Distress Tolerance Handout 1C

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Improve the Moment

Improve

With Imagery:

Imagine very relaxing scenes. Imagine a secret room within yourself, seeing how it is decorated. Go into the room whenever you feel very threatened. Close the door on anything that can hurt you. Imagine everything going well. Imagine coping well. Make up a fantasy world that is calming and beautiful and let your mind go with it. Imagine hurtful emotions draining out of you like water out of a pipe.

With Meaning:

Find or create some purpose, meaning, or value in the pain. Remember, listen to, or read about spiritual values. Focus on whatever positive aspects of a painful situation you can find. Repeat them over and over in your mind. Make lemonade out of lemons.

With Prayer:

Open your heart to a supreme being, greater wisdom, God, your own wise mind. Ask for strength to bare the pain in this moment. Turn things over to God or a higher being.

With Relaxation:

Try muscle relaxing by tensing and relaxing each large muscle group, starting with your hands and arms, going to the top of your head, and then working down; listen to a relaxation tape; exercise hard; take a hot bath or sit in a hot tub; drink hot milk; massage your neck and scalp, your calves and feet. Get in a tub filled with very cold or hot water and stay in it until the water is tepid. Breathe deeply; half-smile; change facial expressions.

With One thing in the Moment:

Focus your entire attention on just what you are doing right now. Keep yourself in the very moment you are in; Put your mind in the present. Focus your entire attention on physical sensations that accompany non-mental tasks (e.g. walking, washing, doing dishes, cleaning, fixing). Be aware of how your body moves during each task. Do awareness exercises.

With a brief Vacation:

Give yourself a brief vacation. Get in bed and pull the covers up over your head for 20 minutes. Rent a motel room at the beach or in the woods for a day or two; drop your towels on the floor after you use them. Ask your roommate to bring you coffee in bed or make you dinner (offer to reciprocate). Get a schlocky magazine or newspaper at the grocery store, get in bed with chocolates, and read it. Make yourself milk toast, bundle up in a chair, and eat it slowly. Take a blanket to the park and sit on it for a whole afternoon. Unplug your phone for a day, or let your answering machine screen your calls. Take a 1-hour breather from hard work that must be done.

With Encouragement:

Cheer lead yourself. Repeat over and over: “I can stand it,” “It won’t last forever,” “I will make it out of this,” “I’m doing the best I can do,” “Let go and let God,” “Be still and know I am God”.

Thinking about Pros and Cons

Make a list of the pros and cons of tolerating the distress. Make another list of the pros and cons of not tolerating the distress – that is, of coping by hurting yourself, abusing alcohol or drugs, or doing something else impulsive.

Focus on long term goals, the light at the end of the tunnel. Remember times when pain has ended.

Think of the positive consequences of tolerating the distress. Imagine in your mind how good you will feel if you achieve your goals, if you don’t act impulsively.

Think of all of the negative consequences of not tolerating your current distress. Remember what has happened in the past when you have acted impulsively to escape the moment.

Distress Tolerance Handout 1B

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Crisis Survival Strategies

Self-Soothe

Five Senses:

With Vision:

Buy one beautiful flower; make one space in a room pretty; light a candle and watch the flame. Set a pretty place at the table, using your best things, for a meal. Go to a museum with beautiful art. Go sit in the lobby of a beautiful old hotel. Look at nature around you. Go out in the middle of the night and watch the stars. Walk in a pretty part of town. Fix your nails so they look pretty. Look at beautiful pictures in a book (or online). Go to a ballet or other dance performance, or watch one on TV. Be mindful of each sight that passes in front of you, not lingering on any (driving).

With Hearing:

Listen to beautiful or soothing music, or to invigorating or exciting music. Pay attention to sounds of nature (waves, birds, rainfall, leaves rustling). Sing to your favorite songs. Hum a soothing tune. Learn to play an instrument. Call 800 or other information numbers to hear a human voice. Be mindful of any sounds that come your way, letting them go in one ear and out the other.

With Smell:

Use your favorite perfume or lotions, or try them on in the store; spray fragrance in the air; light a scented candle. Put lemon oil on your furniture. Put potpourri in a bowl in your room. Boil cinnamon; bake cookies, cake, or bread. Smell the roses. Walk in a wooded area and mindfully breathe in the fresh smells of nature.

With Taste:

Have a good meal; have a favorite soothing drink such as herbal tea or hot chocolate or coffee (no alcohol); treat yourself to a dessert. Put whipped cream on your coffee. Sample flavors in an ice cream store. Suck on a piece of peppermint candy. Chew your favorite gum. Get a little bit of a special food you don’t usually spend the money on, such as fresh squeezed orange juice. Really taste the food you eat; eat one thing mindfully.

With Touch:

Take a bubble bath; put clean sheets on the bed. Pet your dog or cat. Have a massage; soak your feet. Put creamy lotion on your whole body. Put a cold compress on your forehead. Sink into a really comfortable chair in your home, or find one in a luxurious hotel lobby. Put on a silky blouse, dress, or scarf. Try on fur-lined gloves or fur coats in a department store. Brush your hair for a long time. Hug someone. Experience whatever you are touching; notice touch that is soothing.

Distress Tolerance Handout 1A

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Crisis Survival Strategies

Distracting

“Wise mind ACCEPTS

With Activities:

Engage in exercise or hobbies; do cleaning; go to events; call or visit a friend; play computer games; go walking; work; play sports; go out to a meal; have decaf coffee or tea; go fishing; chop wood; do gardening; play pinball…

With Contributing:

Contribute to someone; do volunteer work; give something to someone else; make something nice for someone else; do a surprising, thoughtful thing…

With Comparisons:

Compare yourself to people coping the same as you or less well than you. Compare yourself to those less fortunate than you. Watch soap operas; read about disasters; others sufferings…(this creates a sense of gratitude; reminds me that things can always be worse and that I am not the only only one in a distressful situation; this takes the power out of the situation)

With opposite Emotions:

Read emotional books or stories (Bible Study); old letters; go to emotional movies; listen to emotional music. Be sure the event creates different emotions. Ideas: scary movies, joke books, comedies, funny records, religious music, marching songs, “I Am Woman” (Helen Reddy); going to a store and reading funny greeting cards.

With Pushing Away:

Push the situation away by leaving it for a while. Leave the situation mentally. Build an imaginary wall between yourself and the situation. Or push the situation away by blocking it in your mind. Censor ruminating. Refuse to think about the painful aspects of the situation. Put the pain on a shelf. Box it up and put it away for a while.

With other Thoughts:

Count to ten; count in another language; count colors in a painting or tree, windows, anything; work on puzzles; watch TV; read… (Mantra: I’m okay and I am where I am supposed to be right now.)

With Intense other Sensations:

Hold ice in hand; squeeze a rubber ball very hard; kneed silly puddy in hand; stand under a very hard and hot shower; listen to very loud music; sex; put rubber band on wrist, pull out, and let go…

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’.

Creating Meaning: Trauma and Substance Abuse

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This lecture is a list of meanings that are typical of people with trauma and substance abuse. The structure of this lecture will be as follows: I will give Meanings That Harm with their definitions and examples, as well as Meanings That Heal to counteract the Meanings that Harm. While reading through these, maybe try to get in touch with yourself and listen to what hits home for you-what hurts for you- and then look at the suggestion to heal. There may be some peace here for you. There is for me.

Deprivation Reasoning: Definition: Because you have suffered a lot, you need substances (or other self-destructive behavior). Examples: “I’ve had a hard time, so I’m entitled to get high.” “If you went through what I did, you’d hurt yourself too.” Meanings that Heal: Live Well. A happy, functional life will make up for your suffering far more than will hurting yourself. Focus on positive steps to make your life better.

I’m Crazy: Definition: You believe that you shouldn’t feel the way you do. Examples: “I must be crazy to feel this upset.” “I shouldn’t be having this craving.” Meanings that Heal: Honor your feelings. You are not crazy.Your feelings make sense in light of what you have been through. You can get over them by talking about them and learning to cope with them.

Time Warp: Your sense of time is distorted; you believe that a negative feeling will go on forever. Example: “This craving won’t stop.” “If I were to cry, I would never stop.” Meanings that heal: Observe Real Time. Take a clock and time how long it really lasts. Negative feeling will usually subside after a while; often they will go away sooner if you distract with activities. (Don’t ruminate!)

Beating Yourself Up: Definition: In your mind, you yell at yourself and put yourself down. Examples: “I’m a bad person.” “My family was right; I’m worthless.” Meanings that Heal: Love-Not Hate-Creates Change. Beating yourself up may echo what people in the past have said to you. But yelling at yourself does not change your behavior; in face, it makes you less likely to change. Care and understanding promote real change.

The Past Is The Present: Definition: Because you were a victim in the past, you are a victim in the present. Examples: “I can’t trust anyone.” “I’m trapped.” Meanings that heal: Notice Your Power. Stay in the present: “I am an adult (not a child); I have choices (I am not trapped); I am getting help (I am not alone).”

The Escape: Definition: An escape is necessary (e.g, food, substances, gambling) because feelings are just too painful. Examples: “I’m upset; I have to binge on food.” “I can’t stand cravings: I have to smoke a joint.” Meanings that Heal: Keep Growing. Emotional growth and learning are the only real escape from pain. You can learn to tolerate feelings and solve problems.

The Good Old Days: Definition: You remember the wonderful highs from something (a drug, an abusive relationship), but ignore the tragedy of it. Examples: “Cocaine made me feel happy.” “I still love my partner, even though he abused me”. Meanings that Heal: See Both Sides. The drug may have felt good but the cost was losing your job; the relationship may have had some positives, but it had some serious negatives too.

Feelings Are Reality: Definition: Because something feels true, you believe it must be a fact. Examples: “I feel like I’ll never recover, so I might as well drink” “I feel depressed, so I might as well kill myself.” Meanings that Heal: Listen To What You Know. Use your mind rather than your feelings as a guide. What do you know to be the best for you? Feelings are valid, but they are not reality.

Ignore Cues: Definition: If you don’t notice a problem, it will go away. Examples: “If I ignore this toothache it will go away.” “I don’t have a problem with substances.” Meanings that Heal: Attend to You Needs. Listen to what you’re hearing; notice what your seeing; believe your gut feeling.

Dangerous Permission: Definition: You give yourself permission for self-destructive behavior. Examples: “Just one won’t hurt” “I’ll buy a bottle of wine for the recipe I want to try.” Meanings that Heal: Seek Safety. Acknowledge your urges and feelings, and then find a safe way to cope with them.

The Squeaky Wheel Gets The Grease: Definition: If you get better you will not get as much attention from people. Examples: “If I do well, my Therapist will focus on sicker patients.” “No one will listen to me unless I am in distress.” Meanings that Heal: Get Attention From Success. People love to pay attention to success. If you don’t believe this, try doing better and notice how people respond to you.

Mind Reading: Definition: You believe you can tell what other people are thinking without having to ask. Examples: “I know he didn’t say hello because he hates me.” “My sponsor would feel burdened if I called her late at night.” Meanings that Heal: Check It Out. Ask the person! You may be amazed by what you find out.

It’s All My Fault: Definition: Everything that goes wrong is due to you. Examples: “The trauma was my fault.” “If I have a disagreement with someone, it means I’m doing something wrong.” Meanings that Heal: Give Yourself a Break. You do not have to carry the world on your shoulders. When you have conflicts with others, try taking a 50-50 approach (50% is their responsibility, 50% is yours).

If This…Then That: Definition: You put off something important while waiting for something else. Examples: “If I get a job, then I’ll stop smoking pot.” “If I lose weight, then I’ll go to AA.” Meanings that Heal: Stay in the Present. Whatever you need to do, start now. Every step forward counts. Putting off an important goal will not help.

Actions Speak Louder Than Words: Definition: You show your distress by actions; otherwise, people won’t see your pain. Examples: “The scratches on my own will show what I feel” “I’d like my partner to find my body after I’ve killed myself.” Meanings that Heal: Break through the Silence. Put feelings into words. Language is the most powerful way for people to know you.

I Am My Trauma: Definition: Your trauma is your identity; it is more important than anything else about you. Examples: “My life is pain.” “I am what I have suffered.” Meanings that Heal: Create a Broad Identity. You are more than what you have suffered. Think of your different roles in life, your varied interests, your goals and hopes.

The Uniqueness Fallacy: Definition: You alone have a particular problem; no one else could possibly understand. Examples: “Unless you’ve lived through what I have, you can’t help me.” “Why bother talking? No one will get it.” Meanings that Heal: Reach Out. Give people a chance to help you. Find a safe person to talk to (therapist, AA sponsor) and try opening up.

No Future: Definition: The future is bleak; there is no hope. Examples: “My life is wasted already.” “I might as well give up.” Meanings that Heal: You Have Choices. No matter what has happened so far, you control the present and future. Notice your choices and choose wisely.

Life-or-Death Thinking: Definition: Things take on life-or-death meaning in your mind. Examples: “I’ll never get over the fact that she (or he) left me.” “I’ll die if I don’t get that job.” Meanings that Heal: Keep Perspective. That is the worst that can happen? If you suffer a loss, you can learn to mourn and move on. The possibilities in life are endless.

Confusing Needs And Wants: Definition: You want something very badly, so that means you have to have it. Examples: “I need to relax with heroin.” “I need to find a romantic partner.” Meanings that Heal: Recovery is the Need. You may want many things, but needs are few. You may want heroin, but you don’t need heroin. Needs are essentials: food, shelter, clothes- and your recovery!

Short-Term Thinking:  You focus only on your feelings today rather than tomorrow. Examples: “I’m more sociable when I drink.” “I’m buying that new outfit even if i can’t afford it.” Meanings that Heal: Think of the Consequences. Imagine how good you’ll feel about yourself tomorrow if you do what you know is right. Imagine how low you’ll feel if you give in to the moment.

Shoulds: Definition: You have rules about how the world should work. If the rules are violated, you feel angry. Examples: “My friend should invite me over.” “I should not have to deal with PTSD.” Meanings that Heal: Soften Your Language. Try to ease the tension (e.g., “I want my friend to invite me over.”). You may still want what you want, but you may feel more tolerant.

Instant Satisfaction: Definition: You seek immediate satisfaction. Life should be easy. Examples: “I need it now.” “I should always feel good.” Meanings that Heal: Work Hard. The most enduring satisfactions come from working hard and having patience: at your job, at relationships, at recovery.

Focusing on the Negative: Definition: You notice the negatives in a situation and ignore the positives. Examples: “That person is a total jerk.” “I can’t do anything right.” Meanings that Heal: Notice the Good. What went right? What is good about you? What was a positive aspect of the situation?

All-or-None Thinking: Definition: Things are either all good or all bad. There is no middle ground. Examples: “Life is only misery.” “I have no power.” Meanings that Heal: Seek a Balanced View. Life is more complex and interesting than “all or none.” Look at things with a balanced view; find the middle ground. Look at what went well, what went badly, and what was neutral.

Source: Lisa M. Najavits

 

 

 

 

Grounding: A Coping Skill for Clients (people) With Emotional Pain

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I received a handout titled Grounding: A Coping Skill for Clients With Emotional Pain in one of my classes. Instead of summarizing the worksheet I will transfer the worksheet onto this blog by hand. I think these skills are extremely helpful and I do some of them myself and they work wonderfully. I hope you can try some out too!

“Three major ways of grounding will be described-mental, physical, and soothing. “Mental” means focusing your mind; “Physical” means focusing on your senses (e.g., touch, hearing); and “soothing” means talking to yourself in a very kind way. You may find that one type works better for you, or all types may be helpful. Note that grounding is different from relaxation training or meditation. In grounding, it is essential to keep your eyes open the entire time and to keep talking out loud. These strategies keep you focused on the outside world.

Mental Grounding

  • Describe your environment in detail using all your senses. For example, “The walls are white, there are five pink chairs, there is a wooden bookshelf against the wall…” Describe objects, sounds, textures, colors, smells, shapes, numbers, and temperature. You can do this anywhere. For example, on the subways: “I’m on the subway. I’ll see the river soon. Those are windows. This is the bench. The metal bar is silver. The subway map has four colors…”
  • Play a “categories” game with yourself. Try to name “types of dogs,” “Jazz musicians,” “States that begin with “A”,” “cars,” “TV shows,” “writers,” “sports,” “songs,” or “cities.”
  • Do an age progression. If you have regressed (mentally) to a younger age (e.g, 8 years old), you can slowly work your way back up (e.g, “I’m now 9” “I’m now 10,” “I’m now 11″…) until you are back to your current age.
  • Describe an everyday activity in great detail. For example, describe a meal that you cook (e.g., “First I peel the potatoes and cut them into quarters, then I boil the water; I make an herb marinade of oregano, basil, garlic, and olive oil…”).
  • Imagine. Use an image: Glide along on skates away from your pain; change the TV channel to get a better show; think of a wall as a buffer between you and your pain.
  • Say a safety statement. “My name is ____; I am safe right now. I am in the present, not the past. I am located in _____; the date is _____.”
  • Read something saying each word to yourself. Or read each letter backwards so that you focus on the letters and not on the meaning of the words.
  • Use humor. Think of something funny to jolt yourself out of your mood.
  • Count to 10 or say the alphabet, very s..l..o..w..l..y.

Physical Grounding

  • Run cool or warm water over your hands.
  • Grab onto your chair as hard as your can.
  • Touch various objects around you: a pen, keys, your clothing, the table, the walls. Notice textures, colors, materials, weight, temperature. Compare objects you touch: Is one colder? Lighter?
  • Dig your heels into the floor-literally “grounding” them. Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground.
  • Carry a grounding object in your pocket-a small object ( a small rock, clay or silly puddy, ring, piece of cloth or yarn, a stress ball) that you can touch whenever you feel triggered (anxious, panicky, etc.)
  • Jump up and down in a gentle way. Only coming off the ground a couple inches.
  • Use all five senses. For example: notice five things around you that are a certain color, notice four things you can physically touch, notice three things that you hear, notice two things that you can feel, notice one thing that you can smell. They don’t have to go in this order; you can mix them up.
  • Notice your body: The weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. You are connected to the world.
  • Stretch. Extend your fingers, arms, or legs as far as you can; roll your head around.
  • Clench and release your fists.
  • Walk slowly, noticing each footstep, saying “left” and then “right,” whit each step.
  • Eat something, describing the flavors in detail to yourself.
  • Focus on your breathing noticing each inhale and exhale. Repeat a pleasant word to yourself on each inhale (e.g., a favorite color or a soothing word such as “safe” or “easy”).

Soothing Grounding

  • Say kind statements as, as if you were talking to a small child. For example, “You are a good person going through a hard time. You’ll get through this.”
  • Think of favorites. Think of your favorite color, animal, season, food, time of day, or TV show.
  • Picture people you care about (e.g., your children), and look to photographs of them.
  • Remember the words to an inspiring song, quotation, or poem that makes you feel better, such as the Serenity Prayer.
  • Remember a safe place. Describe a place that you find very soothing (perhaps the beach or mountains, or a favorite room); focus on everything about that place-the sounds, colors, shapes, objects, and textures.
  • Say a coping statement. “I can handle this.” “This feeling will pass.”
  • Plan out a treat for yourself, such as a piece of candy, a nice dinner, or a warm bath.
  • Think of things you are looking forward to in the next week, perhaps time with a friend, going to a movie, or going on a hike.
  • Create a cassette tape of a grounding message that you can play when needed; consider asking your therapist or someone close to you to record it if you want to hear someone else’s voice.
  • Think about why grounding works. Why might it be that by focusing on the external world, you become more aware of an inner peacefulness? Notice the methods that work for you-why might those be more powerful for you than other methods?
  • Don’t give up.

Try to just pick 1 or 2 things from each category of grounding and see how they work for you. You could always refer pack to this post to try new ones. I have about 11 techniques that work for me; every one will use different techniques for different reasons.

Love,

Shadow.

God, grant me the Serenity to accept the things I can not change, the courage to change the things I can, and the wisdom to know the difference. Amen.

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