DBT for Trauma: Dialectical Thinking and Distress Tolerance

Kirby-Reutter

United States Department of Homeland Security

Key Points

  1. Since people who have gone through traumatic experiences are caught at the extremes of both underthinking and overthinking, the following dialectical thinking skills help clients find more balanced thought patterns: pros and cons, dialectical synonyms, and working the TOM (thought, opposite, middle).
  2. Since people with PTSD are caught at the extremes of both underreacting and overreacting to trauma reminders and other life stressors, distress tolerance skills help clients find more balanced ways to manage their triggers.
    In particular, clients need to learn to visualize their coping skills and create a coping card, which can be either paper or electronic, as an accessible reminder for more balanced functioning.
  3. Since people who have gone through traumatic experiences are caught at the extremes of both under-feeling and over-feeling, emotion regulation skills can help clients find more balanced ways to nurture their emotions.
    The garden analogy aims to help clients understand the necessary paradigm shift away from attempting to control or coerce their emotions towards learning to cultivate healthier emotional habits.
  4. Since people with PTSD are caught at the extremes of too much aggression/independence vs too much passivity/dependence, interpersonal effectiveness skills help clients find more balanced ways to manage their relationships.
    The DEAR Adult skill helps clients learn to describe, express, empathize, assert, appreciate, and apologize in ways that reinforce the relationship through win/win thinking and use of the adult voice, which is the middle path between the parent voice vs the child’s voice.
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