DIALECTICAL THINKING

In dialectical thinking, two seemingly opposing thoughts can be true simultaneously. For example, you can be happy and sad, such as when your friend moves away because they got a better job. You are so glad they got a better job but sad they are moving away. In thinking dialectically, you begin to move into acceptance vs. change. DBT strategies are geared toward directing the client to this change. As the therapy progresses, you move away from black-and-white or split thinking (Bartsch, 2024).

CORE THEORIES AND DYSFUNCTIONS

DBT is based on what is known as the "biosocial model," which teaches emotional dysregulation and extreme emotional responses that come from a combination of biological vulnerability (being "born" more sensitive than others) and invalidating environment (abuse, neglect, etc.) In a situation where a child's emotions are ignored, belittled, or not considered necessary, defense mechanisms and dysfunctions begin to form. This leads to increased behaviors to compensate and seek out the desired and needed attention, care, and affection, ultimately leading to undesirable learned negative behaviors.

Dysfunctions are also viewed through the lens of the biosocial theory. Over the years, maladaptive dysfunctions form to create the behavioral issues that accompany borderline personality disorder. These include emotional dysregulation, such as anger outbursts and intensive reactions to seemingly minor stimuli. Impulsivity and self-destruction, such as self-harm, reckless spending, binge eating, or driving, to name a few. 

It can manifest as black-and-white or split thinking, where an individual believes everything is either "all good" or "all bad," and there is no middle ground (e.g., "You love me or you hate me."). This leads to a marked sense of identity disturbance and an intensive fear of abandonment, which leads to not trusting other individuals (e.g., a friend who does not return a text right away must hate them and is abandoning them).

Dialectical Behavioral Therapy (DBT) is a structured therapy. Unlike talk therapy or other non-directed approaches, specific tasks and goals are in mind. The following is a summary and breakdown of goals typically achieved in DBT therapy. When an individual begins DBT therapy, there are three orders in which problems are addressed: 1) Life-threatening behaviors such as suicidal ideation and self-harm, 2) Interpersonal behaviors that are impacting day-to-day relationships, and 3) quality of life issues. A client seeks to reach many goals in DBT to resolve the above concerns.

Life-Threatening Behavior Goals.

These goals include things such as impulse control, increased emotional regulation, and decreasing the frequency of negative thoughts that lead to self-harm and/or suicidal ideation or attempts. Some specific skills in this group may include ACCEPTS or TIPP and STOP (both skills from distress tolerance).

Interpersonal Behavioral Issues Goals.

Goals regarding interpersonal behavioral skills make up most of the skills learned and practiced in DBT. Specific skills in this group include DEAR-MAN and GIVE FAST. Conflict resolution, how to make and keep friends, and how to restore broken relationships are key learning points during this phase of treatment.

Quality of Life Issues.

Finally, we want to help the client "build a life worth living." We work toward helping clients set and meet realistic goals, find purpose in life, and engage in activities and behaviors that will help them maintain what they have learned. Some key components of this phase are helping the client learn to think dialectically (no more split thinking) and embrace an acceptance vs. change mindset. In other words, they can accept themselves as they are (radical acceptance) while embracing change.

The majority of DBT integrates seamlessly with the Christian worldview. Let's break down the 4 modules and how they fit in with the Christian worldview.

Module # 1- Mindfulness.

Biblical views and connection to mindfulness.

Mindfulness helps clients recognize their thoughts, feelings, and emotions and focus on the present. To link this to a Christian worldview, we focus on being present with God and resting in HIS presence.

Psalm 46:10- "Be still, and know that I am God"  (New American Standard Bible, 1971/1995)

Matthew 6:34 - "Therefore, do not worry about tomorrow, for tomorrow will worry about itself" (New American Standard Bible, 1971/1995)

Interpersonal Effectiveness Skills in DBT teach assertive (not aggressive) communication, healthy boundaries, and healthy relationships for the benefit of all involved. Likewise, the Bible, particularly Jesus himself, has a great deal to say about relationships. Loving others, putting them first, and bearing with one another get top billing.

Biblical views and connection to interpersonal effectiveness skills.

It may be best to look at interpersonal effective skills through the Bible's lens, using the "Four Principles," a set of verses that I have compiled to help reiterate Jesus's relationship blueprint.

#1- Healthy Christian relationships keep their word and mean it. Matthew 5:37 "Simply let your yes be "yes," and your no, "no.". This one is simple: say what you mean, and follow through on what you say you will do. "DEAR MAN" from DBT for assertive communication relates to this. If we look at the example of Jesus, he gave specific instructions on not mincing words. Simply put, with the DEAR MAN skill- you are able to ask or seek what you want/need without infringing on the rights or needs of others. A Biblical example is The Parable of the Two Sons (Matthew 21:28-32).

#2- Healthy Christian relationships forgive one another. Ephesians 4:32 ""Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you." (New American Standard Bible, 1971/1995). The DBT Skill of "GIVE" applies here, as Jesus was explicit that forgiveness was and is essential for healthy interpersonal relationships and that holding grudges damages us. He even modeled this for us in his prayer in Luke 22:34 (The Lord's Prayer)- "Father forgive them..."

#3 - Healthy Christian relationships confront issues directly. When Christians have problems with one another, Jesus tells us to go directly to that person and try to resolve them (New American Standard Bible, 1971/1995). In the same way, the DEAR MAN skill is beneficial for this, as it is a main tool in the interpersonal effectiveness skills toolbox for confronting others and forgiving healthier relationships. You can see an example of DEAR MAN in the videos below.

#4- Healthy Christian relationships don't repeat issues or stir up dissension. Proverbs 17:9 "Whoever covers over an offense fosters love, but whoever repeats a matter separates close friends"  (New American Standard Bible, 1971/1995). This verse works well with "FAST" from the DBT Interpersonal effectiveness skills. It is part of the larger acronym "DEAR MAN GIVE FAST." Jesus would have us not promote gossip or dissension. We can "cover over" an offense by resolving it and moving on.

Emotional Regulation is the most difficult module to work through in DBT and takes the longest. To regulate emotions, an individual must first understand and be able to name them.

Biblical views and connection to Emotional Regulation.

Proverbs 16:32 - "Better a patient person than a warrior, one with self-control than one who takes a city." (New American Standard Bible, 1971/1995)

Galatians 5:22-23- "But the fruit of the spirit is love, joy, peace, patience, kindness, goodness, gentleness, faithfulness, and self-control.  (New American Standard Bible, 1971/1995)

Modifying emotional regulation skills through a Biblical worldview

#1- "Opposite Action". The opposite action in DBT is when we are in emotional distress, and we choose to act the opposite of our desire. Some examples from scripture include praying for the person instead of gossiping  (New American Standard Bible, 1971/1995, Proverbs 17:9)

#2- Check the facts or how we can reduce emotional reactions. Proverbs 17:9 leads us to think twice before repeating an offense or gossiping. If we check the facts of the situation, we can prevent escalated or unnecessary conflict.