What a Dialectical Behavior Therapy (DBT) Session Looks Like

[Music] now that you understand each principle of DBT it's time to see them in action in this episode dr. judy hope performs an example dialectical behavior therapy session dr. ho I've got no questions here all right my glasses are real I'll let you take it away okay well thank you so much for coming to see me Kyle what can I help you with today well my I was diagnosed with depression at nine years old I have had three major depressive episodes in my life after that maybe after the age of 10 or so and I do take an antidepressant every day but I stopped going to therapy maybe three months ago because of a move so I just need to find a new therapist so I heard you were really good night circle I'm really just looking to see how DBT can help me manage some of my depressive symptoms and depressive episodes okay so what types of symptoms are you still struggling with right now well it's actually pretty good right now and it's easy not to have symptoms come up I think when everything in your life is pretty good and everything in my life is pretty good right now so that makes it easier but there is still feelings of hopelessness and helplessness that reoccur there's also feelings of just not being enough like I take a lot of pride in my job at Med circle and what we're doing and what we're doing for people and and you know that in other parts of my life as well I work a lot with animals and people with animals and that that has a lot of pride for me attached to it because I want to help people that way and I but I still have those ones where like is this is this am i doing enough am i making a big enough impact am I am I really helping or am I just telling myself I'm helping and yeah and I think that's kind of in general yeah so sometimes you still struggle with for example thinking whether or not you're valuable worthwhile enough you connect that sometimes to the work that you're doing so obviously when you're doing great and you feel great about it everything's awesome but then you make a mistake or something like that you might take it harder than the average person perhaps I don't know if I take mistakes harder than the average person I pretty much all make mistakes so for me to make a mistake that's okay mm-hmm I just I always want to be putting out the best that I can do and that's that is not always possible and so when when I kind of feel those times are occurring that's hard for me and on a more significant scale while it hasn't happened recently I'd say you know in the last six months there are times where it I'm so depressed you can't you can't get me out of bed I cannot function it doesn't matter how much I'm hearing you or understanding what you're saying it doesn't change my inability to take care of myself like I can't take care of myself I don't eat or I eat too much I mean my life it just becomes a a splatter of mess you know until I can finally dig out of it how do you usually dig out of it well I go to my therapist a lot and then you know sometimes we change medications yeah sometimes it's just a realization right there though I've had those times in my life through therapy I have a realization oh my gosh that's why and then as soon as I know that's why I'm like ah well now that makes sense now you can move on right yeah that makes sense um tell me a little bit about the hopelessness or helplessness that you feel sometimes well I believe that those feelings are hardwired in my brain mm-hmm and I don't I feel like I was born with that and it sucks mm like I have Crohn's disease I I didn't come in contact with some rare bug and get Crohn's disease I just got it they think I it was hereditary right and that's how I relate it to depression I it's not because I like don't exercise enough or I don't believe it's because of these reasons in order that I'm not social or whatever it is it's just my brain is wired differently and its default is to be helpless and hopeless hmm and I have to work against the way my brain is set on a default mm-hmm to not fall in to that category and so if when that happens there's no that we I would have canceled today there's no there's no room for anything in my life hmm when that's full okay so I think for today we're gonna focus on two things I think one is to try to manage this hopelessness helplessness that's kind of long-standing as you mentioned and clearly when you're having problems managing your activities of daily living when you're super depressed that certainly amplifies the hopelessness and helplessness because that just kind of starts to percolate even more like I can't do anything right so I want to focus on that a little bit and I think the other piece I want to focus on is just developing a prevention plans because right now you're doing great yep so it's really about okay how do I sort of reduce my vulnerability to having another significant episode and how do I manage it when I start to see some of those things creep in mm-hmm so we can sort of make sure that we get back to the baseline that I feel more comfortable at okay so the first thing I want to talk about is the hopelessness and helplessness aspect because it is so long-standing and it's something that you were saying that you always have to fight and what have you tried so far to try to fight that like do you just try to try to tell yourself to be positive like what are the things that you've tried in the in my past I have tried overeating I've tried exercising I've tried sleeping and these are all things that I was probably doing on more subconscious level to try to mask whatever I was feeling there even was a period where I'm like am i grabbing that wine bottle because I want a glass of wine or because I'm feeling this way and that was very alarming to come to a conclusion of things that have been successful is there good old tell me about your father there from a psychiatrist or a therapist medication has been wonderful I don't believe I could live the life I'm living without it and being busy mm-hmm is in getting enough sleep are probably the two biggest things that help me keep it at bay I don't feel like I'm addressing it right right I feel like it's a bay right yeah cuz you know we drove up here to film this today and then we're supposed to get on a plane tomorrow morning and be gone for 40 we're just constantly busy busy busy yeah and so that when you're so busy you don't have time to be helpless and hopeless because you're busy right Yeah right exactly so sometimes maybe that distraction is keeping it at bay yes but you don't feel like you've addressed the root right so I think one of the things about hopelessness and helplessness that people find interesting is of course that we are all preferably agents of our lives like we want to be able to be masters of our universe to some degree and when things feel like they're starting to slip out of control that can come up a little bit more often than other times as you said you know sometimes things are hardwired you feel like maybe you are prone to that but I think it still comes from a very human need to want to be masters of our universe in some way none you don't want to have something happen to you that you didn't foresee and therefore don't have an action plan and when there are challenges that come up when you are prone to hopelessness and helplessness that could be your first default is oh I'm not gonna be able to manage this sort of like a message that you tell yourself it's not gonna get better or here we go again and even though cognitive behavioral therapy does work on some of the modifications of these thoughts what I'd like to focus more on is your tolerance of those stressful moments in that time and using that as a route to get to some of the underlying issues I get that we really can't deal with the underlying issues if we can't get to a baseline in the moment and what I mean by that is if you are in fight-or-flight the part of your brain that actually gets activated is the primordial parts of your brain so that's not the frontal lobe that makes good decisions and manages your mo effectively that's the part that's just trying to survive that moment so we have to find a way to get you out of that fight-or-flight activation and bring you back to a baseline where you feel like you know what there's nothing wrong with this moment right now therefore I don't have to activate that fight-or-flight and that leaves you more room to then process the deeper issues if that makes sense it does so with the distress tolerance there's a couple of ways that we can work on this one thing when you're are feeling hopeless and helpless is to try to improve that moment at that very time and so a very simple way is just to self-soothe with your five senses and this just involves you ticking off for each of your senses something that is pleasant for that sense and being able to commit to using those in under one minute and I think that that's really important part of this which is that when you are starting to have that hopelessness or helplessness well up that there's something that you can do to self-soothe in under one minute that's simple so what are something that you can think of for example that would appeal to you visually that would make you feel calm or relaxed what does that involve something visually yeah like for some people some people they like to look at a picture yeah so I really like aquascaping okay it's underwater gardening okay so I watched these video they're more than a minute though I don't know if that would work because I these videos are logged but it is very peaceful and soothing and calming to watch somebody garden underwater essentially but that's not that's not less than it's not a minute it's much more than that so I would just say images of my dog yeah great I've never thought about looking at an image to handle depression so I don't know right yeah and I think it really does show again how simple it can be yeah just in that moment just to improve your moment by looking at something that's happy you know what I love looking at is um real-estate magazines yeah and I was looking at one last night on my coffee table and I thought why don't I look at this more this is so yeah so I could do that for a minute awesome yeah I've had people tell me things like they want to look at a clothing catalog I'm yeah no judgment whatever works for you right yeah so whatever brings you that sense of peace let's try it one more sense like what about like all factory like things that bring you senses of relaxation and calm like when you smell a particular fragrance or any other kind of thing that would you know what calms me down so fast uh-huh a clean organized house if I walk into my house and it's clean and organized oh nice yes if it is chaotic and there's dirty laundry I'm gonna go home too today can I go so all factory it's an environment that's clean organized and not stressed yeah because if my environment look stressed then I get stressed yeah so a sense of cleanliness anything that would evoke that for you yeah sometimes people enjoy like smelling their dryer sheett yeah yeah cuz it like reminds them of a clean house yeah I would that I would just go why am i smelling a dryer if I do that I do have a new detergent called yeah fray I think that's the best not sponsored by fray always only by freight detergent so that scent does call me down okay what about something that appeals to your tastes and people like to you know eat a mint like to a piece of gum like it tends to calm down a bit like is there anything like that for you certain foods no sushi I like sushi I do love a Pellegrino water yeah that to me is a when I was broke when I had no money but I was like I need something to just make me something other than pasta and butter yeah I would buy a bottle of Pellegrino water cuz it's you know a dollar 20 but yeah the joy is like ten dollars or 20 cents yeah I think it's so good absolutely I like that okay great so these are just you know examples you can think some more about it but really it's all about self soothing with your five senses for under a minute and usually people will find that even utilizing one or two of these things it'll change their experience in the mo enough so that they're not engaging their fight-or-flight and they can take a little bit more time to be more concerted about their next step so I have a question about that because in most of my experiences with these major episodes I have been aware that they were coming on mm-hmm and so I've actively made decisions to try to not have them happen mm-hmm and it never worked mm-hmm I would go to go see a movie I would call a friend I would clean my house I would do all these things and it it it seemed inevitable yeah and now if they were to come on again I would believe that it was inevitable right I wouldn't believe that those things would keep it from coming it might delay it yeah but not keep it from coming that's what I believe right and I think part of this is also not rushing to have to prevent it from coming it's a weird idea but DBT is really about accepting the current experience I I don't think I could ever be in a position to accept that type of episode occurring because it is it is the worst thing that's happened to me and it's I could start crying right now thinking about and it's happening three times it's and my mom died when I was 16 those depressive episodes are worse than that day it is it's like being shot with a gun but you're alive yeah you're and you have to live right while you have bullet holes in your body right and no one sees you bleeding yeah why do you what are you talking about there's no bullet holes in you but you feel like you've been shot yeah so I don't I I can't I don't understand how I can write be like well that's gonna happen right it's not about giving up though on being able to change the experience it's just about not being afraid of it coming because you know you have the skills you need to deal with it and it's hard to do that because obviously they've been so incredibly painful for you but you are still sitting here and you survived them yeah and it's sort of like even in the worst occurrence I know that I'm gonna emerge on the other side that is the kind of acceptance that would be helpful for us to delve into a little bit doesn't mean that you like it nobody's saying that you should like it or want it to happen or not want to change the experience once it's here or once you anticipate it being here right but it's about understanding that on the other side you've emerged that there is a part of you that remains intact even after these horrible episodes I do understand that yeah yeah perhaps my hopelessness is exaggerated a little bit because even in the worst moment I understood what it was yes I knew it was almost like I was separated like the true version of me was here yeah and we were on this ride that we didn't want to be on with the fake version of me right so I recognized that it wasn't me I recognized that it wasn't who I was and I recognized it was something that I felt like at the time was happening and I couldn't control it but I knew that it would eventually go away right because I wasn't going to die yeah I was leave it there I like to use the analogy - I like your analogy of the roller coaster and I often use the analogy of people watching a play and there's the actors in the play and sometimes there's horrible things going on in the storyline and then there's a narrator who is talking about what's going on even the bad storylines but they're a little bit removed because they're narrating the entire story and they kind of know the beginning in the end and then there's the audience members who are even on another step more removed because they're watching all of this unfold but they don't necessarily have a personal stake in it mm-hmm and I think that there's all of these different levels of who we are there's a level of us that's like actually the characters experiencing the pain in the turmoil because the storyline is horrible and then there's a narrator who can take a step back and say okay I'm mindfully observing what's happening and yeah this is a really sad story but I'm not emotionally steeped in it to the same level of the pain that the actors themselves might be experiencing and then if you back up another level they're sort of the audience which is the audience will always be there there's different audience members for different plays they're interchangeable but in the end they've always been a group that will be there at any show and that particular piece is the self that has seen you through all of your pain and all of your happy times and remains intact and nothing happens to it that part of you is whole and understanding that sometimes can help with distressful moments that there will be a part of me that emerges whole and there's a part of me that feels broken right now but like you were saying there's these different aspects of yourself and being able to separate out sometimes preserves the part of you that needs to be preserved at a time I so get that that metaphor makes perfect sense to me yeah that's how I feel yeah and it's great because you've already made that connection and of course it's like what do you do with that now and so sometimes we resist these horrible things from happening because we know how horrible it is and there's one thing - until actually say I can stand it but then there's also what do you do in the moment when it's happening right and I think in the moment when you find yourself struggling with hopelessness or helplessness the first thing to do is to spend a little bit of time under a minute just writing your mind again okay we're not in the state of emergency I'm able to handle this whatever I need to do to reengage out whether it's ten deep breaths or self-soothing with the five senses or whatever I need to do to make sure that I can put my mind at a state that is not in fight-or-flight because we don't make it decisions then and it's hard for us to engage our wise mind mm-hmm then after that once you realize that you've sufficiently gotten to a place of calm then it's about introducing some of the deeper level strategies to try to manage the situation so the first one is wise mind it's this principle of engaging both the emotional and logical sides of you to a wise mind that actually can sort of transcend all of that is sort of the 1+1 doesn't equal to it's it's more than that it's more than the sum of its parts it's not just logical and emotion mind together it's something even better where you can actually take a step back and say here's what my emotion mine wants to do here's what my logical mind wants to do but when I gather everything together and also experience that there is a deeper meaning to all of this and what we're going through what would that part of my mind want to do next so when you feel hopeless or helpless I'm imagining that your emotion mind is like screaming for you to run back into bed or do whatever you need to do know and then maybe there's your logical mind that's thinking okay what are the things that have worked in the past mmm can I apply any of them now I should apply them now I should get better why am I not better why is this coming back maybe it's also the part that yells at you and your self criticizes yep so then what would your wise mind do in that experience you're asking me huh yes I I don't I don't know I've never thought about it that way yeah I've I've only tried to ignore my emotions and act on my logic that is truly what I've tried to do yes when my emotions like just get back in bed I'm like I don't really I really shouldn't do that I should do this but I don't want to do that and I probably just end up getting in bed anyway yep because that's the emotion part is so strong in those moments I've never I don't know I don't know how to answer that question yeah and so emotion and logical might often fight each other it's that dialectic that you're talking about the emotion might say I want to get back into bed and your logical mind say you lazy bum you're not getting back into bed you know that's gonna make it worse why don't you do something different for a change right to try to motivate yourself to get out of this and it doesn't work because you're forcing them to compete for it for the next step and it's really about bringing them together acknowledging that they'll do that yeah well and I think that's really where DBT comes in is by teaching you the specific strategies to engage your wise mind so we talked about one of them already which is sort of this idea of radical acceptance how do we accept that moment knowing that there's a part of you that's always going to survive it that is one of the techniques that I think I can do that is one of the techniques that your wise mind can use another technique is to try to improve your positive emotions in that moment so I'm gonna give you at the end of our session today a pleasant activities list there's 250 activities on this list and all I want you to commit to is to pick one of those to do every single day as a means of prevention but also circling the ones that tend to work the best for you as you start to experiment with them that you know can give you a more positive experience in that particular moment and some of these activities are so quick you can do them in like two minutes and that is another wise mind decision so it's not about I can't go to bed or if I go to bed that means I'm lazy beating yourself up but it's more about what if I get in bed for half an hour but while I'm in bed I can do one of these pleasant activities and that is a wise mind decision for that moment and then after the 30-minute passes you do the next thing and the next thing so that you're really encountering each moment as it's happening as opposed to I need a grand way to solve this problem yeah it's worse I'm always looking for the grand way yeah yeah and I think that is the logical mind the logical mind is saying you need the grand way you need to do something right now to fix this once and for all mm-hm and the wise mind would say let's improve the moment let's find meaning in what's going on and you'll find that over time the more that you're able to sort of break down your experience in those pieces the less the hopelessness and helplessness will scare you yeah and that's really yes sort of the core I get that all of that I sososo understand that yeah can you give an example of one of these activities yeah they're like coloring for example yeah or taking a bath yeah or cleaning your room yeah folding your laundry yeah I mean it's it's things that are so so simple there's some you know bigger ones as well but a lot of them you can do on your own and kind of at any time and some of them will also involve other people it might be reading a magazine reading a book for fun all these different types of things that maybe you haven't done just considerably for that purpose once in a while I'm seen in a self yeah but it is a wise mine strategy to not be so black-and-white in your thinking in those hopeless and helplessness moments it's not about if I go to bed then I've just wrecked everything it's like how about you go to bed for 30 minutes and then after that first 30 minute passes let's see what to do next it's that loosening of you have to have a solution yeah I need to practice Oh time yes I know we're just kind of like starting to you know peel back the layers obviously but I think my homework assignment for you first and foremost is to take a look at these pleasant activities and to pick one to practice every day and then as you start to experiment with them to circle the ones that work the best for you and we're gonna start to build your emergency tool kit well let me start feeling hopeless and help us again this is good awesome you delivered knowing that I stepped into this without any preparation it was great it was great that it made sense and my biggest takeaway is for sure I've spent my life fighting my emotional side yeah and negotiating with my logical side right when I really need to be making them work together yeah to have the what it's both valuable yeah I love it alright well we'll in there and go to our next episode Yeah right now [Music] you

Channel: MedCircle

Views: 221,955

Rating: 4.913578 out of 5

Keywords: therapy, dialectical behavior therapy, dbt, psychotherapy, treatment, borderline personality disorder, bpd, anxiety, depression, mindfulness, mental health, mental illness, cognitive behavioral therapy, dbt skills, addiction treatment, personality disorder, cbt, counseling, acceptance, health, online education, help, dbt therapy, psychology, motivational interviewing, borderline, mood, emotions, addiction, video, medcircle, kyle kittleson, medcircle bpd

Id: iQEurMdJtds

Length: 25min 39sec (1539 seconds)

Published: Tue Jun 02 2020