Part Two: Dovetailing Dialectical Behavior Therapy (DBT) and Emotional Intelligence

Dialectical Behavior Therapy (DBT) but First a Disclaimer

The following post is entirely my own interpretation of DBT, and I am solely responsible for the content. I am in no way authorized as a spokesperson for the field of DBT.

In the immediately preceding post, I listed ten mental health skills areas, five derived from emotional intelligence and five derived from dialectical behavior therapy (DBT). That post focused on emotional intelligence and this one on DBT. However, this post is not about providing or consuming DBT. Instead I introduce the four skill sets of DBT along with dialectical thinking teased out as an additional skill set. To be sure, dialectical thinking is the sauce that permeates the four skill sets of DBT, and its separation is not authorized. I do so to highlight it as a mental health skill.

Marsha Linehan is the architect of DBT. She conceived the intervention as a manualized intervention for persons who live with borderline personality disorder. DBT, however, can enhance the mental health of everyone. In my own practice, I present the principles of DBT in psychoeducational doses to my patients as part of individual therapy.

Dr. Linehan’s principles can be found in her seminal book, Cognitive-Behavioral Treatment of Borderline Personality Disorder. As extraordinary as that book is, the one I recommend for beginners is DBT Made Simple by Sheri Van Dijk. You can use this post as an introduction to DBT vocabulary and then turn to Van Dijk for an in-depth look. After that, please get Linehan’s original book. Read it and keep it for reference.

Five Mental Health Skill Sets Gleaned from DBT

1. Dialectical thinking

Dialectical thinking is the ability to see validity on all sides of issues, including controversial ones, and simultaneously accept the contradictions.

Dialectical thinking asks us not to judge the intrinsic worth of people, situation, and objects. We are, however, allowed to judge whether we like or don’t like certain people, situations, and objects. Caveat: Our likes and dislikes are usually best kept to ourselves.

Dialectical thinking is a tough sell because we humans have evolved to prefer negativity and its attendant divisiveness. Social media and much of traditional media make fortunes with snarkiness, trolling, condemnation, and AI programmed polarization.

After noticing the negative, mentally healthy people immediately seek all relevant sources of data before concluding anything. These highly functioning people have cultivated the ability to tolerate ambiguity and to be patient with complexity.

(Dialectical thinking is not one of the four sanctioned DBT skill sets. Instead it is the foundation of DBT, just look at the name, dialectical. For the purpose of this post, I discuss it as a skill to help newcomers to DBT.)

2. (1) Mindfulness

Traditionally, mindfulness is the ability to be in the moment while suspending judgment about external and internal stimuli.

My preference, however, is to define mindfulness as the ability to return immediately to the present as necessary. Mindfulness allows sojourns to the past and to the future while keeping the path clear to the present. Mindfulness should be largely joyful, not a prison sentence to present time.

The measure of mindfulness is willful, focused attention. We scan the environment and then proactively choose what to observe.

Lack of mindfulness has three traps. Ironically, the first is getting stuck in the present. This can be a form of dissociation called depersonalization/derealization disorder (DDD). The real problem with DDD is not the surreality or the outside observer perspective but the being stuck. The second trap is getting stuck in the past and is called rumination, a core component of depression. ((Note: The rumination in depression can be so severe that the future is often blank, i.e. hopeless.)) The third trap is getting stuck in the future and is called catastrophizing, a core component of clinically significant anxiety.

Therefore, the skill set of mindfulness is essential for modulating anxiety and depression and keeping them within healthy bounds. ((The concept of anxiety and depression as health promoting may surprise you. A topic for a future post.))

Pointers on achieving mindfulness

Mindfulness is predicated on a physically and mentally healthy lifestyle and is not a standalone skill. Competence in mindfulness comes as one develops all the skills of DBT and emotional intelligence.
Managing the consumption of media, both social and traditional, is basic to mindfulness.
Mindfulness operates in the background but requires frequent conscious daily doses of a few seconds to a few minutes.
There are many mindfulness skill building exercises. The one I recommend for beginners is physiological coherence breathing (PCB).

3. (2) Distress Tolerance

Distress tolerance is the ability to acknowledge our upsetting emotional reactions to negative people, objects, and situations while acknowledging the positive and neutral aspects of our current context.
Distress tolerance is the ability to withstand emotional reactions and delaying responding until all appropriate data are in.
Distress tolerance is recognizing that the present is not our future or our past.
Distress tolerance is mindfulness in action: Experiencing the moment without attempting escape unless unacceptable harm could result.

Opportunities for developing distress tolerance

Physical exercise for 30 minutes a day in addition to routine labor such as household chores, shopping, etc. The 30 minutes can be divided into exercise snacks as short as 2 minutes.
Twenty minutes three times a week of physical exercise harder than you want such as running, swimming, spinning (not leisurely bike riding), stair climbing, wheelchair workouts, rowing, etc. according to the limbs available to you.
Not automatically looking at your digital devices when standing in a queue, stopped for a traffic light, or in a waiting room. ((The waiting room is a tough situation. If alone, I will refrain from my phone for five minutes. If others are present, I will look at my phone right away to avoid becoming a distraction to others.))

4. (3) Emotional Regulation

Our emotional reactions serve as suggested default responses. Emotional regulation is the ability to respond to challenges, big or small, in pro-self and prosocial ways whether or not they are in agreement with our emotional reactions.

This is a tall order because evolution by natural selection (EBNS) has selected for obeying emotional reactions without question. What had worked in the wild is now an obstacle to self-actualization in civilization.

Emotional regulation is a proactive effort to be aware of our emotional urges and their triggers. Our mental health demands that we study these urges, accept them as part of ourselves, and carefully choose our responses to the challenges of life while taking our emotional reactions into account as only one source of information.

Our individual schemas of reality begin in our heads and cause us to have expectations: Expectations of ourselves, of others, and of the physical world. When our expectations are contradicted, emotional reactions automatically flood our thinking, our desires, our central and peripheral nervous systems, and our internal organs and glands with the result of blinding us to context.

So, emotionally regulated people deal with challenges by thoughtful, analytic responding after considering all the available data beyond the restricted context of emotional reactions. Often the best solution to a challenge is the one suggested by an emotional reaction, but only after considering the range of responses available. All important decisions of life (partners, living arrangements, careers, significant purchases, etc.) should be rooted in emotional reactions but carried out only after analyzing the consequences.

5. (4) Interpersonal Effectiveness

Interpersonal effectiveness is the ability to cooperate with others so that all parties get more from the cooperation. In my experience, the ability to compromise is the essential skill of interpersonal effectiveness. Let me explain: Compromise has dual outcomes, gain and loss. Mentally healthy people are grateful for the gain, and their gratitude overcomes the loss. On the other hand, those people who have growth edges in interpersonal effectiveness are determined never to lose anything, tangible or intangible. The obsession of never relinquishing is just that, an obsession which interferes with mental health.

The willingness to compromise is in line with recent findings that people older than 65 with dispositional gratitude and without a single-minded attitude of loss avoidance are more satisfied.

Please look at the section on Sociability in Part One of this two-part post for more ideas on interpersonal effectiveness.

Endnotes

Writing this post has given me new appreciation into Dr. Linehan’s formulation of DBT. Specifically, interpersonal effectiveness rests on emotional regulation, which rests on distress tolerance, which rests on mindfulness, and all that combined rests on dialectical thinking.
We can use the skills in this post and in Part One prophylactically, similarly to daily physical workouts. Will power and healthy practices cultivated daily are a rehearsal for the inevitable violations of our naïve expectations. If we do not exercise our will power and healthy habits daily, they will not be available to us in the throes of urgent situations and temptations.
Consult a therapist as needed. Life is so complicated that we can’t see everything. The best of parents and schools cannot prepare us for everything. Psychotherapy is an opportunity for lifelong learning, although working with a therapist need not be lifelong.

Good mental health,

Dr. Michael DeCaria

(The featured image is a clematis growing through an wooden fence a few blocks from my house. I was thrilled that Millcreek City chose this photo for inclusion in its 2022 calendar. Photograph by the author)

Psychotherapy and Psychology

Part One: Dovetailing Emotional Intelligence and Dialectical Behavior Therapy (DBT)

Introduction

Marsha Linehan’s dialectical behavior therapy (DBT) in 1993 and Daniel Goleman’s emotional intelligence in 1995 significantly advanced psychology. Dr. Linehan formulated a new cognitive behavioral treatment (CBT) for borderline personality disorder, and Dr. Goleman presented a structural outline of highly functional human behavior. Although the two psychologists came from two different philosophical directions, the former clinical and the latter global, their overlapping findings give us a vocabulary for describing mental health skills.

Dictionary definitions of mental health include meeting thresholds of self-acceptance, positive regard for others, and social functioning. Emotional intelligence and DBT go beyond dictionaries with operational definitions of mental health components.

Together, emotional intelligence and DBT each have five skill areas for a total of ten.

Emotional intelligence:

Self-awareness
Self-regulation
Motivation
Empathy
Socialization

Dialectical behavior therapy:

Dialectical thinking
Mindfulness
Emotional regulation
Distress tolerance
Interpersonal effectiveness

Below I introduce emotional intelligence and its five skills sets. Dialectical behavior therapy and its skills sets follow in another post.

Emotional Intelligence ((A proper introduction with an in-depth understanding of emotional intelligence is best left to Goleman’s publications and talks. My intent is to provide an outline along with highlights that speak to me.))

Emotional intelligence is the ability to recognize emotions in yourself and in others and then use that knowledge to enhance your life and your communities.

Daniel Goleman’s book, Emotional Intelligence: Why It Can Matter More than IQ, is a monumental achievement. The book is one of the few found in both my hardcopy and virtual libraries. The information is so dense that I have read the book three times. If you are a mental health professional or a layperson who wants to be an increasingly effective human being, Dr. Goleman’s book is essential. Here are the five components:

1. Self-awareness

Self-awareness has three abilities:

Acknowledging our different emotions
Recognizing what causes them
Accepting them, i.e., not judging ourselves negatively for having them.

Here is one dictionary definition of emotion: a conscious mental reaction (such as anger or fear) subjectively experienced as strong feeling usually directed toward a specific object [person or situation] and typically accompanied by physiological and behavioral changes in the body. ((“emotion.” 2022. In Merriam-Webster.com. Retrieved February 3, 2022, from https://www.merriam-webster.com/dictionary/emotion. (Author’s addition in brackets) ))

Emotions are complex, and what we call a particular emotion is just the most prominent one mixed up with others. For this reason “emotional episodes” may be more descriptive than “emotions.” Emotional episodes evolved as templates of behavior over evolutionary time to aid animals and us to increase the odds of survival by reacting without thinking. The quality of self-awareness asks us to change without thinking to with thinking.

Here is a list of basic emotional episodes common to people in all cultures: ((This is only one of several lists of emotions that philosophers and scientists have proposed. All such lists are controversial. Nevertheless, this is one that I find the most useful in the clinical setting.))

Fear
Anger
Sadness
Joy
Disgust
Surprise
Embarrassment
Shame
Guilt
Pride of accomplishment

2. Self-regulation

Regulating emotional experiences means accepting the experiences and then behaving in an informed way to modulate them. When we can name an emotional experience, we can feed it or starve it by our actions and inactions.

Evolution by natural selection (EBNS) has resulted in a numerous evolved psychological mechanisms (EPMs). Some of these are urges accompanied by mental and physical discomfort, sometimes extreme, if not acted on. Some EPMs such as an exaggerated fear of spiders or the urge to eat stale food rather than throw it away are silly. Other EPMs, such as the urge to take one’s own life when jilted by a lover or to go to war over national pride, are tragic.

Some common characteristics of emotional episodes:

They have either an approach valence or an avoidance valence. Often, to our consternation, both valences operate simultaneously.
They exist in a temporal context that may be eons old.
They are about our beliefs and about our interactions with the environment.
They can be occasions of great learning.
They are our first response to challenges that violate our expectations.

Obstacles to self-regulation of emotional episodes

Emotional episodes cannot be quickly turned off by will power. If they could, they would be useless.
Emotional episodes are complex.
Emotional episodes are like icebergs: They operate in the unconscious long before awareness.
As a consequence of evolution by natural selection, an emotional episode can be in full operation before cognitive controls kick in.
Our expectations are often based on a desire for coherence of belief rather than the truth.

Strategies for self-regulation of emotional episodes

The regulation of emotional episodes is to prevent escalation of the episodes and not to stop them in their tracks.
Live life daily in synchrony with your circadian rhythm.
I referenced will power in the above bullet list. Although will power cannot turn off an emotional experience, it can be part of a preventive strategy limiting escalation, e.g., anger need not become rage.
Engineer your life to reduce nasty surprises and to maximize joyful surprises.
Know the valence of your emotional episodes and act oppositely. For example, anger is an approach emotion. When you feel angry, withdraw from the focus of the anger and observe the larger picture. Sadness is an avoidance emotion. When you feel sad, embrace the focus of the pain.
Foster expectations of life based on accepting reality.

3. Internal Motivation

Internal motivation is the ability to act consistently in the best interests of yourself and of your communities even if your actions may be unpopular. Internal motivation is not deliberately contrarian; it is informed by foresight, the ability to see the beneficial effects of present behavior in the future.

Internal motivation is a skill set consciously sought after and built on a widely based experiential and academic learning. Acquiring and maintaining internal motivation is an active process.

Internal motivation is not closing yourself off from the voices of others. It means acting in accord with all the data available to you including knowledge received from others. In my view of emotional intelligence, internal motivation requires us to be a citizens of our communities. Cult leaders and their followers may have internal motivation to exploit the common good for their selfish purposes, but that brand of motivation is not emotional intelligence.

Motivation and self-regulation rely on each other.

4. Empathy

Empathy consists of two pieces: (a) the prosocial ability to recognize and distinguish emotional episodes in other people and (b) the ability to recognize how other people’s current situations relate to their emotional episodes.

A note on language: English in all its varieties has a confusing vocabulary around empathy. A few examples are sympathy, compassion, and empathic concern. Then there are the adjectives empathetic and empathic. I will leave it to linguists to sort through the semantics and the varieties of national English and ESL, and I will use empathy as defined above.

Empathy and morality

I subscribe to the school that empathy is the source of morality defined secularly. Empathy is also the source of ethics. Societal institutions such as governments and religions are corrupted by relying only on persons with economic and political power for financing. The result is that governments often forego their Lockean duties to secure basic human rights for all its citizens. Similarly, followers of religion sometimes substitute professed beliefs and solidarity practices for the entirety of a moral code.

Empathy and forgiveness

I do not subscribe to the school that forgiveness is something to attain at all costs. Forgiveness, however, is a wonderful experience, and we should be open to it finding us. I have been able to forgive others when I have realized their capabilities had been taxed by the extraordinary demands often placed on them precisely because of those capabilities.

5. Socialization

We demonstrate socialization by contributing ideas to the conversation, by managing teams, and by working through conflicts. Ultimately, socialization is getting along with others and is the ultimate test of emotional intelligence. We prepare ourselves for socialization by cultivating self-awareness, self-regulation, internal motivation, and empathy.

Contributing to the conversation

Intelligently. We learn to distinguish details; learn to distinguish important from unimportant detail; learn to focus on the important and set aside the unimportant; learn to compare and contrast; and finally learn to rank order.
Humbly. We may or may not be the smartest person in the room. The smartest person is rarely smart enough, anyway. All ideas stimulate other ideas until a viable plan emerges given the resources and time constraints.
Generously: Knowledge is power: Give it away. Mentor others and let the credit go to them. Adam Grant details how doing so allows your communities to prosper and you along with them.

Managing teams

Managing teams is about letting the members work for each other and for you as a leader. Most humans are more motivated by peer relationships than by causes. Treating all the members of the team as fellow humans will contribute to repeated successes over time. I admire the principle of Stoic philosophy that teaches us to live each moment as a gift to ourselves and to others rather than focusing primarily on outcomes. Outcomes matter but they are secondary to each team member’s individual humanity.

Working through conflicts

Because evolution by natural selection (EBNS) has resulted in humans being easily inclined to intrasexual competition, conflicts are inevitable. Emotionally intelligent people utilize self-awareness to check their own urges to compete unnecessarily, and they utilize empathy to recognize urges in others to compete unnecessarily. Emotionally intelligent people are skilled in emotional regulation and in deescalating techniques when unnecessary urges to compete are felt.

Endnote

Thank you for reading this post. If you are new to the details of emotional intelligence, even this little introduction may require a repeated reading. I have read Goleman’s book three times (as mentioned above) and discovered new insights each time. I wonder how many more await me on another reading. I very much welcome your comments. Another post will follow soon on dialectical behavior therapy.

Best regards,