Dialectical Behaviour Therapy

Dialectical Behaviour Therapy (DBT) was first developed in the United States by psychologist Marsha Linehan. Originally designed to treat Borderline Personality Disorder (BPD), DBT has been extended in application to treating a variety of mental illness, particularly suicidal behaviours and self-harm. In DBT the client and therapist work together on acceptance and change-orientated strategies, ultimately aiming to balance and synthesise them. This process is ultimately comparable to the Hegelian dialectical process of thesis, antithesis, and synthesis. DBT is an evidence-based therapy that has proven benefits in treating borderline personality disorder, severe depression and anxiety, drug and alcohol abuse, post-traumatic stress disorder, binge-eating disorders, and various mood disorders.

Mindfulness is a core component of DBT. It helps connect us with the present moment, freeing us from worry about the future or regrets about the past.  Mindfulness anchors us in the here and now, giving us a place of safety and relative calm even in distressing situations. In addition to mindfulness, there are three major components of DBT: emotion regulation, distress tolerance, and interpersonal effectiveness. These modules are supplemented by one-to-one psychotherapy and telephone coaching.

Mindfulness

The practice of mindfulness is the repetitive act of directing your awareness to only one thing in the moment without judgement – this can be a focus on the breath as in traditional mindfulness practices, but it can also be an awareness and concentration on any given task from washing the dishes to tidying the house. It is all about concentrating on what you are doing – if washing the dishes, notice the feel of the bubbles, the smell of the soap, the sound of the water running. Bring your awareness to where you are in the moment, paying attention to what you are doing. If your mind wanders from the breath or from the object of your concentration, gently bring your awareness back to the breath or to the task in hand. The mind is like an untrained puppy. At first, you’ll find it wandering away, rummaging in boxes, chewing the furniture, and jumping on the sofa. But with training and practice, it is possible to quiet the mind and focus on the present moment. When you find your mind has wandered, bring your awareness back to breath, back to body, back to the sounds, sensations, and smells in the room. It takes time and patience to retrain your brain, just like it takes time and patience to train a puppy.

Mindfulness can be readily incorporated into your daily routine – you can mindfully brush your teeth, eat your breakfast, brush your hair, or wash in the shower. Notice how your body feels during these activities – use the senses of taste, touch, smell, sight, and sound. When you are in the shower, notice the smell of the shampoo, the sounds of the water running, the sensation of the water falling against your skin. Become aware of the shower – bring your attention fully to the task at hand. Notice the breath – the rising and falling sensation of the chest, the feeling of oxygen entering your body. Breathe into your body – feel the breath from the tips of your toes to the top of your head. When your mind has wandered, bring your attention back to the shower, back to the physical sensations, back to the feeling of the breath inside your body.

Mindfulness – “What” Skills

There are three key components of mindfulness – observation, description, and participation. Observation involves paying attention to the present moment by noticing the breath and the physical senses – what we see, hear, smell, taste, and touch. Observation also involves noticing thoughts and feelings – a thought as a thought, a feeling as a feeling. Not trying to change thoughts or feelings in any way, but notice them passing in the mind as leaves upon a stream or as clouds in the sky. Rather than trying to control emotions and thoughts, take a step back and notice them – observe thoughts passing in the mind, notice emotions rising and falling. Observation puts some distance between yourself and the thought or feelings – allowing you to notice them without getting caught up in them.

Describing simply involves putting words onto our observations by using simple factual statements – “the chair is made of metal”, “the shower feels warm”, “the umbrella is yellow”, “the breath is shallow”. It can be helpful to mentally say to yourself “thinking” or “feeling” as thoughts and feelings come and go in the mind. This adds a simple description to the thought or feeling – helping you to recognise and put some distance between yourself and the thought or emotion. You become the observer and describer of your thoughts and feelings. Noticing and labelling our thoughts and feelings allows us to step back a little, letting the thought or feeling come and go naturally.

 

Participating means throwing yourself completely into activities of the current moment – becoming fully absorbed by the breath or the task in hand. Participation is immersing oneself in the now – becoming one with the present moment. Children are naturally brilliant at participating, immersing themselves completely in play. It is a skill we tend to lose as adults and need to practice in mindfulness. Whatever you find yourself doing, devote yourself wholly to the task. If washing the dishes, become absorbed by the sound of the water running, feel the bubbles against your skin, notice the smell of the fairy liquid. Focus on what you are doing – participate fully in the task.

Mindfulness – “How” Skills

It is important to know how to practice mindfulness – non-judgementally, one-mindfully, and effectively. Taking a non-judgemental approach is key to developing mindfulness skills. Too often we are ready to criticise and make unkind judgments about ourselves and others. We are often most judgemental about ourselves – this can lead to a downward spiral of negatives thoughts and harmful behaviours. In mindfulness, it is important to be openminded and non-judgemental. This involves sticking to the facts of observation and description. Facts are not judgements. “I notice my breath”, “This chair is yellow”, “The shower is warm” – these are facts. “I’m not breathing properly”, “I hate yellow”, “This shower is pathetic” are judgements. In mindfulness, we stick to the facts and avoid judging ourselves or others.

It is also important to practice mindfulness one-mindfully. It is easy to get caught up multitasking – with our fingers in too many pies. Mindfulness ought to be one-mindful. This means being completely present in this one moment – doing one thing at a time. Notice the breath – concentrate wholly upon the breath. Notice the sounds of the shower, the smell of the soap, the feel of the water against the skin. In mindfulness, we attend fully to the breath or the task in hand. We become one with what we are doing.

Finally, it is important to practice mindfulness effectively – this means doing what works to achieve our goals. There are different ways to practice mindfulness – each participant must do what works for them. You may find it helpful to count the breaths as in the formal practice of mindfulness, or you may wish to notice sounds in the room, to observe an object like a pebble or a seashell, to notice thoughts like clouds in the sky, or imagine yourself as the gatekeeper to your mind watching thoughts and feelings come and go, or notice physical sensations in your body scanning down from head to toe. You may wish to incorporate mindfulness into everyday life when washing the dishes, brushing your teeth, or driving the car. Do what works.

Mindfulness – observing, describing, and participating non-judgementally, one-mindfully, and effectively – can ‘keep us anchored safely in our bodies when the going gets tough. It can grow into a way of life that protects us from unnecessary suffering’ (Christopher Germer).

Emotion Regulation

The central aim of this module is to reduce emotional suffering. The goal is not to get rid of emotions, but to learn how to control and manage emotions by identifying and naming them. Simply naming or labelling your emotions can help you regulate them. It can be helpful to say, ‘I am noticing the emotion ….’ or ‘I am feeling the emotion of …’. While it is not possible to stop emotions from coming, it may be possible to make changes in your environment and lifestyle that can help reduce the impact of negative emotions. 

Emotions in themselves are neither good or bad – judging our emotions negatively is rarely helpful and can often make us feel worse. Simply notice the emotion and let it pass by as leaves on a stream or clouds in the sky. Suppressing emotions or bottling them up is a temporary fix that can often cause more problems later on. In DBT, we learn to notice our emotions, label them, and let them pass by. We do not learn to supress them or get rid of them altogether. Some emotions are perfectly natural and help us to express the way we are feeling. For example, we might feel sad at the loss of a loved one, or happy at passing an exam.

Emotional mind is one of the three states of mind we learn about in DBT. The others being rational mind and wise mind. DBT teaches us to embrace wise mind – the balance of two extremes – through the practice of mindfulness. The goal of DBT is to decrease our vulnerability to emotional mind and help us cope better with difficult events and emotions. 

There are three main reason why we experience emotions: 1) To motivate action, 2) to communicate to others, and 3) to communicate to ourselves. Emotions prepare us to act in important situations. We don’t have time to logically think everything through step-by-step, emotions get us to where we need to be quickly. They help us communicate effectively to others, often by facial expressions. These expressions communicate our feelings faster than words. We can often tell how someone is feeling simply from their body language and facial expressions. Finally, emotions communicate to ourselves – they tell us how we are feeling about a given situation. 

Check the Facts, Opposite Action, Problem Solving

However, emotions are not facts about the world. It is important to check the facts. We may feel anxious or afraid, but we must ask ourselves whether the situation is really threatening. We may feel angry or irritated, but we must pause and ask ourselves if the anger is justified in response to the situation. 

Emotions are complex responses to various events. To be able to identify and label our emotions effectively, it is important to break down the sequence of events: there is the event prompting the emotion, our interpretation of the event, what we feel in our bodies when we experience the motion, and what our behaviour is in response to the emotion. For example, consider the emotion of fear. The prompting event may be being in a social situation, you may interpret the event as people watching you or judging you, biologically you feel breathless, your heartbeat increases, you feel a desire to run away, in response your behaviour changes: you might get out of the situation or avoid it altogether.

DBT equips us with the skills to handle complex and difficult emotions by getting us to check the facts, practise opposite actions, and problem solving. First, check the facts. Does my emotional response fit the facts of the situation? What is the emotion I want to change? What is the trigger prompting my emotional response? How am I interpreting this event? Am I assuming a threat? What is the worst-case scenario? By asking such questions, we can check to see if our emotional response fits the particular situation. Often this can be a very simple and effective way of entering wise mind. 

If checking the facts is not enough, we can practice opposite action. For example, if we are afraid and want to run away, we might try gently approaching and engaging with the situation. If we are angry and want to lash out, we might try taking a step back and avoiding conflict. If we feel depressed and want to stay in bed all day, we might try getting up and making a cup of coffee or going out for a walk. If we feel ashamed about something we’ve done and want to hide away, we might consider confiding the secret to someone we trust. The important thing with opposite action is to go all the way – throw yourself into the task and see if your state of mind improves. Repeat the opposite action until your emotion changes. 

Problem solving can also help with difficult emotions – particularly emotions in response to a difficult situation. Try to think of an effective way to resolve the situation. Look for solutions and answers to the problem. If you are nervous about social situations, try taking a close friend with you. If you get angry and irritable easily, try taking a step back and a deep breath. There is usually always a solution to the problem – be inventive and try to figure it out. 

Remember your ABC

There are three simple skills to help us build a positive life worth living: A – Accumulate positive emotions; B – Build mastery; C – Cope ahead.

It is important to accumulate positive emotions in life – we all need things to make us happy from time to time. Sometimes you may feel too anxious, too tired, or too depressed to be bothered with accumulating positive emotions, but it is important to make the effort. Try to make for yourself at least one pleasant event per day – add little positives into your daily routine. Do something you like doing, something you enjoy. Read a book, play a video game, eat some chocolate (not too much!). Plan pleasant events ahead of time. Put something in the diary, a day out, a walk, going for a coffee, a trip to the seaside. Anything to accumulate positive emotions. 

Build mastery. Mastery is doing things that make you feel competent and confident. This generally involves doing something that is a little bit hard or challenging. Learn a new skill. Try learning a new language or learning to play an instrument. Go to night classes and work towards a new qualification. Over time, accomplishments help to build a more positive view of ourselves, a greater level of confidence, and increased happiness. 

Cope ahead. Think about the situations that are likely to cause you trouble and work out how you are going to manage expected difficulties. Strategize. Think ahead. Plan. Make arrangements. Describe a situation and the problems you are likely to encounter. Decide what DBT skills to use in advance. Imagine the situation. Put yourself into the problematic encounter and think of way to cope with the situation. 

PLEASE Skills    

It is important to take care of your mind by taking care of your body. PLEASE skills are designed to help with this: 

P – Physical wellbeing

L – Treat physical illness

E – Balanced eating

A – Avoid mood-altering substances

S – Balanced sleeping pattern.

E – Get exercise

It is important to think about your physical wellbeing. Mindfulness can help with this. Check in with your body. If you like, do a body scan from head to toe. Notice any feelings, any sensations, any aches or pains in the body. Treat physical illnesses. Remember to take your medication. Make sure you have regular check ups with the GP. Take any necessary vitamins and minerals. Make sure you practice balanced eating. It is important to have a balanced diet, eating a variety of foods and regular intervals. Avoid mood-altering substances. No illegal drugs, no alcohol, no caffeine. Get some balanced sleep. Develop a consistent sleeping pattern. Try to avoid watching TV in bed or being on your phone or tablet. Avoid caffeine, nicotine, alcohol, and heavy meals before bed. Turn off the lights. Keep the room dark and quiet. Give yourself a good half an hour to fall asleep. If you are feeling anxious, try mindfully breathing in and out, counting in your mind from one to ten and ten to one. Get exercise during the day. Go for a walk. Have a swim in your local leisure centre. Try running or cycling.     

Distress Tolerance

Distress tolerance equips us with the skills to manage in a crisis such as when we are thinking about self-harm, suicide, or taking an overdose. There are several skills for tolerating painful events, urges, and emotions. These include: the STOP skill, Pros and Cons, TIPP your body chemistry, distract with wise mind ACCEPTS, self-soothe with the five senses, and improve the moment. These will each be explained in turn. 

What is a crisis? Crises are highly stressful, but short-term events that cause us to engage in risky behaviour such as contemplating suicide, committing self-harm, or taking an overdose. The crisis skills in DBT are designed for crisis situations only. You should not use them as general coping skills, but as specific skills for managing a crisis.

STOP skill

The STOP skill helps us put the brakes on and stop ourselves from engaging in impulsive behaviour: 

S – STOP

T – Take a step back

O – Observe the situation

P – Proceed mindfully

You may find it helpful to say ‘STOP’ out loud and physically take a step back from whatever you were contemplating doing. I find it helpful to say: “STOP. I know this is tough, but I can handle it”. Observe the situation. Take in your environment. And proceed mindfully. You may find it helpful to concentrate on the breath, saying in your mind “breathing in, breathing out”. 

Pros and Cons

This skill involves looking at both the positive and negative aspects of both acting and not acting on impulsive urges. You may want to take a step back from the situation and draw a table with the heading pros and cons. This can help you mindfully evaluate your behaviour.

TIPP your body chemistry

The TIPP skills are for extreme emotional distress and very high arousal. Use these in an acute crisis situation – such as when you are considering self-harm or suicide. 

T – Change Temperature (Splash your face in cold water to trigger the Diving Reflex, or squeeze a cube of ice in your hand until it really hurts)

I – Intensive exercise (run on the spot as fast as you can for ten minutes or do star jumps for a similar length of time)

P – Paced breathing (Even-paced breathing is a technique where you use the diaphragm to expand your lungs with carefully controlled breaths, slowing down your breathing. It can be helpful to say in your mind: breathing in, breathing out)

P – Paired muscled relaxation (From head to toe, squeeze the muscles in your body one at a time. Notice how the muscle feels as you relax. This will help reduce agitation in the body)  

These skills rapidly change your biological chemistry and help to reduce emotional arousal. For example, cold water on the face reduces the heart rate – it is best to plunge your face into ice cold water. Keep some ice cubes handy in the fridge. You can also put a block of ice on your face; or even a bag of frozen peas for a similar effect. 

ACCEPTS

A distraction in a crisis can help you avoid dangerous behaviours. We use wise mind and follow the acronym ACCEPTS: 

A – Activities (find something useful to do: cooking, cleaning, reading a book, going for a walk, playing a video game – anything positive to distract yourself from risky behaviour)

C – Contributing (Contribute to someone else’s well-being, help them out, go and give someone a hand)

C – Comparisons (Compare your situation with someone less fortunate and think how lucky you are. Watching a soap opera can be helpful, especially ones where people have worse problems than our own)

E – Emotions (Change your emotions. This can be a tricky one. Some people find listening to upbeat music or their favourite song helps with this. Find an activity you find pleasurable such as going for a run or playing a video game)

P – Pushing away (This involves leaving the situation physically or blocking it from one’s mind. You could try building an imaginary wall between yourself and your problems or writing down your distressing thoughts on a piece of paper and then throwing it in the bin)

T – Thoughts (Distracting with other thoughts fills the short-term memory. You can do this by singing a song in your head, doing a cross word or a puzzle, watching the television, or playing a video game)

S – Sensations (Change bodily sensations to distract from the crisis. For example, hold an ice cube until it really hurts, taste tabasco sauce, bite into a lemon wedge, or listen to really loud music). 

Self Soothe

Self-soothing can be a really effective way to manage a crisis. The idea being to do something you find comforting, particularly something appealing to the five senses (vision, hearing, smell, taste, and touch). 

Sound: Listen to soothing music, have a conversation with someone caring, listen to an online meditation exercise. 

Sight: Look at pictures that bring up good memories, take a walk and enjoy the environment, look up places you would like to visit online or in a travel magazine.

Taste: Cook and taste your favourite meal, eat your favourite sweets, make some peppermint or herbal tea. 

Smell: Light a scented candle, smell lavender oil, sit outside and take in the fresh air, buy some fresh flowers and smell their scent. 

Touch: Pet your cat or dog, give someone you care about a big hug, carry around a small stress ball to squeeze, take a bubble bath.  

It can be helpful to put together a small box of things you find comforting and open the box during a crisis.

Improving the Moment

IMPROVE skills are a set of strategies that can help you survive a crisis – particularly in a stressful situation that is long-lasting. 

I – Imagery (This takes the form of mental visualisation. Imagine yourself in a special place. It may be a beach or in a library in a comfy armchair with a warm fire. This helps you leave the current situation and place yourself in a better imaginary world. You have to practise imagery when you are feeling okay for it to work in a crisis – you need to get used to the feeling of being in your special place).

M – Meaning (Finding meaning or purpose in life can help many people in a crisis – to know there is a God, for example, who watches over you. We need to find meaning in our lives to survive suffering. Think of what makes a life worth living and consider writing down things that create meaning for you in life).

P – Prayer (Prayer opens you up to the present moment – the secret place where God is. This could mean crying out to God in a crisis or saying a personal mantra you find comforting)

R – Relaxing actions (Find activities that you know calm you down. It could be reading a book, going for a walk, or having a bubble bath. It is easier to resist temptations to self-harm when you feel calm or relaxed)

O – One-thing-in-the-moment (This is similar to the one-mindfully skill. It involves focusing on one task, learning to survive just this moment)

V – Vacation (This means taking time out. Literally take yourself out of the situation. Take a short break, consider asking someone else to look after the children for you for a while, go to the countryside or the seaside for the day. Take time for yourself)

E – Encouragement (The idea behind encouragement is to talk to yourself as you would talk to someone you care about who is in a crisis. Try and encourage yourself – cheerlead yourself, give yourself a pat on the back, try to say positive encouraging things to yourself).

Reality Acceptance 

Acceptance is a difficult skill to learn. It is about learning to accept your life as it is in the moment. Acceptance is not about approval or ‘just being okay with something’. Some things in our lives are traumatic, some things leave us with feelings of guilt, acceptance is not about forgiveness and approval. It is about learning to come to terms with what has happened and trying to move on with our lives. There are six reality acceptance skills to learn: 

1.      Radical Acceptance. This is about accepting what has happened – perhaps saying to yourself, ‘I know this is tough, but I accept what has happened’. Learn to cope ahead – imagine what you would do with your life if you did accept what seems unacceptable.

2.      Turning the mind. Though you may feel like saying, ‘Why me?’ or ‘Why is this happening?’. The idea of turning the mind is that you go inside yourself and make a commitment to turn your mind towards acceptance. And keep doing so until it works.

3.      Willingness. This is the state of being ready to do something positive. It is the opposite of stubborn wilfulness. Wilfulness is giving up, sitting on your hands, it is the opposite of effectiveness. Try to relax your face, smile a little, and open your hands. By changing our posture, we can change our attitude.     

4.      Half-smiling. Try accepting reality with your body. Not by a cheesy grin, but by gently smiling, turning up your lips slightly at the corners. Changing your facial expression can change how you feel.

5.      Willing hands. Clenched hands indicate anger or tension. Try to release the tension in your hands, and open them gently into a willing posture. Changing posture often changes the attitude.

6.      Allowing the mind to wander. Learn to let thoughts come and go in the mind. Imagine the thoughts are like leaves on a stream or clouds in the sky. Just let them pass by. This is acceptance. 

Interpersonal Effectiveness

Interpersonal effectiveness is about learning to assert your own goals, desires, and opinions in a way that positively engages with others. It is also about learning to say no. These skills are particularly helpful for those who suffer with social anxiety as they help you to manage social situations. You may find yourself prone to anxiety and indecision in social situations or you may find yourself angry and irritable with others. Interpersonal effectiveness aims to give us the skills to be more friendly and to make good and lasting friendships with others. 

DEAR MAN Skills

DEAR MAN is an acronym for a set of skills that will help you effectively obtain your objective in a social situation.

D – Describe (Describe what you want. Stick to the facts in description. And avoid judgemental statements).

E – Express (Try to express yourself clearly – say what you feel or believe about the situation. Don’t expect the other person to be able to read your mind or know what you are feeling inside. People are not mind readers).

A – Assert (Assert yourself by asking for what you want or saying no clearly. Do not assume others will know what you want or will be able to read your mind).

R – Reinforce (Identify something positive or rewarding that would happen for the other person in response to your request). 

M – Be Mindful (Focus on your goals, don’t get distracted, don’t get off topic, stick to what you want)

A – Appear confident (Act confidently. Use an assertive tone of voice. Try not to stammer, whisper, stare at the floor, or hide away).

N – Negotiate (Be willing to give in order to get. Offer and ask about other solutions to the problem. Be ready to compromise. Focus on what is effective). 

Relationship Effectiveness – GIVE

G – Be gentle (Be nice and respectful. No attacks. No threats. No judging. No sneering).

I – Act interested (Listen and appear interested in what is being said. Face the person. Try not to interrupt or talk over the top of the person you are speaking with)

V – Validate (Show that you understand the other persons thoughts and feelings. Try to see things from their point of view).

E – Use an easy manner. (Try not to appear tense or irritated. Use a little humour. Remember to smile. Relax your shoulders. Show willing hands. Be open, candid, and friendly).  

Self-respect Effectiveness – FAST

F – Be Fair (Be fair to yourself and the other person)

A – No apologies (Try not to over apologise for making a request. Appear confident in what you have asked. It is a very British thing to apologise all the time. Try not to make a habit of it)

S – Stick to values (Hold fast to what you believe in. Don’t sell yourself out. Stick to your guns).

T – Be Truthful (No lies. Don’t act helpless when you are not. Try not to exaggerate or make up excuses).

Building Positive Relationships

Friendship is an important aspect of life. A good friend will be there for you in distress. It is important to build positive relationship to avoid social isolation and loneliness. Some people find it very easy to make friends, while others find it more challenging. It is not important to have loads of friends, but a few good friends who you meet with regularly is important for your wellbeing and mental health. Friends are essential for happiness. We are social beings designed to live in society with each other. Getting on with others is an important aspect of living. Here are some tips for making friends: 

1.      Come into contact with others. The first step in forming friendships is meeting with people. This can mean going to parties, attending weddings, going to church, finding a club or society to join. We make friends with the people we see most often.

2.      Find people with similar likes and dislikes. Meet with people who enjoy the same things as you. If you like reading, join a book club. If you like sport, take up football. If you have an interest in religion, attend a local church.

3.      Learn conversation skills. Try to open up a little. Be expansive and detailed in your discussions with others. Try not to cut the conversation short.

4.      Make small talk. Talk about the weather, about the football, about what you saw on television last night, or about what you heard on the news. Conversations do not have to be deep and meaningful all the time, they can be light-hearted and fun.  Ask questions about the other person (people like to talk about themselves).      

5.      Self-disclose skilfully. Learn how much to share and what not to share. If meeting someone for the first time, share only a little. The more you get to know someone, the more you can open up and talk freely.

6.      Don’t interrupt. Pay attention to the other person. Listen to them carefully. Face the person who is speaking to you and adopt an open posture.

7.      Be mindful of others. Pay attention with interest and curiosity. Be open to learning new information. Stay in the present moment. 

Ending Destructive Relationships

Some relationships are toxic to our wellbeing. A bad relationship can make our lives miserable. A relationship is destructive when it impacts your physical body, your self-esteem, or your ability to find calm and peace in life. It makes sense to end a destructive relationship. 

However, ending a relationship requires clear thinking. Always decide to end a relationship in wise mind, never in emotional mind. When we are highly aroused or angry, our behaviour is shaped by our mood. It is important to pause, take a deep breath, and revisit the situation when you are calm and in a state of wise mind. 

Always practice safety first when ending a relationship. In a physically abusive relationship, the point of ending or leaving the relationship can be dangerous. Safe housing and a plan for safely leaving the relationship may be necessary. 

Dialectics

Dialectics means that for everything there exists an opposite. Light is the opposite of dark. Up is the opposite of down. Dialectics tells us that opposing points of view can sometimes both be true or merged to form a truth. This is the case with a thesis and antithesis forming a synthesis. There is always more to one side of an argument – look for both sides. Learn to move away from extremes, seeing the world in black and white or all or nothing way can be destructive. It is helpful to have a more balanced view of things and to use wise mind. The goal of dialectics is to be able to see both sides of something. This can be a way of helping us use wise mind in a given situation. 

Validation and Invalidation

Validation is about learning to find some aspect of the truth in another person’s perspective or situation. This involves acknowledging that another person’s emotions, thoughts, and behaviours have causes and are therefore understandable. Dialectics can help us see a situation from someone else’s point of view. This doesn’t necessarily mean we will fully agree with the other person, only that we are able to see where they are coming from. 

Invalidation is the opposite of validation. It means the person finds no truth in your situation. It happens when your point of view is disregarded, when you are treated as an unimportant and irrelevant, or when you are misread or misinterpreted by others. It also occurs when facts that explain your reasonable behaviour in a situation are ignored or distorted. It happens when you are treated as inferior, unequal, or unable to really understand the other person. Invalidation often hurts and it can be tricky to recover from it – especially when it has roots going back into our childhood. 

There are many things you can do to recover from harmful invalidation. Firstly, you can check the facts. Remember that you are and always have been doing the best of your ability. Acknowledge your valid responses and take confidence in yourself. But be prepared to admit when you were wrong. This doesn’t mean you are stupid or blameworthy, you just made a mistake. Everyone does. Learning to share and describe your experiences to someone you trust can be a helpful way to recover from invalidation. Be compassionate towards yourself. Practice self-soothing. 

       

Conclusion

Mindfulness connects us with the present moment and gives us a place of safety in the midst of distress. It brings us into the here-and-now by allowing us to focus on one thing in the moment. In addition to the practice of mindfulness, the three modules of DBT – emotion regulation, distress tolerance, and interpersonal effectiveness – help the client to build a life worth living and to avoid dangerous impulsive behaviours such as attempted suicide and self-harm. 

Recommended Reading   
Baer, Ruth, ‘Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review’, Clinical Psychology: Science and Practice, 10, 2 (Summer, 2003), 125–43. 

Dijk, Sheri Van, DBT Made Simple: A Step-by-step Guide to Dialectical Behaviour Therapy (2012). 

Dimeff L., & Linehan, M. M., ‘Dialectical Behaviour Therapy in the Nutshell’, The California Psychologist, 34 (2001), 10–13. 

Germer, Christopher, The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions (2009). 

Harris, Russell, ‘Mindfulness without Meditation’, HCPJ (October, 2009), 21–24.

Hayes, S. C. & Chad, Shenk, ‘Operationalising mindfulness without unnecessary attatchments’, Clinical Psychology: Science and Practice, 11, 3 (2004), 249–54.

Johnstone, Matthew, Quiet the Mind: An Illustrated Guide on How to Meditate (2012).

Kabat Zinn, Jon, Wherever You Go, There You Are (2004).

Stanton M, Dunkley C, ‘First Steps in Mindfulness Skills’, Nursing Times, 107, 6 (2011), 22–24.

NB I am also personally indebted to Liz Galle (psychological therapist) for her instruction and DBT handouts in the preparation of this article.