Using DBT skills to manage migraine

Dialectical behavior therapy (DBT) is a combination of Cognitive Behavioral Therapy and Zen mindfulness philosophies that was developed by Marsha Linehan to treat clients diagnosed with Borderline Personality Disorder (BPD). Over the years it has been perfected and subjected to studies proving that it is one of the very few effective treatments for BPD. It has also been studied as an effective treatment for  a wide variety of mental health issues.

One of the unique aspects of DBT is its emphasis on dialectics. Dialectics is the incorporation of opposites. In the case of DBT, clients are taught to embrace both Acceptance of the current circumstances and readiness to Change. While simple in concept, the process is much more difficult.


In the case of Migraine, acceptance is multifaceted. Acceptance involves an acknowledgement of reality without placing any value judgement on that reality. Acceptance is not agreement. It is completely separate from individual opinions about the circumstances. Whether you like your situation or not isn’t the point. Acceptance is a recognition of what is without wishing it were different.

  • We accept that Migraine is incurable.
  • We accept that not everyone understands Migraine.
  • We accept that there are few effective treatments.
  • We accept that there is a shortage of qualified doctors.
  • We accept that attacks will happen regardless of how many triggers we avoid.
  • We accept that medication will be a long-term reality.
  • …and the list goes on and on.


At the same time, we embrace the need for personal change to improve our situation.

  • We keep track of attack frequency and severity.
  • We diligently avoid known triggers.
  • We keep looking for the right doctor and treatments.
  • We educate others about our disease to fight stigma.
  • We donate our time and resources to help discover a cure.
  • We believe in the possibility of and hope for a cure.

Both Acceptance and Change are possible with time and practice. Acquiring and practicing DBT skills will help us with this journey.

A true DBT program includes:

  1. Individual therapy
  2. Group therapy
  3. Phone coaching
  4. Therapist consultation team

Personal Experience

I was certified to facilitate DBT Group Therapy in 2007 and led groups from 2007-2009 at a community mental health center. I also taught DBT skills through individual therapy to ASD clients with comorbid mood & anxiety disorders from 2010 to 2012. One of the things I discovered was that these skills are effective tools for nearly anyone who struggles with overwhelming feelings, intolerable situations, or difficulty with interpersonal relationships. That’s just about anyone at one time or another.

Teaching  is one of the best ways to learn. The more I taught DBT groups, the more I learned about using these skills in everyday life. In an effort to “practice what I preached”, DBT skills became part of my Migraine arsenal. They helped me to cope with impossible symptoms, respond to disappointing circumstances, and communicate more effectively with others.

I have wanted to share these discoveries with others for several years. It was just a matter of finding the right opportunity. This series is not designed to encompass an entire DBT program nor is it designed to address the needs of those diagnosed with mental illness. It will provide you with information on how to incorporate the skills taught in DBT group therapy into your everyday life, especially as it relates to Migraine and other Headache Disorders.

The format of this series is as follows:

  1. Introduction to DBT – That’s where you are now.
  2. DBT Mindfulness: the three states of mind
    1. Core Emotions Primer
    2. Our Alarm System
    3. Using “What” Skills
      1. Observe
      2. Describe
      3. Participate
    4. Using “How” Skills
      1. Non-judgmental stance
      2. One mindfully in the moment
      3. Effectively
  3. Distress Tolerance Skills
    1. Self-Soothing Strategies
    2. Distraction
    3. Improving the moment
    4. Acceptance
  4. Emotion Regulation Skills
    1. PLEASE
    2. Building Mastery
    3. Opposite-to-Emotion Action
  5. Interpersonal Effectiveness
    1. DEAR MAN
    2. GIVE
    3. FAST
  6. Wrap-up

I will come back to add hyperlinks to each step as it is published. Please post your questions at the end of each installment.  I will respond to each one as quickly as possible.


If during the course of this series, you believe you would benefit from the full DBT program, please go to for a listing of DBT qualified therapists.

For more ideas on how to incorporate DBT skills into everyday life, please see:
DBT Self Help
Middle Path
Dialectical behavior skills training (from BPD from the inside out)

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