What It’s Like: DBT Group

This group was… Intense. If you’re coming from ACT to this, know this ahead of time. This is why I picked my feature image as a bunch of crayons; such a colourful bunch of people (and that’s not bad).

DBT stands for dialectal behavior therapy. This approach works towards helping one to learn about how one reacts to triggers, and helping to assess which coping skills to apply in the sequence of events, thoughts, feelings, and behaviors to help avoid undesired reactions.

This group was also a closed, public group. This means you need a referral from a team member from Mental Health and Addictions. I overheard that it’s offered at more than one site, and I think I understand why: way less people drop out. It’s held for two hours once a week, and is mostly tailored for those suffering from borderline personality disorder, anger issues, addiction, emotion regulation issues, anorexia, and self-injury behavior. Why was I there? You’ll see people with other disorders treated with DBT methods as they have comorbid conditions. Afterward, I found out that those with PTSD are sometimes treated with DBT method. I had nothing to lose.

If I had to describe this group in a nutshell: the polar opposite of Wednesday’s post. If groups had one distinct personality trait, it would be those participating in ACT are introverts, and DBTers are extroverts.

The first day you do a baseline psychological test, in which you’ll repeat the last day to see if your efforts in the group yields any improvement. The test was different than ACT, I remember it focusing on only depression and emotion regulation. We also weren’t given time within the first session: we were told to do it at our pace and bring it back. I was given my results at the end, but no treatment plan was decided. It felt more like a pat on the back for the effort I put in, sticking with the group, and summation of what I took away.

After the test, you’re given a binder that weighs a few pounds. The facilitators admitted they were still new to this process, so a lot of it felt like an introductory lecture hall. A lot of strait from the binder reading to us, not much creativity. What also made it made it a bit disconnected is that the facilitators had different material than our binders. This made it difficult to follow, and keep a lot of group member’s attention. The facilitators did their best, and I blame this more on them being new at holding their own. They always encouraged people to go to them before, during, and after group. They also were like sponges when people brought up extra resources. Those would come at any time, and was always welcomed.

Like Saitama, my mind would wander. It honestly felt like I was back in school.

The first day you’re asked to think about specific goals you want to reach: behaviors you might want to decrease, and skills you want to increase. After they explained the format, they give you a printout of the rules– my mistake, the guidelines, for this group. I noticed that terminology was very specific as to not be harsh (or possibly interpreted as hostile). As previously mentioned, participants of this group aren’t hiding under the sheets as I was doing. For the most part, if I was in a dangerous situation, they would be the best bodyguards on the planet. No bending of these spines, I wish I had a bit of their gumption. Therefore, I completely understood why no mingling outside group was strongly enforced.

A mindfulness aspect of this group is done, but it varied from week to week. It showed more than just guided meditation as thing being as they are, but different methods such as visualization. An emphasis that behavior and emotion are not one is heavily enforced. Mindfulness is also expanded to demonstrate that used efficiently, you no longer shift the blame of one’s own issues on ‘other’. It also was used as the biased relaxation method, but more in a sense of diffusing oneself from an upsetting situation. One homework asked for each participant to pick one day where they would use a variant of mindfulness (observing, describing etc) and jot down what they noticed.

We then got to a point where a few weeks are dedicated to this type of mindfulness, where we were shown a diagram and explained one should be in a constant state of wise mind.

An example of states of mind.

I fall into the logical mind category, and lucky for me, everyone else participating fell into the emotional mind category. This led to me constantly asking why people reacted the way they did, helping them reflecting if it was the proper choice. In return, they were able to help me narrow down what some somatic responses I was having linked to possible emotions.

We then spent a bit of time on distress tolerance. The important thing to remember about these tactics that they really missed explaining is they’re not supposed to replace the distress. This I learned after by another person trained in DBT. It then becomes one more avoidance tactic, and you don’t end up working on the problem. Things such as volunteering, watch a movie opposite to what you’re ‘feeling’, read, or play a game. There’s also self-soothing techniques that rely on your five senses in the hopes of lowering your distress level. We were then given worksheets to practice a few out in the real world to see what’s effective in our own case. What was forgotten: go back to the issue at a less distressed state and hopefully you reach an outcome.

Next was a bit on radical acceptance, which somewhat linked back to the ACT group but in an easier way to remember: it is what it is. In my own time, I found out that the Japanese actually have an expression used that’s commonly said out loud that echos this sentiment (so you don’t take it personally) shō ga nai [しょうがない]. When it’s beyond your control, it cannot be helped. It’s not giving up or giving in, it’s simply accepting this as they are. I still struggle with this, but I will say I’m improving.
Included in this was being willing, but the explanation became muddled with trying to contradict it with willfulness. I had problems with exercises with willingness. They expected all participants to use the half-smile technique, and the willing hands technique. Half-smile is exactly what it sounds like: no matter what mood you’re in, make a small smile and adopt a serene facial expression. Also speak with your palms always facing upward.

If you’re female, hell if you have ever gone through any state of depression, and you’ve ever been told to just smile, you can understand why that bothered me. I took the principle of the idea, but not the way they expected me to behave.

They really didn’t think this one through.

We then spent a good chunk on emotion regulation, and this is the part where I did a lot of listening. Even with the homework, the facilitators weren’t familiar with alexithymic patients, so I depended on the experiences of the others. They feel deeply, and a lot of the responses where those of a self-protective nature. They are such strong people, and I see now why over-expression can get you into trouble just as much as lack of expression.

The last bit we rushed over, and it had to do with interpersonal effectiveness. I was disappointed it was left at the end, I could have used more understanding in this area.  Tactics such as DEAR MAN were done so quickly and left in the hands of quick-witted retorts that the seriousness fell flat. It boiled down to communication skills, that’s all I retained.

Half way through, about three people dropped out, but we still had close to 10 members. I wish the facilitators had more courage to reign in some of the members as many didn’t understand why cross-talk sucks in group. Cross-talk is when someone is trying to share, and two or more other group members are chatting with each other, not paying attention. Another thing you may want to keep in mind before joining is passive aggressive behavior is rampant. A comment will be made to you or in earshot of you that is meant to push your buttons. You can either take this to the facilitator, or suck it up. It happened a few times to me, and it reminded me of school yard bullying. I took a few comments quite harshly. That’s what many are there for, to fix behavior like this. You have to remember that you’re there for you.

Always be willing, shō ga nai, yo.

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