The reason DBT works for so many individuals who struggle BPD is because the founder/creator of DBT suffered from BPD herself …
EXCERPTS …”
‘I Was in Hell’ — She learned the central tragedy of severe mental illness the hard way, banging her head against the wall of a locked room.
Marsha Linehan arrived at the Institute of Living on March 9, 1961, at age 17, and quickly became the sole occupant of the seclusion room on the unit known as Thompson Two, for the most severely ill patients. The staff saw no alternative: The girl attacked herself habitually, burning her wrists with cigarettes, slashing her arms, her legs, her midsection, using any sharp object she could get her hands on.
The seclusion room, a small cell with a bed, a chair and a tiny, barred window, had no such weapon. Yet her urge to die only deepened. So she did the only thing that made any sense to her at the time: banged her head against the wall and, later, the floor. Hard.
“My whole experience of these episodes was that someone else was doing it; it was like ‘I know this is coming, I’m out of control, somebody help me; where are you, God?’ ” she said. “I felt totally empty, like the Tin Man; I had no way to communicate what was going on, no way to understand it.”
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 Activities, Contributing, Comparisons, Emotions, Push away, Thoughts, and Sensation. These techniques are designed to keep your emotions manageable until you can resolve the problem.
ACTIVITIES
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!)
CONTRIBUTING
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.
COMPARISONS
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.
EMOTIONS
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.
PUSH AWAY
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.
THOUGHTS
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.
SENSATION
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.
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.
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 Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation.
TEMPERATURE
When we’re upset, our bodies often feel hot. To counter this, splash your face with cold water, hold an ice cube, or let the car’s AC blow on your face. Changing your body temperature will help you cool down—both physically and emotionally.
INTENSE EXERCISE
Do intense exercise to match your intense emotion. You’re not a marathon runner? That’s okay, you don’t need to be. Sprint down to the end of the street, jump in the pool for a few laps, or do jumping jacks until you’ve tired yourself out. Increasing oxygen flow helps decrease stress levels. Plus, it’s hard to stay dangerously upset when you’re exhausted.
PACED BREATHING
Even something as simple as controlling your breath can have a profound impact on reducing emotional pain. There are many different types of breathing exercises. If you have a favorite, breathe it out. If you don’t, try a technique called “box breathing”. Each breath interval will be four seconds long. Take in air four seconds, hold it in four seconds, breathe out four, and hold four. And then start again. Continue to focus on this breathing pattern until you feel more calm. Steady breathing reduces your body’s fight or flight response.
PAIRED MUSCLE RELAXATION
The science of paired muscle relaxation is fascinating. When you tighten a voluntary muscle, relax it, and allow it to rest, the muscle will become more relaxed than it was before it was tightened. Relaxed muscles require less oxygen, so your breathing and heart rate will slow down.
Try this technique by focusing on a group of muscles, such as the muscles in your arms. Tighten the muscles as much as you can for five seconds. Then let go of the tension. Let the muscles relax, and you’ll begin to relax, as well.
TIPP
Temperature Intense Exercise Paced Breathing Paired Muscle Relaxation
The distress tolerance skills in TIPP will bring you a step closer to wise mind, where you will be able to make a constructive choice and cope productively.
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.
wwtbyh 