9781119730125

Keep calm, be skillful—and take control!

Dialectical Behavior Therapy (DBT) is one of the most popular—and most effective—treatments for mental health conditions that result from out-of-control emotions. Combining elements of Cognitive Behavior Therapy with Eastern mindfulness practice, DBT was initially used as a powerful treatment to address the suffering associated with borderline personality disorder. It has since proven to have positive effects on many other mental health conditions and is frequently found in non-clinical settings, such as schools. Whether you struggle with depression, anger, phobias, disordered eating, or want to have a better understanding of emotions and how to focus and calm your mind, DBT practice serves the needs of those facing anything from regular life challenges to severe psychological distress.

Written in a no-jargon, friendly style by two of Harvard Medical School's finest, DBT For Dummies shows how DBT can teach new ways not just to reverse, but to actively take control of self-destructive behaviors and negative thought patterns, allowing you to transform a life of struggle into one full of promise and meaning. Used properly and persistently, the skills and strategies in this book will change your life: when you can better regulate emotions, interact effectively with people, deal with stressful situations, and use mindfulness on a daily basis, it's easier to appreciate what's good in yourself and the world, and then act accordingly. In reading this book, you will:

Understand DBT theory
Learn more adaptive ways to control your emotions
Improve the quality of your relationships
Deal better with uncertainty

Many of life's problems are not insurmountable even if they appear to be. Life can get better, if you are willing to live it differently. Get DBT For Dummies and discover the proven methods that will let you take back control—and build a brighter, more capable, and promising future!

Gillian Galen, PsyD, is an instructor of psychology at Harvard Medical School. She is program director and assistant director of training for McLean 3East Intensive Residential Program at the Harvard-affiliated McLean Hospital. She specializes in the treatment of adolescents and their families using DBT.

Blaise Aguirre, MD, is a trainer in, and specializes in, DBT as well as other treatments such as mentalization-based treatment (MBT) for borderline personality disorder and associated conditions. He is the founding medical director of the 3East DBT continuum of care at McLean Hospital, and is on the faculty of Harvard Medical School. He has authored multiple books and lectures regularly throughout the world.

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

What is included with this book?

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.

Amazon no longer offers textbook rentals. We do!

DBT For Dummies

DBT For Dummies

1119730120

Summary

Author Biography

Table of Contents

Supplemental Materials

Write a Review