Very excited to be working on my DBT skills again : )
I got my two new DBT books in a few days ago, and I’ve already started with the DBT skills workbook. The Wellness Planner I’ll start tomorrow (monday) and the Dutch DGT-vaardigheden book was my original book that I used during my actual treatment.
My actual goal is to collect more DBT content:
- DBT Skills Training Manual by
Marsha M. Linehan
- DBT Skills Training Handouts and Worksheets, Second Edition by Marsha M. Linehan
- Dialectical Behavior Therapy Diary: Monitoring Your Emotional Regulation Day by Day by Matthew McKay and Jeffrey C. Wood
- Mindfulness for Borderline Personality Disorder by Blaise Aguirre
- De DGT-Vaardigheden Werkboeken by Marsha M. Linehan
- Omgaan Met Overweldigende Emoties by Matthew McKay and Jeffrey C. Wood
Why would I ever want to learn DBT in English when I finished treatment in Dutch? Because I think it’s interesting to learn it in English, as well as I think I can help more people by knowing everything in English. I also just think it’s fun, the differences between the languages and the way skills are called is really interesting.
Let's Talk About DBT
DBT is an acronym for Dialectical Behavior Therapy. It is a strategic therapy aimed at confronting our negative thoughts and emotions head-on, interpreting them, and then managing them in healthy ways. If you struggle with severe anxiety and depression, DBT is an indispensable mental health toolbox you can't afford to go without.
As a person who grew up and currently lives in poverty in one of the wealthiest countries on earth, persevering through depression and anxiety has been a lifelong battle. Without access to affordable healthcare, I didn’t know how common my issues were or how poorly I was managing them. And because I was in poverty, my time was largely eaten up by things that I felt were necessary to do in order to survive. Little did I realize that I was often making more work for myself and re-subjecting myself to my past trauma over and over again in a miserable feedback loop that was shaving years off of my life.
If you, like me, feel like you have good reason to be anxious and depressed, it can be hard to convince yourself of the benefits of seeking help. I thought, what could a therapist prescribe to me that would remove the sources of my stress? Medications only worked a little bit, but because of my circumstances I always had a lot of breakthrough (a term for when your condition gets so activated that it overwhelms the medication meant to treat it). Therapy can’t make the government or my job treat me better, it can’t make my parents better people, and it can’t promise me that I’m not going to suffer again. Those things are true, but they aren’t necessarily the end of the discussion.
I was reluctant to try DBT because it reminded me a lot of CBT (Cognitive Behavioral Therapy, not… the other thing), which had yielded low results for me. My therapist had told me that I was “quite self-aware” and as we explored the subject, I found I was already doing most of the things CBT trains you to do. Anxiety runs in our family, and I’m a researcher at heart, so of course when I started having panic and anxiety attacks my immediate response was to hit the ol’ Google and figure out what you’re supposed to do about it. I didn’t want to end up like my mom, who has such severe agoraphobia that she can barely drive within our county. I learned these skills from others who came before me, but back then I didn’t have a name to put to them.
Anyway, the point is, CBT didn’t help me and I doubted DBT was going to be all that different. But I was in such a dire state at that time, and my therapist was willing to write me out of work for a whole month to attend a group class on it, so I took him up on that purely because I needed the rest. He wrote me out of work to attend two groups: an Intensive Outpatient Program (IOP) and DBT.
IOP is more focused on people who are considered a danger to themselves or others. It’s sort of your last stop before your therapist recommends you check into a clinic. That group was only a month long, and while I was glad to get some rest outside of the class, I didn’t feel like I got as much from the class itself as I did from the regular one-on-one sessions with the therapist, but it was better than seeing somebody only every one to two months since Kaiser Permanente insists on understaffing their mental health workforce. By the end, I was still pretty scared to go back to work. My therapist told me that if things went poorly, I could always come back and we’d figure something else out. In the meantime, he wrote me off work for Thursdays so I could continue to attend DBT and a Trauma Skills group.
DBT saved my life, and that isn’t an overstatement. It improved my conditions at home and at work, it improved my relationships with friends and family, and it made me feel more secure about myself. Most importantly, it stopped me from feeling like I wanted to walk out in front of a bus.
So what the hell is DBT, and why is it so effective?
DBT is not a single skill, but rather a collection of strategies aimed at training your brain to respond differently to the stimuli that typically cause us stress. And no, it’s not toxic positivity–that was the first thing I assumed when somebody described it to me. It’s the closest we’ll ever get in my lifetime to ‘hacking’ your brain by taking advantage of the way your nervous system already works.
As with any therapy technique, you have to be open to it for it to work. It also requires a lot of practice, which is the hardest part. Those of us with trauma have unconsciously been trained to respond in certain ways to avoid or cope with danger, and we have been unknowingly reinforcing that training our entire lives. DBT helps us recognize the unhealthy responses, examine them in detail, confront the facts, and reprogram ourselves for a different response.
I can’t possibly address every skill that DBT teaches in one post, so I’ll try to do some follow-up articles on the individual sections later. For now, I’ve attached a DBT cheat sheet from DBTSelfHelp.com, which is another great resource if you’re trying to learn more about the subject.
I can talk about what helped me. CBT and DBT do have a little bit of overlap, so I did find that there were a few things I was already doing to manage my anxiety and depression. However, I also discovered more effective ways to do those things and some new skills that I hadn’t thought of.
It also helped me to attend in a group setting more than I thought it would. They did a daily check-in, and this was mostly optional. I attended remotely via MS Teams and we were allowed to type out our check-in or speak on mic. Having your video turned on was also optional, and I found that when a person’s camera turned on, more people felt comfortable sharing their own screens. We wanted to be seen and heard. At least 80% of the class on any given day was dedicated to the check-ins, giving people an opportunity to speak about their feelings, how they were coping, and what was going on in their lives (while avoiding triggering subjects; that’s saved for the one-on-one sessions).
Being the vain little creature that I am, I relished the attention and was praised a lot for my participation–so much so that it was noted on my after-visit summaries. It’s no secret to me that I like the sound of my own voice, but I also love listening to other people. People from all walks of life come to the group. These people all lived within 15 miles of me, so we had a lot more in common than I considered we might. I learned a bunch of good strategies from people who had made the skills work for them.
The skill that helped me the most is ironically the hardest to learn: radical acceptance. First, radical acceptance is NOT just accepting that bad things are going to happen and there's nothing you can do to stop them. Radical acceptance IS accepting that bad things might happen, but that they also might not, or that they may not be as bad as we assume they will be.
A day or so ago, I wrote a (now deleted) journal entry on Tumblr about how I was starting to feel nervous about returning to work after my surgery. It was mostly a vent for the dark cloud that was hanging over my head, and upon reviewing it, I didn’t think it would be very encouraging for others to read, which is why I removed it. It wasn’t a credit to my blog. This article is what I’m writing in its place, but I did have a good nugget in it about how radical acceptance can break us out of our feedback loops by dispelling “fortune-telling” patterns and re-subjecting ourselves to past trauma over and over again.
I was burned out and exhausted by my commute and my overperformance at my job, which was causing me to miss work and fall asleep at my desk often when I did go in, and my supervisor would constantly wake me and call me in to tell me I couldn’t do that. As a member of the working poor, I felt pretty confident about the path I was on. I thought it would go a little something like this:
I still think all that is possible, but I also feel better equipped to deal with that possibility and the fear it inspires than I did before DBT because I‘ve accepted that this path is not absolute. Anything can change, and fixating on that one possibility wasn’t helping me prepare or solve the problem. If anything, it was just making things worse. When I accepted that it may or may not happen, I also accepted that either way it was too soon for me to worry about it.
I’m pretty privileged. I have a union job with my local government, and to the horror of business owners everywhere, my employers can’t simply fire me for falling asleep on the job. They’re obligated as a part of our contract to work with me on adjusting my work and position to consider my health, and my conditions are well documented. Even if I lost my job, I have friends and family that would lend me support, even if all they could offer was leftover food and a driveway to park my car and sleep in. I live in a half-rural, half-suburb with a relatively low violent crime rate and police presence. I have a $10k deferred compensation account, and I get to withdraw all of those funds (subject to taxes, unfortunately) at the time my employment is terminated.
Part of radical acceptance is accepting the facts, and the fact is that I have it pretty good even when I’m suffering. I’ve been through some shit I wouldn’t wish on my worst enemy, but that stuff isn’t happening to me right now. It’s behind me and I don’t have to keep revisiting it and tormenting myself. It’s not a predictor of my future.
Of course, just because you’ve learned the skills doesn’t mean you’re done and cured. Like anything else, these skills require practice to become internalized. I shared the cheat sheet with a good friend of mine and asked her if she would help me practice the skills in a low-stakes environment so that I could condition myself to use them in a high-stakes situation. This sometimes took the form of role-playing, sometimes flash cards, and sometimes just reminding me of what skills to use when I started feeling or thinking a certain type of way. This is a great strategy because it also teaches other people about DBT. You don’t have to be mentally ill to benefit from learning these skills.
That’s all I’ve got for today, but I’m going to try to write some posts later on the subsections of DBT in a bit more depth. Please, if you have never tried or even heard of DBT, look it up. Tell your friends and family about it. Watch Youtube videos about it. Share your own coping strategies with others. No one is an island, and we’re all in this together. The only way we thrive is together. 💖
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Dr. Napolitano is an internationally renowned expert in both cognitive-behavioral (CBT) and dialectical behavior therapy (DBT) with over 15 years experience as a licensed clinical psychologist. Both of the approaches she employs, CBT and DBT, are backed by research demonstrating that they’re effective to treat a wide variety of problems including anxiety, worry, obsessive-compulsive disorder, perfectionism, depression, and problems in emotion regulation.
Dr. Napolitano specializes in the customized application of CBT and DBT with high functioning individuals to help them reach their personal and professional goals. Her approach reflects her extensive training in meditation and mindfulness. She helps individuals maximize their potential and create lives that reflect their values and priorities. Individual sessions are structured and focused on teaching clients the skills they need to change patterns in thinking, behavior and emotional responding that cause distress or interfere with optimal functioning.
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Dialectical Behavior Therapy
DBT is a skills-based therapy derived from CBT (Cognitive Behavior Therapy). Both are effective in treating BPD.
DBT is centered around 4 focused approaches: Mindfulness, Emotion Regulation, Distress Tolerance and Interpersonal Effectiveness. Each module has a breakdown of skills for how to replace negative coping mechanisms developed over one’s life with healthier, positive ones. My favorite is the STOP skill (Stop, Take a step back, Observe, Proceed mindfully). This has been incredibly helpful in keeping me from splitting and has reduced my episodes by about 50%. Skills become second nature with continued use.
DBT is done in both group and individual settings, and you can find Comprehensive DBT programs that offer both group/individual as well as 24/7 access to your individual therapist for skills coaching in crisis moments. It is usually covered by insurance.
If it is not covered by your insurance, there are workbooks, handbooks and flash cards readily available online!
My favorite DBT workbook!
My favorite DBT flashcards!
Marsha M. Linehan's Original Handbook