Written by Ari Rozenberg

Dialectical Behavior Therapy (DBT), in line with its roots in Zen Buddhism and Behaviorism, attends closely to the language that we use. This emphasis on language has been identified as a defining feature of “third wave” cognitive behavioral therapies of which DBT is often considered, is present in various skills in DBT and serves multiple functions. This post is going to highlight some of the main areas in which this attention to language is found.

Non-judgmental stance

In the mindfulness module, we teach the skill of taking a non-judgmental stance. This skill is practiced by putting active effort into noticing and differentiating between our interpretations and value-judgements on the one hand and the objective facts of a situation on the other. And this stance is taken pretty seriously- many DBT programs ring a bell of some sort upon a group member making a judgmental statement as a means of noticing it and redirecting the individual to rephrase the statement non-judgmentally. Some strategies taught for effective implementation of the “non-judgmentally” skill are describing only what we can observe through our physical senses, describing only the consequences of the event, and describing only our subjective reactions to the event (e.g. “I’m noticing a judgmental thought about the situation” or “I’m feeling frustrated at that person”).

In keeping with this stance, we generally speak of behavior in terms of its effectiveness or its consequences rather than in terms of it being “good” or “bad”. We might rephrase our “terrible decision” as our “ineffective decision” (effectiveness being defined relative to our goals). In line with traditional cognitive therapy, the rule of thumb here is that we want to eschew labels and extremes that don’t add substantively to the description. 

Either-Or vs. Both-And

In modeling a dialectical stance, DBT moves away from “either-or” thinking in favor of “both-and” thinking. DBT views a black-and-white thinking style as a significant mediating factor in psychopathology in general and especially in Borderline Personality Disorder (BPD). In fact, this is reflected in one of the symptoms of BPD outlined in the Diagnostic and Statistical Manual-5 of extreme vacillation between idealization and devaluation in interpersonal relationships. 

In learning to make this shift towards balanced thinking, we stress speaking in a way that is in line with the change we want to see cognitively and behaviorally. We might say “my partner is not as emotionally responsive as I would like them to be, and they are supportive in other ways”, or “I can have a disagreement with someone and still be friends with them”. The idea here is to relate to different elements of a given subject as parts of a multi-faceted, complex, and nuanced picture rather than as mutually exclusive and competing with one another. We are looking for both sides, letting go of extremes, and balancing opposites. 

Mechanistically, the linguistic tool of “both-and” is a powerful means of counteracting our brain’s natural tendency to bias our interpretations, attention and memory (i.e., “tunnel vision”) when in a state of distress. In the heat of the moment, be it at the end of an extremely stressful day at work or after an intense argument with a significant other, our habit of speaking (to ourselves and others) in a more balanced way (both-and) can be an invaluable means of down-regulating our distressing emotions and inhibiting our urges to make ineffective decisions. 

Behavioral Specificity

As a behavioral therapy, DBT stresses specificity in speaking about behaviors. It is quite common for us to refer to the behaviors of ourselves and others in vague, broad, and general terms. For example, we might describe behaviors as “out-of-control”, “weird”, “annoying”, “spiraling”, “toxic”, etc. These types of descriptions, while understandable, tend to inhibit our ability to properly analyze a sequence of events and pattern of behavior. Being “out-of-control” can translate to innumerable behaviors, and thus doesn’t help to identify what occurred and what variables influence the behavior. Understanding the particulars of the behavior/s allows us to identify patterns over time and intervene with relevant solutions and alternative responses.

Behavioral specificity is also a powerful tool in obtaining commitment and follow-through on goals. In DBT, we are encouraged to operationalize our goals and state them in concrete and tangible terms. Commitments to “getting better”, “being happier”, or “being nicer to my family”, may be rephrased as “decrease quality-of-life interfering behaviors”, “engage in novel pleasure and mastery-building activities”, and “increase use of validation skills with my family”. And while that may suffice for long-term goals (or “ultimate outcome” goals), there would need to be even further refinement for short-term goals (“instrumental outcome” goals). The idea here is that specificity is the name of the game.

Naming our Emotions

Being able to identify, name and distinguish between emotional states is in a sense the heart and soul of DBT treatment and occupies a significant amount of time. The downside here is that this skill doesn’t come naturally to a lot of people, and the upside is that once acquired, it’s like an emotion-regulation super-power. There’s a  boatload of research studies that link emotional literacy and emotional expression (also known as “affect labeling”) with significant mental health benefits. In fact, researchers in a study published in Nature recently used algorithms to analyze over a billion tweets on Twitter and found that the emotional intensity of users decreased dramatically after expressing their feeling-states with an “I feel…” tweet as evidenced by emotional-language content of tweets in the hours that preceded and followed the affect labeling. 

Mindfulness of current thoughts and emotions

A classic ingredient in psychological distress is cognitive fusion, or over-attribution of significance to our thoughts and emotions. In simple terms, we take our thoughts and emotions way too seriously. We might forget entirely that they’re simply fleeting experiences that are not concrete facts that are glued to us forever. DBT, characteristic of third wave psychotherapies and their focus on process over content, pushes us towards reversing this habit we fall into by engaging in cognitive defusion. We do this in part by being intentional in the language we use to describe our cognitions and emotions. For example, rather than “my life is so hopeless” we might rephrase that as “the thought has arisen in my mind that my life is so hopeless” or “I’m feeling a lot of hopelessness right now”. The idea here is that something as simple as our wording can influence how much distance we can get from our thoughts and emotions.

Bottom Line

TLDR: Being intentional about the language we use is a huge chunk of DBT and improving our mental health. If you want to sound like a true DBT rockstar, lean into “both-and” statements instead of “either-or” statements, start referring to behaviors in terms of “effectiveness”, cut back on calling people “toxic” and get as specific as possible with your goals and emotions.

Notes:

Barrett, L. F. (2017). How emotions are made: The secret life of the brain. Houghton Mifflin Harcourt.

Fan, R., Varol, O., Varamesh, A. et al. The minute-scale dynamics of online emotions reveal the effects of affect labeling. Nat Hum Behav 3, 92–100 (2019). 

Lieberman MD, Eisenberger NI, Crockett MJ, Tom SM, Pfeifer JH, Way BM. Putting feelings into words: affect labeling disrupts amygdala activity in response to affective stimuli.

Kircanski K, Lieberman MD, Craske MG. Feelings into words: contributions of language to exposure therapy.

Nezu, C. M., & Nezu, A. M. (Eds.). (2016). The Oxford handbook of cognitive and behavioral therapies. Oxford University Press.

Farmer, R. F., & Chapman, A. L. (2016). Behavioral interventions in cognitive behavior therapy: Practical guidance for putting theory into action (2nd ed.). American Psychological Association

Linehan, M. (2014). DBT Skills training manual. Guilford Publications.

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Publications.