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How Dialectic Behavior Therapy (D.B.T.) Helps With P.T.S.D.

First Posted: Oct. 4, 2015, 6:06 p.m. CST
Last Updated: Oct. 4, 2015, 6:18 p.m. CST
Post-Traumatic Stress Disorder is a common mental illness amongst veterans and other sufferers

First, before I start, I want to make it clear, I am not a Licensed Clinical Social Worker, a Psychologist, or Psychiatrist. I am a veteran who lives with a dual diagnosis of Post Traumatic Stress Disorder and Borderline Personality Disorder. I am in my fourth year of recovery, and am continuing with my therapy at the VA (Veterans Administration) Hospital in Reno, NV. I am not endorsing any particular treatment or therapy, but I am a veteran in recovery and I am sharing my experience with DBT. It is my intention that by sharing my experience with DBT others may find it helpful in their own journey and recovery. If there are others who are struggling with it, I welcome your comments and observations as well. For privacy you can message me on my main page or on my dedicated page called “Lived Experience.” As I stated this is not an “endorsement,” nor do I make the claim that DBT works for everyone or every situation. What I am sharing is my own experience with DBT, and what works for me, and what I struggle with.

I have found that DBT has been the most effective therapy in alleviating my PTSD symptoms. Borderline Personality Disorder shares many of the same symptoms as PTSD, and thus DBT does help me manage my dual diagnosis. I must also say, that therapy alone does not work in managing my symptoms. It IS NOT a cure. I use the skills I learn in therapy to manage my symptoms in conjunction with a medical regimen of prescribed medication, and individual therapy. Think of it as a tripod - if one of those legs are removed then the structure collapses.

DBT is of course offered in the private sector, but in the VA model, DBT is conducted in a team concept. This of course is my experience, at the VA’s Mental Health Clinic and the PTSD Clinic, DBT is conducted in a group therapy setting, with two group leaders, one of which is a psychologist/therapist. The benefit of group therapy for veterans, is that veterans can support one another and share what works and does not work, and offer alternative perspectives. It is an extension of the military squad dynamic: veterans from different backgrounds, working towards a common goal, and unified by the same purpose.

DBT is a multifaceted treatment for borderline personality disorder and related problems. In addition, DBT has been used prior to the implementation of PTSD-specific treatments such as exposure-based interventions to address difficulties with emotion regulation and distress tolerance. DBT incorporates training in mindfulness as one of four areas of skill-building. In DBT, mindfulness involves three "what" skills (observing, describing, and participating) and three "how" skills (taking a nonjudgmental stance, focusing on one thing in the moment, and being effective). DBT is perhaps, in my experience, the most structured of the group therapy sessions offered at the VA. My group leaders facilitate the group meetings and guide the discussions. I personally react better to that structure and retain more from the discussions and assignments.

I also have a psychiatrist who helps me with my meds or medication. My psychiatrist is solely focused on monitoring and managing my medication, although she is part of the DBT Team and communicates with my group leaders and individual therapist. I have learned over the past 3 years, that open and honest communication and exchange of information with your psychiatrist if crucial in managing my medications and potential side effects.

Another crucial member of my DBT team is my individual therapist. When issues or triggers occur in my life or in group therapy, I am able to discuss it in detail with my individual therapist and receive a more focused treatment than in group. All three sides of this triangle of care are interlocked. Each arm communicates with the others with the veteran at the center. I place the veteran in the center of the triangle as the veteran ultimately is the focus of all their efforts, and to emphasize that as a veteran, I must be engaged and active in my own therapy.

When a medication does not work for me, I don’t just throw up my hands and give up. You certainly, would not do this in combat - so, why should you do it in therapy? Think of it in these terms: 22 veterans die from suicide EVERY DAY. Your life is on the line just as if you were in combat. Therapy is not a diet, and in my experience, when I encountered obstacles, it was usually of my own creation. When I was resistant to medication, it was my own stigmas and prejudices getting in the way. My own thoughts, judgments and opinions telling me “There’s nothing wrong with me,” “I don’t need help,” or “I have it under control.” These were my own stigmas that I needed to overcome as well as my own pride and hubris. These obstructive thoughts persisted even after I sought help and continued into my first round of DBT.

Recognizing these obstacles and overcoming them was crucial in improving my level of care, the success of my treatment, and continued recovery. I received my official diagnosis in 2013, but I have lived with PTSD all of my life. I have had 8 suicide attempts, half of which were in the Marine Corps, and a long history of self-harming behaviors, like cutting and burning. I hold no illusions or hide behind any pretense. I know what is at stake, and I, for one, am in the fight for my life. But I know now, I am not alone, and that I have resources and people on my side. The fight is not as daunting, and its getting easier with practice. Practice is the key - all of my negative behaviors were learned over time. To change those behaviors, many of which have become defaults, takes time and practice. As Dr. Brené Brown once said, “Imperfections are not inadequacies. They are reminders that we are all in this together.” I gave up on perfection a long time ago, and I now strive for practice.


This article was written by Joaquin Rafael Roces. Joaquin is a Marine Corps Veteran, is active in his faith community, and has served as a Eucharistic Minister and Religious Education Instructor for over 15 years. He is a member of the Knights of Columbus, and recently became involved in the parish’s Youth Ministry. He has a dual diagnosis of Post Traumatic Stress Disorder (PTSD) and Borderline Personality Disorder and has been in recovery for three years. In 2015 Joaquin was trained by the National Alliance for Mental Illness to be an In Our Own Voice Presenter. Joaquin travels throughout Northern Nevada working with NAMI to change attitudes, assumptions and stereotypes by describing the reality of living with mental illness and sharing his recovery story. Through the In Our Own Voice presentations, people with lived experience with mental illness share their powerful personal stories.

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