What is Dialectical Behaviour Therapy (DBT)?

What is Dialectical Behaviour Therapy (DBT)?

I have had a bit of a blogging break recently whilst I focused on completing my Dialectical Behaviour Therapy (DBT) and wanted to share with you what I have learnt in the last 10 months. I will run a series over the next few weeks of everything I have learnt.

I would like to add that I have taken part in DBT sessions, but I am not trained and this information is for reference only.  Please contact your GP for medical advice.

What is Dialectical Behaviour Therapy (DBT)?

DBT is a therapy designed to help people change patterns of behaviour that are not helpful, such as self-harm, suicidal thinking, and substance abuse and is often used as treatment for Borderline Personality Disorder, which I have. It is a pretty intense therapy and usually it’s done in a group setting, every week, in two hour sessions. 

What is Borderline Personality Disorder (BPD)? 

BPD sometimes known as EUPD (emotionally unstable personality disorder)is often seen as untreatable and is arguably one of the most stigmatised mental health disorders. To reach the criteria you need to meet at least five of the following.

  • Efforts to avoid real or imagined abandonment, such as rapidly initiating intimate (physical or emotional) relationships or cutting off communication with someone in anticipation of being abandoned
  • A pattern of intense and unstable relationships with family, friends, and loved ones, often swinging from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
  • Distorted and unstable self-image or sense of self
  • Impulsive and often dangerous behaviours, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating.
  • Self-harming behaviour, such as cutting
  • Recurring thoughts of suicidal behaviours or threats
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or problems controlling anger
  • Difficulty trusting, which is sometimes accompanied by irrational fear of other people’s intentions
  • Feelings of dissociation, such as feeling cut off from oneself, seeing oneself from outside one’s body, or feelings of unreality

What are the four DBT Modules:

  • Mindfulness – Which for me is the core to everything DBT. Mindfulness exercises bring you back to the present moment and help you refocus. Mindfulness is not all about breathing and you will find you can do many different mindfulness exercises using different senses. Not all will work for you and they do take practise and patience.
  • Interpersonal Effectiveness – This is to do with how to interact with others. It teaches you how to go about asking for what you need effectively, also how to say no and how to cope with conflict in relationships. People with BPD often have good interpersonal skills, but are emotional vulnerable and struggle under this pressures to effectively to use these skills naturally.
  • Distress Tolerance – This skill has been something I have had to use many times and it has made my life so much calmer and easier. Unfortunately sometimes we need to find a way to tolerate and accept distress skilfully and this is what this module teaches. Mindfulness plays a big part in this skill and the two go in hand in hand. With certain distresses we need to find the ability to accept in a non-evaluative and non-judgemental way with our self and the current situation. This module teaches how to survive in a crisis and accepting life in the moment. The skills you are taught are distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus wilfulness.
  • Emotional Regulation – With BPD you are emotionally intense and this module teaches you how to regulate your emotions. To do this you learn how to identify and label emotions, identify obstacles to changing emotions, reducing vulnerability, increasing positive emotional events, mindfulness to current emotions, using opposite action and applying distress tolerance.

DBT teaches you how to manage emotions and relieve suffering to stop ending up in crisis. It is long, mentally hard, but also very rewarding therapy. I have made some great friendships within my group therapy and it has changed the way I go about life. MY BPD symptoms are greatly reduced and so is my suffering.

 

 

 

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Mental health awareness month - Borderline personality disorder

Mental health awareness month – Borderline personality disorder

Last month was maternal mental health awareness week and I got an amazing response from my blog post of my battle with postnatal depression, maternal mental health awareness week is part of mental health awareness month so I thought I would share my experience with borderline personality disorder (BPD). BPD is still not really talked about and still has a massive stigma attached, people often don’t understand it and it’s something people don’t like to admit that they have. Like everything on this blog I am open about my personal struggles, but I do struggle to write about BPD myself, so I will try to do it justice by being open and honest.

BPD has affected me since my teenage years, but was only diagnosed in January after a suicide attempt. It is thought that around 1 in 10 people diagnosed with BPD will complete suicide, many more will attempt suicide. People really don’t like talking about this and it makes people very uncomfortable. For me I just wanted to end the pain I was feeling in that moment not necessarily end my life, but like most stuff BPD related I act on impulse. Many people who suffer with BPD also self-harm and it’s something that has effected me mildly on and off since my teenage years, again this is something I find very difficult to talk about and so do others.

Since I can remember I’ve had a real fear of abandonment and have taken extreme measures in relationships to stop that happening, which has made things worse and often left me alone. My emotions can me very intense from very happy to very sad and can change quickly. I can start the day feeling elated and end the day with negative, dark thoughts. It’s like being on an emotional rollercoaster and I struggle to predict my own moods. Antidepressants do seem to have made this much more balanced than it used to be, but the dark, intrusive thoughts do creep back in.

BPD affects people in different ways and sufferers usually have problems with impulse control, there are continuing studies into why this part of the brain seems to be wired differently with BPD sufferers. Often PBD sufferers will have an eating disorder, for me I binge eat, I binge so much I physically feel sick, I know if I could be sick I would force myself to be, but I am unable to (I have a strange phobia of being sick and am sick very little even with a sickness bug). My impulse doesn’t stop just at eating it also is a problem with spending, which I am learning how to control. Often drug addiction and alcohol can be become problems for BPD sufferers and it’s something I am very aware of, I did have a mild problem with prescription drugs and have used alcohol in the past to numb emotions, luckily I don’t actually like the taste of alcohol.

With PBD I feel lots of paranoia, this is constant and even amongst good friends, I am forever trying to rationalise these thoughts and worry about what others think of me, It’s pretty exhausting, but I’ve made good progress at coming to terms with this. Questioning these thoughts has helped me understand them better.

Many people still think BPD is a lifelong mental condition and there is no cure, I know I did when I was diagnosed. Luckily with so many advances in treating mental health over the last twenty years there has been a talking therapy developed to help BPD suffers called dialectical behaviour therapy (DBT), which is a form of the better known cognitive behaviour therapy (CBT) that is specialised for BPD patients. I started DBT recently and have found it really helpful, I hope to write a blog post once I have learnt more.

Unfortunately many people with BPD often feel empty and alone and I think the fact that this disorder like many other personality disorders are not talked about just makes the problem worse. Don’t be scared by someones condition, be mindful, open and always caring. People with BPD usually always have great empathy which to me is my greatest personality trait. I understand people and appreciate people for who they are and am great at listening and trying to help people.

Many people with BPD are also diagnosed with another mental disorder at the same time like depression, addiction, eating disorders and anxiety. It might not seem like it at the time but having more than one mental disorder can help work out what care will work best for you.

I hope I have been able to describe how BPD has affected me, but my experience may be different from someone elses, to learn more look at the Mind website  for a full list of symptoms. Keep spreading the love and do everything you can to help mental health awareness month be as powerful as it can be.

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How i'm learning to accept my personality disorder

How i’m learning to accept my personality disorder

Recently I’ve been asked how I’ve been able to be so accepting of my borderline personality disorder diagnosis. I’ve sat back and thought openly on why I have accepted it and why I haven’t let it destroy anymore of my life. The answer is I have accepted it as for me a diagnosis was almost a relief to know why I acted this way, why I was so emotional unstable and why I was so impulsive. I’m not saying I love this diagnosis or I am happy to be like this, but finally in my life I feel I’ve learnt to understand a big part of my personality.

Borderline personality disorder has ruled my life since I was a teenager, but like many people I was unaware, I just assumed I was just a really emotional person and even at times I was a bad person. The thing with borderline personality disorder it’s not always bad, I feel emotions really intensely the good and the bad. At times in my life I have felt such overpowering, wonderful emotions of happiness and love. I have at times cried happy tears and have felt so happy, I feel euphoric and like I can do anything I put my mind too. The other side is that at times I feel the lowest of the low and have intrusive and suicidal thoughts, but now I know that I have borderline personality disorder I do know that these mood instabilities are only temporary and they will even back out again.

Like most people with BPD I also deal with depression and anxiety. These disorders are all separate, but are strongly linked together and play a big part. Before I was diagnosed with postnatal depression after the birth of my second child my anxiety had already been causing massive issues for me throughout my pregnancy. Once my son was born it was quite apparent that the PND was making my borderline personality disorder worse. At the time I had no idea that I had borderline personality disorder, but looking back I was emotionally very unstable and would sit holding my son feeling a rush of love and crying with happiness to then feeling resentment towards him and complete detachment. It was an emotional rollercoaster and it all came to head this January when I tried to end my life. I have now started to recognise my triggers, which unfortunately I cannot avoid, but I  can understand a little better why my symptoms of BPD are getting worse at times.

Most people also assume like I once did that BPD was for life and that you could never be treated for it. Only twenty odd years ago BPD was thought to be a lifelong condition with no treatment. BPD sufferers have a high suicide rate, around 1 in 10 people and for someone who suffers with it I can see why that number is so high. The most effective treatment for BPD is dialectic behavioural therapy (DBT) which was created in the late 1980’s. DBT works in a similar way to cognitive behaviour therapy (CBT) which works well for anxiety and depression. DBT in a nutshell is about accepting yourself as you are and making positive changes in your life. I won’t go into much more detail because if I am honest I really don’t know enough about it yet, as I am yet to start sessions. Knowing that there is a form of treatment does give me hope.

BPD has been a large contributing factor in me sabotaging goals in my life and that is why I have to write about it, as it is such an important therapy for me. Not only does it help me deal with my feelings, it potentially helps someone else, raises awareness and also keeps me focussed on a goal. So yes, I am accepting BPD as I have hope that one day I can say that I no longer have it and that I have overcome it.

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borderline personality disorder

Is my personality broken?

I am even more muddled than I had previously thought and after being under the care of the crisis team AGAIN I got to see a psychiatric doctor for the first time. After pouring all my problems out and leaving myself feeling pretty vulnerable and bare I was asked what seemed like a million questions, I could tell she was getting at something when each thing she asked got me to open up more and I could see she had figured me out, which is a first for anyone. Last week I was diagnosed with something new, not only have I got postnatal depression and anxiety I know have a new diagnosis of borderline personality disorder.

The words echoed around the room and I wasn’t sure what they even meant. Was my personality broken? Was I neurotic? Was I an attention seeker? My only ever experience of knowing anything about this disorder was from watching girl interrupted as a teenager, which I don’t believe was a particularly accurate depiction of the disorder.

It’s taken a few days to settle in and a fair bit of googling to understand what it really means. As always I have ordered way too many books on my kindle and spent every evening devouring the information so I can understand this disorder as best as possible. The more I have learnt the more I have been able to see that this diagnosis fits me well and is something I have struggled with for a number of years. In a way it’s been a huge relief that I finally know what is actually wrong with me and why I am so impulsive, why I throw things in without much thought or consideration, why I am so self-critical and why I feel my emotions so intensely.

With the diagnoses of borderline personality disorder I’ve had the worry of if I should tell anyone, would I be cast out and judged or could I do what my personality does so well and be impulsive with it and just say fuck it. So here I am borderline personality disorder and all. I plan to get to know and understand this new part of me and break the stigma as well as I can. Now mental illness is such a big part of my life I feel helpless to really blog about much else, seeming as it impacts every aspect of my life.

My personality is not broken, it loves so deeply, feels pain so ferociously, acts impulsively and punishes itself so vengefully. Just like anything else in this world it will make me stronger and I will do it justice in being honest with how it really is.

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