Why Dialectical Behavioral Therapy (DBT) for Pregnancy and Infant Loss Grief?
A Brief Overview Of Essential DBT Skills
Following the loss of a pregnancy or infant, emotions are high. Overwhelming. They may feel completely unmitigable. This chaos of emotions can lead to isolation, substance use, relationship issues, work performance issues, self-harm, and suicidal thoughts or behaviors.
Luckily, Dialectical Behavior Therapy (DBT) was originally developed to help individuals experiencing emotional overwhelm. DBT offers a robust set of skills designed to help individuals manage intense emotions, decrease risky behaviors, improve relationships, and navigate challenges more effectively. That’s why I used (and still use) DBT skills to manage the loss of my son. That’s also why I offer DBT to my clients who are actively struggling with their grief following the loss of a pregnancy or infant.
These skills are organized into four main modules, each focusing on specific aspects of emotional and interpersonal functioning. Here is a brief overview of the essential DBT skills and how they can be directly applied to managing perinatal grief.
1. Mindfulness Skills
Mindfulness is the foundation of DBT, enabling individuals to become more aware of their thoughts, feelings, and bodily sensations in the present moment without judgment. This is so helpful following the loss of a pregnancy or infant as thoughts about the past or future may make the emotional overwhelm worse. I will definitely do a more in-depth post on this specifically as it’s such a big topic. But for this overview, let’s just acknowledge that the past tends to bring thoughts of “if only….” and the future is clouded by “we’ll never get...” These types of thoughts are torturous to the grieving parent. Additionally, following the loss of a pregnancy or infant, there is often a sense of confusion, disorientation, disjointedness, and dissociation. Mindfulness skills can be wonderful to help reconnect and reintegrate.
Key mindfulness skills include:
Observing: Noticing thoughts, emotions, and physical sensations as they arise without trying to change them. This helps bring awareness to the present moment and helps cultivate an improved orientation to self.
Describing: Putting words to the experiences. This involves naming emotions emotions and thoughts, which can help ground in the present moment and support reintegration.
Participating: Engaging fully in activities and experiences. This encourages immersion in the present moment, and even allowing for moments of joy…yes, joy!
Practicing mindfulness can decrease emotional overload, calm racing thoughts, and reduce impulsive reactions.
2. Distress Tolerance Skills
Distress tolerance skills are exactly what they sound like - skills used to help tolerate distress. These skills are helpful for managing the emotional crises that often come with pregnancy and infant loss. These skills can be used to decrease or replace risky behaviors such as self-harm or substance use. They can also be used simply to help really difficult moments be a little more tolerable.
Key distress tolerance skills include:
Self-Soothe: Using the five senses to encourage a calmer state of being. This could involve listening to music, taking a warm bath, or engaging in a creative activity.
Distraction: Temporarily shifting focus away from distressing emotions or situations. This can be done through activities like reading, watching a movie, or going for a walk.
Radical Acceptance: This a particularly hard one following the loss of a pregnancy or infant. However, it is necessary for easing distress. Radical acceptance means acknowledging reality as it is, rather than how you wish it to be. When we fight reality, we will always lose.
These skills are essential for managing those acute moments of grief following the loss of a pregnancy or infant.
3. Emotion Regulation Skills
While the first two modules of DBT focus on accepting and tolerating what cannot be changed, the next two focus more on changing what can be changed. Obviously, following the loss of a pregnancy or infant, the loss cannot be changed. The experience itself will always exist. However, as that acute grief is managed, DBT can help to identify patterns that may be controllable.
Emotion regulation skills are designed to help individuals understand their emotions, emotional responses, and emotional patterns. With this recognition comes the ability to make positive changes.
Key skills include:
Identifying Emotions: Learning to recognize and name emotions can provide insight into feelings and help people respond more effectively. This is particularly helpful during the grief following the loss of a pregnancy or infant as many of the emotions may be new, complex, or confusing.
Increasing Positive Emotions: Actively seeking out experiences that promote joy and fulfillment can counterbalance negative emotions. This might include engaging in hobbies or spending time with loved ones. This can be difficult in the depth of acute grief, but with time can help people reconnect with their lives.
Changing Emotions: Developing strategies to alter unwanted emotions, such as engaging in physical activity to counter sadness or practicing gratitude to shift focus from negativity. Again, difficult work, but crucial.
By improving emotional awareness and control, individuals can begin to regain a sense of stability and start piecing themselves and their lives back together.
4. Interpersonal Effectiveness Skills
Like emotional regulation skills, interpersonal effectiveness skills are intended to help people make positive changes. These skills focus on improving communication and relationships with others. This is big following the loss of a pregnancy or infant. Healthy support systems are so important and so helpful during the grieving process. But unhealthy relations can make the grieving process more difficult and more painful. The grieving process itself can also be a stressor on otherwise healthy relationships. Thus using interpersonal effective skills to improve, maintain, or even terminate relations can be a powerful tool.
Key skills include:
Assertiveness: Learning to express needs and boundaries clearly and respectfully. The truth is, a lot of people don’t know what to say or do when a friend or family member loses a baby. It’s ok to directly tell them. This helps maintain self-respect while fostering healthy relationships. It’s also ok to terminate relations or take pauses if people say or do things that are rude, painful, or just unhelpful.
Active Listening: Engaging in conversations with full attention and empathy. This includes summarizing what the other person has said to demonstrate understanding. This can be particularly helpful for a couple to maintain connection and open communication.
Negotiation: Finding a balance between personal needs and the needs of others. This involves compromise and collaboration to build mutually beneficial relationships. Again, this can be important for couples as each party may have different needs following the loss of a pregnancy or infant.
These skills promote healthy social connections while also supporting individual needs.
Conclusion
There is a reason Dialectical Behavior Therapy is such a common form of therapy. It is an evidence-based practice that has been proven to help individuals experiencing high emotional distress. And that is exactly why it is extremely valuable following the loss of a pregnancy or infant. As I mentioned, this is just an overview of the skills. I will go more in-depth as this blog continues. If there is a particular DBT skill or module you’d like me to explore in a blog entry, feel free to leave a comment. If you are interested in learning more about my services or working together, please reach out. I’d love to chat.
