Reading Notes

DBT Sequence: Assumptions

  • People are doing the best they can
  • No one sets out to do harmful or self-destructive things
  • There’s always a reason behind thoughts, feelings and behaviors
    • You don’t always know that reason
  • So why do people behave in self-destructive ways?
    • Ignorance / lack of skills - don’t know how to handle the problem
    • Inaccurate beliefs
    • Constraints
  • There is no guarantee that doing your best is enough to get by in the world
  • Telling yourself to stop doing stupid stuff is remarkably ineffective
  • The goal of DBT is to figure out why you’re doing stupid stuff and then use that to come up with a way of not doing it
  • Behaviors and skills are context sensitive
    • Just because you can accept criticism at work doesn’t mean that you can do so at home
    • Just because you can set boundaries with your friends doesn’t mean you can set boundaries with your parents
  • You cannot control the things that other people do
  • However, you can control your own behavior and this will influence how other people will act towards you

DBT Sequence: Dialectics

  • The core dialectic (the dialectic in dialectic behavioral therapy) of DBT is acceptance vs. change
  • People need to accept who they are
  • People also need to change their behaviors
  • This seems like a paradox
  • However, notice that self-acceptance is, in many instances, a pretty big change

DBT Sequence: Chain Analysis

  • Chain analysis is a technique for finding the cause of the behavior that needs to change
  • Describe the behavior that you want to change
    • Describe it in as much detail as you can
    • Write it down
  • Describe what prompted the behavior
    • Why did you do this thing today rather than yesterday?
  • What made you vulnerable to the behavior
    • Eating/sleeping poorly
    • External stresses
  • Describe in as much detail as you can the chain of events that connected the prompt to the behavior
    • Actions as well as feelings
  • Describe the consequences
    • Especially describe the positive consequences of the behavior
    • You wouldn’t be doing the thing you wish to change unless there was something you were getting out of it
  • Look at the chain of events and for each step in the chain, describe a mitigation
  • Look at vulnerabilities described in step 3 and comes up with ways to avoid making yourself vulnerable
  • Come up with ways to repair the consequences of what you did

DBT Sequence: Crisis Survival

  • Crisis: situation that you cannot immediately solve
  • Not something that happens every day
  • Goal: get you through the immediate stress and carve out time and mental energy to deal with the crisis in a constructive fashion
  • STOP - what you do when you notice you’re in crisis
    • Stop - don’t do anything; take a break
    • Take a step back
    • Observe
    • Proceed mindfully
  • Pros/Cons
    • Write down your options
    • List the good and bad outcomes of every option
  • TIPP - strategies to lower arousal
    • Lower temperature - splash some cold water on your face, rub an ice cube on your forehead, etc.
    • Intense exercise - burn off excess energy
    • Paced breathing
    • Paired muscle relaxation
  • Distract yourself
      • Activities - do something to get your mind off what’s bothering you
      • Contributions - do something for someone else
      • Comparisons - compare yourself to others to make yourself feel better
        • High variance strategy - may or may not work in your circumstance
      • Emotions - trigger a different emotion
        • Listen to some angry music
        • Watch a scary movie
      • Pushing away
        • Visualize the thing that’s causing you distress
        • Now put it in a box
        • Now put that box on a shelf
        • Easy to overuse - put the thing on a shelf, but remember to deal with it at some point
      • Thoughts
        • Do some mental activity that takes your mind off the problem
        • Useful if you’re not actually able to remove yourself physically from the situation that’s causing you distress
        • Can be as simple as counting in your head
      • Sensations/self-soothing
        • Curl up in a blanket
      • Imagery
        • Visualize a peaceful/safe environment
        • Tell yourself a story
      • Meaning
        • Find some sort of purpose for your suffering
      • Prayer
        • Praying for strength can work
        • Praying to have the thing that’s causing you distress removed doesn’t work
      • Relaxation
        • Take a deep breath
        • Focus on noticing tense muscles and consciously relaxing them
      • One thing in the moment
        • Focus on whatever you’re doing right now
        • Don’t regret the past
        • Don’t worry about the future
        • Try to induce a flow state
      • Vacation
        • Take a short break from whatever you’re doing
      • Encouragement
        • “Positive” self talk
        • Doesn’t have to be the standard, peppy encouragement you hear from others

DBT Sequence: Radical Acceptance

  • Remember the litany
    What’s true is already so
    Owning up to it won’t make it worse
    Not being open about it doesn’t make it go away
    And because it’s true, it is what is there to be interacted with
    Anything untrue isn’t there to be lived
    People can stand what is true
    For they are already enduring it
  • What isn’t radical acceptance:
    • Denial
      • Pretending that the problem isn’t there
      • Pretending that proven-ineffective tactics applied one more time will cause the problem to go away
    • Tantrums
      • Asking “why me”
      • Getting mad at the world
  • How do you practice radical acceptance?
    • Notice yourself not accepting reality
    • Tell yourself that you’re going to accept reality as it is
    • Plan what someone else would do in your situation and then carry out the plan (fake it ‘til you make it)
    • Let the recoil (e.g. feelings of anger and hopelessness) wash over you and then proceed with your plans anyway
    • Willingness vs. willfulness
      • Willingness
        • Active participation in reality
        • Doing the best given circumstances
      • Willfulness
        • Trying to fix everything
        • Giving up
        • Attachment to desires
    • Notice avoidance
      • Try to feel that flinch in your brain when you avoid something
      • Mindfulness helps with this

Radical Acceptance Practice

  • No notes here, just follow the link and do the exercise