DILECTICAL BEHAVIOR THERAPY

Khadija Aslam
Psychology professional
What is dialectical behavior therapy

Dialectical

Behavior

Therapy
DBT can be broken down into 3 steps

DB Dialectics
T
Behavior
Therapy
Dialectics
Acceptance
Two opposing
forces can co-exist
simultaneously

change
DIALECTICS
Behavior
It means
actions that
are covert in
natures
Therapy
It mean some
kind of
treatment
plan
what is the rationale behind dialectics
of dialectal behavior therapy
• Dialectical Behavior Therapy (DBT) integrates
dialectics and behavior therapy to address
complex mental health issues, especially those
related to emotion regulation and
interpersonal relationships. Here’s a
breakdown of the rationale behind DB
 . Dialectics
• Core Concept • Philosophical Basis
• The term "dialectics" • DBT is grounded in the
refers to the principle of idea that reality is
balancing opposing forces composed of
or ideas. In DBT, dialectics contradictions and that
emphasizes finding a effective therapy involves
balance between integrating these
acceptance and change. contradictions to create a
more
signification,understandin
g of the individual’s
experiences and
behaviors.
 Application in Therapy
• Therapists help clients acknowledge and
accept their current situation (acceptance)
while also encouraging them to work towards
meaningful change (change). This balance is
essential for managing and transforming
problematic behaviors.
 LET’S DISSCUSS
DIALECTICS FIRST
 Behavior Therapy
Focus on Change: Skills Training:
• Traditional behavior • DBT incorporates specific
therapy emphasizes skills to help individuals
changing maladaptive manage emotions, improve
behaviors through interpersonal relationships,
techniques like and enhance overall
reinforcement, punishment, functioning. These skills
and skills training. include mindfulness,
distress tolerance, emotion
regulation, and
interpersonal effectiveness.
 IN CORPORATED DBT

. Integration in DBT
Structured Approach
Balancing Acceptance and
Validation DBT is structured with
change
individual therapy, skills
DBT’s dialectical approach DBT emphasizes validating the training groups, and phone
ensures that clients do not feel client’s emotions and coaching. This comprehensive
pressured to change everything experiences, which helps build approach ensures that clients
about themselves. Instead, a therapeutic relationship and receive support in various
they learn to accept their fosters a sense of acceptance. aspects of their lives and have
current state while Validation helps clients feel opportunities to practice skills
simultaneously working on understood and supported,
making positive changes. which is crucial for progress.
in real-world situations.
 Applications
• DBT is particularly effective for
Target individuals with Borderline Personality
Disorder (BPD) and other disorders
involving intense emotional
Population: dysregulation, self-harm, and unstable
relationships.

• The primary goals are to reduce

Treatment self-destructive behaviors, improve
emotional regulation, enhance
interpersonal skills, and increase overall
Goals quality of life.
 Dialectics example
• Sometimes during times of adversity, we can
experience the phenomenon of two opposite
feelings, ideas, values, or facts coexisting in
our minds. Some examples of this can be
being angry at a loved one- while
simultaneously missing them, or feeling guilty
over making a choice- while knowing that
you’re making the right choice.
 Example cont.…
• These coexisting opposites are referred to in
Psychology as Dialectics. Our mental health can be
heavily determined by how we accept the dialectics
that confront us.

• Dialectics are two opposing things being true at once,

and opposites that are integrated can lead a person to
greater truths about themselves and others.
Therapists are trained to teach people how to
recognize when a dialectic situation is occurring, to
then encourage self-compassion and acceptance of
interconnected thoughts.
 Example cont..
• One way of doing this is by focusing on the word AND. Below are
some examples of dialectics using AND:

• You can be disappointed in someone AND love them.

• You can understand where someone’s behavior comes from AND
be hurt by them.
• You can want to be with someone AND know that you need to be
apart.
• You can be afraid of change AND be excited for it.
• You can be doing the best you can AND continue to try harder.
• You can feel broken AND know that you will get through this.
 Example cont..
• Interpersonal conflicts, changes, grief, loss,
and growth can leave room for dialectics to
enter our thoughts. Instead of trying to fight
the coexistence of two truths, we can accept
them and treat ourselves and others with
understanding.
 “DIALECTS”
• Dialectics is based on the theory of ‘thesis
(composition), antithesis( converse,observe),
and synthesis”. In simple terms, the
• belief that everything is composed of
opposites, and that when one opposing force
is stronger than the other it results in change.
 Three basic assumptions of ‘Dialects
All things are interconnected.
Assimilation of two opposites
• Change is constant and
unavoidable.
• Opposites can be
assimilated to form a closer
estimation of the truth. Opposite Opposite
#1 #2
 (balancing opposites)
• The philosophical perspective of dialects
(balancing opposites) is the basis for DBT.
• It consistently works to help the individual to find
ways to hold two seemingly opposite perspective
at once.
• DBT promotes balance and avoidance of black and
white or the all or nothing way of thinking.
• It promotes the outlook of ‘both ~ and’ instead of
‘either ~or’.
 Dialects promotes Open Minded
Thinking.
• • Dialectical means two ideas can both be true at the same time.
• • There is always more than one TRUE way to see a situation.
• • There is more than one TRUE opinion, idea, thought or dream.
• • Two things that seem like (or are) opposites can both be true.
• • All points of view have both TRUE and FALSE within them.
• • A life worth living has both comfortable and uncomfortable
aspects:
• • Happiness AND Sadness
• • Anger AND Peace
• • Hope AND Discouragement
 Dialects promotes Open Minded
Thinking.
• • Dialectical means two ideas can both be true at the same time.
• • There is always more than one TRUE way to see a situation.
• • There is more than one TRUE opinion, idea, thought or dream.
• • Two things that seem like (or are) opposites can both be true.
• • All points of view have both TRUE and FALSE within them.
• • A life worth living has both comfortable and uncomfortable
aspects:
• • Happiness AND Sadness
• • Anger AND Peace
• • Hope AND Discouragement
 CONTINUED…
• At the heart of DBT is the ‘Dialects’ - or in
other words, the resolution of the seeming
• contradiction between self-acceptance and
change in order to bring about positive
changes. It
• supports the idea that bringing together two
opposites in therapy brings better results than
• either of these alone.
In Dialectical Behavior Therapy (DBT),
the term "dialectical" refers to the
principle of integrating and balancing
two seemingly opposing concepts. It
comes from the philosophical idea of
dialectics, which involves the
reconciliation of contradictions.
 QUESTTIONS TO BE ASKED FROM
PARTICIPANTS
• In Dialectical Behavior Therapy (DBT),
dialectics are a core concept. A therapist might
explore several questions to help clients
understand and integrate dialectical thinking
into their therapy:
 QUESTIONS CONT..
• 1. What does the term "dialectic" mean to you in
the context of our therapy?
• *2. *Can you identify any areas in your life where
you’re struggling with opposing perspectives or
conflicting emotions?
• *3. *How might you apply the concept of
dialectics to your current challenges or emotional
experiences?
• *4. *In what ways do you notice yourself leaning
towards extremes, and how could a dialectical
approach help you find a middle path?
 QUESTIONS CONT..
• *5. *How can you balance acceptance of your
current situation with the desire for change,
according to the principles of dialectics?
• *6. *Can you think of an example where
integrating two opposing viewpoints might
lead to a more balanced perspective?
• *7. *What strategies have you found helpful in
holding multiple perspectives simultaneous
Acceptance & Change
 Acceptance and Change
Acceptance: Change

• This involves acknowledging • While acceptance is

and validating a person's important, DBT also
current feelings, thoughts, and emphasizes the need for
behaviors without judgment. change. This involves helping
It means recognizing the individuals develop new skills
reality of their situation and and strategies to alter
their emotional responses as maladaptive behaviors and
legitimate. Acceptance is improve their quality of life.
crucial because it helps Change is aimed at addressing
individuals feel understood problems and achieving
and reduces the internal specific goals, which often
conflict and resistance that involves pushing individuals
can arise from self-criticism or out of their comfort zones.
external criticism.
The dialectical balance between
acceptance and change means that
therapy does not solely focus on
either accepting things as they are or
pushing for change. Instead, it seeks
to harmonize these aspects, ensuring
that individuals feel both validated
and motivated to improve their
situations
Questions About Acceptance
 Understanding Current Feelings:

• “What emotions are you currently

experiencing?”
• “How do these feelings impact your daily life?”
 Validating the Experience:
• “What makes these feelings understandable or
reasonable given your situation ?”
• “Can you identify any past experiences that
might contribute to how you're feeling now?
 Exploring Self-Acceptance
• “How do you currently view yourself in light of
these feelings ?”
• “What would it mean for you to accept your
feelings without judgment?”
 Recognizing Personal Strengths:
• “What strengths or skills have you used in
dealing with these emotions ?”
• “How have you managed to cope with similar
situations in the past?”
 VALIDATION DEFINATION IN DBT
• In Dialectical Behavior Therapy (DBT),
"validation" refers to a therapeutic approach
where the therapist acknowledges and
accepts the client's feelings, thoughts, and
behaviors as understandable and valid, given
their experiences and context.
 Exploring Barriers to Acceptance:
• “What challenges do you face in accepting
your current emotions?”
• “ Are there any beliefs or thoughts that make
acceptance difficult for you?”
Questions About Change
 Identifying Goals:
• “What specific changes would you like to
make in your life or behavior ?”
• “How do these changes align with your
long-term goals?”
 Exploring Motivations:
• “What motivates you to want to make these
changes ?”
• “How will achieving these changes improve
your life?”
 Assessing Current Strategies:
• “What strategies have you tried so far to make
these changes ?”
• “Which of these strategies have been helpful
or unhelpful, and why?
 Setting Realistic Goals:
• “What are some small, manageable steps you
can take toward making these changes ?”
• “How can you break down your larger goals
into smaller, achievable tasks?
 Overcoming Obstacles:
• “What obstacles might you face while trying to
make these changes ?”
• “How can you prepare for or address these
potential challenges?”
 Evaluating Progress:
• “How will you measure your progress toward
these changes S?”
• “What signs will indicate that you’re moving in
the right direction?
 VALIDATION DEFINATION IN DBT
• The concept of validation in DBT is crucial because
it helps clients feel heard, understood, and
respected. It involves recognizing that their
emotional responses are legitimate, even if their
actions or reactions might not always be effective
or appropriate. By validating clients, therapists can
foster a supportive environment that encourages
clients to be more open about their experiences
and to engage more fully in the therapeutic
process.
LEVELS OF VAILDATION
Level 1: Pay Attention and Reflect Back

DESCRIPTION Example: If a client says,

"I'm feeling really anxious
about my upcoming
DESCRIPTION: The presentation," the
therapist listens carefully therapist might reflect, "It
to the client and reflects sounds like you're feeling a
back what they have lot of anxiety about the
heard. This involves presentation."
accurately summarizing or
paraphrasing the client's
statements.

Description
Level 2: Validate the Client’s Emotions

The therapist
acknowledges
DESCRIPTION and accepts the
client's emotions
as valid and
understandable,
"It makes sense given their
that you're feeling situation. This
anxious about the involves
presentation; recognizing that
speaking in public the client's
Example: can be very feelings are
stressful." reasonable and
appropriate
Level 3: Normalize the Client’s
Experience

The therapist
helps the
Description: client
understand
that their
"Many people reactions are
feel anxious normal and
before giving a common in
presentation. their situation.
It's a common This helps
Example: reduce
experience, and
you're not alone feelings of
in feeling this isolation or
way." abnormality.
Level 4: Validate the Client’s Behavior
as a Solution to a Problem

The therapist
acknowledges
Description: that the client's
behavior or
coping
mechanisms,
"I can see why even if
you might have ineffective or
problematic,
tried to avoid were reasonable
the responses given
presentation their past
Example: altogether, experiences and
given how current situation.
overwhelming it
feels. You were
trying to protect
yourself from
discomfort."
Level 5: Validate the Client’s Perspective as
a Part of a Larger Context

The therapist
places the client's
experience within
Description:
a broader context,
considering their
history,
environment, and
"Given your history overall life
of struggling with situation. This
social anxiety and helps the client
the pressure you've see their
been under at work, experiences as
it's understandable part of a bigger
Example: that you would feel picture
particularly anxious
about this
presentation."
Level 6: Radical Genuineness

The therapist
conveys deep,
genuine empathy
Description:
and acceptance,
showing a
profound
understanding of
"I really hear how the client's
difficult this experience. This
situation is for you. level involves
Your feelings are expressing a deep
completely valid, connection and
and I’m here with unconditional
Example: " you in this, no
matter how tough it
acceptance of the
client's emotional
gets." experience.
 APPLICATION OF 6 LEVELS OF
VALDATION
• Each level of validation serves to build a
stronger therapeutic alliance and helps clients
feel more understood and accepted. By
employing these levels, therapists in DBT can
address the client's experiences in a nuanced
and supportive manner, ultimately fostering
greater self-acceptance and promoting
effective change.
6 LEVELS OF VALIDATION
Types of validation
 PURPOSE OF VALIDATION
• Validation is used to balance change strategies,
teach the patient how to validate themselves,
maintain the relationship, and reduce emotional
deregulationS.
• Validation is not necessarily agreement, approval,
or condoning behavior but is a stubborn refusal to
treat anyone like they’re bad, crazy, or completely
wrong regardless of their behavior.
• What is validating for one person is not
necessarily the same for another.
 Validation and Challenge:
• Validating a person's feelings and experiences
as real and understandable while also
challenging them to change maladaptive
behaviors
 Validation and Challenge
Validation: Challenge

• In DBT, validation refers to • While validation is important,

acknowledging and accepting DBT also involves challenging
a person's experiences, individuals to examine and
feelings, and thoughts as change their problematic
understandable and behaviors and thought patterns.
meaningful. Validation helps This might include questioning
irrational beliefs, encouraging
to build a therapeutic alliance the adoption of new coping
and encourages individuals to strategies, or addressing
share their experiences dysfunctional patterns. The
openly. It is based on the idea challenge is done in a supportive
that everyone’s feelings and manner that respects the
behaviors make sense given individual’s feelings while
their past experiences and promoting growth and
current context. development
The dialectical approach here
is about finding a balance
between empathizing with a
person’s current state and
encouraging them to strive
for improvement
 Emotional Validation and Behavioral
Change:
• Recognizing and validating emotional
experiences while encouraging behavioral
changes to improve functioning and quality of
life.
 Emotional Validation and Behavioral
Change
Emotional Validation: Behavioral Change:

• This involves helping • Concurrently, DBT focuses on

individuals understand and helping individuals modify
accept their emotions as valid behaviors that are harmful or
and meaningful. By validating unproductive. This involves
emotions, therapists help teaching practical skills in
individuals recognize that their areas such as mindfulness,
feelings are a normal response distress tolerance, emotion
to their experiences. This can regulation, and interpersonal
reduce feelings of shame or effectiveness. The goal is to
invalidation and provide a help individuals manage their
foundation for emotional emotions more effectively and
regulation. engage in healthier behavior
The dialectical aspect of balancing emotional
validation with behavioral change ensures that
therapy is both compassionate and effective,
addressing both the emotional and practical
aspects of mental health.
 summary

The dialectical aspect of

balancing emotional
validation with behavioral
change ensures that therapy
is both compassionate and
effective, addressing both the
emotional and practical
aspects of mental health.
DBT HISTORY
Dialectical Behavior Therapy
(DBT) is a type of
cognitive-behavioral therapy
developed by Dr. Marsha
Linehan. It was initially
created to help people with
Borderline Personality
Disorder (BPD), but it has
since been adapted for a
variety of mental health
conditions. DBT combines
traditional
cognitive-behavioral
techniques with mindfulness
strategies to help individuals
manage intense emotions and
improve their relationships.
Cyclic Interactions:Mindfulness Enhances Emotion Regulation and
Interpersonal Effectiveness:By increasing awareness and presence,
mindfulness helps individuals recognize and regulate their emotions
better, which in turn improves interpersonal interactions.Emotion
Regulation Supports Better Use of Distress Tolerance and Interpersonal
Effectiveness:When individuals can manage their emotions more
effectively, they are better equipped to use distress tolerance skills
when facing crises and to communicate more effectively in
relationships.Distress Tolerance Affects Emotion Regulation and
Interpersonal Effectiveness:The ability to tolerate distress helps
stabilize emotional states, which makes it easier to apply emotion
regulation strategies and engage in effective interpersonal
interactions.Interpersonal Effectiveness Benefits from Improved
Emotion Regulation and Distress Tolerance:Effective communication
and relationship-building are enhanced when individuals can manage
their emotions and cope with distress. Positive interactions can lead to
more supportive relationships, which further stabilizes emotional
states and reduces distress.In summary, the modules of DBT work
cyclically to support and enhance one another. Mindfulness provides
the awareness necessary for all other skills. Emotion Regulation helps
manage emotional responses and supports distress tolerance. Distress
Tolerance skills address immediate crises, allowing for better
application of Emotion Regulation and improved Interpersonal
Effectiveness. Each module reinforces and relies on the others,
creating a dynamic, interdependent therapeutic process.
DBT has Four modules
Cyclic relationship
Four modules of DBT
 Four Modules of DBT
• focuses on • is geared toward
improving an increasing a person’s
tolerance of
individual’s ability negative emotion,
to accept and be rather than trying to
present in the escape from it.
current moment.

Mindfulness
Distress
Tolerance

Interpersonal Emotional
Effectiveness Regulation

• consists of techniques • covers strategies to

that allow a person to manage and change
communicate with
intense emotions
others in a way that is
assertive, maintains that are causing
self-respect, and problems in a
strengthens person’s life.
relationships.
Mindfulness &Cyclic link

Mindfulness: DBT
This is the foundation of DBT and
emphasizes staying present and aware
of the current moment without
judgment. Mindfulness enables
individuals to observe their thoughts
and feelings without getting
overwhelmed by them. It lays the
groundwork for the other skills by
enhancing self-awareness.

Emotional
Cyclic link: Mindfullness
regulation
When a person practices mindfulness,
they become more aware of their
emotions, which makes it easier to
apply emotion regulation skills when
difficult feelings arise.
Emotion Regulation
&
Cyclic link: Mindfulness
Emotion Regulation:

This module helps individuals identify,

understand, and manage their
emotions. The aim is to reduce
emotional vulnerability and decrease
emotional suffering.
DBT
Cyclic link

: As emotions become better

regulated, individuals are more likely
to act mindfully and avoid impulsive
Emotional
reactions, linking back to mindfulness.
Distress
Furthermore, improved emotional
regulation decreases the likelihood of
regulation tolerance
situations that require distress
tolerance.
Distress tolerance and
cyclic link
Distress Tolerance:
This module focuses on accepting and mindfulness
tolerating pain or discomfort without
making things worse. It provides skills
to endure difficult situations without
resorting to destructive behaviors,
such as self-harm or impulsivity.
Emotional
Cyclic link:
regulation
By tolerating distress effectively,
individuals reduce the intensity of their
emotional reactions, improving
emotional regulation. This also helps
them stay mindful during challenging
moments and avoid interpersonal Distress
conflict.
tolerance
Inter-personal
effectiveness and cyclic
link
Interpersonal Effectiveness:
This module teaches skills for
maintaining healthy relationships and Emotional
Mindfullness
asserting personal needs while
respecting others. It focuses on setting
regulation
boundaries, asking for what one needs,
and maintaining self-respect in
relationships.

Cyclic link: Healthy interpersonal

relationships can reduce emotional
distress, making emotion regulation Inter-person
Distress
and distress tolerance more al
manageable. Additionally, maintaining tolerance
strong relationships helps the person effectivness
stay grounded in mindfulness.
 Cyclic Relationship:

o Mindfulness
o is essential for staying present in emotional and
interpersonal challenges.

o Emotion Regulation
o helps manage emotional responses triggered by
interpersonal conflicts or distress.

o Distress Tolerance
o supports navigating intense emotions and
difficult situations without acting impulsively.

o Interpersonal Effectiveness
o enhances communication and relationship skills,
reducing emotional volatility and distress.

o Together, these four modules support one

another, creating a continuous cycle of growth
and emotional resilience.
The therapy focuses on four key areas
Distress
Mindfulness
Tolerance

Emotion Interpersonal
Regulation Effectiveness

DBT
Mindfulness:
• Increasing awareness of the present moment and
accepting it without judgment. This helps
individuals become more aware of their thoughts
and feelings and how they affect their behavior.

Distress Tolerance:
• Building skills to tolerate and survive crises
without making the situation worse. This includes
strategies for managing pain and stress in a
healthy way.
Emotion Regulation:
• Learning to manage and change
intense emotions that are causing
problems. This involves
understanding and controlling
emotional responses to reduce
emotional

Interpersonal Effectiveness:
• Improving communication skills to
build and maintain healthy
relationships. This includes learning
how to assert needs, set boundaries,
and handle conflicts effectively.
 DBT
• DBT often includes individual therapy sessions,
group skills training, and phone coaching to
help clients apply the skills they learn in
real-life situations. It emphasizes a balance
between acceptance and change, helping
clients accept themselves and their current
situation while working toward meaningful
change.