Self Soothing and Distress Tolerance: DBT Skills for Stressful Times
Estimated watch time: 59 mins
Available credits: none
Objectives and Summary:
The purpose of this presentation is to provide education and awareness to clinicians and community members on dialectical behavioral therapy (DBT) as an intervention. The presentation is also meant to share concrete principles and tools with clinicians and members of the community that can help them reduce stress, improve emotional regulation and enhance overall mental well-being.
After watching this presentation, the viewer will:
- Understand the history of DBT, as well as how and why it was developed
- Be aware of the principles that underlie DBT and how they are effective in treating certain mental health disorders
- Have a basic understanding of DBT and potentially be able to incorporate its general ideas into clinical treatment
Presentation Materials:
Presenter, Ritu Anand, LCSW has over 15 years of experience working in a variety of nonprofit environments with different populations including immigrant families and adults, children with disabilities, college students, families experiencing domestic violence, and adults with severe and persistent mental illness. Ritu also has a background as a clinician, trainer, and supervisor in the fields of community mental health and crisis intervention. Ritu is the founder of Creative Healing Collective, LLC.
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Welcome to the Community Education Series, hosted by The Recovery Village and Advanced Recovery Systems.
Ashley:
My name is Ashley. Iām the event director for Advanced Recovery Systems. Just wanted to say, āHappy New Year,ā and thank you for coming to our first webinar in 2021. We will keep continuing to have these every Wednesday from 2:00 to 3:00 p.m., Eastern standard time. And if you want to be a speaker or have somebody in mind, please reach out to me, and we would love to start a conversation and have it set up. So, Iām going to go and introduce our speaker today. Ritu has over 15 years of experience working in a variety of nonprofit environments with different populations, including immigrant families and adults, children with disabilities, college students, families experiencing domestic violence and adults with severe and persistent mental illness. Ritu also has a background as a clinician, trainer and supervisor in the fields of community health and crisis intervention. Ritu is the founder of Creative Healing Collective. Iām going to pass it off to her, and if we can wait for questions at the end of the presentation, that would be great. Weāre going to save some time at the end. But if you want to put it in the chat just so you donāt forget it, you can do that, and I will monitor that. So, thank you for coming, and I will pass it to her.
Ritu:
Thank you, Ashley. I appreciate that intro. Thank you to everybody whoās here. Iām looking in the chat. It looks like we have people from all over the country. Thatās so amazing. I see somebody is a student, so I look really forward to if you guys have any questions at the end of the presentation. But as Ashley mentioned, weāre going to go through the presentation first. And Iām really grateful that you guys chose to spend your afternoon with me, so weāll go ahead and get started. And then like I said, at the very end, we can save some time for questions. Let me go ahead and get adjusted to Zoom; itās been a while.
Today, our presentation is DBT skills, and Iām specifically focusing on self-soothing and distress tolerance. I want to give everyone the disclaimer that DBT, which Iāll go further into what it is ā if youāre not sure what it is, itās a clinical intervention, and you can get certified as a DBT trainer. I am not certified as a DBT trainer, but I have had training and I have used the intervention. I just want to give you guys a disclaimer that this is not a substitute for getting more intensive training, but it is an opportunity to learn a little bit more about the skills, whether youāre a clinician and you want to implement them in your practice or whether you are just a community member. Whether youāre a community member or a clinician, and also for clinicians, we can use these ourselves. I definitely use them.
Letās go ahead and get started. This is just about my background, but I believe Ashley already introduced me, so weāll go ahead and move on. Again, we actually already kind of gave you guys a background, but I just wanted to give you a little bit more information. Iāve worked in assertive community treatment and community mental health. Iāve also worked in intensive psychosocial rehab, and often, our clients were those that were at high risk of recurrent inpatient hospitalization. We often had clients in our caseload that mightāve had a diagnosis of borderline personality disorder, which is one of the diagnoses that can benefit from this intervention, so this was something we often used as a clinical intervention in these environments. Just to kind of give you guys a background on where I was kind of using the DBT intervention, I was using it very often in these settings.
Todayās objectives: Weāre going to go over some history, some core foundational knowledge and then also talk about self-soothing and distress tolerance techniques. The purpose of speaking about these things is I wanted to give tools for you that could help you ease stress, increase relaxation and improve emotional regulation in your day-to-day life but also in times of stress, because I thought that was very relevant for 2020 and 2021 this last week. I think itās relevant in general, but I think especially when we have increased uncertainty times of stress ā where we might be more at risk of being emotionally vulnerable ā these can be really valuable. Give me one second, Iām just gonna do something here. Then I also wanted to give you guys some concrete tools on how to implement some of these practices, whether itās in your clinical practice or whether itās in your personal life. I wanted you to leave the training with some tools as well.
Weāre going to also do that at the very end. In the very beginning of our training, Iām going to kind of give you a little bit more information on DBT as an intervention and the history of it, and then weāll go more into the skills that we are speaking about. Because Iām focusing more on a little bit of history and some tools, itās not going to be as comprehensive. Like I said before, in the very end, I can talk to you more about, āWhere can I learn more? How can I get more knowledge on some of these contexts that Iām touching on?ā Thanks for your patience. There we go.
So, why did I want to present on this topic? As I mentioned a minute ago, I think itās very relevant always, but especially in our last year ā especially in our last week. These skills that Iām going to be speaking to you about were originally developed to treat chronic suicidality and also developed to treat persons diagnosed with borderline personality disorder. But I also think weāre living in, I would say, unprecedented circumstances ā maybe not in the history of the globe, but definitely in my lifetime ā with the global pandemic and with situations happening within our country at this moment. I would say a lot of the things that weāre facing and a lot of the ways our lives have changed due to that are very unprecedented.
COVID-19 has been going on for more than a year ā or I guess early last year. We started to learn about COVID-19, then a couple months after, a lot of places were shutting down. We all may be being impacted differently based on our own circumstances, but many of us have had changes in our day-to-day life based on the pandemic. The way that our routines used to be, the way that our days used to be structured, the coping skills that we used to use or our support systems that we had access to. Our usual coping skills and our methods of self-soothing ā we may not have the same access to them because of the pandemic. Also, weāve had recent events of civil, racial and political unrest in the United States that were going on over the summer. There was just a recent event in the news about a week ago, and many of us might be wondering whatās going to happen in the next week and just be uncertain about the future, whether itās about COVID-19, whether itās about our own personal lives and whatever changes weāve had to go through due to COVID-19, or maybe itās about the future of our political situation. I think itās very timely that weāre speaking about this, and thatās why I wanted to give people concrete tools on how to manage distress and overwhelming feelings because many people are experiencing an increase in mental health symptoms due to all of these things that I just mentioned.
We are going to go a little bit through the history of how DBT was developed. I know I brought it up a couple of times, but weāll go a little bit more in-depth. Again, the original treatment was developed for women at high risk of death by suicide, but I think that these are skills that can benefit many of us, especially in these times. Of course, they can also be used when weāre not in the midst of a global pandemic. They can be used in our day-to-day lives. They can be used if things get better soon; if we get a vaccine and things become more stable, it doesnāt mean we canāt still use these skills. And I think they can be very valuable in times of uncertainty, stress and crisis because we might be more emotionally vulnerable and we might have more emotional distress. We might have more intense emotions and have trouble managing them, but theyāre definitely valuable in times where weāre not having a crisis situation as well. I know in my practice with the clients, Iām seeing thereās a lot of people who are having a lot of changes within the span of a year. And it might be, āIām at home all the time with my partner and weāre really stressed out. We see each other all the time,ā or it might be, āIām really lonely. I donāt get to see my family as much.ā So, thereās a variety of different ways that people are experiencing the pandemic. I think itās really important right now too, considering that we donāt have our usual routines. Maybe we donāt feel safe to go to the gym like we used to, or maybe weāre trying to work out at home. There are just so many different situations that we might be navigating based on our unique personal circumstances, so I think that some of these skills can be very useful, especially right now. Thatās why I wanted to present on this topic.
Letās go ahead and talk a little bit about, āWhat is DBT?ā I donāt know how familiar everybody whoās attending would be with DBT. If youāre not familiar, I want to give you a little bit of background and also talk to you about how it is different than CBT. And if youāve never heard of any of those things, itās okay. Iām going to give you a little bit of a background on both things. And Iāll give you a little bit of definition on certain things we speak about, like borderline personality disorder. But again, I cannot comprehensively get into everything because of time constraints and the fact that weāre meeting for an hour. So, DBT is an abbreviation for dialectical behavioral therapy and it was developed by Psychologist Marsha Linehan. Linehan was originally looking for a diagnosis for people with borderline personality disorder and also looking for treatment for people who were at risk of suicide and self-injury.
She was evaluating the literature on effective psychosocial treatments for other disorders that were already established effective treatments ā things like anxiety disorders, depression and other emotion-related difficulties. What she originally did is she basically came up with, like, a package of evidence-based cognitive-behavioral interventions. She was specifically trying to target suicidal behavior. Iām going to give you a little bit more background on Linehan herself in a moment, but what she noticed is when she was focusing solely on things that were changing peopleās thoughts and behaviors ā weāre going to talk more about cognitive-behavioral therapy, but she was basically focused on how we help people change their thinking and their behaviors ā but she noticed that many clients were feeling criticized, misunderstood, invalidated. And some people were dropping out, or many people were dropping out of treatment. As she was coming through the literature ā as she was assembling an intervention herself ā she was finding that there was something missing with this intervention.
I want to talk to you a little bit about her theory of suicidal behavior. She had a bio-social theory that states that suicidal behavior is a learned method for coping with acute emotional suffering. She looked at suicidal behavior as a skill deficit, and weāll talk more about this coming up, but basically seeing it as a skill deficit, which means that people are trying to kill themselves as the solution for intense suffering because they donāt have any other options that they can come up with. Weāll talk more about this like I said, but a lot of the DBT intervention is focused on skills and skills training that might help people have other methods of problem-solving or managing really difficult, overwhelming and intense emotions.
So, what populations are treated with this intervention? As Iāve mentioned, the intervention was originally developed for people with the diagnosis of borderline personality disorder, and also for people that were having recurrent self-harm and suicidal behaviors. But itās also been found to be effective for patients with substance use disorders, people who meet the criteria for binge eating disorder, depressed, elderly patients. For those of you that may not know a lot about borderline personality disorder, Iām just going to give you a brief description. If you have the DSM, the DSM details all the different symptoms and factors that might lead to a diagnosis, but basically, borderline personality disorder is defined as a pervasive pattern of instability in interpersonal relationships, self-image, affects and marked impulsivity. One of the features of borderline personality disorder might be that someone has a marked reactivity of mood or affective instability. Thatās originally who Linehan was looking for effective treatments for when she developed dialectical behavioral therapy, but these skills can be helpful to other populations. I think that some of the skills that weāre going to talk about today can also be used in a variety of treatment settings. It may not look the same as a setting where people are certified in DBT and theyāre doing therapy based on the model of DBT, which I will detail to you guys in a moment, but I still think that we can use some of these skills with a variety of people. We will talk about them in-depth, but a lot of it is focused on regulating emotions, tolerating distress, improving relationships. I think anybody can really benefit from those.
Letās talk a little bit about Marsha, the founder of DBT. It was really interesting. I didnāt know a lot about her before doing this presentation, but she actually ā herself, at 17 ā she was put into seclusion at an inpatient unit because she was burning her wrists with cigarettes. She was slashing her arms and legs and her midsection with anything she could get her hands on. So, as a very young woman, she was self-harming and she was struggling with symptoms. Once they put her in seclusion, things got worse; she started banging her head against the walls, the floors. I believe I mentioned she was 17 when she was first hospitalized, and in her discharge note, during 26 of 26 months of hospitalization, she was one of the most disturbed patients. Thatās what they put in her discharge note. So, she was informed by her own lived experiences as she decided to pursue a doctorate in psychology.
As she founded DBT, she had been informed by her own experiences. I got this information from a New York Times article, but if you actually look it up, youāll find several New York Times articles about her and her history. In one, sheās giving an interview ā you can watch her speaking about it ā and sheās speaking about a religious experience she had at some point after getting out of the hospital. She had this religious experience where, all of a sudden, she had this moment of love for herself. And I think that informed some of these things weāre going to talk about. Like, weāre going to talk about acceptance, and thatās ā weāll talk further, but I think that informed her. She actually said ā in this article that Iāve cited ā she said, āI suppose itās true that I developed a therapy that provides the things I needed for so many years that I forgot.ā She was motivated by her own circumstances to build on the CBT interventions and add certain things into it.
Letās go ahead and talk about the difference between DBT and CBT. If you guys have not heard about CBT ā you can see a little graphic here ā but what CBT basically says is that we have a set of core beliefs about ourselves that we have internalized based on our past experiences. And these beliefs about ourselves impact how we think about ourselves, how we think about other people, how we may think generally, how our thinking has developed, what we think about the future. And CBT talks about a concept called automatic thoughts. That means automatic thoughts are the thoughts that we just have automatically without even really noticing. Itās like the tape that plays in our head, and often, we have these thoughts based on patterns of thinking, but also our own self-concept and what we have internalized about ourselves.
You can see that in the middle where it says core beliefs ā that triangle. But then surrounding the triangle, youāll see it says, āFeelings, behavior and thoughts,ā and you see these arrows. The arrows just mean that our thoughts influence how we feel, which influences how we behave. But also, our feelings influence our behavior and our thoughts; our behaviors influence our thoughts and our feelings. Theyāre all linked. In cognitive-behavioral therapy, which is an evidence-based treatment, often what the focus is is helping people identify thinking and patterns of thinking. Identify how those thoughts make them feel. Can we reframe those thoughts? Identifying thinking errors, like the ways of thinking that may not be effective or productive or may not make us feel good. Are there other ways of thinking about a situation? So, CBT has a lot of similarities if itās just that it adds on and builds onto that intervention.
Some of the things that are unique about DBT would be the four following, which I will break down for you guys. Iām gonna go over it, and then weāre going to break it all down as well. DBT serves five functions of treatment. Thatās the first thing that makes it different. It is based on a bio-social theory that emphasizes emotion and treatment, and itās also based on dialectical philosophy, and it incorporates mindfulness and acceptance-oriented interventions. Letās talk about what all that means. The five functions of DBT treatment: The first one is enhancing capabilities. In the beginning of the presentation, Iād mentioned to you that Linehan saw suicidal behavior as a skills deficit ā not having the skills to deal with those intense emotions that make people feel like life is not worth living. So, the first function in DBT is that the treatment is meant to enhance capabilities. The assumption is that patients need assistance in developing critical life skills, which includes emotional regulation skills, mindfulness skills, navigating interpersonal situations effectively, tolerating distress and surviving crisis without making things worse.
This is usually achieved with weekly skills training. Usually, itās a group of four to 10. Thatās what they recommend ā four to 10 individuals in a group setting. It would be a skills training. It would be like a group that focuses on skills training. And usually, what would happen is you would use the group setting to let people practice these skills that youāre teaching, discuss the skills. And also, give homework assignments so that people can practice in between sessions as well so that they can really develop these skills that weāre trying to teach, which weāre gonna go over what some of these skills are. Weāre not going over every single skill that DBT teaches ācause the intervention also teaches how to have better interactions with people ā like, interpersonal situations ā but Iām not focusing on that today. Iām going to focus on some of the other ones, like self-soothing and distress tolerance, but the purpose of the weekly skills training would be so that the people attending the group would be able to develop these skills and practice them in a group setting.
The second one is generalizing capabilities, and what that means is we want to make sure that whatever we are focusing on in treatment is also going to work in the personās natural environment, where they go after they come to group or after they come to one-to-one therapy or whatever the program might be that theyāre attending. The way we would do that is giving homework assignments, and a lot of times, this is also achieved in one-to-one therapy. Often, people are recommended to attend both one-to-one therapy and group skills training. Many DBT therapists are also available to people between sessions in case theyāre having a crisis situation.
The third function would be improving motivation and reducing dysfunctional behavior. This would be ā again, itās a lot like what it sounds ā helping the patients have the motivation to change and also reduce behavior thatās inconsistent with a life worth living. The goal for people who are at high risk of suicide is to help them have less behaviors that would contribute to suicide and also to have a life worth living. Often, this is also through one-to-one therapy. A lot of DBT therapists will have something called a diary card, which is basically tracking treatment targets. It might be self-harm. It might be suicide attempts. It might be emotional misery. They would track the treatment goals that theyāre targeting. It might be reducing suicide attempts, reducing self-harm. In one-to-one sessions, as theyāre tracking those behaviors, the clinician would usually focus first, of course, on the life-threatening behaviors. Those would be given priority, but then they would also, depending on what has happened that week, they might also be talking about therapy, interfering behaviors. If a person is absent, late, non-collaborative with the therapist, as well as behaviors that might interfere with the quality of life, then they might talk to them about what led up to the behaviors, whatās reinforcing or maintaining those behaviors. Are there other ways to problem-solve or regulate emotions to reduce those behaviors?
And then the next one would be enhancing and maintaining therapist capabilities and motivation. So, for the therapists that are dealing with people who might be having a lot of suicide attempts ā and there might be other things happening with the patients ā therapists need to make sure that they have the capacity to treat their patients and also that they have support. So, itās really important to have a consultation for therapists. Itās recommended that therapists have a team meeting, like, one to two hours a week that provides therapeutic therapist consultation. The purpose would be supporting the therapist, monitoring the therapist for burnout, validating the therapist, but also providing continued training and skill-building and making sure that the therapist keeps up to date on how to best treat the population and have the support, but also continue to build their skills as well.
And then the very last one would be structuring the environment. The point of this would be structuring the treatment environment to reinforce effective behavior and not reinforce maladaptive or problematic behavior but also helping the client structure their environment. For example, if someone is struggling with substance use, it might be talking about how their environment is ā are they in social circles or in a home situation where substances are available or people are using substances? Is there any way to be able to limit their access to those people or to substances within their environment? If someone is self-harming, we might talk about access to things that they could harm themselves with, or also whoās around them. Are they supportive or are they ā whether itās their significant others, whether itās their family members ā what is their interaction with their social circle, and are there ways that we can encourage the people around them to also have supportive behaviors?
So, that would be the ways. These are the really kind of specific things that are part of DBT that are not necessarily a part of CBT. That kind of is part of what makes DBT unique. And then thereās a couple of other things; thereās also the biosocial theory. This is basically speaking specifically about borderline personality disorder. You can see in the name bio-social: biological and social. Theyāre talking about the different contributions. Through this lens, people who developed borderline personality disorder are biologically disposed towards emotional vulnerability, which means a low threshold for responding to an emotional stimulus, intense emotional responses and difficulty returning to a baseline level of emotional arousal. And then the other part of it is the social part of it. Often, the thought is that there was a lack of skillful parenting.
Children look to their caregivers for a lot of things; they look to their caregivers to be role models for them. They watch their caregivers to see how we behave in certain circumstances. So, if a child is having emotional reactions and they donāt have skillful parenting, they may not learn how to regulate their feelings or even identify their feelings, and that may make it hard, as they get older, to know how to do that. Thatās why with DBT, the interventions are focused on behavioral skills that help people learn how to recognize, understand, label and regulate their emotions. So, the first step. Weāll talk more about this, but the first step is, āWhat am I feeling? Why am I feeling it? What is the feeling? How do I manage the feeling?ā And I think a lot of people might say, āI donāt think itās just people with borderline personality disorder who might have these struggles.ā If we didnāt really see people identifying their feelings, expressing their feelings, managing their feelings, I think many of us might not have seen that we might benefit from developing these skills.
The third factor is dialectical thinking. Basically, what this means is that reality consists of opposing polar forces that are intended. And I think itāll make more sense ā if that doesnāt make sense to you, weāre going to talk more about it. I think itāll start making more sense. But basically, if weāre applying change-oriented treatment strategies, it can create tension within treatment because the patient also has a desire to be accepted rather than changed. But each force ā theyāre different things, right? Being accepted and changing ā theyāre two different things, and they can be in tension and they also can be incomplete on their own. If we only complete, or if we only focus on change ā you have to change, right? We have to change ourselves. That can be incomplete because we may not feel accepted. But if we only focus on acceptance, that can also be incomplete and ineffective because, often, the people who are at very high risk of self-injury and suicide may require extensive changes in their lives to reduce their suicidal behaviors and thoughts and the feelings that contribute to them. Theyāre both kind of incomplete, and if we can kind of put them together, then that might be more of a nuanced and complete way of treating people.
Dialectical thinking can encourage more open-minded and nuanced thinking because itās both instead of either/or. Iāll show you guys some examples, but if you think about it, black-and-white thinking is, āEither Iām good or Iām bad. Either I did good or I did bad,ā where dialectical thinking might be, āI donāt like how I performed today, but I did my best.ā Right? Itās kind of like being able to not just think of things in black and white; thereās more shades of gray. Thereās more nuance. We can be more open-minded. Weāre not going to be as likely to think of things as, āI always fail, I never succeed.ā That kind of thinking can make us feel hopeless. It can make us feel certain types of emotions. That always/never, black-or-white thinking can contribute to negative feelings, and the other type of thinking can kind of hold space for nuance and contradictions.
Iāll give you guys some examples of that. So, I decided to make some examples of things that might apply to maybe this time right now with coronavirus. I am feeling challenged, and I can see some benefits of what Iām going through. Itās not just, āOh, this is great.ā Thereās, like, āLetās just look at the bright side. Letās just look at the silver lining.ā Iām validating the fact that I am feeling challenged, but I can also see some benefits of what Iām going through. The world is suffering, but a lot of growth is happening through this change as well. Iām feeling frightened, and Iām also feeling brave and resilient. I accept myself and I want to make changes. I think you guys can see how there is a ā itās not just one or the other. I can accept myself and want to make changes, which is, again, a lot about what dialectical behavioral therapy focuses on ā acceptance and also learning skills and making changes.
And then one of the last ones is mindfulness and acceptance-oriented interventions. Mindfulness are skills that help us to be in the here and now, and they help us to observe the present moment in a nonjudgmental fashion. Thatās one aspect of DBT. The other one is radical acceptance. Radical acceptance means that we accept the experience of the present moment for what it is without struggling to change or resist it. It doesnāt mean we like it or condone it. Itās not that weāre happy that weāre in a global pandemic ā itās that we acknowledge we are in a global pandemic, or we acknowledge that we are under stress. If we can accept the experience of the present moment and weāre not struggling to change or resist it, that can help us in many ways, which weāll talk about. Because we can kind of accept whatās in our control, whatās not in our control, and we might avoid labeling, like, āThis is good or this is bad,ā but itās like, āThis is what it is. I donāt like it, but this is what it is.ā
Weāre going to talk a little bit more about those things. Again, radical acceptance. The ways that it can help us in terms of our mental health is helping us realize that some things are in our control, but not everything is. Iām not happy about this global pandemic, but I also cannot control the fact that itās here or when it will go away. What I can control is my own ability to manage myself and my safety as we all navigate it. Thatās when we kind of think about whatās within our control. It can produce feelings of stress and anxiety. It doesnāt mean we donāt have stress and anxiety, but it can help us focus on whatās in our control. I gave you guys an example of typical thinking versus radical acceptance. Typical thinking might be, āItās unfair that COVID-19 has been going on for more than a year, and Iām not able to spend time with my family and friends.ā Is it unfair? Yes, itās unfair. I donāt like it. I donāt want to be stuck in the house. I know not everybody is able to stay at home. I know some people are going to work ā and frontline workers ā so everybodyās having a different experience. But yes, it is unfair. Radical acceptance might say, āIām unhappy that weāre in a global pandemic that restricts what Iām able to do, but Iām going to take precautions to stay as safe as I can and figure out how to get the vaccine as a way to reduce my risks.ā It doesnāt mean, āOh, Iām so happy that Iām worried about leaving my house, seeing my family members and that this has been going on for a while.ā Itās not about that. Itās more about validating that Iām unhappy about it, but also Iām accepting that thatās where we are right now.
So, I put the serenity prayer in here. You guys may have heard of this before; itās often used in 12-step groups, and I think it kind of really demonstrates the concept of radical acceptance. It usually says, āGod grant me,ā but not everybody is religious, so it may not apply to you. So, I just put in some other stuff ā God, universe, a higher power ā or you just can take that part out. You can just say, āGrant me the serenity to accept the things that I can not change, the courage to change the things that I can and the wisdom to know the difference.ā And I think thatās a really good reflection ā theyāre talking a lot about whatās in our control. Some things are, some things arenāt. Maybe we have to accept sometimes when things are not within our control and then focus on what actually is within our control. And if we spend a lot of time focusing on things we canāt control, like other people or things that are complicated and beyond us, then we can feel helpless and we can feel distressed.
So, distress ā what is distress tolerance? āCause Iāve been using the word; you may not have known what Iāve meant. Letās talk more about that. Distress tolerance is the ability to tolerate and manage painful, overwhelming or intense emotions, and the ability to use techniques to manage or reduce the emotional intensity of emotions and enhance coping skills and the ability to regulate your emotions. Part of it is being able to identify our emotions. Itās really important too because weāre talking about managing painful feelings, but if we donāt even know what weāre feeling, thatās going to be hard. A lot of times, we have to work on identifying our feelings as part of the skill. And once we are able to ā when we become accustomed to identifying our feelings ā it can help us understand how to manage them as well.
I just put a couple of things about identifying feelings. I put āfeelings are not good or bad.ā Often, when I was running groups in my previous place of employment, we would talk a lot about anger management and that anger is not a bad emotion. Itās an indicator of something. Itās something thatās telling us feelings or information. When we are feeling something, itās information for us to pay attention to; if we donāt pay attention to it, the feeling will still be there ā almost manifest somehow. Anyway, there are not good or bad feelings; feelings are telling us something. Itās telling us to pay attention. And then āfeelings are not facts,ā which just means that sometimes, we can see things through our feelings. Like, we are interpreting situations based on what weāre feeling but that may not be whatās actually happening, and weāll talk more about, well, then how do we counteract that? How do we manage our feelings in a way where we can look at our own assumptions and interpretations of whatās happening?
Identifying feelings ā Iām just giving you a little bit of this. Thereās a lot more about this, but just to give you an idea. A lot of times, our bodily sensations ā our signals ā are giving us a clue as to what weāre feeling. If youāre feeling angry, it depends, but you might tense up. Your jaw might clench. Your shoulders might get tense. You might breathe, shout, or if youāre feeling nervous or anxious, your body might react. A lot of times, itās noticing our body and our signals. In treatment ā often, when I was doing groups, we were using feeling charts as another way. Feeling charts are pictures of emotional expression and what feelings are associated, and then they can be used to help people identify their feelings. With kids or also just in general, if youāre doing work with helping people identify their feelings, sometimes you can use feeling charts, but also journaling, exploring your feelings or being in therapy. I didnāt put that on here, but having the support of someone else where you can process feelings, because feelings can be complicated. And then another thing would be just slowing down, ācause when you slow down ā which isnāt always easy, but weāre going to talk more about it ā youāre more likely to pay attention to your bodily signals. And then mindfulness skills can help us slow down again. Mindfulness is being in the moment. Meditation. I know not everybody likes meditation, but thereās a variety of ways that we can practice the mindfulness ā the slowing down ā without actually having to sit down and meditate for 30 minutes. Weāll talk more about that in just a moment as well.
Iām just looking at the time to make sure weāre not running out of time yet. Weāre going to kind of try to get through these last couple slides. These are the last part of the training ā what are the things I can take home for myself and for my clients? Weāre going to talk about distress tolerance techniques. Acceptance ā weāve already spoken about ā which is learning to have the thinking, which is, āI accept what is happening. I donāt like it, but I accept it.ā But weāre going to talk a little bit about distraction and how to improve the moment. DBT has a lot of acronyms, and you can find worksheets all over the internet that talk about this acronym and break it down for you. Thereās a website called Therapist Aid that has all sorts of worksheets that has the acronyms and examples. Iām going to go over examples for you, but you can also access these. And Iāll talk more about other resources for learning more about DBT in the end, and youāll be able to learn more, but they use a lot of acronyms in DBT.
So, distraction. I want to really quickly say that we tend to sometimes think if we distract ourselves, itās a negative thing. It means weāre avoiding our feelings, and avoidance ā avoiding our feelings ā is a little different than what this is. Distraction is more about using skills that ā Iām going to actually take out my notes because I also need to look at it. So, the way that they refer to a distraction is that our negative feelings will usually pass or lessen with intensity over time. So, itās not about avoiding your feelings ā itās about doing something that could distract you so that the emotional level or the intensity level can reduce so that maybe they are more manageable, these negative or painful feelings. I just want you to think of it in that context. The acronym is ACCEPTS: activities, contributing, comparisons, emotions, pushing away, thoughts and sensations. That probably makes no sense, but Iām going to go through it with you.
Activities ā again, these are all methods that can help reduce the intensity of our feelings. Activities is anything that requires thought and concentration. Engaging in an activity. If youāre at a very high level of emotion ā youāre at eight or a nine of a feeling ā it might be helpful to do something like a hobby, a project or even work or school to get your mind off of it. Doing something that requires focus ā it might just kind of distract you. Contributing, focusing on someone other than yourself. Volunteering, doing a good deed, contributing to a cause. It doesnāt have to be volunteering. It could be, āIām going to call my friend and see how theyāre doing. Iām going to make dinner for somebody. Iām going to write a card to someone. Iām going to call someone and see how theyāre doing, or do a Zoom chat with somebody.ā Just getting the focus off of yourself.
There are also comparisons. So, we tend to often think itās ā I know for me, I donāt. When I see this, I think, āOkay, but we shouldnāt compare ourselves to other peoples.ā We should validate what weāre going through, but I think this is different. Comparison in this sense could be about having perspective. Itās comparing to something worse than whatās happening, but not in a way to invalidate your feelings, but more of maybe a perspective-taking. So, can you think of a time when you were in more pain than you are now? Where things were worse than they are now? Or can you think of someone else who might be struggling more than you are? Itās, again, not to invalidate what youāre going through, but just to maybe reduce the intensity of your emotion by having a different perspective on it. Often, when I was running groups with this concept, a lot of people were able to say, āYeah, Iām going through a hard time,ā but when they were reflecting, they would think about times where things were a lot more difficult and how they were able to still get through it. Often, that would be helpful for them,
Then there are emotions; this is competing emotions. So, this is if youāre sad, you can watch a funny movie. If youāre nervous, you can put on soothing music. Thatās the opposite of what youāre feeling. Pushing away is pushing away negative thoughts out of your mind. It doesnāt mean youāll never think about it, but itās more like putting things on the back burner so Iām not going to think about this right now. Maybe a different day when Iām less stressed out, Iāll come back to this, but right now, this is actually not that important for me to think about. Iām overwhelmed. Iām going to do something else, and then Iāll come back to this later. Thoughts is just doing something like counting to 10, reciting a poem in your head, reading a book ā basically, just trying to do something that requires thought as a way to manage overwhelming emotion. And then sensations would be a safe, physical sensation that might distract you. It could be a rubber band on your wrist, pinching your wrist with a rubber band ā again, not to cause pain, but just distraction. Having an ice cube in your hand and your mouth, sour lime, something that kind of takes you into your senses.
Then weāre going to talk about improving the moment. This is helpful to help us ground ourselves in the present moment, which can help us to relax our nervous system and be more in the moment. That just means weāre in the present rather than being in our thoughts or in our anxious thinking. Weāre getting into our bodies. Letās go through that. Often, we can use the five senses to think of ways to improve the immediate moment. Maybe for our sight, it would be, āMaybe Iāll take a nice walk in a scenic area.ā Lava lamp. We see the way the lava ā I donāt know if people still have those, but my nephew just got one for Christmas. Thatās where I thought of that. Or maybe thereās a calming video on YouTube. We watch it. Thereās all sorts of things that we can do. I just put a couple of things, but I want you, as Iām going through this ā weāre going to come back to this shortly ā I want you to think about what would be for you. Something that would help you soothe your senses when it comes to sight. Touch: It could be a warm blanket. Put the blanket in the laundry and wrap yourself around it. Self-care ā petting your animals, using your sense of touch. Sound could be music you like, or the sounds of nature, or calming sounds. Whether itās the sounds of birds chirping outside, or whether itās the sound of the waves at the beach or itās nature sounds, whatever it might be. Taste: You can have a small treat or take a piece of chocolate if you like chocolate and savor it and eat it slowly and just really taste the scent or smell.
You canāt see it ā I have a scented candle in my old agency, We used to have diffusers running, which would just make it more pleasant. It would smell nice. Thereās certain scents that can be calming ā like, I think lavender is one of them. You could have perfume or cologne and smell it. You could have one of those things that you roll essential oils on your wrist if youāre getting stressed. I know that not everybody has access to all of these things, but for some people, it might just be taking one of those perfume/cologne things out of a magazine, smelling it up, ācause that might be what they have access to. Some people hate the smell of perfume and cologne and that wouldnāt work for them, so I would encourage you to just do whatever works for you.
Iām going to try to run through these because I know weāre kind of running low on time at this point. Iām going to just kind of run through some of these other ones, and some of them are actually related to some of the ones that weāve already talked about. So, opposite action. We kind of already talked about this, but itās kind of like doing the opposite of how youāre feeling. I was saying to you guys, āIf youāre sad, you could watch a funny movie.ā This is where if you feel angry, you might typically shut down or yell at someone, but you do the opposite of what you feel and how you usually behave. If you usually yell when youāre angry ā Iām pretty loud ā right now, make a point to talk, like, in a low, slow voice tone or talk politely. If you usually withdraw when youāre sad, try to kind of get out of that and do the opposite and call a friend.
And then we were talking about feelings are not facts. So, check the facts. If youāre feeling a certain way, ask yourself what triggered this feeling. Why am I feeling angry? What was the trigger? Am I making assumptions or interpretations of what happened? What are the actual facts of the situation, and what am I interpreting? Kind of look into that, and then does my emotion and the intensity of my emotion match the facts of the situation, or does it match my assumptions or my interpretations? Thatās another way to help us regulate our feelings ā really thinking about the facts of what happened and what we are interpreting and what triggered us and kind of being able to analyze it.
Another acronym is PLEASE, and this is focusing on physical ā our mind-body connection. So, treating physical illness, going to get checkups. I know itās kind of hard right now with COVID, but making sure weāre taking care of our physical body, treating physical illness, trying our best to be eating healthy. Nutrition, avoid mood-altering drugs, sleep well, exercise. I think we all know that if weāre not sleeping well, we might be irritable. We might be tired. Our physical health impacts our mood, so thatās why these are also part of the emotional regulation. Thereās also paying attention to positive events. Itās very much human nature that we could have 10 compliments in a day and one person critiqued us, and weāll remember the one critique.
This is basically just ā if we had 10 compliments and we find ourselves focusing on the one critique ā refocusing our brains. Not just focusing on the negative, but looking at the bigger picture. But also, this could be just adding more positive experiences into your routine into your day-to-day. So, whatever you find to be positive. I like to take walks or I like to play with my dog or whatever is positive for you. If you like to listen to music, maybe you can play music as youāre doing your chores. Thatās something my therapist helped me with ā I never thought about it before ā to make chores seem pleasant. Now, when I wash the dishes, I light a scented candle, I listen to music. It doesnāt radically change your life and it doesnāt make everything ā like, if youāre having a hard time, it doesnāt radically change that ā but it does build. The more youāre able to add these positive experiences into your routine, whatever you find to be positive, it builds up over time. Youāll find that youāll just feel more relaxed, more pleasant overall.
Now that weāre starting to wrap up, I just want to ask you to think about one thing you can do based on what we talked about. Whether itās health-related ā it could be something small. Like, am I getting sunshine or am I in the house a lot? Am I moving around? Is my sleep okay? Is there something small I could do to improve my sleep? Is there something small I could do if Iām not getting hydrated? Iāve put a couple things here. You might have something different, but it doesnāt have to be a radical change. It might just be, āI need 10 minutes of sun because I work from home,ā or, āI need to make sure I Zoom with my friends once a week ācause Iām not seeing people,ā if you work from home ā Iām speaking from my own experience. Or, āI need to not look at the news at night because Iām anxious and now Iām staying up all night.ā I want you guys to think about if thereās any one health-related thing you can improve upon, and then I also want you to think of the self-soothing. Using the senses, is there one thing that you can kind of add into your daily routine? Again, one thing that I have right now is a scented candle. Iām drinking tea. Iāve got these things right here for if Iām nervous.
I apologize. I know I went a little bit longer than I meant to, but basically, yeah, I think that would be the end. And now, I would be ready if you guys have any questions. If you have any questions about resources, like how you can learn more, I think we would be ready for that now. Someone put one more resource in the chat, but I will be just sending it now.
Weāre winding down, but we hope you guys can join us at the next presentation. And thank you again, Ritu. Thank you. Have a great afternoon, everyone.Ā
Thank you for watching this video. We hope you enjoyed the presentation.
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