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J.R. Buchanan

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Me, My Thoughts, and I

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Dialectical Behavior Therapy

Yesterday I read a new blog that I'd never seen before. I followed a link from a mental health blog I like, so I hoped that it would be good, and that the title was intended to draw people into something that was worthwhile. The title of the article was, "The Uselessness Of Mindfulness". I followed the link to the blog itself and was disappointed to find that the article indeed did stress the uselessness of mindfulness and several other skills I've learned in therapy, skills that have helped me a lot. The author's take was that just learning about the skills without any work put into using them should make her life better without any real effort. She also mentioned angrily that they did not erase mistakes that she had made in the past, without even trying to explain how she used or did not use them to deal with the effect these mistakes had on the present. Since these skills didn't erase the past, since they took work, well they were useless. At first I was going to make this post a rebuttal of hers, but I decided not to for two reasons. I've learned my lesson about arguing on the Internet (several times over...), and if I rebutted it, I'd have to provide a link to her blog, and as every post I read was downbeat, angry, bitter, and triggering, I decided that I didn't want to provide any publicity for her writings. There's always Google if you really want to be brought down.

If you are interested in reading a blog post with a similar title that is more along the lines of what I expected when I followed that link, here is one, Mindfulness is Useless, Unless....

Mindfulness and other skills are taught in a therapy called DBT, or Dialectical Behavior Therapy. It was originally intended as therapy for Borderline Personality Disorder, created by Marsha Linehan, a therapist who has borderline herself. It has since been discovered to be useful for other diagnoses, and many of us who have taken it feel that anyone, even those with no mental health diagnosis, could benefit from the skills.

Since I feel that DBT, or rather the work done using DBT skills, has made a huge difference for the good in my mental health recovery, I thought I'd write a post about this form of therapy. It is a real commitment (one year per course, usually two are recommend, now, years later I'm taking a graduate group in DBT). In DBT, you learn many skills, 29 when I took it, 30 something now. These are skills that you should have learned by osmosis as you grew up, but might not have. Some people are lacking in many of these skills, some just a few.

The description of DBT below is taken from the notes I took while taking the class 11 years ago. As I said, more skills have been added since then, but I'm not going to go over each one anyway, I'm just going to hit some highlights to give an idea about what this therapy is all about.

The skills are broken down into four groups. The first is Core Skills, which are the basis of the whole concept, One-Mindfully, or mindfulness, is one of these. The second group is Distress Tolerance, the third is Interpersonal effectiveness, and the fourth is Emotional Regulation.

I'll cover some of my go-to skills from these categories below.

In Core Skills, which are what they say, the core of DBT, the skills used most often are Wise Mind and One Mindfully. Wise mind is simple, it describes the state of using both the logical and the emotional mind together. Not pure logic, not all emotion, but wise. It is important that you be able to reach this state. One Mindfully is simple as well. Do one thing at a time. When you eat, eat, when you work, work. If other thoughts or feelings distract you, let go of distractions, and go back to what you are doing. Again, and again, and again. You can do this as an exercise, which is often done, but you can, and should, take this approach in daily activities as well. When doing mindfulness as an exercise, I like to listen to music mindfully, letting go of all distractions and listening to each part of the music carefully. The first thing we do at each session of my graduate DBT group is a mindfulness exercise, the subject of which is brought in by a different member each week.

Distress Tolerance is also an important part of DBT (They all are!). It is also what it claims to be, a set of skills to use when in distress (or when distress is approaching). I'll mention the one I use the most, and the one that I find to be the most difficult. I go to Distraction a lot, it's the DBT skill that I use consciously the most of them all. It sounds simple, doesn't it? Anyone can be distracted from something else, something that is perhaps distressing, right? Well, before DBT, sometimes I got distracted from something unpleasant, sometimes I didn't. In DBT I learned that I could deliberately distract myself to escape distress. One of the things I use for distraction? The computer/Internet. Writing blog posts for instance. Is Distraction all good? We didn't discuss this in class that as far as I can remember, but I do think that sometimes I distract too much, too often, and too well. Still it is quite useful. Some other suggested distractions are, Contributing somehow (blogging again, mental health advocacy, etc.), Intense Sensations (ice, stress ball, loud music, sex, etc.) The hard skill for me? Radical Acceptance. To quote my notes, "From deep within, accept what is. Acceptance is the only way out of hell. Acceptance is acknowledging what is, it is not the same as judging it good." I don't remember if those are my words or not, I made these notes 11 years ago. I can find it hard to simply accept things without judging and without stressing about it. But is the way out of hell...

Interpersonal Effectiveness is a group of skills that help you deal better with other people, something I had trouble with. I was not assertive enough, quite passive when dealing with others. One skill I use often is called DEAR MAN, "Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, Negotiate" A sub-skill here is Broken Record, keep repeating what you want to happen over and over.

The last category is emotional Regulation. Many of us have trouble keeping an even keel emotionally, these skills help. The one I use the most is Opposite to Emotion Action. Here you do the opposite of what your emotion tells you to do. If you fear something or some situation, do it, over and over. When sad or depressed (there is a difference), stay active and do things that make you feel competent and confident. If you are angry, do something nice, avoid someone rather than attacking them, or attempt to empathize with some one instead of harboring resentment.

These skills are harder to do than they seem, just knowing what they are will not help you at all. But working with them whenever needed can save your life, perhaps literally.

Has any form of therapy helped you out? Taken DBT? Or CBT? (Cognitive Behavior Therapy) Let us all know in the comments!

As usual, I'll post future updates to my Facebook and Twitter pages. Feel free to follow or friend or message me.


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