In today’s world, it is hard to stay truly connected with others. We are so used to our digital, screen-to-screen interactions that having in-person, face-to-face conversations can feel difficult to manage.

Dialectical behavior therapy, also referred to as DBT, has an entire module dedicated to offering skills and ways to help people communicate more clearly and interact with others more meaningfully. This module is called Interpersonal Effectiveness and it focuses on how the way you communicate and engage with others impacts the outcome of your interactions.

There are three main skills sets within DBT’s Interpersonal Effectiveness module, each related to a different goal or priority.

Skill Set No. 1: GIVE

If it is important for you to keep and maintain the relationship you have, you will want to focus on the first skill set. DBT offers the acronym GIVE as a way to easily remember these skills:

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• Gentle: Being gentle means being kind and nonjudgmental. Keep a moderate or low voice. Keep from yelling, name-calling, or saying mean or hurtful things, even if you’re “just joking.”
• Interested: People love to talk and be listened to. If you act interested, people will want to keep spending time with you. Acting interested includes maintaining appropriate eye contact (no staring), nodding, and asking questions. Even better than acting interested is being genuinely interested. In my experience, you can always find something interesting or fascinating about a person by discovering what they are passionate about, or relating their story to an experience you’ve had.
• Validate: Everyone wants to be understood. When you validate someone, you are letting them know you understand their emotions, thoughts, and/or experience is real. This is not the same as agreeing with someone’s opinion. Validation is letting someone know you respect their experience.
• Easy manner: Chill out. Relax. Be flexible and easygoing. This doesn’t mean ignore or abandon your values, but realize that not everything has to be a battle to the death. People like to spend time with people who are easy to be with. If everything is an argument, or tensions continue to run high, people tend to end those types of relationships.

Skill Set No. 2: DEAR MAN

If you are wanting someone to do what you want, DBT recommends using the skills in the second skill set, often referred to by the acronym DEAR MAN:

• Describe: Before you can ask for you want, you need to describe the situation objectively. I highly recommend keeping this simple and behaviorally specific.
• Express: Express your emotions and opinions using “I feel” statements. When the other person knows what you’re feeling, you don’t leave them needing to guess or, worse, assume what your emotional experience is.
• Assert: Ask for what you want and say “no” clearly. The other person isn’t a mind-reader, so be as plain and simple as possible, even if it may seem obvious.
• Reinforce: Reinforce for the other person how responding to your request benefits them positively. If they know what’s in it for them, people are more likely to respond in the way we want them to respond.
• Mindful: Maintain focus on your goal. Don’t get sidetracked or off-topic. Ignore attacks, and avoid distractions.
• Appear confident: If you don’t look confident, it’s going to be difficult to be taken seriously by the person you are engaging with. Maintain eye contact, keep good posture, and don’t mumble.
• Negotiate: If all else fails, be willing to negotiate. Getting some of what you’re asking for is better than getting none of what you’re asking for. Ask the other person what they’d offer as an alternative solution to the problem. Also, know when to “agree to disagree” and walk away from a discussion.

Skill Set No. 3: FAST

Are you looking to maintain your self-respect after an interaction? You’ll want to refer to DBT’s third skill set in this module, FAST:

• Fair: Act according to the rule. Be fair to yourself and the other person.
• Apologies: Don’t offer apologies or over-apologize if you are just being you or when making a legitimate request. But apologize where appropriate, and don’t under-apologize if you’ve wronged or hurt someone with your actions, behaviors, or words.
• Stick to your values: If something is important to you, stick to it. Don’t change or “sell out” in order to “fit in,” get what you want, or avoid saying “no.” Sometimes, doing the thing that feels right can also feel most uncomfortable. This doesn’t mean you should avoid it.
• Truth: Be honest. Don’t lie, make excuses, or exaggerate circumstances. Take ownership for your thoughts, behaviors, and emotions.

If you keep these skills in mind, you should have little to no trouble keeping and maintaining important relationships in your life.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT Skills Manual for Adolescents. New York, NY: The Guilford Press.

Stress has a way of upending our lives—it can cause tension in our relationships, anxiety in our thoughts, and tightness in our bodies. You may have a self-care practice in place, or yours may need some shoring up.

Either way, mindful music listening can be a wonderful way to reduce your stress and reconnect with your body and breath. Mindfulness—the practice of being in the present moment—can be practiced at any time and anywhere. I often use mindfulness exercises with people in therapy as a way to tune into their body, breath, and mind. Mindfulness is not about having an empty mind, but simply noticing whatever is there, thoughts and all.

However, if you find mindfulness challenging (or haven’t tried it!), the addition of music can help you stay focused, while simultaneously helping you to connect with music as a source of strength and creative energy. Music can be a powerful way to experience the present moment.

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Take a moment to think about the music in your life. Do you listen to music regularly? Is it live music? Recorded music? What kind of music moves you? Helps you relax? Energizes you? Do you play an instrument or sing? What music do you hear around you (perhaps music your kids or partner listen to)?

Now think about your relationship with music for a moment. Is it a source of frustration or a joy? Do you feel disconnected from music sometimes? Does music soothe you when nothing else seems to work? Do you have a lot of music on your phone but never listen to it?

Whether you listen to music all the time or rarely, mindful music listening can help you slow down and be in the moment. Here’s how:

1. Choose a piece of music to listen to. I usually use instrumental pieces, as lyrics can add a whole extra layer, but it’s up to you. It can either be a familiar or unfamiliar piece (it’s interesting to repeat this exercise with the opposite of what you choose this time, just to notice if anything feels different).
2. Take a moment to breathe and ground yourself—no matter where you are, or what’s going on around you. Inhale gently through your nose, and exhale deeply through your open lips. Notice your body, and tune into how it feels, whether you’re standing, sitting, walking, or laying down. Just notice any physical structures your body is touching (the floor, the chair, or your shoes) as well as any physical sensations (tightness, tension) in your body.
3. Just listen. Use headphones or earbuds if that helps you focus or shut out external noise. Give yourself permission to only listen to the music, without simultaneously checking your email or refreshing your Facebook feed. If it helps, close your eyes (if that’s challenging, it’s likely because you really need the break!).
4. Notice. Let yourself be aware of anything you notice, without judgment or self-criticism. Notice the pace of the music, the sounds of the different instruments, or the shifts in volume. Notice if you’re more aware of a certain part of your body as you listen (i.e., “I often feel vibrations of cello music in my chest”). Notice any thoughts or feelings that come up—perhaps the music is connected to a memory, or perhaps an anxious thought is trying to pop through. Let any thoughts just pass through your awareness, and then gently bring yourself back to the sounds of the music.
5. Reflect. Take a moment to breathe and check in with your body, breath, and mind (see step 2). Does anything feel different? Do you notice any shifts after listening to the piece of music? Do you feel calmer? If the piece you chose didn’t feel like a good fit, what might you look for in another piece (i.e., slower, fewer instruments, louder)?

This short mindfulness experience can be a useful thing to practice daily, much like meditating. You might experiment with different types of music as a way to notice different responses. You may also find that repeating the same piece of music is a sort of touchstone, a way to continually reconnect to that place inside where gentle pausing and noticing can happen with ease.

I’d love to hear what piece of music you chose to listen to. Feel free to leave a comment below.

Many therapists, myself included, feel that the most potent work in psychodynamic treatment is in what’s called “working with the here-and-now.” Addressing what’s going on in the therapy room—and by that I mean what’s coming up between the person in therapy and the therapist—means we’re really cookin’! It puts the “dynamic” in psychodynamic therapy.

If you are at a place with your therapist where you feel okay about talking about your therapeutic relationship, it likely indicates a healthy level of trust between the two of you. You’ve moved from talking “about” issues (such as describing the latest negative interaction with your boss, the last argument with your wife, or the most recent bout of passive aggressiveness with that annoying neighbor) toward experiencing an issue together.

It can be scary. It takes guts. And it’s where so much amazing work happens.

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So if the here-and-now is so important, why do therapists ask so many questions about the past? Why are there so many stereotypes about therapists asking about, say, your mother or father? Heck, why does your therapist want to know about your parents at all? After all, it’s you in therapy, not them, right?

Looking for Patterns

Early on in treatment, many therapists try to get a sense of your early history—questions about where and how you grew up, the family members who were (or weren’t) around, and much, much more. Was Dad down all the time? Did Mom never let you see her cry? Were you the oldest and thus “in charge” of your siblings? Were you always compared to another family member?

Therapists are often looking to suss out patterns, many of which tend to be dutifully followed in a less-than-conscious way. Emotional patterns could be strong feelings that come up for you seemingly out of nowhere. A therapist may ask you if a feeling is familiar. It may lead you to a memory of something small or large, but trusting it and seeing where it takes you can lead to uncovering and healing a long-held wound you didn’t know was still there.

Therapists are also attuned to relationship patterns and how they may be affecting you now. These may be recurring types of relationships (“Why am I always dating the same type of person who treats me this way?”) as well as patterns in your family’s history. For example, a man who feels he needs to hold the family together without showing emotion may have been modeled that by his father, who may have been modeled that by his father, perhaps instilling an unconscious limitation regarding what a father can be.

Using Patterns to Promote Change

In this way we are moving back and forth, examining how your past was the forerunner to who you are now. It dictates nothing. Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.

Someone else with your exact past wouldn’t necessarily be in the same place you are now, but we can often connect dots that led to the issues you may be struggling with.

The past can provide some insight. It’s a reminder that your mental health is not all about “you” because there’s a larger picture of you in an environment, a greater context. The past can help put all of this together to better understand who you are. When you look at a pattern that has led to “you” and realize you’ve been using what you were given the best you could, you invite room for self-compassion. Positive change is very difficult without allowing yourself some of that.

It’s not about the insight, though. Insight-only therapy would make treatment an interesting intellectual exercise, but one that led to little actual transformation. Once we connect with past issues, uncover patterns, and unpack how strong emotions elicited by passing thoughts are actually learned responses to old hurts, we can finally heal those hurts.

That’s what we do when we work with the here-and-now.

We can finally let out anger that previously found its voice as depression.

We can finally cry about something that had been manifesting as resentment in every power dynamic we were on the less empowered side of.

We can truly, deeply laugh at something we once held as morbidly sacred.

Using the present to connect with the past, and then the past to connect back to the present, is how we move forward.

The term self-regulation means “control [of oneself] by oneself.” It refers to a system taking the needed steps to keep itself in balance. Many different systems can self-regulate, including businesses, communities, financial institutions, political campaigns, and industries. In biology and somatic psychotherapy, self-regulation refers to an organism (a biological creature) being in a state of balance.

Self-regulation of biological creatures (such as you and me) occurs on many different levels. For example, someone who has good emotional self-regulation has the ability to keep their emotions in check. They can resist impulsive behaviors that might worsen their situation, and they can cheer themselves up when they’re feeling down. They have a flexible range of emotional and behavioral responses that are well matched to the demands of their environment. Thanks to neuroplasticity, the adaptability of our nervous systems, humans are fortunately able to improve their emotional self-regulation over time.

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Our bodies also have the capacity for self-regulation. There are many examples. On a purely biological level, a well-functioning pancreas keeps our blood sugar in the range our body needs in order to function optimally. Our heart rate speeds up when we exercise, and our muscles need more oxygen and sugar. The heart rate slows when we are in a state of rest, and the muscles need fewer supplies from the bloodstream.

Similarly, the autonomic nervous system works to keep order below the level of our awareness. It regulates and balances many automatic functions of our bodies, including emotions. One of the most important (and frequently overlooked!) functions it regulates is our automatic, instinctive response to perceived threats in the environment. Our threat response system determines whether we are angry and want to fight, or scared and want to flee, or hunker down until the threat passes (freeze). This is known as the fight, flight, or freeze response.

When these responses are out of balance with our environment, we are not self-regulating well and we experience symptoms. This is why self-regulation is so important.

The fundamental goal of somatically based psychotherapy is to restore healthy self-regulation, resilience, and the capacity to be fully present in the moment. By integrating somatic tools into therapy, it is possible to work directly with symptoms “where they live”—in the person’s body and nervous system.

When our fear response is out of proportion to the current situation, we call that anxiety. It would be appropriate to experience a pounding heart, rapid breath, jitteriness, and intense fear if a grizzly bear were trying to attack us. On the other hand, these same physical symptoms are excessive if we are grocery shopping, conversing with a friend, or at home reading a book.

Here’s another example: When Jill was a little girl, her father often had bouts of rage. Since Jill was very small, she was incapable of standing up to him to actively protect herself. Had she tried, his rage likely would have increased, and she would have been physically overpowered. As a small child, she was dependent on her parents; she couldn’t flee by getting a job and moving. She learned that becoming still and quiet was usually effective in avoiding his attention and anger. As an adult, she still tends to “freeze” in many situations where being more active and assertive would be a more effective response. She also may experience fear and anxiety when there is no actual threat to her safety. We can say that because of Jill’s early upbringing, her capacity for self-regulation was disrupted. Now she needs support to develop improved self-regulation skills so she can function better and increase her enjoyment of life.

Whether or not it’s overtly stated, the goal of most therapy is to restore balance—self-regulation—in an individual, couple, or family. Since the threat response and related emotions are biological in nature, it is often useful to include awareness of the person’s bodily responses during the therapy session. For example, a person who has learned to notice when their heart rate is increasing and their jaw is clenching can take specific actions to stop a rage or panic attack before it really gets rolling.

In somatic psychotherapy, the therapist and person in therapy attend to the latter’s history, thoughts, emotions, and relationships, and the relationship between person in therapy and therapist (therapeutic relationship), just like in “regular” therapy. However, they also include a moment-to-moment awareness of what the person’s autonomic nervous system and body are “saying.” The person learns to have two-way communication between mind and body, which is often effective in restoring self-regulation and relief from symptoms.

The fundamental goal of somatically based psychotherapy is to restore healthy self-regulation, resilience, and the capacity to be fully present in the moment. By integrating somatic tools into therapy, it is possible to work directly with symptoms “where they live”—in the person’s body and nervous system. Over time, these efforts to restore self-regulation allow the person to move on with their life, stronger and more resilient than ever.

References:

1. Cook, J. L., & Cook, G. (2009). Child development principles and perspectives (352-355). New York, NY: Pearson.
2. Definition of neuroplasticity. (n.d.). MedicineNet.com. Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=40362
3. Perry, B. D. (n.d.). Self-regulation: The Second Core Strength. Early Childhood Today. Retrieved from http://teacher.scholastic.com/professional/bruceperry/self_regulation.htm
4. Self-regulation. (n.d.). Retrieved from http://www.dictionary.com/browse/self-regulation

A new study is in the works to evaluate mindfulness meditation as a treatment for pain after undergoing back surgery. The experiment is still in the participant recruitment stage at Mount Sinai Hospital in New York City, so results will not be available for a couple of years. However, once completed, the study may lead to the development of new, safer approaches to treating back pain than traditional opioid medications.

Back surgery can cause severe pain that lasts for weeks or longer. Opioids have traditionally been prescribed to treat this issue, but they are widely acknowledged to have dangerous side effects and have fueled an addiction and overdose epidemic. Drug overdose has now surpassed car accidents as the leading cause of accidental death in the United States.

Much of the issue has been attributed to a lack of effective alternative treatments. Mindfulness meditation—deliberately focusing attention on the present moment—has been verified as an effective method for addressing many types of pain, so it is possible the effect could be applicable to post-surgical back pain.

Mindfulness Meditation as Pain Treatment

[fat_widget_right]The researchers were motivated to conduct this study after reading a 2011 Journal of Neuroscience article. In the experiment described in the article, 15 people were subjected to varying levels of pain via heated probes at two different points in time. In between these tests, they participated in four 20-minute sessions of meditation training (one session per day for four days). All sessions were conducted by a trained instructor with more than 10 years of related experience.

A comparison of MRI (magnetic resonance imaging) results from before and after mindfulness meditation training identified significant changes in several key brain areas along with reductions in the intensity of pain (40% less) and the unpleasantness of pain (57% less). The associated regions of the brain include those linked to high-level executive functioning, sensory processing, and contextual evaluations, suggesting the effectiveness of mindfulness meditation as a pain treatment is reliant upon multiple neural mechanisms.

Alternative Treatments for Pain

Even if the experiment is successful as far as identifying meditation as being helpful for patients with pain after back surgery, researchers do not expect the approach to be a replacement for modern narcotics. Instead, the goal would be to implement complementary strategies to help manage anxiety and stress after surgery and reduce the need for higher dosages and/or prescriptions for less severe situations.

There are no guarantees that a significant effect will be found at all. Some critics suggest patients may be unable to achieve the necessary focus for mindfulness mediation to be effective near the time of surgery. But with the mounting pressure on doctors to write less prescriptions for opioid painkillers, researchers are continuing to look into alternative treatments for pain.

References:

1. Ballantyne, J. C. (2015). Assessing the prevalence of opioid misuse, abuse, and addiction in chronic pain. Pain, 156(4), 567-568. doi:10.1097/j.pain.0000000000000105
2. Lagnado, L. (2016, September 19). Can meditation help pain after surgery? Wall Street Journal. Retrieved from http://www.wsj.com/articles/can-meditation-help-pain-after-surgery-1474299114
3. Zeidan, F., Emerson, N. M., Farris, S. R., Ray, J. N., Jung, Y., Mchaffie, J. G., & Coghill, R. C. (2015). Mindfulness meditation-based pain relief employs different neural mechanisms than placebo and sham mindfulness meditation-induced analgesia. Journal of Neuroscience, 35(46), 15307-15325. doi:10.1523/jneurosci.2542-15.2015
4. Zeidan, F., Martucci, K. T., Kraft, R. A., Gordon, N. S., Mchaffie, J. G., & Coghill, R. C. (2011). Brain mechanisms supporting the modulation of pain by mindfulness meditation. Journal of Neuroscience, 31(14), 5540-5548. doi:10.1523/jneurosci.5791-10.2011

Dear GoodTherapy.org,

Sleep is supposed to be restful, right? For a few years now, my nights have been anything but. I wake up exhausted because my dreams are more tiring than being awake. They typically involve a chase of some sort, sometimes by car or boat, but usually on foot. It always feels like I’m trying to move in mud, or like there are invisible arms holding me back when I try to run, and I can never get anywhere as fast as I think I can. When I try to shout in a dream, my voice comes out muffled and restrained. Very often, water is a prominent feature in my dreams—enormous pools, open seas, or floods.

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These dreams are becoming more and more violent, too. Though I almost never die in my dreams, the situation occasionally comes close. I find myself encountering and using weapons I’ve never even touched in real life, let alone used against someone. But my dreams present scenarios in which I must fight for my life, sometimes to the death. 

I am not a violent person, and the thought of killing someone, even in my dreams, horrifies me. I do feel stressed quite a bit in life, and I imagine that’s a big factor in my dreams. But it’s not like I’m encountering life-or-death scenarios or anything. My life is not filled with violence. I have never been to war. I do not play, and never have played, violent video games. Sometimes I watch scary movies or TV shows, but even those don’t fill me with the kind of terror I experience in my dreams. 

I’m growing weary of the trauma of dodging bullets in my dream life. I’ll take any hint or suggestion for how to calm my dream state, whether it’s to eat more leafy green vegetables or stop wearing socks. —Wildest Dreams

Submit Your Own Question to a Therapist

Dear Wildest Dreams,

First of all, thank you for reaching out. I have much compassion for people experiencing nightmares, especially because our brains and bodies physiologically react as if the experience is happening in waking life. Losing sleep also affects memory, everyday responses, and overall health. The good news is nightmares are normal part of human development and are often exaggerated so we may remember them. Dream pioneer Jeremy Taylor writes, “All dreams speak a universal language and come in the service of health and wholeness. There is no such thing as a ‘bad dream’—only dreams that sometimes take a dramatically negative form in order to grab our attention.” In other words, nightmares are a healthy way for us to work through whatever life-changing event or deep internal changes we are going through so we can tend to their messages. Once we face our fears, become engaged with the emotions, and tend to the dream material, we can “transform the energy.”

Take comfort in knowing that when we remember a dream, it means we can do something about it.

Here are some thoughts on the particular themes in your dreams that might shed some light on what may be going on in your waking life. It is important to note that although humans share a “collective memory,” we are also individuals. To truly engage fully with a dream, one must be mindful of these nuances, including personal associations, experiences, and emotional content.

Take comfort in knowing that when we remember a dream, it means we can do something about it.

Chased or Attacked by Someone or Something

The “chase” dream is a common one, especially with women who feel particularly vulnerable in waking life. Often the dreamer is being chased by an ominous being (or beings), which could be anything from “the dark figure” with no recognizable features to monstrous entities such as dinosaurs or zombies. It is important to note who or what is doing the chasing, paying close attentions to the characteristics. Who are you killing? What types of weapons are you using? If it is a vampire, are you dealing with lifeless bloodsucking energy in your life? Perhaps there are parts or patterns that need “killing off” in terms of character traits/people/situations/habits in your life that are no longer working for you. 

Feeling of Paralysis or Heaviness

These types of dreams are common because there is an actual physiological paralysis that occurs naturally during the REM (rapid eye movement) stage in sleep so the dreamer does not physically act out dreams (and hurt somebody!). Sometimes this state might seep into dreams as the condition of not being able to walk, run, or move, especially when in danger. It could also be a symbol of feeling helpless or stuck in a situation in waking life. 

Water in Dreams

The big wave, pool, or flood in a dream is pretty common, and it often indicates either some emotional overwhelm in the dreamer’s waking life or “big material” coming out of the unconscious. Am I feeling overwhelmed? Am I not tending to my emotions? 

Recurring Nightmares and Emotions

You mentioned the nightmares began years ago. I would explore if there was any particular event that happened when the nightmares began. One of the main symptoms of trauma is the affliction of frequent or recurring nightmares.

In my experience as a therapist specializing in dreams, I have noticed that the more engaged a person is in the healing work, the deeper the healing that can take place. This includes getting support from a professional who is trained in working with nightmares and dream analysis.

Warm regards,

Linda

Editor’s Note: This article contains description of childhood abuse, which may be triggering for some readers.

“I have an image in my mind I can’t seem to get rid of,” I tell Dr. Erickson. “A snapshot of a memory that’s always there, and I can’t stop looking at it.”

His office is dimly lit. On the wall facing me are two pictures of shamans, medicine men who heal spiritually. I had thought a psychiatrist might decorate with pictures from the masters—Van Gogh, Monet, or maybe a classical artist like Michelangelo. Below the shamans, on an end table, is a Kokopelli statue set in a dish of smooth stones. Next to that are two huge bookcases filled with copies of publications from the American Psychiatric Association. At least he seems well-read.

“Are you sure it’s a memory?” He sits near the opposite wall, filing my evaluation form into a folder. Today he’s wearing a shirt and tie. If it weren’t for his long hair and ponytail he would seem every bit a doctor.

“Yes. It’s something the attorneys brought up during the deposition. Something I haven’t thought about in a long time.”

He stares at me and says nothing. I realize he isn’t going to prod. It seems a strange way to communicate, not asking questions.

[fat_widget_right]“When I was nine I told kids at school that I’d seen my father’s penis,” I tell him, “that I’d touched it. Only I didn’t know to call it that. They stared at me in shock. That’s when I realized there was something wrong with what I was doing. You only know what you’re told when you’re a child. I didn’t know that other kids weren’t touching their fathers that way.” I pause. “They stopped playing with me after that.”

He’s quiet for a moment. “That’s the image in your mind?”

“Yes, swinging on the playground, laughing. I remember the looks on their faces when I admitted what I was doing. It was all so … innocent.”

“How does that make you feel?”

How does it make me feel? The memory is so old, almost thirty years have gone by, but it still seems like yesterday. It’s the kind of memory I store in one of those chests at the bottom of my mind, but now I can’t seem to put it back.

“Ashamed, sad, like I’ve done something wrong.”

“Do you feel that in your body?”

Another strange question. The memory is in my head. My emotions are in my head, glued to that image of swinging happily, chattering with my friends and having no idea of the impact of my words. My emotions are not imprinted in my body. But I think about the question anyway because I have so much anxiety these days, a tightness in my stomach that feels like a descending roller coaster. Even my nightly dose of Seroquel isn’t alleviating it.

“In my stomach,” I say.

“Images come forward in your mind to help you get what you want. Your subconscious wants to heal. This is its way of communicating that to you.”

“There’s something for me to learn from this memory?”

[EMDR] is very effective for trauma and posttraumatic stress. Once you process the memory, the picture goes away, along with the emotions associated with it.

He nods. “There’s something called EMDR—eye movement desensitization and reprocessing. It’s a therapy like hypnosis that can help speed the processing of memories. It’s very effective for trauma and posttraumatic stress. Once you process the memory, the picture goes away, along with the emotions associated with it.”

I’d like to get rid of the snapshot memory, and the sadness and shame it brings with it. It was different before; it was a private memory I could easily tuck away. I could convince myself it was a single incident barely worth my energy to consider. But I had admitted it during the deposition; I had exposed my shame to a team of attorneys who simply stared at me, stoic and apathetic. I had mirrored their apathy, determined not to allow them to see my pain. I can still see their unimpressed expressions.

“How do I do that?” I ask Dr. Erickson.

“I move my hand in front of you and you follow it with your eyes as you think about the memory. Emotions will come to the surface. As you process the emotions, they will be released. The memory will lose its emotional charge.”

“Will the image go away then?”

“It should.”

Is that what the memory wants—to be felt? Have I tucked away so much of my life that it stubbornly refuses to be hidden any longer? Or is this just a byproduct of the deposition, the aftermath of stress?

What I know is that the memory bothers me. I don’t like looking at those faces of my schoolmates staring in shock, and the memory of realizing I did something wrong. I don’t like being made to feel bad when the onus should be on someone else. Maybe that’s been the problem; the guilt belongs to someone else and not me.

“Okay,” I say.

“Okay what?”

“Okay, I want to try that. I want the image to go away.”

He moves our chairs closer together, so his left arm will be next to my left arm. We’re sitting side by side, but facing in opposite directions. He lets me sit close to the door so I don’t feel boxed in. “An escape route,” he says. Then he stands back from the chairs like an artist appreciating his work.

I know his deliberate manner is meant to make me feel more comfortable, but his ceremonial style has the opposite effect. I hesitate and glance at the door. Am I going to need an escape route? Do his patients routinely flee the room and he’s learned to anticipate it? Or is this merely a psychological strategy?

I take my seat, knowing that I would rather feel part of the scene than an observer.

Nothing will happen with me standing in place, and if it’s all been set up by design then I’m failing and the image will remain. Unwilling to leave and uncertain of how to move forward, I take my seat, knowing that I would rather feel part of the scene than an observer.

He gives me a moment before taking the seat next to mine. We’re too close for my comfort. I have pretty strict boundaries; I’ve never been able to allow people to get very close to me physically. It always feels like they’re suffocating me with their proximity, as if they’ve wrapped their arms around me in a crushing embrace.

I can see the ring he wears and the tiny hairs on his arms, and it makes my body tense. He’s sitting only a few inches from me; I can feel his gaze studying me, and I become self-conscious and begin to fidget in the chair.

“Think about the image,” he instructs. “Think about being on the playground with your friends. Hear their laughter. Think about how you feel as you talk to them. You feel ashamed, sad.”

I hate this already. What kind of therapy begins like this?

He moves his left hand horizontally in front of me. I follow it with my eyes, but I don’t see his hand.

The playground is noisy. I’m swinging with my friends. It’s a Catholic school, and we’re all in uniforms: replicas of one another.

“I’ve never seen a boy’s wiener before,” Kathy says. Her voice is filled with laughter.

“I’ve seen my father’s,” I say. “It looks like a bratwurst.”

“You have not!”

“Yes. I touched it.”

“That’s right,” Dr. Erickson says in a soothing voice. He’s reading the emotions that play across my face. “Stay with it. Let the emotions build and then let them go.”

I don’t know how to let go. I don’t know what I’m supposed to learn from this. It’s all old news, pain long past. It doesn’t belong with me. I’m an adult now, a grown woman who’s made her own way in the world and crafted her own successes. I’m a million years from that little girl on the playground, but the pain is so fresh.

The transformation is rapid. The expressions on the girls’ faces morph from playful amusement to confusion, settling on prudence. They’re judging me. They know something I don’t know. For the first time in my memory, I feel like an outsider, a pariah.

Dr. Erickson stops EMDR. I can feel his eyes on me, but I don’t look at him. I stare, without seeing, at the carpet.

“I have a question,” he says gently. “Whose shame is it?” He moves his hand in front of me, and the image switches.

I’m touching one of my sisters, kissing her on the neck. On Wednesday nights we played a game my father made up, where we had to select small pieces of paper from a hat. On each piece of paper was written something we were supposed to do: kiss a butt, lick a breast, touch a crotch. Each of us would then choose one of our siblings and go into a room with them.

“Where are you?” Dr. Erickson asks. He’s stopped his hand movement and is studying me.

“With one of my sisters.”

“On the playground?”

“No.” Pause. “Every Wednesday my mother would go away and my father would have us sit in a circle, naked. He made up this game.” When I finished explaining the bizarre game, I said, “I’m with one of my sisters in a room … kissing her.”

“Go with that,” he instructs, and begins EMDR again.

It’s all giggles and little-girl fun. It doesn’t feel sexual, just playful. We’re both naked because that’s the way our father wanted it.

I don’t like touch. It’s a mantra I say to myself and it has defined my life. I don’t have relationships and I don’t let people near. But some part of my brain is wondering why I’m not afraid with my sister, why I don’t feel apprehension. I say as much to Dr. Erickson.

“You’re judging her as an adult with rights and wrongs. She’s feeling the comfort of her sister.”

“I liked when we were touching.” It’s the only time I can recall liking touch, when caressing was comforting and nurturing. What happened to that feeling? Darkness falls on me as tears well in my eyes. An enormous sadness overwhelms me.

“I like touching my sister, but I don’t like touching other people. Men. What kind of a person does that make me?”

“Human.”

What I hear is “different.”

The memories fade, but they don’t disappear.

I like the softness of my sister’s skin and the sense of freedom, and I like the closeness as if nothing were going to separate us. Sitting in a psychiatrist’s office, trying to come to terms with my life, liking to touch my sister seems wrong.

I’ve never had a sexual relationship with anyone, male or female. I stopped dating a decade ago; I long since gave up trying to let someone get close. And yet there I was at the tender age of nine, exploring my sister’s body. Was that what was wrong with me?

“I want you to think about the healing white light,” Dr. Erickson says softly. “It’s coming from high above and surrounding you. A brilliant white light taking away all the pain.”

The light bathes me with a warm glow. It calms my breathing, eases my tension and, like a drug, dulls the pain the memory created.

“Let those images go. You don’t need them anymore.”

The memories fade, but they don’t disappear. I like the light surrounding me. It takes me far away from my feelings of guilt and shame.

Laureen Peltier is the author of Hungry For Touch: A Journey from Fear to Desire. She focuses on educating others on the possibility of making a full recovery from PTSD, as well as the benefits of healing past trauma. A passionate speaker for RAINN and other organizations, Laureen is sought-after for medical and nursing schools, and has participated in several online and DVD documentaries focusing on PTSD recovery.

Olympic athletes train for years to reach their common goal: a medal at the Olympics. They push their bodies to the edge of human capability to stand on a podium and collect a gold, silver, or bronze medal. While competing in the Olympic Games requires immense physical ability, the pressure often adds up to a heavy psychological load for athletes, both at the games and beyond.

Sport psychology is not new in the mental health field, but it has gained greater attention, interest, and acceptance in recent decades. The discipline of sport psychology has an inexact placement at the intersection of athletic training and personal counseling, varying widely depending on the sport and the practitioner.

The focus is often directed at how different aspects of competition affect the player or team’s overall mental health. While the well-being of the athlete is the ultimate aim, sport psychologists also promote mental toughness to optimize athletic achievement. At the international games, and with a massive global audience watching, another crucial hurdle faces the sport psychologist: Olympic-sized performance anxiety.

What Is Sport Psychology?

It started with a simple observation by a psychologist named Norman Triplett in 1898. A pioneer in the field of social psychology, he noticed that cyclists typically performed better when in the presence of a competitor. Recognizing cues like that has helped psychologists find not just the best ways to enhance athletic performance, but also to understand the distinct pressures faced by elite athletes. Concerns such as not wanting to disappoint a coach or teammates and striving to meet the expectations of fans can be paired against personal issues, stress, and self-doubt.

[fat_widget_right]Today, sport psychologists work with athletes at all levels to improve their performance, manage performance-related stress and anxiety, help them handle any mental challenges associated with injuries, and encourage athletes to enjoy what they do. Research has shown there is value in tapping into a player’s love for the game. Such efforts can help keep an athlete motivated against grueling training regimens and physical exertion.

Sport psychologists work with their athletes by encouraging them to set high but realistic goals, developing skills to maintain concentration and focus, and by helping them manage stress through controlled breathing and positive self-talk. A common technique used by sport and fitness psychologists to enhance athletic performance is visualization. For example, basketball players often spend practice time not just physically shooting hoops, but also visualizing the basketball dropping into the hoop successfully. Similarly, archers may paint a mental picture of the arrow finding its target, while divers might imagine themselves going into the pool in perfect form with minimal splash.

Sport psychologists also teach athletes to deal effectively with people, both within the sport and in general. They commonly help coaches and family members of athletes as well, watching out for the general well-being of the “team,” even in individual competitions. Particular techniques, including stress-reducing methods, can help those surrounding the athlete to more effectively offer support.

A sport psychologist may be one of the only people in a professional athlete’s life who doesn’t look at the scoreboard. While family members, coaches, and spectators might instinctively or involuntarily judge an athlete based on performance, the sport psychologist is likely looking beyond the outcome with a focus on giving support in the face of defeat and offering perspective in the thrill of victory.

Athletes worldwide appear to be embracing sport psychologists as a crucial member of the team. Olympian Elana Meyers won a silver medal at the 2014 Winter Olympics in Sochi and took bronze at the 2010 Winter Olympics in Vancouver as part of the U.S. Olympic Bobsled Team. Throughout her career, she says her coaches and sports psychologist have worked side by side.

“Recently, we have all been working together to improve my driving, even though we’re not on ice,” Meyers said. “My coach interacts to ensure that the work we’re doing on driving is accurate and appropriate. My sport psychologist interacts with my coach to ensure that my mental environment is appropriate around times of training and competition.”

Occasionally those roles can become blurred, she said. “Sometimes my coach is like my sport psychologist and my sport psychologist acts as a coach.”

On a more global scale, Meyers sees the field of sport psychology expanding, in part thanks to the international games.

“Now it’s openly discussed on Olympics coverage,” she said. “I think sport psychology is becoming mainstream and really elevating athletes’ performances across the world.”

The Modern Sport Psychologist

While individual competitions may not have changed too drastically in the last century, the arenas in which today’s athletes perform have. The 2012 Summer Olympics in London set new records as the most-watched TV event in U.S. history, drawing nearly 220 million American viewers across the two-week games in just one country.

Today’s Olympic athletes must compete in this glaring international spotlight, surrounded by increased technical distractions and sometimes weighed down by the expectations of fans and fellow athletes. The size and scale of modern Olympic Games make the services of a sport psychologist even more valuable, no matter the event.

Today, sport psychologists work with athletes at all levels to improve their performance, manage performance-related stress and anxiety, help them handle any mental challenges associated with injuries, and encourage athletes to enjoy what they do.How sport psychologists operate professionally can vary. Some consult or maintain private practices, while others are on staff with professional teams, leagues, or individual athletes. Their services are now commonly accepted and employed in major sports organizations worldwide, ranging from the National Football League and Major League Baseball in the U.S to Brazil’s World Cup Team.

During the 2016 Summer Olympics in Rio, even more so than in past competitions, sport psychology received individual attention at the games. As media outlets tell the back stories of Olympic stars like gymnast Simone Biles and swimmer Michael Phelps, they seek new angles that include the athletes’ mental toughness and resilience required to win their medals.

Occasionally, sport psychologists may find their own merit judged against an athlete’s performance, as was the case with Brazil’s 2014 World Cup defeat. The coach’s pre-game support for the team psychologist quickly became scrutinized following their loss to Germany.

Yet, those in the field of sport psychology might actually be better equipped to face such challenges through their own personal experiences. Those practicing sports psychology today—who often have backgrounds as former athletes or active sports enthusiasts—have first-hand awareness of the sharp edges of doubt and defeat and the internal drive for athletic greatness.

References:

1. AASP. (n.d.). Applied Sport & Exercise Psychology. Retrieved from http://www.appliedsportpsych.org/about/about-applied-sport-and-exercise-psychology/
2. Joyce, N. (2008, July). The early days of sport psychology. Retrieved from http://www.apa.org/monitor/2008/07-08/sport-psych.aspx
3. O’Connell, M. (2016, August 6). TV Ratings: Rio Olympics Opening Ceremony Falls 28 Percent From London. Retrieved from http://www.hollywoodreporter.com/live-feed/tv-ratings-rio-olympics-opening-ceremony-how-many-watched-917393
4. OCSP Services. (n.d.). Retrieved from https://www.sportpsych.org/services
5. Patmore, A. (2014, July 9). Why sports psychologists couldn’t save Brazil’s World Cup hopes. Retrieved from https://www.theguardian.com/football/2014/jul/09/why-sports-psychologists-couldnt-save-brazil-world-cup
6. Rathi, A. (2016, August 9). What sports psychologists do for Olympic athletes that coaches can’t. Retrieved from http://qz.com/753857/for-olympians-to-reach-the-highest-level-they-need-a-sports-psychologist/

Life can be stressful for anyone, but for people dealing with the negative effects of trauma on top of everyday life, elevated stress levels can be much more common. One course of treatment for experiencing a more positive and peaceful life after trauma is eye movement desensitization and reprocessing (EMDR), a methodology originated by Francine Shapiro. It pairs specific protocols with bilateral stimulation—back-and-forth eye movements, alternating tones delivered through headphones, and/or alternating tactile stimulation such as vibrations delivered through hand-held pulsers. Part of the eight-phase EMDR protocol includes teaching the person in therapy a relaxation technique to recall when needed.

One of the most common relaxation techniques for EMDR is known as “safe place,” also referred to as “calm place.” This technique is part of the second phase of EMDR known as “preparation.” Prior to this phase, the person’s history is taken, assessments are performed to determine if EMDR is appropriate, and a treatment plan is prepared. This matters because before a counselor proceeds with EMDR, a person must be assessed for physical health, support system, and any tendency to dissociate. Therefore, it is imperative that all portions of EMDR protocols are performed only by a trained, qualified EMDR clinician.

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“Safe place” may be thought of as an emotional sanctuary where a person can internally go to recover stability when feeling stressed. Once the person has successfully learned to perform “safe place,” it is used in the reprocessing phase or to close a session. It is also useful in one’s everyday life between sessions when a person feels stress or a disturbance rising to a point they need to take out and use a coping tool from their internal toolbox.

‘Safe Place’ Protocol in EMDR

When “safe place” is taught to a person preparing for EMDR, the counselor will guide the person through the following steps shared by Shapiro (2001):

“Safe place” may be thought of as an emotional sanctuary where a person can internally go to recover stability when feeling stressed.

1. The person is asked to picture an image of a place that generates feelings of calm and safety.
2. The person is asked to focus on the physical sensations and emotions that are conjured while imagining the “safe place.”
3. The counselor encourages a sense of security and may add soothing tones, such as ocean waves, to enhance the effect.
4. While the person concentrates on the image, sensations, and emotions, sets of eye movements or other bilateral stimulation may be included to “install,” or strengthen, the “safe place.”
5. The person is asked to think of a word to associate with the “safe place” and add this to the calm, safe image and sensations. Sets of bilateral stimulation are added.
6. The person is asked to self-cue the image and feelings.
7. The person is asked to think of a minor annoyance and its accompanying emotions. The counselor then guides the person through the exercise until the undesired emotions melt away.
8. The person is asked to think of another disturbance and follow the exercise without the counselor’s assistance to ensure the person can perform the exercise unassisted.

The person should be instructed to practice “safe place” daily by retrieving the positive image, emotions, and sensations via the cue word. People can then use “safe place” to relax and reduce stress any time needed. Shapiro believes people preparing to be treated with EMDR can benefit not only the “safe place” visualization but also from listening to guided visualizations such as those included in Letting Go of Stress (Miller, 2014), as these may increase the the effectiveness of “safe place” as a means of self-control.

While “safe place” for EMDR should be taught by a qualified clinician, anyone can access guided meditation/visualization CDs and podcasts to help to manage stress, fall asleep at bedtime, and promote a positive self-image. These materials may be found for little or no cost through public libraries, iTunes, and online resources. Comments below sharing your favorite guided visualization/meditation resources are welcome.

References:

1. Miller, E. (2014). Letting go of stress. San Anselmo, CA: Halpern Inner Peace Music.
2. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2^nd). New York, NY: The Guilford Press.

Why do people develop addictions and compulsions? In general, their psychological purpose is to push out of conscious awareness anything disturbing. The unconscious mind knows how deeply upsetting some body-mind memories might be, as they could trigger anger, panic, grief, guilt, anxiety, shame, depression, or feelings of worthlessness. Thus, it will do anything it can to distract from them.

That may mean engaging in unhelpful or even self-destructive behaviors. After all, addictions and extreme habits, which can form out of obsessive compulsions (OCD), can be very engaging to the body-mind. This deep engagement with something else, anything else, is a wonderful distraction from unpleasant emotions.

Add to your natural propensity for avoiding pain those media messages suggesting various forms of distraction—porn, alcohol, vaping, shopping, extreme sports, etc.—may enhance your life and make you happy, and you have a recipe for a society inundated with addictions and compulsions. (See Anne Wilson Schaef’s book When Society Becomes an Addict for a deeper explanation of this concept.)

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For all the talk of its potential pitfalls, obsessive and compulsive thinking has worked for humanity’s benefit for millennia. The person who unrelentingly rubbed two sticks together to create fire, Marie Curie in her lab, and Albert Einstein incessantly mulling over ideas are just some of the countless examples of people becoming consumed with something essential and meaningful.

With any form of compulsive or addictive behavior, the important question is: Is it interfering with any aspect of your life? If it is having a deleterious effect in any area, such as relationships, finances, work, or health, you might want to do something about it.

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Fortunately, there are many ways to shift away from unwanted habits. William Glasser, MD, a renowned psychiatrist, wrote a book in 1985 called Positive Addiction. He argued the natural unconscious tendency to avoid psychological pain can be rerouted into positive addictions. In other words, the brain’s proclivity for repetition can be used creatively and productively. Those obsessive, compulsive energies can be channeled into useful and enjoyable distractions such as learning a new language, spending more time with friends and family, reading, exercising, or hobbies.

So is the answer simply reorienting one’s compulsive energies into positive activities? Well, yes and no.

So is the answer simply reorienting one’s compulsive energies into positive activities? Well, yes and no. As a holistic psychotherapist who uses Internal Family Systems (IFS) as one of the arrows in my therapeutic quiver, I would certainly suggest some energy redirection. Ultimately, though, the task is working with the parts of you that valiantly protect your wounded inner child to enable you to unburden some of that pain, as well as coming to appreciate all your other parts (called “protectors” in IFS) that may snort cocaine, drink excessively, gamble, have an eating disorder, or engage in risky sexual behaviors. As counterintuitive as it may seem, all of these things—destructive as they may be—are trying to help you. They will do anything to protect you from being flooded with negative or scary feelings. Anything.

As someone who has been working with people with addictions for over 40 years, I appreciate the way IFS allows a person to gently, yet deeply, explore inner terrain while learning how to compassionately create a new way of relating to all of their parts. Through the IFS process, a person can come to recognize how hard their parts work to give them peace, even if those parts still think the person is a child or teenager. Talking with those parts, getting to know them and their motivations, and developing a new loving relationship with them can be incredibly healing.

Many people with addictions are in 12-step programs, which are wonderful for creating a community of people who share a desire to eclipse the past and evolve. IFS is compatible with those as well.

When you can meet your cravings for temporary oblivion with greater patience and understanding, you may begin to explore your true self. In IFS, that means allowing you to access your inner self-leadership with all its creativity, curiosity, connectedness, confidence, calmness, creativity, clarity, courage, and compassion.

References:

1. Glasser, W. (1985). Positive Addiction. New York, NY: Harper Perennial.
2. Schaef, A. W. (1988). When Society Becomes an Addict. New York, NY: HarperOne.

Productive and meaningful time management is a highly prized skill, but failing to make space in your day for unscheduled time may have a direct and negative effect on your sense of well-being. While many people seek therapy to master situation-specific goals, an overwhelming percentage struggle to let themselves relax and exist without actually doing anything. Without a basic ability to be comfortable being yourself, attaining states of further contentment and well-being through psychotherapy can be much more difficult. As the saying asks us to consider, is our inherent purpose to exist as human beings or human doings?

Our educational and work systems reward deadline-driven industriousness, and our society values people who work hard, meet goals, and build impressive résumés. With the invention of smartphones, digital calendars, GPS maps, and other technological tools, we have become increasingly able to accomplish more things faster than would have been imaginable a few decades ago. The lines between work and personal time blur more than ever as our attention to work email may extend throughout our waking hours and our families and friends distract our work or study periods with text or social media communication. And to what end? Societally, we seem conditioned to believe our worth is tied to using our time “wisely.” However we may define that, we seem to have lost our ability to value our space, solitude, and downtime. Ultimately, this is leading to individual and collective loss of the experience of feeling both content and human.

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In order to understand the remedy for this modern-day issue, it is important to first understand the cause of our discontent. I believe an unfortunate confluence of cultural beliefs and technological advances have come together to rob us of our ability to be present and in tune with ourselves, necessary components to feeling “okay.”

Our society tells us that we must be occupied to avoid “wasting time” such that people begin to believe their self-worth and goodness are tied to their productivity. Much to my surprise, I frequently hear people seeking therapy say they are unable to take time to be present with themselves, as there are “more important” uses of their time. Perhaps our societal belief that “time is money” has been taken far beyond its original meaning, making people captive to their activity. What’s more, as these habits of busyness and speediness take hold, people may become less able to stand being unoccupied and thus seek out momentary entertainment as a means of “killing time.” When was the last time you waited in a long line and didn’t consider reaching for your phone?

If we fill every moment with activity and distraction, we are missing some of the greatest gifts contained within time itself. In order to feel better about ourselves, we must be willing to just “be” rather than “do.”

Layered atop the societal value placed on productivity, pervasive technology and social media have made instantaneous and perpetual distraction easily available. The level of instant gratification that arises out of the momentary amusement has made these devices ever-present in waiting rooms, at dinner tables, and in bed. Every moment of life is filled, and there is no space to simply feel or “be.” In fact, our tolerance and willingness to feel alone, bored, or unproductive, even for short periods of time, is diminishing. This is particularly true for younger people who have never known a world without ubiquitous connectivity, and for whom connection to self and other often comes through screens rather than a felt sense of self experienced through being present in the physical world. Learning to be present with yourself may ultimately enhance genuine real-world connection with others that is mistakenly being sought through screen-based interaction.

The problem with these societal beliefs and our reliance on digital entertainment is that creativity is born out of boredom. Our sense of aliveness comes from being present with the life we live. If we fill every moment with activity and distraction, we are missing some of the greatest gifts contained within time itself. In order to feel better about ourselves, we must be willing to just “be” rather than “do.”

The antidote to busyness and speediness is to spend unscheduled time experiencing being yourself. You may pause and try being yourself while you are in nature, between tasks, or upon waking. I find that doing this exercise in the presence of trees or plants can be helpful, as they provide an excellent example of living entities that are doing nothing more than being fully what they are. If you are unable to easily access flora, any space in which you feel comfortable and able to relax and “be” will work.

In order to “be,” allow yourself to explore what it means to be present with yourself and your surroundings. Notice the thoughts that arise, including any cravings relating to wanting to do something. Allow yourself to be curious about feelings, including those of boredom and loneliness. What sensations do you notice? None of these thoughts, feelings, or sensations is a problem. None is right or wrong. They simply provide information about your state of being at that moment, and this knowledge informs your endeavor to fully be yourself.

Finally, see if it’s possible to be yourself without needing to do or be anything else—just exist as who and what you naturally are. While these directions may seem simple, they contain the essence of what it means to be alive, the cure to our modern state of existence, and ultimately the foundation for building a state of contentment.

Have you ever felt like your emotions are so overwhelming they will never stabilize? Maybe you have an intense urge to return to unhealthy or risky behaviors to make yourself feel better. Dialectical behavior therapy (DBT) has a whole module that focuses on crisis survival skills. These are skills that help you hang in there, or cope, when emotions are overwhelming. It doesn’t make the feeling go away, but these skills can help you get through the intensity of these emotions.

Here is a brief overview of DBT’s crisis survival skills.

Distraction

These strategies are used to distract yourself from distressing thoughts, feelings, or situations that feel overwhelming. The acronym “ACCEPTS” can help with recall in the moment.

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• Activities: Do something. Read, play a sport, or clean.
• Contributing: Do something kind for someone else. Put the dishes away, write a thank-you note, volunteer your time.
• Comparisons: Compare your situation to someone else’s. This can help shift your focus away from your situation.
• Emotions: Making yourself experience a different emotion can help distract you. Watching funny online videos, listening to love songs, or catching up on your favorite soap opera are all examples of how you can distract yourself from overwhelming emotions.
• Pushing away: Don’t allow yourself to think about it. You can use a timer to set a limit on your thoughts or type it all out in an email draft (or go “old school” and write it on paper), and put it away so you don’t focus on it for the time being. This skill is a two-parter, though. When you feel more able to hang in there, go back and address whatever it is you pushed away. Otherwise, it will just keep growing.
• Thoughts: Distract yourself with other thoughts that make it difficult to think about anything else. Say the alphabet backward, count down from 100 by 7s or 3s, or do a crossword or Sudoku puzzle.
• Sensations: Intensify other physical sensations. Eat a strong mint, pet your dog, or squeeze a stress ball.

Self-Soothe with Six Senses

These strategies can help you feel better and in control by using your five senses (and a sixth: movement) to ground you to this person, place, time, and situation.

• Vision: Look at photos that put you in a good mood, or go to a beautiful place and admire the views in person. These can be related to friends and family, nature, animals, or more.
• Hearing: Listen to relaxing music or the sounds around you.
• Smell: Find smells that relax you. Lavender is a solid go-to if you need help getting started.
• Taste: Eat or drink something calming, such as mint or herbal tea. Focus on how pleasant it tastes.
• Touch: Touch something relaxing. Curl up in your favorite blanket or pet your cat.
• Movement: Move around. Dance, go for a run, or do some other exercise.

IMPROVE the Moment

You can’t necessarily change the fact something is happening, but you can change the way you feel, think, or react using these skills.

• Imagery: Use guided imagery, or even your own imagination, to visualize more pleasant outcomes or circumstances.
• Meaning: My mother loves to say “everything happens for a reason.” Being able to understand or acknowledge why something happened, or its purpose, can help you feel better about the fact it is happening.
• Prayer: You can either pray in the traditional sense or use this skill as a form of meditation or journaling. Basically, you can use prayer as a way to connect spiritually or reflect on past, current, and future circumstances.
• Relaxation: Indulge in something relaxing. Go to the beach, get a massage, or even take a nap.
• One thing in the moment: Focus on one thing in that moment. You can focus on your breathing, the sounds you hear, or the way your chair feels.
• Vacation: This can be an actual trip or a “mental vacation.” If you can’t leave the situation or you’re unable to take a physical vacation, escape in a book or a movie.
• Encouragement: Use positive self-talk. Pin inspirational quotes on your Pinterest page or write them in a journal. Reflect on how awesome you are. Reflect on what you’re doing well right now.

Pros and Cons

Considering the short- and long-term pros and cons to a decision can be helpful in deciding how to react to a situation or feeling.

TIPP the Scale

This is a newer skill set introduced in the latest update to the DBT Skills Manual for Adolescents. These skills are used when managing extreme emotions or urges. Using these strategies may help adjust your body chemistry.

• Temperature: Run cool water over your inner forearms or chew on ice to physically “chill out” and “cool down.”
• Intense exercise: Do 20 jumping jacks, 10 push-ups, or run in place for 1 minute.
• Paced breathing: Slow down and count your breaths. You can use “square breathing” (count to four as you inhale, hold for four counts, count to four as you exhale, hold for four counts, repeat).
• Progressive muscle relaxation: Concentrate on squeezing one muscle, then release. Move on to the next muscle group in your body. You can find scripts online that walk you through this or do it on your own.

It is important to note that one skill might not be enough depending on how intense your emotion or urge is. You might need to try a few to find what works best for you. As with anything, it’s also possible that something might work in one moment and not in another. Have a willing attitude as you give these skills a try, and partner with a therapist trained in DBT if you want support.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. New York: The Guilford Press.