Dialectical Behaviour

Therapy (DBT ) and

Acceptance and
Commitment
Therapy(ACT
Dr.Madura Gunawardana, PhD
Senior Psychologist
The word “dialectic” (in dialectical behavior therapy)
means to balance and compare two things that
appear very different or even contradictory. In
dialectical behavior therapy, the balance is between
change and acceptance
What is a Personality Disorder ?

A personality disorder refers to a long-term

pattern of thinking, behaviour and emotion
that is dysfunctional, extreme and inflexible. It
causes distress and makes it difficult to
function in everyday life. People with
personality disorders find it hard to change
their behaviour or adapt to different situations.

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Types of Personality Disorders
Cluster A personality disorders involve unusual and eccentric thinking or
behaviors. These include:

Paranoid personality disorder: The main feature of this condition is paranoia,

which is a relentless mistrust and suspicion of others without adequate reason
for suspicion. People with paranoid personality disorder often believe others are
trying to demean, harm or threaten them.

Schizoid personality disorder: This condition is marked by a consistent pattern

of detachment from and general disinterest in interpersonal relationships.
People with schizoid personality disorder have a limited range of emotions when
interacting with others.
Schizotypal personality disorder: People with this
condition display a consistent pattern of intense
discomfort with and limited need for close relationships.
Relationships may be hindered by their distorted views
of reality, superstitions and unusual behaviors.
Cluster B personality disorders involve dramatic and erratic behaviors.
People with these types of conditions display intense, unstable
emotions and impulsive behaviors. Cluster B personality disorders
include:
•Antisocial personality disorder (ASPD): People with ASPD show a
lack of respect toward others and don’t follow socially accepted norms
or rules. People with ASPD may break the law or cause physical or
emotional harm to others around them. They may refuse to take
responsibility for their behaviors and/or display disregard for the
negative consequences of their actions.
•Borderline personality disorder (BPD): This condition is marked by
difficulty with emotional regulation, resulting in low self-esteem,
mood swings, impulsive behaviors and subsequent relationship
difficulties.
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•Histrionic personality disorder: This condition is marked by
intense, unstable emotions and a distorted self-image. For people
with histrionic personality disorder, their self-esteem depends on
the approval of others and doesn’t come from a true feeling of self-
worth. They have an overwhelming desire to be noticed by others,
and may display dramatic and/or inappropriate behaviors to get
attention.
•Narcissistic personality disorder: This condition involves a
consistent pattern of perceived superiority and grandiosity, an
excessive need for praise and admiration and a lack of empathy for
others. These thoughts and behaviors often stem from low self-
esteem and a lack of self-confidence.

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Cluster C personality disorders involve severe anxiety and fear. They include:

•Avoidant personality disorder: People with this condition have chronic

feelings of inadequacy and are highly sensitive to being negatively judged by
others. Though they would like to interact with others, they tend to avoid
social interaction due to the intense fear of being rejected.

•Dependent personality disorder: This condition is marked by a constant

and excessive need to be cared for by someone else. It also involves
submissiveness, a need for constant reassurance and the inability to make
decisions. People with dependent personality disorder often become very
close to another person and spend great effort trying to please that person.
They tend to display passive and clinging behavior and have a fear of
separation.
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Obsessive-compulsive personality disorder (OCPD):
This condition is marked by a consistent and extreme
need for orderliness, perfectionism and control (with no
room for flexibility) that ultimately slows or interferes
with completing a task. It can also interfere with
relationships.
 DBT - Founder
Dialectical behaviour therapy (DBT) was developed in
the 1980s by the American psychologist Marsha Linehan,

Standard CBT as insufficient for treating chronic self-

harm and suicidal behaviours, such as those stemming
from borderline personality disorder (BPD).

Effective at helping people manageing their

overwhelming emotions. Research shows that
dialectical behavior therapy strengthens a person’s
ability to handle distress without losing control or acting
destructively.

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•DBT is Effective for …..
Borderline personality disorder (BPD).
Self-harm.
Suicidal behavior.
Post-traumatic stress disorder (PTSD).
Substance use disorder.
Eating disorders, specifically binge eating
disorder and bulimia.
Depression.
Anxiety.
 Its main goals are to teach people

1. how to live in the moment

2. Develop healthy ways to cope with stress,

3. Regulate their emotions,

4. Improve their relationships with others.

Techniques of DBT

1. Core Mindfulness
Mindfulness helps to focus on the present or "live in the moment."
and pay attention to what is happening inside someones thoughts,
feelings, sensations, and impulses) what's happening around
(what you see, hear, smell, and touch) in nonjudgmental ways.
Mindfulness skills helps to slow down and focus on using healthy
coping skills when in the midst of emotional pain. This helps to
avoid engaging in automatic negative thought patterns and
impulsive behavior.
Ex : Pay attention to the breath….inhale exhale….
Distress Tolerance

Distress tolerance skills help accept own self and current

situation.
DBT teaches several techniques for handling a crisis, including:

•Distraction
•Improving the moment
•Self-soothing
•Thinking of the pros and cons of not tolerating distress
•Radical Acceptance
Distraction –

Run up and down the stairs. If you're inside,

go outside. If you're sitting, get up and walk
around. The idea is to distract own self by
allowing the person's emotions to follow
his/her body.
IMPROVE Strategies
Imagery. By using mental visualization develop a different situation
in mind than. Envision a place that is peaceful, relaxing, and safe. This
could be a place you have visited, or one created by your own .
Meaning. finding or creating some purpose and value in the pain
that you’re experiencing can help you endure your emotions and get
through a difficult situation.
The relationship that ended? Perhaps it’s an opportunity for greater
self-awareness and reflection. In a difficult situation, try to remind
yourself of what good can come of it. Remember, when one door
closes, another one opens.
Prayer. Whether you consider yourself religious, spiritual, or follow a
different belief system, you can ask for strength from your own divine
being. This could be from a higher power, or even from yourself. This
helps yourself make effective decisions.
Relaxing Actions. Engage in an activity that you find calming and relaxing.
getting a massage, practicing yoga or meditation, or even simple skill building
like deep breathing. Engaging in a mindfulness or relaxation activity will help
you avoid ineffective or unhealthy behaviors and change how your body
responds to stress.
One thing in the moment. Focus your entire attention on one thing in the
current moment to allow yourself an opportunity for calm. Thinking about past
or future suffering only increases distress and you can miss the positive or
neutral nuances of the moment

Vacation. Allow yourself to stop dealing with the situation for a short period of
time and focus on yourself. Try to unplug and read a book for an hour, get a
coffee from your favorite café, or go for a walk and take the scenic route.
Encouragement. Talk to yourself as you would talk to a loved one who was in
crisis. Saying positive and encouraging things will increase your well-being. try
to use more encouraging words, “I can stand it, it won’t last forever, I’m doing
the best I can”.
Self Soothing – Make comfort for five Senses
1.Visual
2. Hearing
3. Smell
4.Taste
5.Touch

Thinking the Pros and Cons of Not tolerating the Distress

 Radical Acceptance
Radical Acceptance Coping Statements
“This is the way it has to be.”
“All the events have led up to now.”
“I can’t change what’s already happened.”
“It’s no use fighting the past.”
“Fighting the past only blinds me to my present.”
“The present is the only moment I have control over
“The present moment is perfect, even if I don’t like what’s happening
Radical Acceptance Exercises
Read a controversial story in the newspaper without being judgmental about
what has occurred.
next time you get caught in heavy traffic, wait without being critical.
Watch the world news on television without being critical of what’s
happening.
Listen to a news story or a political commentary on the radio without being
judgmental.
Review an unpleasant event that happened in your life—one that is not too
upsetting—and use radical acceptance to remember the event without
judging
 DISTRACT FROM SELF-DESTRUCTIVE BEHAVIORS
Instead of hurting own self, hold an ice cube in one hand and squeeze it.
The sensation from the cold ice is numbing and very distracting.
Write on yourself with a red felt-tip marker instead of cutting. Draw exactly
where you would cut. Use red paint or nail polish to make it look like you’re
bleeding. Then draw stitches with a black marker.
If you need to make it even more distracting, squeeze an ice cube in the
other hand at the same time.
Gently snap a rubber band on your wrist each time you feel like hurting
yourself.
This might cause some minor temporary pain, but it causes less permanent
damage than cutting, burning, or mutilating yourself.
Draw faces of people you hate on balloons and then pop them.
 DISTRACT YOURSELF WITH PLEASURABLE ACTIVITIES

Talk to a friend on the telephone.

Go out and visit a friend. Invite a friend to come to your home.
Text-message or email your friends.
Organize a party. Exercise. Lift weights.
Do yoga,
Stretch your muscles.
Go for a long walk in a park or someplace else that’s peaceful.
Go outside and watch the clouds.
Go jog. Ride your bike. Go for a swim. Go hiking
Interpersonal Effectiveness
Interpersonal effectiveness helps to become more assertive in a relationship ,be
able to say "no") while still keeping a relationship positive and healthy.
IT will learn to listen and communicate more effectively, deal with challenging
people, and respect yourself and others.

GIVE
Use the acronym GIVE to improve relationships and positive communication:
•Gentle. Don't attack, threaten, or judge others
•Interest. Show interest with good listening
•Validate. Recognize the importance of the other person's thoughts and feelings
•Easy. Try to have an easy attitude (smile often and be light-hearted)
Emotion Regulation

Navigate powerful feelings in a more effective way.

When you are able to recognize and cope with intense
negative emotions ( ex : anger), it reduces emotional
vulnerability and helps you have more positive emotional
experiences.

“Identify how you're feeling and do the opposite. If you are

feeling sad and want to withdraw from friends and family,
make plans to see your loved ones “
 RECOGNIZING YOUR EMOTIONS WORKSHEET

1. When did the situation happen?

2. What happened? (Describe the event.)
3. Why do you think that situation happened? (Identify the causes.)
4. How did that situation make you feel, both emotionally and physically
5. What did you want to do as a result of how you felt? (What were your
urges?)
6. What did you do and say? (What actions or behaviors did you engage in
as a result of how you felt?)
7. How did your emotions and actions affect you later?
(What short-term or long-term consequences were there as a result of
your actions?)
4 Stages of DBT
Dialectical behavior therapy is also divided into four stages of treatment:
•Stage 1: During the beginning of treatment, the most serious and
self-destructive behaviors are the first things addressed. This may
include issues such as self-injury or suicidal behaviors.
•Stage 2: Next, treatment moves on to address issues that affect a
person's quality of life, such as their interpersonal effectiveness,
emotional regulation skills, and ability to tolerate distress.

•Stage 3: The next step is to focus on issues related to self-esteem

and interpersonal relationships.
•Stage 4: At this point, treatment is focused on helping people get the
most out of their lives, including finding ways to experience greater
happiness, strengthen their relationships, and pursue their life goals.
 Acceptance and
Comitment Therapy
( ACT)
 ACT was developed in the 1980s by
psychologist Steven C. Hayes, a professor at
the University of Nevada. The ideas that
coalesced into ACT emerged from Hayes’s
own experience, particularly his history
of panic attacks. Eventually, he vowed that
he would no longer run from himself—he
would accept himself and his experiences.

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 Acceptance and Commitment Therapy (ACT)
encourages people to embrace their thoughts
and feelings rather than fighting or feeling guilty
for them.
 Six core processes of ACT

•Acceptance

•Cognitive Defusion

•Being Present

•Self as Context

•Values

•Committed Action
1.Cognitive defusion: Learning methods to reduce the tendency
to reify thoughts, images, emotions, and memories.
2.Acceptance: Allowing unwanted private experiences (thoughts, feelings and
urges) to come and go without struggling with them.
3.Contact with the present moment: Awareness of the here and now,
experienced with openness, interest, and receptiveness. (e.g., mindfulness)
4.The observing self: Accessing a transcendent sense of self, a continuity of
consciousness which is unchanging.
5.Values: Discovering what is most important to oneself.
6.Committed action: Setting goals according to values and carrying them out
responsibly, in the service of a meaningful life
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 Being Present
can be understood as the practice of being aware of the
present moment, without judging the experience. In other
words, it involves experiencing what is happening without
trying to predict or change the experience.

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Thank you