Fix my amygdala.

July 2, 2008 9:39 AM

Is dialectical behavioral therapy a good idea for me even though I'm not suicidal and I don't have BPD? Otherwise, will you help me figure out what therapy will work for me?

Sorry about yet another "find a therapist for me" question. I've seen therapists before I haven't had good luck. I know the difference between a psychiatrist and a psychologist and a LCSW. I think need something other than talk therapy. Basically, to outline my two problems: 1. my amygdala is broken and I need to get control over my emotions/impluses and 2. I need to stop being a victim.

Okay, so, I have PTSD. I thought it went away, but I'm coming to the realization that my "fight or flight" response is just as strong as ever, but is now taking the form of extreme anger instead of panic attacks. Generally, if this anger becomes uncontrollable, I don't have enough time to count to ten or try mindfulness techniques. I don't really realize the depth of what's happened until after the damage is done. I've never hurt someone else (well, not physically), but half the time I say something that should get me punched, and the other half results in trying to hurt myself. For example, after a random guy in a taxi flipped me off for no reason, I walked home and smashed my head against a wood floor -- the bruise was there for a week. I didn't do it intentionally, it just kind of happened and I can't figure out why I did it. There was no thought process whatsoever between the trigger and the mile walk back to my apartment. Well, nothing that I remember. This is basically par for the course when I lose it.

I also had a recent realization that my father is an abusive asshole and my mother has a martyr complex (unfortunately I'm pretty much forced to be close to them at this point). This coincides with my third realization that I seem to have this giant neon sign over my head that says "PLEASE TAKE ADVANTAGE OF ME." I need to get the giant "kick me" sign off my back and I need to learn how to say "no" to people without bursting into tears and thinking I'm a horrible person. I don't want to blame my shit upbringing or PTSD for all my problems. I just want to fix them.

I have atypical depression, but I think it's well-controlled with medication. When nothing's bothering me, I'm pretty much the happiest I've ever been (and I don't have to sleep for 14 hours a day anymore, which is pretty fabulous). This is a huge reason why I'm not on sedatives or an SSRI or anything else that would get me to calm down.

So I'm trying to find some therapy that will actually do something for me. The only thing I know is that talk therapy doesn't work for me (or I'm incapable of finding a good therapist and I'm too spineless to say "this isn't working for me"), and I want to try something that has some sort of rigid structure that I can adhere to. Is DBT a good idea for me? Maybe CBT? Do I need to work on one thing at a time? Please don't tell me to check myself into a hospital; I've never done grievous harm to myself ever, and I am not suicidal. I'm certain that I'm not close to a Falling Down moment.

posted by giraffe to health (7 comments total)

I'm not a psychologist, but CBT has been extremely helpful to everyone I have ever known who has undergone it.
posted by Nattie at 9:43 AM on July 2

Ask the doctor who is prescribing your medication(s) for a referral to a therapist.
posted by Carol Anne at 10:35 AM on July 2

I was just diagnosed with BDP, and am waiting on my referral for DBT.

What I can say is, that before this diagnosis, I considered myself "atypically depressed" with mood reactivity, but general sadness etc. Depression is still a part of my psych profile, but apparently isn't the major issue for me, just the most easily identified.

I also know that BDP is considered a form of severe, ongoing PTSD. Not to say that you are borderline by any means, but just to point out the similarity. Like you, I also dont want to blame my shit upbringing, or this 'disorder' but knowing about how these things can affect me is a huge start.

In light of the treatment I'm being offered, I would say that yes, DBT will probably help. Then, I don't really know that it will help me yet, but I'm confident.

Good luck!
posted by sunshinesky at 10:40 AM on July 2

DBT might be a good fit for you. As you probably know, there are two parts - a group session where you learn the basic skills and individual therapy where you work on how to apply the skills plus your own issues contributing to the problem. The skills group focuses on
core mindfulness skills: being more aware of yourself, especially when things are starting to build up
emotion regulation skills: building alternatives to explosive anger
interpersonal effectiveness skills: getting rid of the "kick me" sign
and distress tolerance skills: learning to be in uncomfortable situations without going off the deep end.

To my understanding, DBT is good at helping you get your life under control first and only then addressing the root causes of the problem.

DBT is very well defined, well specified approach to therapy. CBT is an umbrella for therapists who focus on more on the solving the current problem by changing your thinking, believes and behaviors than delving into your past. (So DBT is a specific subset of CBT). CBT usually includes homework assignment to let you practice specific skills or become more aware of specific behaviors.

If you possibly can, I suggest finding 3 different therapists (or at least 2) who seem reasonable and set up an initial appointment with each of them. It is easier to start with the one out of three that you feel most comfortable with than to pick one and then have to decide to if it is going well enough or if someone unknown other therapist would be better.
posted by metahawk at 11:20 AM on July 2

I haven't even read this yet, because if the world were in my hands, every single human would take a year-long DBT program with refreshers every other year at minimum. DBT is by far the best therapy/life tool that's ever, ever made its way into my life. No BPD for me, either. "Just" depression. OK, now I'll go read. But my recommendation won't change. Do it. DBT, baby.

For real.
posted by Stewriffic at 1:25 PM on July 2

OK, so reading up on what's going on with you makes me even more certain that you will benefit from this. You say you need to get control over your emotions. Excellent. One of the four DBT areas is Emotion Regulation. Another is Distress Tolerance, for when you have the emotions and you have to deal with them. Add in the Interpersonal Effectiveness, which is basically "Learn how to ask for something or say no in such a way as you'll a) be most likely to get what you want, while maintaining a good relationship with the person and not getting walked all over."

These three skills (because you are learning how to do something AND practicing it) are all linked together with the core concept of Mindfulness. Mindfulness in itself is very powerful force for the internal good. I've been practicing it a lot recently when I've been in the garden, and my mood and outlook haven't been better for months.

Thanks for asking this, because it reminded me that it's time for me to review all DBT skills and especially be more intentionally mindful.

Much care your way.
posted by Stewriffic at 1:40 PM on July 2 [1 favorite]

Thanks so much, everyone. Guess I'll be doing a bit of research today.
posted by giraffe at 3:41 AM on July 3