Coping with Grief Using Dialectical Behavior Therapy (DBT)

Coping with Grief / Coping with Grief : Isabelle Siegel


Over the years, we’ve talked a lot about the different therapeutic approaches commonly used to manage grief. Despite our love for Dialectical Behavior Therapy (DBT) as a coping method for grief, we’ve never explicitly discussed the approach (although we have talked about dialectical thinking in grief, which you should definitely check out).

So what is DBT? In short, DBT is an offshoot of Cognitive Behavioral Therapy (CBT; For those of you who don’t know, CBT centers on the principle that our thoughts, feelings, and behaviors are fundamentally linked. If you’re interested in learning more about CBT, you can click here).

The CBT Triad.

Like traditional CBT, DBT focuses on change: If we can change the way we think, we can change the way we feel. However, DBT adds something new: It also focuses on acceptance: We must accept the things we cannot change. Sounds a lot like some of the stuff you’ve read here at What’s Your Grief, doesn’t it?

DBT includes four modules—Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance—each of which I could probably write an entire article about. And, on top of that, each module has a bunch of sub-skills. However, today I’ll focus on providing a general overview of DBT and how it can help you as a griever.


Mindfulness – An Accept Skill

We’ve talked a lot about mindfulness here at What’s Your Grief. According to the creator of DBT, Marsha Linehan, mindfulness is:

…the act of consciously focusing your mind in the present moment without judgment and without attachment to the moment.

Linehan, 2015

You can probably see where we’re going with this. Grief and mindfulness can sometimes seem like they’re at odds… But they don’t have to be.

When we grieve, we tend to live in the past (What if I had…?) or in the future (When will I move forward?). DBT asks us to focus on the present: to accept things as they are without judgment. Yes, that without judgment piece is crucial and, yes, it’s harder than it seems. You can read more about the importance of self-compassion here.

So what does mindfulness look like in grief? Next time you find yourself thinking “Gosh, I’ll never get through this,” try reminding yourself: “Yeah, this sucks… And I’m doing my best right now to cope.” (“And” is a key word in DBT!).


Interpersonal Effectiveness – A Change Skill

In this module, Linehan focuses on both getting what you want in relationships and nurturing relationships, all while maintaining self-respect. She uses several amazing acronyms, but today we’ll focus on the most popular: DEAR MAN.

DEAR MAN is an exercise Linehan invented to help people express their needs to others. It involves:

Describing the Situation

Expressing Feelings

Asserting Wishes

Reinforcing

(Staying) Mindful

Appearing Confident

Negotiating

So what does this look like for grievers? Well, that may depend on what your most basic grief need is. But here’s an example:

My friend just told me, “I thought you’d be over it by now” and doesn’t realize the impact it has on me. So I…

  • Describe the Situation – You expressed the belief that my grief is something I need to “get over” or “move on from.”
  • Express Feelings – This makes me feel like I’m a failure AND that you don’t respect how much this loss has affected me.
  • Assert Wishes – I would appreciate it if you refrain from making such comments.
  • Reinforce – I want you to consider how your comments will affect me before making them.

You also want to… 

  • (Stay) Mindful – Remain present and goal-oriented.
  • Appear Confident – Don’t waver in your request.
  • Negotiate – If necessary, negotiate!

Emotion Regulation – A Change Skill

According to Linehan, emotion regulation entails getting our emotions under control. Of course we can never fully control what we feel and when we feel it (and emotions are never good or bad), but Linehan provides some skills aimed at both understanding our emotions and decreasing the frequency of unpleasant ones.

We’ve talked a bit about keeping negative emotions in check before, but we love the exercises Linehan suggests to do so. There are many great ones, but today we’ll focus on just two.

  1. Check the Facts

In grief, our emotions are often motivated by our (sometimes inaccurate) interpretations of a scenario. “Check the Facts” is an exercise used to change our emotions by changing our interpretations. If that doesn’t make sense, here’s a quick example:

I feel guilty following my dog’s death.

Interpretation: I could have done more to prevent my dog’s death. If only I taken him to the vet earlier… 

Check the Facts: I did everything I could to prevent my dog’s death. In reality, he wasn’t having any symptoms that led me to think he needed to be taken earlier. Even if I had, taking him to the vet earlier would likely not have made a difference.

  1. Opposite Action

This is one of my favorite coping tools, especially for grievers. It involves acting opposite of how we feel and what our emotions are telling us to do.

While it’s sometimes healthy to wallow in grief, Opposite Action can come in handy when your grief is getting in the way of the life you want to be living. For example, if it’s been a while since your loss and you’re still turning down invites to join friends for dinner… but feelings of isolation/loneliness are starting to kick in… it may be time to challenge yourself to implement Opposite Action. Next time a friend invites you somewhere, you’ll probably feel the urge to turn them down. This time, commit to making plans and throw yourself into them.


Distress Tolerance – An Accept Skill

This is probably my favorite module of DBT, particularly for grievers. According to Linehan, distress tolerance is: 

the ability to perceive one’s environment without putting demands on it to be different; to experience one’s current emotional state without attempting to change it; and to observe one’s own thoughts and action patterns without attempting to stop or control them.

Linehan, 1993, p. 147

You can probably see right off-the-bat why this is so important in grief. When we’re grieving, we usually can’t change the situation. We can’t undo the loss, we can’t take away the pain. That means it’s time to radically accept the situation for what it is. Perhaps most importantly, it means accepting that life can be worth living even in the presence of tremendous pain.

If this is hard to buy into, that’s totally okay. DBT in general is hard work, and it takes time to get to a place where acceptance feels possible. For now, keep these skills in mind, share your thoughts in the comments, and—as always—subscribe to What’s Your Grief.

Let’s be grief friends.

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