DBT -- Eichs

Jean Eich: Dialectical Behavior Therapy Skills Training with Adolescents: A Practical Workbook for Therapists, Teens & Parents

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Dialectics. "The main idea of dialectics is that there is an opposite of everything, and we tend to be the most effective when we can find balance between opposites. So, being dialectical means finding balance."

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Mindfulness Module. Mindfulness skills are core skills, as they are an important part of everything done in DBT.

States of Mind. 

• Emotion Mind: focus on emotions, "our feelings are in charge, and our thoughts and behaviors are driven by them." 
• Reason Mind: focused on facts, "our thoughts and behaviors are guided by facts." 
• Wise Mind: "able to feel our emotions and focus on facts. In Wise Mind, we make decisions based both on how we feel and the facts." 

What Skills. To get into Wise Mind, we use our What Skills -- Observe, Describe, and Participate.

• Observe = notice or pay attention >> external events and internal events >> we simply notice and then let it go (pay attention and don't get caught up in one thought, emotion, or experience). 
• Describe = give words to what we noticed without judgment. Not "Math is the worst subject" but "I feel frustrated with math." 
• Participate = using the information we gathered when we observed and described to make effective decisions. 

How Skills. How do we use the What Skills to get into Wise Mind? We act non-judgmentally, one-mindfully, and effectively.

• Non-judgmental = focus on facts, separate facts from opinions. 
• One-mindful = focus on one thing at a time (e.g. when doing homework, only focus on homework). Four steps to help you be one-mindful: focus on one thing at a time, notice when your mind wanders, re-focus on one thing at a time, repeat steps 2 and 3 as often as needed. 
• Effective = make decisions that will help you reach your goals (must first figure out what your goals are). 

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Distress Tolerance Module. Skills that will help you deal with distress or difficult/uncomfortable emotions. The goal is not to get rid of difficult emotions but to learn to cope with these emotions when they arise.

Crisis Survival Skills. Skills that will get you through a crisis; you need to find the balance between dealing with the problem and taking a break. It's important to know when to take a break from the situation. If you answer no to any of the following questions, you might want to take a break: Am I in Wise Mind? Are those involved in Wise Mind? Do I have what I need to fix the problem? Is this a good time to fix the problem?

• Wise Mind ACCEPTS. Different ways to distract yourself. A -- distraction through Activities (e.g., exercise, video game, texting a friend). C -- distraction by Contributing or helping someone else (e.g., call a grandparent, help sibling with homework). C -- distraction by Comparing yourself to someone in a worse situation (e.g., compare yourself to when you first started DBT). E -- distraction by using Emotions or doing something to create a new feeling (e.g., watch a funny movie, listen to happy music). P -- distraction by Pushing Away or physically or mentally leaving a problem situation (take a walk, write down your thoughts and tear them up, block out thoughts about the problem). T -- distraction by changing our thoughts or adding thoughts that have nothing to do with stressors (e.g., think about something else, sing your favorite song, imagine what you would do if you won the lottery, name an animal for every letter of the alphabet). S -- distraction by focusing on one of your five Senses (hold an ice cube, eat a spicy food, take a hot shower, listen to loud music, sniff strong perfume).  
• Self-Sooth. Using the five senses to comfort and nurture you. Visual -- draw, look at beautiful pictures on Tumblr, look at old pictures, gaze at stars. Hearing -- listen to music, listen to the rain, birds. Smell -- use scented lotion, light a candle. Taste -- have chocolate, eat fruit, eat ice cream. Touch -- use a favorite lotion, hold a stuffed animal. 
• IMPROVE the Moment. Replace negative events with positive ones, how to improve your thoughts or physical sensations. I -- Imagery, using your imagination to create a situation that feels more comfortable and safe, try to include five senses (imagine beach, remember favorite time). M -- Meaning, finding a purpose for what you're going through ("Going through this will make me a strong person," "Having this experience will help me understand others better"). P -- Prayer, connecting to something greater, opening yourself up to the moment (say a prayer, go for a walk and connect with nature). R = Relaxation, help your body feel more comfortable and calm (take a hot shower, do deep breathing, drink hot tea, do stretches). O = One Thing at a Time, remind yourself to focus on just one thing at a time (say, "One day at a time," do a puzzle and focus on puzzle). V = Vacation. taking a break from your stressors, should be no more than one day (spend day at mall, go to restaurant and order new dessert, get a manicure). E = Encouragement, become your own cheerleader, root yourself on (make a list of your positive qualities, tell yourself "I can do it!" or "I am strong!"). 
• Half-Smile. Make a slight smile. Your body associates smiling with being happy. Sit still, relax your face muscles, try not to put an expression on your face. Notice how it feels to have your face relaxed and expressionless. Then slightly smile and notice how your face feels. Although the effects of this exercise are not supported by the latest evidence. 
• Creative Outlet. Examples: drawing, writing poetry, coloring, playing instrument, dancing. 

Accepting Reality Skills. Help you focus on being effective with accepting reality (or with things you cannot change). An important DBT idea is pain versus suffering. Everyone experiences pain, it comes and goes. Suffering is common but can be avoided. Suffering happens when you do not deal with or accept pain -- e.g., when you pretend everything is okay, bottle up your emotions, perseverate on a crisis, try to change something you have no control over. When you accept reality, you can avoid suffering. 

• Pros and Cons. Helps us better understand reality. Must look without judgment at costs and benefits of decision. Examples: pros and cons of skipping school, going to party.  
• Radical Acceptance. Accepting what you cannot change so you can spend your time and energy on times you can change. 
• Turn the Mind. Changing your thoughts so that you can radically accept. Imagine a fork in the road: one fork leads to radical acceptance, the other to suffering. This involves practice, turning our thoughts to radical acceptance again and again. 
• Willingness.  Doing the best you can with what you have. 

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Emotion Regulation Module. Learning to understand and balance your emotions. Primary emotions are reflexive, happen automatically in response to triggering event. Secondary emotions are created by the way we think about our primary emotions. Example: I have to give speech in class (triggering event) >> I feel fear (primary emotion) >> I think, "Everyone else feels fine about giving speech" >> I feel shame (secondary emotion). 

• PLEASE. Take care of your health to reduce emotional vulnerability. PL -- treat Physical Illness (take care of yourself when sick: see doctor, get extra sleep). E -- balanced Eating (eat veggies, only eat sweets as a reward, have fruit as a snack after school). A -- Avoid mood-altering drugs (also limit soda). S -- balanced Sleep. E -- balanced Eating (at least 20 minutes of daily exercise). 
• Build Mastery. Do something that helps you feel confident, capable, and in control. Do daily chores (take shower, clean room, do homework). Do things you're already good at. 
• Just Act. Instead of saying, "I'll get this done today."
• Give Myself Credit. Appreciating your efforts or work towards a goal. "I did my best!" "I'm proud of myself for trying something new!"
• Build Positive Experiences. Doing something that is pleasurable and fun. For example, watch a funny video, text a friend, learn karate. 
• Opposite to Emotion. Doing the opposite of what you feel. Example: I feel depressed >> I feel like staying in bed >> instead I spend time with a friend. 
• Feel Your Feelings. Being mindful of your feelings -- noticing and experiencing your feelings, including feeling painful feelings without turning them into suffering. Not stuffing, which involves ignoring emotions (when you do that, they don't go away). Not sticking, which involves holding on to emotions and trying to keep them around (e.g., replaying a stressful situation); this leads to suffering because emotions naturally come and go, and stickers don't let them go. Feeling Your Feelings involves noticing your feelings without holding on to them. Observe and Describe your emotion, body sensations, thoughts, urges, and when you are ready to feel something new, let the old emotion go. 

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Interpersonal Effectiveness Module. Three goals: (a) build and keep healthy relationships (GIVE), (b) make requests and say no (or be assertive, DEAR MAN), and (c) feel good about yourself in relationships (FAST). 

• Attend to Relationships. Talk to and spend time with others regularly. Don't let problems build up. Use your skills to avoid problems. Balance sharing with listening. 
• GIVE. G -- be Gentle (kind and respectful) (don't call names, don't swear). I -- act Interested (actively listen, ask questions). V -- Validate (acknowledge the other person, show that you understand the other person's opinions, feelings). E -- Easy manner (being easy going, not taking things too seriously, make a joke, smile, let little things go). 
• DEAR MAN. D -- Describe (state the facts of the situation). E -- Express (express your feelings and opinions about the facts, use "I" statements). A -- Assert (ask for what you want or say no clearly). R -- Reinforce (do something that makes what you want more likely) (e.g., state the positive impact of the other person doing what you ask -- "I feel happy when you call me back) (e.g., share the negative impact of the other person not doing what you ask -- "I care about our relationship less when I don't hear from you") (e.g., offer the other person a reward for doing what you ask, can just be a thank you). M -- Mindful. Stay focused on your goal, do not get distracted. Techniques: Broken Record (keep asking or saying now), Ignore (ignore attempts to change the subject), Take a Break (if you or the other person is in Emotion Mind). A -- Act confident (make eye contact, speak clearly, straight posture). N -- Negotiate.  
• FAST. F -- Fair. Balancing your wants and needs with those of the other person. A -- no Apologies. Don't apologize for things that are not your fault. S -- Stick to your values. Don't give up what is important to you for what is important for someone else. T -- be Truthful. 
• Boundaries. Use DEAR MAN to assert your boundaries. Use FAST by not apologizing for your boundaries. Use GIVE to be respectful, don't blame others for not knowing your boundaries.