Dialectical Behavior Therapy, or DBT, is a groundbreaking, evidence-based treatment that has fundamentally changed the prognosis for individuals diagnosed with Borderline Personality Disorder (BPD). Developed in the late 1980s by psychologist Dr. Marsha Linehan, DBT directly targets the severe emotional dysregulation and patterns of self-destructive behavior that define BPD. It operates on a core principle, or “dialectic,” of balancing acceptance and change, teaching individuals to both accept themselves and their intense emotions in the present moment while simultaneously working to build a more stable and meaningful future. For anyone struggling with BPD, learning the core skills of DBT is not just therapeutic; it can be life-saving, providing a concrete roadmap to manage emotional pain, improve relationships, and build what Dr. Linehan calls a “life worth living.”
While comprehensive DBT is delivered through a combination of individual therapy, group sessions, and phone coaching, its foundational skills can be learned and practiced by anyone seeking greater emotional stability. These skills are organized into four primary modules, each designed to address a key area of difficulty associated with BPD.
Core Mindfulness: The Foundation of Control
Mindfulness is the bedrock upon which all other DBT skills are built. It is the practice of being fully aware and present in the current moment, without judgment. For a person with BPD, whose mind is often racing between past regrets and future anxieties, mindfulness provides an anchor to the present reality.
The “What” Skills: Observing, Describing, and Participating
The “What” skills are the core actions of mindfulness. The first is Observing, which involves simply noticing your thoughts, feelings, and bodily sensations as they come and go, like clouds passing in the sky. You don’t grab onto them or push them away; you just watch.
Next is Describing, where you put words to what you observe. For example, you might say to yourself, “I am noticing a feeling of tightness in my chest,” or “A thought about my argument yesterday just entered my mind.” This practice creates distance between you and your emotional experience, reminding you that you are not your emotions.
Finally, Participating means throwing yourself completely into the current moment’s activity. Whether you are washing dishes, talking to a friend, or walking outside, you engage all your senses and become one with the action, which quiets the chaotic internal chatter.
The “How” Skills: The Attitude of Mindfulness
The “How” skills dictate the way you practice the “What” skills. The most crucial is practicing Non-Judgmentally. This means seeing thoughts, feelings, and events without labeling them as “good” or “bad,” “right” or “wrong.” It is about letting go of self-criticism and simply acknowledging what is.
Practicing One-Mindfully means doing one thing at a time. In a world that glorifies multitasking, this skill encourages focusing your full attention on the task at hand, which prevents the mind from becoming overwhelmed. Lastly, practicing Effectively means focusing on what works to achieve your goals, rather than getting stuck on being “right.”
Distress Tolerance: Surviving Crisis Moments
People with BPD experience emotional pain that can feel utterly unbearable, often leading to impulsive or self-destructive actions to escape it. Distress Tolerance skills are designed to help you survive these crisis moments without making the situation worse. These are not problem-solving skills; they are “get through the moment” skills.
Crisis Survival Skills: TIPP and More
The TIPP skills are a powerful set of techniques designed to rapidly change your body’s chemistry to reduce extreme emotional arousal. This acronym stands for:
- Temperature: Drastically changing your body temperature by splashing your face with cold water or holding an ice pack can trigger the mammalian “dive reflex,” which quickly slows your heart rate and calms you down.
- Intense Exercise: Engaging in a brief burst of intense physical activity, like running in place or doing jumping jacks, can help burn off the powerful energy that comes with anger or anxiety.
- Paced Breathing: Slowing your breathing down, especially by making your exhales longer than your inhales, activates the body’s parasympathetic nervous system, which acts as a natural brake on stress.
- Paired Muscle Relaxation: Tensing and then relaxing different muscle groups throughout your body can release physical tension, which is closely linked to emotional tension.
Other popular crisis survival skills include the ACCEPTS and Self-Soothe techniques. ACCEPTS involves distracting yourself with Activities, Contributing to others, making Comparisons to a time you felt better, generating different Emotions, Pushing the situation away temporarily, focusing on other Thoughts, or noticing different physical Sensations. Self-soothing involves comforting yourself through your five senses, such as lighting a scented candle (smell), listening to calming music (sound), or wrapping yourself in a soft blanket (touch).
Radical Acceptance
Radical Acceptance is one of the most challenging yet transformative skills in DBT. It is the deep, non-judgmental acceptance of reality as it is. This does not mean you approve of a painful situation, but that you stop fighting against the facts of it. Fighting reality only creates more suffering, while accepting it frees you to figure out how to move forward effectively.
Emotion Regulation: Understanding and Influencing Your Feelings
While Distress Tolerance is for surviving a crisis, Emotion Regulation skills are for managing day-to-day emotional life. The goal is to reduce emotional vulnerability and learn how to influence feelings when they become overwhelming or unhelpful.
Reducing Vulnerability: The PLEASE Skills
Your physical state has a massive impact on your emotional resilience. The PLEASE skills help you build a strong physical foundation to better handle emotional stress. This involves treating PhysicaL illness, balanced Eating, Avoiding mood-altering substances, getting adequate Sleep, and getting regular Exercise. Tending to these basic needs makes you less vulnerable to being hijacked by intense emotions.
Changing Unwanted Emotions
DBT offers several strategies for changing an emotional response once it has begun. The first is to Check the Facts. This involves objectively looking at a situation to see if your emotional reaction and its intensity are actually justified by the facts. Often, our interpretations, not the events themselves, are the source of our pain.
If an emotion is unjustified or unhelpful, you can use Opposite Action. This means identifying your emotional urge (e.g., the urge to isolate when sad) and deliberately doing the opposite (e.g., calling a friend). Acting opposite to the urge sends a powerful signal to your brain that can change the emotion itself.
Interpersonal Effectiveness: Building Healthy Relationships
The intense emotions and fear of abandonment associated with BPD can make relationships chaotic and unstable. The Interpersonal Effectiveness module teaches skills for navigating social interactions, getting your needs met, and maintaining self-respect.
Getting What You Want: The DEAR MAN Skills
When you need to ask for something or say no to a request, the DEAR MAN skills provide a clear, effective script. It stands for:
- Describe: Stick to the facts of the situation.
- Express: Clearly state your feelings using “I” statements.
- Assert: Ask for what you want or say no clearly.
- Reinforce: Explain the positive consequences of getting what you want.
- (Stay) Mindful: Keep your focus on your goal and avoid getting sidetracked.
- Appear Confident: Use a confident tone of voice and body language.
- Negotiate: Be willing to find a middle ground.
Keeping the Relationship: The GIVE Skills
Sometimes, maintaining a positive relationship is more important than winning an argument. The GIVE skills help you do this. Be Gentle (no attacks or threats), act Interested (listen without interrupting), Validate the other person’s feelings, and use an Easy manner (a little humor or a smile can go a long way).
Keeping Your Self-Respect: The FAST Skills
Finally, it’s vital to maintain your self-respect in any interaction. The FAST skills remind you to be Fair to yourself and others, make no needless Apologies, Stick to your values, and be Truthful without excuses.
A Path Forward
Learning and mastering the skills of Dialectical Behavior Therapy is a journey, not a destination. It requires persistent practice, self-compassion, and a commitment to change. For individuals with BPD who have long felt lost in a sea of overwhelming emotion, these skills are more than just psychological techniques; they are life rafts. By providing concrete tools for mindfulness, crisis survival, emotional management, and healthy relationships, DBT offers a clear and hopeful path toward stability, control, and a life that is not only bearable but truly worth celebrating.
