DBT: A Good Therapy for Highly Sensitive People?

In a world of therapy styles and modalities, highly sensitive people can often wonder where to turn for treatment for some of the issues that stem from their sensitivity, such as anxiety or depression.

While therapy and non-traditional help methods are never one size fits all, Dialectical Behavior Therapy (DBT), a type of skills-based treatment approach, has been shown to be an effective option for maintaining all-around wellness, but especially for managing strong emotions.¹ But how effective is DBT for Highly Sensitive People? First, let’s discuss the facets of DBT and how they can apply to our lives. 

DBT uses a four-pronged approach to treatment. These prongs are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.² While the ideal DBT course involves a group setting, instructional meetings, and individual therapy,³ the course can also be practiced online, through books, and even skill cards. During the typical in-person individual therapy, the program will move in this order: addressing major areas of concern or harmful behavior (such as self-harm), accepting who you are as a person, setting practical goals for your life, and learning to have more joy in life.⁴ Let’s discuss these skill groups in more detail. 

The first group of the course is mindfulness. Mindfulness teaches the brain to observe its “thoughts and feelings non-judgmentally” and moves our focus to the present.⁵ Mindfulness can be beneficial in calming the mind and nervous system. It is seen as the core element to build the other three skill groups upon.⁵

Distress tolerance, the next skill group, is seen as an “extension” of mindfulness.⁶ It uses skills to quickly bring down intense emotions, as well as exercises to accept the situations we find ourselves in.⁶ A huge part of these skills is preventing crisis from getting worse.⁶

Emotion regulation teaches a well-rounded approach to understanding, being effective with your emotions, problem solving, and more.⁷ It develops resilience during difficult times by helping you make the right decisions.⁷

Lastly, interpersonal effectiveness ties a social aspect into the program and instructs you how to build trust and be assertive within your relationships.⁸

All around, DBT is a phenomenal way to cope with intense emotions and develop a healthier mindset. But does DBT provide the type of treatment we HSPs need or are there better alternatives? Here are some pros and cons to consider:

Pros: 

1. DBT Provides useful skills to manage overarousal and enhance relationship

Managing overarousal is a profoundly important skill for a HSP to have. It means being able to know how to get out of overstimulating situations and being able to change our view of our arousal when we can't. Some of these lessons are taught in the mindfulness and distress tolerance categories of DBT. ⁵ ⁶ Also, the DBT mindfulness skills correspond with some of Dr. Elaine Aron’s overarousal tips in The Highly Sensitive Person, such as “reframing a situation” or “witnessing your overarousal”.⁹

DBT’s interpersonal effectiveness skill group may also be beneficial for HSPs because it teaches proper boundaries and shows how to build trust.⁸ HSPs often struggle with setting boundaries because of our empathy and tendency to be people-pleasers.

Lastly, DBT can help an HSP to make the right decision. HSPs often struggle with “decision fatigue”, which is when we become exhausted when choosing what to do.¹⁰ According to Lori L. Cangilla, a licensed psychologist, HSPs “use their depth of processing to take in large amounts of information from the environment and relate it to their internal experiences”. ¹¹ This means we can be especially at risk for decision fatigue. However, DBT can assist with this fatigue by allowing us to enter Wise Mind, a state where we are utilizing our emotions and our intellectual intelligence to make a decision.¹²

Overall, DBT is a well-rounded and developed treatment approach for HSPs to manage overarousal and enrich our relationships.

2. DBT is easy to learn and practice

As discussed, there are countless avenues to learn DBT from, and you don’t always have to participate in group therapy or the instructional meetings if you prefer to practice independently or don’t have a local option. you can find a comprehensive course of DBT for free through dialecticalbehaviortherapy.com, or many other places online! Lastly, most DBT skills can be practiced anywhere in any situation, and don’t require materials.

Cons:

1. Is it deep enough?

This is mostly speaking from personal experience so take it with a grain of salt, but what if using DBT skills constantly reduces us from our natural state of feeling and experiencing catharsis?

As an HSP, it’s always bigger than just having issues with controlling our emotions. Deep, important, and often existential issues are at the root of our struggles, and our emotions are signals to pay attention to that!

I had to come to terms with this when at a point in my life, I felt like I was performing all the self-soothing skills right, yet I still felt intense emotion. I knew that this was something I had to feel and rethink from the inside out. It’s important to keep our emotions in check, but not to ignore our emotions by using skills. This was a trap I fell into, and it could be damaging, especially if you're not doing another type of therapy alongside DBT.

2. DBT may not be one-size fits all

For an HSP, it’s especially valuable to do whatever feels right for us in the moment, because even certain skills can be overwhelming to practice. For instance, using a mental body scan when I’m frustrated is overstimulating and proves to be counterproductive for reducing stress. Are DBT skills what really make you feel relaxed? Maybe you have more personalized coping skills, like watching a favorite TV show or exercising. While DBT skills can be useful, it’s important not to leave behind the tools we know are effective. 

Now that you have a bit more information on what DBT is and know some of the pros and cons, let’s discuss some potential alternatives in the therapy/treatment world for HSPs. 

Alternatives

1. Depth Therapy

While DBT is a great solution for intense emotions, therapy that goes deeper will often offer more resolution for the problems HSPs go through. One of these forms of therapy is depth therapy. Depth therapy is beneficial for complex emotional issues, as well as “those on a spiritual journey” and empaths, which highly sensitive people often are.⁹

It studies the understanding and exploring of ourselves and our unconscious minds.¹³ Depth therapy will explore more of the complex parts of ourselves that DBT can’t touch and can even uncover issues we were unaware of. 

2. Cognitive Behavioral Therapy

Another great therapy option is Cognitive Behavioral Therapy (CBT). CBT is a type of therapy that challenges thoughts and attempts to shift unhealthy perspectives.¹⁴ CBT can be especially useful to HSPs because its “techniques involve teaching individuals how to identify the signs of sensory overload and implement effective strategies to manage the overstimulation”.¹⁵ This is hugely important for an HSP. In addition, CBT is trusted and is often seen as the “gold-standard” of psychotherapy.

An interesting difference between CBT and DBT is that CBT attempts to shift our perspectives from wrong to right, while DBT tries to accept the way we feel as we are.¹ This can be good or bad depending on what type of perspective you wish to take with.

3. Highly Sensitive Coaching

While not a form of therapy, highly sensitive coaching is a new and potentially very well-rounded approach, and it might include elements of DBT depending on your coach. This could also be a way to improve career, relationships, or your relationship with yourself. Many coaches can be found on Instagram or on other highly sensitive websites.

Conclusion

Ultimately, DBT is a fantastic way to cope with intense emotions, overwhelming situations, and is a great way to enhance your interpersonal relationships. However, there are other therapy options like depth therapy and CBT that offer the self-discovery element that DBT lacks. One treatment style is never for everyone, but with proper discernment you can find the one that is best for you. 

This article was originally inspired by a writing prompt from highlysensitiverefuge.com.

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