What Happens in DBT? DBT in a Nutshell

Ordinarily DBT is a fairly involved treatment with several different parts to it, including individual therapy, telephone consultation, a therapist consultation team, and group skills training. Although we will focus on the skills in this book, it can be helpful to know about the other aspects of DBT:

· Individual therapy: Individual therapy in DBT takes the form of a one-­hour session each week, during which the therapist uses CBT to help you reach goals that are important to you, reduce behaviors you want to reduce, manage problems such as depression and anxiety (among others, if relevant, such as substance use, eating disorders, or self-­harm behaviors), and, often, improve relationships.

· Telephone consultation: Telephone consultation in DBT involves the individual therapist’s being available to you in between sessions for as-­needed phone calls (or for conversations by e-­mail or text messages) to help you deal with crises or emergencies, learn to apply new skills in your everyday life, and manage issues that have come up in your relationship with your therapist.

· Therapist consultation team: The therapist consultation team involves a weekly meeting, much like a support and supervision group, of DBT therapists that focuses on how the therapists can be as effective as possible with their clients, manage the stress that goes along with being a therapist, and learn how to get better at what they do.

· DBT skills training: Clients learn practical skills in the areas of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance in a weekly group session, usually involving two therapists and six to ten clients.

This last component of DBT, the DBT skills, is what we will focus on in this book. Throughout most of this book, we will focus on how you can use DBT skills to effectively deal with anxiety and anxiety problems and improve your life in other ways, such as by increasing your sense of joy and happiness, improving your relationships, and achieving goals that are important to you. The four different sets of skills that are taught in DBT are (Linehan 1993b):

· Mindfulness skills: These skills help you learn to pay attention to your experiences in the here and now and to live more in the present moment.

· Emotion regulation skills: These skills help you learn to identify and better understand your emotions; reduce your vulnerability to negative emotions (such as anxiety); and learn strategies to manage, accept, or change your emotions.

· Interpersonal effectiveness skills: These skills help you learn to identify your goals in interpersonal situations and then, from there, figure out how to get your needs met, ask for what you want, and refuse unwanted requests while enhancing your relationships with others.

· Distress tolerance skills: These skills help you learn to tolerate and deal with overwhelming emotions, thoughts, or situations that are hard to change, by learning to think through your options in a crisis; use distraction or self-­soothing; and accept yourself, your situation, and your experiences for what they are.

In chapter 3, we will give you a road map to these skills, what they are, and how they can help. Then, in future chapters, we will help you figure out how to use the skills to manage anxiety-­related problems, such as:

· Obsessions and compulsive behavior

· Anxiety, stress, and tension

· GAD, worry, and rumination

· PTSD

· Social and other phobias

· Panic disorder and agoraphobia

Before we move on to chapter 3 and cover the skills in more detail, we want to give you a few important things to keep in mind as you learn how to use DBT for anxiety problems. Knowing these points will help you to have the right, or most effective, mind-­set as you learn the skills.