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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 @Winterz and @Former-Member, it is super nice to meet you here on the DBT thread. Seeing you pop by reminded me that I really need to find my mojo and get on with working on the next module. Both @CheerBear and I seem to keep getting squished by buses that knock us around a bit and thus this is a bit of a stop-start adventure...and that's ok.

@Winterz I totally agree with you that CBT and DBT are quite different, although I wouldn't call them opposites. DBT (along with some other therapies such as ACT) are often called "third wave" behavioural therapies, where behaviourism was the first wave, and CBT was the second wave. DBT is actually a form of CBT, but as you said, it adds a lot of acceptance to the concept. Linehan titled her treatment manual, wherein she introduced the world to DBT back in 1992, Cognitive Behavioural treatment for Borderline Personality Disorder: https://www.bookdepository.com/Cognitive-Behavioral-Treatment-Borderline-Personality-Disorder-Marsha-M-Linehan/9780898621839?ref=grid-view&qid=1522127954554&sr=1-3. In it she discusses that this then-new therapy, which she was calling DBT, includes a lot of CBT strategies, but adds to it the idea of acceptance/mindfulness.

It's really interesting that you find CBT helpful in any situation. I find CBT useful in SOME situations, but I find it super unhelpful regarding a lot of my muddles. This is because my muddles are attachment and trauma based, so changing my perceptions and thoughts doesn't address the underlying issues at all. The thing I need most in the world is a sense of connection and safety, which thankfully I am now finding with my new psychologist (who I call TTT, as in therapist-take-thirteen, around here).

I super agree with you @Winterz, that becoming adept at mindfulness takes a LOT of practice. Like you, I am still working on managing my super gigantic emotions better. It's a work in progress.

@Former-Member ooooh I'm super excited to hear you have ordered the DBT book! Yes, I am a VERY big fan of getting to the source of our muddles. It is a source of frustration to me that the vast majority of therapists out there only want to teach "coping skills" rather than helping people to actually heal. It truly is possible to heal from trauma...the challenge is finding a therapist to do this sort of work with!

As you've probably noticed, we are travelling through the manual very very sloooooowly, so I'm sure you'll catch up in no time.

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

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

Here it is @CherryValentine ..... 👋

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

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

Thanks all for welcoming me and I look forward to the chats about DBT.

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

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

@Phoenix_Rising

Your sorting through the issue of NOT being people savvy but being called manipulative is good/important/relevant to me etc .... Not great that it happens, but it really clears up some muddles ... as you say. Maybe they are other people's muddles tho and we are all in the big puddle together ...

a la @Decadian

I cant help it. I do the as in Rome thing ... it happens naturally in conversation ... I think ???

Yeah it would be great to get on with this show .. no pressure

Best to have ALL of you along, big feelings too, not just your head or your fingers typing mindlessly away.

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

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

That's cool if you disagree with me that CBT and DBT are 'almost opposite. We just differ in opinion.
Therapists specialise in different methods of Counselling and when I changed from CBT therapy to DBT therapy, my therapist would often point out that I was using CBT strategies rather than DBT . Which is when I realised the difference.
I did also say that I personally prefer CBT but that is just me. If it doesn't work for you, fair enough.

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

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

Being people savvy to me means being aware of what is socially acceptable and being considerate of, pleasant to and interested in others so that I will not be disliked and will be respected by most and loved by a few.

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

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

Hello @Winterz, @Former-Member

hello @Former-Member. @Phoenix_Rising, @Appleblossom xx

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

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

Hello @Winterz,
I’m interested to know if you actually participated in a group when you “did DBT” ?

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

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

Hi all,

@Winterz yep, it's cool for you to believe that CBT and DBT are almost opposites. Just to clarify though, it isn't MY opinion that DBT is an extension of CBT, it's the opinion of Marsha Linehan, the developer of DBT. As I mentioned, she titled her seminal work on DBT (i.e. the treatment manual for BPD) Cognitive-Behavioural Treatment of Borderline Personality Disorder. She discusses how DBT relates to CBT on pages 20-22 of the manual (Linehan, 1992). According to Linehan, DBT utilizes a lot of CBT techniques, but also builds on it by:

  • Focusing on acceptance and validation of behaviour as it is in the moment.
  • Focuses on addressing therapy-interfering behaviours.
  • Emphasises the therapeutic relationship more than is done in CBT.
  • Focuses on dialectical processes.

Whereas CBT focuses on change, DBT balances change with acceptance. According to Linehan, the focus on dialectical processes sets DBT off from standard CBT, but not as much as it appears at first glance (Linehan, 1992).

I would love to hear more about the sorts of strategies your therapist considered part of CBT rather than DBT (only if you want to share of course).

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

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

I have a question for everybody, that I've been pondering for the past few weeks. What are your thoughts on the dialectic of accepting a situation as it is, while also taking a stand against it?

I strongly believe in the value that all it takes for evil to prosper is for good men to do nothing. This is very much a core value that I choose to live by, even though sometimes it would be much easier to simply walk away. Do you think that in standing up and saying "that's not ok" a person is failing to accept reality as it is? I don't. I think perhaps for me, the idea is that I will stand up and say something is not ok, while at the same time accepting that in taking a stand, I may or may not change that particular aspect of the world.

I would super love to hear your thoughts on this.

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