Dbt Diary Cards

[Hashi]

My T gave me a DBT diary card yesterday. She explained how to fill it in, but when I started doing it, I thought this is not going to tell me what I need to know.

As I understand the card, you note the urges, you note what skills you tried and you note whether you acted on the urges or not. So the point seems to be, were the skills useful to stop you acting on the urges. (Is that right?)

My issue is that I only partly care about whether the skills stopped me acting on the urges. It doesn't tell me anything about whether the skills helped with the misery of the urges. They could still be at level 4 or 5 afterwards, even if I didn't act on them. Or, they could have gone down to 1 or 2. But there's nowhere on the card I have to say what the urges were after.

I know it's a behaviour therapy, so I understand about monitoring the actions, but if the skills are supposed to help with distress tolerance, acceptance etc then surely the urges are meant to reduce too if the skills are effective?

I think I'll just add to the card myself what the urges were after, then talk to T about it next week, but I wondered what other people think of the diary cards, and is there some point that I'm missing?

 

[Ted Moen]

Kind of ... it's not about the strength of the urges, it's about acting appropriately in your current situation. When you use the psychological tool to manage your behavior in your current situation, first by learning not to act on the old stuff then by learning to act appropriately (the way you would have if the old stuff weren't interfering) in your current situation, you will begin to get your current needs met in your current situation by behaving in your own best interest in your current situation. As you learn to focus on getting your current needs met in your current situation combined with working throughout the old stuff with your therapist the intensity of the old stuff will gradually lose some of it's intensity, and you will gain confidence in your ability to act appropriately in your current situation.

But, at least as I experienced it, the reduction in intensity is not an incremental, measurable thing. It's more like it's very intense and very intense and very intense and suddenly one day the feeling pops up that you are in control of your behavior regardless of the intensity of the old stuff trying to interfere. And that feeling is so good for a person learning to live with ptsd ...

Ted

 

[anthony]

I thought this is not going to tell me what I need to know... ...My issue is that I only partly care about whether the skills stopped me acting on the urges. It doesn't tell me anything about whether the skills helped with the misery of the urges.

You're missing the point of behavioural change, and your own attitude doesn't help when you cite "I only partly care" when referring to your own behaviour in which you want to change.

Firstly, your therapist cannot do the work for you, nor do they have a magic wand to wave to make you different or changed. You must do the work, therefore, you must care about following the instructions to the best of your ability.

Secondly, change does not occur in one action. The recording is for nothing other than to find what does work and what does not work. The change will not occur in that moment. Behavioural change takes months to actually change from a negative to a positive... in other words, to remove the affect / minimise it to near nothing. But there is no point in putting that effort into any specific method in which you find you don't like or isn't even doing a thing for you.

You are going to need patience and a very proactive attitude in order to change behaviour. Every behaviour can be changed, but only you can do it. Your therapist is only there to help you not waste time with things that aren't going to work, and help you identify things that may or will work... which you carry forward with your efforts over the coming months.

It takes that time to change instinctual behaviour and replace it with a new instinct, a more positive one.

 

[Hashi]

Thanks for your responses.

Ted, it's helpful to hear your experience of this. It sounds like you've done really well. The possibility of a sudden change rather than an incremental one is interesting. It also makes sense about learning to get current needs met while going through the old issues in therapy. That was a big reason for me wanting to do DBT. I realised I needed better skills if I was to continue with trauma work.

anthony, what you said is also helpful. I'm afraid I wasn't very specific when I said I only partly care. In one sense I meant that the final behaviour is only part of what I care about, because I care about the thoughts too. For example I gave up smoking a few years ago and although I still sometimes have the urge to smoke, it's occasional and short lived. If I was craving cigarettes intensely for a large part of every day, then even though I'm not smoking I wouldn't consider that I'd successfully given up.

The end behaviour is only part of it for me, and the reason I chose DBT is because it's about both acceptance (in ths case, having the urges without acting on them) and change (identifying the chain of events in order to behave differently earlier and so reduce the urges). So I was expecting to be monitoring the urges as well as whether I acted on them.

I can see what you and Ted are saying about the process having it's own dynamic, and taking time. I also agree that I have to do the work, the therapist won't do it for me. (Ah, if only she could! I think I'd pay any amount.)

It's been very helpful to read both your views. I feel a bit clearer now about what I want to ask my T about the diary cards. I'm still really challenged on how to physically fill them in!

Thanks,

Hashi

 

[Meadowsweet]

I apologise in advance if I'm understanding you completely wrong. Please just ignore me.

But you bring up something that worries me about behavioural therapies. I've been brought up by someone who was very keen for me to face fears. He would encourage us to climb rocks etc with positive self talk "if you don't think about falling you won't" sort of thing.

He meant well, but he was critical of failure or wimping out of stuff. But I recognise that this has sometimes been a damaging behaviour to me. My dad wasn't violent, but nowadays the feelings of dissapointing the patriarch are also connected to more abusive punishments.

So there's a side of me that will go out and face something I fear, because I'm afraid of upsetting the person who wants me to do it. But, at the other extreme, I can be stubborn and refuse to try or succeed. It kind of gives me back a sense of power over the situation.

I hope that being aware of these feelings will help me to stop them interfering with therapy.

I'm sorry I'm a bit ignorant with regards to therapies and I'm not clear of the difference between DBT and CBT. But I hope that I can work on these challenging bits in the cognitive side of CBT and not just be sent out to change behaviours before I'm able to do it constructively.

So it sort of seems like you are feeling that your distress and your behaviours are being treated seperately, and in some ways that sounds like you're doing as you are told, without it changing the way you feel about it.

 

[anthony]

I once hoped they would fix me... how wrong I was. Sounds very positive Hashi... which means an excellent reference point.

 

[freakofnurture]

Hashi, if the cards your T gave you don't fit your needs, design you own cards, or make an additional card :)

EDIT: Aaaand there I go only reading half of the post before replying ô.o Well done, freak.

When I was an inpatient DBT, I got a diary card on which I could fill in my level of tension hourly. It was nice to see my progress in an objective way. I had to make my own card to follow my skills experimentation, too.

Nowadays I have a diary card to note my meds, training, if I was able to work around the house, if I was able to write, how well I slept and how my mood was. It's mostly to give me an objective look at how I feel. Turns out, my mood is a lot more stable than I thought.

 

[Hashi]

Thanks, everyone. I've talked to T again about it now, and come up with a version I think will help more. Thanks to the input here, I feel OK recording just a bit about urges/distress afterwards.

Meadowsweet, thanks for your thoughts. I understand what you mean, but this isn't about making yourself do things, it's just to keep a record of what went on each day so you can identify patterns and have more awareness. For example, I've already noticed that something I have to do every day upsets me more than I realised so now I'm doing it earlier to see if that will help. In time, I might see that a particular soothing skill works well so I'll know to always try that one.

The link between distress and behaviour is to do with unhealthy coping methods - how strong the urge was, what emotions you were feeling, what healthy coping skills you tried, then whether you still acted on the urge. My view is that it's not just whether I did it but whether I was still feeling desperate to.

DBT has a lot of focus on learning skills like self-soothing, to support you through change. The behavioural aspect is firstly to do with stopping or reducing damaging behaviours like self-harm. Facing things you fear is there in the emotional skills, but I don't think it's like exposure therapy because DBT wasn't developed for that, it was developed as a way to manage distress and urges like suicide and self harm (or anything - like aggression, addiction etc) so that the underlying issues can be worked on in therapy.