Many of my psychotherapy patients ask for a Dialectical Behavior Therapy or DBT cheat-sheet to have handy when: life happens, you feel overwhelmed, and you can't seem to remember what to do in the moment! This is a basic list to remind you that you DO have other options at your disposal to help you better manage your relationship problems, trauma symptoms, addiction and eating disorder triggers, anxiety, depression, self-harm urges, interpersonal effectiveness, stress and strong emotions. With the holiday season comes stress, and with no shortage of emotional triggers, people struggle with: alcohol and food in abundance, family stressors and memories that reignite feelings of anger, loss, sadness, longing and loneliness.
Even though situations and stressors are present, one goal is to help you make healthier choices for yourself! A good place to start is to remember to focus, breathe and be mindful. When the skills don't work (as they often don't), remember to move to Distress Tolerance and take a Vacation from whatever you're experiencing. Practice Radical Acceptance, Self-Soothing techniques and use Distractions. Therapy clients can use diary cards to keep track of the invalidating thoughts and behaviors that create ongoing problems. Diary cards can also be used to record helpful coping mechanisms. Remember: personal success, effectiveness, positive feelings and change is possible when you practice. If you are new to Dialectical Behavior Therapy, you can learn more about DBT Treatment here...
Quick reference list of skills for DBT users. Here you go...
Whether you're trying to manage eating disorder symptoms or alcohol/substance abuse problems, creating a "coping skills" toolbox -- a place to keep things that can help you feel calmer and more grounded is a practical and helpful tactic in supporting your recovery goals. Instead of using symptoms and negative behaviors, turning to your toolbox can give you other options that immediately engage your five senses and include healthier distractions, self-soothing strategies and making different choices in the moment.
What you will need for your self-regulation and coping toolbox:
Tactile (something to feel) - textures, warm or cold objects, stuffed animal, stress ball, the ground beneath your feet
Visual (something to see or look at) - flowers, photos, art, vivid colors
Auditory (something to hear) - music, focusing on sounds in the environment, meditation guides, books on tape
Olfactory (something to smell) - essential oils, perfume, candles
Gustatory (something to taste) - gum, mints, sweet or sour candies
How to Distract yourself when you have the urge to reward yourself in negative ways or when you have self-destructive urges:
Do you push people away, and if so, do you know what it is that you do, and why? Chances are, you might not be aware that you do this. Generally done out of fear, it's easier to tolerate ending it, before you are rejected, or hurt someone else before theyhurt you. Often, this behavior is unconscious, or you may have some awareness that you do this. When you push others away you guarantee that you will be alone. You also miss out on important and possibly rich opportunities by avoiding potential pain that may or may not ever happen. Your life can improve by becoming aware of this reflexive and habitual pattern.
Think of ONE thing that you do that pushes people away.
Think of ONE thing that you do that draws people closer.
Find a comfortable spot to sit, either seated or lying down. Take a moment to focus on softening your body and releasing any tension in your shoulders. Close your eyes.
Focus your attention on your breathing. Observe what it feels like to be "in" your body, in this moment, as you slowly breath in and then breathe out. As you spend a few minutes here, Imagine that you are “riding the wave” of your own breath. You feel safe.
Next, shift your attention to your thoughts. Begin to notice your thoughts. They are just thoughts. Nothing to do in this moment but
Most of us have default behaviors that we do automatically when we feel stressed, distressed or upset about something. Some behaviors are more problematic than others, for sure. Clients seek therapy to discover new and more adaptive ways of dealing with powerful feelings and emotions. Some common self-destructive coping mechanisms that create a vicious cycle of suffering are:
Anger and negativity often remain long after you leave someone or someone leaves you. Anger is a power emotion. If you want to heal and move on, releasing anger is the only way to really free yourself from the other and release the energetic bind. Sometimes the fear is that if we give up the anger, we lose the connection altogether, and so we unconsciously hold onto the anger to maintain the connection. The questions are: What other ways can you imagine having a connection? What kind of connection do you wish to have? Do you really want to be free?
How have you left things, and are you still connected through anger?
Are you someone who over identifies with your emotions or physical sensations? It's easy, even habitual, to get caught in the tide of strong feelings and emotions. Sometimes they come upon you without warning -- fast and fierce -- leaving you feeling distressed and emotionally dysregulated. You may even feel like you're not in the here and now, but back in the there and then. This feels like something else, some other experience in the past. Emotions can feel strong, and overwhelm, but remember, you are NOT your emotions. To increase your self-esteem and sense of agency, notice when powerful feelings arise within you. Identify what may have triggered this in you. You might typically say "I CAN'T do this. I'm completely overwhelmed." Try a reframe by saying "I FEEL completely overwhelmed." How does this simple shift help? By understanding that "overwhelm" is a feeling, and YOU ARE NOT YOUR FEELINGS. "Feelings" are temporary states, transitory. Feelings pass. Ride it out, or in DBT speak, surf the wave. The psychological impact of this strategic shift can be incredibly helpful.
FAST is a wonderful mnemonic device to help you gain enhanced self-respect and increased self-esteem as you negotiate easy and even the more challenging interpersonal situations that you may encounter in your daily life. It's borrowed from the truly awesome DBT treatment and here's how it goes...
Fair - Be fair when you negotiate. Make sure that you accurately interpret situations. When working with others, one goal may be to come to solutions that are ethical and benefit everyone involved.
Apologies - No, do not apologize for disagreeing because doing that contradicts your values. You have a right to your opinion and viewpoint. This is about being true to yourself because you gotta learn to love you.
Stick - Stick to your values. Boldly. Not sure what your values are? Work with a therapist, coach, trusted friend or parent to help you get clear about where you stand on things. Never soften on your values to make others happy or to gain their favor. This erodes your sense of self.
Truthful - Be truthful when you communicate. Authenticity and honesty helps you feel better about yourself, which leads to a happier and more authentic life. Again, this is hard if you're a people pleaser, but people will respect you more, and you'll love yourself for it.
Stay tuned for more #shrinkthinks and DBT self-help.
You can read lots of self-help books and pay thousands of dollars in workshops and webinars, but in my opinion, a happy, healthy, well-balanced life can be achieved by paying attention to the following: Sleep, meditation, nutrition, love, exercise and play. #wisewords
Interrupt those negative, life-draining thoughts that serve to maintain faulty brain wiring AND keep you looping in the familiar. The next time a negative thought, or the memory of pain or anger comes to mind, simply say to yourself "stop," "go away," or “I release you” and visualize yourself free and without this negative distraction. Learning to interrupt habitual, repetitive thoughts or distortions, called "thought stopping" or "thought interrupting" in CBT, can be a challenge, and definitely takes practice. So what do you do with the empty space once you decide to banish unhelpful thoughts? It's important to replace the negative cognitions with a more realistic thought or experience that is reassuring, beneficial and more aligned with the changes you'd like to make for yourself.
Okay, so sometimes thought stopping doesn't work. Why? For some, the CBT strategy of "thought interrupting" backfires, to such an extent that all they can think about is the thing, thought or feeling that they're trying to stop. If this describes you, then end the struggle because, for now, acceptance may be the most helpful solution.
What does acceptance look like? One example is: "I tend to worry about things a lot because I
When dealing with a loved one who is depressed, we often, quite naturally, default to strategies that are an attempt to help them feel better about themselves or their situation. Well-meaning attempts to cheer someone up such as "positive reframing" or "positive evaluation statements" aren't the most helpful solution for many people struggling with depression.
Instead, some benefit more from an empathic stance which involves simply listening to and sympathizing with the way they are feeling, not listing all the things they should feel grateful for and why they should cheer up.
Why do you worry so much? Because you believe that your worry, which leads to more anxiety and distress, keeps you safe. If you worry enough, and keep worrying, then maybe, you can stop it from happening. You have an odd relationship with your worry and chronic anxiety. It may keep you up at night, but in your bones, you also believe that it helps you avoid bad things. So in a way, your worry works for you. You believe that it prevents problems or accidents, it prepares you for the worst and you also believe that you may find some solutions in your chronic worry.
Wrong, it's faulty thinking at work here. Worrying doesn't really help and worrying doesn't
Practice the imaginal technique of holding the desire to act out or do something that you know doesn't serve you in one hand (left hand: I really want to have that third drink because I'm out and having so much fun with friends) and the consequences in the other hand (right hand: three drinks turns into seven and then I'm sloppy drunk-texting former lovers, or worse!). This is your imagination, so really hold them in your hand -- feel the weight, color and texture of these two very different actions. Remember this applies to many things, like food, shopping and other reckless behaviors, impulses or compulsive behaviors. Try this:
Doing (fill in the blanks) only helps or feels good for a short amount of time, but then it just makes things worse later. I can say no, or cope without it for another hour because the consequences suck! One hour at a time.
You can also write this down, two columns on a sheet of paper, and tuck it away in your wallet. Pull it out as needed.
What to do, and how to think? The best answer may be to take the Middle Path. What follows are tips for individuals whostruggle with extremes and "all or nothing" thinking:
1.Be open to seeing things from different angles. There can be many ways to solve a problem. Do some research and investigate how other people have solved similar problems. Who do you admire who may have some good skills in this area? Don't be afraid to ask for help.
2. Change is constant; nothing stays the same, not ever. This is life. Things may feel stressful and hard now, but very few things remain the same. Life may not always feel this difficult.
3. When viewing a problem or situation try to spend some time in the "gray area." Many think in "all or nothing" terms. Extremes in thinking or "black and white" really limits the quality of one's life. Learning to tolerate the "gray" can lead to a richer, fuller and more fulfilling life.
4. What is the Middle Path? It is Balanceplain and simple. The middle path is between acceptance and change -- it take both in order to live a balanced life. #shrinkthinks
What's your story? When you use "limited thinking" you may find that your mind begins to shape your reality. Learn to notice just how often these thoughts show up in your daily life. When they appear, ask yourself, "Is this really true and accurate?" Your real truth may be quite different from the story you habitually tell yourself. Learn to ground yourself in what's accurate and true, and the stories you tell yourself may, in time, become more positive and hopeful. #shrinkthinks
Questions of the heart: Can I be hungry and experience desire? Can I be hungry for love? Can I desire work and success? Can I allow myself to be nourished by food? Can I experience pleasure and Joy? Can I feel connected and loved by others? Can I feel powerful and effective without feeling guilty? Is it safe for you to feel full, nourished, effective and powerful?
This week, as we reviewed distress tolerance and handling difficult emotions in my eating disorder seminar, I was reminded of the concept of "radical acceptance." What does radical acceptance look like?
1. Learning to develop complete acceptance that comes from within.
2. Understand that painful emotions are a part of life -- they are normal and to be accepted.
3. Stop fighting (both emotionally and behaviorally). Learn to accept difficult emotions as a normal part of being human.
Try these strategies borrowed from DBT Therapy: IMPROVE the moment
I Imagery – e.g. visualize yourself in a safe place
M Find some meaning in the situation
P Prayer (what ever form that takes for you) meditation, spirituality, affirmations
O One thing at a time
V Vacation – take some time out of the situation, "me" time, or imagine yourself in an idyllic situation E Encouragement – use positive and calming self talk
Not relationships or anything else in this life. It's helpful to know that any relationship will feel different according to our thoughts in the moment. This can be both scary and liberating -- the power of acceptance and letting go! We have a lot of control and power over how we respond to people and events, thus the possibly of change and a different outcome can be a reality. Acceptance of what is, the sweet release and finally peace, is always available to us.
Instead of looking for problems, scan for areas of acceptance and gratitude.
When you have a crabby habit of mind, you often try to correct imperfect situations and you get overly concerned with other people's faults. You then may do your fair share of "turning against" the "bids" of others. You scan the world for evidence to justify your reactions. (You left the milk out again!) - John Gottman
Some people have a chemical imbalance and may need an antidepressant to improve their mood and chronic irritability, while others need to change the way they respond to triggers and happenings in the environment.
If this describes you, try this shift: Instead of looking for problems, scan for areas of acceptance and gratitude.