By: Agustina Jorquera, M.Ed, RP
Have you ever been to a DBT skills group and heard someone say, ‘I was so dysregulated, and none of the skills worked, nothing worked’. Right about now is the time when group facilitators ‘jump into the rescue’ seeking alternatives and troubleshooting. All of these efforts are met with a redundant ‘no, they weren’t working, I tried everything’. Most people put their heads down, throw their hands in the air and discouragement envelops the room.
One of the traits that makes DBT different from other modalities is that the therapeutic approach is couched in skills with the overarching aim to regulate emotions and lead a life worth living. When the skills don’t seem to work, it can be discouraging and send one further along down a helpless spiral. Let’s think about why DBT skills sometimes fail us. We will start with a few myths to dispel about DBT skills and some questions for thought:
- DBT skills are not aimed at making situations better, but rather, function to prevent situations from getting worse. This is especially true of interpersonal effectiveness skills. They don’t guarantee that your goal will be met, or that your friend will like you if you DEAR MAN to get the sweater back from their closet. They help you increase those chances, and if you don’t get the goal, met… well, you get to go home with your composure intact.
- Not one single skill will always work on its own (in fact, only if we are lucky does one skill work). They need to be layered on top of one another. This is especially true of the distress tolerance skills like TIPP. I first need to start with temperature tipping (and do it repeatedly!), and then, I will move to some form of exercise (and do it for about 15-20 minutes mindfully!), and then I will move to the progressive muscle relaxation and paced breathing (and again, do it mindfully for another 15 minutes or so!). Therefore, the TIPP skill should take about 1 hour to complete as I am layering one skill in the acronym after another.
- If I have checked in with my expectations on the purpose of DBT skills (not to make me necessarily happy or content, but rather, to prevent me from further spiralling) and have layered the skills, and I continue to be met with my situation getting worse, then I must check into my biological factors. a) Have I eaten today? b) Have I taken prescribed medication as prescribed? c) Have I taken care of any physical pain? d) Have I slept sufficiently? e) Have I avoided mind-altering substances? f) Have I gotten outside to get fresh air and some movement?
- If the above is met with a balanced, YES. Then, I must look at my reinforcers. Are my strong emotions, and perhaps, even my dysregulated behaviour maintaining something for me? (i.e., is my only way to get needs met if I scream because it’s only then that people typically listen?). Well, if this is the case, then we must listen to our emotions and decide to problem solve or act opposite to them if they will lead us down a helpless path.
- If the above is checked and it turns out that I am feeling strongly and have electively acted opposite to destructive urges, then I am confronted with the good old Radical Acceptance. In this skill, there lies the other skill – feeling the wave of emotion. In other words, you must tolerate feeling and not do something destructive or ineffective. The feeling may include going for a paced walk, listening to music that may match your mood or journaling. Doing an activity that is healthy in the presence of a strong emotion is part of feeling an emotion effectively.
Next time that ‘no skills’ seem to work, check in on the above. Not that it will magically give you the answer – however, the process of checking in with yourself with the above guideline, is a skill – mindfulness of one’s abilities to grow more introspective in ourselves.