Have you ever reacted to a crisis in a way that you later regretted? In retrospect, after learning all the facts, would you have handled the situation differently? Most of us have or we wouldn't be human.
For those in recovery, crisis and chronic stress can be the perfect recipe for relapse—feeling angry, defensive or judged. You may think others don't appreciate you or the efforts you're making towards positive changes in your life. Your personal relationships then suffer.
Dialectical Behavior Therapy (DBT) teaches "distress tolerance" skills that can help you ride out a crisis and avert relapse when faced with an unbearable, stressful situation or life event. You can learn different responses that don't involve using or other destructive behaviors.
What is DBT?
DBT is a form of cognitive behavior therapy that was created in the 1970s by Psychologist Dr. Marcia Linehan. It was originally used to treat people diagnosed with Borderline Personality Disorder.
Since then it has shown favorable outcomes in treating addiction and substance use by helping to diminish cravings and avoid impulsive and harmful behaviors. DBT was the first psychotherapy to formally incorporate mindfulness and Zen influences from Buddism.
DBT skills can be learned in individual counseling as well as in weekly support groups. I started attending a weekly group and we are taught skills from four different modules.
The 4 Modules of DBT
Mindfulness is the foundation of DBT. The core mindfulness skills taught are: observe, describe and participate. It's not second nature to respond to life and things that happen to us in a non-judgemental and mindful way. Yet this is exactly what we learn in the DBT core skills.
2. Interpersonal Effectiveness
In relationships with others, there is bound to be conflict at times. This is unavoidable, but you can learn ways to communicate more effectively. This particular set of DBT skills are similar to what is often taught in assertiveness and interpersonal problem-solving workshops.
3. Distress Tolerance
Focusing on changing distressing events and circumstances is a common approach to mental health treatment. DBT emphasizes learning to bear pain skillfully. This can be achieved through acceptance skills including radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.
4. Emotion Regulation
One fascinating note about how DBT skills differ from traditional counseling is realizing that just because you are feeling an emotion right now doesn't mean you are bound to that feeling—even in the following minutes.
Learning how to properly identify and label emotions helps you to sit with your feelings and apply distress tolerance techniques. This is one facet of DBT that can be so useful in relapse prevention.
Applying the STOP Skill
The STOP skill is the very first skill covered in the distress tolerance unit of DBT. When we are in the midst of a crisis or something has happened suddenly to derail us, we are used to reacting and feeling helpless and at the mercy of those circumstances.
Understanding and applying the STOP skill will help you learn to accept a distressing situation and work through it without using or relapsing.
Here is what each letter in STOP skill stands for:
S = StopAs soon as you realize you may be "flying off the handle" STOP. Freeze. Refrain from allowing your emotions to take over (this will feel unnatural at first) and STOP everything you are doing immediately. You can even visualize a red STOP sign in front of you.
T = Take a step back
Step away from the situation, take a break, leave the room, BREATHE. At this point, you may be experiencing some physical symptoms of stress or anxiety. Allow those feelings to come and realize that it's just a response to the current stressor.
O = Observe
Once you are removed from the situation (whether physically or mentally) you can now access the circumstances from a fact-based and non-judgemental point of view. When you're in the midst of a crisis you may not have all of the information or you may be misinformed.
P = Proceed mindfully
Now that you have calmed down and can see a different perspective, think about the next steps to take. What will make the situation better or worse? This involves moving into a "dialectal" state of mind and remembering that two opposite views can be true at the same time.
For example, you may be very upset with your partner at this moment AND you also love them dearly. Both things are true. Utilizing the STOP skill helps prevent black and white thinking. You gain new perspectives and acceptance in all areas of your life.
Using the STOP skill will become easier the more you practice. Learning to react less impulsively will help strengthen your recovery and improve your relationships with others.