Where Do I Start? If You Feel Lost, Hopeless, or Confused, Start Here on Your Mental Health Journey

What is DBT?

Dialectical Behavioural Therapy (DBT) is an evidence-based therapeutic approach that can help with mood dysregulation. This includes (but not limited to) borderline personality disorder, bipolar disorder, depression, and anxiety.

Who is DBT for?

The DBT framework can work for anyone who struggles with mood regulation, regardless if you have a diagnosis or not. It can also be helpful for those with severe presentations, like suicide ideation, self-harm, or addiction.

What is the Strategy?

DBT takes a harm-reduction approach, meaning that its goal is to reduce the risk of harm to yourself (and others). Therefore, DBT starts by addressing what is causing the most harm. The first step then would be reducing life-threatening behaviours, including suicide ideation, self-harm, and other harming behaviours like severe substance abuse.

Once these issues are addressed and managed, the second tier is to reduce what is called ‘therapeutic interfering’ behaviours. This means that anything that would sabotage you getting help and getting better is addressed. Examples might be missing important appointments (therapy, doctor, etc. ), skipping medication doses, not participating in suggested tools to help your situation (not completing therapy homework assignments), and being resistant or not cooperative with the people who are trying to help you.

Once resolved, the final step is to increase factors that contribute to a positive quality of life (and vice versa, reducing factors that decrease your quality of life). This is where you will learn skills to help you reduce stress, increase joy, enhance your relationships, and become the person you want and deserve to be.

Summary

Following a DBT-informed framework to addressing your mental health can be a useful strategy if you have severe presentations that are life-threatening and actively harming or if you need support with emotional regulation. It starts by addressing the most harmful factors, to improvement-interfering behaviours, and finally focuses on improving your quality of life. A therapist or counsellor who is trained in DBT can help you with a personalized treatment plan, goal setting, and structure to help you achieve the life you want and deserve.

You may remember Maslow’s Hierarchy of Needs from introductory courses in psychology or in pop-psychology references. The accuracy of the framework to the human mind remains debated, but in terms of helping you get a grounding on where to start to address your mental health, it can be a helpful guide.

What is The Hierarchy of Needs?

Simply put, it is a tiered framework for how the human mind triages problems that we may face in life. Often presented as a pyramid in images, the bottom tier starts with basic human needs and gradually evolves to the highest need of self-actualization.

Who is The Hierarchy of Needs for?

The utility of this model is that it is meant to be universal and cross-cultural, meaning anyone can benefit from using it as a guide. Originally proposed as a rigid, linear model that was followed with fidelity, its modern interpretation allows for more flexibility and variation. For instance, different cultures may ‘reorder’ the stages or emphasize certain needs over others.

What is the Strategy?

Starting at the bottom of the pyramid, the person will focus first on satisfying their physiological needs. This includes basic human needs including sustainable access to drinking water, nutritious food, adequate shelter, quality sleep, exercise, and clothing. Once these basic needs are met, the person is able to focus on the next higher needs. Safety and security includes steady employment, good health, a safe environment, and healthy family relationships. Next is fostering quality friendships, feeling social acceptance and belongingness, and intimacy. Then comes feelings of confidence, achievement, respect, and individual identity, and followed finally by self-actualization that is the epitome of developing a moral framework, creative spark, a feeling or purpose or meaning in life, and desiring to achieve your inner potential and personal goals.

Summary

The Hierarchy of Needs can help you set goals for stabilizing essential human needs first and working up to more complex goals. Setting a solid foundation in basic human needs to optimize your physiological health can help support you through more complicated goals of developing relationships and self-esteem (for example, it might be hard to focus on fostering friendships if you are experiencing food instability). Working with a therapist or counsellor can help you access community resources, provide insight into relationship dynamics, and give you tools to build self-esteem and self-actualization.

Mindfulness is gaining popular momentum in Western cultures and has been a part of many Eastern cultures for centuries. It can sometimes carry a religious or spiritual connotation, but modern mindfulness practices to support mental health have been secularized and studied as an evidence-based therapeutic approach.

What is Mindfulness?

Being mindful means having awareness of the present moment. This can look like being focused on your present surroundings and not distracted by rumination or worries about the future. It can also look like having insight and awareness of what emotions you are currently feeling, what thoughts you are thinking, and allows the opportunity for you to choose where your attention goes.

Who is Mindfulness for?

I personally believe mindfulness is for everybody. It is flexible and personalizable that no matter your starting point, age, culture, or religion, you can create space for mindfulness in your everyday life. The best part is that even a short daily mindful practice (we are talking 1-2 minutes a day) consistently over time can improve mental health symptoms.

What is the Strategy?

There are many different Mindfulness tools that you can use to be more mindful of your thoughts, feelings, and the present moment. One popular tool is mindful breathing. This involves practicing noticing your breathing with your 5 senses (sight, smell, taste, sound, and touch) and developing insight into your internal state (feeling muscle tension and relaxation). When you practice mindful breathing consistently, you may find that you can recognize your emotional state more acutely, experience reduced stress and anxiety, and be able to access a state of calm and relaxation intentionally.

You can use the same Mindfulness skills in any activity, not just breathing. Mindful eating is another way you can practice mindfulness on a daily basis. Paying attention to how your food looks, smells, tastes and feels, and sounds like as you eat it can help you start to notice small details that may have gone unnoticed before. It helps bring you into the present moment, instead of being distracted by thoughts other than what is right in front of you.

Summary

In short, doing a short Mindfulness practice once a day can help reduce daily stress and anxiety, a great place to start if you are looking for a place to begin improving your mental health. It allows you to choose to be aware of what the present moment has to offer you and can help you improve interoceptive and emotional intelligence skills. Westernized Mindfulness is evidence-based and can be tailored to fit in your personal life. A therapist or counsellor trained in Mindfulness can teach you different Mindfulness techniques and guide you on where Mindfulness can benefit you in your life.

Life is complicated, and mental health is no exception. The DBT Framework, Maslow’s Hierarchy of Needs, and Mindfulness are just a few methods that can help you start to improve your life and how you feel. Sometimes, however, it’s not enough. There can be complicated interactions, underlying medical or psychiatric conditions, and difficult situations that may need more support. If you have already tried getting better on your own without seeing lasting improvement, if you are continuing to feel worse and worse, or if you feel like you need some help and guidance, therapy is a place where you can access services and treatments that can benefit you. A trained therapist or counsellor will work with you to map out what is going on, build a personalized treatment plan, and provide practical tools and tips that can help you feel better.