Wednesday, January 23, 2019

Distress Tolerance Module

DISTRESS TOLERANCE SKILLS


Using Crisis Survival: Distraction with Wise Mind Accepts
     A Activities
     C Contributing
     C Comparisons
     E Emotions - use opposite
     P Pushing Away
     T Thoughts
     S Sensations


Using Self Soothe with five senses:
     Taste
     Smell
     See
     Hear
     Touch


Using Improve the moment:
     I Imagery
     M Meaning
     P Prayer
     R Relaxation
     O One thing at a time
     V Vacation
     E Encouragement


Using Pros and Cons
Guidelines for Accepting Reality:
     Observing your Breath
     Half Smiling
     Awareness

Awareness Exercises

Willingness
Radical Acceptance
Turning your mind (Distract)


DISTRESS TOLERANCE

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  • Distress Tolerance Module
  • Sunday, December 9, 2018

    Radical Acceptance

    Radical Acceptance 

    Everything is as it should be.
    Everything is as it is.

    o Freedom from suffering requires ACCEPTANCE from deep within of what is.
    Let yourself go completely with what is.
    Let go of FIGHTING REALITY.

    o ACCEPTANCE is the only way out of hell.

    o Pain creates suffering only when you refuse to ACCEPT the pain.

    o Deciding to tolerate (endure) the moment is ACCEPTANCE.

    o ACCEPTANCE is acknowledging what is.

    o To ACCEPT something is not the same as judging that it is good, or approving of it.

    o ACCEPTANCE is turning my suffering into pain that I can endure.

     Four Options for Painful Problems 


    1. Solve the problem 
    2.  Change how you feel 
    3.  Accept it 
    4.  Stay Miserable 


    Serenity Prayer 

    God grant me the Serenity to ACCEPT the things I cannot change, the courage to change the things I can and the wisdom to know the difference.

     Turning the Mind 

    o Acceptance of reality as it is requires an act of CHOICE. It is like coming to a fork in the road. You have to turn your mind towards the acceptance road and away from the “rejecting reality” (“I don’t have to put up with this!”) road.
    o You have to make an inner COMMITMENT to accept. The COMMITMENT to accept does not itself equal acceptance. It just turns you toward the path. But it is the first step.
    o You have to turn your mind and commit to acceptance OVER AND OVER AND OVER again. Sometimes, you have to make the commitment many times in the space of a few minutes.

    How to Practice “Radical Acceptance” 

     “The curious paradox is when I accept myself just as I am, then I can change.” – Carl Rogers

    In Dialectical Behavior Therapy (DBT), the word “dialectic” refers to balancing and comparing two things that seem to be quite different – even contradictory. In DBT, this balance is between change and acceptance. For many people, there is a tendency to engage in behaviors that are self-sabotaging or causing unnecessary suffering. There is a clear need to change destructive or maladaptive behaviors while simultaneously working towards radical acceptance of yourself just the way you are.

    It can be very difficult for many people to truly and completely – “radically” – accept themselves when they strongly dislike certain ways that they are behaving or otherwise living their lives. Radical acceptance is the key toward ultimately making lasting changes in your life. Radical acceptance requires that you look upon yourself, others, and the world in an entirely new way. You must be willing to let go of your ideas about how you “should be” and simply accept the way that you are… in this present moment. When you radically accept something, you are completely releasing judgment of it and avoiding any attempts to fight against or change it.

    For example, if you were to radically accept this present moment in time, it means that you would acknowledge that everything that “is” right now is the result of a very long and complicated chain of events. You are responsible for some of this present moment and you are not responsible forsome of this present moment. Many events have happened to bring you to precisely where you are right now. McKay (2007) points out that “the present moment never spontaneously leaps into existence without being caused by events that have already taken place.

    Imagine that each moment of your life is connected like a line of dominoes that knock each other down.” The idea is that this present moment is the complex consequence of many events – some caused by you and some caused by other people. It does no good to place blame on whose “fault” any of it is. The reality is that no matter who “caused” your circumstances in this moment in time, you have to deal with them nonetheless. It is in your best interest to accept this moment precisely as it is and then begin to make real behavioral changes.

    When you radically accept the present moment, you are allowing yourself the opportunity to recognize and take responsibility for the role that you have played in creating the current reality. Things are rarely “all” anyone’s fault. When you are able to assume responsibility for the only things that are truly within your control – your thoughts and behaviors – then you are taking back an enormous amount of power over building a meaningful life that can enable you to feel happy, proud, and fulfilled.

     Radical Acceptance Coping Statements 

     To help you begin using radical acceptance, it's often helpful to use a coping statement to remind yourself. Below are a few examples:
     “This is the way it has to be.”
     “All the events have led up to now.”
     “I can’t change what’s already happened.”
     “It’s no use fighting the past.”
     “Fighting the past only blinds me to my present.”
     “The present is the only moment I have control over.”
     “It’s a waste of time to fight what’s already occurred.”
     “The present moment is perfect, even if I don’t like what’s happening.”
     “This moment is exactly as it should be, given what’s happened before it.”
     “This moment is the result of over a million other decisions.”



    7:07




      3  min:


    5min


    9:24

    Thursday, December 6, 2018

    Turning the Mind & Willingness



    • Life is like a game of cards
    • It makes no difference to a good card player what cards she gets
    • The object is to play whatever hand she gets as well as possible
    • As soon as one hand is played, another hand is dealt
    • The last game is over and the current game is on
    • The idea is to be mindful of the current hand, play it as skillfully as possible, and then let go and focus on the next hand of cards

    Distress Tolerance Group # 7: Turning the Mind, Willingness versus Willfulness

     Willingness is accepting what is, together with responding to what is, in an effective and appropriate way.
    It is doing what works. It is doing just what is needed in the current situation or moment
    Willfulness is imposing one's will on reality- trying to fix everything, or refusing to do what is needed. It is the opposite of doing what works.
    Distress Tolerance Homework Sheet 2: Acceptance and Willingness
    • Life is like hitting baseballs from a pitching machine
    • A person's job is just to do her best to hit each ball as it comes.
    • Refusing to accept that a ball is coming does not make it stop coming
    • Willpower, defiance, crying, or whimpering does not make the machine stop pitching the balls; they keep coming over and over and over.
    • A person can stand in the way of a ball and get hit, stand there doing nothing and let the ball go by as a strike, or swing at the ball.

     Willingness versus Willfulness

    • Skills for tolerating and surviving crises
    • Skills for accepting life as it is in the moment
    • Used in situations which cannot be changed and your feelings about the situation are not likely to change anytime soon
    • Skills for reducing suffering  
    •  Willingness is accepting what is, together with responding to what is, in an effective and appropriate way.
    • It is doing what works. It is doing just what is needed in the current situation or moment
    • Willfulness is imposing one's will on reality- trying to fix everything, or refusing to do what is needed. It is the opposite of doing what works.
    • Turning the mind is choosing to accept
    • Acceptance seems to require some sort of choice
    • People have to turn their minds in that direction, so to speak
    • Acceptance sometimes only lasts a moment or two, so people have to keep turning the mind over and over and over.
    • The choice has to be made every day- sometimes many, many times a day, or even an hour or a minute

    Wednesday, December 5, 2018

    TIPP




    Temperature
    Intense exercise
    Paced breathing
    Paired muscle relaxation

    PROGRESSIVE MUSCLE RELAXATION


    9.5 minutes

    PACED BREATHING

     
    10 minutes

    https://ilovedbt.com/

    TIPP stands for TemperatureIntense exercisePaced breathing, and Paired muscle relaxation.

    TEMPERATURE

    When we’re upset, our bodies often feel hot. To counter this, splash your face with cold water, hold an ice cube, or let the car’s AC blow on your face. Changing your body temperature will help you cool down—both physically and emotionally.

    INTENSE EXERCISE

    Do intense exercise to match your intense emotion. You’re not a marathon runner? That’s okay, you don’t need to be. Sprint down to the end of the street, jump in the pool for a few laps, or do jumping jacks until you’ve tired yourself out. Increasing oxygen flow helps decrease stress levels. Plus, it’s hard to stay dangerously upset when you’re exhausted.

    PACED BREATHING

    Even something as simple as controlling your breath can have a profound impact on reducing emotional pain. There are many different types of breathing exercises. If you have a favorite, breathe it out. If you don’t, try a technique called “box breathing”. Each breath interval will be four seconds long. Take in air four seconds, hold it in four seconds, breathe out four, and hold four. And then start again. Continue to focus on this breathing pattern until you feel more calm. Steady breathing reduces your body’s fight or flight response.

    PAIRED MUSCLE RELAXATION

    The science of paired muscle relaxation is fascinating. When you tighten a voluntary muscle, relax it, and allow it to rest, the muscle will become more relaxed than it was before it was tightened. Relaxed muscles require less oxygen, so your breathing and heart rate will slow down.1
    Try this technique by focusing on a group of muscles, such as the muscles in your arms. Tighten the muscles as much as you can for five seconds. Then let go of the tension. Let the muscles relax, and you’ll begin to relax, as well.

    TIPP

    Temperature
    Intense Exercise
    Paced Breathing
    Paired Muscle Relaxation
    The distress tolerance skills in TIPP will bring you a step closer to wise mind, where you will be able to make a constructive choice and cope productively.

    Awareness Exercises

    Awareness Exercises

    1. Skills of Mindfulness
    In a nutshell, mindfulness is about being completely in touch with the present moment and being open to experiences as they come. Mindfulness is made up of a number of skills, all of which require practice. These skills include awareness, nonjudgmental/nonevaluative awareness, being in the present moment, and beginner's mind. You can learn more about these skills in this article, as well as ways of strengthening these skills.


    ·    Awareness
    One skill of mindfulness is learning how to focus your attention on one thing at a time. This includes being aware of and able to recognize all the things that are going on around you (for example, sights and sounds), as well as all the things that are going on inside you (for example, thoughts and feelings).
    ·    Nonjudgmental/Nonevaluative Observation
    This skill is focused on looking at your experiences in a nonjudgmental way. That is, simply looking at things in an objective way as opposed to labeling them as either "good" or "bad." An important part of this skill is self-compassion.
    ·    Being in the Present Moment
    Part of mindfulness is being in touch with the present moment as opposed to being caught up in thoughts about the past (also called rumination) or the future (or worry). An aspect of this skill is being an active participant in experiences instead of just "going through the motions" or "being stuck on auto-pilot."



    2. Mindful Awareness of Your Breathing
    Focusing on each and every breath is an excellent way of beginning to increase your awareness of the present moment. This basic mindfulness exercise takes you through a number of steps that will help you learn how to be more mindful of your breathing.

    3. Being Mindful of Sounds
    Practicing mindfulness of sounds can be an excellent exercise for getting in touch with your present moment external environment, as well as practicing and improving the mindfulness skill of non-judgmental observation. This article takes you through a simple exercise designed to increase your non-evaluative awareness of sounds in your present moment environment.

    10 minutes:


    4. Sitting Meditation
    Sitting meditation is an excellent way of practicing mindfulness, as well as learning how to bring acceptance to your thoughts and feelings.  

    5. Eating Mindfully
    Life can become very busy and stressful, and as a result, we often rush through our day without taking time to really notice and enjoy present moment experiences. One way of getting in touch with the present moment is through mindful eating. We often eat our meals quickly without even paying attention to the rich experience of eating.  

    6. Beginner's Mind
    Beginner's mind, a skill of mindfulness, focuses on being open to new possibilities. It also refers to observing or looking at things as they truly are, as opposed to what we think they are or evaluate them to be.  



    7. Mindfulness of Thoughts
    Mindfulness can be a wonderful skill to practice when it comes to coping with your PTSD symptoms; however, it can be difficult to be mindful of thoughts, especially those that usually accompany a PTSD diagnosis. People with PTSD may struggle with unpleasant thoughts and memories of their traumatic event. These thoughts can take control over a person's life. Mindfulness can be used to take a step back from your thoughts and reduce their power to impact your life. This simple exercise will help you learn how to be mindful of your thoughts.

    ·    Try to view your thoughts as simply thoughts -- only objects in or events of your mind. It may be useful to imagine your thoughts as simply clouds passing through the sky or leaves passing down a stream. Notice them enter your consciousness, develop, and then float away. There is no need to seek out, hold onto, or follow your thoughts. Just let them arise and disappear on their own.

    1:45 minutes


    8. Mindfulness of Emotions
    Practicing mindfulness of emotions may be quite beneficial if you struggle with intense and unpleasant emotions. An exercise for promoting mindfulness of emotions is presented here.
    ·    Now, pay attention to any sensations in your body that arise. Notice the thoughts running through your mind. Notice also how you feel. What emotions are present as a result of imagining this situation? Are you experiencing one emotion or multiple emotions?
    ·    Once you have identified an emotion or multiple emotions, notice any urges to avoid or push away those emotions and respond by bring a sense of curiosity and compassion to that experience.
    ·    Focus your attention completely on the emotional experience. Notice what the emotions feel like in your body. Do you have muscle tension? Is your heart racing? Do you feel an urge to cry? Bring all of your awareness to those experiences without judging or changing the experience. If you notice that you are trying to change or judge your emotions, notice that and refocus your attention on simply observing your emotions. Also notice whether your emotions stay constant or change throughout the exercise.

    6:00 minutes

    9. Mindfulness of Everyday Activities
    Mindfulness can be a very useful skill to learn for managing PTSD symptoms and anxiety in general. This article presents some ways that you can bring mindfulness to your everyday activities.
    ·    Going for a walk
    ·  Exercising
    ·  Cooking
    ·  Listening to the radio
    ·  Watching the television
    ·  Drinking a cup of coffee
    ·  Waiting in line at the grocery store


    10. Mindfulness of Physical Sensations
    Practicing mindfulness of physical sensations can be an excellent exercise for getting in touch with your present moment experience, as well as practicing the mindfulness skill of non-judgmental observation as it applies to your own body.
    ·    Allow your awareness to expand to your body as a whole, simply allowing your awareness to expand to any physical sensations in your body. Notice if you are experiencing any tension or pain in your muscles. Notice if you are experiencing any hunger. Bring awareness even to what the air feels like against your skin.
    ·    If you notice that you are judging or labeling any bodily sensations, bring your awareness back to the sensation as it is instead of how our mind tells us it is.
    ·    There is no need to go hunting for sensations of to hold onto sensations, simply just notice any sensation as it arises.
    ·     



    PRACTICE

    Scenario One
    Going to work, you are caught by your supervisor coming in 30 minutes late. How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?

    Scenario Two
    You are in a family situation, everyone is saying that you should go get a job and that you did not do that because you are lazy. How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?

    Scenario Three
    You re in an excellent mood and you like to go shopping, your friends refuse to go shopping with you. How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?

    Scenario Four
    You are in the doctor's office, and she refuses to prescribe the sleeping pills because she thinks that you might overdose on it? How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?


    Note: Exercises 1 and 3-8 are adapted from the Miracle of Mindfulness: A Manual of Meditation (pp. 84-87) 1976, Boston, Beacon Press, Copyright 1976 by Thich Nhat Hanh, Adapted by permission.

    Thursday, November 29, 2018

    The DBT Travel Guide App


    "The app provides information about DBT and BPD. The DBT Travel Guide contains more than 200 different skills and mindfulness exercises. The app can provide support in moments of crisis through its crisis section. For the DBT therapist, the app contains a ‘think of’ scheme, full of practical guidelines. Furthermore, the app offers the possibility to write down agreements between client and therapist and to digitally fill in the diary card."

    Sunday, November 18, 2018

    DBT at WPCS in Gladstone, OR

     

    see also my DBT blog and selfhelpdbt.com
     
     
     Jane Leu Rekas, LCSW, CHt
    Western Psychological & Counseling Services
    880 82nd Dr., Gladstone, Building A

    ADULT DBT Wed 6:00-7:30pm
    or 
    ADULT DBT Thurs 2:00-3:30pm 
     
     
     
    Mindfulness is balancing emotion mind and rational mind.
     

    ADULT DBT Wed 6:00-7:30pm
    10/17/18 Intro to DBT Mindfulness 1
    10/24/18 Mindfulness Skills 2
    10/31/18 break
     
    Distress Tolerance is when you have a problem you 
    cannot solve, but you don't want to make it worse.
    11/7/18 Distress Tolerance 1
    11/16/18 Distress Tolerance 2
    11/21/18 Distress Tolerance 3
    11/28/18 Distress Tolerance 4
    12/5/18 Distress Tolerance 5
    12/12/18 Distress Tolerance 6

    12/19/18 break
    12/26/18 break
    1/2/19 break

    1/9/19 Intro to DBT Mindfulness 1
    1/16/19 Mindfulness Skills 2
    1/23/19 break
     
    Emotion Regulation is having less negative emotions
     and vulnerability, and more positive emotional experiences.
    1/30/19 Emotional Regulation 1
    2/6/19 Emotional Regulation 2
    2/13/19 Emotional Regulation 3
    2/20/19 Emotional Regulation 4
    2/27/19 Emotional Regulation 5
    3/6/19 Emotional Regulation 6
    3/14/19 break
    3/20/19 Intro to DBT Mindfulness 1
    3/27/19 Mindfulness Skills 2
    4/3/19 break

    Interpersonal Effectiveness is asking for what 
    you want and saying no effectively.
    4/10/19 Interpersonal Effectiveness 1
    4/17/19 Interpersonal Effectiveness 2
    4/24/19 Interpersonal Effectiveness 3
    5/1/19 Interpersonal Effectiveness 4
    5/8/19 Interpersonal Effectiveness 5
    ADULT DBT Thurs 2:00-3:30pm
    10/18/18 Intro to DBT Mindfulness 1
    10/25/18 Mindfulness Skills 2
    11/1/18 break
     
    Distress Tolerance is when you have a problem you 
    cannot solve, but you don't want to make it worse.
    11/8/18 Distress Tolerance 1
    11/15/18 Distress Tolerance 2
    11/22/18 Thanksgiving
    11/29/18 Distress Tolerance 3
    12/6/18 Distress Tolerance 4
    12/13/18 Distress Tolerance 5

    12/20/18 break
    12/27/18 break
    1/3/19 break

    1/10/19 Intro to DBT Mindfulness 1
    1/17/19 Mindfulness Skills 2
    1/24/19 break
     
    Emotion Regulation is having less negative emotions
     and vulnerability, and more positive emotional experiences.
    1/31/19 Emotional Regulation 1
    2/7/19 Emotional Regulation 2
    2/14/19 Emotional Regulation 3
    2/21/19 Emotional Regulation 4
    2/28/19 Emotional Regulation 5
    3/7/19 Emotional Regulation 6
    3/14/19 break
    3/21/19 Intro to DBT Mindfulness 1
    3/28/19 Mindfulness Skills 2
    4/4/19 break
     
    Interpersonal Effectiveness is asking for what 
    you want and saying no effectively.
    4/11/19 Interpersonal Effectiveness 1
    4/18/19 Interpersonal Effectiveness 2
    4/25/19 Interpersonal Effectiveness 3
    5/2/19 Interpersonal Effectiveness 4
    5/9/19 Interpersonal Effectiveness 5