Dialectic Behavior Therapy (DBT) is a different version of Cognitive Behavior Therapy which, while not designed specifically to treat pain patients, Dr. Giardina has found to be effective.
Mindfulness
Based in Eastern philosophy and spirituality, mindfulness is the practice of intense and constant awareness of your world. It can be a hard sell for pain patients, who often crave escape. But by living in your body fully, with all five senses engaged, you benefit in two ways: a) you don’t “miss” any increase in pain which may signal a new injury of illness, and b) you fully experience the pleasures of life that co-exist with the pain.
Yin and Yang
Bridging from the previous section, it can be said that DBT is about the appreciation of co-existing experiences, which can at times seem like opposites that shouldn’t co-exist. For example, you can be in chronic pain, while experiencing the physical pleasure of a kiss from a loved one or a hug from your child. The good and the bad can all occur at once, and to ignore your experience is to “throw the baby out with the bath water.” DBT teaches patients to accept reality, and by doing so, actually lessen distress than can result from denying facts and symptoms.
Distress Tolerance Skills
A unique aspect of DBT is learning personalized and varied methods for tolerating the emotional distress that results from chronic pain – this is referred to as “self-soothing”. Dr. Giardina aids patients in tailoring each patient’s skills to match his or her individual personality and situation. Knowing how to tolerate distress effectively can greatly increase a patient’s sense of power and control. Proper and frequent use of social supports is an essential part of this equation.
Finding Balance
DBT emphasizes the ability to see that extreme thoughts ("I am in the most pain ever") are not healthy, and that sometimes there is more gray area than you realize ("I am in pain, but I am also enjoying this family reunion"). Using words such as “always” and “never” can greatly alter your perspective and expectations – and create unnecessary distress than can be called “catastrophizing.” Dr. Giardina shows pain patients how to recognize illogical statements and unhelpful patterns, and thus achieve better overall life balance. Swinging wildly from one extreme to another is unlikely to actually center you.
