DBT: Improve Stability and Satisfaction in Relationships

Dialectical behavior therapy (DBT) is the “gold standard” treatment for borderline personality disorder (BPD), with accumulating evidence that DBT is also effective for a range of mental health difficulties with underlying emotion dysregulation. Although only one to two percent of the general population likely meets criteria for BPD, many individuals have difficulties regulating their emotions and maintaining interpersonal relationships. Alan Fruzzetti, director of the DBT research program at the University of Nevada, Reno, also notes that while a large portion of the population does not meet criteria for BPD, many individuals currently have a borderline relationship.

Importantly, a borderline relationship is not a relationship with a person with BPD. Instead, a borderline relationship is an unstable relationship whereby there is intense emotion dysregulation, invalidation, and inaccurate expression of emotion. Individuals do not need to meet criteria for any mental health difficulty to be involved in a borderline relationship. If you or a loved one feels stuck in a borderline relationship, DBT skills can be incredibly beneficial toward generating relationship stability and satisfaction. In this specific blog post, each DBT skill module will be linked to relationship stability and satisfaction.

Distress tolerance skills focus on managing crisis situations and tolerating pain without making things worse.

Have you ever felt completely overwhelmed? Perhaps, you had a morning where your child puked, you received an extra bill, and your boss gave you a negative review. When humans are overwhelmed, it can be extremely difficult to prevent oneself from engaging in problematic behavior (e.g., yelling accusation, hitting) toward the people who are closest to us. Distress tolerance is the key to learning how to not make a relationship more negative than it already feels like in the moment.

Distress tolerance teaches people how to stop themselves and manage their own crisis situations prior to generating a conflict with another individual. Distress tolerance also teaches people how to work with reality, instead of against reality, to accomplish what is needed in the moment. Through radical acceptance, the puke, the bill, and the boss can be tolerated as they are, so each respective task can be addressed. Learning how to tolerate distress is better than intense conflicts of emotion dysregulation, increasing relationship stability.

Emotion regulation skills provide people with a comprehensive understanding of when to stay with emotions and proceed with urges, and when to alter emotional states and act opposite to urges.

When the crisis is under control, often people are still left with the day-to-day shame, guilt, envy, sadness, anger, and other uncomfortable emotions that are tough to manage.  Emotion regulation skills also teach people how to build positive emotions and decrease the chances that uncomfortable emotions will arise as frequently or as intensely. People’s ability to manage day-to-day emotions is largely tied to relationship stability and satisfaction. If a loved one is going to be helpful to you when you feel guilt, the loved one will, at a minimum, need you to be able to identify that guilt is what you are experiencing. On another note, if you feel sad, but you convey anger to other people, other individuals will not respond constructively to your emotional experiences.

Finally, the ability to generate positive emotions of love, joy, and pleasure have a huge impact on relationship satisfaction. You may have heard psychologist and marriage specialist John Gottman say that for every negative interaction, relationships need five (or more) positive interactions. The magnitude of this ratio is not trivial. This is behaviorist science at play. Too much negativity pulls people apart.

In order to use emotion regulation or distress tolerance skills, DBT introduces mindfulness as a core skill.

As you may know from the popular press, mindfulness is nonjudgmental, purposeful attending to the present moment. There are also other layers to mindfulness. Mindfulness involves doing one thing at a time, acting with effectiveness rather than forcing reality to be different than it is, and being specific and factual rather than adding judgmental labels to reality. With nonjudgmental mindfulness, the term nonjudgmental is used in a very specific way, rather than the way this term is often used colloquially. This refers to avoiding labels, generalizations, and unproductive negative evaluations, for example: saying that the fruit is spoiled, rather than the fruit went bad.

Translated to close relationships, mindful people have awareness of how they are feeling and what they are saying. They pay close attention to other people’s facial expressions and describe them nonjudgmentally. For Example they say, my partner opened the door, appeared angry, shouted, my heart palpitations increased, I removed myself, and returned in five minutes. With mindfulness, it is as if one can slow down time in the heat of an intense conflict to be able to communicate what is needed. Conversely, when engaged fully and attentively in an activity that is loved, time flies by, and these are some of the greatest moments that life brings.

Finally, DBT has a skills module that applies directly to relationships: interpersonal effectiveness.

Interpersonal skills in DBT, like all the other skills, are very practical and behaviorist. Although there have been many theories of how to navigate relationships, Dr. Marsha Linehan, who designed DBT, was interested in practical skills that work. Interpersonal effectiveness teaches people how to balance asking for what they want and need in relationships, with keeping one’s own self-respect in the relationship, and maintaining the relationship over time. In other words, how to balance asking your loved one to give you a ride because your car broke down, with feeling your own sense of dignity and self-worth, and keeping a positive relationship with your loved one. Interpersonal effectiveness also reviews practical aspects of building new relationships and deciding when to end or step back from a relationship. These skills are practiced through role-play and trial and error, as behavioral rehearsal is needed to learn new skills, not just reading from a book.

DBT skills are incredible tools for building stability and satisfaction in relationships.

In my own life, I have used DBT skills to decrease excessive interpersonal conflict, validate other people and myself, and form satisfying relationships. One caveat to the DBT skills being beneficial for relationships is that it is important to learn the DBT skills in community and to engage in regular rehearsal. You can purchase Marsha Linehan’s DBT skills handouts and worksheets book on your own, though it is my experience that the utility of the skills also relates to the science of figuring out how to apply the skills effectively to your life. Therefore, the best option is to join a DBT skills group or to find another way to learn the skills with mentors who have expertise in behaviorist principles of managing relationship dysfunction.

In sum, we can all takes steps to be more effective in our day-to-day relationships, and each behavior makes a difference for our own personal satisfaction and by generating greater peace in the world around us. DBT skills are practical behaviorist tools to make this happen, within the context of the DBT community and mentors who teach and apply the skills.

About the Author
Samuel Eshleman Latimer (he/his), Psy.D., is a clinical psychology postdoctoral fellow that specializes in dialectical behavior therapy and effective conflict management. Samuel also works to help people find relief from anxiety, trauma, and relationship distress. Samuel believes that people do not need to choose between learning effective techniques that are based on science and developing warm, genuine relationships, as both of these styles complement each other. Click Here to learn more about Samuel’s experience and therapeutic style.