Lesson 10. CBT and DBT. 6 ways to develop coping thoughts and addressing thoughts ........... II.
Updated: Mar 16, 2022
Updated and expanded.
This lesson was very Informative about the differences between CBT and DBT. It was useful to get some professional clarity and confirmation about the differences between the two models of psychotherapy and how the two are used to address different things, issues and components of mental illness if that's the correct expression.
It was interesting to have confirmed that DBT is a modified form of CBT that employs traditional CBT techniques, but also implements other skills from zen Buddhism like mindfulness, acceptance, and tolerating distress tools. This lesson made it so much clearer to me how this model of therapy is so much more suited to treating BPD and PTSD and why. It's an eye opener.
The zen Buddhism aspect of DBT is an exciting thing. Loo forward to learning more about how this intersects with traditional psycho therapy.
On a practical level, it was an ahha kind of thing to learn and hear about the introjection guilt tripping voice issues and how important it is to unwind those triggered thoughts, links and negative associations.
The triggers.
This is something I need to work hard on and it is prevalent to some painful complicated head fucks I have going on right now concerning "parent" issues. Anger. I have a lot of mess from the past that eats into this one very much. I have some very active demons, past and present to address on this front.
Another eye opener, even to be going over this stuff AGAIN, but I will press on with trepidation.
I fucking hate it actually. I have a lot of pain and resentment and unanswered questions and, well, hurt. Right now. Keeping it locked down and not dropping some ugly truth bombs on people is taking a lot of effort.
Still, I have to cope with it.
The final ahha thing I'll address quickly, as not to submit a too lengthy a brief is the observing our thoughts practices. All of them, each tool covered in this lesson is intriguing and exciting and how the fuck did I not learn this as a child and young man? I know why but I still find it embarrassing. I'm very keen to get practicing these techniques as much as possible. As obvious as some tools seem, some have escaped me over the years and as i say, some were just not taught in the mellay of traumatic head fucks that turned my mind into a war zone. I need to take these DBT sessions seriously and I do.
Slowing my thought processes down in times of stimulation is so vital to my successful recovery from this horrid condition. I'm struggling with this over the past few days. I have to keep strong and not undue any good work achieved so far.
I have a very noisy mind right now. It's exhausting.
Enough whinging though, here are some notes and things on this DBT sessions subject matter:
Introjection:
Introjection
From Wikipedia, the free encyclopedia: In psychoanalysis, introjection (German: Introjektion) is the process by which the subject replicates behaviors, attributes, or other fragments of the surrounding world, especially of other subjects. It is considered a self-stabilizing defense mechanism used when there is a lack of full psychological contact between a child and the adults providing that child's psychological needs.[1] Here, it provides the illusion of maintaining relationship but at the expense of a loss of self.[1] Cognate concepts are identification, incorporation,[2] and internalization. To use a simple example, a person who picks up traits from his or her friends (e.g., a person who begins frequently exclaiming "Ridiculous!" as a result of hearing a friend repeatedly doing thus[further explanation needed]) is introjecting.
Projection has been described as an early phase of introjection.[3]
Reasearch from https://www.goodtherapy.org/blog/psychpedia/introjection :
Introjection, one of many defense mechanisms posited by Sigmund Freud, occurs when a person internalizes the ideas or voices of other people. This behavior is commonly associated with the internalization of external authority, particularly that of parents.
WHAT IS INTROJECTION?
Introjection is the opposite of projection. Projection occurs when a person projects feelings or characteristics onto another person. Introjection, which is common among children and parents, occurs when a person internalizes the beliefs of other people. A child might take on elements of parents’ personalities or beliefs by adopting their political ideology, concept of right and wrong, or ideas about sex. When people introject, they identify with a person or object so strongly that they cannot separate that person or object from themselves.
While everyone learns from the external world and takes on elements of other people’s beliefs and ideas, introjection occurs with minimal thought. A woman who adopts her friends’ views, after they have been carefully explained and considered, is not introjecting, but a child who reflexively adopts a parent’s views without thought can be said to be introjecting.
Introjections involve attitudes, behaviors, emotions, and perceptions that are usually obtained from influential or authoritative people in one’s life. They are neither digested nor analyzed; they are simply adopted as a part of one’s personality as concepts that one considers should be believed or behaviors that one thinks ought to be followed. Introjections do not involve an individual’s personal integrity or morality.
HOW THE ENVIRONMENT AFFECTS INTROJECTION
A person may absorb the characteristics or attitudes of subjects in the immediate surroundings. While caregivers are usually the first people whose attitudes a young child may adopt, the moral code and behaviors of teachers and peers may also significantly influence a child’s value system. These influences may conflict with the values that caregivers wish to promote, and they may be particularly strong in the period before the child learns to self-govern and develop individual beliefs and personality. For example, a boy who is usually cheerful at home may begin to kick his dog and pick on his younger sister after experiencing bullying at school.
INTROJECTION AS A DEFENSE MECHANISM
Freud characterized introjection as a mature defense mechanism that is commonly used by psychologically healthy people. Some mental health professionals believe that introjection is a protective strategy that children employ in order to cope with unavailable parents or guardians: By unconsciously absorbing the characteristics of parents, children reassure themselves that some aspect of the parent is present even if the parent is physically absent. Depending on the types of attitudes that are picked up, introjection may lead to positive or negative effects.
POSSIBLE POSITIVE EFFECTS OF INTROJECTION
A person may introject positive traits and beliefs such as compassion, loyalty, morality, or a desire to help the poor. Introjection may also help an individual to cope with separation or even the loss of loved ones. For example, exclamations that a daughter says something “just like her mother,” following the death of the mother, may elicit vivid, happy memories. Introjection may also foster a sense of responsibility if an inexperienced youth is determined to do things “just like Dad.”
POSSIBLE NEGATIVE EFFECTS OF INTROJECTION
Introjections may also have negative connotations. A child exposed to negative parenting may constantly feel worthless, incompetent, or guilty, feel unable to freely express emotion, and find it difficult to discover identity or a sense of self. With this obstacle to self-development in place, a child may begin to lose confidence and may also become self-critical.
Introjection may lead individuals to pay an inordinate amount of attention to the beliefs of others rather than their own personal needs.
Another negative effect of introjection is the internal conflict that may arise from attempts to reconcile different or incongruous concepts. For example, a child who idolizes and copies the “ideal” father may experience inner turmoil upon discovery that the father was involved in criminal activity. An individual may also experience internal conflict if, deep down, that person does not truly agree with the attitudes adopted from other individuals.
Introjection may lead individuals to pay an inordinate amount of attention to the beliefs of others rather than their own personal needs. Some teenagers may focus entirely on upholding parental beliefs and fulfilling expectations rather than making their own decisions about the future. A person in a relationship may internalize the other partner’s comments about appearance and behavior and begin to act in that manner.
Negative introjection can also be part of a cycle of abuse. A person in an abusive relationship, for example, might begin to believe the claims of a partner who is abusive and internalize feelings of worthlessness or failure. In some cases, the victim might introject the abuser’s personality so strongly that the victim then becomes an abuser. The support of a therapist or other mental health professional may help mitigate the effects of abuse and prevent this from happening.
THERAPY FOR NEGATIVE INTROJECTION
It is possible for a person to overcome negative internalizations with therapy. Psychoanalysis may be used to uncover and resolve deep-seated unconscious material, even when it has been buried since childhood. Therapists may also employ cognitive behavioral therapy to help people analyze negative beliefs and gradually replace these beliefs with more realistic and accurate thoughts.
Negative introjections may contribute to mental health conditions such as depression and anxiety. When this is the case, therapy may also be helpful in addressing and treating these conditions. With the help of a mental health professional, a person may often be able to address and resolve the effects that negative introjections have had and develop strategies to avoid being further affected in the future.
References:
Defense mechanism of the week: Introjection. (2012, January 19). Jennifer De Francisco. Retrieved from http://www.jenniferdefrancisco.com/defense-mechanisms/defense-mechanism-of-the-week-introjection
Definition: Introjection. (n.d.). Purdue University. Retrieved from http://www.cla.purdue.edu/english/theory/psychoanalysis/definitions/introjection.html
Projection and introjection. (n.d.). ChangingMinds.org. Retrieved from http://changingminds.org/disciplines/psychoanalysis/concepts/projection_introjection.htm
Another interesting read here: https://www.sciencedirect.com/topics/medicine-and-dentistry/introjection
and here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030717/
All very close to the knuckle and, well, yep, trying to unpick this all at 40 odd is frustrating. ⬆⬆.
We discussed this dude and some neuro sciencey stuff ⬆⬆ Interesting stuff but on further research it get gets very neuro science heavy, research stuff that is beyond me, however there is some really cool stuff to glean from his work. Some of which can be found here:
https://guilfordjournals.com/doi/pdfplus/10.1521/pedi_2013_27_099
A heavy read.
Or some such stuff. I dunno 🤷♂️⬆⬆
Slides from the sessions discussions:
cognition /kɒɡˈnɪʃ(ə)n/ Learn to pronounce
noun
the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses.
We discussed cognition and CBT ⬆️⬆️
“In DBT, there’s not a heavy reliance on changing thoughts. There’s an implicit process that happens, so that as the client is mindful, as they’re more accepting, as they validate themselves and ask for validation, they start to change any resistance they may have. They start to be kinder to themselves, catastrophize less, ground themselves in reality and accept reality, but it’s not the active challenging process that happens with CBT.”
https://www.cumminsbhs.org/cbt-vs-dbt/
What is difference between CBT and DBT?
Cognitive-behavioral therapy or CBT teaches you how your thoughts, feelings, and behaviours influence each other. ... Dialectical behaviour therapy or DBT is based on CBT, with greater focus on emotional and social aspects. DBT was developed to help people cope with extreme or unstable emotions and harmful behaviours.
I.E. ....... meeeeee! FFS. ⬆⬆
The most noteworthy difference between CBT and DBT is the kind of change they create for the client. CBT primarily helps clients recognize and change problematic patterns of thinking and behaving. By contrast, DBT primarily helps clients regulate intense emotions and improve interpersonal relationships through validation, acceptance and behavior change.
For depression, anxiety, OCD, phobias and PTSD, research has shown that CBT tends to be the more effective treatment. For borderline personality disorder, self-harm behaviors and chronic suicidal ideation, DBT tends to be the better choice. Lucky old me, I tick almost all of those boxes bar the OCD which I had as a teenager and the phobias which I don't really have per-se.
If you have borderline personality disorder, you have probably heard of both cognitive-behavioral therapy and dialectical behavior therapy. Are these modes of treatment different or simply variations of each other? Let's take a closer look at these types of behavioral therapies and how they are related.
Here's some more nicked lit':
Cognitive Behavioral Therapy
Cognitive-behavioral therapy, or CBT, is a form of therapy that aims to restructure and change the way a person thinks and behaves. Whether or not this therapy is beneficial depends strongly on the relationship between the individual and their therapist.1 The individual's willingness to make a change is also a crucial factor.
Examples of techniques used by a cognitive-behavioral therapist include cognitive restructuring and behavioral changes, like reducing self-defeating behaviors and learning how to respond to problems in a healthy, adaptive manner. In cognitive restructuring, a patient is taught to identify negative reactive thoughts and modify them.2
How Cognitive Behavior Therapy Works
“In DBT, there’s not a heavy reliance on changing thoughts. There’s an implicit process that happens, so that as the client is mindful, as they’re more accepting, as they validate themselves and ask for validation, they start to change any resistance they may have. They start to be kinder to themselves, catastrophize less, ground themselves in reality and accept reality, but it’s not the active challenging process that happens with CBT.”
Dr White
Dialectical Behavior Therapy
Dialectical behavioral therapy, or DBT, is a modified type of CBT that was uniquely developed to treat borderline personality disorder. This approach is called "dialectical" because it involves the interaction of two conflicting ideas, which are that improving the symptoms of BPD involves both acceptance and change.3
It focuses on skills like mindfulness or living in the present, regulating emotions, tolerating distress, and effectively managing relationships with others. DBT is the only empirically supported treatment for borderline personality disorder.
DBT is composed of four elements that the individual and therapist usually work on over a year or more:3
Individual DBT therapy, which uses techniques like cognitive restructure and exposure to change behavior and improve quality of life.
Group therapy, which uses skills training to teach patients how to respond well to difficult problems or situations.
Phone calls, which focus on applying learned skills to life outside of therapy.
Weekly consultation meetings among the DBT therapists, which offer a means of support for the therapists and to ensure they are following the DBT treatment model.
This type of therapy focuses on some of the common symptoms of BPD including impulsivity, exaggerated mood changes, unstable relationships, poor sense of self, and the fear of abandonment. DBT also helps people with BPD work on skills such as being able to tolerate distress, regulating emotions, and effective interpersonal behavior.
One major focus on DBT is to help people learn how to deal with powerful emotions and learn new ways of coping with strong feelings without resorting to unhealthy coping mechanisms. Distress tolerance, for example, centers on helping people recognize and accept painful feelings without engaging in harmful behaviors like self-harm.
How Dialectical Behavior Therapy Works
How to Decide Which BPD Treatment Is Right for You
If you have borderline personality disorder, there are treatments that can help you manage your condition. Please speak with your doctor about finding the right therapist and treatment model for you so you can feel better and improve your quality of life.
Borderline Personality Disorder Discussion Guide Get our printable guide to help you ask the right questions at your next doctor's appointment.
Differences Between Dialectical Behavioral Therapy and Cognitive Behavioral Therapy
DBT is simply a modified form of CBT that uses traditional cognitive-behavioral techniques, but also implements other skills like mindfulness, acceptance, and tolerating distress. The good news is that DBT has been found to be considerably more effective in treating people with borderline personality disorder.
Dialectical behavioral therapy is recommended as a first-line treatment for borderline personality disorder and has been shown to reduce the need for medical care and medications by as much as 90%.
It's interesting to note that some cognitive-behavioral therapists incorporate certain elements of the DBT model into their treatment sessions. Also, other forms of CBT have developed that use the elements of DBT. For instance, mindfulness-based cognitive therapy utilizes traditional cognitive-behavioral techniques with mindfulness to treat depression.
https://www.verywellmind.com/cbt-dbt-treating-borderline-personality-disorder-425195
In our research and practice, we have seen the connection between Zen mindfulness and DBT. Behavior therapy has an inherent compatibility with Zen principles. Behavioral Tech trainer and Zen teacher, Randy Wolbert, breaks down for us the seven points of overlap between Zen mindfulness and DBT and how these links came to be.
While learning and practicing DBT, Randy began independent mindfulness practice and later became a Zen student of Marsha Linehan. This began his journey of Zen study, practice, and teaching, and from the beginning the role of mindfulness in DBT was clear.
As Randy puts it, when Marsha Linehan was first developing her model, she saw the need to modify behavior theory in order to successfully work with clients who have borderline personality disorder. “Linehan realized that she needed to include elements of acceptance to her treatment in order to both decrease the extreme suffering of her clients and to facilitate the changes necessary for them to build a life worth living.”*
But how to translate that realization into the treatment model? This led Linehan on the journey of seeking out an existing practice of acceptance that could be folded into the DBT model, which ultimately led her to the Zen model of mindful meditation.
See Randy’s chapter “Modifying behavior therapy to meet the challenge of treating BPD:
Incorporating Zen and Mindfulness” in the newly-published Oxford Handbook of Dialectical Behaviour Therapy for the full story.
The essence of Zen is seeing reality as it is, which is the starting point for changing patterns of behavior.
“Linehan translated the principles of Zen practice into a set of ‘how’ and ‘what’ skills (Linehan, 2015). These skills require staying mindful of the current moment, seeing reality as it is without attachment, and accepting reality without judgment. If a thought or emotion is observed as only a thought or emotion, then the individual can be free from the attachment to that thought or emotion. Furthermore, as the ability develops to observe our own experiences as a means of understanding the world, it then allows ‘disattachment’ from experiences and the ability to describe them without judgment.”*
So, as it becomes clear that there is compatibility between these practices, how does Zen mindfulness get folded into behavior therapy? Randy breaks down the seven points of overlap:
Both Behavior Therapy and Zen recognize no self or no independent self. Behavior therapists, rather than focusing on the concept of an independent or permanent self, focus on learning experiences and their transactions with environmental events. Patterns of behavior exist but they are always changing. In Zen the idea of an independent self is a delusion.
Both behavior therapy and Zen recognize unity; Zen as the oneness of the universe and behavior therapy as the connection between behaviors and the context in which they occur.
While it may seem to contradict unity, both approaches also recognize individuality.
Both Zen and behavior therapy adopt a non-judgmental worldview reflected in the way that they interact with each other, students, and clients. Both are adherents to the law of cause and effect.
The focus of both Behaviorism and Zen is the present – as the present moment is the only reality.
Zen and behavior therapy emphasize practice. Practice in Zen is meditation and walking the eight-fold middle path. Practice in Behavior therapy is learning and practicing new skillful adaptive behavior to replace maladaptive behaviors.
Zen believes that suffering exists and avoidance of suffering leads to worse suffering. This is similar to the behavior therapy technique known as exposure and opposite action. Experiencing rather than avoiding leading to less suffering.
In short, “the goal of behaviour therapy is change. The goal of Zen or mindful practice is simply mindful practice. The side effects of mindful practice appear to be decreased suffering, increased happiness, increased control of your mind, and the capability of experiencing reality as it is without delusion.” Therein lies the convergence (and divergence) of Zen and DBT!
https://behavioraltech.org/zen-mindfulness-in-dbt/
I'm unsure what is "fun" about this but hey ......... we discussed the above in class.
Facts matters! Getting facts down on paper when stressed out and stuck in a bad one really helps. A journal really helps with all of these skills. I keep journals. A key tool I now use to cope with the over loading stresses in life and reminding myself about gratitude in life.
Observe: – Start by noticing your environment and what is going on around you. – Begin to attend to your feelings, thoughts and any bodily sensations without reacting to them. – Non-judgmentally observe your emotional state (observe without trying to change).
Observing is a skill that practices mindfulness, just being in the moment and observing without judging or putting a value on something. Describing is an experience that you dislike, like maybe washing dishes, and just noticing everything about it without focusing on your feelings. This is a way to stay in the present and to be mindful about what is going on. The next skill in the group of "what" mindfulness skills is Describing. You take an experience such as washing the dishes and say to yourself statements about what you observe. "The water is gray. The soap feels slippery in my hands. The dish is hot." This describing skill also helps us to stay in the present. At times, when I was very distressed and there was no one to talk to, I would describe aloud the things I could feel and see to keep myself in the present. We can also use the describing skill to apply verbal labels to feelings. "I feel disappointed about missing the party. I feel happy to see my friend. I feel sad." Being able to verbally describe events such as washing the dishes and feelings like disappointment is necessary both so that we can communicate our thoughts and feelings to others and so that we can manage our feelings. We need to learn not to take our thoughts and emotions literally, as fact.
For example, feeling afraid does not necessarily mean that something is threatening or dangerous to us. Our fear may come from some past experience, or from something that has some connection to the current situation, or from confusion about the event that triggers our fears.
Note:
Having a feeling or a thought about something does not mean that that thought or feeling is fact. Thinking "No one likes me" or "I am unlovable" does not mean that these statements are true. They are just thoughts, or just feelings.
Practice describing the events around you and putting your feelings into words will help you to figure out whether your thoughts and feelings actually fit the
situation. You may have an upcoming exam. You may feel anxious and nervous. You may think, "I am going to fail this exam."
Describe those feelings.
Do you have physical symptoms - sweaty hands, butterflies in your stomach?
Describe your thoughts/What are you thinking about this exam?
Are these thoughts connected with the exam?
Are your feelings actually connected with the outcome of the exam? (Remember that you don't know the outcome yet.
Describing those thoughts and feelings helps us to see how the thoughts and feelings are actually separate from the actual exam. As Marsha Linehan says,
"Thoughts are just thoughts, feelings are just feelings."
This doesn't mean that the thoughts and feelings aren't real. They ARE real. They are just not the event or the situation itself. They do not necessarily explain or predict events in our lives.
Discussion
Today pick one experience that you have - cooking a meal, going for a walk, walking your dog, watching a TV show. Observe the experience, without judging or evaluating it.
Describe what you are doing or seeing, . What do you see, hear, touch? Do you feel something. Give words to your feelings. Keep them free of judgments or evaluations. Can you see that your thoughts and feelings about the experience are separate from the experience itself.
Keep a journal, for a day or several days, recording your experiences on paper. See how this works.
https://www.dbtselfhelp.com/html/describing.html
🔴🔴
These homework practices seem child like to some people who have their emotional well being shit locked down. For me, it's a fucking mission and a very important one, to keep sight of reality or at least everyone's shared reality in this life, which I guess is mine too!
And if it all seems childish to you, you have entirely missed the point. Entirely.
I have people I want to visit more often and places I want visit go more often but the crippling anxiety that spirals out out of control into full on rage and splitting madness kills that for me all to often. And in my past has ruined it for my ex partner and other loved ones etc, because I'm a mentally ill angry anxious raging red hot horrible abusive cunt. I cant let that happen again.
I've heard some things:
This type of homework is really helping me keep focused and calm and ahead of any rapid decline in mental health. These simple "childish" everyday homework practices are retraining my mind to cope and be a better human.
So to the short sighted fuckers that throw cheap, stigmatized, ill informed, one sided judgments at me and shit stir about my past and shit behaviours that I fully admit too and own, fuck you! You people must be entirely perfect?
These DBT tasks are changing my life for the better slowly. I am getting better again but this time for good, I hope.
"I was ill" .
🖕
Found this online upon further research. a good read ⬆⬆
https://www.dbtselfhelp.com/What_Skills.pdf
All things I am consciously working on every day, sometimes with success, sometimes not but getting it locked down more and more. Practice. ⬆⬆
This blog, books I am reading, art, retraining for a job I actually want and can cope with happily, journals, being more picky about my people and environments, working on the T total thing, embracing positive thinking, rejecting my parents stupid fucking mind sets, rejecting the life limiting put downs and neglect and abusive from my past, trying to aim higher and think bigger are all things I am slowly but surely dealing with.
I am trying to cope with my fucked up intruding self hating thoughts and turn them around into positive self affirming thoughts, utilizing all the tools, skills and practices DBT has to offer.
It's hard work, but one thing at a time.
I have goals. I will achieve them! The most important one is to be my own friend and ensure i do not repeat toxic mistakes of the past.
I want to move away. The only reason I haven't yet moved is for my cats. They love it here. But the time is near to move on. For good. And that is hand in hand with a new job and a new creative vision and the ability to move on and up and away! Positive goals to aim for.
In the short term, I have two big exams next week and I am pumped up for them, ready and excited to smash 'em!
Positive Mental Attitude!
Enough said. To much in fact.
Peace out mother fuckers
M.
(Submitted to DBT path ✅ done)
(Blog private bits edit ✅ done)
