Dialectical Behavior Therapy is a mouthful. So we say DBT. But what does it mean?
Marsha Linehan, a genius badass academic/clinician based out of the University of Washington, pioneered DBT in the 1990s as a treatment for chronically suicidal people with borderline personality disorder. Since then, DBT has earned evidence-based status as treatment for a host of other concerns. Although the full DBT protocol is necessary for achieving results with severe mental illness, literally anyone in the world could benefit from learning a bit about the basic principles, which involve fundamental knowledge on regulating emotions, tolerating distress, strengthening relationships, and that often-alluded to, rarely understood concept: mindfulness.
For a tiny taste of DBT, voilà The Five Options for solving any problem:
1. Change it
2. Change how you feel about it
3. Accept it
4. Stay miserable
5. Make things worse
Let's apply this template to a problem we will define as "loneliness." As mammals, we reflexively prefer pleasure to pain, amirite, and want to reduce negative emotions as much as possible. So our preferred choice is usually #1, to change loneliness. So we might make plans with a friend, or if we're single, try a dating app, or if we're feeling lonely while in a relationship, address an empathic rupture that may have occurred.
Sometimes the change option isn't available, either in the moment, longer term, or indefinitely (such as when the problem is "mortality"). In that case, the next best option is #2, change how we feel about it. What are some ways to do this? Remember that loneliness is often a temporary, normative part of life! Your operating system is working as designed if you sometimes feel lonely. Loneliness doesn't make us less than, it makes us just like others... Remember also that past early childhood, there are very few make-or-break moments where we fundamentally rely on others to survive. We all need people AND this is not an emergency. Another option would be to recognize loneliness as a reminder to contribute to someone else in our lives -- for example, text that friend whose mom died a while back, or chat up the elderly neighbor who has been dying to regale someone about the aphids on his roses in exhaustive detail. Also, do all the basic biological stuff like remember to eat, balance sleep, take meds, moderate drinking, etc. to reduce the intensity of loneliness, especially for highly sensitive folks.
If you've tried #2 and the feeling isn't changing, your best bet is to practice acceptance. This doesn't mean passivity, this doesn't mean we won't still pull for change over time, it just means that in the moment, the pain is what it is. This allows us to humanely self-validate, to have "clean" pain that is dignified and manageable, vs. #4, suffering that feels shitty, dirty, and intolerable. Often what keeps us in #4 are beliefs like "I can't stand this," "It will always be this way," or "This isn't fair" that undermine our coping skills, as well as behaviors like social media compare-and-despair. We pull a #5 when we are using no skills, and that's when we see things like drinking a bottle of wine at home alone, eating an entire pizza (I see you. my gluten-sensitive compatriots), and texting the emotionally unavailable and sexually selfish ex we just dumped. That's two steps back.
I have had clients post the official DBT handout version of this on their fridge until reflecting on this hierarchy becomes second nature. What can I do to make things better right now? What am I doing that is making things worse? This skill draws on the central dialectic (synthesis of opposites) at the heart of DBT, the balance of acceptance and change. And of course it's good, clean fun to dream about (and not act on) how one could make things worse, too.
Rebecca Robinson, LMFT provides expert online, evidence-based therapy to deep-thinking/deep-feeling adults in California and Pennsylvania.