Dear *****i, I have experienced DBT training and done some DBT couples therapy, so I know how it's intended to work. I think it's not unusual for BPD to manifest with major physical symptoms together, such as your sleep disturbances. Minimizing the effects of your physical symptoms on your psychological imagery and accompanying thoughts is DBT's goal--because physical, emotional and mental functioning all work together. So your thoughts and feelings both participate in the catastrophic magnification arising along with physical issues--such as a life-threatening medical diagnosis producing the same types of dramatic & dire thoughts and feelings as a combat-residue PTSD. Both my wife and daughter have chronic pain and/or life-threatening incurable illness, so I know the challenges you and your husband both face. PTSD, Attention Deficit Disorder and High Physiological Sensitivity in childhood are all conducive to later BPD diagnosis, especially under the impact of incurable or lifethreatening illness, which my wife and daughter both have. A major challenge in couples therapy lies in the intersection between the basis of of secure bonding, which is ultimately to have confidence that your partner will receive, accept, respect and reliably respond compassionately to your key emotions: excitement, distress, fear, anger and shame/hurt, and the approach of DBT to your presenting psychological problems: His PTSD would likely lead him to withdraw (with underlying shame/hurt) or lash out angrily in any relationship, and your BPD emotional instability would lead you to amplify your own distress, fear, anger and shame/hurt--and thus increase his tendency to withdraw. Yet DBT attempts to teach you how to manage your emotions by unhooking your CENTER (established through time spent in Mindfulness Meditation) from the winds of your changing emotions, but it's not as well suited to developing his compassionate receptivity, because it emphasizes the preservation of rational thinking instead of the emotional rapport that is central to secure bonding in a couple.
Couples therapy is a very difficult skill, and managing what may well be a very adversarial interaction may be more difficult when the method is aimed at dampening the emotions instead of seeking their sources in the partners' deeper needs for/from each other. This second approach is the goal of Emotionally Focused Couples Therapy (in which I have more training than DBT. This approach has been growing for a few years longer than DBT (around 25yrs), and it has methods for managing both the volatility of BPD and the reticence of PTSD; and it's planned to succeed in 12 to 20 sessions. IF your marital problems show up as escalating arguments leading to periods of withdrawal, and you're not seeing sufficient improvement from DBT, it may be because DBT is not designed as a couples therapy. It might be wise to continue the DBT skills training and meditation practices, but seek out and interview EFCT therapists in your area to gain greater satisfaction and security in your marriage. This could be particularly valuable if your husband has been receiving inadequate therapy for his combat related issues, which is normally the case. Doing Emotionally Focused Couples Therapy might give him both the incentive and the means to develop the expressiveness that enhances intimacy, subject, perhaps to limitations imposed by his brain injury: So you'd want a very capable EFCT practitioner. But EFCT theorist Sue Johnson has published work on using this humanizing therapy for PTSD.
And one more aid in this process is brand new on the scene, but well known to me: A recent article published on a German study of combat veterans showed that Low Dose Naltrexone, a generic drug used to prevent opiate addiction, is significantly effective in promoting self-awareness of internal and external realities and reduces depression, both of which could promote connection with loved ones. You can find this research article as an English language abstract on the NIH website Pub Med by using keywords naltrexone and post traumatic stress. My own 4p article on naltrexone for autoimmune diseases and depression is free online thru Google under my name and naltrexone. I'm suggesting that low dose naltrexone (which is cheap, around $20/month compounded from Skipspharmacy.com) could enhance your husband's ability to cope more effectively with his PTSD in intimacy and socializing, and thus also make better use of emotionally focused or other intimacy-enhancing therapy. I don't know if the VA or his doctor would be aware of this research or willing to prescribe low dose naltrexone (4.5mg compared to 50mg that is FDA approved for preventing exaddicts from getting high on opiates or alcohol) for PTSD yet. But you can take the article's abstract and my whole article (both of which I can send if you can't find them) to many GPs. Of course it would be better for other vets if you persuaded a VA doc to give it a try and monitor results, because it's a cheap and beneficial influence with no significant negative side effects (except one gets drunk more quickly and may dream more vividly unless one takes it in the morning). I've been taking it for osteoarthritis for just under 10 years with no disease progression, since it prevents most autoimmune diseases and many cancers from progressing by suppressing inflammation. My daughter got rid of her migraines 10 years ago, and they've stayed away even after she had to quit it because she needs narcotics for her widespread non-autoimmune joint pain. Besides a STRONGER immune system that doesn't "attack-self" LDNtx gives greater pleasure with any activity that produces endorphins, like sex, love, massage, sports and exercise, socializing, comfort foods (fats & sugars), laughter, discovery, learning, excitement, enjoyment and mastery. It's high time that the govt started capitalizing on this little-known use of naltrexone whose early research it mostly funded; but Big Pharma hates it, because it's been off patent since 1984/98 but it's better than all those expensive patented immunosuppressant drugs they have to warn us about on TV. So you might even be able to have some influence in getting a VA to put that into use (and monitor its effects of course).
I know this is quite a bit to digest. But it sounds like you've already learned a lot about your challenges as a couple. So I hope that some of what I've added here will be useful to you. And I'll take it farther in any direction you want. Just ask and comment.
PS I'll comment on a few features you've mentioned about your dreams next time.
I'm glad my comments might have helped your DBT therapist I'm not informed enough to offer assessments of as much value as your therapist. but I agree that marriage counseling is far more difficult to manage than DBT as individual training.
I am curious about the connection between your dreams and BPD. I wonder if the sleep studies are being pursued because your mood when you wake up in the morning has been preset by very violent dreams, and this turns into emotional cyclones in your waking life. Perhaps you are extremely sensitive both to emotions and physical sensations of many kinds, including pain, and these inputs both in the previous day and during your sleep show up as violent dreams, which then carry over to the next day and thus perpetuate themselves in emotional volatility: a central feature of BPD--also very similar to PTSD, which highly sensitive people would be more likely to experience in childhood traumas. If this is somewhat true, then another type of DBT strategy could be to reenvision a dream and revise it thru the influence of conscious intention to moderate and calm down the violent aspects -- thus practicing "rewriting your dreams" to make them more conducive to calmer experience of both imagination and outer/interpersonal events.