Dialectical Behavior Therapy (DBT) offers skills that may help some people cope with anxiety. With its roots in cognitive-behavioral therapy, DBT integrates mindfulness techniques, distress tolerance skills, and emotion regulation strategies to provide a comprehensive framework for managing anxiety.
Preliminary research suggests that DBT skills training may reduce anxiety in some adults with emotion-regulation difficulties, but evidence for individual anxiety disorders remains limited. DBT skills training is not the same as comprehensive DBT, and it has not been established as a replacement for disorder-specific CBT. By promoting a dialectical approach that emphasizes acceptance and change simultaneously, DBT empowers individuals to confront their anxiety while fostering a deeper understanding of themselves and their emotional experiences.
At THE BALANCE, selected DBT principles or skills may be integrated into an individualized plan following assessment. Private residential treatment is available in Mallorca, Zurich, London; London offers private residential mental health treatment. These arrangements are distinct from inpatient hospital care, and individual DBT-informed sessions should not be described as comprehensive DBT.
Anxiety disorders involve more than occasional nervousness before a big presentation or worry about an upcoming event. For many people, it can be an overwhelming and debilitating experience that impacts their daily lives in various ways.
Understanding the different types of anxiety disorders and their symptoms can help people seek appropriate care. These symptom lists are not diagnostic: a clinician considers persistence, distress, daily functioning and possible physical causes. New or severe chest pain, breathing difficulty or other concerning symptoms should not be assumed to be anxiety; seek urgent medical assessment. If you cannot keep yourself safe, seek immediate emergency help.
Anxiety Disorders And Their Symptoms
Generalized Anxiety Disorder (GAD)
- Persistent and excessive worry about various aspects of life
- Restlessness, irritability, muscle tension, and difficulty concentrating
- Physical symptoms such as fatigue, headaches, and stomach problems
- Recurrent, unexpected panic attacks involving sudden intense fear or discomfort
- Physical symptoms like heart palpitations, sweating and trembling
- Persistent worry about further attacks or changes in behavior to avoid them; fear of places where escape or help may be difficult can indicate accompanying agoraphobia
Social Anxiety Disorder:
- Fear of being judged or rejected in social situations
- Avoidance of social interactions and events
- Physical symptoms like blushing, sweating, or trembling in social settings
Specific Phobias
- Intense fear of specific objects or situations, such as heights, animals, or flying
- Avoidance of triggers, which can disrupt normal daily activities
- Immediate anxiety response when facing the feared object or situation
The Impact Of Anxiety On Daily Life And Functioning
Living with an anxiety disorder can be incredibly challenging, affecting various aspects of a person’s life. It’s like constantly having a cloud of worry and fear hovering overhead, making even the simplest tasks seem daunting.
Some ways anxiety can impact daily life include:
- Struggling to maintain focus at work or school due to constant worry
- Difficulty forming and maintaining relationships due to fear of judgment or rejection
- Disruption of sleep patterns, leading to fatigue and irritability
- Avoidance of social situations or activities that could trigger anxiety, limiting one’s experiences and opportunities
The Need For Effective Treatment Approaches
Given the significant impact of anxiety disorders, it’s important to assess contributing and maintaining factors and offer treatments supported for the particular disorder, including CBT and, where appropriate, medication.
One promising approach is DBT, which combines elements of cognitive-behavioral therapy with mindfulness techniques. It helps individuals recognize and change negative thought patterns while also teaching practical skills for managing intense emotions and improving interpersonal relationships.
A 2014 pilot trial of 44 anxious and/or depressed adults with high emotion dysregulation, without borderline personality disorder, found greater anxiety improvement with 16 weeks of DBT skills training than with an activities-based support group. Dropout and short follow-up limit the conclusions; this was not a comparison with CBT [1].
When it comes to managing anxiety and other challenging emotions, DBT has emerged as a promising approach, offering practical tools and strategies for building resilience and emotional regulation.
Let’s discover the origins, core principles, components, and how DBT differs from other therapeutic approaches.
Origins and Development
Developed by psychologist Marsha M. Linehan in the late 1980s, DBT was initially created to treat individuals with borderline personality disorder (BPD) who were experiencing suicidal thoughts and engaging in self-harming behaviors. Over time, it has evolved to address a wide range of mental health issues, including anxiety disorders.
Linehan’s approach was influenced by cognitive-behavioral therapy (CBT) and emphasizes both acceptance and change [2].
Core Components of DBT
The following describe the acceptance-and-change principle and four DBT skills areas. Comprehensive DBT also includes individual therapy, skills training, between-session coaching and a therapist consultation team [2]:
- DBT emphasizes the idea of balancing acceptance and change, acknowledging that individuals can accept themselves while also striving for growth and improvement.
- Mindfulness is a core component that involves cultivating awareness of the present moment without judgment, allowing individuals to observe their thoughts and emotions without getting overwhelmed by them.
- DBT equips individuals with the skills to tolerate and survive crises without making impulsive decisions or engaging in harmful behaviors.
- Through DBT, individuals learn to identify and understand their emotions, regulate intense emotional responses, and develop healthy coping mechanisms for managing distress.
- DBT focuses on improving communication and interpersonal skills, enabling individuals to establish and maintain healthy relationships while setting boundaries and asserting their needs.
How DBT Differs From Other Therapeutic Approaches
DBT is unique, and that’s what makes it stand out in the world of therapy. Here’s how it sets itself apart from other approaches:
Combining Acceptance and Change: DBT doesn’t just focus on changing problematic behaviors; it also emphasizes accepting oneself as they are. This combination of acceptance and change is a cornerstone of DBT.
Mindfulness and Emotional Regulation: DBT places a strong emphasis on mindfulness and emotion regulation; these are also used in other therapies.
It teaches individuals to understand and manage their emotions effectively.
A Comprehensive Toolbox: A wide range of DBT skills for anxiety are offered in therapy sessions that could be used in everyday life. These tools empower people to navigate challenging situations more successfully.
Targeted for Specific Issues: While DBT was initially developed for borderline personality disorder, it has been adapted for various mental health challenges, including anxiety, depression, and substance abuse.
Supportive and Collaborative: DBT therapy sessions often involve both individual and group therapy. This collaborative approach allows individuals to gain insights from their peers and build a support network [2].
Let’s now explore some of the key DBT techniques that can help individuals better manage their anxiety and improve their overall well-being.
Mindfulness Practices
The Power of Being Present: Mindfulness practices encourage individuals to stay fully present in the moment, focusing on their current experiences without judgment.
Mindfulness practice aims to increase awareness of thoughts and feelings and support more deliberate responses to anxiety triggers. Some people experience increased anxiety or distress during meditation or mindfulness; pause the practice and discuss it with your clinician if this happens.
Breathing Techniques for Calm: Gentle, regular breathing may help with anxiety but is not unique to DBT. Breathe only as deeply as is comfortable, without forcing it [8].
Emotion Regulation Strategies
Identifying and Labeling Emotions: DBT teaches people to recognize and label emotions and examine their triggers; this does not by itself establish the causes of an anxiety disorder.
By acknowledging and understanding their emotions, individuals can begin to regulate their responses more effectively.
Cognitive Reframing Techniques: DBT emphasizes the importance of reframing negative thought patterns into more balanced and realistic perspectives.
By challenging and restructuring negative thoughts, individuals can reduce the intensity of their anxiety and develop a more positive outlook.
Distress Tolerance Techniques
Grounding Techniques for Stability: Grounding techniques aim to help people reconnect with the present moment during distress; they cannot guarantee prevention of dissociation.
Activities such as focusing on the five senses or repeating grounding affirmations can provide a sense of stability and control.
Self-Soothing Strategies: DBT encourages the use of self-soothing strategies such as engaging in relaxing activities, practicing self-care, or seeking comfort from supportive individuals.
Self-soothing is one distress-tolerance skill for coping with difficult emotions [2].
Interpersonal Effectiveness Skills
Effective Communication Strategies: DBT teaches individuals how to communicate their needs and boundaries effectively, fostering healthier and more fulfilling relationships.
By learning assertiveness and active listening skills, individuals can navigate interpersonal challenges with greater confidence and understanding.
Setting Healthy Boundaries: Establishing and maintaining healthy boundaries is crucial in managing anxiety within relationships. DBT equips individuals with the tools to recognize and assert their boundaries, creating a sense of safety and respect in their interactions with others.
DBT-informed skills may be considered within an individualized anxiety treatment plan. Adding more therapies does not necessarily improve outcomes, and combinations should have a clear clinical rationale.
Let’s explore how DBT can be integrated with other treatment approaches.
Complementary Supports Alongside Treatment
Mind-Body Therapies: Practices such as yoga, meditation, and tai chi may offer relaxation or help some people manage anxiety symptoms, but their benefits and suitability vary.
These practices should not be presented as proven ways to increase DBT’s effectiveness for anxiety or as substitutes for established treatment.
Expressive Arts Therapy: Engaging in creative activities like art therapy, music therapy, or dance therapy can provide alternative channels for emotional expression and self-exploration.
Creative activities may offer opportunities for expression, but an added anxiety-treatment benefit from combining expressive arts therapy with DBT has not been established.
Collaborative Approaches For A Comprehensive Plan
Cognitive-Behavioral Therapy Integration: DBT developed from CBT. Where disorder-specific CBT is indicated, additional DBT skills should have an agreed purpose rather than displace the recommended treatment [11].
The treating clinician should coordinate approaches and review whether the additional work is useful.
Medication Management: Collaborating with psychiatrists or healthcare providers for medication management can be beneficial, especially for individuals with co-occurring mood disorders or severe symptoms.
Medication may be appropriate for an anxiety disorder, with or without a co-occurring mood disorder. Benefits, adverse effects, interactions and withdrawal risks require prescriber review; do not start, change or stop prescribed medication without professional advice [11].
Considerations When Using DBT With Other Modalities
Treatment Plan Consistency: Maintaining consistency and coherence within the treatment plan can be challenging when integrating DBT with other therapeutic modalities. Ensuring clear communication and coordination among the treatment team is essential to avoid conflicting or contradictory strategies.
Individualized Treatment Needs: Each individual’s treatment needs are unique, and what works for one person may not work for another. Tailoring the integrated treatment plan to meet the specific needs and preferences of each individual is crucial for achieving optimal outcomes.
Time and Resource Constraints: Integrating multiple treatment modalities may require additional time, resources, and coordination among different healthcare professionals. Considering the time and resource constraints, it is essential to prioritize and streamline the integration process to provide the most effective and efficient care.
Considering DBT-informed support for anxiety requires discussion of the evidence, treatment demands, potential concerns and limitations.
Let’s explore some of the key considerations in implementing DBT for anxiety.
Challenges In Implementing DBT For Anxiety
Treatment Adherence: Maintaining consistent adherence to the DBT techniques and practices can be challenging, particularly when individuals are facing severe anxiety symptoms.
Regular practice and ongoing support may help engagement, but persistent difficulties should prompt review of the treatment’s suitability, pace and goals.
Emotional Intensity: Managing intense emotional experiences during DBT sessions can be overwhelming for some individuals, especially when addressing deep-seated anxiety triggers.
Creating a safe and supportive environment that fosters open communication and trust is crucial in helping individuals navigate these emotional challenges effectively.
Misconceptions Regarding DBT As An Anxiety Treatment
Limited Applicability: Some may believe that DBT is only suitable for individuals with specific personality disorders and not for those experiencing anxiety.
DBT skills have been studied beyond personality disorders, but adaptability does not establish effectiveness for every anxiety disorder or justify routine use in place of established treatments.
Sole Reliance on Skills Training: There might be a misconception that DBT solely focuses on teaching coping skills without delving into the underlying causes of anxiety.
Highlighting the integrative nature of DBT, which combines skill-building with emotional exploration and understanding, can provide a more accurate understanding of its comprehensive approach.
Limitations And Areas For Further Research
Long-Term Efficacy: Evidence for DBT as a treatment for individual anxiety disorders remains limited, including long-term outcomes. Skills-training findings should not be generalized to comprehensive DBT or treated as proof of superiority to established anxiety treatments.
Accessibility and Affordability: Before starting therapy, discuss availability, fees, insurance coverage and suitable alternatives with the provider. US readers can consult NIMH’s help-finding information [3]. Treatment choice should reflect clinical needs as well as practical access.
Tailored Treatment Approaches: Further research should evaluate which DBT-informed approaches, if any, help people with particular anxiety disorders, for whom they are suitable, and how benefits and harms compare with established treatments.
When considering DBT for anxiety, ask about practitioner training, the evidence for your particular difficulties, and whether the service offers comprehensive DBT or selected DBT-informed skills.
At THE BALANCE, assessment guides whether selected DBT principles or skills fit the individual plan. Private accommodation and amenities describe the setting, not evidence that treatment will be effective.
Tailored Treatment Plans: Our assessment-led treatment plans consider individual needs, preferences and previous care. Personalization does not guarantee clinical benefit.
Holistic Approach: Our individualized plans may include psychological care and complementary practices alongside selected DBT-informed skills. Each intervention should have a clear purpose; combining approaches does not establish greater effectiveness for anxiety.
Luxurious Environment: Our private residential settings offer accommodation and practical support around the agreed treatment plan. Comfort and amenities are not evidence of anxiety-treatment effectiveness.
Expert Therapeutic Support: The individual plan identifies the professionals involved and their responsibilities. Relevant practitioner expertise and the proposed scope of DBT-informed work should be confirmed before treatment.
Innovative Techniques: Selected DBT principles or skills may be used when they fit the assessed needs, with response reviewed within the wider treatment plan.
Comfort and Privacy: Private settings and individualized sessions support discretion. Confidentiality remains subject to consent, applicable law and clinical safety responsibilities.
