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Let's do Dialectical Behaviour Therapy (DBT)

Phoenix_RisingSenior Contributor26 Sept 2017, 8:31 am AEST

Let's do Dialectical Behaviour Therapy (DBT)

Good morning Forum Land,

So... @CheerBear @Zoe7 and I have decided to embark on an adventure of working through the DBT skills training manual together but not. That is, we all bought the manual at the same time, but we will probably work through it each in our own muddled puddled confuddled way. Consequently, who knows how this thread will end up looking. That's ok, that's why it's an adventure.

We would super love other Forumites to join us on this adventure if they want to. You definitely don't need to own the manual to join us, though if you want to, this is the book we are working from: DBT Skills Training Manual (second edition) by Marsha Linehan published in 2015. The manual has LOTS of worksheets in it, but happily, you can download those for free from this website: https://www.guilford.com/companion-site/DBT-Skills-Training-Manual-Second-Edition/9781462516995

It is important to be aware that this manual is not a self-help book. This is the manual designed to train therapists in how to deliver DBT to clients. Therefore, it can make for challenging reading at times. Personally, I find it hugely validating reading the way in which Linehan addresses the all-too-common negative and stigmatising attitudes that many mental health professionals have towards clients with Borderline Personality Disorder (BPD). However, others may find it distressing realising just how pervasive these attitudes can be across the mental health profession.

DBT was originally developed specifically to treat people with BPD. However, there is now a strong evidence base showing that is effective across a wide range of mental health issues. This is due to the core focus of DBT being on emotion regulation. DBT has also been shown to be effective in helping non-clinical populations manage their emotions. It may be of particular interest to some people in Forum Land, that DBT skills training has been shown to be effective in helping the carers of those with mental health issues cope with the challenges associated with that caring role.

As I said, I'm really not sure how this adventure is going to pan out...but we will never know if we don't try, will we! The manual begins with an introductory chapter outlining the theoretical basis for DBT. It has lots of nice little subheadings which breaks it up into easily manageable chunks. Thus I'm thinking @CheerBear and @Zoe7, that we could tackle the introduction based on these subheadings. Ideally I would love to do a little bit each day, but given the muddle that is my world, that is unlikely to happen. I expect it is far more likely that some weeks I will have a lot to say, and at other times, weeks may go by where I have nothing to say. I am guessing it will be the same for you...and that is a bazillion percent ok.

I superly duperly hope that some other Forumites decide to join us. But if not, that's ok too. I'm just as happy playing by myself.

And on that note, let the adventure begin...

Finding your way in the DBT adventure.

The following is a bit of a guide to navigating your way around what I anticipate will end up being quite a lengthy thread. The link will take you to the relevant page. Here in Forum Land, there are ten posts per page so you may need to scroll down a little way to find the actual post. The relevant headings are in large blue font to help you find them easily.

What is DBT? (This bit is on this first page so just scroll down).

Understanding Emotion Dysregulation

Are People With BPD Manipulative?

Accepting Our Emotions

The Consequences of Emotion Dysregulation

An Overview of DBT

Orientation, Goals and Guidelines

Pros and cons of learning and using DBT skills

Pros and cons of using DBT skills versus self-harming

Introduction to mindfulness

Mindfulness "What" Skills: Observe

Mindfulness "What" Skills: Describe and Participate

Mindfulness "How" Skills: Part One - Nonjudgmentally

381 replies

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In response to: Let's do Dialectical Behaviour Therapy (DBT)

Unknown userMember31 Dec 2017, 10:53 am AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

@Phoenix_Rising

I have been giving a bit of thought to the question of how to do an essay in a tsunami strength storm.

For me the answer is that is the average person is unable to do this, only a very skilled captain can navigate a boat through a fierce storm successfully.

Waves are a good analogy. As toddlers even the smallest ripple can cause a tumble. As a little one grows and strengthens, they can remain upright when the waves increase, even learning body surfing skills along the way. As an adult, if they don't want to be continually dumped by the waves they learn how to surf or drive a boat. Some people welcome the surf - seeing bigger waves as a challenge to be mastered. They have learned how to understand it and are not afraid of it. For the average person there is a level if strength and resilience needed to manage on the water, knowing what to do if one gets caught in a rip.

It takes experience for a person to be able to manoeuvre a vessel that is able to withstand fierce storms, a surfboard is inadequate for the task.

So, when a storm hits, for most if us, the challenge is to bunker down until the it passes; sometimes there is a safe harbour we can head to, other times we just have drop anchor, batten down the hatches and ride the storm out. We might come out battered and bruised but we survive.

Investing in wet suits life jackers and rafts, surf boards, canoes is useful - acquiring tools that help us to cope with and even enjoy the waves.

Sometimes the gentle waves can knock us down, this is either because we have not built up strength and resilience to withstand any disruption to the water surface or because we have been hit by so many waves our strength is depleted. I think MI does this, complex trauma, grief, even regular strength waves compounding. It takes time, first to regain strength and then to slowly peel back the layers, learning methods and practicing them to be able to cope when the next wave comes in, sticking as close as possible to the beach, negotiating the ripples first ...

In response to: Let's do Dialectical Behaviour Therapy (DBT)

AwpgirlSenior Contributor31 Dec 2017, 2:55 pm AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

@Phoenix_Rising I have a diagnosis of Severe PTSD and attend a psychiatrist who has alot of BPD patients as does my psychologist.
Everything in that you have posted resonates with me.
In fact everyone's posts resonate with me.

I have asked my psych and psychologist are they sure I don't have BPD as I seem to share alot of the symptoms.
I thought you would be interested in the answer.
My boyfriend who has dated girls with BPD has even asked if I'm sure I don't have it.

I had childhood trauma at age 7; 12 ,then in adult years in 2010;2012 and 2014.
I was a fully functioning adults up until the traumas in 2010;2012 &2014. I had no sign of mental illnesses; just my physical illnesses.
The trauma memories I had from childhood very tightly locked away.

The incidenct that occurred in 2010 was horrific and "unlocked" my childhood traumas. Not only that but my now ex husband didn't believe me. Double trauma whammy.

My medical team explain the difference like this. I shared some of the traits of a person with BPD. When my trauma is activated I share all the traits of someone with BPD however when I am calm and my trauma is not activated I don't.
Does that make sense?

Plus I suffer severe dissociation when mybad trauma is triggered. Do BPD patients suffer that as well?

So to summarise my doctor explained that the BPD traiits are transient in me depending on the level of trauma activation; however someone with BPD has the traits all the time.

Either way he says it's irrelevant. We are both groups of misunderstood mental health patients that need love and support when we act badly and DBT is the best therapy for both groups

In response to: Let's do Dialectical Behaviour Therapy (DBT)

AwpgirlSenior Contributor31 Dec 2017, 3:00 pm AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

This will bey third attempt to do DBT from home. I'm going to check out the DBt self help website and start this week with everyone here. I have a bit of catching up to do

I am wondering; do you have to go through it sequentially or can you pick and choose the topics most relevant?

I'm seeing my shrink on the 11th I'll also see if he has additional resources.
Off to out some time into my calendar for this. How long do you think I should spend? Are you guys doing one session a week or something different?

In response to: Let's do Dialectical Behaviour Therapy (DBT)

AwpgirlSenior Contributor31 Dec 2017, 3:11 pm AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

@Adge I just found that page and it will be very helpful

In response to: Let's do Dialectical Behaviour Therapy (DBT)

AwpgirlSenior Contributor31 Dec 2017, 3:13 pm AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

I have found an app for my phone called DBT self help and Diary card.
It's a paid app however I had some google credit
I'll let you guys K ow if it's worth the $5.75

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

AdgeSenior Contributor31 Dec 2017, 3:25 pm AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

Very good @Awpgirl Hopefully the DBT Self-help site will be helpfulf for you.

Adge

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

Phoenix_RisingSenior Contributor01 Jan 2018, 7:40 am AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

Good morning DBT adventurers,

@Awpgirl I super love the fact that one of your names is Phoenix! I found it super interesting what you shared regarding the distinction your psych makes between complex PTSD and BPD. I have never heard that argument before. I wonder if it is research based or whether it is their personal opinion. If I was a betting person, I'd say it is their personal opinion. But then, from what I can tell, pretty much everything around the discussion of C-PTSD vs BPD is personal opinion.

I'm wondering if @Determined has some thoughts about the idea that people with BPD show the traits of BPD all the time whereas those with C-PTSD only show them when their trauma is activated {waves to Determined}. I remember a few months ago, Determined and I were talking about whether BPD is episodic or not. My personal experience is that I am me 24/7 and thus the language of being "unwell" vs being "well" makes no sense to me. This doesn't mean I am in crisis 24/7 - whether I'm in crisis or not depends on what is happening in my world.

My personal view on the C-PTSD vs BPD debate is that BPD should have been renamed C-PTSD in the DSM-V. I know the argument against doing this was that not everyone with BPD has a trauma history. My counter-argument to this is that the vast majority of people with BPD do have a trauma history and those that don't have most likely been misdiagnosed with BPD. I absolutely 100% own this as my personal opinion and do not in any way claim to be "right."

@Awpgirl I definitely agree with your psych when he says it is irrelevant as to whether you have a C-PTSD label or a BPD label. C-PTSD is not even technically a formal diagnosis because it was not included in the DSM-V. The thing that does bug me is when people get given both labels. I see no value in that at all and I believe it can only increase distress by giving someone the idea that they have two issues to deal with rather than one.

Awpgirl I personally think it is fine to drift around the DBT modules and pick the ones you find most relevant. Mindfulness is very much the cornerstone of DBT and this is why it is the first module in all of the suggested weekly schedules in the DBT training manual. However the sequence of the other three modules does vary across the different schedules.

The plan that @CheerBear and I are following is the 24 week schedule so in THEORY we would work through the whole program in 24 weeks. However, given we both tend to get caught up in muddles in the real world a lot, we decided to change the word "weeks" to "steps". So, we are following the schedule, but no, we aren't getting through the session plan for each week in a week. It's a bit of an ad-hoc adventure...and that's ok.

Having said that, I have actually been writing the next installment over the past few days and I plan to post it on Wednesday.

I'm super excited that you are joining us @Awpgirl.

Oh...I almost forgot...you asked if people with BPD dissociate. Yes, one of the diagnostic criteria for BPD is transient, stress-related paranoid ideation or severe dissociative symptom. This doesn't mean that everyone with BPD dissociates. There are nine diagnostic criteria and a person needs to meet five or more of them to receive a diagnosis of BPD. I personally do dissociate a lot.

@Former-Member I super appreciated your thoughts about whether someone can ever do something requiring high level thinking (such as write an essay) while in the middle of a tsunami strength storm. It very much reinforces to me how incredibly unhelpful the "just do it" message is. I have found one of the most useful phrases I have learnt over the years is "I can't do it right now." It's not that I can't do it...it's that I can't do it right now.

Happily, I am through my degree now and thus I don't have to write any more essays - yay! However, I have exactly the same issue here in DBT adventure land. This is precisely why we aren't moving through the manual as quickly as I would like to. When I am in crisis my brain shuts down and I very much go into survival mode. At that point, I simply cannot think. I super struggle with concentration issues all of the time - hence why things take me a loooooooong time. However, when I'm in crisis, it goes from things taking a long time, to things simply being impossible. Thank you for validating the idea that some times we simply cannot "just do it."

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

DeterminedSenior Contributor01 Jan 2018, 11:20 am AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

@Phoenix_Rising

I have little experience with ptsd outside of the forums so drawing a comparison is with BPD is difficult for me.

I will agree though that for my darling there is little in the way of "well" vs "unwell", there are peroids where she can appear well but it takes only a minor blip to tip the balance in the wrong direction. I think the phrase "its only the depth that varies" is the best way to sum it up.

Re the truma, my darling has not had any specific truma as such, (at least not that sh has ever addmitted to) but there have been distressing family dynamics that I believe have been traumatic for her. There is a strong family history of mi in my darlings family so I have often wondered if being fragile to begin with has increased the intensity of some of these events making them traumatic for her? Just my theory. I suppose it also comes down to what is considered truma and can this vary for different people?

Little people are wanting my attention so got to run, back later with some additional thoughts. (Feel free to remind m if Im not back before tomorrow lol)

In response to: Let's do Dialectical Behaviour Therapy (DBT)

CheerBearSenior Contributor01 Jan 2018, 11:25 am AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

Hi everyone.

It's really cool to see new and older faces about in this thread! I'm really looking forward to getting back in to the DBT adventure.

I've been pondering the idea of being able to "just do it" since the conversation kicked off here, so much so that it has contributed to some stuckness for me as I haven't been able to find an answer I feel ok about. With study on the forefront of my mind as I look at my plans this year and this conversation continuing here on the DBT thread, I wanted to reply this morning (with my apologies if it seems like this would have been better to write weeks ago).

After my post here I experienced a big hit to my confidence as I questioned whether I really could just do it or whether I was talking rubbish. I went off on a bit of a wild search for the answer to what it is that may play into some people being able to "just do it". I found a whole range of factors that may contribute to it but no clear answer, and I melted. I melted so much that on the Friday before Christmas when my psychologist brought up goals for 2018, my response to the idea of study was "I am kidding myself if I think I will be able to do it". I spoke about being in the space of needing to survive and how when I am in that space, it becomes very difficult to do anything other than what I absolutely need to do at the time. I asked this question @Phoenix_Rising:

@Phoenix_Rising wrote:
@CheerBear from what you describe, does that mean that if you had to write an essay in the days before you went to the break place, you'd be able to?

to which the response was that had I had an essay to write it's likely that I wouldn't have been in this space in the first place (the days leading up to an admission to a mental health respite facility for anyone reading who that may not make sense to) which I think I agree with.

In the days leading up to the break place (and during the times that have followed where I have experienced suicidality) it felt impossible to do anything more than what I needed at the time, and what I needed to do felt exceptionally painful and difficult. I don't think I would have been able to find the cheese at the supermarket if it had mysteriously changed places, or been able to follow a recipe unless I was doing so as a means of distraction, and I don't think I would have been able to hold a conversation for more than a moment. I get how things can be impossible and therefore how very unhelpful it is to be given a "just do it" message. When I think of being told to just do it, I think of things like this:

I don't know whether I would have been able to write an essay in the days leading up to the break place stay. I do know that on my list of what I 'need' in life, study and what comes with that, seems so high up that I consider it (probably) essential for my survival. Because of that, believing I will be able to do it (whenever "it" is) is really hugely important for me - even if I may be kidding myself.

I am planning on studying this year, even though I see the potential for huge storms again, so maybe at the end of the year I will have the answer that I can't find now that I too am curious to find 🙂

In response to: Re: Let's do Dialectical Behaviour Therapy (DBT)

Unknown userMember01 Jan 2018, 12:03 pm AEDT

Re: Let's do Dialectical Behaviour Therapy (DBT)

Ohhhh what are you going to study @CheerBear? (Not sure if I've already asked you this..... I have a terrible memory!) I'd love another study buddy on here!
Have stuff to say about the rest of your post..... but I need more cognitive space than I have right now to do that.
*goes to the library to download the next chapter of the dbt book*

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