Tag Archives: linehan

A much needed update, DBT Skills, and NAMI article

15 Mar

I haven’t really done an actual “update” all week, as I felt I needed to post about the article I read the other day and the home prejudice environment.  So here is a summary of how the last week has been…

Monday:  Monday I had a counseling appointment.  I brought my sister because she has been wanting to meet my case manager and my case manager has wanted to meet her as well as other members of the family.  She was the most likely to come and not make me look like a fool.  I was really anxious all morning and the night before.  My sister said I was “acting weird” during the appointment and that my reason was “so it would be hard to read my emotions.”  I do act the way I did on Monday a lot but not as severe.  My sister was only there for part of the appointment as she needed to get to work for a meeting.  I was trying to think of what was different this Monday as opposed to other appointments.  This is what I came up with: my case manager and my sister are the two people that I trust and the two that know the most about me.  They may know more about me than I know about myself.  My issues is I have the memory issues that make me forget who I have said what to and when and all that stuff.  Often I repeat something to someone thinking I haven’t told them, or someone says something to me that I don’t remember telling them.  Obviously there is no way I have told the two the exactly same things in the exact same way.  I guess I was just anxious about one telling the other things they may not already know, that I must have not mentioned for some reason.  Also they are the two I care most about the opinions and advice and feedback I get from.  with my paranoia that people get together and talk about me trying to influence me is different because now they have actually met each other.  Before it was easier to say I’m just being paranoid, they don’t even know each other.

Tue:  Tuesday I had DBT in the morning.  The leader was in a rush as this class was only going to be an hour as opposed to the normal hour and a half.  We talked about building positive experiences, pleasant activities, and opposite action.  I’m going to share some of the highlights I think from class.

The point of building positive experiences is to have something to look forward to every day  We talked about pleasant activities as far as short term goals and long term goals.  A short term goal to look forward to could be planning on baking if you like that, or going out to eat, or anything that can pretty much be accomplished in a day.  Long term goals are things to look forward to that will take some time, such as planning a vacation, looking forward to holidays, etc.  Another aspect of building positive emotions is to be mindful of them or be aware.  The part I thought was most important was to be unmindful of worries.  This is described as distracting from thinking about when the positive experience will end, thinking about whether you deserve this positive experience, and/or thinking about how much more might be expected of you now.  Personally when I am having positive experiences I often do these things, especially thinking or worrying about when it’s going to end.  Sometimes so much that I’m missing out on the positive experience.

With opposite action the handout focused on four main emotions and how to deal with an opposite action from each.  I’m going to pretty much copy the handout word for word.  The first emotion is fear.  Oposite actions include: do what it is your afraid of over and over and over (often caalled exposure therapy when dealing with anxieties or phobias); approaching events, places, tasks, activities and people you are afraid of (very similar to the first one); do things that give you a sense of control and mastery (do things you are good at to build confidence); and then overwhelmed make a list of small steps or tasks you can do and do the first thing on the list.  Next emotion is guilt and shame, there are two ways to do opposite action and they depend on whether the emotion is justified or not.  If the emotion is justified (or fits in with your wise mind values) repair the transgression, apologize, do something nice for the person you offended; commit to avoiding the mistake in the future, and to accept the consequences gracefully and then let it go.  When the emotion is not justified you need to do what makes you feel guily of ashamed over and over and over (like fear) and to approach and not avoid.  The next emotions are sadness or depression.  There are two opposite actions: to get active, approach, and not to avoid (do what you don’t want to do and you will most likely feel better about at least doing it) and to do things that make you feel competent and self-confident (which also helps with self-esteem.)  The last emotion is anger.  The opposite actions are to gently avoid the person with whom you are angry, rather than attacking, to avoid ruminating.  The other opposite action is to do something nice rather than mean or attacking (similar to guilt and shame that is justified.)

The rest of Tuesday.  Tuesday in ASL 4 we were suppose to present our song to the class, a few things happened where she had changed it to where you could present in groups instead of in front of the class.  A few students complained as they had been practicing all weekend and students started presenting in front of the class even though it was not required.  About 8-10 students presented, including me!  I decided to go up there because it would fit with my goal of doing something outside my comfort zone.  We now need to do a video project of the song so I just need to tape it, this is mainly because she didn’t see most the class’ because they chose not to present.  Tuesday I spent the night at my sisters and helped her set up her new iPhone.

Wed:  I didn’t sleep well at my sister’s the night before so I slept a lot of Wednesday.  I went to math class where we got back the test we had taken Monday.  I got a 67 out of 67.  ^7 was the curve set my the top three scores which were 68 and two 67’s.  However, the average score for the class was in the 30’s.  It was a lot harder than the first test.  I checked my e-mail when I got home from class and say that I had recieved an e-mail from NAMI (www.nami.org) or the National Alliance for the Mentally Ill.  The e-mail was about their upcoming national confrence in seatle.  One of the speakers will be Marsha Linehan the founder of DBT.  There was a little interview in the article.  I’m going to pull this quote out of it, (I’m sorry I couldn’t find the link on the website)

NAMI:  You are the founder of DBT.  Can you explain, in a nutshellm what DBT is and how it is effective in treating BPD?

Linehan:  DBT is a cognitive behavioral therapy (CBT) originally designed for people who are highly suicidal- it began as an intervention to reduce suicide.  Because I was looking for all the people in the treatment to be highly suicidal, most of them ended up having BPD, because suicide risk is a common symptom with that illness.  In reality, DBT is a treatment for high risk, severe, multi-diagnostic individuals.

The treatment itself is based on the theory that BPD and suicide are problems due to the inability to regulate emotions.  You can’t regulate unhappiness.  It’s a skills-based model of treatment- the person needs help, they need to know how to build a life worth living, how to solve problems of low motivation, learning how to mobilize themselves.  That takes skill.  There are specific skills- building protocols: mindfulness, emotion-regulation skills, distress-tolerance skills and intrapersonal skills.

The bottom line of the treatment is based on the notion that therapy had to address the enhancement of skills in modifying and getting out of toxic environments while at the same time keeping therapists motivated and skilled.