Ashleigh Wykes

May 6, 2021

The 4 DBT Modules – Explained By A DBT Therapist

8.3 min read|

Dialectical behavioural therapy is a leading treatment that’s helping individuals with a range of conditions. It may be that you’ve heard about it before. Or you’re considering joining a DBT programme, or just want to find out more. Whichever the reason, you’re in the right place. In this post we will explore the 4 core DBT modules: Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness.

Module 1 – Mindfulness

Mindfulness is the 1st module that all participants will learn in a DBT programme. Adapted from traditional mindfulness concepts from eastern cultures, DBT delivers mindfulness in a practical and accessible way. It is based on the teachings of Jon Kabat-Zinn, one of the main figures responsible for bringing mindfulness to the west. Paying attention, on purpose, to the present moment, nonjudgmentally describes mindfulness.

You’ll explore the usefulness of mindfulness in DBT. It can be important to consider what mindfulness means, so often individuals may have tried traditional meditation practices, deciding that this is not something that will work for them. Whilst mindfulness can involve traditional meditation practice, in reality this is a small part of what Mindfulness is, and what it can offer.

The Core Principles of DBT Module 1

DBT teaches us to bring the mindfulness skills of wise mind, observe, describe, and participate into our daily life to help us manage emotions, thoughts and problems more effectively. It’s the foundation on which the other skills are learnt and applied. Cultivating awareness to be able to sit with difficult states of mind, identify problems before they spiral out of control and allowing us to implement skills that will make either the make situation better or at least help us cope in a way that doesn’t make it worse.

How Long Module 1 Runs For

Short 2-week Mindfulness bursts in between the other modules allow participants to gradually build mindfulness skills. Enabling them to check back on these skills regularly.

Module 2 – Distress Tolerance

This DBT module of Distress Tolerance focuses on managing crisis situations and difficult events in our life. Essentially it’s how to not make a bad situation even worse.

We can act out on unhelpful urges in moments of desperation. Whether that’s self harm, substance misuse, disordered eating, gambling or any other risky or unhelpful behaviours. The problem is that whilst some of these strategies provide short term relief, distraction and comfort. Often, this is short lived. Causing more problems and lowering self-worth when we’re not living in accordance with our values. Taking us further away from our goals and the life we want to live.

Distress tolerance teaches skills to manage crisis more effectively, helping us tolerate problems and manage impulsive behaviours. Skills like pro’s and con’s and the stop skill help manage impulsive urges. This is by thinking through what are the consequences of acting on these urges. At first it can very difficult to stop yourself acting on an impulsive urge. It might seem almost impossible. However, with practice it can make a very real difference to our lives. Increasing our choices about how to respond to any situation.

Distress Tolerance Skills

TIPP Skills

TIPP skills are DBT’s core crisis skills. They work as well as some of the unhelpful strategies above. But do not come with the same risks and consequences. Breathing techniques, using Ice and intense exercise prove a quick way to reduce distress. Particularly when the flight or fight response has been activated.

Distraction Skills

Distraction skills are taught to help us ride out a difficult situation that we can’t change, often these skills are encouraged to be used only when we can’t solve the problem, this might be because of external factors or because we are so overwhelmed that problem solving is not possible in the moment.

Acceptance Skills

Another key aspect of Distress Tolerance is Reality Acceptance. This area of Distress Tolerance looks at how we can manage pain through reality acceptance skills. The basic premise is that the more we try to avoid pain, the more suffering we create. Through radical acceptance, turning the mind, and other skills we can learn to process pain in a healthier way. Freeing us of emotional misery and build the life we want to live. This of course is not easy. Even the best therapists struggle with the idea of acceptance, however many are a testament to the peace and freedom they find by accepting painful realities.

Now importantly this does not mean approval, forgiveness and it certainly does not mean we are passive. Often through accepting ourselves and our circumstance, this can often be the catalyst for making positive and sustainable changes.

How Long Module 2 Runs For

In the DBT programme this module runs for 5 – 7 weeks, there are also additional teaching weeks especially around addiction that is suitable for some individuals.

Module 3 – Emotion Regulation

The emotion regulation DBT module is focused on helping individuals manage their emotions more effectively. This initially includes learning what emotions are, there purpose and function in day-to-day life and the factors that interfere with us regulating our emotions.

Have you ever thought that some emotions are bad? Or that you should not express certain emotions? These are known as emotion myths. There is a lot of research that shows that what we believe about emotions can impact our emotional wellbeing. DBT offers a comprehensive model of emotions. Helping individuals understand how they work by looking at the individual components that make up an emotional experience. This includes internal and external factors. So whilst we can’t change our emotions by just willing ourselves to feel differently (or worse someone telling us how we should feel!). There are many ways that we can intervene to take more control of our emotions. Some of these skills such as checking the facts, opposite action to emotion and problem solving are ways of changing unwanted emotions.

Another key aspect of this module is exploring emotional vulnerability. This looks at factors that make us more vulnerable to feeling certain emotions, experiencing higher reactivity, and acting on emotion urges – even though we don’t want to.

The Approach To Emotion Regulation

Firstly, we consider the role of positive emotions. There’s a lot of evidence that suggests increasing positive emotions are important for building resilience to negative ones. The absence of positive emotions is absolutely going to increase our vulnerability to sadness, anger, shame etc. So, learning to build both short term and long term positive emotions is a topic that is explored in detail. Skills like cope ahead can be a great way to deal with situations you know are likely to be difficult. Planning ahead, practicing how you will cope have been proven to be an effective strategy in many situations.

Lastly this module looks at the concept of taking care of our mind by taking care of our body. Physical health. Good sleep hygiene. Avoiding drugs and alcohol. Getting regular exercise, and a balanced diet all support our emotional wellbeing. Problem solving difficulties in these areas both short term and long term can have the ability to help us support our mental health, help us deal with extreme emotions and ultimately change improve our relationship with our emotions, so that we can navigate emotional experiences more skilfully.

How Long Module 3 Runs For

In the full DBT programme the emotion regulation runs for 7-8 weeks. Practicing these skills in between session are highly encouraged and working alongside a therapist helps individuals to implement these emotion regulation skills.

Module 4 – Interpersonal Effectiveness

Do you find it difficult to ask for things or say no? Are you frequently finding that interactions with family and friends can end in conflict? Struggling to maintain boundaries?

The interpersonal effectiveness module targets relationship and social skills. Interpersonal skills can be tricky to navigate, however with guidance and practice it’s very possible to build up confidence and skills so that we can maintain and build healthy long-lasting relationships.

We encourage individuals to think about areas they struggle with. Then, through discussions and role play, they develop interpersonal skills in a safe environment. Topics range from assertiveness training, to building relationships and self-respect effectiveness.

The skills DEAR MAN GIVE FAST offer a practical, step by step skills to navigate these areas. Helping us improve our communication style in day to day interactions and help us to manage conflict more skilfully.

An important area for many is exploring and learning about boundaries. But, what are they and how do you maintain them? Learning to establish healthy boundaries can be an important factor in maintaining positive relationships. Often being too rigid or too flexible can present problems. So, getting to know your boundaries and values, helps guide you through various interpersonal situations. It’s worth noting some relationships are harmful and interfere with the quality of our life. Using problem solving skills to overcome difficulties can be used in these instances. However, there may be times that a relationship is destructive and that we need to consider if its sustainable long term. Learning when and how to end a relationship is also a topic that is covered in this module.

How Long Module 4 Runs For

Interpersonal effectiveness runs for 6-7 weeks and each week focuses on a particular topic area.

To Conclude

Whilst DBT offers individuals to build skills in each of these four areas, many topics overlap with other modules. Which is why we recommend you complete all 4 DBT modules at least once.

Hopefully, you have a little more insight into each of these modules. If you have any questions or want to find out about our DBT programme at Home Counties Therapy fill in the contact form below for our free call back service.

Ashleigh has worked with individuals that have Personality Disorders, Autism, and Anxiety for the past 6 years. Offering therapeutic support and outreach in several settings. She has comprehensive knowledge of DBT therapy and is experienced in working with clients who have complex mental health conditions. She has run numerous workshops and corporate training days.

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