Dialectal behaviour therapy, or DBT, was created by Marsha Lineham to treat BPD. It focuses on trying to create more time between a trigger and the reaction, as well as reduce the person’s skills deficit to stop unhealthy reactions and coping mechanisms.
DBT focuses on 4 core modules: mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation.
The below picture shows all of the skills you learn in the modules.
Mindfulness is the most important module in DBT but I’m finding it the hardest. Staying present is particularly difficult for me as my mind is very overactive, I find it very difficult to focus on just one thing at a time.
Throughout the mindfulness module, people learn the What skills: Observe, describe and participate and the How skills: one mindfully, effectively and non-judgementally.
The What skills help people to observe their emotions from a distance, describe their emotions using just facts and participate in the present activity they are doing.
The How skills reinforce the What skills by helping people to stay focused on the present moment, focusing on how to be effective for the situation or task and being non judgemental. If you see a situation without judgement it is neither good nor bad, it just is.
Distress tolerance skills are used in crisis situations when you’ve already been triggered. They are so important for people with BPD as we often have a difficult time soothing ourselves and calming ourselves down.
Distress tolerance skills focus on trying to distract or prevent people from acting on a negative impulse or behaviour. They are also designed to try to make the situation more tolerable for the person with BPD, as we have a hard time regulating our emotions and will reach emotion level 10 both quickly and frequently.
The picture above provides an explanation of each acronym: TIPP, STOP, ACCEPTS and IMPROVE.
STOP is my favourite so far because when I remember to use it, it helps me to take a step back from a situation and stops me from lashing out in anger immediately, which later leads to me feeling really bad about myself for being a bad person, and nobody likes believing they’re a bad person.
I have a really hard time with IMPROVE because I’m not religious and I find imagery slightly triggering because of my dad. ACCEPTS is useful but really difficult to remember when you’re triggered.
Emotion regulation skills focus on helping people to understand the exact emotion they’re feeling and to try to create more positive emotions through actions.
I have a hard time figuring out how I’m actually feeling and I know I’m not alone in this. People with BPD experience so many emotions throughout the day, they usually default to a certain few. For me, this is usually confusion, excitement, anger and fear. Fear and confusion are my top two, I’m frequently afraid and I’m unsure as to why.
Emotional regulation skills firstly help to identify and describe the exact feeling I’m feeling. In the book, you’re provided with a list of a wide range of emotions which can be used to help. I have a really hard time with this and it sometimes can take a long time before I can identify what I’m actually feeling. The longest was 4 days, during which time it was very difficult for me to regulate my emotions, but I am new to this!
Emotion regulation skills are also used to help promote positive emotions. The acronym ABC PLEASE is used above and it’s something I need to incorporate into my everyday life.
Last, but definitely not least, is interpersonal effectiveness skills. This is represented by the acronyms DEARMAN GIVE FAST (above).
People with BPD often have a hard time setting boundaries or asking for what they want because of our core fear of abandonment or rejection. We often apologise, tolerate bad behaviour from others or go along with what other people want, even if we don’t want to, to avoid being abandoned or rejected.
The acronym DEARMAN GIVE FAST helps us to express our desires in a non-threatening and gentle way, and reminds us to compromise and take other people’s wishes into consideration as well. When I have tried this skill I have found it to be effective, but it is very difficult to use because I’m not used to sticking up for myself. I’m much more used to putting other people before me.
On the above sheet as well are a few other acronyms such as VITALS, SMART and AAA, alongside the 4 options 4 problems and the behaviour analysis. These are all used to try to analyse our current behaviours to see whether it’s helpful, and to create a life worth living.
Living with BPD is mentally exhausting sometimes, both for me and those around me. The above meme might seem funny but it is actually a very accurate description of a day in the life with BPD when my symptoms are triggered.
I work very hard everyday to try to control my symptoms and get better, even though recently it seems I’ve been getting worse but that’s only because change is difficult. I have spent the last 13 years of my life reacting and behaving in a certain way, that’s a long time of bad habits to change but I’ll get there.
I’ve been having trouble with accountability since starting DBT because I’ve been doing it myself, without professional help. So I’ve decided to use this blog and any of you who read this as accountability.
Each week, I will focus on one skill and at the end of the week, I’ll write about how it went.
This week, I’m going back to focussing on STOP.
This skill is really important to me that I master it completely because I’m not a bad person and I’m tired of acting as though I am.
Wish me luck!