DBT Program

Dialectical behavior therapy, also known as DBT, is the core method we use in our mental health and eating disorder programs. Originally developed in the 1970s by Marsha M. Linehan, Ph.D., DBT is used to teach people the skills they need to cope with and manage challenging situations and intense emotions.  

The four core skills taught as part of dialectical behavior therapy are: 

• Mindfulness 
• Interpersonal effectiveness 
• Emotion regulation 
• Distress tolerance 

More than a simple therapeutic method, DBT helps individuals who are suffering from eating disorders and other mental health concerns develop life skills that play a role in building healthy relationships and successfully practicing conflict resolution. These skills can help clients manage their mental health disorder symptoms and abstain from eating disorder behaviors both during and after treatment. 

Mindfulness involves developing the capacity to stop the “chatter” of the mind and nourish present-moment awareness of physical, emotional, and relational experiences. The team at Carolina House strives to help clients increase their awareness of the experiences they are having without making them feel judged. By practicing mindfulness skills, clients can identify potential triggers, negative emotional states, and problematic choices that often result in engaging in eating disorder behaviors or magnifying symptoms of other mental health disorders. By practicing mindfulness, clients can come to understand how their choices impact their experiences and ultimately increase their capacity to make wise decisions. 

Interpersonal effectiveness refers to how a person develops and practices strategies for working through interpersonal conflicts with a healthy balance of assertiveness and consideration for others. By learning how to appropriately make requests, say no, and communicate the feelings they are having, clients can find healthy ways to have their needs met without damaging their relationships or losing self-respect.  

At Carolina House, we teach clients “Dear Man” skills to simplify how they can successfully practice interpersonal effectiveness. The letters in “Dear Man” stand for: 

D: Describe

E: Express

A: Assert

R: Reinforce

M: Mindful

A: Appear Confident

N: Negotiate

Emotion regulation involves recognizing intense emotions, learning to accept how those emotions impact experiences, and developing skills to help manage those emotions. Emotion regulation is important for teaching people who have eating disorders and other mental health disorders to identify and process their emotions without becoming angry, depressed, or anxious. 

We teach our clients various ways they can come to accept emotions as a necessary step toward effectively addressing their needs. Our clients often experience overwhelming and debilitating emotions, and it is important that we focus on how that emotional distress impacts the behaviors associated with eating disorders and other mental health disorders. We then work to help our clients understand, accept, reduce, and change the emotional states that are causing them pain and leading them to act in negative ways. 

Our emotion regulation module is centered on three main goals: 

• Accurately identifying and labeling emotions and understanding how they impact functioning and behaviors 
• Reducing vulnerability to negative emotions and increasing positive emotions 
• Working on changing emotional states through the use of various skills, including opposite action (intentionally acting in a manner that is the opposite of how a person is feeling so that the intensity of the negative emotion is lessened) 

Having emotion regulation skills can help people make choices that result in the development of a healthy lifestyle, cultivate positive relationships, work toward achieving personal goals, have a positive outlook on life, and maintain a nonjudgmental view of emotions. 

Distress tolerance involves learning how to tolerate distressful emotions and challenging situations. The reality is that there are many times when we are not able to solve problems, no matter how skillfully we act. By developing distress tolerance skills, we are not able to change challenging situations, but we can learn how to work through those situations without suffering. The team at Carolina House teaches a number of distress tolerance skills, including: 

• Distracting 
• Awareness 
• Radical acceptance 

These skills can help clients work through difficult situations, find ways to solve problems, reduce suffering, and minimize the potentially harmful long-term effects that come with not knowing how to cope with distress.