Insomnia & Dialectical Behavioral Therapy

Many people advocate CBT or Cognative Behavioral Therapy for insomnia. But I am in a program using DBT or Dialectical Behavioral Therapy to help me get some zzzz's. I started in Boston at Harvard, and now am at a program for 5 more weeks close to my home on Tues, Wed and Thurs from 9:30 AM until 12:30 PM. It is working quite well. Got up today at 7:30 on a SATURDAY went to bed at midnight without the use of drugs. So what is DBT? It was first credited to Dr. Marsha Linehan who came uo with the principles of DBT for Borderline Personality Disorder patients, but it is now used for Bipolar and yes SLEEP! And it works!! I am amazed, I was the biggest skeptic.

DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of mindful awareness, distress tolerance, and acceptance largely derived from Buddhist meditative practice. DBT is the first therapy that has been experimentally demonstrated to be effective for treating BPD. Research indicates that DBT is also effective in treating patients who represent varied symptoms and behaviors associated with spectrum mood disorders, including self-injury. Linehan created DBT in response to her observation of therapist burnout after repudiating patients’ motivation to cooperate in successful treatment. Her first core insight was to recognize that the chronically (para)suicidal patients she studied had been raised in profoundly invalidating environments and required a climate of unconditional acceptance (not Carl Rogers’ humanistically "positive" version, but Thich Nhat Hanh’s metaphysically neutral one) in which to develop a successful therapeutic alliance. Her second insight concerned the need for a commensurate commitment from patients to (be willing to) change—subject to their skillfulness in the present moment--based on 'radical acceptance' of their dire level of emotional dysfunction.

Linehan united commitment to the core conditions of acceptance and change through the Hegelian principle of dialectical progress, in which thesis + antithesis → synthesis, and proceeded to assemble a modular array of skills for emotional self-regulation, drawn from Western (e.g., CBT and an interpersonal variant, “assertiveness training”) and Eastern (e.g., Buddhist mindfulness meditation) psychological traditions. Arguably her signal contribution was to elide the adversarial paradigm implicit in the hierarchical modernist therapeutic alliance, using the deconstructive spirit of Hegel and the Buddha to substitute a postmodern alliance based on intersubjective tough love.

Learning to be mindful, to focus, to breathe will help make the application of the modules be more effective. It is paramount to your success in reducing stress and coping.Remember: Sometimes the skills will not work. This is when you need to quickly go to the Distress Tolerance module and take taking a vacation from the situation that you are in, practice radical acceptance, do a lot of self soothe, and distract activities. The key to success is the practice of DBT skills.Overview of DBT skills (4 basic modules)

1. MINDFULNESS (Wise Mind)Using the What Skills:
Observe
Describe
Participate
Using the How Skills:
Non-judgmentally
One-mindfully
Effectively

2. INTERPERSONAL EFFECTIVENESSUsing Objectiveness effectiveness: (Dear Man)
D Describe
E Express
A Assert
R Reinforce
M Mindful
A Appear Confident
N Negotiate
Using Relationship Effectiveness: (Give)
G Gentle
I Interested
V Validate
E Easy Manner
Self-respect effectiveness: (Fast)
F Fair
A Apologies (no Apologies)
S Stick to value
T Truthful

3. EMOTION REGULATIONUsing Reduce Vulnerability: (Please)
P & L Treat Physical Illness
E eating
A Altering Drugs (no drugs unless it is medication to be taken as prescribed by your doctor)
S Sleep
E Exercise
Using Build MasteryBuild Positive experiencesBe mindful of current emotionOpposite to emotion action

4. DISTRESS TOLERANCEU

Using Crisis Survival: Distraction with Wise Mind Accepts
A Activities
C Contributing
C Comparisons
E Emotions - use opposite
P Pushing Away
T Thoughts
S Sensations
Using Self Soothe with five senses:
Taste
Smell
See
Hear
Touch
Using Improve the moment:
I Imagery
M Meaning
P Prayer
R Relaxation
O One thing at a time
V Vacation
E Encouragement
Using Pros and ConsUsing Accepting Reality:WillingnessTurning your mindRadical Acceptance


For more about DBT I recommend two work books: Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance on amazon.com at: http://www.amazon.com/Dialectical-Behavior-Therapy-Skills-Workbook/dp/1572245131/ref=sr_1_1?ie=UTF8&s=books&qid=1257605235&sr=8-1

The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life also on amazon at: http://www.amazon.com/Dialectical-Behavior-Therapy-Workbook-Disorder/dp/1572246286/ref=sr_1_2?ie=UTF8&s=books&qid=1257605235&sr=8-2

Websites:

http://www.dbtselfhelp.com/