CBT, Polyvagal Theory, and DBT: How I Use This Combination in Psychotherapy With My Clients

Ever feel like no matter how much self-work you do, you keep reacting the same way in stressful situations? That's because your brain and body are wired by past experiences- and breaking those patterns takes more than just insight.

• CBT (Cognitive Behavioral Therapy) tells us that we all develop schemas-- deep rooted core beliefs about ourselves, others, and the world. If you grew up feeling unsafe, unseen, or unworthy, you might carry schemas like:

  • "I am not enough."

  • "People will abandon me."

  • "I have to be perfect to be loved."

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• Polyvagal Theory explains that these schemas don't just live in our thoughts- they're stored in our nervous system. If your body learned to expect rejection or danger, you may automatically shift into:

  • Fight (anger, control, defensiveness)

  • Flight (overachieving, avoiding, people-pleasing)

  • Freeze (numbing, dissociating, shutting down)

• DBT (Dialectical Behavior Therapy) helps us step in and change these patterns in the moment. Through skills like:

  • Opposite Action- Challenging your schemas by acting against old patterns of behavior that are no longer suiting you.

  • Distress Tolerance- Regulating your nervous system so old triggers don't take over.

  • Mindfulness- Noticing when a schema is running the show and shifting your response.

Healing Takes the Whole Nervous System

CBT helps us recognize and reframe our schemas.

Polyvagal theory helps us regulate the nervous system reactions that reinforce them.

DBT gives us skills to change how we respond-- so we're no longer controlled by old patterns.

Healing is more than a mindset-- it's rewiring your thoughts, body, and actions to create new emotional safety within and new ways of being.