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em

Dialectical Behaviour therapy

DBT is a therapy with a growing amount of evidence to support its effectiveness. The thing about DBT that stands out from other therapies is that it was developed especially for the purpose of treating BPD. It was developed by Marsha Linehan in 1991 and is based upon the theory that psychosocial treatment of BPD is as important as traditional psychotherapy. A structure of treatment goals forms part of DBT and these include reducing parasuicidal behaviours, reducing behaviours which interfere with the therapeutic relationship and finally reducing those behaviours which directly impact upon the sufferer’s quality of life. Studies have shown that DBT is effective in achieving these goals.

The theory behind DBT maintains that some people, due to invalidating environments during upbringing and due to biological factors as yet unknown, react abnormally to emotional stimulation. Their level of arousal goes up much more quickly, peaks at a higher level, and takes more time to return to baseline. As a result borderlines experience crisis-strewn lives and extreme emotional lability (emotions that shift rapidly). DBT is a method that teaches skills that will help handle the rapid mood changes more effectively.

Dialectical Behavioural Therapy (DBT) consists of two parts:

Psychotherapy sessions (one per week) in which a particular problematic behaviour or event from the past week is explored beginning with the chain of events leading up to it, going through possible alternative solutions that might have been used, and examining why more useful solutions to the problem were not used.

Both between and during sessions, adaptive behaviours are taught and reinforced especially as they occur within the therapeutic relationship. The emphasis of DBT is on managing emotions rather than crisis intervention.

DBT also involves weekly 2.5-hour group therapy sessions in which interpersonal skills, distress tolerance skills, emotion regulation, and mindfulness skills are taught.

From the Priory Clinic in summary – “Dialectical Behaviour Therapy then is a novel method of therapy specifically designed to meet the needs of patients with Borderline Personality Disorder and their therapists. It directly addresses the problem of keeping these patients in therapy and the difficulty of maintaining therapist motivation and professional well-being. It is based on a clear and potentially testable theory of BPD and encourages a positive and validating attitude to these patients in the light of this theory. The approach incorporates what is valuable from other forms of therapy, and is based on a clear acknowledgement of the value of a strong relationship between therapist and patient. Therapy is clearly structured in stages and at each stage a clear hierarchy of targets is defined. The method offers a particularly helpful approach to the management of parasuicide with a clearly defined response to such behaviours. The techniques used in DBT are extensive and varied, addressing essentially every aspect of therapy and they are underpinned by a dialectical philosophy that recommends a balanced, flexible and systemic approach to the work of therapy. Techniques for achieving change are balanced by techniques of acceptance, problem solving is surrounded by validation, and confrontation is balanced by understanding. The patient is helped to understand her problem behaviours and then deal with situations more effectively. She is taught the necessary skills to enable her to do so and helped to deal with any problems that she may have in applying them in her natural environment. Generalisation outside therapy is not assumed but encouraged directly. Advice and support available between sessions and the patient is encouraged and helped to take responsibility for dealing with life’s challenges herself. The method is supported by empirical evidence which suggests that it is successful in reducing self-injury and time spent in psychiatric in-patient treatment.“

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brassed2bits

Hi Em

Good to see your post about DBT. I am on the DBT programme here in the UK at the moment, and would like to offer the following comments ;

The structure of DBT is like no other. It is really rigid - you have to stick to discussing present difficulties which interfere with Therapy and your quality of life. Discussing the past is not allowed. Stopping self harm is the big issue in DBT. Finding other ways of coping.

There is a 'no nonsense' approach to the programme. All topics and issues are discussed matter of factly and you are confronted 'head on'. I think it is quite brutal in some ways. You have to get used to it and go with it.

Homework and the feedback of it is compulsory. No one gets away without completing it. Diary sheets too ...

The methods and ideas that are taught in the group sessions are not rocket science! I was amazed at how so much of DBT is common sense ... BUT, applying the techniques in real life, at crisis point, is VERY HARD.

Trying to learn all they teach,and put it into practice without using the coping mechanisms you have always used, and endure 1 hour of therapy every week, plus living life ... well ......

Anyway, I am sticking with it, reminding myself that I have no choice. I need to get control over my SI otherwise it will be too late.

So if anyone is waiting for DBT ... remember,

It is not an easy ride, or fun, or a 'talking therapy'.It is about learning new skills to cope with life, and it can be difficult, frustrating, confusing, and annoying. Is it worth it? Well I am still here ......

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Cassie

What wonderful insight you provided us with, as a participant. Thank you so much brassed!!!

Great to know a participant's experience of DBT.

Thank you so much for your post.

Cassie :wub:

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chickenways

thanks, that is interesting ..

as i am in the proces of finding out about all the different possible aproach etc..

cheers

chicken

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Vorpalblade

i have been in DBT for over a year now. the only thing about it at my hsopital is that we dont have the 1 to 1 therapy that should run alongside the group course.

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Hole

Thank you. I had never heard of this therapy before.

Too bad there's nothing like this where I live. Most people have never even hread of BPD and therefor there is no therapy especialy for us.

Sucks!

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lilac lakes

i took part in dbt for 6 months but when the CPN who ran the course left it was never replaced by anything so now we have nothing. i didnt really find it all that useful and dont really agree with some of the base rules anymore.

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mrs tree

I found when I started DBT it took a while before anything made any difference and wondered if it ws ever going to help.

I finished DBT just over two years ago and since I finished i have lapsed in using the skills and have forgotten them but when my T tells me to read up on them it does come flooding back.

My T says ( and i agree with him) DBT helps have coping stratergies that make you more able to function but doesn't deal with the underlying reason for the way you are feeling.Linehan believes you can measure happiness by levels of SH I don't agree.

I am glad I did it but the use it or lose it does apply.

Mrs Tree

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ninjamick

hi all im ninjamick

i have anti social personality disorder as well as borderline personallity disorder and a total pain the backside syndrome lol but i notice some of you you are doing therapy well im doing a cognetive therapy on a 1 2 1 basis its not too bad ive so ive been told that ive calmed down a lot the answer is within the question

i question everything for example what is me writing on this forum achevieing well to answer it i think it a sence to feel im not alone and im not a freek or strange and if i could help 1 person from my expericnes brill and now when i fell angry i just go for a walk or punch a punch bag or a run that helps but most of the time i question my anger for example why am i angry can i deal with situation differently whats the best way i some times come up with wriong answers but hey im human i think im entitled to make mistakes in anyway i hope this helps :P

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star24

i have just started dbt and it scares me and it's a lot of information it's overwhelming to me. i had one session and cause of a holiday i wont have another session for 3 more weeks yey:)! i want to learn about it but im afraid im gonna fail and not be able to do it, i have a bad memory how am i gonna remember all the things to do?

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Betsy

ninjamick.. welcome! post in the introduction area as most people could miss this post. glad you joined us.

star.. dbt is a lot of info. it is also a lot of work, practice, practice, practice. it doesnt come natural to us.. our thought patterns run to emotions and dbt is asking us to be grounded in reality.. hard.. but it really can be helpful.

cbt and dbt to me are just differnt icing on the same cake.. in fact almost everything i read turns out to be the same in the end. it is just expressed a little differently. what is easier and more natural to one person may be the opposite to another.

anyway.. i think any method you persue is valid. anything that helps you to get out of your emotional mind and into your wise/thinking/rational mind.

just my oppion

bets

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hotmofo

thanks for posting all this about dbt.ive been waiting for a space to come up after i was referred.i hope it can help me.xx

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Guest wife

this is all really interesting

I have asked for DBT to hep me with my BPD but am told no-on ein my local psych hospital is trained to do it

Jay

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Lizzie

I started DBT in January this year and stuck at it for three months. Unfortunatly I found it too difficult and dropped out of the program. I couldnt deal with talking about emotions as I have a bit problem with this as it stirs up a whole lot of problems involving my abuse, my whole childhood and even my adulthood. Since I started the therapy my self harm behaviour increased and even with dropping out it still is on the increase.

I have reached the stage that I dont think anyone can help me and it would be better if I could just end evrything and not suffer anymore.

Sorry if I not supposed to mention things like this but it is the first time that I have posted.

Lizzie

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Miko

Star

Mind map the issues and also action plan just one or two goals with dates against the specific actions

e.g phone Fred this afternoon to find out about X

Depending what he says, schedule X with Y for around middle next week if poss, - this evening

And so on. One can tweak timings and actions as appropriate as one goes. E.g Fred is now refusing the idea of X (he is two faced) so I am having to resort to an alternative.

Notice boards not having got through to me I now keep my most important pieces of paper in shopping bags with the handles in the middle

Lizzie

In my opinion it doesn't necessarily matter what the emotions were, simply that they arose and interfered. I ended up too scared to do anything. It is vaguely logical to find that to some extent illogical. I think action planning which some people are teaching me about offers a way through in that the emotions just have to stand on the side lines and watch my real life unfold from here, it doesn't matter if I feel them or not, because once an action is on the plan (and in the shopping bag) there is far more inevitably about it.

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lostsoul

hole - and anyone else -

you can buy a book on amazon called 'the dbt manual' by marsha linehan, or something close to that title.

it's a teach yourself dbt so even if they do not have a programme in your area, you can learn a lot about it from the book

xx

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StetsonKennedy

For anyone who is not being offered DBT, or is doing it but wants some more info, I found this website really good:

http://www.dbtselfhelp.com

It has the Marsha Linehan manual handouts and worksheets, and also really good examples of the main principles to explain how to apply them to your life.

I'm currently working through this stuff on my own, as and when I need it, and it's already been very helpful, in addition to regular counselling.

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hotmofo

(((pip)))

me too......i want the referral to come through,but im scared that when it comes to the crunch im going to be a cop out.xx

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innermuddle

Just wanted to say that DBT is a valuable therapy. I ahve only been doing it for four weeks but it is ok. the structure is very rigid and you have to take it seriously and it requires a lot of hard work and participation from me but i know if i can conquer the self harm i will have achieved lots. Will it cure me from BPD? well i dont know the answer to that but i believe it can help me live wth and cope better with my symptoms and thus have a better quality of life.

I live in Hampshire and it has only just been started in my area so i guess we are the guinea pigs of the therapy but it is going ok. I have a 2.5hour group and then a one hour one to one session each week so its a big committment but if you can go on the programme i would recommend it

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Madsheep

thanks em for info it wasreally helpful

got appointment next week

to go through report for dbt assesment

good to know others at same stage in process

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pip

Even reading this thread on DBT has meade me tense.

My CPN says it is ok if I can't do it

- it just means I am not ready.

I am really frightened of failing

- again

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Elke.

I have the DBT manual, but when I was in the clinic once they offered me to take a look at the DBT ward and consider it.

I have decided to go and changed my mind for years.

Reading this, it really sounds like it would be too tough for me. (My therapist said "OH NO! You will only get hurt more there!") Think I will stick and continue with the Manual and check out that link...but for all of you who believe they can hang in there and pull it through I wish you success.

Elke

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Rew

DBT isnt workin for me, i have a low attention span and find it really difficult to engage with people, but i'll keep at it, you never know!

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mort

DBT is a really difficult therapy to undertake.

But with only 5 weeks to go of my year I would recommend it to anyone lucky enough to get on to a course of it. There were 8 in my group initially and are now 5 of us left and it has helped us all in varying degrees. (3 of us are also members here so this place helps too, thank you!) :)

DBT has been a lot of hard and emotionally draining work with many highs and lows. But it is aimed so specifically at bpd that it has shown me ways of accepting and being me that do not involve harmful ways of behaving (most of the time.)

For me mindfulness is the key to it all and has helped me to access the other skills of interpersonal effectiveness, emotional regulation and distress tolerance. Being aware of where I am in that moment and trying not to judge that feeling or thought (or me) and not worrying endlessly over the past, present or future. I still feel the emotions just as intensely and with dramatic mood swings, but am less likely to feel a secondary emotion as a result of the initial one and no longer feel constantly on guard out of fear of my possible behaviours.

Also keeping a diary of urges, emotions, and the links between those and my actions has helped me to see that the I am able to feel the whole range of emotions (sometimes all in an hour!) but that the emotion doesn't automatically lead to impulses, harm or despair.

In my dbt experience feelings are never invalidated but positive ways of reacting to the emotions have been the key to awareness and acceptance. By the way acceptance doesn't mean condoning but just not ruminating in downward spirals that inevitably led me to despair in the past. So basically I feel more in control of me and I can hope now. :)

The work is well worth it as it has dramatically changed my life so much for the better already that I am not wanting it to end now and just wish I had attended every group and individual session and done every piece of homework!

take care all and hugs

mort x

PS The skills learned also apply to other PD's such as AvPD and ocd's too (well have for me) :)

PPS Still working on my posting addictions tho, so sorry for the length of this! :lol:

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