Creating a Life Worth Living Through Dialectical Behavioral Therapy (DBT)

Thrive • May 25, 2022

By Thrive Wellness Reno DBT Therapist Shannon Servi, LCSW

With foundations in cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT) is typically a year-long therapeutic modality intended to help individuals learn necessary skills for reducing suffering and fostering happiness in their lives. Useful in treating complex and co-occurring conditions simultaneously, DBT addresses struggles clients have with processing and regulating their emotions. Through four types of foundational skills, DBT therapy encourages situationally effective responses. The implementation of these skills provides participants with practical and powerful tools for improving their entire life.

EMOTIONAL DYSREGULATION AND DIALECTICAL BEHAVIORAL THERAPY (DBT)

Characteristic of many different types of mental and behavioral health disorders, emotional dysregulation describes difficulties regulating emotional responses. Those with emotional dysregulation challenges may:

  • Respond to certain circumstances with seemingly unwarranted levels of emotional intensity, especially in situations evoking sadness, anger, fear, guilt, shame, and even love 
  • Become easily displaced from their emotional baseline and find it difficult to return to a more level emotional state

Emotional dysregulation can greatly impact one’s ability to function effectively, have healthy relationships, carry out daily activities, and experience joy in their life. Associated contributing factors of emotional dysregulation may be related to exposure to adverse childhood experiences (ACEs) , which include traumatic experiences of abuse or neglect in one’s early years. 

Some of the mental and behavioral health conditions emotional dysregulation are associated with include eating disorders and substance use disorders . Oftentimes, problematic behaviors such as binging and purging, restriction and avoidance of feared foods , and substance abuse are used by individuals as a way to cope with the severe emotional pain associated with emotional dysregulation. 

Developed in the 1980s by clinical psychologist Marsha Linehan, DBT was intended to treat borderline personality disorder (BPD) , as Linehan herself struggled with BPD and found that effective interventions for the condition were lacking. 

Since its development, DBT has been one of the most tested interventions and has been found to be helpful in treating many different kinds of mental and behavioral health conditions which are often contributed to by emotional dysregulation struggles. DBT is an especially effective therapeutic modality for disorders that are complex, co-occurring, and often unsuccessfully addressed by other interventions alone. One of the strengths of DBT is the flexibility built into its structure that allows providers to incorporate additional approaches such as eye movement desensitization and reprocessing (EMDR) therapy , emotionally focused therapy (EFT), and internal family systems (IFS) therapy to address complex conditions. In fact, research has found DBT to be effective at treating chronic and pervasive struggles such as persistent suicidality , self-harming behaviors , severe depression , and substance use.

DBT can be used to treat:

When creating DBT, Linehan considered what it meant to live life effectively. Drawing on this consideration, DBT establishes individuals’ commitment to healing by asking them to explore what gives their life meaning. Once an individual has some ideas about what brings them meaning, they can begin to establish goals for achieving what they believe to be a “life worth living.” Then, the method meets participants where they are by validating their suffering while simultaneously promoting positive change. DBT works to balance the principles of acceptance and growth through acknowledgment of current circumstances while also working to make meaningful changes that get individuals closer to their “life worth living” goals.  

THERAPEUTIC FORMAT OF DBT

An adherent DBT treatment program involves individual therapy, skills group therapy, diary cards, and access to therapeutic skills coaching to integrate the DBT skills into a person’s life.

  • Individual therapy: During weekly individual therapy sessions, clients work one-on-one with their therapist on creating their “life worth living.” Participants discuss any challenges and takeaways in applying the DBT skills and work towards their personal treatment goals. Therapists use clients’ diary cards as references during their individual therapy sessions.
  • Skills group therapy: During weekly skills group sessions, participants learn the four modules of DBT skills, including mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. Each module contains specific skills that clients practice applying in their everyday lives. Curriculum timelines can vary by provider and program. Thrive’s DBT skills group program lasts 16 weeks. For more specifics, be sure to ask your program’s contact.
  • Diary cards: Throughout their treatment, participants record their personal data on their diary cards. Clients identify and report behaviors that are causing problems in their lives and that they wish to change, called target behaviors. Additionally, diary cards often track emotions, internal and external circumstances that trigger their emotions, called prompting events, and skills participants have used throughout the week. By documenting this information, the therapist and client can explore behavioral patterns. The goal is to identify the function of these behaviors and establish more effective ways of responding in various situations – usually through the use of learned skills.
  • Skills coaching: Another unique aspect of DBT is access to skills coaching. While outside of therapy, clients may reach out to their therapist via phone call or text for real-time skills coaching during challenging situations. This specific element of adherent DBT programming increases the probability of practicing skills effectively outside of the group and individual sessions.  

Initial DBT treatment typically lasts one year, with participants completing a full skills group curriculum twice during that time frame.

THE FOUR DBT SKILL MODULES

While developing DBT, Linehan found that four areas are necessary for living an effective, fulfilling life. 

The four modules of DBT are:

  1. Mindfulness: Mindfulness, which encourages individuals to quiet their minds, is essential to learning and practicing DBT. When experiencing chaos and confusion, mindfulness practices can allow individuals to reconnect to the present moment, quiet negative thoughts and emotions, tune in to their body, and connect to their inner wisdom. 
  2. Interpersonal effectiveness: Black-and-white thinking associated with emotional dysregulation can create problematic volatility within relationships. Because, as humans, we are nourished by supportive, connected relationships, DBT provides skills for navigating relationships in healthy and productive ways.
  3. Emotion regulation: The emotion regulation portion of DBT focuses on reducing vulnerability to negative emotions by educating participants on how emotions function. This section also teaches individuals ways to reduce their vulnerabilities by establishing habits that support physical well-being such as practicing good sleep hygiene and nourishing their body adequately and consistently . This section also teaches strategies to accomplish their “life worth living” goals.
  4. Distress tolerance: Inevitably, everyone experiences circumstances that cause stress and suffering, so DBT teaches clients ways to accept and tolerate uncontrollable, undesirable events without engaging in behaviors that may make the situation and their own agony worse.

An extensive therapeutic course in living life effectively, DBT guides individuals in implementing the skills in ways that allow them to reach their “life worth living” goals.

HOW DBT WORKS

Intended to overcome all-or-nothing or black-and-white thinking patterns, DBT seeks to help individuals balance opposing perspectives. As participants learn the different skills and how to apply them in an effective manner, they begin to hold the seemingly conflicting principles of acceptance and change in tandem. They begin to accept themselves and uncontrollable circumstances, while also doing what they can to improve their situation and promote their overall growth and well-being. 

DBT AT THRIVE WELLNESS

Thrive Wellness offers DBT to clients struggling with emotional dysregulation resulting in a variety of problematic behaviors and disorders, including eating disorders, chronic suicidality, self-harm, substance use, severe depression, trauma, obsessive-compulsive disorder (OCD), and co-occurring conditions. If you or a loved one may be struggling with emotional dysregulation and unhealthy coping mechanisms, please reach out . Our experts are here to help you thrive mentally, emotionally, and behaviorally so you can lead a life that’s worth living and brimming with fulfillment. 

About the Author

Thrive Wellness Reno DBT Therapist Shannon Servi, LCSW

Shannon Servi completed her master’s in social work at the University of Nevada, Reno and has worked in the mental health field for over a decade, helping people heal from eating disorders. In addition, she has experience working with individuals struggling with borderline personality disorder (BPD), anxiety, depression, obsessive-compulsive disorder (OCD), bipolar disorder, substance use, and grief. Shannon predominately practices dialectical behavior therapy (DBT) and has training in cognitive behavioral therapy (CBT), exposure and response prevention (ERP), motivational interviewing, perinatal mood and anxiety disorders (PMADs), and emotionally focused family therapy (EFFT).

It is one of Shannon’s beliefs that our pasts do not have to dictate our future and we are often stronger and more resilient than we realize. Recovery is possible. Healing is possible.

Shannon is a homegrown Nevadan and enjoys sunshine, comedy, poetry, and quasi-competitive board games. And dogs. She loves dogs.

Favorite Quote:

“Everyone may not be good but there’s always something good in everyone. Never judge anyone shortly because every saint has a past and every sinner has a future.” Oscar Wilde

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By Brianna Villalpando, LMSW, LCSW March 19, 2025
Teen eating disorders are serious. As a parent or caregiver, one of the most difficult situations you can face is noticing that your teen may be struggling with a basic human need like eating. Adolescence is already a rough period for many teens filled with fluctuating emotions, changing bodies, and social pressures. However, sometimes coping with these challenges can manifest in unhealthy ways, like developing complicated relationships with food, body image, control, or exercise. Many teens face body image issues as their bodies mature, excessive pressure to meet unrealistic expectations fueled by social media and peers, and emotional instability and anxiety during their adolescent years, all of which can combine to create the perfect storm for an eating disorder. These challenges can often make your teen more vulnerable to unhealthy coping mechanisms , such as restricting food intake, excessive exercise, or engaging in disordered eating behaviors . If you’ve started noticing signs that something may not be right, it’s essential to take action to help your teen get the support they need. Recognizing the Signs of an Eating Disorder Eating disorders can vary in appearance, but there are some common signs and symptoms to watch for. If you notice any of the following behaviors or changes in your teen, it may indicate a problem that requires further attention: Preoccupation with body image : Teens with eating disorders often show increased focus on their weight or appearance, frequently expressing dissatisfaction with their body. Excessive discussions about dieting : If your teen frequently talks about dieting, food restriction, “getting skinny,” or often makes weight-related comments, this could be a red flag. Obsession with calorie counts : Teens who are obsessed with tracking every calorie, comparing the caloric content of foods, or controlling their calorie-intake may be struggling with an eating disorder. Skipping meals : Frequently skipping meals or not eating regularly is a common sign that something is wrong. Eating in isolation : Eating alone or avoiding family meals may signal discomfort with eating or shame around food. Excessive exercising : Over-exercising or using exercise as a way to purge calories can also point to an eating disorder. Spending long amounts of time in the bathroom : This could be a sign of emerging or purging behaviors, such as vomiting after meals. Hoarding foods : Hiding food or being secretive about eating may indicate issues with food control and secrecy around eating habits. Irregular periods or thinning hair : In females, a disruption in menstrual cycles or thinning hair can be physical signs of the effects of an eating disorder on the body. How Can I Talk to My Teen About Eating Disorders in a Supportive Way? Approaching a conversation about eating disorders with your child requires sensitivity and care. It's important to emphasize empathy and understanding, conveying that your primary concern is your teen's health and well-being. Initiating this conversation compassionately can create an environment of trust and openness to explore the problem. Selecting a calm, comfortable, and private setting is vital so your teen feels safe discussing a sensitive topic that may cause them to feel anxiety or shame. Effective communication hinges on using open-ended questions and active listening. Encourage your teen to share their thoughts and feelings without fear of judgment. By actively listening, you validate their experience, making them feel heard and understood. Before diving into the conversation, educating yourself about eating disorders can provide a solid foundation for discussing the issue knowledgeably. Some quick preparation with research allows you to dispel myths and provide accurate information when you talk to your teen. Why It's Crucial to Seek Medical Help When you notice warning signs, it’s important not to wait to get help. Eating disorders can be life-threatening, both physically and emotionally. They take a serious toll on a teen’s health, affecting their metabolism, hormonal function, and overall well-being. Beyond the physical impact, eating disorders can often involve deeply ingrained psychological and emotional challenges, such as low self-esteem, anxiety, depression, and trauma. After an initial conversation, the first step is to schedule an appointment with a medical provider. Your teen’s primary care doctor or a pediatrician can help evaluate their physical health and provide guidance for next steps. Be prepared to discuss the specific behaviors or signs you’ve observed, as this will help your provider better understand the situation. The doctor may conduct a physical examination, lab tests, and discuss your teen's emotional and psychological state. Building a Support Team Once you’ve taken the first step to ensure your teen’s immediate medical needs are addressed, it’s time to build a multidisciplinary treatment team . This may include: Therapists : A licensed, specially trained therapist who specializes in eating disorders or adolescent mental health can help your teen address the emotional and psychological root causes of their disorder. Medical doctors : Your teen’s doctor can monitor their physical health during the recovery process, ensuring they are safe while navigating the challenges of nourishing their body. Nutritionists or dietitians : A professional who specializes in eating disorders can create a nutrition plan tailored to your teen’s specific needs and help them rebuild a healthy relationship with food. Psychiatrists : In some cases, medication may be prescribed to address underlying mental health issues contributing to their behavior. Act Quickly and Seek Professional Guidance It’s crucial to act as soon as you recognize signs of an eating disorder in your teen. The longer eating disorders go untreated, the harder they can be to overcome. Recovery from an eating disorder is a complex journey, involving both physical and mental obstacles to tackle. It can be incredibly difficult for both the teen and the family to manage this process at home without professional support. A well coordinated team of medical providers, therapists, and eating disorder specialists is essential in guiding your teen through their recovery. This team can help monitor your teen’s progress, provide emotional support, and ensure that your teen is getting the care they need for both short and long-term recovery. Supporting Your Teen on Their Recovery Journey Eating disorders are serious, but with the right care and support, recovery is possible. If you suspect that your teen may have an eating disorder, don’t hesitate to reach out for help. Seek medical advice first, and build a support team of professionals who can work together to provide comprehensive care. Eating disorders are complex, and it’s not something you or your teen should have to face alone. Taking swift action and offering compassionate support will help your teen regain control of their health and their life so that they can thrive through their adolescence and beyond. At Thrive, we offer specialized treatment for anorexia, bulimia, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID). Our adolescent intensive outpatient and partial hospitalization programs have not only changed lives, but saved them. If you believe your teen is struggling, don't hesitate to reach out for help, we are ready to conduct a complimentary intake assessment today. To learn more about eating disorders, download our free guide "Recovery is Real" filled with practical insights and strategies to help a loved one navigate the journey toward recovery.
By Brianna Villalpando March 12, 2025
It can be difficult to know when it's time to reach out for help. We often try to manage stress, anxiety, sadness, or relationship issues on our own, thinking it’s just a phase or something we can work through to “get over.” But sometimes, these feelings or behaviors persist and can start affecting our overall mental and emotional well-being. The truth is, seeking therapy shouldn't be a last resort. Therapy is a valuable tool for anyone looking to better understand themselves, improve their emotional health, and work through life’s challenges. If you’ve been wondering whether it’s time to seek therapy, there are a few key factors to consider when performing a self-evaluation. Here are five signs that it might be time to reach out for additional support: 1. Is My Mood Affecting My Life or Relationships? One of the most telling signs that you may need support is noticing that your mood is negatively impacting your daily life or interpersonal relationships. Have you noticed an increase in conflict with friends, family, or colleagues? Are you feeling stuck in patterns of negativity that seem hard to shake? If your mood is affecting how you function at work, school, or in your personal life, it may be time to talk to a therapist. Pay attention to your behaviors; are you withdrawing from activities you usually enjoy? Are you reacting more intensely to situations than usual? If your emotional state is beginning to impact your relationships, interactions, or your ability to move through everyday life, a therapist can help you explore underlying causes and develop tools to improve your social wellness. 2. Am I Isolating Myself to Avoid Conflict? There’s a big difference between being introverted and isolating yourself as a way to avoid conflict. If you find yourself consistently pulling away from social situations, not because you need time to recharge, but because you’re avoiding uncomfortable conversations or emotional confrontations, this could be a sign of a deeper issue. It’s natural to want to avoid tension or discomfort, but consistent isolation can worsen feelings of loneliness and make it even harder to work through conflicts. Therapy can help you learn healthy coping mechanisms, problem-solving and communication skills, so you can feel more comfortable facing conflict in a productive way rather than shutting down or avoiding it at the cost of self-isolation. 3. Are My Emotions Out of Control? Do you ever feel like your emotions are so overwhelming that you can't regain control? If you're finding it difficult to calm yourself down, quiet your thoughts, or manage your feelings, this might be a sign that therapy could be helpful. Emotions like anger, disgust, fear, anxiety, or sadness are natural, but if they start taking over your thoughts and actions, it can be exhausting and difficult to complete daily tasks. A therapist can help you understand why your emotions are so intense and teach you strategies to regulate them and regain a sense of balance. 4. Have I Experienced Trauma That’s Affecting My Daily Life? Trauma comes in many forms, it could be from a single incident or from ongoing experiences that have affected your sense of safety, connection, or well-being. Sometimes, trauma is tied to experiences in childhood, but it can also be linked to recent events, like accidents, loss, or abuse. If you've experienced trauma and are struggling to perform basic daily tasks or meet your needs, therapy can be incredibly beneficial. Unresolved trauma can lead to feelings of anxiety, depression, or being stuck in past experiences. A trauma-informed therapist can help you process these experiences, understand their impact on your life, and work toward healing and recovery. 5. Am I Hurting Myself or Others? If your mood or behaviors are causing you to hurt yourself or others, it’s crucial to seek help immediately. Whether it’s through emotional or physical self-harm , or unintentionally inflicting harm on the people around you, this is a serious sign to find support from mental health professionals. A therapist can provide a safe, nonjudgmental space to talk about what you’re going through and help you work toward healthier ways of coping. If you’re in immediate danger or experiencing thoughts of self harm, it’s essential to reach out for help as soon as possible. There’s no shame in seeking support when you're struggling with harmful thoughts or actions. Why is Professional Mental Health Support Necessary? Although there may be barriers to seeking therapy, reaching out for professional mental health support is worth it to address the emotional and psychological issues that you shouldn’t have to deal with alone. Therapists have the knowledge and tools needed to guide you through your struggles, offering insights and solutions that aren’t available outside of the therapeutic setting. Their expertise promises not only a deeper understanding of your challenges, but the application of practical methods and skills to resolve them in your everyday life. Additionally, trained mental health professionals offer personalized strategies and coping mechanisms tailored to your unique situation and needs. These strategies are informed by evidence-based practices and a therapist’s experience working with and healing emotional and mental struggles. Personalized therapy helps clients receive the most relevant and effective guidance for their personal challenges. Embracing the Journey Toward Mental Wellness Recognizing that you might need support is the first step toward feeling better and getting the most out of life. Therapy isn’t just for when things are at their worst; it’s a proactive way to improve your emotional health, work through challenges, and build skills for resilience. If you relate to any of these situations, it might be time to reach out and explore therapy as an option. It’s okay to need help, and you don’t have to navigate this journey alone. If you’re unsure whether therapy is right for you, consider talking to a mental health professional to discuss your concerns and explore specialized support options available to you. You deserve to feel your best, and therapy can be a stepping stone to help you reach your goals. Are you in need of support? At Thrive Wellness, we offer personalized therapy and treatment to support you in whatever you're going through, don't be afraid to reach out for help . We also offer a FREE comprehensive guide to wellness in our “How to Thrive” guide . This guide offers practical, easy-to-follow habits that promote physical, mental, and emotional well-being. Start your journey towards a balanced and fulfilling life today with these simple yet transformative steps.
By Sage Tippie February 14, 2025
This Eating Disorders Awareness Month, we’re focusing on fighting the misinformation and stereotypes surrounding eating disorders that so often create barriers to diagnosis and treatment. Myths about eating disorders can perpetuate harmful stereotypes and keep people from receiving effective and timely treatment when they need it. It’s no secret that the field of eating disorders is riddled with misinformation, leading to confusion, stigma, and shame for those struggling. In this blog post, we'll explore the common myths about eating disorders and fight them with concrete facts in the hopes of building a more informed and educated community when it comes to these serious mental health conditions. Eating Disorder Myths Versus Facts Myth: Only those who are medically underweight have an eating disorder. Fact: Someone can have an eating disorder at any weight. In fact, less than 6% of those diagnosed with an eating disorder are medically underweight. There is even a specific diagnosis for those who are not underweight showing the symptoms of anorexia called atypical anorexia. People of all sizes are at risk for serious complications from an eating disorder, not just those that are underweight. Myth: Only women have eating disorders Fact: Although often associated with teen girls, eating disorders can affect those of any gender and age. While stereotypes and stigma surrounding eating disorders may tell us that men are not commonly affected by them, research has found that nearly 25% of those who present for eating disorder treatment are male. Keeping an open mind around who can be affected by eating disorders allows for more accurate and timely diagnosis and treatment for those who need it. Myth: Eating disorders are just about food. Facts: While eating disorders always involve an unhealthy relationship with food or body image, they also are rooted in biological, psychological and sociocultural aspects. Eating disorders cannot be treated just by changing eating behaviors, but by addressing the mental aspect of the illness as well. This is why integrated treatment involving a team of social workers, primary care specialists, therapists, and in some cases occupational therapists or psychiatrists is so crucial: a holistic approach is needed to treat all aspects of an eating disorder. Myth: Eating disorders aren’t that serious. Fact: Eating disorders are extremely serious and life-threatening mental disorders that require dedicated treatment. In fact, anorexia nervosa has the second highest mortality rate of any psychiatric disorder. By taking eating disorders and their diagnosis and treatment seriously, we can save lives. Myth: Eating disorders are a choice. Fact: Just like any other illness, eating disorders are not a choice or a phase, nor is recovery from an eating disorder just a simple decision to start eating more or less. Recovery is not dependent on willpower, but on ongoing professional treatment and long-term support. The recovery process can be lengthy and challenging, requiring patience and a supportive environment and team on your side. It is a gradual, step-by-step journey, rather than an instantaneous decision made on one person’s part. Myth: Eating disorders always involve negative body image. Fact: Avoidant/restrictive food intake disorder (ARFID) does not have to do with body image. Those with ARFID may avoid many foods because of texture, taste, color, or smell, or feared outcomes of eating like choking or vomiting. Like any other eating disorder, ARFID is serious and requires specialized treatment like exposure-response prevention therapy. Myth: Eating disorders only affect White people. Fact: Although Black, Latina/o/x/e, Indigenous/Native, and Asian people are historically underrepresented in studies of eating disorders, large-scale studies have found that rates of eating disorders are the same or higher in all racial and ethnic groups as compared to white individuals (NEDA). Removing racial stereotypes around eating disorders can help to remove barriers that BIPOC individuals commonly face when seeking treatment. Dispelling the Myths: A Path Towards Understanding By addressing and dispelling these myths, we can create a safe space that promotes understanding and empathy. Eating disorders are not choices or phases, but debilitating mental health issues that can affect anyone. Recognizing the seriousness of these disorders is so important in reducing stigma and ensuring that those who are struggling receive the care and support they require. This month and every month, we encourage you to fight misinformation and stick up for those experiencing eating disorders, because knowledge and education can be one of the greatest assets to recovery for those who need it. If you or someone you know is in need of eating disorder support, don’t be afraid to reach out , our team of healthcare professionals are here for you. To learn more about eating disorders and the journey to recovery, download our free eating disorders guide .
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