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lesson 4: Dialectical behaviour therapy

Wow, I can`t believe this our last lesson. Time has been flying by. This week is all about learning what is Dialectical Behaviour Therapy (DBT) and learning some techniques and exercises to help with mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. A mouthful, I know, but these strategies and exercises will help you in so many different areas of your life. 

Before I do dive it, I want to state that the information and strategies I am giving you comes from being certified in DBT and from "The Dialectical Behaviour Therapy Skills Workbook."This is an AMAZING resource. 

So, first of all what is DBT?

 Dialectical behaviour therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships.

While it is impossible to give you all the strategies involved with DBT, I have decided to give you an exercise/strategy in the following categories:

- Distress Tolerance 

- Mindfulness 

- Emotion Regulation 

These exercises will be on the basic level and if you ever wanted to take any of the above mentioned areas and expand, get in contact with me and we go do some advanced training with you. 

But, for this lesson, you will notice I have guided you through each activity separately and through audio format so you can actually try these activities with me guiding you through them. 

distress tolerance skills

At some point in our lives, we all have to cope with pain, distress, hard times, struggles and hardships. It is part of life. Knowing how to handle these hardships is vital on how you work through it. Our pain can be physical (cancer, broken limbs, puck to the face), it can be emotional (anxiety, depression, sadness, frustration, anger). Either way, pain is inevitable. It is a natural emotion. The thing with pain though is that for some people emotional and physical pain can be more intense and occurs more frequently. If this is the case, having coping mechanisms is extremely important. Even if it isn`t often, these strategies can help you master those pesky emotions of yours. 

When feelings become overwhelming, some people have a tendency to cope with these emotions in unhealthy ways. It could be drinking, overeating, binge eating, binge watching TV, avoidance, and many other unhealthy ways people tend to cope. Now, I am not judging, we all have been there and it is TOUGH, so don`t be hard on yourself. Take this as a way to more effectively deal with those challenging feelings and emotions. 

You might be thinking, well where do I fall in distress tolerance? If you are not sure, take a look at the checklist below and check the ones that you cope with when you experience stressful situations. 

__ 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 dangerous behaviours, such as cutting, hitting, 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 relationships. 

__ You use food to punish or control yourself by eating too much not eating at all, or by throwing up what you eat. 

__ You attempt suicide or engage in high risk activities. 

__ 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. 

All of these strategies are paths to even deeper emotional pain. 

In your homework section, I want to you complete the "Cost of Self-Destructive Coping Strategies" worksheet, head on over there and to that first before you continue. 

Did you complete it? If not, don`t go any further. 

Ok, now that you have that done, it is quite clear that your self-destructive coping strategies lead to prolonged pain into long-term suffering and we gotta change that.

On the call, we are going to talk about how to deal with these strategies and it is going to include:

1.) Distraction

2.) Radical Acceptance

3.) Relaxing and soothing

4.) Visualization

By now, you should be a guru on visualization and you know how important it can be in so many areas of your life. It is a vital tool when you are distressed and can help you get out of this state and help you cope in a healthy way. 

I understand that in the moment it can be a challenge to remember how to visualize properly, you might forget how to do it, what to say, etc. So below is a link to a visualization activity that will help you. 

mindfulness skills






This will come of no surprise to you as you have heard me preach about mindfulness for so long now. DBT therapy places a huge emphasis on mindfulness and it is one of the best coping skills available if practiced. So just a refresher, mindfulness is often referred to as meditation, being in the moment, being present, and being calm. Depending on who you talk to, you will get a unique version of what it means to them. 

In this section, I am just going to give you some additional mindfulness stratagies to help you "be in the moment". It is proven that while in the moment, you can`t be anxious, depressed, etc. Don`t believe me? Give it a shot. 

Before we dive in, my view of mindfulness and the view of DBT is the ability to be aware of your thoughts, emotions, physical sensations and actions IN THE PRESENT MOMENT without judging or criticizing yourself or your experience. 

YOU HAVE RADICAL ACCEPTANCE... more about this on the call. 

Obviously, mindfulness is a skill that needs to be practiced just like anything else. Most people get distracted, zone out, focus on problems, think about the what ifs, etc and are so far from being present.... the gosh darn brain. Because of all these thoughts which are linked to feelings and emotions, you are left feeling anxious, frustrated, angry and ALL OF THE EMOTIONS. 

So here are a couple of common ways in which all of us have been "unmindful". Check that ones you can relate to:

___ While driving or traveling, you don`t remember the drive or which roads you took.

__ While having a conversation, you suddenly realize that you don`t know what the other person is talking about. 

__ While having a conversation, you have already begun thinking about what you are going to say before the other person has finished talking. 

__ While reading, you suddenly realize that you have been thinking about something else and you have no idea what you just read. 

__ While walking into the room, you totally forgot what you came in to get. 

__ After putting something down, you can`t remember where you just put it.

__ While taking a shower, you`re already planning what you have to do later and you forget if even washed your hair?

All these are fairly harmless  BUT it just goes to show how "unmindful" we are during most of the day which comes of no surprise why you might be anxious or have racing thoughts. 

On the call I am going to talk about "A Single Minute" exercise and "Single Object" exercise.

In addition to these, the link below is going to take you through an exercise called "Inner-Outer Experience" and you can pop this bad boy on daily or even when you need to become more present and mindful. 

Emotional regulation

Your emotions... what the heck are they? To put it simply, emotions are signals within your body that tell you what is happening. When something feels good, when something is stressing you out, when something does not feel right or when you feel bad. In many ways, your emotions are like an instant news service that gives you constant updates about what you are doing and what you are experiencing. 

We have two types of emotions. 

1.) Primary Emotions: your initial reactions to what is happening. These are strong feelings and they come on quickly. You don`t have to think about these bad boys, they just happen. For example; you won the lottery, you saw a car accident, a death in the family, these are all primary emotions. 

2.) Secondary Emotions: These are emotional reactions to your primary emotions. Or, feelings about your feelings.  Example: You yell at your partner for leaving the toilet roll empty (primary feeling) but then feel guilty for yelling at them. Anger was your primary emotion, guilt was your secondary emotions. 

Even though emotions are COMPLICATED, they do serve a purpose. 

- Survive (fight or flight)

- Remember people and situations

- Cope with situations in your daily life

- Communicate with others

- Avoid pain

- Seek pleasure

But, we are all here to learn how to cope with the ongoing emotional roller coaster.  In DBT there are 9 emotion regulation skills that will help you gain control of your emotions and the behaviours associated with them. I can`t possibly cover all 9, but knowing what they are definitely helps:

1.) Recognizing your emotions

2.) Overcoming the barriers to healthy emotions

3.) Reducing your physical vulnerability

4.) Reducing your cognitive vulnerability

5.) Increasing your positive emotions

6.) Being mindful of your emotions without judgement

7.) Emotion exposure

8.) Doing the opposite of your emotional urges

9.) Problem solving.


On the call, I will briefly go over these. But for right now, we are going to do an exercise on Emotion Exposure. 






Emotion exposure is facing your emotions instead of avoiding them.  It helps you develop the capacity to accept feelings and be less afraid. Is it guilt, sadness, happiness, anger? Whatever emotion you want to work on it will be the focus. It might be helpful to keep an emotion log and see what emotions come up during your week. That can give you a better way to understand what emotion you want to work on first. 

The idea behind this is as soon as you start feeling the emotion you have chosen to work on do the following Emotion Exposure activity. 

Phew, ok I know that was a lot but I wanted to share these strategies as they have helped both my clients and I in so many ares of life. Don`t feel like you need to get all these down right away. Take some time to listen and practice and come back to these strategies as you navigate through life. 

There is so much more information and strategies with DBT so if you do want to explore it further, please reach out. 

“Courage starts with showing up and letting ourselves be seen.”

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