We are DBT therapists and co-hosts of Therapists in the Wild, a DBT skills podcast. AMA!

my sister is big believer in DBT and I've seen her make tons of progress. She's really struggling with the current vivid situation and 2 week ago had her first hospitalization in years due to stress of impending homelessness etc. She was in solitary for 8 days though and held it together grinding her DBT skills and she's come out feeling more confident in her skills.

My question though is: I know mindfulness exercises are typically thought of as being positive experiences, but I personally have a lot of problems when I try them myself, so what is the best place to start for someone who has panic attacks to guided meditations?

u/waiguorer in DBT, mindfulness is intended to help people develop a nonjudgmental awareness of their sensations and environment. The goal is not actually for it to be a positive experience (although some people find it to be). For someone who experiences panic and is very aware of physical sensations, I would recommend starting with mindfulness exercises that focuses on external experiences as opposed to internal sensations.

What are some basics that anyone can incorporate into their lives?

u/thrwaway8921 Great question! Mindfulness is the core of DBT and is taught first as mindfulness skills is needed in order to use any of the other skills. The most basic DBT mindfulness skills are to Observe and Describe what is going on inside and outside of you. Observing means wordless watching using your 5 senses - I like to think of this as similar to how a baby or a dog watches their environment without words. Describe is putting words to that experience after you have accurately Observed what is going on. That being said, we believe that all of these skills can be applied and incorporated into everyone's lives :)

Hello! What do you think the significance of “judgements” or judging has in mental health or specifically DBT?

u/BrendanTheHippy we love this question! Learning to reframe judgments to describe "just the facts" is a foundational component of DBT. In fact, the founder of DBT has said that learning a nonjudgmental stance is the most revolutionary aspect of the treatment. Judgments can be harmful because they distort reality. For example, if I walk into a party and immediately say to myself, "this party is awful," then the party becomes awful. The reality has shifted and it becomes a self-fulfilling prophecy. Instead of problem-solving and trying to change the situation, I become stuck in this distorted reality. Judgments can get in the way of relationships, and they can lead to anger and frustration. Learning to just notice judgments as they arise, and then reframe them using just the facts, can significantly reduce suffering.

My partner is a professional DBT therapist. She deals with difficult clients and their trauma daily, and does her best to "leave her work at work" but now that we both work from home it can be harder for both of us. It's also tougher now that she can't as easily debrief with coworkers after a difficult session.

I want to be a good partner but sometimes her work takes a lot of patience and energy both of us. What are some things I can do to support her when she's having a hard day?

u/three_two_one_G0 we are so impressed by this question! As DBT therapists ourselves, we can relate to the difficulty of leaving work behind. The quick answer is: this is why we love DBT, because it helps us with self-care as well as supporting others in our lives. The validation strategies in particular have improved our relationships. Maybe you could ask her what would be most helpful for her!

My SO was diagnosed with BPD after years and years of struggling. What should she expect when going into DBT? How long until she finds some sort of emotional regulation or sense of self worth?

u/NvizoN This is a tough one to answer. It really depends on the person, the severity of their issues, how supportive their environment is, and their commitment to learning and practicing the skills. A typical course of DBT is one year, although some people find relief sooner and for others it takes longer.

Hi! What do you think about teaching therapeutic skills/strategies in public schools?

What I've learned in therapy over the years applies to my specific problems, but I've found (and you mentioned, as well) that they can be applied to a wide variety of problems. Would it be worth it to educate children about healthy coping mechanisms, or are most already taught this stuff in a normal upbringing?

u/squid_online Yes! Love this question. I agree that teaching these foundational skills as a preventive approach makes so much sense. I have been involved in a program called DBT STEPS-A, which is a specific application of DBT for kids in schools. So far the research looks promising!

Can you give a basic explanation of DBT? How is this approach similar and different to other forms of therapy like CBT? When is one approach better than another?

u/mimariposa DBT is a form of CBT that balances change-based and acceptance-based approaches to help people live lives worth living. CBT is mainly focused on change-based strategies. Using DBT vs. CBT depends on the need for acceptance strategies versus pure change, as well as on the specific clinical concerns.

Let's talk empirical evidence.

DBT was shown to be effective for treating patients with BPD.

DBT has not been proven effective for personality features such as interpersonal instability, chronic emptiness, identity disturbance, depression, suicidal ideation, survival and coping beliefs, or overall life satisfaction. DBT was no different in reducing depression than any other therapy.

Part of the problem here is that there are no large scale studies on the subjects above. I could be wrong, but I've only read a few studies with ~25 subjects, which are functionally useless. Do you guys have any planned research proposals to bulk up the evidence for DBT in non-BPD-related areas?

(Forgive the direct tone of this question, but any therapy that was "inspired by Zen Buddhism" has to be rigorously tested for efficacy.)

u/Sarah-rah-rah This is a great question and I completely agree that a treatment inspired and heavily influenced by Zen Buddism (not to mention pulling strategies and ideas from other existing treatments) should be rigorously tested. Our training has been geared much more toward clinical work than research so I can't confidently speak to planned research proposals related to DBT in non-BPD populations. Definitely agree that it is a very important area of study.

Hooray, I love DBT! Is there any recent literature (of any length or medium), either by Linehan or other experts, that you would suggest for someone who's a bit out of practice? I'm no longer in the behavioral health field, but I'd love a "refresher course" just for my own curiosity and self-betterment.

u/PepurrPotts Hi! Yes, absolutely. We love the book called "Doing Dialectical Behavior Therapy: A Practical Guide" by Kelly Koerner. Our podcast can also hopefully help with that!

DBT seems like a really cool and helpful tool, even for people that don't "have" to have it. I like how structured the approach is.

Are there any resources I can use as a mostly healthy person with some depression/anxiety to "self-teach" myself? Or do you think that would not be worthwhile? I feel like it could boost my quality of life.

u/musicandpoptarts Yes absolutely, we definitely believe DBT is an very effective treatment for people with and without BPD. If you want to learn more about the skills but don't feel a comprehensive DBT program is appropriate for your issues, I would suggest learning and practicing the skills and seeking treatment as needed. Liza always suggests doing this with a skills buddy if possible to hold you accountable. You can learn these skills in a variety of ways depending on your learning style - watching YouTube videos, reading the DBT skills manual by Marsha Linehan, or listening to our or other DBT skills podcasts :)

Are there online DBT groups now that we are locked down for COVID?

u/jbash1020 Yes, many practices that offer DBT also appear to be offering online DBT groups at this time. I would start by looking for a DBT practice and then look into their online group options.

What do you think of the Dodo bird verdict in psychotherapy?

By Dodo bird verdict, I mean the claim that different therapies (humanist, pdt and cbt) all have similar results and that common factors make up for most of the effect.

edit: syntax

u/midnightking very interesting question! Hadn't heard of this until now. There has been some research that shows common factors accounting for some success in treatment.

I’m a clinician. In individual DBT, is it possible to complete trauma processing (emotional experiencing) parallel to stage 1 behaviour control/stabilization? Thanks.

u/f3ckdepression great question. I'd say it depends on the person's level of risk and existing coping strategies. The research on DBT-PE (refer to Dr. Melanie Harned's work) tends to suggest to wait until Stage 2.

Thank you. I’m always concerned about model fidelity. I’ve had clients insist they want to start working on processing trauma in the first stage of treatment and I’ve always explained that it’s not ideal until they are more equipped (for lack of a better word) to cope with the intensity of that work. Then I also struggle with wanting to be client centred and give them what they are asking for. I will check out that reference.

Edit: why am I being downvoted? Please let me know, genuinely curious and would love to hear from the users downvoting me.

u/f3ckdepression didn't downvote you! sometimes Reddit can be weird like that? :)

Why are clinical psychologists so diagnostically inaccurate? (See: "Being Sane in Insane Places")

u/DeadPoster this is very unfortunate when it happens because it can prevent people from getting the care they need if they don't even know what their diagnosis actually is or the treatments available for their particular issue. In my opinion, part of the problem is that many therapists don't get adequate training in how to accurately diagnose and determine differential diagnoses for disorders that have similar but distinct presentations.

A group DBT class has helped me work through a lot of issues in my life and I feel has made me more effective as a person.

What's your favorite module? Why?

u/bent42 so glad your DBT class has been helpful. Our favorite module is mindfulness because it is so widely applicable to all the other modules. But we also love distress tolerance because who doesn't love dunking your face into a bowl of water for TIP?! Hard to choose ;)

Hey! Awesome to see fellow DBT therapists on here, my trainer was in the first cohort to be Linehan board certified. Definitely checking into your podcast this afternoon!

• Are each of you considering getting board certified?
• Favorite skill to teach?
• Most challenging skill to use?
• What do you guys do for self care to help with burnout?

u/kmmac we love these questions - thank you :) We are considering getting board certified. Liza's favorite skill to teach is opposite action, and Molly's is Wise Mind. Many skills are challenging to use, and perhaps radical acceptance is among the most challenging. We use all of these skills to help with self care for burnout, especially Participate and Self-Soothe!

Have you, in your own respect, successfully treated someone for clinical antisocial personality disorder?

u/jays0n93 interesting question, we have not.

In your podcasts, do you address all of the criticisms of DBT as an effective form of treatment for BPD? What do you make of the higher than standard ineffective / relapse rates?

u/roguedeckbuilder the main purpose of our podcast is to teach DBT skills to people who don't have access to DBT and want to learn the skills. For that reason our episodes so far have mainly focused on teaching a specific skill each week. If we end up branching out, that sounds like an interesting topic for a future episode :)

Thanks for doing this AMA!

My question is where would you suggest a lay person start if they want to learn DBT skills (other than your podcast!)? Are there good books, workbooks, or online resources that you'd recommend?

u/Kara_S great question. I would suggest reading the DBT Skills Training Manual by Marsha Linehan (2nd edition). It has so much great info and is written in a way that I think many people find very user-friendly. If you're looking for another DBT podcast, I love To Hell and Back by Charlie Swenson.

I suffer from bpd and did 2 of the 4 parts of dbt before a court case against my step dad happened and I wasn't present, even on the days I could get to the therapy, so I left. Since then I've left my house maybe once a month, if that.

My question is, I suppose, what sort of life can someone with bpd expect? For me at least this feels like a life sentence, and even if I was able to finish the dbt I fear I would still be as bad. How profoundly might the therapy actually help someone like me? I know that's a very difficult question to really quantify but I can't think how else to word it

u/plankzorz While we do not know and cannot get into the specifics of your situation given that we're not your individual therapist, we do believe that BPD is based on patterns of behavior that can change with the right treatment. We know it can feel hopeless sometimes, hang in there!

The one thing that I can’t and haven’t been able to do is forgive. I don’t see how I can forgive the men who were supposed to be my friends and assaulted me. I have taken groups past DBT, am a neuropsychology student, and feel like I can’t forgive... I don’t want to forgive. That should still be okay, right?

u/mrmeowmeowington I am so sorry that happened to you. I am not aware of any DBT skill that requires someone to forgive. DBT is intended to help people build meaningful, fulfilling lives that feel "worth living." The closest skill I can think of to what you're referring to is Radical Acceptance, which involves facing reality as it is even if it is extremely painful to do so. But even with that skill, what you decide to do with that is up to you depending on your own goals and values.

Do you have any guidelines for having a public podcast despite the nature of your work? I have a masters degree in therapy and am in my 4th year of a Clinical PhD, but I also have a YouTube channel with a few thousand subs where I discuss new and politics, and my opinions on the two as a democrat. This is not something I want to give up as it’s a hobby that I enjoy, so I’m wondering how you guys manage your online life and your publicity despite the nature of our work?

u/ZooterScooterHover great question! As a rule of thumb: we only share information we feel comfortable with clients knowing.

Any (general) advice on getting into a PhD program in clinical psychology?

u/olive0508 great question. There are lots of online forums (like grad cafe) that discuss the specifics of each program and what is needed to get accepted. It's a long road and well worth it :)

What are you doing to ensure your work is anti-racist?

u/Daisyducks thank you so much for this excellent question. Despite the fact that DBT tries to level the playing field between therapist and client, there is of course a power differential based on the nature of the roles, and particularly when there is a privilege difference based on race. We understand that it is the therapist's job to bring these issues up in the room, as the person with more power. And, there is so much work to be done in the field and for us personally. Continuing to ensure that our work is antiracist is a career and lifelong practice.

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u/Phalanx976 It's Therapists in the Wild