DBT for anxiety

When anxiety overwhelms you it can take over your ability to concentrate and harm your physical body with things like muscle tension and stomach issues. DBT, dialectical behavior therapy, treats anxiety not by trying to get rid of it entirely, because that’s impossible, but by teaching skills like mindfulness to help you better regulate it. There is a body of evidence to support that these skills can help you to both reduce the intensity of your anxiety, and accept that you will always have some of this emotion. Read on to learn about how DBT for anxiety works.

Defining anxiety

Anxiety is a healthy part of the full range of human emotions. It serves an evolutionary purpose: detecting and responding appropriately to stressors or threats kept us alive through generations. Anxiety grows problematic when it is intense or frequently felt enough to interfere with the way you want to live your life. If that’s the case for you, you are very much not alone. Many people who experience intense anxiety feel trapped by it. Fears and worries can block their pursuit of their goals and cloud their understanding of themselves and the rest of the world.

Some fears and anxieties are part of everyday life for most people, as a healthy response to a stressful or high-pressure situation. For example, you would expect to experience fear or dread around a breakup conversation or an upcoming interview. These day-to-day worries cross over the threshold for an anxiety disorder when they make you unable to have that hard conversation or bring you heart palpitations during the interview.

How can someone tell if they have anxiety?

Avoidance is one signal that you are dealing with more moderate to severe anxiety. If you find yourself avoiding certain situations or tasks, or missing out on things you enjoy because of your feelings of dread or fear, that could mean you are dealing with an anxiety disorder. 

Also, more serious anxiety tends to generate physical symptoms: muscle tension, body shaking, difficulty breathing, or faster heart rate. There is some evidence of a connection between more serious anxiety and gastrointestinal complications like irritable bowel syndrome.

The frequency of overthinking or worrying can be an indicator of serious anxiety as well. If you find yourself ruminating, or getting lost in a spiral of negative “what-ifs” every day or for hours at a time, that’s a sign as well. If you do meet the criteria for an anxiety disorder, what it is exactly that you worry about can help determine what kind of anxiety you have. If you worry about all different kinds of things or worst-case-scenarios, that is more generalized anxiety, versus having worries about other people’s perceptions of you and fearing their judgment, which is more social anxiety.

There is a growing body of evidence to say that DBT can help change the overall amount of anxiety that you experience, and can help you build acceptance of the amount of anxiety that you have. Take one study from 2017, titled “Differential Role of CBT Skills, DBT Skills and Psychological Flexibility in Predicting Depressive versus Anxiety Symptom Improvement.” Researchers at McLean Hospital, a teaching hospital at Harvard Medical School, found that “DBT skills and psychological flexibility predicted anxiety symptom change.” The greater the self-reported use of DBT skills and psychological flexibility, the greater the anxiety symptoms improved. This study involved 173 patients and 56% of them were female.

One big caveat though to whether their findings will be generalizable to you: 88% of the participants in this study were White, with only 5% identifying as African-American, 5% as Asian, 3% as Latino. Finding research that includes a larger sample size of people of color is difficult, due to system racism. This is a sound study with useful data, which is why I include it here. But I have to acknowledge this serious limitation before we move on.

DBT will not ever get ride of all of your anxiety. Be suspicious of any treatment that says it will! Again, anxiety is a healthy emotion designed to help keep you safe. What DBT does is help you learn to live with this emotion and to better regulate it.

How DBT Works for Anxiety

Full Focus Therapy is grounded in DBT, a type of behavior therapy that works to develop skills and deepen understanding in areas like mindfulness and emotion regulation. Mindfulness skills help people with anxiety notice when they are on the way to getting overwhelmed and stay with those thoughts and emotions despite the discomfort. Emotion regulation skills help you name what emotions and fears are getting triggered, decide what the next right step is in how you deal with those feelings, and then follow through on your decision. This is how you avoid getting pulled out to sea with those worries and it’s how you avoid acting on them and making your situation worse. 

Many of the skills we teach in DBT are useful for helping you regulate the emotion of anxiety. Your focus narrows down to the one scary or negative or uncomfortable thing, which your brain tells you is a threat. This can happen with internal sensations as well. Truly, anything that the brain deems threatening, such as a stern look on your partner’s face or the feeling that you are beginning to be overwhelmed, takes up everything. Entire internal and external worlds of different sensations and things to notice get blurred out.

The classic example is the student giving a presentation in class, hyperfocusing on his friends’ reaction, and losing his train of thought in the process.

Treating Anxiety with Mindfulness

The mindfulness skills from DBT come in right at that moment: they help you expand your focus back out beyond what is threatening. Using these skills properly adds back in other details, the full tapestry of your life, that you lose focus on when a threat puts your anxious mind on high alert.

As with most things in anxiety, awareness of a threat is a helpful instinct we evolved so we can stay alive a little longer, taken too far. So: back to today’s concept. The key goal of mindfulness, according to Marsha Linehan, who founded DBT, is to participate in your life with full awareness. Attentional control is one of the aims of mindfulness.

Attentional control is one of the tools in your toolbox that helps you zoom the focus back out, so that you can be aware of what else is happening in the world, beyond the threat. We’re not ignoring the stern look or the sense of doom here- we stay aware of the threat’s existence. We just zoom out the lens a little bit so that we notice what else is happening at the same time.

Take panic attacks, as an example. The threat during a panic attack is an internal one, like shortness of breath, that we interpret as a signal of threat. When anxiety narrows our focus down to only the shortness of our breath, we can convince ourselves that we cannot breathe at all, even that we are going to die. It’s overwhelming. Unless: can we zoom out, perhaps to our heartbeat, perhaps to the feeling of whatever we are wearing against our skin? Yes, there is fear, we are aware of the fear, but what about excitement or frustration as well? Can we zoom out still further, and bring awareness to the ground underneath our feet or the smell of the air conditioning? Attentional control is how we learn to make ourselves zoom out, when anxiety is screaming at us to stay hyper-zoomed in.

As you move through mindfulness, you learn strategies for how to better control what you pay attention to. This can give you back access to all of the data your anxious mind blurs out. From there, you can get some distance from the original threat. And with distance, you can sort out what your options are for how to deal with that threat, ultimately choosing the next right step.

Click here to read more about how DBT works to reduce anxiety through four modules: emotion regulation, distress tolerance, interpersonal skills, and mindfulness. And you can read more about how LGBTQ+ friendly therapy in general works to reduce anxiety symptoms and improve overall mental health.