DBT for Anxiety
18% of adults in the US have an anxiety disorder.
DBT is increasingly used as an effective approach for managing anxiety and related issues such as emotion regulation.
Is DBT effective for this anxiety?
The effectiveness of DBT for anxiety has been the subject of many studies and new literature has come to market about its effectiveness for reducing anxiety. This is no surprise considering that DBT was originally developed with a focus on emotion regulation which is closely tied to one's ability to manage anxiety. That said, at The DBT Center of Marin we offer Informed DBT which means that your therapist may integrate DBT with other modalities to optimally address anxiety. Such modalities are evidence-based, cognitive-behavioral interventions specifically for the treatment of anxiety disorders.
What are anxiety disorders?
Anxiety disorders are characterized by significant or ongoing feelings of fear or anxiety to real or perceived challenges in your life. Common symptoms can include; excessive worry, restlessness, rumination, panic attacks, avoidance of people, places and/or situations, disturbed sleep, physical symptoms (headaches, stomachaches, nausea, other sensations), irritability, difficulty concentrating. Anxiety can be mild or debilitating and harm your quality of life.
How does DBT support this diagnosis?
Extreme feelings of fear and anxiety are distressing and often result in unwanted symptoms, behaviors, and consequences. DBT can help clients learn to tolerate intense feelings, modify ineffective behaviors, and reduce symptoms of anxiety. Through individual weekly psychotherapy, skills groups, and phone coaching, DBT provides clients with skills to better tolerate extreme emotions; and guidance on how to apply these skills to the unique situations in their lives. The result is an ability to manage worry, fear, rumination, panic attacks, and other symptoms of anxiety that get in the way of living life to the fullest.
Do you have anxiety?
Recommended Reading
Which DBT modules are most relevant for anxiety?
Learn how to manage symptoms of anxiety through the 4 components of DBT: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.
1) Mindfulness: Learn how to be truly present.
Mindfulness skills teach you how to be grounded to the present moment, and focus on your current situations. This is especially useful for those who struggle with rumination and excessive worry about future or past events. By being grounded in the present, you are better able to effectively deal with current circumstances, and cope ahead for future stressors.
2) Emotion Regulation: Learn to manage, change, and accept the different emotions, so that your emotions don’t control you.
Mild or excessive anxiety can be paralyzing, causing you to miss out on important events, act in ways you don’t like or even regret, and even make you feel controlled by your emotions. DBT teaches Emotion Regulation skills to stop unwanted emotions from starting in the first place, regulate or change such emotions once they start, and learn to accept and become comfortable with unavoidable emotions.
3) Distress Tolerance: Learn to tolerate painful emotions and situations that seem unbearable, and avoid behavior that can make things worse.
Fear and anxiety are powerful emotions that can often seem unbearable or intolerable. Distress Tolerance offers tangible skills to use in place of unhealthy or destructive behaviors that can make things worse. The Distress Tolerance skill Radical Acceptance can help you learn to better tolerate panic provoking thoughts. Radical Acceptance, as opposed to fighting reality or ruminating on why and how something should be different, can have a transformative effect on those who tend to replay situations over and over in the false belief that understanding a situation better can lead to change. Too often, this rumination only leads to more anxiety and panic.
Distress Tolerance skills also focus on self-soothe techniques to develop a better ability to tune into the five senses and tune out worry and rumination. Such techniques lead to an increased ability to tolerate future anxieties and cope with the aftereffects of upsetting events.
4) Interpersonal Effectiveness: Learn to communicate with others in respectful ways while maintaining healthy boundaries and upholding positive self-respect.
For those struggling with anxiety, worry around social interaction can be a common source of distress. Sometimes even the act of asking for what you want and saying no to what you don’t want can prompt tremendous worry, fear, or avoidance. Feelings of anxiety can even prompt you to say yes to things that you don’t want to do, disregarding your boundaries and damaging your self-respect.
Interpersonal effectiveness skills provide clear instruction on asserting what you want and need from others, building trust, upholding self-respect, strengthening positive relationships and ending destructive ones. Interpersonal Effectiveness skills also provide tools to head off problems and better resolve conflicts before they become overwhelming.
References to research that demonstrate the efficacy of the treatment for the diagnosis
1. This study found “an emphasis on the development of DBT skills and the cultivation of psychological flexibility may prove beneficial for the amelioration of anxiety symptoms.”
Webb CA, Beard C, Kertz SJ, Hsu KJ, Björgvinsson T. Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement. Behav Res Ther. 2016 Jun;81:12-20. doi: 10.1016/j.brat.2016.03.006. Epub 2016 Mar 30. PMID: 27057997; PMCID: PMC4860036
2. This study investigated which specific emotions (hostility/anger, fear, shame/guilt, and sadness) decrease during DBT, and whether comorbid depression, anxiety disorders, and PTSD moderate these outcomes. Their findings corroborate that DBT reduces several specific emotions, and comorbid PTSD and anxiety disorders may facilitate this effect for fear, shame/guilt, and sadness.
Fitzpatrick S, Bailey K, Rizvi SL. Changes in Emotions Over the Course of Dialectical Behavior Therapy and the Moderating Role of Depression, Anxiety, and Posttraumatic Stress Disorder. Behav Ther. 2020 Nov;51(6):946-957. doi: 10.1016/j.beth.2019.12.009. Epub 2019 Dec 30. PMID: 33051036.
3. This study assessed DBT skills therapy as a stand alone treatment for emotion regulation, and found that “DBT-ST is a promising treatment for emotion dysregulation for depressed and anxious transdiagnostic adults.”
Neacsiu, AD, Eberle, JW, Kramer, R, Wiesmann, T, & Linehan, MM. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial.