One of the moral imperatives of our time is creating universal access to quality mental health care. (I thought that even before this story happened, tho.) Oh, you don’t think we need a revolution in mental healthcare??? I guess you’ve never been shot at in a school or a McDonald’s, then. Right? Right. Try opening …
" /> Jason Holborn | Cybercarnet/Weblog - DBT: Dialectical Behavioral Therapy, or, Crisis? There's An App For That!

DBT: Dialectical Behavioral Therapy, or, Crisis? There’s An App For That!

One of the moral imperatives of our time is creating universal access to quality mental health care.

(I thought that even before this story happened, tho.)

Oh, you don’t think we need a revolution in mental healthcare???

I guess you’ve never been shot at in a school or a McDonald’s, then. Right? Right. Try opening a newspaper and tell me we don’t need to do radically, spectacularly better.

The debate on health care is over; sorry America, how you couldn’t get it together to be part of the debate and all, but the rest of the world has more or less figured it out. What was once debatable, or even controversial, is now recognized by, um, the world as a vital component of civilization’s investment into itself.

Today, we have to talk about radically transforming mental health care in the same way we transformed physical health care.

A year ago, Toronto’s biggest and best and only mental hospital facility mis-diagnosed me with borderline personality disorder. Get this: I went in to talk about my private crisis from recent multiple suicides, my own suicidal thoughts, and also, other personal issues of distressing confusion (I know, I know, I’m a whiny cry-baby with issues on the internet — but who isn’t?). They gave me a quick, breezy diagnosis for borderline personality disorder after a brief talk, along with a pamphlet on reading material. The waiting list for the cure — dialectical behavioral therapy — is a year and a half long. Then they shut the door on me as I started to — you guessed it — cry over the devastating news. (Guess what’s not welcome at the Toronto mental health hospital? Tears! It really makes them uneasy. So, you can just tell that they’re all very keenly gifted with the mentally ill’s “issues”.)

Now, the interesting thing is: I don’t actually have borderline personality! But they made me believe for about six weeks that I did, and I read a lot in that six weeks.

So, to summarize:

I went to CAMH prompted by a couple surprise suicides and personal distress and I came out with a diagnosis for borderline personality.

Overall, I enjoy learning something, and so, I enjoyed reading these books on borderline personality.

Mostly, I became interested with Dialectical Behavioral Therapy.

Get this, Team: Borderline Personality is this weird umbrella term that encompasses perhaps several different actual disorders, and some people even claim it doesn’t exist. But what’s important is that people who have it are crazy and need help. One autobiography I read had a vivid image of the author cutting up their 8-yr old hands and wrists and then showing all the blood and open wounds to an 8-yr old who had jilted them: “Look what you made me do.” That’s borderline personality.

So, here’s the thing:

There’s no cure.

The mental health system bolts from these people, for decades!, refusing to treat them because it’s a waste of time. There IS no cure. Health care professionals really want to steer clear as possible from these untreatable and very hurtful personalities.

Until fairly recently, when a psychologist, Marsha Linehan, is diagnosed with borderline personality. She jets to Asia to get away from it all, and immerses herself in Zen Buddhism, and then one day, as she meditates beneath a fig tree, with a bright star overhead guiding wise sages to the spot, the goddess of wisdom founts forward from her forehead, and Marsha Linehan has the idea of a lifetime: Zen Buddhism + Cognitive Behavioral Therapy = Dialectic Behavioral Therapy, or, DBT.

She returns to the West, with DBT, and starts treating borderline personality with it.

It’s a recognized (usual) cure for borderline disorder; Marsha Linehan will probably go down in History.

Not only is DBT often a cure for borderline personality, it has also been used with success in treating depression, suicidal thoughts, eating disorders, and a host of other issues humans seek help with.

I was totally onboard! I wanted in on this DBT thing!

Was I going to wait a year and a half for this?? And, from a notoriously bad institution not known for its efficacy?

Reader, I admit: I have come to despise CAMH, and I admit my bias: it should be shuttered, the province needs to open up a whole new mental health facility from the ground up. I don’t really buy any pitches of “changing leadership” or “altering direction” or whatever as being all that serious about true change. Our mental health system needs to see true change.

I looked into a DBT alternative; the only private Toronto alternative would cost whopping tens of thousands of dollars for one year of DBT.

I decided to reject this idea.

Naturally, I turned to my “What What Steve Jobs Do?” tattoo, and sat down at the nearest Apple device, and searched the App Store for a DBT Apple-cation.

I downloaded a Dialectical Behavioral Therapy app, and it’s incredibly simple.

And it’s essentially taught me (some light, modified, app-version of) Dialectical Behavioral Therapy.

And Reader, it’s a kind of personal revolution.

I wish I had the time to sit down and share daily all the great changes that the DBT app has created in my life! I’m singing an Ode to the power of Steve Jobs and design and computing and Marsha Linehan here.

Is my life perfect? No. Is the DBT app a miracle? No! Does the DBT app’s skill drill block or stop or transform or replace my worst automatic thoughts five to a dozen times a day and keep me out of (some) trouble? Yeah, it does.

Dialectic Behavioral Therapy: Get into it.

So, I personally happen to use this app: DBTSkillCard.


It’s incredibly simple; maybe it’s too simple for an app that costs more than $1.99. When you’re getting results tho, what does it matter? I’m getting tens of thousands of dollars of mental health help for less than twelve bucks. I’m not about to quibble.

You enter into this Zen room, and face the DBT Bubble.


This is basically “it”, this is the app that’s making a difference for me.

The user nudges the Bubble left or right, marking Yes or No to each DBT skill.


You simply touch the Skill button if you don’t know what the skill is; the app briefly outlines it. It also briefly outlines a practical Example of the Skill in daily life. Most of these skill outlines and accompanying examples are usefully illustrative.


On a day-to-day basis, I think differently now. And I owe it to a DBT app on iTunes!

Throughout each day of life now, my brain catches itself making an assumption about a situation; or fantasizing about what I wish I had said differently five minutes or years ago; or winding itself up over how somebody manipulated me or wronged me and got away with it; or desperately regretting something I did foolishly; or just plain hating some creep in the street who is yelling at some tiny woman (which is an assumption about a situation: maybe the tiny woman made a mean comment which triggered traumatic sexual abuse or genocide or physical trauma memories for the “creep”), and after my brain catches itself, it changes track.

Because of this tiny dinky overly-simplistic app, I notice things more — the flaked paint on bridge railings, the bark on a tree, the number of steps between lampposts on the boardwalk (32 (this is exactly the kind of thinking that Sherlock Holmes demonstrates!)).

Because of this app. I’m a little bit more peaceful and serene now, because of access to Dialectical Behavioral Therapy, provided to me NOT by the local mental health hospital, but by an app on the Apple App Store. Incredible.

I get the impression from reading that “automatic thoughts” are a big focus and deal in psychology and in disorders, and this app has definitely helped me get in touch with some automatic thought thinking.

I can’t think of a single person I know who would not benefit in some small or great way from this app.

And that’s the thing.

What is this sick joke?

The largest, best and only mental hospital (in a city known for its diversity and tolerance and acceptance and “progressive streak”) wants to put people in need of help on a waiting list for 18 months. And you don’t even get a psychologist! You get group DBT. And I went in specifically for help with suicidal thoughts and distress over suicide, not “borderline personality disorder”.

This app is really and honestly pretty simple.

It appears to have been made by a patient who found it boring to do the daily physical, paper DBT skillsheet.

Not even by a doctor, but (so it seems) by a patient.

And CAMH can’t find any money to get a staffmember or two or three together to make an even better app than this?

A million downloads at $1.99 is almost $2million. Five million downloads is essentially $10million. Or, they could just offer the app for free.

This is the kind of 21st century healthcare thinking we need at CAMH. Instead, we have a pack of fuddy-duddies (who, by the way, were among the last fuddy-duddies in the world to hold the rear-guard in getting transgender kids to play with army trucks and dolls to make them more normal. That’s CAMH.).

This mediocre app is really changing my life, and long before I ever would have qualified for “help” in a roomful of total strangers on the CAMH wait list. BTW, that wait list was for borderline personality… not for people who’s social network is committing suicide.

Sorry, but an institute full of career, educated professionals in the 21st Century could have and might have thought to itself a long, long time ago that, Gee, an app would be a great, vital, self-sustaining, life-saving bridge to many people on our many wait lists. All these university educated, diploma decorated people have cars and houses and condos and they all have smartphones and iPhones and tablets and apps, and all of them realize that apps are more universally and affordably accessible than they are.

I mean, really, they could offer a print-out pdf DBT starter kit to help you out on your 18 month wait list while you wrestle with a string of tragic suicides, and self-loathing and disgust. A paper print-out, that you pay your own cash and resources to print on your own. That’s real help. Paper. The original app.
But they don’t even do a paper hand-out. They just leave you in a spiritual crisis over suicide — on an 18 month wait list. For borderline personality.

I can’t understand the puzzle: why is the government, which, let’s face it, is our best invention along with the wheel and fire and the internet, so incredibly stupid? What is the reason? Tim Horton’s donuts and coffee can install a dozen different electronic payment hardware systems over a decade, constantly updating the software, and the public transit system just can’t for anything come up with a weekly bus pass that doesn’t start on a Monday. What’s the answer to this riddle? Why does government for the people suck, while vampire corporations that use humans for batteries to spur their growth keep getting it righter and righter and righter? What’s wrong with this picture??? Because hello, this picture is of US, you and I.

It’s not just CAMH. Seriously, this app which has changed my life and dragged me part ways out of the gutter is actually pretty mediocre. It’s nothing fancy. I could design a better app.

Why hasn’t John Hopkins or the Mayo Clinic or St. Michael’s Hospital or the Sorbonne or any other professional organization come up with a superior app that offers better DBT skills to the masses who need it?

Don’t look at me, Team — I got no answers. But I do know that CAMH doesn’t have any, either.

It occurred to me recently that I hadn’t had unbeatable, crazy automatic thoughts of suicide in a while, for the first time in YEARS. Because of DBTSkillsCard. Try it!

Feeling depressed? Isolated? Anxious? Overwhelmed by fear and doubt? Plagued by incessant thoughts of death and dying and suicide and ropes and guns? Struggling with borderline personality, or depression? Unhappy with the way you think your thoughts and feel your feelings? You can download the DBTSkillsCard app off of the App Store. There’s lots of other DBT apps out there, too. I am totally into it, and maybe you might be, too.


Jason Holborn