I
started Dialectical Behaviour Therapy (DBT) properly this week, I say properly
because I’ve already done what they call the foundation course. Tuesday was my
first individual session and this coming Thursday will be my first group
session - they started the individuals the week before the groups. Due to the
commencement of DBT I thought I’d write a little about Borderline Personality
Disorder (BPD) with which I am diagnosed but only just, enough to warrant
treatment. I’ve had a look through my blog to see what I’ve already posted
about BPD and DBT, finding that I posted a weighty article about BPD back in
June 2013 and not much about DBT. Below is a little excerpt from Spectrum regarding
BPD along with the diagnostic criteria. In bold and underlined are the ones I
identify with, and just underlined are the ones I only sometimes or partially
identify with.
According to the DSM-IV-TR (American Psychiatric Association, 2000),
borderline personality disorder is diagnosed when there is a persistent pattern
of unstable interpersonal relationships, mood and self-image, as well as
distinct impulsive behaviour, beginning by early adulthood and present in
a variety of contexts. These difficulties are indicated by five (or more) of
the following:
1. Frantic
efforts to avoid real or imagined abandonment.
2. A
pattern of unstable and intense interpersonal relationships characterised by
alternating between extremes of idealization and devaluation.
3. Identity
disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity
in at least two areas that are potentially self-damaging (e.g. spending, sex,
substance abuse, reckless driving, binge eating). This does not include
suicidal or self-harming behaviour.
5.
Recurrent
suicidal behaviour, gestures, or threats, or self-mutilating behaviour.
6.
Affective
instability due to a marked reactivity of mood - intense feelings that can last
from a few hours to a few days.
7.
Chronic
feelings of emptiness.
8. Inappropriate
intense anger or difficulty controlling anger.
9.
Transient, stress-related paranoid
ideas or severe dissociative symptoms.
Not all people diagnosed with BPD will present in the same way, as there are over 100 combinations of symptoms possible, if someone has five out of the nine criteria.
The diagnosis of BPD is only made when it is
clear that these behaviours have been present over time (usually starting in
early adulthood) and across a range of situations.
Reference:
As you can see I identify strongly with three
of the nine traits and partially with four of them, meaning I don’t quite fit
the diagnosis. I should strongly identify with five of the traits. Because of
this I’m unsure whether I should be pursuing DBT. I don’t know if there are
people more deserving of my place, if I’m going to be sitting in the group not
being able to identify with the topics because we’re talking about one of the
traits I don’t suffer at all, or just sometimes or a little bit. I also have a
lot of trouble with my memory and concentration. The group sessions go from
3:45 – 8:30, there are two breaks but that’s still a really long time it’s
helped by being interactive but I get fidgety and restless and just don’t take
anything in.
Below is the entire description of Dialectical
Behaviour Therapy from the PsychCentral site. I don’t know how reputable that
website is but having read through everything posted below I can tell you it’s
right. I don’t have a good enough understanding of this to write it in my own
words, but I know enough to be able to say this is right.
Dialectical behavior therapy (DBT) is a specific type of
cognitive-behavioral psychotherapy developed in the late 1980s by psychologist
Marsha M. Linehan to help better treat borderline personality disorder. Since its development, it has
also been used for the treatment of other kinds of mental health disorders.
What is DBT?
Dialectical
behaviour therapy (DBT) treatment is a cognitive-behavioural approach that
emphasizes the psychosocial aspects of treatment. The theory behind the
approach is that some people are prone to react in a more intense and
out-of-the-ordinary manner toward certain emotional situations, primarily those
found in romantic, family and friend relationships. DBT theory suggests that
some people’s arousal levels in such situations can increase far more quickly
than the average person’s, attain a higher level of emotional stimulation, and
take a significant amount of time to return to baseline arousal levels.
People
who are sometimes diagnosed with borderline personality disorder experience
extreme swings in their emotions, see the world in black-and-white shades, and
seem to always be jumping from one crisis to another. Because few people
understand such reactions — most of all their own family and a childhood that
emphasized invalidation — they don’t have any methods for coping with these
sudden, intense surges of emotion. DBT is a method for teaching skills that
will help in this task.
Characteristics of DBT
- Support-oriented: It helps a person identify
their strengths and builds on them so that the person can feel better
about him/herself and their life.
- Cognitive-based: DBT helps identify thoughts,
beliefs, and assumptions that make life harder: “I have to be perfect at
everything.” “If I get angry, I’m a terrible person” & helps people to
learn different ways of thinking that will make life more bearable: “I
don’t need to be perfect at things for people to care about me”, “Everyone
gets angry, it’s a normal emotion.
- Collaborative: It requires constant attention
to relationships between clients and staff. In DBT people are encouraged
to work out problems in their relationships with their therapist and the
therapists to do the same with them. DBT asks people to complete homework
assignments, to role-play new ways of interacting with others, and to
practice skills such as soothing yourself when upset. These skills, a
crucial part of DBT, are taught in weekly lectures, reviewed in weekly
homework groups, and referred to in nearly every group. The individual
therapist helps the person to learn, apply and master the DBT skills.
Generally,
dialectical behaviour therapy (DBT) may be seen as having two main components:
1. Individual weekly
psychotherapy sessions that
emphasize problem-solving behaviour for the past week’s issues and troubles
that arose in the person’s life. Self-injurious and suicidal behaviours take
first priority, followed by behaviours that may interfere with the therapy
process. Quality of life issues and working toward improving life in general
may also be discussed. Individual sessions in DBT also focus on decreasing and
dealing with post-traumatic stress responses (from previous trauma in the
person’s life) and helping enhance their own self-respect and self-image.
Both between and during sessions, the therapist actively teaches
and reinforces adaptive behaviours, especially as they occur
within the therapeutic relationship. . . The emphasis is on teaching patients
how to manage emotional trauma rather than reducing or taking them out of
crises. . . . Telephone contact with the individual therapist between sessions
is part of DBT procedures.
(Linehan, 1993)
(Linehan, 1993)
During
individual therapy sessions, the therapist and client work toward learning and
improving many basic social skills.
2. Weekly group therapy
sessions, generally 2 1/2 hours a session and led by a trained DBT
therapist, where people learn skills from one of four different modules:
interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion
regulation, and mindfulness skills are taught.
The Four Modules of Dialectical Behaviour Therapy
1. Mindfulness
The
essential part of all skills taught in skills group are the core mindfulness
skills.
Observe,
Describe, and Participate are the core mindfulness “what” skills. They answer
the question, “What do I do to practice core mindfulness skills?”
Non-judgmentally,
One-mindfully, and Effectively are the “how” skills and answer the question,
“How do I practice core mindfulness skills?”
2. Interpersonal Effectiveness
Interpersonal
response patterns taught in DBT skills training are very similar to those
taught in many assertiveness and interpersonal problem-solving classes. They
include effective strategies for asking for what one needs, saying no, and
coping with interpersonal conflict.
Borderline
individuals frequently possess good interpersonal skills in a general sense.
The problems arise in the application of these skills to specific situations.
An individual may be able to describe effective behavioural sequences when
discussing another person encountering a problematic situation, but may be
completely incapable of generating or carrying out a similar behavioural
sequence when analysing her own situation.
This
module focuses on situations where the objective is to change something (e.g.,
requesting someone to do something) or to resist changes someone else is trying
to make (e.g., saying no). The skills taught are intended to maximize the
chances that a person’s goals in a specific situation will be met, while at the
same time not damaging either the relationship or the person’s self-respect.
3. Distress Tolerance
Most
approaches to mental health treatment focus on changing distressing events and
circumstances. They have paid little attention to accepting, finding meaning
for, and tolerating distress. This task has generally been tackled by religious
and spiritual communities and leaders. Dialectical behaviour therapy emphasizes
learning to bear pain skilfully.
Distress
tolerance skills constitute a natural development from mindfulness skills. They
have to do with the ability to accept, in a non-evaluative and nonjudgmental
fashion, both oneself and the current situation. Although the stance advocated
here is a nonjudgmental one, this does not mean that it is one of approval:
acceptance of reality is not approval of reality.
Distress
tolerance behaviours are concerned with tolerating and surviving crises and
with accepting life as it is in the moment. Four sets of crisis survival
strategies are taught: distracting, self-soothing, improving the moment, and
thinking of pros and cons. Acceptance skills include radical acceptance,
turning the mind toward acceptance, and willingness versus wilfulness.
4. Emotion Regulation
Borderline
and suicidal individuals are emotionally intense and labile – frequently angry,
intensely frustrated, depressed, and anxious. This suggests that borderline
clients might benefit from help in learning to regulate their emotions.
Dialectical behaviour therapy skills for emotion regulation include:
- Identifying and labelling emotions
- Identifying obstacles to changing emotions
- Reducing vulnerability to “emotion mind”
- Increasing positive emotional events
- Increasing mindfulness to current emotions
- Taking opposite action
- Applying distress tolerance techniques
Reference:
http://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/?all=1
I
went through the assessments to do DBT a while ago, I think it’s been a couple
of years now, but my doctor decided against having me do it because he worried
I could be triggered by the struggles the others in the group are going
through. I still worry about that because I am easily influenced by the
suffering of others; I only have to see an ambulance to think of all the times
I’ve been in them and what I could do to bring on one of those situations (that’s
quite embarrassing to admit publicly).
I’ve
become a bit lost in writing this. I don’t have a clear point to make, maybe
just that I’m worried and reluctant about DBT starting this week. I don’t know
how it’s going to fit in with my very frequent hospital admissions because you
only have to miss two sessions to be kicked out and made to start that module
from the beginning. Unless of course you elect to quit, something I’d probably
choose over going over the same content from the start.
That’s
this blog post done. Sorry it was long and didn’t really make a point.
