DBT for Anxiety: 4 DBT Techniques to Cope With Anxiety

What Is Anxiety?

Everyone gets worried from time to time, but an anxiety disorder refers to a chronic pattern of anxiety that impacts functioning and causes distress. Research shows that over 40 million adults in the U.S. (approximately 1 in 5 people) have an anxiety disorder, such as generalized anxiety disorder, social anxiety disorder, panic disorder, or a specific phobia.¹

Common symptoms of anxiety include:

• Increased heart rate
• Feelings of dread or doom
• Sweating or feeling hot
• Sleep problems
• Appetite changes
• Discomfort in social situations
• Chest tightness
• Sense of hypervigilance
• Muscle aches or tension
• Panic attacks
• Feeling lightheaded or dizzy
• Sense of restlessness

What Is Dialectical Behavior Therapy (DBT)?

DBT is a specific modality of talk therapy that was originally developed for treating borderline personality disorder. It has roots in both cognitive-behavioral therapy and mindfulness. However, many therapists use some or all of this modality to support clients experiencing anxiety and other challenging emotions.² DBT can also treat depression, which commonly co-occurs in individuals dealing with anxiety. Today, it is adapted in both individual and group therapy formats.

Dialectic refers to ‘opposites,’ and this theory works by helping people combine and integrate opposing ideas. This promotes a sense of acceptance and self-empowerment. It can also support changing unwanted behaviors and making better prosocial choices. People who practice DBT can learn how to understand their anxious thoughts and cope with them effectively.

How DBT Works for Anxiety

Untreated anxiety can often feel frustrating and distracting. In some cases, it can be extremely debilitating and affect one’s relationships, self-esteem, and functioning. DBT techniques for anxiety offer guidance and supportive treatment. Therapy works by helping clients recognize their triggers, choose appropriate coping strategies, and practice more mindfulness and acceptance. The goal isn’t to cure or eliminate anxiety, instead, people learn how to better manage their symptoms.

How Effective is DBT for Anxiety?

Research shows that DBT can be effective for anxiety, with one study showing that DBT led to improved outcomes in executive function and reduced symptoms of anxiety and depression in people with generalized anxiety disorder.³ Another study showed that DBT was associated with reduced anxiety in medical students during the COVID-19 pandemic.⁴ Radically-Open (RO) DBT is sometimes used successfully for patients with treatment resistant anxiety.

That said, there aren’t many specific studies examining DBT on various types of anxiety disorders. For example, research consistently shows that exposure and response prevention (ERP) is the gold standard of treatment for specific phobias. It’s likely that DBT is best for people who want to feel more empowered with their emotions and in control of their responses.

DBT Vs. CBT for Anxiety

DBT for anxiety is an offshoot of cognitive behavior therapy (CBT) for anxiety. Many therapists implement concepts from CBT and DBT modalities in their treatment process. CBT focuses more on changing negative thoughts (i.e. reframing the anxious situation) whereas DBT focuses on accepting negative thoughts, embracing them, and releasing them. DBT also emphasizes social connectivity and emotional regulation.

What Anxiety Disorders Can DBT Treat?

There are several types of anxiety disorders. The majority of research has focused on DBT treating generalized anxiety disorder, the most common anxiety disorder. However, therapists trained in DBT can apply these principles and interventions to all types of anxious symptoms.  It’s also recommended for people who wish to change how they cope with anxiety (i.e. self-harm, substance use, disordered eating).

DBT is effective in treating anxiety disorders like:

• Generalized anxiety disorder
• Social anxiety disorder
• Panic disorder
• Separation anxiety disorder

4 DBT Techniques to Cope With Anxiety

Comprehensive DBT consists of education and interventions from the four different modules. The goal of DBT is to help people learn how to better regulate their emotions and tolerate distress. DBT is transdiagnostic with techniques that can help people experiencing various physical and emotional anxiety symptoms. In treatment, clients learn how to simultaneously accept certain outcomes while changing other ones.⁵

Here are the four components of DBT and how they help people cope with anxiety:

1. Mindfulness

Anxiety often refers to a sense of panic about what’s to come. There’s a fear something bad will happen, and the body and mind react to that fear. Mindfulness for anxiety entails an awareness of the present moment. Being more mindful can help you avoid ruminating on the past or obsessing about the future. It can also support greater gratitude and a sense of purpose.

DBT introduces many mindfulness skills, including the ‘Wise Mind’ which refers to a blended state of one’s rational, reasonable mind and one’s mood-dependent, emotion mind. Being in ‘Wise Mind’ often allows people to feel more present and calm. Other mindfulness techniques may include observing physical sensations, noticing breath, doing single tasks at a time, and engaging in meditation practices.

2. Emotional Regulation

Everyone experiences fluctuating emotions, but people with anxiety struggle to regulate their fear and worry. Anxiety can feel like a consuming emotional state, which can affect your physical and mental health.  Learning emotional regulation includes identifying emotions, coping with the intensity of difficult emotions, and detaching from excessive emotional suffering. This work can reduce and stabilize anxiety symptoms.

DBT introduces several acronyms for emotional regulation. For example, the S.T.O.P skill consists of ‘stop, take a break, observe, and proceed mindfully. A.B.C. Please focuses on accumulating pleasant emotions by doing pleasant things, building mastery, and coping ahead to prepare for difficult situations. Opposite action encourages people to respond differently than they normally would to an emotion.

3. Interpersonal Effectiveness

Anxiety can be a social problem, and someone with anxiety may struggle to set boundaries, form friendships, assert their needs, or enjoy interactions with others. The interpersonal effectiveness module in DBT focuses on understanding triggers and practicing new ways to strengthen connections with others. This, in turn, can result in reduced anxiety and improved self-confidence.

One of the most popular interpersonal effectiveness skills in DBT is D.E.A.R M.A.N, which stands for describe (the situation), express (your feelings), assert (what you want), reinforce (reward the person for respecting your needs/wants), mindful (stay focused on your specific goal or boundary), appear (confident and competent), and negotiate (be open to compromise).

4. Distress Tolerance

Many people with anxiety struggle to tolerate uncertainty, which can cause significant distress in daily life. Distress tolerance refers to the ability to manage negative emotions effectively. This can help when you feel overwhelmed or tempted to engage in harmful coping strategies. Distress tolerance isn’t about getting rid of the stressful situation- it’s about handling it without making it worse.

In DBT, distress tolerance can include T.I.P.P (tip the temperature, intense exercise, paced breathing, paired muscle relaxation). These physical interventions can help reduce extreme anxiety rapidly. Therapists will also often explore the cost-benefit analysis, where you assess the risks and benefits of engaging in a certain behavior. In addition, radical acceptance can be a significant part of distress tolerance.

What Are DBT Sessions Like?

Individual therapy sessions are typically around 45-60 minutes with a therapist trained in DBT. Crisis issues, such as suicidal ideation or self-harm behaviors, are treated first. Then, it’s important to address and reduce the distress associated with anxiety. DBT therapists work with diary cards that track emotions and behavioral patterns as homework. You will be instructed to fill the cards out and review them in sessions.

How to Find DBT Treatment for Anxiety

If you are interested in seeking DBT for anxiety, it’s important to find a DBT therapist for your needs. A therapist professionally certified in DBT has the highest knowledge of the model with a demonstration of clinical excellence. Insurance may cover therapy sessions, and it’s important to review mental health options with your individual healthcare provider.

Therapists may offer both in-person and online DBT. You can use an online therapist directory to look for a professional near you. Keep in mind that wraparound DBT programs generally offer skills training groups, individual therapy, a consultation team, and DBT phone coaching. These programs can be beneficial for people experiencing significant mental health distress or co-occurring disorders. Some therapists may also recommend finding a psychiatrist as part of your care team to provide anxiety medication management.

In My Experience

It’s important to note that, although anxiety is not curable, it can be managed. Many people with anxiety learn how to accept their fears and still live productively and meaningfully. DBT offers the ability to integrate this acceptance along with making adaptive changes that can improve your relationships, self-esteem, and ability to cope.