Dialectical Behavioral Therapy Is Saving My Life
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Dialectical Behavioral Therapy Is Saving My Life

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whatexactlyisdialecticalbehavioraltherapyMy psychiatrist recently referred me to a distress tolerance group at Kaiser, one focusing on mindfulness. Though they’ve dubbed it distress tolerance, it’s really a Dialectical Behavioral Therapy (DBT) group designed to move you from reactivity to reflection, anxiety to peace and rageful anger to acceptance. Even the Buddha taught that these aren’t the easiest states of mind to attain.

I attended a DBT group in the past at Cedars Sinai, and found the concepts extremely refreshing and progressive. At its core, DBT is a fusion of CBT and Buddhist mindfulness. When practiced on a daily basis, it can offer powerful relief from emotional highs and lows, substance abuse and general bad behavior. Yours truly definitely needs this, specifically on the road, in any and all customer service interactions and when shit hits the fan in my personal or professional life and I start spiraling down into a morass of negative self-talk.

It’s always the stories that get me, not the inciting incident. It’s not that so-and-so dude rejected me, it’s that when he rejected me I told myself this nice fairy tale: “I’m ugly and fat. I’m also unloveable. I have baggage and all men think I’m insane. They’re intimidated by me. I’m too pretty and slim, maybe. It’s my obnoxious opining. I’m worthless. Love will always elude me.” By the time I’ve told myself this story, I either want to down a six pack, slit my wrists, or protect myself from men altogether. That’s what SLAA would call “anorexia”—starving yourself in the love and sex department.

So now I’m in this new class and the facilitator for some reason gets through to me better than any therapist I’ve had in the past. The words resonate with me better than the steps of AA. Maybe it’s because she’s French and has this nonchalant, matter-of-fact way of presenting the tools without being overly earnest or empathetic. I find these traits patronizing and infantilizing when I encounter them from mental health clinicians.

Aurelie will just ask rhetorically, “Is it helpful to get caught up in the story? Does that serve your long-term interests? No.”

Of course, snapping out of those negative thoughts—which lead to negative emotions and “problem behaviors” like flipping someone off or drinking and using—eludes most humans on the planet. In order to snap out of them, you first have to become mindful.

In case you haven’t heard about the thing that’s all the rage, mindfulness is simply the act of being in the moment, being aware of what’s around you, slowing down, and doing one small thing at a time. This might be washing your hands, brushing your teeth, or making your bed and focusing on that task as you complete it, without letting your thoughts fly over the rainbow. Interestingly, the slowing down actually makes you more productive and efficient.

The other main tool used to achieve this state is mindfulness meditation. This requires you to pay attention to your body, the sounds around you, and, most importantly, your breath. It’s not so much about escaping your thoughts as it is becoming aware of them. You do this while also continuing to come back to your breath, or the feel of your feet on the floor or your ass in the chair, to re-center yourself.

I hate doing this, and I also hate doing “one thing mindfully.” At first, it caused me great anxiety to slow down, seeing as how I’m a writer and my bread and butter relies on all the thoughts and ideas swimming around in my head.

“If my mind becomes slow and blank and Zen, where will my ideas go?” I asked myself. But having an open mind is crucial to beginning a practice of mindfulness, so I just started doing it anyway.

That’s when I noticed my room was cleaner—because I had slowed down and could actually see my surroundings—and I got my work done faster. When I sat down to write an article I just worked on that one article instead of checking my email and Facebook and bank account and Twitter and the New York Times homepage over and over and over. Of course, the goal of distress tolerance isn’t to boost productivity, but stop the destructive chatter in your head and the destructive actions that ensue from said chatter.

So once you start these mindfulness exercises, the hope is that you’ll be far more aware when a disturbing thought or emotion arises. Then, you can pause, step back, become curious about it with non-judgement, and use a tool called “Observe and Describe.” The goal here is to neither invalidate nor engage that thought or emotion but to not be the thought or emotion.

You might say, “Okay, I’m very anxious right now. But it’s understandable that I would be anxious, given I have $20 in my bank account and am waiting for checks that are overdue from such-and-such client. But will drinking or using or calling the people who owe me money and telling them that they’re fucking douchebags serve my long-term interests? No. So what can I do with this anxiety?”

The above example shows the influence of CBT on DBT. You’re redirecting your thoughts before the story of “I’m not going to be able to pay my rent. I’m going to be homeless. I’ll lose my car,” starts. DBT and CBT teach that this story is simply not helpful. You’re not a selfish and self-pitying person to go there—it’s an all-too-human response, but it just doesn’t serve your long-term interests. Not only will it make you feel like shit, it’ll paralyze you from taking steps to actually solve the problem. By “Observing and Describing” you can become more “Effective” (another tool)—when you can contain that emotion you can then think clearly to take action to properly solve the problem.

I’m telling you, this stuff works. But, you do have practice the tools every day.

One of my favorite aspects of DBT is the realism of it. A key philosophy is “The world isn’t fair. It’s not going to be fair and it never has been. So don’t get caught up in the ‘But this isn’t fair and this shouldn’t be happening!’ Instead, pause, breathe, accept what’s happening, decide what it is you can change and take steps to change it, and for the stuff you can’t change, accept it and move on.”

Sound at all like the Serenity Prayer?

For me, spotting those initial disturbing thoughts and emotions, which can set off a “Behavioral Chain” leading to problem behavior, is absolutely key. And the more you do it, the easier it gets. Once you’ve identified the problem thought or emotion, you can use the “Distract” tool—deep breathing, listening to calming music, taking a jog, reading, calling a friend, lighting soothing candles, doing an art project, soaking in a hot bath, cooking—before the thoughts and feelings snowball into “I need to drink or kill myself or kill that douchebag on the road, right now!”

For me, “Not getting caught up in the story” is perhaps the most powerful concept I’ve learned in this new class. It’s always the story that leads me to a drink, to rage at AT&T reps, or even to convince myself I’m a shitty writer and should therefore blow off my work and sleep all day. It’s amazing how soothing it is to just step back and acknowledge your feelings without judgment. “I’m depressed. It’s understandable that’d I’d be depressed since I didn’t sleep well for two days. So, what can I do about it? I can take a hot bath, light some candles and try to nap.”

That’s way better than beating myself up for being depressed, which only leads to more depression.

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About Author

Tracy Chabala is a freelance writer for many publications including the LA Times, LA Weekly, Smashd, VICE and Salon. She writes mostly about food, technology and culture, in addition to addiction and mental health. She holds a Master's in Professional Writing from USC and is finishing up her novel.