What Dialectical Behavior Therapy Has Taught Me So Far
Official diagnosis by the good doctor: borderline personality disorder (BPD). And yes, I am in fact a good candidate for this special type of therapy, dialectical behavior therapy (DBT).
The instability of my moods and self-worth are (partly) to blame for my unstable relationships. The abandonment. The people I’ve lost who I agonize about.
To say this diagnosis changed my life would be an understatement. I have others, but this one is different. Bigger.
Sometimes, when I think about what all comes with living with BPD, I get so overwhelmed at how hopeless it all seems, that recovery was never a road meant for me. But more often than not, I know that’s just the disorder talking. And they all do it.
And I couldn’t decide on the drive to the hospital… Is it better or worse not to have it? Because if I don’t then what is wrong with me and if I do, well, the mess that is my life makes much more sense. But I also don’t want this. It’s so much bigger than just depression or anxiety. It’s overwhelming and required a huge change in my life that, yes, has been for the better (for the most part) but certainly hasn’t been easy.
But I understand myself a little bit better, I think, learning that I have BPD. I guess that’s the silver-lining.
Unstable, unsure, abandoned.
It’s the most frustrating, helpless feeling. It’s exhausting – for me, for everyone in my life. But I can’t help it. And I don’t want to apologize for my mental illness, in fact I am done apologizing for it, but getting the people in my life to understand has been the biggest challenge that sometimes seems hopeless.
Before starting DBT, I first had to understand what BPD was.
Here are my symptoms:
- Fear of abandonment.
- Unstable or changing relationships.
- Unstable self-image, struggles with identity.
- Suicidal behavior or self-injury.
- Varied or random mood swings.
- Constant feelings of worthlessness or sadness.
- Problems with anger and loss of temper.
- Stress related paranoia, loss of contact with reality.
My “co-morbidities:” depression, severe social anxiety, post-traumatic stress disorder, panic disorder, ADHD, self-harm and various sleeping problems.
So that’s more than a lot to deal with. But as I learned about the disorder, recognized my symptoms, identified my co-morbidities – it all made sense to me.
All I knew going in to DBT was that it’d be around five to six months and that it’s a group setting – which immediately caused a reaction in me. I worried about someone I know being in the group, if my anxiety would even cooperate and all sorts of other things… Turns out, it was probably the best thing I could do for myself at the time, and I actually found myself worried about when group would end.
It’s a strange feeling — being in a room of strangers who know you in a way that probably nobody else ever will. We knew nothing about each other’s lives, our personalities — but we knew what we were all going through was very similar. The first 20 minutes it was clear we knew and understood each other like nobody else in our lives.
DBT is made up of four modules, and each has specific sets of skills to go with them.
Mindfulness was first. Mindfulness is the practice of being aware fully and present in the moment. It’s called One Mindfully.
Emotion Regulation was next, which is a guideline of how to change emotions you want to change.
Third was Distress Tolerance — how to tolerate pain in difficult situations, not change it.
Lastly, Interpersonal Effectiveness – how to ask for what you want and/or say no while maintaining respect for self and others.
The Middle Path was the unofficial fifth module, I guess. The gist of it — two things can be true at once.
I struggled, and continue to struggle with Mindfulness. But I committed myself to at least try. It’s surprising how difficult being one-mindful can be; putting everything else in your mind aside for just this moment and focus on this one thing. This is where my ADHD puts me at a disadvantage in a big way. Judgments were another big part of mindfulness — on others and yourself. For me, it wasn’t so much about other people, it was how often and badly I was judging myself. I will always struggle with this, I think. An important quote I learned from this: “Don’t judge your judging.”
Emotion Regulation might be the most important one for me, personally. The most challenging. A particularly difficult part is having — trying, to incorporate Mindfulness into it. Being mindful of your emotions by identifying them, know what they do for you. And most importantly, for me, letting go of painful emotions using mindfulness, remembering that emotions are not facts.
Parts of distress tolerance and emotion regulation are interchangeable, I think. Part of one of the skills for emotion is called Coping Ahead, which is to have a plan; rehearse it ahead of time so that you’re prepared for whatever outcome. It’s very relevant in Distress tolerance. Experience your emotion; do not try to get rid of it or push it away, but also not to hold onto it. Remember you are not your emotion, remember when you felt differently. And do not judge your emotion. This, I feel, is important. Every day it’s a struggle for me but I really do believe it – it’s OK to feel however you’re feeling. Invalidating your own emotions only does more harm to you.
Interpersonal Effectiveness, though challenging, is so, so useful and important. I said it before, but trying to get others to understand is the most difficult and frustrating thing. This at least gives us a script, so to speak, to start from.
DBT is something you have to continue practicing daily. You cannot just finish the group program and forget about it, about what you learned and assume you’re all better now. It’s an on going thing. And hopefully it will become easier to manage later on, but that will only happen if you take the responsibility of using your DBT skills every single day.
Like I said in the beginning – this disorder is so much bigger than you probably realize at first. It’s going to take work and you’re going to want to give up — I know I have, but I really think it’s worth it. You’re worth it.
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Thinkstock photo via OGri