DBT for Bipolar: Making a Life Over
After 30 years searching for something to help me navigate the extreme moods of my bipolar disorder, something’s finally working.
People who see me infrequently, like my dentist or distant relatives, and they say, “Allison, you seem like a ‘new’ person. You’re so much calmer.” They don’t know what it is, but they’re sensing the absence of my urgent self-absorption and pressured speech.
I just completed a few semesters of dialectical behavioral therapy (DBT) at a nearby psychology school. While a one-year commitment is required, most people in my class are in their second or third.
DBT combines once a week group ‘class’ with weekly individual work to process use of the new skills.
Dialectical Behavior Therapy Is a Type of Cognitive Behavioral Therapy
DBT is Marsha M. Linehan’s update on 1950’s cognitive behavioral therapy (CBT), which is based on behavioral science.
In the late 1970’s, Dr. Linehan was using CBT with a group of women who were prone to suicide attempts, all or nothing thinking, and self-harm. She realized they met the criteria for borderline personality disorder (BPD).
Dr. Linehan felt CBT had clinical limitations for this population and took it upon herself to write her own program.
Doctor as Patient
Having suffered silently with BPD herself, Dr. Linehan wrote DBT as if she were treating herself. In 2011, she ‘came out’ with her diagnosis to fight the stigma surrounding this mocked misunderstood, much-maligned diagnosis.
DBT is the ‘gold standard’ for BPD but has also been well-researched and proven useful for thorny, difficult behavioral problems like substance abuse, eating disorders, depression, and bipolar disorder.
The Zen Sense
The first thing she did was integrate some Buddhist tenets, particularly mindfulness and ‘radical acceptance,’ into her work.
She knew the only way to reach her patients was to let them know she understood, and their actions made perfect sense, considering the pain they were in.
The Definition of Dialectics
Dialectics are opposites. The two principle dialectics in DBT are acceptance and change. As students, we’re taught to accept ourselves where we are, at the same time being committed to positive change.
While we balance these dialectics in our minds, our goal is to walk ‘the middle path. This ends the black-and-white thinking so painful to those of us with bipolar disorder.
In DBT class, we start off with a relaxing exercise so we can get centered in the now. Mindfulness and being in the present is not a normal mental state for human beings.
Hotwired as Hunter-Gatherers
Our default setting hasn’t evolved as quickly as we have. Cognitively, we grind through various past scenarios to feel secure about having enough food, supplies, and additional things to survive tomorrow.
This planning is called prospecting. With food usually at our fingertips, we needn’t obsess about imaginary shortages, but it takes deliberate effort to stop, think, and mindfully find the moment at hand.
Easy Does It
In the DBT module “distress tolerance,” we’re taught simple strategies like focusing on the tenor of someone’s voice, the carpet in the room or even the wallpaper to bring us back to reality. We’re also encouraged to ‘check the facts’ regarding things we’re stressed about.
Real Life Learning
My first module was ‘interpersonal effectiveness.’ This was a lucky break because my life’s dysfunction was most keenly felt in my isolation and fractured family relationships.
‘DEAR MAN’ is my favorite interpersonal effectiveness skills teaching (so far). The initials help you set and remember your goals before a problematic encounter with another person.
These days, I view human interactions like currency. If the coins are tarnished with emotion, it’s hard to realize what I truly want.
Practice scripts and class rehearsals help us choose our priorities. The scripts and rehearsals are a warm-up for the NEW skills we’re incorporating.
Choices One, Two and Three
Do I have an objective? For example, something I want or need? Should the focus be the relationship? Or do I need to establish or reinforce my self-esteem?
An Objective? Choose DEARMAN
- Describe (to the other person) the situation as it exists, without attitude or inflection.
- Then, express your feelings about it. Listen to what they say in return.
- Next, assert your wish. A reinforcing statement might be needed.
- You might even have to restate the request.
- Stay mindful and truly listen.
- Appear (or sound) confident, even if you’re not.
- Negotiating comments let others know you’re both calm and serious and not leaving the table without some deal.
After some trial and error, I’ve learned the GIVE option fits my personality the best.
GIVE allows me to focus on the relationship between the other person and me – rather than myself. I leave my ‘objectives’ behind, and it’s not ‘All about Allison’ anymore.
- Be gentle with the other person.
- Interest and validation go hand-in-hand. Being attentive and reinforcing another person shows you’re hearing about them and value the relationship.
- Easy manner. I tend to be too intense and forget to smile or simply breathe!
There’s flexibility in DBT, so I give myself more ‘e.’
My second ‘e’ stands for Go easy on the exchange of information. Speak just as much as, or less, than the other person.
Looking Inside and Out
Today, before I even speak, I think about being on the receiving end of nonstop chatter and those endless e-mails I used to specialize in. Today I try to limit myself to making one point or request at a time. Two is my absolute limit.
The Inverse Value of TMI
I have a new saying: “If talk is cheap, then over communication is like writing a bad check.”
Holding my tongue, (especially when I’m hypomanic), is a stretch, but I’m learning how, thanks to DBT for bipolar. My next module is mindfulness. I wouldn’t miss it for the world.