“Asking
for help isn’t a sign of weakness, it’s a sign of strength. It shows you have
the courage to admit when you don’t know something, and to learn something new.”
Barack
Obama
*Please
note: this article is not to be used as an alternative to professional help,
support, guidance, and Therapy*
In 2012, I (Campaign Founder, Aimee) made a suicide attempt which saw me end up on life support and when I woke up, I was detained under Section 3 of the 1983 Mental Health Act and admitted to a psychiatric hospital. The hospital was over 100 miles away from home and specialised in my diagnosis at the time of Borderline Personality Disorder (BPD), which meant that it facilitated the recommended therapeutic treatment for the Disorder; Dialectical Behaviour Therapy (DBT). Typically, it takes 12 months to complete a cycle or course of DBT, but my mental health had been poorly for quite a while, so I ended up actually being sectioned and undergoing DBT for two and a half years! So, after our Social Media Assistant created content on dissociation – which DBT has helped me to stop using as a coping mechanism – I was inspired to put this article together where I’ve trawled through the entirety of DBT to share with you all the most relevant and appropriate skills and techniques to support the mental health of survivors of rape and abuse…
The ‘D’
from ‘DBT’ means Dialectical and this is thought of as being where opposites
meet and is taken from the idea that change, and acceptance can be combined. It
is aimed at providing you with tools for dealing with hard situations and calls
upon four core skills: mindfulness, distress tolerance, emotional regulation,
and interpersonal effectiveness.
One of
the most important aspects to learning DBT which I want everyone to know before
they get into it, is that for a long time, I was left feeling completely stupid
and with every single technique and skill I learnt, this just got worse. And
this was mostly because I felt like a fool for not thinking to try the coping
mechanisms it teaches by myself. How had I not thought to try ‘self-soothing’
or engaging in ‘distraction activities’ when I was struggling? Why hadn’t I
thought of these things that could have worked instead of self-harming? What
was so wrong about me that I didn’t put that little bit more effort and thought
into something that could have meant keeping myself safe? How dumb could I be?
Recognising
my failures to had managed my mental health in a safe and responsible way, also
left me feeling incredibly responsible for all the emotional and medical/physical
hardships I had gone through and all the upset I had put my loved ones through with
my self-harm and suicide attempt. I guess I hadn’t really taken responsibility
until then because I’d been so convinced that it was the only way I could cope
with how I was feeling, what I was thinking, and all that I had – and was –
experiencing. I’d thought that I didn’t have a choice, and if I didn’t; then
how could it be my fault when my Mum was crying or when I was having my shin
drilled into (for an IO) to administer lifesaving medical treatment? How was I
guilty or to blame for anything when I didn’t have any other options? So, to
discover that actually, I did have alternative ways to cope… Well, it left me
feeling very guilty, but I learnt – through the Therapy – that I had been using
tunnel vision because I hadn’t been able to see outside of this one-track-mind
that hurting myself was the only – and the most effective – way to cope. If, at
any point, I’d found insight and the ability to look outside of this mindset
and thought process, then of course I’d have coped in healthier and safer ways.
Those
thoughts and feelings of being responsible for not thinking of alternative
coping methods, meant I got the distinct feeling that things were getting worse
before they got better. And this is the final thing I wanted to say before I
jump into the actual Modules; DBT isn’t an ‘instant fix’ or even an ‘easy fix.’
It can be a long process, and it can very often feel like things get worse
before they get better. Unfortunately, there’s no magic wand in mental illness
and even where medication is completely the answer, it doesn’t necessarily help
immediately (often anti-depressants and anti-psychotics or other psychiatric
medication can take weeks or even months to actually build up in your system and
start helping/working, but sedatives and sleeping tablets can obviously take effect
within minutes). In my opinion, this is so wrong because mental illness can be
so dangerous that it should be something that’s quickly and easily mitigated in
some way.
So, in
undertaking DBT, be prepared for long, hard work that takes a lot of strength, effort,
time, and energy. Be prepared for that notion of things worsening. Don’t lost
hope that there will be improvements and positive changes and achievements along
the way on your therapeutic journey though. Stay determined and dedicated to
the process through the thought that there’ll come a point where all this time
and effort will end up feeling completely justified and totally worthwhile.
When you’ll be grateful for all your own hard work. When you’ll stop thinking ‘why
did I have to work so hard when I didn’t put myself in this position?’ And
instead, you’ll just think ‘look at how hard I can work and the changes I can
make!’
This
Module is typically the first to be taught in beginning to undergo DBT because
it ‘sets the stage’ for the other Modules by teaching you several exercises that
are aimed at observing your thoughts and feelings in a very non-judgmental way.
I think that this Module and the exercises within it (I’ll also talk you through
some of them) can be beneficial for someone with the traumatic experience of
rape and/or abuse, because there is often a lot of very wrong, self-blame in survivors
and that often entails judgment and giving a critique of your own thoughts and
feelings. For me, my rapist/abuser wasn’t taking any responsibility or
receiving any consequences, and I was so desperate for someone to, that I made
it me.
Mindfulness Skills Most Helpful For
Survivors
1.
Observing: The exercise for this skill is
about looking at an object and noting down (you can get an online activity form
to do this, here)
observations of it e.g. its colour, smell, taste etc. and then you add any
thoughts or feelings you experienced too. The premise of this skill which makes
it really relevant for survivors is that it’s all about keeping your mind on
one track. It’s about keeping just one thought in your concentration at once. Often,
as a survivor of rape and/or abuse, you can find yourself struggling to
concentrate on a task because your mind is too preoccupied with thoughts and
memories of your experiences.
2.
Mental
Body Scan: This
skill is about recognising your body’s needs and requirements by taking some
time out of your day to really concentrate and focus on your body by moving your
awareness slowly from your feet all the way up your body to your head (there’s
a PDF worksheet for this exercise, here).
The reason this can be helpful for survivors is because I (and I’m sure I’m not
the only person to do this) often found that I’d been so focused on just
getting through the day or on keeping busy to distract myself from thoughts,
feelings, and memories, that I’d forgotten to have a drink or eat something!
3.
Internal
Vs External: The
exercise for this skill is all about controlling whether you’re focused on
internal or external events by first observing physical aspects to your environment
e.g. the smells and sights etc and then concentrating on your internal thoughts
and feelings and any physical sensations. Before doing this exercise, you can
find out whether you naturally focus more on internal or external events by
completing the checklist here.
I thought it would be helpful for survivors because when you’re experiencing an
overwhelming thought or feeling, this is often purely because you’re focusing
too much of your energy on it and by doing so, you can become unsafe and upset.
4.
Describe
Your Emotions: This
is a very obvious one in terms of how to practice the skill e.g. an exercise
you can do for it, as well as why it would be useful for survivors. As a
survivor, you can experience some really difficult feelings that leave you
struggling to cope and result in you finding yourself unable to describe or
name them. A helpful resource for this includes an enormous list of emotions you
can choose from to describe either how you’re feeling right now or how you felt
in a particular situation and you can find it here.
5.
Wise
Mind: This
skill was actually first created by Marsha Linehan (a DBT Psychologist) who
came up with the idea that we each have an ‘emotional mind’ and a ‘reasonable
mind’ and then ‘wise mind’ is an overlapping, combined centre of both of these.
It is where you’re aware of your emotions, but you can still consider facts and
logic. An exercise in this skill is to think of a problem in your life and then
use your wise mind by collecting evidence and information around it, identify
your emotions, consider your long-term goals… (you can find the rest of the
considerations and the entire exercise here).
I thought this helpful for survivors because after experiencing a trauma, it
can be incredibly ‘easy’ to almost instinctively focus on your overwhelming
emotions and this skill can help you in a way that has the potential to stop
these from being overwhelming and consuming your life.
6.
Negative
Judgements: Such
judgements, are defined as being both ‘unconscious’ and ‘unproductive.’ There’s
an exercise here
which helps you to become more aware of negative judgments becoming automatic
thoughts for you. I thought this relevant for survivors for reasons which I’ve
mentioned earlier around the fact that you often find yourself incorrectly blaming
yourself and/or taking some sort of responsibility for your trauma.
Despite
being in total control of yourself, there are things in life that you just can’t
control – they’re out of your control – and whilst this is a ‘normal part of
life,’ you can struggle to tolerate the distress it causes. Distress Tolerance
is therefore defined as being an ability to manage actual or perceived emotional
distress with your tolerance levels determining how you decide to manage the
situation. This can be especially relevant for survivors of rape and/or abuse
because these are traumatic experiences that can very understandably lead to a
survivor struggling to tolerate any other signs of distress. This is often
because other upsetting and distressing experiences can lead to reminders,
memories, and actually even flashbacks of the traumas.
Distress Tolerance Skills Most Helpful
for Survivors
1.
Cost
Benefit Analysis:
This tool can be powerful in enabling a survivor to list the costs and benefits
of engaging in a particular behaviour or action and it can help you to see,
more clearly, things which can often be overlooked. An exercise for this skill
can be incredibly straight-forward but a little time-consuming; it involves
thinking of a problematic behaviour such as self-harm, and then listing costs
and then benefits of engaging in that behaviour. You then list costs and benefits
of engaging in an alternative behaviour (which could actually be hard to think
of – and this is a valid difficulty) and finish up the exercise by scoring
these with a scale of 1 -5, with 5 being that it is really important and 1
being that it is a completely unimportant aspect. You can download a PDF
worksheet for this exercise here.
This skill can be helpful for survivors because often you can engage in
behaviours that are aimed at coping with the aftermath of your trauma, but
which actually aren’t helpful from a long-term perspective.
2.
Recognising
Signs of an Emotional Crisis:
This skill is aimed at improving your awareness of when you’re beginning to struggle
and fall into an emotional crisis. This can be important for survivors because one
of the most dangerous elements to struggling in this way is that it often feels
as though it hits you by surprise and being taken off-guard can be a huge catalyst
for you becoming unsafe. A huge reason for this – for me, at least – is that the
abuse and rape came completely surprise, so to have an emotional crisis happen
that way is a huge reminder of the trauma. An exercise in this skill is very
straightforward and involves considering your thoughts, emotions, and
behaviours before and during a crisis, any sensations, environment, and key
triggers (there’s a PDF worksheet on this here).
3.
Distracting
Activities:
Finally! One of my absolute favourites! And a very obvious one! I really enjoy
this skill because it’s almost a bit of healthy and safe escapism, and that’s
something my mental health and risk levels massively benefit from. It also isn’t
really a difficult skill to really master because often, you already know the
activities you enjoy doing and spending your time engaging in (if you’re
struggling to think of something though, there’s a massive list of activities here).
My favourites are playing The Sims Freeplay, blogging or working on the Shake
My Hand Campaign, and watching TV Shows or Movies on Netflix or Disney Plus! For
survivors, doing some distracting can really help to take your mind off
difficult thoughts, feelings, and memories.
4.
Grounding: This is another skill that’s
almost a part of distracting activities because it’s all about shifting your
focus from distressing and unsafe thoughts, feelings, and sensations. A difference,
however, is that whilst distracting is about focusing on another activity,
grounding techniques are centred around the thought of bringing yourself back
to the ‘present moment.’ This can be a really useful skill for survivors who
struggle with flashbacks and dissociation (which I did) because these are both
destabilising experiences that can lead to you losing touch with reality and becoming
numb to what’s actually happening. There are a variety of grounding techniques which
can differ from mindful breathing (which you can find instructions on how to
do, here)
to doing a mental body scan (which was talked about in the Mindfulness Module here).
5.
Self-Soothing: This is another of my
favourite skills in DBT and it’s basically all about doing something nice for
yourself (there’s a list of self-soothing activities which are aimed at
pleasing different sense e.g. taste, smell, touch etc. here).
A huge difficulty that I faced with this skill – and I’m sure it isn’t unique
to myself – was the notion that I didn’t deserve to feel any better. That I didn’t
deserve anything nice or pleasant, and a huge reason for this was the
self-blame and the responsibility I was wrongly taking for the abuse and the
rape.
6.
Actions
Based on Values:
To support your life satisfaction, it can be really important that you set
goals, develop values, and create strategies to act accordingly with those.
Having some sort of sense of purpose can make emotional distress more
manageable and tolerable and this can matter to survivors who often lose track
of their values because they’re so focused on negative thoughts, feelings, and
experiences. If you’re struggling to name or label your values and purpose, there’s
a huge list of some suggestions as well as an exercise for this skill, here.
For
some, Emotion Regulation sounds incredibly similar to Distress Tolerance, and
so there’s a whole section dedicated to explaining the differences, here. The
way I understand it though, is that one concentrates upon emotions and the
other is ‘distress’ which isn’t always centred around your emotions; it can
include other experiences too. Emotion Regulation is also defined (in the above
link) as being ‘the process of managing and responding to your emotional storms
in healthy and constructive ways. It’s about recognising and understanding your
emotions and choosing how to express and act on them.’ This can be relevant to
survivors of rape and/or abuse, because often, after a traumatic experience, you
can get the feeling that your emotions are running away with themselves! That they’re
uncontrollable and impossible to regulate.
Emotion Regulation Skills Most Helpful
for Survivors
1.
Recognising
Your Emotions: In
DBT you’re taught that we have immediate/primary emotions which are instant
responses to something and secondary emotions which are the feelings come in
response to the primary emotion. Learning to recognise which you’re experiencing
and how/why you’re reacting to it in a particular way, can really help in
recognising early warning signs that you’re going into a mental health crisis
or becoming unsafe. This can be useful for survivors who might struggle to put
a label on how they feel and so they’re unable to gain insight into their
motivations for negative behaviours and unhealthy coping mechanisms. You can find
an exercise to help you with this skill here.
2.
Being
Effective: This
skill is all about learning to do what needs to be done in order to meet your
needs or goals. A good exercise for this skill is to list short-term goals and
then all the actions and steps you need to take to achieve them, and then doing
the same for any long-term goals you may have too (there’s a PDF worksheet for doing
this exercise here).
This skill is helpful for survivors who might find it difficult to be effective
in life and this is typically because their confidence levels have been ridden down
by their rapist/abuser and the traumatic experience they’ve gone through.
3.
Cognitive
Distortions:
This is part of a skill labelled ‘Emotions and Cognitive Vulnerability’ but I
wanted to pick out the aspect of that which I feel is most important and most
helpful for survivors. There are three main cognitive distortions: All or Nothing
Thinking which is where you think of an event in a biased way. Then, Catastrophising;
which can sometimes mean turning a situation into having more significance that
it needs to or should have. Finally, Overgeneralisation which is where you can
lose a lot of hope by thinking that if a situation has upset you once, it will
upset you every time it happens. These distortions are all relevant to
survivors of rape and abuse because they’re thought processes you can often
develop through experiencing a traumatic situation. There’s a worksheet for an
exercise around this skill here.
4.
Self-Validation: Validation is a response from people
which I find extremely important and beneficial to my mental health, so to
develop and learn to do it for myself has been really special and useful. There’s
a PDF worksheet for the two levels that are regarded as part of this skill
available to download here.
I think that other survivors of abuse and rape could benefit from this skill
too because rapists and abusers almost always tear apart – or tear down – the
survivor’s confidence levels and levels of self-assurance.
This
final module of DBT utilises the useful foundational skills that the previous
three modules should have helped to build within you and for your mental health.
It’s said to be a means of navigating relationships, asserting your needs, managing
conflict, and maintaining respect for yourself and others. I found this module
useful because I have often personally struggled to be assertive in telling
someone – especially professionals – what would help me and how they could
better support me. For a long time, I was labelled an attention-seeker, but
eventually; I learnt to be less offended and that this was because I – and my
coping mechanisms – were completely misunderstood and misinterpreted. So, in a bid
to change this and stop feeling incorrectly labelled and personally insulted, I
was almost forced to learn how to explain my behaviours myself. And, in my opinion,
that was helpful because once professionals and services understood this, there
was a lot less talk of attention and being dramatic, but I also feel I shouldn’t
have had to develop that skill under pressure and for the reasons I did. I
think this skill can help other survivors for similar reasons; because I imagine
I’m not the only one who has struggled with people holding judgements about
them and their coping mechanisms.
Interpersonal Effectiveness Skills Most
Helpful for Survivors
1.
Communication
Style: There’s a
survey/questionnaire to determine your personal communication style (such as assertiveness,
aggressive, and passive etc.), here.
This exercise is set to help you understand why you communicate the way that
you do in order to become more mindful of how you interact with other people. This
might help other survivors because going through a trauma like rape and/or
abuse, can leave you reluctant to communicate with others because you likely
feel betrayed by this other person (your rapist/abuser) and that can affect the
trust you have in people in general.
2.
Interpersonal
Boundaries: Despite
being social beings who are ‘programmed’ to seek interaction, support and a
sense of belonging from others, can mean that we lose sight of being individual
and holding certain boundaries in certain circumstances. In this skill, it can
be important to be mindful of the situation by being aware of the type of
information and how much of it others are sharing to shape how you act too. It’s
also important not to copy others and to act in a way that is according to your
values in so far as your ultimate motivations and the relationships you want to
have and develop. This might be helpful for survivors who can struggle to stay loyal
to your boundaries because often, your boundaries are defied, manipulated, and
betrayed for the rape and abuse to occur. There’s a worksheet available for
this skill too with part one of it being here
and part two here.
3.
Modulating
Intensity: This
skill is so important and there’s actually another worksheet with an exercise
for it, here.
Some steps for this skill are around level of urgency to your need the level of
your vulnerability and adjusting your level of intensity. For me – and I’d
imagine a lot of other survivors – it’s been massively about prioritising and
figuring out exactly what I need and want in life and how much each of these things
matter to my safety and my emotional wellbeing in general.
4.
Resistance
and Conflict:
This final skill of the final module, is all about three elements; validating another
person’s point of view, repeating your own, and asking for specific information
where there is a conflict in these views (you can read about each of these here).
Conflict can be significant to a survivor’s mental health and levels of
risk/safety because the trauma of rape and abuse is often focused and centred
around the idea of conflict because you have someone forcing a behaviour or act
upon you.
Resource:
The
most used resource for this entire piece was: Dialectical Behavior Therapy:
DBT Skills, Worksheets, Videos.