DBT for Depression

Are you struggling with depression?

Depression isn’t just feeling sad, or being down after a significant change — depression is a serious clinical issue, and it can have a big impact on quality of life.

Signs of depression include:

• Feeling hopeless, or as though you have nothing to look forward to and that things cannot improve

• Feeling as though you can rarely escape from sadness

• Struggling to enjoy things that once provided you with satisfaction

• Frequently experiencing feelings of guilt, or feeling as though you’re being punished

• Having thoughts of ending your own life

• Not wanting to spend time with other people

• Always feeling tired, no matter how much sleep or rest you get

• Unintentionally gaining or losing weight

• Struggling to concentrate or make decisions

• Feeling as though everything you do takes a great amount of effort

What causes depression?

Depression can occur for many reasons. Perhaps you’ve had a recent life change, such as a divorce or a death in your family that you’ve struggled to adjust to. Or maybe you’re feeling stuck in a job or relationship in which you feel unfulfilled, and you can’t see a way out. Some people are prone to depression, due to it running in their family. Others experience it as a result of traumatic experiences or from chronic feelings of loneliness. 

The impact of depression is serious

Regardless of the cause, depression can lead us to act in ways that aren’t aligned with who we want to be. It’s hard for depressed people to find pleasure in the things that they used to enjoy, or fulfillment in relationships that they normally treasure. Thus, depressed people often pull away from activities that once meant the world to them, and struggle to engage with their loved ones. 

It’s also not uncommon for people who struggle with depression to attempt to find relief through behaviors such as binge drinking, drug use, binge eating, impulsive spending, gambling, and other actions that can be problematic. While these strategies may feel helpful in the short term, they often result in increased feelings of shame, which can fuel depression. 

Depression can get so bad that it can lead to thoughts of self-injury and suicide, and a perception that the world would be “better off without me.” Depression, particularly severe depression, can feel unbearable. 

If you’re struggling with depression, DBT can help.

One of the many conditions that Dialectical Behavioral Therapy can be useful for is depression. 

As a highly structured treatment, DBT can help people who suffer from depression build a life that’s not only worth living, but worth loving.

To see how DBT can help intervene with depression, we’ve provided a case study below. 

Depression: Party of One

Luke was at his wit's end. He had tried talk therapy on and off for several years for his depression. He had cycled through multiple medications. But nothing had worked — things had actually gotten worse. If therapy and meds didn’t work, did that mean he was to be alone in this depressed hellscape forever?

Rock bottom came when Luke had lost his job following 14 days when he couldn’t seem to motivate himself enough to get out of bed. He drank nearly a case of beer and smoked several joints daily. He spent most of his time watching Netflix or surfing social media. He was too tired to do anything else.

He rarely saw friends anymore, both because he felt exhausted all the time and because he didn’t want to tell them that he’d lost his job (again). Life felt like a joyless, meaningless fog. Sometimes, he punched a wall until his hand bled just so he could feel something. 

Something had to change. Luke did a little research and learned about DBT as a treatment for depression.

Starting a DBT Program: It Takes Two to Tango

Soon after Luke got matched with a DBT therapist, they established something that the therapist called “Life Worth Living Goals”. Luke was skeptical but was willing to try — he felt like there wasn’t much to lose, so why not give it a shot? Luke told his therapist that he wanted a life in which he found a job in his field (graphic design), actually saw friends regularly, left the house every day, and found a way to “experience happiness without a fear of when it would end.” 

Luke and his therapist worked as a team to tackle the casues and the symptoms of his depression. Luke and his therapist began using a diary card to monitor his problem behaviors of not leaving the house, drinking to excess, staying in bed all day, punching walls, and watching excessive amounts of TV.

Together, they were able to isolate the problems, figure out the functions of those behaviors and replace them with more effective patterns using something the therapist called Behavior Chain Analysis. For example, they discovered that Luke was more likely to stay in bed on days that his parents called or texted him and scolded him for not getting a job. This caused him to believe they did not understand his pain and suffering, which, in turn, caused him shame (increasing his pain and suffering further). He was often so angry at himself that he would hit the wall, you guessed it, causing more shame.

Once they knew the pattern, they established a rule that Luke would call his therapist immediately for coaching in alternative behaviors the next time he got a chastising text from his parents.

And DBT Skills Groups Make Three

An adherent DBT program offers the client 3 touchstones for support:

1. Individual and/or family sessions

2. Between-session coaching calls

3. Group skills classes

Luke needed some fresh options for coping with his shame and negative self-talk. He needed to learn how to break the chain of depressed emotions and behaviors that weighed him down and kept him from living a life worth loving.

Luke’s therapist enrolled him in a DBT skills class, where, each week, Luke and others like him would learn and practice new ways of coping and communicating.

Luke started practicing the skills he was taught in group. He was surprised to find that the TIPP skill he learned in group decreased his urges to punch walls — he’d felt intense shame regarding this behavior, and finding that he wasn’t doomed to be a wall puncher forever gave him something he hadn’t felt for a long time: hope. 

Over time, Luke started making changes in his life. He used the Interpersonal Effectiveness skills he learned in group to set boundaries with his parents around conversations regarding his employment status. He used the Build Mastery skill to start applying to jobs again. When he got rejected from some of the jobs he applied to, he used the Radical Acceptance skill to acknowledge that rejections were a part of finding a new job. Luke had one moment in which he had very high urges to punch a wall after he got rejected for a job, but he utilized skills coaching and called his therapist for advice on how to get through the moment without harming himself. 

Luke also started reaching out to friends again, even some he hadn’t connected with in years. He used the Check-the-Facts skill whenever he started catastrophizing about how much they might judge him for falling out of touch. He began to build new relationships – Luke ended up picking up a few shifts at a local doggy daycare and got connected to the local chess league through a coworker. He’d forgotten how much he liked being around dogs, and how much he liked playing chess. 

Graduating from treatment

A year after starting DBT, Luke was ready to graduate from treatment. During their final session, he reflected with his therapist on the changes that he had made. Luke had returned to engaging in a moderate amount of TV and alcohol consumption, and no longer punched walls.

Luke had also fulfilled all of his life-worth-living goals- he had reconnected with old friends and made some new ones, he left the house daily, and he was back in graphic design as a freelancer for several local businesses (including the doggy daycare). Most importantly, Luke was no longer afraid of when the other shoe would drop. He felt like he could feel happiness without being fearful of when it would end. 

Are you ready for a way out of suffering?

If you’re struggling with depression, know that a structured, evidence-based treatment like DBT can help. As seen in Luke’s story above, working with a DBT therapist involves setting specific goals and making small steps toward getting your life back. It also means learning highly applicable skills that can help you regulate your emotions so that your depression doesn’t lead you to act on behaviors that make things worse.

DBT is a compassionate treatment, one that’s down to earth, and meets you where you’re at – it just involves a willingness to change.

To begin your life worth living, use the link below to speak with our intake team.

For additional recources to help with Depression, visit our resources page.