DBT

[rxtravaganza]

I am wondering if any of you fellow BPD-ers are doing individual or group DBT work and if that is helping? I have been reading numerous sources saying that it's a far more effective approach than CBT for our condition, and I'd like to hear if some of you have accounts on this. Pros & cons?

Specifically, I'm wondering how it works to undo negative learned behaviours and help build more constructive ones, how it addresses building confidence and self-esteem, and how it works to deal with conflict and aggression (internal and external)?

Any advice and resources would be appreciated!

[manuel_moe_g]

I really like the Dialectic Behavioral Therapy (DBT) Self Help Subreddit

http://www.reddit.com/r/dbtselfhelp

it is awesome!

[quickfall]

I don't have BPD, full disclosure. But beyond a shadow of a doubt, DBT is much, much better for BPD than traditional CBT. It's also much more intensive. CBT is really an antiquated therapy nowadays; DBT and ACT are the waves of the future.

The mechanisms by which it leads people to living much better lives is that it allows you to both be "crazy" and "normal" at the same time, as opposed to CBT, which focuses way too much on thoughts. Don't get me wrong, being able to recognize your own thoughts is a good thing (rather than being at their mercy), but the problem with CBT is that its effectiveness relies on someone who's incredibly emotionally and mentally taxed to go into their own brain (and into relatively complex regions) and strike down these abstract things called "thoughts." In reality, no one can control their thoughts, and in fact, CBT probably encourages thinking MORE negative thoughts. How?

Well, here's an example: think about a polar bear for at least one minute. Imagine it's fur, the temperature it's in, what its eyes look like, how big its paws are, etc. Think about it in great detail for at least one full minute.


Done? Good. Now, DO NOT THINK ABOUT THE POLAR BEAR. Whatever you do, DO NOT think about that polar bear. Think about anything at all, but that damned polar bear. DO NOT think about the polar bear!

What just happened? OF COURSE you thought about the polar bear! This is the fallacy of CBT--it's telling someone that they need to immediately stop something that they do essentially 24/7, which is impossible, and on top of that it offers no replacement that serves the same function as those thoughts. As crappy as it is, negative thoughts and behaviors develop because they serve a function for you, even if they're ultimately problematic. And what happens is that your thoughts pin you into a corner, make you exhausted, and you come to rely on those thoughts and behaviors because even if they're shitty, they're at least familiar.

Conversely, DBT doesn't ask you to examine your thoughts or try to take them apart. All you need to do with them is recognize them, notice them, and file them away. Then the key part is that you continue engaging in healthy behaviors and remain as fully present and mindful as possible. It's hard as hell at first, but over time, it will get much easier. Rather than giving the impossible goal of changing your thoughts, DBT allows you to experience whatever thoughts you might have, as long as you commit yourself to not giving into them. By doing this, you're teaching yourself, your brain, and your body, that you can function successfully in spite of those damned negative thoughts, and eventually they'll hold less power over you.

The point is that negative thoughts are never going to go away, and even the most "healthy" people have them. So trying to get rid of them isn't going to help. What will give you the most strength is kicking those thoughts' asses and saying "Fuck you--I'm going to function anyway." DBT give you validation of anything and everything you feel without judgment, and teaches you to give that to yourself.

I could go on and on about how much promise I think DBT and ACT hold for the future of therapy, but I won't. I hope this has helped. If you want to try some texts on your own, there's some Dialectical and Behavior Therapy workbooks you can buy. The Happiness Trap is also a good book (even though it sounds like typical self-help crap, it's a solid book, I promise). Look out for authors like Marsha Linehan (she created DBT out of a quest to cure her own severe BPD), Steven Hayes (he's more of an ACT guy, but it's still good stuff), Kelly Wilson, and...hmm, that's all I can think of right now.

Best wishes!

[rxtravaganza]

It's taken me a while to come back and check this, but thank you both so much for your input! Quickfall, your detailing of the difference between CBT and DBT in plain language really gave me connective tissue that I've lacked when psychs have explained it to me.

Cheers to you both.

[Impetuous]

One of my parents was a misdiagnosed (and consequently untreated) borderline, she's completely regressed to about age 8 now. (That's a disclaimer and cautionary tale all wrapped up in one sentence, lol!)

I asked my therapist to refer me to a dbt group, just to exorcise my mother's demons from my head. Instead of referring me, she offered to work one on one with me on the portions of therapy most needed. That's fair to me, I wouldn't want to be draining a resource from people in greater need. So I suppose my point is that it can be done both ways depending on the patient's needs. For me, it's worked wonderfully! A few months in, I was able to drop an antidepressant on my own. I've learner a lot about staying in the moment with people in my life, it's gotten me to venture out of my own head (wow! It's bright out here and pretty too!) I've also learned a lot about asserting myself and taking responsibility for my role in relationships, all things I never learned about growing up!

On the flip side, a part of me would like to participate in a group. I believe there would be some learning opportunities for me there. My mother is still living, a group could help me get some practice learning to manage my interactions with her. A group member isn't going to have the inherent "hooks" that come with a parent. There's also the modeling I could gleen from more mature members. Being someone that always likes to bring something to a party, I could offer reflection of how counterproductive behaviors impact any children in the lives of participants.

(After rereading this post, I see why my therapist is keeping me "in house." I'm still not very steady with the self preservation thing. (Thanks Dad!)

[bigeekgirl]

(After rereading this post, I see why my therapist is keeping me "in house." I'm still not very steady with the self preservation thing. (Thanks Dad!)

I so relate to that idea. It is not uncommon for me to hope my therapist "enjoys" our time together or that I'm not too taxing. Co-dependent, much? I've thought about a group, but I wonder if that would be a similar problem for me. I'm *much* happier distracting myself with other people's problems.

As for the DBT stuff, it sounds like it would be super helpful. I've got Boardline traits learned from my mother rather than having the disorder myself and I've gone the CBT route in the past. CBT was effective for me in a band-aid sort of way in part because I'm "studious" and want to please my therapist. I use the crap out of my tools, but I still have cracks in my foundation. The cracks are what seem to be giving me trouble and I know from listen to Paul and Dr. Drew, relationship focused therapy is the only way to go to learn how to "be a person" in all the ways I didn't as a child and even in my 20s.

[Arkay]

I started DBT about 2 months ago with a therapist and working through Thomas Marra's workbook "Depressed and Anxious". I think the workbook exercises have been more helpful than the therapy to be honest, but I am still trying to feel out the therapist. If there was a group in my area I think it would be great to try.

[Bigfun]

Arkay thank you for your input. My psychotherapist has mentioned I should find an outpatient group to do DBT but I'm strapped financially and time wise and saw the work book on amazon. I was thinking I could at least try the workbook while I figure out my schedule.

My therapist has told me it might be to dangerous to do anything one on one with my history so I'm going to ask him about what he thinks about me getting the workbook first, but it's good to see your benefiting from using it.

[quickfall]

I'm surprised/disheartened to hear that people are being given the option of one-on-one therapy without the group component. All the evidence points to both being absolutely integral to DBT's success, and most DBT-certitied practitioners won't let someone in until they're ready to commit to both the group and their own therapy.

I'd suggest, if you can't find a local group, perhaps try to find an online one that could act as a substitute. Group therapy sounds like the bane of one's existence, but it's one of the best experiences one can have. The reason it feels so aversive at first is because it requires you to be frank about your behaviors, thoughts, and feelings, in front of a bunch of people who are judging you (for better or worse), and avoiding those types of experiences are really good ways to stay in one's rut.

[manuel_moe_g]

Hi quickfall,

I am scared about group therapy. What if the group members are judgemental or close-minded?