Let's do Dialectical Behaviour Therapy (DBT)

Good morning all

Hi @Phoenix_Rising I can very much relate to your focus on emotion dysregulation and I have written a similar focus in my goals etc (which I will share in a post in a moment). It's interesting as distress tolerance was initially where I thought I would gain most, but over the last couple of weeks I am definitely experiencing emotional hypersensitivity and can see working on this area might be really helpful right now. Plus I think need these skills to tolerate the distress tolerance stuff anyway 😛

You mentioned you were curious to know how others experience emotion dysregulation. I experience anything from teariness and snappiness to - drop and curl up in a ball, an extreme need to move which results in pacing, restlessness and agitation, a full blown panic response, or a blank frozenness. For me my responses very much depend on where I am at the time, with a version of freeze being a default if I am around others (particularly little ones). I'm interested in hearing whether others also experience situation dependent reactions like my "stop, don't move, don't say a word right now". I am not sure it's entirely healthy as it seems a lot like bottling it up to me, which then seems to make things more intense anyway. All of my big feelings are accompanied by big physical responses also.

I felt a pang writing that assumption, especially with the word "need" there. It's an interesting approach in general and I think the ideas work though.

Hi @Appleblossom I really appreciate your use of the word "confines" when talking about emotion dysregulation, and I am wondering if it is a similar thing to what I mentioned above. My experience with needing to restrict or contain what can feel too big to keep in, is that it pours out in other ways. Perhaps pouring from the depths, when it is misunderstood or misinterpreted by others, is where a big problem rests?

Which brings me to something that irks me, and that I think is relevant here. I find it hard to read words such as "conventionally accepted" and "socially tolerable" when they're used to describe what emotion dysregulation is not (which is what Google brings up, as opposed to Linehan's definition here ). I believe that a lot of problems occur when thinking feeling humans are hurt by the social world, and then those problems reoccur and are made even more problematic when the social world can't tolerate a person's expression of their experiences. It makes me angry (which I have to be careful to contain ). I too feel I should be free to choose who I show and how much to.

Thank you for sharing Apple. I got a quiet smile when I read where you plan to start

Hi @Appleblossom, I really enjoyed reading your post. I definitely do not respond well if someone tells me what I am feeling (e.g. "you're angry"). I am fine with someone taking a guess (e.g. it sounds like you're angry, is that right), providing that they are genuinely open to me saying that no, I'm not angry, I'm scared/hopeless/despairing, or whatever it is that I'm feeling and that they have misinterpreted as anger. I have had a lot of experiences where I have not been angry, someone has told me I'm angry and THEN I've got angry!

It definitely does not work for me for any mental health professional to TELL me what I am feeling. It sounds like you had an unhelpful psychologist there, Appleblossom. I personally have no interest in seeing a psychiatrist, I just want to find a GOOD psychologist...and goodness knows they are darn difficult to come by!

I like what you said about being able to access your emotions in many ways. For me, the issue isn't accessing my emotions, it's managing them. My emotions are well and truly accessible. I am interested in hearing more about the idea of accessing emotions if you feel like sharing???

I think you are totally right that everyone can benefit from the DBT skills. If you do a bit of googling, you will find books about DBT for just about any population (including non-clinical populations) that you can think of. For example, there are DBT books for kids, teenagers, carers etc. DBT was specifically developed for people with BPD, but it has well and truly moved on from there over the past 25 years.

@CheerBear thank you for sharing the ways in which you experience emotion dysregulation. I can super relate to the extreme need to move, that you described. I guess that for me that just comes out as rocking rather than pacing etc. Freezing sounds yuck. I'm not sure that I have that experience. If I'm super stuck, e.g. if the police are already on my doorstep, I dissociate. That sounds different to freezing. I'm not sure...

Yeah, I think it is the wording of that assumption about needing to change etc. that bugged me because I really am fine with the idea that I am 100% ok as I am right now and yet I also need to learn new strategies etc. Or maybe...for me the issue is whether I'm saying it to myself or if someone else is saying it to me??? Maybe I'm more ok with telling myself I need to learn new ways of managing my super big feelings, than I am with someone else telling me.

I totally agree that terms like "conventionally accepted" and "socially tolerable" are unhelpful terms in describing emotion dysregulation @CheerBear. I actually thought about this a bit when (P) died. The vet was a little freaked out at the way I was so super calm until she declared (P) dead, and then I collapsed over him and wailed my heart out. However in other cultures, that is considered a perfectly normal response to the death of a loved one. I think part of the issue in our society is that safe healthy expression of big feelings is not encouraged and, indeed, is at times pathologised. It seems that as a society, we are not very good at simply sitting with intense emotion.

Thank you for sharing your thoughts Appleblossom and CheerBear.

Hi everyone,

I wanted to share where I got to with my goals.

In considering my goals, particularly in terms of the skills available in the modules, it got me thinking about what might drive the "problems in living" that I experience (and that I can choose to address). Emotion dysregulation is a big part of it for me also. When I am triggered, my emotions can become massive and chaotic. I lose my ability to stay 'present' as I get lost in 'back then when all the bad stuff happened', or wander ahead to the unknown 'what might come next that will mess with me more'. Similarly, my interpersonal skills seem to rapidly disappear. I can freeze and stop talking altogether or panic and my words come out in bits and pieces. I forget what I need or want to say and I have trouble listening and hearing, or concentrating. I can also have difficulty with asserting myself when I am triggered, either through becoming passive or by being aggressive (which I don't think happens as much as others say it does as I think people find assertiveness confronting and they default to calling it aggression as a defense mechanism to avoid facing a potentially uncomfortable reality - buuuuut that's a whole different issue )

The short version of the above is that I think emotion regulation skills might really help me.

Similarly, I can experience pretty significant distress following triggers, tricky interactions with others, and trips down memory lane (or ahead into "what-if" future land). I can also feel pretty miserable sometimes about where my life is, and those feelings take me nowhere great - so distress tolerance skills will be a big one for me too.

Here are my goals:

Behaviours to Decrease
1. Lack of emotional control (up and down and all over the place, extreme emotions)
2. Shutting down/flying off when I am emotional
3. Not accepting reality and becoming completely overwhelmed and stuck (wanting out) because of it

Skills to Increase
1. Emotion Regulation - so I can successfully manage my emotions before they become extreme (and extemely unhelpful)
2. Emotion Regulation/Distress Tolerance - so I can accept and tolerate my emotions when they do become extreme
3. Distress Tolerance (reality acceptance) - so I can find more acceptance in the fact that this is not the life I planned, expected, hoped for or wanted.

This is where I got with my Pros and Cons of Using Skills worksheet

A current situation/problem: Becoming overwhelmed and extremely emotional whenever I attempt to sort out my current housing 'mess'.

My goal in this situation: To be able to look for houses, explore housing options, and work with housing support, in a way that will assist me to meet my housing needs, without 'falling down' or 'falling apart' during or after.

Here's my pros and cons for the above

PROS

Practicing Skills
* More likely to make a sensible (wise) decision
* More likely to reach my goal
* Chance to try a new approach and learn from it

Not Practicing Skills
* It will be a familiar approach
* May be easier

CONS

Practicing Skills
* May be frustrating
* Might take extra time
* Requires extra effort
* I may feel disappointed if I try and don't succeed

Not Practicing Skills
* May cause problems in the relationships I have especially with housing support workers (if I keep going like this)
* I may end up stuck in the same situation for longer
* I may end up in a worse situation

I have found this way of making a pros and cons list so helpful in lots of situations over the last few years. For me it works much better than a standard two column Pros and Cons kind of one, which is why I went through it in a table (which looks like this)

What I read from the above is effectively that no matter which way I look at it, it's worth giving this a go. Two big stand outs for me are "the same or worse situation" and "likely to make a wise decision".

Thanks for reading

Thank you @Phoenix_Rising you would probably be more quickly direct than I. I dont mean to sit on feelings. It is just that for most of my life there has bee no=one who cares.

It has taken me til recently to be able to recognise when I have been hurt, verbalise it and feed it back into a relationship. I have one friendship with a male with whom that is being recognised and validated. He is like a bull in a china shop with a good heart. My richer brother was also like a bull in a china shop and only realised before he died what a mess he had made. He howled out his sorries to me. Sad but true. Our family just had too many stressors that meant typical scenarios were irrelevant.

@CheerBear

By "Therapuetic confines" I guess I mean ... opening up feelings to work on them for the purpost of getting better .... not for public consumption. Big feelings are fine at home ... if you have a home that is a personal sanctuary ....running in the rain ... in a forest or on a beach ...

Like both of you concepts like

"socially acceptable"

or "conventional"

are pretty annoying as they are VAGUE, SHIFTING, CULTURAL, situation specific etc ...

I am totally saying that the SOCIETY behind the SOCIALLY ACCEPTABLE need a little help in emotional understanding. Two way street. Not just the ones like us who are hurt and working on it anyway.

Also Australian society is so multi cultural it is almost meaningless to have one concept of socially acceptable ... IMO.

I have a phone call to do tonight re these kinds of issues ... with our 80 year old American who is rigid and knows it all ... but has NO IDEA how many assumptions she projects onto others without even bothering to check. Endless strings of cliches .... drives me mad ... but its necessary as my son's CARER.

@CheerBearYOU can do it re the housing muddle. One step at a time. Stigma is hard re property agents etc ... hope you get somewhere good enough for you & your lovely homey-school of fish.

Re access to feelings:

In our Shakespeare readings ... I have had to play a pregnant country lass, a princess, soldiers and lords ready to fight even murder, servants and clowns.

Musically, I might play a funeral march, a funky jazz piece, a calming piece or a romantic one.

I think for me the big thing to learn re emotional regulation ... is FILTERS & SETTING BOUNDARIES.

Still keep going on with it.

We can all learn from this thread.

Good morning everyone.

In a moment I'm going to post a post here on the DBT thread about weighing up the pros and cons of using the DBT skills when having the urge to SH. I am tagging some people here who I thought might be interested in the upcoming post. I won't tag anyone into the next post and it is a bazillion percent ok to totally ignore both this post and the following one. However, if anyone does feel that they would like to help me add to the list of pros and cons that I'm working on (or tell me that some of the ones I have come up with are totally stupid!), you are extremely welcome.

@CheerBear @outlander @Sans911 @BlueBay @Former-Member @Former-Member @Appleblossom @Teej @Former-Member @Former-Member

will look out for it @Phoenix_Rising ps nothing is stupid when your trying to help others

Pros and cons of using DBT skills versus self-harming.

Good morning everybody,

Here in the DBT adventure, we are considering the pros and cons of using the DBT skills versus not using them. This is despite the fact that we haven't yet got up to finding out exactly what the DBT skills are. As CheerBear explained in her post last week, the idea is to create a table that lists both the pros and cons of using the skills and the pros and cons of not using the skills. Thus we end up with a table that looks like this:

Although it may initially seem like doubling up by focusing on both the pros and cons of both options, often it is not and a tip we are given on the DBT worksheet to make this more of an effective approach is to focus on what does rather than does not happen for each option when writing our list.

Over the weekend I was reflecting on the fact that there are many of us here in Forum Land (including me) who super struggle with the urge to SH, and I thought I'd have a go at considering the pros and cons of acting on those urges. I am super interested in hearing your thoughts about this list. I have done it as a bit of a general brainstorm. That is, I have included pros and cons that I think may be relevant to some people even though they aren't relevant to me. Similarly, not all of the pros and cons that are relevant to me, will be relevant to you. There are no right or wrong answers here. So, can anyone think of any other pros and cons that we might weigh up when considering whether to use the DBT skills to get through giant feelings rather than engage in an act of SH?

A current situation/problem: Experiencing super gigantic emotional pain and having the urge to engage in SH.

Practicing Skills

Pros

• The more I practice using the skills, the better I will get at them.
• After getting myself through the big feelings, I will feel good about having been able to do that.

Cons

• The emotional pain will probably take longer to pass if I use the skills rather than SH.
• Practicing skills is much harder work than engaging in an act of SH.
• It takes a huge amount of effort to navigate big feelings using the skills.
• I will be totally alone with my giant feelings.

Not practicing skills

Pros

• My immediate emotional pain will be relieved if I SH.
• The process of going to hospital etc. might kind-of distract me from the emotional pain.
• There is the chance I might get some care and support from others if they can see how much pain I am in.
• It is easier to just do what I have the urge to do.
• It will validate to myself how much emotional pain I am in.

Cons

• Might make my situation more complicated by having to go to hospital etc.
• If I engage in an act of SH, I might end up adding to my emotional pain with additional feelings of self-hatred, guilt, etc.
• Might cause distress to other people and then feel bad about that.
• Might get negative, inappropriate and unhelpful responses from other people that add to my emotional distress.
• Might cause physical damage to my body that I will feel bad about later.

Well that's all I can think of right now. I wonder if anyone else has some more ideas?

Hi everyone

Thank you so much for sharing your thoughts about this and opening up this discussion @Phoenix_Rising. I really appreciate the sense that I am getting that DBT is very much about supporting people to make the best decisions for themselves that they can regardless of whether they're considered socially tolerable/conventional/acceptable. Looking at a pros and cons of using skills in the context of SH, really highlights to me how nonjudgmental and empowering this approach is.

Until I joined the forum I would have said that I haven't SHed for a long time. I know that isn't true though, as there are behaviours I do (one in particular around eating) that I now know are forms of it. I have also had increasing urges to SH in different ways and can act destructively sometimes, which for me means lots of different things. I'm going to call the mash of things I experience, "exploding" (even though it can be imploding too). Side note here: I stopped reading your last post at your list so I could write mine before checking whether there was much different - this is what I came up which I don't think there is much I have neccessarily added, but it was helpful for me to think about.

A current situation/problem: "Exploding" when my emotions are too big to contain

Practicing skills

Pros

I, and others, can focus on the actual issue rather than being distracted by the 'explosion'
People may be more likely to work with rather than against me
I feel a sense of pride when I think and act 'constructively' (not the best word to use but I can't think of a better one at the moment)
I might feel like I am living in a way that better aligns with my values
I might feel more in control of myself and the situation if I approach it skillfully

Cons
I would need to find another outlet for some of the built up energy
I might feel frustrated for not doing what I want at the time
It might feel like putting my feelings on hold
It is so hard to switch into thinking things through mode, and if I don't or it isn't successful I might feel disappointed in myself

Not Practicing Skills

Pros

Exploding can give me a sense of relief
It can feel empowering to do what I really want to do without having to think about it at the time
Exploding can get attention/I can be 'seen' and noticed (why does that sting so much to write?!)
Exploding is a distraction from emotional pain and a break from the actual problem at hand

Cons
Exploding often makes things worse in the longer term
People judge and pathologise "explosions" in a way that can have harmful impacts on me
Exploding can lead to feelings of regret and remorse as I can hurt myself and others (and 'things')

Wow that was much harder to do that I thought it would be. I am very interested in hearing from anyone else who may want to share or have anything to add also.

Hi everyone,

Super big thank you @CheerBear for sharing your pros and cons re. exploding. I'm not totally sure what exploding looks like in your world, but I certainly know that I explode - and I super hate that I do. I can relate to a lot of those pros and cons that you listed.

I exploded during my session with my turtle whisperer yesterday. We figured out that nothing in the world was going to stop the explosion but that it also wasn't ok for me to direct my explosion towards her. So, I went to another space, did what I needed to do to get the big feelings out, and then came back to her. I found that super helpful (although super hard at the time) because it validated the fact that I simply could not contain the explosion, while simultaneously being respectful of her. I super wish others could help me problem solve like that, rather than simply telling me to not do something that at this point in time I simply do not know how to not do.

I am super interested in your comment that it stung to say that exploding can get attention or that you can be seen/noticed. I felt the same way when I wrote some of those pros for not practicing skills when wanting to SH. I recognise that for me, the squirmy feeling is because we are so often told that people SH "just to get attention." I LOATHE the use of the word "just" in there. It is absolutely 100% true that I have SH'd at times in order to draw attention to my immense distress in the hope that someone will help me with it. Equally, if I was to accidently set my clothes on fire, I would run into the street screaming, to draw attention to my immense distress in the hope that someone would help me with it.

Seeking attention when one is in immense pain is a perfectly normal human behaviour. The problem is that people seem to only regard this as acceptable behaviour when they can see/understand the source of pain. For those of us who experience the pain of atypically intense emotions, trying to get help with that pain is criticised and pathologised. However, to me, it is no different to anyone seeking help to relieve any other sort of pain.

I have been thinking a little about the idea that it stung to say that exploding can gain attention as being on the pros side of my list earlier. I 100% agree that it is normal to seek attention when in pain, yet my experiences of this have not been that way. I think a lot of this ties in with the idea of primary and secondary emotions. My experiences of seeking attention have sometimes (often) led to enormous feelings of shame. So I am going to try and reduce that by sharing something thanks to the safe and validating environment here.

During my hospital admission a while ago now, I SHed. I did this in part to release some of the emotional hurt I was experiencing, but I also definitely did this to draw attention to the incredible pain I was in which was a mix of fear, sadness and anger, hoping someone would see it and listen to me. It was pathologised and I was stamped with a label and deemed an attention seeker. I see it now as not being able to say what I needed to say, and so much of that was because no-one gave me a chance to feel safe enough to say it. What I had to say was that I was experiencing abuse which led me to hospital in the first place. It went unnoticed and the diagnosis I was given handed him an incredible amount of power over me and a free ticket to do as he wanted (he said I couldn't make good choices for myself, I was 'crazy' etc. and I thought people would be less likely to believe me after the diagnosis, which happened for a while), as well as an opportunity for others to dismiss and ignore me. I was judged, labeled and shamed and it had huge consequences for me. The experience took a lot from me, but gave me insight into the horrible world of stigma and how damaging it can be.

So I will say without shame, that I have SHed for attention. And I seriously wish someone had stopped and listened to the extreme pain and total desperation that was behind that.

These three assumptions:

All behaviours (actions, thoughts and emotions) are caused
Figuring out and changing the causes of behaviour works better than judging or blaming
People are doing the best they can

Seem so relevant and helpful when talking about SH as a whole I think.