Dialectical Behavior Therapy DBT Made Simple: Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes

Unlimited CEUs are available at AllCEUs.com This episode was pre-recorded as part of a live continuing education webinar. ALLCEUs.com/Counselor Toolbox. I want to welcome everybody to today's presentation on DBT or dialectical behavior therapy made simple. This presentation was actually based off the book by the same name dialectical behavior therapy made simple move bad graphics there and I really like this book because it presents DBT skills in a very usable format there are a lot of us who aren't ready to launch into being a formal DBT practitioner but we are intrigued by how DBT works and some of the skills and all that kind of stuff this is a great introduction if you're not if you haven't really studied DBT and you want to figure out how you might be able to use it with your current client base great place to start especially if you're working with clients who aren't at the level that Marsha Linehan was working with when she developed DBT where there's a lot of self-injury I personally like to err on the side of being conservative when I'm starting with new techniques and you know I use newer things that until I get a good feeling for how they work and what the outcomes going to be I use those newer things with less acute clients and I use my old tried-and-true with clients that may be struggling a bit more and I want to make sure that when I put something out there it usually hits the mark not to say that I do it every time so we're going to go over the basics of DBT will review the B and DBT what you need to know about behavior there is a ton of stuff I got my minor in behaviorism I took class is in behaviorism 416 college credit hours so there's a ton of stuff we could go over and we're not going to cover anywhere near that right now and most people don't want to cover anywhere near that at all so understanding and DBT there's a few things you need to know but it's not crucial to be a behaviorist we're going to talk about mindfulness again and it is really unimportant and interesting to me that over the past few years how much mindfulness has been incorporated in most every new sort of mainstream therapy now it's not exclusively the therapy but there is a core element of mindfulness that we're talking about and I think prior to the emergence of the term mindfulness we talked about it but we didn't have a label to put on it and mindfulness with the label gives us the ability to have some skills groups that are specifically tailored around mindfulness which from a therapeutic perspective is wonderful and from a business perspective can also be wonderful we'll talk about reducing emotional reactivity developing distress tolerance skills what clients need to know about emotions including regulating the painful ones and increasing the positive you know I harp on that concept of you can't just eliminate bad you have to add positive otherwise you're going to have a person who's just kind of sitting there going well I can't do what I what I used to do but I don't have any other tools and we want to help clients become more effective in relationships we find that a lot of the traumas that people experience especially people with high emotional reactivity can go wet way back and to where they were knee-high to a grasshopper and they were expressing how they felt they were expressing their heightened sensitivity and they were being invalidated they were being told this you need to suck it up this isn't that bad so from the get-go they had difficulty expressing how they were feeling what was going on with them and they were in an environment that was invalidating so there's a lot of relation ship stuff that people need to look at in terms of their anxiety and frustration levels I mean when you keep getting told you're wrong you feel some particular way and you tell someone this is how I'm feeling and they tell you no you shouldn't feel that way yeah it's going to increase anger and frustration and your sense of isolation and helplessness so with DBT we help people examine some of these things provide self validation but also develop tools for handling this emotionality so the clients that we're working with are typically clients with a higher amount of emotional vulnerability they react to things others wouldn't react to and their reaction is more intense than others so instead of being you know a 2 on a scale of 1 to 10 their reaction is more like a 4 or 5 sometimes that's because they have a whole bunch of pent-up stuff that they're trying to keep bottled up and then this is sort of the straw that broke the camel's back but more often than not they are just highly sensitive and their recovery time is longer than others which makes sense if you get more reactive if you get more of an adrenaline rush it's going to take longer to come back to baseline than a person who only had half the adrenaline rush totally makes sense however if the person is in an environment where other people don't share these same characteristics they're going I don't fit in everybody else is fine and I'm still feeling not fine they have an inability to regulate emotion again because when they were growing up they didn't develop that emotional vocabulary that ability to communicate to others what was going on and the validation that okay this is how you feel let's figure out how to deal with it many times this particular set of clients was told you need to suck it up get over it if not that bad so they didn't learn the tools to tolerate distress they didn't learn the tools to handle their emotions we want to help them understand why they feel the way they feel if they get upset about something okay let's look at why because there's a lot more to feelings than just that surface level and these particular clients typically have difficulty expressing expressing the emotion in an effective way so it comes out as either gushing or passive-aggressive or angry because when they've tried to express it the only way they know how they've been shut down sometimes they will bottle it up because people keep telling them they're wrong so they're like well I'm in excruciating agony but nobody understands so I am just going to go drink myself into a stupor not the healthiest way to handle things so this is the clients that we're dealing with they're highly sensitive which means that they get really revved up and it takes a while for them to calm down and they need to help figuring out how to navigate in a world where other people may not get as revved up or may be able to calm down more quickly one of the underpinnings of DP DBT is dialectical therapy for dialectical theory sorry everything is interconnected there's an action and there's a reaction if I scream at someone I'm probably pushing them away they're probably going to be like oh I don't want a piece of that so if I scream at somebody I push them away but what else goes along with that then I'm more isolated I have fewer social supports which means I may feel more stressed because I can't spread it out and get support which may increase the frequency and/or the intensity with which I scream at people to push them away so it's a sort of self-perpetuating cycle if you will some of the examples of action and reaction addiction if someone uses drugs if someone engages in a behavioral addiction there is an epinephrine rush there's a dopamine rush there is a lot of excitatory stuff going on in the brain and the person goes that felt good I want to do that again but the brain has said we're not equipped to handle that level of stimulus so we're going to shut down some of the gates turning it down to protect itself the brain does the person uses again they don't get quite the same rush when they sober up some of those doors some of those gates are shut so it takes more for them to feel happy than it did before they started using so now they've created a situation where when they sober up they're still feeling pretty crappy so they use again so there's an action reaction now likewise when they stop using as the brain recovers the action of stopping using in the brain recovering produces the reaction of getting more positive neurotransmitter secretions and actually seeing color in the world if you will I already gave you the example of anger when people are really angry it pushes everyone away most people don't want to hang around with somebody who's just angry all the time it's exhausting so being angry all the time pushes people away people who tend to be angry all the time part of what I hear from from them is nobody wants to be my friend I'm all alone nobody gets it well let's look at how you got to be all alone so you push these people away and now you're feeling frustration how can we deal with that depression when someone's depressed sometimes they'll stay in bed all day what does that do that messes up their circadian rhythms so then they don't know when they're supposed to sleep they don't know when they're supposed to be awake when they do sleep with not quality sleep so they get more fatigued so they want to sleep more and then they can't seem to wake up and it intensifies their feelings of helplessness and hopelessness and then finally social interactions for our final example when you have a positive social interaction with someone what comes back you want to hang out with them again when you give out positive vibes if you will positively gets positive most time I mean as clinicians we see someone hurting and most of us are more than more than likely to run over and go how can I help but after we get past that when we're talking about just social life when you put out positive you get positive in return when you put out negative you may be surrounded by other negative people or you may be all by yourself so let's look at what the action reaction was reality is in a constant process of change so helping clients remember how they perceive something now may be different than how they perceive it in an hour if you get an evaluation and it is not a good evaluation and it's just devastating you know it hurts you're dealing with that right now but in an hour when the adrenaline has a chance to go away when you've had a chance to you know lick your proverbial wounds in an hour how do you feel is it the end of the world still or have you kind of adjusted most of us have learned how to tolerate de-stress ride the wave whatever you want to call it and an hour later we're like okay that really sucked but it's not the end of the world some of the things we can ask clients to do is look at what things change their perception between you know something happens and they feel one way and an hour later or a day later or six months later they're like that wasn't that big of a deal what changed their perception was it just time or how do they change their perception another thing we can ask them to do is figure out what when they're in a crisis when they're upset what is their emotional mind saying what is their heart saying if their heart could talk what is their reasonable mind or their detectives saying taking the two of those and this is the dialect the heart in the head and combining them and going alright now what can I get out of that I may not be able to do exactly what my heart wants I may not be able or I may not want to do exactly what my head says I should do so how can I find a compromise where can I find that middle ground finally the truth is always evolving and can be found by integrating multiple perspectives and tolerating the two opposite things may coexist two opposite things may coexist let's talk about these perspectives simultaneous if you go to a crime scene and you ask five people who saw it take place what happened you don't get the same response you're going to get five different reports now there's going to be some overlap but there's also going to be some interpretation of what happened based on their prior learning experiences doesn't mean they're wrong no that's their reality so if you take five different realities and merge them all together hopefully you get something closer to an objective reality when there's an interpersonal disagreement and I was watching gaali The Daily Show the other day and Trevor Noah was talking about how in this particular election if you're a Hillary supporter and something comes out about Hillary you can get frustrated that the news is focusing on this and not focusing on all the Donald Trump stuff if you are a Trump supporter and something bad comes out about Hillary you can get excited that they're not focusing on the bad stuff about Trump and they are focusing on the bad stuff about Hillary so its perspective is it a good thing or a bad thing that something's coming out and how are you interpreting it what is meaningful to you longitudinally means thinking about things from you know what was meaningful when I was six versus what is meaningful when I'm 26 one example would be what if a child says you know my mom had no use for us and and that's why she left and a lot of kids feel that way or a lot of kids don't understand why mommy or daddy chooses alcohol and drugs over them because that's their exception as they grow up and gain more knowledge learn more about addiction hopefully sooner rather than later they start to understand that yes the parent left yes the parent chose alcohol and drug addiction however does that mean that the parent loves you any less so we need to talk about what that means another example is in abusive situations where a parent is supposed to love the child but the parent also beats the child so the child's going well if mommy loves me but mommy beats me then I must be bad it has to be something with me because mommy tells me she loves me and but then I don't get it helping the child or the adult the adolescent kind of rectify those two things that they can they can coexist your parent can love you but they can also do things that are harmful and hurtful at the same time does it mean that you are bad what other things could it mean so one of the things that is interesting in DBT is the fact that there are skills training groups and in individual sessions a lot of clients with high emotional reactivity really want to deal with whatever their present crisis is they really want to deal with them so it's not a time to start teaching a whole lot of skills in skills training groups clients are able in a relatively neutral environment to learn some basic skills and then we can take from those training groups and apply them in individual sessions in a more heated situation where the person is telling you about their current crisis so your main skills include core mindfulness which is increasing self-awareness of thoughts feelings and urges when you have an emotion anger what thoughts are you having what feelings physical feelings are you having you've already labeled the emotion as anger so what physical feelings are you having what secondary emotions are you having oh we don't ask that a lot so there's anger but there's also probably other stuff in there guilt resentment jealousy what's going on and what urges are you having when you have these thoughts when you have these physical feelings and reactions what is your desire what is your behavioral urge this helps people start to understand what's going on with them and go okay I see how the dots are connecting and the cool thing is that you only have to kind of break one of the links in the chain to interrupt this behavior so if they feel an adrenaline rush coming on you know they know they're anxious they can feel their blood pressure coming up if they're mindful and aware of that happening then they can intervene earlier than if they wait until they're in full-out thought feeling urge I've got to make it stop mode core mindfulness also helps clients develop an understanding of their emotions as things that don't have to be acted on and this is a new concept this is a really new concept for a lot of people and you know it's interesting because my daughter is 12 almost 13 and I was typing a response to something on Facebook the other day and I was pretty passionate about it and we were getting ready to go out and put the chickens up or something I'm like hang on a second let me just finish this post that I'm doing and she looked at me she's like you're going off on somebody about something aren't you I'm like well and she's like you don't need to let them get you that upset I'm like really my 12 year old is telling me this so I finished my post it was polite but it was to the point and you know we went on and did that but her awareness of the fact that you can get angry you can get sad you can get whatever it is but you don't have to follow through with a particular behavior I thought was pretty good for 12 interpersonal effectiveness helps people develop assertiveness skills so they can say this is how I feel you don't have to feel that way and you don't have even have to agree that I should should feel this way but it's how I feel it is what it is and we also help people identify the goals of their relationships and skills and activities needed to achieve those goals so how do you effectively communicate how do you create a win-win situation how do you negotiate and compromise instead of thinking of things in terms of black and white emotion regulation skills is your third group of skills that you're going to deal with helps people label and effectively communicate feeling States if you're telling someone that you're angry and you use and when I was in counseling 101 our first counseling class we were told we were not allowed to use the words happy mad sad glad or afraid we had to find some sin on him but we were not allowed to use those five words in class because she wanted us to develop a deeper repertoire of emotion words so we developed an understanding of irritated and enraged and those sorts of things you can do a lot of really cool activities with not charades you put 15 or 20 different emotions in a hat on little pieces of paper people draw them draw them from the hat and then they've got to act out that emotion so they get a sense of what it might feel like what it might look like and then you can talk about what types of thoughts might go through your head when you're feeling like that emotion regulation helps us understand the function of emotions and why we don't want to eliminate them is anger a functional emotion heck yeah anger and fear tell you there's a threat there is something you either need to defeat or get the heck away from now does nurturing it and holding on to it and whatever we do with it is that functional that's generally not as helpful anger and fear are our body's way our minds way of saying you need to do something and that's it then you get up and you do something you either let it go you fix it or you get away from it happiness is an emotion we don't want to get rid of that that one either because it says I want to do it again and thinking about kids when they're little some of the things they want to do we were talking yesterday about peekaboo and I was sharing with my daughter that small children are so thrilled I mean they can be amused for 20 minutes or more if you just cover your eyes there you go peekaboo and you do it again and again and they laugh every time and you're just sitting there looking at them going how can you find this amusing this helps children laughter is cathartic laughter is helpful anything we do that makes us laugh that makes us happy it's something we want to do again now whether the child really finds it all that confusing or they just think it's fun to watch us make complete fools of ourselves which i think is probably more it it's providing joy to that child learning the connection between thoughts feelings and behaviors and how to break the chain as people start labeling their feelings they can say when I get angry this is what I first notice when I get angry my thoughts my feelings my behavioral urges are so they can figure out what can they do a lot of times the first intervention focuses on those behavioral urges we don't want you to go out and use we don't want you to go out and cut we don't want you to do something that's self harming so when you feel this emotion what else could you do and then we start talking about distress tolerance and how to get through those periods where emotions feel overwhelmed and your distress tolerance skills are really just your survival skills and alternatives to self-harm it's saying I met a lot of distress right now however I'm making the choice not to engage in an unhelpful behavior so some of the assumptions in DBT are that clients are doing the best they can with the tools they have at this point in time nobody gets up in the morning and says I want to be miserable so I'm going to half-ass it today you know we really we get up and we go I want to have a good day and if people don't end up having a good day you know life happens so you're doing your best and you're surviving the best way they can clients want to get better if the situation they're in is causing them distress they generally don't want to keep doing it do you want to keep banging your head into the wall no you know so the old adage goes why does Johnny keep banging his head into the wall because it feels so good when he stops so we want to say all right you're doing this behavior and it ends up having a bad consequence let's take addiction for example you get under a lot of stress you get angry you go out you drink you pass out you wake up the next morning during that short period where you were drinking you're inebriated and you are unconscious you didn't hurt that is the reward that we're looking at it's not that they didn't want to get better it's not that they were choosing alcohol it was that they were choosing to survive so we need to figure out how to help them work harder and smarter so what are you going to do instead let's give you some more tools to work with it is hard changing from that knee-jerk reaction that has worked most of the time to changing to something else which is a new skill or a new tool that's exhausting that's hard it is hard work therapy's hard work but we're going to provide you some tools so you can do it efficiently and we'll be there to support you and help you figure out how to you know tweak how your using that tool to make it more efficient for you this helps them stay motivated clients need to remember that even if they didn't create their problems they gotta fix them sometimes stuff happens and it is out of that person's control but they've got to figure out how they're going to live with that if someone in their family some of their clothes - passes away yet they're going to feel grief they're going to go through all those stages and it really stinks they didn't create that they didn't you know cause the person to die but they have to figure out how they're going to live with it so it's not their problem anymore so they don't stay grieving for 5 10 15 years clients need to learn to act skillfully in every area of their lives and one thing that is pointed out in the book is the fact that there are a lot of people with high emotional reactivity who are very successful in one or two areas of their life you know they may be you know very very successful at work but their home life is a shambles or they may be you know really good at home but interpersonally you know in social situations and at work not so much so we need to help clients learn how to generalize these skills and use them in every area of their life and finally and one of the most important in my opinion is clients cannot fail in therapy if we give them the tools and they're doing their best and we're working with them then we need to stop back and look and say okay how did the techniques how did your knowledge or what we've been parted to you not meet the standards that it needed to how did we fail how did the therapeutic process fail not the client the client is doing the best they can the therapeutic process may not have been as effective treatment priorities obviously the first priority if somebody is suicidal or engaging in self-harming behaviors including addiction that's our primary thing then we look at behaviors that interfere with therapy calling in not showing up to appointment showing up late and this includes the clinician and obviously we're not going to discuss that with the client but we need to be cognizant of things that we may do that interfere with therapy and we've all had clients before that have been more challenging than others and you're like okay you know so-and-so is coming today and you know that they're trying to work you know they're trying to do their best however you're just really struggling at that point in time because it's exhausting and this is when DBT therapists or therapists in general need some support then we want to identify suicidal or self-harm ideation and misery so we're not talking about the behaviors we've gotten down to the point where the person just thinks about cutting or thinks about committing suicide or thinks about using how do we deal with those obsessions or ideation if you will once we have eliminated the self-harming behaviors they're engaged in therapy they're not idealizing they're not thinking constantly about self-harming behaviors they've made a lot of progress and we're going to focus on treatment gains so let's keep this going you know you don't want to hurt yourself look how far you've come and what are some other goals that have been identified by the client now in each one of these places we need to interject mindfulness emotion regulation interpersonal effectiveness and distress tolerance so if you're working with someone who is actively suicidal or engaging in self-harming behaviors obviously make sure they're safe if they need to be in a facility so they are safe then that's a whole nother step but you get to the point where you're working with the person and you have them start becoming mindful of what triggers their suicidal impulses you start addressing the emotions that just flare up and feel like a tsunami as opposed to a ripple start looking at that emotion regulation start looking at interpersonal effectiveness when you start feeling this way how can you assertively communicate this and to whom can you assertively communicate this and finally when you start feeling feeling this way before you engage in self-harming behaviors what distress tolerance techniques might be available now remember somebody at this level at level one suicidal self-harming behaviors when they have an emotion when they get overwhelmed it's not just a little overwhelmed it's drowning in a tsunami overwhelmed so they're not going to go well waiting my therapists say all of these things need to be written down they need to have them somewhere accessible that they keep with them at all times so they can look back on it and go okay this is what I need to do and it may be as simple as a phone number of someone they need to call now if you're familiar with the DBT theory and the DBT structure a lot of you know doing true dialectical behavior therapy involves phone consultations with the clinician between appointments and a whole lot of other stuff not just skills groups and individual therapy for the purposes of this particular presentation we're just going to focus on the skills that one would use in the dialectical behavior therapy skills that one could use in traditional therapy taking it to that next level developing a consultation group all that other stuff is a huge undertaking and a whole nother task it's wonderful but it's more than we can cover right here and then we move down once we've got got it to the point where the person is not actively trying to harm themselves and again I say suicide cutting addictive behaviors because all of those have the potential for self harm or maybe even accidental suicide address those first then we move down to behaviors that interfere with therapy and we go through the list again when you're engaging in these behaviors maybe you're coming late to de sessions you know let's talk about mindfulness what is it that's motivating that or why does therapy feel like it's something you don't want to come to start talking about what feelings and what thoughts surround therapy as far as a priority what's changed move down to emotion regulation sometimes coming to therapy and talking about emotions all the time is just exhausting so how can we deal with that draining factor one mistake I find that a lot of my patients make when they start therapy is thinking that therapy's easy you know I'll just go to therapy an hour a week and everything will be fine and I'll get better and I'm like no no that's that's not it I'm sorry you need to plan for therapy to be a part time job for the next eight to ten weeks because it's going to take a lot of energy even if it doesn't take a lot of time between sessions it's going to take a lot of energy you're going to be drained so you need to figure out how you can prepare for that and prevent it from interfering with your life which will potentially make you want to drop out of therapy suicidal or self-harm ideation and misery again go through the list maintaining treatment gains and then clients generally have their own goals so sometimes you work on that at the end sometimes you can work on a goal concurrently with some of these other priorities and it's sort of the carrot at the end of the stick it's something the client wants to work on it's a positive behavior we're increasing in addition to addressing eliminating the negative behaviors stages of treatment attaining basic capacities identify behaviors that pose a direct threat to clients or other people safety monitor the frequency intensity of behaviors using a behavior tracking form she gives you examples of a lot of these forms and a lot of these protocols in the book you can also go to DBT self-help links calm and there are a lot there's a lot of the stuff just on general DBT there we want to address suicidal behaviors behaviors to interfere with therapy general misery maintaining playing games and client initiated goals in stage one we want to get the ball rolling in stage two the person has kind of gotten control of their emotions they can label them they feel when they're coming on they have some interventions that work they're feeling stable they're not feeling great but they're feeling stable so in stage two we want to go on to reducing traumatic stress and the traumatic stress can come from negative relationship experiences related to emotional dysregulation those invalidating environments that i talked about earlier and lack of interpersonal skills so they feel rejected all the time their self esteems low so they have a hard time validating themselves they've always kind of been told that they're wrong or they're overreacting or they're this or they're that so they don't feel good about themselves and then they have a hard time getting validation from anyone else so they're pretty lonely they're pretty isolated so we want to reduce some of this and help them feel validated and help them feel good about themselves which takes us to stage three of increasing self-respect and achieving in dual individual goals teaching them how to set boundaries teaching them how to be assertive the B and DBT benefits we want to look at the positive and negative reinforcement when somebody does something you know I gave the example earlier of drinking if an alcoholic relapses and drinks again what were the positive benefits of that it numb the pain the negative well I kind of mixed up my reinforcements here but the negative reinforcement was it made the pain go away the positive reinforcement was it made him feel good so not only did it make the go away but it had the additional increasing serotonin making them feel good making them feel generally more sociable we also want to look at the punishment what were the consequences of using you know if you woke up and you had 500 less dollars that's that's punishing if you woke up and you've realized that you had relapsed and you felt guilty about it that's that's also punishing that's adding a negative feeling on top of it so we want to look at the consequences of the behavior and we have to look all along the behavior not just when the person used or when the person cut but what was the end goal of that behavior and what were the rewards we want to talk about intermittent reinforcement think about the kid in the candy store who or even in the grocery store we were in Publix one time my son was about four and he was hungry and he did the thing that all little kids do at some point or another and he wanted candy and you don't have to have the candy right next to the checkout aisle and I I said no it's about time for dinner and he's pleased I was like no it's about time for dinner and he looks at me with no volume control whatsoever and says well so much for Publix where shopping is a pleasure I was mortified but I didn't give in when you give in at a certain point then the child or the animal or whomever learns that hey this is where I've got to start this is where the the threshold is so if I just start acting like this I will get my own way and we also need to model effective coping effective emotion regulation we don't want to be screaming at our clients or screaming at our staff that's kind of not what we want them to learn from us remember that reinforcers increase the likelihood of a behavior and punishments reduce it you don't do things if there's it's more punishing than reinforcing vulnerabilities increase the likelihood of a fight-or-flight response so if you wake up in the morning and you're tired and you're sick and you've got six million things that you've got to get done that day you're already vulnerable because you've got stress going on which means you have less energy to deal with whatever is thrown your way when you get to the office and finally we want to look in order to understand some of this for people we do backward chaining so client a has an outburst we said okay that's what happened it's not what you wanted to have happen let's look at how we got there coworker said something and sensitive okay and that led to the outburst I think there's more to it than that because co-workers have said things that were insensitive before and you haven't had an outburst so what else happened well let's go back a little bit farther when you woke up you felt drained already you didn't feel like you slept well and you knew you had a lot going on and you were just like coffee okay was that enough have there been times who felt drained and people were rude but you didn't have an outburst yes okay so let's go back a little bit further you had to put your cat down the day before that was a traumatic draining event so all these things added together you see where there was a major stressor and you got the message from your brain by waking up the next morning that you're drained you don't have the happy chemicals you don't have as much energy so you need to kind of play it close to the best however that person came in and said something insensitive and you didn't have the energy reserves to deal with it which led to the outburst so what could we do differently next time remember that triggers or stimuli whatever you want to call them caused a reaction they remind a person of a prior situation in which a behavior was either rewarded so if they lashed out and they got controlled guess what they're probably going to do again in a similar situation lash out or it was punished they lashed out it did no good and the client felt an increasing sense of helplessness so in a similar situation lashing out may or may not be repeated based on whether it was rewarded or punished so they need to look back at prior instances of that behavior and when was it rewarded and what about alternate behaviors were they ever rewarded or were they ever even tried triggers may communicate to the person that there's a threat it says warning you need to do something ok so if somebody's already a little hyper vigilant a little hyped up they may react extremely but triggers could also prompt feelings of well-being if you've ever opened your phone and there's been a picture your kid on there and you're just like ah that was a trigger to triggers aren't always bad and we want to increase positive triggers and decrease negative triggers shaping and I know I'm going a little bit fast but I got behind shaping means rewarding successive approximations so for example if you're dealing with somebody who has anger issues level one is not throwing things or being physically aggressive maybe they get in fights with their spouse but they're not throwing things or being physically aggressive awesome progress not perfection level two now we want to say not only are you not going to throw things or be physically aggressive but you're going to try to disengage until that urge subsides until the adrenaline and the norepinephrine subsides enough and you feel like ok we can have a calm discussion level 3 would be taking it the next step and saying ok I didn't throw anything i disengaged I calm down now I can actually come back and have a calm discussion these levels progress over time level 1 it may take a month before the person gets to that point but I hope not but it may level 2 it may take a month or more for person to remember I need to just walk away I need to disengage I need to go to the bathroom whatever it takes for that person to let the adrenaline rush go away once they've mastered those skills then they can work on calmly discussing the issues and if they start to get upset again disengaging and coming back addiction or self-harm I have two levels here level one is engaging in a secondary coping behavior I'm not going to be real particular about what that is if you are not cutting or using drugs illegal drugs then you know let's go with it right now we're talking about harm reduction so even if it is smoking which is a drug I realize walking eating which again is not the healthiest reaction but it's a whole lot better than using crack or cutting yourself so once the person gets used to not engaging in that primary urge to what if that they had then we say level two let's take a mindfulness minute to evaluate the situation and then choose a behavior consistent with your goals so you take a timeout you've got that secondary coping behavior going on now let's take a look at what's happening instead of just trying to shove it down and forget about it mindfulness means developing an in-the-moment awareness of how you are emotionally mentally and physically and exploring the interconnection of thoughts feelings and physical sensations remember that distress in one of those areas leads to distress in others if you're sad you may have a foggy head and you may have aches and pains you may just feel lethargic if you are sick or in pain you may be grumpier and you may have a harder time focusing because the pain is distracting you so remember that they're all interconnected and we want people to become aware of the emotional wave so when they get upset they can say okay this wave is a tidal wave and I am you know down here I'm not even finished right or I'm at the top and I'm coming down reminding them that most emotions will dissipate within 5 to 15 minutes if we don't stoke the fires we want to reduce emotional reactivity and one of the acronyms is please PL means treat physical illnesses be healthy remember not feeling good not going to help your mood eat a nutritious diet don't use mine or mood altering drugs and less prescribed by a doctor get plenty of sleep and exercise exercise releases serotonin can do a whole lot to help people deal with pent up stress if you will build positive experiences it's not just about eliminating miserable stuff you want to have fun things each day even if it's five minutes what was one positive thing you did for yourself today and be mindful of your current emotion if you're angry you're angry don't tell yourself you shouldn't be just say I am and then you can move on from there distress tolerance another acronym accepts activities so do hobbies watch a video go for a walk if you're feeling really upset try to do something to distract yourself contribute do volunteer work compare yourself to people who are coping either the same as or less well than you and go okay other people can do this I got this two emotions try to distract with the opposite if you're feeling really down try to watch a comedy push away a distressing situation by leaving it mentally for a while which kind of goes back to distracting you're just pushing that out of your head going I'm not going to think about that right now and you can even tell yourself those exact words thoughts think about something else so get engaged in puzzles or a book or something to distract you for me it's cartoons you know I don't know why and sensations if you distract with intense sensations you're focused on that if you're holding ice cubes you're going to focus on after about three or four minutes trust me so what a clients need to know about emotions and there's a whole chapter on that but basically like I said earlier we want to decrease the negative emotions they're there for a reason but we want to decrease the intensity and develop an understanding of what causes depression anxiety anger envy frustration irritation whole lists whatever it is for the person in that person and what are the ones we can eliminate what are the unnecessary irritants we can just get rid of because there are some things that you know we should get upset about but there are some things that we can eliminate we don't have to bother ourselves with and increasing the positive what are some positive things that you can do you can't be happy and depressed at the same time so how can you increase the positive keep a list of positive things things that make you smile things that make you happy some days it'll feel like you need a crowbar to get you out the door to do them but getting out and doing them makes you feel that much better interpersonal effectiveness teaching assertiveness distress tolerance emotion identification and communication so if the person can assertively say this is how I feel and this is what I really need or want in order for it to be resolved it'll be a whole lot more effective than throwing a tantrum or acting out or walking away or being passive-aggressive in order to be interpersonally effective people need to understand their own needs you know that's you know obvious but also the needs of others what is it then another person needs the whole empathy thing what do they need in order to support you what do they need in order to want to support you and then we want to help people explore situations to using dialectical theory so taking multiple perspectives in an argument or in a interpersonal situation to try to imagine what was the other person thinking or feeling dear man is your acronym here describe the situation objectively express why this is an issue or a need and how you feel about it assert sharing clearly what your being what you're feeling and asking directly for what you want need not passive-aggressively not going well I wish there was something that could be done well if there's something you want done say what it is reinforce what you want done and why it's a good thing by offering a positive outcome or a win-win be mindful focusing on what you're requesting and not getting distracted by all this other stuff appear confident and be willing to negotiate you know my kids want pizza a lot because they're kids they want pizza and I have to negotiate that but sometimes they will come to me and they will make a case for why they deserve pizza and create a win-win situation they're like hey and by the way mom you won't have to clean up or cook dinner so there you go and I'm like okay find whatever you win now obviously our clients are dealing with a whole lot more than pizza but you can apply this in non-threatening situations to help people master it before you start applying it to the more emotionally Laden stuff so DBT is a great tool to help clients become more aware of their emotions identify the thoughts feelings and urges associated with those emotions develop a greater sense of self-awareness regarding the whys of emotion why do I feel this way why do I act this way when I feel this way they develop an awareness of their vulnerabilities which make them more likely to be emotionally reactive or sensitive most of the time when you say you know when you don't feel well you tend to be grumpier people are like yeah you know you're right but I'd never thought of that so helping people understand that mind-body connection and DBT provides an awesome framework for teaching skills groups that benefit an array of clients who have difficulty with emotionality and I can't remember exactly when in the next couple of weeks there's a class that we're going to do on DBT and mindfulness skills for adolescents and if you work with adolescents or you just remember being an adolescent adolescence is a time of high emotionality I don't care who you are so DBT skills can be really useful for that particular group like I said this book was this presentation was based on a book by Cheri Van Dyke DBT made simple you can get it at new Harbinger publications if you want to I will be putting out a I believe I figured out it was a 10 hour on demand class if you want to learn more and really get all the tips tools and tricks that she has in that book that will be available probably in two weeks but if you want to just peruse it in the library I'm pretty sure I've seen it at like borders and Barnes & Noble too so you can look at a copy and see if that's something that interests you are there any questions if you enjoy this podcast please like and subscribe either in your podcast player or on YouTube you can attend and participate in our live webinars with doctor Snipes by subscribing at all CEUs comm slash counselor toolbox this episode has been brought to you in part by all CEUs com providing 24/7 multimedia continuing education and pre certification training to counselors therapists and nurses since 2006 use coupon code consular toolbox to get a 20% discount off your order this month

Channel: Doc Snipes

Views: 140,429

Keywords: cheap ce, ADACB, addiction, counselling, alcohol and drug, cadc, ccapp, ce, lcsw, continuing education, counseling, lcdc, lmft, lpc ce, nbcc, online training, mindfulness, online ceu, Dawn-Elise Snipes, dbt, hpcsa, mental health, online education, dialectical behavior therapy, cognitive behavioral, LPC CEUs, LMHC CEUs, ceus, NAADAC CEUs, unlimited ceus, addictions academy, lpc, counsellor, kati morton, integrative behavioral health, yt:cc=on, donnelly snipes, DBT, Linehan, Distress Tolerance

Id: Bjs8kUyhEWA

Length: 55min 18sec (3318 seconds)

Published: Mon Nov 07 2016