April 30, 2025 • 12 mins
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. 🎧💙
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the MedLink Health Connections
podcast.
Today we are joined by CarolineBruin, a licensed clinical
social worker here at MedLinkGeorgia.
She's a graduate of theUniversity of Georgia and has
been with MedLink since 2024,providing telehealth
psychotherapy to patients ages 6to 65.
Caroline uses trauma-informedand strengths-based approaches
(00:22):
and also blends in techniqueslike CBT, dbt, ifs, act and
creative arts therapy.
Today, we're going to focus onDBT what it is and how it's
different from other forms oftherapy.
Caroline, thank you so much forbeing here.
Can you start off by telling uswhat DBT is and how it works?
Speaker 2 (00:42):
Hi Tangela, thank you for having me here today.
In answer to your question, dbtis an acronym for the therapy
modality dialectical behaviortherapy.
To summarize for Marsha Linehan, the creator of DBT, and
according to Harvard MedicalSchool, dbt equips individuals
with skills to address strongemotions, cope with challenging
(01:05):
circumstances and improveinterpersonal relationships.
Dbt can be used in individualtherapy or group therapy
settings and skills are taughtin four main areas Mindfulness
skills, distress toleranceskills, interpersonal
effectiveness skills and emotionregulation skills.
Dbt often differs from othertherapy modalities as it
(01:29):
emphasizes validation ofemotions, as well as increasing
the capacity to hold space fortwo or more opposing experiences
and emotions to be truesimultaneously.
So, instead of viewingcircumstances or feelings and
extremes such as all good or allbad, dbt encourages a balanced
(01:49):
perspective, or what is oftenreferred to as walking the
middle path.
Dbt was also the first form ofpsychotherapy to formally
incorporate mindfulness.
Speaker 1 (02:01):
Can you explain the main components of DBT and why
it is structured the way it is?
Speaker 2 (02:08):
The four main areas or components of DBT are the
practice of mindfulness,distress, tolerance,
interpersonal effectiveness andemotion regulation.
The purpose of DBT structure isto provide people with tangible
and practical skills to engagein mindfulness of their thoughts
, emotions and interactions withthemselves and with their
(02:31):
environments, so thatindividuals may have an
increased sense of agency,acceptance and ability to
regulate emotions.
Speaker 1 (02:40):
So distress tolerance is a key part of DBT.
What are some simple techniquespeople can use in their daily
lives?
Speaker 2 (02:48):
Great question.
Distress tolerance skillsassist people with addressing
strong emotions and navigatingemotional crises.
Marsha Linehan states that thegoals of distress tolerance are
one, to create to survive crisissituations without making them
worse.
Two, to accept reality as it isin the moment.
(03:10):
And three, to become free,specifically of having to
satisfy the demands of your owndesires, urges and intense
emotions.
Distress tolerance skills aredivided into three categories
crisis survival techniques,sensory body awareness and
reality acceptance.
These skills also assistindividuals with grounding.
(03:33):
What is grounding?
The University of New Hampshiredefines a grounding skill as a
technique that helps you in thepresent or helps keep you in the
present and helps reorient youto the here and now and to
reality.
So what does all of this mean?
The way that I prefer toconceptualize distress tolerance
(03:54):
skills is to first think of athermometer, specifically a
thermometer to measure theintensity of our emotions.
The bottom of the thermometeris a 1 and the top is a 10.
When, feeling calm andcopacetic, you would be at a 1
on the thermometer and a 10would be the most dysregulated.
You could be the angriest, thesaddest, the most anxious, just
(04:17):
the most.
When beginning to escalate ormove up the thermometer, there
may be physical warning signssuch as clenched fists, muscle
tension, shakiness, increasedheart rate or many others.
These warning signs canindicate that we are moving up
the thermometer toward what Ilike to refer to as the crisis
(04:37):
zone, which is about a seven orabove on the thermometer.
When in the crisis zone over aseven or above on the
thermometer the crisis survivaltechniques are known to be
highly beneficial as they helpus to tolerate distressing
moments and de-escalate or moveback down the thermometer.
One of my personal favoritedistress tolerance skills is a
(04:58):
crisis survival technique calledTIP, t-i-p-p, which is an
acronym that stands fortemperature change, intense
exercise, paced breathing andprogressive muscle relaxation.
Again, when feeling highlydysregulated or beginning to
increase to a seven or above onthe thermometer, tip assists
(05:19):
with de-escalation and grounding.
The letter T of the acronym TIPstands for temperature change
and may involve holding an icecube in your hand until it melts
, placing a frozen or coldcompress on your forehead or the
back of your neck, slowlysipping ice-cold water,
splashing cold water on yourface or taking a warm shower or
(05:41):
bath.
The shift in temperature helpsto shift us away from
distressing thoughts or emotionsand grounds us in the present
moment.
The letter I of the acronym TIPstands for intense exercise.
Marsha Linehan explains thatthe purpose of intense exercise
is to calm the body when it isrevved up by emotion, by
(06:04):
expending your body's stored upphysical energy, by running,
walking fast, jumping, playingbasketball, lifting weights, etc
.
The first letter P in theacronym TIP stands for paced
breathing, or what I sometimesrefer to as box breathing.
Paced breathing or boxbreathing involves breathing
(06:26):
deeply into your belly, using aslow pace and, ideally,
breathing out more slowly thanyou breathe in.
Box breathing is a quick andsimple means of implementing
paced breathing in which youbreathe in for the count of four
, hold the inhale for the countof four, breathe out for the
count of four and hold theexhale for the count of four.
(06:47):
For optimal effectiveness, Irecommend repeating the box
breathing steps at least fivetimes.
So again, it involves breathingin for the count of four,
holding the inhale for the countof four, breathing out for the
count of four and holding theexhale for the count of four.
When escalated, the heart rateincreases.
(07:08):
The breath controls the heartrate.
Therefore, bringing ourattention to our breathing can
assist with decreasing the heartrate and calming the body.
The second letter P of theacronym TIP stands for paired or
progressive muscle relaxation.
To calm down by pairing musclerelaxation with breathing out,
(07:34):
breathing out.
To understand this part of thetechnique, it may be helpful to
review paired or progressivemuscle relaxation step by step,
as described by Marsha Linehan.
The first step is, whilebreathing into your belly,
deeply tense your body muscles,but not so much so that you
cause a cramp.
Second, notice the tension inyour body.
Next, while breathing out, saythe word relax in your mind.
(07:56):
Then let go of the tension.
Lastly, notice the differencein your body.
As a reminder, the skill tip isnot intended to completely take
away or resolve the emotionentirely.
Rather, it is intended toassist with alleviating the
intensity of the emotion in themoment.
Speaker 1 (08:19):
So Marsha Linehan created DBT based on personal
experience.
How has that shaped theapproach and its effectiveness?
Speaker 2 (08:30):
of Washington and is Director Emeritus of the
Behavioral Research and TherapyClinics, a consortium of
research projects developing newtreatments and evaluating their
(08:51):
efficacy for severelydisordered and multi-diagnostic
and suicidal populations.
I find it important to note thisinformation, as Linehan's life
is a true testament to thedialectics emphasized throughout
DBT, meaning it is possible formultiple different things to be
true at the same time.
Not only is Linehan anaccomplished scholar, but she
(09:12):
also developed DBT based on herown experiences with mental
health symptoms.
The Del Rey Center for Healingshares that Linehan had a
schizophrenia diagnosis at ayoung age and was even in an
institution.
Later, linehan learned that shewas misdiagnosed and that her
actual diagnosis is borderlinepersonality disorder.
(09:33):
Linehan developed DBT based onher research and education in
psychology, as well as her ownjourney with mental health
symptoms.
As well as her own journey withmental health symptoms, many
individuals with mental healthsymptoms and or diagnoses
experienced an upbringing inprofoundly invalidating
environments.
This led Linehan to focus DBTon creating a therapeutic
(09:55):
alliance between the patient andtherapist in which emotions are
validated while also reflectingmaladaptive behaviors and
thought patterns and teachingmore effective and balanced
alternatives.
Speaker 1 (10:07):
What can benefit most from DBT, and what kind of
mental health challenges does ithelp with?
Speaker 2 (10:14):
Research indicates that DBT can be effective in
treating adults and adolescentsexperiencing borderline
personality disorder andadolescents experiencing
borderline personality disorder,suicidality, depression,
anxiety, substance use disordersand eating disorders.
With that said, I am of themindset that any of us may
(10:35):
benefit from learning andpracticing DBT skills,
especially for the purpose ofreinforcing healthy coping with
strong emotions or maladaptivebeliefs about ourselves and
environments.
Speaker 1 (10:46):
If someone is interested in DBT, what is the
best way for them to get started?
Speaker 2 (10:52):
Marsha Linehan has written many books about DBT
that may be beneficial to anyonewanting to learn more about the
modality, including theDialectical 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, dbtand Me or the Skillful Podcast
(11:14):
are also great places to start.
However, I may be biased, as Ibelieve that the most effective
means of getting started withDBT would be to schedule an
appointment with a behavioralhealth provider.
If you happen to already beworking with a behavioral health
therapist and have an interestin DBT, I recommend
communicating this interest toyour therapist and your next
(11:36):
therapy session.
Should you wish to establishbehavioral health services with
MedLink, please reach out to usat 706-521-3113, extension 6772.
It's been a pleasure sharingthis information with you today
and thank you for theopportunity.
Speaker 1 (11:55):
Thank you for tuning in to the MedLink Health
Connections podcast.
We hope you found today'sepisode informative and
inspiring.
If you enjoyed the show, pleasesubscribe, rate and leave a
review on your favorite podcastplatform.
Remember, the informationshared in this podcast is for
educational purposes only andshould not replace professional
medical advice.
(12:15):
Always consult with yourhealthcare provider for any
medical concerns.
Stay connected with us onsocial media and visit our
website at medlinkgaorg for moreresources and updates.
Until next time, stay healthyand take care.
Welcome to the MedLink Health Connections
podcast.
Today we are joined by CarolineBruin, a licensed clinical
social worker here at MedLinkGeorgia.
She's a graduate of theUniversity of Georgia and has
been with MedLink since 2024,providing telehealth
psychotherapy to patients ages 6to 65.
Caroline uses trauma-informedand strengths-based approaches
(00:22):
and also blends in techniqueslike CBT, dbt, ifs, act and
creative arts therapy.
Today, we're going to focus onDBT what it is and how it's
different from other forms oftherapy.
Caroline, thank you so much forbeing here.
Can you start off by telling uswhat DBT is and how it works?
Speaker 2 (00:42):
Hi Tangela, thank you for having me here today.
In answer to your question, dbtis an acronym for the therapy
modality dialectical behaviortherapy.
To summarize for Marsha Linehan, the creator of DBT, and
according to Harvard MedicalSchool, dbt equips individuals
with skills to address strongemotions, cope with challenging
(01:05):
circumstances and improveinterpersonal relationships.
Dbt can be used in individualtherapy or group therapy
settings and skills are taughtin four main areas Mindfulness
skills, distress toleranceskills, interpersonal
effectiveness skills and emotionregulation skills.
Dbt often differs from othertherapy modalities as it
(01:29):
emphasizes validation ofemotions, as well as increasing
the capacity to hold space fortwo or more opposing experiences
and emotions to be truesimultaneously.
So, instead of viewingcircumstances or feelings and
extremes such as all good or allbad, dbt encourages a balanced
(01:49):
perspective, or what is oftenreferred to as walking the
middle path.
Dbt was also the first form ofpsychotherapy to formally
incorporate mindfulness.
Speaker 1 (02:01):
Can you explain the main components of DBT and why
it is structured the way it is?
Speaker 2 (02:08):
The four main areas or components of DBT are the
practice of mindfulness,distress, tolerance,
interpersonal effectiveness andemotion regulation.
The purpose of DBT structure isto provide people with tangible
and practical skills to engagein mindfulness of their thoughts
, emotions and interactions withthemselves and with their
(02:31):
environments, so thatindividuals may have an
increased sense of agency,acceptance and ability to
regulate emotions.
Speaker 1 (02:40):
So distress tolerance is a key part of DBT.
What are some simple techniquespeople can use in their daily
lives?
Speaker 2 (02:48):
Great question.
Distress tolerance skillsassist people with addressing
strong emotions and navigatingemotional crises.
Marsha Linehan states that thegoals of distress tolerance are
one, to create to survive crisissituations without making them
worse.
Two, to accept reality as it isin the moment.
(03:10):
And three, to become free,specifically of having to
satisfy the demands of your owndesires, urges and intense
emotions.
Distress tolerance skills aredivided into three categories
crisis survival techniques,sensory body awareness and
reality acceptance.
These skills also assistindividuals with grounding.
(03:33):
What is grounding?
The University of New Hampshiredefines a grounding skill as a
technique that helps you in thepresent or helps keep you in the
present and helps reorient youto the here and now and to
reality.
So what does all of this mean?
The way that I prefer toconceptualize distress tolerance
(03:54):
skills is to first think of athermometer, specifically a
thermometer to measure theintensity of our emotions.
The bottom of the thermometeris a 1 and the top is a 10.
When, feeling calm andcopacetic, you would be at a 1
on the thermometer and a 10would be the most dysregulated.
You could be the angriest, thesaddest, the most anxious, just
(04:17):
the most.
When beginning to escalate ormove up the thermometer, there
may be physical warning signssuch as clenched fists, muscle
tension, shakiness, increasedheart rate or many others.
These warning signs canindicate that we are moving up
the thermometer toward what Ilike to refer to as the crisis
(04:37):
zone, which is about a seven orabove on the thermometer.
When in the crisis zone over aseven or above on the
thermometer the crisis survivaltechniques are known to be
highly beneficial as they helpus to tolerate distressing
moments and de-escalate or moveback down the thermometer.
One of my personal favoritedistress tolerance skills is a
(04:58):
crisis survival technique calledTIP, t-i-p-p, which is an
acronym that stands fortemperature change, intense
exercise, paced breathing andprogressive muscle relaxation.
Again, when feeling highlydysregulated or beginning to
increase to a seven or above onthe thermometer, tip assists
(05:19):
with de-escalation and grounding.
The letter T of the acronym TIPstands for temperature change
and may involve holding an icecube in your hand until it melts
, placing a frozen or coldcompress on your forehead or the
back of your neck, slowlysipping ice-cold water,
splashing cold water on yourface or taking a warm shower or
(05:41):
bath.
The shift in temperature helpsto shift us away from
distressing thoughts or emotionsand grounds us in the present
moment.
The letter I of the acronym TIPstands for intense exercise.
Marsha Linehan explains thatthe purpose of intense exercise
is to calm the body when it isrevved up by emotion, by
(06:04):
expending your body's stored upphysical energy, by running,
walking fast, jumping, playingbasketball, lifting weights, etc
.
The first letter P in theacronym TIP stands for paced
breathing, or what I sometimesrefer to as box breathing.
Paced breathing or boxbreathing involves breathing
(06:26):
deeply into your belly, using aslow pace and, ideally,
breathing out more slowly thanyou breathe in.
Box breathing is a quick andsimple means of implementing
paced breathing in which youbreathe in for the count of four
, hold the inhale for the countof four, breathe out for the
count of four and hold theexhale for the count of four.
(06:47):
For optimal effectiveness, Irecommend repeating the box
breathing steps at least fivetimes.
So again, it involves breathingin for the count of four,
holding the inhale for the countof four, breathing out for the
count of four and holding theexhale for the count of four.
When escalated, the heart rateincreases.
(07:08):
The breath controls the heartrate.
Therefore, bringing ourattention to our breathing can
assist with decreasing the heartrate and calming the body.
The second letter P of theacronym TIP stands for paired or
progressive muscle relaxation.
To calm down by pairing musclerelaxation with breathing out,
(07:34):
breathing out.
To understand this part of thetechnique, it may be helpful to
review paired or progressivemuscle relaxation step by step,
as described by Marsha Linehan.
The first step is, whilebreathing into your belly,
deeply tense your body muscles,but not so much so that you
cause a cramp.
Second, notice the tension inyour body.
Next, while breathing out, saythe word relax in your mind.
(07:56):
Then let go of the tension.
Lastly, notice the differencein your body.
As a reminder, the skill tip isnot intended to completely take
away or resolve the emotionentirely.
Rather, it is intended toassist with alleviating the
intensity of the emotion in themoment.
Speaker 1 (08:19):
So Marsha Linehan created DBT based on personal
experience.
How has that shaped theapproach and its effectiveness?
Speaker 2 (08:30):
of Washington and is Director Emeritus of the
Behavioral Research and TherapyClinics, a consortium of
research projects developing newtreatments and evaluating their
(08:51):
efficacy for severelydisordered and multi-diagnostic
and suicidal populations.
I find it important to note thisinformation, as Linehan's life
is a true testament to thedialectics emphasized throughout
DBT, meaning it is possible formultiple different things to be
true at the same time.
Not only is Linehan anaccomplished scholar, but she
(09:12):
also developed DBT based on herown experiences with mental
health symptoms.
The Del Rey Center for Healingshares that Linehan had a
schizophrenia diagnosis at ayoung age and was even in an
institution.
Later, linehan learned that shewas misdiagnosed and that her
actual diagnosis is borderlinepersonality disorder.
(09:33):
Linehan developed DBT based onher research and education in
psychology, as well as her ownjourney with mental health
symptoms.
As well as her own journey withmental health symptoms, many
individuals with mental healthsymptoms and or diagnoses
experienced an upbringing inprofoundly invalidating
environments.
This led Linehan to focus DBTon creating a therapeutic
(09:55):
alliance between the patient andtherapist in which emotions are
validated while also reflectingmaladaptive behaviors and
thought patterns and teachingmore effective and balanced
alternatives.
Speaker 1 (10:07):
What can benefit most from DBT, and what kind of
mental health challenges does ithelp with?
Speaker 2 (10:14):
Research indicates that DBT can be effective in
treating adults and adolescentsexperiencing borderline
personality disorder andadolescents experiencing
borderline personality disorder,suicidality, depression,
anxiety, substance use disordersand eating disorders.
With that said, I am of themindset that any of us may
(10:35):
benefit from learning andpracticing DBT skills,
especially for the purpose ofreinforcing healthy coping with
strong emotions or maladaptivebeliefs about ourselves and
environments.
Speaker 1 (10:46):
If someone is interested in DBT, what is the
best way for them to get started?
Speaker 2 (10:52):
Marsha Linehan has written many books about DBT
that may be beneficial to anyonewanting to learn more about the
modality, including theDialectical 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, dbtand Me or the Skillful Podcast
(11:14):
are also great places to start.
However, I may be biased, as Ibelieve that the most effective
means of getting started withDBT would be to schedule an
appointment with a behavioralhealth provider.
If you happen to already beworking with a behavioral health
therapist and have an interestin DBT, I recommend
communicating this interest toyour therapist and your next
(11:36):
therapy session.
Should you wish to establishbehavioral health services with
MedLink, please reach out to usat 706-521-3113, extension 6772.
It's been a pleasure sharingthis information with you today
and thank you for theopportunity.
Speaker 1 (11:55):
Thank you for tuning in to the MedLink Health
Connections podcast.
We hope you found today'sepisode informative and
inspiring.
If you enjoyed the show, pleasesubscribe, rate and leave a
review on your favorite podcastplatform.
Remember, the informationshared in this podcast is for
educational purposes only andshould not replace professional
medical advice.
(12:15):
Always consult with yourhealthcare provider for any
medical concerns.
Stay connected with us onsocial media and visit our
website at medlinkgaorg for moreresources and updates.
Until next time, stay healthyand take care.
Popular Podcasts
New Heights with Jason & Travis Kelce
Football’s funniest family duo — Jason Kelce of the Philadelphia Eagles and Travis Kelce of the Kansas City Chiefs — team up to provide next-level access to life in the league as it unfolds. The two brothers and Super Bowl champions drop weekly insights about the weekly slate of games and share their INSIDE perspectives on trending NFL news and sports headlines. They also endlessly rag on each other as brothers do, chat the latest in pop culture and welcome some very popular and well-known friends to chat with them. Check out new episodes every Wednesday. Follow New Heights on the Wondery App, YouTube or wherever you get your podcasts. You can listen to new episodes early and ad-free, and get exclusive content on Wondery+. Join Wondery+ in the Wondery App, Apple Podcasts or Spotify. And join our new membership for a unique fan experience by going to the New Heights YouTube channel now!
The Breakfast Club
The World's Most Dangerous Morning Show, The Breakfast Club, With DJ Envy, Jess Hilarious, And Charlamagne Tha God!
Fudd Around And Find Out
UConn basketball star Azzi Fudd brings her championship swag to iHeart Women’s Sports with Fudd Around and Find Out, a weekly podcast that takes fans along for the ride as Azzi spends her final year of college trying to reclaim the National Championship and prepare to be a first round WNBA draft pick. Ever wonder what it’s like to be a world-class athlete in the public spotlight while still managing schoolwork, friendships and family time? It’s time to Fudd Around and Find Out!