Putting together different DBT-Skills

I will try to clarify some emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness skills that I hope might be useful.

Mindfulness practices:

These are daily and for low levels of distress. You can try them in high distress but may find that unless you’ve been practicing them regularly they may be inaccessible.

We start with selecting a joyful, peaceful, powerful, in love, or safe moment to focus on. Even if the moment had a down side we can hold both realities or truths at the same time (a dialectic), alternating focus back and forth. We’re searching for a full body experience of the moment. It is the both the same as, but the opposite of, thinking about a stressful moment and that feeling flooding back.

This is a mindfulness practice that, once a couple of potent memories have been identified, can be practiced in 10-15 second periods throughout the day. You wait till the body feeling of the emotion returns to know you’re done.

Another practice that helps straighten out our thoughts is “Everything is perfect” on inhale and “As it is” on exhale; give yourself full permission to mutter “Even if I don’t like it” – I’ll write more on non-judgment later but this practice is at the heart of it.

Distress tolerance practice:

When a moment hits hard it is time for TIP!
Temperature: Increase heat for depression and cold for anxiety or anger
Intensive: a 20 second burst of activity, jumping jacks etc.
Pressure: Palms up push on the bottom of your table, hug yourself tightly, put a coffee table type book on your chest laying down

If still not calm decide if your head is spinning or you feel agitated physically:

Spinning mind: Do the ABCs – pick a topic (cities, names, cars…) and go through the alphabet matching (i.e., Audi, BMW, Chevy, Dodge…) sounds easy but quite complex – if you can’t match a word/letter skip it rather than frustrating yourself

Agitation: hold an ice cube till it melts; inhale to a beat of 4 or 5, exhale to a beat of 6 or 7; repeat two more times to restabilize your system

Now, you’re ready for a ‘chain analysis’. Stop, note the distress and ask yourself when was the last time I felt better/stable/good…..

From that point track events and reactions, how quickly or slowly, overwhelm set in. Where there any actions that I can consider changing in the future without judging my reactions/actions in the past; for instance, sometimes the immediate impulse to behave worsens the situation rather than improves it. (This can be an empowering process if non-judgment is practiced)

The most important part of the exercise is to restore the feeling of sanity. When a chain analysis is done it should make perfect sense to me why I feel as bad as I do.

Emotional Regulation and Interpersonal Effectiveness practice:

Opposite action, opposite action, opposite action for down regulating an emotion. For instance, someone disappoints or irritates me. I may thank them for being involved with me as a friend; gratitude is the best antidote for anger. I will find a better more peaceful time to address their behavior. Knowing I have an action plan is empowering; knowing why I’m choosing to do what I am doing is also empowering; practice smiling inside because there is a secret plan the other person does not know about that is going to help me get my way/point across/etc.

Rather than being defensive to criticism practice listening, reflecting back what was said and see if you got it right, thank them for their concern and point of view and tell them you’ll think about what they said. Go to a trusted friend or therapist and ask for help in determining how accurate the perceptions are 2%? 50%? 97%? Maybe they see a ‘blind spot’ if so you can thank them again; if not then if you want you can tell them there is likely some truth to it but you don’t see it.

Jon Ubick copyright 2013

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Self-soothing making it work for you

SELF-SOOTHING PRACTICE

Everyone is familiar with the idea of self-soothing as it relates to how we calm ourselves with our words or ‘self-talk’. For instance, we might tell ourselves, ‘it will be okay,’ ‘I’ve survived worse,’ ‘this too shall pass,’ or just having the wisdom to know the difference between what we can change and what we can’t change. Believe me, without the kind of self-soothing we are going to practice these will likely feel hollow.

We are going to talk about something completely different. If our brains are stuck in a depressive loop we might not notice if something ‘good’ or pleasurable happens, it just might not register. We actually have to re-build brain pathways that are capable of experiencing joy, calm, equanimity, pleasure, peace, or love. Think of them as dormant and needing a good spring rain.

Let’s start preparing our brains for new experiences, it won’t happen on its own. It takes practice, then some more practice, followed by more practice…you get the idea. Some days you might find the practice ‘makes’ you anxious, bored, or uncomfortable. On those days, just notice without judgment, if you do judge practice not judging the judgment, keep practicing and chalk it up as a success. Remember, your brain is not used to some experiences and they initially may be out of reach.

About 99% of the time when I teach the practice of self-soothing the immediate cognitive reaction is that I’m asking you to over-indulge, like the attempts you may have tried at self-soothing with food, drugs, sleep, or sex. The distinction that I make is that indulgence is inherently self-destructive and soothing is healing. We all have the inner wisdom to decide what is beneficial for us, and if we error on that, we learn from it and modify; it’s the way wisdom works.

STEP 1 – GET: Identify your five senses. Touch your eyes, ears, nose, tongue, and finger tips if it helps you remember.

STEP 2 – READY: Match a pleasurable experience that you can create for each sense. This is both the easiest and hardest part. Easy compared to the actual practice and hard if everything in the world feels dark or gray. If any suggestion makes you wince, move on and honor that reaction, find something that seems like it might work. If you are not currently experiencing at least a half hour of calm and equanimity each day you may find it harder to identify pleasurable experiences, you may have to imagine a time when you were happy, or think about what happy people do.

Some examples that my clients have come up with (feel free to benefit from their experiences):

SIGHT – remember this is the primary sense for the sighted: A picture from nature, a beach, mountain, forest, an animal…

A picture of a pet, or a loved one (maybe a baby photo of yourself or a favorite baby), or if you have a spiritual practice something related to that…

A flower, the flame of a candle, a fire in the fireplace, a mandala or tanka, clouds, the moon and stars, sand on a beach, a patch of grass, bark on a tree, a leaf you’ve found, a favorite piece of art or architecture (try seeing a detail heretofore not noticed), your own hand, fireflies, aurora borealis…

…come up with your own, close your eyes and try to remember something that struck you as beautiful. Pick one or two you can try today. Remember this is the primary sense for sighted humans.

SOUND: A chime, Bach piano concertos, types of music that are calming, children playing in a park, a clock ticking, your own singing, humming or chanting, relaxation music, a guided meditation, singing in a language you don’t understand…

A fountain gurgling, waves crashing, or river trilling, birds singing, the silence of a mountain top, or desert, if you live in an area where there are frog croaking or crickets cricketing…

…use your imagination and give your idea a try. This is about practice and discovery. Which two might work for you?

SMELL: Essential oils or scented lotions, lavender, rosemary, citrus, take a orange/lemon/lime and scrape the skin with the back of your thumbnail to release the oils, cloves…

Baking or cooking, put some gingerbread in the oven and bake it, cook some onions on low/medium heat toss in garlic if you like that smell (use them in a recipe later), put on a pot of coffee…

Roses, freesia, gardenias, herbs, spices, pine…

Scented candle, cologne…

…smell is a very powerful memory sense. Think of a happy moment and any associated smells. Pick one or two that you can you can carry with you in a pocket and smell throughout the day.

TASTE: A single chocolate chip melting on your tongue, chai spice tea, coffee, a single ginger snap…

A mint leaf, basil, a drop of an essential oil…

Think about a favorite taste and how you might sample it.

TOUCH: A bubble bath with epson salts (your skin will feel very slippery to your hand), a hot shower maybe targeting your scalp, shoulders and back (notice how your whole body feels water touching it…

A piece of smooth rock, wood, metal, or glass…

Almost every culture has some kind of a string of beads; ‘worry’ beads (ironically used for calming), prayer beads, rosary beads, malas, crystal, wood, other beads. As you sit and breathe move one bead between your thumb and index finger each full breath or on the inhale and again on the exhale, notice the texture…

Massage the meaty portion of your hand between your thumb and index finger (lightly at first and deeper as comfortable), hold your hands in a limp manner and with your finger tips lightly and loosely tap your scull, boney ridges of the face, shoulders, chest, legs, hips (you body will be the part experiencing the ‘touch’)…

Let me know what you discover to be soothing so I can add it here.

Hopefully, you get the idea.

STEP 3 – GET: Pick a regular place and time to practice. If we think ‘oh I’ll try this’ without picking a specific place and time (our intention) it is very likely that it won’t ‘just happen’. Even when we pick a place and time notice if something gets in the way, learn from that, and modify if needed.

STEP 4 – SET: Regarding time we have to ask ourselves “Am I ready, willing, and able?” Able means I think I can sit and practice for at least 3 minutes. Willing means no one is forcing me to practice and I’m doing this because I think it might be helpful to me; I’m doing this for me. Ready means I’ve thought through what means I am going to use to soothe my senses and have them available in the place I’ve chosen to practice.

STEP 5 – AND: Make two five-senses soothing practices. For instance, you may choose to put a flower or candle next to your hot bath which has scented oils and epson salts in it while soft music is played and let a single chocolate chip melt in your mouth (you probably won’t get out of the bath to get a second one). Did you pick out the five senses being targeted?

Or you may choose to have a picture of your dog in front of you (or your dog in your lap) as you listen to silence punctuated by the breakthrough noise we usually filter out (tick-tock, cars going by, doors closing, foot steps, your own breath), while rubbing lavender lotion into your hands, and sipping on chia spice tea.

As can be seen these take a little planning. One client joked “my therapist is telling me to have a good time.” Really what I am asking is that you practice having good times. They are essential to feeling like life is worth living.

Make your own practice, preferably two so you can see if you like one more than the other. Keep modifying until you find what works for you. The examples given are not exhaustive but illustrative.

STEP 6 – GO!: Now the hard part, practicing. See if you can set aside five minutes a day, or several times a day to have a five-senses break. It is a good way to get out of your head and counterbalance your ‘pain body’. As we practice we are actually changing our brain pathways and rebalancing our neurotransmitters and preparing for new experiences.

You may realize that once your brain is stuck in depression and upset finding joy and peace take effort. The more difficult this is for you tells you how much work is needed and how shut down these processes have become. No matter how big the task you can only take one step at a time, and sprinting won’t help if you have miles and miles to go. Recognize that ‘a journey starts with one step’, you can only take one step at a time, and be realistic about how far the distance may be. Now you have some steps to take, in fact 6 Steps. If you notice a week goes by without practicing, don’t judge (or if you do judge practice not judging the judgment), and practice. I promise you this only seems simple. Good luck and let me know how it goes. I’ve helped many people ‘trouble-shoot’ the process of developing a practice so if you get stuck re-read the steps and if still stuck write me.

GENERAL THOUGHTS: This practice crosses the DBT categories of mindfulness, emotional regulation, and distress tolerance. Once you have a habit of experiencing satisfying moments you will be able to use this in a crisis. Imagine a fight with a family member with phones being slammed down and words said that can’t be taken back, then a piece of mail arrives that you were dreading, followed by you pet pooing on the carpet. You may be so overwhelmed that you give your self time to self-soothe before even thinking about how to deal with the onslaught so you can find equanimity to deal with life as it is. But that’s a different DBT category: Interpersonal Effectiveness.

©12/28/11 jon ubick, psy.d.

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the ‘pain body’

many people i know, including myself, find the concept that E. Tolle uses, ‘the pain body,’ to be helpful to understanding of their experience of the world, whether, frequently or infrequently. from experience the frequently-experienced is the more exhausting of the two and infrequently is almost tolerable.

the pain body is, as i understand it, the part of self that is adept at accumulating ‘bad’ experiences, connecting them to each other, and recruiting any new painful stimuli into the experience. all pain is activated all the time in this state. formerly neutral experiences can even take on a fear that you missed that you were being hurt or shamed at the time they occurred and now feel quite awful. (learn its distinctive voice ‘this always happens’ ‘you never’ ‘you should(n’t) have’ ‘ ‘ – so that you can identify it when it starts)

i should add here, the pain body isn’t malicious, it’s not trying to hurt you, it’s not trying to make you miserable, it’s not trying to ruin your life! it just does.

understanding that it is just in extreme distress and pain and really needs some soothing, a balm, calm, stillness, a rest, and respite. it’s easy to misunderstand the pain body’s intention because it appears harsh, violent, panicked, accusatory, angry tone (now you know why you appear that way sometimes too!)

we know from the latest findings in the study of chronic pain that this phenomena is a neurological-body with a life of its own. it’s true that ‘neurons that fire together wire together’ and we get a compounding effect that is additive, then starts multiplying, takes on geometric proportions, and can simply make life unbearable.

this concept is helpful to some for understanding the intensity of the present moment.

of course, the picture would not be complete without mentioning the ‘pain body’s’ ability to anticipate more pain in the future and in doing so further making ‘now’ hopeless.

if there is any way to lessen the devastation of this process it must be found. understanding the ‘pain body’ doesn’t take away the pain but can reduce the suffering pain causes.

i’ll write next about developing a self-soothing practice, developing a plan for dealing with extreme distress, and making a life worth living.

©12/04/11 jon ubick, psy.d.

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DBT Blog

About this type of therapy. Coming Soon

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