Traditional Therapy Methods Being Merged

Gray Matter's Role in Our Brain

Examples of Interpersonal Communication

Dialectic Behavioral Therapy was created in 1975 by Marsha Linehan, a suicide researcher. She worked with the most extreme cases in the nearby hospitals to "get them out of hell". 

She was also tormented by severe mental illness as a teenager. 

Marsha's research discovered that between the two main modes of psychotherapy available at the time, both were needed to successfully keep patients in remission for extended periods. Behavioral or humanistic therapy (see chart) alone seemed to anger and frustrate patients with no lasting effect. However, combining the two, which hadn't been done before, allowed patients to stay out of the hospital significantly longer.

DBT is primarily used for patients with borderline personality disorder, but today successfully helps with:

-Most types of personality disorders 

-Substance abuse 

-Depression/anxiety/PTSD 

-Binge eating 

-Bulimic tendencies 

It can help anyone hoping to rewire certain behaviors. Still, more importantly, people in this therapy showed growth in gray matter (see chart). Though this benefits many things, impulsivity decreases, which is a massive win in these illnesses [1].

Final breakdown, DBT consists of 4 pillars:

Mindfulness: A mental state or attitude in which one focuses one's awareness on the present moment while also being conscious of, and attentive to, this awareness (OED). 

-Are you present in the moment, or do you always have your phone? Do you get to places and don't even remember driving there? Do you experience dissociation? Does your mind wander when you have conversations, even when interested in the topic?

Distress Tolerance: Distress tolerance is a person's ability to manage actual or perceived emotional distress. 

-People with low distress tolerance tend to become overwhelmed by stressful situations. They may sometimes turn to unhealthy or destructive ways of coping with these difficult emotions [2].

Emotional Regulation: Emotional regulation is the ability to exert control over one's own emotional state. 

-It may involve rethinking a challenging situation to reduce anger or anxiety, hiding signs of sadness or fear, or focusing on reasons to feel happy or calm [3].

Interpersonal Effectiveness: The ability to interact and communicate with others (see chart) [4].

Bibliography 

[1] https://psychotherapyacademy.org/.../history-of.../

[2] https://www.verywellmind.com/distress-tolerance-2797294

[3] https://www.psychologytoday.com/us/basics/emotion-regulation

[4] https://www.indeed.com/.../resumes.../interpersonal-skills

DBT (dialectal behavioral therapy), means a great deal to me as someone who has chronic depression and anxiety. It breaks my heart how hard it is to get help so I would love to post about the skills I have learned on here for free. Today's post is called "Next Best Thing". I have heard many different names for this, this just happens to be what we used in my IOP group. This is an in the moment skill, meaning it takes less effort than some of the other skills. Thinking in a crisis moment is hard. Here are three steps that might help! Each person is different. Not every skill works for every person, but give it a shot and see if it helps!

1-Think about the thought or feeling that is the strongest right in this moment. It could be loneliness or financial stress or self hate. It can be anything. Or if you don't know, simply focus on the moment and feel that emotion.

2-(Possibly the most important step) Don't hate yourself for having this thought. When we try to willpower things away instead of acknowledging them head on, we often feel worse.

3-Pick the next best thing or feeling. 

Trying to go from sad to happy instantly simply doesn't work. The saying "happiness is a choice" is a super watered down concept and completely unhelpful for most of us in this moment. Often when I'm overwhelmed with feelings, I can't think of anything but that particular emotion. Trying to fix it can be exhausting. For me, journaling is the next best thing. I can't be happy out of nowhere, but I can journal about anything and everything in my head. Even if it is messy and only serves as a way to help process, this can feel so freeing. For some people it's a cup of hot cocoa and a few minutes listening to your favorite song or reading a book. What is your go to "Next Best Thing?"

-Tiff

Late Night DBT Skill

Anyone else a night owl? If you're like me, the tendency to stay up isn't about the video games or reading under the covers (Though I do love a good book!). It's sleep avoidance because I struggle with racing thoughts before bed. My mind doesn't shut off. My distortions replay over and over. This has been my baseline since I was a child.

I should've done more today

I should've said (or not said) this when talking to that person

I left chores undone

I have a test tomorrow...

the list is endless. 

Here is a skill that helps build your distress tolerance. There are times when we should absolutely be distressed. It isn't about not having a flight or fight reflex, it's about rewiring the trauma that causes this reflex to go off over and over again. 

T.I.P.P.

Remember everyone is different, what works for one person may not for another. Tweak it if needed. In reference to the chart shown, here is my take on this skill.

TEMPERATURE: Shower before bed if washing your face with cold water isn't doable.

INTENSE EXERCISE: Go outside and get fresh air and walk a bit (heavy exercise for some is exactly that).

PACED BREATHING: Box breathing works so much better for me than just "in, hold, out". Also referred to as square breathing. (See instructions below).

PROGRESSIVE MUSCLE RELAXATION: This last one is hardest for those of us who are tense so often that we can't distinguish tight and loose muscles. Try tensing your entire body at once and then release. Sometimes this helps you realize what problematic areas you may have. 

-Tiff

DBT Skill for Encouragement

Getting From Zero to One 

If you are like me, you struggle with motivation, even with the things you love. 

You aren’t lazy. 

Depression has many side effects including a loss of interest in engaging with life. My main therapist is always quick to remind me that getting from zero (sitting on the couch or in bed depressed) to one is often the hardest part. This doesn’t have to be huge! Think about something important to you, and then choose one small thing to take you in the direction of it. Maybe it’s showering before work because you know it makes you feel more confident. From inaction to action. Some people benefit from counting down. It sounds silly but works well for me on gloomy days. I count back from 3 and the deal I have with myself is that no matter how hard it is, I get up on 1. Always. If this doesn’t work for you no worries, there are plenty of tactics out there for getting from zero to one. 

I have another one. 

A personal one.

On days when the depression is especially bad, I have this reoccurring thought I use:

“The woods are lovely, dark and deep, 

But I have promises to keep, 

And miles to go before I sleep,

And miles to go before I sleep.” 

-Robert Frost. 

As a disclaimer, I am taking Frost’s words slightly out of context. However, my older brother loved Robert Frost and would quote his work to me often in letters. As encouragement to keep going, follow the things I believed in, and to know I could be whatever I wanted to be if I worked at it. My brother is no longer here, but his words and quotes are always in my mind. When I hear his words, I think of him, and it makes me believe in myself. It helps me feel happy instead of sad when I remember him, which lifts my depression ever so lightly.

For me, this quote is my zero to one.

Find your zero to one, it can be anything, and then live. Remember you, my dear, are never alone. 

-Tiff

DBT Skill for Difficult Conversations

F.A.S.T. Cultivating Self Respect 

Conversations are nerve-racking for neurodivergent people, especially those with people pleasing issues! When we talk to others, especially a boss or family member that is older than we are, our resolve crumbles. Even worse, we constantly doubt and gaslight ourselves into thinking it’s our fault. 

Fear not! 

With a little bit of practice, this skill will help you. 

FAIR: Consider both sides of the story, weighing needs equally. Don’t assume one side or the other is more valid, just share your perspective assertively AND truly listen to theirs. Be open to a conversation or compromise that supports the whole. We often think of our next response while the other person is talking instead of validating their feelings or seeking understanding. Truly listen to what they are saying they need. 

APOLOGIES: Don’t apologize unnecessarily to keep the peace. I know it’s incredibly hard for some of us to tolerate the potentially negative reaction of others, but it’s important to respect yourself enough to determine whether you have done something that needs an apology. 

STICK TO YOUR VALUES: Know what you can and can’t compromise and then be confident. Don’t apologize. Stay confident and firm without giving into the need to gain their approval. Again, this one is so hard for people pleasers but it’s important to understand your own needs. 

TRUTH: Do not exaggerate, make excuses for your behavior, or lie. This includes manipulation. Hold yourself accountable when needed but separate your actions from theirs. You are not here to take the fall. A resolution should include both sides seeing how they can work differently in order to create a healthy environment for all. 

I used to be that person that said sorry for being sorry. I cannot tell you enough how wonderful it feels to treat myself like a human with needs just like the people around me. You matter. If this is too hard to grasp, you write it on a sticky note, put it somewhere you’ll see it every day, and then say it. Every time you see it, say it. Your mind can’t rewire or learn if it never considers a different way of thinking. 

You matter. 

You matter. 

You matter. 

-Tiff