Today was a good day SOMEWHAT

Well its 1am and not tired one bit I hate this when there are days I can sleep and days I cant. Its my fault because when I woke up at 8 to get kids ready I was exhausted these darn increase in my meds are killing me.Now I understand why my mom was always tired when she lived with us and had no energy. So I took a nap from 9am till about 2pm but I will be heading to bed soon. Just wanted to let others know today was an okay day. I think I was depressed some thinking about stuff but going out with my family and doing something was nice. I just wish the kids would behave alot better. But they are kids and they will act like that. I love my husband to death he always knows how to make me smile. I dont know what I would do without him in my life. I am debating on doing my therapy since its going to cost me $120 a month but Tom seems to think I need it and hes right. It will take some time getting use to the group meetings but its good for me. I just want to be better and not worry so much. Tom had been applying at numerous jobs and I hope someone calls him back because I want nothing but for him to be happy. I pray someone calls him back to give him a job interview and gives him a job he is worth. I am thankful he has a job BUT he hates it has for years. He is way underpaid and I dont mean just by a few dollars I mean by about 40% he isnt appreciated for his job and he has really lazy people who work there. But its a job so thats always good but I want nothing for him to be happy. Other then that I have nothing more to say but I hope everyone has a good weekend

I have my first DBT group therapy today ( anxious)

I am very nervous cause its something new and around other people I do not know. Only good thing is they understand me and know what I am going through. I was told I could go to both meetings a week if I choose to since I pay no copay for it I might. I am willing to do anything to get better because I am sick of the feelings I feel all the time and that no one understands me. Its hard dealing with this mental illness and it hurts when some don't understand that I am not making it up. I have had doctors tell me I have this condition and I did alot of reading and research on it. For those who say I am on the computer 10 hours or so a day. I am not on that much I check my stuff in the morning then I get stuff done. Later on in the night I log on again because I have nothing else to do with the kids doing other stuff. I just want others to understand what I am going through or for those ashamed to not be ashamed. I still have issues with it myself but it will take along time for me to get better. I will post about how my session went later. Thank you for all the encouragement I Have gotten.

What is DBT ( Dialectical Behavior Therapy )

Dialectical Behavior Therapy Frequently Asked Questions

What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) is a treatment designed specifically for individuals with self-harm behaviors, such as self-cutting, suicide thoughts, urges to suicide, and suicide attempts. Many clients with these behaviors meet criteria for a disorder called borderline personality (BPD). It is not unusual for individuals diagnosed with BPD to also struggle with other problems -- depression, bipolar disorder, post-traumatic stress disorder (PTSD), anxiety, eating disorders, or alcohol and drug problems. DBT is a modification of cognitive behavioral therapy (CBT). In developing DBT, Marsha Linehan, Ph.D. (1993a) first tried applying standard CBT to people who engaged in self-injury, made suicide attempts, and struggled with out-of-control emotions. When CBT did not work as well as she thought it would, Dr. Linehan and her research team added other types of techniques until they developed a treatment that worked better. We’ll go into more detail about these techniques below, but it’s important to note that DBT is an “empirically-supported treatment.” That means it has been researched in clinical trials, just as new medications should be researched to determine whether or not they work better than a placebo (sugar pill). While the research on DBT was conducted initially with women who were diagnosed with BPD, DBT is now being used for women who binge-eat, teenagers who are depressed and suicidal, and older clients who become depressed again and again.

Why do people engage in self-destructive behavior?
A key assumption in DBT is that self-destructive behaviors are learned coping techniques for unbearably intense and negative emotions. Negative emotions like shame, guilt, sadness, fear, and anger are a normal part of life. However, it seems that some people are particularly inclined to have very intense and frequent negative emotions. Sometimes, the human brain is simply “hard-wired” to experience stronger emotions, just like an expensive stereo is “hard-wired” to produce very complex sounds. Or, it could be that severe emotional or physical trauma causes changes in the brain to make it more vulnerable to intense feeling states. Additionally, sometimes clients have mood disorders – Major Depression or Generalized Anxiety -- that are not controlled by standard medications and thus lead to emotional suffering. Any one of these factors, or any combination of them, can lead to a problem called emotional vulnerability. A person who is emotionally vulnerable tends to have quick, intense, and difficult-to-control emotional reactions that make his or her life seem like a rollercoaster.

Extreme emotional vulnerability is rarely the sole cause of psychological problems. An invalidating environment is also a major contributing factor. What is an invalidating environment? The “environment,” in this case, is usually other people. “Invalidating” refers to a failure to treat a person in a manner that conveys attention, respect, and understanding. Examples of an invalidating environment can range from mismatched personalities of children and parents (e.g., a shy child growing up in a family of extraverts who tease her about her shyness); to extremes of physical or emotional abuse. In DBT, we think that borderline personality disorder arises from the transaction between emotional vulnerability and the invalidating environment.

Back to the example of a shy child: If a shy child is teased by his siblings or forced to go into social situations he wants to avoid, he may learn to have tantrums to let others realize that he’s scared. If his shyness is only taken seriously when he has an outburst, he learns (without being conscious of it) that tantrums work. He has not been “validated.” In this case, forms of validation could have included telling the person that being shy is normal for some people, teaching him that shy people have to work harder to overcome social anxiety, or helping him learn skills for managing shyness so it does not interfere with his life.

This is a relatively benign example. Some individuals, however, grow up in situations where they are abused or neglected. They may learn more extreme ways of getting other people to take them seriously. Further, because they are in painful circumstances, they may learn to cope with emotional pain by thinking about suicide, cutting themselves, restricting their food intake, or using drugs and alcohol. A vicious cycle can get started: The person is really sad and scared, she has no one who listens to her, she is afraid to ask for help or knows no help is available, and so she tries to kill herself. Then, when her pain is treated seriously at the hospital, she learns (without being conscious of it) that when she’s suicidal, other people understand how badly she feels. Repeated self-injury can result if it is seen as the only means for getting better or achieving understanding from other people.

What kind of therapy do clients receive in DBT?

Clients in standard DBT* receive three main modes of treatment – individual therapy, skills group, and phone coaching. In individual therapy, clients receive once weekly individual sessions that are typically an hour to an hour-and-a half in length. Clients also must attend a two-hour weekly skills group for at least one year. Unlike with regular group psychotherapy, these skills groups emerge as classes during which clients learn four sets of important skills – Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Clients are also asked to call their individual therapists for skills coaching prior to hurting themselves. The therapist then walks them through alternatives to self-harm or suicidal behaviors.

It should be noted that in standard DBT, it is the individual therapist who is “in charge” of the treatment. This means it is the individual therapist’s job to coordinate the treatment with the other people – skills group leaders, psychiatrists, and vocational counselors. In collaboration with the client, the therapist keeps track of how the treatment is going, how things are going with everyone involved in the treatment, and whether or not the treatment is helping the client reach his or her goals.

In some situations, DBT clients may also be on medications for problems like major depression bipolar disorder, are transient (short-term) psychotic episodes.

What are the top targets and goals of treatment in DBT?

The most important of the overall goals in DBT is helping clients create “lives worth living.” What makes a life worth living varies from client to client. For some clients, a life worth living is getting married and having kids. For others, it’s finishing school and finding a life partner. Others might find it’s joining a religious or spiritual group and buying a house near a place of worship. While all these goals will differ, all clients have in common the task of bringing problem behaviors, especially behaviors that could result in death, under control. For this reason, DBT organizes treatment into four stages with targets. Targets refer to the problems being addressed at any given time in therapy. Here are the four stages with targeted behaviors in DBT:
 
Stage I: Moving from Being Out of Control of One’s Behavior to Being in Control

Target 1: Reduce and then eliminate life-threatening behaviors (e.g., suicide attempts, suicidal thinking, intentional self-harm).

Target 2: Reduce and then eliminate behaviors that interfere with treatment (e.g., behavior that “burns out” people who try to help, sporadic completion of homework assignments, non-attendance of sessions, non-collaboration with therapists, etc.). This target includes reducing and then eliminating the use of hospitalization as a way to handle crises.

* “Standard” refers to outpatient DBT as it is researched and developed at Dr. Linehan’s research lab

Target 3: Decreasing behaviors that destroy the quality of life (e.g., depression, phobias, eating disorders, non-attendance at work or school, neglect of medical problems, lack of money, substandard housing, lack of friends, etc.) and increasing behaviors that make a life worth living (e.g., going to school or having a satisfying job, having friends, having enough money to live on, living in a decent apartment, not feeling depressed and anxious all the time, etc.).

Target 4: Learn skills that help people do the following:

                        Control their attention, so they stop worrying about the future or obsessing about the past. Also, increase awareness of the “present moment” so they learn more and more about what makes them feel good or feel bad.

                        Start new relationships, improve current relationships, or end bad relationships.

                        Understand what emotions are, how they function, and how to experience them in a way that is not overwhelming.

                        Tolerate emotional pain without resorting to self-harm or self-destructive behaviors.

Stage II. Moving from Being Emotionally Shut Down to Experiencing Emotions Fully

The main target of this stage is to help clients experience feelings without having to shut down by dissociating, avoiding life, or having symptoms of post-traumatic stress disorder (PTSD). In DBT, we say that clients entering this stage are now in control of their behavior but are in “quiet desperation.” Teaching someone to suffer in silence is not the goal of treatment. In this stage, the therapist works with the client to treat PTSD and/or teaches the client to experience all of his or her emotions without shutting the emotions down and letting the emotions take the driver’s seat.

Stage III. Building an Ordinary Life, Solving Ordinary Life Problems

In Stage III, clients work on ordinary problems like marital or partner conflict, job dissatisfaction, career goals, etc. Some clients choose to continue with the same therapist to accomplish these goals. Some take a long break from therapy and work on these goals without a therapist. Some decide to take a break and then work with a different therapist in a different type of therapy.

Stage IV. Moving from Incompleteness to Completeness/Connection

Most people may struggle with “existential” problems despite having completed therapy at the end of stage III. Even if they have the lives they wanted, they may feel somewhat empty or incomplete. Some people refer to this as “spiritual dryness” or “an empty feeling inside.” Although research on this stage is lacking, Marsha Linehan added it after realizing that many clients go on to seek meaning through spiritual paths, churches, synagogues, or temples. Clients would also change their career paths or relationships.

Although these stages of treatment and target priorities are presented in order of importance, we believe they are all interconnected. If someone kills herself, she won’t get the help that she needs to change the quality of her life. Therefore, DBT focuses on life threatening behavior first. However, if the client is staying alive but is neither coming to therapy nor doing the things required in therapy, she won’t get the help needed to solve non-life threatening problems like depression or substance abuse. For that reason, treatment-interfering behaviors are the second priority in stage I. But coming to treatment is certainly not enough. A client stays alive and comes to therapy in order to solve the other problems which are making her miserable. To truly have a life worth living, the client must learn new skills, learn to experience emotions, and accomplish ordinary life goals. Therapy is not finished until all of this is accomplished.

How is DBT different from regular Cognitive Behavioral Therapy?

DBT is a modification of standard cognitive behavioral treatment. As briefly stated above, Marsha Linehan and her team of therapists used standard CBT techniques, such as skills training, homework assignments, symptom rating scales, and behavioral analysis in addressing clients’ problems. While these worked for some people, others were put off by the constant focus on change. Clients felt the degree of their suffering was being underestimated, and that their therapists were overestimating how helpful they were being to their clients. As a result, clients dropped out of treatment, became very frustrated, shut down or all three. Linehan’s research team, which videotaped all their sessions with clients, began to notice new strategies that helped clients tolerate their pain and worked to make a “life worth living.” As acceptance strategies were added to the change strategies, clients felt their therapists understood them much better. They stayed in treatment instead of dropping out, felt better about their relationships with their therapists, and improved faster.

The balance between acceptance and change strategies in therapy formed the fundamental “dialectic” that resulted in the treatment’s name. “Dialectic” means ‘weighing and integrating contradictory facts or ideas with a view to resolving apparent contradictions.’ In DBT, therapists and clients work hard to balance change with acceptance, two seemingly contradictory forces or strategies. Likewise, in life outside therapy, people struggle to have balanced actions, feelings, and thoughts. We work to integrate both passionate feelings and logical thoughts. We put effort into meeting our own needs and wants while meeting the needs and wants of others who are important to us. We struggle to have the right mix of work and play.

In DBT, there are treatment strategies that are specifically dialectical; these strategies help both the therapist and the client get “unstuck” from extreme positions or from emphasizing too much change or too much acceptance. These strategies keep the therapy in balance, moving back and forth between acceptance and change in a way that helps the client reach his or her ultimate goals as quickly as possible.

THE THREE FUNDAMENTALS OF DBT: CBT, ACCEPTANCE, AND DIALECTICS

1) Cognitive Behavioral Therapy

CBT and DBT therapists do not think that clients can be helped through insightful discussions, although insight can be helpful at times. Learning new behaviors is critical in DBT and is a focus in every individual session, skills group or phone call (for coaching). “Behavior” refers to anything a person thinks, feels, or does. Cognitive behavioral therapy uses a wide variety of techniques to help people change behaviors that inhibit a “life worth living.” In DBT, as in CBT, clients are asked to change. Clients track and record their problem behaviors with a weekly diary card. They also attend skills groups, complete homework assignments and role-play new ways of interacting with people when in session with their therapist. In addition, clients work with their therapist to identify how they are rewarded for maladaptive behavior or punished for adaptive behavior. They expose themselves to feelings, thoughts or situations that they feared and avoided, and they change self-destructive ways of thinking. What we have just described in layman’s terms are the four main change strategies: Skills Training, Exposure Therapy, Cognitive Therapy, and Contingency Management.

A great book on one main technique in behavior therapy – contingency management – is Karen Pryor’s Don’t Shoot the Dog (Bantam Books). Karen Pryor is a dolphin trainer who opened Hawaii’s first ocean park. The principles an animal behaviorist like Pryor uses to teach animals are the same principles we can use with ourselves to change ourselves and make our relationships better. Karen Pryor’s book is fun, humane, and

easy to understand. Contrary to popular belief, behavior therapy is not cold and technical. Rather, at its best, it is about learning to change while treating ourselves and each other with respect and kindness. If you read this book (and it can be read in an evening), you’ll know a lot more about how one of the main strategies cognitive behavioral therapy works. You can also take a lot of the techniques and apply them to your life at home, work, or school.

2) Validation (Acceptance)

As we noted in the above paragraphs, cognitive behavioral therapy techniques were not enough to help clients who were suicidal and chronically self-harming in the context of Borderline Personality Disorder (BPD). It’s not that the techniques were ineffective; it’s just that as stand-alone interventions, they caused clients a great deal of distress. Clients found the pushing for change invalidating. In a simple example, it’s as if therapists were saying to someone with severe burns on the soles of their feet, “just keep walking and your feet will get stronger…try not to think about the pain,” though each step was excruciatingly painful, and the patient was depressed and had no experience with keeping her mind off severe pain.

Linehan and her research team discovered that when the therapist weaved an emphasis on validation with an equal emphasis on change, clients were more likely to be collaborative and less likely to become agitated and withdrawn. So what is validation? It means a number of things. One of the things it does not mean, necessarily, is agreement. For instance, a therapist could understand that a client abuses alcohol to overcome intensive social anxiety, and yet realize that when the client is drunk, he makes impulsive decisions that may lead to self-harm. The therapist could validate that: a) her behavior makes sense as the only way she’s ever gotten her anxiety to go down; b) her parents always got drunk at parties; and c) sometimes when she’s drunk and does something impulsive, the impulsive behavior can be “fun.” In this case, the therapist can validate that the substance abuse makes sense, given the client’s history and point of view. But the therapist does not have to agree that abusing alcohol is the best approach to solving the client’s anxiety.

In DBT, there are several levels and types of validation. The most basic level is staying alert to the other person. This means being respectful to what she is saying, feeling, and doing. Other levels of validation

involve helping the client regain confidence both by assuming that her behavior makes perfect sense (e.g. of course you’re angry at the store manager because he tried to overcharge you and then lied about it) and by treating the other person as an equal (i.e., as opposed to treating her like a fragile mental patient).

In DBT, just as clients are taught to use cognitive behavioral strategies, they are also taught and encouraged to use validation. In treatment and in life, it is important to know what about ourselves we can change and what about ourselves we must accept (whether short term or the long term). For that reason, acceptance and validation skills are taught in the skills modules as well.

There are four skills modules all together - two emphasize change and two emphasize acceptance. For example, it is extremely important that clients who self-harm learn to accept the experience of pain instead of turning to self-destructive behavior to solve their problems. Likewise, clients who cut themselves, binge and purge, abuse alcohol and drugs, dissociate, etc., must learn to simply “be with” reality, as painful as it may be at any given moment, in order to learn that they “can stand it.” DBT teaches a host of skills so that clients can learn to stand still instead of running away. DBT also teaches clients how to work to understand why their lives are so hard.

3) Dialectics

“Dialectics” is a complex concept that has its roots in philosophy and science. We won’t go into its background here but we will attempt to explain what we mean by dialectics and give examples of thinking dialectically. “Dialectics” involves several assumptions about the nature of reality: 1) every thing is connected to everything else; 2) change is constant and inevitable; and 3) opposites can be integrated to form a closer approximation to the truth (which is always evolving). Here’s a brief example about how these assumptions would come into play in a DBT program. Suppose you are silent in groups. The other group members are affected by your silence and they try to get you to talk. You affect them and they affect you. Perhaps the group pushes you so hard that you feel like quitting and you talk even less. Then the other members get tired of your silence and withdraw. Paradoxically, this makes you feel better and causes you to talk a bit more. As you become a true member of the group, the leaders shift the way they run the group in order to manage the tension between you and the other members. In other words, you are all interconnected, influencing each other in each moment.

As time passes in the group, there are inevitable changes. Perhaps the group becomes more skilled at getting you to talk. Perhaps you take some risks and talk more. Maybe a new member enters the group while an older

member of the community transitions out and the group struggles to adjust to the new arrangement. You also may become aware that your thoughts and feelings change throughout the group, as does every other group member’s. You notice that the group is constantly evolving, constantly readjusting itself. Thinking dialectically means recognizing that all points of view—yours, the other members – have validity and yet all may also be wrong-headed at the same time. If the group is working together dialectically, the group leaders and the members are in constant flux, looking at how opposing points of view can be in play and yet be synthesized. In short, the group is always balancing change and acceptance. Throughout, the group leader and the members would try to hold on to the idea that everyone is doing the best he or she can AND that everyone has got to do better.

DBT also involves specific dialectical strategies to help clients get “unstuck” from rigid ways of thinking or viewing the world. Some of these are traditional Western therapy interventions and others draw on Eastern ways of viewing life. If you read Linehan’s (1993a) text, you can read about these strategies in chapter seven and review the examples she gives. But here are two examples. Suppose a client makes a strong initial commitment to do a year’s worth of DBT. Rather than simply saying “Hey, that’s terrific!” the therapist would gently turn the tables on the client by asking, “Are you sure you want to? It’s going to be very hard work.” This strategy, called “Devil’s advocate,” causes the client to argue in favor of why and how she will complete the therapy and not drop out. In this case, the therapist guides the client to strengthen her (the client’s) arguments for being accepted into treatment, rather than the therapist trying to convince her to stay. “Making Lemonade out of Lemons,” another strategy, also helps the clinician handle similarly tough situations. For instance, a client may complain that she absolutely hates her group therapist and wants to switch skills groups. The therapist might respond with an opposing suggestion: This can be seen as a learning opportunity in handling intense negative emotions towards authority. The therapist could then show the similarity between the client’s group therapist and other persons of authority (teachers, bosses, supervisors), and demonstrate this as a chance to tolerate a person one can’t stand but has to work with. As these examples illustrate, the point of all dialectical strategies is to provide movement, speed, and flow so that therapist and client do not become stuck in “I will not do that” vs. “Oh, yes you will!”

Suggested Reading

Linehan, M.M. (1993a). Cognitive behavioral therapy for Borderline Personality Disorder. New York: Guilford Press. This is the published treatment manual for the entire treatment. Many lay-people say this is a difficult read, though very helpful. For that reason, many start by reading the skills manual listed next.

Linehan, M. M. (1993b). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press. This manual gives an excellent overview of DBT and the skills-training in the program.

Pryor, K. (1993). Don’t Shoot the Dog! New York: Bantam Doubleday Dell Pub. This is a great introduction to principles of learning and behaviorism by a dolphin trainer. Her techniques apply to all of us.

There are 4 modules one must do

The four modules

 Mindfulness

Mindfulness is one of the core concepts behind all elements of DBT. Mindfulness is the capacity to pay attention, non-judgmentally, to the present moment. Mindfulness is all about living in the moment, experiencing one's emotions and senses fully, yet with perspective. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Buddhist practice, though the version taught in DBT does not involve any religious or metaphysical concepts.

Skills within the Mindfulness module

The "What" Skills

Observe

This is used to non-judgmentally observe one’s environment within or outside oneself. It is helpful in understanding what is going on in any given situation.

Describe

This is used to express what one has observed with the observe skill. It is to be used without judgmental statements. This helps with letting others know what you have observed.

Participate

This is used to become fully involved in the activity that one is doing. To be able to fully focus on what one is doing.

The "How" Skills

Non-Judgmentally

This is the action of describing the facts, and not thinking about what’s “good” or “bad”, “fair”, or “unfair.” These are judgments because this is how you feel about the situation but isn’t a factual description. Being non-judgmental helps to get your point across in an effective manner without adding a judgment that someone else might disagree with.

One-Mindfully

This is used to focus on one thing. One-mindfully is helpful in keeping your mind from straying into emotion mind by a lack of focus.

Effectively

This is simply doing what works. It is a very broad-ranged skill and can be applied to any other skill to aid in being successful with said skill.

Distress Tolerance

Many current approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by psychodynamic, psychoanalytic, gestalt, or narrative therapies, along with religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.

Distress tolerance skills constitute a natural development from DBT mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although this is a nonjudgmental stance, this does not mean that it is one of approval or resignation. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows individuals to make wise decisions about whether and how to take action, rather than falling into the intense, desperate, and often destructive emotional reactions that are part of borderline personality disorder.

Skills within the Distress tolerance module

Distract with ACCEPTS

This is a skill used to distract oneself temporarily from unpleasant emotions. The acronym breaks into:

Activities: Use positive activities that you enjoy.

Contribute: Help out others or your community.

Comparisons: Compare yourself either to people that are less fortunate or to how you used to be when you were in a worse state.

Emotions (other): cause yourself to feel something different by provoking your sense of humor or happiness with corresponding activities.

Push away: Put your situation on the back-burner for a while. Put something else temporarily first in your mind.

Thoughts (other): Force your mind to think about something else.

Sensations (other) – Do something that has an intense feeling other than what you are feeling, like a cold shower or a spicy candy.

Self Soothe

This is a skill in which one is comforting, nurturing, kind, and gentle to oneself. You use it by doing something that is soothing to you. It is used in moments of stress or upset.

IMPROVE the Moment

This skill is used in moments of distress to help one relax. The acronym stands for:

Imagery: Imagine relaxing scenes, things going well, or other things that please you.

Meaning: Find some purpose or meaning in what you are feeling.

Prayer: Either pray to whomever you worship, or if not religious, chant a personal mantra.

Relaxation: Relax your muscles, breath deeply, use with Self Soothe.

One thing in the moment: Focus your entire attention on what you are doing right now. Keep yourself in the present.

Vacation (brief): Take a break from it all for a short period of time.

Encouragement: Cheerlead yourself, tell yourself you can make it through this.

Pros and Cons

Think about the positive and negative things about not tolerating distress.

Radical Acceptance

Letting go of fighting reality. Accept your situation for what it is.

Turning the Mind

Turn your mind towards an acceptance stance. It should be used with Radical Acceptance.

Willingness vs. Willfulness

Being willing and open to do what is effective. Let go of a willful stance which goes against acceptance. Keep your eye on the goal in front of you.

Emotion Regulation

Individuals with borderline personality disorder and suicidal individuals are frequently emotionally intense and labile. They can be angry, intensely frustrated, depressed, or anxious. This suggests that these clients might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include:

• Identifying and labeling emotions
• Identifying obstacles to changing emotions
• Reducing vulnerability to emotion mind
• Increasing positive emotional events
• Increasing mindfulness to current emotions
• Taking opposite action
• Applying distress tolerance techniques

Skills within the Emotion regulation module

Story of Emotion

Used to understand what kind of emotion one is feeling. To use this, list the following:

1. Prompting event
2. Interpretation of the event
3. Body sensations
4. Body language
5. Action urge
6. Action
7. Emotion name, based on previous items on list.

PLEASE MASTER

Having ineffective health habits can make one more vulnerable to emotion mind. This skill is used to maintain a healthy body so one is more likely to have healthy emotions. It is an acronym that stands for the following:

PhysicaL Illness (treat): If you are sick or injured, get proper treatment for it.

Eating (balanced): Make sure you eat a proper healthy diet, and eat in moderation.

Avoid Mood-Altering Drugs: Do not take non-prescribed medication or illegal drugs. They are very harmful to your body, and can make your mood unpredictable.

Sleep (balanced): Do not sleep too much or too little. 8 hours of sleep is recommended per night for the average adult.

Exercise: Make sure you get an effective amount of exercise as this will both improve body image, and release endorphins (making you happier).

MASTERy (build): Try to do one thing a day to help build competence and control.

Opposite Action

This skill is used when you have an unjustified emotion, one that doesn’t belong in the situation at hand. You use it by doing the opposite of your urges in the moment. It is a tool to bring you out of an unwanted or unjustified emotion by replacing it with the emotion that is opposite.

Problem Solving

This is used to solve a problem when your emotion is justified. It is used in combination with other skills.

Letting Go of Emotional Suffering

Observe and experience your emotion, accept it, then let it go.

 Interpersonal Effectiveness

Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.

Individuals with borderline personality disorder frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing his or her own situation.

The interpersonal effectiveness module focuses on situations where the objective is to change something (e.g., requesting that someone do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.

Skills within the Interpersonal effectiveness module

DEARMAN - to get something

Acronym for the skillset used to aid you in getting what you want when you ask:

Describe your situation.

Express why this is an issue and how you feel about it.

Assert yourself by asking clearly for what you want.

Reinforce your position by offering a positive consequence if you were to get what you want.

Mindful of the situation by focusing on what you want and ignore distractions.

Appear Confident even if you don’t feel confident.

Negotiate with a hesitant person and come to a comfortable compromise on your request.

GIVE - giving something

This is a skill that can aid you with maintaining your relationships, whether they are friendships, coworkers, family, romantic, etc. It is to be used in conversations. It is another acronym that stands for the following:

Gentle: Use appropriate language, no verbal or physical attacks, no put downs, avoid sarcasm unless you are sure the person is alright with it, and be courteous and non-judgmental.

Interested: When the person you are speaking to is talking about something, act interested in what they are saying. Maintain eye contact, ask questions, etc. Do not use your cell phone while having a conversation with another person!

Validate: Show that you understand a person’s situation and sympathize with them. Validation can be shown through words, body language and/or facial expressions.

Easy Manner: Be calm and comfortable during conversation, use humor, smile.

FAST - keeping self respect

This is a skill to aid you in maintaining your self-respect. It is to be used in combination with the other Interpersonal Effectiveness skills. It is another acronym, and it stands for the following:

Fair: Be fair to both yourself and the other person.

Apologies (few): Don’t apologize more than once for what you have done ineffectively, or apologize for something which was not ineffective.

Stick to Your Values: Stay true to what you believe in and stand by it. Don’t allow others to get you to do things against your values.

Truthful: Don’t lie. Lying can only pile up and damage relationships and your self-respect.

So as you can see it can take YEARS for one to get better using this method

Therapist Session today

So I met my new therapist today that deals with DBT she did an assessment and told me what I would be doing. I will be seeing her once a week for as long as I need to could be along time. I will also be doing my group therapy once a week to where I am with other people like myself. I do hate how some people think its all in my head ( well pun intended) but its not. I would do anything to take away all the pain and suffering I endure every single day. I wish I could take others pain away to. I am friends with quite a few BPD like myself on facebook and I wish I could give them all a big hug when they have their bad days cause I know how they feel. For 11 yrs I denied every having a problem and I know I have a problem and slowly I am working on fixing it. I know that some think that by me claiming disability its being lazy and I do feel bad trying to get it but I cant function around crowds. I get along with strangers just fine but not authority figures or employers. I have lost a few jobs because of my Mental issues but I always thought I was fine.

Therapist says next week she is going to go more into what BPD is and how I got it. I told her my worse fear is that I got help to late and my oldest daughter seen to much and is scared of me. She thinks getting the help was the best thing. I grew up with my moms mental state and I use to dispice her but I dont anymore because I understand what she was going through now. Since becoming a new christian I try to see things in a different light. I believe GOD does things for a reason. I would of never met my husband had I never moved out here and i only moved out here because of the things that happened to me. He is the love of my life and hes been through alot with me. He married me for better or worse and I am lucky to have such a great guy in my life.

I know I complain alot but who doesnt have bad days I just express them more. I try to be happy and I am sometimes but alot of times little things can make me upset. This is why I am going to do DBT http://en.wikipedia.org/wiki/Dialectical_behavior_therapy It will reteach me how to deal with my emotions. For anyone wanting to know me better look up Borderline Personality Disorder its not well known I had never heard of it till I was diagnosed to me its a curse just like any other mental illness. But with mine I can get better but can take YEARS and might not work but the thing is I also have PTSD and MDD which make it harder. So before anyone thinks anything just imagine yourself in my shoes or anyone who has any kind of illness mental illnesses are just as bad as anything thing else. I do have sympathy for anyone with any kind of element.

Hate to see others down

When I read how others are down especially those with BPD it breaks my heart because I know how they feel. My Physiologist seems to think I can recover that BPD have it in their mind they dont want to get better. I wanted to tell her its not that simple. That is the misconception with BPD because it deals with emotions so we can retrain ourselves with DBT but it can takes YEARS. I am wanting to get better cause who wants to feel this way. I want to work so I feel like I am worthy of something. But also I dont like crowds and I dont just suffer from BPD. I suffer from MDD and anxiety and have fear of making friends. I always wonder what others think about me or if I am talking to much. Living with BPD is a curse in my opinion. When I am happy its the best feeling in the world but it doesnt last long. We can be happy one second and upset and pissed the next. Without my meds I would be worse yet my doctor says those with BPD can be cured and not have to take meds. I still dont see how its possible for that to happen. For most of my life I have dealt with Mental illnesses and having to see it first hand with my mother. If I really could I would love to talk to teenagers who have any issues and tell them seek help now dont wait till you have a family. I already feel bad cause my oldest acts like I use to sometimes and its my fault. I know I have scarred her for life and over time she will get better. Our relationship isnt the best and its hard for me to love always has been. I love my children but I wish they had a better mom.

To anyone who has family with any MI or yourself I feel for you just pray for them or think about them we like to know that others care.

Start DBT Tuesday

So I am going to go to the place I wanted to in February but couldn't because I had my kids during the day well at least one. I will be going to see this therapist Tuesday that deals with BPD so it should be different. The good thing is its only $30 copay and then the Group therapy they dont charge you a copay so that will be nice considering Group is once a week. The times work for me cause its 1230-2 and my kids will be in school now not sure how that will work when ones sick or they are on vacation but I will figure something out. I am kind of nervous about doing this but its for the best. I want to work but husband says wait and see how my SSI works he is most likely going to get a part time job which I feel bad about but its his choice. To anyone who is reading my blogs thank you.

http://en.wikipedia.org/wiki/Dialectical_behavior_therapy

Dialectical behavior therapy (DBT) is a system of therapy originally developed to treat persons with borderline personality disorder (BPD) by Marsha M. Linehan, a psychology researcher at the University of Washington.^[1][2] DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD.^[3][4] Research indicates that DBT is also effective in treating patients who present varied symptoms and behaviors associated with spectrum mood disorders, including self-injury.^[5] Recent work suggests its effectiveness with sexual abuse survivors ^[6] and chemical dependency.^[7]

Nervous about my therapy session

Getting nervous about my therapy session since I have never done one before not sure what she will ask or want me to say but I need it. I will update when I get home how it went hopefully good.

First therapy session tomorrow

So tomorrow is my first ever therapy session and I am very nervous about it. I have to be there at 945 and kids get dropped off at school at 9 I dont know why I scheduled it so early cause it takes me 30 minutes to get there. But I am hoping maybe it will help and also looks good for my SSI and my Phys wanted me to do therapy. So hoping tomorrow turns out well. Have to tell her about my emotional outburst I had this weekend went 7 months without a anger outburst so guess thats good. Just have had alot of stress lately and increase in meds might of done it to. But wish me luck on my therapy its a first for me.

This week as been emotional draining. For 7 months I hadn't had an anger outburst but I did on Saturday night. See most BPD self harm by cutting me I hit myself and bite myself so hard to take the pain away. I got so mad I threw stuff around. I just been so stressed with figuring out how to pay bills and wishing my husband could find a job where he is worth what he does. If he only made just a little more we would be okay. I am worried my electricity is going to be turned off. I wasn't even able to buy my kids any school clothes. I just feel like a failure so much. I stopped going to my Celebrate Recovery meetings at church because I just cant afford the gas to drive there and back. My bible study starts up again for health Sunday and afraid I cant make it either. One of the woman were willing to figure out driving arrangments but I hate asking for help. I wasn't even able to enjoy church yesterday and of course he talked about low self esteem so that really got to me. He is doing a whole 5 week series on emotions. What really hurts is when people tell me I could work that MI are nothing that people with them work all the time BUT they hide the fact they have an issue because of the stigma that comes with it. See what gets me is Bipolar is high on the list for the worse one BUT they usually can function. What I have is an emotional illness. We act out in anger and the littlest things set us off. It could be something as small as someone calling you lazy when they dont understand. Everyday is a stuggle. I also suffer from Major Depressive Disorder which is way worse then depression. I am writing to let others know they are not alone if they feel the same way and also to write my own personal journal

Its almost 5am I took an ambien so I better try to sleep
I had a terrible day Saturday so much that I took 2 ambien at once and 3 mg of clomazepam but I know better now just it so hard when noone understands you. Its just been a really rough week. I just want people to understand BPD and other MI and that it is heartbreaking and drains the life out of you. So goodnight I will post more info as I find it

10 Things Every Autistic Child Wishes You Knew

Mental Illness Stigma

From Mitch Friend of mine

I always believed it's a sane person that admits their crazy.
I think everyone is a bit mental defective or challenged, but that's what makes life interesting.
People who think they're normal are the ones that have a problem.
We all get depressed at times for whatever reasons, could be a chemical imbalance, something traumatic that happened, or you're just not happy with your life.
The answer is learning how to deal with it, if you get obsessed with it, that could be worse, accept it and the hell with those that think they're better then us.

Removing The Stigma of Mental Illness

What Borderline Personality Disorder feels like...(TRIGGER)

My story of my everyday struggles

Story of my life and my everyday stuggles with mental issues ( Please Read especially for anyone dealing with their own issues)

by Teresa Criner on Sunday, July 18, 2010 at 12:26am

Alot are going to think I am crazy for putting all of this out there but to me talking about it actually helps and getting the word out does to. It makes people understand me more and know where I am coming from.

My childhood was not the easiest by any means. I had a mom who had her own mental issues which made it very hard to have the love I needed from a mother. I always had to take care of myself and see how miserable she was. We moved around alot more times then I can count. I went to 12 different schools and because of that I never truly made any friends my whole life. I was never taught how to love anyone. I dont recall much of my childhood the farthest I can go back is when I was 7yrs old when we lived in El Paso Tx. I do remember some good times. I use to blame my mom for everything but I dont anymore. I still cant imagine how she had no idea that her own child was being abused. See my step father who I always thought as a dad had sexually abused me from 12-16. I was always ashamed of it and wonder why me. It sickens me when I hear about children who had to deal with this. Because of this I have a hard time trusting anyone around my children especially men. What made it worse was there were 2 other guys who tried stuff on me to. I thought why was God punishing me what had I done to deserve this miserable life I had.

When I was 16 I was living with my Aunt Donna ( god rest her soul) because my mom had been stationed in GA for the army. I stayed with her so I could finish school and so did my brother who was 3 at the time. She had ask me some stuff and I denied it at first but finally told her. We had taken my stepdad to court but he was let off due to no evidence and witnesses. I guess they thought I made the story up. My brother lived with my aunt for awhile and my mom hated her family for it. But to me it was the best thing because she stayed with the creep. I still dont understand why but she did. She later left him when she went to Korea for the army.

So I moved to KC that summer of 1995 I had to deal with a whole new school and it wasnt easy especially when your 16 but looked like you were 12. I was always afraid of what others would think of me and even at 31 my self esteem is very low. I was probably the only 16 year old who had never had a boyfriend or kissed anyone. I always felt weird and an outsider. I tried my best to be happy and not let others know I was dealing with any issues.

I was so bad that in May of 1996 I took a ton of pills to end my life. I was so sick of life that I wanted all the pain and suffering to end. For some reason God didnt think it was time for me to go. I wish my dad had forced me to get help then or at least admitted me to the hospital just maybe I would of gotten help sooner. My whole life changed when I met a guy who was much older then me in Sept of 1996. Little did I know what I had. He always loved me and treated me well. He knew what happened to me a few weeks after we met. I remember him crying about it and I knew he was the one for me. I loved him but never truly gave him the love he needed. Like I said love was hard to me. He made me happy and gave me a reason to live. I know am in love with this guy and been married for 11 yrs and will be together almost 14yrs. Its the one true thing God gave me. I sometimes think I went through hell to meet him. Had I not moved here I would of never met him. He has given me three children. He loves me for who I can be and not my faults. He took his wedding vows seriously for better or worse and I know I have had more worse then better. I am the lucky one to have him in my life

I have lost lots of things because of my issues. A few jobs because I cant get along with others. I have really bad anxiety that I seldom get out of the house. I cant work due to my mental status. I know alot will say your just lazy its all in your head ( in reality I guess it is) but you know what I mean. It really hurts when others dont understand me and it breaks my heart.

I was in denial so long and use to scream and yell at those closest to me. I have no idea how my husband dealt with me but he did. Somewhere he knew I would get help and be better. I finally admitted on Jan 18 2010 that I Needed help. I was on a emotional roll coaster and thought about death almost every single day. I finally admitted myself to a hospital and got the help I needed. It was very hard at first and it still is. I am not ashamed to let others know that I have mental issues. That is what is screwed up about todays society. We are shunned so much because others are afraid of us.

I was diagosed as being Borderline Personality disorder (http://en.wikipedia.org/wiki/Borderline_personality_disorder ) and I did lots of reading about it. It really explained alot to me and I understood that was what I Had.

I also suffer from PTSD where I get flashbacks at the worst times I can. I have really bad social anxiety and have been known to have panic attacks. I suffer from MDD or major depressive disorder. Medicine can only do so much for me and I know for the rest of my life I will always be this way. I do have memory issues and did before taking the meds.

I do not wish this on anyone and to those who do suffer I feel for you its a tough life to live. Everyday is a struggle I have my good days and my bad. I have issues with sleeping and have to take stuff to sleep. I also sleep sometimes all day and have to force myself to get out of bed. If it wasnt for my family I would never function.

If I do post negative things just know its one of my bad days and I dont realize what I am saying half the time.

If you have gotten this far and read my story then thank you
If you are thinking I am just crazy and lazy and its just something I want to complain about please take me off your friends list I dont need people like you anyways.

To anyone who also suffers just know you are not alone and there are people who do understand. I am always here if anyone ever needs to talk I understand what you are going through and if I ignore you please dont think I am ignoring you.