Tag: dialectical behavior therapy

 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 subscribe either in your podcast player or   on YouTube you can attend and participate in our live webinars with dr. Schneider I   subscribing at all CEUs comm slash counselor toolbox this episode has been brought to you   in part by all CEUs calm providing 24/7 multimedia continuing education and pre-certification training for counselors therapists and nurses since 2006 have used coupon code consular toolbox to get a 20% discount on your order this month.As found on YouTubeHi, My name is James Gordon 👻🗯 I’m going to share with you the 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