Praxis Blog

DBT: Practical Skills for Everyday Living

Author: Shelly Frank, PhD

On January 20th of this year, the first COVID-19 case was confirmed in the U.S., igniting public health and economic crises beyond our imaginations and which continue to plague us. With the growing number of cases here far exceeding other countries—even at their peak contamination rates, including China and the totality of the European union—we are continually faced with innumerable uncertainties that are causing more Americans to struggle with anxiety and/or depression than any other prior point in our history (Anxiety and Depression Association of America, 2020). 

Questions like, “When can we go back to work?”, “Will I even have a job when this is over?”, and “How and when will I ever be able to date again?” are common drivers of worry, despair, stress, and even fear. 

Life can easily feel out of control, especially for individuals who are already vulnerable to mood, anxiety, and other problems related to emotion regulation deficits. Moreover, with prolonged isolation associated with social distancing guidelines, and stimulus overload from the daily media bombardment about the pandemic, it’s not surprising that clinicians are seeing a surge in mental health problems (Garfin, Silver, & Holman, 2020).

When I first taught this course at the end of 2019, my goal was simple: to help broaden non-dialectical behavior therapy (DBT) therapists’ ability to enhance their practice—and thus, their ability to help their clients—with practical skills for improving self-regulation, relationships, communication, and ability to cope with everyday stressors. With the onset and intensification of the global pandemic and, more recently, the social unrest stemming from systemic racial inequities and inexcusable loss of Black lives, DBT skills have never been more needed—not just for our clients, but for ourselves as well. 

Three things that perpetually challenge us these days, particularly related to living through a pandemic, are: 

  1. Pervasive and often overwhelming uncertainty
  2. The inherent loss of control that comes with our future being dependent on the whim of a novel virus
  3. The innumerable losses associated with our previous way of life. And this can have a high cost. 

For example, I’ve seen many patients have significant setbacks because of something as basic as the inability to go to the gym now. Exercise is a common mainstay of mood stability and stress reduction for depressed and anxious individuals, and when our daily routines are suddenly shifted and we don’t have easy access to both the structured exercise environment and the social exposure it affords us, clients can easily become depressed and start experiencing notable disruptions in basic self-care and activities of daily living. 

Similar triggers include extreme anger and shaming reactions from people who withdraw from us on the street or in a store if we are not able to stay six-feet-safe. For clients who struggle with negative schemas and various forms of avoidance—key treatment targets for trauma survivors—this can elicit a cascade of self-critical thoughts, flashbacks, and heightened fear states, all of which can contribute to mood instability and even self-harm. 

We all are faced with constant reminders of how drastically different our lives are now, compared to just a few months ago: 

  • businesses are boarded up (some permanently)
  • store shelves are empty
  • free access to activities, places, and goods is on hold indefinitely 

It’s not surprising that statistics on mental health problems are steadily rising.

Fortunately, there are things we can do to cope more effectively with the “new normal,” both for ourselves and for our clients. Something as basic as a five-minute daily mindfulness practice can help us be more present and aware so we can consciously turn toward painful emotions (rather than avoid them!) and actively choose to live within our values, despite the many challenges that now characterize our way of life. 

See also: How Avoiding Emotions Keeps Them at High Intensity

Learning how to “ride” emotional waves as we encounter triggers, rather than get hijacked by our limbic systems, can help us weather the storm—no matter how long it lasts. 

Developing “coping kits” of go-to skills and things we can do to manage distress and self-soothe can help us tolerate uncertainty, grieve the losses of pre-pandemic living, and improve our ability to self-regulate—thereby mitigating anxiety- and mood-related problems. 

Also, learning how to identify and effectively express our emotional and interpersonal needs can help us build and maintain healthier relationships, even with social distancing in place—a vital component of combating despair and building resilience to mood-related problems. Finally, all of these skills and practices combined, can lead to increased psychological flexibility, a core process underlying mental health and wellbeing (Hayes & Hofmann, 2018).

Learn DBT Skills to Help Your Clients Manage Challenging Emotions and High-stress Situations.