DBT seems to be working

[Ginger Kitten]

What is DBT mean? Thank you

It's 'dialectical behaviour therapy', it's prescribed for those with emotionally unstable (borderline) personality disorder. It was developed by someone who had it herself and who also worked in mental health services, so I guess she developed a programme that would help her too. Basically, it's about emotional regulation, which means controlling your emotions. I was given it too, because I suffer from the mood swings of bipolar disorder, but they won't normally agree to that: my psychiatrist had to almost insist they found me a place in a group setting. But I won't ever be considered for it again because the 'protocol' in my Trust (psychiatric services of NHS) means only those with EUPD get it. It's the only thing that's ever really helped, so it annoys me a bit, but I can't do anything about it - other than pay for it priviately, which I can't afford to to. I just dig out my notes when I feel emotionally vulnerable, but it's not the same. One of the main stays of DBT is mindfulness, which is essentially a form of meditation, to still the mind, but there are many other strands of DBT too. I recommend you ask about it, if you have a personality disorder; forget it if, like me you have got a mood disorder - you won't 'qualify'.

 

[Bizzarebitrary]

the 'protocol' in my Trust (psychiatric services of NHS) means only those with EUPD get it.

Awfully limiting, I'm very sorry to hear that. In my case it worked wonderfully well for depression.

Dr. Linehan and others have adapted DBT to many other mental health conditions. I believe the modules mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness are transdiagnostic. So I'm a little surprised that NHS would reserve DBT for personality disorders alone. Could that be for budgetary reasons?

 

[Ginger Kitten]

I don't know, possibly, but I get the feeling they think if they give it to one person with bipolar they'll have to offer it to others and then they'll be inundanted and won't have the funds. There's no way of knowing what's going on in my MH Trust. My pdoc has tried for a 2nd time to get me into a group and the dept concerned (I forget the name) point-blank refused.

Actually, I read about DBT on the Net and asked him for it. All the Trust offers otherwise is CBT which I have never found helpful. So it's a dead-end, no point in thinking about it, unless privately. Incidentally, are you in the UK or elsewhere? If you're in the US you're likely to be able to access more therapies such as DBT if you're on a private healthcare plan. We're limited to what we can get on the NHS because resources were stretched even before Covid.

Thank you for replying and Happy Easter Sunday.

 

[Bizzarebitrary]

Incidentally, are you in the UK or elsewhere? If you're in the US you're likely to be able to access more therapies such as DBT if you're on a private healthcare plan.

I'm in the US and my public health plan helped pay for DBT psychoeducation and skills classes. These were led by two therapists and our groups were 10-14 patients with various diagnoses. That may help keep costs down.

Like other cognitive therapies, DBT requires a lot of participation--completing homework in addition to class work. Since a lot of the work must be done individually it may be possible for you to self-direct by reading a book and completing the worksheets, I don't know. There may also be online groups you can join that are UK based which would give you support.

 

[Ginger Kitten]

Thank you BizarreB. I'd come to the same conclusion as you and started looking for online programmes over the weekend. They do exist, but I don't think they would be as effective as proper one to one therapy. But this morning my support worker rang me and I asked her if she would go through some DBT materials I have with me and also work on some stress relief strategies. She was enthusiastic about this. So we will see. I've set wheels in motion at least. Thank you for your reply. Kind regards, GK.

 

[Ginger Kitten]

Awfully limiting, I'm very sorry to hear that. In my case it worked wonderfully well for depression.

Dr. Linehan and others have adapted DBT to many other mental health conditions. I believe the modules mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness are transdiagnostic. So I'm a little surprised that NHS would reserve DBT for personality disorders alone. Could that be for budgetary reasons?

The US (and Australia, I hear) is way ahead of the UK in the treatment of mh conditions, just one example being the fact that DBT, while developed for EUPD, is now seen as transdiagnostic in America (as you say). It isn't here and it will probably take years before it is - if it ever is. CBT is used as a general panacea for all ills, and I've been given it 4 times, despite my saying it doesn't work for me.

So you see what we're dealing with over here. This country is not at the forefront of creative thinking on treating mental illness. Things might change, because mh is high profile at the moment (due to Covid) and the fact more and more celebrities (and the two Princes) are talking about their own experiences. But it takes decades for anything to change - hence the NHS is still relying on CBT (which admittedly works for some conditions and some people), which was first introduced here nearly 40 years ago! It's hard to tolerate sometimes.

 

[Bizzarebitrary]

Things might change, because mh is high profile at the moment (due to Covid) and the fact more and more celebrities (and the two Princes)

I've been very impressed by the elevation of mental health as a matter of public discussion in the UK. Institutions that I view as rather conservative--the royal family and the British armed forces--have raised the profile of MH as you say, and perhaps more people are now willing to seek help (or at least have that conversation).

I pay attention to mental health care in the UK because in some ways, I feel you are ahead of the US--especially in coverage and making resources available.

I forgot to mention that it took me 3 full cycles of DBT (nearly a year and a half!) before I could really use the skills. I'm optimistic that you won't need to be "marinated in DBT" like I in order to see results, yet the organ responsible for cognition is the very one that's impaired by mental illnesses. That small ugly fact didn't occur to me when I began the program. I had to learn how to be patient with the DBT program, and with myself. That was actually a significant part of the healing process for me.

 

[Ginger Kitten]

Yes, the profile of mental health has been raised, but not the provision of services within the NHS. It is a huge and cumbersome organisation, different Trusts work in different ways, but overall it is still conservative, otherwise my Trust would be willing to open up DBT to treat more than one condition. You have to live here to understand, I think. I was surprised to hear you would think we are more advanced than the US in this regard BizarreB, but I can see why you think that. You really can't know another culture until you experience it directly, so I guess that's why I think it's better over there and you think it's better over here! It's probably neither, just different. All the best, GK.