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Thread: DBT for Depression & Anxiety

  1. #1

    DBT for Depression & Anxiety

    Dialectical behavior therapy provides tools for taking control of emotions and behavior

    Dialectical behavioral therapy (DBT) teaches people to better regulate their emotions to serve their goals, increase their sense of personal identity, improve their judgment, sharpen their observational skills and reduce the sense of crisis in their life. DBT is a psychosocial treatment developed by Marsha M. Linehan, a psychologist at the University of Washington, for individuals with borderline personality disorder, but it has been proven effective as a therapy for people with other diagnoses, such as depression, bipolar and anxiety disorders, as well.

    In Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression and Anxiety, Thomas Marra, Ph.D., (2004 New Harbinger Publications Inc) provides a blueprint anyone can follow to put this therapy to work in their life.

    In the book, Marra teaches you to identify dialectics: competing demands that require different and incompatible responses. For example: You want to feel good, but you don't have the initiative to take part in activities that could be enjoyable. He focuses on the dialectics we respond to with contradictory reactions:

    Activity: I don't let my momentary feelings interfere with my long-term plans.
    Passivity: When I'm anxious or depressed, I stop and wait for a better day.

    If you're depressed, you may be passive out of a sense of incompetence, hopelessness or lack of energy. But sometimes passivity is appropriate, for instance, as a way to tolerate feelings while you wait for a more propitious time to act.

    DBT invites you to consider balance and strategy on a continuum at any particular moment. Balance means that your responses aren't always extremes. The strategy is to change your responses along the continuum depending on your goals, not on your mood.

    DBT is about learning to regulate and tolerate your feelings, to change your feelings and their intensity and learn how to endure unpleasant feelings when appropriate.

    Emotions, Marra emphasizes, just like sight, hearing, taste and touch are a form of information processing vital to our quest for survival. Sometimes our senses fail us. What we thought we saw turns out to be something else. Yet, if our emotions are invalidated, we feel ourselves invalidated. "Feelings," says Marra, "are never wrong. They just are."

    With anxiety, depression and bipolar disorder, meaning shrinks. We avoid potentially meaningful situations as our interpersonal world shrivels, notes Marra. Depression causes us to question the meaningfulness of our lives. But the engagement in meaningful activities and relationships reduces depression. Marra's asks us to search for the things that are important in our lives:

    • What would I miss if it were taken from me?
    • Where do I go when I need comfort?
    • Does this speak to both my heart and my head?

    Mindfulness, an important element of dialectical behavioral therapy, is the ability to improve your observational skills and enhance your interaction with your environment. Mindfulness comes from the Buddhist tradition. Emotional regulation begins with identifying the emotion, what thoughts are accompanying the emotion, what prompted it, what behavior results from it, and what, if any, consequences resulted.

    Taking control of your life takes energy, courage, patience, humility and sensitivity, says Marra. But dialectical behavioral therapy is a tool that can bring about improvements to anyone's life.

    Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression and Anxiety, Thomas Marra, Ph.D., (2004 New Harbinger Publications Inc) can be used as a self-help tool, or ask your doctor for a recommendation to a DBT therapist or program.
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

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  3. #2

    Re: DBT for Depression & Anxiety

    The dialectics of depression
    by Renee Hoekstra, Psy.D, Boston DBT Groups blog

    Dialectics has to do with the concept that two seemingly inconsistent or incompatible ideas can both be true. Conflicting realities have elements of truth that can both fit together despite being conflicting. One is not more true than the other, and one is not more true at the expense of the other.

    The treatment for depression generally involves behavioral activation--taking some sort of action to increase contact with pleasurable events or rewarding activities. Depressed people become easily overwhelmed, tend to avoid people and activities, and withdraw from life. This inactivity also decreases contact with naturally rewarding interactions. The agenda of behavioral activation is to get people engaged with with people, activities, or events that generate pleasure, give meaning, and provide a sense of accomplishment. Without these things, it kind of makes sense that people get depressed. So the message is essentially: Put your energy towards getting active, engaged, and connected!

    On the other hand, people who are depressed often feel a great deal of misery. Often they struggle with unreasonable guilt and low self-esteem. They may have made multiple attempts at making connections and have had bad experiences. They may have reached out and been punished for it. They may feel so bad about themselves--and have worked so hard on changing who they are--that they got lost along the way. They may have stopped liking themselves because they worked so hard to make things different. They may have become exhausted at the prospect of change. They may have a very strong need to be accepted as they are--without having to do something, keep changing, and keep trying.

    Do you see the dialectic? 1) Changing behavior is a part of the treatment for being less depressed. Get involved! 2) Don’t try to be or become something that you are not. You are fine just the way you are!
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  4. #3

    Re: DBT for Depression & Anxiety

    "The agenda of behavioral activation is to get people engaged with with people, activities, or events that generate pleasure, give meaning, and provide a sense of accomplishment. Without these things, it kind of makes sense that people get depressed.

    The depression makes you do even more depressing things and avoid cheery things.... Wow. It's no wonder why it just gets worse with time if nothing is done about it. My advice to bummed out people (not suicidally depressed!) is to get OFF THE COUCH and peel off the comfies and shower and clean up and dress up and GET OUT. Sure you don't feel like going out! You're depressed! Sometimes just doing some dishes or cleaning something can make me feel better - and give me a small but badly needed sense of accomlishment. And once I start, it often leads to something else! It's not a cure for depression, but it seems that the fight against depression is won one little decision and action at a time. Just one little thing that requires ACTION to get the ball rolling. Slumping in a dark room and staring at the wall.... yep, that would depress even a happy well-adjusted person!

    This article just makes sense to me. Love it!

    Thanks Daniel!

  5. #4

    Re: DBT for Depression & Anxiety

    Secrets of Psychotherapy (Part 4) : Change or Acceptance?

    ...Acceptance is acknowledgment of what is. Acceptance is non-judgmental, not a matter of deeming something good or okay. Freedom from suffering requires accepting rather than resisting reality. Choosing to tolerate pain or distress in the moment is acceptance. Accepting rather than avoiding painful emotions actually alleviates suffering.

    Dr. Linehan's emphasis on the dialectical relationship between change and acceptance in treatment is an excellent example of what needs to happen in any truly effective psychotherapy. To begin with, there are certain things in life that cannot be changed, and some that can be--albeit often only with sustained effort. This recognition is reflected in the famous serenity prayer of Alcoholics Anonymous: "God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference." Also inherent in the AA approach is the requirement to accept one's utter powerlessness over alcohol (or other substances or addictive behaviors) as a prerequisite for change. The problem must be unequivocally accepted before it can be changed.

    Basically what must change is our refusal to accept ourselves and others as we and they are right now. This is a true paradox. When people first come for psychotherapy, they frequently hope to change themselves and/or others in ways that are simply not possible. But, by definition, wanting to change something or someone implies there is something wrong-- some insufficiency, inadequacy, flaw, weakness, inferiority--an inherent imperfection that needs changing. Many patients hold beliefs of being unlovable and unworthy of love as they are. What is lacking is the ability to unconditionally accept themselves just as they are in this moment, despite their human imperfection. (See my previous post on the "inner child.") At the very same time, certain changes must clearly be made. Changes in self-defeating perceptions, attitudes, old myths of oneself, life-style, and other destructive behavior patterns. But the paradox is that sometimes it is only through acceptance of what Carl Jung called the shadow that such changes can happen.

    The acceptance of life on its own terms--the inevitability of suffering, the vagaries of fate, the tragic quality of existence, the reality of evil, impermanence, loss, illness, aloneness, insecurity, finitude, aging and death--is as essential as any behavioral or psychodynamic technique, pharmacological intervention or cognitive restructuring designed to directly change or "fix" the troubled patient.(See my previous post on The Trauma of Evil.) Accepting our own neurotic tendencies, resistances, defense mechanisms (see previous post), complexes, biology, temperament, typology (see previous post), feelings, thoughts, impulses, shortcomings, idiosyncrasies--and our innate capacity for destructiveness along with our strengths, talents and creative potentialities (the daimonic)-- is in itself a major therapeutic change for the discouraged, guilt-ridden, self-loathing, hyper-moralistic, narcissistic, repressed, dissociated or perfectionistic patient. Indeed, acceptance--of oneself, one's emotions, thoughts, behavior, problems, and one‘s proportionate responsibility for them--is precisely the kind of philosophical or spiritual reorientation required in psychotherapy for any real and lasting change to occur. And much of that enduring change adds up to acceptance.
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

  6. #5

    Re: DBT for Depression & Anxiety

    A related workbook for bulimia:

    The Dialectical Behavior Therapy Skills Workbook for Bulimia: Using DBT to Break the Cycle and Regain Control of Your Life

    And some research studies.

    A quick summary of the research:

    Recent studies show promising results for using DBT in the treatment of eating disorders, particularly binge eating disorder and bulimia. For example, the first few published clinical trials reported 82 to 90 percent rates of abstinence from binge eating at the end of a 20-session DBT therapy program. With ongoing research, DBT may become a widespread approach for treating eating disorders.

    Treating Eating Disorders Using Dialectical Behavioral Therapy |
    And from that same article:

    How DBT Can Help

    Because of the emphasis on regulating emotions and finding healthier coping mechanisms, DBT is increasingly being incorporated into contemporary eating disorder treatment. Eating disorders are often characterized by deeply negative emotions, impulsive behavior, and desperate attempts to relieve emotional or psychological pain. According to eating disorder specialists, DBT is a natural fit in treating these life-threatening conditions.

    Specifically, DBT teaches eating disorder sufferers to identify triggers for disordered eating and find better ways to respond to stress, such as breathing or relaxation exercises, taking an emotional timeout, or finding a healthy distraction. It also guides eating disorder sufferers through the practice of mindful eating, increasing awareness of emotional responses to food while preparing and eating meals. To combat guilt, shame, and other self-defeating emotions, DBT encourages people to recognize and accept their feelings without judging them as “good” or “bad” or acting out behaviorally.

    According to Thomas Marra, Ph.D., author of Dialectical Behavior Therapy in Private Practice: A practical and comprehensive guide, the goals of a DBT approach to eating disorder treatment are:

    Increasing the variety of emotional inputs available in a patient’s environment;

    Increasing the variety of need fulfillments;

    Validating the worth of the individual;

    Increasing frustration tolerance, learning strategic behavior skills;

    Increasing sensory input (mindfulness) to substitute sensual activities for food satiety.

    DBT is also easy to understand and implement, allowing eating disorder sufferers to put a label on each skill so they have practical things they can do in the moment to make the situation better. As patients master specific skills, they are more aware of problem behaviors, are able to think before they act, and feel confident in their ability to deal with conflict in healthy ways.

    Treating Eating Disorders Using Dialectical Behavioral Therapy |
    There's also some videos at YouTube:
    "What lies behind us and what lies before us are tiny matters compared to what lies within us." ~ Ralph Waldo Emerson

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