What is Dialectical Behaviour Therapy (DBT)? 

Dialectical Behavior Therapy (DBT) is a framework that is a type of Cognitive Behavioural Therapy that was developed by Marsha Linehan. Originally, DBT was developed to help clients that were diagnosed with Borderline Personality Disorder. Throughout the years, it has continued to evolve and is now used for many different mental health issues, including depression, anxiety, disordered eating, and substance dependence, etc. The foundation of DBT is creating acceptance while trying to create positive changes. Furthermore, encouraging the client to find balance between them. To establish this foundation, the framework of DBT is organized into four skill areas. Those skill areas include: distress tolerance, acceptance and emotional regulation, mindfulness, and interpersonal effectiveness. Mindfulness is used to help clients become more aware of their thoughts and emotions without feeling judgement towards them. Distress Tolerance is a skill for clients to further support difficult emotions and situations without using harmful behaviours. Acceptance and Emotional Regulation is learned techniques to help manage unwanted emotions with acceptance and useful coping strategies. Finally, Interpersonal Effectiveness is a skill that addresses ways to show up in personal relationships effectively. 

How Does DBT Help to Break Negative Thought Patterns?

Negative thought patterns can be rooted from different experiences, leading to self-doubt, rumination, all-or-nothing thinking, and catastrophizing. DBT therapy has been found helpful in breaking negative thought patterns because of the combination of different strategies. Firstly, DBT incorporates Cognitive Behavioral Therapy strategies with the addition of mindfulness and acceptance skills. Let’s break down these strategies into more detail to better understand how they may be helpful in breaking those negative thought patterns. 

Mindfulness 

The skill of mindfulness has been found to be effective in gaining control over negative thinking patterns. Clients learning mindfulness through DBT therapy, learn the practice of being present in the moment without judgement. When the client is able to observe their thoughts without judgement, it gives the client more control over their negative thoughts. Thus, eventually breaking the negative thought pattern. 

Cognitive Restructuring

Frequently in DBT, clients are encouraged to examine their thoughts and beliefs that are coming up. More specifically, when clients examine their negative thoughts and beliefs, also known as cognitive distortions – it is the beginning stages of cognitive restructuring. Cognitive distortions can look different for each individual. For example, ‘all-or-nothing’ thinking, catastrophizing, overgeneralization, personalization, mental filtering, and jumping to conclusions.  The goal of cognitive restructuring is to challenge the cognitive distortions (negative thinking and beliefs) and reframe them with more realistic and balanced thoughts.  In the following section, we will explore these distortions in more detail.

Distress Tolerance

When clients have negative thinking patterns, it can increase emotional distress. For example, the client may be experiencing more anxious thoughts. However, using distress tolerance skills can be helpful in combating emotional distress. Ultimately, when clients experience negative thinking patterns, the client uses learned distress tolerance skills to aid in self-soothing the emotional distress and having acceptances for their situation. Self-soothing can look like using different coping strategies for when there is a peak in anxiety symptoms. It should be emphasized that having acceptance is still recognizing the painful emotions but knowing they are temporary. 

Behavioural Change

When therapists consider behavioural change, in DBT it examines the maladaptive behaviours the client is experiencing. As clients begin identifying their negative thought patterns that ultimately lead to the maladaptive behaviours, it is important to continue reinforcing new adaptive behaviours. There are a variety of maladaptive behaviours but the more commonly identified ones include self-harm and substance dependence. As the client incorporates the learned DBT skills and the new adaptive behaviour, it leads to more positive thinking patterns and eventually breaking those challenging negative thinking patterns. 

Radical Acceptance 

As discussed above, radical acceptance is a key component of practicing DBT skills. Radical acceptance aids in breaking negative thought patterns in many ways. By incorporating radical acceptance, it encourages clients to have acceptances on the negative thoughts and emotions. By acknowledging the thoughts and emotions as valid, it eliminates the ability to have self-criticism and self-blame. Without self-blame and criticism, clients start breaking negative thought patterns. Radical acceptance also aids in reducing emotional suffering and self-judgement for mistakes, negative thoughts, and many more. 

DBT and Overcoming Cognitive Distortions

As we discussed briefly, cognitive distortions are part of negative thinking patterns. Cognitive distortions are described as biased thinking that ultimately leads to negative emotions and behaviour. In DBT therapy, clients are encouraged to identify different cognitive distortions they experience. For example all-or-nothing thinking, catastrophizing, overgeneralization, personalization, mental filtering, and jumping to conclusions. All-or-nothing thinking appears as extreme one-sided thinking. For example “I am very successful” or “ I am a complete failure”. Catastrophizing thoughts would look like them assuming the worst outcome and leading their decisions based on the worst outcome. Overgeneralized thinking is when the individual makes broad conclusions based on a previous experience. For example, failing a class as a youth and believing they will never succeed in adulthood. Personalization is when the individual blames themselves for outcomes that were out of their control or having the belief that everything is their fault. Mental filtering is when the individual focuses solely on the negative aspects of a situation without recognizing the positive aspects. Finally, jumping to conclusions is when the person assumes they know or predict the negative outcomes in a situation. 

By how can an individual actually overcome cognitive distortions? The main approach is by challenging these distortions, and then reinforcing the new learning thinking with new behavioural skills. Starting with understanding what challenging cognitive distortions would look like. Similar to CBT, the main objective is to replace irrational thoughts with more balance and realistic ones. This could look like using thought stopping, cognitive restructuring, and alternative thinking. Thought stopping is a technique that helps clients to recognize the distorted thought and consciously stopping it. Once it has been stopped, the client would replace it with more balanced or neutral thinking. Cognitive restructuring is identifying the distorted thoughts and questioning if they are valid. Finally, alternative thinking encourages clients to create alternative and more balanced thoughts. It may sound like “I can learn from this experience” or “I can try again”. In the next step overcoming cognitive distortions, is reinforcing the new thinking with the new behavioural skills. As we discussed above, the DBT foundation is based on four skill areas; however the following specific skills have been found to be helpful, distress tolerance, acceptance/emotional regulation, and interpersonal effectiveness skills. Similar to breaking a negative thought pattern, it is important to explain how these specific skills can aid in this step. The client would use their distress tolerance skills to support when they experience intense negative emotions to avoid using maladaptive behaviours (self-harm, substance use, and emotional outbursts). The goal is to have the client avoid harmful actions when they have a negative thought. Acceptance would look like the client accepts the reality of their situation and sometimes circumstances are out of our control. Acceptance has been found to be helpful in cognitive distortions specific to personalization and catastrophizing. After the client has learned emotional regulation skills, it is critical to be able to regulate emotions when they experience distortion. When a client experiences anxiety about an experience they had and they start to have a cognitive distortion. However, when a client is able to regulate themselves, they are significantly less likely to experience the distortions, as a result. Finally, interpersonal effectiveness skills are helpful when navigating social situations. Clients would be able to reduce their distortions that are connected to social experiences. For example “They do not like me” or “I alway mess up when speaking”. As clients learn the DBT skills, the therapist will encourage them to practice outside of session. This opportunity aids clients to practice reinforcing the new behaviour. Eventually leading to new pathways of behaviour and thinking. The goal is for the client to automatically experience positive behaviour and positive thinking.

How Can DBT Aid in Mental Health Recovery?

Dialectical Behavior Therapy is a vital part in mental health recovery because it aids clients in addressing and managing various mental health challenges. Moreover, it is beneficial in breaking negative thought patterns and overcoming cognitive distortions. Ultimately leading to lower emotional distress. Incorporating techniques from mindfulness, emotional regulation, and cognitive restructuring; DBT helps clients identify distorted thinking and replaces it with more neutral and realistic thoughts. This process enables stronger emotional control and stronger behaviour patterns, fostering long-term mental health recovery. By promoting acceptance, emotional resilience, and the development of effective coping skills. DBT empowers clients to create a life worth living, free from negative thinking and self-destructive behaviours. 

How can Journey Psychology Help

At Journey Psychology, we specialize in incorporating DBT therapy through our advanced and evidence-based approaches. We are committed to supporting clients on their healing journey. We recognize that mental health recovery from negative thinking patterns and cognitive distortions can be complex. That is why we work closely with clients to create a safe, compassionate, and professional space. Our experienced therapists will work with the client to design a unique personal approach to meet clients goals. By doing so, they can incorporate DBT and a variety of their therapeutic techniques. If you are ready to begin your healing journey, Journey Psychology is here to help. Contact us today to learn more about how we can support you and connect you with a therapist using Dialectical Behavior Therapy. 

References:

Safilian-Hanif, C. (2024, January 24). Overview of DBT. Dialectical Behavior Therapy. International Psychology. https://dialecticalbehaviortherapy.com/ 

CAMH (n.d.). Dialectical Behavior Therapy (DBT). CAMH. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/dialectical-behaviour-therapy#:~:text=Dialectical%20behaviour%20therapy%20(DBT)%20is,Mental%20Illness%20%26%20Addiction%20Index 

Grouport (n.d.). Combating Negative Thoughts with Dialectical Behavior Therapy Introduction. GrouportTherapy. https://www.grouporttherapy.com/blog/dbt-negative-thoughts#:~:text=DBT%20helps%20individuals%20identify%20the,influence%20their%20emotions%20and%20behaviors. 

Smart, R. (2024, May 27). Understanding Cognitive Distortions in DBT and CBT. TheraHive. https://www.therahive.com/blog/understanding-cognitive-distortions-in-dbt-and-cbt 

Greenwald, A. (2020, September 10). DBT Self Help: Distorted Thinking: Cognitive Distortions. EYMT. https://eymtherapy.com/blog/dbt-self-help-distorted-thinking-cognitive-distortions/