A very helpful and tech-savvy user and blogger, Debbie Corso, at healingfrombpd.org created a video walkthrough of the app. We’ve also created PDF documentation for the app so you can pick your method of learning. Both cover the highlights very well and should get you started on your way to being effective with the app.
I hope you find it as helpful as I did!
It’s been a long time coming but Version 2.0 has been released. The feedback and response has been incredible and I think that the people who’ve bought the app have been rightfully thrilled with it. It’s universal so it’ll run on your iPhone/iPod touch and iPad.
A minor bug fix release is now out. As you can see by the steady stream of updates, this app will continue to be supported for the long-term. We are continually improving it and building upon our solid foundation. We hope you find it useful.
After quite a long review process (unrelated to the awesomeness that is this update, I’m sure), version 1.2 is out now. We did a ton of work on the PDF output so it’s much more readable and I hope useful. Some new skills have been added and there are new achievements to unlock. Get it now!
You can have a look at the fancy new PDF output here.
Last week I completed an interview with the editor of the Psych Central DBT blog. You can read the interview here.
A minor bug fix and a new skill: TIP!
More new skills are coming soon, but I really wanted this one in the app and it just didn’t make it out of my head in time. Thanks to those users who sent in crash reports so we could kill that bug quickly.
As I was digging through the articles I’ve collected to read and post about, I came across this one with some research conducted by some local mental health professionals, amongst others. The study described in the article was a large multi-site data analysis in which adolescents with a Major Depressive Episode were followed-up over the course of several years after treatment.
The researchers found that:
We’ve long known that a past major depressive episode predicts a future one. As a result, this finding is not surprising. What is interesting about the research here is that there is a predictive factor of both gender and co-occuring anxiety disorder.
As far as clinical implications go, this finding highlights the importance of skills acquistion for self-recovery after the completion of therapy by a trained professional. In addition, the should focus not just on the management of the depression symptoms but also of the anxiety features present. I’d like to see more follow-up on specific types of therapy and the longevity of their effects, but longitudinal study is hard and expensive, so we may never get to see that clinical application of these findings.
Depression isn’t forever, but like an unwelcome houseguest, it finds its way back. Be ready.
Footnotes:
[1] This was not a study looking at the efficacy of various types of treatment, just a look at the efficacy of all treatments. The treatment options for participants in this study received either Cognitive Behavioral Therapy, fluoxetine (prozac), a combination or a placebo.
We are often asked this question by friends and family and, while there are a number of websites devoted to DBT, it’s hard to get a clear answer on this very important question. Keep in mind that there is no one, specific answer you’ll get to this question. Ask 10 DBT therapists “what is DBT?”, though, and you’ll likely get some combination of these points:
All of these descriptions are accurate but they don’t really help explain what DBT means and how it might help you more than other types of treatment like Cognitive Behavioral Therapy (which, itself is an EST for a variety of conditions).
When we’re asked what DBT is, depending on the audience, we will go into talking about how DBT is a “third-wave psychological treatment which is based on CBT but adds some essential components like Mindfulness and Acceptance.” Again, this is a completely accurate description, but doesn’t give you a sense of what that actually means.
Dialectical Behavior Therapy is a treatment that works on a number of levels, including some of the same ones found in Cognitive Behavior Therapy. In CBT, there has been, historically, a great emphasis placed upon changing and challenging your thoughts to change how you feel. This is all well and good for many situations and emotions, but there is an essential piece of the puzzle missing. Emotions aren’t just the product of thoughts. As emotion researcher Paul Ekman talks about in his book, Emotional Awareness: Overcoming Obstacles to Psychological Balance, emotions are not just thought about, they are felt, physiologically. As a result, you may be able to successfully challenge your thoughts but still feel the way that you do.
This line of thinking about emotions also leads one to the somewhat judgmental conclusion that if you would just “think differently,” you would feel differently. That is, it’s your fault you feel as you do. While it may be your responsibility to address how you feel, change the situations you find yourself in, and accept your lot in life, it most certainly not your fault. Just like it’s not your fault if you get wet when you’re standing in the rain.
DBT focuses on a model of emotion that takes into account not only the thoughts that precede an emotion, but also the physiological changes one experiences prior to its onset. It teaches ways to address those changes so that you can approach emotions in a multi-faceted way. In DBT, You will learn the skills required to effectively challenge your thoughts.You will learn how to change your physiology. But, most importantly, you will learn how to understand and accept your emotions to help keep them from taking over your life. This, I believe, is the key difference between DBT and CBT and the reason DBT is applicable to many conditions aside from the currently researched ones. It is surely not the only treatment that could work, but I find that it is the most useful approach to take.
DBT is a principle-driven, as opposed to protocol-driven, approach to therapy. You will not have an “agenda” per se set at the beginning of a session, for example. What are the principles that can help us understand your current situation and what technique would be helpful to address it?
A comprehensive DBT program is important to help you learn these skills and generalize them to your environment.
DBT will also help you address interpersonal problems that have arisen in your life and get through those times that are so overwhelming all you can hope to do is tread water. On top of all of this is the notion that Mindfulness is a key to your psychological well-being.
When one talks about DBT as a treatment modality, it’s important to recognize that it’s not just about skills training group. These groups are an essential part of any DBT program, but it’s not the only part. A comprehensive DBT program will incorporate all of the following components:
Further, behavior tracking using “diary cards” is important to help you monitor what is going on in your life and how you are using skills to deal with your life. These diary cards also give your therapist a chance to get a quick glance of your week and see where things need to be addressed.
The concept of mindfulness is often referred to when initially helping clients with feeling overwhelmed - with work, family, emotions - to help them control and manage their thoughts and feelings. The concept taught during DBT skills groups often revolves around doing one thing in the moment. Technically, this is called the skill of “one-mindfulness” when teaching the Core Mindfulness section of DBT. During teaching, we often refer to multitasking In Real Life like we do when we try to multitask on a computer.
The metaphor goes something like this: before we could multitask, focusing on one window at a time made us more productive. Or rather, we maintain that computers are not able to be as efficient when multitasking because they get bogged down with too many programs open.
As a power computer user, I always found this analogy to be lacking. Well, as a power Mac computer user, I found it to be lacking. I’m typing this article on a computer that weighs less than 3 lbs. with a processor that is “slow” by many standards with probably 20 applications open. And my computer isn’t slowing down at all. (For those interested, this is what I’m using.)
The truth is, I like multitasking on my computer. As a “good” “mindful” person, I’ve felt guilty about that. I admit it, it always drives me crazy to see someone use a full screen view on their Word document, with big white borders on the sides (my eyes hate to see all that white screen), or even worse, with text stretching across the length of their computer’s widescreen monitor (how does that make for comfortable reading?). It always struck me as a waste of valuable screen real estate to make a window actually full screen. Modern computers have advanced windowing systems and memory management specifically so we could multitask. How could technology be so focused on giving us the ability to multitask if the act is inherently inefficient?
I couldn’t reconcile my view on being one-mindful and its importance in developing a sense of balance with my avid use of multiple windows and applications on my computer. That is, until I read an article by Lukas Mathis about how we are incorrectly equating multitasking on a computer with multitasking in real life.
However, the argument that multitasking on computers is bad because humans can’t multitask is flawed. It uses the word «multitasking» in two different ways, but implies that the two kinds of multitasking are somehow the same thing. They’re not: a task (or an app) on a computer, and a task performed by a human don’t map to each other one-to-one. In fact, a single task performed by a human can easily make use of several applications running concurrently on a computer.
(Ed. note: emphasis mine)
Computers and programs are like single atoms. Well designed apps do one thing and do them very well. The idea I’m proposing is that we be mindful one molecule of behavior at a time. In chemistry, a molecule is the smallest unit of a compound that still retains the properties of that compound. Nothing added and nothing taken away. You can’t have a molecule of water without 2 hydrogens and 1 oxygen atom. No one would claim that H2O is anything other than one thing - a molecule of water. Similarly, many of the complex tasks we undertake as humans involve more than one atom of behavior but can be grouped into molecules of behavior. Within the molecule of writing, there’s typing, reading, cutting, pasting, etc. There isn’t, however, listening to music, watching YouTube or responding to emails. Those are impurities in your compound.
So, while multitasking for computers is a desired state, it’s not in humans. We’re more complex than computers and necessarily work on the molecular level. There. In one article, I solved my cognitive dissonance of having 20 applications running at once (and liking it!), justifying how I can be mindful while doing it and proving we’re better than Watson. That’s a trifecta if I ever read one!
If it’s raining outside, and you happen to be out there, you’re probably going to get wet. That is, unless you’ve prepared by bringing a raincoat, umbrella, poncho or trash bag.
This truism is often the way I frame my discussion of emotion. It’s generally accepted by most people that when it’s raining outside, you’ve got a couple options to avoid getting wet - prepare by bringing the aforementioned gear or don’t go outside. To expect not to get wet without doing either of those things is kind of absurd1. Natural reactions - getting wet - to everyday occurrences - rain - are, umm, natural, and, double ummm, normal.
We don’t expect people not to get wet just by willing themselves to be dry or by believing that if they only thought about things differently, they’d stay dry.
Or that if “normal” people were in the same situation, they’d be dry.
It’s. Just. Not. True.
If someone is able to stay dry in a rain storm, chances are they’ve got a nice big golf umbrella, a good pair of hiking boots and a fancy Gore-tex jacket. You may not have any of those things right now, but you can learn to get them. And, in the meantime, you can work on using what you’ve got, maybe a trash bag or an old newspaper, to keep yourself as dry as possible.
With that tidy metaphor out of the way, let’s get down to the business of learning about emotion. Understanding it so that we know what we’re dealing with. Emotion comes from prompting events. These events can be internal (e.g., thoughts) or external (e.g., a car accident). They can be actual or they can be just perceived. It doesn’t really matter because in dealing with emotions, perception is reality.
A prompting event can lead to an interpretation of that event. These interpretations are deeply personal and are often what people think of when they try to deal with emotions. I don’t know how many times I’ve heard, “If I could just think differently, I wouldn’t feel so bad.” That’s sort of true. And sort of not true at the same time. In other words, just thinking about things differently (or changing your interpretations), is not always going to work to change how you feel2. If it always were so easy, self-help books would be all anyone ever needed for therapy and I’d be out of a job!
A prompting event can also lead to any number of physiological reactions. When you get frightened and get goosebumps? That’s the sort of thing I’m referring to. Flushing face, tension in your shoulders. Additionally, interpretations can also lead to physiological reactions. “Someone’s broken into my house and my life’s in danger” will lead to a racing heart and quickened breathing, for example. These physiological reactions are hard-wired and not something that we can just stop doing3 right away.
We then have what are called, in DBT parlance, “action urges.” These are the things that you are driven to do as a result of the situation/interpretation/physiological reaction. When you’re scared, you run. When you’re angry, you lash out. When you’re ashamed, you hide. Again, these are all considered hard-wired reactions. Think of it from an evolutionary perspective. Back in the day, things that caused fear were often life threatening. It made sense to run when your life was threatened. Right?
So, we have at least 3 sources for the formation of an emotion. There are other potential sources, such as history and vulnerability factors, and we’ll get to those in another post. But, to get back to our metaphor, there are 3 storm fronts that are moving your way and there’s not much you can do to keep them from getting to you. At least right now, all you can do is cope with them4.
Footnotes:
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