DBT for Anxiety

I’ve written about The Intake before.  When you’re in crisis, they can be very hard to endure.  The longest intake I’ve ever done was about four hours.  I left the inpatient treatment center at midnight.  I wrote in my last post that parents often feel judged for their child’s mental health crises.  Well, there’s no time when you’ll feel more vulnerable than when you’re completing an intake on behalf of your child.  It feels like an interrogation, and you feel like a suspect.  The person doing the intake is gathering as much history as they can.  They want to know how stressful the family environment is.  They want to know if your child has faced any kind of abuse.  Are you an abuser?

I had to do an intake for Eadaoin this week.  Her time with the crisis stabilization program came to an end which is a good thing.  Jane, her in-home therapist, found a Dialectical Behavior Therapy (DBT) support group for adolescent girls, and, as a condition of attending the group, Eadaoin would need to continue with outpatient therapy.  By some miracle, our insurance will cover this program.  This is exactly what Eadaoin needs.  I am a huge proponent of DBT.  Cognitive Behavior Therapy deals with thoughts and teaching us how to change them.  DBT deals with skills.  Everyone on the planet could benefit from DBT largely because one of the primary goals of DBT is increasing distress tolerance and then learning containment.  Learning mindfulness is also one of the goals of DBT as well as proper self-advocacy skills.  In my mind, DBT ought to be offered in high schools.  What I learned during the intake session is that I have to attend the group with Eadaoin so that I learn what she’s learning at the same time so that I create a culture at home that helps reinforce what she’s learning in group.  I’m so stoked.  I don’t know if she’ll be, but I am.

I already practice containment and have taught the girls to use it.  Some people call it ‘compartmentalizing’.  It’s a necessary skill for all people but particularly for sensitive people prone to rumination, brooding, dangerous introspection, catastrophizing, and perseveration (Guilty!).  The basic principle is that you imagine some kind of box.  For visual thinkers, this is not difficult.  For people who do not think in pictures, this might be a challenge, but challenges can be overcome.  Your box can be anything you want.  My box is platinum and covered with sapphires.  I didn’t really consciously create that.  That’s just what appeared in my imagination so I went with it.  I also like the idea of a Russian lacquered box or even a Fabergé egg.  It’s a container of some kind, and it’s precious.  Some of the intricately carved jade boxes at our local museum in the Asian arts section have captured my imagination as well.  Anyway, choose a box.  Or, as Eadaoin did, choose a room.  Eadaoin’s anxiety feels so huge to her that she needed a room.  Her room is in a hollowed-out tree.  There is red and white mushroom furniture and little plates of sweets and twinkling lights.  It’s very her.  Your container of choice is where you will place the ideas and tasks that catalyze your fears and worries.  You can put them there as well as take them out.  The point is that you can begin to exercise control over how and when you think about what worries you.

For example, I realized the other day that I had not yet called my accountant to get the tax hullabaloo underway.  I panicked.  I was in the car driving.  I couldn’t very well do anything about it at that moment so I simply put the entire thought process in my platinum box.  I told myself that I would take it out of the box when I got home and feel upset about it then.  You know what? That’s exactly what I did! I then emailed my accountant ASAP.  It sounds a little too easy, doesn’t it? Initially, it’s not.  The actual act of engaging in this process called ‘containment’ builds new neural connections in the brain.  The more that you do it, the more complex your neural connections around containment will become.  The more complex the connections become, the faster you’ll be able to contain.  For the most part, I can contain myself in less than a minute around most intense situations.  There are still a few situations that still give rise to panic in me, but the principle is still the same.  I know that I can contain myself.  I’ve been consciously practicing this skill for eight years now.  If I feel strong panic arise and a need to ruminate or perseverate, which I do sometimes, I can tell myself the truth about it: I know how to contain in other areas.  I can learn to do that with this thought process, too.

Dealing with anxiety isn’t about making the anxiety go away.  It’s about: 1) learning and increasing distress tolerance 2) learning and practicing containment and 3) figuring out what is true.  Anxiety exploits a bit of truth and then builds an empire of fear and uncertainty around it.  For example, using my tax worries as an example, my thoughts went something like this:

“Ohmigosh! I forgot to call the accountant! What’s the date?! What if she’s too busy? What if she died? Why didn’t she call me? Was I supposed to call her? What if I can’t find her number? What if her email changed? Is it March already? I can’t believe I didn’t call her.  How could I forget something like that?”

The only truth in any of those thoughts was the statement that I forgot to call my accountant.  Oh, and it’s March.  That’s it.  The rest of the progression is a slew of cognitive distortions and self-judgment.  One bit of truth used as a springboard into the pit of despair known as anxiety.  My body’s response to this was to hold my breath and feel sick to my stomach.  Thank you, cortisol and adrenaline! So, I shut it down by putting it in my box.  As it turns out, she wasn’t dead.  I had her email address.  We scheduled an appointment.  It all worked out.

I watch Grace, Milly, Eadaoin, and Doireann as well as my husband do the Anxiety Dance all the time.  “What if…”, “How could I…”, “It always happens…”, “It’ll never work out…”, “I just can’t deal with this…”, “I should have known…”, and on and on and on.  There is a better way to think.

If any of this sounds familiar to you and you don’t have access to DBT, then I recommend this as a starting point:

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Click on the image for the link!

This is an excellent workbook, and it is part of a DBT series.  I have the original.  There is one for PTSD and even eating disorders.  Check it out!

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