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The four facets of dialectical behavioral therapy that can help you establish more productive routines


By Laura J. Petracek, PhD, LCSW

Adapted from The DBT Workbook for Alcohol and Drug Addiction: Skills and Strategies for Emotional Regulation, Recovery, and Relapse Prevention by Laura J. Petracek, Ph.D., LCSW


In 1979, just shy of three years sober, my emotions began to unravel. I was dealing with depression and crying every day. I was very fortunate to have sober women in my life, including my sponsor, who lovingly and without judgment encouraged me to seek outside help. I took their advice and was eventually diagnosed with a manic depressive illness (which today is called bipolar disorder). I was able to find a combination of medications that helped to reduce symptoms of mania and alleviate my depression.


More than 30 years later, I experiences another difficult patch. Issues at work combined with a freshly empty nest made me very vulnerable to the emotional dysregulation that came with my diagnosis. Emotional dysregulation is a term used to describe an emotional response that is poorly regulated and does not fall within the traditionally accepted range of emotional reaction to a situation or scenario. Colloquially, society has often unkindly referred to these behaviors as “mood swings.”


After many failed medication changes and therapeutic treatments, my psychologist recommended Dialectical Behavior Therapy or DBT. DBT is a combination of cognitive, behavioral, and mindfulness therapy. The goal of DBT is to change negative thinking patterns and destructive behaviors into ones with positive outcomes. DBT effectively helps people regulate their emotions, build self-management skills, and reduce anxiety and stress. DBT is a research-based way to establish coping mechanisms to implement in environments that may elicit old, destructive substance abuse patterns.


For some, this could be addictive behaviors – my specialty in my practice and the subject of my books – but it can also be applied to behaviors or habits we want to change to become healthier, happier, and more productive. From eating habits to our morning routine, the four facets of DBT can help us reach our goals.




Mindfulness skills include being in touch with your own feelings and those around you and furthering acceptance of self and others. One way of becoming aware of yourself is to remain present in the moment and to focus on your immediate feelings, thoughts, and behaviors.


Mindfulness refers to bringing one’s attention to the here and now. Mindfulness is when you realize your thoughts are “somewhere else,” and return to your breath. Maybe you visualize your breath in the body, count your breaths, or use a breathing technique like “block breathing.” It involves recognizing and observing your feelings. Like shining a warm, soft light, it is compassionate and nonjudgmental. By being in the here and now, you can attend to thoughts, feelings, and behaviors without emotional dysregulation. Mindfulness is a valuable tool that helps you make thoughtful decisions.


Honest and Effective Communication


The quality of our relationships influences our well-being and our sense of self-esteem, our self-confidence, and our very understanding of who we are. Two critical components of honest and effective communication are asking for things and saying “no” to requests when appropriate. Factors to consider when asking for something or saying “no” are:

  • Priorities: Is your “ask” or need very important to your mental health and well-being? Be more insistent about your request, or more firm about your “no.”

  • Relationship: Are you feeling like your relationship with someone is weak, tenuous, fragile, or injured? Consider lessening the intensity and number of your requests, or finding a compromise instead of issuing a straight “no.”

  • Self-respect: Is your self-image or self-esteem on the line? Make your requests known, and establish and hold boundaries.


Emotional Regulation


Emotional regulation as a skillset focuses on understanding the source of our emotions and reactions and applying specific skills to manage them instead of being controlled by them. These skills focus on lessening our vulnerability to negative emotions and reframing them as positive emotional experiences. We can take it skill by skill to strengthen our foundation of emotional intelligence to tackle and handle painful feelings and to help foster positive ones.


Emotion regulation skills include:

  • Letting things go

  • Wearing the world like a loose garment - to perceive things as something the world and life will always press at us and around us, but do not have to touch us but “lightly”. Most things are either outside our control or ultimately unimportant.

  • Incorporating positivity into our lives.


Tolerating pain and distress


At some point, we all have to deal with pain and distress. Our pain can feel overwhelming at times. When we’re in emotional pain, the dimensions of time disappear. There are two types of distress tolerance skills: crisis survival skills involve learning how to ride out an overwhelming situation and; reality acceptance which helps us de-escalate our emotional response by accepting life as it is.


Pain tolerance skills us navigate through a challenging situation without making things worse. Here are some examples of crisis survival skills:

  • Distancing yourself from a situation

  • Distracting yourself with other activities

  • Self-soothing behaviors

  • Thinking your reaction through, imagining you did lose your cool or choose a negative coping mechanism

  • Breathing and muscle relaxation


Accepting the reality of a situation can help us respond more appropriately and productively. When we fight the reality of a situation, we only make it worse. Denial is a very common defense mechanism that we can all work on reducing. Some skills for this include:

  • Turning the mind: Noticing or observing that you're not accepting something, committing to yourself to accept reality as it is, and repeating those steps as many times as it takes.This helps distract you and deal with issues without avoidance.

  • Willingness: In DBT, willingness refers to recognizing the reality of the situation and being an effective problem-solver. It is the opposite of fighting what is happening and refusing to tolerate the facts around you.

  • Half-smile: In DBT, there is a practice called “half-smile.” When you are feeling down, sad, annoyed, upset, bored, or depressed, make the effort of a half-smile. It helps neutralize the possible escalation of these feelings.

  • Willing hands: This is a DBT concept to let go and move on. Your open hands are letting go of the pain you could otherwise be holding on to, and you’re allowing yourself to move forward without being weighed down by painful past events.


These are skills that can help us succeed in all areas of our lives. I have successfully worked in psychology and social work for over 30 years while managing my mental health and sobriety. Nobody should feel shame or self-loathing discussing mental health struggles.


For more information on these concepts and more skills, please refer to The DBT Workbook for Alcohol and Drug Addiction: Skills and Strategies for Emotional Regulation, Recovery, and Relapse Prevention.


Laura Petracek, Ph.D., LCSW is a certified DBT therapist who, as a recovering addict herself, uses her own experiences with recovery and treatment to help others. Dr. Petracek received her Master of Social Work from the Wurzweiler School of Social Work and her Ph.D. in Clinical Psychology from the California Institute of Integral Studies. She has worked in the field of psychotherapy for more than thirty years, twenty-six of which have been spent as a practicing Clinical Psychologist in California. Dr. Petracek is an LGBTQ+ member and ally. She believes that mental illness can feel like you’re in a freefall because you’ve lost control of your mind but emphasizes that it’s okay not to be okay. She is committed to providing the highest quality psychotherapy services, as a psychologist and author, that honor where individuals are on their personal growth journeys. Dr. Petracek is the author of The Anger Workbook for Women and The DBT Workbook for Alcohol and Drug Addiction.

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