Depression and Dialectical Behavioral Therapy

[gcc922]

Hello,

After struggling with clinical depression for about 25 years and trying cognitive therapy and various meds with little lasting success, I may soon be starting DBT. However DBT is used to treat people with borderline personality disorder, which I haven't been diagnosed with and as far as I can tell don't have.

Does anyone know if DBT is used often for the treatment of clinical depression?

I feel my depression is more existential in nature, but existential therapists are apparently few and far between, so maybe DBT is an alternative? I'll be asking my doctor more questions about this, but thought I'd get a "second opinion" here.

Thanks!

Edited August 5, 2008 by gcc922
and a grammatical error!

[Natalie]

Hi Gcc922-

This is a great question, thanks for asking it. But first, I would like to applaud you for having the courage to try something new after dealing with depression for such a long time. I am so very glad that you haven't given up hope and are willing to move forward.

DBT was originally designed by it's founder Dr. Marsha Linehan, to treat people who were suicidal and depressed. Over time, she (along with many other therapists that she trained) realized that the principles of the therapy (a combination of change and acceptance practices) would apply to and work well with individuals with Borderline Personality Disorder. One of the reasons that this gets so much attention is that there are very few scientifically studied therapy approaches that have been shown to work with this group of people. So naturally, people were quite excited to have a treatment option.

However, this form of therapy has been quite successful for people with chronic depression (which it sounds like you have been dealing with). If you would like more information about Dr. Linehan and this form of therapy, I suggest you take a look at, and listen to our podcast interview with her: http://www.mentalhelp.net/poc/view_index.php?idx=119&d=1&w=9&e=300

Keep us posted and share your experiences with us. I imagine that there are many individuals out there who are curious about what DBT "is like." Good luck to you.

[gcc922]

Thanks!

I gave up on therapy and meds for about 3 years, but "things" just piled up and I was unable to handle it alone anymore. I tend to intellectualize almost everything and have a miserable time with most emotions, so my doctor said DBT might be a way of getting (and potentially keeping) things more balanced.

I met with the doctor today and the process(es) have started to get me into a DBT group, etc. I also asked about the borderline personality disorder (BPD)aspect and she said that while I don't have BPD, I do injure myself emotionally by beating myself up for a variety of things (a bad habit I got into years ago).

Basically I sought help again because this is no way to live.

[Mark]

I tend to intellectualize almost everything and have a miserable time with most emotions, so my doctor said DBT might be a way of getting (and potentially keeping) things more balanced.

DBT was originally designed to help people who were either chronically suicidal or chronically self-injuring learn how to cope in alternative, less harmful ways with their overwhelming emotions. As Natalie pointed out, it works by teaching you cognitive stragegies on the one hand, and acceptance strategies on the other hand. These acceptance stratagies - patterned after meditation and christian monastic contemplation practices originally - help people cultivate a detached "witness" perspective from which their emotions are less threatening and overwhelming. Developing these skills (also called Mindfulness skills these days) helps people learn how to calm themselves mentallly and emotionally and makes it possible for them to apply cognitive strategies by simple virtue of opening up a space where they can be applied (where before people were feeling too overwhelmed to apply them). In this sense, these skills may help you too, even though you are not suicidal or self-injurious, as you too appear to get overwhelmed after the "dam" of your intellectualization breaks.

Another way you might approach the same thing would be to focus on strategies that would help you develop alternative means of coping besides intellecutalization - such as strategies that would help you get more into your body and work out some of your upset physically. So - exercise and/or combination exercise/meditative sorts of things like yoga might be helpful to you as well. All by itself, exercise has an antidepressant effect and it combines well with other treatment approaches and it doesn't cost much, and generally it is good for you, so why not look into it?

Mark

[Grant]

Thanks!

I gave up on therapy and meds for about 3 years, but "things" just piled up and I was unable to handle it alone anymore. I tend to intellectualize almost everything and have a miserable time with most emotions, so my doctor said DBT might be a way of getting (and potentially keeping) things more balanced.

.

I too tend to intellectualize stuff and found that DBT was a little to remedial for me. It felt very patronizing and seemed to rob me of my greatest strength; my smarts. I abandoned it pretty quickly. Just putting in my opinion about it. I struggle with depression pretty heavily and I wasn't happy with DBT, which seem to go against some pretty harsh reality in favor of some daft almost Law of Attraction type beliefs.

[gcc922]

I too tend to intellectualize stuff and found that DBT was a little to remedial for me. It felt very patronizing and seemed to rob me of my greatest strength; my smarts. I abandoned it pretty quickly. Just putting in my opinion about it. I struggle with depression pretty heavily and I wasn't happy with DBT, which seem to go against some pretty harsh reality in favor of some daft almost Law of Attraction type beliefs.

Thanks. I don't think I have anything to lose so I'm going to give it a try. I'm currently reading Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective by Mark Epstein, I've just started the section about meditation and it mentions things that are similar to what I know of DBT.

I have a private session with a therapist next Wednesday that will at least in part be an "intake interview" to determine whether I'll be a good candidate for the program. I'm both a little excited and a little apprehensive about it.

[Mark]

DBT is remedial in the sense that it seeks to teach skills that many people who self-injure do not have (e.g., self-soothing skills). This is not at odds with intellect. It is actually something quite separate from intellect. You can be a very smart person (verbally, mathamatically, etc.) but not have well developed emotional coping skills. Vice versa, you can have well developed emotional coping skills, and not be very bright at all. So please do not think of something like DBT as being at odds with being bright. It's really not. Just like you cannot learn to drive a car by reading a book about driving (you have to drive), you cannot think your way into development of good emotional coping skills. You have to practice them.

[Catmom]

I haven't specifically been in DBT but have been in CBT for quite awhile and I can understand Grant's reaction to some of these strategies.

At one time, I dismissed CBT out of hand, thinking that it couldn't help to try to govern my thought process. I was wrong. I am extremely bright, but have lacked emotional coping skills for most of my life. Unfortunately, my intelligence could easily morph into intellectual arrogance that kept me from seeing a better way to live.

Those who have read my other posts know that this lack of coping skills led to my becoming a compulsive gambler and abusing prescription drugs.

Anyway, once I messed my life up enough, I became willing to consider that maybe I didn't have all the answers. Realizing that I had been wrong about so many things was a very freeing experience. I then had gcc922's attitude of "why not give it a try since my ideas haven't worked out so well."

Long story short, Mark is right: smarts and emotional coping skills are not at all the same thing.

Catmom

[Guest ASchwartz]

Hi Catmom and all,

Because you have been through cognitive behavioral therapy already all you need do now is add self soothing techniques to your life. How? Join a meditating group and, or, try yoga. These things really help. You know, self soothing is something that seems to elude most of us. We all need to learn to

"chill out" in healthy ways.

Allan

[gcc922]

Thanks! Yeah, that makes sense. I'm meeting with a therapist who's involved with the DBT group this coming Wednesday (September 3). I'm looking forward to it, but I'm rather apprehensive about being in group therapy since I find it difficult to open up to strangers. I have a long-standing habit of observing more than interacting.