THE DBT MODULES
DBT skills groups are organized into modules. The four modules are described in more detail below and are meant to complement one another while holding the dialectic of "acceptance" and "change." The Distress Tolerance and Mindfulness modules are considered "acceptance" modules whereas the Interpersonal Effectiveness and Emotion Regulation modules are considered "change" modules.
Mindfulness
Mindfulness is a foundational skill in DBT; all other skills rely on one's ability to practice mindfulness effectively. Many people hear "mindfulness" and think about long periods of meditation, being “zen,” and practicing yoga. These are certainly examples of mindfulness activities; however, you do not have to meditate or clear your mind or like yoga to benefit from mindfulness or practice mindfulness. The benefits of mindfulness will be more apparent when the practice of mindfulness is frequent and intentional practice, but it does not need to take the form of long periods of meditation. It can last only seconds at a time to start. Many people find meditation to be uncomfortable, time consuming, or too difficult to maintain because their judgements about “not doing it right” or becoming distracted are so strong. That is okay! Those who dislike mediation can still benefit from practicing other types of mindfulness. So if it is not meditation, what is mindfulness? Well, mindfulness is intentionally and non-judgmentally paying attention to the present moment. Almost any activity can be done mindfully. We can read mindfully, brush teeth mindfully, worry mindfully (and yes, this is different from ruminating), and even watch TV mindfully. The mindfulness module of DBT skills group can teach you how.
Emotion Regulation
Emotion regulation is the ability to inhibit impulses and ineffective behavior that occurs when we are in “emotion mind.” Emotion regulation can be automatic or purposeful. The first goal of this module is to increase purposeful control over responses. Once the skills are learned, the next goal is to practice them so often they become ingrained and automatic. When skills are overlearned, they can be used easily in the situations where we need them most. Some of the skills in this module are meant to be used when emotions are moderate and our urges (e.g., yelling, avoiding, using substances) are not helping us accomplish our goals or stay true to our values. Other emotion regulation skills focus on building emotional stamina over time by taking care of our bodies (and our brains). This helps to reduce our vulnerability to “emotion mind” over time and keep us in “wise mind” more often.
Interpersonal Effectiveness
Interpersonal effectiveness skills are communication skills; they help us to maintain positive relationships and navigate tricky conversations effectively. The interpersonal effectiveness module breaks skills down into their component parts and teaches them as corny acronyms so we can remember them easily, practice them regularly, and eventually use them automatically even when uncomfortable emotions surface. The interpersonal effectiveness module covers three main facets of communication, including maintaining relationships we care about, maintaining our self-respect, and being assertive to try to get our needs met. The module also includes supplemental skills on being mindful of others, ending destructive relationships, and “walking the middle path,” that is, being “dialectical” in our approach to relationships by using validation and behavior change strategies effectively.
Distress Tolerance
The distress tolerance module, like the mindfulness module, is considered an “Acceptance” module. This means the focus is on accepting reality as it is and accepting some level of pain and discomfort in order to reduce suffering. Distress tolerance skills reduce suffering by increasing our ability to tolerate unpleasant, uncomfortable emotions, particularly during moments of crisis or intense emotion. The distress tolerance module also includes crisis management skills to help us quickly bring intense emotions down a bit. Other crisis management skills help us to “STOP” acting impulsively and distract ourselves with something pleasant or neutral to prevent ourselves from making a situation worse. The distress tolerance skills help us tolerate intensely unpleasant emotions. These skills are powerful and important, and they work best in conjunction with other skills. These skills help us when it seems like things could not seem to get worse, and we must use other skills in order to make our lives truly better.