DBT For Dummies. Gillian Galen

Similar to shame, if your guilt fits the facts, you need to apologize for the transgression. If your guilt is unjustified, then you must not apologize. Instead, change your body posture by walking tall with shoulders back and maintaining good eye contact while talking with a confident, steady, and clear voice.

Tying Specific Behaviors to Specific Reactions

Everyone has default and automatic behaviors. These behaviors can lead to specific and often automatic reactions, and how we handle these automatic responses can make the difference between effective and ineffective outcomes. DBT focuses on the careful paying of attention to these patterns of behavior with the goal of considering, if need be, alternative behaviors in order to create an alternative reaction.

      Understanding physical responses and conscious feelings

      Emotions are neurological phenomena that occur in response to a trigger event. The trigger could be an interaction with another person, a sight, a sound, a smell, a thought, or just about anything. Once the emotion has occurred, it causes us to take action. Every emotion is activating and hard-wired as a part of our evolutionary biology. This is so that when we experience an emotion or feeling, we act. Here are some examples:

       Thirst tells us that we need to hydrate, and so it activates us to find water to drink.

       Hunger tells us that our body is short on fuel and to find food to eat.

       Fear tells us that there is a threat in the environment and to find safety.

       Extreme temperature tells us that we are about to overheat or freeze and to find shade or warm clothes.

       Fatigue tells us that our body needs rest and to slow down and get some sleep.

      

Emotions are mediated by various brain circuits. Emotional states have two distinctive components:

       A pattern of characteristic physical responses: Emotional physical states are the responses of our hormones, muscles, heart, bladder, stomach, and so on.

       A conscious feeling: Conscious feelings are the thoughts we have that are associated with the situation.

      When we’re frightened, for instance, we not only feel afraid but also undergo unconscious body changes such as an increase in heart rate and respiration, dryness of the mouth, muscle tension, and sweaty palms. The conscious part of the experience consists of the thoughts we have about the situation.

In DBT, therapists work with the patient to connect the specific reactions and thoughts the patient has to the emotions they are experiencing. By mapping these out, they help the patient more easily recognize the emotions with a goal of realizing the automaticity of typical responses and the ideal of developing a greater repertoire of behavioral reactions. We review the impact of emotions and what to do with them in Chapter 10.

      Establishing new pathways

      There is an old saying that “you can’t teach an old dog new tricks.” If this were true, there would be no need for therapy and particular DBT treatment. DBT is all about teaching new skills (tricks) to replace old behaviors when the behaviors have been maladaptive.

      So, what does behavior change look like in the brain? Neural pathways are the bundles of nerves that connect one part of the nervous system to another. They are like the cable that connects your phone to its charger, or the TV to the cable box. These bundles of nerves are connected to each other by dendrites. Think of a dendrite roughly as the plug that goes into the wall or your phone. A big difference between plugs and dendrites is that the number of dendrites increases each time a behavior is performed. Another way to think about repetition is to consider the grooves that a car makes on a dirt road. The more cars that travel on the road, the deeper the grooves become.

      The bundles of nerves communicate with each other via a process known as neuronal firing. When brain cells communicate frequently, the connection between them strengthens. Another process that happens is myelination. Myelin is the covering of the neurons. Think of it as the plastic sheathing around a copper cable. Over time, the more a behavior is repeated, the more myelin wraps around the nerve cells.

      Over thousands of instances of the repetition of behaviors, myelination and dendrite formation leads to communication between nerve cells becoming faster and more effortless. With enough repetition, these behaviors become automatic. The behavior of walking is one example of this. When a child learns how to walk, they often fall and are clumsy. After thousands of repetitions, walking becomes automatic.

      

However, just because we have created the neural pathways that lead to certain behaviors, this doesn’t mean that we’re stuck with those behaviors forever. If we want to change our automatic behaviors, we must participate in new activities. By engaging in new behaviors, we’re training our brains and our brain cells to create new neural pathways. Just like our old behaviors, the new pathways get stronger the more we repeat the new behaviors. Eventually, the new behaviors can become the new normal.

If we go back to the behavior of the child walking, initially the child moves around by crawling, and crawling is the automatic behavior caused by the repetition of crawling and leading to the strengthening of the brain cells. When the child starts to walk, eventually the new “walking” pathways become stronger than the “crawling” pathways, and walking becomes the new normal. This can be done with all behavior, even though it can be more difficult if the behavior has lasted for a long time.

      

It can be easy to give up, because it can feel like nothing is changing. Research shows that it takes somewhere from three to six months for a new behavior to become more automatic, although this varies a lot by person. If you’re in DBT, your therapist will want you to persist until your new behavior becomes more habitual. This will include your DBT therapist providing you with ideas for overcoming obstacles that might interfere with engaging in the new behaviors. We delve more fully into these ideas when we review the skills in Part 3 of this book.