Frequently Asked Questions

With all of the many psychotherapy theories and therapies available today, it is understandable that you may never have heard of Dialectical Behavior Therapy.

• What is Dialectical Behavior Therapy?
• What new psychological coping skills does DBT offer?
• Why does this book address both anxiety and depression. Are not these two separate disorders, and very different ones at that?
• Can I really be helped with a self-help book?
• How do I know if DBT is really the approach that is best for me and my problems?
• What if I need more than this book and this approach can provide?
• Do you offer workshops to help me digest the quantity of information this book provides?
• My psychotherapist has never heard of DBT. Should I share the book with them?
• I'm a therapist interested in your professional textbook, DBT in Private Practice, but I'm a solo practitioner. Is the book relevant to my practice?

What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) is a new form of treatment that assumes that conflict between competing (and frequently contradictory) emotions, wants, demands, and expectations make feelings intense and linger beyond their usefulness. These competing needs and wants are called "dialectic conflicts" because we want to satisfy both sets of needs or wants, but because they conflict a satisfactory resolution is frequently not possible. DBT helps to identify areas of conflict. Another assumption of DBT is that invalidation of emotions (either by yourself or by others) increases the intensity of emotions. DBT helps you to accept emotions just as they are, and to form new strategies to deal with emotions such that either the environment or you change in ways that make your feelings less intense and more adaptive. Finally, DBT assumes that high emotional intensity causes us to frequently avoid or escape our emotional experiences (because they are unpleasant). Such avoidance and escape increases emotional intensity over the long run. DBT offers new psychological coping skills to replace avoidance and escape of emotional experience.

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What new psychological coping skills does DBT offer?

In order to decrease emotional avoidance and emotional escape DBT offers Mindfulness as a meditative strategy. Mindfulness increases your powers of observation, your acceptance of reality as it is, and paradoxically provides new calm and freedom. (2) DBT teaches Meaning-Making Skills. With intense emotional arousal (such as depression or anxiety), people become so focused on their emotions that they no longer attend to what is important and meaningful in their lives. Meaning-making skills helps you to refocus on what is wise and valued by you. (3) Emotion Regulation Skills help you to change or shift emotions more easily. (4) Distress Tolerance Skills help you endure feelings that cannot be changed. (5) Strategic Behavior Skills help you to be effective in every day behavior. This skill set encourages you to attend both to the environment and to your objectives, and to be strategic with your actions even when emotions are strong and urgent.

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Why does this book address both anxiety and depression. Are not these two separate disorders, and very different ones at that?

Yes, depression (or mood disorders, as psychologists and psychiatrists describe them: major depressive disorder, dysthymic disorder, bipolar disorder) and anxiety (panic, agoraphobia, phobias, social anxiety disorder, obessive-compulsive disorder, post-traumatic stress disorder, acute stress disorder, and generalized anxiety disorder) are two very different sets of problems. However, research indicates that people who are prone to any kind of depression are also prone to anxiety disorders, and patients with anxiety disorders are frequently prone to depression. Much more frequently than is recognized people suffer from a combination of symptoms from each of the two categories, rather than only one. This book and approach is designed to deal with such complexity.

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Can I really be helped with a self-help book?

That really depends. Some people, particularly those who have suffered from their symptoms for a relatively brief period of time (weeks and months, but not years) can certainly profit from the information and exercises presented in this book. If you have the patience, concentration, and dedication to actually "work" the exercises rather than simply read the book like a novel, you can substantially profit from the book. Even if you need the help of a professional coach (be it psychologist, psychiatrist, or counselor), having the strategies of this book available to you along with psychotherapy can speed the emotional recovery process. Recent reviews of the experimental literature in psychology (Scheel, Hanson, and Razzhavaikina, 2004) indicate that most psychologists provide homework assignments to their patients, and those patients who actually "work" the psychological homework improve better and faster than those who don't. This book could thus be your psychological "homework" even if you are engaged in other treatment interventions to improve your situation.

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How do I know if DBT is really the approach that is best for me and my problems?

No approach is right for everyone. There is no "one size fits all" in mental health practice. DBT is designed for people who have high emotional arousal (you feel intensely), slow return to emotional baseline (it takes you a long time to calm down once you are stressed), with high sensitivity to emotional threat (you think about and watch for what can or has gone wrong, more than having a balance between focusing on both the good and the bad). Take the quiz on page 11-13 of the book to determine if DBT is right for you.

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What if I need more than this book and this approach can provide?

It is a great sign of personality strength when people can ask for help, and when they know their own limits. Call your local psychological or psychiatric referral service and ask if anyone in your area specializes in DBT or the approach that you think is best for you.

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Do you offer workshops to help me digest the quantity of information this book provides?

Yes. First, do as many of the exercises and worksheets as you can. Obtain the services of a psychologist, psychiatrists, or counselor in your area. Work as much of the material as you can locally. Once or twice per year we offer workshops in the Monterey area for practice of the principles and strategies employed in the book. Check this website for further information on upcoming workshops.

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My psychotherapist has never heard of DBT. Should I share the book with them?

Yes! DBT is a newer form of treatment. Give them a copy of the book and invite them to read the research reviews on Mindfulness and DBT contained in this website. They then will be in a much better position to help you work the assignments and understand the DBT strategy to treatment of mixed depression and anxiety.

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I'm a therapist interested in your professional textbook, DBT in Private Practice, but I'm a solo practitioner. Is the book relevant to my practice?

Yes, DBT is a theory and technology applicable to a wide variety of disorders (including mood, anxiety, impulse control, addictions, personality, eating, and complex comorbid or mixed conditions). If you see patients in deep emotional pain, the textbook is written for private practitioners who want to use this exciting new approach with their clients.

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