Tag: coping skills

CEUs are available at AllCEUs.com this episode was pre-recorded
as part of a live continuing  education webinar on-demand, CEUs are still available for this presentation   at AllCEUs.com/counselortoolbox I’d like to welcome everybody to today’s
presentation of dialectical behavior therapy   techniques emotion regulation we are going to
start by reviewing the basic premises of   DBT and the reason we’re doing that we’re only
going to do it in this one because emotion regulation we’re starting kind of at
the beginning but we want to go over what is   the theory underlying a lot of what we’re going
to talk about we’ll learn about the HPA axis and   this isn’t something that Linehan talks about
in DBT but it is important for understanding   our physiological stress reactions will define
emotion regulation identify why emotion regulation   is important and how it can help clients ourselves
staff yay and we will finally explore some   emotion regulation techniques there are things
besides just preventing vulnerabilities that   we can provide to clients to help them regulate
their emotions before moving into that distress   tolerance realm of skills and activities so basic
DBT premises everything is interconnected when you   get up in the morning if you’re having a bad
the day you know you didn’t sleep well your back   hurts you’re cranky you got a lot of stuff to do
it’s raining outside you know yay   you’re noticing all the negatives your thoughts
maybe more negative you may be more likely to   notice the negative you may be more likely to have
what we call commonly call a bad attitude if you   start to have a better attitude what happens to
what you observe and we’ll talk about that in a   little while the reality is not static what is true
right now in the present may not be true which is you know was the future from what
the present was half a second ago so reality   changes when we look at a situation when we look
at an event, we’re looking at how am i reacting and   what is my feeling about the situation right now
you know we can learn to change where we’re at but   with the information, I have right now what’s
going on and a constantly evolving truth can   be found by synthesizing different points of view
because most of the time as humans it’s just kind   of part and parcel of being humans we don’t have
the whole picture and I did the best I could with   these little graphics here think back if you will
to some of PJ’s experiments when he was trying to   demonstrate egocentrism when we’re looking at
this yin and yang sort of model the girl’s stick   figure what does she see if you ask her what
color is this orb she would probably say black   because we’re assuming she sees the black side
if we ask this little thick figure model over   here what color is the orb she’s seeing the white
side so he’d say white now if we asked a little   confused guy who is standing kind of on the third
side or the south side he sees both of them so he   hears the stick figure girl say it’s black he
sees a stick figure boy say it’s white and he’s   going well it’s kind of both you can synthesize
both perspectives and figure out that this is   an orb that has multiple colors even though she
can’t necessarily see those colors and he can’t   necessarily see those colors so BBT says let’s try
to take a look and see if there are blind spots   see if there are things we’re not seeing or things
we didn’t observe the basic assumptions of DBT   and well people do their best if we didn’t think
that we probably wouldn’t be in this profession so   people are doing their best with the tools they
have and the knowledge they have at any given   time and I added that extra part people
want to get better and be happy most people don’t   want to be miserable if it seems like they don’t
want to get better then we need to ask ourselves   what is the benefit to staying miserable why is
it is scarier more threatening more awful to look at   getting better or being happy and that’s one of
those motivational things we’re not going to go   there today but in general people are going to
choose the most rewarding option when prevents   presented with multiple options okay now this
one area in that I kind of diverge from the official   statement is clients need to work harder and be
more motivated to make changes in their lives I’ve   had a lot of clients who have been working their
butt off but they may not have the right tools   it’s like trying to unscrew something that is
Phillips head with a butter knife they’re working hard but it’s not going anywhere because
they can’t get any traction so I crossed out the   work harder and I tend to replace it with work
smarter clients need to work smarter they need to   have more tools they need to have more effective
tools and some of the tools they have may be awesome if we just tuned them up a little
bit sharpen their oil and grease them whatever you   need to do and be more motivated to make changes
in their life and you’re saying well they’re in   therapy they’re coming here for whatever reason
there why aren’t they motivated to make changes   well again let’s look back at motivation and what’s
the most rewarding choice is if they tried to make   changes before and it hasn’t worked out and
they’ve been told that it was their fault they   were being resistant or you know they were blamed
in some way or they just felt disempowered what’s   going to make them motivated to try to do that
again please let me run the gauntlet most   people don’t want to do that so we need to help
clients work smarter and understand that they are   working hard and they need to continue to do so
and we’re going to help them get more effective   tools and we need to help them get more motivated
we need to help them see that this time it’s going   to be different maybe a little bit different
but this time we’re trying something new it may   be different even if people didn’t create their
problems they still must solve yep you know   if you grew up in a dysfunctional household you
didn’t create that problem but it is negatively   impacting you today so you’re going to have to fix
it if you want to be happy which is the   whole goal of the lives of suicidal or addicted
people are unbearable and when we’re talking   about DBT we’re generally talking about people
who are highly emotionally reactive and suicidal self-harm those behaviors are away at this point
that they’re trying to figure out how to tolerate   what seems like an unbearable situation in their
head addiction is much the same way it provides   some relief from something they feel they have no
control over people need to learn how to skillful   live skillfully in all areas of their life well
yeah because every area is interconnected if   you’re stressed out at work do you just
leave work go home and you have not stressed out   anymore no that’s not the way it works it would
be great if it did but it’s just not even if you   don’t take all your stresses of work home with you
it has taken a toll on your energy level so when   you get home you’re more vulnerable to emotional
upset or just fallen asleep on the couch at 6:00   p.m.

Whatever it is so we need to help people
learn how to live skillfully in each area so   the exhaustion or negativity or whatever it is
from one area doesn’t bleed over into the other   area so we need to learn how to juggle stresses
in all of our areas to prevent vulnerabilities   and people cannot fail in treatment when someone
relapses when someone you know backslides whatever   word you want to use I look at it as a learning
the opportunity I say okay you made a different choice   than we wanted you to make a different choice than
you were hoping you would make so let’s learn from   and figure out why that was the most rewarding
choice than what was on your treatment plan   the goal that you’re working toward why what
happened what were you more vulnerable so you   didn’t choose the newer behaviors because they
weren’t as readily available let’s use this as   a learning opportunity to figure out what’s going
on it’s not a failure it’s a learning moment or a   teachable moment so what is emotion regulation
emotional dysregulation will start there   results from a combination of high emotional
vulnerability so you’ve got somebody who is   kind of reactive and extended time needed to return to
baseline so that when they get upset it takes them   longer to de-escalate and get back to baseline
and an inability to regulate or modulate one’s   own emotions so I want you to think about some
the time that you’ve been driving on the interstate   and you’re just driving along cruising along and
heaven forbid if this has happened I hope not   but if it did you’re probably just late a semi comes
along and runs you off the road onto the shoulder   and oh my gosh you get onto the shoulder your legs
just to go in like this you can’t even press the   gas pedal because you are so stressed out you’re
gripping your knuckles are white from gripping the   steering wheel so tight your heart racing you’re
breathing fast you’re in full-out fight-or-flight   mode so you went from a1 on the stress meter
you know kind of cruising along aware of the   fact that you need to be cognizant of dangers to
a5 of oh crap that could have been bad alright so you take a couple of deep breaths you
your breathing goes down a little bit you get to   the point where you can press the gas
pedal and you pull back out onto the highway now   are you returning to baseline and just like
la-dee-da cutting around like you were before most   likely not you’re a little bit more
on edge and you’re checking your bat rearview   mirror more often you’re looking back making
sure nothing’s in your blood spot more awesome   so you’re not returning to that same level of less
stress Tunis if you will you stay a little bit   elevated because your brain is gone you know I
thought it was kind of a safe situation but I’m   realizing now that not so much so I’m going to
keep you on higher alert and it’s going to take   longer for you to return to baseline because
you’re looking for those threats now you’re   much more aware that it could happen to people who
come from invalidating environment people who are   regularly chronically stressed they’re constantly
looking around for anything else that is going to   threaten them anything else that’s going to stress
them out so they’re not going from a 1 to a 5 back   down to a 1 again they’re going from a 1 to a 5
back down to a 2 and then back up to a 5 and then   now we’re only going down to a 3 it’s that
stress is ramping up so we need to figure out how   to help people deescalate get back down to that
one and realize okay I got this that was an unpleasant situation but I got this now emotional
vulnerability refers to the situation in which   an individual is more emotionally sensitive or
reactive than others or then they normally would   be you know some people this is kind of and when
we’re talking about personality disorders this is   pervasive when we’re talking about someone who
has been under a bunch of stress for six months   this may be a situational sort of thing that we
need to help them figure out how to get out of   but it may not be something that is completely
and utterly pervasive in any event when you are   stressed you know you’re already kind of on edge
and something happens do you react the normal way   that you normally would if you were just like
sitting there and going off oh well okay let’s   figure out how to handle this or does it throw
you up sort of into the stratosphere and for a   lot of people with emotional dysregulation when
they’re their relaxation is on the brink   of chaos so they’re standing there teetering
and they’re going okay I cannot take one more   wind or it’s going to push me over and then they
call them damp they get upset and they’re kind   of on freefall for a while they get their balance
again but then they’re still right there on that   precipice they never come down so what
we want to look at is what’s going on with these   people that’s making them more reactive that’s
making them more alert and more hyper-vigilant to stresses and stressors some of these may be
because of differences in the HPA axis which   play a role in making people more vulnerable or
reactive and we’re going to talk about the HPA   axis in a minute environment of people who are
more emotionally reactive or often invalidating   and what does that mean well pick Jane Jane
has had a heck of two years you know   there’s just been death after death a job loss
she lost her home she’s living in an apartment   right now but she’s not happy and you know yeah
you can just pile stuff on okay so James struggling right now she’s holding on and really
trying to do the next right thing she’s trying   to make ends meet trying to do what’s right
by our kids just feeling stressed out and   then something happens something that most of us
would react with it to you know it’s annoying but   it wouldn’t throw us into utter chaos well James
on that precipice Jane’s already at a four maybe   a four and a half depending on the day so when
this happened just that too puts her on a scale of one to five puts her at a
six-and-a-half which is in freefall but people   may not understand that they may not understand
what’s going on in Jane’s life and they’re like   this is not that big of a deal why are you just
overreacting which makes Jane feel guilty   Phil is self-conscious and feels misunderstood so
then she feels isolated and rejected and we’ve   talked about basic fears being rejection isolation
failure loss of control and the unknown well James   kind of experiencing all of those right now and
the people around her instead of being validating   and going okay you were already stressed out I
can see how this was just the straw that broke   the camel’s back they’re going what is your
the problem so she doesn’t feel like she’s got   social support she’s out there on an island unto
herself so we want to help Jane with emotional   regulation because we know she’s up here and we
know she doesn’t like going into that freefall   but how do we help her emotional regulation is the
ability to control or influence which emotions you   have when you have them and how you experience or
express them and that’s a quote straight out of   Linda hands book so emotion regulation prevents
unwanted emotions by reducing vulnerabilities   so you can go through life you can go through
the day you can experience stress but instead   of feeling overwhelmed or enraged you might feel
mildly irritated for a second and then choose to   move on emotion regulation helps people learn how
to change painful emotions once they start so you   don’t get stuck nurturing that emotion or feeding
into it and being angry with yourself because you   got angry about something you have no control over
it teaches that emotions in and of themselves are   not good or bad they just are it’s your brains
hardwired way of responding based on waiting for   it the information that it has at this particular
point in time spiders if you’re afraid of spiders that is your brain’s way you see a spider and you
feel fear it’s your brain’s way of going threat   spiders can be a poisonous big threat so you want
to get away from it that’s your body’s way your brain’s way of going let’s survive we want to do
this now you can figure out you can learn more   about spiders so in the future when you encounter
then you realize that they’re not you know 99% of   them are not threatening to humans but right now
at this moment your brain is saying warning getaway you probably want to do that so it teaches
that emotions internet themselves are just   prompting us to do something they are survival
responses and suppressing them makes things worse   telling yourself I shouldn’t feel afraid does that
do any good if your kid comes to you and tells you   that you know I’m having a crappy day or I
hate this does it usually do any good to tell them   well you shouldn’t feel that way feel better you
know just be happy does that work I’ve never had   an experience where that worked now it may work
for some people but so we want to help people   identify their emotions and not get consumed
by the emotions are effective when acting on   the emotion is in your best interest so sometimes
it’s in your best interest expressing your emotion   gets you closer to your ultimate goals sometimes
expressing your emotion gets you closer to your   short-term goals like making the pain stop
and true pain is unpleasant however in the   big scheme of things 15 minutes from now 3 hours
from now is that getting you closer to the goals   that you want to achieve or was it just a
stopgap expressing your emotions will influence   others in ways that will help you so if you want
to influence others in ways that are positive and   will help you then emotions can be very kinder
that can be very helpful emotions are sending you   an important message and we already talked about
that so I’m thinking the devil’s advocate amigos   well I can think of a client that goes you rage
is a great emotion to express is it in my best   interest yeah gets people to leave me the heck
alone does it get me closer to my ultimate goals   yeah it reduces my stress by getting people to
leave me the heck alone will it influence others   in ways that will help you, yeah it make them
go away and are these emotions sending you an   important message yet rage is telling me that
these people like everybody are a threat to me   so in the short term when you look at it that
way it can be tricky to see but we want to help   people get outside of this immediate threat and
say where you want to be what happiness looks like to you or however you want to define
that ultimate goal and then once you get into   distress tolerance was your Thursday talk about
how do you endure unpleasant emotions so you don’t   take the stopgap route now on to our favorite
HPA axis the hypothalamic-pituitary-adrenal axis   is our central stress response system and doesn’t
get too caught up and all the psychobiology of   this I think it’s good to be cognizant of but
we’re not prescribing hypothalamus   place in the brain release is a compound
called corticotropin-releasing factor or CRF   which triggers the release of adrenocorticotropic
hormone from the pituitary gland which triggers   the adrenal glands to release stress hormones
particularly cortisol and adrenaline now your adrenal glands are actually on your
kidneys and why is that important what I want you   to see or understand is there are a lot of systems
involved there are a lot of hormones involved   there’s a lot of stuff involved it’s not just box
you know you’re releasing a bunch of chemicals in   your body that are altering the neurochemicals
and the other hormones to prepare you for spiders   the adrenals control chemical reactions over large
parts of your body including the fight-or-flight   response and produce even more hormones than
the pituitary gland so you’ve got these adrenals   this is kind of your stress area if you will it
produces steroid hormones like cortisol which   is a gluteal corticoid which means it makes your
body release glucose what we know is that glucose is blood sugar energy all right so it increases the
availability of glucose and fats for the long-term   fight-or-flight reaction it also produces sex
hormones like DHEA and estrogen okay why is that   important because we know that when estrogen
goes up serotonin availability goes up so if there are the adrenals are busy doing something
else it may cause other hormonal imbalances and   it also produces stress hormones like adrenaline
that is going to ramp you up they’re going to   increase your respiration increase your heart rate
all that kind of stuff so once you have that whole   reaction we talked about and the perceived threat
passes cortisol levels return to normal great this   is what happens in the ideal situation but what if
the threat never passes what if we’re working with   a client who is constantly fearing rejection
and isolation they need external validation   because they don’t feel good enough as they are
they don’t have social support because their   emotional reactivity kind of pushes everybody
away so they’re constantly feeling this threat   of rejection isolation failures loss of control
and the unknown they’re holding on just like you   were holding on to the steering wheel after you
ran off the road and you got back on you know   you kept chugging because you wanted to get to
your destination but you were scared witless okay so you’re chugging along what’s going
on what’s going on in that body the amygdala   and the hippocampus are intertwined with the
stress response the amygdala modulates anger   fear or fighter flight and the hippocampus helps
to develop and store memories when you’re under   stress and think about a time when you are under
a lot of stress were you effective at learning and   paying attention to the good things and the bad
things or were you just trying to make the pain   stop and make the threat go away from the brain of the
child or adolescent is particularly vulnerable   because of its high state of plasticity which is
why do we see people who tend to have personality   disorders much of their trauma and stuff really
started early in their development and which is   why it’s pervasive in every area or many areas
of their life, bad things are learned emotional   upset prevent learning new positive things to
counterbalance it if you’re in a bad mood if   you’re scared if you’re threatened you know if
you’re hungry homeless put whatever stuff is   there are you paying attention to the
bluebirds that are flying around and singing   pretty songs or are you paying attention
to the fact that you got an a on a test maybe   not so, we need to understand this person who lives
in a chronically stressful environment may also   have an overactive HPA axis so they’re already
they’ve already got some adrenaline and   cortisol going on they live kind of in this state
of hyper-vigilance and then something happens and   they’re just like through the roof kind of like
when you scare a cat what happens to the brain   one is a chronic threat to its safety and a constant
the underlay of anxiety is constant undercurrent as   it learns your brain forces synaptic connections
from experience and pruned away connections that   aren’t utilized by people who feel a lack of control
over their environment are particularly vulnerable   to excessive stimulation of the stress response
now it’s not just children abuse and neglected   children pop right up there but abuse and
neglected adults think about a client you’ve   worked with who’s been in an abusive relationship
for years does she have all the happy connections   or is she pretty much terrified exhausted and
stressed out most of the time adults with   anxiety or depressive disorders it doesn’t even
have to be an abusive or neglectful situation if   you have someone that forever whatever reason has
clinical anxiety or depressive symptoms they are   in this state of constant threat and constant of
people if you will so they’re not seeing they’re   not able to learn and take in as much of the
good stuff so there’s more bad stuff coming in   they’re paying attention to more of the bad stuff
or unpleasant stuff the synaptic connections   that form the foundation of people’s schema of
themselves in the world become skewed towards   the traumatic event at the expense of a synaptic
Network-based on positive experiences and healthy   relationships so we had this client here and these
are her negative experiences she has a lot of them   and she’s got these going through her head a lot
and it’s not they don’t just go away whenever she   meets somebody and she’s like well they’re going
to leave me whenever something happened she feels   isolated and alone she may fear so she’s got
really strong connections to those memories   and past experiences and when you’re in the midst
of all this, there’s not a lot of happy stuff and   even when she appears happy a lot of times she’s
faking it she’s not seeing and remembering all   the happy stuff she just wants to avoid the pain
another example I could give you is thinking about   a city planner now a city planner only has a
the certain budget just like we only have a certain   amount of energy the city planner looks and says
what roads and what connections between cities get   the most traffic and let’s devote our resources
and strengthen those connections because we know   we’ve got all kinds of traffic going over there
and those roads that don’t travel those   back roads we don’t need to pay much attention to
them right now because we need to make sure that   those roads that are used the most are strong
but that’s the best analogy I can give without   putting out strings and everything else but so
the hyper-vigilant state active IDEs activated   by the stress response that disrupts our ability
to focus and learn you know we’re just trying to   not die we’re trying to not be consumed by pain
it impairs the ability to form new memories and   recall information due to the physiologic changes
in the hippocampus, it’s not time to learn and   process and do all that kind of stuff have you
ever tried to study for a test when you had 16   other things going on that you are stressed about
how well did you remember this stuff over here sometimes people relate things to prior experience
well most of the time so maybe they’ve had a lot   of dysfunctional relationships and they start to
get in a relationship which side is going to be   triggered the negative memories are the positive
memories and then you have somebody who may be   attached to some positive relationships they start to
get into a relationship and they remember some of   the positives because there have been some really
good relationships but you know they may remember   the negative too but most likely they’re going
to remember more strongly the positive so what’s   their reaction going to be if we’re trying to help
our clients develop a healthy support system we   need to help them address some of those highways
that are going towards the negative memories emotion regulation is transdiagnostic or useful
with many disorders it helps people increase their   present focused emotion awareness it says right
now right here right now what are your feelings   what are your physical sensations what are your
thoughts and what are your urges it helps people   increase cognitive flexibility because it helps
the kind of step back and take a look and say   okay what are my options let me step back from
being intertwined with this feeling and go okay   I feel angry got it what are my options here what
do I usually do what I want to do when I’m on   autopilot what are some other options I could
do that might help me move toward where I want to   go identifying and preventing patterns of emotion
avoidance and emotion-driven behaviors we don’t   want to get into the situation of constantly trying
to avoid unpleasant emotions by lashing out by   hurting ourselves or by doing things reactively
when I feel this way I must smoke a cigarette I   must cut myself I must fill in the blank we want
to help people find alternate ways and be able   to step back and say that is an option is it the
option I want to choose today increasing awareness   and tolerance of emotion-related physical
sensations sometimes these physical sensations   are just so powerful and so overwhelming and
sometimes the rush of adrenaline and that foggy wibbly-wobbly feeling you get in your head when
you have just adrenaline coursing through your   veins is so overwhelming that people don’t know
what to do with it and are afraid it won’t stop   so let’s help them increase their awareness and
tolerance of this helped them understand that it   passes and use emotion-focused exposure procedures
when they get upset help them think about things   in the group sessions that get them a little bit
revved up you know we don’t want to precipitate   a full-scale crisis or talk about something that
happened last week that got them upset and let’s   apply these procedures emotional behavior is
functional to change the behavior it’s necessary   to identify the functions and reinforcers of the
behavior so when they did it you know let’s talk   about cutting because you know that is one of
those behaviors that we see are self-injury it’s what is the function of that behavior cutting
or self-injury is a way of inflicting physical   pain where the person has control and they focus
on that and they feel a sense of mastery when the   stuff going on in their head feels completely
uncontrollable and intolerable it diverts their   attention and it also is something that they
they can control how much pain they’re in so   that’s how it’s functioning now is the best
the response we want no but we can see why somebody   might engage in that behavior and what reinforces that
behavior well when they do that not only do they   get a reprieve from this emotional turmoil that
they don’t feel like they can touch or control   or do anything with but their body also releases
endorphins release natural painkillers to kill   that physical pain which makes them feel a little
a bit better so they’ve got kind of a double whammy   on reinforcers there so we understand that
now we need to find something else that they   can do and help them figure out how to tolerate
the turmoil emotions function to communicate to   others and influence and control their behaviors
and serve as an alert or an alarm to motivate   one’s behaviors so let’s talk about the first
one communicate to others so I’m communicating to   a rat around me the people around me through my
emotions what’s going on if I’m angry I’m lashing   out I’m going to influence people’s behavior and
they’re probably going to back off if I am sad   or crying or scared that might bring them closer
and in a more supportive sort of thing you know   again you’ve got to look at some of the behavior
self-injury can elicit a caretaking response but   these emotions before somebody start
acting out the behaviors the emotions serve as   a cue that okay Sally is getting ready to go in
free fall so they can start reacting sooner and   it serves as an alert or an alarm to the person to
motivate their behaviors if they know you’re   on the precipice if you know you’re right on the
edge of being vulnerable cranky being irritable that day can motivate your own
behaviors to figure out how to reduce some   of your vulnerabilities and identify obstacles to
changing emotions now we can’t just say be   happy and all of a sudden somebody’s like oh I
don’t know why I didn’t think of that I’m just   going to go ahead and be happy that’s just not
how it works we want to look at organic factors   do they have an organic long-standing chemical
imbalance of some sort and it may not be neurochemical it may be hormonal they may have too
much estrogen too much testosterone too little   estrogen too little testosterone whatever let’s
figure out you know have them go see their doctor   and figure out if there is something fibroids
or moans whatever that might be affecting their   mood okay once we identify anything that we can
tweak there we can’t measure neurotransmitters   we’re out of luck there because they’re found
in so many places in the body that there’s no   way to isolate how much serotonin is actually
in the brain can’t do it yes we want to look at   other factors that are biological imbalances
neurochemical imbalances that are caused by   chronic stress that cause addiction to sleep
deprivation and nutritional problems so what sort   of chemical imbalances are we precipitating
by keeping the stress going and keeping the   adrenaline going keeping your body revved up
all the time we want to look at obstacles well   let me stay with biological factors here real
quick the organic things if we can refer to the   physician and we can figure out ways to address
those that give the person one step forward so   they’re not feeling as depressed or they’re not
feeling as reactive people with hyperthyroid you   know when their thyroid is overactive may have
some anxiety issues or some other mood issues   that can be addressed with medication then we
Looking at situationally caused things is the ways we can help them reduce their chronic stress
sometimes there are some easy right-now sort of   solutions other times but chronic stress comes
from issues that are so long-standing it’s going   to take a while it’s not that we can’t do it but
it’s going to be a process so we move on and we   say okay addiction we know that when people use
stimulants rev them up and then they crash and   it makes them more than emotional yo-yo caused
by the substances or the addictive behaviors   also makes them more vulnerable to emotional
reactivity sleep deprivation is all kinds of   hormones out of whack and tends to make people more
irritable that’s one almost everybody can look at   addressing right now and nutritional problems
if they’re not eating well not eating at all encourage them to see a nutritionist to
make sure they’re getting something balanced that   they will adhere to not something that
they look at and go yeah that looks great but no   way I’m eating nuts skill factors what can we help
they with we can identify cognitive responses that   are obstacles which as I can’t do that
I won’t do that resistance in some way my response   to that obstacle is set to look at it and weigh
the positives and the negatives do a decisional   balance exercise to address the cognitive
responses and figure out why is the dysfunctional   or unhelpful reaction more rewarding why is it
more rewarding to be angry or scared than to look   at doing things and thinking of things that will
help you feel happier what’s the disconnect generally, it comes back to prior failures and fear of
failure because they’ve been down that road before   and it’s such a letdown when they’re feeling
good for like three weeks and then they   crash behavioral responses that are obstacles to
changing emotions if somebody lashes out when they   get upset they lash out and throw things
and then they feel guilty so this behavioral   response may lead to having more difficulty
changing emotions because we’ve got to help   them figure out how to pause before the behavioral
the response so they don’t compound the situation with   more negative emotions and environmental factors
people places and things being in environments   where you’re surrounded by people who either agon
negativity or who bring out you know they’re there   with you they’re talking about conspiracy theories
they’re just negative about everything or they’re   critical of you or remind you of situations where
you’ve been criticized before so first, we want to   help people identify and label emotions a lot
of our clients are relatively Alex Simon you   know they have a small repertoire if any of
noting their emotions they just generally go   from situation to reaction and label what they
felt is kind of a mystery so we want to help them   and doing it retrospectively is fine at first
because that’s probably all you’re going to be   able to get the event profiting the emotion what
were your thoughts your physical sensations and   your urges help me describe this in enough detail
that if we were going to give it to an actor or an   actress they could recreate the situation what
expressive behaviors were associated with that   emotion you know did you cry did you throw
things did you hit the wall what were your   interpretations of that event at the moment not
retrospectively but at the moment what   were your interpretations of what was going on
what history before the event increases your   vulnerability to emotional dysregulation lots
of big words what happened before that that   already stressed you out or had you on edge
and you know we go through a whole bunch of   different things and this is you know behavior
chaining we’re looking at kind of what led up to   the event what made you more vulnerable and what
were you feeling at that time and then what were   the after-effects of the emotion or the reaction
on your other types of functioning so after this   event and you went into freefall and you got angry
and you lashed out and you screamed and you threw   things how did that affect your work how did that
affect your relationships with your family how   did that affect your mood and just generally your
sense of being in yourself for the rest of the day changing unwanted emotions okay so we started
labeling them we figure out what we’re feeling   we figure out that yeah when we feel that way
we act in ways that you know make us feel worse afterward what do we do about it let’s change
All alright we already talked about the obstacles   and we’re trying to address those but in a moment
check for facts ask yourself what are the facts   for and against your belief if you believe that
someone did something to be antagonistic towards   you okay what was their motivation what is the
facts for and against that also ask yourself is   this emotional or factual reasoning am I making
a decision based on how I felt I felt attacked   therefore I must have been being attacked or
facts you know I felt attacked yes but that was   because this person said ABCDE and all of those
were very attacking and I felt like I needed to   defend myself so those are to check the facts sort
of steps or you can go with problem-solving so   let’s change the situation that’s called cause
any unpleasant emotion like I said with spiders at the moment you may not have enough information
to not feel scared but maybe your spouse loves hiking and camping and you want to go but
you’re afraid of those aren’t spiders so how   can you change the situation so spiders don’t
trigger that same reaction increase knowledge   increase exposure there are a lot of different
ways but problem-solving says ok what can I do   so my reaction my correct reaction is not one of
threat or anger but it is one of at least mild   acceptance prevent vulnerabilities which helps
reduce reactivity if you are a hundred percent   you know you get up and you’re like this is going
to be a good day to day things that come your way   are probably going to roll more like water off a
duck’s back then smack you upside the face like a   mud pie so we want to prevent vulnerabilities from the turn
down the stress response because when you’re not   when you’re not up here already then you know
you can fluctuate a little bit more and they   help the person be aware of and able to learn and
remember positive experiences so if you turn down   that vulnerability and somebody’s in a good place
or a better place than they were at least they’re   going to be able to notice and we’re going to
want to encourage them to notice the positive   experiences you know instead of thinking that all
people are threatening all people are going to   hurt me all people are going to leave they might
notice that you know there’s Sally over here who’s   worked here for 15 years with me and you know
she’s there she sometimes calls in sick but then   she comes back she’s generally in a good mood
you know she’s not such a bad person and   you start noticing some of the things that are
not self-fulfilling processes building mastery   through activities that build self-efficacy
self-control and competence smuggle we don’t   want to say you don’t want to set a goal
where somebody needs to go an entire week without   having an emotionally reactive response let’s
say go for hours or maybe even a whole day that   would be wonderful but first, we’ve got to talk
about how to reduce those vulnerabilities so we   set the person up for success what things can you
do and well and we’re going to get down here in a   minute what can you do if you wake up and you’re
feeling vulnerable you know the creepy crowds   are going around they cancel school
for the entire week for school the county   school system kids are off for an entire week
because of illness right now but you wake up in   the morning and you’ve got a fever and a sore
the throat you’re like I don’t want to go   to work and get out of bed today what can you do
to prevent being grumpy and overly reactive   throughout the day’s mental rehearsal and this can
go for if you’re getting ready to do something   scary or threatening seeing yourself do that and
do it successfully and this can even be during the   day just envisioning yourself getting up and eating
your breakfast driving to work going through your   day seeing that one person at the office that
always has some sort of snarky comment to say or   whatever irritates you laughing at it or dealing
with it just fine going through everything in your   day as you would like to see it happen envision it
see see what you can do rehearse it rehearse how   to handle negativity you know if you know you’re
going to have to go in for your annual evaluation   with your boss okay so mentally rehearse how it’s
going to go how are you going to react what’s   going to happen so you’re prepared for it you have
your responses and it takes some of the unknown   out of the situation physical body mind care pain
and illness treatment and the acronym for this is   please I changed one of them to laughter
it used to be physical illness and that was both   PNL but I like laughter anyway we’ll get there
when you’re in pain or when you’re sick you’re   vulnerable to being a little bit cranky you know
that’s just because your body is already saying you are   weak you know back in the day when you had to
defend yourself against predators the sick ones   and the ones that were in pain were the ones
that usually got taken out first as a part of   our brain that still remembers that for whatever
the reason so when we’re in pain or when we’re sick   our body keeps that cortisol keeps our cortisol
levels higher and the stress response a little bit   higher so we want to deal with those things but
know if we wake up and we’re in that situation  moment that was a little bit more vulnerable
so we need to handle it with care and laughter you can’t   be miserable and happy at the same time laughter
releases endorphins laughter helps people feel   a little bit better and find something to laugh at
and have on my phone I keep comedy skits every   once in a while I’ll just pop one in even if
I’m not having a bad day pop it in because I   like to laugh eat two-sport mental and physical
health avoid addictive or mood-altering drugs   or behaviors that are going to put you on that
the up-and-down roller coaster that goes up and it   goes even further down than you were when you
started to get adequate quality sleep and exercise also helps increase serotonin and release
endorphins which help people be in a better mood mindfulness is a judgemental observation and
description of the current emotions we’re not   going to go deep into this right now
another class on mindfulness and you can also   google it remembering that primary emotions
are often adaptive and appropriate I know I   said that like six times much emotional distress
is a result of your secondary responses shame over   having it I shouldn’t feel this way anxiety
about being wrong you know maybe this   is the wrong way to respond or you know what if
I’m wrong about this or rage doing due to feeling   judged for feeling that way I feel this way
and you’re telling me I shouldn’t how dare you   so mindfulness is kind of an exposure technique
because it helps people identify that yes I feel   that way but it helps them learn to step back and
figure out how to not judge that and just go okay   I feel that way better or worse whatever that’s how I
feel exposure to intense emotions without negative   consequences that non-judgmental acceptance just
going all right is what extinguishes the   secondary emotional responses of feeling guilty
about it or feeling ashamed or angry at yourself   for being angry so think of it this way if you
can’t see this one’s the best Bruce Lee picture I   could come up with scenario one is an unpleasant
experience the person has an unpleasant emotion and then feels guilt shame or anger for feeling that
an emotion so instead of having to deal with one   emotion one-on-one now you’re having to fight for
different unpleasant emotions and you start acting   to try to stop the avalanche of negativity in the
absence of adequate skills now Bruce Lee he was   able to take out four or five at a time but most
of us you know we would be beaten because all of   these adversaries would be coming at us and
we would be building on them in scenario two and   this is where we want people to get they have an
unpleasant experience which is part of life they   identify unpleasant emotions again part of
life is sucky but part but they can deal with one emotion they’re like okay I’m
angry what do I do about it instead of I’m angry   what do I do about it and I’m guilty and you
see how you know she’s got this she can take that   one emotion so what we’re helping people do is
uncomplicated this regulation is common to many   disorders people with dysregulated emotions
have a stronger and longer-lasting response   to stimuli yes they’re already kind of stressed
out they’re already hyper-vigilant if you want   to say they’re already wound up a little bit and
then something happens and it amps for months now   we have a scale of 1 to 5 if they’re already on
a 4 and it amps them up 2 points they’ve fallen   off the scale they’re in freefall so we need to
understand that what we perceive as an excessive   emotional reaction they may not have been starting
from the same place that we were, we’re starting   from a 1 if they’re starting from a 4 you know
then their reaction to the same thing you seemed   pretty reasonable emotional dysregulation is often
punished or invalidated and increases hopelessness   and isolation emotional regulation means we help
people use mindfulness to be aware of and reduce   their vulnerabilities so we help them take it so
they’re not at a 4 there may be a 2 you know   they’re in therapy for a reason we’re going to
help them work on the other stuff and get them   down to a 1 but right now let’s help them figure
out ways, they can take down their stress response   take down their just underlying anxiety, and stuff
identify the function and reinforcers for current   emotions when they happen was understand where
they came from because they’re functional do that   chaining worksheet check for facts ok now that
I know how I feel I know what my reactions are   I know what my thoughts are I know what my urges
are let’s check the facts in the situation for   and against that forces people to kind of step
back which lets the urge sail out some and then problem-solves what can I do right now to improve
the situation and what can I do in the future   so I don’t necessarily experience this exact
the same situation again how can I break that mold okay so emotion regulation doesn’t provide us
with a whole lot of distress tolerance skills, emotion regulation is really about preventing
vulnerabilities and helping people figure out   okay here’s where I’m at how do I pause so then
I can choose from my disgust distress tolerance   problem-solving or interpersonal effectiveness
skills but it’s a big step how awesome would   it be if you could eliminate some of your
vulnerabilities and think about it just for   a minute or two what vulnerabilities you’ve
got going on in you right now and how many   of those you know could you potentially over
the next week or two kinds of address sleeping and eating maybe you have 16 things going on
and you could pare it down to eight there   are a lot of different things that you might
be able to kind of pull out of the rabbit hat   if you will and what kind of a difference
would it make if you’re talking to your staff and looked around at your organizational environment
what vulnerabilities are there environmental   vulnerabilities physical vulnerabilities my best
friend’s working somewhere right now where pretty   much everybody is required to work doubles because
they are so short-staffed they’re going to start   getting vulnerable pretty soon so look around
what can you do to moderate that so they can   model effective emotional regulation but they
can also not be emotionally dysregulated by a   client who has emotional dysregulation issues all
right so that concludes our discussion today if   you have any questions I would love to hear them
if you want to discuss that’s awesome if you want   to get on to your next client you know I totally
understand that I want to wish everybody a happy   Valentine’s Day for me I don’t particularly pay
a lot of attention to Valentine’s Day but it is   the eve before half-price chocolates
and that is my kind of my kind a day you you you you if you enjoyed this podcast please like and
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