This was an odd week for DBT; one of the group leaders was absent, so we only had the secondary therapist there – she’s nice enough but seems like a frowzy grandma. And only four of us attended, so there was a lot more “sharing” than usual. No one could get out of saying something at each turn.
The material we covered was more emotion regulation, but having finished up the Linehan module, it was actually a chapter from a book I recently purchased, “The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder” ($15 on Amazon.) It reinterprets the original content in presentation and with some specificity to the condition.
That alone sparked interesting conversation. Another group member said, to the effect of, “The doctors always diagnose me bipolar, but I read books about it and think, that’s not me. But when I read about Borderline Personality Disorder, it was like I was reading all about myself.” So I replied that I’d had the exact same experience with one doctor, except reversing the two conditions. I have to wonder how often that happens…
Anyway, it was the first time anyone openly discussed diagnoses in group, although some were easy guesses based on things they said. I once saw some of the Dx codes on the receptionist’s check-in sheet, and I’m the only bipolar in the group.
The main things we went over were from chapter 7, “What to Do About Your Emotions.” The first topic was how to stop avoiding emotions, with yet another handy acronym, which seems much less tortured than Linehan’s embarrassingly contrived acronyms.
- Watch: Observe and note the experience of the emotion.
- Avoid acting: Don’t act immediately – it’s an emotion, not a fact, and you don’t have to do anything about it.
- Think: think of the emotion as a wave that will eventually go away on its own if you don’t struggle against it.
- Choose: choose to experience the emotion; even if it’s hard, it’s in your best interest and over time you will get better at handling emotions.
- Helpers: emotions are helpers that serve a purpose.
When we discussed that point, I said that I take issue with the assertion that all emotions have a purpose. What, hypomania’s purpose is to tell me to sleep? Depression’s purpose is to remind me to keep popping my pills? Or make sure that I notice it’s October or February? This is where pretty much every emotion regulation thing falls apart for me; they assume that all emotions are somehow reactive and meaningful. I’m sorry, but I think that sometimes emotions are biological misfires that do not serve any purpose, or at the very least, are physiologically amplified so far beyond their original purpose as to be destructive.
The other part of the chapter that we spent some time on was the Opposite-to-Emotion Action worksheet. It’s a table with columns for a situation, the emotion experienced, the urge to act attached to the emotion, the actual action taken, and the aftereffects. This is a substantially clearer presentation than in the original DBT content. Much like the big grid I filled in that made me think about how I experience each different emotion – autonomically, thoughts, reaction urges, actions taken, etc – this way of analyzing the ways I’m trying to use the DBT skills is far better for me. It’s better aligned with the way my mind has been trained to work as a researcher; a structured self-analytic approach tends to bring the most catharsis.
I’ve been working through the emotion regulation section on the DBT-for-bipolars book alongside the DBT-for-borderlines version in group and find it much more useful for me. I’d suggest that anyone who needs DBT skills go look for a workbook that fits their needs – don’t pay too much for Linehan’s workbook just because it’s the grandma of them all, especially if you’re not borderline. I saw versions for anxiety, bulimia, and depression; there are probably more, and they are likely more usable than a workbook focused at a completely different disorder than what you’re dealing with. Besides which, the newer workbooks are a lot more appropriate for self-guided use. The one I’ve got makes more sense, has clearer descriptions, is less hokey and dated, and a number of the worksheets are substantially more useful to me than anything in traditional DBT.
So, anyone want a practically new copy of the $40 “Skills Training Manual for Treating Borderline Personality Disorder” for say, $15?