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The Four Modules of Dialectical Behavior Therapy

Dialectical Behavior Therapy is a psychosocial treatment developed by Marsha M. Linehan specifically to treat individuals with Borderline Personality Disorder. There are four modules of Dialectical Behavior Therapy: (1) Core Mindfulness; (2) Interpersonal Effectiveness; (3) Distress Tolerance; and (4) and Emotion Regulation.

Core Mindfulness:

Mindfulness comes from the Buddhist (Zen) tradition. The essential part of all skills taught in the Dialectical Behavior Therapy skills group are the Core Mindfulness skills.

• Observe, describe, and participate are the core mindfulness what skills. They answer the question, "What do I do to practice core mindfulness skills?"
• Non-judgmentally, one-mindfully, and effectively are the how skills and answer the question, "How do I practice core mindfulness skills?"

Interpersonal Effectiveness:

Interpersonal response patterns taught in Dialectical Behavior Therapy skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. These include effective strategies for asking for what the person needs, learning how to say no, and coping with interpersonal conflict.

People with Borderline Personality Disorder frequently possess good interpersonal skills in a general sense. The problems arise, however, in the application of these skills to specific situations. A person may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out similar behavioral sequences when analyzing his/her own situation.

The Interpersonal Effectiveness module focuses on situations where the objective is to change something (i.e., requesting someone to do something) or to resist changes someone else is trying to make (i.e., saying no). The intention of the skills taught here is to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.

Distress Tolerance:

Dialectical Behavioral Therapy emphasizes learning to bear pain skillfully. Distress Tolerance skills constitute a natural development from Core Mindfulness skills. They have to do with the ability to accept, non-judgmentally, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval. In other words, acceptance of reality is not the same thing as approval of reality.

Distress Tolerance behaviors are concerned with the person’s tolerating and surviving his/her crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include: radical acceptance, turning the mind toward acceptance, and willingness vs. willfulness.

Emotion Regulation:

People who have Borderline Personality Disorder and suicidal people are emotionally intense, and their emotions change quickly and frequently. They are often depressed, anxious, angry, and intensely frustrated. This suggests that these people might benefit from help in learning to regulate their emotions. Dialectical Behavior Therapy Emotion Regulation skills include:

• Identifying and labeling emotions
• Identifying obstacles to changing emotions
• Reducing vulnerability to “emotion mind”
• Increasing positive emotional events
• Increasing mindfulness to current emotions
• Taking opposite action
• Applying Distress Tolerance techniques

About the Author

David Oliver is the founder of a one stop source of information on how to cope and deal with borderline personality disorder.

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