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Let's do Dialectical Behaviour Therapy (DBT)

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)

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

LoL @Phoenix_Rising@ that was disability support services (blaming that one on auto correct) I think the term disability is a barrier to people accessing the service. It was for me anyway

What were you studying at uni?

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

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

I found the definition on complex trauma interesting @Phoenix_Rising, my darling would fit the definition of the complex childhood trauma. I had often wondered about that aspect of her BPD diagnosis.

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

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

*Important to note that she was raised in a home where she was loved, provided for and looked after. Her parents did everything possible to look after her and still do.

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

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

It was coincidental, that at the time we were talking about waves @CheerBear someone else on forum was talking to me about surfing in real life at specific well known beaches. ie not metaphorically.

I do not mean to minimise the damage that tsunamis irl can cause. I have long been interested in oceanography and not sure a eleventy zillion dollars will calm the seas forever, but I also get where you are coming from. It also was nice for me that the image of an aircraft carrier popped into my mind. It reminded me of positive "memories of my dad taking me to Garden Island to see his old boats and captains. The world felt safer and logical and I felt protected as he showed me around them explaining all the bits and pieces and reasons why.

It felt so good to just have my mind be as it is, without me having to exert control over it to manage negative thoughts.

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

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

@Phoenix_Rising thanks for your kind words and thoughts. The app is brilliant. It contains a daily DBT diary a crisis support area practise skills and then for each DBT skills it has a method to input and try it out.

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

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

Hi @Determined ROFL!!!!! I initially assumed it was supposed to be disability services, but then when @CheerBear responded without drawing attention to it, I figured it must be some new politically correct term for disability services. That is super funny.

At my uni, the counselling service was distinct from disability services, which I always thought was very odd. I approached disability services once and they had no idea how to support me. However, the uni counsellor was awesomely amazing and I am continuing to grieve for her two years on from my graduation. I did a BA with a psychology and philosophy double major, and then went on to do my honours in psychology.

@Awpgirl That app sounds super cool. I am keeping a running list of resources to add to this thread at some point, so I will add that one to my list.

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

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

Mindfulness "What" Skills: Describe and Participate.
Good afternoon DBT adventurers,


Hands up who can remember where we were up to in our DBT adventure? Given it was LAST YEAR that I wrote the last installment, I will forgive you for not remembering (plus I may possibly have had to read back on the thread to remind myself where we were up to!).


So, a quick recap. We are looking at the first DBT module, which is mindfulness. Linehan identifies three "what" skills (i.e. what we do in mindfulness) and three "how" skills (i.e. how we do mindfulness). In my last summarizing-the-DBT-manual post, we looked at the first "what" skill, namely observing. You can read that post here.


In this post, I'm going to look at the two other "what" skills and then next week I plan to cover the three "how" skills. Of course, based on my track record to-date, when I say "next week" that could mean that the next post is anything up to a month away!

The mindfulness skill of describing.
Why describe?

  • Describing involves putting into words that which is observed. The benefit of describing a phenomenon is that it helps us to distinguish between what we are actually observing and our thoughts about what we are observing. For example, suppose your partner arrives home late from work on the night you had planned to go out to dinner together. In such an instance, it can be easy to have thoughts such as; my partner doesn't even love me enough to make sure they are home on time. However, this is a thought ABOUT the event rather than a description of the event itself. An accurate description of the event would simply be, my partner is late getting home.
  • Describing events to other people gives them the opportunity to correct or validate our perceptions and descriptions.
  • Writing down descriptions of our observations allows us the chance to observe the information. That is, when we write about something, the very act of writing often helps us to process what we are observing.
  • Research has shown that when a person labels and describes their emotions, this in itself helps to regulate emotions.

Describing: What to do
NOTE: If it wasn't observed, it can't be described.

When describing an observed phenomenon, the aim is to stick to the facts. Now...I am a bit stuck on this next bit, so I'm hoping some of you are going to help me out. According to Linehan (2015), although we can observe and therefore describe our own internal experiences (e.g. I observe a feeling of sadness arising), we can only ever guess or make assumptions about what others are thinking.
I totally understand and agree with this. However, what I don't understand is how this concept fits with the concept of theory of mind. That is, it is often said that people with autism have a poor (or totally lacking) theory of mind, meaning they can't "mind read." But isn't Linehan saying that NOBODY can mind read? That is, that people can only ever guess what another person is thinking? So...isn't it better to not guess at all, than to make guesses which are likely to be incorrect?


I know I DETEST it when people try to tell me what I am thinking or feeling. One of the situations where I often experience this is if I go into crisis in response to something that someone says. The person will often tell me "you just don't like what I have to say." That is simply not true. If you say something and in response I drop to the floor and start screaming and self-harming, it isn't because I don't like what you said, it's that an intense trauma-related memory has been triggered in my brain by whatever you just said.


Another area where I super notice this is in the tendency for people to describe the behaviour of others as being "manipulative." This is a bit of a hobby horse of mine - you can read about that here. I find it intriguing that people think they can "know" that another person is being manipulative. Linehan addresses this issue on p. 191 of the DBT manual where she explains that the statement, I feel manipulated often gets translated into, you are manipulating me. It is perfectly legitimate for someone to describe their own internal experience of feeling manipulated, but this does not mean they can then infer that the other person is being manipulative. No one can observe the thoughts, feelings, or intentions of another person.


Questions.
Can you think of any times when someone has told you what you are thinking or feeling?
Can you think of times when you've told someone else what they are thinking or feeling?

Practice Exercises for Describing.
These exercises are taken from Mindfulness handout 4B in DBT Skills Training Handouts and Worksheets (Linehan, 2015, p.58).

  • Lie on the ground and watch the clouds in the sky. Find and describe cloud patterns that you see.
  • Find things in nature (e.g. a leaf, a drop of water). Describe each thing in as much detail as you can.
  • Describe what a person has done or is doing now. Be very specific. Avoid describing intentions or outcomes of the behaviour that you do not directly observe. Avoid judgmental language.
  • Describe your feelings as they arise within you. For example, "A feeling of anger is arising within me."
  • Describe your thoughts when you feel a strong emotion. For example, "I feel X and my thoughts are Y."
  • Describe thoughts, feelings, and what you observed others do. For example, "When you do X, I feel Y, and my thoughts are Z."

The mindfulness skill of participating.
The third mindfulness "what" skill is participating. According to Linehan, "participating is entering wholly and with awareness into life itself, nonjudgmentally, in the present moment. Participating is the ultimate goal of mindfulness" (Linehan, 2015, p. 192).

Have people heard of the concept of "flow"? It is a state of mind wherein you get so completely absorbed in an activity, that you lose all track of time. I super like being in a state of flow. Anyway, this is what Linehan means by participating. When you are in a state of flow, or, as Linehan describes it, participating, you lose a sense of yourself as being separate to the activity you are doing. This means that fully participating in an activity is mutually exclusive to any sense of being self conscious. You just "do" without thinking about the doing. You don't worry about what others might think of you, or whether you look silly or whether you are doing the activity right...you simply do it.


I really notice how much I mindfully participate when I'm playing my violin...and I notice how much I make mistakes when I stop mindfully participating. That is, I often mess up a piece in a lesson even though I could play it perfectly fine at home. I know this is because at home I simply play, whereas at my lesson I think far too much about my playing and consequently I mess up (and then tell my teacher "awwwwww but I could do it at home!!!!").

Can you think of any activities you do (or would like to do) that particularly lend themselves to practicing the skill of participating fully? Along with my violin playing, I find that I get into a state of flow when doing yoga, playing in my garden, and doing jigsaw puzzles. When my brain is working well, I also get into a state of flow when I'm learning something new about, well, pretty much anything really. I super enjoy learning for learning's sake.


A participating practice exercise
On pages 194-198 of the DBT manual, there are a whole lot of suggested exercises for "real" DBT groups to do. Reading through the list, I have to say that if I was in a group and was asked to do some of these things...yeah...that wouldn't be happening! This is because they involve physical touch, such as group members holding hands. Nope, this little turtle would definitely not be doing that! However, there is one suggested exercise that, when I read it, I thought it sounded super fun. So...I've tested it out and I can highly recommend it.


For this exercise you need a raw egg and a flat surface such as a kitchen bench or a bare table (no table cloth allowed!). Now, all you have to do is balance the egg on its end (the larger end). Here's my egg yesterday.

It took a while. I don't know exactly how long because, well, I was mindfully participating and thus lost track of time. If your egg ends up splattered on the kitchen window after you throw it in frustration, it might be helpful to practice observing and describing your emotions a little more before having another go at participating in this exercise.
Have fun! I would super love to see photos of people's balanced eggs.

When to observe, when to describe, when to participate.
One of the key points about these three "what" skills is that we can only do one of them at a time. That is, we are either observing OR describing OR participating. So, how do we know which skill we need to use in any given situation?


According to Linehan (2015), when we notice a problem in our life, we first need to observe the problem and our response to it, and then accurately describe the problem and our response. This will help us to figure out what we need to do differently and/or what skills we need to learn to solve the problem. Once we know what we need to do and have the skills to do it, we can dive in and actively participate in the situation.


I can see how my violin playing exemplifies this. When I'm learning a new technique, I practice super slowly, super focusing on every tiny detail of it (and sounding like a dying cat in the process!). But then, once I have got the hang of the technique, I can use it effortlessly in the piece of music. At this point I would have shifted from observing and describing, to participating. Does that make sense?

Here endeth the lecture on the three mindfulness "what" skills. So, now all we need to do is PRACTICE!

Here is a cool video that summarizes the three DBT "what" skills: https://www.youtube.com/watch?v=vmnI6pPBmfA

I'm super keen to hear people's thoughts, ideas, reflections and anything else you may want to share. Happy DBT-ing!

@Awpgirl @CheerBear @Faith-and-Hope @Determined @Appleblossom @FiFiNash @Shaz51 @SGde3a @mentalstuff @Gypsy7 @Former-Member @Neelix @Former-Member @outlander @NatalieS @Catcakes @Former-Member @Adge @Former-Member @Former-Member @Former-Member @NikNik @Former-Member @Former-Member

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

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

You’re clever @Phoenix_Rising !
As you know, I have completed all modules of DBT, but it’s been a while.
I need to reread this later when the household isn’t so busy 🤓

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

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

@Catcakes thank you for saying I am clever. Do you think I am clever because of the post I wrote, or because I can balance an egg?

I feel I've really added to my skill set here. I can balance an egg, stand on my head, and do inferential statistics. Wow, I really do excel at the important things in life. If anyone happens to see a job that requires that skill set, can you please let me know?

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

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

It’s the egg thing 😉

here is is a drawing I made whilst I was doing my DBT course.

i struggled at first and I used drawing to feel more comfortable staying in the room.

@Phoenix_Rising,also @Former-Member

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