Category Archives: Articles

DBT Skills – Distress Tolerance #2 : ACCEPTS


The DBT distress tolerance acronym ACCEPTS is a group of skills to help you tolerate a negative emotion until you are able to address and eventually resolve the situation. In an early season of the 90’s sitcomFriends, Monica is dating Pete Becker. He calls her from out of town and says, “We need to talk.” Monica wonders if it is a good talk, or a bad talk? She is in psychological distress waiting for his return. The skill set she would use while waiting for Pete to come home is ACCEPTS.

This DBT skill stands for ActivitiesContributingComparisonsEmotionsPush awayThoughts, and Sensation. These techniques are designed to keep your emotions manageable until you can resolve the problem.


Engage in an activity, and this can be just about any healthy activity. Read a book, make strawberry jam, go for a walk, call your friend, wash the dishes. Anything that keeps you busy and keeps your mind off the negative emotion will help. If you finish, move on to a new activity. (You could potentially have a very productive day while awaiting that dreaded situation!)


Do something kind for another person. Giving service can help you relieve emotional distress in a couple ways. An act of service is also an activity that, as mentioned above, will help get your mind off of the problem at hand. Additionally, we feel good about ourselves when we help someone else, and that in itself can help you deal with stress. Help cook dinner, mow the neighbor’s lawn, or bake cookies for a friend or relative. Each of these contributing ideas will distract you from your current situation.


Put your life in perspective. Is there a time when you’ve faced more difficult challenges than you’re facing today? Maybe not—maybe this is the most intense situation and most intense emotion you’ve ever experienced. (If so, you may need to jump back up to the TIPP section.) If that’s the case, is there another person who has suffered more than you? Are you in your safe home, while in another part of the world someone else is searching for food and shelter after a natural disaster? The goal of this exercise is not to add more distress and emotional pain to your current situation. Instead, use this skill to add a different perspective to what you’re experiencing right now.


You have the power to invoke the opposite emotion of your current distressed feeling. If you are feeling anxious, practice meditation for 15 minutes. If you’re feeling depressed, go ahead and Google Image search “adorable puppies”. (If you’re in need of a real laugh, search “ugly puppies”.) Adding a dose of the opposite emotion helps reduce the intensity of the negative emotion.


When you can’t deal with something just yet, it’s okay to push the problem out of your mind temporarily. You can push away by distracting yourself with other activities, thoughts, or mindfulness. You can even set a time to come back to the issue. You know that it will be addressed, and you can relax in the interim.


Replace negative, anxious thoughts with activities that busy your mind, such as saying the alphabet backwards or doing a Sudoku puzzle. These distractions can help you avoid self-destructive behavior until you’re able to achieve emotion regulation.


Use your five senses to self-soothe during times of distress. A self-soothing behavior could be taking a warm bath with a lavender bath bomb and relaxing music, eating a comforting snack, or watching your favorite show. Anything that appeals to your senses can help you cope with the present situation.


Push Away

The dialectical behavior therapy skills in ACCEPTS help you tolerate your distress until the appropriate time to resolve the situation. Once you’re ready and able to address the problem head on, other skills, such as DBTinterpersonal effectiveness, can help you get your needs met.

DBT – Distress Tolerance Skill #1: TIPP


You’re at your emotional breaking point. Maybe the worst has happened, or maybe it was just the “last straw”. The DBT distress tolerance skill you need is TIPP. This skill is designed to bring you down from the metaphorical (hopefully not literal) ledge.

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


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


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


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


The science of paired muscle relaxation is fascinating. When you tighten a voluntary muscle, relax it, and allow it to rest, the muscle will become more relaxed than it was before it was tightened. Relaxed muscles require less oxygen, so your breathing and heart rate will slow down.

Try this technique by focusing on a group of muscles, such as the muscles in your arms. Tighten the muscles as much as you can for five seconds. Then let go of the tension. Let the muscles relax, and you’ll begin to relax, as well.


Intense Exercise
Paced Breathing
Paired Muscle Relaxation

The distress tolerance skills in TIPP will bring you a step closer to wise mind, where you will be able to make a constructive choice and cope productively.

Doctors discover telehealth’s silver lining in the Covid-19 crisis original article



Telehealth has many advantages, including keeping patients safe from possible exposure to the coronavirus that causes Covid-19, improving access to care, cutting health care costs, and contributing toward a greener earth by cutting down on car trips to see doctors in their offices. It also offers its own type of personal and lighthearted or even heart-warming connections.

Over the past few weeks, I have had conversations with several colleagues about this new wrinkle in our professional lives. Here are some of the things we enjoy about telemedicine in the time of Covid-19:

Seeing our patients in their pajamas.

We can work in pajamas, too.

Finally “meeting” the dogs and cats they talk so much about.

Gently reminding them about social distancing as their grandkids play on their laps.

Feeling amazed after a successful FaceTime visit with an 89-year-old.

Getting magnified views of chin hair, moles, nostrils, and other facial features of patients who aren’t fully familiar with the cameras on their phones or computers.

Conversing about their home décor and choice of wall color.

Realizing that it’s now acceptable to enjoy a cup of coffee with our patients.

Actually seeing ourselves as we chat, and fixing our hair or smiles in response to the image in the video window.

iPads are now a legitimate business expense.


Coronavirus is causing a mental health crisis. Here’s how to fight it.

Original article



The fact that many people are unable to see their friends and loved ones in person only makes the situation worse. “Social distancing is really hard on people, and it’s especially taking its toll on people who are isolated at home alone,” Meredith said. “Loneliness can be a big source of stress.”

Even under more normal circumstances, prolonged loneliness can contribute to depression and anxiety, as well as to physical health problems. One 2016 study, for example, found that being lonely was associated with an increased risk of stroke and heart disease. Today, the ordinary risks of loneliness could be magnified by the stress of living during a pandemic. For people who are social distancing right now, “there is a high risk that they’re going to become more anxious, much more depressed, and it’s going to have longer-term effects,” Rima Styra, an associate professor of psychiatry at the University of Toronto, told Vox.

Overall, a lot of people around the world are experiencing a dip in mental well-being. Factors from “looming severe shortages of resources” to the “imposition of unfamiliar public health measures that infringe on personal freedoms” are likely to increase emotional distress during this time, psychiatry professors Betty Pfefferbaum and Carol S. North wrote in a paper published this week in the New England Journal of Medicine.


When to let a friendship go 😞



What a blessing friendship can be. Studies have suggested that those with really solid friends live longer. Like all deep relationships, however, even your platonic ones are bound to have their shaky moments. But if those tiffs, or lingering feelings that you’re not getting out as much as you’re putting in, happen more often than not, your friendship could be unhealthy, or even toxic.

“Friendships can be protective and rewarding, nurturing and uplifting. If a friend has the opposite impact, we may want to reconsider our relationship and reconfigure that person’s role in our lives. It doesn’t mean you need to end the friendship altogether—maybe you still see them for social gatherings—but they shouldn’t be who you turn to for emotional support,”

Recognizing that you’re in the midst of a toxic friendship by evaluating the signs is the first step toward extricating yourself—a painful but necessary process. “As you get older, it’s important to evaluate your friendships. If they’re not healthy or serving a positive purpose, it’s time to phase those people out,”

What Is Nostalgia Good For? Quite a Bit, Research Shows

Original article:

Science of Nostalgia – It was first thought to be a “neurological disease of essentially demonic cause,” but it turns out that nostalgia is good for your brain. And there’s science to prove it.



“Nostalgia made me feel that my life had roots and continuity. It made me feel good about myself and my relationships. It provided a texture to my life and gave me strength to move forward.”

Nostalgia has been shown to counteract loneliness, boredom and anxiety. It makes people more generous to strangers and more tolerant of outsiders.

Nostalgia does have its painful side — it’s a bittersweet emotion — but the net effect is to make life seem more meaningful and death less frightening. When people speak wistfully of the past, they typically become more optimistic and inspired about the future.

“Nostalgia makes us a bit more human,” Dr. Sedikides says. He considers the first great nostalgist to be Odysseus, an itinerant who used memories of his family and home to get through hard times, but Dr. Sedikides emphasizes that nostalgia is not the same as homesickness. It’s not just for those away from home


Covert Narcissists and CPTSD



The covert Narcissist will use their targets personal information to attack them, whereas healthy relationships allow for vulnerability, the narcissist will use vulnerabilities against their victim as ammunition and show no empathy to their victims as they have none.

These behaviours will wear the victim down but the skill the narcissist has in throwing just enough crumbs or plausibility to win/ entrap their victim again and again is truly astonishing. The behaviours of the covert narcissist are psychopathic and waver on the verge of evident danger and covert danger which is how they get away with it for so long…. until they don’t when the victim finally breaks free if they are able to. Setting free from the narcissist is not easy as the covert narcissist fears abandonment and will attempt to keep the loop going as long as possible, in fact the victim is their prey and they ‘own it’, they are predatory and dangerous. The victims to this abuse are often left feeling like they are a shell of their former selves and shattered at what has happened, it is like experiencing a bomb and being left shell shocked. Should the narcissist fail to keep their victims they will move on to their next person or better known as narcissistic supply without so much as a look in the rear view mirror they are recklessly harmful.

The Narcissist is unlikely to be self-reflective and will not accept accountability for their own actions, this is another good clue to help identify if you’re in the presence of a narcissist; they are hungry for Power, control and thrive on inflicting hurt and pain in any perverse form.

The effects of this crazy making behaviour and way of relating leave its indelible mark on their victims. This abuse can even lead to psychological trauma, PTSD and CPTSD.


Narcissistic Personality Disorder

Read the original article here:

Know someone who expects constant admiration, who thinks they’re better than everyone else, but flies off the handle at the slightest criticism? These tips can help you recognize and cope with a narcissist.

It’s more accurate to say that people with narcissistic personality disorder (NPD) are in love with an idealized, grandiose image of themselves. And they’re in love with this inflated self-image precisely because it allows them to avoid deep feelings of insecurity. But propping up their delusions of grandeur takes a lot of work—and that’s where the dysfunctional attitudes and behaviors come in.

Narcissistic personality disorder involves a pattern of self-centered, arrogant thinking and behavior, a lack of empathy and consideration for other people, and an excessive need for admiration. Others often describe people with NPD as cocky, manipulative, selfish, patronizing, and demanding. This way of thinking and behaving surfaces in every area of the narcissist’s life: from work and friendships to family and love relationships.

People with narcissistic personality disorder are extremely resistant to changing their behavior, even when it’s causing them problems. Their tendency is to turn the blame on to others. What’s more, they are extremely sensitive and react badly to even the slightest criticisms, disagreements, or perceived slights, which they view as personal attacks. For the people in the narcissist’s life, it’s often easier just to go along with their demands to avoid the coldness and rages. However, by understanding more about narcissistic personality disorder, you can spot the narcissists in your life, protect yourself from their power plays, and establish healthier boundaries.


“… As a counselor herself, she knew that talking about her depression would help her feel better…”

La conversacion by Etienne



Depression is one of the most commonly diagnosed forms of mental illness. There is an increased awareness of depression as a medically treatable condition. Most people experience occasional depression as the random feeling of being lonely or sad. With major depression, however, a person feels like they’re stuck in a cave with no hope of escape. By choosing to discuss her situation with me, my friend had thrown out a lifeline. As a counselor herself, she knew that talking about her depression would help her feel better. I felt honored to be on the receiving end of the conversation. She’d been there for me in the past when I had been caught in psychosis. This time, I got to be the listener.

There’s hearing and then there’s listening. Hearing is the passive activity of taking in audible sounds. Listening is a skill that facilitates effective communication. Active listening is a communications technique which acknowledges the other person’s feelings while deciphering the message they’re conveying, creating a sense of empathy and nonjudgemental reflection. The party speaking feels validated rather than merely heard. Paying attention to the other person’s words, and repeating ideas and phrases to confirm that you understand what they’ve said, demonstrates respect for their feelings, creating a sense of closeness. This is the result we all strive for when we’re sharing—to be listened to and understood.