Dialectical behavior therapy is an evidence-based psychotherapy that is primarily used to help treat people who suffer from emotion regulation issues, especially for those suffering from borderline personality disorder.
Our ability to regulate our emotions, or lack thereof, is the difference between experiencing pure equanimity and experiencing complete and utter psychological suffering.
The inordinate amount of mental anguish so many of us experience on a daily basis is axiomatically due to our ineptness at regulating our emotions. Sure, the capricious nature of the human mind can sometimes be a positive experience. However, this is often not the case.
There are dozens of different dialectical behavior therapy skills available for anyone to use to help make their life easier, but for the sake of helping you to reduce anxiety specifically, I’m only going to touch upon the skills that are most useful with regards to coping with the emotion of anxiety.
If you think the following dialectical behavior therapy skills may be useful to you, then I encourage you to pick up DBT Skills Training Handouts and Worksheets by Marsha M. Linehan. However, if you’re only interested in learning the skills that are most pertinent to helping you cope with anxiety in particular, then this article alone may suffice.
Radical Acceptance (dialectical behavior therapy)
One of the most useful dialectical behavior therapy skills for reducing unnecessary psychological suffering is that of radical acceptance. Just as the name implies, it requires you to radically, or entirely accept whatever it is that you cannot control. As trite as it may sound, much of our suffering is due to our inability to accept that which we cannot control.
The deep hatred we have for those who have nefariously screwed us over in the past or the impending doom we feel when an unavoidable panic inducing event approaches nearer is largely due to our failure at accepting reality.
Just as our future cannot be directly altered in a way that we can fully control, nor can our pasts be altered either (shocker, I know). Being unable to radically accept things that have occurred in the past or things that will inevitably happen in the future will only prolong your suffering.
Think of how many people who hold grudges toward others who have wronged them in the past. Does it make any logical sense to do this? What benefits does their grudge serve them? Are there any grudges that you’re currently holding at this very moment? If so, do you believe they are truly justified? Why?
You may claim that you actually have accepted what has happened to you (or will happen to you), all while simultaneously feeling vindictive toward whomever is involved. Such incongruity poses a problem here as both of these actions are in direct conflict with one another.
Radically accepting events in your past that have given you immense anxiety entails much more than simply uttering the phrase, “I accept what happened.” Rather, it requires deep introspection, honesty, and emotional excavation.
It is one thing to tepidly proclaim to your attorney that you have accepted that your spouse cheated on you behind your back. However, it is an entirely different thing to radically accept the events that happened by realizing that there was no way those events could have ever not happened.
Radically accepting being wronged by someone can relieve your anxiety to an incredible degree. Be that as it may, there are many other things in our lives that need to be radically accepted too insofar as we are wholeheartedly devoted to living a more equanimous life. For many years I was unable to accept the reality that I have GAD and OCD. I knew I had it, clearly, but I was unable to be at peace with it for many years.
This led to frequent spells of self-loathing where I recall deeply hating myself on a daily basis. You too may feel the same way at this very moment. You may hate that you suffer from anxiety and wish that you could just be like everyone else.
For so many years I looked at people who at the surface appeared to be happy and mirthful and recall truly hating them. I would often walk around being extremely envious of other people’s happiness, wanting them to suffer just as I was suffering. I felt that it wasn’t fair.
Why did I have anxiety disorders while the vast majority of my peers did not? Why did my sister, who grew up similarly as I did not develop the mental illnesses I developed? In what universe is that fair? Why did her childhood experiences not permanently affect her as they did me? I would sometimes be envious of her just as I would anyone else who appeared to be “normal.”
There were many times in my life where I literally hated everyone and everything, including myself. What did this hatred do for me other than prolong and exacerbate my suffering? Granted, this was at a time where mindfulness meditation was a foreign concept to me, as was dialectical behavior therapy.
Nevertheless, the years of emotional torment I experienced, as well as the deep hatred I had for everyone was largely due to my inability to radically accept my mental illnesses, among other things. I eventually grew to accept this reality as time went on. Although, it did take much longer than I had ever hoped.
I remember telling my therapist that if I chose to accept “x,” then that meant I would also be approving of everything that was associated with “x.” This is a large reason as to why so many people believe their grudges to be rational and justified, as well as the reason why many anxious people believe that if they choose to radically accept their anxiety, then that is analogous to saying they’re okay with it and that it needn’t be changed.
Although it may feel right to withhold such convictions, refusing to radically accept such a reality will only bring about further psychological suffering. To believe otherwise is simply an illusion.
It wasn’t until I read Free Will by Sam Harris when I was truly able to radically accept virtually everything that has ever happened to me in my life, whether I believed it to be just or not. My incredulity toward the concept of free will has allowed me to experience an amount of equanimity and forgiveness for others that would have otherwise never existed.
For me personally, to realize that free will is just an illusion made it extremely easy to forgive those who have wronged me in my life, as well as to even forgive myself for the mental conditions I have.
Things in the past I would have normally found utterly impossible to accept are now nothing more than events which took place that could have never not taken place by virtue of the fact that they indeed did take place. A consequence of me losing my belief in free will was that it helped me to radically accept that which I cannot control. What do you think can help you radically accept that which you cannot control?
Checking the Facts (dialectical behavior therapy)
A great deal of our suffering is due to how easily convinced we are that our anxiety is veridical. The impetus to challenge our emotions is almost never even an option that we would ever entertain during moments of high anxiety. We feel a certain way, therefore it is “us.”
As I have already explained, our emotions often mislead us and should not be believed in every instance. Checking the Facts is a dialectical behavior therapy skill that is extremely useful at helping to decipher whether or not your anxiety is justified.
I don’t know about you, but this is something I have struggled with for quite some time, especially with regards to my OCD. I would often obsess about arbitrary things and was never truly confident as to whether my obsessions were rational or not. This confusion is often experienced with people who suffer from social phobia too. Is your anxiety always irrational? Surely, it’s not. But how can you know for sure?
How do you know when your fear is justified or when it’s superfluous? Checking the facts can significantly help you to solve this conundrum. First, let me explain how to check the facts as it was taught to me in my DBT group, as well as how it is described in Marsha Linehan’s book DBT Skills Training.
Linehan professes that many emotions and actions are set off by our thoughts and interpretations of events, not by the events themselves. This is antithetical to what most people believe to be true as we often believe that our emotional states are based solely on outside influences. This is simply an illusion, and by examining our thoughts and checking the facts, we can be more adept at altering our emotions.
Linehan lays out 6 questions we should ask ourselves when we are in a situation where we need to check the facts in order to see if our fear is justified or not.
The six DBT questions are as follows:
1) What is the emotion I want to change? We can use fear here, but you can also use any other emotion for that matter.
2) What is the event prompting my emotions? Describe the facts that you observed through your senses.
3) What are my interpretations, thoughts, and assumptions about the event? Think of other possible interpretations.
4) Am I assuming a threat? Assess the probability that the threatening event will really occur. Think of as many other possible outcomes as you can.
5) What’s the catastrophe? Imagine the catastrophe really occurring. Imagine yourself successfully coping with the catastrophe via mindfulness meditation, radical acceptance, etc.
6) Does my emotion and/or its intensity fit the actual facts? Assess whether or not the situation is deserving of your anxiety based on objective observation of the actual facts of the situation.
It’s paramount that you answer these questions as objectively as you can. Looking objectively at the actual facts and not your interpretation of the facts will allow you to have a better grasp of reality, and therefore what degree of anxiety is justified in any given situation.
Opposite Action (dialectical behavior therapy)
Another dialectical behavior therapy skill that is very useful at helping to changing one’s emotional response to anxiety is by using Opposite Action. The only time you should use this dialectical behavior therapy skill is when your emotions do not fit the facts, or in other words, when your anxiety is irrational or not useful. Every emotion has what is called an action urge.
For fear in particular, the action urge is to run away or to avoid whatever it is that is giving you anxiety. The opposite action that you would implement to help you overcome your fear is to approach your anxiety head on by not avoiding it.
Conveniently for you, Linehan lays out 7 steps on how to effectively implement opposite action when you’re experiencing an influx of unwanted anxiety.
The 7 DBT steps are as follows:
1) Identify and name the emotion you want to change.
2) Check the facts to see if your emotion is justified by the facts.
3) Identify and describe your action urges.
4) Ask “wise mind” (use your logical faculties to decipher reality, not your emotions).
*If your emotion does not fit the facts or if acting on your emotion is not effective:
5) Identify opposite actions to your action urges.
6) Act opposite ALL THE WAY to your action urges.
7) Repeat acting opposite to your action urges until your emotion changes.
You may be wondering what it is that you can do specifically to oppose or resist your deep inclination to run away whenever you’re fearful. Well, Linehan provides us with 7 more steps to accomplish just that. These additional 7 dialectical behavior therapy steps are as follows:
1) Do what you are afraid of doing . . . Over and over.
2) Approach events, places, tasks, activities, and people you are afraid of.
3) Do things to give yourself a sense of control and mastery over your fears.
4) Keep your eyes and ears open and focused on the feared event.
5) Take in the information from the situation (i.e. notice you are safe).
6) Change your posture and keep a confident voice tone (i.e. keep your head and eyes up).
7) Change your body chemistry (by using mindfulness meditation, for example).
Using these dialectical behavior therapy steps will allow you to overcome your fear with a much better success rate than if you were to just go in on sheer determination alone. The only caveat with using opposite action is that it takes a lot of practice. You will need to practice using opposite action on many different occasions for you to truly become adept at it. The more you practice this dialectical behavior therapy skill, the more proficient you will become at it.
It is also important to note that simply using opposite action is not enough as you also have to commit to behaving and thinking antithetically to your anxiety. You cannot do the opposite (such as facing your fears), while simultaneously repeating to yourself over and over again how afraid you are or that something catastrophic is going to happen to you now that you’re facing your fears.
Indulging in such thoughts will only waste your time and lengthen your suffering. So, it is absolutely imperative that when you use opposite action, you do so wholeheartedly with complete commitment behaviorally and psychologically if you hope to obtain any worthwhile benefits from it.
Cope Ahead (dialectical behavior therapy)
The dialectical behavior therapy skill of coping ahead is one of the most useful skills in this article. I, myself, have used it on several occasions and can attest to how useful it is at helping to soothe the mental anguish associated with obsessively worrying over an upcoming event. Just as the name implies, coping ahead allows you to be better prepared for an anxiety provoking situation, such as when or if you face your fears head on.
In dialectical behavior therapy, there are 5 quintessential steps to successfully use the coping ahead strategy as a means of significantly decreasing your overall anxiety. These 5 steps are: 1.) Describe the situation that will make you anxious. 2.) Choose a coping mechanism you’d like to use in the situation. 3.) Imagine the situation in your mind as vividly as you possibly can. 4.) Picture yourself coping effectively. 5.) Practice relaxation after rehearsing (i.e. mindfulness).
With the first step, you will want to describe in detail the situation that you are fearful of. It’s essential that you remain objective with your description as subjective biases will only build a wall between you and your ability to cope effectively. All you need to do here is just describe the situation, the people who will be there, the location it will take place at, and any other pertinent information. Besides describing the event itself and presumably everything it will entail; you should also name the emotions and actions that are likely to interfere with your ability to cope.
In the second step of this dialectical behavior therapy skill, you will need to decide which coping mechanism you will use throughout the situation. This can be mindfulness meditation, radical acceptance, or any other coping skill with which you find to be useful.
When deciding which dialectical behavior therapy technique you’re going to use, it is very important to be specific by writing out in detail how you will actually go about using your chosen skill to help you successfully cope with your emotions and action urges. The more detailed you can be about exactly how you’re going to cope, the better prepared you will be when the time comes for you to actually use these dialectical behavior therapy skills in real time.
Step three may be the most challenging of the five steps as it requires you to momentarily suspend what you know to be true and to pretend that you are actually in the anxiety provoking situation you fear.
To do this effectively, you’ll want to find a quiet place where you know you won’t be disturbed. Find a comfy chair and gently close your eyes as you drift off into another reality. You will need to explore your imagination and utilize any and all facts that you’re aware of in the situation for you to utilize this technique proficiently. Once you have a clear idea of what the situation will look like, by visioning people, the details of the room/venue, and yourself, you can now move on to step four.
Step four of this dialectical behavior therapy skill requires you to imagine what you thought out in step three and to rehearse in your mind exactly what you can do to cope effectively in the situation. You’ll want to rehearse your specific actions, your thoughts, what you will say, and how you will say it. Even more importantly than doing this is to rehearse coping effectively with new problems that may also arise.
With this in mind, you’ll want to use your imagination to explore all of the possible situations that can occur and how you will uniquely cope with each of them. For example, if you suffer from Glossophobia (fear of public speaking) and are scheduled to give a speech in front of a large crowd in the coming weeks, you can rehearse in your mind what would happen if you were to stutter over a sentence. You can envision the slight embarrassment you’d likely feel as you stumbled over your words in front of everyone.
Then, you imagine yourself coping with the situation in whichever way you see fit. This may be you imagining yourself coming up with a witty and funny line to say after you flub your words so that you dispel any awkwardness that would have otherwise seeped into the room. You can also think of how you will bounce back if you happen to forget your train of thought mid-sentence or if you trip while walking onto the stage.
The more mishaps you can conjure up in your mind, along with the specific way(s) in which you can effectively cope with those mishaps, the more prepared you will be for when and if it happens in real life and the better your ability will be to successfully cope with them when they occur.
In the final step of this dialectical behavior therapy skill, you simply practice some sort of relaxation technique after you are finished with step four. This step is important by virtue of the fact that it can be both psychologically and physically draining to replay in your mind situations that you’d much rather suppress. So, after you are finished with step four, you can do a quick 10-minute mindfulness meditation session, or you can just take a walk outside if that is more up your alley.
Basically, you should just take a brief moment to get back into the present so to clear your mind and ease your body. Assuredly, you know how to relax? If not, you may want to check out my blog post on How to Meditate (The Ultimate Guide).
Pros and Cons (dialectical behavior therapy)
Similar to coping ahead, this dialectical behavior therapy technique is best used some time before the anxiety provoking situation occurs. In fact, both coping ahead and using a pros and cons table can and likely should be used one after the other given how they both help you to “cope ahead.” Back in my days of dialectical behavior therapy, my therapist would use a large whiteboard during our sessions when showing me how to use this technique. On the whiteboard, she would draw four large squares.
The title of the top left square would say something like “Pros of acting on urges.” The title of the top right square would say “Cons of acting on urges.” The bottom left square would say “Pros of resisting crisis urges.” And the bottom right square would say “Cons of resisting crisis urges.”
Depending on how many different responses I had for each one of these squares, we often could only fit two squares on the whiteboard at a time before erasing it and writing in the remaining two squares. When writing my own pros and cons table, I would often devote an entire sheet of paper for “one square” as this gave me ample room to add in as many reasons as I could possibly think of, whether it be in favor of or against acting on or resisting my urges.
Writing out my concerns in such a pragmatic way allowed me to step out of the realm of discursive thought and literally see my logic before my very eyes. Oftentimes, I would realize that my reasons were completely irrational, and they wouldn’t even make it on paper.
Improve the Moment (dialectical behavior therapy)
During times of high stress, we all have an inherent desire to improve the moment. Sure, there are certain situations we may find ourselves in where we actually want to stay angry or jealous, but as far as the emotion of anxiety goes, most of us desperately want it to disappear and never come back again.
One useful way in which you can improve the moments when you experience intense anxiety is by using imagery. For example, you can imagine something, someplace, or someone that makes you happy and brings joy into your life. This can entail dwelling on a fun vacation you recently took or a particular person who is near and dear to your heart.
Besides the joy you will feel when dwelling on such things, an additional consequence of this will be less anxiety as you will be redirecting your attention away from discursive thought and toward something pleasant, such as happy memories.
Another useful way to improve the moment is to find meaning or purpose within a panic inducing situation. I have practiced doing this for so many years that it is now second nature to me.
When I find myself in an anxiety provoking situation, such as being in a crowd or speaking to a stranger, I don’t look at it as if I’m in actual danger, but instead I recognize that my mind and body are simultaneously experiencing the symptoms of my anxiety disorders and that this is a perfect opportunity to practice my coping skills. I am often, not always, but often able to disassociate myself from the threatening feeling that anxiety instills in me by seeing it for what it truly is.
I create a purpose for myself in these stressful situations by telling myself, “Okay, here we go. Let’s be mindful now. Time to observe the way I feel.” It becomes a challenge for me and somewhat of a game to see how adeptly I can cope with the stressful situation. Assuredly, there are some situations where I will not be able to think so pragmatically and coherently.
Nevertheless, I find that the more I practice seeing irrational anxiety as just a game to test my coping skills, the very coping skills I have been describing throughout this article thus far, then the easier it will be for me to remain calm even in the face of a potential panic attack.
Another useful way to improve the moment is by repeating positive affirmations to yourself. These inspirational mantras can and should be used during times of stress and anxiety as a means of redirecting your discursive thoughts toward more positive ones. Some affirmations you can repeat to yourself are, “I can do this,” “I will be okay,” “This is just temporary,” etc.
It doesn’t take much introspection to understand how such mantras can be very useful to someone experiencing a high amount of anxiety. However, it’s important to remember that the point of repeating such statements is not to lie to yourself, as this will likely do more harm than good.
Telling yourself that you will be okay or that your anxiety is just temporary are but honest depictions of reality. Conversely, it would not be a good idea to repeat to yourself affirmations such as, “I’m not anxious” or “I don’t have anxiety problems.” Lying to yourself in such a way will only increase your self-loathing in the long run as you will surely know deep down that you in fact are anxious.
We can’t talk ourselves out of mental illness. Trust me, I’ve tried. However, what we can do is help pump ourselves up to improve our confidence and willingness to fight back when we experience anxiety.
Personally, when I find myself in an anxiety provoking situation, I will often repeat the affirmations, “Okay, time to be mindful. Let’s play this game and see if I can cope.” I may also affirm to myself, “This is just temporary. Before I know it, I’ll be happy again.” Such affirmations are nothing more than veridical depictions of reality.
S.T.O.P. (dialectical behavior therapy)
So often do we wish we could just mute the precipitous nature of our anxious mind by simply stopping our racing thoughts right in their tracks. Conveniently enough, the dialectical behavior therapy acronym S.T.O.P. is designed to help you do just that. At its very essence, it is a tool devised to help you be more mindful and less reactive to your anxiety.
Here is what the S.T.O.P. skill looks like:
Stop – Do not just mindlessly react to your anxiety. Make a conscious effort to stop such automaticity.
Take a step back – Take a step back from the situation. Take a deep breath and do not let your feelings make you behave impulsively.
Observe – Objectively and nonjudgmentally observe the contents of your thoughts, the aroused physiology arising in your body, and the environment around you.
Proceed mindfully – Act with a sense of heightened awareness as you continue about your day.
The S.T.O.P. dialectical behavioral therapy skill can be used during times of crisis, as well as during times of slight perturbance. This skill may be especially useful for those of you who are new to mindfulness meditation and would like a more structured, step-by-step way to enter into the present moment when stress arises. Assuredly, the more you practice using each letter of this acronym, the quicker you will be at disarming panic attacks, as well as thwarting further psychological suffering.
If you haven’t already noticed it by now, many of the techniques I’ve been describing throughout this text can and should be used simultaneously. I implore you to practice the coping skills I’ve been describing as often as you can. Practice these skills ad nauseam. Practice them until they become second nature.
To home in on your ability to successfully use these techniques when it matters most – that is, in times of intense anxiety – it is very important that you learn these skills by themselves first so you can have your full undivided attention put toward learning them. Then, once you have acquired a certain degree of adeptness with exposure therapy, mindfulness meditation, and dialectical behavior therapy, you can then use two or all three of these techniques together insofar as it is practical and productive to do so.
Obviously, if you were in real danger, such as if a bear was attacking you, it would be counterproductive in that moment to try and remain mindful and calm so to increase your equanimity and reduce your mental suffering. In times such as this, as well as in many other situations where there is a real threat, you will want to use your anxiety as a tool to help save your life or to help protect you from harm.
However, as far as irrational anxiety goes, being mindful is virtually always a great idea. And if you can be mindful while exposing yourself to your fear via imaginal exposure or in vivo exposure then you are creating healthy behavior habits which can truly change your life for the better.
For example, if you suffer from social phobia and want to overcome your fear of being around other people, then you can use in vivo exposure and mindfulness together by going into a crowded area such as a busy supermarket to help you more easily conquer your fear of being around other people.
Add in some dialectical behavior therapy skills to this equation, such as radical acceptance and improving the moment, and you have then increased your chances of successfully coping with your anxiety tenfold.
Regardless of what your emotional problems are, as long as the main emotion you’re trying to minimize is anxiety, then you will indeed be able to advantageously use exposure therapy, mindfulness meditation, and dialectical behavior therapy together in some way. It is the amalgamation of each constituent technique used together which will allow you to handle situations you never thought you could handle before.
What was once paralytic anxiety will be nothing more than a miniscule annoyance. This can and will happen for you insofar as you become adept at using these three techniques in your life.
Thomas is the founder and CEO of PsychTimes.com. He deeply enjoys writing about psychology, mental health, well-being, and ethics. Besides writing, he’s also deeply interested in the many different aspects of digital marketing, specifically search engine optimization. It is due to his love of both psychology and digital marketing, as well as his deep desire to help people who are suffering from mental illness which has inspired him to create this very site.