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  1. DBT SKILLS 2: MINDFULNESS ~ “WHAT” SKILLS Intro and Disclaimer found here: https://www.depressionforums.org/forums/topic/150755-dbt-skills-for-recovery-posts/?tab=comments#comment-1457564 Previous thread here: https://www.depressionforums.org/forums/topic/150756-dbt-skills-1-~-wise-mind-mindfulness/ This section is a mixture of the manual I was given and notes I took when watching a video of Marsha Linehan talking about the “What” skills. When I take notes, I always try to write things down word for word because it’s the way I am. So sorry about that. Also, I have included some of my own experiences and wrapped up the basics (as it seems to me) at the end. There are three “What” skills: 1. Observe 2. Describe 3. Participate These skills are useful when in a situation that is unpleasant, or one that can lead to or cause harmful behaviours. I had written something in quotes and wrote a comment – both of these are things I would never have written myself, so I’m assuming that they are from the video. The first is a question: “What do I need to do?” The second: in Mindfulness, live life with your eyes open. Observe · Just notice the experience · Step back · “Live life with your eyes open” · One thing at a time! Keep your mind on one thing. Focus on that one thing. · Notice the experience without describing it. · If you are distracted, just notice the distraction. Gently come back to the one thing you are trying to focus on. (see the similarity to the meditation steps in the previous post – Wise Mind ~ Mindfulness?) Describe · Put words on what you are observing. · Stick with facts only, don’t interpret what you observe · Know the difference between thoughts/interpretation and facts. For an example, if you see a face, your interpretation of the face being possibly being angry is not necessarily a fact. What you are actually seeing and need to describe is the facial expression itself, as in certain parts of the face being scrunched, eyebrows turned down, mouth is scowling etc. Participate · Allow yourself to be involved in the activity/in the moment · Let go of rumination · Use your Wise Mind and remain calm and neutral (Past conditioning may make this very difficult at first) · Accept the situation. These skills will seem strange and simple at first. But when you start to think about using them when a situation in your life occurs, you may ask yourself afterwards, “How the heck am I going to use these skills when I’m in the heat of the moment?” This is where Mindful Meditation can come in, as you can train yourself to be calm more often. Also, using the ”What” skills in regular everyday life to “practice” will help you to create a habit, so that when the need arises, you will have the skills more readily available to you with the particular situation. What we need to do in order to use this information is to actively use these skills with something very simple. When I was taking this course, I used to look at things while preparing for my backcountry hikes. I noticed flowers and described them in my head with things like their colour, their size, etc. First I noticed them; then I described them in my head. Participation was difficult for me in this case. I felt that participating would mean to experience the flowers by touching them, smelling them and maybe tasting them if they were edible (and I could pick them to do so). But of course these particular flowers were in neighbourhood gardens. What I did figure out, is while I taught my piano lessons (I’m a piano teacher), I used to stare out the window at the mountain that I like to climb. I used to also daydream about something I wanted very badly. I was not 100% present in those cases. What I figured out one day, was actually participating in the lessons, giving the child my full attention and fully helping them is what gave me much more satisfaction, feelings of success and made the time go by so much faster. All this and more: the child enjoyed the lesson more, they benefited more, and it seemed to me that they noticed the difference. I too enjoyed the lessons more, even when I wasn’t in the mood to teach. I sometimes still drift, looking at the mountain, but I gently accept that it happened and bring my mind back to my student. It’s Your Turn! So just get out there, try it for one thing. Maybe even bring a notepad with you and write the things down under headings of the three elements. Or do it with something in your kitchen! Maybe there is a food item on the counter. Observe its location and existence, describe what it looks like, then participate by tasting it, touching it, feel the sensation in your mouth as you chew, or as it melts, smell it etc. Share your findings/experiences in this thread. I think it will be very interesting to get people’s insights and feelings about how they used the “What” skills. Talk about the differences, talk about the things you had trouble with, and even the things you found easy. Talk about how you can improve or progress for next time. Come back and post about any improvements/progress if there was any later.
  2. Dialectical Behavior Therapy What Is Dialectical Behavior Therapy? Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships. When It's Used DBT was originally developed to treat borderline personality disorder. However, research shows that DBT has also been used successfully to treat people experiencing depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, and substance abuse. DBT skills are thought to have the capability of helping those who wish to improve their ability to regulate emotions, tolerate distress and negative emotion, be mindful and present in the given moment, and communicate and interact effectively with others. What to Expect DBT treatment typically consists of individual therapy sessions and DBT skills groups. Individual therapy sessions consist of one-on-one contact with a trained therapist, ensuring that all therapeutic needs are being addressed. The individual therapist will help the patient stay motivated, apply the DBT skills within daily life, and address obstacles that might arise over the course of treatment. DBT skills group participants learn and practice skills alongside others. Members of the group are encouraged to share their experiences and provide mutual support. Groups are led by one trained therapist teaching skills and leading exercises. The group members are then assigned homework, such as practicing mindfulness exercises. Each group session lasts approximately two hours, and groups typically meet weekly for six months. Groups can be shorter or longer, depending on the needs of the group members. DBT can be delivered by therapists in many ways. For instance, some people complete the one-on-one therapy sessions without attending the weekly skills group. Others might choose the group without regular one-on-one sessions. How It Works DBT is a cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., in the 1980s to treat people with borderline personality disorder. Those diagnosed with BPD often experience extremely intense negative emotions that are difficult to manage. These intense and seemingly uncontrollable negative emotions are often experienced when the individual is interacting with others—friends, romantic partners, family members. People with borderline often experience a great deal of conflict in their relationships. As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change. What to Look for in a Dialectical Behavior Therapist DBT assumes that effective treatment, including group skills training, must pay equal attention to the behavior and experience of providers working with clients as it does to clients’ behavior and experience. Thus, treatment of the providers is an important part of any DBT program, and therapists should practice the skills themselves. They need to know basic behavior therapy techniques and DBT treatment strategies. Look for a mental health professional with specialized training and experience in DBT. The Linehan Board of Certification, a non-profit organization, has developed certification standards for clinicians. In addition, it is important to find a therapist with whom you feel comfortable working. More on Dialectical Behavior Therapy The Chaos That Borderline Personality Disorder Can Cause Borderline personality sufferers try to relieve their inner turmoil. By Elizabeth Svoboda What Is DBT? Transforming destructive behaviors into positive outcomes. By Greta Gleissner LCSW Sources Chapman AL. Dialectical Behavior Therapy: Current Indications and Unique Elements. Psychiatry. Sep 2006;3(9):62-68 Panos PT, Jackson JW, Hasan O, Panos A. Meta-analysis and systematic review assessing the efficacy of Diabletctical Behavior Therapy (DBT). Research on Social Work Practice. 2014;24(2). Valentine S, BankoffSM, Poulin RM, Reidler EB, Pantalone DW. The use of dialectical behavior therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology. Jan 2015;71(1):1-20.
  3. Dialectical Behavior Therapy Dialectical behavior therapy (DBT) provides clients with new skills to manage painful emotions and decrease conflict in relationships. DBT specifically focuses on providing therapeutic skills in four key areas. First, mindfulness focuses on improving an individual's ability to accept and be present in the current moment. Second, distress tolerance is geared toward increasing a person’s tolerance of negative emotion, rather than trying to escape from it. Third, emotion regulation covers strategies to manage and change intense emotions that are causing problems in a person’s life. Fourth, interpersonal effectiveness consists of techniques that allow a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships. When It's Used DBT was originally developed to treat borderline personality disorder. However, research shows that DBT has also been used successfully to treat people experiencing depression, bulimia, binge-eating, bipolar disorder, post-traumatic-stress disorder, and substance abuse. DBT skills are thought to have the capability of helping those who wish to improve their ability to regulate emotions, tolerate distress and negative emotion, be mindful and present in the given moment, and communicate and interact effectively with others. Read More What Is DBT? What to Expect DBT treatment typically consists of individual therapy sessions and DBT skills groups. Individual therapy sessions consist of one-on-one contact with a trained therapist, ensuring that all therapeutic needs are being addressed. The individual therapist will help the patient stay motivated, apply the DBT skills within daily life, and address obstacles that might arise over the course of treatment. DBT skills group participants learn and practice skills alongside others. Members of the group are encouraged to share their experiences and provide mutual support. Groups are led by one trained therapist teaching skills and leading exercises. The group members are then assigned homework, such as practicing mindfulness exercises. Each group session lasts approximately two hours, and groups typically meet weekly for six months. Groups can be shorter or longer, depending on the needs of the group members. DBT can be delivered by therapists in many ways. For instance, some people complete the one-on-one therapy sessions without attending the weekly skills group. Others might choose the group without regular one-on-one sessions. How It Works DBT is a cognitive-behavioral treatment developed by Marsha Linehan, Ph.D., in the 1980s to treat people with borderline personality disorder. Those diagnosed with BPD often experience extremely intense negative emotions that are difficult to manage. These intense and seemingly uncontrollable negative emotions are often experienced when the individual is interacting with others—friends, romantic partners, family members. People with borderline often experience a great deal of conflict in their relationships. As its name suggests, DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change. What to Look for in a Dialectical Behavior Therapist DBT assumes that effective treatment, including group skills training, must pay as much attention to the behavior and experience of providers working with clients as it does to clients’ behavior and experience. Thus, treatment of the providers is an important part of any DBT program, and therapists should practice the skills themselves. They need to know basic behavior therapy techniques and DBT treatment strategies. Look for a mental health professional with specialized training and experience in DBT. The Linehan Board of Certification, a non-profit organization, has developed certification standards for clinicians. In addition, it is important to find a therapist with whom you feel comfortable working. References Chapman AL. Dialectical Behavior Therapy: Current Indications and Unique Elements. Psychiatry. Sep 2006;3(9):62-68 Panos PT, Jackson JW, Hasan O, Panos A. Meta-analysis and systematic review assessing the efficacy of Diabletctical Behavior Therapy (DBT). Research on Social Work Practice. 2014;24(2). Valentine S, BankoffSM, Poulin RM, Reidler EB, Pantalone DW. The use of dialectical behavior therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology. Jan 2015;71(1):1-20.
  4. DBT SKILLS: WISE MIND - MINDFULNESS Intro and Disclaimer found here: https://www.depressionforums.org/forums/topic/150755-dbt-skills-for-recovery-posts/?tab=comments#comment-1457564 Mindfulness is also known as Meditation. It has been taught in many religions. In the 1980s, Jon Kabat-Zinn introduced it to help hospital patients cope with chronic pain problems. It has more recently been used in psychotherapy. Studies showed that these skills were effective at reducing the odds of having another major depressive episode; reducing symptoms of anxiety, reducing chronic pain, decreasing binge eating, increasing tolerance of distressing situations, increasing relaxation, and increasing skills to cope with difficult situations. Marsha Linehan considers mindfulness to be one of the most important core skills of DBT because of these findings. (DBTSW) Mindfulness is basically being aware: noticing things, your physical position, the sensations you feel, the things you hear, the things you smell, the things you see. How you are feeling. Mindfulness is *staying in the moment.* It is noticing things without judgement and accepting them as they truly are. (Almost exact quote from DBTSW as well as Nat notes) Mindful Breathing The primary focus in Mindfulness Meditation is the breathing. However, the primary goal is a calm, non-judging awareness, allowing thoughts and feelings to come and go without getting caught up in them. This creates calmness and acceptance. 1. Sit comfortably, with your eyes closed and your spine reasonably straight. 2. Direct your attention to your breathing. 3. When thoughts, emotions, physical feelings or external sounds occur, simply accept them, giving them the space to come and go without judging or getting involved with them. 4. When you notice that your attention has drifted off and is becoming caught up in thoughts or feelings, simply note that the attention has drifted, then gently bring the attention back to your breathing. It’s ok and natural for thoughts to arise, and for your attention to follow them. No matter how many times this happens, just keep bringing your attention back to your breathing. (Man. exact quote) My experiences: ~ Experience A ~ My husband once taught me a meditation similar to the above. I have no idea what his source was, as this was 25 years ago at the time of this posting. 1. When paying attention to your breathing, count each breath until you get to 10. 2. Every time you reach 10, begin at 1 again. 3. If you get past 10 as you may have mindlessly kept going (this always happens to me at one point), as listed above, gently bring your attention back and once again begin at 1. Most times I fell asleep, lol. I was always relaxed when I didn’t fall asleep. I’m pretty sure that I fell asleep because I was so relaxed. ~Experience B ~ In my class, we ended every class with Mindful Meditation. We were usually running out of time and sometimes it was as short as two minutes! Sometimes it was a visual meditation, and either way it was always vocally directed by one of our facilitators. I still felt more relaxed afterwards. There was a feeling of…the words I want to use is fresh and new. Wise Mind This section is not made up by me of course. My manual has a picture of two circles that are close enough together that there is an overlap in the middle. I’m assuming this came from the Marsha Linehan originally. Each circle had a label: Reasonable Mind and Emotional Mind. The overlap section was labelled as Wise Mind. Wise mind is what we want to aim for being in. The following information I am sharing is purely my notes. Some of this info may have come from the sources I’ve cited, I don’t know, it is word for word what I have written down as a list during class discussions. Reasonable Mind Wise Mind Emotional Mind Water Air/Earth Fire Calm Grounded Emotions in control Problem solving Warm Out of control Logical Curious Sensitive Cold Calm Chaos Facts Have time Stormy In control Better decisions Unpredictable Analytical Intuition Vulnerable Little emotion I am in control Hot/passion Practical Balance Impulsivity Free from conflict Anxiety Peace Intense Unhibited Overwhelming Explosive Danger Poor decisions Can you tell that a bunch of people with BPD, Depression and Anxiety came up with the above items? The Emotional column looks pretty busy! (Nat) Edit: i should add here that Mindfulness increases your chances of achieving a wise mind. The more skillful you become, the more your wise mind will be present. *End edit* At this point, I’m not sure what to add without getting into a whole bunch of stuff. There’s just too many worms to explode everywhere. So I’m going to cut it off here and see where it leads. I do hope this all helps some people, if it is even one person, it will make my day or more. Comment below if you wish. Discuss. Talk it out. Ask questions. Next Thread: https://www.depressionforums.org/forums/topic/150791-dbt-skills-2-~-the-what-skills/
  5. DBT SKILLS FOR RECOVERY POSTS Disclaimer and Intro: Soon, over time, there will be new threads about DBT posted here in One Step At A Time. IMPORTANT NOTE: I am not a qualified DBT professional. I am only sharing partial information that I have learned based on a 9-month course that I took, the materials I was given (based on the manuals written by Marsha Linehan), my notes from the course and a book entitled The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation & Distress Tolerance by Matthew McKay, PH.D., Jeffrey C. Wood, PSY.D. & Jeffrey Brantley, MD. I will reference items as follows: Manuals: Man Notes: Nat The book: DBTSW Please note that Depression Forums (www.depressionforums.org) is also not a licensed DBT site. These threads are being created in order to share information, open discussions, questions, possibly help others and open doors to working through some things we need to address. Maybe there will be an exercise or two for us to share as well. DBT was originally developed by Marsha Linehan, a psychologist who suffered from BPD, for BPD patients. DBT can help EVERYONE though, even those who do not have mental health issues. The skills are helpful and useful for everybody. All of information posted in these threads will follow the format of the Skills Diary Card that was used in my course, which may or may not be the same as the one created by Marsha Linehan. I know that my course was based on her manuals, but it was also adapted to fit the needs of our local health authorities. These posts will probably be very long, as there is a ton of information to share. Please note that not all of the information will be shared because of this, and really, the detailed information should be saved for courses, and proper research. Links between this thread and the individual threads themselves will be listed for easy locating. Please check here periodically for changes, such as new links, as the threads will be created over time. One way to know that changes have been made, is to follow the thread (click follow at the bottom of this post) and you should receive notifications when changes and additions are made. PLEASE! If there is any information that is incorrect, let me know *by PM* and I will research it and make the appropriate edits. The information I am sharing in this post and the related threads is how I understand it and experienced it. Thank you, Natasha
  6. Hi I'm Andra, aged 21. I was diagnosed with Borderline Personality Disorder and Major Depression in April of 2011, though I have known something was wrong with me since I was 5. I currently take Lexapro (Esitalopram) 20 MG, and Abilify (Aripiprazole) 2 MG I waited on a waiting list for DBT 6 months and finally got in in October. It's going great. I love it. I can't speek highly enough of DBT Therapy. I like people and helping people so if anyone ever needs support or a chat buddy I'm here. and I guess that's a bout it :)
  7. D3vo

    Dbt Therapy

    Are any of you a part of, or have been a part of DBT therapy? For those who do not know, DBT is Dialectical behavior therapy. It is used to treat Borderline Personality Disorder with a set of skills and with behavior modification. It's been really helpful for me.
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