MedLink Health Connections Podcast

Calm the Chaos: DBT Tips with Caroline Broom

• MedLink Georgia • Season 1 • Episode 9

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Struggling with intense emotions or relationship challenges? You’re not alone — and there’s help. In this episode, Licensed Clinical Social Worker Caroline Broom from MedLink Georgia walks us through Dialectical Behavior Therapy (DBT), a powerful approach that blends validation with meaningful change.

Caroline breaks down practical DBT tools like mindfulness, distress tolerance, and emotion regulation — including the life-changing TIP technique to manage emotional crises. You’ll also hear the inspiring story behind DBT’s creation and how it can support those facing anxiety, depression, eating disorders, and more.

Tune in to learn skills you can use right away — and take the first step toward emotional balance and connection. 🎧💙

Speaker 1:

Welcome to the MedLink Health Connections podcast. Today we are joined by Caroline Bruin, a licensed clinical social worker here at MedLink Georgia. She's a graduate of the University of Georgia and has been with MedLink since 2024, providing telehealth psychotherapy to patients ages 6 to 65. Caroline uses trauma-informed and strengths-based approaches and also blends in techniques like CBT, dbt, ifs, act and creative arts therapy. Today, we're going to focus on DBT what it is and how it's different from other forms of therapy. Caroline, thank you so much for being here. Can you start off by telling us what DBT is and how it works?

Speaker 2:

Hi Tangela, thank you for having me here today. In answer to your question, dbt is an acronym for the therapy modality dialectical behavior therapy. To summarize for Marsha Linehan, the creator of DBT, and according to Harvard Medical School, dbt equips individuals with skills to address strong emotions, cope with challenging circumstances and improve interpersonal relationships. Dbt can be used in individual therapy or group therapy settings and skills are taught in four main areas Mindfulness skills, distress tolerance skills, interpersonal effectiveness skills and emotion regulation skills. Dbt often differs from other therapy modalities as it emphasizes validation of emotions, as well as increasing the capacity to hold space for two or more opposing experiences and emotions to be true simultaneously. So, instead of viewing circumstances or feelings and extremes such as all good or all bad, dbt encourages a balanced perspective, or what is often referred to as walking the middle path. Dbt was also the first form of psychotherapy to formally incorporate mindfulness.

Speaker 1:

Can you explain the main components of DBT and why it is structured the way it is?

Speaker 2:

The four main areas or components of DBT are the practice of mindfulness, distress, tolerance, interpersonal effectiveness and emotion regulation. The purpose of DBT structure is to provide people with tangible and practical skills to engage in mindfulness of their thoughts, emotions and interactions with themselves and with their environments, so that individuals may have an increased sense of agency, acceptance and ability to regulate emotions.

Speaker 1:

So distress tolerance is a key part of DBT. What are some simple techniques people can use in their daily lives?

Speaker 2:

Great question. Distress tolerance skills assist people with addressing strong emotions and navigating emotional crises. Marsha Linehan states that the goals of distress tolerance are one, to create to survive crisis situations without making them worse. Two, to accept reality as it is in the moment. And three, to become free, specifically of having to satisfy the demands of your own desires, urges and intense emotions. Distress tolerance skills are divided into three categories crisis survival techniques, sensory body awareness and reality acceptance. These skills also assist individuals with grounding. What is grounding? The University of New Hampshire defines a grounding skill as a technique that helps you in the present or helps keep you in the present and helps reorient you to the here and now and to reality. So what does all of this mean?

Speaker 2:

The way that I prefer to conceptualize distress tolerance skills is to first think of a thermometer, specifically a thermometer to measure the intensity of our emotions. The bottom of the thermometer is a 1 and the top is a 10. When, feeling calm and copacetic, you would be at a 1 on the thermometer and a 10 would be the most dysregulated. You could be the angriest, the saddest, the most anxious, just the most. When beginning to escalate or move up the thermometer, there may be physical warning signs such as clenched fists, muscle tension, shakiness, increased heart rate or many others. These warning signs can indicate that we are moving up the thermometer toward what I like to refer to as the crisis zone, which is about a seven or above on the thermometer. When in the crisis zone over a seven or above on the thermometer the crisis survival techniques are known to be highly beneficial as they help us to tolerate distressing moments and de-escalate or move back down the thermometer. One of my personal favorite distress tolerance skills is a crisis survival technique called TIP, t-i-p-p, which is an acronym that stands for temperature change, intense exercise, paced breathing and progressive muscle relaxation. Again, when feeling highly dysregulated or beginning to increase to a seven or above on the thermometer, tip assists with de-escalation and grounding. The letter T of the acronym TIP stands for temperature change and may involve holding an ice cube in your hand until it melts, placing a frozen or cold compress on your forehead or the back of your neck, slowly sipping ice-cold water, splashing cold water on your face or taking a warm shower or bath. The shift in temperature helps to shift us away from distressing thoughts or emotions and grounds us in the present moment. The letter I of the acronym TIP stands for intense exercise. Marsha Linehan explains that the purpose of intense exercise is to calm the body when it is revved up by emotion, by expending your body's stored up physical energy, by running, walking fast, jumping, playing basketball, lifting weights, etc.

Speaker 2:

The first letter P in the acronym TIP stands for paced breathing, or what I sometimes refer to as box breathing. Paced breathing or box breathing involves breathing deeply into your belly, using a slow pace and, ideally, breathing out more slowly than you breathe in. Box breathing is a quick and simple means of implementing paced breathing in which you breathe in for the count of four, hold the inhale for the count of four, breathe out for the count of four and hold the exhale for the count of four. For optimal effectiveness, I recommend repeating the box breathing steps at least five times. So again, it involves breathing in for the count of four, holding the inhale for the count of four, breathing out for the count of four and holding the exhale for the count of four. When escalated, the heart rate increases. The breath controls the heart rate. Therefore, bringing our attention to our breathing can assist with decreasing the heart rate and calming the body.

Speaker 2:

The second letter P of the acronym TIP stands for paired or progressive muscle relaxation. To calm down by pairing muscle relaxation with breathing out, breathing out. To understand this part of the technique, it may be helpful to review paired or progressive muscle relaxation step by step, as described by Marsha Linehan. The first step is, while breathing into your belly, deeply tense your body muscles, but not so much so that you cause a cramp. Second, notice the tension in your body. Next, while breathing out, say the word relax in your mind. Then let go of the tension. Lastly, notice the difference in your body. As a reminder, the skill tip is not intended to completely take away or resolve the emotion entirely. Rather, it is intended to assist with alleviating the intensity of the emotion in the moment.

Speaker 1:

So Marsha Linehan created DBT based on personal experience. How has that shaped the approach and its effectiveness?

Speaker 2:

of Washington and is Director Emeritus of the Behavioral Research and Therapy Clinics, a consortium of research projects developing new treatments and evaluating their efficacy for severely disordered and multi-diagnostic and suicidal populations.

Speaker 2:

I find it important to note this information, as Linehan's life is a true testament to the dialectics emphasized throughout DBT, meaning it is possible for multiple different things to be true at the same time. Not only is Linehan an accomplished scholar, but she also developed DBT based on her own experiences with mental health symptoms. The Del Rey Center for Healing shares that Linehan had a schizophrenia diagnosis at a young age and was even in an institution. Later, linehan learned that she was misdiagnosed and that her actual diagnosis is borderline personality disorder. Linehan developed DBT based on her research and education in psychology, as well as her own journey with mental health symptoms. As well as her own journey with mental health symptoms, many individuals with mental health symptoms and or diagnoses experienced an upbringing in profoundly invalidating environments. This led Linehan to focus DBT on creating a therapeutic alliance between the patient and therapist in which emotions are validated while also reflecting maladaptive behaviors and thought patterns and teaching more effective and balanced alternatives.

Speaker 1:

What can benefit most from DBT, and what kind of mental health challenges does it help with?

Speaker 2:

Research indicates that DBT can be effective in treating adults and adolescents experiencing borderline personality disorder and adolescents experiencing borderline personality disorder, suicidality, depression, anxiety, substance use disorders and eating disorders. With that said, I am of the mindset that any of us may benefit from learning and practicing DBT skills, especially for the purpose of reinforcing healthy coping with strong emotions or maladaptive beliefs about ourselves and environments.

Speaker 1:

If someone is interested in DBT, what is the best way for them to get started?

Speaker 2:

Marsha Linehan has written many books about DBT that may be beneficial to anyone wanting to learn more about the modality, including the Dialectical Behavior Therapy Skills Workbook modality, including the Dialectical Behavior Therapy Skills Workbook, building a Life Worth Living, coping with Cancer and many more. If you prefer, podcasts, dbt and Me or the Skillful Podcast are also great places to start. However, I may be biased, as I believe that the most effective means of getting started with DBT would be to schedule an appointment with a behavioral health provider. If you happen to already be working with a behavioral health therapist and have an interest in DBT, I recommend communicating this interest to your therapist and your next therapy session. Should you wish to establish behavioral health services with MedLink, please reach out to us at 706-521-3113, extension 6772. It's been a pleasure sharing this information with you today and thank you for the opportunity.

Speaker 1:

Thank you for tuning in to the MedLink Health Connections podcast. We hope you found today's episode informative and inspiring. If you enjoyed the show, please subscribe, rate and leave a review on your favorite podcast platform. Remember, the information shared in this podcast is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for any medical concerns. Stay connected with us on social media and visit our website at medlinkgaorg for more resources and updates. Until next time, stay healthy and take care.