Self-Soothe. Get yourself some hot cocoa, coffee, soda, juice or water. Drink your beverage slowly focusing on the sensations of taste, smell and temperature. Intense Sensations. Go to the kitchen and take a piece of ice, and some napkins. Hold the ice in your hand, and use the napkins to absorb the melting water. Focus on the intense cold sensation of ice in your hand.
Distract yourself. Pick up a magazine and focus your attention on the pictures or an interesting article. Bring your mind to whatever you are reading or looking at, redirecting it from upsetting thoughts and feelings.
Practice deep breathing. Place one hand on your belly, inhale slowly counting to 5, feeling your belly expand. Pause. Exhale slowly, counting to 5, feeling your belly deflate. Practice this deep breathing 10 times.
Use Relaxation. Give yourself a little neck and shoulder massage- you can rapidly tap your fingers on your neck and shoulders or rub your neck and shoulders. Focus on
different muscles in your body from your head to your feet telling yourself to let go of tightness and tension.
Watch skills video. Ask a staff member to set up the TV with a distress tolerance video. Focus on the skills presented in the video and choose one to practice right now.
Pray. Pray either to a higher power, your own wise mind, or just open yourself up to peace and serenity. Open your hands, uncross your arms and legs, slow your breathing and focus on acceptance. Ask for strength to bear the pain in this moment. Breath in and out while telling yourself something like “I breathe in peace and breathe out
distress” or “acceptance will help ease my suffering.”
Self-encouragement. Think of what you might say to someone in a similar situation as you. Give yourself the same encouragement and support. Tell yourself things like “I can get through this” or “This won’t last forever.”
Use imagery. Imagine a wall between yourself and the situation. Or imagine a peaceful, happy, secure place. It can be someplace you have been or someplace that you create in your mind. Imagine in detail what your place looks like, any soothing smells, if there are any comforting people or animals with you, what it feels like where you are sitting or laying, what sounds you can hear…
Make comparisons. Distract yourself by thinking about problems that you don’t have or that you no longer have. Focus on something that someone else is struggling with, or find a magazine article about a problem that doesn’t apply to you. Consider ways that you are better off now than you were at other points in your life.
Focus on thoughts. Count backwards from 100. If you lose track, start over again. Make a shopping list. Describe the furniture in the room or other objects in front of you.
When painful events happen in your life and you cannot change them, solve them, or make them go away.
Reality Acceptance Skills Set
Radical Acceptance
Turning the Mind
Willingness
Radical Acceptance
Radical Acceptance is accepting that…
Reality is what it is
Everything has a cause
Life can be worth living even when there is pain
Remember …
Pain + Non-Acceptance = Suffering
It is easy to accept things you like
It is hard to accept things you hate, disapprove of , or that cause you a lot of pain.
The higher the pain, the harder the acceptance
If you want things to change, accept them first, then change them
Reality is always changing and if you want to influence how it changes, you must first
accept it.
Turning the Mind
What is Turning the Mind?
It is like walking down a road and coming to a fork where one road is accepting and one
road is rejecting and choosing to turn toward the accepting road over and over again.
Steps to Turning the Mind
Notice …
anger, bitterness, annoyance, falling into the sea of “Why me?”
when you are trying to…
escape reality
block things out
hide how you feel
Make an inner commitment to turn your mind toward acceptance
Practice turning your mind toward acceptance over and over again.
Willingness
Willingness is …
Allowing the world to be as it is
Agreeing to participate in the world as it is
Actively participating in reality
What you need to overcome a threat
Willfulness is …
Saying NO, NO, NO
Denying
Pushing Away
Avoiding
Steps to Turning Willfulness to Willingness
Ask yourself,
“What is the threat?”
“What is the catastrophe?”
Notice and observe willfulness
Radically accept the willfulness
Turn your mind towards willingness, acceptance, and participating in reality just as it is.
When it becomes difficult to Turn The Mind, adopt a willing posture (open arms & palms,
half smile)
Getting started with Reality Acceptance Skills
Find small things to Practice Accepting first
Write yourself a note that says Turn the Mind, hang it somewhere, & practice every time
you look at it
Notice and observe Willfulness
Practice Willingness by participating in reality
Adopt a Willing Posture (open hands, arms, half-smile)
Remember Acceptance is Difficult and requires much time & practice to be effective.
DBT can transform your life and the lives of others. Anyone can use DBT—it is versatile and personable.
DBT: Not Just for Borderline Personality Disorder
By KAT DAWKINS
You may think Dialectical Behavioral Therapy is only for those that live with borderline personality disorder. However, I am an example of a person with bipolar disorder that has benefited from this approach.
What is Dialectical Behavioral Therapy?
Dialectical Behavioral Therapy (DBT) is an approach that combines cognitive and behavioral therapies together. It also incorporates other methodologies including Eastern mindfulness techniques.
DBT allows the learner to build skills in areas like mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
The concept of dialectics comes from philosophy in which two opposing points (the thesis and the antithesis) are brought together in a new understanding of the concept at hand, through a synthesis of these opposing view points. DBT seeks to moderate the black-and-white thinking that people with BPD and all of us sometimes get into. Here are some hints about thinking dialectically:
Shift from either-or to both-and thinking. Avoid the polarized words like always, never, every time and you made me. Be descriptive of the situation without judging the situation as good or bad. Example: “My father always treats me unfairly” becomes “Sometimes my father treats me unfairly and at other times he treats me fairly.”
Look at all sides of a situation and use varying points of view. Find the meaning in each side and understand the reason another person my have a different view of the situation. Try to see the situation through other people’s eyes. (Keep on your TOES – through other’s eyes).
No one has absolute truth when it comes to interpersonal situations. All truth is colored by a person’s beliefs and feelings. Be open to alternative explanations.
Use “I feel…” statements, instead of “you are…” or “that’s the way it is…” statements. Rather than “you are always so mean to me” say “I feel you are being mean to me right now. That makes me feel angry.” A statement of feelings is most often true, whether or not the situation is being looked at dialectically.
Accept that different viewpoints may be valid, even if you do not agree with them.
Do not assume that you know what other people are thinking. Check your assumptions by asking. Ask, don’t tell.
Do not expect others to know what you’re thinking or feeling.
Dialectical thinking requires a balance of viewpoints and a synthesis of feelings and opinions. It requires that you open your mind to other ways of thinking.
Wise Mind is the balance of Reasonable and Emotional Minds
Wise mind is a balance between Reasonable (or Rational) mind and Emotional Mind. Like many skills in DBT, it’s a synthesis of the two opposing mental forces (that’s what dialectics is all about). Marsha Linehan, the inventor of DBT, states: “”Wise mind is that part of each person that can know and experience truth. It is where the person knows something to be true or valid. It is almost always quiet, It has a certain peace. It is where the person knows something in a centered way.”
There are 3 states of mind when we think about Wise Mind and Mindfulness. They are described as follows:
Reasonable Mind
When you are in reasonable mind you are devoid of feelings and emotions. You are like a robot or computer, completely logical and reasonable, yet disconnected from the rich emotional experience of the things and people around you.
Reasonable Mind
Pros
Cons
Logical
Boring
Controlled
Limiting
Sensible
Inflexible
Emotional Mind
When you are in emotional mind, you are devoid of reason, living by feelings and emotions. You are spontaneous/impulsive and can be chaotic and unpredictable, completely driven by your current emotion.
Emotional Mind
Pros
Cons
Creative
Chaotic
Caring
Painful
Motivating
Exhausting
Wise Mind
When you are in Wise Mind, you are calm and serene with a balance of reason and emotion, of reasonable and emotional minds. You can be logical, controlled, sensible, creative, caring and motivated. The Pros of both mind states are available to you. You can maintain both your good judgement and your equanimity. Wise Mind makes for sound decisions, even when faced with difficult situations. In Wise Mind, you can face/do hard things.
DBT begins with a set of assumptions. It is important for both the participant in DBT and their loved ones to keep these in mind when interacting with the therapy and in their daily lives. These assumptions are:
People are doing the best they can. (This includes the person with BPD and their loved ones)
People want to improve.
People need to do better, try harder and be more effective and more motivated to change.
People may not have caused all of their own problems, but they have to solve them anyway.
The lives of the suicidal, depressed, anxious and angry people are painful as they currently are being lived.
All people must learn new behaviors in different situations in their lives.
Many of us have distress and frustration in our lives. Your car keys are lost. You don’t have enough money to pay the bills. A friend rejects you when you ask to go out on Saturday night. You get a flat tire on the way to a big meeting. Stuff happens in life. Sometimes you can do something about it. Sometimes you can’t.
The IMPROVE DBT skill is for when you have to tolerate the distress or frustration that you’re facing. It’s for those times when you can’t do anything about the crisis at hand or can’t do anything right away to solve the problem. When there is no immediate solution to a problem, you can improve your mental and emotional situation using the IMPROVE skill. Like many skills in DBT IMPROVE is an acronym. It stands for:
Imagery
Meaning
Prayer
Relaxation
One thing in the moment
Vacation
Encouragement
Imagery: Use you imagination to image a better situation than the one that you’re currently in. Imagine a situation in which everything will turn out OK. Go within yourself and imagine a time in which you were not in crisis or a time in which you used your skills to get through a crisis successfully.
Meaning: Sometimes old crises can provide meaning to new ones. What meaning did you find in getting through other previous trials? If you’re a spiritual or religious person meaning can come through understanding the spiritual meaning or the will of God. You can ask yourself “How can I grow?” or “How can I prove to myself that I can get through hard situations?”
Prayer: Prayer can be talking to God or to the spirit of the universe. It can be opening yourself up to God’s will and accepting the situation as is. It can be asking for guidance from your Higher Power, however you perceive that power.
Relaxation: Do you tighten your muscles in a crisis? Many people do. The physical pain and exhaustion that this causes can worsen a crisis. Relax you muscles. Breathe. My dentist or doctor tells me that it will hurt less if I relax my muscles. Tense your muscles and then release the tension. Breathe in and out slowly and deliberately.
One thing in the moment: If you bring old emotional issues into the situation, you’re likely to make things worse. If you say, “This always happens to me!” or “Why do bad things continually happen to me?” This compounds the issue. Focus on this moment, this issue. Do what you can do to focus on the now and not bring in old problems. If you’re suffering in the moment, adding old suffering just throws fuel on the fire. Stay in the moment.
Vacation: Have you ever said to yourself, “I need a vacation from all of this!” Well, take one, however brief. It doesn’t have to be in Hawaii or in a far-flung place. You can take a brief vacation at home, doing something you enjoy. Don’t take a mind vacation though. Drugs and alcohol, for example, will likely make any problem worse. Sometimes a vacation can be a walk around the block. A vacation can be a brief break from the difficult task at hand, but it shouldn’t be a complete avoidance. It shouldn’t be a permanent vacation.
Encouragement: Encouragement is like self cheerleading. Tell yourself you can do and face hard things. Come up with examples of when you’ve acted effectively in the face of a difficult situation. Validate yourself and your abilities.
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