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…

Pros and Cons of Mindfulness

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Reasonable Mind Potential Pros:

  • Emotionally Calmer
  • Rational
  • Focus on the facts rather opinions
  • Logical
  • Plans
  • Pay attention
  • “cool”
  • Intellectuality
  • Teachable
  • Work
  • School
  • Decision Making
  • Problem solving

Reasonable Mind Potential Cons

  • Emotions can drive us into reasonable mind and into “Analysis Paralisis”, being hyper focused, obsession, analyzing too much and we fall out of action and get stuck.
  • Dosconnection
  • Supresion
  • Problems in relationships
  • Problems negotiating
  • Rigididty
  • Apathetic
  • Workaholic

Emotional Mind Potential Pros:

  • Motivates communication and action
  • Love
  • Helps us feel joy and pleasure in life
  • Gives us drive
  • Passion
  • Creativity
  • Music
  • Dance
  • Literature
  • Art
  • Compassion
  • Spontanuity
  • “Artistic Energy with beautiful distortion”

Emotional Mind Potential Cons:

  • Emotions are in control
  • Influences our thinking and behavior
  • Hot Thoughts
  • Distortions
  • Behavior matches emotional state
  • Miss the big picture; tunnel vision
  • Self-image distortion
  • Clouds our judgment in a positive or negative light
  • Overreaction or under-reaction
  • Can lead to destructive behavior
  • Making bad decisions
  • Mania is a very emotional state of being and it can be very impulsive as well, just as depression is, which causes people to make destructive decisions and then have shame/guilt after the fact.
  • Impulsiveness
  • Knee-jerk reactions
  • Short term results; long term consequences
  • Drug use/addiction
  • Permiscuity
  • Panic/anxiety
  • Emotions build on one another e.g., sadness turns to anger
  • Aggravated by illness
  • Lack of sleep
  • Chronic pain

Wise Mind is Only Positive:

  • Acceptance
  • True Forgiveness
  • Stress/sense of urgency decreases
  • Knowing what we need through our day
  • Stronger sense-of-self
  • Truth
  • Balanced
  • Integration of Rational and Emotional Mind
  • Intuition
  • Validity
  • Calm/peaceful awareness
  • Respond rather than react
  • People are equal
  • No judgment

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

 

 

 

 

 

 

 

 

 

 

 

Mindfullnes? What’s That?

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“Trauma is fundamentally a disorder in the ability to stay in the here and now.” – Bessel Vander Kolk MD (Dr. Bessel Vander Kolk is a doctor who specializes in Trauma. If you type the name into Google you can learn a little more.)

Mindfulness is a subject that ties in to all of the classes I take in treatment. Mindfulness is by far the most beneficial tool that I have learned because it provides support, healing, and coping in each struggle I face. I hope your able to benefit from this information as well.

What is Mindfulness?

Psychologist and mindfulness meditation teacher Jon Kabat-Zinn has simply defined mindfulness in this way: “Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.”

This sounds simple, but mindfulness is a skill that takes practice to cultivate and maintain. Why? Let’s consider the different parts of the definition…

“Paying attention”

  • How much of the time are you really paying attention to whats happening in your life- as opposed to thinking about something else, remembering things, imagining possible futures, and acting out habitual patterns or more accurately, reacting to people and situations based on old habits of perceiving, thinking, feeling, and behaving?
  • Paying conscious attention can be especially hard when a current interaction reminds us of past hurts or betrayals-and before even realizing it, we can automatically and defensively respond as if those old experiences are happening again.
  • All of us have our habitual patterns, our vulnerabilities to automatic reactions based on past experiences of hurt, our “buttons” that can get “pushed.” This is particularly true when we are already stressed and/or in a hurry. Truly paying attention in our lives is a challenge for anyone.

“On purpose”

  •  It takes a conscious decision, and effort by one’s mind and brain, to pay attention to what’s happening in the present. In fact, such choices and efforts are required over and over again, since we are continually pulled back into habitual ways of processing information and responding to things.
  • Too often we’re on “auto pilot,” not even trying to pay attention to what’s actually happening in the unique situations and interactions that make up our lives. (Personal perception:This happens to me a lot when I am at home and when I have idle time. I believe that having structure and sticking to the “next indicated step” view each day allows me to become more mindful each day.)

“In the present moment”

  •  Most of us, most of the time, are absorbed in memories of the past or visions and plans for the future.
  • For most people, it is rare to be aware, without some amount of distraction or multitasking, of what is actually occurring in the present moment.
  • Particularly when strong emotions arise, people often respond not to situations as they are, but to reactive perceptions and thoughts based on painful experiences in the past. In the most extreme instances, one may not be “here” in the present but “back there,” reliving the past through responses to present situations. (Personal perception: For me this looks like Dissociation and Flash Backs. However, now that I know this information and believe in it’s value, I am now able to “bring myself back”  by using the grounding techniques that I wrote about in another post, and searching for the “trigger” that “sent me back there” mentally.)

“Non-judgmentally”

  • This is one of the hardest things to achieve. We so often react intensely to our experiences, particularly unwanted experiences, and to our initial responses to them.
  • “This is horrible!” “What an idiot!” “How could I do that?!” “I can’t take this anymore!” “Here I go again.” You know the ways you can instantaneously and automatically judge situations, other people, and your own thoughts, feelings and behaviors – often in a chain reaction of increasing judgment and distress.
  • “I need…” “I want…” “I deserve…” Positive judgments and the cravings they evoke can also be a problem, particularly when they are automatic and intense. We can lose out focus, forget what’s important, get caught in cycles of addiction, selfishly take advantage of others, etc.
  • In contrast, the non-judgmental quality of mindfulness brings great freedom – to see things more clearly, to evaluate situations with some distance from our habitual emotional reactions and impulses, to observe emotions and impulses as they arise without either trying to escape them or letting them carry us away.
  • We all have at least glimpses of this potential, when we are feeling so positive and relaxed that something which would normally cause strong judgment and negative emotions is seen as no big deal, more clearly for what it is: a passing unwanted experience or temptation to indulge.
  • But to bring this non-judgmental quality into our daily lives, consistently, even at very stressful times, this is something many of is can hardly imagine. Yes it is possible, by practicing mindfulness (and kindness).
  • And for those who are vulnerable to remembering and reliving painful experiences from the past, to strong waves of emotion, to intense self-criticism – the cultivation of non-judgmental mindfulness can bring tremendous relief and freedom from old patterns. (I am currently in this stage of mindfulness. I do experience memories of painful experiences, strong waves of emotion, and self-criticism, but when I practice mindfulness and stay in the present I am now able to decrease the intensity of the pain, or pressure to engage in familiar cycles of behavior-or destructive coping skills; such as addiction.)

Example of an action/situation where I am mindful: Being at the beach walking the pier creates mindfulness and allows positive sensations to run through my body, which allows my mind to become more open, more positive, more rational, so that I can think about my life as it is at this point, in a positive and peaceful way. Which then creates an ability to think about the decisions I need to make in a rational, emotional, and wise approach. I can not make decisions in the past or future; only in the current moment.

In what areas could you benefit from being more mindful? Practice mindfulness any chance you get. I will be posting a couple more lectures on mindfulness to help solidify the material, the benefits, and ways of being mindful.

To the people that follow my blog posts,

I sincerely thank you for following and reading the posts I create. Having the knowledge that people are reading and potentially benefiting from the information given, inspires me to continue writing. Thanks so much.

Love,

Shadow