DBT – Time To Talk Tuesday

It has been awhile since I last wrote a post in Time to Talk Tuesday’s and in a way I have been hiding in the sand about my mental health refusing to acknowledge it to myself and that is when things get worrying. I am now in therapy and I have been waiting for the entry module to roll around for DBT and now it finally has; which is good because I have well and truly fallen back into old patterns which I really didn’t want too.

What is DBT I hear you ask? Or more WTF is DBT! Well it is a form of group therapy that started in America and it is called Dialectical behavior therapy although more commonly known as DBT. It is a group therapy that is designed to help people with or who have traits of Borderline Personality Disorder to better manage their emotions, as well as helping people with self harm issues amongst others. It is broken down into several modules of varying lengths (depending on the needs of the group I guess) and in between each module there are two weeks of mindfulness which is where new members can be brought into the group as people are “cycled out” when the course has finished for them.

Before you start you have to attend two “pre-commitment” sessions which explains the process and allows you to see if this is for you or not. The therapy lasts 6 months and then you are expected to not access the mental health team for at least another 6 months as you are to be putting the tools you have learnt from the DBT to help you manage the triggering situation. Also any regular contact with your mental health worker is supposed to decrease – now for me as I was supposed to be seeing someone on a weekly basis which went to nothing as there was a pretty poor communication link between them meant I was left with nobody until I went to see the crisis team due to having a breakdown (waste of time as ALWAYS) and then my new social worker got in touch and apologised that I was just left. So not seeing someone as often isn’t going to be a big deal for me as I’m now used to sub par mental health support.

The whole idea of this therapy is teach myself and the others in the group to live more in the moment and better deal with triggering situations by using our newly learnt skills in our toolkit to help deescalate our emotions rather than feed into them. So for me I am in for self harm and the borderline personality disorder traits that make my life incredibly hard because I just spiral downwards and things trigger me incredibly easily. So I am hoping that the skills I learn in each of the modules and the practise along with the homework….yes homework will help ground me quicker than I am currently taking.

The modules are as follows but isn’t necessarily the order I am doing them in:

  • emotional regulations
  • mindfulness
  • distress tolerance
  • mindfulness
  • interpersonal effectiveness
  • mindfulness

In our first mindfulness week we were given a folder and some handouts to look over that began to explain what mindfulness is etc. The general handout #1 explained the goals of the skills training, we had to mark down what we wanted to get out of the course.

So the specific goals – behaviours we want to decrease were:

  • mindlessness, emptiness, being out of touch with self and others, judgementalness (in ourselves and others) ♥
  • interpersonal conflict and stress, loneliness ♥
  • absence of flexibility, difficulties with change
  • up-and-down and extreme emotions, mood dependent behaviour, difficulties in regulating emotions ♥
  • impulsive behaviours, acting without thinking, difficulties accepting reality as it is, willfulness, addiction ♥

The skills we want to increase were:

  • mindfulness skills
  • interpersonal effectiveness skills
  • emotion regulation skills ♥
  • distress tolerance ♥

We then had to write out our own personal goals with regards to behaviours and skills but from the hearts above I don’t feel it is necessary to add mine.

The one handout that really resonated with me and probably does with a lot of chronically sick or mentally unwell people was general handout 5 which spoke about the “Biosocial Theory”; which is long but talks about different ways emotion and actions can be affected.

Emotional vulnerability is BIOLOGICAL: it is simply how some people are born.

  • they are more sensitive to emotional stimuli, they can detect subtle emotional information in the enviroment that others don’t even notice
  • they experience emotions much more often than others
  • their emotions seem to hit for no reason, from out of the blue
  • they have more intense emotions
  • their emotions hit like a ton of bricks
  • their emotions are long lasting

Impulsivity also has a BIOLOGICAL basis: regulating action is harder for some than others.

  • they find it very hard to restrain impulsive behaviours
  • often without thinking they do things that get them into trouble
  • sometimes their behaviour seems to come out of nowhere
  • they find it very hard to be effective
  • their moods can often get in the way of organising to achieve their goals
  • they cannot control behaviours linked to their moods.

An invalidating SOCIAL environment can make it very hard to regulate emotions:

  • An invalidating environment doesn’t seem to understand  your emotions
  • it tells you your emotions are invalid, weird, wrong or bad
  • it often ignores your emotional reactions and does nothing to help you
  • it may say things like “don’t be such a baby!” “Quit your blubbering.” “Quit being such a chicken and just solve the problem.” or “Normal people don’t get this frustrated.”
  • People who invalidate are OFTEN DOING THE BEST THEY CAN:
  • they may not know how to validate or how important it is to validate, or they may be afraid that if they validate your emotions, you will get more emotional, not less.
  • they may be under high stress or time pressure, or they may have too few resources themselves
  • they may just be a poor fit between you and your social environment (wait for it…) you may be a tulip in a rose garden (hahahaha what an analogy)

An ineffective SOCIAL environment is a big problem when  you want to learn to regulate emotions and actions:

  • your environment may reinforce out of control emotions and actions
  • if people give in when you get out of control, it will be hard for you to get in control
  • if others command you to change, but don’t coach you on how to do this, it will be hard to keep on trying to change

It’s the TRANSACTIONS that count between the person and the social environment:

  • biology and the social environment influence the person
  • the person reciprocates and influences his or her social environment
  • the social environment reciprocates and influences the person.
  • and so on

I felt like that was very relevant to me and yes it was long winded but it made me feel less crazy and I hope you feel less “crazy” too! Biology and the environment really do have a massive influence on us. In fact that the theory made me feel so normal I read out the whole thing to 00Steve and then we discussed my personal vicious cycle and I cried because it was a relief to finally be able tell him as I REALLY struggle to tell him anything to do with my mental health as I feel stupid for feeling that way. Not that he makes me feel like that but it is how society has conditioned me to feel like that.

As I work through the modules I will think about whether I write my thoughts on the process here on the blog but if DBT is something you think may help you ask your mental health team about it. Also if you have got this far I think you deserve a medal!

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