DBT For Dummies

Introduction 1 About This Book 1 Foolish Assumptions 3 Icons Used in This Book 3 Beyond the Book 4 Where to Go from Here 4 Part 1: The Nuts and Bolts of DBT 5 Chapter 1: Entering the World of DBT 7 Looking at the Main Pillars of DBT 8 Getting an Overview of DBT’s Treatment Modes and Functions 8 The four modes of therapy 9 The five functions of treatment 9 Focusing on the DBT Theoretical Framework 10 Checking Out the DBT Stages of Treatment 11 Surveying DBT Skills 12 Walking through the Mechanics of DBT 12 Treating Specific Conditions with DBT 13 Chapter 2: Understanding Dialectical Behavior Therapy 15 Beginning with the Biosocial Theory 16 Types of dysregulation 16 The invalidating environment 18 Focusing on the Functions and Goals of a Comprehensive Treatment 20 Motivating the patient and the therapist 20 Teaching the patient new coping mechanisms 20 Incorporating new skills into the patient’s daily life 21 Supporting the therapist 21 Structuring the patient’s environment 22 Checking Out Modes of Treatment 22 Skills training 22 Individual therapy 23 Phone/skills coaching 23 A therapist consultation team 24 Incorporating Dialectics 24 Searching for multiple truths in any situation 25 Moving from contradiction to synthesis 26 Chapter 3: Accepting Multiple Points of View 29 Questioning Your First Reaction 30 Realizing your first reaction may be exaggerated 30 Matching your reaction to what is in front of you 31 Holding off on taking action 32 Expanding Your Perception 32 Considering your therapist’s point of view 33 Coming to an agreement 34 Moving forward with a purpose 35 Looking at Yourself with Friendly Eyes 35 Chapter 4: Moving from Impulsive to Spontaneous 37 Distinguishing Impulsivity and Spontaneity 38 Moving Beyond Your First Reaction 39 Taking a breath 39 Finding your emotional balance 40 Opening Up 42 Seeing different perspectives 42 Widening your range of emotions 44 Breaking free of rigid choices 45 Transforming Negatives into Positives 47 Setting new thinking patterns 48 Switching self-destructive behaviors to healthy ones 49 Increasing your trust in your responses 50 Part 2: Gaining Understanding 53 Chapter 5: Understanding Your Emotions 55 Recognizing How You’re Feeling 56 Distinguishing between primary and secondary emotions 56 Paying attention to what you feel 58 Confronting Disproportionate Reactions 60 Realizing that your reaction may be overblown 61 Getting from recognition to regulation 61 Identifying and Handling Problem Areas 63 Looking at what causes you distress 63 Figuring out coping solutions 64 Chapter 6: Understanding Your Behaviors 65 Being Aware of How Your Emotions Manifest in Action 66 Identifying and Handling Emotional Triggers 67 Limiting their disruption 67 Minimizing their power 68 Tying Specific Behaviors to Specific Reactions 70 Understanding physical responses and conscious feelings 71 Establishing new pathways 72 Chapter 7: Understanding How You Think 75 Tapping into Your Self-Talk 75 Practicing mindfulness of current thought 77 Using cognitive reappraisal 78 Checking the facts 79 Looking at Your Reactions 81 Recognizing what you feel about your feelings .81 Assessing your assumptions 83 Accounting for your self-judgments 84 Chapter 8: Understanding Your Relationships 87 Recognizing Relationship Dynamics 87 Looking at what you bring 88 Accepting another person’s perspective 90 Enhancing Communication 91 Checking in with your own dialogue 91 Opening up to honest listening 92 Accepting a range of perspectives 92 Making Room for More Possibilities 93 Being willing and able to create a new dynamic 93 Enhancing good practices and letting go of hurtful ones 94 Part 3: Exploring DBT Skills 95 Chapter 9: Thinking about Mindfulness 97 Exploring Your Own Mind 98 Discovering mindfulness at its core 99 Surveying the three states of mind 99 Practicing mindfulness with the WHAT skills 100 Using the HOW skills in mindfulness 103 Making space and setting a routine 106 Understanding Types of Mindfulness 107 Concentrative mindfulness 107 Generative mindfulness 108 Receptive mindfulness 111 Reflective mindfulness 111 Realizing the Benefits of Mindfulness 112 Enjoying greater focus 112 Easing into relaxation 112 Creating healthy space in your psyche 113 Calming your emotions 114 Chapter 10: Regulating Your Emotions 117 Turning the Keys of Emotion Regulation 117 Decreasing emotional vulnerability with ABC PLEASE 118 Practicing opposite action 121 Being kind to yourself 123 Being Your Own Emotional Support 124 Reappraising your feelings 124 Adopting healthy self-soothing practices 125 Chapter 11: Building Your Distress Tolerance 127 Managing Difficult Moments with Crisis Survival Skills 128 Distracting yourself 129 Soothing yourself 131 Recognizing That Everything Has a Cause 132 Checking out a real-life example 132 Changing your perspective 133 Curbing Impulsive Behavior 134 Foregoing short-term gratification 134 Improving your situation 135 Using pros and cons 137 Doing Your Own Crisis Management 138 Acceptance of your situation 138 A quick TIPP 144 Alternative rebellion 145 Chapter 12: Increasing Your Interpersonal Effectiveness 147 Before You Begin: Being Aware of Obstacles 148 Mastering the DEAR MAN Skill 149 Describe 150 Express 150 Assert 151 Reinforce 151 Mindful 151 Appear confident 152 Negotiate 152 Practicing the Art of Validation 153 Discovering different validation methods 154 Validating when you disagree 156 Problem-solving and validation 156 Communicating with GIVE Skills 157 Staying True to Yourself with the FAST Skill 158 Combining GIVE and FAST 159 Putting It All Together 159 Chapter 13: Walking the Middle Path 161 Finding the Balance 161 Validation 162 Behaviorism 162 Dialectics 164 Embracing Cooperation and Compromise 165 There’s more than one point of view to each situation 166 Change is the only constant 167 Change is transactional 167 Part 4: The Mechanics of DBT Therapy 169 Chapter 14: Exploring Therapy Basics 171 One on One: Individual Therapy 171 Finding an individual therapist 172 Setting a reachable goal 173 Getting the most from individual sessions 174 All Together: Group Therapy 175 Joining a group 175 Sharing strategies 176 Gaining from the group 176 Time to Connect: Phone Coaching 177 Before you begin: Setting parameters 177 Calling for help 178 Asking for validation 179 Repairing the relationship 179 Sharing good news 180 Chapter 15: Embracing Dialectics 181 In the Beginning: Stumbling onto Dialectics 181 Thinking Dialectically 182 Looking at the Main Dialectical Dilemmas Tackled in Treatment 184 Emotional vulnerability versus self-invalidation 185 Active-passivity versus apparent competence 185 Unrelenting crisis versus inhibited grieving .186 The Dialectical Dilemmas of Parenting: Walking the Middle Path 186 Making light of problem behavior versus making too much of typical behavior 186 Fostering dependence versus forcing independence 187 Being too strict versus being too loose 188 Understanding Therapist Dialectical Interventions 189 Irreverence versus reciprocity 189 Environmental intervention versus consultation to the patient 189 Problem-solving versus validation 190 Chapter 16: Structuring the Environment 191 Adding Structure to Two Different Environments 192 Addressing a Problem in Five Ways 193 Building a Framework 194 Making commitments 194 Holding true to your plan 196 Structuring Individual Sessions 197 Reviewing your diary card 198 Paying attention to target hierarchy 198 Doing a chain analysis on the highest target 199 Weaving in solution analysis 201 Moving down the hierarchy to discuss skills related to current life situations 202 Putting Structure in Different Contexts 203 Prison settings 203 School settings 204 Hospital settings 205 Therapy for people with developmental disabilities 206 Chapter 17: The Therapist Consultation Team 209 Joining a Consultation Team 210 Therapy for the therapists 210 Consultation team agreements 213 Sticking to the Agenda 215 Structuring a meeting 215 Understanding team roles 216 Chapter 18: Tracking Your Experience 219 Keeping a Daily Diary Card 219 Recording your emotions 220 Tracking your reactions 222 Identifying the skills you use 224 Analyzing Your Behavior 226 Chain analysis 226 Solution analysis 229 Missing links analysis 231 Chapter 19: Gaining and Keeping Motivation 233 Having Motivation for Therapy 233 Distinguishing motivation and ability 234 Moving to acceptance 235 Increasing Motivation 236 Ideas from CBT .236 The DBT approach 238 Maintaining Motivation 240 Your eyes on the prize 240 When motivation fails 241 Part 5: Putting DBT into Action for Specific Conditions 243 Chapter 20: Building Mastery for Mood and Personality Disorders 245 Addressing Borderline Personality Disorder 245 The nine DSM criteria for BPD 246 Dr Linehan’s five areas of dysregulation 249 Managing Your Moods 253 Dealing with depression 253 Handling mania 255 Alleviating Anxiety 256 Understanding anxiety’s components 256 Checking out anxiety’s common presentations and chemistry 258 Tempering excessive anxiety 259 Experiencing anxiety as a helpful signal 261 Chapter 21: Taming Trauma 263 Understanding the Basics of DBT PE 264 Breaking down types of avoidance 265 Seeing how DBT PE works 265 Knowing when you’re ready to start 267 DBT-PTSD: Exploring an Alternative Model 267 Digging into the Dilemma of Dissociation 268 Chapter 22: Tempering Addictions 271 A Word about Dopamine 271 Working through Substance Dependence 272 Distinguishing substance use and substance-induced disorders 273 Looking at DBT skills for substance use disorders 275 Seeing how DBT for substance use disorders is different from standard DBT 278 Knowing how DBT for substance use disorders is different from other therapies 279 Considering DBT for SUD alone, without emotion regulation problems 280 Overcoming Eating Disorders 281 Binge eating disorder 281 Other eating disorders 283 The DBT model of treatment for eating disorders 284 Gaining Ground on Body Dysmorphic Disorder 287 Addressing perceived flaws 288 Handling particular problems 291 Getting a Grip on Behavioral Addictions 292 Activities that may become addictions 293 When to use DBT for behavioral addictions 295 Chapter 23: Dealing with Counterproductive Behaviors 297 Tackling Self-Invalidation 298 Removing yourself from the cycle with self-validation 298 Stepping away from shame 299 Experiencing exposure 301 Seeking reassurance 303 Handling Self-Hatred 306 Thinking of self-love as opposite action 307 Looking at the elements needed to practice self-love 308 Balancing Solitude and Connectedness 309 Aloneness 310 Loneliness 310 Emptiness 312 Part 6: The Part of Tens 315 Chapter 24: Ten Mindful Practices 317 Observe an Itch 317 Observe the Urge to Swallow 318 Observe Your Hands 318 Observe Your Breath by Ladder Breathing 318 Describe a Social Media Post 319 Describe a Difficult or Painful Emotion 319 Describe the Sounds around You 320 Participate in Standing on One Foot 320 Participate in Writing with Your Non-Dominant Hand 320 Participate in Driving a Car 321 Chapter 25: Ten Ways to Live an Antidepressant Life 323 Engaging in Exercise 323 Trying Meditation 324 Eating a Less Refined Diet 324 Being Careful with Alcohol and Various Drugs 325 Getting Enough Sleep 325 Maintaining Social Interaction and Connection 327 Adding Recreation and Relaxation to Your Routine 327 Accessing Green Space and the Environment 328 Taking Care of Pets and Other Animals 328 Making Time for Faith and Prayer 329 Chapter 26: Ten Myths about DBT 331 Myth: DBT Is Used Only with People with Borderline Personality Disorder 331 Myth: DBT Therapists Teach Skills from a Manual; It’s Not a Real Therapy 332 Myth: DBT Takes Years Before You Feel Better .332 Myth: DBT Is a Suicide Prevention Therapy 333 Myth: If No Other Therapy Has Helped, DBT Won’t Either 333 Myth: Once You Start DBT, You Need to Continue It Forever 333 Myth: You Have to Accept Buddhism to Do DBT 334 Myth: DBT Is a Cult 334 Myth: There Is Very Little Evidence That DBT Works 334 Myth: DBT Isn’t Interested in “Root Causes” of Mental Illness 335 Index 337