Dialectical Behavior Therapy (DBT)

Happy Friday!!! It being Friday, that means it is time for me to do my educational feature. I have decided to do the topic of Dialectical Behavior Therapy (DBT). The reason being is because I did the topic of Borderline Personality Disorder (BPD). I got the following information off of the  Linehan Institute; Behavior Tech at:   http://behavioraltech.org/resources/whatisdbt.cfm

What is DBT?

Overview

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

What are the components of DBT?

In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.

  1. DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.
  2. DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
  3. DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
  4. DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

What skills are taught in DBT?

DBT includes four sets of behavioral skills.

  • Mindfulness: the practice of being fully aware and present in this one moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change emotions that you want to change

There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings.

What does “dialectical” mean?

The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

How does DBT prioritize treatment targets?

Clients who receive DBT typically have multiple problems that require treatment. DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are:

  1. Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
  2. Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
  3. Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
  4. Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Within a session, presenting problems are addressed in the above order. For example, if the client is expressing a wish to commit suicide and reports recurrent binge eating, the therapist will target the suicidal behaviors first. The underlying assumption is that DBT will be ineffective if the client is dead or refuses to attend treatment sessions.

What are the stages of treatment in DBT?

DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.

  1. In Stage 1, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
  2. In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
  3. In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
  4. For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

How effective is DBT?

Research has shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning. For a review of the research on DBT, click here. In this video, DBT Developer and Behavioral Tech founder Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

Dive Deeper

Philosophy and Principles of DBT

DBT is based on three philosophical positions. Behavioral science underpins the DBT bio-social model of the development of BPD, as well as the DBT behavioral change strategies and protocols. Zen and contemplative practices underpin DBT mindfulness skills and acceptance practices for both therapists and clients. DBT was the first psychotherapy to incorporate mindfulness as a core component, and the Mindfulness skills in DBT are a behavioral translation of Zen practice. The dialectical synthesis of a “technology” of acceptance with a “technology” of change was what distinguished DBT from the behavioral interventions of the 1970s and 1980s. Dialectics furthermore keeps the entire treatment focused on a synthesis of opposites, primarily on acceptance and change, but also on the whole as well as the parts, and maintains an emphasis on flexibility, movement, speed, and flow in the treatment.

True to dialectics, DBT strategies are designed in pairs representing acceptance (validation, reciprocal communication, environmental intervention on behalf of the client) and change (problem solving, irreverence, consultation-to-the-patients about how they can change their own environment). Strategies are further divided into procedures; a set of principles guides the selection of strategies and procedures depending on the needs of the individual client. Clients are also taught a series of behavioral skills designed to promote both acceptance and change. A focus on replacing dysfunctional behaviors with skillful behaviors is woven throughout DBT.

DBT is a principle-based treatment that includes protocols. As a principle-based treatment, DBT is quite flexible due to its modular construction. Not only are strategies and procedures individualized, but various aspects of the treatment, such as disorder-specific protocols, can be included or withdrawn from the treatment as needed. To guide therapists in individualizing priorities for targeting disorders and behavioral problems, DBT incorporates a concept of levels of disorder (based on severity, risk, disability, pervasiveness, and complexity) that in turn guides stages of treatment and provides a hierarchy of what to treat when for a particular patient. In contrast, skills training is protocol based. Once a skills curriculum is determined, what is taught in a session is guided by the curriculum, not by the needs of a single client during that session.

The Development of DBT

In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, and non-suicidal injury. Trained as a behaviorist, she was interested in treating these and other discrete behaviors. Through consultation with colleagues, however, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD). In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Dr. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.

In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

They added acceptance-based or validation strategies to the change-based strategies of CBT. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: clients must change if they want to build a life worth living.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play. Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become entrenched in arguments and polarizing or extreme positions.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

In her original treatment manual, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993), Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must:

  1. Enhance and maintain the client’s motivation to change
  2. Enhance the client’s capabilities
  3. Ensure that the client’s new capabilities are generalized to all relevant environments
  4. Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
  5. Structure the environment so that treatment can take place

As already described, the structure of DBT includes four components: skills group, individual treatment, DBT phone coaching, and consultation team. These components meet the five critical functions of a comprehensive psychotherapy in the following ways:

  1. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
  2. Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
  3. Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
  4. Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
  5. The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home

True to dialectics, DBT strategies are designed in pairs representing acceptance (validation, reciprocal communication, environmental intervention on behalf of the client) and change (problem solving, irreverence, consultation-to-the-patients about how they can change their own environment). Strategies are further divided into procedures; a set of principles guides the selection of strategies and procedures depending on the needs of the individual client. Clients are also taught a series of behavioral skills designed to promote both acceptance and change. A focus on replacing dysfunctional behaviors with skillful behaviors is woven throughout DBT.

DBT is a principle-based treatment that includes protocols. As a principle-based treatment, DBT is quite flexible due to its modular construction. Not only are strategies and procedures individualized, but various aspects of the treatment, such as disorder-specific protocols, can be included or withdrawn from the treatment as needed. To guide therapists in individualizing priorities for targeting disorders and behavioral problems, DBT incorporates a concept of levels of disorder (based on severity, risk, disability, pervasiveness, and complexity) that in turn guides stages of treatment and provides a hierarchy of what to treat when for a particular patient. In contrast, skills training is protocol based. Once a skills curriculum is determined, what is taught in a session is guided by the curriculum, not by the needs of a single client during that session.

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.
  4. In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

They added acceptance-based or validation strategies to the change-based strategies of CBT. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: clients must change if they want to build a life worth living.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play. Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become entrenched in arguments and polarizing or extreme positions.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

In her original treatment manual, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993), Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must:

  1. Enhance and maintain the client’s motivation to change
  2. Enhance the client’s capabilities
  3. Ensure that the client’s new capabilities are generalized to all relevant environments
  4. Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
  5. Structure the environment so that treatment can take place

As already described, the structure of DBT includes four components: skills group, individual treatment, DBT phone coaching, and consultation team. These components meet the five critical functions of a comprehensive psychotherapy in the following ways:

  1. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
  2. Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
  3. Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
  4. Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
  5. The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home.

DBT has personally saved my life and am grateful to have had the opportunity to take an intensive outpatient DBT program. DBT is awesome and it is one of the best decisions I have made in my life. Have an awesome Friday and Peace Out!!

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Mental Health Awareness Week; Day 1

It’s the first day of Mental Health Awareness Week. As I was preparing for this week I realized one major thing. I realized that part of what I wanted to do was give you what the criteria of what the diagnoses are and if I did that then I would be infringing on the copy write law of the DSM 5. So, I decided that I’m not going to put up the criteria for any diagnosis because I don’t want to break any laws. I do have other ways that I will try to educate you all on any diagnosis I discuss.

I plan on discussing the particular diagnoses that I am diagnosed with as well as the one I no longer meet the criteria for. I also plan on continuing the discussion of various types of diagnoses after Mental Health Awareness Week is over. In discussing any diagnosis I hope that I am able to convey what I want to say as well as how I have dealt with the symptoms of a particular diagnosis. If it’s a diagnosis I do not have then I hope to be able to convey on how other have dealt with the particular diagnosis. Being able to convey what I desire to convey in regards mental illness is a pretty huge task for me. I desire to educate people who don’t struggle with mental illness because I hope with education it can stomp out the stigma of mental illness.

Stomping out the stigma of mental illness is a major goal of mine. I know reality is that it wont happen in my lifetime however if I can just be one part of the factor to start the process of stomping out the stigma of mental illness then I have don’t my job. Their are many of us out there in the world trying to stop the stigma of mental illness and we will not stop till it is completely eliminated.

I think I have said enough about what I hope to convey and will continue this discussion tomorrow. I hope that you will continue to read my blog as I continue on my journey with my struggle with mental illness as well as the journey of educating other on mental illness. Peace Out!!!!

It’s A Beautiful Sunny Wednesday!!!

     It’s a beautiful day in the neighborhood. So beautiful that my boyfriend and I went rollerblading around a lake. In fact the lake is a local park. We went around the lake twice and each time is 3.3 miles so that equals 6.6 miles. All I can say is that I got my exercise in today. We also had a picnic at this park. We had fried chicken, macaroni salad and lemonade. It was all very tasty. All I know is I am tired now. I’ve had a busy day.

     I started out the day by going to see my shrink. My shrink in not a psychiatrist, he is a Psychiatric Nurse Practitioner. I discussed with him about the increased PTSD symptoms due to the 5 year anniversary of a trauma and how it triggered eating disorder urges and self harm urges. He of coursed asked if I acted on any of those urges and I said no because I didn’t act on those urges. He has a good since of humor and I like that. I’ve only been working with him for a little of a year when my last psychiatric nurse practitioner retired. I had worked with her for 7 years and grew to trust her. I specifically asked my therapist for a male prescriber because I usually only work with women when it comes to doctors and mental health stuff due to my trauma history. Diana my therapist was happy to oblige to my request and new who to suggest and thankfully he had room for another client. Anyway my shrink and I discussed if we needed to change meds or if a med increase needed to happen and thankfully he agreed with me that neither needed to happen. Like I said my shrink has a great sense of humor and it turns out that we have a similar sense of humor.

    After I saw my shrink I went to my volunteer job. I love my volunteer job. Like I’ve said in previous blog post, I volunteer at local homeless shelter that specializes in Mental Illness and Co-Occurring Disorders. The clients there are always so appreciative of everything they get. Well most of the clients are. I enjoy my volunteer job.

   When I get back from my volunteer job that’s when my boyfriend and I went and had our picnic in the park and rollerbladed around the lake in the park twice. We got back to his place in time to watch the news. The big topic is still the legalization of being able to sell pot in my state. It became legal yesterday. In fact it even made NBC’s Nightly news  again tonight. That makes two nights in a row. I just want them to not make a big deal about it. I just don’t care. I don’t smoke the crap but that’s me.

    Anyway my boyfriend is finding it difficult to pick out a movie to watch. I’m thinking I might just pick one out before his head explodes. I’m thinking a comedy is in order. I love comedies.

    I should get going because my boyfriend and I want to watch a movie. I hope you all enjoy the rest of your Wednesday. Enjoy the nice warm weather everyone. Peace out and don’t get sun burned.

Love Is A Beautiful Thing

     Love is a beautiful thing. Today, I was the Best Woman (instead of the Best Man) in one of my closest friends wedding. She got married to her long time girlfriend. They are now Wife and Wife. My friend wore a white tux with a purple vest and bowtie while her now wife wore a white wedding dress. They were both beautiful. I was in a black tux with a purple comber bun and bowtie. Even though wearing black in 86 F degree weather is quite hot, its better than wearing a dress. I’m not a big dress fan. I’m a “tom boy.” Anyway it was a beautiful wedding. The reason why my friend and her now wife chose to get married today was because of the date, 7/7/14. They not only think its lucky but they are both math teachers. They chose today because 7+7=14 or if you look at it date wise 7/7/14. They said their I dos at 7:07pm and 14 seconds. I am so happy my friend was able to get married to the woman of her dreams.

     Well, I worked this morning and it wasn’t a very good day at work. It wasn’t a good at work because I found out that one of my favorite elderly customers passed away. Her daughter came into the store this morning and told me and my co-workers. In fact I went to her 91st birthday back in May. I was told by this customer that I’m part of her family. That’s why her daughter and other children want me to give the eulogy at the funeral. I said yes. It’s going to be tough on me. Let’s get on a happier topic. I may not like my current job and it has nothing to do with death. I don’t like it because its not a career that I want to be in. Since I feel like I am in a dead in job, I’m going to review my resume’ tomorrow as well as look at jobs in the field that I want to be in. If I find a job opportunity to apply to I will not only apply but write a cover letter for that particular job.

     Speaking of a job opportunity I finally heard back for an organization I applied to, to become a volunteer. That particular organization is American Foundation for Suicide Prevention (AFSP). I’m hoping things go well with becoming a Field Advocate for them. Not sure what’s in store. I’m still waiting on more information. They do a lot of work regarding suicide prevention as well as try to get laws passed to help those who struggle with mental illness. I’m now waiting to hear back from National Alliance on Mental Illness (NAMI). I’m wanting to volunteer for them as well. In a couple of weeks I’m suppose to start training for a local Peer Support Warm Line. In all honesty, I fear that I might me taking too much on too quickly. I just want to not work a grocery store anymore. Nine years just seems way too long to be working at one and I feel like if volunteer in the mental health field then I’m more than likely to get a job as a Peer Counselor. You would think that volunteering at homeless shelter that specializes in mental illness is enough but I don’t think so. I’m hoping that I will be able to give of my time because I don’t have money to give. Plus giving of your time means much more than giving money a great deal of the time.

     Any way another thing I did was go and see my therapist. I of course got there an hour early like I do a lot of the time. While waiting to see my therapist I read A Tale of Two Cities, by Charles Dickens. I’m enjoying the book immensely. Diana (my therapist) and I talked about the 5 year anniversary of the trauma I experienced. We talked about the increase PTSD symptoms and the self harm urges I’ve been having. We also discussed the minor urges regarding the eating disorders. Diana is a little concerned about the self harm urges as well as the eating disorder urges and we discussed ways on how I can continue to NOT harm myself my cutting or starving myself or binging and purging. We discussed on what skills I could do. We discussed what could help in conjunction with my DBT skills. I told her I can look over my WRAP. WRAP stands for Wellness Recovery Action Plan.  Thankfully she has enough confidence in me that I wont relapse with the cutting or the eating disorders that we didn’t have to do a safety contract. Diana says that I am making “Wise mind” decisions and that I don’t have to worry about becoming Borderline again. She says I’m still a recovered Borderline because I’m far from meeting the criteria again. She tells me just as long as I am doing what I am suppose to be doing in my recovery I don’t have to worry. Plus I am far from being Borderline again or least that’s what she tells me. I am extremely fearful of becoming Borderline again. Diana keeps reassuring me that I don’t have to worry about it. She also told me that she was proud of me for all the hard work I am doing with my recovery process. Its difficult to hear someone tell me that they are proud of me but its cool to hear at the same time.(Side Note: Diana is a pseudonym for her protection and the protection of her other clients.) Oh boy its 11:00pm pacific time.

    Speaking of what time it is I better end this blog entry for now. I am a little tired. I’ve been up since 4am pacific time because of work. I hope I didn’t bore you all with this extremely long blog. Enjoy the last hour of your Monday. Oh yeah Happy 7/7/14. Goodnight and don’t let the bedbugs bite. Peace out everyone.

An Accomplished Week

     Well another Saturday is coming to a close and I am looking back on the week to see what I accomplished. I’ve accomplished a great deal. I worked 3 days this week which equals to 13.5 hours. I went to a 3 day training regarding Co-Occurring Disorders. I also went to a 4th of July party. So I accomplished a great deal this week.

      I had a great time at the 4th of July party I went to yesterday. Yes, I did get overwhelmed a little due to PTSD however I was surrounded by people who care about me. I enjoyed watching the fireworks. They were surprisingly good this year. Still not as good as Disneyland. I really enjoyed all the food I ate. I do have to admit that I had urges to binge and purge with all the food I ate. Its been a while since I had any urges regarding the Anorexia and/or Bulimia. I think the urges popped up because of the PTSD. Overall, I enjoyed my time at the 4th of July party,

     My PTSD symptoms are acting up because tomorrow (Sunday, July 6, 2014) is the five year anniversary of me being date r*p*d by my boyfriend at the time. My current boyfriend has been extremely supportive of me regarding this horrific anniversary. Unfortunately, my boyfriend is working at the moment. He wont get off work till tomorrow morning. He is doing an overtime (OT) shift. I am going to be honest with you. I have been fighting urges to cut today. I still get urges to self harm quite frequently but I choose not to because it just makes the situation worse.

     I know I spoke about this yesterday but I’m going to bring it up again. I really enjoyed the Co-Occurring Disorders training I attended. I loved learning the science of addiction. Its quite fascinating on what the brain does and how it reacts to different things including how drugs and/or alcohol effects it. I reread the material again. In fact I know I will reread it again because I can always learn something new every time I read it.

     Speaking of reading, I continued reading A Tale Of Two Cities, by Charles Dickens. It helped me a great deal today because it got my mind off of things. It got my mind off of the urges to cut. Yes, I may be a Recovered Borderline but unfortunately I still get urges to self harm. Its what do with the urges. I have to use my DBT skills. Reading is one of those skills. I love to read.

     Another thing I did today was go to Half Priced Books and bought two psychology text books for only $13.51. I’m not in school but I love to learn. I bought the psychology books in hopes to learn more. I also want to see what colleges and universities are teaching future therapist and social workers because they maybe helping me someday in the future. I didn’t make it through my first year at a community college because of my mental illness. So I’ve been trying to educate myself by buying various types of text books when they are cheap and out of date.

      I best be going because the local news is now over. That means Saturday Night Live is on next. SNL always make me laugh. Humor make me feel better. Well I best be going. I hope to blog again tomorrow. Enjoy the last 25 minutes of your Saturday. I’m glad I’ve accomplished so much this past week. Good night and peace out.