Leaving DBT

I’d heard such good things about DBT and the wide array of issues it can help with. But once I began the therapy things very quickly went downhill for me. My voices were so loud in the group, defiant they wouldn’t be silenced, that it was difficult to concentrate, and I had so many questions that didn’t feel welcome. I felt like I was expected to just absorb the information given and make it work.  The skills of Dialectical Behavioural Therapy seemed to contradict each other and some sounded like they were straight out of ‘The Little Book of Calm’.

One of the skills ‘Radical acceptance’ is about just accepting the past. I wondered why anyone is in therapy at all if radical acceptance is the ideal cure. Society constantly asks us to radically accept whatever has happened to us. But I don’t know anyone who has found the societal kicking to ‘just get on with it’ healing. I became more and more sceptical of some of the skills, no matter how open minded I tried to be. It made me realise that in order to be more mindful I needed to understand myself and get properly assessed. Until this happens I can’t put everything aside and ‘just be mindful’ as DBT asked me to.

Another of the barriers for me was that my mood does not tend to swing violently on a day to day basis. I could go weeks or months where I didn’t have a real life depression to practice skills with. I practiced anyway, several hours on each homework and two visits to the clinic every week. However when there was a real life situation where a skill could be used, I found that dissociation meant I couldn’t apply any techniques. I found it increasingly more and more humiliating going to one to one sessions and hearing about all the things I should have done, when at the time I wasn’t aware of being in my body; let alone the whereabouts of my DBT worksheets. My OCD and general perfectionism made me incredibly anxious about the whole process. I tried bloody hard, but I couldn’t be the perfect DBT student. This alone made me despise myself even more than I did already. My mind had set me up with that goal, but unfortunately that goal became a big part of my DBT process failing.

DBT works for a lot of people and this is only my opinion. But the more I went to DBT the more I felt like I was in a sitcom about therapy. Everything from the clinking of the chimes at the beginning and end of a mindfulness activity and even some of the skills would have made great comedy material. One of the more notably bizarre skills was half smile and willing hands in which you look slightly sinister and wait for serenity to come upon you. My uncertainty as to whether DBT was the correct path for me seemed to frustrate my 1:1 therapist greatly. She said that by trying to get me involved she had been utilising the ‘foot in door’ technique and now she would move on and use the ‘door in face’ technique by suggesting I move on. I said that sounded like mind games. She said: “that’s DBT”.

In the end I realised that the amount of hours I was putting into something that was rendering me totally miserable was stopping me from being able to do things that did actually make me feel better. Energy is a precious commodity and after about two months and many hours I couldn’t sacrifice anymore of it. I did meet some lovely people in the DBT group who I admire immensely and wish the best of luck in their therapy. In the meantime I am having more assessments to work out what to do next. No therapy works well for everyone, we are all individuals. I was absolutely terrified that me leaving the therapy would mean I would not be offered any help again. This luckily did not happen and everyone working with me respects my choice and my right to receive treatment.  The ‘Mouse Does DBT’ category will now become ‘Mouse Tries’, a series of blogs about different techniques that may help people with mental health problems.

A mouse with crossed arms and closed eyes with the words 'oh well' above it's head

Mouse Does DBT: STOP Skill

The STOP skill is a way to slow down a crisis. When a trigger happens you can picture the stop sign:

S – Stop. Stop everything right now.

T – Take a step back. Get out of the situation or just give yourself a break.

O – Observe. Observe how you feel, what the situation really is and the sensations it’s giving you. What are other people doing and saying?

P – Proceed Mindfully. Think around the scenario from every angle. Before deciding on an action think of how you feel, how others feel and whether the action you want to do next will make things better or worse.

(Please note that Upside Down Chronicles has no training or therapeutic expertise, only experience. This series ‘Mouse Does DBT’ is to support people going through DBT themselves, or for those interested in the therapy. Please contact your GP if you need further support for mental health problems.)  

Mouse Does DBT: “How” Skills

Week Two brought Mouse to the “How” mindfulness skills. Though Mouse wasn’t sure why they were called that, or how to do them…

Non-judgementally

To be non-judgemental is to be factual and not emotional. Using the wise mind you can disarm the judgemental thoughts that we all have about ourselves or others. The disarmament comes from simply recognising when a thought is a judgement, not a fact.  For example:

img_0565-1

The first two mice are non-judgemental. They are stating facts about the state of the cake. However the third mouse is in emotion mind and is using emotion based judgements to define the cake. It’s really hard to be non-judgemental, particularly if you are so hating of yourself that you see the judgemental thoughts as fact. “I’m ugly.” “I’m stupid”. “I’m worthless”. We all have those pesky thoughts. But by realising that they are judgements rather than truths they can be less upsetting.

One mindfully

Doing things one-mindfully is about using the whole of your awareness in a task. One thing at a time, even if the thing you are doing feels insignificant. Notice the tiny details like the backgrounds of film scenes or how many buttons are on a shirt. One mindfully can be practiced using the ‘what’ skills from last week.

Effectively

Effectiveness is about practice. A lot of practice. Practicing these skills again and again until you become more mindful, and thus more effective.

Next in Mouse Does DBT, Distress Tolerance!

(Please note that Upside Down Chronicles has no training or therapeutic expertise, only experience. This series ‘Mouse Does DBT’ is to support people going through DBT themselves, or for those interested in the therapy. Please contact your GP if you need further support for mental health problems.)  

DBT: First Fortnight Thoughts 

If you’ve been following the start of my ‘Mouse Does DBT’ series you will know that I have recently started an intensive course of Dialectical Behavioural Therapy. So far I am undeniably sceptical. I’m intrigued how and if this therapy will help me.

DBT is practical- which is a good thing. The practical approach means that the skills are useful for any human being on the planet- regardless of if they have illness. I have noticed that DBT is incredibly hard work. Coming out of my first group session I felt like I had been run over by a bus on the M25. Once I had recovered from it, there was stacks of reading and a piece of daily homework to do. After my first one to one I was terrified. I was told that I (like everyone else) will inevitably get things wrong in DBT. Even though I logically know this, it isn’t a comfortable thought for me. I desperately want to get everything right so that I have the best possible chance of recovery.  The therapist also said that she would tell me if she felt that I was not working hard enough- but what if I truly do work my hardest but DBT just doesn’t work for me? 

To mice sitting around a coffee table with a box of tissues on. One of the mice is wearing a lanyard.

The frustrating thing is that I am already aware of many skills that could help me. I can talk breathing exercises and self soothe boxes until I’m blue in the face. Unfortunately dissociation means I am zoned out, cut off and unaware at the exact moment I should be using any of these techniques. To the outside world it looks like a seizure and I am completely unaware of everything around me. 

Apparently with DBT I will one day be able to break down the chain of events that lead to a dissociative episode and eventually catch it before it strikes. At the moment disociation feels like the plug for my consciousness being pulled out suddenly for reasons I’m not always aware of. I can’t even imagine having the time and prior knowledge to slow -let alone stop- an attack. 

At the moment I have serious doubts over whether DBT is for me. There’s no way of knowing for -realistically- a few months at the least. I find it frustrating that even when I am not depressed and feeling pretty good I still have to go to therapy that stresses me out. I am aware that it would be completely stupid to stop going, because I know in my heart of hearts that depression will inevitably come knocking for me again. When that happens I need all the help I can get. I’ve got to keep going, keep trying to understand the skills and keep talking to all the professionals. I always find my own way in the end and in the long term DBT will do me no harm even if (worst case scenario) it does me no good.  

Mouse Does DBT: ‘What’ Skills

 It was explained to Mouse that mindfulness could be practiced in different ways- some of them are covered here in the ‘What’ skills. 

Observe

A white mouse holds a magnifier to their face 'observe' is written alongside. Copyright upside down Chronicles. Observing is about just noticing as thoughts and feelings come and go. One way to do this is to imagine that your mind is a conveyer-belt and you are passively watching your thoughts trundle by. You are paying attention to the thought as it goes; acknowledging its existence and letting it pass without judgement. You can also observe by noticing the rate of your breathing or by doing a body scan meditation to recognise any physical sensations you may have. You can also observe things external to yourself, like watching people in a cafe or admiring the tiny details in a beautiful view. It’s noting the facts of what is going on in as much detail as possible.

A cartoon image of a conveyer belt. A brown cardboard box is moving along on it. It is labelled 'mouse's thoughts'. Copyright upside down chronicles
Describe

A mouse holds a magnifying glass to the word describe. A question mark above his head. Copyright upside down Chronicles.Describing is all about focus and understanding. In the group session all the mice were each given a chocolate Minstrel. Using the describe skill they tried to find words for the shape, texture, taste, smell and colour of the chocolate. Doing her homework Mouse found that the easiest way to practice this skill was to describe her beauty regime as if she was filming a YouTube tutorial video. She described the products she used, how they felt on her fur, how she applied them and how they change the way she looks. As well as describing actions and objects you can use the same description exercise for thoughts and feelings. Putting words to something as abstract as feelings makes them seem less scary and more controllable.

Participate

A white cartoon mouse poses with one hand on his hip and one in the air in a Saturday night fever dance pose. Music notes around him and the word 'participate'. Copyright upside down Chronicles. Participating is about actively being in the moment. Focusing on the one task you are doing and then doing it with all your might. This could be: singing to the song you are listening to or not allowing yourself to slip into the background during social situations. By taking part in everything you do fully you can stay in the here and now.

What a lot of people don’t understand is that mindfulness is not about clearing your mind. Clearing your mind is actually not very mindful at all. Mindfulness is about acknowledging the moment you are in and accepting things for how they are. These ‘What’ skills are a way to focus and engage with the now. Practicing these skills is hard as you have to try and let the thoughts that interrupt your mindfulness exercise drift past on your brain conveyer belt without letting them pull you completely off task. Mouse’s conveyer belt seems to be being used to transport tonnes of manure around her mind. What skills will need some work.

(Please note that Upside Down Chronicles has no training or therapeutic expertise, only experience. This series ‘Mouse Does DBT’ is to support people going through DBT themselves, or for those interested in the therapy. Please contact your GP if you need further support for mental health problems.)  

 

Mouse Does DBT: The Wise Mind

Welcome to a brand new blog series- “Mouse Does DBT”. DBT skills explained by mice!

A cartoon drawing of a white mouse sitting on a blue seat. Mouse holds a tiny toy mouse in her paws and has a thought bubble above her head with grey lines through it. It looks like TV static. Image copyrighted- UpsideDownChroniclesMouse has been having trouble with her thoughts. Sometimes she’s too high and hyper, others she is too depressed to move. Sometimes she is neither, but she is always incredibly anxious. So mouse was referred to DBT (dialectical behavioural therapy) and after some assessments and a waiting list she was finally invited to join group and 1:1 therapy.

Mouse was really nervous about coming into the group. In fact she wasn’t even sure if it would help. She was given a cup of tea and then she just listened to the conversations of people coming in and sitting down.A picture of mouse sitting on a blue chair. Inside the outline of mouse's body is grass, a snow topped mountain and a blue sky. A sun is rising behind peaceful mouse's ears. Copyright- UpsideDownChronicles.

The group starts with a Mindfulness exercise. At the sound of a chime the group’s leader began to slowly read a relaxation exercise for everyone to follow. You had to imagine you were a mountain standing strong and confident breathing in and out.

Mindfulness is the main base for Dialectical Behavioural Therapy. This mindfulness begins with the search for the ‘wise mind’. The wise mind is a hybrid between your emotional and reasonable mind. All three minds live inside all of our heads. For example; if you were out shopping your emotional mind would be the one telling you to buy everything you fancy right there and then. Your reasonable mind would say: “It’s nice but you don’t need it.”. The wise mind however would say “Maybe wait until next payday, if you still want it then you could buy it.”. The reason one of the first parts of DBT is trying to find the your wise mind is because it is the wise mind that is best placed to understand situations and make decisions. The wise mind is the most diplomatic and rational of the three minds and therefore decisions are safer when made in wise mind (or wise mouse)’s hands.

A cartoon image of a pink brain, inside the brain are three mice. On the left is emotion mouse crying into tissues, Wise mouse is in a lotus position levitating and looking blissful. On the right is reason mouse, standing with his hands on his hips and wearing sunglasses. Copyright UpsideDownChronicles.
Like in the mountain exercise, guided meditation is a good way to find your wise mind. Ideas to do this include: thinking ‘wise’ as you breathe in, and ‘mind’ as you breathe out and imagining being a snowflake on a lake. Alternatively (mouse’s favourite) you can imagine walking down a spiral staircase- from the top of your head to the tips of your toes. You can stop on the stairs any time, noticing your senses. You can find some more visualisation exercises here or alternatively you could try a children’s mindfulness book to help you start with the basics. The more time we spend in Wise Mind the better.

(Please note that Upside Down Chronicles has no training or therapeutic expertise, only experience. This series ‘Mouse Does DBT’ is to support people going through DBT themselves, or for those interested in the therapy. Please contact your GP if you need further support for mental health problems.)  

 Did Somebody Say DBT?

Recently I’ve been having assessments to see if I’d benefit from a therapy programme that uses DBT and Mindfulness. After many worksheets and conversations I have been put forward for a full programme. This means one skills group and one 1:1 session a week for about a year.

What is DBT?

Dialectical Behaviour Therapy is all about breaking down negative and destructive cycles and creating better ways of coping for yourself. It has foundations in Mindfulness and Cognitive Behavioural Therapy and allows people to develop a more in depth understanding of their negative thought and behaviour cycles. It involves practical skills of how to take action to avoid dangerous behaviour. It is also about helping you to accept your struggles as part of the make up of who you are, but not your whole definition.

The Assessments

What came over very strongly during the assessments was how much hard work DBT involves. It means two sessions, plus my CPN appointment and then homework on top- every week! From what I gather it seems the skills need to be practiced near constantly (even when they aren’t required) in order for them to develop into instinct at times of need. It’s about acknowledging the problems you have, why they may be valid, why they may not, and finding strategies to overcome them.

During the assessments I had to talk about some very difficult things that I find painful. The assessment is important because it ensures that you are suitable and will benefit from the therapy. I think the wonderful Ruby Etc. shows the trouble in seeking help from services perfectly in this diagram. In mental health services you are either ‘too mad’, ‘or not mad enough’. Luckily(?) for me during this assessment it appears I struck the middle ground.

53dc12b5-81e4-4a68-879d-981c7377c82e-2127-0000029786e40de0_tmp
I’ve wanted for a while to include more help and advice on Upside Down Chronicles. I’d like to be able to share skills and strategies with others and enable people to try techniques for themselves. I know how hard it is to get the help from services, so maybe getting second hand skills from UDC might just help someone. Obviously I’ll be writing as a person experiencing the therapy- not as a therapist or expert myself.  I don’t know when there will be a space for me to start the course, but I am very excited to be finally offered some formal help.

If you want to have a look and a head start, the book the programme uses has been published online for free here.