Posted by Dinah on March 18, 2004, at 10:20:18
In reply to Dear diary « Ilene, posted by Dr. Bob on March 17, 2004, at 23:59:48
> > We saw my pdoc on Monday. She lent me a copy of Marsha Linehan's "Skills Training Manual for Treating Borderline Personality Disorder" even though she says I am not borderline. I would like to do the therapy in this book--DBT, or dialectical behavior therapy--because it addresses my objections to CBT (cognitive behavior therapy) and is directed at people who share my characteristics. (I wonder why I'm not borderline, considering.)
> > Linehan says that the core disorder in BPD is emotion dysregulation, which is produced by emotional vulnerability, among other things. One of the characteristics of emotional vulnerability is "a slow return to emotional baseline once emotional arousal has occurred". When something happens to upset me I can't get back to normal for hours, even when I know I misinterpreted something, or I can feel myself over-reacting, or I know I'm seeing the worst in a situation. I'm aware of this when it happens, but I can't figure out a way to make it stop. This makes me question the efficacy of CBT, which assumes that if you recognize your irrational assumptions, your mood will improve.
> > Linehan says an "invalidating environment" is the crucial developmental circumstance in producing emotion dysregulation. Her first example of an invalidating family environment is when a child says she is thirsty, and parents say, "No, you're no. You just had a drink." She must have overheard my mother.
> > There's more, of course.
That's exactly how I felt when I first read Linehan's "Skills Training Manual for Treating Borderline Personality Disorder" and "Cognitive-Behavioral Treatment of Borderline Personality Disorder". It was a huge ah-hah moment. No one had ever considered that I might be borderline, but the descriptions of easy emotional arousal, slow return to baseline, and invalidating environment really struck a chord with me.
And I, too, thought DBT was a more validating version of CBT and I might be more likely to stick with it. Unfortunately there are no DBT groups in my area. I brought the skills manual in to try to work with it with my therapist, but other things cropped up and I never got around to doing it on a long term basis.
Is DBT an option for you in your area?