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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

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

AppleblossomSenior Contributor01 Jan 2018, 1:18 pm AEDT

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

"Cognitive space" now thats a better concept than cognitive deficit. @Former-Member

I think that is part of the answer to being able to complete those complex tasks whilst dealing with a storm.

Sometimes the space can come from extra time.

Sometimes the space can come from extra confidence and support.

There is also the Tough and Tender minded dichotomy.

Being a mum, and for lots of other reasons non gender realted, sometimes the tender minded aspect can swamp us with big feelings while the tougher aspect can be more focussed and cerebral.

I've been tossing up future study options this year, but with mothering commitment BIG for at least 6 months I might wait til next semester or next year.

It could be a good year to work on the more relaxing feeling connectedness part of life.

Love this thread. @Phoenix_Rising I try and explain. I would not dump you, but not sure how you feel about me.

Gentleigh Bentleigh can good.

Surfing a tsunami thrilling or terrifying ???

Cheers ALL

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

DeterminedSenior Contributor01 Jan 2018, 1:19 pm AEDT

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

@CheerBear what are you planning to study? Will it be at a university?

It would be well worth while investigating what support services are available to you...

I access durability support services (I do struggle with the naming of that, and have raised this concern at a student rep meeting) and would not be able to do it (study) with out the accommodation's that have been made. I only accessed this initially at the instance of a lecturer who could see I was struggling.

I agree with what @Phoenix_Rising said, there is no 'just doing it' when under pressure, when I am in a crisis I slip into auto mode and am unable to do the simplest of tasks, something I find incredibly frustrating (my main issue is burnout but depression is an issue during long periods of crisis).

Last semester 2 of my major assessment's were submitted with a pass grade even with the benefit of 2 weeks extension on each. Both assessments while complex and not intended to be 'easy' were not unreasonably difficult and at the beginning of semester I was aiming for high 80s or even above 90% grade . In the end no amount of additional time was going to make ant difference 😞. At the same time I dont think it is good to just put life on hold incase something goes wrong. (Keeping in mind that everyones circumstance is different, and basing this on my enviornment).

This inability to function under pressure makes it impossible to maintain full time employment, the main reason for my study is that it would not be healthy for me to be doing nothing.

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

CheerBearSenior Contributor01 Jan 2018, 1:36 pm AEDT

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

Ooh @Determined, have you and @Former-Member crossed paths in a study thread?

I'll be returning to study @Determined (hopefully). There's a similar service through uni but the institution I am with seems very keen on grabbing students and less keen on helping them through a course (it's been an ongoing issue). My psych is already on to it though.

From what I have caught of your story, you have a huge load you carry and that does make things really hard. Total respect for how much it doesn't work to try to just do something you can't. Also huge respect for being able to recognise there are times when you can't do something too.

Burnout is definitely something I have to keep an eye on also and probably occurs following times I have pushed through (or tried to) when perhaps it would have been healthier for me to step back.

@Appleblossom I like the idea of tough and tender minded. Most tsunamis are pretty terrifying for me. Not sure about others and whether there's an element of thrill to it for them, but for me, nope. Just mostly really scary.

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

AppleblossomSenior Contributor01 Jan 2018, 1:48 pm AEDT

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

SO maybe you need to surf them in an aircraft carrier @CheerBear with lots of good soldiers

for a bit of protection and

you can always fly away if needed.

I just love @Phoenix_Rising

wave theme.

Being a surfer when I was young and also in the physics lab.

Just finding ways to insert options into the

COGNITIVE SPACE.

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

CheerBearSenior Contributor01 Jan 2018, 1:53 pm AEDT

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

Maybe @Appleblossom. Or maybe I will keep hunting for eleventy billion dollars so I can change the things in the world which seem to cause a lot of tsunamis (and also invest in a giant fluffy unicorn to hold on to and ride on the back of!) 🙂

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

DeterminedSenior Contributor01 Jan 2018, 1:56 pm AEDT

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

@Former-Member, I could also do with a study buddy, I think you may have told me this already but what are you studying?

I do recall a while ago seeing a study thread of yours but has been a crazy year so never got back to it and couldn't find it later.

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

AwpgirlSenior Contributor01 Jan 2018, 4:02 pm AEDT

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

@Phoenix_Rising I would say that it is their personal opinion. My diagnosis & prognosis is "guarded" I only know that one label attached to my case is severe PTSD.

I also dissociate alot usually requiring hospitalization due to my behaviours during that time.

To be honest I am happy that I have finally found a medical team i trust. It has taken years

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

Unknown userMember01 Jan 2018, 9:43 pm AEDT

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

Gosh...... been trying to read a few chapters of the book this evening and I keep dissociating/zoning out and losing time.
I'm no sure what I'm finding so distressing as to trigger it, but i hope the contents of the next few chapters explain how to cope with this!!!!!

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

AwpgirlSenior Contributor02 Jan 2018, 1:14 am AEDT

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

@Former-Member I have had a similar time the last 24 hours. I'v decided to go to bed and hope I wake up improved if not I will be heading to hospital

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

Phoenix_RisingSenior Contributor03 Jan 2018, 8:50 am AEDT

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

Good morning DBT adventurers,

I had been hoping to post on this thread yesterday but the day went a little awry as tends to happen sometimes. Oh well, it is what it is.

I super love the way @Determined @CheerBear and @Former-Member seem to have teamed up as study buddies through the conversation here. Yay for the power of Forum Land. I almost wish I was still at uni so that I could join in...oh wait...no I don't!

@Determined I think you raised an interesting point about the concept of trauma. When we talk about trauma in the context of BPD, we tend to be talking about complex trauma, which is repeated and/or ongoing trauma rather than a discreet traumatic event. Here is a nice explanation of how complex trauma is generally defined: https://www.blueknot.org.au/Resources/General-Information/What-is-complex-trauma

I'm glad you have found your uni so supportive of your situation @Determined (even if they do use the term "durability support services"!). My uni was also extremely supportive - hence why I was able to take 12 years to complete my 4 year program.

@CheerBear I'm feeling a little sad that our conversation here led to some stuckness and melting for you, although it sounds like the melting stuckness was ultimately helpful, maybe??? I love that you asked your psychologist my question. Does that mean I owe you some money for the session?

Your psychologist's response that you probably wouldn't be days away from needing to go to a break place if you were writing an essay, made me smile. Back in 2012 I was trying (and not succeeding) at writing an essay. It was due in two days time. I went into crisis and a friend (who has since dumped me) called the crisis team on me, which led to me getting locked up in the psych ward. My friend emailed the lecturer who was super understanding and told me via my friend to forget about the essay, he would give me an extension, it would all be fine. I got out of the psych ward 2 days later, went back to writing the essay which I submitted a couple of days later, and ultimately got 96% for it. The subject? Clinical psychology. The essay topic? A critical evaluation of DBT.

I SUPER like the picture you posted @CheerBear. I agree that it sums up the "just do it" message very well! I also love your plan to change the world when you find eleventy billion dollars or, failing that, find a giant fluffy unicorn to ride. The conflation of those two ideas made me laugh a lot!

@Awpgirl I am so super pleased for you that you have a medical team you trust. I can very much relate to the agony of trying to get to that place. I saw my first therapist in 1996. From 1999-2015 I was in a complex and abusive relationship with my psychologist. Since I left him in 2015, I've churned through 12 therapists. So yep, I'm very much hearing you when you talk about how difficult it is to find helpful helping people. Happily, I THINK I've found a good match in the psychologist I met just before Christmas. Around here I refer to her as TTT (as in therapist-take-thirteen). Helpful helping people can help SO MUCH...and unhelpful helping people can do SO MUCH harm.

How are you going with the app that you found? It sounds like things are super tough for you at the moment.

@Former-Member Which book are you reading? Is it the DBT skills training manual or the book on attachment that we were talking about elsewhere? Both can be quite a heavy read. I find that when I'm reading super heavy stuff, it works best for me to read only a few pages at a time, and then go and do something else.

Ok, I think that's it from me for now. I plan to post the next installment of our adventure later today.

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