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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)

Hi @Phoenix_Rising & everyone.

I could not do that "linky" thing, to put a link in here. I've never known how to do it.

Anyway, I tried & tried - practiced & practiced.

Here it is (I think). You asked for the DBT Self-Help Website link, so I hope (think) this should do it....

http://www.dbtselfhelp.com/

I still can't figure out (after many many attempts), how to shrink photos so that the site will accept them. I keep getting the message "Image too large" - Rejected....

Adge

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

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

Yes, please "Teach me your Jedi ways"...

I'm with @Awpgirl on that one. I need all the Force I can get.

The Good side of course - not the Dark Side thanks. I've seen far too much of the Dark Side of the Force already....

Adge

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

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

@Adge yay someone understands me ❤️❤️❤️
Balance of shadow & light our task is

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

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

Today I have multiple tasks; which instsrlf creates a higher level of anxiety in my body.

I feel it will be a good opportunity to practise doing one thing at a time and doing each task as mindfully as I can.

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

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

Good evening DBT-ers,

Sorry I've been a little AWOL. Yet again I sort-of got squished by a bus. However, the good news is that I have pretty much got the next installment of the DBT adventure ready to go tomorrow. My aim is to post it in the morning.

@CheerBear I super liked your description of your egg balancing adventure that you wrote for @Awpgirl. I wonder if you were inspired to have a go @Awpgirl???

What musical instrument do you play @Awpgirl? I am learning the violin and I definitely find it to be an awesome mindfulness activity. I find that when I'm learning a new technique, I use the observing and describing mindfulness skills, and when I'm playing more familiar pieces I use the participating skills. Computer games, art, snowboarding and dancing sound like great examples of activities that you can fully participate in @Awpgirl.

How did you go getting through your day of multiple tasks @Awpgirl? I always find that writing a list helps me to focus on doing one thing at a time rather than freaking out over how many things I have to get done.

@Adge Super big thank you for sharing the link for the DBT online group. I will put it on the list of resources that I am compiling. How about I start a couple of threads in the "about the forum" section of Forum Land to help you figure out how to do the linky thing (I'm so going to use that term in the title of a thread!!!) and the photo shrinking thing???

Ok, well until tomorrow DBT-ers...

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

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

Can wait to read it @Phoenix_Rising but no pressure either 🙂

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

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

Excellent @Phoenix_Rising

How to do linky things (links to sites), & how to shrink photos to make them fit - I haven't worked that one out yet...

My bus hasn't got off me yet (I'm still under it), metaphorically-speaking...

I've been recovering from a virus (& ear infection) for weeks, & my energy is zilch (0). Which explain why I've not been posting much...

Adge

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

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

Mindfulness "How" Skills: Part One - Nonjudgmentally.
Good morning DBT-ers,
I finally managed to write the next installment of the DBT adventure - yay! In the last couple of installments, we've been looking at the mindfulness "what" skills of observing, describing and participating. You can read back over those posts here and here. In today's post we are looking at HOW to observe, describe and participate. There are three how skills: nonjudgmentally, one-mindfully and effectively. We will look at the first of these this week and then the remaining two next week time my brain is functioning enough to write about them. Ready? Let's go...

Nonjudmentalness
I'm going to preface this section by saying that I don't understand some of this stuff so I'm super hoping someone can help me out. Nonjudgmentalness involves letting go of evaluating and judging reality. According to Linehan (2015, p. 200), there are two types of judgments: those that discriminate and those that evaluate.

Judgments that discriminate.
To discriminate is to discern or analyze whether two things are the same or different, whether something meets some type of standard, or whether something fits the facts. For example, a jeweler discriminates whether a stone purported to be a diamond is really a diamond or not, and a judge discriminates whether an action is against the law or not. Discriminations are necessary.

Judgments that evaluate.
To evaluate is to judge someone or something as good or bad, worthwhile or not, valuable or not. Evaluations are something we add to the facts. They are based on opinions, personal values, and ideas in our minds. Evaluations are not part of factual reality.

Our aim in nonjudgmentalness is to let go of judgments that evaluate as good or bad, and to keep judgments that discriminate and see consequences.

According to Linehan (2015, p. 200), the terms "good" and "bad" are sometimes used as shorthand for describing consequences. For example, if a piece of fish is all slimy and stinky we often say it is "bad." Similarly, if it is raining on a special day such as New Year's Eve, we often say the weather is "bad." Alternatively, if it is nice and sunny on a special day such as a public holiday, we often say the weather is "good." Given that we use the terms "good" and "bad" like this so often in every day speech, it is easy to forget that we are making a value judgement based on consequences, rather than stating a fact. That is, the reason rotten fish is considered "bad" is because eating it would make us sick. The reason rain on New Year's Eve is considered "bad" is because it makes for a soggy fireworks display. The reason sunny weather is considered "good" on a long weekend is because it makes BBQs, camping trips, and visits to the beach more fun than if it is raining. However, there is actually nothing intrinsically "good" or "bad" about any of these things. For example, if my favourite thing to do is to splash around in puddles, then for me, a rainy long weekend would be "good." Do you see? The goodness or badness is an evaluative judgement that we place on something - the thing itself has no inherent goodness or badness, it simply is what it is.

Judgments that evaluate as good or bad are in the mind of the observer. They are not qualities of what the observer is judging. "Good" and "bad" are never observed.

The nature of nonjudgmentalness.
Nonjudgmentalness is describing reality as "what is," without adding evaluations of "good" and "bad" to it.

Why be nonjudgmental?
⦁ Judgments can have damaging effects on relationships.
⦁ Judgments can have negative effects on emotions.
⦁ Changing the causes of things works better than being judgmental.

Nonjudgmentally: How to do it.
According to Linehan, the aim is to let go of "good" and "bad". For example, avoid saying that a person or their behaviour is either "bad" or "good" and avoid calling yourself a "bad person" or a "good person." The aim is NOT to replace "bad" with "good." That is, the aim isn't to shift from calling yourself a bad person, to calling yourself a good person. The aim is to ditch the terms "good" and "bad" altogether.

Now this is the bit where I get stuck. When I was reading this idea of ditching the terms "good" and "bad," the thought crossed my mind as to whether this means that telling someone they did a "good job" is unhelpful. Then I discovered that Linehan actually answers this question in the very next paragraph (which I suppose means I'm not the only person who has wondered about it).

Right after telling us to drop the terms "good" and "bad," Linehan argues that it is fine to use positive terms such as "good job." This makes no sense to me at all. She says; positive judgments have far fewer negative consequences than do negative judgments. In general, once we reduce our internal judgmentalness, we can go back to using the phrase "good job" and the like to mean specific things. So...it seems to me that after presenting a whole argument for why we should not use the terms "good" and "bad," Linehan backflips and says that it is ok to tell someone they've done a good job. To me this negates her whole prior argument.

To me, this whole idea that things are not inherently good or bad is a philosophy that I do not totally subscribe to. I believe there is good and bad in the world. I believe that acting in a caring way towards others is a good thing, and that doing harm to others is a bad thing. I will be super interested to hear what others think about this whole idea.

Let go of "should."
According to Linehan, when being nonjudgmental, we let go of saying and thinking that things should be different than they are. We also let go of saying that we ourselves should be different than we are (Linehan, 2015, p. 203). What do people think about this???

What nonjudgmentalness is not.
⦁ Being nonjudgmental does not mean we approve of something. Instead, it means recognising that things are as they are, and that everything has a cause. We have a much better chance of changing things we don't like by figuring out what causes them rather than simply declaring them bad.


⦁ Being nonjudgmental does not mean denying consequences. Some behaviours lead to outcomes that we want and some behaviours lead to outcomes that we don't want.


⦁ Being nonjudgmental does not mean keeping quiet about preferences or desires. Asking for change is not being judgmental.


⦁ Values and emotional responses to events are not judgmental. For example, I don't like eating vegetables, but that doesn't mean that I believe eating vegetables is "bad." Similarly, I super like eating chocolate, but that doesn't mean that I believe eating chocolate is "good." Wanting, desiring, or admiring something is not judging. Hating or feeling disgusted by something is not judging.


⦁ Statements of fact are not judgmental, but judgments often go along with the statements of fact. For example, the statement "I am fat" could simply be a statement of fact. However, if (by thought, implication or tone of voice) it is added that being fat is bad or unattractive, then a judgment has been added.

So...what do people think about this whole idea of being non-judgmental? Personally, some of this makes a lot of sense to me and some of it doesn't make any sense at all, so I'm super interested to hear what others think. Linehan says that this concept of being non-judgmental is tricky to get your head around, so maybe I just need to think about it more. On the other hand, maybe it takes time to get your head around because ultimately it is nonsensical. I'm not sure right now.

Here's an exercise from the manual that I thought would be cool to try...
Describe a disliked characteristic of yourself or another person. Aim to describe it without using judgmental words.

I'll go first...

I often get into muddles because I hear words differently to the way most people mean them. I tend to hear the literal meaning and often this is not what the speaker is trying to convey. This doesn't make me stupid or bad, it just means I spend a lot of time being a muddled little turtle.

I wonder who else wants to have a go???

Happy DBT-ing.

@Former-Member @Adge @Appleblossom @Awpgirl @Former-Member @Catcakes @CheerBear @Former-Member @Determined @Faith-and-Hope @FiFiNash @Gypsy7 @mentalstuff @NatalieS @Neelix @outlander @Shaz51 @SGde3a @Former-Member @Former-Member @Former-Member @Zoe7 @Lt72884 @Former-Member @Former-Member

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

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

Thanks @Phoenix_Rising for that beautifully written instalment of DBT.
Something I noticed when involved in DBT myself was that I lacked sufficient memory for Linehan’s acronyms. Whether this was due to long term medication use, insomnia, chronic stress or busy ness of life I’m not clear.
We were urged to “practise” skills over and over in order that they become second nature. Being non judgmental was certainly something that required a LOT of practise.
I have difficulty accepting that things are what they are every day.

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

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

Hi @Catcakes,

Yeah, I have to admit I'm not really into all the cutesy acronyms. There aren't any in this first module, but we will run into them in the subsequent modules.

I'll be super interested in your thoughts regarding the whole nonjudgmental thing. As I said in the post, I do agree with a lot of what Linehan says, but I think her own argument implodes in parts and becomes nonsensical.

I think in some ways, some of my communication issues occur because I actually do take a non-judgmental stance on a lot of things but people hear my statement of the facts as including judgment and therefore become defensive, which I find super frustrating.

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