Will DBT help you manage your problems?
The UK National Institute for Health and Care Excellence (NICE) recommends DBT for BPD/EUPD.
I can help with an assessment if you think your problems meet the criteria for BPD/EUPD. However, the DBT skills are useful for most people and DBT therapists use them daily.
What has caused your BPD/EUPD?
It's thought to be a combination of nature and nurture.
“Nature” or biological factors include high sensitivity and hyper-responsiveness due to genetic and epigenetic factors with innate physical/neurological characteristics.
“Nurture” or social factors include growing up in an invalidating environment, where you might have been neglected, abused, humiliated, ignored, mocked, told you are worthless, forced to be perfect.
How effective is DBT?
It depends what we are using DBT to work on. There is good evidence for the effectiveness of DBT for all of the problems mentioned above. There is good evidence for both individual plus skills group with telephone coaching as well as for skills group only. The choice of which model usually depends on the severity of the problems we are working with. For BPD/EUPD, around half of those who undertake DBT no longer meet the criteria for BPD at the end of therapy. DBT is very good at reducing behaviour which occurs often and has been difficult to change. It increases our ability to manage intense emotions, handle relationships, and get a life worth living.
Risk management in DBT
I am unable to provide therapy for anyone who currently self-harms or has suicidal behaviours. This is because I do not have a multi-disciplinary team including psychiatrists and care co-ordinators to manage the risk safely and effectively.
What will I do with my individual therapist in DBT?
Every session starts with mindfulness practice.
You will meet me weekly and keep a daily diary of the main behaviours which are ruining your life, “target behaviours”. We will screen share your diary at every session and pick out a target behaviour to study together. You will do something called a “chain analysis” where you work out your thoughts, feelings, behaviours (and urges) and body sensations in the run up to the target behaviour, as well as what happens in the short and longer-term afterwards. The aim is to work out what “reinforces” the behaviour (makes it stronger and makes it keep happening). This might be a pleasurable feeling (positive reinforcement) but more often is the chance to avoid aversive (bad) internal feelings and states (negative reinforcement).
We will then carry out a “solution analysis”, thinking of things you could do differently next time, and make a plan for you to take away.
If you find yourself having a strong urge to carry out a target behaviour between sessions, you are expected to call me, within specified hours. Outside those hours you should know who else you might call. This is known as telephone coaching.
When I am on leave or if I am unwell, I will arrange for a colleague in GWM to be available for you if needed.
What will I do in the skills group sessions?
Because all our groups are online, they often involve people from all around the world. There are 3 modules which each last 8 weeks: Interpersonal Skills, Emotion Regulation, Distress Tolerance. A Mindfulness module is taught in a 2-week period at the start of each of the other 3 modules to accommodate new members of the group and revise the skills for others.
What is EUPD/BPD?
Longterm patterns of relationship instability, uncertainty about your self-image, extreme mood swings, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by 5+ of the following (based on the American Psychiatric Association criteria):
- Frantic efforts to avoid real or imagined abandonment (relentless texting, checking social media, seeking reassurance of 'love')
- Unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation
- Identity disturbance (you don't really know who you are as a person)
- Potentially self-damaging impulsivity in at least two areas (such as: spending, sex, substance abuse, reckless driving, binge eating as ways of distracting from unpleasant moods)
- Recurrent suicidal behaviour, gestures, or threats of self-mutilating behaviour (when you feel you can't bear distressing circumstances)
- Mood instability (0 to 100 in no time at all)
- Chronic feelings of emptiness (you don't really know how you feel)
- Inappropriate, intense anger or difficulty controlling anger (like a toddler tantrum but in an adult body; 'they made me'; 'it's their fault')
- Transient, stress-related paranoid ideation or severe dissociative symptoms (zoning out)