How to Use the 4 Steps of Dialectical Behavior Therapy | DBT PART 1

about dialectical behavior therapy specifically how it can help your mood and your relationships it is a hot topic these days uh dbt as more and more people start to learn about all of their therapy and treatment options um dr judy as people start to filter in here what are you most excited about uh uh covering today well just the fact that we're gonna be giving people a practical of skills that they can use right now during these uncertain times i know that there's a lot of people who are complaining about pandemic fatigue and political stress and you know just all of the unknowns has really worn on them over the months and dbt is so appropriate for all of these different issues that could come up in these different stressors because we're going to be teaching four different categories of skills that will be able to be applied today to start to change in your feelings awesome awesome uh dr judy is also holding the second part of this series or these live classes uh tomorrow if you would like to register for that class you can use the links below this video or just go to medcircle.com live we'll be taking your questions today if you are watching this live on zoom if you're watching on youtube uh hello but we will not be able to see your questions you guys can chat in the box of course but to participate in this session or future sessions make sure you register and attend live through zoom again you can do that at medcircle.com live for those of you on zoom please uh submit your questions in the q a box below uh certainly we want detail but if you can keep it maybe five sentences or less that will help us get through as many questions as possible that being said med circle series at med circle live events are for educational purposes only this is not aimed to replace or replicate treatment in any way dr judy our first question today what is dialectical behavior therapy well dialectical beaver therapy is a skills based therapy technique it's a group of techniques that were born out of and inspired by cognitive behavioral therapy and it was developed by marsha lingham who has been very open about her own emotional and behavioral struggles in fact she was diagnosed with borderline personality disorder but before that she was actually committed to what we used to know as asylums um obviously those don't really exist anymore but people really misunderstood her and didn't really know what to do with her so in her teenage years they had difficulty knowing what to do and she ended up in an asylum in her early adult years then she realized that no matter what even with something more long-standing like borderline personality disorder you can develop tools to help yourself and she is also a psychologist and a researcher so she actually developed this set of techniques and then eventually tested it on thousands of patients and research subjects and now it's been shown to work not only for borderline personality disorder but basically for all different kinds of stress and different types of interpersonal problems and other things that anybody might deal with no matter you have a diagnosis or not your class that you held it was a two-part class on med circle on cognitive behavioral therapy one of our most watched classes to date certainly i get emails still about uh people just expressing their appreciation on how that helped them change their life let's talk about what cbt is how it does relate to dbt but then also what are the differences because this is where i get confused all the time absolutely so one of the key differences with cognitive behavioral therapy and dialectical behavior therapy is that the cbt model doesn't work on emotions directly it posits that there is a relationship between thoughts behaviors and feelings and that by changing your thoughts and changing your behaviors you'll be able to access your feelings and change them as well because if you imagine basically a model that has bi-directional arrows going between those three components thoughts behaviors and feelings if you change your thoughts then it's going to have an impact on your feelings and if you change your behaviors it's the same thing so cbt puts less emphasis on regulating your emotions directly but basically as a byproduct of doing cbt skills and mostly by changing thoughts and changing behaviors and also changing how you approach relationships you're going to be able to affect your feelings dbt is a little bit different because it has more of a focus on accepting your feelings and your thoughts changing them although they do talk about changing them as alternative strategies and also it talks about dealing with your feelings directly through the techniques that they brand as emotion regulation and distress tolerance so dbt has a huge view of accepting whatever negative state you're in and when you're unable to change it what you can do to deal with it so if you are truly in a bad situation how do you tolerate that distress until it passes have negative feelings how do you regulate those feelings directly and so i actually think that dbt and cbt are amazing compliments for one another because it's basically just sort of different ways to get at the same set of issues which is just stress for most of us no matter what you're dealing with there's always an issue of managing stress and i think that there's sort of these different but complementary approaches to doing it in tomorrow's session we've titled it the dbt part 2 the essential treatment toolkit dr judy has agreed to actually not only take questions that you've written but also if you are brave enough to come on camera or at least come on audio and ask your question uh dr judy has agreed to do this this is some feedback we've gotten to improve these classes so again if you've not registered for tomorrow's class you can do so at medcircle.com live we'll also have bridgette put the link in our chat on youtube and here on zoom as well let's get into the questions because i know we're going to have a lot dr judy our first question uh comes from med circle member who's asking how long do people need dbt well it really depends on how quickly you're responding to the model dbt is designed to be more of a short-term and focused type of treatment so for a lot of people they get tons of benefits by being in treatment for three to four months but a lot of times when people really enjoy that model and they also have a great relationship with their therapist they might receive dbt for a year um and at that point sometimes towards the end of those sessions it's really just like a check-in with your therapist and basically trying to improve on how you're already utilizing dbt and basically working on those advanced skill sets but in research we know that people respond very well to dbt within three to four months with what type of minds uh they respond within three to four months oh in three to four months yes okay um next question is dbt or any other therapy uh can that solve moral obligatory questions like what is the meaning or the purpose of life i think that dbt is not as well equipped for those questions i think acceptance and commitment therapy is more equipped for those questions i don't know have we done an act class yet maybe no we have not we have the axe series but not a class we need to do that next i think because i feel like this is the one two three punch dbt dt and at and actually that's what my book is based on too my book uses all three models because i really think that they're all very complementary and act is all about meaningfulness and values and existential questions so i think that that's probably where you're gonna get more of that uh education when we talk about relationships and improving our moods what type of components of dbt will be leveraged during a session and maybe share some examples of questions that a psychologist or therapist would be asking yeah so dbt has four components and the four components are mindfulness strategies emotion just emotion regulation distress tolerance and interpersonal effectiveness and because gbt is more of a type of therapy that focuses on the here and now the therapist will be asking you questions in which you will be able to respond about the pain points that are current in your life so of course at some point you will get into your history and why those pain points developed in the first place but it's really about solving the problems that you're having today and very much so about how you cannot react from an emotional mind and start to utilize your wise mind so in dbt there is this model that you have two sides of your mind you have the reasonable and reasonable or rational mind and you have the emotional mind and both of them come with their pros and cons in dbt there's actually no judgment that one is better than the other although i would say that sometimes when people have self stigma they wonder why they can't be more reasonable but it's not actually reasonable to always be in your reasonable mind you know there's some things that you should apply your logical mind to and some things you shouldn't but that when you combine these two parts of your mind but in a more elevated way you kind of create this third better mind called the wise mind and it's really taking the best components of your logical mind and your emotional mind to make good decisions that you will feel good about instead of reacting in the moment and then having more regret later or hurting your relationships or hurting yourself excellent uh our med circle member is asking hi my eight-year-old daughter is autistic with a pda profile i think she has alex alexa she doesn't unders she doesn't understand how she's feeling when she doesn't feel right and describes it as cranky she says she's bored or punchy wants to smash something she hates when i mention deep breathing or anything relaxing i've even tried your blowing bubbles idea but she doesn't want to do it when she's in this mood is there something i can try many thanks oh well thank you so much with a great question and for those of you guys who don't know what alexithymia is it is this inability to describe your own internal emotional state and also understand other people's emotional state when somebody is spectrum they have a higher risk of displaying this type of symptom and by the way this is not a symptom that is only um on the spectrum people who are not on the spectrum can also have this symptom it's also not a diagnosis but it's a way to describe a syndrome that can sometimes affect how people do and their well-being and also how they respond in therapy and so when people don't have the words to describe how they feel oftentimes their emotional distress comes out in their body so as an adult that kind of person might say that they have a headache or a stomach ache when they're stressed or when they're depressed a child when they can't convey their emotional needs but they're obviously upset will sometimes act out as this med circle member is talking about and i think the most important thing is to help your daughter to reset um in a different way so again the deep breathing it usually gets them into a very very quick place of relaxation and rest and restoration but sometimes it can be hard to calm them down enough to even do that and so if that's the type of problem and this mother is saying that this is what she's dealing with sometimes it's helpful to use the ddt strategy of distraction so dbt in terms of distress tolerance talks about this type of technique where basically you distract from issues that you might be struggling with and in some ways it's almost like directing their attention to something else other than their emotional state of distress so it could be distracting them with a toy distracting them with a positive activity uh distracting them with something busy that they can help you with but it's really about thinking um of a way to direct their attention away from their distress and oftentimes we categorize that as a distress tolerance strategy because it's sort of like when you can't really change what's going on and maybe when you don't have the words to process it you just turn your attention away from it for just a little while so that they can achieve a state of calm through that distraction and then you don't avoid it because that would not be a good coping strategy but once they're calm then you can come back and process the situation in a better way um when people have alexa thymia especially as children it could be good to show them emotion cards um so that they don't have to come up with the emotion word themselves but they can just look at pictures of faces and try to ascertain which one feels most like them and so that's another way in which you can start to understand a little bit more about their emotional states really great tips um just as a reminder that sorry we're getting a lot of questions here um you can go to medcircle.com live to register for the next event on dbt these will be provided in the med circle video library within 48 hours so if you would like to review this video later you can do that if you have not gone if you are not a med circle member and you would like to learn more i recommend going to medcircle.com we have a new homepage which allows you to choose one of the best reasons that brought you to med circle maybe it's to help yourself or help someone you love and it'll walk you through how to get the most out of a med circle membership and you can start with a week free trial so there's no obligation no risk and if you're a member of the military if you're a health care professional if you're a teacher if you're a student we have lots of discounts for lots of different people if you think you may be qualified for a discount please send me an email kyle medcircle.com kyle medcircle.com and i'll make sure to get you set up with any discounts that we may have available but of course the free week is for everybody and you can choose membership options as well we have lots of options to hopefully fit everybody's needs let's go to our next question they're asking the difference between dialectical behavior therapy and acceptance and commitment therapy okay so here are the similarities dbt and act are both really focused in the concepts of acceptance and sometimes people ascribe that to eastern or buddhist ideas you don't have to be religious to think about those ideas i mean when people say i'm trying to achieve zen that's also sort of a buddhist idea but it isn't religious in nature but it's this idea of just accepting where you are in life as opposed to wanting to strong arm or change it so that's a similarity between both but the difference is is that act really focuses on developing skills that we call psychological flexibility so psychological flexibility is all about doing what's needed in whatever situation you're in so in many ways act says sometimes if you want to cry it's fine and sometimes if it's not the time to cry that's okay as well and sometimes maybe you do want to yell and that's also okay under certain circumstances but it's really about doing the things that bring you meaning in your life even if you're in pain a lot of times people will say well when i'm less stressed when i'm less busy when i'm less depressed and when i'm less anxious then i'll go hang out with my friends then i'll go look for a new job right it's very easy to get into that state of mind and act says no do the things that provide you with meaning and the byproduct is that you actually then feel better your mood gets better because of the fact that you are living your life with conviction and according to the values that you have so app does a lot of values-based work which dbt does not do because the ebt focuses on some other aspects and act doesn't necessarily um focus squarely on interpersonal effectiveness but again through pursuing your values your relationships improve act also utilizes a lot of metaphors so they like to tell stories about oh like the unwelcome guests at a party and that's a metaphor for your thoughts for example as a way to teach their skills and dbt utilizes acronyms to teach their skills so for example there's a dvt strategy called dear man and it's part of their interpersonal effectiveness strategies where you learn to communicate more assertively and get what you want and and it's called dear man like m-a-n m-a-n dear man so it stands for seven different skill sets within the interpersonal effectiveness module that teaches you how to communicate better and get what you want from your relationships all right dear man love that uh let's go to our next question is there any limitation for the application of dbt so in terms of the limitations of applications of dbt i think the limitations are that dbt doesn't spend a lot of time digging super deeply into your childhood and i think that if people were interested in that type of work where there's a lot of deep introspection about early life factors then probably psychodynamic therapy would be the best type of therapy for that and psychodynamic therapy is a bit uh more active uh for you in terms of free association but it's less active in terms of learning skills it's more about insight development so i think that they're not necessarily contradictory methods i know a lot of people who have a psychodynamic therapist and then they go to dbt groups for example um and you can definitely use both but i think that that's one of the limitations of dbt is that it doesn't really delve super deeply into your past like cd and like act of course they talk about it and they touch on it but it's just not a central focus of the intervention i also think that dbt would be difficult to do if the person was extremely ill and also needed medication treatment one example would be somebody who has very severe schizophrenia even though psychological treatments like dbt will be absolutely necessary so is medication so dbt would only be a part of the formula would dbt be actually useful for somebody if they weren't ready to dive into you know some childhood trauma or something dbt and cbt are the techniques that i recommend people who are a little bit defended towards the inside development work people who are a little resistant maybe to therapy in general or maybe have some self-stigma i think dbt and cbt are great for those types of individuals because oh it's learning skills it feels very educational and it doesn't have to get into these scary places that the person isn't willing to go to yet of course once people have been in therapy for a while they see the benefits then they loosen up and they're more open but that doesn't happen right away and so it's kind of funny with some of my most um competent professionals uh ceos of big companies doctors firefighters um none of them want to go to psychodynamic therapy but they will go to dbt or cbt next question says i have been in dbt groups for years i don't feel it works for me i still struggle fiercely i have serious issues with impulse control and urges for self-harm especially since the pandemic started how can i control the urges to improve my moods so it's so great that you've been in ddt for a long time and you know i would say that sometimes dbt doesn't work for people and you have to try a different technique although what i'm hearing is that maybe the emotional dysregulation piece is still really prominent for this person and emotional dysregulation is really difficult because when we feel that way we tend to then act out in ways that are not very healthy for us or the people who are around us and one of the dbt set of techniques when people are feeling emotional distress is to try to reduce their painful emotions in the moment and so there is a uh again an acronym for how people can reduce the vulnerability to their emotion mind more as a preventative strategy so these are skills that i would suggest everybody do kind of on a daily basis throw it into your routine so that you're kind of set up and inoculated against more moments of distress and the acronym for this set of skill sets is p l a um let's see p l e a s e master so it's please master and so the components are treat physical illness so make sure that your medical status and your physical body is in good shape balanced eating stop using mood alterating drugs balance sleep exercise and achieve mastery somewhere in your life do something that makes you feel competent and these are more preventative strategies that people should be thinking about every day but on top of that when you are starting to feel distressed there are some other techniques to try the first one is just to increase positive events in your life when you're distressed the most likely thing you'll do is you'll isolate yourself and that obviously decreases the probability that good things can happen to you so it's this idea of creating positive experiences for yourself it doesn't even have to involve other people it can just be i know that i like listening to music i know i like having my cup of coffee it can be really simple things that you can do in the moment i know that i like smelling nice candles right do the things that will just improve your mood even just for a minute because that really helps you to change out of that emotional mind also another technique is to really try to bring your focus back to the present moment of course what we call mindfulness when you're really distressed so it can be difficult so my two best techniques for that is one is grounding so really focus on the stuff in your environment and plant your feet on the ground and try to visualize yourself being connected to the earth almost like the your body is like the stem of a big strong tree and just really feel the physical environment touching your body to bring yourself back to the present state another one of my really favorite techniques when you're already really distressed is the 54321 technique where you engage your senses and you just narrate to yourself and when you say you count down from five so five name five things you can see in your environment four name four things you can touch three three things that you can smell two two things that you can taste and one one thing that you can hear so you can do them in any order that you want but basically each of the numbers will be one of your senses that exercise takes under one minute but the reason why it works is it directs your attention to what's around you and your mind cannot compete with multiple ideas at the same time so direct your mind to the present moment the rumination and the worries and the anxiety they dissipate because multitasking is a myth that's a lot your mind actually can't multitask so if you're focused on one thing you can't be focused on the other thing and these things are really important because they just take you briefly out of that state of agitation it breaks up your thoughts that we're really self-harming into a place where it's much more neutral so that would be another great technique and then the last one is opposite action so when you're feeling a lot of emotional distress opposite action is all about thinking about what to do if you were in the opposite emotional state that you're in so if you're feeling really angry and you want to yell at your partner ask yourself what's the opposite action here would it be actually to give my partner a hug even though i'm not 100 happy with him right now right um if you're uh feeling extremely depressed and want to isolate opposite action might be oh actually still pick up the phone and call my friend like i told her i would today right so thinking about what you will do and acting as if acting as if you actually felt the opposite the research really shows that when you do this it actually changes your mood state and it's not even conscious so it's an amazing technique when you're in a very emotionally dysregulated place for look we have a lot of people listening to this right now live you guys have to actually take these tips with you i do not hear them and go well that sounds nice and then forget about it this is this is the moment okay where you actually improve your life by taking what dr judy is recommending and finding a way to implement it and nobody asked for my opinion but i'm going to give it anyway if you take one of these techniques and you never use it until you're in that state of anxiety or frustration or sadness you may forget about it and so there you have three options here you have the 54321 technique you have the opposite technique and you have the grounding technique choose one of them and do it today at some point even if you're having the best day in fact especially if you're having the best day practice it and that ground or the 54321 technique is something dr judy has mentioned before and when you practice it when you're having a good day and then tomorrow when it's not so good you've already got a repetition under your belt you see that it actually does have an impact in a when you were in a happy state or a better state and you will be more likely to implement it and see the positive change you're looking for you signed up for this class it's it's the middle of the week you sat down or you're washing dishes and listening to this don't just listen and then not implement you gotta implement these these strategies and this and these techniques so make a commitment to yourself in the comment section i want you to tell the world which technique you're to do today you got to do at least one okay either the grounding technique 54321 or opposites okay i'm going to do the 54321 because that's my favorite one so you make a commitment to yourself to do that today and watch what happens watch what happens dr judy knows us about me don't tell me to like go take a bath when i'm depressed because come on like i i need more than that but she brings evidence-based strategies time after time after time and if you're only listening to them you're not you're not helping yourself you've got to implement them so make a commitment to implement them today and then you're going to see you're going to see um let's go to another question [Music] help with curbing sugar cravings and obesity patients how okay so one of the things that is really interesting about dbt is that oftentimes when we think about making decisions from wise mind it can be applied to all kinds of unhealthy behaviors and trying to cultivate healthy ones and sugar cravings and obesity have a real medical connection when people are medically obese they actually do have disturbances in a variety of their endocrinological signs and one of them is leptin leptin is a hormone that tells you how hungry you are and when you feel full when people are medically obese they have a difficult time regulating their leptin and their left hand sometimes gives them mixed messages and so it's a really tough thing to disentangle because like which one came first the chicken and the egg but basically we find this disturbance in a much higher rate in obese patients than people who are of normal weight so there is an aspect of this where sometimes you might think you're hungry and you're not other times you you know you actually are kind of on the mark so it's hard to know but one of the rules of thumb and this is not necessarily dbt but it's just another scientific strategy to use is to really ask yourself if you feel that craving if you actually are hungry for something that's like a real whole food like salad chicken a piece of protein something that's actually more of a meal that would be good for you or even thirst sometimes you just need to drink water and you're not actually having a craving for sugar right and it's really important to distinguish between the two this is an actual craving and cravings are always more based in emotion and whatnot but having food that fulfills you and sustains you that's hunger right and if that's the case instead of reaching for sugar you should actually be eating something nutritious or drinking water if it's thirst but if you have identified that it is a craving and you're like i'm not hungry but i just really want that cookie a really good technique is to set a timer for 20 minutes and distract yourself and this is a dvt technique just distract yourself um with an activity with something to do that would bring you some joy and pleasure and just set a timer for 20 minutes and give yourself permission that in 20 minutes if you still feel that craving and you want that cookie then you may have that cookie what is really amazing is that 95 of the time after the 20 minutes pass you no longer really want the cookie first of all you've been spending 20 minutes doing something that you kind of like a hobby listening to music distracting yourself calling a friend uh maybe watching something funny on netflix um but secondly all cravings physiologically pass in that time so there's a medical fact that is inherent in that particular skill so i think that you can kind of combine what we know about science and physiology with a dbt strategy to try to curb your issues with emotional eating excellent um are there any differences between mindfulness and dbt this person says they often get confused between the two mindfulness is one of the four categories of skills in dbt but dbt also has a lot of other skills so when people say that they utilize mindfulness technically they are taking a page out of the book of dbt but dbt doesn't own mindfulness mindfulness is much more general it's like a technique that is inherent in everything it's like mindfulness based cognitive behavioral therapy acceptance and commitment therapy life coaching i mean everybody uses mindfulness and so it's really like a generic technique that has been bundled into a bunch of other therapeutic techniques and so the best answer is that dbt includes a mindfulness module but mindfulness can also be applied in all different other areas and can be used on its own tomorrow we'll be doing the second part of this dbt class and we'll talk about the four modules more in depth they're the core mindfulness distress tolerance interpersonal effectiveness and emotion regulation you'll also have the opportunity to ask dr judy your questions on camera or via audio if you would like of course you can submit them via text as well you can go to medcircle.com live to register for tomorrow's class and the producer just told me they're not on camera so you can come on and do audio just not on camera thank you for the clarification uh what is the difference this is a term i've never heard dr judy the difference between radical dbt and acceptance and commitment therapy and and i do want to let people know that if you've no if you're a med circle member and you've not watched the act series go watch the act series watch.medcircle.com search acceptance and commitment therapy it's a great series with dr judy sure well radical acceptance is a concept within dbt i'm not sure if there is a type of dvt called radical det but radical acceptance is a main theme within dbt literature and radical acceptance is so much harder to do than it sounds i actually posted something on instagram about radical acceptance so i love this question because it's really this idea of like even when you're in the worst state of distress and things are just not going well then you made this ridiculous radical uh decision to embrace the moment anyway and i've heard other people talking about this in different ways i've heard people saying that this is a really crazy thing that i heard someone say this is again these people are so wise beyond their ears i don't know how people can do this but um sometimes people in the middle of an illness will say at least i'm still alive and i can feel what's happening to me you know that example of radical acceptance instead of saying why me you know why am i the one getting sick this person is saying at least i'm still alive and i can feel these sensations like so it is a really advanced technique in my opinion it is taught within the larger dbt literature um act obviously has a lot of acceptance tenants to it but act instead of just accepting also encourages you and in fact tells you very directly to live your life actively even when you're stressed out yeah so i think that that's really the difference is that the idea of acceptance in dbt is not that it's not active but sometimes it's just like sit with it and be okay with it act as like sit with it and be okay with it but also what is one thing that you really value today and you should do it anyway even if you're in pain and i think that that's the extension of that idea understood um how can you use dbt techniques for long-term crisis or hardships to get you through the situation until or to get you through until the situation gets better well dbt actually has a whole set of crisis survival strategies and i know that we're going to get more into this tomorrow when we talk about the members only class but as a preview and again as i mentioned dbt loves acronyms so um the crisis survival strategies are sort of in these four different areas the first one is to distract with wise mind accepts and so wise mind accepts a c c e p t s they stand for activities contributing comparisons emotions pushing away thoughts and sensations and obviously all of those things bear more explanation because you're like emotions but what does that mean so obviously there's technique trips packaged into that but the acronym helps you to remember them and during crisis cycle your way through those seven types of strategies another one that we've talked about before is just self-soothing with the five senses this is a great one even when you're in long-term stress because guess what guys when you're in long-term stress you're in chronic fight or flight and that is not good for your mind or body the human body and mind are constructed to withstand crazy amounts of stress for short periods of time you think about us evolutionarily um you know basically what our ancestors were doing is that they were running away from a bearer for several hours and then either they outran the bear and could relax or they got eaten so then they're dead so you know they don't run from a bear for eight months at a time unfortunately with the pandemic that's how most of us are feeling of always being in fight or flight and having that chronic hyper vigilance and that's not good for us it actually ends up messing a lot with um with how we are able to deal with stress and make good decisions and people feel tired and so the self-soothing with the five cents is just a really quick way to bring your body and mind into the opposite system so instead of fight-or-flight you bring yourself into the rest and restoration system and this is just things like listening to your favorite song smelling your favorite candle touching the fuzzy blanket all of these things can really help in moments of crisis tomorrow we're also going to be talking in more detail about another set of crisis survival strategies um which is categorized as improving your actual moment so even if you're in long-term stress you can improve the next five the next 10 minutes the next hour and the acronym is improved so i m p r o v e so we'll talk about all of those tomorrow as well but i think that it's a really nice set of strategies and as you can see these acronyms just help you to like remember things when you're in a crisis moment and like start cycling through like okay did i do my eye did i do my m and then until something works basically is the idea and most of the times before you get to the bottom of the list you're going to feel better or as you practice them you're going to be like i like the p and r and improve but not the other ones that's fine because everybody should have their own unique set of toolkits that work for them after they test everything out this med circle member says uh she's interested in becoming a dbt coach but she's not a social worker she's wondering if that's possible to become a dbt coach because she's seen uh the tremendous benefit her daughter has experienced from dbt well dbt coaches um tend to be certified therapists it's possible you can use dbt just in for example your life coaching work if that's something that you decide to do you just wouldn't be able to brand yourself as a certified dbt coach and so the programs that are available the ones are that are especially available through marcia linahans program which is the developer of dbt they generally require that the person has some type of a mental health counselor license but i would encourage you if this is something that you are passionate about that there's actually a lot of different routes to becoming a mental health counselor and involving varying degrees of formal training and financial investment for example like not everybody has to go to school for five to ten years to be a ddt coach right there's there's actually a few different routes so i would encourage you to look into it and i would really encourage you actually to look into marsha linehan's organization because maybe some of the rules have changed and will change and certainly there's a need for people who really know what they're doing and have passion for this type of work and so i'm going to go ahead and throw this link in the chat box so you guys can see it but basically um dr linehan's certification process and everything else that you might want to know about her organization and of course the origin of dbt is at this website dbt-lbc.org excellent and again if you're listening to this on replay it's dbt-lbc.org awesome thank you dr judy this is a great question which technique can you use if extended family specifically an ex-spouse due to divorce are re-triggering you every time there is a family celebration due to bad and dysfunctional behavior well it's very very difficult obviously when you can't control somebody else's behaviors but i think dbt has some great um applications here the first one is um well actually there's so many but um i think emotion regulation skills definitely play a role here we spend some time talking about those today distress tolerance you know being able to tolerate the moment that you're in just to get through the next couple of hours without acting out yourself and doing something that you regret but also um dbt has a a whole slew of interpersonal effectiveness strategies that i think could be very very helpful in this regard and so the interpersonal effectiveness module which we've actually talked less about is really about um working in a way that kind of gets the type of interpersonal outcomes that you want even with difficult people and so one of the acronyms that we had mentioned earlier is dear man and dear man stands for describe express assert and reinforce and then man stands for mindful appear confident and negotiate so you know without getting into the deeper details because we may not have time for that today i will just say that if you are having to have these get-togethers with this difficult ex-spouse the a and the r are really important here of the dear man so asserting yourself by asking for what you want or saying no very clearly and also reinforcing or rewarding the person ahead of time by explaining consequences so basically set your boundaries up before you even go to this event yeah have a conversation with this person and say it's been a little bit challenging getting along at these family get-togethers i still actually think we need to do them you know for the sake of our extended family and for our children or whatever the case may be and uh i would like to kindly request a couple of things maybe some boundaries maybe some topics that are off limits maybe um if you start to behave in this way then i will be leaving early you know maybe there's certain zero tolerance behaviors and it's just important to communicate that ahead of time so that you don't get triggered as easily and also you have an exit plan or a way to handle it when they come up i love that um and one of my favorite things i've ever heard oprah say is no is a complete sentence you don't have to say no and explain yourself no is a complete sentence so i that is just freeing to me to fully understand i i want to get through these three questions uh dr judy three different people are asking if dbt could help with complex post-traumatic stress disorder another person wonders if it could be used to treat bipolar disorder and then finally a third person is interested in its effectiveness on children diagnosed with oppositional defiant disorder so cptsd bipolar and odd okay well a quick answer and then i'll expand is all of the above yes okay actually there has been research in all three areas and in fact i have the workbooks for the research in all three areas on my bookshelf there's that there's actually a workbook called dbt for bipolar disorder um there's also a workbook for children to apply dbt strategies and several actually i just own one of them and then for complex ptsd absolutely i think that it's a core uh treatment for people with complex ptsd because people with complex ptsd have difficulty with self-regulation because of all the trauma they've been through they're constantly in a state of hyper vigilance and fear and so the ddt is very very helpful for them because it helps them to start to regain control in their life and regain control of their emotions and their actions with bipolar disorder because of the fact that people with bipolar disorder sometimes will have a difficulty managing their own mood swings dbt can help a lot with that and children with oppositional defining disorder oftentimes when we look at the reasons for why somebody develops oppositional defiant disorder it's because their emotions are not being expressed in a proper way and it's not being channeled in a proper way so out of the anger and distress they start to act out and they take it out on the people that they supposedly love and so teaching them self-regulation strategies will help them to decrease those oppositional behaviors excellent um we're when i hear dbt i immediately immediately think treatment for borderline personality disorder is dbt the best approach for bb bpd or can it also use cbt or act yeah you know borderline personality disorder can respond to all of those different strategies cbt f and dt and i don't think there's really one way to skin a cat although i think the reason why dbt has been touted as the main gold standard for borderline personality disorder largely is because that's where the research started so it's kind of funny when we think about what research shows and why they show that this is the gold standard treatment sometimes it's because the interest has just been there and we already talked about the fact that a lot of the initial research came out of marsha linehan's own lab and then decades later after she developed dvt she says oh hi guys by the way i have borderline personality disorder and now it all makes sense that she was kind of coming up with an intervention for herself and you know researchers are human beings too so people tend to study the things that interest them most and obviously this interested her because she was suffering from that condition once dbt became more popular rise we saw that it also applied to other things similar to cbt cbt was first originally developed mostly to treat depression it's the gold standard for depression but now that we have more research we see that cbt can also operate on things like borderline personality disorder and also the same with act out of the three act probably has the least research even though it's growing every day and it does have a good amount of research it's just not as robust yet as cbt which started first and then dbt which came after that and the main reason is just because act is newer it's the baby so if you think about cbt as the grandparent dbt maybe is the mother and then act as like the next generation and so it's just behind on research because we've had less time to collect it but there's a lot of energy around containing custodia right now and med circle has in-depth series on cognitive behavioral therapy dbt and acceptance and commitment therapy and we have multiple series on cbt for example dr judy did a series with us on trauma focus cbt so if you are clearly interested in dbt my recommendation is that your next step is go to watch.medcircle.com you can see our full library there you can see all the series we have on different treatments and therapies this is great whether you're in the treatment program thinking about going into therapy your child is in the middle of therapy or you're thinking about bringing them into therapy i was in therapy since nine years old i didn't learn or hear the phrase cbt and still i started working on med circle and it is different when you understand the therapy that you're involved in or know somebody who's involved in it's different so that is my next recommendation for people who are interested in learning more watch.metcircle.com we have time for a few more questions dr judy this person says my mother has lewy body dementia her anxiety and depression are getting worse even though she is being treated has regular therapy and medications can dbt help her absolutely and you know it's so tough when somebody has really body dementia because it really is a whole body and mind illness um and there's something that they can control but a lot that they can't and that's why dbt can be really valuable in tolerating the stressful moments and regulating the emotions that come with having a chronic illness that is debilitating and also is progressive so i i think that dbt has a lot of applications for people with medical illnesses that are more long-term and really help them to feel like they have agency again which is such an important part of when you're suffering from something chronic um being able to instill that sense of competence and confidence in yourself in a way yes um i want to share this statement this person says i just finished going to dbt for 10 months it is life-changing and you learn to use your skills within two weeks it's amazing thank you for this class i suffered for 30 years with regular therapy radical acceptance is freeing i'm a better functioning person thank you for helping us all dr judy is so on point thank you for sharing that because your story and just that little snippet will inspire others to seek out uh similar answers and therapies that work for them dr judy for people who don't feel comfortable seeing a therapist right now but are interested in perhaps implementing some of these strategies could they use a work a workbook and then like do at home dbt yeah actually i have a workbook right here to recommend okay so there it is the dialectical behavior therapy skills workbook nice okay and this is practical dvt exercises for learning mindfulness uh interpersonal effectiveness emotion regulation and distress tolerance so this is the four different areas that we talked about in terms of the categories of skills and it's a really really important and a great resource because oftentimes the dbt workbook will be utilized as a companion in therapy for people who are actually working with their therapists but it will also be utilized for individuals who might be trying to do it on their own and it is written in a way that can be helpful for somebody who maybe doesn't have a therapist to guide them but they can sort of guide themselves and so one of the things that i really love about this book is that um you basically have a way of going through the uh modules bit by bit and it's not as it's not as overwhelming because basically you do one or two activities a day and it's a wonderful resource so that you can learn some of these skill sets uh piece by piece and because it's a workbook you know it comes with places for you to write in it i'm sorry it's like too bright in here but um you can kind of see that there's ways in which you can fill it out i just put the link to the book um that you can purchase on amazon and you can buy the paperback version or the kindle version but um it's a really really good resource and goes through all of the skills in a very easy to digest way excellent you you guys are just great i'm looking at all the comments and the questions i love it you guys are empowered some of you are not patients you're supporters of children or spouses or friends in mental health but you are empowered you are getting educated it's so great to see because you're just going to have such better outcomes when you when you practice this stuff and implement it tomorrow we'll be doing a 90-minute session with dr judy participants who join us live will be able to submit their questions uh on audio this will allow you to dr judy and yourself to have perhaps some clarifying questions back and forth of course this is not treatment it's just education um and dr judy has posted the links in the zoom chat also for the dbt workbook for children which is really great so we'll have more resources and more insight on the dbt model and strategies you can utilize tomorrow go to medcircle.com live to register for that event if you are not a med circle member go to medcircle.com and start your free trial you'll uh be taken through a very quick uh demonstration of what med circle is what we provide for you and how you could leverage and benefit from a med circle membership and of course if you think you are eligible for a discount uh send me an email kyle medcircle.com i want everybody who wants a med circle membership to have a med circle membership if you're already a med circle member download our app medcircle.com app it's the best way to consume content um all right that being said dr judy thank you so much for being here um i i can't let you go without really quick talking about stop self sabotage because there are so many uh components of what we talked about here that are included in your book stop self sabotage could you explain uh for people who have not read your book who who would be the best person to read your book who would benefit most from your book well absolutely and thank you so much kyle for that uh wonderful um plug for my book i just went out that i a couple hundred books away from hitting twenty thousand books um whoa i'm very very excited about it that it's been able to how many people i believe um honestly when i wrote this book i'm like if 500 people read it and get some help from it i'd be happy and now i'm 200 books away from 20 000. and so um i've been so happy that this book has touched so many lives so far it's been translated to seven languages also and that's just sales from america so i'm not actually sure what the international sales are but um this book is based in the strategies that we've been talking about today it includes dbt strategies as well as cbt and act and it's a six-step program to eradicate self-sabotaging and self-defeating behaviors from your life whether it's relationships or career or kicking bad habits or starting healthy ones all of us have the propensity to self-sabotage especially when we're stressed and when we don't know where to turn and so this book is a self-help book you're able to take yourself through my program that i've been utilizing with my patients for over 10 years and it's a real uh labor of blood sweat and tears and i'm just really really happy that so many people have read it and are benefiting from it i mean i have recommended it to everybody i can talk to the reviews speak for themselves you can learn more about dr judy and also order her book and listen to her podcast all of her links are on her med circle doctor page so you can uh visit her doctor page there thank you for being here i'm going to stick around and answer questions people had about memberships and uh upcoming live events but dr judy it's always wonderful seeing you and thank you for sharing your knowledge and insight with our members remember whatever you're going through you've got this awesome thanks dr judy we'll see you tomorrow see you guys tomorrow thanks again for everything i know that there was a lot of questions we didn't get to so hopefully we'll get to talk more tomorrow about them yes absolutely awesome thanks dr judy um so thank you um i'm not gonna say anyone's names here but i do see all your comments we will go through the four uh modules tomorrow in more detail um so going through all your questions here um so someone's asking if we will have dbt cr uh groups uh that's something we might be offering in the future uh it could be it's actually something we are uh discussing so be on the lookout for that um [Music] uh so this video will be posted within 72 hours in your med circle library um for people who are asking for the different grounding techniques it's literally called the five four three two one technique uh the other one is called a grounding technique and then the uh the opposite technique and again those are just the names dr judy used you could probably google them or uh when this video is posted in the library you'll be able to get those details on how to implement them so tomorrow to register you go to medcircle.com live now tomorrow tomorrow's class requires you to be a med circle member you can start in fact you have to start with a seven day free trial so you can start a trial today you can attend tomorrow's class it'll give you you know entire week to check out our series maybe register for other classes that are of interest to you and if you cancel during those that first week you won't be charged anything otherwise when you initially sign up for your trial you can choose for a monthly membership or an annual membership certainly the annual is uh cheaper per month but both you can or but by your monthly membership you can cancel um at any time it's just a month to month uh it's it's a great look it's great membership okay it's a great membership we made it great so there we go um do you have to be a member to watch today's live meeting here today you can watch it uh live for free um thank you for being here and our but to watch it in our video library you would need to be a member or start a trial um lots of people are saying i'm a member and i love it thank you that's so great to hear um happy birthday to the person whose birthday it is uh good good good good and we will we're doing a longer session tomorrow so we hope uh we can get to more questions a lot of this a lot of these questions even though if i didn't read your question verbatim i see that it was a lot of people asked the same question so we got it um answered all right you guys got that dr romney will be on very soon you can also binge watch or listen to all of dr romney's past life classes and oliver series yes you can sign up for tomorrow's class today in fact you would need to sign up for tomorrow's class today um before it closes out again medcircle.com live live um sorry i'm not being very clear yes to watch this video the recorded version you will in our video library you will need to become a med circle member so to become a member you can go to medcircle.com you will start with a seven day trial so there's no risk no obligation you can re-watch this and if you're like i just wanted to rewatch this and i i don't like anything else you can quit no problem um and it won't cost you a thing because your first seven days are free hopefully you see the value in this type of education in these type of classes and you would continue on either with an annual membership or a monthly membership here's what i tell people when they go i don't know if i should get the monthly or if i should get the annual if you are truly becoming a member for one thing kelly stop hey um if you're becoming a member for one thing like i just need information for my child because they were diagnosed with adhd i don't want to learn anything about myself i don't want to learn anything about my husband i don't want to learn anything about my boss i don't know i probably just do the monthly because in a couple months you're going to get probably enough content to get educated to get empowered and then you can make the choice to cancel it what happens with most people though is they come in for one item they come in because they are doing their depression for they're struggling with their depression and they want to learn about therapies and depression and medication all these things but then as they start to learn more they have more questions about their relationships in their life maybe they have a narcissistic parent maybe their child is showing some oppositional diet and defiant disorder whatever it is and then all of a sudden they go oh i realize this is a much more comprehensive education that i need so then i would suggest going to the annual because it's so much cheaper it's 50 cheaper by doing the annual um that's it uh yes and we have lots of different video series on borderline personality disorder those feature uh clinical psychologist dr romney okay i'm still here available for you guys even though we're going to shut this down kyle at medcircle.com thanks for being here rock it out today leverage those grounding techniques five four three two one that's the one i'm gonna do today for sure um and that's it talk to you guys uh soon and i'll see most of you tomorrow bye

Channel: MedCircle

Views: 214,412

Keywords: dialectical behavior therapy, dbt, dialectical, behavior, therapy, negative, emotions, self sabotage, treatment, cbt, cognitive behavioral therapy, trauma, emdr, borderline personality disorder, bpd, mental illness, psychotherapy, mindfulness, mental health, counseling, borderline, depression, addiction, online education, personality disorder, help, anxiety, psychology, kati morton, acceptance, motivational interviewing, recovery, counselling, medcircle, mood, therapist, video, coaching, youtube, interview, class

Id: IFnDyxu0ZRY

Length: 62min 50sec (3770 seconds)

Published: Wed Oct 28 2020