Dialectical Behavior Therapy (DBT) Skills | Mental Health CEUs for LPC and LCSW

Everyone appreciates today's presentation on

skills

in

dialectical

behavior

al

therapy

. This presentation is based in part on

dialectical

behavior

therapy

. A Practical Guide by Kelly Koerner. This is one of the books: If you want to practice dialectical therapy, don't just look at some of the books. tools which is definitely a must read, then it is also partially based on the Simple DBT Dialectical Behavior Therapy Skills Workbook and DBT for Substance Abusers. This is an article published by Marsha Linehan, so the links to it are in their class, but just to give you an idea of ​​the breadth of what we're going to see today in the short time we have together, what we're going to do is Looking at why DDT was created, we will understand emotional regulation.

Dysregulation and Regulation will identify DBT assumptions about both clients and therapists, and we will explore

skills

to help clients learn stress tolerance, emotional regulation, and interpersonal regulation. effectiveness as an aside that we're taking, or I took the information from this course and combined it with a lot of other information to make a six-hour on-demand course that will be available at the end of the week, but for now we'll just look at the highlights in the 1 hour intro, so why do we care? Why do we want to learn more about DBT skills and tools? Many of our clients experience emotional dysregulation or the inability to change or regulate their emotional signals.

Answers Think for a moment about any of your clients if they are depressed, if they are anxious, if they have problems controlling anger, if there is something wrong with their emotional states, if they can't stay stuck, or if their behavior is receptive. so they can engage in self-destructive behaviors, risky behaviors, or addictive behaviors that they have tried to change and failed, leaving them helpless and hopeless in many of our clients, we try not to fit them in, but we try to fit them in. put them in this box, if you are depressed, then we will look at these things and one thing that I hope you understand from these webinars is the fact that every client is different and there is no box that we can put them in. and you are just as well, how can you do group therapy?

Group therapy is really great because you can adapt it, and that's part of the challenge of doing psychoeducational group therapy, is adapting the tools and helping people adapt the tools to comply. your individual needs. but they can get feedback and see how different tools can be slightly modified to suit different individual needs and unsustainable emotional experiences that lead to self-preserving behaviors like addiction, you know, to numb the pain and distract them. non-suicidal self-harm we talk about cutting we talk about the type of things and then even suicidal behavior at a certain point the pain has to stop, so some people may eventually go as far as trying to stop the pain by stopping the pain. they exist instead of hurting anyone else, people with emotional dysregulation have high sensitivity, so these people tend to be very hypervigilant, they are aware of a lot of things that will happen now that it was originally created and I want you to really have to do it. think was originally created as a tool or protocol to use with people with borderline personality disorder.

What do we know about people with BPD? They grew up in really ineffective environments, so they had to be very attentive to everything that was happening for their own safety, so you have someone who is naturally or lovingly attentive; These situations are too widespread; Dangerous situations are too widespread, so the world tends to seem more and more dangerous, and people who are out of control due to emotional dysregulation are easily dismissed as having too many vulnerabilities and not eating well. essed what contributes to them not being able to sleep well, not being able to concentrate yadda yadda, we talk about vulnerabilities, one thing dr.

Turner talks about there being no emotional skin and compares it to someone who has third degree burns, and everything, even the air when you touch it, is a shame, there is no middle ground, no, it is very uncomfortable, or not. It doesn't hurt, or they are people who are cruel about emotional dysregulation, they are also very reactive, so they are alert, they are aware of everything that is happening, and every time something happens that triggers their consciousness, they jump to this moment. fight or flight response, then they take a while to decalcify, so we're talking about situations where someone is alert, whether they're on edge, maybe because of past situations or not, they have this kind of constant fight or flight or response regular fight or flight and again I will refer to our kind of dream fatigue that talked about how the body can only take so long to be all hands on deck before it goes back to being like old, is what I surrender to. and then the feeling of depression, helplessness and apathy begin to occur in people with emotional dysregulation.

They are as if they were flat and non-existent emotions; They can't even handle it when they have to, or they're too reactive and then the person is not in a valid environment for some of us on a scale of 1 to 10, as far as being a hindrance, it's probably like an 8 for someone with emotional dysregulation, think about a time when you were very stressed or had a lot of vulnerabilities, maybe you had a new baby at home so you weren't sleeping and your other children were misbehaving. there were just all kinds of things going on and you responded to something with an 8 and everyone said that doesn't deserve that much of a response - what happens to people with emotional dysregulation?

It is their environment, everyone looks at them and sees them. What's wrong with you, it's not whether we bother, we have to help people understand that their experience is their experience, and it's not my place to say if it's a 2 or an 8, for me it's not, it's a 2 , but let's see why it's an 8 for you so the emotional response and this is clear I didn't get the red eye reduction when I took this photo and I had bruises but bless his heart when I got it it was a rescue and he He had such terrible problems and is so alert to this day.

He only had him for about four months, but he is very aware of stimuli and people can be very aware of stimuli, so when someone moves, he looks for the appearance of them. You are going to leave me? only again when he notices something changes when there is a threat he goes into the hands-on business and becomes 'some kind of thing and starts acting, goes to look for toys and brings them to me because we have to put him in the garage because we have visitors or something and you know, the climate control is not horrible, but it will sit out there and until I come in or come out and tell it everything is going to be okay now, look.

As a person, that's not a valid answer. It's like answering at ten o'clock, having to spend minutes in the garage while from his perspective he doesn't react much because in the past when they put him in the garage they left him out there for days for months, who knows, I don't really know their story very well, now I use it to emphasize the fact that people with emotional dysregulation, we don't know what they experienced, what they did, trying to survive. They may be trying to survive a situation from their past. You know, when there were six of us and we went back to the abandoned discussion we had the other day, but it's important to understand that all these things play together, something happens and the body's response system picks up these stimuli and says it's dangerous, it's not dangerous. or with that the brain decides to fight or flee and then they go to the survival response with the treatment.

What we want to do is help people feel that feeling and not have to react immediately until they can label some and use a combination to evaluate their cognitions and decide whether their perception is based on the present moment or the last moment, of so that The emotional reactions of primary disability caregivers dismiss the invalid; We were just talking about the child or person being teased or shamed for their emotional response, we have probably all met or worked with parents who have very emotional children who tend to get frustrated and overwhelmed by the constant drama this child seems to present. , so often the child is not taught how to calm down or make the parents nervous, they just like to let it go and disappear, which is not helpful because the child is not learning how to deal with it, the child is not taught child to be aware. to find out what the cause is, and in most situations the child is not taught effective cognitive processing in validating environments if the child becomes angry, even if it seems out of proportion to the event, the caregiver will take the child and tell him it's OK.

I hear you're upset, now let's talk about it and we'll guide the child maybe without thinking about it, but just be a good parent, guide the child through this process of de-escalation and cognitive processing of the secondary trauma or invalidation. and I put it here. Coping skills can be overwhelmed by trauma or intense stress leading to this state of high alert grief; Think about the people who survived Hurricane Katrina or Hurricane Andrew. I'm from Florida so I think it's hurricanes but any big event that is continuous and scary at some point is the last nerve so anything can cause a crisis that many people don't need severe support during these times and can shame for being weak or needy, sometimes no one has the ability to cope, and everyone's simultaneous compensation is a lot of what we saw with Katrina, but other times there may be people who do well and don't understand why other people We don't deal with it well and we see it as abnormal and we want to give up that it is important for us to communicate with people because we have already noticed that the crisis is a normal reaction to an abnormal event that was abnormal, maybe it is the specific incident?

Or is it the fact that this type of incident was the straw that broke the camel's back during a whole series of incidents that led to the abnormal that caused this person to cause excessive stress? The other day I was talking to a woman who has had half a dozen significant losses in the last six years and I said, "Wow, you know it's pretty intense to have all those losses and now she's also starting her own practice and everyone else and I". I'm like oh wow, I can't imagine the stress this woman is going through. Most people are not prepared to face the crisis alone.

We are a friendly group, a group of people we trust, so if we have this reaction, we have it and it seems out of character. disproportionately and people distance themselves from us because they see us as abnormal or dysfunctional, we lose any social support that could have acted as a buffer which in turn feeds back and the feeling of hopelessness, helplessness and isolation worsens, causing a The crisis can differ between people depending on existing stress or

mental

health

problems, and it can also vary over time for the same person, perhaps overwhelming today, perhaps not overwhelming in six months because all the stressors Previous ones I'm dealing with now have had time to work on themselves.

It is important that we help people understand that their reaction is their reaction and go from there, not say that it is bad or excessive, or whatever; The result of this kind of unpredictable reactivity leads me to frantic efforts to bluntly remove or protect what I need to get the feelings out, because I can't stand this kind of pain if you ever have a fire that has had to be cleaned up or even a fire. open wound that had to be cleaned, you know it was pretty numb. If you think about it, you can see why people would want to get some novocaine withdrawal if this support system is not valid, which has additional pain and is also distressing.

When rejected, many times people withdraw, which eliminates any opportunity for social support and this also exacerbates this feeling of rejection and they do so in an attempt to protect themselves, people learn that in invalid environments they learn who they are and how it leads them. . to rejection, that's why they avoid threats, they avoid themselves out there; They avoid relationships because they fear rejection and avoid thoughts, feelings, and sensations that could lead to invalidation. I don't want to feel these things, because if I do them and communicate them, you can tell me I'm wrong. We've laid the groundwork, now we see where this is a problem, so what do we do about it?

The first thing we want to do is look at some DBT assumptions about clients doing their best to get the tools they need right now, and I really believe that clients want to get better, that they wouldn't be in your office if they didn't want to get better for a reason or another, it could be an inadvertent referral and they want there to be a way to end it there. their office because they hope that something can change and benefit them, they cannot fail in DBT if they go through the dialectical behavioral therapy, the protocol and it fails, then the protocol fails themor we, as doctors, fail to understand it right now.not implement.

Today we only talk about tools found in DBT, not how to do dialectical behavior therapy, evidence based practice wants to make it clear that clients exist in an unbearable state experiencing this pain to prevent them from having to learn new behaviors in all contexts. , not only at work, not only in their relationships, but they have to learn how to function and deal with life on life's terms in all contexts, so that they can go to the supermarket, whatever they can get in a traffic jam, they can do it. to be in a crowded airport and not feel like the walls are collapsing on them.

Customers are not responsible for all of their own problems, we know that there are some things that they have no control over, but they cause problems, but they are responsible for all of their own solutions, and we are going to talk about the four options for solving problems. solve g in a few minutes, but they are responsible for choosing to do something and clients must be motivated to change the motivation and choose the most rewarding option among the available options, yes, everything they do now is the most rewarding option available in their toolbox, so we're going to give them new tools, but then we have to teach them how to make the tools effective if you just give me a jigsaw and tell me go work on wood and whatever it is, I don't I'm a carpenter, but I'm not going to know what to do with it so I can go back to using my circular saw or whatever, which can be very inconvenient.

We need to help clients learn how to use these new tools so that they are more rewarding to use than old behaviors, whether they simply numb the pain or distract them. Assumptions about therapists, clarity and compassion are paramount to being clear with our clients about what is going on, let's not talk in generalities. trying to avoid the Socratic questioning we would normally do. We want to be clear about what we are doing and what we want to look at. We must be precise. We shouldn't really say which last week caused all the problems in your relationships if you had four different fights.

These are four different things we need to consider. We have to be precise in identifying all the things that cause and we are going to talk about chains of behavior in a few minutes, so we have to be precise, we also have to be compassionate, even if we disagree, or if we think the reaction is excessive to put ourselves in their place in their raw state in their minds, we must be compassionate and say, "It's okay, you survived, you did the best," let's see what caused you to make those decisions. and which one would choose better next time The therapeutic relationship between DBT or therapists is the desired outcome, but the client cannot fail and therapists treating patients with ongoing emotional dysregulation need support.

It is important for us to remember that patients who are always in crisis are exhausting because they are always in crisis. We're responding in a crisis way, not that we should all be upset and excited because that's just the wrong thing to do, but it takes a lot of energy to use the DBT tools so that we can model the DBT tools and so that we can help. The client comes out of his emotional state so that he can use his mind, so the first step is central awareness until he realizes what is happening and cannot solve it, that is why we want to help him in his rational integration to pay attention. . for your cognitive, this is what happened to your emotional mind, this is how it felt in the rational mind, so you can take the facts, you can take your feelings and you can say with what I know and what I felt, what would be What is the best interpretation of this or the correct interpretation of this event right now for me and what can I do about it?

One of the things DBT talks about is the fact that truth is subjective, what is truth for? One person may not be the truth for another because we all had different experiences, but we need to help people who don't respond and stay in that cognitive mind. If you are a star fan, think that he was the AI ​​that was kind. humanoid robot type of thing or and we also don't want people to act on their emotional thoughts just based on feelings and try to turn feelings into facts because feelings aren't facts, they're feelings, so we want to help them integrate these two things. , and It's harder and it really sounds.

It takes time to pay attention to using effective, non-judg

mental

observation and description of the experiences of those thoughts and feelings, and to identify what the objective evidence is for and against what is happening. Up here, how I feel, look at all the evidence, let's look at the bigger picture, not just one small aspect, and what my feelings are about this event, to be in touch with what is happening in your mind and within your body. One of the first steps, so I talked about the four options, if there is a problem, you have four options that you can tolerate, you will grind your teeth and Barratt sometimes you just can't do anything about it. a lot changes your beliefs about the event instead of seeing a traffic jam as a waste of time and just a total headache, you can see that it's a time to check voicemail and maybe return some calls, do it in a productive way. billable, you can fix the problem or change the situation while you are in traffic and of course stop using Google Maps to know where the next exit is to get off so you can change the situation, or you can choose to just stay miserable and choose to continue being miserable is a valid option when customers make these decisions.

We have to look at why it was the choice, why the option was more rewarding than all the others, why it is sometimes more rewarding to be unhappy for some people, what they know and are afraid of, if they feel happy, they may feel disappointed. and sad if what they are doing now. Some people put up with the problem because it's what they know and it's hard to bear it, deal with it and put up with it, then they muster up the energy to try to change what's happening so we want to look again and ask or we ask ourselves. , because they may not immediately know the choice you made, why was it more rewarding?

Why did you choose the other three options? So tolerance becomes distorted and we are going to talk about a lot of acronyms, here acronyms are really important in DBT because it helps clients get a return and a point. There are some worksheets. There are many online worksheets for DBT, but the acronyms we are going to touch on here are some of the highlights that are important for you to remember tip temperature. balance the current physiological temperature. I'm not necessarily recommending this, you don't want to do this if you have a heart condition, you obviously don't want to suggest this to clients who have a history of child abuse, especially not all. involving drowning.

So it's a little tricky one of the things I suggest to some of my clients, but holding ice cubes, but the suggestion in the book is to hold your breath for as long as you can breathe into a sink full of ice water and then get out. Breathe in and inhale again, repeat as many times as necessary until you feel calmer. Guess what we're talking about. Breathe when you slow down. What do you do when you hold your breath? and our heart rate will naturally slow down when your heart rate your brain slows down say oh the threats go away yippee yeah I can call the dogs.

There are other ways to slow your breathing besides pressing on your head. Hold the ice cubes. One of the reasons it can be useful is instead of cutting the person. , is a distraction technique; The person focuses on the pain because holding ice cubes for a long time hurts rather than cutting themselves, but it also gives their body something to focus on going. Oh, my heart rate is higher because there is pain and the pain goes away. I can lower my heart rate to rewire my brain to function. That's why the heart increases, it's not because there is emotional discomfort from extreme physical pain, exercise increases body temperature, but it also increases heart rate if you are sitting still and your heart rate is 120 beats per minute because you are in a frying pan. , it is very uncomfortable and in your condition it is very uncomfortable and your mind goes away.

I don't understand that you don't move, why does the heart race when you start exercising, that's why it helps to walk and move the big muscles, the body becomes less confused, it's like oh my heart beats fast because the body moves like that when the person stops moving, then the heart rate starts to slow down and that's true even if you're walking, if you're taking a client for a walk, if they're upset and you're talking about whatever. The most disturbing thing is that I have invariably found that when they come back in, they can start to calm down a little more and that their heart rate naturally starts to slow down when they stop exercising. and then progressive relaxation, you're going to move from head to toe or from foot to head as you prefer, but from head to toe, normally how we do it, focus on the muscles, focus on the breathing, breathe slowly , relaxes the muscles, forces the body and to relax, to address physiological arousal, an exercise as intense as a progressive relaxation, all of these things serve as an ability to distract the person from any cognitive or interpsychic nature or whatever you want say, and all these things explain to the brain why the heart rate goes so fast or if it helps lower the heart rate, so that you know there is something to tell them, it is important that you brainstorm with your clients if you become physiologically aroused If you get angry and you are just your hands shake your palms you sweat you breathe fast your heart rate speeds up how do you calm down? what works for you and we hurt you again another acronym has been adopted to distract if there is emotional turmoil then you If you can let go of that adrenaline because you have that initial fight or flight response and then the body is fine, we reevaluate and see if there is still a threaten to engage in activities that help distract you from whatever is happening when the kids are disappointed.

You know, if they get stressed because they're sitting in the lobby and in the doctor's office and they know they're going to get a sa chhoti, we give them something to do. We read a book we talk about because then they don't focus on the fact that they have the opportunity to contribute to the well-being of others, do something good for someone as a volunteer, do something productive that allows you to focus on another person, comparing yourself to others those who do worse, which does not work for everyone; You can also compare yourself in the present with your old self and focus on the better you are.

Do it now, compared to what you did six months ago, it doesn't always work, you know there are options, not all of them are. It's not going to work for all people. emotions do the opposite if you feel very sad look for a comedian, go to youtube and google a comedian and watch a parody, two or ten, so you do something that makes you laugh and makes you happy, sing silly songs, a stupid, stupid dance comes out and there are very few things I find funnier than just laughing at a baby when I'm having a really bad day.

I'll find those stupid videos of babies laughing at torn paper. If you can't help but laugh with them, build an imaginary wall between them. Yourself in the situation, imagine pushing the situation away with all your might or blocking the situation in your mind and telling yourself every time it arises, you have to disappear, so if you start thinking about something that is particularly painful, as soon as possible possible. When it comes to your mind and comes to your consciousness, go, no, I am NOT going to think about it. The thoughts that some people count to a hundred, whatever it takes to get over the initial rush, some people sing to me.

I think I've said before that I had this irrational fear of bridges, but when I drive over a bridge I sing and it's usually not songs on the radio, it's usually songs that I've sung to my kids. I'll sing the ABCs, which doesn't require a lot of cognitive interaction because I'm doing pretty well just crossing the bridge and yeah, I know I should be over it, but I'm not and that's how it is. 10 game is. I like this one, think of 10 things that you like, think of 10 things that are green, think of 10 things that you see where we're going here and you can incorporate all the different senses if you do it in several iterations. 10 things you smelled yesterday 10 things you see now 10 things you hear on the way to work helps people focus on more than just what's happening here. the game 5 4 3 2 1 is similar to the ten things that identify the game 5 things you see 4 things you smell 3 things you can touch and follow them to sensations l As I mentioned in the last slide, can sensations help distract ? you from what is happening until you have the opportunity to get the first adrenaline rush through the cold band ice cubeselastic and I don't like this one, but some people do put an elastic band on their arm and each time they start holding on with a negative thought, smell, find some good smells, smells that bring back good memories, smell to taste, maybe Whether it's roses, maybe it's a specific purse perfume, maybe you just go to Walmart and start smelling all the air fresheners. , anything that makes you happy, I suggest you avoid the taste because if you know you start to use discomfort tolerance, you start to move towards emotional eating, I've seen it happen so I would avoid it for most people, but if they're just desperate to get there, then you know we're going to do it because choosing how to lead from their cognitive or intrapsychic sensations improve the moment when the images go to their happy place regardless of what their happy place means to find an alternative meaning for what's happening now may be Linehan refers to it as lemonade, we all know how to do it, but we're not necessarily the best, but try the lemon, I try to look for the optimistic meaning in whatever, even if someone is not religious, you can use it with radical acceptance but accept it as it is. and don't try to change it, just put it there for the relaxation of the universe, it's always good to relax one thing at a time and not focus on a problem, but focus on something that we talked about about discomfort tolerance and improving the moment. so focus on one thing like your breathing, start breathing, your breathing calms down if you have to focus on something else then move on to the tension in your neck, maybe you have to lower your shoulders and release the tension in your neck, concentrate on physiological things, concentrate.

In other ways, ideas, the abstract things that are in your head and in your emotions, can help people endure distress until they can think more clearly. Vacations, take some time, sometimes you just need to get away from it for a few minutes. I'm sure we've all been there where you just were, like you know what I did and you close your computer screen, you get up, you walk out of the building and of course there's no one there, but you get out of the building and do a couple of laps around campus and then you're like, "Okay, I can deal with this again, just clear your head before you try to tackle whatever it is that's cheering you up because you can't necessarily trust someone else to talk to themselves." in a positive and reassuring way, now back to those stupid memes and videos that I love so much.

There is one that has a kitten on a laundry wire and says hang in there I love having those things on my screensavers, maybe it's juvenile, but it is. whatever. I'm happy and it reminds me that you know, even when I'm not in a state of emotional distress, it reminds me that it's okay, it's still there, you have it and it also has all factor, so I always like anything with all factor. the goals of emotional regulation, so once you've tolerated this distress, you've gotten over that initial impulse, that initial I can't stand this pain or discomfort, then we need to move on to emotional regulation, helping people identify the labels and Understanding your emotions and the functions of those emotions decreases unwanted emotional responses and decreases emotional vulnerabilities, so what you are going to do is identify and label the emotions, their functions.

I'm afraid, okay, you're afraid, tell me why, what's the function of you being afraid? What do you want to do? And what do you think is causing this fear? There is no self-awareness. Through questions like that, talking about it, people will begin to understand where their emotional reactions are coming from and will be able to choose whether or not to continue with the behavior that I guess I didn't put on a behavioral train. Analytics is how you can help people get past that and that's a couple more slides. Police, we want to monitor our thoughts. Check the facts.

See how to perform opposite actions if you want to hurt. seek to be kind to yourself if you want to escape maybe you need to stay and then look for problem solving reduce vulnerability through the ABC p accumulate the positive remember that vulnerabilities are those situations that happen before any distress whatever those things are that make you more likely to be irritable, overwhelmed, angry, depressed, to get sad about anything rather than not, so we want to eliminate those vulnerabilities or reduce them as much as possible, so we're going to accumulate positive diary photographs of gratitude, if everyone has them. the things in their life that interest them they have on their phone, you know, little picture galleries they have as screensavers they have reminders about why they get up in the morning they develop mastery so they master the skills that they need to deal with emotional distress and discomfort cope ahead of time plan for distressing situations if you are preparing for an annual review and things like that stress you out a lot rehearse ahead of time plan how to deal with them ahead of time find out how you're going to react if things go wrong figure out how you're going to react if things are going well figure out how you are going to deal with the situation and physical vulnerability prevention maintain your

health

chronic pain chemical chemical imbalances hormonal imbalances all of these can cause vulnerabilities or preparing yourself makes you predisposed to feel like something is at eight when it's only two sleep Enough when we are sleep deprived it is much harder to deal with life on life's terms and exercise Exercise is a great way to release or use up some of the stressful energy that you release during the day.

Behavior chain analysis. The first thing you do is that a strict behaviorist will have slightly different explanations for how to do this, but bear with me. Name the behavioral reaction that happened now. If you're thinking about the ABC, this will be your C, your consequence, what happened when you identified the triggering event, ABC is that would be the a, what was the triggering event, now this is where it differs a little bit, so we want to look. In the behavioral links, then you had the activating event and then there was this reaction and in the middle there were automatic beliefs and we have thoughts there, but there were also sensations, events and feelings between what happened and your reaction, what sensations did you have? you felt you blushed you felt nervous you felt scared you felt sad you had a pang of something what feelings were there and what events happened did you act a certain way did you scream you screamed what happened because these are all the things that are going to go into what finally ended being the behavioral reaction, so I want to look at the short-term positive and negative effects of what you did, the behavior of the reaction, if you started yelling and throwing things, okay?

What was the short-term positive effect? What was the benefit? Because that's what you chose. Which means it was probably the most beneficial response you could come up with in your highly emotionally charged mind at the time. So what were they? the immediate short term benefits and negative and then look at the long term positive and negative effects if you react to this discomfort by shouting and throwing things what will be the impact? impacts, are there any potential positive effects of this? And many times it is not like that, but we want to ask the question in case there are, because some people will have a positive effect and we must address that this is something like if we go back to motivational interview what we think about when we talk about balance exercises Decisions Address problematic links with skills If there were sensations or actions that exacerbated the distress, then we need to look at distress tolerance If you suddenly had this immediate panic reaction and you couldn't breathe, we need to work on your distress tolerance skills so that you don't get to that point where, just for lack of a better phrase, you find yourself having nervous thoughts and feelings if your thoughts become negative and start racing and your feelings are negative and anxious and worried and all those negative words. , we want to look at emotional regulation, you know, if you can get through it, get over that initial rush and you're still stuck in the negativity, then we want to look at In emotional regulation most of the time we'll look at both of them and then the third component once. that we have learned how to overcome the initial flood, the initial call to all hands on deck and then the people have learned. to regulate your emotions and identify useful responses and instead of talking about good and bad we want to talk about useful and less useful responses, so we need to look at interpersonal effectiveness and how to interact with other people to make that validating environment exist that we want .

To start with the interpersonal and intrapersonal, if you are effective with yourself and then move on to others, describe what is happening, evaluate how you feel, what your reactions are, what is the best next step, affirm your choice, reinforce the good things, be aware, appear confident and be willing to do it. Negotiate and yes, sometimes we have to negotiate with ourselves because there is something we really want to do right now and this is very true with people with addictions, many times they really want to use and they know the long term consequences of using. They're not where they want to be, so they have to negotiate with themselves to say, "Okay, I really want to do this right now, but I'm going to choose a different option in their relationship with others," we want to encourage them to be kind. to be harsh critics, which is often what they have achieved their entire lives, to be kind to other people, to accept them, to model how they want to be treated, to be interested in what other people have to offer, what else they have to offer people. many people with emotional dysregulation cannot manage their own life on life's terms, they cannot even begin to manage other people's things, so they often seem disinterested, validate other people and their experiences and have an easy way You know, sometimes we get too intense and if everything in your world is a zero or a ten, it's easy to be intense about everything as they develop emotional regulation, things will be different, you know, they'll have fours and fives in there. , but practicing not being intense and exaggerated in everything and then in your relationship with yourself be quick be fair with yourself do not judge only fair avoid apologies stick to values ​​and be sincere 12 step recovery, first step begins with honesty being honest with yourself the second step we start talking about hope and faith, which is sticking to your values ​​and being fair to yourself being compassionate comes a couple more steps down that is not difficult or harmful for any of our clients to teach them to be fair, be kind to themselves and be honest with themselves and others, so how does treatment progress?

When we talk about dialectical behavior therapy as an evidence-based practice. The first stage is basically security. We want people to move from behavioral control of the disc to behavioral control of the disc. behavioral control we don't want people to get a phone call, maybe a couple has to go on a weekend trip, and someone with behavioral disk control could send them into a state where they self-harm, so we want to make sure that I have the skills not to self-harm and you know you can't just say well, you can't cut the person, okay, then finish it, what am I going to do instead if I can't cut, if I knew how to do something else?

I would be doing it right now, we need to help them increase their self-care behaviors rather than cutting back on what they can do and I've talked before about some of the interventions that I've used with some of my clients who self-harm. It's not ideal, it's not where you want to end up, but going from self-harm to, like I said, holding ice cubes or using a pen to draw on yourself is definitely preferable to cutting yourself, so we want to look at small steps that don't move away from you. . Knowing five or six episodes of self-harm per week is nothing, you are setting your client up for failure.

We want to reduce the intensity of the self-harm so that the skin does not break so that they do not harm themselves. Reduce behaviors that interfere with therapy. We usually call resistance and that can be being late which can always be and try to derail therapy sessions it can be being bossy it can be secretive whatever it is that is interfering with the therapeutic process it is important to understand that the behaviors that interfere with therapy can also be be displayed by the counselor if the client is experiencing a lot of emotional discounting role. Sometimes counselors will start showing up late to sessions and start forgetting to check the chart before coming in and remember what the assignment was.

The assigned counselor will begin to forget to do things, so we must ensure that both the counselor and the client are engaging in participatory motivational therapy behaviors. We want to increase the quality of life behaviors anddecrease behaviors that interfere with quality of life, so if they are engaging in addictions if they are not sleeping if they are changed smoking if they are and again these are things when we look at the priority list my main focus at the beginning will be self-harm, You know, I don't want them to engage in those behaviors and then we'll start to look at other things that create vulnerabilities that make them more likely to be unhappy or to react in situations that would make them unhappy.

We will increase basic behavioral skills. Mindfulness and sharp awareness that encourage clients not just when they are upset, but to do mindful body scans four or five times a day to know where they are and to know if they are starting to feel vulnerable if they are feeling exhausted. All of a sudden, if they're feeling confused, then they know to be kind to themselves, distress tolerance, we talked about those skills, interpersonal effectiveness, we talked about those skills, emotional regulation and active problem solving, so all of these will be introduced into stage one, but they are presented that the client has been using their old behaviors for much longer than stage 1 will last, so we must remember that we have to help clients strengthen these behaviors.

Remember to use them if you use them for the first time. out of five times like one more time than they used them last week, let's focus on the positive movement forward and not what we think they should have done, we don't want to set goals that will set them up for failure. In stage two we want to help clients moderate emotions from unbearable and uncontrollable to modulated and emotional. We want to feel the feelings well. I mean, in theory we do, so we don't want people to completely go numb and turn into robots, but we don't want to either.

We want each emotional experience to be like debriding a third degree wound. We want something in between. We need to help them decrease intrusive symptoms like flashbacks, flashbacks, and interrupters. The things that created the situation where they feel unpleasant and unacceptable for who they are. decrease the avoidance of emotions and I know that sounds a little contradictory by increasing emotional awareness again we don't want them to become numb we want them to feel because if they feel then they can choose how to act and how to react decrease withdrawal increase exposure to life many times clients with emotional dysregulation they have withdrawn because they don't want to be rejected, so they don't go out with friends, they don't experience life on life's terms, they just sit in front of the TV and watch Netflix. we want to reduce self-invalidation, help them understand that their experiences are their experiences and that they are neither right nor wrong.

Their choices may be useful or less useful, but at any time that is for the best and they can see their best options. to survive, so let's not be critical. I'm just happy you're still here and we want to reduce the dependency on mood behaviors. Part of this process we are going to teach people how to create SMART goals that are specific, measurable, achievable, realistic and time-bound. limited SMART goals and make sure they are successful by validating them and teaching them to self-validate encourage them to imagine the possibilities when they succeed when they achieve this goal what will be different how wonderful it will be encourage them to take small steps steps, not all or nothing, you know, we want to get rid of the dichotomies, small steps towards recovery and applauding yourself for trying, encouraging them to lighten their load, getting rid of things they don't need to stress about right now, you know.

Maybe now isn't the time to start remodeling the house and then sugar-coating the pot. Encourage clients to provide themselves with rewards for successfully completing a goal, perhaps going an entire week or, for some clients, even an entire day without self-harm. I encourage you to practice these skills yourself because you will see how much we really don't do and how useful these skills can be, but it also gives you more information on two ways to help explain gratitude to customers and help them apply these tools to themselves. Think about the skills that you've used that are useful to us or the skills that you could have used that would have been useful to you last week because you're going to be asking clients to do this, so let's do it for ourselves so we can We can get Instead and think about what skills might have been useful to a client you worked with over the past week.

Many disorders involve some amount of emotional dysregulation; Such dysregulation may be caused by high sensitivity and reactivity due to innate characteristics. and poor environmental adjustment or external trauma and lack of support, or both, DBT seeks to first help the person replace self-defeating behaviors with self-care behaviors and then moves toward emotional regulation and interpersonal effectiveness to help people develop self-control. support system and learn how to feel feelings, including good ones, a variety of tools are taught to clients to help them set SMART goals, identify and understand emotions and their functions, decrease unwanted emotional and behavioral responses, and develop a relationship compassionate and supportive approach with themselves and others, finally remember that not all tools are going to work for all people, it takes some experimentation, prepare your clients for that, otherwise if they try something and doesn't work, they will feel rejected and validated and like failures again, it is a process to work together.

Help them discover how they can begin to interact with life and integrate the two dichotomies of thought and emotion to make wise decisions that help them live happier and healthier lives.