DBT Skills Groups at Charlie Health: What They Are and How They Help

Dialectical behavior therapy (DBT) is a type of talk therapy with decades of evidence backing it up. One critical component of it, DBT skills, is so effective that it proves helpful even beyond traditional DBT treatment.

Charlie Health’s virtual Intensive Outpatient Program (IOP) weaves DBT skills throughout every client’s personalized care plan. Here’s what you need to know about DBT skills groups, how they show up in our IOP, and how they can help young people with various mental health challenges.

First things first: What is DBT?

DBT is a modular form of mental health treatment that’s typically conducted through a combination of individual therapy, skills groups, telephone coaching, and a consultation care team. DBT takes place in several parts because, according to the founder, psychologist Marsha Linehan, problem-solving daily issues and building new skills requires more than a typical 60-minute talk therapy session.

The “dialectical” in DBT refers to holding space for two opposing thoughts at the same time. In DBT, an important dialectic is acceptance and change. This could look like a thought along the lines of, “I know that I have made mistakes, but they don’t make me a bad person. I want to do better.”

DBT was designed to support people struggling to regulate their emotions because of past trauma and present mental health challenges. By holding space to understand and balance opposing thoughts, people can avoid black-and-white thinking and other unhelpful thought patterns that make it harder to sit with distressing emotions.

What are DBT skills?

Learning DBT skills enables people with mental health challenges to develop new skills in place of unhelpful behaviors or patterns in response to intense emotions and emotional distress. There are four main skills that are taught in DBT:

1. Mindfulness

Mindfulness, which is the practice of being aware and present in the moment, is a core component of DBT skills. DBT mindfulness skills can include:

• The “wise mind”: The built-in wisdom we all have.
• Observing: The ability to observe emotional responses.
• Describing: The ability to objectively describe emotional responses.
• Non-judgmentalness: The ability to refrain from labeling emotional responses, people, or things as good or bad.

When mindfulness skills are strengthened, people can observe and accept what they’re feeling and allow full awareness and presence in the moment to reduce the severity of intense emotions.

2. Distress tolerance

Distress tolerance skills help people manage and self-soothe the discomfort of distressing situations rather than changing it or engaging in unwanted behaviors (e.g., self-harm, substance use).

Examples of DBT distress tolerance techniques include:

• TIP(P): A technique involving changing temperature (T), engaging in intense exercise (I), using paced breathing (P), and doing paired muscle relaxation (P).
• STOP: A technique involving stopping (S), taking a step back (T), observing (O), and proceeding mindfully (P).
• Body-scan meditation: A mindful practice of scanning the body, releasing tension, and relaxing muscles. 
• Radical acceptance: Practicing complete and total acceptance of the self, others, and situations.

3. Interpersonal effectiveness

Interpersonal effectiveness skills help people deal with interpersonal conflict, build new friendships, and end ones that aren’t serving them. 

Examples of DBT interpersonal effectiveness skills include:

• DEAR MAN: A technique involving describing (D), expressing (E), asserting (A), reinforcing (R), practicing mindfulness (M), appearing confident (A), and negotiating (N).
• GIVE: A technique involving being gentle (G), showing interest (I), validating (V), and using an easy manner (E).
• FAST: A technique involving being fair (F), apologizing (A), sticking to values (S), and being truthful (T). 
• Walking the middle path: Finding the balance between two polar opposites (dialectics).

4. Emotional regulation

Emotional regulation skills help people manage their emotions before they become too intense or lead to unwanted behaviors. In DBT, emotions are understood as brief, involuntary, impactful to the whole system, and patterned.

Examples of DBT emotional regulation skills include:

• ABC: A technique involving accumulating positive emotions (A), building mastery (B), and coping ahead of time (C).
• PLEASE: A technique involving treating physical illness (PL), eating balanced meals (E), avoiding mood-altering substances (A), getting enough sleep (S), and getting regular exercise (E).
• Pleasant events: Listing pleasant activities for reference.
• Emotion diaries: Keeping track of emotional responses and what triggers them.

What are DBT skills groups?

As its name suggests, DBT skills groups are dedicated to learning DBT skills. DBT skills groups incorporate handouts and homework to help people practice the skills in their daily lives. Even separate from the comprehensive DBT protocol, DBT skills training has been shown to be an effective treatment when combined with other therapeutic modalities.

At Charlie Health, DBT skill-building is a part of our IOP supported groups, so all clients are able to engage in and benefit from it. When helpful, Charlie Health clinicians also bring DBT skill-building into the individual and family therapy aspects of care.

Charlie Health also offers opt-in skills-based family support groups, including a DBT skills group that mirrors the DBT skills curriculum clients receive.

How can DBT skills groups be helpful for young people?

DBT was first developed by Linehan in the 1980s to support people who had been diagnosed with borderline personality disorder (BPD) and experienced suicidality. 

However, because DBT is especially helpful for emotional dysregulation and suicidality, it has since been adapted for treating additional mental health conditions often marked by the same features, including:

• Anxiety
• Bipolar disorders
• Depression
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Self-harm
• Substance use disorders
• Suicidal behavior

The Charlie Health clinical team credits the inclusion of DBT skills groups as one of the reasons our clients see positive mental health outcomes. A peer-reviewed study published in the Journal of Medical Internet Research showed that Charlie Health clients reported a 58% reduction in self-harm, a 60% reduction in depression symptoms, and a 71% reduction in suicidal ideation.

DBT skills groups at Charlie Health

Charlie Health’s IOP combines DBT skills groups with a range of evidence-based therapeutic modalities through individual therapy, family therapy, and supported groups with peers. Every Charlie Health client can learn and practice DBT skills as part of our high-touch, fully virtual program—flexibly scheduled to fit within your teen or young adult’s schedule.

Do you think Charlie Health might be right for your teen or young adult? Get in touch today. We’re available 24/7, 365 days a year to support you.