219 ‒ Dialectical behavior therapy (DBT): skills for overcoming depression & emotional dysregulation

[@PeterAttiaMD]

In this episode, we discuss: 0:00:08 The basics of dialectical behavior therapy (DBT) & how it differs from cognitive behavioral therapy (CBT) 0:06:15 Treating depression with CBT: history, effectiveness, & how it laid the groundwork for DBT 0:15:22 Marsha Linehan’s inspiration for developing DBT 0:20:10 Explaining borderline personality disorder (and associated conditions) through the lens of DBT 0:38:15 How work with suicidal patients led to the development of DBT-a dialectic between change and acceptance 0:49:04 Details of DBT: defining the term “dialectical” and how to access the “wise mind” 0:56:29 Practicing mindfulness and radical acceptance in the context of DBT 1:09:50 Applying “radical acceptance” to tragic scenarios 1:02:00 1:16:15 The five domains of skills taught in DBT 1:23:30 Why Marsha chose borderline personality disorder as her focus when developing DBT 1:13:30 1:26:15 Is there any benefit in doing DBT for someone without a pathological condition? 1:31:50 The DEAR MAN skill of DBT 1:44:44 Adapting DBT skills for adolescents and families 1:31:00 1:47:55 Identifying vulnerability factors, increasing distress tolerance, and the impact of physical pain 2:01:19 The DBT chain analysis: assessing problem behaviors and identifying vulnerability factors 2:08:15 Why the regulation of emotions can be so challenging 2:11:58 The importance of mindfulness skills in DBT 2:16:15 Opposite action: an emotion regulation skill 2:23:42 Advice for those wanting to explore DBT 2:29:13 Finding a well-trained DBT therapist

[@xuvivian912]

Al mc

[@amoghdurgam5621]

This was a brilliant podcast please have this guest on again

[@amleveaux]

lol. lo. 💩 😅 😊😊😊😊😊😊😊😊 2:06:56 k😊😊😊 😊

[@user-ue1nv9jf8c]

Thanks

[@davidclarke9215]

@@amleveauxwhat are you talking about? This is an amazing talk

[@6789uiop]

I've followed Dr Attia for many years. He's a gift.

[@TherapyGymnastics]

Thank you very much for the excellent discussion. DBT is extremely effective. DBT can change the neuro reactivity and neuro chemistry of the brain. DBT saves people’s lives and can literally prevent suicide. If you have never lived or experienced BPD, please don’t judge the value of DBT to change people’s lives. Thank you for bringing this very effective therapy process to the public. There are some wonderful DBT apps. Peace

[@King_Lewyy]

What DBT apps do you recommend?

[@deepalipimpale309]

Can you please share the names of DBT apps ?

[@senseofwonder4734]

This is unquestionably for me, and I imagine hundreds of other listeners, the most valuable conversation I've ever listened to. I have struggled severely for 40 of my 52 years of life with severe depression and difficulty with emotional regulation, much the result of life circumstances. Regardless of the source, I've never had therapy with the use of DBT. Never. And I'm an aprn with education and moderate resources. I've wasted thousands of dollars and hundreds of hours going to therapy that at best did not help and at worst made my rumination and pain even worse. I do live in Arkansas, and I would rate this state's mental health resources as extremely poor. I've been reading on DBT, but this conversation has clarified it and given me the tools to approach it on my own, even without access to a skilled therapist. I've gone on Amazon and ordered a workbook. THANK YOU to both of you. Your work is important and life changing. Dr Rizvi, thank you- that doesn't feel like enough. Please know how much your clear description and explanation of DBT will mean to thousands of listeners like me. You are a gift to the world. Specifically to Peter Attia, I've listened to hundreds of hours of your podcasts and read Outlive. My life is better because of it. I sometimes bemoan the fact that I don't have the financial resources to pursue the level of investigation into my health through labs and vo2max, perhaps an appt at your clinic. HOWEVER....i do find genuine hope and utility in the knowledge you share and your impeccable assimilation, dissemination, and generous application of the most current science. It is not just for the elite wealthy. You've made it available to everyone. Thank you, I can't say it enough. In the depth of struggle, I can turn to science for comfort and count on The Drive , Peter Attia and his wonderful colleagues!❤

[@jackperry6269]

couldn't agree more.

[@senseofwonder4734]

@jackperry6269 thank-you for reading my comment. Pretty lengthy, I realize, but it felt good to share my deeply felt thoughts. So glad you agree!

[@jackperry6269]

@@senseofwonder4734 no worries. It was interesting. I love reading KZbin comments. They're fascinating. You sound like you've been through hell. always here to chat if you need it!

[@kirstinstrand6292]

Fabulous, surely you have spoken the thoughts and feelings all of fans of Dr. Attia's. I'm not sure how other doctors will compare with Dr. Attia and his cutting-edge knowledge.

[@kirstinstrand6292]

I re-read your comment and was thrilled to 2:36:04 see that you will try being your own therapist. I did it, not using DBT, which would be uncomplicated for you, given all those years of therapy (sad for you... I know). Man, what fun! This is how you will one day look back on your self treatment and feel really good 👍 about this year(s) you're about to enter. By the way, I didn't have a method manual to guide me, but I spent MANY years in analysis. Terminated, not free! That's where I developed my therapy skills - although it was a slog. Anyway, you can do it! ❤

[@xalian17]

Wasn’t expecting Attia to say he was in DBT. I’ve started my journey. Glad to hear the testimony of others

[@JonUbick]

They brought real change to the field - My former assistant and I created an Intro to DBT for Antioch University and it is the most loved and demanded course!

[@Cathy-xi8cb]

Distress tolerance is far harder to develop than it appears. Wanting to self-harm when someone doesn't return your call/text promptly means that you really have NO emotional regulation skills, no distress tolerance at all. You need DBT yesterday!!! BTW, this starts in toddlerhood. When no one teaches you how to handle your broken cookie or not being able to play outside, you won't be great at handling a breakup or losing a job. Learn resilience now because life is tough for all of us.

[@4eversearch]

Exceptionally good discussion, presented with exceptional clarity to match. Agree with other commenters: Dr Attia , in addition to his many talents, is incredibly generous person making these loads of wisdom available to everyone interested. Many thanks. P.S. the subject of emotional regulation and basics of CBT and DBT should be taught in schools. Much, much more important that many garbage subjects being force on kids nowadays. I venture a guess that learned emotional intelligence would be the strongest deterrent for horrific school shooting

[@jackperry6269]

thank you Peter Attia for all your content. Thank you for destigmatising and exploring these issues. You are amazing.

[@Callitout-kl1uq]

I’m finally admitting to myself that I likely have BPD. I’ve learned to “control” it but I’ve also self isolated and have not dated in many years. As many have said, lack of disease is not the same thing as health, and I’m definitely lacking emotional/psychological health. My therapist has just recommended DBT and I hope it can help. I also now recognize BPD in my father, which explains a lot about my family of origin. However, I also know that DBT is not about diving into your past. I’ve done that a good bit and it can help you gain insight but it doesn’t resolve any issues. That is my goal and I hope for all those here that you find healing.

[@JonUbick]

What an amazing reservior of early DBT history - anyone who has been lucky enough to have Marsha as a teacher, now retired, has been changed by her. I love when I find this type of thing with pioneers of DBT Koons, Manning....

[@ToddHoff]

She was terrific. So clear and informative. That's hard to do.

[@judylarsen7622]

By far the best episode so far. So personal. Spot on. Thank you!

[@echase416]

It’s important for the Public to understand that can be used .

[@tb8827]

Indeed. PTSD among other disorders.

[@unchartedexe]

I say this like every third episode, but this is one of your best podcasts. REALLY helpful to hear real world examples. Thank you!!

[@dwightdelahunt6165]

Excellent; very rewarding and helpful. Such an articulate offering from both Peter and Shareen

[@ShawnFaherty]

Great discussion and I appreciate the honesty and openness of both Attia and Rizvi. I agree that everyone will benefit from these skills. It's sort of like next level mindfulness which was discussed.

[@Shirley-nt9sz]

Intelligent and thoughtful conversation, perfectly paced

[@good_call]

Such an overlooked subject, thanks for providing information about DBT!

[@kjs87]

Great episode, one of my favorites! I think the universe is trying to tell me something about DBT. I am a grad student who just completed a paper about DBT 2 weeks ago then this past weekend I watched an episode of She-Hulk with my son and the Hulk spoke about DBT, now this podcast drops 🤔

[@vanhoudtshoorn]

Thank you for this beautiful, informative conversation💖. Very much appreciated.

[@Lea4-22]

Shireen and Peter: explanation of who can benefit from methods of DBT, people considered with mild to moderate conditions vs suicidal persons or whatever is definitely a good idea considering the shortage of mental health providers. and the needs of the individuals who feel comfort in talking and are actually given the tools to analyze themselves with a moderator learning the CBT/DBT skills of Marsha. I started counseling recently and as usual, I began to study the skills by purchasing Marsha's workbook book in hardcore and Kindle version. KZbin/Podcasts and the new language of the field. BTW: Recently my counselor said Medicare will soon cover treatment for counselors with certain certifications. Also, over the years all my psychiatrists strongly recommended "talk" therapy because they didn't have time to do more than diagnose and medicate (my observation). Plus I felt out of place in the waiting room with most individuals e.g., seriously ill patients waiting to be seen by a physician's assistant for psychiatrist or whatever they are called.

[@denisemc607]

Thank you for taking both of your valuable time to provide this deep dive into this therapy! It will change my life and save lives for sure ❤ love you Peter!

[@vanhoudtshoorn]

It is through the exercise of the powers of the soul that human progress is achieved. ‘Abdu’l-Bahá has said that the soul “can discover the realities of things, comprehend the peculiarities of beings, and penetrate the mysteries of existence. All sciences, knowledge, arts, wonders, institutions, discoveries and enterprises come from the exercised intelligence of the rational soul.”

[@trismegistus3461]

1:44:44 Adapting DBT skills for adolescents and families

[@alouise3557]

Thank you Tris! I cannot sit through this long video. No patience. 😊

[@jcs1090]

So awesome to see Peter Attia struggling with same stuff I do/did. Well handled.

[@mathphd8900]

Excellent episode. People who suffer with BPD have it very difficult nowadays. A friend of mine has been struggling with this for years and has tried many many ways to get help, also DBT treatment and are not to a great point yet. Unfortunately, lately things have gotten even worse for them since an ex went online in the internet and trying to cancel them with all kinds of accusations that are jot quite true. Very very tough!

[@kirstinstrand6292]

The challenge regarding ALL therapists is to find one that's been in practice 20+ years and who is worthy of you. Get a referral from a friend who has tested out the practionioner.

[@kirstinstrand6292]

Meaning someone worthy 2:26:53 of your complicated history and intelligence.

[@eugeniebreida1583]

What a gruesome line of questioning, Dr Attia!

[@clifdunbar7405]

Personal response ability is the biggest monster but very rewarding when Gods power allows you to walk out victoriously triumphant

[@sarah.ohsarah]

Thank you for this video! Very interesting and I really enjoyed it.

[@bhvnraju8493]

Curious, interesting and enlightened talk of PSYCHOLOGY. Both of you 🙏🙏

[@Svelasc2]

Would be great to do an episode on EMDR and bilateral therapies.

[@pollyana555]

This episode was fantastic. I have learned so much and all Dbt really makes sense to me. I got curious and will research more about the exercises. Thank you both very much! ❤

[@hailynewma9122]

one difference between structured and unstructured can be that with structured you only retrieve information about what the therapist already knows/has experience with and what may be hidden (unconscious) in the client might never come to the surface. And, of course, if entirely unstructured you may get lost …

[@kirstinstrand6292]

There are no perfect therapists. Just find one well experienced in the therapy that you feel you need.

[@silviahayakawa6655]

@peterattia what’s a good DBT workbook? Thank you in advance.

[@Etcher]

Came here from the recent Sam Harris discussion. Very impressed Dr. Attia subbed!

[@helenshih9086]

Wonderful interview, learnt a great deal, hope to get trained in DBT❤

[@yvonnekneeshaw2784]

I found this FASCINATING. THANK U! 🙌 I’ve taken CBT “mind over mood” X 4 about 15 years ago & it totally helped. I’ve had chronic pain for most of life (now 67). In past year My thought is primarily “I no longer enjoy living in this body of mine”. I had never heard of DBT before. Not sure if this is best direction for me. Perhaps ACT? Please can u recommend excellent book(s) or videos to watch on this subject of lifelong debilitating chronic pain & which might help me?Your questions were awesome & so was your guest. 💟💥👏

[@Freedomexpresstrain]

Hellom I share this journey with you as a fellow chronic pain person. Pete Walker, a pioneer in the field of specializing in trauma has a wonderfully eye-opening book called "From Surviving to Thriving" that has helped me unravel some of the reasons for somatic pain and the connection to how emotional pain gets stored in the body as physical pain. I also understand how complex of a subject it is and it's not a one treatment fits all kind of therapy. I thought it useful to suggest the book. You are not alone. Thanks for sharing yourself.

[@RawGuruRecords]

is there special type of TV or monitor technology necessary to make it appear this clearly on camera for a virtual conversation like this?

[@barbbrazes869]

Excellent conversation! Helpful information! Thanks!

[@MarkAnthony-wo9fr]

I have borderline personality disorder and 8 week into DBT and thus far no improvement. Very cynical about whether or not it will aid me

[@LilachLavy-Emanuel]

Thank you for this excellent talk.

[@BradOntheGo]

Interesting... Subform of CBT. Now/recently hearing about Metacognitive BT. Another complex and technical approach to handling 'undesired' psychological behaviors.

[@murraywebster362]

Hi Peter and Shireen, I have a logical problem with Peter's Q "what does BPD cause? (or something like that). By analogy: the tips of some of my fingers go white and numb sometimes so, I have Renaud's disease/syndrome/condition. I then read/hear, that Renaud's syndrome CAUSES white fingerers - which is incorrect. Renaud described symptoms, which were then labelled "Renaud's xxx". It was, and still is, an observation of symptoms. Saying that Renaud's (description of symptoms) causes the symptoms is illogical. I may be wrong - in fact likely to be wrong given your expertise, experience and intelligence - But, asking what does BPD cause appears to me to be akin to asking: what symptoms does this description of symptoms cause.

[@kirstinstrand6292]

I think I understand your concerns. If I'm interpreting your comments correctly, they are logical. I think DBT works best for those who fit the behavior characteristics of DBT. Myself, I've been driven to find the source of all my issues. The process took much longer than DBT. Yet, I, or my style of thinking, could only work my way through all my chaos, much like peeling an onion, as the saying goes. All my life, I've been more reasonable and wise compared to peers. Lacking the emotional side of ourselves comes with its own unique problems, however.

[@GetUnlabeled]

If the med is effexor or like, I agree the withdrawal symptoms were unbearable, and, it did finally end, I had to eventually choose to just cold turkey and within 2 weeks I barely had any more symptoms

[@echase416]

People don’t have to undergo this torturous withdrawal. I asked her pharmacist for information about a ‘fluoxetine cross-taper withdrawal’.

[@evanrosenlieb8819]

Sort of misleading to even mention Marx -- purely in regard to dialectics Marx was purely using Hegel. To the extent DBT is using dialectics sounds like they are coming out of the Hegelian tradition than anything to do with MArx.

[@liliwhite66]

Please read Marsha Linehan’s memoir, Building a Life Worth Living.

[@evanrosenlieb8819]

Really disappointing to me to see other people coming out of the woodwork here to attack the interviewee here for perceived political or cultural opposition. Dr. Attia (or Dr. Rizvi) if you are out there I really enjoyed this conversation and found it interesting and useful!

[@4eversearch]

Why would you pay attention to stupid ppl idiots out there ?. Apply DBT: you cannot remove all the imbeciles from the public forum, but can ignore them and enjoy a superb discussion of two gifted people, AND Dr Attia letting us listen for free,:):):)

[@rgcamsf]

Thank you both!

[@toddboothbee1361]

Is taking refuge in a belief in a life after death a kind of denial? A blunting of acceptance, at least?

[@tb8827]

I had a co-worker charge at me screaming. This can be scary.

[@carriebenzinger7629]

Thank u both for your time, discussion & putting this out there for everyone- VERY interesting.

[@jennyvanderhoff2663]

Is alcohol or drug addiction considered as SELF HARMING?

[@mares3841]

Thank you

[@jabaerga1]

Great video! Thank you ❤

[@xavinaut]

Thank you for this

[@patriciagriffin1505]

please have Gary Craig on your show to discuss EFT that has been proven to b more effective in treating CPTSD than cbt or dbt

[@zxsw85]

Thank you Peter

[@natasha09179]

Just a reminder that BPD is highly stigmatized, so if you think you may have BPD, be very careful about disclosure. It is a label with a lot of baggage in pop culture. For example, people may immediately jump to thinking of Angelina Jolie’s character in “Girl, Interrupted.”

[@user-ue1nv9jf8c]

Thanks so much

[@alouise3557]

The biggest problem? Do a search for DBT therapists and you'll find a LIST of them that do CBT (easy way) and do not care to learn anything else. It's like they get licensed, and don't care to expand learning. I'm nearly 50 and disgusted that my insurance (state provided) offers very few Psychologists, and only social workers, and MOST are young late 20s beginners who are in probably their first jobs and don't do DBT. If anyone knows of actual SESSION examples that others can watch and pick up skills from, please advise. Thanks.

[@kirstinstrand6292]

I hear you! How about starring a small group of like-minded ppl, and most importantly 🤔 run an ad for DBT graduates, meet and brainstorm ideas for support and friendly guidance. 🤔

[@alouise3557]

@@kirstinstrand6292 I'm too lazy for that. Lol

[@bennguyen1313]

The philosophy reminds me a bit of advaita vedanta (one-ness).. that offers a direct approach to the realization that the feeling of self (subject/object) is an illusion. Greg Goode is a psychologist in New York that uses it for patients.

[@katherinelalli776]

I had a terrible experience in DBT.

[@katherinelalli776]

DBT tells people their trauma is irrelevant while putting them through more trauma.

[@mares3841]

Would your daughter be satisfied with a clip cuff on her ear that gives her that addition she wants without the piercing? Can she consider that she might grow out of it? Piercings do not always close. Back to what does she want out of it? Maybe the root desire has profound consequences. Here's just my opinion: too bad your wife is copping out by saying, "whatever!" which just drops a rudder on your thoughtful parenting. Boooo!

[@TheNalimo]

Please try to use abreviations as little as posible as your viewers are not familiar wtih them. Instead of BPD for example, it would be more useful if you would say what it stands for. Otherwise great talk!!! :) CBT, DBT, BPD.....

[@InDifferentPurpose]

Her face describes to me someone who doesnt know what to do with herself and is stuck that way.

[@palashvictor]

❤️❤️❤️❤️❤️

[@선미란-o7x]

유익한 내용 잘들었습니다 학교 현장에서 청소년 자살예방 및 자해 행동 하는 학생들에게 적용 하겠습니다 DBT 관련 박사 논문 진행 중 입니다.

[@r.j.23537]

So because she had an experience with God the interviewer is trying to suggest that she was Schizophrenic 🙄

[@clintstinkeye5607]

I call my invisible friend, Dilbert the Lurker, and I am positive that I am completely rational because Dilbert told me so.

[@carl7856]

Rich White people problem… Seriously?

[@BradOntheGo]

I believe the reference was to a time when those were the patient demographics that could 'pay' for treatment over extended periods of time. Now available/applied to others and in less volume of sessions.

[@TimTheMusicMan]

When I hear this I immediately think how right Tom Cruise was.

[@SSD92_x]

Look at how much she looks up and and directs her eyes away from Adam each time Adam questions her, then she proceeds to fill the time with utter nonsense “Back in those days’” she’s pulling out utter nonsense, presenting her opinions as facts. There’s not once instance where she can actually give clear answer. Heck I don’t think she can even define dbt

[@evanrosenlieb8819]

Did you even consider that your analysis of her eye movements might be influenced by the fact that they are teleconferencing and most likely she is trying to manage looking both into the camera and at the screen that she can see Peters face on?

[@zzc8505]

And this is a "professor"? So inarticulate, with "uh" and "ahm" after every other word, seriously. She can't articulate one sentence smoothly without inserting those highly irritating parasites. I can't imagine sitting through her lecture and listening to all these "uhm," much less sitting to her in a therapy session.

[@Sheikdaddy]

To those being critical: Be a borderline male your entire life and being rejected for DBT by every group because you're male. People hear the word sexist and assume it only applies to females. In need of desperate help and I have been rejected for being male as being untreatable. But I didn't know that Rutgers had DBT and I'm hoping they return my call for treatment. When nobody wants to help you because of your biological sex it doesn't matter what sex it is. Hopefully her group can be different than the others in NJ, if they call back. Many mental health professionals nowadays are too mentally ill to even recognize how they are making things worse sometimes. It's disheartening to have psychiatrists be emotionally damaged by the patients and the disorders they publicly claim to treat. But I have hope it only takes one good therapist to help pains in the ass with extreme emotional dysfunction to get better and not end up homeless for no good reason.

[@blueberry4082]

I’m sorry to hear that, but the fact that they see it as a female disorder comes from misogyny

[@Sheikdaddy]

@@blueberry4082 And by saying that and focusing on that it causes Misandry. If you're going to focus on one side you neglect the other so men can't get help now. You're saying that it's misogynistic that "we only tried to help women with the disorder". And that continues today and when you call every DBT group your insurance will cover until sorry you're a man what are you supposed to say? When a man cannot get treatment because he's not a woman what is the word? Saying it was caused by misogyny is focusing on past anger, the exact problem that border lines need to deal with. Saying it's focused on women caused misogyny is saying that mental illness diagnosis is are negative judgments not tools for help. Because you guys are focused on misogyny you're still stuck trying to help women and ignoring the men which may be why I still can't get a call back even from her group. Radically accept that the past is the past and focus on now and how to deal with reality.

[@blueberry4082]

@@Sheikdaddy Well, sexism targets both men and women. Also misogyny and patriarchy hurts both men and women. A lot of girls with ADD don't get diagnosed because it's considered more of a male disorder. A lot of girls were told that they were day dreaming. I'm just saying it's the root of the issue. And it's not only about helping women, but calling women too emotional and unstable. Like the word hysterical that historically was used to describe women. I hope it changes, basically equality is the solution to all problems.

[@Sheikdaddy]

@@blueberry4082 I have family who doesn't want to get mental help because they look at it as some kind of scarlet letter judgment. But diagnoses are guides for help. If a woman is diagnosed with BPD she gets help. If a man gets diagnosed with BPD he gets discriminated against. They're not labels of judgment they are diagnosing medical problems to get treatment. If you're willing to give treatment to a woman and not willing to give treatment to a man, the original reasons from past generations are irrelevant. Fix the problems now instead of holding onto anger from people probably no longer alive. The root cause of all problems is the big bang or God are we going to stay angry at that or focus on now and dealing with the current problems of our realities? Not everything is men's fault or women's fault, that attitude is causing modern men dysfunction and causing women relationship nightmares. I am human, and so are you.

[@blueberry4082]

@@Sheikdaddy you keep talking about anger, but you’re the angry person here. I just agreed with what the guest of this podcast said. I don’t play any role in this. Go yell at doctors and health care system and insurance companies.

[@wmartonejr]

Thank You @Peter_Attia_MD