In seeing many mental health conditions as disorders of emotion dysregulation, DBT is focused on emotions and how they feed ineffectual action patterns. In addition, patients typically have access to therapists between sessions for skills coaching if they are in a crisis. In individual sessions, patients review difficult situations and feelings they faced the prior week and engage in problem-solving by actively discussing ways of behaving that might have delivered a positive outcome. Patients are asked to keep a diary tracking their emotions and impulses, a tool that helps them gain awareness of their feelings, understand which situations are especially problematic for them, and use the information to gain control over their own behavior. In addition to keeping patients present-focused, it slows down emotional reactivity, affording people time to summon healthy coping skills in the midst of distressing situations. Mindfulness training is an important part of DBT. They review their own past and present experience for instances of all-or-nothing thinking, seeing everything in extremes of black or white, devoid of the nuance that is more generally the nature of life. For example, patients learn to identify when they are catastrophizing-assuming the worst will happen-in order to avoid acting as if it were the case. It helps patients recognize and challenge the varieties of distorted thinking that underlie negative feelings and prompt unproductive behavior.
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