I have been through lots of therapy and lots of therapists in my life and my contention is that therapy can’t be used to actually treat uncontrolled, serious mental illnesses. Now, don’t get me wrong, therapy can be supportive to a person with an uncontrolled, serious mental illness and therapy can be useful to a person with an uncontrolled, serious mental illness (such as in the case where the therapist tracks your bipolar symptoms and report changes to your doctor) but therapy cannot be used to actually treat a serious and uncontrolled mental illness.
When people ask me about bipolar treatments or bipolar therapy here, I tell them about the research on the therapy or treatment and I tell them this, “different bipolar treatments and bipolar therapies work for different people so try it and see if it helps.”
And I consider this good advice. It’s absolutely true. Different bipolar treatments and bipolar therapies do work for different people – but that doesn’t mean that I, personally, believe in them.
And, to be clear, it’s not so much that I don’t believe in them entirely, it’s more that I don’t believe in them for me.
Enter mindfulness-cognitive therapy or mindfulness meditation.
Yesterday I was at my psychiatrist’s and I wasn’t doing terribly well. It seems I’m a little stressed. Turns out being a well-known mental health writer is a smidgen more challenging than one might think.
And so one of the recommendations my doctor made was to do some mindfulness training in a local program.
Instantly I felt myself rile against the idea. Internally I was feeling very resistant against yet more therapy.
And I realized why – therapy feels like an insult. The idea that I need more therapy seems to suggest that I’m not handling my disease in the best way possible. This seems to suggest that I don’t know everything already. More therapy feels like I’m doing something wrong and have to be fixed. The idea of more therapy suggests that someone else knows something that I don’t. And boy am I tired of bipolar treatments that don’t work.
In spite of what some people intimate, I do endorse non-drug solutions and one of the best adjunct treatments to medications is psychotherapy. Many types of therapy can work for different people, but one current and research-backed therapy is dialectical behavior therapy (DBT).
Now, don’t let the big words scare you – this is not a scary therapy. This is simply a therapy that uses reason to integrate and synthesize opposite points of view. Meaning, the techniques taught are designed to find a balance in emotion, behavior and acceptance.
Dialectical behavior therapy was designed specifically to treat borderline personality disorder; however, it has shown usefulness in mood disorders and research is currently underway to see if DBT techniques are also useful in other disorders. This therapy represents a huge breakthrough as the first indicated treatment of borderline personality disorder.
What Does Dialectical Behavior Therapy (DBT) Teach?
Dialectical behavior therapy is more about teaching and doing than it is about talking. It is simply not talk-therapy.
Dialectical behavior therapy teaches:
- Mindfullness – involves non-judgementally observing and describing the self and the environment. Involves being fully “present,” in the moment and participating in the activities and world around you.
- Distress tolerance – involves accepting and minding meaning in distress rather than focussing on changing the stressful environment. Involves self-soothing techniques.
- Emotion regulation – involves learning to maintain and regulate emotions; becoming less reactive to the situations around you.
- Interpersonal effectiveness – involves learning how to effectively interact with others to obtain needs, say no and handle interpersonal conflict.
Other techniques such as self-management may also be added to the DBT teachings. It is often done in a group therapy setting.
What is Dialectical Behavior Therapy (DBT) Like?
Now, I admit, I have not had DBT, so I am not speaking from personal experience, but I have talked to local DBT experts who run a four-stage DBT program specifically for borderline personality disorder, and it looks like this:
Stage 1 of DBT
- Decreasing or eliminating self-injurious behaviors
- Decreasing or eliminating behaviors that interfere with therapy
- Reducing or eliminating hospitalization as a way of dealing with distress
- Decreasing behaviors that interfere with quality of life
- Increasing behaviors that enable a person to have a life worth living
- Increasing behavioral skills that help to build relationships, manage emotions and deal effectively with life problems
Stage 2 of DBT
- Decreasing post-traumatic stress
Stage 3 of DBT
- Increasing self-respect
- Setting individual goals
- Solving life problems
Stage 4 of DBT
- Developing the capacity for freedom and joy
Does Dialectical Behavior Therapy (DBT) Work?
That depends on who you ask, but the research says yes, it works.
In randomized clinical trials, DBT was more effective than usual treatment in reducing suicidal and self-injurious behaviors, treatment dropout, hospitalizations, and self-reports of anger and anxious ruminations.Increased rates of global adjustment were observed after one year of treatment, and these gains were maintained over the subsequent year.
Dialectical Behavior Therapy (DBT) and Self-Harming Behaviors
Because many people with borderline personality disorder have self-injurious behaviors, dialectical behavior therapy has developed specific techniques for handling this behavior. I have been asked about these techniques repeatedly and will go into them next time.
Dialectical Behavior Therapy (DBT) Resources
You may not be able to find a therapist who specializes in DBT in your area. This is too bad considering how effective it is. Do not give up; however, as books, workbooks and online resources can walk you through DBT. Here are some DBT book resources:
- Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan
- Sometimes I Act Crazy: Living with Borderline Personality Disorder by Jerold J. Kreisman, MD and Hal Straus
- Stop Walking on Eggshells; Coping When Someone You Care about Has Borderline Personality Disorder by Paul T. Mason and Randi Kregor
- Cutting: Understanding and Overcoming Self-Mutilation by Steven Levenkron
- The High-Conflict Couple: A Dialectical Behavior Therapy Guide to Finding Peace, Validation and Intimacy by Alan Fruzzetti
- Surviving a Borderline Parent – How to Heal You Childhood Woulds and Build Turst, Boundaries and Self-Esteem by Kimberlee Roth and Freda B. Friedman
DBT article resources:
- Dialectical Behavioral Therapy: Current Indications and Unique Elements (free article)
- Dialectical Behavior Therapy: Current Status, Recent Developments and Future Directions
- Dialectical Behavior Therapy for Borderline Personality Disorder
DBT and borderline personality disorder website resources:
- Behavioral Tech
- DBT Self-Help
- Treatment and Research Advancements National Association of Personality Disorders (TARA)
- Borderline Personality Disorder Resource Center
- Priory Medical Journals
Note: resources provided by local DBT group and not personally endorsed.
Admit it – you haven’t kept up with your bipolar reading. Come on. I know it. I can barely keep up and I write the bipolar articles.
Luckily for you, I like you a lot, and I’m happy to give you a little cheat sheet on what’s been getting attention at Breaking Bipolar. We’ve got mental illness and higher education, mental illness and physical pain, how to tell if it’s a med side effect and oh so much more.
Articles Breaking Bipolar Over at HealthyPlace
- Is it a Med Side Effect? – What is a medication side effect and what isn’t a med side effect? How can you tell?
- Temperature Dysregulation – Or Why I’m So Cold – Speaking of side effects – did you know psychiatric meds can change how your body temperature feels?
- Yes, You Can Get a Higher Degree With Bipolar Disorder – So many people have written me to say how successful they have been in school. Read this for inspiration and hope. Some people have taken 10 years to get their degree – but they got it. Article includes tips on being successful at school.
- Mental Illness Means Physical Pain Too – People think mental illness is “just” in your head. They would be wrong about that.
- Is It Really Never the Psychiatrist’s Fault? – I’m tired of doctors acting like they never make a mistake.
- Being Thankful Even When Anhedonic – Even when I can’t feel pleasure I can feel grateful for the things that go right in my life.
- How to Keep Going When Medication Doesn’t Work – And for your final dose of hope and encouragement, here are some tips on continuing mental illness treatment even when everything is going wrong.
Popular Articles at the Bipolar Burble
And just in case you haven’t been glued to the Bipolar Burble, here are a few things you should read here:
- Questioning the Evidence of the Efficacy of Therapy for Depression – Interesting information on how evidence-based therapy for depression really is. Less so than I would have thought. And do you think CBT is intellectual and analytical? I do, but a commenter disagrees.
- When to Get Off Antidepressants if You’re Bipolar – The first in a three-part series on getting off of antidepressants.
- Important Safety Warnings for St. John’s Wort – Please read if you’re on or thinking about trying St John’s wort.
- Cutting Supplemental Security Income Hurts Mentally Ill Children – A guest post by Allison Gamble that garnered a lot of reads.
- Psychiatric Myths Dispelled by Doctor – Fighting Antipsychiatry – Have you read this article yet? It garnered more comments than any other at the Burble. It’s always a hot topic.
This week I learned three new things about psychotherapy and depression.
I’m a fan of psychotherapy for everyone. In fact, if we could get the mid-East folks to sit down for some good counselling, I think it would be more effective in bringing peace than anything you can do with a gun.
With that said, there are limitations to therapy and sometimes therapy is not all it’s cracked up to be. So this week, a look at three perspectives on psychotherapy:
- Psychotherapy is no better than placebo in treating depression?
- Which type of psychotherapy is better for depression?
- How does psychotherapy change the brain?
1. Is Psychotherapy Better Than a Placebo in Treating Depression?
When the study came out a couple of years ago alleging that antidepressants were no better at treating mild-to-moderate depression than a placebo, the antipsychiatry world went crazy (if you will). All their dire claims, it seems, had been proven true.
Well, the sky hasn’t fallen yet, but interestingly the same kind of analysis, when applied to psychotherapy, can also allege that psychotherapy is no better than a placebo too.
Of course, there is no such thing as a placebo in therapy. There is no “inert” counselling session. Scientific literature attempts to compare cognitive behavioural therapy (CBT), interpersonal therapy (IP) and others against wait-listed participants and those who have received therapy not containing the specific therapeutic technique being tested. Basically, they tell a therapist not to therapy. Which is a pretty tough thing to ask a human to do. And naturally, humans aren’t going to do it well.
Does Psychotherapy Work to Treat Depression?
I would say yes, therapy, various types, including cognitive behavioural, interpersonal and supportive therapy, all help treat depression. However, some suggest the jury is still out on how effective therapy really is in treating depression.
2. What Therapy is Best for Depression?
[push]Psychologist Gary Greenberg states CBT is more of an ideology and a “method of indoctrination into the pieties of American optimism.”[/push]
When selecting a therapy for depression one has many choices but the prevailing one in the scientific community right now is cognitive behavioural therapy (CBT). Everybody loves it. It’s the golden child. CBT is a highly intellectual and analytical therapy that is short-term and action-oriented so it’s no wonder that people like it.
In the same article as the one talking about therapy effectiveness in the treatment of depression, they also discuss which therapy is best for depression, and it kind of seems like none of the therapies are best. (This could be because, statistically, some people respond better to one treatment while others respond to other treatments and when you lump them all together, a similar percentage responds to each.)
3. What Does Psychotherapy Do to the Brain?
As I have mentioned several times, depression decreases brain volumes over time – ie, depression shrinks your brain. It does this through decreasing neurogenesis (the creation of new neurons); however, electroconvulsive therapy (ECT) and antidepressants have both been shown to increase neurogenesis and brain volume.
Interestingly, so does psychotherapy.