Acceptance Based DBT
for Emotion Regulation
Sandra Georgescu, Psy. D.
Paul Holmes, Psy.D.
DBT – one of the 1st CBTs to integrate
acceptance/mindfulness and behavior
change strategies
DBT – one foot in the 2nd & another in the
3rd wave of behaviorism
DBT’s leap into the 3rd wave
The Field’s Timeline
Hayes, (2004)
DBT as Originally Packaged
Intensive Outpatient Treatment involving:
Individual Psychotherapy
Skills Training Group
Telephone Consultation
Therapists’ Consultation Group
Uncontrolled Ancillary Treatment
 Pharmacotherapy
 Acute
Inpatient Psychiatric
DBT - Stages of Treatment
Pre-treatment - Commitment, Orientation & Agreement
on Goals
Stage I - Stability, Connectedness & Safety
Stage II - Exposure & Emotional Processing of the Past
Stage III - Ordinary Happiness & Unhappiness
Stage IV - Capacity for Sustained Joy
Stage I Targets
Severe Behavioral Dyscontrol  Behavioral Control
Decrease control of contrived private
1. Life threatening behaviors
2. Therapy interfering behaviors
3. Quality of life interfering behaviors
Increase Behavioral Skills
Core Mindfulness
Distress tolerance
Emotion regulation
Interpersonal Effectiveness
Relationship Between Knowledge & Action
Become more discriminating in our actions
Contact with Consequences results
in refined knowledge
Moving Forward
Meaningless Dialectic
Data on emotion and thought suppression
Relational Frame Theory (RFT) – provides
us with a nominalist model for
understanding mind from a behavioral
Meaningless Dialectic in DBT
(content is not the
problem, just notice)
Cognitive Restructuring
(content is the problem;
evaluate & change it)
Avoidance of Private Experience
Escape from events & objects
Escape from private experience
 Thought suppression (Marcks & Woods, 2005; Bower &
Woody, 1996, Abramowitz, Tolin & Street, 2001 )
 Emotion suppression (Gross & Johns, 2003; Gross, 1998;
Gross & Levenson, 1997)
 Experiential Avoidance (Feldner, Zvolensky, Eifert & Spira,
2003; Hayes, Strosahl, Wilson, et al. 2004; Chawla & Ostafin,
Relational Frame Theory (RFT)
Language about mind was avoided in the 1st
wave & mentallistic in the 2nd wave
Rorty (1997) – when we’ve explained the
use of language in society, we’ve made
sense of the term “mind”
RFT may have provided us us with a
functional conceptualization of mind
 Mind is unidirectional – once you have it, you
got it
Acceptance Based DBT for
Emotional Regulation
Implications Individual Session
Cognitive restructuring strategies are replaced by:
 Mindfulness of thoughts, rules and stories – is this the 1st
time you’ve ever had that thought
 Willingness to experience this thought as just that, a thought
rather than whatever it may say it is (acceptance) – is it ok
to have that thought given that it’s here?
 Functional assessment of thoughts and stories is carried out
in the context of their commitment to a valued direction in
 Workability of buying thoughts (short & long-term) is the
measuring stick that helps inform choices
Private Experience
Lots of questions about it…exposure
Is it ok to have that thought…. As a thought
not as what it says it is?
If not, more questions…. About workability,
about the thought(s) in a different
context….but its always the SAME thought!
DBT & Values
In it’s original DBT proposes “life worth
living” as a direction for movement…in
treatment and in life…
No definition or process is identified for
defining what “life worth living” means…
Values on an individual basis
Utilizing the Values Living Questionnaire,
Values compass or Bulls eye to assess the
direction that people want to give to their
An anchor for commitment: conversation to
be had as part of pre-treatment; beginning
to define the areas that are meaningful and
the directions that people would like their
lives to take
ACBS Values assessment tools
Close close
In the
Developed by T. Lundgren &J.A. Dahl
….and Skills Training
Skill training modules renamed to reflect an
acceptance/ongoing life process instead of a
if/then contingency
Cognitive restructuring strategies have been
removed from all handouts & replaced with
acceptance/mindfulness consistent interventions…
 extended mindfulness practice
Valued Living has been added to Emotion
Regulation Skill Area to help extend existing
behavioral activation exercises and provide an
anchor/purpose to skill use
Skills Training
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
Skills Training
Living in the Present (Mindfulness)
 Goal - to develop an unattached awareness of
experience. It is training in perspective-taking.
 Participants are taught that one cannot control
thoughts and feelings. They can only control what
they attend to.
 Learn to be open to all things and focus only on one
 Learn to differentiate between being lost in
experience and being present in an experience.
 Learn to recognize and practice choosing in the gap
between an urge and the action typically associated
with it.
Skills Training
Living with Distress (Distress Tolerance)
 Considered more active forms of mindfulness.
 The DT activity becomes the focus of attention.
 Participants are taught to take their distressing
thoughts and feelings with them as they engage
in a DT skill.
 Learn to re-contextualizing experience.
 Learn to attend to the process of experiencing
rather than continuously evaluating the
Skills Training
Living with Emotions (Emotion Regulation)
Emotions are adaptive
Emotion is an early brain form of communication
Emotion is where your language and body meet
An emotion is an indicator of a specific way in which you
need to take care of yourself
 Skills emphasize practice identifying emotion and
lesson it is attempting to convey
 Identifying language that would help direct you towards
actions that would make certain emotions more present
e.g. meaning driven behavioral activation/exposure
Skills Training
Living with Others
 To live meaningfully will involve other people
 Practice observing your limits while honoring
the limits of others
 Being fully present non-judgmentally, validating
one’s emotions and perceptions and
communicating honestly
 Practice making requests and saying “no”

ACT-ifying DBT - Joanne Steinwachs, LCSW