Anxiety, DBT, and The Dialectic

I have four daughters, and, for whatever reason, they are all susceptible to anxiety.  Studies have shown that people born with a smaller hippocampus in comparison to others tend to struggle with anxiety and a propensity to develop PTSD after trauma.  My husband has a diagnosed anxiety disorder, and he reports that he has been anxious as far back as he can remember.  Anxiety isn’t just butterflies in your stomach.  It can be a crippling fear that is felt all over the body resulting in symptoms like vomiting, migraines, an inability to breathe at times, and even agoraphobia.

While my third daughter has a generalized anxiety disorder (GAD), her GAD exists for entirely different reasons than my second daughter’s or my youngest daughter’s or my first daughter’s.  My oldest girl becomes anxious because she is a high achiever, and she has linked her future happiness with her present achievement.  If she doesn’t perform well on a math test, then she won’t get into a good college.  If she doesn’t get into the right college, then she won’t get a good job.  If she doesn’t get a good job, then she’ll be a bum living in her parents’ basement for the rest of her life.  None of this is true.  This is all-or-nothing thinking perpetuated by manipulative high school teachers trying to get their students to behave or do well on standardized tests so that government funding continues.

My third daughter has a schizophrenia spectrum disorder that developed when she was in the fifth grade.  This is very rare.  She is anxious because she doesn’t know if what she is seeing and hearing is real.   She has experienced psychosis so she knows that it’s possible for her brain to feed her information that is false.  There are times then when she asks me if what she is observing is real.  Every morning and evening she shows me her medication container in order to see if she has taken her medications.  She sees an empty container.  Do I see the same thing? This inability to trust her own perceptions and recall of experience is what perpetuates her anxiety.

My youngest daughter has an autism spectrum disorder specifically Asperger’s syndrome.  She is anxious because she is aware that there are social cues, social rules, rules that govern social behavior, and rules within interpersonal relationships, and even linguistic expressions like idioms that are supposed to be used at certain times, but she does not know or fully understand the rules or their application.  She, therefore, often feels left out or excluded even after trying to implement what she has learned.  It’s sort of like being the only one in a group not to get the joke–all the time.  This is very anxiety provoking.

My second daughter is a very sensitive girl.  She was born sensitive.  When I was pregnant with my first daughter, she would stretch out as if she were lying by a swimming pool.  Her tiny feet would stab me in my abdomen, and I would poke those tiny feet in an effort to get her to reposition herself.  Consistent with her hard-wired personality, she wouldn’t reposition herself.  She would kick me and stretch out even more.  My second daughter, on the other hand, when poked would curl up and move to the opposite side of where she had previously been as if to say, “Did I offend you? I’m sorry!”  She was the same as a little girl.  She didn’t like crowds.  I could see that she was socially anxious.  She wanted to follow her bold big sister around everywhere.  She liked having one friend.  She didn’t like loud music.  She liked Beatrix Potter, bunnies, and delicate things that she could collect.  She is someone who responds to approval and verbal encouragement so when she started failing math she took in personally.  When her teachers started accusing her of being lazy, she took it very personally.  When she struggled to make friends in middle school while also failing math, she really took it personally.  Her social anxiety began to expand and include performance anxiety around math.  That larger anxiety began to include fear of her math teachers who refused to help her.  She began to believe that it was useless to try because trying never helped her do better in math.  Why bother? As she made friends, she discovered that they did fine in math. She decided that she must be stupid because only stupid people fail in school.  That’s what her teachers implied.  When she started high school, her anxiety grew into a monster.  She began vomiting in school.  She couldn’t even make it through the day.  Where did it start? It began in the kernel of social anxiety.

Every one of my daughters is anxious, but their anxiety is very different even though their diagnosis, on paper, is the same.  Why am I writing about anxiety on this blog?  This topic belongs on my other blog (and maybe I’ll put it there).  Well, my second daughter’s anxiety crippled her to such a degree that I had to remove her from school and homeschool her.  Because I now have connections in the county due to my third daughter’s illness, I was able to get immediate in-home help for my daughter in the form of a crisis stabilization therapist who came to our home twice a week to provide us with services.  The result of that service was that my daughter just started a 25-week DBT (Dialectical Behavior Therapy) Skills Group, and I am required to attend as well so I will be learning the skills, too.  This is fabulous!

I’ve written about DBT on this blog in the past, and that’s why I wanted to talk about this.  Many of us may have the same or similar diagnoses, but why we have those diagnoses may be completely different.  Your anxiety is yours.  My anxiety is mine.  My daughters’ anxiety is theirs.  We may be sitting in the same room together, but how we arrived there is as unique to us as our DNA.  DBT, however, will be relevant to you regardless of why you require a therapeutic intervention.

So, let me just start with one basic premise, and it is the foundational idea behind DBT.  It is called the ‘dialectic’.  What is the ‘dialectic’? It is the notion that we can hold two opposing ideas in our mind at the same time and be comfortable with it.  We can even agree with those two opposing ideas.  What does that look like? I’ll use my daughters’ anxiety issues as example:

  • “I can do poorly in one of my classes and still get into a good college.”  Is this true? “I can do poorly in a class.”  and  “I can get into a good college.”  Those are two opposing ideas to my daughter.  This is perfectionism.  “I don’t have to be perfect to be successful.”
  • “I see things that are not real, but I can trust what I see.”  Is this true? A person treating my daughter would say that it is, but why is this true?
  • “I am failing math, but I am not a failure.”  How many of us equate the event of failing with our identities? Can we fail but still be successful at the same time?
  • “I am not succeeding socially now, but I will do better and learn how to navigate social scenarios in the future .”  Is this true? Is poor social intelligence indicative of future social successes and even future friendships? Is this a legitimate conclusion, or not? Why?

How about this?

  • “I can be anxious and still be successful.”
  • “I can feel scared and still be courageous.”
  • “I can be a victim of abuse and not think like a victim or act like a victim.”

And, one of the premises of DBT:

“I am doing the best that I can, and I can learn to do better.”

 This is just the very beginning of DBT–learning about the ‘dialectic’.  It is, however, vital that we step back and take an inventory of our thinking.  Are we able to enter into the dialectical approach? Can we practice it? What are some of your ‘dialectics’?

Here are some of mine:

  • “The person opposite me can be right, and I can be right, too.  It doesn’t have to be win/lose.  Right/wrong.”
  • “I can have a ‘bad day’ as a parent.  It doesn’t mean that I’m a bad parent.  I can be a good mother and still have a bad day.”
  • “I can have a need that is important and needs to be met, and I can still live a full life without that need being met right away or even in the immediate future.  I can tolerate discomfort and uncertainty even if I don’t like it.”

Tell me what you think. Thoughts?


The Dialectical Behavior Therapy Skills Workbook for Anxiety: Breaking Free from Worry, Panic, PTSD, and Other Anxiety Symptoms



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