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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The day I tried to end it all

The day I tried to end it all

On the 7th of February last year I tried to end it all. I woke up in a hospital bed with a drip in my arm and wires across my body. I had no idea where I was, how I had got there and I didn’t understand what was going on. The day before I had sent my now ex husband out, as I needed some peace and promised him I wouldn’t do anything stupid. I had lied to him and for the first time in weeks I was emotionless, I felt no fear, no guilt and no sadness. Today was the day I wouldn’t have to feel anymore. I didn’t think of the consequences of my actions and just saw it as the only way out. I was fed up of fighting PND (postnatal depression) anymore and felt like I had lost any type of control I had over it. It was a permanent solution to a temporary problem, but I couldn’t see that at the time.

That day whilst under the crisis team care I went into hospital to see my doctor who decided after two weeks they would discharge me. I told them I still felt suicidal and I was scared to be discharged without any other support. Just that conversation sent me into a downward spiral and I felt hopeless even though they said they would see me again in three days. I went home to end it and took as many lorazepam I had (about 10mg), coupled up with a handful of quetiapine (antipsychotics) and zopiclone (sleeping tablets), which I washed down with whiskey. I don’t even enjoy the taste of whiskey, but it was the strongest alcohol in the house. I sat back and let the feeling of calm wash over me, whilst I slipped in and out of consciousness, finally at peace.

What happened next I don’t really know, but this is what I was told afterwards. An old school friend had been checking in with me by messaging me on and off. I didn’t make a huge amount of sense so she contacted my sister and a well fair check was arranged. My husband returned home with the kids and around the same time someone from the crisis team and also a police officer took me to hospital.

The next morning when I had realised what had actually happened the feeling of guilt was horrendous. Knowing my children had seen me in such a state and that I had lied to my husband was terrible. I knew from that moment that I needed to fight, my children didn’t deserve this and if I kept going like this, I would lose them one way or another. I would either be sectioned, dead or I would lose my children and all would take me away from the children I love so much.

I was taken in to talk to someone from the crisis team and told that if I was sectioned that I would never get better. As I have BPD (borderline personality disorder) the worse thing for me, would to be sectioned, they gave me the choice, but I declined. 40% of all inpatient have BPD and once you’re in, its hard to ever get out, as this condition is untreatable with medication and the only way to over come it is to complete DBT (dialectical behaviour therapy).

I started DBT quickly after, but I found it impossible to attend as I couldn’t get help with childcare and had to quit. Eventually once my marriage broke down and I started to get help again I was able to start DBT. I am now 5 months in and it has changed my life. It’s changed the way I deal with my emotions, given me inner peace and helped me regulate when I go into crisis. Things still haven’t been perfect and I still struggle, but I am always making progress. To see where I was a year ago and how I am today, I am proud. I am a better person, I am happier and I’m back to being the mother I want to be. I know that as a single parent that I need to get better as I could lose my children if I don’t and that is my driving force behind my progress.

I share my story in hope that it helps other people going through the same struggles. Admitting you feel suicidal does not mean your children will be taken away from you. I know this was my biggest fears, but social services were actually pretty helpful to me and arranged extra support I needed.  If you need support ask for it, call Samaritans, contact PANDAS, text a friend. Please don’t suffer alone as it’s too much to take on by yourself and it needs to be shared. This does not make you weak, but actually incredibly strong. Life can change so much in a year and I am proof of it. Keep fighting, you’ve got this.

Progress is key.

Samaritans

PANDAS

 

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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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#MaternalMHMatters

Maternal mental health awareness week

Today marks the first day of the very first maternal mental health awareness week #MaternalMHMatters so I thought I would write a post about my experience of postnatal depression now I am out of the other side. This week marks two years since my son was born and the start of my long battle of postnatal depression and maternal mental health problems. A child’s birthday is a time to celebrate and reminisce about all the amazing memories you have made in the first two years of life, but for me as a PND survivor it also reminds me of the very tough battle we had to overcome. I say we, as PND didn’t just affect me, it affected my baby, my daughter, my husband, family and friends. I had everyone rotting for me and encouraging me, but until I found the strength to fight it, they were powerless to really do much.

Many memories of my early days at home are tarnished, I didn’t understand why I was struggling so much more second time around, I didn’t know how to stop the negative thoughts and guilt and felt at PND’s mercy, powerless and broken. I muddled through and painted on a smile, but with my husband I couldn’t keep up the facade and the mask slipped. He saw me broken, distant, fragile and angry, he didn’t know why and he didn’t know how to help. My maternal mental health was at breaking point and I needed help, fast.

One morning I was struggling through the piles of washing, whilst my husband slept off his night shift when I decided to dry the clothes outside in the sun. My garden was full of clothes drying and I finally felt like I had a mini defeat that day, then the heavens opened and monsoon season decided to reach North Bedfordshire. Despite my efforts, everything was soaked through and yet again I was back at square one with wet clothes, nothing clean in the house and Mr T crying in the background wanting feeding, again. I collapsed on the floor and once the tears started they wouldn’t stop. Miss J confronted me and cuddled me and kept telling me it would be ok, which made me feel even worse. I knew then and there I needed to speak to my Doctor and get the help I needed, I couldn’t keep pretending and couldn’t let my daughter keep seeing me like this.

It took me five months to finally get help and I really wish I had done it sooner. I missed so much of my sons first five months of life and let the guilt rip me apart and the anxiety take over. Maybe if I had got help sooner my PND wouldn’t have lasted two years, I don’t know. The antidepressants didn’t work for me, but I just assumed I needed to keep fighting and because the antidepressants I was on was the safest option when breastfeeding I thought I had no choice of changing them. Every few weeks I would have them increased, yet nothing was changing and everything around me was crumbling away. Eventually I saw a doctor who listened to me, answered my fears and changed me on to something that actually worked. It wasn’t an easy journey and plenty of ups and down, but eventually I noticed I was having more good days then bad days. I saw hope and clung on to it.

These two years have been tough, draining, but they have also taught me many other things. I know the importance of life, appreciate people for their faults and I have found who I am again. Sitting in hospital in February of these year with an IV in my arm after attempting suicide made me realise that I couldn’t go this far down again, I was lucky to be found when I was and I have thought so many times how different it could have been. I am unconditionally loved in this moment, I always have been and I always will be. I need to be healthy for my family, let go of guilt, nurture my soul and gradually heal. PND is shit, but it can change, it can heal and you can recover. I did it and I now love my life.

Share you own stories of maternal mental health, support others, don’t stigmatise and we can fight this together. #MaternalMHMatters

Read my blog post on how to help someone with postnatal depression

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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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