Speak Your Mind - Dialectical Behavior Therapy Transforming Lives

dialectical behavior therapy better known as DBT was first developed to help people with borderline personality disorder it's groundbreaking and life transforming find out more about how and why DBT works and how elements of this treatment can be helpful for all of us next on speak your mind welcome to speak your mind I'm dr. Carolyn Phelps licensed psychologist with the Human Development Center in our first episode of the season we talked about borderline personality disorder the fact that it's one of the most misunderstood mental health conditions and was once considered to be nearly untreatable but thanks in large part to dr. Marsha Linehan and her development of dialectical behavior therapy or DBT as it's better known borderline personality disorder is now considered to be very treatable so that was kind of like a tweetable treatable hope alert there tonight we're going to be talking about DBT what it is when why it works for people with borderline personality disorder and how elements of DBT can be helpful not just in the treatment of other mental health conditions but for all of us in our everyday lives if you have questions about DBT call them in now locally dial two one eight seven eight eight twenty eight forty four or call toll free at and for people that are seeking DBT to work on emotion regulation it that is one of the things that can be really disruptive is is and interfere with that sense of self is real fluctuating moods and really fluctuating or conflicting thoughts for many of the people that I work with that have had suicide ideation it is extremely validating for them to come to DBT and to be able to talk about one of the dialectics for many people which is both wanting to die and not wanting to die because you know oftentimes people might say well you know which is that that can't you know either you are you aren't might get into that hole you're being manipulative kind of interpretation but for people that I've worked with it's true it's very confusing you know that they can have both of those feelings at once and not know how to rectify those so it is the ability to hold two opposite truths at the same time then and why Joanne does DBT seem to be so much more effective for people with borderline personality disorder than say more conventional treatments well I think primarily because it's skilled based so we talked also last time about how there's a biological component as well as a nurture social component that develops the disorder so learning skills can help people learn how to navigate their way through all those conflicting emotions and conflicting thoughts and beliefs and so it's different in that we have group as well as individual the group is the means by which people learn the skills in a setting where they feel supported by other people who have struggled with some of the same issues that they have and it's a diet it's really a teaching group but it's a very supportive one and you get homework to practice the skills and then the individual therapy is really where people might think more easily about but it's actually about where we reinforce skills where we help people figure out how it applies in their lives and then there's the other part which is very different from other forms of therapy which is what we call the coaching calls and coaching calls are there so that we can be present as a therapist where people actually live and where they're actually struggling so they can call and have access to their individual therapist when they're in crisis so this is really taking therapy beyond the office right and into a person's life then and treatment is relatively long-term right Patti yes standard DVD is the model is that people would participate in the skills training weekly and the individual therapy once a week for a year and the group the groups themselves are often two and a half to two and a half hours long so you're really making an investment in your life just by agreeing absolutely and committing to DBT that that to me is I'm just sort of having that thought about this that that is the first commitment to your new life is this commitment that you're making to the treatment absolutely and I what I guess I want to emphasize that treatment isn't just about stopping behaviors that are damaging or potentially damaging but more importantly it's about how do you build a life that's worth living and how do you move into that so not just in terms of identifying what you want from your life but then what skills do I need to in order to get there and so so that's a concept for all of us right that we all need a life worth living not just figuring out what's the next what's the next thing that I do on my list of things to do but how do i how am i making sure that I'm doing something that's giving meaning to my life and how even a how do you help people even figure that out oh gosh I'm still on in my mind is still on dialectics and I suppose this might be part of the answer that part of how we help people figure that out is also being is to be able to embrace the idea of dialectically balancing acceptance of the person acceptance of ourselves just how we are in this moment doing the best we can and balancing that with the idea that we need to be able to make some changes to have that life worth living and so we begin really basically by learning core mindfulness skills we hear a lot about mindfulness nowadays it was kind of a new term for many of us when we first started learning about DDT so in fact that in in DBT there are four different skill sets right and so so you have just started talking about one of those those skill sets which is core mindfulness and for our viewing audience who who may not you know maybe they've heard the term but they don't know exactly what that means tell us a little bit about what mindfulness is how its practice and maybe an example of a skill that would be a mindfulness skill okay so the the terms that we use to teach about mindfulness are to be able to observe to be able to put words to what we're observing so describing and you observe and describe in order that you can effectively participate so those are the the what skills of mindfulness and I gets a little bit confusing about why we break it down that much but I like the examples of thinking about anytime you learn how to do something new whether it's playing a musical instrument or learning how to drive you have to observe how it's done and then put words on that and you observe and describe and observe and describe until you can participate naturally without having to think about it but then when you get stuck and you don't know how to do something you might go back and start observing and describing again I think about that for any of us if we're a little discombobulated or you're tired you're not thinking clearly you might stop and say okay now what was I doing where did I put my pen you know so we observe and describe kind of naturally in our own but when we're learning a new skill we need that and then there are the house skills which are really important which is one mindfully being able to focus attention just on what's happening in this moment non-judgmentally which is really a really critical concept and non-judgmentally I like to say doesn't mean just being Minnesota nice that it means being able to not add information or filter out information but to be able to see things exactly as they are without interpreting or making assumptions which is very very tricky it's a very refined skill to be able to do and I think that's a skill that you know kind of the reason why we have to practice these things over and over again is that a lot of us human beings are really good at the judgment part and so boy we're going to need a lot of practice with the non judgement all right because actually we need judgments to get through our days so it's not about never being judgmental or having judgments it's about being aware when you're in calling an opinion if you like a fact and one of the clues I talk to my clients about is if you feel very strongly if you have a strong emotional connection with that thought it is more than likely that there is some judgmental pieces going on with it because the one goes with the other so it's not that you can't have opinions it's more that you need to be able to distinguish between an opinion and a fact you need to be able to distinguish between what you think is happening with what is happening I often think about when I was first in art classes as a kid and I was taught that you had to look and draw what you see not what you think you see and that's the hard part for people - and they call it core mindfulness because those mindfulness skills are at the heart of every other skill that you learn in the program if you you've got to keep practicing those ones in order to be able to really practice the other skills we teach so those are really the sort of like the super foundational super foundational skills and one of the things that we know in general about mindfulness is that it has just a whole host of health benefits as well not just mental health or spiritual health but physical health benefits and so here's an example again of a core group of skills that you know this is not just just for people the skills are not just for people with who happen to have borderline personality disorder but all of us can benefit right and there's a reason why it's been integrated into many many therapies and also just in practices I mean people can go to mindfulness classes they can pick up mindfulness apps on their phones they can go google mindfulness and they'll find more than a few ways to practice those skills and there's some there's ways for every person out there but my shorthand for remembering mindfulness is two words pay attention I love that pay attention pay attention pay attention to what you're feeling pay attention to what you're thinking pay attention to where you are pay attention to what you're doing pay attention to this moment because so much of the time anymore we're not paying attention we're driving and we're listening to the radio and we're making a list in our head and we're doing and we're doing and we're doing and in order to pay attention you have to focus in on one thing and that is the be in the moment oh I love that I think we can I can I can remember that I can remember to pay attention a second set of skills are emotion regulation skills absolutely so the emotion regulation skills are just what they say they are the skills that we teach in order to help people to having use their mind from the skills to be aware of what they're feeling to then learn how to regulate them and the shorthand we use is we get our clients to rate the intensity of whatever emotions they're experiencing because more often than not people come to us they're only paying attention and have an awareness of women their emotions are really intense if you did it on a zero to ten they're paying attention when it's seven eight nine ten you know range and they're kind of missing the one two three four five six s I tend to foreshorten say to folks so emotion regulation is for when it's between times like a 2 and the 6 so they might be getting a little bothersome and that's when you can regulate we would use a different set of skills when we're up in the eighth nine-tenths so they are there are some basic skills that ms Linehan is very fond of acronyms and they help people remember and one of the foundational skills is what they call the pls skill and this is again one that we everybody can benefit from so it's we it makes you pay attention to things that affect our emotional state so physical illness it's a poor bit but that's the PL and physical illness we all know that when we have the flu or we're feeling rundown we tend to be more irritable maybe a bit more tearful those kind of things so take it pay attention to that so that you don't assume that because you're being emotional that it's all quote-unquote your fault the e is for balanced eating now that's different for different people but I don't know about anybody else but when my blood sugar goes low don't get between me and the fridge because I can be quite crabby and I and I and I need to eat and I need to eat now so we know that or we see kids wean if they have too much sugar you know they get well well we and we know actually that when people's blood Sugar's drop that that affects one's mood and then your ability to regulate your mood I mean yeah that's kind of the scientific connection with that as well yeah right and then there's the avoid mood altering drugs that's the a and alcohol and the reason we want our clients to avoid them is because we want them to pay attention to their emotions not mask them or numb them out and then the S is balanced sleep I think that's self-explanatory for most people we know what we like when we don't get enough sleep or we get too much and then the e is for exercise and there's been boodles of research about the benefits of consistent exercise with regards to depression and helping manage your moods you know and in fact I think the new research is saying now that if we could bottle the benefits of exercise into a little bottle and have that the liquid medicine that we would all be feeling much better and so that that is the degree to which exercise works and is helpful and someday we have to start I think that would be pay attention to to to to that to that research then patty I often think about and then you'll correct me if I'm wrong is that in some ways emotion regulation skills are taking it's like replacing the on/off switch and replacing it with a dimmer switch that has gradations in there yeah that's how I explained it to to the people who I see is that a fair way of I can make sense when when I was doing DBT therapy in an outpatient setting that's how I would you know would go up to the whiteboard and draw like a little gauge we all have seen gauges in our car or on machinery where that range in between is the safe zone but it's when you know our engine is in that freezing cold zone or overheated that there can be damage done and we want to be real careful them so it's not that emotion regulation is not to make emotions go away in fact we're trying to get away from that tendency to manage by not feeling but to be able to tolerate emotions by having them be in that manageable range and the third group of skills is interpersonal effectiveness skills so why don't you tell us a little bit about those skills okay so the interpersonal effectiveness skills we look at learning how to skillfully identify what your objectives are what is it that you're trying to accomplish if you're making a request you want something from someone or you want to be able to say no to something and kind of set a self-respecting boundary so we go through the steps of how to express that really clearly in to assert what you want and to try to motivate the other person to see why there would be something in that for them we talked last week about manipulation so it's not manipulation so much is honestly trying to kind of weigh out the benefits of getting the assistance or respecting the boundary that you're setting we work on in a relationship effectiveness what kind of things do you need to do to maintain or improve a relationship and that those are the kind of things that might come really naturally with the people that we have a safe comfortable bond with but if it's in a relationship that's more challenged or that isn't so good but you need to maintain that relationship say a boss or someone who has some kind of authority you need to keep that relationship you need to get more deliberate about how do I do that how can I ask for what I want or what I need in a way that Minds or tends to the relationship at the same time yes that keeps that person liking me because I need to not have this relationship fall apart or get worse and then the third set of skills that we teach is around self-respect how do i balance all of that how do I make a request or say no do so in a way that the other person likes me and that I feel okay about myself that I don't sell out or compromise my my self-respect in that process so ideally were able to do all of those things at once but we break them down because they're kind of individual processes and then eventually people can pull those all together and then we Hance enhance that with a little bit more of like scaling what are the things that I consider when I decide how intensely to ask for something or to say no we don't get taught that and we don't all know it intuitively or if we haven't had success in relationships we don't know how to gauge that so you go through step by step and look at things like does the person have authority over me does that is it appropriate to the relationship is it good timing but that's really key for highly sensitive folks because we may feel an urgency to get something accomplished in a relationship and it might just not be good timing and I think a lot of times you know just those the basic assertiveness skills miss all of those nuance pieces of that you know which is that timing timing is every everything what I like about this notion of interpersonal effectiveness is I think a lot of people think we're supposed to be naturally good at this and that you know if if you haven't had good teachers in your life why would you be good at this right I mean we learn from a very early age and so many of the skills that we think we know intuitively we actually learned you know as infants we learned how to read expressions we learned how to mirror expressions and if we happen to be unfortunately for their own reasons that they may not have control of they people did not respond in a way that was effective or they were fairly flat and so there wasn't a lot to read that's hard for people to learn and I'm going to interrupt you because we're getting short on time and we have to get to my favorite set of skills and my favorite set of skills are the reality acceptance distress tolerance so talk a little bit about that Joanne so distress tolerance skills are broken into two areas one is the crisis skills and that's what you do when you're actually in crisis but given shortens time we'll go to radical acceptance which is basically reality acceptance skills and people again can find all kinds of things online about radical acceptance radical acceptance is one of the toughest skills that you will ever learn and you never get it down where radical acceptance is something we have to practice over and over and over again and really it sounds so simple but it is actually hard it is the place where you start to realize that you are not accepting the situation or the facts of the matter or way of where you're at and you kind of want to hold your breath and make it go away or stamp your feet we're all those things internally and so what she talks about is reality acceptance is really about being able to learn how to be where you are it does not mean that you think it's okay or that you agree with it or you condone it in any way but it does mean you have to pay attention to what is in this moment because if you don't know what the reality is how are you going to change it and you have a little breathing radical acceptance exercise that you do that's one of my favorite things that that you do okay and so teach it to us right now because it's it's easy and you it's it's very easy so what you do is you think of something that you're struggling to accept and you start there and then you go to your breathing and you just pay attention to your breathing and you settle your breathing down breathing in through your nose and out through your mouth and when you've taken several of slow breaths and you've regulated your breathing then you allow yourself to think of that thing you're struggling with and then on the next in-breath you say to yourself I don't like it and as you breathe out you tell yourself I can't control it and then as you breathe in you say to yourself I accept it and then you just breathe out and then you go back to the beginning breathing in I don't like it breathing out I can't control it breathing in I accept it and just breathe out and the gift of this you repeat it and you repeat it the gift is that because you're regulating your breathing is like you're softening your body to allow yourself to open to acceptance and when you start doing it when you get to I accept it you go alright but as you practice it over and over and over you get to a softer place to allow reality to be what it is I think that is a beautiful thing for us to end on because we're getting really short on time there was one call that came in that said if you have loved if you have a loved one who needs DBT how do you convince them to seek treatment well for one thing you could show them the show because it will be streamed and available online you also can go to youtube and or Google search borderline personality disorder there are a lot of people who have short documentary films these are people with borderline personality disorder themselves who are talking about what it's like to have borderline personality disorder and what it's like to move through treatment I think that would be a wonderful thing to do so reality reality acceptance absolutely radical acceptance one of my favorite I have to tell you that I've had to do a lot of that today because and I'm going to do a shout out to Joanne fear-filled is leaving the human development centered this is the last thing that she has done for us as part of the Human Development Center so I have had to say I don't like this I can't control it and I got to tell you I'm going to have to do a lot of work on the acceptance I did however get her to agree or at least so I think to come back next season and join us here on the show thanks so much for joining this discussion don't forget to visit us on the web at speak your mind online org where you can find a schedule of our topics and resource links join us next week when we'll be talking about addictions and families I'm dr. Carolyn Phelps thanks for watching and good night you you you

Channel: PBS North

Views: 64,826

Keywords: Speak Your Mind, speak

Id: jMcIgNx3I2w

Length: 26min 57sec (1617 seconds)

Published: Sat Oct 22 2016