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#1 Sunshineinmyface

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Posted 31 December 2005 - 03:52 AM

An introduction:

DBT is dilectical behavioral therapy. The treatment/therapy was pioneered by Marsha Linehan in 1991 and she has gone on to write lots about it and speak about it and have workshops teaching therapists how to teach it in groups or individual therapy. She must be sitting pretty well financially. She is associated with the University of Washington in Seattle, WA.

Her thoughts were the methods she came up with could help people with borderline personality disorder, especially those in crisis. However, the methods Linehan developed are used by many therapists with people suffering from depression, anxiety, post traumatic stress disorder, etc. Anyone who is experienceing distress in their lives.

DBT targets behaviors in a desecending hierarchy:
--decreasing high-risk suicide behaviors and self harm
--decreasing responses or behaviors that interfere with therapy
--decreasing behaviors that interfere with or reduce one's quality of life
--decreasing and dealing with post-traumatic stress responses
--enhancing respect for self
--acquisition of the behavioral skills

For those unfamiliar with the therapy, I should have defined "target behaviors" as behaviors one wants to change because it is causing distress or worse and behaviors you want to work on. So they can be behaviors you want to eliminate or decrease the frequency of or increase the frequency of.

The general goals of skills training is to learn and refine skills in changing behavioral, emotional, and thinking patterns associated with problems in living - those causing misery and distress.

Behaviors to decrease are:
1. Interpersonal chaos
2. Labile emotions, moods
3. Impulsiveness
4. Confusion about self, cognative dysregulation

Behaviors to increase:
1. Interpersonal effectiveness
2. Emotion regulation
3. Distress tolerance
4. Core mindfulness

At the core, DBT teaches skills/tools to use when one is having difficulty in the behaviors to decrease that cause distress. And, difficulty gaining positive behaviors, which increase the quality of your life.

Linehan's material is set out in four parts: interpersonal communication, emotion regulation, distress tolerance, and mindfulness. There are skills/tools for each area to help one gain mastery in dealing with each of the above four areas.

The most glossed over and misuderstood area I have found is "mindfulness". So i have asked a lot of questions of the therapist and researched a bit. The other four areas are clearly enough labeled to get an idea of what the area may involve.

To understand mindfulness consider your brain has two parts: the cognative part (thinking logically) and the emotional part. Usually problems occur when only the emotion part/mind is used but the cognative part can result in problems as well. Linehan encourages us to put the two parts together so they over lap. The overlapped portion she calls the wisemind. The wisemind uses both parts and intuition to make a decision that is more balanced than a decision by either part alone.


(Source: My therapy group materials are sections from Skills Training Manual for Treating Borderline Personality by Marsha Linehan 1993, and that is where I get this stuff).

I will leave this as the first post and have more to come soon, hopefully.

If you would like to see Marsha Linehan, although it is not her best picture, and listen to some jazzy music go to: faculty.washington.edu/linehan

there are two other sites which explain DBT that are pretty good if you are interested:

www.middlepath.org/DBT/Article_Archive/dbtinnutshell.html This one has Dr. Linehan supposedly putting this in a nutshell, but she is very wordy and tends to get off point at times.

www.dbtselfhelp.com this is run by someone else but the information seems like Linehan's this has sessions on DBT one can do themselves.

Sunshine

#2 Sunshineinmyface

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Posted 02 January 2006 - 07:38 AM

Anyone interested in me going further with this?

#3 verysadcat

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Posted 02 January 2006 - 11:59 PM

I'm glad you are getting good things from this, sunshine.

I've been through a group therapy treatment on DBT three times so far and though I can see that it's excellent therapy, I just can't get it to work for me. something just won't let it sink into my mind.

I posted somewhere else here about this to see if anybody had tried it or found it useful.

I have most of that book in handouts and I try to read them again and again but I just am not at the space in time where it works for me or something. :?

but keep posting -- I'm willing to bet that a lot of folks here will get a lot of good out of it.

hugs,
Di

#4 Sunshineinmyface

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Posted 03 January 2006 - 01:28 AM

Maybe your meds are not right. When i started the therapy i was numb and non-participating.....my meds were not right. I could not understand the stuff at all. The part of my brain that did analyzing just did not work. I could not analyze anything.....and normally that is one of my strong suits so i was very sad about that and basically just there in body. Then the meds swung me into a hypo phase and that is why i realized the meds were wrong and the diagnosis was wrong too.

Thanks for the input dear.

#5 marga

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Posted 03 January 2006 - 10:05 AM

Anyone interested in me going further with this?

Keep posting... I'm reading 8)

#6 Sunshineinmyface

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Posted 04 January 2006 - 10:48 PM

Mindfulness is the first area Linehan addresses in her materials and it is the slipperies of the section, in my opinion to understand and thus learn and use.

I have some good information from Cindy Sanderson, PhD. which the therapists pulled out in my treatment. Her email address is csanderson@behavioraltech.org and she asks for feedback. The therapists got this from the web, but of course could not remember the site. Ms. Sanderson lists some sites and other resources to check out which I will put at the end. Words in quotes are those of Linehan, all the rest is Ms. Sanderson.


A Definition of Mindfulness: "awareness without judgment of what is, via direct and immediate experience."

You are mindful when.

:wink: You are mindful when you eat dessert and notice every flavor you are tasting, instead of eating the dessert while having a conversation and/or looking around the room to see who you know. Mindfully eating is focusing all your attention and senses on what you are doing to the exclusion of distractions. Eating (and a lot of other things) are more enjoyable when done mindfully.

:) If you are being mindful, you are not thinking about "is it good or bad for me to have this dessert", instead you are having dessert and enjoying it.

:D You are mindful when having gotten free from/of your anxiety or self-consciousness (without the aid of alcohol or street drugs) you dance to music and experience every note, instead of wondering if you look graceful or foolish.

:wave: You are mindful when thinking about someone you love or someone you hate, and you pay attention to exactly what your love or your hate feels like. You are not caught up in justifying the love or hate to yourself. Rather, you are just diving into the experience, with full awareness that you are diving in.

:hm: You are mindful when you walk through a park, and you actually walk through the park with attention. This means you let yourself "show up" in the park. You walk through the park aware of your feelings about the park, or your thoughts about the park, or how the part looks, or how you feel in the park gathering information from your senses. For example, you are aware of the sensation of each foot striking the pavement or the smell(s) on the breeze. This is different than taking a walk in the part and not "showing up" - instead, walking through the park while you are distracted by thoughts of what you'll have for lunch, or the feelings towards a friend with whom you have just argued, or worries about how you are going to pay this month's bills.

If you stop and think about it, you will realize that very few of us devote ourselves to living mindfully, meeting each moment of life as it presents itself, with full awareness, letting our judgments fall away.

Instead, we do things automatically, without noticing what we are doing. We churn out judgments about ourselves and others. We regularly do two or three tasks at once. We frequently get so caught up in our thoughts and feelings about the past or future that we are lost in them, disconnecting from what is happening right now in front of us. There are lots of rewards for living this way --we can get a lot done quickly, think of ourselves as efficient, and be seen by the world as productive and smart. In highly industrial or technological societies, a high value is placed on doing a lot at once. In fact, people sometimes make fun of each other by saying "What's wrong with you? Can't you do two things at once?"

We also live without awareness because sometimes living with full awareness is very painful. We can avoid painful thoughts, feelings, and situations when we are afraid or angry or ashamed or sad because we are convinced that we can not do anything to change AND because we are convinced we cannot stand to live with the feelings.

Example: For instance, have you ever avoided bringing up a problem in a relationship with someone because you are afraid the other person will get mad at you, attack you, or leave you? We keep avoiding bringing up the problem because we feel so scared. So, we get ourselves on the fear "hook" temporarily by not talking the problem over. In the meantime, we are ashamed of ourselves for not speaking up. We get more and more annoyed with the other person. We try to ignore what he or she does that bothers us, but the problem gets worse and worse. Finally we give up, letting the relationship end perhaps. Maybe the problem could have been solved; maybe not, but we will never know.

There are so many ways mindfulness could help the example above and here are a few below:

:y: We could use mindfulness skills and bring our full attention to the feelings of annoyance, instead of pushing that feeling away or trying to talk ourselves out of the distressful feeling. Maybe we are afraid we cannot stand to feel annoyed, but actually, watching how we feel inside, we realize, "hey, it's just annoyance for 10 minutes and I CAN stand it."

:w: We could use mindfulness to become a great detective and notice exactly how and when we feel annoyed. Maybe it is when the other person had three cups of coffee before seeing you; maybe it is when both you and the other person are tired; and, maybe it is when the other person had a bad day at work. In this way, we use awareness to get specific and clear about what contributes to the problem. The more specific we get about what goes into the problem, the better chance we have to solve it. We could ask the other person to drink less coffee or switch to decaffeninated coffee; or we could make plans to get together when we are both rested; or we could not meet the other person or give them space when they have bad work days.

:car: We could use mindfulness skills to watch how our mind generates thoughts like "It shouldn't be this way; why can't we just get along! Real friends don't have problems." Listening to our thoughts, we realize that our expectations do not fit with reality, so we work at changing our expectations.

:dance: To summarize, mindfulness is awareness, without judgment, of life as it is, yourself as you are, other people as they are, in the here and now, via direct and immediate experience. When we are mindful, we are awake to life on its terms -- fully alive to each moment as it arrives, as it is, and as it ends. Of course, in order to build and maintain mindfulness requires specific skills that are practiced over and over and over and over.

:ban: How and Why to Practice Mindfulness.

Mindfulness is a skill that can be learned like any other. There is nothing mysterious about it. It is like learning to ride a bike or cook good meals or paint. We start with easy practice and progress to harder practice. You take classes to be taught the skills [or someone in the class tells you what they are learning] and we make friends with people who are interested in a support group to keep us going when we get discouraged.

Sometimes you will feel like you are making a lot of progress; other times you will be discouraged. But, it is certain that if you practice, practice, practice, your skill at mindfulness will improve.

So what is the practice? The practice of mindfulness is "the repetitive act of directing attention to only one thing in this one moment." And if you are brand new to mindfulness, you may respond with either "I can already do that" or "Why on earth would I do that?"

My reply is:
a) it is a lot harder than it sounds.
b)the reason you do this kind of practice is to gain control of your attention.
c) third -- it is to free yourself of judgment. Judgment of others is unfulfilling, and judgment of yourself leads to stress and suffering. (Courtesy of Ruben.....thanks Ruben)

I hope you will stop and think about the following sentence:

Whatever your attention is on, that is what life is for you at any given moment.

Example: Perhaps you have decided to take a break from working so you can make yourself some tea; as you stand at the stove, your mind wanders off and ruminateds about a conversation you had yesterday. You do not get a break because your mind is not on the tea; your mind is worrying and carrying you away.

Example:Perhaps you are sitting in a session with a therapist who cares about you and has a kind expression on her face; but you are not looking at her face...not really. Instead, you are feeling so self-conscious and ashamed that you begin to "space out". You miss out on a moment of connection with a person who cares for you and instead have one moment of connection with a person who cares for you and instead have one more moment of rejecting yourself.

"The repeditive act of directing your attention to only one thing in this one moment" means training your mind to pay attention to what YOU choose to pay attention to instead of letting your mind hijack you.

There are lots of metaphors that describe what the untrained mind is like and they provide a good contrast to the trained mind. Here are several:

:?: Your mind is a TV that is always on but you cannot find the remote. The TV set gets 300 cable channels but because you do not control the remote, your untrained mind keeps playing the same painful or scary or enraging show over and over again.

Posted ImageThis one is from Zen. The untrained mind is like a new puppy. You tell your puppy to sit and stay, but your puppy immediately runs away, rummages in your closet, chews up your new shoes, and goes through the garbage.

Posted Image This is a Christian contemplative, Thomas Merton. He said the untrained mind is like a crow flying over a wheat field in winter. The crow spies lots of thing that sparkel in the field, swoops down to pick them up, only to discover that what's glittering in the field are old pieces of scrap metal, not something delicious to eat or something to use for a nest.

If you train your mind to pay attention, then you have found the remote control, trained the puppy, and become a smarter crow. To teach your mind to pay attention, you practice paying attention over and over again. He is an example of a typical practice:

Get in a comfortable position that won't cause you discomfort, with your feet on the floor and your back straight but not tense. Sit very still, breathing normally, in a quiet room. Now, just watch your thoughts for a few minutes. Don't try to force your thoughts (e.g. you get stuck on one thing, like planning what you're going to do after you read this) just notice that your thoughts wandered and gently bring your mind's attention back to watching thoughts. If you start to judge yourself ("I'm terrible at this"), your thoughts (That's a stupid thing to be thinking"), or the practice ("this is a real waste of time") just notice your judgments and go back to watching your thoughts. Practice for five minutes.

Your mind is like a boat that is tied to a chain with an anchor. Mindfulness is the anchor and chain that gently pull the boat (your attention) back each time the waves start to carry it away. Even if your mind wanders of 1,000 times, you've done the exercise if you gently pull your attention back to your point of focus. There is no right or wrong to it. All that matters is paying attention to your experience while you do the exercise as well as you can. You can do this type of practice with anything you care to bring your full and undivided attention to. In doing so, you will learn a lot about yourself, about other people, and about any situation in which you find yourself. And, just like a muscle gets stronger and stronger with exercise, your capacity to move your attention to what you want it to focus on will grow stronger with practice.

The Goal of Mindfulness Practice
In DBT, the goals of mindfulness practice are simply to practice and to experience "Wise Mind." You are in wise mind when your emotions and your thoughts work together so that wise action is easy, even when your life and/or circumstances are really hard. You are in wise mind when you can meet each moment of life as it is, NOT as you would have it be, and respond to life skillfully. People have different names for wise mind, for example: "true self," "spirit," and "being centered."
The name does not matter, what matters is the capacity to have it. And EVERYONE has that capacity.

Notice I am not saying the goal of mindfulness practice is happiness or having a life free from trouble or having an expereince of nonstop joy. However, people who practice mindfulness will tell you that they get better at enduring pain, better at solving problems, better at not creating misery for themselves, and better at participating fully in those moments of life that are joyful.


Mindfulness reading list:

Skills Training Manual for Treating Borderline Personality Disorder, Marsha M. Linehan.

Pubmed (http://www.ncbi.nlm....trez/query.fcgi) - Search engine for medical abstracts and articles from John Kabat-Zinn, Zindel Segal, and other experts on Mindfulness Practice.

Books: Wherever You Go, There You Are: Mindfulness in Everyday Life by Jon Kabat-Zinn

The Miracle of Mindfulness by Thich Nhat Hanh

Websites:

www.shambhala.com - publishers of books on Mindfulness Practice
www.parallax.org - Resources on Mindful Living[/u]

#7 Sunshineinmyface

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Posted 07 January 2006 - 01:45 AM

Just a bump...i find this so helpful i am hoping it will help some others also.

#8 Sunshineinmyface

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Posted 26 January 2006 - 08:12 AM

Bump for those who may be interested at my suggestion and those who said they were interested in Mindfulness


Sunshine

#9 rubenoid

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Posted 26 January 2006 - 02:02 PM

I have not heard of mindfulness as it relates to this form of therapy, but I find it very interesting that some therapists are taking this approach. Mindfulness meditation is a common Buddhist practice, and it is something that I have tried to regularly practice as well. The activity in which I have been the most mindful is eating an orange.

Mindfulness Meditation: Eating an Orange
I find that it takes me about twenty minutes to eat an orange. First I am careful to peel away as much of the rind and pith as I can, enjoying the citrus smell. I focus my gaze on the orange and watch its transformation. I enjoy the way the orange feels in my hands. I peel each segment away from the whole and begin to focus on eating it. I put the segment in my mouth and push on it with my tongue against my upper teeth, feeling a sensation of vitamins and health that is the orange juice. I slowly chew the rest of it thinking about the fiber that my body is getting. Usually I do not wash my hands for several hours so the orange smell remains and I can be reminded in the midst of my afternoon drudgery of that small amount of time where I was able to focus, free of judgment or opinion.

I also practice mindfulness when walking, when doing the dishes, when playing the piano, and I take a mindfulness meditation course. I'm not nearly as mindful as I would like to be, but saying that is not very mindful! I am on a path toward mindfulness.

a) it is a lot harder than it sounds.  
b) the reason you do this kind of practice is to gain control of your attention.

You are right, and I would like to add a third -- it is to free yourself of judgment. Judgment of others is unfulfilling, and judgment of yourself leads to stress and suffering. Mindfulness meditation may sound mundane, but it's by focusing on the easiest and most natural things we do (eating, walking) that we can actually focus on a new behavior.

I'm going to add another book to your reference:
Peace Is Every Step by Thich Nhat Hanh - a great introductory level book toward understanding the basics and the reasons behind mindfulness practice.

#10 red-rabbit

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Posted 30 January 2006 - 02:38 PM

Interesting stuff will read it properly when I get time...

Cheers

#11 this is me

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Posted 30 January 2006 - 10:31 PM

Thanks for this

We looked at this in class and it seems that DBT does work.

I am thinking of doing my thesis on the combo of DBT and EMDR for treatment of childhood abuses could you PM me all of your web resources for this??

#12 Samantha

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Posted 09 February 2006 - 07:31 PM

This is some great information!

Thank you!

(((((((Sunshine)))))))

(((((((Ruben)))))))

Love,

Sam

#13 Sunshineinmyface

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Posted 09 February 2006 - 11:04 PM

((Samantha))

Glad you found it helpful. I will post some more.


Sunshine

#14 SheilaD

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Posted 20 February 2006 - 03:44 AM

awesome sunshine
thanks for posting this stuff!!!

:) :) :) :)


love sheilaD

#15 romper

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Posted 28 March 2009 - 01:23 PM

I know this is an old thread but i found it very interesting!
I tried DBT once but got too ill again and had to stop unfortunately.
This has made me decide to call my hospitals out-patient services on monday and see if i can try again.
Thank you for all the information, i will try to find the books in our library!
romp

#16 Sunshineinmyface

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Posted 24 April 2010 - 10:12 PM

:bump: for those having negative thoughts bombarding them..

#17 iwant2stop

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Posted 18 May 2011 - 01:33 AM

hi, i am new to this form. i have struggled with mental illness all my life, i am in my 50s. i have not been to a therapist in 20 + years but i was struggling and afraid of my thoughts so i went. i have seen her for the last two month, she diagnose me with BPD, PTSD, and major depression. she wants me two go to a dbt group, but i have not been in a group of people other then my church in 30 years, i do not LIKE being around people, any way i was happy to find this board so i can at least start to learn about dbt, i ordered the book first on your list, the one written by the doc that started this therapy. you have a lot of great info here thanks so much for taking time reach out and help the hopeless.

#18 GollumGollum

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Posted 12 September 2014 - 06:03 PM

Thank you for the information! I'm looking at starting DBT (after a couple months of CBT), and your posts gave me a better sense of what to expect.