Introduction to Dialectical Behavior Therapy and Codependency

In talking with our readers, we consistently hear a need for ways and techniques toward recovery. Being that codependents tend to engage in “mind-reading” and “future-telling”, combined with a lack of ability to deal with troubling emotions, Dialectical Behavior Therapy hits the mark quite well to help codependents develop the appropriate skills.

Dialectical Behavior Therapy can be extremely useful for codependents because it teaches four critically important skills: distress tolerance, mindfulness, emotion regulation, and interpersonal effectiveness.

The technique was developed in 1993 by Marsha Linehan and has been shown to help individuals handle distress without acting destructively. My sister, Jennifer, used the technique during her recovery shortly after she became aware of her codependency issue. During the initial months of many approaches to counseling and support, Jennifer maintains that DBT Therapy was one of the most effective activities to lead her toward a strong recovery.

A lot of evidence suggests that feeling intense, overwhelming emotions can be hardwired from birth; it can also be as a result of intense trauma which shapes the brain structure. Whatever the case, Dialectical Behavior Therapy can help one develop the skills needed to cope with codependency.

The Four DBT SkillsDBT Skills Workbook

Let’s look at the skills more closely. In their book, “The Dialectical Behavior Therapy Skills Workbook”, McKay, Wood and Brantley define the skills as:

  1. Distress Tolerance – to help cope better with painful events by improving resiliency and softening the effects of upsetting circumstances
  2. Mindfulness – to help experience the present moment for fully while decreasing focus on painful or frightening events from the past or future. Mindfulness also helps overcome habitual negative judgments.
  3. Emotion Regulation – to help recognize feelings and observe emotions without becoming overwhelmed, modulating feelings without destructive reactions.
  4. Interpersonal Effectiveness – to help express yourself, set boundaries, and negotiate solutions to problems while treating relationships respectfully.

To look at a practical example, let’s say a good friend of mine notifies me that she just lost her job. As a codependent, I may quickly jump to the conclusion that she needs my financial support immediately or else her world will quickly fall apart since she barely makes ends meet as it is. I become quickly overwhelmed as I imagine both of us scraping by and sacrificing to pay our bills. I didn’t deserve for this to happen to me, and I’m anxious thinking about how I’ll get through it.

Pause…

The truth is, the loss of my friend’s job has nothing to do with me; I’m by no means the center of the issue, and it’s not up to me fix it. By stopping my panic moment before it starts, I can save myself much distress and perhaps even some rash decisions.

At a very basic level, a positive next step for me would be to distract myself to snap out of the triggering moment since it could lead to a potential unhealthy series of events. Later, when I’ve calmed down and I’m thinking more clearly, I can use other skills to navigate the situation.

Here’s a video discussing how DBT can apply to your interpersonal relationships, including standing up for your rights, getting respect, refusing requests, and getting your opinion taken seriously…

In their book, McKay, Wood and Brantley offer several basic and advanced exercises for each of the four skills mentioned. Let’s take a look at some very basic exercises for the first skill – Distress Tolerance.

Basic Distress Tolerance Exercises

For Distress Tolerance, they recommend distraction, and self-soothing & relaxation techniques. The following are exercises you can practice when you reach stressful triggering moments:

Basic Distraction

Use Pleasurable Activities Such as:

    • Exercise
    • Go hiking
    • Organize a party
    • Get a massage
    • Cook your favorite dish
    • Play with your pet
    • Write a nice note to a friend or loved one
    • Pay attention to someone else
    • Do something with someone else grocery shopping, volunteer work, or house-cleaning
    • Take attention off yourself by going to the park or mall, observing the people and activities going on around you
    • Thing of someone you care about – keep a picture of them in your wallet or purse. This could be someone you care about like a spouse or family member, or someone you admire like Gandhi, Jesus, or the Dalai Lama. Take the picture out when you’re distressed and imagine a healing, peaceful conservation you would have if that person were with you.

Distract Your Thoughts:

    • Remember fun or exciting events from the passed. Try to remember as many little details as possible from those memories.
    • Look outside at the natural world and observe. Listen to the sounds and smell the smells.
    • Imagine yourself getting praise from someone that matters to you. What did you do? What did this person say about you? Why does this person’s opinion matter to you?
    • Imagine your wildest fantasy coming true. What would it be like and who else would be involved?

Basic Self-Soothing & Relaxation

Soothing the Senses

    • Burn scented candles or incense
    • Bake chocolate chip cookies
    • Buy fresh-cut flowers
    • Go to a place that’s soothing to look at, like a park or museum
    • Draw or paint a picture
    • Listen to soothing music
    • Listen to an audio book
    • Listen to a radio talk show or podcast you enjoy
    • Listen to running water, like a fountain or stream
    • Listen to a self-guided meditation
    • Cook your favorite meal
    • Chew gum
    • Take a warm bubble bath
    • Get a massage
    • Wear your most comfortable clothes and shoes

Advanced Emotion Regulation Skills

To get a little more advanced once you’ve mastered the ability to short-circuit the trigger cycle, here are some techniques you can use for Emotion Regulation:

Being Mindful of Your Emotions Without Judgement

While breathing slowly, focus your attention where you are feeling an emotion or sensation in your body. Is it in your chest, stomach, shoulders, throat? Become aware of the strength of that feeling. Is it growing or diminishing? Is it pleasant or painful? Try to name the emotion and its qualities. Now try to notice your thoughts. Do you have any thoughts or judgements about the emotion? Now imagine that each judgment is one of the following:

    • A leaf floating down a stream, around a bend and out of site
    • A computer pop-up that briefly flashes then disappears
    • One of a string of boxcars that flashes by as a train passes
    • A cloud moving across a windy sky
    • A message on a bill board that you pass quickly on the highway

Find which image works best for you, and when a judgement begins to manifest, turn it into one of these images and watch it pass away.

Realize that all emotions, feelings, and your judgements along with them are like a rising tide. They will take there turn to rise up and then pass away. Your job is to simply observe them and allow them to happen without reacting to them.

Finish the exercise with several more calm breaths.

Emotion Exposure

Take several deep breaths and notice how your breath feels as it enters your lungs and diaphragm. Notice how your body feels, particularly your chest and stomach. Now feel any sensations on your shoulders and face.

Notice your emotions, how do you feel? Keep your attention focused on that feeling and magnify it until you have a strong sense of it. Describe that exact feeling to yourself. What thoughts does it bring on? How intense is it? Feel whether or not it amplifies or dips in intensity. If the emotion were a wave, at what point would you be on – the crest, the leading edge, the bottom?

Notice any changes in the feeling. Have any new emotions appeared and intertwined into the original feeling? Just keep your attention on your feelings and continue to describe in words to yourself any changes that happen as they are happening.

You may realize that you need to block an emotion temporarily or push it away. If this happens, try and resist the urge to do so just a little longer, at least until you’ve had the chance to observe it for a few moments.

Now notice what it feels like not to act on your emotions, not to blow up or avoid them, storm out or do something destructive. Remain aware of the feeling without action. Remind yourself that as the wave passes away, that feeling like this are every-changing. Day in and day out, you experience different emotions, and none of them last forever, they are always arising and always passing away. Soon this wave of emotion, whether good or bad, will pass away soon, and you’ll experience a different emotion.

If any judgment arises – whether on yourself, someone else, or even the emotion your feeling – just notice it and then let it go. Keep watching until it diminishes completely.

Finish with a few more mindful breaths

As you become more used to focusing on your feelings, you’ll be able to practice for longer periods of time. This exercise will strengthen your mindfulness skills and increase your confidence and effectiveness.

If you’re interested in more, the full Dialectical Behavioral Therapy Skills Workbook can be found here.