Mindfulness. Take two.

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(DBT lectures are meant to be followed in order, because they build off one another.)

Mindfulness consists of psychological and behavioral skills drawn from Eastern Mindfulness practices.

Mindfulness skills help you to:

  • Be grounded with a stronger sense of self.
  • More consciously observe and experience yourself and your environment.
  • Reduce your feelings of emptiness.
  • Reduce cognitive disturbances such as dissociation ( where one compartmentalizes certain thoughts, emotions, memories, or splits off from them because they are too overwhelming) and delusions (ideas/beliefs system that is maintained in spite of evidence to the contrary and where one feels detached from one’s body or mental processes).
  • Increases your awareness of the present moment, without judgment.

3 PRIMARY STATES OF MIND ARE PRESENTED IN DBT:

REASONABLE (RATIONAL) MIND

“You are in your Reasonable Mind when you are approaching knowledge intellectually, are thinking rationally and logically, attend to empirical facts, are planful in your behavior, you focus your attention, and you are “cool: in your approach to problems.”

It is your rational thinking, logical mind. It is that part that plans and evaluates things logically. It is your “cool” part.”

  • Thinks rationally and evaluates things logically
  • Attends to facts
  • Plans behavior
  • Focuses attention
  • Approach to problems is “cool”

Reasonable mind can be beneficial:

  • People can build roads, homes, cities.
  • Can follow instructions
  • Solve logical problems.
  • Do math or science.
  • Run Meetings.

It is easier to be in Reasonable Mind when you feel good.

It is harder to be in Reasonable Mind when you don’t feel good.

We would use the Reasonable Mind to balance a checkbook; figure out the fastest way to get from A to B; etc. Reasonable Mind gives you a way to solve your problems.

EMOTIONAL MIND

“You are in Emotional Mind when your emotions are in control – when they influence your thinking and your behavior.”

  • Thinking and behavior are controlled by the current emotional state.
  • Thoughts are “hot” (In CBT and DBT, “Hot Thoughts” are thoughts that cause a lot of emotional suffering and can cause distorted thinking – thought after thought- like a “snow ball effect” and we can end up spinning with them).
  • Reasonable and logical thinking is difficult.
  • Facts are amplified of distorted to be congruent with the current emotional state.
  • The energy of the behavior is also congruent with the current emotional state.

Emotional Mind can be beneficial:

  • Intense love motivates relationships.
  • Intense devotion or desire motivates staying with hard tasks.
  • Intense love or hate has fueled wars.
  • Feeling passionate about people, causes, beliefs.
  • Emotions are what motivates us into action.
  • Emotions are what keep us attached to others and building relationships.
  • Motivation or reason to want to solve your problems.

Problems with Emotional Mind occur when:

  • The results are positive in the short term but negative in the long term.
  • The experience itself is very painful or leads to other painful states and events (e.d. anxiety and depression).

Emotion Mind can be aggravated by:

  • Illness
  • Lack of sleep; tiredness
  • Drugs; alcohol
  • Hunger, bloating, overeating, poor nutrition
  • Environmental stress (too many demands)
  • Environmental threats
  • Lack of exercise

WISE MIND

  • The integration of Reasonable Mind and Emotional Mind
  • Adds intuitive knowing to emotional experiencing and logical analysis.
  • That part of each person that can know and experience truth.
  • It is the place where the person knows something to be valid or true.
  • It is the place where the person knows something in a centered (balanced) way.
  • It is almost always quiet and calm in this part of your mind.

Mindfulness Skills help balance Emotion Mind and Reasonable Mind to achieve Wise Mind. Mindfulness Skills facilitate the development of, and ability to, access Wise Mind.

  • You can not overcome or control Emotional Mind with Reasonable Mind.
  • You can not create Emotion Mind with Reason.
  • Everyone has a Wise Mind. Some people perhaps have not experienced it.
  • No-one is in Wise Mind all of the time.
  • It is easy to confuse the Emotional Mind and Wise Mind because both have the quality of “feeling” something to be true. Intense emotions can generate feelings of certainty that mimic the Wise Mind.
  • Wise mind is in your heart (emotions) and in your head (reason). Certainty comes from both.
  • You must go within and integrate the two.
  • Wisdom, wise mind, or wise knowing is knowing by observing, knowing by analyzing logically, knowing by what we experience in our bodies (kinetic and sensory experience), knowing by what we do, and knowing by intuition.

E.g., Patient makes a statement: “I feel un-loveable” as if the feeling state provides information about the empirical reality. Question the patient: I’m not interested in how you feel. I’m not interested in what you believe or think. I am interested in what you know to be true in your Wise Mind.” The dialectical tension here is between what the patient feels to be true (emotion Mind) and what she thinks to be true (Reasonable Mind). The synthesis is what she/he knows to be true (Wise Mind). Linehan Pg. 42

 

 

 

 

 

 

 

 

 

 

 

Introduction To DBT

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The main course – as I like to call it – I take in outpatient treatment is called DBT. DBT stands for: Dialectical Behavior Therapy. It is an intense therapy method used for many different reasons. I call it a course because it is just as hard as the courses I take in college! Maybe even a little harder, because the homework I get for the lectures are all about being mindful and in touch with myself and being in the process of actively changing my “wiring” so to speak. I hope that sharing DBT with you will be beneficial and hopefully not to challenging to understand in this medium.

Here goes. I am starting from the very beginning.

Introduction to Dialectical Behavioral Therapy (DBT)

1. Dialectical: Any systematic reasoning or argument that places opposed or contradictory ideas together and seeks to resolve this conflict.

2. Biosocial Theory of DBT: This involves a biological disposition (not necessarily hereditary) in an environmental context.

A. Emotion Regulation: The combination of an emotional response system that is oversensitive and overactive with an inability to modulate (manage) the resulting strong emotions and actions.

1. Emotional Vulnerability Characteristics:

  • Increased sensitivity
  • Increased intense response
  • Slow return to baseline

2. Emotion Modulation Goals:

  • Decreased inappropriate behavior
  • Increased organization to act appropriately
  • Self-soothe physiological arousal
  • Refocus attention when “emotional”

B. Invalidating Environment & Effect on Emotional Vulnerability:

1. High emotional sensitivity, plus a lack of validation of emotional experiences, teaches the child to distrust his/her emotional responses, leading to either overreaction to emotions or under-reaction (ignores)  of needs or preferences.

2. This combination leads to behavior changes reinforced by the invalidating environment and may result in a Vicious Cycle: the invalidating environment leads to inappropriate behavior by the individual which results in more invalidation. Both the environment and the child (now adult) may exhibit the following behaviors:

  • Responds erratically & inappropriately to the individual’s experience (thoughts, feelings, sensations, etc). The invalidating environment is especially insensitive when individual’s experiences are not validated by the public (outside of invalidating environment).
  • Responds in extreme fashion  (overreact or under react) to the individual’s experiences that DO have public agreement/validation.
  • Ignores or disregards needs and/or preferences, as well as beliefs and communications. Further, the invalidating environment might punish the individual’s assertiveness.
  • Emphasizing controlling emotional expressiveness, especially “negative” feelings. Emotional pain is trivialized and attributed to the person’s negative traits. For example, the invalidating environment may blame the individual for their emotional pain, such as accusing them of lack of discipline, lack of motivation, or failure to adopt a positive attitude.
  • Restricts demands a child may make upon the environment.
  • Discriminates against the child based on arbitrary characteristics of the individual.
  • Using abusive punishment to control behavior.

C. Effect of Invalidating Environment:

It increases emotion dysregulation by failing to teach the child to label and manage arousal, to tolerate stress, and to trust his/her own emotional responses as valid interpretations of events. The child learns to invalidate his/her own experiences, making it necessary for them to scan the environment for cues about how to act and feel. The invalidating environment oversimplifies life’s experiences and the task of solving life’s problems. Therefore, it fails to teach how to set realistic goals. Moreover, by punishing the expression of “negative” emotions and erratically reinforcing emotional communication only after escalation by the child, the invalidating environment teaches the individual to adopt an all or nothing emotional expression style that vacillates between extreme suppression and extreme reaction.

3. Consequences of Emotion Dysregulation and Invalidating Environment

A. Impulsive Behavior (especially parasuicide) is maladaptive but effective. EX:

  • Overdosing: increased sleep, which decreases emotion dysregulation;
  • Parasuicide Act: distract or get attention to decrease emotional pain.

B. Inadequate Development and Maintenance of Sense of Self: One’s sense of self is formed by observations of oneself and of others’ reactions to one’s actions.

  • Emotional consistency and predictability, across time and similar situations, are prerequisites of identity development. Unpredictable emotional changes lead to unpredictable behavior and inconsistent thought, which interferes with identity development.
  • In addition, the numbness associated with suppressing emotions is often experienced as emptiness, which decreases sense of self.
  • If an individual’s sense of events is never “correct” or unpredictably “correct” (the situation is an invalidating environment), then the individual may develop an over-dependence on others.

C. Chaotic Relationships: Effective relationships depend on a stable sense of self, capacity for spontaneity in emotional expression, appropriate regulation (management) of emotions and toleration of emotional pain. Emotion dysregulation interferes with these abilities.

Note: In a healthy, non-chaotic relationship, both people feel ‘free to be me’.