What Creative Arts Therapies Teach Us About DBT Skills Training

In the ever-evolving realm of mental health, therapists are always exploring new and innovative methods to enhance traditional treatments. Creative arts therapists have led the way in utilizing art-based interventions to teach DBT skills.

Creative arts therapy combines visual arts, movement, drama, music, writing, and other creative processes to support clients in their healing process. Many mental health clinicians have embraced creative arts therapy interventions to improve their clients' health and wellness.

There is a growing body of research that indicates that therapists can utilize creative interventions to help clients learn and generalize DBT skills. In this post, I will provide a brief literature review of therapists who have been doing this integrative work and provide an example of how drama therapy can be utilized to teach the DBT skill of wise mind.

Expressive arts therapists use creative strategies to teach skills and concepts from the behavioral therapies.

Source: Pexels/Pixabay

DBT and Art Therapy

Research indicates that integrating art therapy into established psychotherapy forms, such as cognitive-behavioral therapies, can have significant positive effects on client well-being. For example, a study by Monti et al. (2012) demonstrated the potential of mindfulness-based art therapy (MBAT) in alleviating emotional distress, highlighting the power of combining art therapy with the core feature of mindfulness in DBT. Though this study did not specifically discuss DBT, it demonstrated that implementing mindfulness, a core component of DBT, can assist individuals who are facing significant physical and emotional stressors.

Building on research that examined mindfulness and art therapy, several practitioners have contributed articles that specifically address the integration of DBT and art therapy within clinical populations. For example, researchers Huckvale and Learmonth (2009) led the charge by developing a new and innovative art therapy approach grounded in DBT for patients facing mental health challenges. Furthermore, Heckwolf, Bergland, and Mouratidis (2014) demonstrated how visual art and integrative treatments could help clients access DBT, resulting in stronger generalization and implementation of these skills outside of the session. The clinicians concluded that this integrative approach to treatment could reinforce skills, contribute to interdisciplinary team synergy, and enact bilateral integration.

Other notable examples from art therapists include Susan Clark’s (2017) DBT-informed art therapy, a strategic approach to treatment that incorporates creative visual exercises to explore, practice, and generalize DBT concepts and skills.

Expanding Beyond Visual Art Therapy

DBT has now been integrated with other expressive art therapies, including drama and music. Art therapists Karin von Daler and Lori Schwanbeck (2014) were instrumental in this expansion when they developed Creative Mindfulness, an approach to therapy integrating various expressive arts therapies with DBT. Creative Mindfulness “suggests a way of working therapeutically that is as containing and structured as DBT and as creative, embodied, and multi-sensory as expressive arts” (p. 235). These clinicians incorporated improvisation into their work, a tool that can be simultaneously playful, experiential, and grounding, ultimately producing substantial new insights for clients.

Moreover, music and drama therapists have recognized the benefits of multisensory skill teaching, expanding the creative techniques used to teach DBT skills (Deborah Spiegel, 2020; Nicky Morris, 2018, and Roohan and Trottier, 2021).

My Own Experience Integrating Drama Therapy and DBT

Personally, I am a big advocate of both dialectical behavior therapy (DBT) and drama therapy. In fact, I love these modalities so much that I dedicated not only my master's thesis but also my dissertation to better understanding how to reinforce DBT skills through dramatic techniques. In the process, I developed a new approach called Action-Based DBT that uses dramatic interventions like storytelling, embodiment, and role-playing to create a supportive environment for participants to learn skills in a more personalized and embodied way. An expert panel review demonstrated that this format can effectively support skill learning, especially for clients who struggle with the standard format of DBT skills training. Additionally, mental health clinicians found the program easily adaptable across populations in both individual and group settings.

Embodying the Mind States

To illustrate this approach and its effectiveness, the following is an example of how drama therapy methods can teach the DBT skill of wise mind within the context of an action-based DBT group.

The facilitator begins the group session by reviewing general guidelines and introducing the targeted DBT skill for the day: wise mind. The group then participates in improvisational warm-up activities to promote creativity, positive social interaction, and group connectivity. Following the warm-up, the facilitator distributes the DBT mind states handout (Linehan, 2015) and provides brief psychoeducation on this skill.

Three chairs are placed in the front of the group room, facing the semi-circle of clients. Each chair had a piece of colored construction paper taped to the front, reading as Reasonable, Wise and Emotion. The facilitator explains that each chair represents one of the three mind states: reasonable mind, emotion mind and wise mind.

To encourage exploration of the mind states, the facilitator can assign a more specific role to each state of mind. For example, the reasonable mind is The Computer, the emotion mind is The Tornado, and the wise mind is The Sage.

Group members are invited to think of a scenario in which they felt they had difficulty accessing their wise mind.

Clients then take turns embodying each mind state by sitting in the chair and speaking from the respective role. When a client first sits in a chair, the facilitator aids in enrolling the individual by asking questions about the role (i.e. The Computer, The Tornado, The Sage). For example, the facilitator may ask about the posture, tone of voice, or a “catchphrase” for this role. The client then embodies the role and responds to questions from the group as the specific mind state.

After the embodiment, clients engage in verbal processing.

The wise mind directive supports clients in developing kinaesthetic awareness of the three mind states. Embodying these mind states within the context of a supportive group and engaging in verbal processing around the experience can increase awareness of the mind states, which is helpful for clients who are trying to understand their emotional response to lived events outside of the group setting.

Conclusion

The creative arts therapies offer a dynamic pathway to teaching and reinforcing DBT skills. Incorporating visual art, drama, or music in the process of learning DBT skills allows clients to engage with these concepts in a multisensory and embodied way.

In my personal experience, weaving drama therapy techniques into DBT skills training has proven to be profoundly impactful. The Action-Based DBT approach, with its emphasis on storytelling and embodiment, offers an immersive and experiential learning environment that can be especially beneficial for those who find traditional methods challenging.

Looking ahead, my next post will delve into how storytelling can be harnessed to teach DBT skills in a way that is both engaging and memorable.

To find a therapist, please visit the Psychology Today Therapy Directory.