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:

Bipolar disorder (in conjunction with medication management)
BPD
Eating disorders
Depression
Self-harming behaviors
Suicidal thoughts and behavior
Substance use disorders
Obsessive-compulsive disorder (OCD)
Trauma

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:

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.
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.
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.
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

The post Creating a Life Worth Living Through Dialectical Behavioral Therapy (DBT) first appeared on Thrive Wellness.

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Breaking Down Barriers: Debunking the Most Common Eating Disorder Myths

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 .

Why Eating Disorder Awareness Matters

By Sage Tippie • February 6, 2025

Did you know that February is Eating Disorder Awareness month? Here at Thrive, we're passionate about educating our community and providing tools for eating disorder recognition while offering the specialized support and treatment that those with eating disorders deserve. Join us this month in the conversation around eating disorders and putting an end to harmful stereotypes and misinformation. Let's cover six reasons why building awareness around eating disorders is so crucial. 6 reasons why eating disorder awareness is important 1. Eating disorders are serious. Despite often being termed as a "choice" or a "phase," eating disorders are an incredibly serious psychological condition that require specialized treatment and support. Anorexia Nervosa has the second highest mortality rate of any psychiatric diagnosis in the United States, and every 52 minutes, 1 person dies as a direct consequence of an eating disorder (NEDA) . By spreading awareness and providing early intervention in eating disorder treatment, we can not only change lives, but save them. 2. Eating disorders are more common than you think. 9% of the US population will have an eating disorder at some point in their lives and 22% of children and adolescents worldwide show symptoms of disordered eating (NEDA). Since eating disorders can be challenging to detect, many go undiagnosed. Raising awareness for eating disorders and educating our community partners about their symptoms can allow us to catch eating disorders as early as possible and bring these statistics down. 3. Fight harmful eating disorder stereotypes. A common stereotype in association with eating disorders is that of the "thin, white, affluent female," however, anyone is at risk of an eating disorder despite their appearance or background. Stereotypes associated with eating disorders around weight, gender, age and race can create serious barriers to seeking care and major disparities in treatment. People experiencing an eating disorder can face challenges in seeking and receiving treatment or may feel unworthy of recovery when they don’t fit a stereotype, preventing them from gaining needed support and treatment. Promoting diversity and representation through awareness and education can help to break down the harmful stereotypes that have historically surrounded eating disorders. 4. Eating disorder recovery is not a one person job. Family and loved ones’ involvement in eating disorder treatment is crucial for recovery. Family-based therapy (FBT) has proven to be effective in 50% of patients being treated for anorexia nervosa, and is effective in the treatment of other eating disorders as well. A strong support system and steadfast relationships through the struggles associated with eating disorders can lead to more effective and long-lasting recovery. With more awareness and education, people will be better equipped to provide assistance to their loved ones in recovery. 5. You’re not alone. Eating disorders can be an isolating and painful disorder, making those experiencing it feel like they’re the only ones, or that no one understands what they’re going through. Building an informed community through awareness and education can be the first step towards diagnosis and treatment for those who need it. 6. Recovery is Real. Those with eating disorders are capable of long-term recovery through appropriate treatment. Research has found that the earlier intervention takes place in the treatment of eating disorders, the better the odds of long-term recovery are. Awareness and education around eating disorders helps the people that need support find it sooner, resulting in a repaired relationship with food and the body and a fuller life. How can I get involved in eating disorder awareness efforts? To get involved in eating disorder awareness efforts, start by educating yourself about the complexities and different types of eating disorders. By gaining a deeper understanding, you can become a more effective advocate. You can also consider participating in local or national events such as walks, trainings, or online webinars that aim to raise awareness, provide support to those affected, and offer education around eating disorders and their diagnosis. Another simple step for building awareness can be using your social media platform to share factual information, personal stories, or relevant resources that can help demystify eating disorders and reduce stigma. Additionally, supporting legislative efforts that promote mental health education and funding for eating disorder research can help in creating systemic change. By taking these steps, you can contribute to this important movement and work alongside us to foster acceptance, encourage early intervention, and ultimately save lives. Eating Disorder Treatment and Support Thrive offers a free eating disorder guide with more information about eating disorder symptoms and recovery. If you or someone you know is struggling with eating or body image, don’t be afraid to reach out to professionals for support. At Thrive Wellness, we offer a number of treatment options for all ages and genders, including a partial hospitalization program, an intensive outpatient program, outpatient therapy, occupational therapy, nutrition services, and more. Don’t wait to get started on treatment, contact us for a free eating disorder assessment today.

Alcohol and Mental Health: How Alcohol Effects Anxiety and Depression

By Thrive • January 24, 2025

You’ve probably heard of “Dry January” or are even participating yourself. More and more people seem to be experimenting with or embracing sobriety from alcohol, but what benefits are there from abstaining? In this article, we’ll explore alcohol’s effects on mental health, the symptoms of alcohol use disorder (AUD), and the benefits of cutting back on drinking. Alcohol's Effects on Mental Health Commonly consumed as a way to relax after a long day or to lighten up in social interactions, alcohol is a widely used and culturally accepted drug despite warnings of its dangers by health experts . When a person regularly drinks, it can result in a slew of complications for their physical and mental health. Although often consumed in an attempt to escape stress, sadness, or other unpleasant emotions, alcohol itself is a depressant that can contribute to negative feelings and exacerbate existing mental health conditions, especially with prolonged use. Alcohol influences thoughts, mood, and behaviors by impacting the central nervous system in a way that slows the communication between the brain and the body. Without the ability to process information effectively, the brain isn't able to regulate emotions and consider consequences effectively which may promote unhealthy behaviors, including drinking to excess. Ways that alcohol can affect cognitive functioning include: Lowering inhibitions Contributing to poor judgment Causing confusion Causing lapses in memory Disrupting sleep Contributing to shifts in mood Alcohol and Mental Disorders According to the Journal of the American Medical Association, 37% of people with alcohol use disorders also have at least one serious mental illness. Furthermore, alcohol abuse commonly occurs alongside depression and anxiety . Research has shown that those with major depressive disorder and those with generalized anxiety disorder were more likely to report life‐time moderate to severe alcohol use disorder than those without these conditions. Frequently, individuals struggling with depression or anxiety self-medicate by drinking alcohol. Although alcohol may provide temporary relief, it expends the chemicals in the brain which help ward off anxiety and depression. When the initial effects of the drug fade, individuals are typically left feeling more depressed or anxious than they did before they began drinking. Related: Eating Disorders, Substance Abuse, and Substance Abuse Disorders Alcohol Use and Depression The slowed functioning of the brain caused by alcohol can allow individuals to numb to their suffering. As such, those experiencing depression may be inclined to drink to avoid the sadness, pain, and hopelessness associated with depression. This maladaptive coping behavior is so prevalent that research shows a clear relationship between alcohol use disorder (AUD) and major depression. Using alcohol while depressed can be extremely dangerous. Not only can alcohol negatively interact with antidepressants, but it can also place individuals experiencing depression at an increased risk for suicidal thoughts and behavior . If you're experiencing suicidal thoughts or behaviors , you can reach the National Suicide Prevention Hotline at 1-800-273-TALK (8255). Alcohol Use and Anxiety According to a study on anxiety and AUD , a person with an anxiety disorder is two to three times more likely to develop an alcohol abuse disorder. When individuals with anxiety drink alcohol, they may feel an initial alleviation of their symptoms as well as a sense of euphoria. However, the symptoms of hangovers and alcohol withdrawal following heavy drinking can heighten feelings of anxiousness and interfere with ones daily obligations, contributing to even more agitation. This feeling of dread and anxiety associated with a hangover is commonly referred to as " hangxiety ," but for those with existing anxiety conditions, this side effect of drinking can feel unbearable. Individuals with anxiety may be driven to drink more to tamper their stress and re-establish the sense of euphoria, resulting in a dangerous cycle of alcohol abuse. Unhealthy Drinking Behaviors and Alcohol Use Disorder (AUD) Most who regularly drink alcohol don't have AUD, which develops when addiction is present. However, alcohol-related side-effects on mental health are still common, and they may still benefit from mental health support . Signs of unhealthy alcohol use include: Feeling a need to consume alcohol to make it through the day Feeling unable to stop consuming alcohol Progressively feeling a need to increase consumption of alcohol Drinking to prevent or alleviate symptoms of hangover or withdrawal Feeling ashamed of ones alcohol consumption Having loved ones express concern over drinking habits AUD is a condition that is often driven by genetics, abuse, trauma, or unhealthy family dynamics. Healing from AUD is possible and it can be treated with the help of mental health professionals and a dedicated treatment plan. Signs of AUD include: Alcohol use that interferes with the ability to carry out daily activities Drinking despite the behaviors adverse effects on their life Often drinking more or for a longer period of time than intended Persistent desire and unsuccessful attempts to curb alcohol use Revolving their schedule around drinking Experiencing strong cravings for alcohol Continuing to drink despite experiencing recurring illness or social issues as a result of alcohol use Giving up activities one used to enjoy in favor of drinking Using alcohol during situations where its physically hazardous to be impaired Continuing to use alcohol despite knowing that it exacerbates a known existing health condition Developing a tolerance for alcohol, or needing more alcohol to feel the same effects Experiencing alcohol withdrawal or drinking more to avoid withdrawal What are the Mental Health Benefits of Going Sober or Drinking Less Alcohol? Reducing or eliminating your alcohol consumption can lead to a variety of mental health benefits, improving your overall quality of life. When going sober or cutting back on your alcohol consumption, some of the benefits you can look forward to are: Improved mood stability, including reduced feelings of depression and anxiety Improved sleep quality Enhanced cognitive function Increased energy levels Improved concentration and productivity Increased self-esteem More authentic social interactions Improved relationships Limiting your alcohol consumption has the capability to change your life for the better, as it can help you establish a healthier mental environment, build better connections, and improve your physical health. Support for Alcohol Abuse and its Mental Health Impacts As humans, it can be uncomfortable for us to process difficult experiences and feel intense emotions. Therapy can help heal the source of your struggles driving alcohol abuse, while also guiding you in implementing healthy strategies for processing painful emotions. Through professional mental health support, you can be empowered to embrace life without having to rely on alcohol. Thrive offers outpatient therapy for substance abuse struggles in addition to other mental and behavioral health conditions. Reach out to learn more. Additional Resources SAMHSAs National Helpline : A free, confidential, and 24/7 service for individuals and families facing mental health conditions and/or substance use disorders, reachable by calling 1-800-662-HELP (4357) or texting 435748 (HELP4U). National Institute on Alcohol Abuse and Alcoholisms (NIAAA) Treatment for Alcohol Problems : A guide for individuals and their loved ones who are looking for options to address struggles with alcohol use.