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5 Key Skills of DBT Therapy

DBT Skills to Survive and Thrive During Crisis

DBT Skills to Survive and Thrive During CrisisThere are various forms of therapy that counselors and psychologists use with their patients to help meet therapeutic goals. Some common therapies include Cognitive Behavior Therapy, Interpersonal Therapy, and Exposure Therapy. One other type is called Dialectical Behavior Therapy (DBT), which is been shown to be highly effective with certain populations. 

DBT, which was developed by Marsha Linehan in the 1980s and originally used to treat those with Borderline Personality Disorder, is actually a sub-type of Cognitive Behavior Therapy. “Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others,” (VeryWellMind). 

The ‘D,’ which stands for Dialectical, means the integration of opposites. It suggests that two things that seem opposite can occur together simultaneously. For instance, if a brother and sister get into a fight, it is possible that they are angry at each other and still love each other. DBT is big on using the word and instead of but to show that two emotions can coexist. Thinking this way helps those using the skills get “unstuck from extreme positions.” 

Using Dialectical behavior therapy (DBT) can help a client presenting with a range of illnesses and disorders, and many key skills used in DBT are also helpful for anyone, including therapists, as a way to reduce stress.

Anyone can use and benefit from Dialectical Behavior Therapy’s strategies. 

The four modules of DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, and each of these modes contains many skills. When stress levels rise toward crisis, these skills from the Distress Tolerance module can be particularly effective for returning to a relaxed state.

Five common DBT skills that can be used to tolerate distress include:

  • Self-soothe
  • IMPROVE the Moment
  • Using Pros and Cons
  • Turning the Mind
  • TIPP

1. Self-Soothe

Self-soothing is a DBT therapy skill.Self-soothe is a specific DBT skill under the Distress Tolerance module. This key skill works to restore a sense of calm by using the five senses to comfort oneself. When not in crisis, identify things or activities that help you feel good. Activating multiple senses can make the behavior more effective.

Examples of self-soothe coping skills in each of the five categories include:

  • Sight: look at nature; watch a soothing video; look at pictures that make you happy; go to a museum; people-watch
  • Smell: use essential oils; bake cookies; smell things that bring up good memories; burn a candle; smell nature
  • Touch: touch something warm and fuzzy; pet an animal; touch items with various temperatures; get a massage; put lotion on; hug someone
  • Taste: eat something sweet or savory; drink herbal tea; eat your favorite food; suck on a peppermint or ginger candy; eat food mindfully
  • Sound: listen to calming music; listen to sounds around you at that moment; hear bird calls; sing your favorite song; listen to your pets 

When a crisis hits, it’s difficult to think straight, so figuring out ahead of time what works is the crucial part of this skill. Individuals using self-soothe should be proactive and develop their “toolbox” of coping skills that will work in any situation, although it is good to understand what might be effective at work may not be effective at home, school, or another environment. 

One additional thing to know about the self-soothe skill is that you need to choose things to put in your “toolbox” that you are interested in, that are realistic to utilize, and to add in items/experiences that can be a “Plan B” in case one doesn’t work out. 

For example, your top self-soothe choices may be to pet your dog and take a bubble bath; however, these are things that can only be done in certain situations and are not available to a person 100% of the time. 

Overall, self-soothe is one of the easiest DBT skills to use. 

2. IMPROVE

IMPROVE the Moment is another DBT skill under the Distress Tolerance module. The purpose is to reduce the intensity of emotions when they seem too high to handle. 

IMPROVE is an acronym that stands for:

  • Imagery: Imagery means to imagine the situation being resolved positively; think happy and positive thoughts; think about the outcome you want. 
  • Meaning: Finding meaning in an unpleasant situation, such as knowing the experience can be used to help others, can help make these situations more tolerable.
  • Prayer: Prayer can take many forms, such as reciting the Serenity Prayer or simply tuning in to greater consciousness; prayer does not have to always be religious-based.
  • Relaxation: Relaxing the body by focusing on the breath or taking a walk can help calm the mind; there are guided relaxation videos online and on apps to help. 
  • One Thing at a Time: Focusing on one thing at a time can reduce the feeling of being overwhelmed; resist the urge to think of everything on your plate at once, which can be stressful. 
  • Vacation: Taking a vacation does not have to be taken literally; you don’t have to fly to Cancun! It simply means separating from the day-to-day stressors for a while, and this can be as simple as turning the smartphone off and being quiet for an hour.
  • Encouragement: Encouraging oneself with phrases such as “I got this” or “I’m almost done,” can help one get through a difficult time; positive affirmations work! 

The experts at Mindsoother say this about the IMPROVE skill:

IMPROVE the Moment can be quite valuable when dealing with overwhelming emotions or unexpected situations. There are many strategies involved with this skill, so find the strategy that works best for you. The goal is to learn to deal with difficult emotions more effectively. Take note of how have you generally dealt with crises in the past, and see if these strategies work better. It’s important to let go of old habits if they are not beneficial. Instead, establish new coping strategies that are more likely to lead to positive and healthy results.

3. Using Pros and Cons

Pros and Cons are an effective DBT therapy skill.This DBT skill is especially useful in combating potentially harmful urges. It can be a short, mental list of reasons for and against a certain action, or it can be a detailed, written list to thoroughly examine a situation.

We all use pros and cons while making decisions, whether we realize it or not. When using pros and cons related to DBT, you will be more specific and deliberate. Some people may be able to use this skill in their head or aloud; however, it is beneficial for many to write it out or type it to be able to visualize it better. 

DBT Tools describes the process of using pros and cons:

  1. Describe the crisis behavior you are trying to avoid.
  2. Examine the pros and cons of the crisis behavior / acting on your urges.
  3. Examine the advantages & disadvantages (or pros and cons) for each of the viable options.

As well as what to do when an urge occurs when pros and cons could be beneficial:

  1. Review your pros and cons. Get your list and read it over again.
  2. Imagine the positive consequences of resisting the urge.
  3. Think about the negative consequences of giving into the crisis behaviors.
  4. Remember past consequences when you acted on the crisis urges.

The DBT skill pros and cons are super easy to use and something everyone does already. 

4. Turning The Mind

This DBT skill is about the internal, mental effort required to make a decision. It is about turning away from the idea of helplessness and toward the idea of personal empowerment. Think of it like coming up to a fork in the road. You look at your two options, one you know may not be great for you but it’s comfortable, and the other will take you out of your comfort zone, yet you know in the end it’ll be the best choice. 

The focus of Turning the Mind is often on acceptance of the given situation. This acceptance can make the difference between continuing to suffer and achieving peace of mind.

5. TIPP

TIPP is an acronym, and the skill is often used at the height of a crisis. “This is another method that you can use to cope with overwhelming emotions. If you feel a strong wave coming all over you and you don’t know how to deal with it, this technique will help you. Usually, when people find themselves in situations like this, their ability to think clearly is diminished – you are not centered in your wise mind, but in your emotional mind.”

This is what TIPP stands for along with examples on how to use the skill:

  • Temperature change: submerging the face in cold water or holding an ice cube on the eyes or cheek; using a cold or hot pack
  • Intense exercise: running, rowing, swimming, etc., even for very short periods; this can blast the negative energy and encourage the brain to produce calming endorphins.
  • Paced breathing: slow-paced breathing while counting; guided breathwork and/or meditation
  • Paired muscle relaxation: going through each part of the body and systematically tensing then relaxing the muscles; there are videos online and apps for this

The TIPP skill can be used anywhere almost at any time; however, some of these are not as discrete as some of the other skills. Again, TIPP is to be used when emotions are very high and difficult to manage; other skills should do the job when a basic coping skill is needed.

Conclusion to 5 Key Skills of DBT Therapy

Overall, the skills used with Dialectical Behavior Therapy are effective ways to handle distress and to navigate daily frustrations and events. DBT is an evidence-based therapy that has been successfully used for decades. Anyone can learn and utilize DBT skills. Those listed in this article are just a few of the dozens of skills and techniques employed in DBT. The more they are practiced, the more effective they will be. While a deep understanding of this form of therapy is necessary to treat clients, many of the key skills of DBT can be used by anyone to bring a deeper sense of calm and contentment into daily life.

Brittany Cerny

Master of Education (M.Ed.) | Northeastern State University

Behavior and Learning Disorders | Georgia State University

Updated May 2021

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