HHCI Seminars – A Brief Introduction to Radically Open DBT

[Music] so I'm so grateful that you come out on this rainy dreary night and I hope we can have kind of a conversation tonight about our ODB tea and my goal is to give you an idea about what our is it's a very complicated therapy so I'm going to try to give you just an overview of it and hopefully answer any questions that you might have and meet your goals for being here tonight does that sound okay all right let's get started that's just a disclaimer I make no profit from this I'm I'm not selling anything I have no conflict of interest so I've been a therapist for many many years and it's a passion for me I care about the people I see and it's really important to me when I go in that room that I can do the very best job I can and I'm sure that's the same for you you wouldn't be here if it wasn't and there was so much pain involved in the people that for the people that we see and in my practice for a long time there was a group of people that I couldn't help I didn't know what to do to help them and those people turned out to be mostly people with the diagnosis of borderline personality disorder so then I'll learn DBT and I had something to do I had something that could work I had such a way to help them but there was still a group of people and I wasn't reaching and I don't know if you're seeing this type of client or not but people would come into the practice and they would have very intense anxiety and we have very limited ability to form relationships perfectionistic they weren't getting into trouble but they weren't connecting and they were miserable chronically depressed not able to really make a life that they could enjoy and live DBT wasn't reaching them and so that's when I discovered ro DBT it's I think that I've been blessed in a way to be alive now at this time because we as therapists I think are at a crossroads our profession is changing and it's changing well let me ask you can you is therapist does everyone who comes to see you get better do you have people that you struggle to help yes okay so I'm okay that's why I think we're a crossroads because our profession is starting to make some developments that are making a huge difference in the way that we practice and the people that we can help right now we have a significant number of people that aren't benefiting from the treatments that we're offering a significant number of people that have chronic disorders and aren't getting well at our existing treatments just aren't working we're not reaching a large number of people that need our services not from lack of trying but our treatments aren't matching they're not working with the people that we're seeing in years back we tended to blame the client treatment-resistant client a client isn't doing what we asked a non-cooperative sometimes I think maybe that was a way we had to protecting ourselves because it's so hard to watch a client not get well especially in certain diagnoses we're not doing a very good job chronic depression anorexia very difficult to treat in depression right now we're helping that 1/3 one-third are getting somewhat better and one-third are not improving at all so what about all these evidence-based treatments and I'm talking about one tonight what about our evidence-based treatments well part of the problem is that a lot of times the evidence-based treatments are being tested with a very select group of people for example if they have a new treatment for a panic disorder its tested just on people that have panic disorder and nothing else and that diagnosis is very carefully done with a lot of assessment to be sure that there's nothing else going on that's not the client that you and I see what we see in the real world are people with very complex disorders mostly we see people that are coming in with a multitude of diagnoses I I see people sometimes that have 8 9 diagnoses what's going on with that and how does that help you know what to do to help the person when they come in with 6 7 8 diagnosis you see one of the things that's going on that we've realized and it's going to help us as clinicians is to recognize that a large number of people that we haven't been able to help it's because they have an underlying personality disorder and when I first started working as a clinician we didn't address personality disorders at all because we didn't know what to do but we're starting to learn what to do and we're learning how important it is to pay attention to underlying personality disorders so remember I was talking about the multiple diagnosis 45% other people that have depression also have a personality disorder 51% people with anxiety also have a personality disorder sixty-five percent of the people that have anxiety also have an eating disorder 2% of people have an eating disorder have a personality dessert so if we try to treat just the anxiety disorder we try to treat just the depression it's gonna be a real challenge because what's really maybe going on is that underlying personality disorder how frequent our personality disorders is it really enough to impact our treatment then with the people that we're seeing it's much more prevalent than we originally thought the research is showing something like this that the distribution of personality soars this is for chronically depressed mid to older adults sample and in that sample look at the personality disorders that they found and the number one personality disorder don't look what do you think the number one personality disorder would be most people guessed borderline because Portland personalities always gotten a lot of publicity but it's not the most prevalent 39% is obsessive-compulsive personality disorder paranoids 11% gets a tipple was three narcissistic five borderline was ten but the point for me here that i want to share with you is look at the large number of people in a depressed population that had a personality disorder total is 73% so if you think about the people that are coming in to see you a large number of the people especially people who are responding to initial treatment probably have a personality disorder and the the other thing that we're beginning to realize is that our diagnostic system is kind of broken that our diagnoses aren't helping us determine the treatment that is best suited for the client and this is being recognized by ni mhm it's being recognized by the people who hand out all these large result research grants which is where our therapies come from so much so that they will no longer fund any research that's based on a diagnosis diagnosis what we're looking for our treatments that are called trans diagnostic if you guys heard that term trans diagnostic what it means is we need an underlying core disorder that we can treat the disorder in not the diagnosis and I'll explain more about that later but the National Institute of Mental Health they will not fund any more research they want trans diagnostic methods like methods that it's a new way of classifying psychopathology to try to look at the underlying core and what can we treat that's underlying these diagnoses that makes sense so that one treatment can be used for many different people and be effective so that's where ro DBT comes in ro DBT is a trans diagnostic treatment and it is a treatment for people who have what we call maladaptive over control our LGBT is informed by dialectical philosophy behavior therapy mindfulness and mal amante Sufism which is meditation like Zin it has been researched for over 20 years and it has a strong research basis it's been treated with over that they've treated over 350 patients in research trials over the world now in comparison when DBT was first released there were 22 patients it had been seen in the research trials so he waited a long time before he actually released the treatment it is evidence-based and here are the main research trials that have been done um three with anorexia nervosa and it's really gotten some amazing results with anorexia which almost nobody is getting and the last one is a research study that was done without the treatment developer involved and it was only like our Oh DBT has an individual component and it has a skills class just like DBT and the last one was done only with a skills class and they still got significant changes and results so if you are interested in the research I could talk about it more but I want to sort of move on tonight but I'm happy to give you those if you are interested so what is the difference between our Oh DBT and other therapies I mean how what's going on let's get more specific about it being trans diagnostic so in our Oh DBT it's not anorexia that's the problem it's not obsessive-compulsive personality disorder that's the problem the problem is the underlined uh-oh they're the underlying maladaptive over-control personality and I'm going to explain more about this but the over the maladaptive over control personality leads to what we call social signaling deficits and those social signaling debits leads to an inability to form close connections with other people so what we're coming down to is the idea of loneliness and in the research recently well not so recently but they are beginning to say they're beginning to look at they're beginning to find that loneliness in itself is something we need to treat that loneliness has been seen to come first before the depression and before the anxiety the [Music] world health organization the director has said that we have an epidemic of loneliness in the world researchers are saying we need a treatment that not says loneliness is part of depression but it's something that we need to treat directly it is in itself a cause for many of the disorders that people are suffering from so we just say hey people join a group go to church invite your neighbors over the problem is it doesn't work like in fact they were I think as Australia that sort of tried that to try to set people up to with groups of people and there's some people that can do that but there's a whole group of people that I've been talking about they can't and it comes from that over control personality that they have and they're not able to connect with they don't have the skills to connect with other people so just putting them in a group of people doesn't work you so what we're saying is that anorexia is not the problem because before the person built the anorexia they had perfectionism before they developed anorexia they had rigid rule governed behavior lots of rules about the way that they could interact with other people they had inhibition of emotion difficulty expressing emotions to other people and they had sort of an designee to be in control that came before the anorexia that is what we're saying is the underlying cause and it can lead to different disorders but those symptoms are what lead to the disorders that we are calling diagnosis so we're going to look to what does it I mean by social signaling why are we talking about social signaling and why is that so important in our OD bTW so remember I said loneliness is this comes from a deficit and social signaling comes from that over controlled maolin personality right so the way it came about was looking at evolutionary science how we developed how we came to be the tribe we are today so what we needed to survive as human beings can you think about that per minute 200,000 years ago how did we survive there's thick skin dinosaurs pterodactyls claws and although these big claws we're thin-skinned we can't fly can't run that best how did we survive because what we're trying to look at is what worked for us and one of the things that we know is that we developed and that there's a cooperative gene that actually developed that we as humans have and that is one of the things that helped us bind together as a tribe and try being a member of the tribe was part of survival and we still have that we still have if you feel left out or rejected think about how painful that is we've all had that experience public speaking and then the main reason most people fear public speaking is because you look out and they'll be this one person perhaps that has a flat face they're not giving any signals that you're doing a good job we read that and learn more about that later but we read that as rejection and we hate it because being out of the tribe is scary because that's the way we survive so this group of people that can't connect fill out a tribe all the time and our job in therapy is to help them get back in the tribe and help them connect and help them overcome and it's but this is a way of understanding why it's so important because our survival depended on being part of the tribe sharing food able to fight off predators being able to help each other buy or share things so social bonds in self-control are really important that comes about through evolution that and it's really important it's important in relationships to be able to have self-control is important you inhibit your urge I get mad at you I don't just punch you in the face I got self-control you could be glad to hear that and it helps us to pursue long term goals for our tribe so self-control started to become very valuable it meant that people wouldn't eat up all the food of the tribe they could save it for any day and were winter self-control means that you could work together have common goals so evolution through evolution self-control became very important lack of self-control it's very eye-catching lack of self-control is when you were impulsive you're loud you were just to give me that you make me mad I don't want to be with you anymore I hate you I wait a minute why won't you play with me you know that kind of stuff lack of self-control is borderline personality disorder so one of the things I'm trying to make a comparison with is self-control became very valued by the tribe and very necessary one of the reasons that mental health is focused on borderline personality disorder and the lack of self-control is because it's so loud it's in our face and it goes against the tribe and so we see that as pathological and we worked to treat it and that's I think that's one of the reasons it's gotten so much attention are you with me is this making sense okay but all of it controlled was kind of overlooked because they're not roaming the streets and gangs they're not yelling they're not telling you they hate you one minute and they love you the next they're not acting on the impulse if you don't feel like going to work so they don't go to work that's not happening with over control people they are hybrid detail focused they're perfectionistic they are they have duty they have obligation they see mistakes everywhere including themselves they're hyper critical and they tend to work really hard to prevent problems really hard and fix things they want to fix things so those are people that really don't look like there's anything wrong with them they're expert at looking like there's nothing wrong with them they can come into your office and tell you they're depressed and it's really hard to figure out what's going on because they work hard they have a job there's often high achievers so what's going on and they look they don't show the distress that they're feeling inside so over control is very pro-social it's something that we kind of desire they desire to be correct they valued rules they have the ability to delay and they have a strong sense of self sacrifice and duty but can help to the good thing this says it's a the therapist is actually laying on the couch and the client is sitting in the chair and it says everyone accuses me of being the control freak so the question is we don't want to turn anybody into borderline personality disorder but can you have too much of a good thing can you have too much self control and this is the way we kind of looked at it in mental health in terms of self control we kind of looked at it if psychological well-being is on this axis up and down axis and self control tendencies is this way we sort of at a is the more control the better we've been teaching people how to control let me take you how to control your anger let me teach you how to control being sad let me teach you how to control I've sort of looked at it that way the header and if you look at it from the evolutionary science point of view you can see how maybe that came about how we valued self-control so much that we were a little bit blind to this whole group of people that have too much self-control so this is the new model it's a bell curve kind of makes sense too so over here is that little group awake do I have a little white yes right here I get excited by little things so right here this is the under control people here's psychological well-being here's self-control so the more self-control goes out this way this is the most self-control and this is the most psychological well-being so it's actually that there's a level of optimal control that people can have that really makes their lives easier to live that they are able to have contentment they're able to live their life in a way that is rewarding under control is right here there's weather person with BPD is but over here is another group of people and this is the maladaptive over control group of people they have too much control they are so rigid that they can't enjoy their life their rules are too strict they can't express their emotions they are tend to be mmm their facial expressions can be fake or were there seen that way and they constant really know how to have fun they don't know how to relax they may have three degrees from Ivy League universities not necessarily but they may but they don't know how to celebrate their child's birthday they don't know how to play so this is the model from which our ODB tea is coming that we have people over here that we need to pay attention to so how does that sort of layout with diagnosis so let's take a look at that but this over here is the under control these are the diagnoses that tend to be with more of an under Crone control temperament so the the to working at the research is sort of researchers all over the world actually have started to agree that under personality types that underline the diagnosis or two one of them is under controlled and the other one is over controlled people have different names for it but they're coming down to basically two under controlled and over controlled and so we want to trans diagnostic treatment that can treat all these diagnoses for under control and all of these for over controlled effectively and we're looking at that underlying cause so essentially obsessive-compulsive personality disorder which was 39% of those people that were depressed I think it was already night is over here on over controlled treatment resistance anxiety and mostly all the internalizing disorders if you're familiar with that term internalizing disorders tend to be over here on over controlled there are let's see one of the couple of comments I want to make binge purge eating disorders what we actually know is that binge purge eating disorders can be in either category there can be a binge purge person who is um it just happens there's like no set to it there's no pattern to it but there are some people that schedule their binges and and schedule their purges and they it's very planned out that person is probably has over controlled maladaptive over control so sometimes we have to look underneath there's something else that I want to bring up and that is that I think for a while I don't know that if it's true for you or not but for a while we thought I think that there was sort of a general idea that if somebody did self harm that that probably indicated that they were had borderline personality disorder but what we know is that's not true at all people can do self harm and also be over here with over control it's how they do it if somebody does help harm impulsively and it doesn't seem to matter who sees it it's more likely to be under control not necessarily BPD that under control if it's planned very carefully it's done in private and it's typically done to punish themselves because over control people have a very strong sense of justice and fairness and that they need to do the right thing and so they will punish themselves sometimes with self-harm and they'll be very private so just willing to make that point uh people ask them times about tension deficit where does that Paul don't really know yet research is still working on it and so I can't really answer now any questions so far yes yes that's where we're going like you as clinicians the idea is that if you have someone with an under control personality temperament that treatment is completely different than someone who has an over controlled underlying personality temperament that is over controlled I'll think about it for a minute if someone is too rigid to will oriented inhibits their emotions do we really want to teach them how to have more control you know we want to teach these folks over here how to have more control these folks over here we don't lighten up we chill out a little have some fun so it is it's a completely different treatment yes yes yes in yes in certain situations if the symptom appears to be under control okay so we let me just make it harder all right why not let's say that you had a client okay I recently had a client who had anorexia severe severe anorexia and she was screaming at her mom calling her name's treated her terribly now that sounds like a contradiction it sounds like I've got an over control disorder the anorexia and an under control behavior like screaming yelling at people but here's the thing people who have over controlled are different in public than they are in private and so in a situation that they consider private they may behave in ways that they're angry or they are more they're not following the rules so much so you have to determine with me she was the most sauce but she wouldn't even disagree with me in the beginning and she was the most soft-spoken person so you have to determine is it a private behavior where they think no one is seeing them which by the way includes a car you know how people pick their nose in her car okay that seems to be a private is considered private I don't know your office for some people may also be private it's sanctioned you can I can sort of let my emotions go with you so assessment has to be done pretty carefully to see how do they behave at work how do they behave in what they consider more public situations where they don't they're not sanctioned to dis let go a person with under control can't do that they're always Wow they're always impulsive they're all they cannot say in this situation I'll be this way and in this situation I'll be a different way good question okay so over control this is what we've been talking about just summarizing over control is a problem emotional loneliness secondary to low openness not expressing themselves not letting people know who they are and social signaling deficits so four core deficits of someone who has over control black except if 'ti and openness and what that means is to have cycle psychological health and to learn we have to be open to feedback we have to listen to other people say hey Karen you talk too much sometimes you know so people don't like that so you know why don't you kind of tone it down a little bit so you're gonna you know I think you'd get along bare with your friends people who are over controlled do not accept feedback out of their life no walk away they get angry enough they just don't they don't listen you don't know what you're talking about they're very closed to feedback they avoid new situations because they like predictability so they'll stay in the same kind of situation oh we're an oak deli at the same place they'll go to work the same way they go home and watch the same shows that they stick to a routine they also have lack a flexible responding if they used to do if they usually take a walk at seven o'clock in the evening and somebody drops by and says hey you know you let's play some cards I have to go for my walk mom calls I said I can't talk to you right now it's time for me to repair my meals for next week it's there's no flexibility in the responding and so we need flexibility like if we go to London we got to have the flexibility to drive on the other side of the road and that's part of psychological health and someone with over control can't do that lack of emotional expression and awareness and this is the one that gets to social signaling so people who have over controlled do not show on their face and in their interactions what they're experiencing on the inside and sometimes they're not even aware of what they're experiencing on the inside so I come into you and I say yes I'm feeling very anxious are you going to help me are you gonna fix it this isn't helpful there's or it can be like this you're gonna help me I know you will yeah then and I'm exaggerating a little bit but there's a mask that someone with over control wears because they can't allow themselves to be vulnerable and without vulnerability you can't connect to other people and so it's hidden what they're expressing and there's a reason for it I mean they have grown up in families where it wasn't allowed or they grew up in families where the expression of emotion was so scary and overwhelming that they shut themselves down they grew up in families what was important to achieve and be perfect and so you can't let someone see that you're not feeling confident or perfect or that you have any faults so they wear a mask but unfortunately that becomes like an armor because he blocks our ability to connect with it with each other because emotions communicate to other people the way you know if you can trust me or not often is by my showing you Who I am showing you how I feel and what I think and if I inhibit my opinions I am inhibit my emotional expression you don't know who I am you don't trust me because you don't know who I am and you don't connect but they are totally unaware that that's going on they sometimes they know they have a they've been told they have a flat face sometimes in flat face is just one part but a lot of times they have no idea how they are looking to other people and then there's the they have very aloof and distant relationships because they can't connect and what we know is to have psychological health we have to have at least one connection in our lives that is intimate and close and so part of our work with people who will a big part of our work with people who are over controlled is working toward their being able to connect with other people all of that of course leads to that emotional loneliness that we've been talking about now here's here's the thing what would you guess I am and I do have a style and you guys do too because I've been I've been talking about over controlled and under controlled in a pathological way but we all tend to be either under controlled or over controlled and it's not necessarily pathological so I you heard me use the word maladaptive maladaptive ever controlled maladaptive over control so people can be over control to not be a maladaptive people can be under control not be maladaptive so there's a difference that everybody has a personality we want to have a personality and that's your personality type so how many of you would say that I am under control how many of you would say that I am over control how did you know how did you know structure my what organization thorough you know I'm surprised cuz I think I have so much expression in my face I think people they think I'm under control but I'm not you're right I am over control I am a wreck adult it's that by the way you just did something really important because the research shows that other people pick up on it sometimes within 30 seconds that you get how somebody else is now you don't necessarily get it about yourself I guess I'm gonna out myself here it took me a year me to figure out that I was over the top I thought I was under control for the longest time now we go into the RO trainings I'd say it because so many people actually a lot of therapists er over control but I thought it was different so I go into the RO trains and say hi Here I am I'm Karen I'm your under control person and they would all just but and they kept it so they kept giving me feedback and so finally I listened so you're not usually so good at knowing yourself so that you might ask your friends and there is a word checklist that you can use to assess your own style if you want to know and it's available in the RO textbook I have a copy I can send here but you just have to choose one or the other are you impulsive or you're deliberate and then there's a whole list of them and it doesn't matter this is not pathology it doesn't matter if you've got all B's that still does not mean it's maladaptive it just means that your personality style is kind of cold to know what it is it's also cool because our control clients will ask you over control clients will read the book on ro DBT and come in and sit down so I read the book what type of personality do you have you know and so it's kind of cold because what we want to model remember people who are over control tend to be uptight so what we want to model is a little bit more laid-back it's not such a big deal yeah I'm over control that there's not something wrong with it cuz there's not remember all the positive things about being over control you know that if I have surgery I want a surgeon that's over control you know I want somebody this very perfectionistic we just don't we want to take care of the maladaptive part not change who they are so bio temperament we already talked about that oh well let me just say this so one of the ways to know sometimes when it's hard to figure it out about someone who is over controlled or under control is to go back to about age four or five and say what type of child were you were you the kind of child that was getting in trouble snatching cookies from other kids or gobbling them up as soon as you got the cookie are you the kid that was running around or we're the kid that was shy and timid at age four and five temperaments evident sometimes that's before the environment sort of comes in and changes things a lot especially people might have had trauma or things happen that it's sort of hard to figure out what their underlying temperament is and so the looking at age five age four is sort of one of the ways to do that what were you like then and by the way there's a research that the children who were over controlled as kids often were bullied and picked on and so what we we think we don't know this yet but some of the shootings and things like that that are happening with kids is saying wow you'd never know that he was going to do that we think that maybe their over control people because over control people in prisons tend to be like that it's like nothing nothing nothing then they did something that was very planned and big and then that was it they're in prison so that over control people sometimes when they step in stuff and stuff and stuff then they kind of explode so I don't how to get into oh and they were bullied and they feel left out I feel like they don't fit in the tribe so it comes out as this bitterness and resentment towards schools toward organizations etc so bio temperament matters thank you um this is an old study and it was done to look at something totally different but it when we go back and look at the research we sort of beginning to see how we can see the differences in temperament of young children and so this is the first video that I want to show you and just look and see if you can tell who's over controlled and who's under control oh can you stop it just a second I didn't give you enough of an explanation the researcher comes in and he says got something for you here this is a marshmallow you can eat this marshmallow now but if you wait I'm gonna leave the room for a few minutes if you wait til I come back I'll give you another one you can have two so this is what the kids do when the researcher leaves the room I'm sorry and they controlled her over look at her trying to cope under control are over yeah so it's that's the thing like at age 4 and 5 we can see this start now this is not maladaptive this is just temperament that we're looking at but what is the person learn so the person that comes into this world with a temperament that is under controlled they learn if I escalate things if I get bigger then good things happen that's when [Music] I throw temper tantrums until I get my way or I beg and beg and beg and beg until they give in to me or I threaten to do things I'm gonna cut my wrists if you don't do this for me they they learn if you get bigger and bigger bigger that good things happen but that's not what the our control person learns the only control person in this family it's different and they learn if they inhibit and don't express what's going on on side that men good things happen to them so they get more and more inhibited so the environment works with the genetics the biology the problem is for the over control person that they learn this they've got this already genetics a tendency to inhibit be more reserved be more restrained and they learn from their family that that's good stiff upper-lip never leave them to let them see you sweat but when the context calls for some expression like a friend drops by and you don't get it you don't get that emotional expression them say hey how you doing you get the flat face it matters that not being able to express your emotions matters and what we know what what emotion would you say this person is expressing what emotion irritation anger most people to see a flat face see if I can do it see anger and that's the cup of evolution because we were designed to be sensitive to something that could be threatening and a flat face is we don't know what it is so we'll we tend to see it as anger to protect ourselves so that's why cooperative smiles when we meet people is the way say I'm not gonna hurt you yeah not that but so when someone doesn't do that then it triggers us to get threatening so that can happen by the way in the office with you when somebody comes in and they don't signal hi how are you and they've got this one it can cause sort of a threat reaction in you and that keeps you from being the best therapist you could be so we have ways of teaching you how to deal with that because that's what hardwired you can't help it it's hardwired to react to a flat face as are they angry at me what did it you know so the expression of emotion matters oh well here we go uh this is sort of trying to look at the biology on this was it were attachment Studies but I want you to look at it from the view what we're talking about about social signaling and how it affects other people babies this year are extremely responsive to the emotions and the reactivity and the social interaction that they get from the world around them this is something that we started studying Oh 34 years ago when people didn't think that infants could engage in social interaction and there's still phase experiment what the mother did was she sits down and she's playing with her baby who's about a year of age and she gives a greeting to the baby the baby gets a greeting back to her this baby starts pointing at different places in the world and the mother's trying to engage her and play with her they're working to coordinate their emotions and their intentions what they want to do in the world and that's really what the baby is used to and then we ask mother to not respond to the baby the baby very quickly picks up on this and then she uses all of her abilities to try and get the mother back she smiles at the mother she points because she's used to the mother looking where she points yeah the baby puts both hands up in front of her and says what's happening here oh she makes that screeching sound like come on why aren't we doing this even in this two minutes when they don't get the normal reaction they react with negative emotions they turn away they feel the stress of it they actually may lose control of their posture cause of the stress that they're experienced it's a little like it's the bad and the ugly the good is so all that happened was the mother equipped just became blank she was still there just became blank and so it's just an example of how powerful social signaling it be so how is social Celia strongly affects our relationships and my message to you is that that is one of the core ways there are Oh DBT looks at helping people who have maladaptive over control like people with autism and Asperger's syndrome would fit in this category too and so one of the ways we look is by looking at social signaling how they're signaling to other people or how they're signaling what's inside them and so I want we're going to do one more thing because I'm running out of time but I want to try to give you an experience of social signaling yourself okay I'm going to set it up by the first thing I'm going to do is play this video this is just a comedy show and it's but it's about signaling with eyebrows and it turns out that evolutionarily our eyebrows are very important in the way we social signal to other people so after this we're going to do a little experiment okay things I'll be talking about tonight will involve hugging my eyebrows up it's not to say that I don't put them down from time to time probably shoulda mentioned at the start wowsers people just end up looking at your eyebrows the relisted oh you're saying watch Steve doodle it's a firm move of a diamond but it is important to know where your IRAs are when you're talking and always have your eyebrows off when you're asking someone where the toilets are dude sir don't we going do you know the toilets huh [Music] or is that your daughter is it is that your daughter [Music] you know the toilet zone so that's just an example for you that ro DBT is a therapy that people have to feel because if I just told you hey your eyebrows are important you probably said what did you learn tonight this lady and now you so you have a feeling for it you know about what we're talking about about this social signaling had impacts other people and how it affects you so there's a training coming to Houston in April for rap the open DVT you're interested and I think my time is up is that right I have till 8:00 oh wow okay all right so then we can we can um okay so we're going to learn something else and then I'll take questions so this is what we're going to learn the person who is over controlled tends to live in what we call threat so neurologically there are like five different sets neurological sets that you can be in one of them is safety when I'm is novel one of them is threat one is reward and one is overwhelmed so we go up and down through all the neurologically ways of responding our nervous system has substrates and when our nervous system actually switches like if we're in safety then it switches to a different substrate if we go into threat for example so threat is when we are hyper alert and we're tense and we think there's danger and we are neurologically in that substrate we're threat safety it's when we're all chilled out our voice is melodic we're relaxed when we're in safety is the only time that we can form relationships because when we're in threat we're just alert to danger and our voice is not melodic we're not smiling we're not sending out friendly signals we're hyper-focused on danger and so what we know is the people who tend to have maladaptive over controlled tend to live and threat they live in that tension and they live with that hyper alertness to danger and social situations feel dangerous to them and a lot of times especially if they've been bullied as children which a lot of them were then they feel this threat being around people yes safety so safety is relaxed chilly now drinking hot tea and our face can move we've got all these muscles in our face we can make all these expressions we only used about a hundred of the muscles but that's it and we can swivel our neck we can look around so safety is where we're collegial we want to make friends we want to have fun the next one is novel and novels like the the animal that's like hmm what is it what's going on I don't know what this is so if we heard a loud noise outside we might all stop and listen what is that a novel you're trying to figure out is it say is it is this like something I'm going to enjoy is this a rewarding experience or is it a threat like a novel let's say we're having lunch together in a restaurant and we see a big group of people down at the into the road and they're like shouting novel is what is it what's going on because we're not sure yet you generally speaking you can only be in one substrate at a time so if you're in safety you can't also be a novel so safety gets shut off when you move into novel you know ve L novel okay so now if you have a temperament that tends to be over controlled you see this group of people at the end of the street you stop your novel what do you think you're going to think danger it's a riot let's get out of here let's move us get the other way they perceive danger they lean toward danger okay what if you're not over controlled you see that group of people down the end of the street novel what is that what are you gonna say yes let's go check I think it's a parade it's a party let's go so it's a different way of perceiving the world and they live tend to live pretty much in threat oh the five safety novel threat reward this is exciting it's gonna be wonderful and overwhelmed which is frozen and by the way overwhelmed is where people with anorexia and chronic depressant pression tend to be therein overwhelmed when you're an overwhelmed you don't feel anything you're numb um it's like the frog that plays dead when he's in danger and it's just it's a way of not feeling because you're so scared you're just overwhelmed you're so scared hang on so the person with overwhelmed the problem it brings up a problem for treatment because when you come out of overwhelmed you're going into threat so nobody wants that so they go back to overwhelmed yeah it's like I don't want I come start to come out of anorexia and I start to eat and everything so scary I don't want that so I go back where I can be numb so part of another part of our Oh DBT is how we work with people who live in threat and how we work with people that tend to be overwhelmed and how we help them activate their social safety system and it can't come through the head it has to come through the body because remember this is biological so all of the cognitive behavior therapy that we do is not going to be that particularly helpful to you tell yourself to relax you tell yourself to be calm there is no danger the body reacts so much faster to cues in the environment it's like if the body the nervous system reacts like in two milliseconds the brain reacts in 20 so all that's pretty fast but if our body reacts first it doesn't do any good for the brain to get me as much later that the brain says hey there's no danger and the bunny's already frozen and sending messages of danger so we had to find a way to work with the body so what we do is we're going to teach people how to activate their social safety system because the body and the brain surprise they're not separate so we can work with the body to send the message to the brain that we're okay so if you're out running actually this is happening because I'm terrified of snakes so I can be out running and you see and I go ah because I thought it was a snake and after I've already jumped I see that it's a stick and finally and that I can label it a stick but already been in panic and jump before I ever get to the word so words don't help we need to work with the body and help people be able to activate their social safety system so I'm going into a group of people I'm going into a gathering at work I need to activate my social safety system because I go into threat when I'm around other people so the answer it's huge answer because a lot of what ro DBT is is about how to help people come out of the threat substrate and out of being overwhelmed but one of the ways is to activate the special safety system so this is remember the eyebrows you do remember right okay the eyebrows have a lot to do with our social safety system we don't raise our eyebrows when we are feeling threat so one of the ways through a simple way to activate the poem is through what's called the big three plus one so what you do everybody do this with me you ready because it's something you have to feel okay so I want you to sit up in your chair clench your muscles eyebrows clinched your draw tense everything not even frown now I want you to take a deep breath a really deep breath I want you to raise your eyebrows and I want you to lean back and do a closed mouth smile you can you feel it now yeah what you're doing it takes practice for some people but what you're doing is you're activating social safety we're doing we're activating the muscles that work leaning back if we're if we're alert hyper alert for threat we usually sit straight so if we lean back we're sending the message to the brain we're say closing I'll smile it says safe and raising your eyebrows says say so that's and that's something you can do anywhere and you're not gonna look weird quote so that's one of the ways of activating the social safety system now I'm gonna stop for questions in just a second I'll say one more thing is that okay yeah so as a therapist we have certain ways we look in our clients we are compassionate caring people and we try to communicate that with the way that we look so can you show me your therapy look what do you what do you want your therapist look when someone comes in it's okay don't laugh just give me your therapist look okay so check yourself so a lot of us is therapists are taught to be serious and lean forward you so if you happen to be an over control person what do you think that says to them yes the over control person sees that as you looking concerned which you may be trying to do but what they say when you ask a group of people who are over controlled what they say is if there was nothing so wrong with me or so awful with me why would you be looking so concerned they see it as you're saying there's something wrong remember they're hyper sensitive to threat they grew up in a perfectionistic family it's important to them to do things right so when we look concerned they're saying what I do you must think there's something really wrong with me if you're looking that concern so the therapist in our Oh DBT is taught to have closed mail cooperative smile lean back and be chill we got this no problem we can fix it but you want to signal safety just by your own body manner now that's hard because you have this person we tend to mirror people right ten so you got this person sitting there very tense very serious it's hard to discern lean back soon because you wouldn't you sort of mimic them but that sense what when you do that that increases their threat you want to see because they can feed off of you it's transactional so if you can be in your safety system then they don't feed not they feed off of you with safety versus threat okay I talked a little longer than I said I would but I was so glad I was wrong about the time you guys it's been so nice the feedback from you is made it easy for me just to keep talking I could probably talk all night so thank you for being such a great audience and I want to try to answer any questions that I can [Music]

Channel: Hope and Healing Center & Institute

Views: 14,133

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Id: R7UnolBg_1M

Length: 67min 19sec (4039 seconds)

Published: Fri Feb 21 2020