Friday, 2 June 2017

DBT therapy.

What is DBT therapy?
DBT stands for dialectical behavioral therapy! Still none the wiser? Dialectics look at different view points on the same topic or situation - for example to people facing opposite directions will have a different view what the world looks like in that location! Behavioral looks at your behavior, and well, therapy is kinda self explanatory! So bringing that together DBT is a therapy that involves looking at different viewpoints or perspectives on topics and issues and how these effect our behavior. For example, because of my life experience when someone is looking in my direction and laughing I assume they are laughing at me, which triggers thoughts and behaviors, however someone with different life experience might have a very different response and look around to see what is being laughed at so they can laugh too. It's made up of skills therapy, where you learn skills, often in a group setting, and practice them day to day, and one on one therapy (this isn't always offered, especially on the nhs, and I didn't have this, but the skills were still helpful). 

Who made DBT? 
Marsha Linehan founded DBT for her patients with borderline personality disorder, something she had firsthand experience of as a sufferer herself, and it was also something she practiced herself.

Who can it help? 
DBT was designed to help people with borderline personality disorder, a disorder characterized by emotional instability, unstable relationships, and intense emotions among other things. However it isn't limited to being used for BPD, it's also used in eating disorder treatment. Personally I don't think there is anyone out there who couldn't benefit from at least one of the DBT skills, and many would benefit from most of them. Like with any therapy you do have to be committed, but if you are it can really help.

How is it structured? 
This will vary from place to place. When I did DBT we met once a week for 2 hours at the local mental health outpatients. During this time we would have 2 minutes each to give a summary of the skills we had used this week and how effective they were from our diary cards (more on them later!), then we would start to learn about the skills that were designated to this week (part way through this we would have a break for fags, coffee, toilet ect), and then finally we would be given our homework! Homework consisted of diary cards and sometimes a sheet to help us to work through the skill we were focusing on that week. Diary cards are a card where you track your urges, behaviors, emotions and the skills you used each week, they are a key part of the therapy, and in my experience those who don't do them struggle to participate in the therapy and often drop out. It is a years programme here, which covers every skill twice, in 6 week topics with 2 weeks mindfulness in between. 

So what are these skills? 
DBT covers 4 topics, distress tolerance, interpersonal effectiveness, emotional regulation and mindfulness. 
Within distress tolerance we look at the skills distraction, self soothing, improving the moment, radical acceptance, pros and cons, STOP, and TIP. Distress tolerance skills are used to manage difficult emotions, thoughts, and experiences, and to get you through crisis or difficult times. 
Within interpersonal effectiveness we look at DEAR MAN (used to get your needs met), GIVE (used to maintain relationships), FAST (to maintain self respect), and intensity of asking. Interpersonal effectiveness is aimed at trying to help communicate effectively in order to create, maintain and end relationships we want to in a healthy way. 
Emotional regulation looks at Accumulating positives, building mastery, coping ahead, and PLEASE (setting a baseline for more stable emotions). Emotional regulations purpose is to aid you to set a base for your life which helps to lower the intensity of emotions, the day to day basics that help you get or stay well. 
In mindfulness we look at emotional mind, rational mind and wise mind; observing, describing and participating; being non judgmental; living one mindfully; and doing what is effective. Mindfulness has many purposes, including getting through crises, being more connected and aware in daily life, learning to ride the wave of emotions, learning to let your thoughts be and not act on them, and more! 
I'm working on blogs that go into these in more depth, so that is to come for anyone interested!

Does DBT help?
Short answer is YES! Not all therapies are for everyone, but everyone I know who has completed DBT has benefited from it in some way, most in many ways! Personally it had a huge impact on my quality of life, it didn't cure me, I've had more other therapies since and am awaiting more treatment, but it's highly likely I'd be dead if I hadn't done DBT, that's not me being dramatic, that was my reality. DBT helped me be able to STOP and THINK, then act - instead of ACTING them STOPING and THINKING (oh crap!), which is something many with BPD struggle with, and many others. I learnt to be able to ask when I needed help instead of denying myself or thinking if I asked I could be rejected so best not to ask! I'm also much better now at riding the waves of emotion and letting my thoughts just be thoughts most of the time. My life is less chaotic and my base of day to day is more stable most of the time. I was quoted when I finished DBT saying

"I'm now living more days than I'm surviving"

Is it hard?
It depends what you mean by hard! The concepts and skills are not hard to understand, however they do take a lot of practice, and not just when you need them, you have to practice when you don't need them in order to build strong neural pathways for when you do need them. 

What use are skills really?
Skills are incredibly useful if you utilize them. Our brains often take us very quickly from emotion to action when an emotion is triggered, like a motorway (neural pathway) in our brains that is built on years of repetition, whether that's self harm, drugs, drinking, smoking, skin picking ect. With DBT we are trying to build more healthy neural pathways in our brains for when different things are triggered, however we can't just do it once and expect a motorway, it takes a lot of repetition to get a motorway. The skills will start out as dirt tracks, they may be a bit bumpy and uncomfortable, but keep doing them and you'll soon have a B road which is a bit smoother but still doesn't come automatically, keep practicing and you'll soon have an A road, a bit quicker still but keep practicing and you'll eventually have a new motorway, a new way of coping and dealing with an emotion that benefits you in the long term rather than hindering you!

What happens when you finish DBT?
When you've finished going to group after a year it can be a bit of a shock, you'll probably miss it at first, I know I did, especially the people I'd met.ive kept in contact with a few, 3 of us meet once a month in a local cafe who have a room reserved for us and go over a skill each month taking it in turns to bring some thoughts around the designated skill and a mindfulness activity, to help us keep on with practicing our skills. I'm one for journaling, so for me my life post DBT included writing in my journal a diary card type summary of each day, with skills used and emotions and behaviors tracked. I'm now actually back to filling out diary cards again, as my current care co-ordinator is the local personality disorder lead who is responsible for DBT where I live, which is very helpful! But essentially, if you want the positives to keep coming you've got to keep practicing! You may also be able to do a short course top up within primary care, I did, and it definitely helped to go over the skills, and learn the new ones as more were added shortly after I left the group. 

I can't get DBT on the NHS/where I live/for my condition/for another reason.
DBT isn't very well funded, especially within the NHS because it's fairly new to the U.K. In terms of therapies, it is done for personality disorders and eating disorders in secondary care, but they do also do some groups in primary care, they don't call them DBT though, it's often called emotional skills group, but the skills are DBT skills. If you have a care co-ordinator then ask if DBT is available, if they don't know ask if it's possible to meet or speak to your local personality disorder specialist. But if you can't get DBT on the NHS then it's definitely worth having a look online, you can get a lot of information and the skills online, or purchase the books on amazon and teach yourself, if you need any help or support or don't understand something let me know and I'll see what I can do! Also, in my upcoming blogs I will be delving deeper into the skills. 

This is only my experience, and based on what I have learned, but I hope it gives you a clearer idea of DBT.

Also a quick note, I am in the process of changing my surname, so if that comes up that is why! I have also changed the blog address, to coincide with a summer project, and it will be staying as lizzispeaks for the foreseeable future (I have no plans on changing it!).