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DBT therapy doesn't work (I read and practice skills for 30 mins a day M-F), meds don't work, consistent cardio doesn't work. Where do I even go from here? (long rant, sorry) (lemmy.world)
submitted 7 months ago* (last edited 7 months ago) by dingus@lemmy.world to c/mentalhealth@lemmy.world
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Quite frankly I'm just at a loss at this point. Been on the therapy and meds journey for almost a year now, and did the whole exercise shebang consistently for like 2 years. I was doing cardio for an hour every 1-2 days.

I am getting quite disillusioned and don't understand what I'm even doing anymore. I'm getting so caught up in various things that I'm just confused as all hell. Every time I think I figure something out, I end up so wrong it's almost like it's not even funny.

I have intense reactions to rejection. I have extreme and intense negative emotions that persist for many hours and days after a trigger and they are very painful and difficult to deal with and can impair functioning. I have a lot of social anxiety, which I did not think contributed much to this. But now I'm wondering if I have a pattern of social anxiety --> extreme rejection sensitivity --> extreme emotional dysregulation.

I have been on escitalopram (Lexapro), then lamotrigine (Lamictal), and now quetiapine (Seroquel). I do not have ADHD. I do not have bipolar disorder. I don't even have persistent depression. I have periodic extreme episodes that cause a lot of distress and can cause functional impairment like how my work threatened to fire me. I also have intense shame and self-hatred, often babbling to my online friends nonsense about how I'm a "demon" when I get this way. I am also totally normal 90% of the time. It's only the remaining 10% that causes the struggle.

People always tell me to "go to therapy". I am. I have seen multiple therapists and have been consistent with this one since the fall. People tell me I don't put enough work. I am. People tell me I am not honest enough to my providers. I am. People tell me try a different therapist. I have tried many (I stick with my main one for continuity and so that I don't have to keep rehashing my backstory).

At this point I feel like I don't know what is down and what is up. I no longer understand what my problem is anymore. Every time I think I figure out what my issue is, every time I think I figure out a technique to help me, I'm wrong.

I'm starting to think that this is who I am. It is unchangeable. I experience a lot of pain and sensitivity where others don't. I wish that wasn't the case, but I think it can't be changed.

Idk where do I go from here, friends? Thank you to those who have read my entire rant lmao.

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[–] SoleInvictus@lemmy.blahaj.zone 7 points 7 months ago* (last edited 7 months ago) (1 children)

Hi! CPTSD here thanks to untreated BPD dad. My partner also has CPTSD from an even shittier childhood. Between the two of us, we've done everything you've mentioned here and worked most of it out. I can write a novel - and I will, right here! Here's what came to mind reading your post. Feel free to ask anything, I'm an open book.

I'm going to second EMDR, but only if you think this is rooted in trauma or any past experiences. If your life has otherwise been idyllic, skip this.

It took me years to try it, then I made more progress with six months of weekly EMDR than I did during the years I waited. It dredged up formative experiences that had impacted the basic assumptions I had about myself and the world, and it's those assumptions, like a "Me Operating System", that made other issues so difficult to handle. Since I could see them I could challenge them, and that changed my fundamental view of everything. It was super difficult and I was a pissy little bastard pretty much the entire time. It was still worth it and I'd do it again.

It takes years to make the first big changes when you have a personality and/or trauma-related disorder, because you're using your wonky brain to fix your wonky brain. It fucking sucks. And it's never going away, just getting better managed. I'm over two decades in on treatment and I still sometimes do the same shit I did when I started. The difference is it's very infrequent now, I can typically stop it immediately, and it's comparably mild if I don't.

You'll make the slowest progress at the beginning, so it's hard to see. I remember beating myself up because nothing seemed to get better, which was making it even harder to improve. I eventually moved my goalposts way back and learned to become my own cheerleader. I have victory conditions, really small achievements where I take a moment to recognize that I did something right and check in to see how I'm feeling. If I was upset, I'd find a mirror, make eye contact with myself, and talk myself down, comforting myself like I might want an ideal friend to do. Sometimes I'd just hug myself and say I was sorry I was upset and cry a bit (or a lot) until I felt better. The point was being my own best friend, even if I didn't feel like it. Especially when I didn't feel like it.

And herein I explain, at great length, training myself like a dog.

You're already hitting my first victory condition: recognizing the behavior. This is huge. Soooo many people don't, literally ever. Every damn time you do something you want to change, you congratulate yourself for noticing. If you don't feel like it, tough shit: you still go through the motions.

The second condition is changing something in the moment. Anything. I'm also rejection sensitive and my main reactions are to fight or freeze. If I found myself spinning up, even if all I did was hijack my own angry rant and say "aaaand I'm all pissed off and shouldn't be doing this", then gave in and still picked a fight... great job, I did better than doing nothing at all! I'd later congratulate myself for condition one, recognizing the behavior, and condition two, actually changing something, even if just a little and even if it was ultimately a flop.

The third is stopping in the moment. Sure, you may have started, but you derailed yourself. Three levels of congratulations!

Fourth is doing something else entirely. Anything else, even if it's silly. Yesterday, I was at the gym. It was undergoing renovations so it had that construction plastic film up everywhere. Thinking I was alone, I was being a good little weirdo and batting at it like a cat. Then I noticed a woman had stepped into the area and was watching me. I was startled, so I felt the cold shock of adrenaline, followed by embarrassment welling up, all of which used to lead to anger or freezing. Instead, I just looked her in the eye and said, deadpan, "meow". I laughed, she laughed, crisis averted.

It's all about recognizing incremental progress and heaping on the praise. I call the praise part "training my own dog". Calm me is rational and can think through shit. Emotionally flooded me isn't very bright and needs to be trained, so I give that "me" positive reinforcement when they do a good job. Just like a dog. I sometimes give myself treats when I do a very good job.

There's much more, like learning to be better at emotional regulation so I don't have to rely on dysregulated me being a good dog, but this is what got me over the hump of "everything sucks, I suck, and I'm never getting better".

Edit: oh oh! Look up amygdala hijacking in reference to getting really upset and going on rants where you later look back and are like "...WTF?" My partner does this HARD if they've been pushing themselves too hard for too long. I at first thought they were delusional and, well... they were. Temporarily. Because their brain had mostly shut down.

The more you can learn about psychology and neuroscience, especially affective neuroscience, the more you'll be able to recognize what drives certain aspects of your behavior, which will help you figure out what to do about it. Knowledge is power and all that.

[–] dingus@lemmy.world 2 points 7 months ago* (last edited 7 months ago) (1 children)

Funny you should mention EMDR. I have heard of it, but to be honest it had always sounded a bit like quackery to me lol. The DBT book I have actually referenced EMDR as one of the exercises! They mentioned that it is unknown whether or not the eye movements themselves actually help with the trauma, but rather just that the therapy and exercises as a whole is what seems to help people.

It's really hard for me to figure out wtf kind of therapy will work best. There are many more modalities that I had heard of when I started this journey lol. EMDR, IFS, etc. Most recently I have heard of MBT. I should investigate more into all of these. MBT sounds interesting to me, as it seems to be a newer treatment for emotional dysregulation. Of course this means that most therapists are not going to be familiar with it enough to use it.

DBT is what I've been trying to use so far, but it's been exhausting trying so hard every day for months and months only for the pain to not begin to be touched. I started this journey to try to help with my intense and distressing negative emotions. And I eventually found that DBT was supposed to be the "best" treatment for emotional dysregulation.

Yeah I have heard of both emotional flooding and an overactive amygdala, but not necessarily amygdala hijacking. From the things I ever read, I'm guessing that my amygdala is for some reason wayyyy hypersensitive compared to most people. I was sensitive even as a child. It's frustrating because even though these techniques might help to calm with a behavioral response, it doesn't seem to help with the emotional side.

I wish there was a therapy techniques or medication that could help my amygdala chill the fuck out lmao.

[–] SoleInvictus@lemmy.blahaj.zone 2 points 7 months ago (1 children)

I'm also on the fence about if EMDR itself works or if I'd get similar results if I was doing anything else repetitive that also required my full focus. I think it just got my overactive mind to get out of its own way, but it worked!

DBT might not be the thing for you, or may be more helpful later. My early therapy was almost exclusively CBT, which is luckily what I needed since my internal narrative was real ugly. I picked up on DBT later and I think it would have been harder to learn and less effective early on.

I'm sorry you're in the funk. A lot of us have been there, so we can relate and commiserate. I can assure you it does get better if you keep at it. The work may never become easy, but it does get easier as you do and learn more over time.

[–] dingus@lemmy.world 3 points 7 months ago* (last edited 7 months ago) (1 children)

Well, like I said...I chose DBT specifically because it is supposed to be the gold standard for emotional dysregulation lol. I learned last year that it's my core issue! But I guess it's trauma/chronic invalidation based (granted that's how you have the issue in the first place). CBT I find kind of hard to apply and invalidating...it's like my whole life I have always felt that my thoughts and feelings are wrong. It's always been hard because I am never able to trust myself. The cognitive distortions don't really help me much.

DBT seems a lot more gentle in questioning your thoughts instead of just giving you a long list of how you're wrong. Like in one chapter, my book states to compare your level of anxiety to what is actually happening. Are you in real danger? If yes, act. If no, that's ok that you're anxious. Let yourself feel anxious in the moment, but try to use calming techniques to help. I find it harder to apply for anger and guilt, but it's a start.

Thank you. I guess I hate that it's almost like I'm back in school but the reward isn't really improvements or getting a good grade lmao!!

I think I need to try to celebrate little wins more. I have celebrated these before, but it feels like my wins are so few and far between anyway lol.

[–] SoleInvictus@lemmy.blahaj.zone 2 points 7 months ago* (last edited 7 months ago) (1 children)

I think I need to try to celebrate little wins more. I have celebrated these before, but it feels like my wins are so few and far between anyway lol.

You might be doing better than you realize. Change on this stuff is so slow that it can sneak up on you. Do you journal at all?

[–] dingus@lemmy.world 2 points 7 months ago

Not really. Idk what I would really have to journal about. My life is pretty mundane. My therapist had me filling out an emotion log for a while but tbh I stopped doing it. I could only log stuff certain times a day so I ended up reflecting more than noticing in the moment. Now when I feel something negative, I don't wait until the end of the day to reflect and log, but I try to do it when I notice it come up.

I mega failed a couple of weeks ago. Had an incredibly sustained stressful week where all of my skills failed to soothe me. I tried to use them repeatedly and repeatedly and tried riding the waves again and again. It culminated in a very heightened, distressed state in the end where I could not ride the last wave. I forgot all of my skills and didn't use TIPP and could not calm down without saying some things that scared a lot of people. I haven't been that bad in many months, but I also hadn't had that many sustained stressors/triggers in a long while either.

Every time I make a couple of steps forward, intake 17 steps back.

[–] Redacted@lemmy.zip 5 points 7 months ago (1 children)

Chronic anxiety is a bitch. Kinda reads like borderline personality disorder but im no expert.

Even of its not, no one therapy has ever solved any of my problems for long. It usually takes me doing a tour through multiple different therapeutic stuff to help.

My problems are not yours, so i cant really say where to go next, but maybe try something youve already tried but gave up on previously. Maybe this time will be different :)

[–] dingus@lemmy.world 3 points 7 months ago* (last edited 7 months ago) (1 children)

Funny you should mention borderline personality disorder. I've thought for a while now that I've met a ton of the traits. It's supposed to be responsive to therapy, particularly DBT, which is why I was interested in seeking it out. My current therapist only uses general DBT concepts which is frustrating but I have a comprehensive DBT skills book that I have been working through to supplement. While the skills seem to occasionally help with mild issues/triggers, unfortunately they don't seem to begin to touch the pain of larger ones.

[–] kurodriel@lemmy.dbzer0.com 3 points 7 months ago (1 children)

Look, i've had almost the same experiencie over the years, and now I've investigating the possibility of being in the spectrum. What I tought I was learning while growing UP seems to be masking mecanism.

Maybe try to look UP how undiagnosed adults on the spectrum behaves and ser if It rings a Bell.

[–] dingus@lemmy.world 1 points 7 months ago (1 children)

Funny you should say that because my therapist suggested maybe I get tested for neurodivergence. That maybe something like that is why they have difficulty helping me.

Some questions for you:

  1. What made you start thinking of that for yourself? What is it that you noticed within you?

  2. How would being diagnosed as on the spectrum help your treatment? I'm not trying to be snarky, I'm legitimately asking in earnest. It's not like there's a pill for autism or anything after all!

See the thing is that I really don't at all fit autistic traits.

I have absolutely zero sensory sensitivity (unless very very occasionally being overwhelmed with crowds counts...but not super often).

I am generally a dispassionate person without any real interests. Only thing is I can obsess over negative things, getting the right "formula" for social interactions at work, and right now I obsess over mental health things lol. I have been incessantly chatting with multiple AI models for extended periods of time each day for the past idk how many months now lol. But I don't know that I did that prior. Most of my obsessions are social anxiety related, not autism special interests.

I am very good at eye contact when I am comfortable. I only have difficulties when I am upset or very socially anxious, which is how neurotypicals are too. I used to have a hard time as a child when my social anxiety was much more severe.

I am very very good at reading body language, facial expressions, etc. It is second nature to me and does not require any extra mental effort or focus. I am not at all drained by it and am instead energized by most social interactions (unless I am in places where my social anxiety is turned on)! As a pre teen and teen, I actually did struggle a LOT with learning and understanding nonverbal social cues. But I think that was being a slow learner combined with severe social anxiety. I don't at all see it as masking because it's unconscious now and not draining.

I don't stim. Many people fidget when bored or focused and I do stuff like that too, but not as a self soothing thing like that. For example I fidget at work but not elsewhere. I don't have to consciously "surpress" it. I just flat out don't need to do it anywhere else.

Sorry for being so long winded lol. I guess that's just how I post on Lemmy.

[–] kurodriel@lemmy.dbzer0.com 3 points 7 months ago (1 children)
  1. Anxiety, hyperfixation, irritability, difficulty dealing with schedule changes, mental inflexibility, etc. It is not that strong, but enough to drain me during bad periods. Neither therapy or meds actually helped me, I felt stuck and without a visible way out. A little while my therapist suggested I get a neuropsycological evaluation (direct translation, don't know if the name in actually this in english). And I got a strong possibility (investigating now) of being on the spectrum, altough my "support level" is the lowest (my characteristics aren't that high in ant of the spectrum characteristics. And most of my expereriences seemed to fit in the problems undiagnosed adults goes through.
  2. It seems too early to day anything with confidance, but so Far, I feel like I understand the reason behind my feelings and behaviours.

It is called spectrum for a reason, you don't need to fit them all, and could have manageable levels in some of them, but having to compensate in others. As you therapist said, and undiagnosed neurodivergency could be a reason the therapy poor results, It is like they aré following a script that wont work on u.

[–] dingus@lemmy.world 1 points 7 months ago

Well best of luck on your journey, man.

[–] unknown@piefed.social 3 points 7 months ago (1 children)

If you think you're stable enough, have you considered trying psychedelics, like magic mushrooms or ayahuasca?

Ego death and a good hard introspective trip could really help you reset things in your head.

[–] dingus@lemmy.world 1 points 7 months ago (1 children)

It's funny that more than one comment has mentioned this now lol. I can't say I'm overly interested in figuring out how to obtain that (considering I'm not keen on figuring out illegal means) or doing that on my own. I feel like I'm more likely than some to have a bad trip. I don't have anyone to be a trip sitter. I don't know that something like that would really be permanently life changing for me.

[–] unknown@piefed.social 1 points 7 months ago

You know your mind best.

[–] BCsven@lemmy.ca 3 points 7 months ago (1 children)

DBT becomes something to be aware of and practise all day. It has to become a part of your thought process to break the feeling though action chain. It takes time.

[–] dingus@lemmy.world 1 points 7 months ago (1 children)

That's for sure. Sometimes I remember and sometimes I don't lol. I am wondering how long tho because this is painful af.

[–] BCsven@lemmy.ca 1 points 7 months ago

I think it is a different journey for everyone. Everyone's trauma is different. Medicines help get you through crisis stages but it is gaining DBT skills that have the most effect.

[–] Randomgal@lemmy.ca 2 points 7 months ago (1 children)

Have you tried psychoanalysis? I can recommend you the lady I talk to if you want.

[–] dingus@lemmy.world 1 points 7 months ago (1 children)

I'm tired honestly lol, but curious. How is this different than all the other shit out there? What is it?

[–] Randomgal@lemmy.ca 2 points 7 months ago* (last edited 7 months ago) (1 children)

Hmm... I don't know how to explain it but I could DM you their website. It's less clinical, we don't talk about my diagnosis or stuff like that. Instead... You just talk until you start saying stuff you didn't know you wanted to say, if they makes sense. More questions less answers.

Edit: they have a pay what you can system, just so you know. It goes down to 0 lol

[–] dingus@lemmy.world 3 points 7 months ago (1 children)

Thing is I feel like most therapists I've seen are like that. They just sort of meander and let me meander and talk. They try to give some input after. I mean like, at the end of the day, I definitely appreciate feeling validated, but at the same time it is not really touching my issues.

[–] Randomgal@lemmy.ca 0 points 7 months ago* (last edited 7 months ago) (1 children)

I mean you can also just surrender to a life or misery, idk.

[–] dingus@lemmy.world 1 points 7 months ago

I mean that's not a particularly helpful statement. I just feel lost and don't know how to find a therapist that can actually help me. I've spent so much time and money and effort on this stuff. :(

[–] RumorsOfLove@lemmy.dbzer0.com 2 points 7 months ago (1 children)

Do you have safe trusted people around you?

[–] dingus@lemmy.world 1 points 7 months ago* (last edited 7 months ago) (1 children)

What do you mean by that? I live alone. Most of my friends are online. There is one irl person who has help me a lot two of the times that I was in a huge crisis, but we aren't close people who hang out. She has been amazing to me but I can't always be calling her in the middle of the night lol.

[–] RumorsOfLove@lemmy.dbzer0.com 1 points 7 months ago (1 children)

solo mushroom trip . it allows you to change neural pathways in your brain for the better . unlike pharmacrap which temporarily prevents you from feeling sadness

[–] dingus@lemmy.world 1 points 7 months ago (1 children)

Ah yeah no I don't have anyone to be a trip sitter or anything.

Thing is I tried an SSRI. I honestly had really wished for the "emotional blunting" side effect that people complain about. My issue has always been intense emotions. I was hoping for something to turn down the volume dial but it didn't lol!!!

[–] RumorsOfLove@lemmy.dbzer0.com 2 points 7 months ago

I asked about people because I couldnt recommend tripping around untrustworthy roommates, abusive family, etc. This is because trippers can be vulnerable to suggestion. However, on your own, you would be safe.