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Marsha Linehan, the creator of Dialectical Behavior Therapy, outlined strategies for any problem that you face.
No Matter What the Problem, There Are Only Four Things You Can Do
By KARYN HALL, PHD
When faced with a difficult problem, you might find yourself paralyzed over deciding what to do. Emotionally sensitive people often have difficulty making decisions, tend to ruminate about issues and can become increasing upset as a result of thinking about the issue over and over.
Searching and searching for the right solution, perhaps one that won’t upset others or cause pain or loss, adds to anxiety and upset. How can someone find just the right solution and know what the right solution is?
Marsha Linehan, the creator of Dialectical Behavior Therapy, outlined strategies for any problem that you face. Remembering these options can help decrease the struggle of not knowing what to do. The four options are Solve the Problem, Change Your Perception of the Problem, Radically Accept the Situation, or Stay Miserable.
Continue reading No Matter What the Problem, There Are Only Four Things You Can Do →
Quote on Radical Acceptance from Dr. Marsha Linehan:
“Radical acceptance is not simply a cognitive stance or cognitive activity; it is a total act. It is jumping off a cliff. You must keep jumping over and over because you can only accept in this one moment. Therefore, you have to keep actively accepting, over and over again in every moment.
If radical acceptance is jumping off a cliff into the deep abyss, then there is always a tree stump coming out of the cliff just below the top and the minute you fall past you reach out and cling onto that stump. And then you’re on another cliff’s edge, asking perhaps, “How did this happen?” Then, you jump off the cliff again.
Radical acceptance is the constant jumping off, jumping off, jumping off and jumping off, yet again. Radical acceptance is also the nonjudgmental acceptance of the repeated grabbing onto the tree stump.”
ANNE* ALWAYS felt she was different from everybody else and, having had a difficult early childhood, by the time she was a teenager she did not think she belonged in this world.
A therapy that helps to rebuild broken lives
SHEILA WAYMAN
Tue, Dec 27, 2011
ANNE* ALWAYS felt she was different from everybody else and, having had a difficult early childhood, by the time she was a teenager she did not think she belonged in this world.
“I believed I was invisible – I didn’t think people saw me,” she says. “I was insecure and very mixed up about my own identity; I did not know who I was, or how to fit in to life.”
From her mid-teens on, she attended a succession of psychiatrists and counsellors and was prescribed various medications for her “mood”. However, becoming a wife and mother gave her a new, positive feeling of belonging, and she moved on to become a mature student, followed by short-term work placements and voluntary work.
But when, in her 40s, life threw up challenges over which she had no control, her thoughts and emotions began to change rapidly.
Old fears of being abandoned returned; she became angry and impulsive. She started to self-harm and contemplate suicide; she misused alcohol and became dependent on prescribed medication.
It was only then that she was diagnosed with borderline personality disorder (BPD) and she began to understand the impact it had on her.
BPD is a broad category of mental health problems, often defined by “really powerful emotional distress and sometimes a lot of problems in relationships”, says Jim Lyng, a counselling psychologist with Cluain Mhuire, a community-based adult mental health service in the southeast of Dublin.
Affecting an estimated 1-2 per cent of the population, the disorder is characterised by impulsive and often life-threatening, self-destructive behaviour. Problems tend to start to show before a person reaches adulthood, as they begin to cope with their emotions in extreme ways.
“In a heightened state, people start to make desperate choices,” he explains. Talking of deliberate self-harm or attempts at suicide as “cries for help” misses the point, he suggests. “They are desperate attempts to cope.”
Luckily for Anne, she is living in one of the few areas of Ireland where the successful, evidence-based treatment programme of dialectical behaviour therapy (DBT) is available. Within weeks of diagnosis, she started DBT at Cluain Mhuire.
DBT was developed by Dr Marsha Linehan from the University of Washington to help people with a history of repeated self-harm and suicidal behaviour, many of whom would be classified as having borderline personality disorder.
And it was only this year Linehan disclosed that she has struggled with the disorder herself – so first-hand experience informs the therapy. Continue reading A therapy that helps to rebuild broken lives- DBT →
In DBT, in the distress tolerance module, there is a concept of willingness versus willfulness. I find this concept particularly important and akin to the being right (willfulness) vs being effective (willingness) concept. Here is some information about willingness versus willfulness:
WILLINGNESS
- Cultivate a WILLING response to each situation
- Willingness is doing just what is effective in each situation, in an unpretentious way.
- Willingness is listening very carefully to your WISE MIND, acting from your inner self and your deepest core values.
- Willingness is becoming aware of your connection to the universe and to the person you are interacting with.
- Willingness engenders listening and mentalizing.
- Ask yourself, in 5 years from now, will the situation that causes the distress matter?
WILLFULNESS
- Willfulness is like sitting on your hands when action is needed, refusing to make changes that are needed.
- Willfulness is about the desire to be right in a situation, regardless of what is needed to get through effectively.
- Willfulness causes you to fight any suggestions that will improve the distress and thus make it more tolerable.
- Willfulness is being rigid and inflexible.
- It is the opposite of doing what works, of being effective. Willfulness is trying to fix every situation or refusing to tolerate the distressful moment.
That last example in willfulness is particularly important to read and consider. Often, I find the loved ones of borderlines to be “fixers” and try to solve each problem for the borderline. Being willing to listen, and really hear what the other person is feeling and going through is usually more effective, despite the distress it may cause, than telling the other person what to do or giving advice.
Adapted from dbtselfhelp.com, with edits and additions by Bon
 DBT iPhone App Are you in DBT? Do you want to know more about it? The creator of the new DBT iPhone application has graciously provided me with a coupon code for a free version of the app. If you’d like to receive this coupon code and want to download the app to your iPhone for free, please send me a direct message on twitter @bondobbs. I only have one, so I expect it to go fast.
UPDATE: You can also claim this code by commenting on this post and providing your email address (which is not shared). I will email you the code and instructions if you have problems redeeming it.
UPDATE 2: Code is gone! Sorry. However, if you’re still interested in the app go to www.diarycard.net
UPDATE 3: I got another code. The last one went fast. If you want it comment on this post.
UPDATE 4: Sorry the second code is gone. Yet, if you want the app for free, comment here. I will not post the comment, I’ll just ask for more codes and email them if I can get them. The codes are limited. Act fast!
UPDATE 5: OK, I’ve given away several codes. I have one more… the final one for me. If you want the final code, please comment on this thread. I will not post the comment, but will send you the code.
FINAL UPDATE: All codes are now gone. Thanks to Sammy for providing them to my readers!
 The Holidays can be a time of stress The holidays are often thought of as a time of warmth and happiness, family gathered around the table creating wonderful family memories. But for many of us, it can also be a time of angst and anxiety. (link to the article)
There are many reasons you may feel stress. Perhaps you are a student struggling with school and are afraid of criticism from your family. You may be unemployed and don’t want to face questions about your job search or finances. Maybe you’ve put on or lost “too much” weight this year and are feeling self conscious. If you have been struggling with depression, mood swings or anxiety, you may be more emotionally vulnerable. This time of year could remind you of someone who has become ill, passed away or moved.
There are as many reasons for holiday stress as there are individuals. All of them are what we at Silver Hill call “triggers” – they can bring about or literally “trigger” feelings of anxiety, loss and frustration.
The holiday season and family events can be enjoyable and help build meaningful connections with the people in your life, but if triggers set you off, you may instead find yourself caught in a riptide of emotion.
In the Silver Hill Dialectical Behavior Therapy (DBT) Program, we teach our patients strategies to deal with triggers like these. Three of the strategies are Radical Acceptance, Coping Ahead and Wise Mind.
Radical Acceptance
People usually do not change much from year to year. Personality traits you find irksome will still be there. Your snarky nephew will continue to be snarky. The self-obsessed sister will still be self-obsessed. Your mother-in-law will continue to make comments about your appearance or weight.
Expecting them to be kinder and gentler will only lead you to disappointment. Remember, unrealistic expectations are disappointments waiting to happen. Making matters more interesting, people tend to regress when they are around family. You may too. So if your brother really was a “brat,” don’t be shocked if he becomes a grown-up version of his former self. Accepting this fact, and dealing with the people as they are, will reduce your stress.
But Radical Acceptance works to your advantage because the flip side is also true: People who were good will most likely still be good. Your ever warm and wonderful grandmother will continue to be that way. The cousin with the infectious laugh will not let you down, and your always helpful brother-in-law will be his old self too.
Find a way to accept your own personal cast of characters, the good and the bad. It will help you with the next strategy called “Cope Ahead.” Continue reading Family Dynamics Around the Holiday Table →
A new DBT diary card app for the iPhone. I personally don’t have an iPhone, so I haven’t tested it, but the images look group. Here is the text of the About page (most of it) from the www.diarycard.net page:
This app was developed by Dr. Sammy Banawan in Durham, NC. Dr. Banawan maintains a full-time private practice in Durham where he also did his internship and post-doctoral fellowship at the Duke University Medical Center. During his post-doctoral fellowship, he worked directly with Dr. Marsha Linehan and her colleagues in continuing to adapt DBT for a variety of psychological conditions.
While this app was developed by a mental health professional, it is not intended to replace a therapist. You will get the most from the app with the aid of a DBT-trained psychotherapist. Remember that if you are actively suicidal or engaging in self-injurious behaviors, you need to be working with a therapist.
This application was created in an effort to bring psychotherapy practices up to 21st century standards. As more and more people carry around mini-computers in the form of smartphones, having to use sheets of paper to record something like behaviors or emotions seems a little ridiculous. It was also designed with the utmost in customizability in mind since no two people are working on the same sets of issues or with the same sets of treatment targets.
Over years of experience treating patients using Dialectical Behavior Therapy, we started to get a sense of what most people need to track and what types of coaching is useful and that’s where the app starts. As you use it and add more of your own information into it, the app will start to be even more helpful to you.
By her own admission, Talya Lewis was a strange child – as early as kindergarten:
Lewis: Like I remember one day I came in with white sticky tape wrapped all around my arm, and I told everyone that it was a cast and I had broken my arm.
Desperate for attention, she convinced her mother she couldn’t see, and got prescription glasses. By age 8 – her behaviors were self-destructive:
Lewis: I had a game, and I called it TP, and TP actually stood for taking pills. I would rummage in my parents’ medicine chest and I would take their pills.
This was only the beginning. Over the next years, Talya knocked her front teeth out with a hammer, started taking drugs, cutting herself, her behavior out of control in school. Her parents, whom she describes as distant socialites, didn’t seem to notice. But then came the wake up call.
Lewis: I overdosed on a bottle of sleeping pills in my high school, in the front lobby, and that was the beginning of what ended up years of long-term confinements in a private psychiatric hospital.
Talya was diagnosed with Borderline Personality Disorder, or BPD. Philadelphia therapist Edie Mannion describes it as a severe and complex mental illness with many symptoms:
Mannion: Difficulty regulating emotion, like a broken emotional thermostat, and difficulty controlling impulses, and what I see as mostly a profound amount of emotional pain. Continue reading Understanding Borderline Personality Disorder from WHYY →
A mere critical stinging comment can just as easily send a person suffering Borderline Personality Disorder into “emotional anaphylactic shock.”
… from an insightful blog post by Sonia Neale. Here is the text of the post:
Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance
By SONIA NEALE
Sometimes, the smallest things in life can cause the greatest pain and physical reaction. A bee’s sting is almost invisible to the naked eye and yet can easily kill someone when they have an allergic reaction. A mere critical stinging comment can just as easily send a person suffering Borderline Personality Disorder into “emotional anaphylactic shock.”
When a person has a life-threatening reaction to the poison from a bee sting, an ambulance is called and the person is taken to hospital where they receive treatment for their illness as well as respect and dignity but when someone suffering an emotional reaction to life circumstances presents at emergency, they are sometimes treated with rejection, intolerance and disdain. People can die from a bee sting and Borderlines can “die” from their own personal rage and self-hatred. If you present at emergency with a swollen face and throat unable to breathe with all your body organs shutting down, is some doctor or nurse going to say, “OMG, it’s a tiny bee sting, how bad can that be, look at you, get over yourself,” like they sometimes do when Borderlines present at hospital with similar symptoms.
Yet both types of people are in much pain and danger. One is considered entirely physical and the other is considered entirely emotional. Or is it entirely emotional? When a sensitive person with a history of trauma has an emotional “bee-sting” reaction to someone’s criticism there is a definite physical reaction.
Borderlines tend to be hypervigilant, which means they live with permanent muscle tension and a certain excess of adrenaline pumping round their system at any given time. So when criticism hits, the body goes into an emotional anaphylactic state where cortisol floods the brain and body system and a type of blackout occurs where nothing anyone says or does registers. Your body has gone into “shock.” When I used to get into such a state someone could have cut my arm off and I would not have noticed.
Things are said during this time that are simply appalling. I have used language I would not use in normal everyday life. I have said things that are deeply hurtful and as my husband has said, “you can mend a vase but the cracks are always there for those to see.” My therapist says it is best to repair those cracks with gold. Her favourite quote, by Barbara Bloom is “When the Japanese mend broken objects they aggrandize the damage by filling the cracks with gold, because they believe that when something’s suffered damage and has a history it becomes more beautiful.” I prefer her take on this matter.
Therapy has taught me that my perception of events and criticism is usually erroneous. Even if people are critical and disrespectful, it is about them and not me. If my ideas get criticized it is not because I am a loser and I deserve to die, it is because we both have a different belief system and ways of handling situations. There is no right or wrong, just opinions.
I have criticized my therapist on many occasions including recently when she raised her colleagues’ fees in the light of almost certain public benefit cuts. Her reply was that her practice survived before the benefits were given and hopefully will survive after the benefits are cut. She raised her fees because she valued herself and her colleagues. She did not feel the need to get upset or question herself or her actions because she believed that what she was doing was the right thing to do. Continue reading Borderline Emotional Anaphylactic Reaction: Mindfulness and Acceptance →
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Release date October 1, 2009.
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Swedish DBT researchers and clinicians prepare to release a DBT app for the iPhone. Yesterday, I received a message from Andres Nordlund. It read:
My name is Andreas and I follow your web and twitter messages.
I’ve noticed and applaud your efforts to help BPD and self-harm in particular.I would like to make you aware of my newest project which is a DBT Self-help app for Iphone. Developed by myself in collaboration with some of Swedens top DBT-therapist we hope that this App really will contribute to therapy effects, especially with skill acquisition and generalization into everyday life and crisis situations.
Please read more att www.dbt-app.com and help spread the word, this app can help both therapists and clients.
The website (which is sadly still under construction) includes the following information about the app:
The user will have the opportunity to learn about:
- Using effective skills to manage and regulate emotions, to act in relationships and presence in his life.
- To cope with overwhelming feelings, without acting impulsively.
- Identify and regulate their emotions and change their behavior to increase positive emotions in life.
- To increase awareness and strengthen its attention to what is happening here and now.
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