Let's do Dialectical Behaviour Therapy (DBT)

Hi @FiFiNash and welcome! It is very nice to meet you and see you here 🙂

I was excited to read your post and hear that you are interested in joining in too. I don't like to speak for other people, however I can say with quite a bit of confidence that @Phoenix_Rising is likely to agree that it is great to see you here!

I think the plan here so far is to continue for a little longer (a couple of days maybe) providing some background information on DBT and then jump into the skills themselves. I also think we are still working out how this adventure will work, but I have a feeling we'll get there together (all of us).

Feel free to add anything you'd like to whenever you'd like 🙂

Before we get to the actual doing bit, which yes I am super busting to get into @Phoenix_Rising, I thought it might be helpful to have an overview of what DBT actually involves. If I have misintepreted anything or if someone thinks something could be said in a more helpful way, please let me know as I am definitely at the early learning stage of this All of the info below has come from Marsha Linehan's DBT Skills Training Manual (2nd edition), 2015 (I am not going to reference this beyond here).

An Overview Of DBT

DBT involves learning, practicing and applying skills in order to skillfully and effectively work through problems and towards personal goals. The skills used in DBT are both acceptance and change skills, which reflect the key dialectic: the need for a person to accept themselves as they are, and the need for them to change. The skills are drawn from four modules:

⦁ Mindfulness (acceptance skills)
⦁ Emotion Regulation (change skills)
⦁ Distress Tolerance (acceptance skills)
⦁ Interpersonal Effectiveness (change skills)

Most DBT schedules (programs) also use information from a General Skills module, which serves as an introduction to DBT and provides participants with an opportunity to understand the format and structure of the particular program and sessions, clarify rules, and begin to settle into an environment conducive to therapeutic progress. The General Skills section also provides tools for identification and analysis of problematic/potentially more helpful behaviours, prompts participants to consider their own goals for therapy, and allows participants to understand the overall goal of DBT which is:

"to help individuals change behavioral, emotional, thinking, and interpersonal patterns associated with problems in living (p.127)"

Something I found particularly useful in the General Skills section was Handout 1A: Options for Solving any Problem, which lists four possible ways of managing problems, and refers people to modules/skills that may assist them to take a certain direction. The four options and skills suggested for solving any problem are:

1. Solve the problem (use interpersonal effectiveness and emotion regulation skills)
2. Feel better about the problem (use emotion regulation and mindfulness skills)
3. Tolerate the problem (use distress tolerance and mindfulness skills)
4. Stay miserable (use no skills)

I thought this was a really useful way (even if I am jumping ahead a little) to capture how the modules and skills work together to make DBT something actually helpful! Now for the point of this post - an overview of the modules

Mindfulness
When I found out that not only was this a module in DBT but that it was actually a core component of DBT, I admit that I wanted to post my book back (for a moment). I struggle with just hearing the term "mindfulness" as I have found it to be a buzz word, and my defensiveness and frustration with its use makes me jump to something along the lines of "how is listening to the birds going to fix things?". However, I stopped and considered why mindfulness was so important in DBT and it helped settle my frustration (and I didn't post my book back).

Mindfulness is "the act of consciously focusing the mind in the present moment without judgment and without attachment to the moment (p.151)".

In the module, mindfulness skills are taught in terms of what skills (what you are doing when practicing mindfulness), how skills (how mindfulness can be practiced), and wise mind (accessing your inner wisdom). Linehan describes two types of mindfulness practices - opening the mind by allowing whatever comes to attention, and focusing the mind through attention to specific internal or external events. It is also suggested that the two stances we can take during mindfulness practices are gaining distance from occurrences by watching what is happening, or becoming involved in what is happening by moving forward and in to it.

Mindfulness practices are the foundations of many DBT skills. The ability to accurately observe and describe, without judgment or attachment, internal and external events, are crucial in enhancing our ability to approach problems skillfully. Practicing mindfulness can increase the level of control and focus we have over our attention, and allows us an opportunity to respond rather than react to a situation. Mindfulness improves our potential to experience reality as it really is, and can enhance our connection with our 'self' as well as others (and everything around us).

Emotion Regulation
Phoenix_Rising has written a fabulous summary of components of emotion regulation/dysregulation so I'll try not to double up too much here.

The goal of this module in DBT is to increase a person's understanding of and control over their emotions (not to remove emotions) in order to reduce suffering. Emotion regulation skills in this module are aimed at increasing a person's capacity to control and influence what emotions they experience and how they express them, while recognising that total emotional control is not possible.

The module includes sections that provide participants with an understanding of the functions and roles of emotions, ways to describe and name emotions, and barriers to regulating emotions. Also included in the module are strategies and skills for changing emotions, improving emotional resilience, increasing positive emotions, and managing difficult and extreme emotions.

With practice and attention to consciously regulating emotions, it is expected that with time, emotion regulation will become a more automatic response.

Distress Tolerance
The goal of distress tolerance is "learning to accept pain skillfully (p.416)". Linehan mentions that many mental health treatments attempt to change situations, whereas distress tolerance is primarily about acceptance of a situation. As pain and distress are considered natural and normal occurrences, skills which allow us to experience them without adding to them or making them worse, are important and useful.

Distress tolerance is comprised of two sets of skills - crisis survival skills and reality acceptance skills. Crisis survival skills are targeted at surviving crises without worsening the situation (as the very nature of high-stress, crisis situations, carries a real risk of additional negative outcomes caused by behaviours which make the situation worse). Reality acceptance skills are designed to assist a person to accept the reality of their life, including what may feel and be experienced as distressing, and supports a person to find peace and contentment within themselves and their lives, even if the life they are living is not as they would like it to be.

It is really important to mention here that acceptance does not mean approval - a point which I (and apparently a great deal of others), have been very tripped up with before.

Interpersonal Effectiveness
Skills within the interpersonal effectiveness module encourage the use of techniques to navigate relationships so they have desirable outcomes. Interpersonal effectiveness skills enable a person to gain what they want from relationships, maintain relationships that are important to them, begin and end relationships, and work through change and acceptance within relationships.

This module addresses factors such as assertiveness, self-respect, identifying the goals of interpersonal relationships and transactions, conversational skills, mindfulness (of self and others) within the context of relationships, reinforcement and punishment, and the importance of validation including recovery from invalidation.

Well that was long! If anyone would like to add anything (at all) to this, or share their experiences related to anything that stands out after reading through, please do

Hi @FiFiNash, it is super nice to "meet" you. You are extremely welcome to join the DBT adventure. As you have probably figured out, we haven't got very far yet. I don't think we are a "group" in the way this term is used in DBT. That is, the thread is a public thread open to anyone to read and comment on at any time. I think it is highly probable (and desirable) that people will wander in and out, and that is absolutely totally fine. Please jump in with any thoughts or comments at any time.

Hi @roachy @BPD-Cinderella @Abs @glitterbee @Former-Member @Dolf @lolamay @Treve @aggieg, I super enjoyed engaging with you all at Topic Tuesday last week and I thought I'd just let you know about this thread in Forum Land where we are working through the DBT skills manual: Let's do Dialectical Behaviour Therapy. If you want to join us on this adventure, you would be very welcome.

Hi @CheerBear and anyone else reading along.

CheerBear I super liked reading your overview of the DBT modules. Those four options of solve the problem, feel better about the problem, tolerate the problem, or stay miserable are super cool. I know that for me, a lot of my muddles aren't fixable right now. Indeed some of them will almost certainly never be fixable. Being stuck in an unfixable muddle can fuel feelings of hopelessness and despair. Thus, the idea that we can always do SOMETHING when we are super struggling is kind-of empowering - even if the something means just focusing on being still and breathing (which is often the case for me when I am super dysregulated).

CheerBear it made me giggle to think of you wanting to post your book back when you realised mindfulness is a core part of DBT. Indeed, I'm pretty sure Linehan was the first person to really introduce the idea of mindfulness to the world of psychology. DBT, along with a couple of other therapies such as Acceptance and Commitment Therapy (ACT) are known as "third wave" behavioural therapies. That is, psychology has kind-of moved from behavioural approaches, to cognitive-behavioural approaches, to cognitive-behavioural approaches that incorporate mindfulness. I totally agree with you that mindfulness is currently a painfully over-used buzz word in the world of mental health, and I imagine a lot of people feel the way you do about it. I guess I was lucky in that I was introduced to the concept quite a few years ago before it became such an "in" thing. Of course, mindfulness isn't actually new - other cultures have known about it for thousands of years. It's just kind-of new in the world of Western psychology.

Anyway, after CheerBear's super cool overview, it seems like we are super close now to starting the actual doing bit. I am super enjoying this adventure - I hope you are too fellow adventurers.

Hello @FiFiNash and welcome to the forum

@Phoenix_Rising @CheerBear Thought we needed a nice relaxing place for DBT HQ

@Zoe7 I super super SUPER love the new DBT HQ. That looks like an amazing space to be super productive and also an amazing space to just be. I think at the moment both @CheerBear and I are in a just being phase due to life circumstances...and that is a bazillion percent ok. You need time to be in order to do.

Good morning to anyone who may be reading and a big hi to anyone who is lingering around wondering what is happening with this thread/adventure/project.

As @Phoenix_Rising mentioned, life circumstances seem to interrupt plans sometimes, as it seems has happened here. I am also a bit unsure about how best to go about actually "doing" this together here. The plan at the moment is to follow Linehan's standard 24 week adult DBT schedule but instead of going about it "week-to-week", approaching as "step-by-step" so as to make sure this is not too much for everyone and to allow it to be flexible around life things happening (sounds important to me!).

I have left this on the board above the desk for now

And am keen to hear whether anyone may have any ideas about how they would like to see this "done". Is there anything you would like to see or do here together?

🙂

Good morning @CheerBear and everyone else,

Your post-it note super made me giggle @CheerBear. I have a super funny picture in my brain of you running around like an energizer bunny going "we're up to the doing bit, we're up to the doing bit, we're up to the doing bit...er...how do we do the doing bit Phoenix_Rising?"

I have been sidelined by, well, life for the past couple of weeks, but I am moving back into a headspace to continue this adventure now. My aim is to have the next bit of the adventure appear here on Monday. Stay tuned! {Wanders off to DBT headquarters to find that pesky little energizer-carebear.}.