Clinical

Personality Disorders

Talia Malon Scientific , , , ,

Please view the post, ‘Personality’ for a definition and discussion on development of a personality. This also includes a brief outline of the clusters that personality disorders are grouped into. Personality disorders are also used as classifiers with depression.

There are many types of personality disorders and to simplify things, they are grouped into three clusters: Cluster A, Cluster B, and Cluster C.

Cluster A Personality Disorders

Cluster A disorders are characterized by odd and eccentric behavior or thinking. These disorders include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

  • Paranoid personality disorder is characterized by a lack of trust and suspicion of others, unjustified belief that others are ‘out to get you’, hesitancy to confide in others, angry or hostile reactions and a tendency to hold grudges. The essential feature for paranoid disorder is interpreting the actions of others as threatening or demeaning. This type of person may appear jealous, secretive and emotionally ‘cold’.
  • Schizoid personality disorder is characterized by a lack of interest in social or personal relationships, a preference to be alone, a limited range of emotional expression, inability to have pleasure in activities, and inability to pick up on normal social cues. The essential feature for schizoid disorder is appearing introverted, withdrawn, and distant. This type of person is often absorbed in their own thoughts and fears closeness with others.
  • Schizotypal personality disorder is characterized by peculiar dress, thinking, beliefs or behaviors, odd perceptual experiences, flat emotions, “magical thinking”, and the belief that casual incidents or events have hidden messages. The essential feature for schizotypal disorder is a pattern of peculiarities. This type of person has difficulty forming relationships and may act inappropriately during social interactions.

Cluster B Personality Disorders

Cluster B disorders are characterized by dramatic, overly emotional, or unpredictable thinking or behavior. These disorders include borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder.

  • Borderline personality disorder is characterized by impulsive and risky behaviors, unstable self-image and self-esteem, up and down moods, intense fear of abandonment, ongoing feelings of emptiness and intense displays of anger. The essential feature for borderline disorder is abrupt and extreme mood changes and self-destructive actions. This type of person is impulsive, self-destructive, socially dependent and have a difficulty with their sense of identity. This disorder is often misdiagnosed as bipolar disorder.
  • Antisocial personality disorder is characterized by a disregard for other’s needs or feelings, persistent lying and stealing, recurring problems with the law, aggressive behavior and lack of remorse for behavior. The essential feature for antisocial disorder involves ignoring social norms while acting out their conflicts, no respect for others and no remorse for their actions. They are at a higher risk for substance abuse because of their behaviors.
  • Narcissistic personality disorder is characterized by fantasies of power, success and attractiveness, failure to recognize other’s needs and feelings, exaggeration of achievements or talents, arrogance, and expectation of constant praise and admiration. The essential feature for narcissistic disorder involves having an exaggerated sense of self-importance and a constant need for attention. This type of person is over sensitive to failure and prove to extreme mood swings between self-admiration and insecurity.

Cluster C Personality Disorders

Cluster C disorders are characterized by anxious, and fearful behavior or thinking. These disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder.

  • Avoidant personality disorder is characterized by sensitivity to criticism or rejection, feelings of inadequacy, inferiority or unattractiveness, avoidance of interpersonal contact, social inhibition and fear of disapproval, embarrassment or ridicule. The essential feature for avoidant disorder is excessive social discomfort. This type of person usually has no close relationships, although they would like to and are upset at their inability to relate well to others.
  • Dependent personality disorder is characterized by excessive dependence on others and the need to be taken care of, submissive or clingy behavior, fear of fending for yourself, lack of self-confidence, difficulty disagreeing with others and tolerance of poor or abusive treatment. The essential feature is a pattern of submissive and dependent behavior, rely on others to make decisions. This type of person is usually uncomfortable and helpless if they are alone and can be devastated if a relationship ends.
  • Obsessive-compulsive personality disorder is characterized by a preoccupation with details, orderliness and rules, extreme perfectionism, a desire to be in control, excessive commitment to work and an inability to discard broken or worthless objects.The essential feature for  obsessive-compulsive disorder is a striving for perfection and rare satisfaction with their achievements. This type of person is reliable, dependable and methodical, but inflexible to change. They are highly cautious and pay specific attention to detail.

This is just a brief summary of a few of the more typical personality disorders. Although you may identify with the traits of various disorders, a doctor would need to decide whether or not you should be diagnosed with it. Every person can identify with various aspects of personality disorders because no one person’s personality is perfect. We’re all different and that’s ok.

  1. Mayo Clinic
  2. Mental Health America
  3. American Psychological Association
  4. US National Library of Medicine
  5. Psychology Today
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Personality

Talia Malon Scientific , , ,

Personality is a very fluid idea. Often times, our actions or reactions are blamed on our personality. “That’s just how they are.” But personality is actually developed through the situations and environments we experience during adolescence. Our personality is affected by our temperament and our character. The APA defines personality as, “individual differences in characteristic patterns of thinking, feeling and behaving”. Personality can also be defined as a set of traits or characteristics that uniquely influence a person’s behaviors and thoughts is various situations.

Personality evolves over time. It does not remain stagnant. Our behaviors and traits are influenced by our life experiences and relationships. Personality traits are also reinforced by our experiences. In many ways an unhealthy personality trait can be reaffirmed when a life event doesn’t go as planned. However, in this way you may also be committing a self-fulfilling prophecy. A self-fulfilling prophecy is when a person unintentionally and/or unconsciously fulfills a preconceived notion or idea, whether it be positive or negative. The only experience I have ever had with self-fulfilling prophecies have been negative.

There are also illnesses regarding personality. These of course, would be considered personality disorders. A person can have certain individual traits of a disorder without having the disorder. A personality disorder is defined as “a pattern of thoughts, feelings and behaviors that are consistently exhibited over a long period of time and create emotional and mental distress”. Personality disorders exist on a continuum from mild to severe, but left untreated it can reduce a person’s quality of life. Personality disorders can also be considered ‘fatal flaws’.

Personality disorders are grouped into three clusters based on their similarities and symptoms. Cluster A disorders are considered odd or eccentric behavior. This would include schizoid or paranoid personalities. Cluster B disorders are dramatic, emotional or erratic behavior. This would include narcissistic or histrionic personalities. Cluster C disorders are considered anxious and fearful behavior. This would include avoidant, dependent or OCD personalities.

In the next post I will be discussing the various personality disorders within their clusters, their traits and how they are diagnosed. Please remember that even if you display some of these traits, that does not mean that you have a personality disorder. No one is perfect.

  1. American Psychological Association
  2. Mind for Better Mental Health

Acceptance

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Acceptance is important in your life. It allows you to make peace with the your past and move forward with your life. The first step to acceptance is learning what acceptance is versus what it is not.

Acceptance is not forgiveness, forgetting, letting it go, being ok, denial, allowing it, agreeing with it or understanding.

Acceptance is making space, letting yourself off of the hook, especially from suffering and ‘It is what it is’.

There are 10 steps towards acceptance.

  1. Honor the full sweep of your emotions.
    1. Seek to fully feel your emotions and express those emotions that you feel. Understand your emotions, thoughts & embrace them as valuable feedback for your life.
  2. Give up your need for revenge but continue to seek a just resolution.
    1. Let go of your natural instinct to hurt back or take revenge from the person who hurt you. Revenge will give you a false sense of power over another, however this power is considered ‘cheap thrills’ & will ultimately hurt you more over time. Mindfully turn away from retaliation and look to empower, grow & strengthen yourself.
  3. Stop obsessing about the injury and re-engage with life.
    1. Gain awareness to stop & replace repetitive toxic thinking patterns which only cause ongoing distress, trauma and harm. You have to create a conscious awareness and be mindful.
  4. Protect yourself from further abuse.
    1. Accepting the wrongness of the actions allows you to learn how to distance and protect yourself in the future. Use the pain of the experience to learn & grow and take precautions to ensure your safety in the present and future. Make changes.
  5. Frame the offender’s behaviour in terms of their own problems and personal struggles
    1. Try to see things from the offender’s point of view. The wrongful actions are about the person who acted wrongly. “Their neediness to feel important by tearing others down”. The more you know about them and their situations, the more you won’t take their behavior personally. Never let another person’s actions dictate how you feel about yourself.
  6. Look honestly at your own contribution to the injury.
    1. Examine how your actions, approach & choices may have contributed to the situation.This is not about blaming yourself. Authentically examine your own life, self & issues to look at how your own fears, past experiences and beliefs, etc, prevented you from seeing that you deserved so much better. That you didn’t deserve to be hurt. Allow the pain of experience to teach you that you are more than a victim. The person who most needs your forgiveness is yourself.
  7. Challenge your false assumptions about what happened.
    1. Identify and challenge any limiting beliefs or false assumptions. Identify toxic or limiting patterns, and don’t edit or rationalize these ideas. Ask yourself, ‘Is it true? What toxic thinking pattern does it fall under? What limiting belief underlies this thinking? It is an empowering or a limiting belief?’ Is this typical of your thinking? If so, why? If not, why are you thinking in this manner?
  8. Look at the offender apart from his offense, weighing the good against the bad.
    1. Look at the person separate from their actions. Also look at the person & their behaviors for their impact on you and your life. Has their impact been mostly positive or negative?
  9. Decide carefully what kind of relationship you want in the future with the person who wronged you.
    1. How do you relate to this person overall? Is reconciliation possible? If not, is it possible to even interact with the person? Is forgiveness an option? Be gentle with yourself & take time to sort through your emotions. Learn to trust yourself and your feelings.
  10. Forgive yourself for your own failings.
    1. Fully forgive yourself for any of your own mistakes or failings related to the situation. As Maya Angelou has said, “When you know better, you do better”. Your mistakes or failings stem from ingrained old ways of getting your universally human need to matter met. Forgiving yourself will make it easier to let go of obsessive thinking patterns, such as blaming yourself for what happened, which would only keep you from living your life fully engaged with the people and activities you love.

Learning to accept situations, especially ones that are out of your control, will give you more control over your own life. Acceptance is not forgiveness but rather the willingness to allow yourself to learn from the experience rather than allowing the situation to continue to harm you.

Cutting

Talia Malon My Story, Scientific , , ,

To this post I would like to attach a TRIGGER WARNING. This post will contain information about self-injurious behavior which may be triggering to some people.

I used to cut. I found it therapeutic and punishing. I felt like I needed to cut because I needed to be punished. I felt like I needed to be punished because I was a bad person, because I was always doing something wrong, because it felt like there was something wrong with me. There had to be something wrong with me, right? Afterall, that’s why I don’t have any friends. Right?

I was very wrong. Cutting or self-injuring as it is known, is the deliberate act of harming your body. Self-injury is an unhealthy way to handle your issues and is most often done impulsively. There are many ways to self-injure, but I don’t want to get into the how of self-injury. I would like to discuss the why.

For me, there were three reasons why I cut myself. The first was because I was feeling too much emotion and I couldn’t find a way to let it out. These emotions were negative, but I must admit that they were triggered by specific situations and instead of addressing these situations and facing my emotions, I cut to let these emotions out. The second was when I felt numb. I cut because I couldn’t feel any emotion and I wanted, no I needed to feel something, anything, even if it was physical pain. The third reason was because I felt a need to punish myself. There had to be something wrong with me and because I couldn’t figure out what it was, I cut and I punished.

I learned that self-injury wasn’t going to fix my problems. Self-injury could, if continued, make my problems worse. Often, it is seen as a cry for help. Self-injury is not meant to be suicide but it can often follow that path if the person doesn’t seek help.

If you see someone who is self-injuring, talk to them. Don’t accuse them of doing something wrong, just ask them what is wrong. Often times having someone honestly ask, ‘what is wrong’ or ‘is everything ok’ can open up the self-injurer to seeking help. Sometimes all we need to know is that someone cares.

Self-injuring can be a part of mental illness and needs to be treated as such. Therapy can help a self-injuring person with this issue. It can be a temporary, situational issue like mine or it can be a continuing circle. Self-injury is never the answer, and although I understand why people do it, I hope you’ll seek help. I hope you’ll find the help and treatment you need. You don’t need to hurt yourself, you don’t need to punish yourself. Everything will be ok.

Cutting

Mayo Clinic

My Life In Outpatient Treatment: Week 5

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This is a continuation, part 5, of my daily journal while in outpatient treatment for depression, anxiety and avoidant personality disorder. Please click for Week 1, Week 2, Week 3 and Week 4.

Week 5, Day 23:
They don’t think I’m ready to change. That I’m holding myself back but I don’t know what is holding me back.
I have a whole list of things I need to work on with my outside therapist. I will be discussing this in more detail in “Reprogramming Myself”.
I’m supposed to focus on myself. Focus on accepting myself, 24/7.
I’m holding onto ideals that I need to let go of. I have to let go of the old relationship with myself.
But I don’t want or like to put effort into something, unless I know the results.

Day 24:
How do you keep your mind occupied and/or disengaged from negative thinking? Especially when you’re doing something that doesn’t require much thought and your mind begins to wander.
Use games, distractions, ask myself what, and why; be logical about it, and breath.
“Rumination is like fire. You feed it fuel and it grows.”

Day 25:
I decided that I would like to write a letter to myself saying goodbye to the negative me and to the expectations that I had for myself before I became depressed. See letter.
How can I forgive myself for not meeting the expectations I set for myself? Or the expectations I feel are coming from other sources, namely my family? Is that what is holding me back from being able to change?
“He who angers you, controls you.”
We also talked about acceptance today. Acceptance is: “It is what it is”; making space; and letting yourself off the hook (from suffering).
Acceptance is not: denial, forgiveness, forgetting, letting it go, being ok, agreeing with it, allowing it or understanding it.

Day 26:
Today is my final day. I thought it would be more difficult than it was.
I discovered that May in mental health month and the ribbon is a dark green. One of my fellow patients is helping me create a logo for ADAPT. I’m so excited about that!!
After talking with my therapist, I realized I need to write down my goals. I need to have short term and long term goals. During session today, I felt very much in control of myself, my thoughts & my emotions. Let’s hope this continues!!!!
“Wake up from your thoughts and experience life!”

This is the end of journaling while during the outpatient treatment program. I’m interested to hear your thoughts and comments on my journey and I hope that my journey will help yours! Believe me, that it isn’t an easy fight. Sometimes you have to slog through mud, blizzards, ice and treacherous terrain, but I know that any fight is worth my chance of becoming a better and healthier person. You can view Week 1, Week 2, Week 3, and Week 4 at each link.

Alternative Medications & Therapies

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There are multiple different ways to deal with depression and anxiety. This includes alternative medications and therapies. For mild depression, often herbal supplements are easier and more capable of helping than medication.

There are many different types of herbal supplements and remedies. I am only going to discuss three in this post. These would be St. John’s Wort, Omega-3 fatty acids and SAMe. St. John’s Wort is one of the most popular herbal supplements to treat depression. “In 2000, the FDA issued a Public Health Advisory letter stating that the herb may interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and those used to prevent organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Consult with your doctor before taking any herbal supplement” (NIMH)1. Omega-3 fatty acids are found in nuts, flaxseed and oil as well as cold-water fish. More research is needed to determine if Omega-3 fatty acids can help with depression however, just a note that it may interact with other medications. SAMe is a synthetic form of a chemical occurring naturally in the body. More research is also needed to see how SAMe effects depression, however it should be taken carefully by people with bipolar disorder as it may trigger mania.

There are also different types of alternative therapies. These include expressive or creative arts therapy, dance & movement therapy, music therapy, animal-assisted therapy and light therapies. These alternatives can help those with mild to severe depression and are often used in conjunction with talk therapies.

Expressive or creative arts therapy is when a patient used expressive acts such as writing, art, or music to help themselves emotionally. Art therapy encourages patients to express their feelings through the use of artistic materials like paint, markers or pencils. Expressive therapy allows a person to express themselves emotionally, through a helpful medium and allows them to find coping skills and deal with traumatic events while healing. Dance and movement therapy or DMT follows the same theory as expressive or creative arts therapy. The patient uses dance and movement to express their feelings and thoughts about their life situations. DMT is based on the idea that the body and mind are interconnected and that movement can affect their minds and thoughts.

Music therapy is something people use daily without realizing it. Please click here to read more about music and its affect on a person’s mood. Music is often used to aid in meditation and relaxation. Often patients will either listen to music that they relate to or make music to explore ways of expressing oneself.

Animal-assisted therapy includes working with various animals to help patients cope with their wishes and develop ways to communicate. Companion animals are often used in hospitals, nursing humans and psychiatric wards to bring comfort and joy to those with despair. There are claims that working with animals has a physiological benefit through increased level of activity and the act of caring for another. Interacting with animals is believed to improve confidence and increase acceptance and empathy. I will be discussing the use of Emotional Support Animals in a future post.

Light therapy is most often used to treat seasonal affective disorder or SAD, which is a form of depression that occurs during the winter months. Light therapy is the use of a full spectrum light in either a lamp or a box, that a person uses for periods of time. This can help those who struggle when daylight is at its shortest.

Aromatherapy is also used as a self-sooth or de-stress technique. Incense, candles and essential oils are all used for aromatherapy. Other complementary or alternative treatments for depression are meditation, yoga, spirituality, exercise and acupuncture. I will be discussing meditation in a future post.

These are just some of the alternative and complementary medications and therapies that can be used to treat depression, however these will not replace traditional therapy and medications for moderate to severe mental illnesses. These therapies can be used in conjunction with modern medicine to lessen the affects of your disease.

Anxiety and Depression Association of America
National Institute of Mental Health
National Center for Complementary and Integrative Health
Mayo Clinic

Self-Soothing

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One of the biggest coping skills taught in outpatient treatment is self-soothing. Self-soothing falls under DBT or the Dialectical Behavior Therapy. It is used when a person is feeling distressing, and when situations and emotions are overwhelming. Self-soothing is also known as a deterrent to self harm, because instead of doing something to hurt yourself, you’re doing something that gives you comfort and pleasure. These suggestions can help you feel better, calm down, and even feel relaxation or pleasure. Self-soothing most often uses the 5 senses; touch, taste, sight, smell and hearing. Try a variety of these items until you find a combination that works for you.

SIGHT: Be mindful of every sight, but do not linger on any. Allow the sights to calm you.

  • View pictures of family/friends.
  • View pictures of your favorite vacation spot or place you wish to go.
  • Look at art or go to a museum.
  • Go for a nature walk.
  • Walk through a pretty part of town.
  • Buy some flowers for your home.
  • Light a candle and watch the flame.
  • Watch an uplifting movie or video.
  • Be creative.
  • Painting, markers, crayons & a coloring book or sketch pad.
  • Mandalas (Coloring Castle, Free Mandalas, Printable Mandalas).

HEARING: When you are listening, be mindful, letting the sounds come and go. Be mindful of different sounds and let them flow through you.

  • Listen to relaxing music (via youtube, pandora, etc).
  • Listen to sounds of the ocean, forest, rain, or other sounds of nature.
  • Listen to a small animal.
  • Sit by a waterfall.
  • Play a musical instruments if possible.
  • Sing your favorite songs.
  • Do a guided meditation.

SMELL: Notice all the different smells around you and take in all the smells.

  • Smell a meal being cooked either at home or in a restaurant.
  • Walk in a garden or in the woods.
  • Breath the smells of nature.
  • Light a scented candle or incense.
  • Use essential oils.
  • Use hand lotion and/or drawer packets.
  • Use perfume or bath salts (Epsom salts).
  • Bake some bread, cake or cookies.

TASTE: Let the taste run over your tongue and slowly down your throat. Mindfully taste each new thing.

  • Cook a favorite meal.
  • Drink a soothing drink like hot chocolate or tea (especially blends for stress or anxiety).
  • Chew gum.
  • Eat hard candy or chocolate.
  • Go to a potluck and eat a little of each dish.

TOUCH: Take a bubble bath. Pet your dog or cat or cuddle a baby. Put on a silk shirt shirt or blouse, and feel its softness and smoothness. Sink into a really comfortable bed.  Float or swim in a pool, and feel the water caress your body.

  • Play with sand.
  • Use hand lotion.
  • Use a heating pad, back massage pad, or rice pack (hot or cold).
  • Play with modeling clay.
  • Dance.
  • Use a stress ball.
  • Play with silly putty.
  • Pet an animal or cuddle a baby.
  • Take a bubble bath.
  • Float or swim in a pool and feel the water caress your body.
  • Brush your hair.
  • Sink into a really comfortable bed.
  • Nap with a soft and furry blanket.
  • Use a weighted blanket (Bought Blanket; Sew-able Blanket; Tyable Blanket; No-Sew Blanket).

The entire point of self-soothing is to do something that is comforting to you and to continue doing it until you feel better.

DBT Self Help: Self Soothing

Outpatient Treatment Center

Talia Malon Scientific , , , , , ,

To make the next few posts easier to understand, I want to describe to you the treatment center that I was admitted to, the various programs they have and the types of therapies we learned about.

At this center, there are three levels of treatment; Inpatient Hospital Treatment, Partial Hospitalization Program, and Intensive Outpatient Program. There is also a residential facility for patients with eating disorders. In all of these programs, the adults are separated from the adolescents.

With inpatient treatment, there are various units to which a patient could be assigned. This includes the Special Intensity Unit for patients who are experiencing more acute symptoms of their mental illness. While in inpatient care the doctors, therapists and nurses work together to address the patient’s disorder and work towards long-term recovery. After discharge from inpatient treatment, the patient continues care with the Partial Hospitalization Program or PHP.

Partial Hospitalization Program or PHP, is considered the highest level of outpatient treatment. PHP is a full day program that consists of group, individual, family and other various therapies. PHP is the follow up to inpatient treatment but can also be the starting point for another patient. Each patient is placed within different programs where it is deemed that they will receive the most amount of beneficial therapy.

Intensive Outpatient Program or IOP, is a half day program that helps patients transition to life outside of the program. It is often a follow-up to inpatient treatment and PHP. IOP offers group, individual and family therapy along with transitioning to daily routines. It is considered the lowest level of outpatient treatment for the program and transitions patients to life outside of treatment including setting up schedules and appointments with outside therapists and psychologists.

The center also includes an after care program which is a once a week group therapy session. This allows for continued group therapy alongside your individual outside therapist and doctors.

Each day started with our morning check-ins. With these, we described how we felt at the moment, any questions or concerns we had with medications or therapies and how our previous evenings had occurred. After check in, we had our one hour group therapy session which met daily. During these sessions anyone was free to talk about anything and everyone was allowed to talk, discuss and suggest ideas and solutions. After group therapy, we would either have expressive (art) therapy, music therapy, medication education, emotional regulation, or weekend planning depending on the day. The last hour before lunch, which was also the last hour for the IOP patients, was spent learning about different therapies, issues and ideas dealing with mental health or if you were fighting an addiction, learning about co-dependence on drugs and/or alcohol Many of these classes have given me ideas and information to use for posts.

After lunch the PHP program would continue with two more class periods. During the first class period, patients would learn about distress tolerance, cognitive behavioral therapy or CBT, expressive therapy and anger management. During the second class, patients learned about mindfulness skills, healthy alternatives, communication skills, expressive therapy, and interpersonal effectiveness. Expressive therapy is taught often because it allows patients to express how they feel in a safe environment. Please read Alternative Medications & Therapies for more information on expressive therapy. During the day, we are also pulled out by our doctors, therapists and APNs for meetings and check-ups.

At the end of the day, we would fill out our daily wrap up sheets, detailing how we felt and if we felt we could stay safe during the evening. After the program, our doctors, therapists and staff would meet to discuss our continuing treatment and eventual discharge.

The program I attended is an accredited program within the nation. But if you think you need more help than a weekly therapist appointment please check within your area for a program that can teach you to manage your mental illness.

More Changes

Talia Malon My Story , , , ,

As I related earlier, I was taking a step to see my doctor and find a new psychiatrist to get on medication to help my depression. I saw my primary care physician for a full physical and blood work to ensure that my depression was not related to thyroidism or a physical issue.

In some ways, I feel lucky because everything came back normal. I’m not suffering from a physical medical issue. At the same time, I feel like treatment would be easier if it had been a thyroid or blood sugar issue. Mental issues are harder to diagnose and medicate. While there are tests to diagnose mental disorders, they are genetic and extremely expensive.

After getting the all clear from my primary care physician, I made an appointment to see a psychiatrist on the recommendation of my therapist.

Less than a week before my first appointment with the new psychiatrist, my therapist decided that the process needed to be expedited. After getting my parents involved with the situation,  they accompanied me to a hospital with an inpatient and outpatient treatment center where I was evaluated for their mental health program for the second time.

This time, I am considered a candidate for the program. I am enrolled in a program (IOP – Intensive Outpatient Therapy) and I start tomorrow.

I’m nervous about it. At this point, I just want change. I want to be happy again. But I’m also afraid that this program won’t work. My depression is telling me that I’m never going to be happy again, that it’s just not possible for me to be happy and healthy. At the same time, I’m hopeful that this program will ‘fix’ me and help me learn to get better.

DBT: The Skills

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This post is written in conjunction with DBT: Dialectical Behavioral Therapy.

There are four sets of behavioral skills taught in DBT; Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Acceptance is emphasized through mindfulness and distress tolerance, while change is emphasized through interpersonal effectiveness and emotion regulation.

Mindfulness is one of the primary coping skills that is taught in my outpatient program. According to DBT, there are 3 primary ways to refer to our states of mind; emotion, reasonable, and wise mind. Emotion mind is when our thoughts are being controlled only by our emotions and therefore our reasoning and thought-process can appear illogical. Emotion minded people are also known for being ‘hot’. Reasonable mind is when our thoughts are logical and rational. In reasonable mind, our thoughts are fact based with no emotion involved and these people can be known for being ‘cold’. Wise mind is the combination of emotion and reasonable mind. Wise mind is part emotion, part reason and is often considered a sense of intuition.

The three ways to achieve wise mind are to observe ourselves, our environment and our situations, describe the things we observe and participate in the moment, in a way that makes us forget about everything else. We should also consider a non-judgemental stance not only towards others, but also towards ourselves because it can affect the way we view ourselves, our environments, our situations and other people.

Interpersonal effectiveness is the ability to increase the changes that you will reach the outcome you are looking for in a specific situation, while not hurting the relationship you have with others or losing self-respect. This includes using objectiveness, self-respect and relationship effectiveness. Objectiveness effectiveness in known as DEAR MAN, and will be covered more in depth in another post. Relationship effectiveness is known as GIVE. Give stands for be Gentle, act Interested, Validate and have an Easy manner. Self-respect effectiveness is known as FAST. Fast stands for be Fair, no Apologies, Stick to your values and be Truthful. The point of interpersonal effectiveness is to be able to effectively communicate your needs in a healthy manner.

Emotion Regulation is being able to identify what you are feeling in the current moment. It is also being able to recognize when you because angry, frustrated, depressed, distressed or anxious and focuses on the tools that can be used to deal with these intense emotions. Emotions come from our reactions to things and people in our environment and our reactions to the things going on inside ourselves. There are also primary and secondary emotions and while neither of these types of emotions are good or bad, to get to the original problem and work on solving it, it is necessary to deal with the primary emotions. To deal with emotions, we also need to reduce vulnerability, using PLEASE. Please stands for treating PhysicaL illness, balancing Eating, avoiding mood-Altering drugs, balancing Sleep, and getting Exercise. It is also necessary to build positive experiences, be mindful of current emotions, letting go of painful emotions, and practicing opposite to emotion.

The final behavioral skill is distress tolerance. This can also be known as Crisis Survival Strategies. There are 4 sets of skills for dealing with the distressing activities and events in our lives. These 4 skills are distracting, self-soothing, improving the moment and thinking of pros and cons. Distract uses the acronym ACCEPT to find different things to engage your mind and move on from the issue. These are distract by Activities, Contributing, Comparisons, Emotions (opposite to emotion), Pushing away, Thoughts and Sensations. By Improving the moment, you can use Imagery, Meaning, Prayer, Relaxation, One thing at a time, Vacation, and Encouragement (IMPROVE). Other distress tolerance coping skills include using pros & cons, accepting reality and radical acceptance.

Many of these coping skills will be discussed more in depth in a future post.

DBT Selp Help -A website written by people who have been treated with DBT

National Alliance on Mental Health – Fact Sheet

Mayo Clinic– Facts

The Linehan Institute: Behavioral Tech – DBT Overview

National Institute for Mental Health

Dialectical Behavioral Therapy Skills Handbook