Virtual Group Discussions Services for Agencies and Systems Prepare for DBT Certification Consultation Services Training in Suicide Interventions Online Training Courses Streaming Videos International Affiliates Store Resources BTech Blog Newsletter FAQs What is Dialectical Behavior Therapy (DBT)? The Crisis Prevention Institute (CPI) is an international training organization that specializes in the safe management of disruptive and assaultive behavior. New Training Options: To adhere to social distancing protocols, we now offer more flexible training programs with a reduced classroom delivery option for new NCI instructors and virtual. “The teachings, language, and passion of Focus 3 helped us clarify and identify the behaviors we wished to teach and model across our program. The Performance Pathway and R Factor systems we learned were foundational in helping our program create a leadership training model that last year resulted in our first ever 5A state championship and 13 seniors who were accepted into college.”. Powered by Create your own unique website with customizable templates.
A team cannot be expected to perform well right from the time it is formed. Forming a team is just like maintaining a relationship. It takes time, patience, requires support, efforts and members often go through recognizable stages as they change from being a collection of strangers to a united group with common goals.
Bruce Tuckman presented a model of five stages Forming, Storming, Norming, and Performing in order to develop as a group.
The first stage of group development is the forming stage. This stage presents a time where the group is just starting to come together and is described with anxiety and uncertainty.
Members are discreet with their behavior, which is driven by their desire to be accepted by all members of the group. Conflict, controversy, misunderstanding and personal opinions are avoided even though members are starting to form impressions of each other and gain an understanding of what the group will do together.
Typical consequences of the forming stage include achieving an understanding of the group's purpose, determining how the team is going to be organized and who will be responsible for what, discussion of major milestones or phases of the group's goal that includes a rough project schedule, outlining general group rules that includes when they will meet and discovery of what resources will be available for the group to use.
At this stage, group members are learning what to do, how the group is going to operate, what is expected, and what is acceptable.
The second stage of group development is the storming stage. The storming stage is where dispute and competition are at its greatest because now group members have an understanding of the work and a general feel of belongingness towards the group as well as the group members.
This is the stage where the dominating group members emerge, while the less confrontational members stay in their comfort zone.
Questions around leadership, authority, rules, policies, norms, responsibilities, structure, evaluation criteria and reward systems tend to arise during the storming stage. Such questions need to be answered so that the group can move further on to the next stage.
In this stage, the group becomes fun and enjoyable. Group interaction are lot more easier, more cooperative, and productive, with weighed give and take, open communication, bonding, and mutual respect.
If there is a dispute or disruption, it’s comparatively easy to be resolved and the group gets back on track.
Group leadership is very important, but the facilitator can step back a little and let group members take the initiative and move forward together.
Once a group is clear about its needs, it can move forward to the third stage of group development, the norming stage. This is the time where the group becomes really united.
At this stage, the morale is high as group members actively acknowledge the talents, skills and experience that each member brings to the group. A sense of belongingness is established and the group remains focused on the group's purpose and goal.
Members are flexible, interdependent, and trust each other. Leadership is distributive and members are willing to adapt according to the needs of the group.
This stage of a group can be confusing and is usually reached when the task is successfully completed. At this stage, the project is coming to an end and the team members are moving off in different directions.
This stage looks at the team from the perspective of the well-being of the team instead of the perspective of handling a team through the original four stages of team growth.
Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Marsha M. Linehan to help better treat borderline personality disorder. Since its development, it has also been used for the treatment of other kinds of mental health disorders.
Dialectical behavior therapy (DBT) treatment is a type of psychotherapy — or talk therapy — that utilizes a cognitive-behavioral approach. DBT emphasizes the psychosocial aspects of treatment.
The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family, and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.
People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.
Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply, and master the DBT skills.
Generally, dialectical behavior therapy (DBT) may be seen as having two main components:
1. Individual weekly psychotherapy sessions that emphasize problem-solving behavior for the past week’s issues and troubles that arose in a person’s life. Self-injurious and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process. Quality of life issues and working toward improving life, in general, may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.
Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviors, especially as they occur within the therapeutic relationship[…]. The emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises […]. Telephone contact with the individual therapist between sessions is part of DBT procedures. (Linehan, 2014)
During individual therapy sessions, the therapist and client work toward learning and improving many basic social skills.
2. Weekly group therapy sessions, generally 2 1/2 hours a session which is led by a trained DBT therapist. In these weekly group therapy sessions, people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught.
The essential part of all skills taught in the skills group is 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?”
The interpersonal response patterns –how you interact with the people around you and in your personal relationships — that are taught in DBT skills training share similarities to those taught in some assertiveness and interpersonal problem-solving classes. These skills include effective strategies for asking for what one needs, how to assertively say ‘no,’ and learning to cope with inevitable interpersonal conflict.
People with borderline personality disorder frequently possess good interpersonal skills. They experience problems, however, in the application of these skills in specific contexts — especially emotionally vulnerable or volatile situations. An individual 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 a similar set of behaviors when analyzing their own personal situation.
This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended 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.
Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.
Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, 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: acceptance of reality is not approval of reality.
Distress tolerance behaviors are concerned with tolerating and surviving 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 versus willfulness.
People with a borderline personality disorder or who may be suicidal are typically emotionally intense and labile — frequently angry, intensely frustrated, depressed, and anxious. This suggests that people grappling with these concerns might benefit from help in learning to regulate their emotions.
Dialectical behavior therapy skills for emotion regulation include:
Learning to properly identify and label emotions
Identifying obstacles to changing emotions
Reducing vulnerability to “emotion mind”
Increasing positive emotional events
Increasing mindfulness to current emotions
Taking the opposite action
Applying distress tolerance techniques
By John M. Grohol, Psy.D.
Linehan, M.M. (2014). DBT® Skills Training Manual, Second Edition. New York: Guilford Press.
McKay, M. & Wood, J.C. (2007). The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & … Tolerance. New York: New Harbinger Publications.
Van Dijk, S. (2012). Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions and Balance Your Life. New York: New Harbinger Publications.