.
Key steps/ Techniques:
Step 01: identify the crisis:
You must first recognize what kind of situation you are in:
 Are you emotionally overwhelmed?
 Are you temped to act impulsively (scream, quit, self-harm)?
 Is this situation you can’t solve right now (loss, rejection, waiting)?
Step 02: use the STOP skill:
This DBT skill is about pausing to prevent things from getting worse.

S Stop Freeze! Don’t act on emotions or

impulses
T Take a step back Breathe deeply. Create space between
feeling and reaction
O Observe Notice. What’s happening, your
thoughts, emotions, physical sensations
and surroundings
P Proceed mindfully Choose the skill that will help most right
now
Step 03: Choose a Crisis Survival Skill based on your needs:
TIPP Skills (Use these if your emotion is physically intense)
These change your body chemistry quickly
1. Temperature: Hold an ice cube, splash cold water, place a cold pack on your
face.
 Activates the drive reflex to slow heart rate and calm panic.
2. Intense Exercise: Do jumping jacks, sprint in place, punch a pillow
 Release adrenaline and burns off distress energy.
3. Paced Breathing: Inhale for 4 seconds, exhale for 6 seconds.
 Calm the nervous system
4. Progressive Muscle Relaxation: tense and release each muscle group.
 Reduces physical tension linked to stress
Distract with ACCEPTS (When you need to get your mind off the pain)

Skill Examples

A Activities Clean your room, bake something, paint

C Contributing Call a friend to check in, volunteer, write a thank you message

C Comparisons Think of a time you felt worse and made it through. Compare to
others who’ve survived
E Emotions Watch a funny movie, listen to sad or uplifting music. Trigger a
different emotion
P Pushing Away Mentally, put the problem in a box and deal with it later. Distract
yourself from thinking
T Thoughts Do math problem, name 10 animals, count backward from 100

S Sensations Hold something cold or hot, snap a rubber band on your wrist, chew a
strong gum

Five Senses to Calm Yourself:

This gives your mind and body comfort.

Senses Examples
Sight Look at calming images, nature, candle art, photos
Sound Listen to music, nature sounds, white noise, calming videos
Smell Essential oils, coffee, fresh laundry, flowers
Taste Eat a small treat mindfully (chocolate, tea, mints)
Touch Hug a soft pillow, take a warm shower, wrap in a cozy blanket

Use more than one sense at a time. Pay attention to the feelings.

IMPROVE the moment-Change your inner experience of the situation

 Skill Explanation
I Imagery Visualize a peaceful place or positive outcome
M Meaning Remind yourself: This pain might have purpose. Find value
in struggle
P Prayer Ask for strength or guidance
R Relaxation Do breathing exercises, meditation, stretch, take a bath

O One thing in the moment Practice mindfulness: focus on what you have doing now

V Vocation Take a brief mental/ physical break: a walk, music, or rest

E Encouragement Use positive self-talk: I’ve survived this before. I can again

Step 04: Skills for accepting reality (Radical Acceptance):

The agony is genuine and sometimes you can't avoid it. Radical acceptance
means:
 Accepting reality as it is, without denying or fighting it.
 Letting go of the thought that things "should" be different right now.
 Telling yourself that this is how things are. I don't like it, but I have to deal with it.

This makes things less painful, even if the pain stays the same.
Goals for Emotion Regulation:
Emotion control helps you:
 Know what your feelings are, where they originate from, and what they mean.
 Make it less likely that you'll have very strong emotions.
 Make emotional pain less and emotional strength stronger.
Methods
 Name and recognize your feelings
 You can use an emotion chart or "feelings wheel".
 Tell the difference between basic emotions like anger, sadness, fear, joy, disgust,
and surprise and more complicated ones like shame, guilt, and jealousy.
 Be really clear about how you feel. Is it "frustrated," "disappointed," or "irritated"
instead of merely "upset"?
Steps:
 Stop and think about how you feel.
 Use a chart of feelings that can be color-coded or shaped like a wheel.
 Ask yourself, "What emotion goes with how my body feels, what I'm thinking,
and what I want to do?"
Look at the Facts
It's not facts that make people feel things; it's how they see things. This phase helps
you question assumptions that aren't helpful.
Steps:
 Ask: What happened? What is going on?
 Do the facts back up how I feel?
 Am I getting something wrong (like mind reading or catastrophizing)?
 What proof backs up or goes against my understanding?
 Do the opposite thing
This method is employed when your feelings are strong but not based on facts
or logic.
Emotion Natural Urge Opposite Action
Fear Avoid Approach (if safe)
Anger Attack, lash out Gently express or show kindness
Sadness Withdraw, isolate Get active, engage with others
Shame Hide, avoid Be open, connect, practice self-kindness
PLEASE Master
A DBT acronym to reduce vulnerability to intense negative emotions by taking care
of your body and brain.
Component Explanation
Physical illness Get treatment; take medications if prescribed
Limit substances Avoid alcohol, drugs, or excessive caffeine
Eat balanced Maintain regular, healthy meals; avoid blood sugar crashes
Avoid sleep loss Keep a regular sleep routine; avoid all-nighters
Sleep well 7–9 hours a night; wind down properly
Exercise Even light daily movement can improve mood and reduce stress
Build Positive Experiences:
Making a life that is balanced, happy, meaningful, and rewarding.
For a short time:
 Every day, do something fun, like listen to music, cook, go on a stroll, play a
game, or call a friend.
 Figure out what your values are (for example, learning, creativity, and
connection).
 Make sure your aims are in line with those values.
 Make tiny changes every week or month.
Skills for solving problems:
If an emotion is real (based on facts), fix the problem that is making it happen.
 Clearly state the issue.
 Come up with ideas for solutions, even if they seem impossible.
 Pick the one that works best and is most realistic.
 Make a plan and follow through.
 Check and make changes if necessary.
 Be aware of your current feelings ("Ride the Wave")
 Learn to watch your feelings without letting them take over.
 Sit with the feeling. Don't fight it, ignore it, or associate too much with it.
 Pay attention to your body's feelings, thoughts, and urges.
 Say, "This is sadness." It hurts a lot, but it will go away.
 Think of the feeling as a wave that goes up, reaches its peak, and then goes down.
Goals for Interpersonal Effectiveness:
 Ask for what you need directly and politely.
 Say no plainly and without feeling bad.
 In all of your relationships, stand up for yourself and your boundaries.
Ways:
Use this to be strong and get things done:
 Stick to the facts.
 Tell how you feel.
 Give a reward or benefit.
 Keep your aim in mind. Don't let anything get in the way.
 Look confident your body language, voice, and words.
 Be willing to give in when you negotiate.
 Keep your relationships healthy
Use gives to become closer to those who are important to you:
 Be gentle.
 Ask questions and show that you're listening.
 Recognize how they feel.
Stay calm, make jokes, and be open to change.
Dialectical Behavior Therapy (DBT) helps people deal with strong emotions
and live healthier lives by using both practical methods and philosophical ideas. At
its heart lies dialectics, which means finding a balance between accepting things as
they are and trying to change them. Clients are told to accept two things that seem to
be opposing at the same time, like "I'm doing my best" and "I can do better." Chain
Analysis is a major part of DBT. In this exercise, clients break down their problem
behaviors into a series of events to figure out what caused the behavior, what thoughts
and feelings led to it, and what better things they may do in the future. Clients
sometimes use "diary cards" to help with this process. These are daily recording tools
that keep track of feelings (on a 0–10 scale), desires (such self-harm or binge eating),
behaviors, and the use of DBT skills. These cards help find patterns, keep track of
progress, and plan therapy sessions. DBT helps people understand themselves better
and achieve sustainable, good changes by integrating self-awareness, accountability,
and skill-building.
Dialectical behavior therapy (DBT) uses:
Dialectical behavior therapy (DBT) works really well for persons who have
trouble controlling and dealing with their feelings. DBT has been shown to work for
treating and managing many different mental health issues, such as:

 BPD, or borderline personality disorder.

 Self-harm.
 Behavior that leads to suicide.
 PTSD, or post-traumatic stress disorder.
 Addiction to drugs and alcohol.
 Eating disorders, include bulimia and binge eating disorder.
 Sadness.
 Worry.
 It's vital to remember that DBT works for these disorders since they are all
assumed to be caused by unhealthy or dysfunctional ways of dealing with strong,
unpleasant emotions. DBT teaches people healthy methods to deal with their
difficulties instead of relying on things that make them worse.
Benefits:
Research on DBT shows that therapy lowers the risk of hospitalization,
suicide, and anger. DBT therapy has many benefits that can improve a person's life,
such as:
 DBT can help you comprehend what you're feeling if your strong thoughts and
feelings are making you feel bad. When you can tell that you have
complicated feelings and that they might be stronger than they are, you can
learn how to control your emotions.
 The fundamental benefit of DBT is that it helps you control your emotions,
which will help you deal with the feelings you have in life.
 DBT will help you get along better with other people since it will teach
individual how to the skill of DBT is how to deal with stress. Individual will
learn how to deal with moments of trouble or crisis by accepting them. This
kind of therapy will give individual the strength to take the situation as it is,
don't think about the situation anymore.
 Mindfulness is generally the benefit of DBT therapy since it teaches people
how to be aware of their own thoughts and feelings. 5. Handling a Crisis
When you're in a crisis, it's easy for your emotions to get out of hand, and your
actions can too.
 DBT can teach individual how to handle crises better, which will help
individual make better, healthier choices while keeping individual emotions in
check.
 DBT teaches individual skills and ways to deal with problems that make
stronger. Individual will know exactly what to do to keep individual emotions
in check when things get stressful or go wrong. That strength will help
individual feel ready to handle anything.
 DBT enables individuals to develop deep, lasting connections with other
people.
Who Can Use DBT?
 DBT was first created to aid people with borderline personality disorder, but it
can also help people with other mental health issues. DBT is most effective for
those who have complicated mental health issues that are hard to treat in
conventional ways. It can also help with symptoms like:
 Harming oneself
 Trying to kill yourself
 DBT may help those who have trouble controlling strong emotions or
are going through a crisis.
DBT can also help with other problems, such as:
 Learning how to control feelings and change actions might help lessen strong
feelings like anxiety.
 DBT can help people with depression get the tools they need to take control of
their lives, manage their emotions, and start to feel better.
 People with bipolar disorder can benefit from the behavioral modifications and
skills you learn in DBT to help you control your emotions.
 People who are addicted to drugs, gambling, or food frequently have very
strong feelings. DBT can help you learn how to control these feelings, which
may help you get over these addictions.
 DBT teaches skills that can help everyone, but people with more complicated
mental health problems often find that this type of therapy finally gives them
the results they want.