Author: belladonna98

Research Position Paper- belladonna98

The Need for DBT on Campus

A freshman in college sits in her dorm, swallowed by assignments and wanting some kind of escape. She gets a text from her boyfriend; there’s a party going on. That’s perfect, she thinks, I need a night where I don’t have to worry about anything. At the party, both she and her boyfriend get a bit carried away. Six shots isn’t that many, she thinks, trying to rationalize her consumption.

Afterwords, she gets in a fight with her boyfriend. She barely remembers what it was about, she just knows that she was incredibly hurt by some of the things he said. He called her worthless, saying that he was the only one who would ever like her. She didn’t realize he could get so nasty. After all this, she is much more stressed than before that night, and all the assignments are still there waiting to be done. She comes out of the experience with a lot of regret and no progress at all.

What this girl experienced is actually quite common. As a college student, I hear stories like this all the time. I once heard a fight like the one described above get physical outside my dorm. It was obvious the two students were drunk. A night that was supposed to be fun had gotten very dangerous very fast. It’s a common problem; student’s don’t know how to deal with the stress of college so they turn to parties and relationships without thinking, and it can actually hurt more than it helps.

The point of these stories was to give an example of a very common issue among college students called dysregulation. This can occur in many forms, the most prevelant among students being emotional dysregulation and relationship dysregulation. Basically, these aspects of student’s lives become unhealthy and stressful, causing negative effects on student’s lives. But there is a way to treat dysregulation, called Dialectical Behavior Therapy.

In its original, most intensive form, Dialectical Behavior Therapy (DBT) is very regimented and time consuming. Clive J. Robbins and Zachary Rosenthal describe the therapy, originally developed by Marsha Linehan, as requiring multiple group and individual therapy sessions weekly, skills training, phone coaching, and meetings among a person’s team of therapists. I do not subscribe to this definition, described in the DBT section of Acceptance and Mindfulness in Cognitive Behavior Therapy. DBT, when used most efficiently, is whatever dialectical behavior skills a person needs in order to improve her life.

Marsha Linehan (this information was relayed to me by Clearviewtreatment on borderlinepersonalitytreatment.com) found that five different types of dysregulation occur in patients with Borderline Personality Disorder (BPD). These are emotion dysregulation, interpersonal dysregulation, self dysregulation, behavioral dysregulation, and cognitive dysregulation. Each type reveals some sort of dysfunction in each aspect of a person’s life. DBT was created to treat this dysregulation, which, though commonly found in patients with BPD, can affect anyone at any time.

The website of Sierra Tucson describes four main principles of DBT: “1. The primacy of the therapeutic relationship, 2. A non-judgmental approach, 3. Differentiating between effective and ineffective behaviors, and 4. Dialectical thinking.” These principles, specifically the first two, apply to both patient and therapist, assuring that all parties are comfortable with and prepared for what is to come. The third and fourth dictate what the patient will learn. Dialectical thinking leads to radical acceptance by teaching patients to become aware of their own judgments and accept them, according to Rachel Gill of ilovedbt.com.

Four treatment modules go along with DBT’s principles: “1. Mindfulness, 2. Distress Tolerance, 3. Emotion Regulation, and 4. Interpersonal Effectiveness.” These go hand in hand with the principles, teaching patients through various methods to accept and handle the reality in front of them. Mindfulness leads to learning distress tolerance and so on, each skill building on the next, teaching patients how to handle their life’s dysregulation.

The workbook Don’t Let Your Emotions Run Your Life for Teens breaks down DBT perfectly to fit most people’s lifestyle. The book teaches individual skills and outlines which situations call for which skills, giving exercises on how a person is going to apply said skills. It builds upon itself, starting with the basics that apply to everyday life and getting more specific as it goes. That is how DBT should be, and that is how I learned to apply it to my own life.

People with BPD struggle enough with everyday life. The disorder is almost entirely made up of life-interfering behaviors such as impulsive actions, dysregulated relationships and emotions, and some symptoms of depression such as lack of motivation. We cannot expect such individuals to keep up a schedule like Robbins and Rosenthal require. However, we should supply them with the skills necessary to improve their daily lives.

College students who show many signs of dysregulation lead incredibly busy lives. None of us have time for class, homework, and a social life in general let alone when paired with multiple therapy sessions a week with phone coaching in between. Along with the lack of time, society still stigmatizes going to therapy as a sign of weakness, which may deter many college students from such a regimented form of DBT. Students will still need to go to therapy, but at a more relaxed pace, giving them more time for it and welcoming less judgement.

A less intense form of DBT is an effective compromise for all recipients of the therapy. Going to therapy once a week and working from a book like Don’t Let Your Emotions Run Your Life for Teens was enough to make a difference in my life, and could do the same for many others. For BPD patients, it requires less effort and is not as overwhelming. For college students, it takes up less time and welcomes less stigma. DBT can be redefined, and this new definition will help many people.

This relaxed form of DBT would be absolutely perfect for college students, as previously stated. They suffer from serious dysregulation. But why?

At college, new students experience immense change. According to Brian Harke of the Huffington post, students come to college “overly optimistic and confident in their ability to manage the challenges they will encounter at college.” They struggle to manage new, unprecedented stress. Students who attempt to cope by delving into extreme parties or unhealthy relationships radically dysregulate.

Of course, there is the academic side of college, the main cause of stress. Students think that they can handle college academics, and often get a reality check in the form of a failed test or paper. College academics can get so stressful that experts write entire books on how to deal with said stress, such as “College Success” created by the Extended Learning Institute and Lumens Learning. But stress is not limited only to academics in college.

Many students know only the positive stories they’ve heard from their parents about “The College Experience” of decades ago. Talking about the “College Experience” as if there is a standard for activities in college does not help students in the least. Instead, pressure is put on them to achieve not only academically but also socially. The wild and sometimes-exaggerated stories set even more expectations for students to fulfill, so forced relationships and parties with unfamiliar and possibly unhealthy people occur. Non-organic interactions can cause dysregulation, as they did not happen naturally, they are forced, and they are unhealthy. Obviously, not all relationships and parties are inherently unhealthy or cause dysregulation, but it is important to consider the related statistics.

82% of college students have admitted to using verbal violence against a romantic partner, often brought on by the use of drugs or alcohol. In that vein, 44% of college students have been classified as binge drinkers. In those relationships and parties seen as part of the college experience, a good amount of dysregulation exists.

The immense change that college students are undergoing, and the pressure felt by many of them causes the dysregulation described by the earlier statistics. Not only academic pressure, but that to somehow “succeed” socially, if that is even possible. A student under almost constant stress who is not recieving help is bound to suffer from dysregulation. This brings me to my original point; college students need DBT. Once we stop looking at dysregulation as a part of being at college and see it as a real problem that has a clear solution, we are on the path to fixing it.

But of course there are naysayers. Therapists whose patients don’t improve with DBT complain that it doesn’t work in extreme cases of BPD and emotional dysregulation. In one case, Shireen L. Rizvi had a patient named Barbara whose condition was not improved, and whose disorder may have been worsened, by the improper application of DBT. Barbara had BPD, social anxiety, severe depression, PTSD, and was an abuse survivor. Rizvi’s treatment was incompetent.

Over the course of six months, Rizvi struggled to treat Barbara, later blaming her failure on the “therapy-interfering behaviors” of her patient such as asking her therapist very personal questions, calling her in crisis daily, and not making eye contact. Rizvi’s response to these behaviors is what makes her argument that DBT didn’t work here completely invalid. Rizvi admitted to outright ignoring some of Barbara’s behaviors in many ways. She failed to indulge in and therefore validate the behaviors. The very basics of DBT state that a patient must feel validated in order to receive treatment. Maybe partially answering a question or asking her why she didn’t make eye contact would have been an improvement. Rizvi instead let them agitate her and obstruct her own practice.

While Barbara did overstep the patient-therapist line (she had had a romantic affair with a previous therapist, so she didn’t understand it in the first place) Rizvi’s response should have been one of understanding and willingness to help, not one of agitation and rejection. Rizvi admitted to being a “novice therapist”, but as someone who is not even a therapist yet, I can see that that is no excuse. She looked at Barbara and saw not a person but a set of symptoms: mistrust of authority, boundary blindness, disassociation, crippling anxiety. Well-administered DBT could have helped Barbara; her therapist did not.

Therapists need to take into account the state of their patients and how to best treat them. They cannot look at every patient as the same textbook set of symptoms, they have to see the patient as a whole person. Barbara may fit the criteria for rigorous DBT, but would not be able to handle it. She most likely would have done better under a less structured form of DBT, as one who has had little structure in her life to begin with. She is not familiar with such intense dedication to one thing, a thing which she is not even convinced is worthwhile yet. So, giving her small tidbits of DBT in her therapy sessions would not only have given the therapy more meaning to her, but made her more receptive to it.

Another example of DBT failure is one I found on a forum for people with BPD. This time, we see the patient perspective on the issue. A user we’ll call Cabdriver gave a list of explanations on why DBT wasn’t working for him and how it was flawed. The list consisted of a combination of him not practicing his skills and his therapist punishing him for it. He found the skills boring and unhelpful, and would lie to avoid punishment and say that he did them when he hadn’t.

Therein lies the problem: a therapist should never punish a patient. Apparently, Cabdriver’s therapist would become irreverent or even take breaks from therapy when Cabdriver didn’t practice his skills regularly. This is probably an extreme case, but it is troubling. Again, I reference that one of the key principles of DBT is validation, and a patient cannot possibly feel validated if he is constantly fearing punishment. A person can’t fear his therapist; therapy is supposed to be a safe space where someone can admit to anything without judgement. He may be held accountable for his actions, but he shouldn’t have to fear a slap on the wrist. Patients are adults; treat them as such.

The solution here lies in both the patient and the therapist trying a bit harder. The therapist needs to try to convince Cabdriver that the skills are worthwhile, as the punishment approach is ineffective and downright patronizing. Maybe Cabdriver needs a new therapist altogether. But he also must realize that the skills are there to help him, and they aren’t as black-and-white as they seem. Cabdriver often said things along the lines of “Have a problem? Practice your skills!” However, “practice your skills” can simply mean applying a new approach to a situation or changing thinking. It doesn’t always mean “sit and be mindful and all the world’s problems will disappear.” In the end, everyone involved with DBT just has to be open minded and accepting, and go from there.

Obviously not all college students are Barbara or Cabdriver and not all therapists are Rizvi. However, they may still have therapy interfering behaviors and not be the most eager to start DBT. That is why a very relaxed form of it is best. Reluctant patients shouldn’t be completely immersed in the therapy, or shut out like failures. Introducing DBT slowly in small pieces makes much more sense. The therapist doesn’t even have to officially declare “We’re going to do DBT now.” She can simply give skills that pull from DBT and mention the name, intriguing the patient. Patients who recognize the value of DBT are receptive patients.

Patients have to believe that the skills will help them, and that they can implement them successfully. Emotional validation, as Robins and Rosenthal say, is one of four core principles of successful DBT. The safer and more empowered a patient feels, the more likely they are to use therapy skills outside of the office, as I stated when giving cabdriver a solution. But of course, the person has to practice the skills in order for them to help. If someone completely ignores their skills and makes no progress, then what?  Successful therapists guide their patients through that process, from belief, to validation, to empowerment, to practice. The unsuccessful, who treat their patients like children throwing fits, drive patients away.

The bottom line is, it all comes down to the proficiency of the therapist. If they look at patients as textbook sets of symptoms who all need the same thing, no progress is going to be made. However, if they change their style to meet each patient’s needs, looking at them as a human being, it makes all the difference. This kind of care could benefit everyone, from the most resistant BPD patient to the scared college student. Therapists just have to be willing to try.

So, with the right therapist, the correct form of DBT, and a little effort, college dysregulation can be a thing of the part. Obviously I’m not offering a magic way to make student’s problems go away; I simply want to offer them a healthy alternative to the common coping mechanisms. Parties and relationships can be great, but only when they are done right. Often they become stressful, defeating their purpose of trying to relieve stress. Teaching college students DBT would give them coping mechanisms that work for them and benefit them in every way. If the girl from the story had DBT, her life would be vastly improved. Hopefully in the future, we can give the proper help to her and all students like her.

Works Cited

@DbtPeers. “An Introduction to Dialectical Thinking According to DBT.” DBT Peer Connections. N.p., 18 Oct. 2013. Web. 21 Nov. 2016.

Clearviewtreatment. “Five Areas of Dysregulation in People with BPD – Borderline Personality Treatment.” Borderline Personality Treatment. N.p., 12 Oct. 2011. Web. 21 Nov. 2016.

“Dialectical Behavioral Therapy & Treatment – Clinical Excellence at Sierra Tucson.” Sierra Tucson. N.p., n.d. Web. 21 Nov. 2016.

Ed.D., Brian Harke. “High School to College Transition, Part 1: The Freshman Myth.” The Huffington Post. TheHuffingtonPost.com, 22 June 2010. Web. 06 Nov. 2016.

ELI (Extended Learning Institute at NOVA), Lumen Learning. “College Success.” Candela Learning. N.p., n.d. Web. 06 Nov. 2016.

Rizvi, Shireen L. “Treatment Failure in Dialectical Behavior Therapy.” Cognitive and Behavioral Practice 18.3 (2011): 403-12. Science Direct. 2011. Web. 13 Nov. 2016.

Robbins, Clive J., and Zachary Rosenthal. “Dialectical Behavior Therapy.” Acceptance and Mindfulness in Cognitive Behavior Therapy. John Wiley & Sons, n.d. Web. 30 Oct. 2016.

Shook, Nancy J., Debora A. Gerrity, Joan Jurich, and Allen E. Segrist. “Courtship Violence Among College Students: A Comparison of Verbally and Physically Abusive Couples.” SpringerLink. N.p., Mar. 2000. Web. 06 Nov. 2016.

User Cabdriver. “DBT: How Is It Working for You?” RSS. N.p., 19 Sept. 2010. Web. 23 Nov. 2016.

Van Dijk, Sheri. “Don’t Let Your Emotions Run Your Life for Teens.” Google Books. Instant Help Books, n.d. Web. 30 Oct. 2016.

Wechsler, Henry, George W. Dowdall, Andrea Davenport, and Sonia Castillo. “Correlates of College Student Binge Drinking.” American Journal of Public Health, n.d. Web. 06 Nov. 2016

Reflective- belladonna98

Core Value I. My work demonstrates that I used a variety of social and interactive practices that involve recursive stages of exploration, discovery, conceptualization, and development.

I’m not going to lie, I could have done a bit better on this value. Sometimes I left feedback unanswered and didn’t revise when I should have. However, these incidents were not the majority. On the majority of my assignments, such as my first Stone Money assignment and my Research Proposal assignment, I replied to feedback with appropriate revisions. I did my best to improve my writing, not only in these cases, but in general, when I completed my short argument rewrites. In those cases I strove to add more content and research, such as adding a patient perspective into my Rebuttal Rewrite. This was not my strongest value, but I still demonstrated a sufficient understanding.

Core Value II. My work demonstrates that I placed texts into conversation with one another to create meaning by synthesizing ideas from various discourse communities. 

I have been quite active in discussing work with my Professor and others. I almost always replied to feedback, giving rewrites when required. This can be seen in my Definition Rewrite post. I also attended “office” hours on Monday, December 5th in order to literally converse about my writing. In class, I have discussed other student’s writing, helping them to understand assignments as they did the same for me, specifically in the Missing Dollar exercise. That was a collaboration between many students. Collaboration is an important part of the writing process, and I believed I engaged in a good amount in order to understand this value.

Core Value III. My work demonstrates that I rhetorically analyzed the purpose, audience, and contexts of my own writing and other texts and visual arguments.

I was given a great opportunity to demonstrate my understanding of this value, by giving feedback to three different students’ works as an exercise. My comments on yankeeskid6, prof2020, and dublin517’s posts provided insight on how I fully understood how to analyze text. analyzing my own text with the help of Professor Hodges was also very helpful. He helped me with my original Causal Argument, telling me that my argument that dysregulation is a part of college was both causation and definition. I fixed this in my Causal Rewrite, in which my argument was clearer. I feel I now have a great understanding of how to analyze text effectively in order to improve it.

Core Value IV: My work demonstrates that I have met the expectations of academic writing by locating, evaluating, and incorporating illustrations and evidence to support my own ideas and interpretations.

I have met this core value, and demonstrated my proficiency in this value in many of my works. I have often gone above the minimum number of sources needed, showing my willingness to not just do what is required for a grade, but what is required for quality writing. I have also added new sources where none were required, demonstrating my willingness to always improve. These qualities are most evident in my Definition Rewrite, in which I exceeded the minimum number of sources and added new sources that were not present in the original Definition post.

Core Value V. My work demonstrates that I respect my ethical responsibility to represent complex ideas fairly and to the sources of my information with appropriate citation. 

I did my best to uphold this value by properly citing my sources and trying to interpret their content in the clearest way possible. This skill came from learning how to Purposefully Summarize, in which I summarized and interpreted three articles in order to fit three arguments. I was mostly successful in my summaries, but improved as the semester progressed. As for citations, I started weak but finished strong. Professor Hodges corrected my MLA-style citations in my original Stone Money post, which were corrected in my Stone Money Rewrite. I always gave proper credit to my sources. This may have been my strongest value of all.

Bibliography- belladonna98

1. Ed.D., Brian Harke. “High School to College Transition, Part 1: The Freshman Myth.” The Huffington Post. TheHuffingtonPost.com, 22 June 2010. Web. 06 Nov. 2016.

Background: This Huffington Post article gives insight on the “Freshman Myth,” or the unrealistic optimism that college freshmen have as they enter their first semester. It details how challenging the academics of college are, and how students are often not prepared to face such challenges. It also offers solutions to prevent academic culture shock early on so students are not caught off guard once they actually get to college.

How I Used It: I used this article to prove that students are often not prepared for college, and that the academic stress can cause dysregulation in students’ lives.

2. Shook, Nancy J., Debora A. Gerrity, Joan Jurich, and Allen E. Segrist. “Courtship Violence Among College Students: A Comparison of Verbally and Physically Abusive Couples.” SpringerLink. N.p., Mar. 2000. Web. 06 Nov. 2016.

Background: The article gives statistical analysis on the percent of college students who have engaged in verbal and physical violence with romantic partners, and why they did so. It shows that the majority have engaged in verbal violence.

How I Used It: This helped me prove verbal violence, a form of relationship and emotional dysregulation, is common among college students. The statistics were invaluable in proving that dysregulation exists in everyday college life, and is part of the “college experience.”

3. Wechsler, Henry, George W. Dowdall, Andrea Davenport, and Sonia Castillo. “Correlates of College Student Binge Drinking.” American Journal of Public Health, n.d. Web. 06 Nov. 2016.

Background: The article gives statistical analysis of how many college students engage in binge drinking, showing that almost half do so.

How I Used It: These statistics helped me prove that binge drinking, a form of behavior dysregulation, is common among college students.

4. ELI (Extended Learning Institute at NOVA), Lumen Learning. “College Success.” Candela Learning. N.p., n.d. Web. 06 Nov. 2016.

Bakcground: This online textbook offers insight to college students on how to handle everything from finances to emotional health. It is a sort of how-to guide for college, geared towards freshman who don’t know what they’re doing. It offers life skills and academic skills to help the transition to college go a bit smoother.

How I Used It: I used this book to illustrate just how stressful the transition to college is, specifically academically. People write entire textbooks trying to teach us how to deal with it!

5. Rizvi, Shireen L. “Treatment Failure in Dialectical Behavior Therapy.” Cognitive and Behavioral Practice 18.3 (2011): 403-12. Science Direct. 2011. Web. 13 Nov. 2016.

Background: This article chronicles Shireen Rizvi’s experience with a patient, Barbara, and their collective failure to implement and practice DBT correctly. Rizvi uses this story to argue that DBT does not work for everyone, specifically in extreme cases of BPD, such as Barbara’s.

How I Used It: I used this article to prove that it is not DBT that fails, it is the therapists that do. When therapists fail to see their patients as people, and cannot adapt DBT to each one’s specific needs, they fail to help their patients at all. But DBT itself does not fail.

6. Robbins, Clive J., and Zachary Rosenthal. “Dialectical Behavior Therapy.” Acceptance and Mindfulness in Cognitive Behavior Therapy. John Wiley & Sons, n.d. Web. 30 Oct. 2016.

Background: In its section on DBT, it outlines the basics of the therapy and for whom it is necessary, citing people with personality disorders. However, it also breaks down common emotional issues known as dysregulation that can be found in all corners of humanity. The ones I will be focusing on are emotional, behavioral, and relationship dysregulation, as these are very common in college students. The article gives examples of how DBT can help these kinds of dysregulation.

How I Used It: This article helped me not only discover the basics of DBT when used in people with personality disorders, but also those who suffer from everyday dysregulation. This gave me a definition to work with, and a jumping off point to start to redefine DBT.

7. User Cabdriver. “DBT: How Is It Working for You?” RSS. N.p., 19 Sept. 2010. Web. 23 Nov. 2016.

Background: In this forum, user cabdriver gives other members a list of the factors that led to him believing that DBT failed him. These include everything from not doing his homework to “the existential emptiness of DBT.” Each point is elaborated on, giving me a great patient point of view.

How I Used It: This was a great argument to rebut. I used this as an example of a patient who is against DBT, and then attempted to disprove said patient’s argument.

8. @DbtPeers. “An Introduction to Dialectical Thinking According to DBT.” DBT Peer Connections. N.p., 18 Oct. 2013. Web. 21 Nov. 2016.

Background: This article gives a nice definition of dialectical thinking. It also teaches DBT patients how to implement it into their daily lives.

How I Used It: This was very useful in my definition argument, helping me define dialectical thinking.

9. Clearviewtreatment. “Five Areas of Dysregulation in People with BPD – Borderline Personality Treatment.” Borderline Personality Treatment. N.p., 12 Oct. 2011. Web. 21 Nov. 2016.

Background: This gives very clear-cut definitions of the five most common types of dysregulation, often found in people with BPD.

How I Used It: This was invaluable for my definition argument, giving me definitions  to apply not only to those with BPD, but to all college students.

10. “Dialectical Behavioral Therapy & Treatment – Clinical Excellence at Sierra Tucson.” Sierra Tucson. N.p., n.d. Web. 21 Nov. 2016.

Background: This is another article that outlines the basics of DBT, but it also includes the benefits. These include decreasing harmful behaviors and learning to make emotion-independent choices. It also gives a list of disorders that DBT can treat. However, the benefits seem to be universal.

How I Used It: This was immensely helpful in my definition of DBT. It also helped me prove that DBT has universal benefits, regardless of mental state.

11. Van Dijk, Sheri. “Don’t Let Your Emotions Run Your Life for Teens.” Google Books. Instant Help Books, n.d. Web. 30 Oct. 2016.

Background: This wonderful book teaches teens how to apply DBT skills to their lives, step by step. It covers pretty much everything a teenager could need, from recognizing emotions to mindfulness and more. This is the book I used in therapy when I was first introduced to DBT and it helped me immensely, and I thought it could help me in this paper as well.

How I Used Ii: This book shaped my personal definition of DBT. It helped me give an example of how DBT doesn’t have to be as structured and rigid as many people believe it should be.

Causal Rewrite- belladonna98

The Neglect of College Students’ Emotional Well Being

At college, new students experience immense change. According to Brian Harke of the Huffington post, students come to college “overly optimistic and confident in their ability to manage the challenges they will encounter at college.” They struggle to manage new, unprecedented stress. Students who attempt to cope by delving into extreme parties or unhealthy relationships radically dysregulate.

Of course, there is the academic side of college, the main cause of stress. Students think that they can handle college academics, and often get a reality check in the form of a failed test or paper. College academics can get so stressful that experts write entire books on how to deal with said stress, such as “College Success” created by the Extended Learning Institute and Lumens Learning. But stress is not limited only to academics in college.

Many students know only the positive stories they’ve heard from their parents about “The College Experience” of decades ago. Talking about the “College Experience” as if there is a standard for activities in college does not help students in the least. Instead, pressure is put on them to achieve not only academically but also socially. The wild and sometimes-exaggerated stories set even more expectations for students to fulfill, so forced relationships and parties with unfamiliar and possibly unhealthy people occur. Non-organic interactions can cause dysregulation, as they did not happen naturally, they are forced, and they are unhealthy. Obviously, not all relationships and parties are inherently unhealthy or cause dysregulation, but it is important to consider the related statistics.

82% of college students have admitted to using verbal violence against a romantic partner, often brought on by the use of drugs or alcohol. In that vein, 44% of college students have been classified as binge drinkers. In those relationships and parties seen as part of the college experience, a good amount of dysregulation exists.

The immense change that college students are undergoing, and the pressure felt by many of them causes the dysregulation described by the earlier statistics. Not only academic pressure, but that to somehow “succeed” socially, if that is even possible. A student under almost constant stress who is not recieving help is bound to suffer from dysregulation. This brings me to my original point; college students need DBT. Once we stop looking at dysregulation as a part of being at college and see it as a real problem that has a clear solution, we are on the path to fixing it.

Works Cited

Ed.D., Brian Harke. “High School to College Transition, Part 1: The Freshman Myth.” The Huffington Post. TheHuffingtonPost.com, 22 June 2010. Web. 06 Nov. 2016.

Shook, Nancy J., Debora A. Gerrity, Joan Jurich, and Allen E. Segrist. “Courtship Violence Among College Students: A Comparison of Verbally and Physically Abusive Couples.” SpringerLink. N.p., Mar. 2000. Web. 06 Nov. 2016.

Wechsler, Henry, George W. Dowdall, Andrea Davenport, and Sonia Castillo. “Correlates of College Student Binge Drinking.” American Journal of Public Health, n.d. Web. 06 Nov. 2016.

ELI (Extended Learning Institute at NOVA), Lumen Learning. “College Success.” Candela Learning. N.p., n.d. Web. 06 Nov. 2016.

Rebuttal Rewrite- belladonna98

DBT Doesn’t Fail- Therapists Do

 

Therapists whose patients don’t improve with DBT complain that it doesn’t work in extreme cases of BPD and emotional dysregulation. In one case, Shireen L. Rizvi had a patient named Barbara whose condition was not improved, and whose disorder may have been worsened, by the improper application of DBT. Barbara had BPD, social anxiety, severe depression, PTSD, and was an abuse survivor. Rizvi’s treatment was incompetent.

Over the course of six months, Rizvi struggled to treat Barbara, later blaming her failure on the “therapy-interfering behaviors” of her patient such as asking her therapist very personal questions, calling her in crisis daily, and not making eye contact. Rizvi’s response to these behaviors is what makes her argument that DBT didn’t work here completely invalid. Rizvi admitted to outright ignoring some of Barbara’s behaviors in many ways. She failed to indulge in and therefore validate the behaviors. The very basics of DBT state that a patient must feel validated in order to receive treatment. Maybe partially answering a question or asking her why she didn’t make eye contact would have been an improvement. Rizvi instead let them agitate her and obstruct her own practice.

While Barbara did overstep the patient-therapist line (she had had a romantic affair with a previous therapist, so she didn’t understand it in the first place) Rizvi’s response should have been one of understanding and willingness to help, not one of agitation and rejection. Rizvi admitted to being a “novice therapist”, but as someone who is not even a therapist yet, I can see that that is no excuse. She looked at Barbara and saw not a person but a set of symptoms: mistrust of authority, boundary blindness, disassociation, crippling anxiety. Well-administered DBT could have helped Barbara; her therapist did not.

Therapists need to take into account the state of their patients and how to best treat them. They cannot look at every patient as the same textbook set of symptoms, they have to see the patient as a whole person. Barbara may fit the criteria for rigorous DBT, but would not be able to handle it. She most likely would have done better under a less structured form of DBT, as one who has had little structure in her life to begin with. She is not familiar with such intense dedication to one thing, a thing which she is not even convinced is worthwhile yet. So, giving her small tidbits of DBT in her therapy sessions would not only have given the therapy more meaning to her, but made her more receptive to it.

Another example of DBT failure is one I found on a forum for people with BPD. This time, we see the patient perspective on the issue. A user we’ll call Cabdriver gave a list of explanations on why DBT wasn’t working for him and how it was flawed. The list consisted of a combination of him not practicing his skills and his therapist punishing him for it. He found the skills boring and unhelpful, and would lie to avoid punishment and say that he did them when he hadn’t.

Therein lies the problem: a therapist should never punish a patient. Apparently, Cabdriver’s therapist would become irreverent or even take breaks from therapy when Cabdriver didn’t practice his skills regularly. This is probably an extreme case, but it is troubling. Again, I reference that one of the key principles of DBT is validation, and a patient cannot possibly feel validated if he is constantly fearing punishment. A person can’t fear his therapist; therapy is supposed to be a safe space where someone can admit to anything without judgement. He may be held accountable for his actions, but he shouldn’t have to fear a slap on the wrist. Patients are adults; treat them as such.

The solution here lies in both the patient and the therapist trying a bit harder. The therapist needs to try to convince Cabdriver that the skills are worthwhile, as the punishment approach is ineffective and downright patronizing. Maybe Cabdriver needs a new therapist altogether. But he also must realize that the skills are there to help him, and they aren’t as black-and-white as they seem. Cabdriver often said things along the lines of “Have a problem? Practice your skills!” However, “practice your skills” can simply mean applying a new approach to a situation or changing thinking. It doesn’t always mean “sit and be mindful and all the world’s problems will disappear.” In the end, everyone involved with DBT just has to be open minded and accepting, and go from there.

Obviously not all college students are Barbara or Cabdriver and not all therapists are Rizvi. However, they may still have therapy interfering behaviors and not be the most eager to start DBT. That is why a very relaxed form of it is best. Reluctant patients shouldn’t be completely immersed in the therapy, or shut out like failures. Introducing DBT slowly in small pieces makes much more sense. The therapist doesn’t even have to officially declare “We’re going to do DBT now.” She can simply give skills that pull from DBT and mention the name, intriguing the patient. Patients who recognize the value of DBT are receptive patients.

Patients have to believe that the skills will help them, and that they can implement them successfully. Emotional validation, as Robins and Rosenthal say, is one of four core principles of successful DBT. The safer and more empowered a patient feels, the more likely they are to use therapy skills outside of the office, as I stated when giving cabdriver a solution. But of course, the person has to practice the skills in order for them to help. If someone completely ignores their skills and makes no progress, then what?  Successful therapists guide their patients through that process, from belief, to validation, to empowerment, to practice. The unsuccessful, who treat their patients like children throwing fits, drive patients away.

The bottom line is, it all comes down to the proficiency of the therapist. If they look at patients as textbook sets of symptoms who all need the same thing, no progress is going to be made. However, if they change their style to meet each patient’s needs, looking at them as a human being, it makes all the difference. This kind of care could benefit everyone, from the most resistant BPD patient to the scared college student. Therapists just have to be willing to try.

Works Cited

Rizvi, Shireen L. “Treatment Failure in Dialectical Behavior Therapy.” Cognitive and Behavioral Practice 18.3 (2011): 403-12. Science Direct. 2011. Web. 13 Nov. 2016.

Robbins, Clive J., and Zachary Rosenthal. “Dialectical Behavior Therapy.” Acceptance and Mindfulness in Cognitive Behavior Therapy. John Wiley & Sons, n.d. Web. 30 Oct. 2016.

User Cabdriver. “DBT: How Is It Working for You?” RSS. N.p., 19 Sept. 2010. Web. 23 Nov. 2016.

Definiton Rewrite-belladonna98

DBT Should Help, Not Hurt

In its original, most intensive form, Dialectical Behavior Therapy (DBT) is very regimented and time consuming. Clive J. Robbins and Zachary Rosenthal describe the therapy, originally developed by Marsha Linehan, as requiring multiple group and individual therapy sessions weekly, skills training, phone coaching, and meetings among a person’s team of therapists. I do not subscribe to this definition, described in the DBT section of Acceptance and Mindfulness in Cognitive Behavior Therapy. DBT, when used most efficiently, is whatever dialectical behavior skills a person needs in order to improve her life.

Marsha Linehan (this information was relayed to me by clearviewtreatment on borderlinepersonalitytreatment.com) found that five different types of dysregulation occur in patients with Borderline Personality Disorder (BPD). These are emotion dysregulation, interpersonal dysregulation, self dysregulation, behavioral dysregulation, and cognitive dysregulation. Each type reveals some sort of dysfunction in each aspect of a person’s life. DBT was created to treat this dysregulation, which, though commonly found in patients with BPD, can affect anyone at any time.

The website of Sierra Tucson describes four main principles of DBT: “1. The primacy of the therapeutic relationship, 2. A non-judgmental approach, 3. Differentiating between effective and ineffective behaviors, and 4. Dialectical thinking.” These principles, specifically the first two, apply to both patient and therapist, assuring that all parties are comfortable with and prepared for what is to come. The third and fourth dictate what the patient will learn. Dialectical thinking leads to radical acceptance by teaching patients to become aware of their own judgments and accept them, according to Rachel Gill of ilovedbt.com.

Four treatment modules go along with DBT’s principles: “1. Mindfulness, 2. Distress Tolerance, 3. Emotion Regulation, and 4. Interpersonal Effectiveness.” These go hand in hand with the principles, teaching patients through various methods to accept and handle the reality in front of them. Mindfulness leads to learning distress tolerance and so on, each skill building on the next, teaching patients how to handle their life’s dysregulation.

The workbook Don’t Let Your Emotions Run Your Life for Teens breaks down DBT perfectly to fit most people’s lifestyle. The book teaches individual skills and outlines which situations call for which skills, giving exercises on how a person is going to apply said skills. It builds upon itself, starting with the basics that apply to everyday life and getting more specific as it goes. That is how DBT should be, and that is how I learned to apply it to my own life.

People with BPD struggle enough with everyday life. The disorder is almost entirely made up of life-interfering behaviors such as impulsive actions, dysregulated relationships and emotions, and some symptoms of depression such as lack of motivation. We cannot expect such individuals to keep up a schedule like Robbins and Rosenthal require. However, we should supply them with the skills necessary to improve their daily lives.

College students who show many signs of dysregulation lead incredibly busy lives. None of us have time for class, homework, and a social life in general let alone when paired with multiple therapy sessions a week with phone coaching in between. Along with the lack of time, society still stigmatizes going to therapy as a sign of weakness, which may deter many college students from such a regimented form of DBT. Students will still need to go to therapy, but at a more relaxed pace, giving them more time for it and welcoming less judgement.

A less intense form of DBT is an effective compromise for all recipients of the therapy. Going to therapy once a week and working from a book like Don’t Let Your Emotions Run Your Life for Teens was enough to make a difference in my life, and could do the same for many others. For BPD patients, it requires less effort and is not as overwhelming. For college students, it takes up less time and welcomes less stigma. DBT can be redefined, and this new definition will help many people.

Works Cited

@DbtPeers. “An Introduction to Dialectical Thinking According to DBT.” DBT Peer Connections. N.p., 18 Oct. 2013. Web. 21 Nov. 2016.

Clearviewtreatment. “Five Areas of Dysregulation in People with BPD – Borderline Personality Treatment.” Borderline Personality Treatment. N.p., 12 Oct. 2011. Web. 21 Nov. 2016.

“Dialectical Behavioral Therapy & Treatment – Clinical Excellence at Sierra Tucson.” Sierra Tucson. N.p., n.d. Web. 21 Nov. 2016.

Robbins, Clive J., and Zachary Rosenthal. “Dialectical Behavior Therapy.” Acceptance and Mindfulness in Cognitive Behavior Therapy. John Wiley & Sons, n.d. Web. 30 Oct. 2016.

Van Dijk, Sheri. “Don’t Let Your Emotions Run Your Life for Teens.” Google Books. Instant Help Books, n.d. Web. 30 Oct. 2016.

Robust Verbs-belladonna98

Vancouver has a monumental problem with heroin addicts committing crimes to support their habits. The city has implemented a “free heroin for addicts” program in order to try to stop the addicts, who are driving up the crime rate in Vancouver. Addicts have a hard time getting through daily activities such as jobs, interactions, and relationships because they are using. The users will do whatever they deem necessary to obtain their drug, including stealing. While the aforementioned program will help reduce crime, it will not help ween users off of heroin, focusing on the safety of the city rather than the users themselves. By providing the drug, the city keeps addicts off the streets and out of hospitals. Many addicts are unable to pay hospital bills, creating more problems for the city. The “free heroin for addicts” program will give heroin to addicts in the cleanest, safest way possible. It will save the city but leave the addicts struggling with the same addiction they started out with.

Enough About You-belladonna98

Our society is driven by money. The rich achieve great feats while the poor struggle to accomplish the most basic tasks. However, value is not only found in physical money. We place our trust in the government and the banks that our money is being handled properly, to avoid hiding actual, physical money under our mattress. Many people have no idea how the banks handle this money. Either someone has money or she doesn’t; the concept seems very simple. But this assignment opens eyes to the realities of a variety of currencies, such as the Yap Fei, US gold, French francs, Brazilian cruzeros, and debit accounts. The currencies all have one thing in common; no one sees them physically transferred. When we get paid, we are not handed a check, we are presented with a number on a screen that represents how much money is in our checking account. We just have to trust that that screen is correct.

Rebuttal Argument-belladonna98

DBT Doesn’t Fail- Therapists Do

Therapists themselves have had many failures in implementing DBT, stating that in some extreme cases of BPD and emotional dysregulation, it doesn’t work. In one case, Shireen L. Rizvi had a patient named Barbara who was not affected, and whose disorder may have been worsened, by DBT. Barbara had BPD, social anxiety, severe depression, PTSD, and was an abuse survivor.

Over the course of six months, Rizvi struggled to treat Barbara, often blaming her “therapy-interfering behaviors” such as not making eye contact, asking her very personal questions, and calling her in crisis almost daily. The response to these behaviors is what makes the argument that DBT didn’t work here completely invalid. Rizvi admitted to outright ignoring some of these behaviors, when the very basics of DBT state that a patient must feel validated in order to receive treatment. Instead of indulging in and therefore validating these behaviors, maybe partially answering a question or asking her why she didn’t make eye contact, Rizvi let them agitate her and obstruct her own practice.

While Barbara did overstep the patient-therapist line (she had had a romantic affair with a previous therapist, so she didn’t understand it in the first place) the response should have been one of understanding and willingness to help, not one of agitation and rejection. Rizvi admitted to being a “novice therapist”, but as someone who is not even a therapist yet, I can see that that is no excuse. She saw someone who clearly had a mistrust of authority and no concept of patient boundaries, and did not take that into account. The bottom line is, she didn’t try hard enough to understand Barbara as a person rather than as a set of symptoms. It is these therapists who most often fail with DBT. It is not the therapy’s fault; it is the fault of the therapist administering it.

Therapists need to take into account the state of their patients and how to best treat them. They cannot look at every patient as the same textbook set of symptoms, they have to see the patient as a whole person. Though a person may fit the criteria for rigorous DBT, the person may not be able to handle it. This is another issue with the Rizvi case. Barbara most likely would have done better under a less structured form of DBT, as one who has had little structure in her life to begin with. She is not familiar with such intense dedication to one thing, a thing which she is not even convinced is worthwhile yet. So, giving her small tidbits of DBT in her therapy sessions would have not only given the therapy more meaning to her, but may have made her more receptive to it.

Another example of DBT failure is one I found on a forum for people with BPD. This time, we see the patient perspective on the issue. User cabdriver gave a list of explanations on why DBT wasn’t working for them and how it was flawed. The list consisted of a combination of them not practicing their skills and their therapist punishing them for it. They found the skills boring and unhelpful, and would lie and say that they did them when they didn’t to avoid punishment.

Therein lies the problem, a therapist should never punish a patient. Apparently, cabdriver’s therapist would become irreverent or even take breaks from therapy when cabdriver didn’t practice their skills regularly. This is probably an extreme case, but it is troubling. Again, I reference that one of the key principles of DBT is validation, and a patient cannot possibly feel validated if they are constantly fearing punishment. A person can’t fear their therapist, therapy is supposed to be a safe space where someone can admit to anything without judgement. That isn’t to say that they won’t be held accountable for their actions, but they shouldn’t have to fear a slap on the wrist. They’re adults, treat them as such.

The solution here lies in both the patient and the therapist trying a bit harder. The therapist needs to try to convince cabdriver that the skills are worthwhile, as the punishment approach is ineffective and downright patronizing. Maybe cabdriver needs a new therapist altogether. But they also must realize that the skills are there to help them, and they aren’t as black-and-white as they seem. Cabdriver often said things along the lines of “Have a problem? Practice your skills!” However, “practice your skills” can simply mean applying a new approach to a situation or changing thinking. It doesn’t always mean sit and be mindful and all the world’s problems will disappear. In the end, everyone involved with DBT just has to be open minded and accepting, and go from there.

But obviously not all college students are Barbara or cabdriver and not all therapists are Rizvi. However, they may still have therapy interfering behaviors and not be the most eager to start DBT. That is why a very relaxed form of it is best. If someone doesn’t want to do something, it makes no sense to completely immerse them in it against their will, or shut them out like a failure. Introducing DBT slowly in small pieces makes much more sense. The therapist doesn’t even have to officially declare “We’re going to do DBT now.” They can simply give skills that pull from DBT and mention the name, intriguing the patient. If they see that these skills are helping them, and they know they come from DBT, they will be more eager to dive deeper into the practice.

But of course, the person has to be willing to use the skills in order for them to help. If someone completely ignores their skills and makes no progress, then what? That’s where the emotional validation comes in. As Robins and Rosenthal say, that is one of the core principles of successful DBT. Patients have to believe that the skills will help them, and that they can implement them successfully. The safer and more empowered a patient feels, the more likely they are to use therapy skills outside of the office, as I stated when giving cabdriver a solution.
The bottom line is, it all comes down to the proficiency of the therapist. If they look at patients as textbook sets of symptoms who all need the same thing, no progress is going to be made. However, if they change their style to meet each patient’s needs, looking at them as a human being, it makes all the difference. This kind of care could benefit everyone, from the most resistant BPD patient to the scared college student. Therapists just have to be willing to try.

Works Cited

Rizvi, Shireen L. “Treatment Failure in Dialectical Behavior Therapy.” Cognitive and Behavioral Practice 18.3 (2011): 403-12. Science Direct. 2011. Web. 13 Nov. 2016.

Robbins, Clive J., and Zachary Rosenthal. “Dialectical Behavior Therapy.” Acceptance and Mindfulness in Cognitive Behavior Therapy. John Wiley & Sons, n.d. Web. 30 Oct. 2016.

User Cabdriver. “DBT: How Is It Working for You?” RSS. N.p., 19 Sept. 2010. Web. 23 Nov. 2016.

Causal Argument- belladonna98

The Neglect of College Students’ Emotional Well Being

At college, people experience change. According to Brian Harke of the Huffington post, students come to college “overly optimistic and confident in their ability to manage the challenges they will encounter at college.” This can cause an amount of stress that student have never dealt with before, and therefore do not know how to manage in a healthy way. Many students may look to partying or relationships to cope with their stress. These relationships and parties are not inherently problematic, but when they are forced or done with the wrong people, they can create dysregulation.

First off, of course, there is the academic side of college, the main cause of stress. Students think that they can handle college academics, and often get a reality check in the form of a failed test or paper. College academics can get so stressful that people write entire books on how to deal with said stress, such as “College Success” created by the Extended Learning Institute and Lumens Learning. But stress is not limited only to academics in college.

Many students know only what other people have told them in terms of college. For many students, information and stories come from their parents, who have most likely been out of college for many years and are focusing only on the good. They talk about the “College Experience” as if there is a standard for activities in college, like partying or falling in love. This puts pressure on students to not only achieve academically in the ways they have been encouraged to, but also to achieve socially. The wild and sometimes-exaggerated stories set even more expectations for students to fulfill, so forced relationships and parties with acquaintances occur. These non-organic interactions can cause dysregulation, as they did not happen naturally, they are forced, and they are unhealthy. This is not to say that to say that all relationships and parties are inherently unhealthy or cause dysregulation, but it is important to consider the related statistics.

82% of college students have admitted to using verbal violence against a romantic partner, often brought on by the use of drugs or alcohol. In that vein, 44% of college students have been classified as binge drinkers. In those relationships and parties seen as part of the college experience, a good amount of dysregulation exists.

The immense change that college students are undergoing, and the pressure felt by many of them causes the dysregulation described by the earlier statistics. Not only academic pressure, but that to somehow “succeed” socially, if that is even possible. If a student is under almost constant stress and/or feels pressure to succeed and they are not receiving any type of help, dysregulation is bound to happen. This brings me to my original point; college students need DBT. Once we stop looking at dysregulation as a part of being at college and see it as a real problem that has a clear solution, we are on the path to fixing it.

Works Cited

Ed.D., Brian Harke. “High School to College Transition, Part 1: The Freshman Myth.” The Huffington Post. TheHuffingtonPost.com, 22 June 2010. Web. 06 Nov. 2016.

Shook, Nancy J., Debora A. Gerrity, Joan Jurich, and Allen E. Segrist. “Courtship Violence Among College Students: A Comparison of Verbally and Physically Abusive Couples.” SpringerLink. N.p., Mar. 2000. Web. 06 Nov. 2016.

Wechsler, Henry, George W. Dowdall, Andrea Davenport, and Sonia Castillo. “Correlates of College Student Binge Drinking.” American Journal of Public Health, n.d. Web. 06 Nov. 2016.

ELI (Extended Learning Institute at NOVA), Lumen Learning. “College Success.” Candela Learning. N.p., n.d. Web. 06 Nov. 2016.