DBT (Dialectical Behavior Therapy) is a treatment for depression which has been paramount in changing my attitude as well as the stories I tell myself. It has made a big difference in my life.
It occurred to me recently, though, that I’ve never written a post about it; I’ve just poked and prodded at it. That’s been a big oversight on my part, and it changes now.
WHAT, EXACTLY, IS DBT?
I can’t remember the first time I ever heard of DBT, but I know I refused to even try it for about a decade. My long-time therapist, Ya’el, would mention it every now and again, and I would blow it off.
I had a few reasons for doing this. First, I’m no good at commitments. Just look at how many blog posts I published in all of 2020 – only eight. Another reason I wouldn’t do it is because no one was ever able to give me a clear understanding of what DBT was. Why would I sign up for something I don’t understand even on a basic level?
One of the other big reasons I kept blowing off the recommendation to do DBT is because I had what I call an “emotional allergy” to groups. I’d been in several of them over the years, and I usually found them intimidating. So I tried to avoid them.
That’s right, folks – DBT is a group treatment experience. Group?! Oh no! No way am I joining a group!! Yeah, that’s what I thought at first, too.
Besides, with all the treatment I’d gone through over the course of 30 years, I figured I knew all there was to know about myself. How could yet another group help?
Little did I know that DBT would change my life.
In a word, it teaches you how to live a life worth living. It teaches you how to identify what you’re feeling and how to change the way you look at it, the way you react to it, and the way you feel it. It’s a simple idea, really, but it’s not easy.
In fact, there is so much to learn that the DBT Skills Training Handouts and Worksheets book, written by the creator of DBT, is 422 pages long and is composed mostly of worksheets. These worksheets allow you to practice each new skill you learn in between sessions.
One of the most important things it teaches is that, no matter the situation you find yourself in, there is always more than one way to react to it. In fact, when you run into a problem, whether it be a situation, a feeling, or a thought, DBT teaches that we always have five choices:
- Solve the problem
- Change how you feel
- Radical acceptance
- Stay miserable
- Make things worse
The choice is ours to make, each time.
A FEW EXAMPLES
Here’s an example of a skill called “Opposite Action”. The group facilitators (my group had two) teach you how to act opposite to what you’re really feeling.
For instance, my life has pretty much been ruled by Fear. I know that’s not a good thing, and I don’t enjoy it, but it almost feels like Fear is my default emotion.
For a really intense feeling, and when that emotion does not fit the facts of the situation – ie., there is no reason you *should* feel so strongly about what’s happening – there are a few skills that can help you change what you’re feeling.
Opposite action is difficult, and it takes a lot of practice and guidance from people who know what they’re talking about, but it works.
For example, when humans feel Fear, the urge is usually to run away and/or avoid the trigger, right? Only that’s not so effective. The opposite action would be to stay and confront that emotion, to expose ourselves to the Fear.
I know, right?! LOL That’s a scary thought, and it is very hard to do. It takes practice. And though your Fear may not go away completely, it will get to the point where you can manage it.
What about Shame? That seems to be a big one among the people I know that have depression.
The urge when we feel Shame is to hide or avoid, keep things to yourself. The opposite action is to stop hiding and tell your secret. Speak it out loud to someone. It’s another crazy idea, but it’s very effective at dismantling our triggers and allowing us to move forward instead of sitting in our Shame ad infinitum.
Something I’ve always been pretty good at is jumping to conclusions and transporting myself into the future. That’s a good way to cause yourself unnecessary worry.
Though it’s impossible, I like to be prepared for every possible outcome of a situation (talk about causing yourself anxiety!). But sometimes I get carried away and throw myself haphazardly into the unknown. I tend to think in absolutes – black and white – and judge my own thoughts and feelings.
When I do that, I lose sight of the truth, the reality of things, the way things actually are. It usually makes me more anxious (which is a function of Fear) than I usually am, which is no good for me.
When I feel overwhelmed by an emotion, it’s a good time to practice the skill called “Check the Facts”. Now, this may sound like an easy thing to do. But this handout and worksheet, like all of them, are designed to get specific.
They ask six particular questions (such as “What is the emotion I want to change?” and “Does my emotion and/or its intensity fit the actual facts?”). In other words, if you’re interested in feeling better, there are concrete steps you can take.
I’m also the kind of person who reads the directions over and over before I start a project, so following the six steps on the “Check the Facts” worksheet gives me confidence that I do, in fact, have some power over how I feel (something I NEVER believed before). They give me hope (something I had waaaaay too little of before).
One of the bigger ideas in DBT is to look at things non-judgmentally and be mindful of the present moment. The goal is to act from your “Wise Mind”, as they call it, that space in your brain where emotion and reason blend.
This is the space where you want to act from; if you’re ruled only by your “Reasonable Mind”, you end up being cold, distant, and emotion-less, and values are not important. There are no gray areas and no mushy feelings to deal with. This can lead to loneliness and lack of connection, among other things.
Reasonable Mind is not all bad, though. This is what allows you to focus when you’re performing a task.
Likewise, if you get stuck in “Emotion Mind” like I was, emotions rule your life. For me, that looked like chronic overwhelm and crisis after crisis. For a long time, I ran from one fire to another, even unwittingly causing them sometimes.
My life was ruled by Fear, and that’s no way to live. There was little room in my mind for reason, for facts, for logic. I was only able to react to my circumstances by being overwhelmed with unpleasant emotions and not being able to make any “wise” choices.
DBT argues that both Reasonable Mind and Emotion Mind are necessary to live a happy, well-adjusted life. And I agree. But the overlap between the two – the Wise Mind – is really where it’s at. This is where the wisdom resides in each of us. Here, Reason and Emotion both have value and we are able to achieve Balance.
The DBT group I was in met every week for a year. When we were all present, there were nine of us, plus Kim and Linda, the facilitators. (We were allowed a small number of excused absences.) Yes, twelve months is a long time to be vulnerable, and it’s a big commitment.
But it is so worth it.
Here’s the basic rundown: A DBT group addresses five areas of life: General Skills (Group Orientation and Analyzing Behavior), Mindfulness Skills, Interpersonal Effectiveness Skills, Emotion Regulation Skills, and Distress Tolerance Skills.
For three hours every Tuesday morning for that year, the nine of us would go to group and report on the skills practice we’d done over the previous week.
Actually, first we would do a mindfulness exercise, which Kim and Linda tried to make fun (like tossing a ball to each other so we would start paying attention). Then we would all share our homework and discuss it. We would then get a ten-minute break and come back to learn a new skill(s) and find out which worksheets were due the next week. Pretty standard structure for a group.
I totally get not liking groups, trust me. But I gotta tell you, getting called out on being too proud or too stubborn or even too afraid to change or on how you have a pattern of sabotaging your relationships is pretty powerful, especially when done in a group setting. And I think it’s the way to get the most out of DBT.
I once had a therapist who said she could do DBT with me as an individual. Not really understanding the difference but not willing to try a group, I agreed. But it was a complete waste of my and her time. There was no structure, no book, no homework. There was no accountability.
Needless to say, that therapeutic relationship didn’t last long.
Now, I don’t know if this is the norm for DBT groups or if it was something my clinic did, but all of us in group had to see one of the facilitators for individual counseling once a week, and we all saw psychiatrists. DBT is holistic like that.
THINK ABOUT IT
If you’re trying to maneuver among your strong and overwhelming emotions, or if your partner describes you as a cold person who acts like an automaton and doesn’t know how to show love, think about giving DBT a try.
I guarantee you will learn things about yourself, along with the specific skills and steps that can help you feel better. You’ll even start to think before you react.
I know, one year is a long commitment, but maybe you should give it a try anyway. And if you do, give yourself some time to feel comfortable. Don’t just quit at the first sign of discomfort.
It took about six months before I had the revelation that, yes, DBT can actually help me! What Kim and Linda were teaching was finally starting to make sense to me. I dumped the attitude, opened my ears and my mind, and started paying serious attention.
I can’t say enough about the liberation I felt through DBT. No longer was I a prisoner to my anger, my fear, my shame, my anxiety, or my depression. I had methods to get over it now.
I’m not saying I’m perfect about it, of course not. Now that I’ve been out of DBT for a few years, I probably don’t use my skills quite as much as I should. But that’s normal. No one’s perfect.
Old habits die hard.
I still have the book, complete with hundreds of notes to myself, highlighted text, phrases that I underlined or circled or starred, even the phone numbers of some of my fellow group members. I even refer to it once in a while!
I never want to lose sight of the fact that I am not my depression anymore; it does not define me any longer. Instead, I have the option to practice the skills I learned, which I know for a fact help me feel better.
If you’d like to feel better, too, check it out. Just Google “DBT”. You can even look it up on YouTube and watch this video of an individual session.
I will leave you with a word of warning: Not all insurance companies cover DBT. Apparently, it depends on how your clinic bills it. Make sure you’re covered before you incur a giant and prohibitive out-of-pocket expense.
As always, thanks for reading this extra-long post. And let’s Keep it Real out there!
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