Dialectical Behavior Therapy (DBT) offers a set of skills to help with many different emotional and relational difficulties. The four pillars of DBT are Mindfulness, Emotion Regulation, Interpersonal Effectiveness and Distress Tolerance. Each of these pillars offers a number of skills to practice in that area. I have selected three DBT skills that I believe can make a significant difference for those managing depression.
Depression is an experience that includes a slow-down or freeze response in the nervous system. People managing depression may feel numb, detached, hopeless and sad. These internal experiences may cause them to isolate from relationships, get stuck in their difficult emotions, struggle to complete normal activities. Often, those managing depression feel misunderstood by the people in their life, especially when they are encouraged to “think positively” and “just get over it.” In fact, people managing depression are often expending enormous effort to engage in their life in the most simple ways. The following set of DBT skills can be used together or individually to improve depression symptoms and help catalyze healing and forward movement.

1.Emotion Regulation Skill: Opposite Action
When we are using Emotional Regulation skills, we are paying attention to whether or not our emotions fit the situation we are in. Opposite Action is a skill that we reach for when we have determined that our emotions DO NOT fit the facts of the situation. This is often the case with depression. Depression is like a lens that makes life look harder and sadder than it actually is.
All emotions have an action urge, an instinctual action that the emotion makes us want to do. When our emotions DO NOT fit the situation, we benefit from acting opposite to the action urge. Here are some common emotions experienced in depression and suggestions for opposite action.

• Hopelessness --> Action Urge: give up -->Opposite Action: stay engaged, keep trying
• Sadness --> Action Urge: isolate, wallow, freeze --> Opposite Action: share, express, move
• Numb --> Action Urge: disengage, stop moving --> Opposite Action: gentle movement, embodiment

 
2.Interpersonal Effectiveness Skill: Making Requests
Making Requests is a relationship skill that is very closely related to making boundaries. Requests highlight what we need from another person. While they can be vulnerable to make, they are also vital to communicating our needs with others. Loved ones are not mind-readers and need invitations and instructions to know how to care for those managing depression.
People experiencing depression are almost always misunderstood by the people who care for them most. Unless they have experienced depression themselves, loved ones will likely minimize the depressed experience. From the outside, it may appear that it would only take a few simple steps to recover from depression. If only that were true.
In order to stay connected with loved ones and to receive the care they absolutely need, those managing depression need to lean into this skill of making requests. They need to speak about how they are feeling and the effort they are expending to engage with their lives. They need to ask their loved ones to be patient with them, to use encouraging language, to offer comfort and presence rather than solutions.
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3.Distress Tolerance Skill: Radical Acceptance
We reach for distress tolerance skills when we are going through circumstances that are too big and/or too hard for us to change. Depression often comes on the tails of a big and hard life event, such as the loss of a loved one, a difficult transition, a painful event or unmovable circumstances. When there is truly nothing we can do to change our circumstances, we need to shift our focus toward acceptance.
We are using radical acceptance skills when we work to create openness and willingness toward our difficult circumstances. Willingness is a powerful mindset shift and means that we will stop fighting against what is inevitable. Endlessly fighting against unfavorable circumstances is a recipe for suffering. Pain is inevitable in our lives, but suffering is a choice. We can still live meaningful lives in the midst of painful circumstances. When we give up the fight, we are more able to find acceptance. . . and peace. 

​Social anxiety can be consuming and can really limit the life experiences one might be open to. Imagine having to overcome a wave of panic, accompanied with rapid heartbeat, muscle tension and even blurry vision when walking into certain social circumstances. This dizzying experience can feel disorienting and even dissociative. When this happens regularly, it is understandable that we might start to avoid situations that cause this response all together. When this becomes a pattern, we may experience a narrowing of life experiences, a decrease in self-esteem and a reduced willingness to try new things.
 
It is possible to learn skills that help us navigate social events with more ease. Feeling confident and calm in social situations allow us to be present with ourselves and with others in the room. We are more able to be genuine and operate within our natural personality, making higher quality connections.
 
There is one skill that has been the most helpful for our clients who are unlearning social anxiety. It is the DBT Mindfulness skill OBSERVATION. To understand this skill the most, let’s take a quick look at Mindfulness. When we are practicing mindfulness, we are 1) noticing our internal/external environment,2) without judgement and 3) without minimizing or enhancing what we find there. It is simply a practice of noticing. Noticing what we are feeling in any given moment. Noticing what is happening around us. Noticing what might feel like a threat. Simply noticing. Mindfulness practices like this slow us down and bring us into the present moment. And when we break this mindful practice into even smaller skills, one of the most impactful skills is that of OBSERVATION. We are simply taking in information, through our senses, thought processes and relationships. To observe skillfully, we need to create enough distance from what we are encountering to fully take it in. And this observable distance can make a big difference for social anxiety.
 
Let me explain a little more clearly. Imagine yourself preparing to go to a social event where you do not know anyone. You are expecting to walk into a room of people milling around and forming small conversation groups, and you are expected to go and have a good time. Practically speaking, this might be a business networking event, an awards ceremony, a college orientation day, etc. What I am encouraging you to try, is to enter the event as an OBSERVER first and foremost. Find a comfortable place in the room to sit or stand. Once you are there, take a few deep breaths that bring you into the present moment and allow the room to stop spinning. As you do this, you are creating an observable distance from which you can take in all that is happening in the room in that moment. Notice what is happening around you. Notice how many conversation groupings there are, how are the people in conversation feeling, are there other nervous people present, where are the food and beverages located, are there people who are also looking for someone to talk with? You are simply noticing what is happening in the room. And from this observation point, you might start to notice where you’d like to be in the room. You may prefer to stay right where you are at, you may notice a conversation you’d like to join, you may notice that you’d like to get a drink before doing anything else. Regardless of where you go from here, mindfully observing your surroundings has allowed you more choice to be genuine in your interactions. And with practice, you may just feel more open and confident in new social situations!