As a support worker for those with mental health difficulties, I was always better at managing other people’s problems. After work, the heavy façade would collapse, leaving me alone with horrific thoughts and emotions. With a family history of mental illness, I ended up trying various antidepressants and CBT therapy.
Still, I had the longing feeling that something wasn’t right. My mood, since adolescence, had shifted between intense highs and devastating lows. Following a candid conversation with my GP, I finally got to see a psychologist. After discussing my symptoms honestly, I was referred to Dialectical Behavioural Therapy (DBT)
DBT, developed by psychologist Marsha Linehan for Borderline Personality Disorder, tackles symptoms like poor distress management, and suicidal behaviour. A highly effective treatment, it is often done in group settings, allowing patients to practise valuable skills together.
From seeing the psychologist to my first pre-group session, it took about 11 months. Fortunately, it was worthwhile, teaching me so many valuable skills that transformed my mental health. Here are five of the most important things I learnt during this time.
1) The Power of Dialectical Thinking
The foundation of DBT, ‘dialectical thinking’ requires you to embrace opposing ideas and truths. This was powerful, and helped in challenging the black and white thinking that came with my mental illness, e.g. “They either love me or they hate me.”
Through group discussion, we moved away from either/or thinking, transitioning to using and/both statements: “They can love me and still be upset with me.” We practiced writing these statements, eventually crafting more nuanced narratives.
One such statement was used as a core ethos throughout our therapy:
“I accept myself as I am, and I also can work towards change.”
This narrative was crucial because it gave me the confidence to work toward recovery while accepting my shortcomings.
2) Tolerating Distress through Radical Acceptance
Distress tolerance skills taught me how to navigate difficult situations without resorting to harmful coping mechanisms. My favourite of these skills was radical acceptance.
Radical acceptance involves embracing reality as it is, instead of rejecting it. At its core, it challenges the need to be in control. While it’s easy to feel that situations should be fairer, my therapists explained that this only added to my suffering. Clarifying the distinction between pain and suffering, they explained: “pain is unavoidable, while suffering comes from resisting this pain.”
Realising that many things can’t be changed, I focused on controlling my reaction to situations. Through this approach, I noticed a reduction in my suffering, remaining kind to myself when I occasionally slipped into judgemental thought patterns.
3) Mindfulness
A collective realisation, across our group, was that we felt disconnected from the present. Mindfulness was our therapists’ solution, carefully woven throughout the DBT programme. Defined as “focusing the mind on the moment without judgment”, we concentrated more on our day-to-day tasks.
Whether I was cooking, cleaning or travelling, I tried to fully focus on the process, acknowledging distracting judgments, but not giving into them.
Practicing this, I rode the bus alone, listening to the surrounding conversations, picking up on their cadence and tone. Despite my nosiness, this process was beneficial, as I focused on the present, not the destination.
Our therapists kept encouraging us to practice this skill, and over time it became more natural. I could truly focus on a meal, or a song and its lyrics. While it wasn’t always easy, I started to find hidden gems in these small moments.
4) Emotional Regulation Through Opposite Action
Opposite action is perhaps one of the most difficult skills. In short, it’s about doing the opposite of what your emotions would urge you to do.
It’s about breaking the harmful habits emotions can form. For example, when I am feeling sad, there is a tendency to isolate myself. Through the opposite action, I consciously choose to make plans and socialise. Despite the difficulty of this, especially during a depressive episode, it’s all about breaking patterns and forming healthy habits.
Acting on unhealthy emotions often leads to negative outcomes, increasing feelings of guilt and shame. These uncomfortable emotions can then cause another harmful action, repeating the cycle again.
Opposite action is an effective way to break this cycle. By deciding to socialise rather than avoid contact, I’m not just challenging the emotion, but paving the way for a more positive outcome.
5) Interpersonal Effectiveness through FAST
Difficult conversations can be triggering for those with mental health problems. Instead of addressing relationship issues directly, it’s easy to bury our concerns, leading to resentment.
The acronym, FAST, is an important skill to use during these difficult times, acting as a framework for conflict resolution:
F – Be fair to yourself and the other party, validating their feelings as well as yours.
A – Don’t over apologise, you are allowed to make a request.
S – Stick to your values, be clear on what you believe.
T – Be truthful, don’t exaggerate or hide details.
While simple, this framework is great for effective communication. Having used it both professionally and personally, it allows you to create an honest discussion that validates both parties. This often results in a positive outcome that avoids resentment while clearly explaining your point.
The Accessibility Issue
While these skills are helpful, the accessibility of DBT is effectively a postcode lottery. Waiting lists can be long, and it depends on therapist availability. While the NHS is trying to improve access, it will not be a quick process.
During my wait time, I used free online resources. DBT Self Help was a great tool, featuring a DBT encyclopedia and a break-down of each module. Another resource was a DBT workbook given to me by a friend, which was significantly cheaper than an hour of private therapy. Video resources are also plentiful across YouTube, often made by psychological experts, and are helpful for more visual learners.
For those experiencing crisis, these resources can be life-saving:
- Samaritans: 116 123 (free, 24/7) – confidential support for anyone in distress.
- Crisis Text Line: Text SHOUT to 85258 – free, 24/7 text support.
- NHS 111: Call 111 or visit 111.nhs.uk – urgent mental health support and local services.
Words by Thomas Stanier
Support The Indiependent
We’re trying to raise £200 a month to help cover our operational costs. This includes our ‘Writer of the Month’ awards, where we recognise the amazing work produced by our contributor team. If you’ve enjoyed reading our site, we’d really appreciate it if you could donate to The Indiependent. Whether you can give £1 or £10, you’d be making a huge difference to our small team.