Dbt

[Ozcat]

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.“

Other Treatments

[Ozcat]

Dialectical Behaviour therapy

Hello from Australia. Ive just started the DBT programme, must say I haven't learnt anything new in being mindfull and distress tolerance, seem pretty basic so far. But Im probably a high functioning, inward BP. I don't cut myself, I have a university degree, but I have a very low self esteem and never had a very good opinion of myself. Yea it bugs me that I can't talk about past traumers because I have PTSD too. I always worry about saying the wrong thing and upsetting people, or being wrong and making a total dick of myself, but theres been times when Ive got myself into situations I feel confident in that moment, but then I lose the confidence and find the situation causes me traumer as a result. Its like going full steam to a wedding and suddendly running out the door at the alter., especially when it comes to love or sex, so I just don't bother. Maybe therapy will change that? Thats my biggest problem, interpersonal relationships so It will be good when we get to that module.

[shadowman]

i just wonder... wheter DBT therapy is any good for fighting

anxiety problems, self-insecurity, and building up a healthy amount of self-esteem????????????????

cause that is my main focus

i was already taught to sign up for the waiting list for dbt, but was not shure wether i should go for it,

or if i should try something else instead?

Edited October 3, 2007 by shadowman

[Heidi_]

Hi shadowman.. I don't think DBT is the best therapy for building self-esteem and becoming more yourself, try something else, I don't know where are you from and what are your options, but for these things you've mentioned I would try psychoanalytic psychotherapy.. if you are from bigger city try "psychoanalytic self psychology", you wonnt regret it, I can almos guarantee you that ;) it has really deep approach and building self esteem from very core of person's self.. good luck.

[Heidi_]

I just have to say this, I really don't like this DBT therapy, I don't see nobody really gets REALLY better, temporarly from it, or if they do the steps are really little - having bpd isn't really good way to live, I don't like that ppl are accepting bpd as life long diagnose, it is so wrong way to fight it, and I don't even know how many people doubt it is totaly curable, this thing is really bad also because nobody would even go trough any illness, even cold, if you don't believe you can cure it...

I don't know why there is this attituted in world and proffesionals about people with BPD should be just treaten to lower their symptoms, like we are some outcasts,.. that is what I think - DBT is treatment for outcasts, for those ones without hope - and this is wrong, almost every person with bpd can be 100% cured.. It is vicious cycle and it is stopping many people to get cured..

I was 2 years on/off in DBT and similar approaches, and didn't make any progress, and in 1 month of Self Psychology treatment I made miracles - especially in terms of self-esteem!!

I am not talking against DBT totaly, I think it is good to combine DBT with some other, deeper approaches, like psychoanalytic psychotherapy...

It looks so sad to me when I see that some people with bpd are going trough years and years of DBT and similar treatment and never got really better, they always have ups and downs, that is no way to live, and major responsibility for this have medical proffesionals who encourage DBT too much, bpd is too serious disorder to have such shallow treatment.. :unsure:

Edited October 3, 2007 by Heidi_

[Little]

I'm going to start DBT next week and I really don't know what to expect. I don't know exactly how it works.

[doormouse]

...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've opted to stay away from DBT. For one thing, like you said, it doesn't actually address the underlying issues. If it can help people make it through life, fine. But it doesn't sound like it's for me.

Another thing, the first time someone got "in my face" to confront me about my many maladies would be unfortunate for both of us.

I don't deal with that well. Another wonderful survival skill learned well.

I've been reading through this thread cos after five years of endless assessments and nothing happening EVER the NHS psychotherapist re-assasing - AGAIN (in between accusing me of ignoring a letter I never recieved, calling me a liar and having a go at me for not remembering what I'd said to him 18 months ago....)decided to mention, right at the end of the meeting that there was now a DBT group at the centre, and that he was going to refer me to meet the people who run it. My problem is this - whilst I know that DBT has a reasonable evidence base, and I've read linehans book and her papers, this group runs without the individual therapy, and I'm not really sure I agree with the principles of it for me right now. About five years ago I begged to be refered somewhere - anywhere! - for DBT because I was slef harming constantly, OD'ing, the works, but it now its just not like that. I think it could have been really helpful for me then - and Imight not have been so bad for quite so long - but now I SH very little, I work, haven't been actively or dangerously suicidal for years (the feelings may be there but the inclination isn't..) - essentially, most of the time I cope ok. I do have issues with relationships, but really mostly with my family, and members of the opposite sex.

What I really want is long term psychodynamic therapy to sort out the underlying issues - thjis psych says it would just be like "picking a scab", but I feel like part of the problem is that these issues are constantly "bleeding" anyway, and I've just never been able to stop and face them, and I can;t do it on my own. The thing is, I've agreed to meet with the dr who runs the DBT group, but I just know that if I feel like it really isn't right for me I'll just get told - AGAIN (like when I had a really really bad experience with CAT a while ago) thatI'm "avoiding therapy", or not taking what's offered,.and therefore I obviously am not interested in enaging with therapy......

Just wondering guys......

any advice?

Mousex

[Hedgehog]

I DBT to be superficial, unrealistic and not challenging. It gets bogged down with the same stuff every week and never actually goes any where. I managed 4 months before I quit. It was frustratingly slow and the group sessions were like returning to secondary school.

The only two useful bits were the diary cards; it was helpful to check in with my emotions and record how much I was drinking. I also found reading the teaxtbook that goes with the workbook vaguely interesting in terms of knowledge of BPD but it didn't help at all with the symptoms.

[Vorpalblade]

Sounds like you and I had totally different experiences of DBT Hedgehog.

I guess you get out what you put in.

[icu_baby]

I don't get it. I left NY 3 years ago because I couldn't find a doctor who knew anything about DBT so I ran away to South East Asia where there is no therapy at all. HOW THE HELL DOES SOMEONE FIND A DBT SPECIALIST? Sorry for shouting but I feel locked out of the getting help loop. I have heard there are waiting lists to get into a DBT program. Can someone please send some advice on how I can go about finding one, hell I can move to England if necessary (I carry a british passport but have lived in NY since I was a child). And what about the cost? I mean my mother is so pissed off with the mental health professionals we have been engaged with since I was seven years old and so now she thinks DBT is probably rubbish. I asked her if she would pay for treatment and she said no. How does one get around this. I am so tired of this bullshit, I mean living with depression, suicidal thoughts and the bloody bpd! I admit it I'm jealous of you all who are receiving treatment and have found a caring therapist.

Dear KavanIce. Plase don't gie up. I live in sydney which is quite a large city and I found it hard to find a therapest who does DBT. I even rang up the psychiatric members board to find someone who deals with personality disorders to no success. Then I finally emailed a professor who did research into BPD and he got in contact with his collegues and gave me two referals that did DBT, both were private psychiatric hospitals. I didn't even consider these. Both have a waiting list. I need to get insurance and there might be a 12 month waitng period to get the right level of cover (2 months if your condition is non-prexisting but how do you prove that????). So all in all I have a 12 month waitig period which is ok, I don't mind as long as I can get into the program eventually. If I had the right level of insuarance already I would only have a 3-6 month waiting period.

I also suffer from depression, suicidal thoughts and BPD but please hang in there. You can alway continue see a 1 on 1 therapist in the meantime. If you need to talkk please feel free to msg me.

icu_baby

[TKM2306]

Thanks for letting us know--however, those of us in the U.S. don't have access to DBT on a consistent basis. There are NO providers of DBT within a 500 mile radius of my town. I too am a clinician, and have considered doing the continuing ed. for DBT, however, I believe that poses ethical issues for me that I do not want to face.

[PipC]

I started the group sessions of DBT last week and had my second session today. Most of the other people in the group are younger than me and their lives seem to be in more turmoil than mine is. But that's also why I think it' taken so long for me to open up enough to get the level of help I'm now getting. I've never looked as if I've been struggling as much as I have because I've kept it all in.

So in the last two weeks for the first time ever I've heard people talk about the things that I've thought and felt for the last 20 years. the thing is though they're talking about it and how they are managing those things and that made me feel hopeful.

At the same time though I couldn't really believe I was in there. I wandered what my friends would think if they saw me in there. It felt a bit like watching a TV documentary, but I was in there as well.

There was a sense of hope though.

[butterfly2008]

Just a little story about my experience at a DBT based treatment centre. About 20 "patients" attended a 13 week program here in Canada from Monday to Friday , then went home for weekends. No meds were allowed, and many of us were not even told that we were all there because we were diagnosed as BPD. I thought that I was there for treatment of depression. Now there were very good things about the program, the main one being talking with fellow patients, and finding out that I was not alone. I learned for the first time to actually speak about my feelings, etc. That was a huge and helpful step for me. There was a harshness, no nonsense approach about the program, and I often felt like I was being treated as a misbehaving child, e.g. you could not be one minute late for a session, or you were not complying with the program and you would be immediately sent home. There was almost an atmosphere of fear. The worst thing for me was some of the messages that we were given - one, that we "chose" to behave the way we did, that we could choose to be happy (I could not understand that then, and I do not understand that now, how and why would anyone ever choose to be depressed?) The other big message was that we chose to be "ill" so that we could avoid responsibility. I could not sleep more than 3 or 4 hours a night while I was there due to nervousness, homesickness (I was 1500 miles from home), lack of meds, I just dont know. I began to feel as if I were being brainwashed, and began to believe that I was just faking depression, that I was deliberately choosing to be ill so that I could avoid responsibility (I was the mother of 7 children (5 were my husbands from a previous marriage), I had been a teacher/principal for over 20 years, I had loved my job and would not knowingly and deliberately avoid it), and that I was "choosing" to be depressed. I just could not figure these things out. When I came home (they sent us all home after 8 weeks of treatment instead of the 13 because of a provincial strike that the hospital fell under). I wondered about things when I watched several of the "nurses, therapists" etc, run around with their "pro-strike" buttons on as they eagerly prepared to send us home, and take part in the strike. It did not make sense. When I got home, I was much better due to the fact of the support and caring of fellow patients, the genuine caring of one nurse/therapist, and I did learn many new things about myself I did not know before. But I was left permanently confused, to this day. When I get depressed,(I still go through periods of severe long-lasting depression about once every year or two, I not only feel the guilt and shame that comes with the depression, I also feel the added guilt and shame that I am not thinking right, that I am only seeking attention, and that I am avoiding responsibility. It is a rough road for those that do not fit into the right slots. I think in the long run, that the best thing to do is to gain the self-confidence and knowledge about your own needs and pick and choose what applies to you. It is not the "miracle" for every one, but there are many good things there. Just know your own needs and take what you can from what is offered. One of the main things we were taught was to "never give your power away to anyone", that applies to the DBT teachings also. Not every little message and truth they present is true for everyone.

Anyways, rant over. In conclusion, my experience with DBT was that there are some wonderful skills that can help one tremendously, and there are also some that can really hurt. Be wise and true to yourself, and know what is right for you. Take what is good for you, and leave the rest.

Long rant over.......

Val

[gklimt]

I start DBT on Wed. I'm looking forward to it. I know it's going to be tough, but I don't think I can be tough any longer. I have to learn to live this way or die.

Wish me luck.

[butterfly2008]

Good luck, qklimt, I do send hopeful wishes for you. It is a tough road, yes, but there is help in there. Be strong, and be true to yourself. Take care.

val

[NickyP]

If anyone needs help wtih their DBT homework or needs some help understanding what has gone on in your session please feel free to PM me :)

[Venna]

I think DBT is a life-saver! I did it a few years ago and and it helped me understand my bpd beter.

The things i think helped a lot are:

My therapist had a pager. I'ff i had a crisissituation i could page him 24/7. He then called me back and helped me find a way out. Together we talked about the things i allready learned but could not think of because i was so in disstress. The thing is that you can ask for help before you hurt yourself. Not something i did easily but after some dry practice, i really felt i could trust him enough to call him i'ff something was very wrong.

DBT doesn't forbid you to harm yourself. Some therapies say you can't hurt yourself or you will be excluded. I think that is *** You seek help because you didn't learn how to cope with your emotions and then they say:" We're going to help you but you must stop hurting yourself" Wasn't that just why i came for help!? DBT helps you find out why you do the things you do and then try to find another way to get what you need when you hurt yourself. They understand you don't hurt yourself (or others) because you like it... but because you don't know another healthy way to do so!

It is also very important that they tread you as a person with bpd not as a borderliner. I'ff you're treated as a borderliner they just see borderline. Every human being is unique, every human being with bpd is also unique, so you need a treadment that fits you. Maybe washing dishes to distraced yourself helpes you, i trow the dishes across the room. Look for the things that help you. DBT helps you with that things!

I definitely recommend DBT! It was/is a lifesaver for me!

LoL Venna

[sarahjane]

does anyone know if its available in my area??? i live in nuneaton warwickshire!!!!!!! a small town near coventry

[NickyP]

you need to ask your psychiatrist, and if there is provision then he may, or may not refer you on. :)

[™Michelle1]

I went to my first one last week and im on a small waiting list to be

in a womens group..which will be nice because i love the support system

she said this is about a year process but i can still attend after my

year is up which i probably will.

My Therapist diagnosed me as suffering "Low Grade Depression"

and said the group therapy will work wonders for me

She's a big believer in postive thinking and is going to teach

me these tactics because im a very negative person.

she also said that she will not bring up my past unless i bring it

up and want to talk about it (not sure why)

I have a question,what is the difference between a Phychiatrist

and a Therapist/Counsler ?

I've always wondered.

[rebeccaborderline]

Psychiatrists are medically trained, they are doctors. They are the only ones who can prescribe (except GPs), and also the only ones who can diagnose you with any mental illness (again except GPs in some cases); Therapists/counsellors can't diagnose

Therapists/counsellors come in different types, depending on their level of training, ie from psychotherapists downwards. Unfortunately anyone with 6 weeks training from the local college can call themselves a counsellor as its not well regulated, although Im sure your counsellor is better trained than that if they're doing DBT. Its perfectly legitimate to ask them what qualifications they hold if you want to know.

Good luck with it, DBT is supposed to be very good

reb

Edited April 13, 2008 by rebeccaborderline

[™Michelle1]

Thank you for claryfing it for me Reb

I knew there was a difference but wasn't sure what

it was

[edpinkgurl]

I just finished off DBT yesterday the less session. It was ok... I think it's helping a bit but I definately still need to practice a lot of the stuff. Like it's weird how apparently people do all this studd naturally and I'm like what this seems so weird. Like we are suppost to say a positive affirmation each day but I can't even seem to get myself to do it because well I don't believe it or feel I deserve it. Mindfullness is a key thing, practiced a bit but find it really hard. Also the forums are good some are useful some I had trouble doing. Especially one on Adversive strategies, as i start to realize how manipulative I actually am and I hate it cause I wish I wasn't. And we did this sheet on I want they want for relationships, but I was doing it tried to even talk to my boyfriend and he didn't kno what he wanted and I didn't know what I wanted so had hard time doing it so ya, I don't know. Anyways the Interpersonal stuff is the hardest I know it is so ya.

[brummie83]

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.“

Other Treatments

Hi

Does anyone know of anywhere in London or nearby (Hertfordshire/Essex) where you can get on to a DBT course. The CPN has told my wife and I that it is not accessible through the NHS locally. Does anyone know if there is somewhere where you can get it privately?

Thanks

Chris

[NickyP]

are beckton and blackheath near you? a little searching shows that those Trusts they offer it.

also look on the BACP website see if any of their therapists offer it.