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Online DBT Therapy

Phi Atratus
  • Jan 06, 2022
  • 6 min read
woman with problems during therapy

Dialectical behavioral therapy (DBT) is a subtype of cognitive behavioral therapy (CBT) that focuses on changing dysfunctional thinking patterns into healthy ones while putting an emphasis on understanding and accepting your difficult or painful emotions. It is achieved by skill training in which you can learn how to improve your social abilities, regulate your emotions, become conscious of the present moment, and be able to tolerate discomfort.

DBT therapy is widely used by therapists to treat a wide variety of mental issues and problems. When applied in different contexts, dialectical behavioral therapy has proven to be incredibly effective and helpful. That is why it's worth your consideration when choosing treatment in general. Thanks to its unique structure, DBT translates well to online. According to research, online dialectical behavioral therapy works just as well as the traditional, in-person version, making it a great alternative. 

What Is Dialectical Behavioral Therapy All About?

DBT therapy was created as a form of psychotherapy tailored for clients with borderline personality disorder (BPD), who are prone to reacting intensely and unusually to specific emotional situations due to their higher level of arousal. That can be seen, for example, in extreme mood swings or "black or white" thinking. 

Marsha Linehan, the founder of the DBT approach, noticed how society widely misunderstands these experiences and fails to provide people with BPD with essential coping skills. That, in turn, unavoidably leads them to feel isolated and jump from one crisis to another. Dialectical behavioral therapy acknowledges the client’s need to be accepted and provided with fundamental skills that support well-being. 

The DBT model stresses the importance of moving between the two seemingly incompatible and contradictory qualities of acceptance and change. Throughout the therapeutic process, clients learn to navigate and embrace both of these aspects simultaneously. In order to start working towards the change, it's crucial to confront and accept the difficult emotions first. While traditional cognitive behavioral therapy stresses the importance of altering and improving dysfunctions, DBT explains how this cannot happen without cultivating acceptance towards the self. 

Online DBT Therapy

DBT therapy consists of:

  • Individual psychotherapy
  • Group skill training
  • Phone consultations in-between sessions 

All these components included in the in-person format translate very well into online DBT therapy. Research shows that online DBT therapy is just as effective as the traditional form of dialectical behavioral therapy. For example, the participants of this study took part in the skills training delivered online and reported lower anxiety, depression, and general distress levels compared to the in-person group.

Nevertheless, those who struggle with intense self-harm or attempted suicide are strongly recommended to choose in-person DBT therapy over online therapy.

Online therapy is a great solution for many individuals who travel, have an unstable working schedule, live in rural areas, or are simply busy. So many of us can benefit from online therapy since it's more affordable, convenient, and accessible than the conventional format, as evident during the global pandemic.

What Can DBT Help With?

There's significant scientific support demonstrating that dialectical behavioral therapy can be effective in treating various mental issues and problems, including: 

  • Borderline personality disorder 
  • Eating disorders
  • Post-traumatic stress disorder (PTSD)
  • Substance abuse
  • Self-harm behaviors
  • Attempted suicide

Throughout the process of DBT therapy, there's a specific hierarchy of goals to achieve:

  • Firstly, therapists make sure to keep you safe and work with you to reduce any risk of self-harm or suicidal tendencies. Additionally, they aim to remove potential resistance towards the treatment. 
  • Then, you can expect to receive help in identifying obstacles that stand in the way to improving your well-being. 
  • Lastly, you will move on to the central part of the treatment – skill training, where you will learn how to replace unhelpful behavioral patterns with healthy ones.

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DBT Therapy Techniques

DBT therapy, either online or in-person, is largely reliant on its therapeutic techniques. While some of those can be done without a therapist, most of them require the guidance of a therapist to be effective. DBT therapy techniques are divided into these 4 modules:

1. Core mindfulness

Awareness is the first step towards making a change, which is why mindfulness is the basis of all DBT skills.

The therapeutic work focuses on learning the ability to become self-aware and rest in the present moment without trying to alter it in any way. Clients are encouraged to practice core mindfulness by slowing down and observing their present experiences in a non-judgmental manner. Additionally, they're taught to notice different states of mind:

  • The reasonable mind uses logic and acts according to generally-accepted rules.
  • The emotional mind is used to make sense of the world around us and to assess the importance of different events, such as close relationships, failures, successes, etc.
  • The wise mind helps us regain inner balance.

Mindfulness helps broaden our awareness and deepen our relationship with ourselves and become more attentive to other people while staying grounded in the present moment.

Example: Mindful walking

Every day, we need to get from point A to point B, whether it's a commute from home to the office or from the bedroom to the kitchen. Try taking a walk in a park or around your house. Pay attention to your pace, the shifting balance of your body, the feeling of your feet coming in contact with the ground, and the texture of your socks and shoes. Direct all of your attention to this activity as if you were experiencing it for the first time ever. Notice as many details as possible. 

2. Distress tolerance

DBT training continues with learning healthy ways to bear the discomfort and pain of life – a natural and unavoidable part of human existence. Facing hardships from a place of radical self-acceptance rather than self-hatred reduces stress, anger, and anxiety levels while preventing us from acting impulsively.

DBT therapists mainly encourage clients to practice self-acceptance instead of judging, criticizing, or self-harming when faced with a problem. The objective is to develop the ability to accept life just as it is in the present moment. The clients are also taught basic strategies to apply in crisis. It all helps build psychological resilience, which becomes crucial in challenging and uncertain times.

Example: TIPP

TIPP is an acronym that symbolizes the emotional tipping point where we're almost collapsing or have just collapsed. This exercise is designed to move us away from the verge of an emotional breakdown and bring us down to a more balanced state. The acronym TIPP stands for:

  • T – Temperature: When we're in the heat of our emotions, our body temperature is physically higher as well. Cool down by washing your face with cold water or drinking a refreshing cold beverage.
  • I – Intense exercise: Curb the intensity of your emotional states with an equally intense physical exercise. Not only will it occupy your attention, but the additional oxygen can help lower stress levels. Once you’re exhausted, you won’t have the energy to stay sad or angry anymore. 
  • P – Paced breathing: Our bodies produce a fight or flight response in specific situations. Breathing exercises reduce any distress or tension built up in our bodies and help us regain balance.
  • P – Paired muscle relaxation: This technique focuses on tightening and releasing the tension in your body, muscle by muscle, 5 seconds at a time. Intentionally relaxing your body leads to a slower heartbeat and breathing. This, in turn, helps you achieve a calmer state of mind.

3. Interpersonal effectiveness

The priority here is to equip clients with appropriate interpersonal skills and the understanding of how and in which context to apply them. This is useful as plenty of people, including BPD patients, have excellent interpersonal skills but tend to struggle using them correctly in emotionally vulnerable or volatile situations. This module of DBT creates an opportunity to maintain healthy and stable relationships with others by learning effective communication methods, assertively handling conflicts, and replacing harmful behaviors with self-respect.

Example: FAST

FAST is an exercise that helps maintain self-respect and consider your own needs and values in a social context. Each letter in the acronym stands for a rule to practice:

  • F – (Be) Fair: remember that you deserve just as much respect as others. Avoid fulfilling someone else's needs at the expense of your own. On the other hand, be careful not to send passive-aggressive signals. Practice assertiveness, mindful listening, and work towards a compromise. 
  • A – (No) Apologies: People tend to over-apologize to avoid confrontation, calm down the other person, or come across as unproblematic. It can only further perpetuate a lack of self-respect, leading to low self-esteem, frustration, and resentment. Observe your habits and set an intention to be authentic and genuine when apologizing. 
  • S – Stick to values: Wanting to please other people sometimes makes us sacrifice our own well-being and moral compass. Know your core values, stick to them, and don't compromise them for others. You always have the right to speak up for yourself or avoid situations that don’t feel right for you. 
  • T – (Be) Truthful: Telling white lies, stretching the truth, or playing the victim might seem like a convenient way to avoid a conflict or solve an issue. But in the long term, the price of such lies is feelings of shame, guilt, and anxiety, not to mention the harm that lying does to your close relationships when the truth eventually does come out. However, being truthful keeps you safe and connected to reality. 

4. Emotion regulation

DBT emphasizes the importance of understanding the different functions of emotions, the relationships between the mind and the body, and the influence emotions have on your experience in general. Clients learn how to identify, label, and reduce the intensity of their feelings. The therapeutic work of DBT focuses on rationally recognizing your emotions.

Clients can also expect to be taught how to:

  • Detect obstacles for emotion regulation.
  • Apply mindfulness and distress tolerance techniques in a challenging emotional state.
  • Increase positive emotional events.

Example: STOPP

STOPP is an exercise used to manage emotional responses in challenging situations. It stands for:

S – Stop!: Take a moment to slow down.

T – Take a breath: Become mindful of your breathing.

O – Observe: Notice your thoughts, the situation you're reacting to, and sensations in your body.

P – Pull back: Change your perspective and look at the bigger picture. Observe your thoughts and decide whether they're factual or blown out of proportion. Imagine what your trusted friend would tell you in this situation.

P – Practice what works: You know what works best for you, and you probably can guess what the appropriate thing to do is. Make a choice that goes with your core values, not against them. 

How to Get Started? 

Online dialectical behavioral therapy is a unique form of treatment that joins the element of traditional cognitive behavioral therapy with a mindfulness approach. DBT also provides the clients with skill training that helps them thrive in life in general. If you struggle with emotion regulation and wish to regain control over your life, online DBT therapy might be just for you.

If you're interested in learning more about online therapy, look no further. DoMental is the place to begin your online counseling journey wherever you are, whenever you need.

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