Remembering to Use DBT Skills When Emotionally Dysregulated

We recently reached out to the students in our private/secret Facebook group (open to students and alumni of our online DBT classes) to get their feedback on a question we often get from students utilizing their weekly DBT skills coaching benefit.

The question is:  How do you remember to use the DBT skills when in crisis?

Read on for the insightful answers that came in that we hope inspire you to stay skillful, even on the tough days.

Do you use any of these methods to remember to be skillful?  Do you have other ideas?  Please share them in the comments below.

Avoiding Mood Altering People (Emotion Regulation)

In our online Emotion Regulation 1 class today, one of our students shared that this past weekend she attended a family dinner where a relative made insensitive remarks about minority groups, and this really offended her.  She noticed her anger rising to 95 on a scale of 0-100.  After the incident, she filled out an Emotion Regulation 1A worksheet and discussed it in group today.

While checking in about the homework she completed, she shared that days later she is still feeling some anger toward the person.  Part of this is because she openly and respectfully expressed her dismay at his behavior, and rather than take responsibility for the comments that he made and offering a sincere apology, he gave her a business-like email response accepting no responsibility.

Unable to change her relative's ways and his response, she needed to figure out how to take care of herself.

Here are the ways that she is using DBT skills and her Wise Mind to cope as effectively as possible:

• Took her day off from work as a chance to rest and self-soothe
• Did the 1A worksheet
• Expressed her angry thoughts about this person in a safe way by writing them in her personal journal rather than giving in to urges to break things, which she would later regret
• Did tasks that made her feel masterful including housework
• Structured her day to include meal times and bed time so she didn't sink deeper into the overwhelm of the emotion and neglect these important aspects of her day
• Set boundaries, including a clearly expressed message about how her feelings were hurt (using the DBT Skills set of DEAR MAN)
• Avoided mood altering substances, which is something she struggles with when feeling emotionally triggered.
• Reached out to safe people for support
• Realized that, in the future, she will carefully consider how she is feeling emotionally before exposing herself to people that upset her... she will "Avoid Mood Altering People."

In doing these steps, the student helped to reduce her anger and kept herself safe and distant from potentially sabotaging behaviors.  She found ways to manage and tolerate the distress that arose from the upsetting interactions with her family member.


Do you sometimes find yourself in situations with "mood altering people"?  How might you skillfully handle situations like that faced by this student?  How might you take care of yourself in terms of your exposure to such people?

Over Disclosure on the 99¢ rack (Boundaries)

Recently in one of our online DBT Groups in which we were all reading Brene Brown's The Gifts of Imperfection, we discussed the subject of how sharing our story, our lives, and our business, with people who have not "earned it," is like devaluing our experience.  We likened our over disclosure to putting our business on the 99¢ rack instead of protecting it as a much higher valued and precious part of ourselves.

When we struggle with boundary issues, it can be difficult to contain ourselves when a seemingly kind and receptive person is willing to listen to our hardships and struggles.  It can be very tempting to "tell all" in the time it takes to wait for a bus with a stranger or at work with colleagues who we then have to face every day going forward.  We might regret our choice to tell so much and then be left with a feeling of shame.

The good news is, when we recognize the pattern to over disclose, we can begin working on our boundaries to reduce this behavior.  There are a number of DBT skills that can help us be effective at this, and the module of Interpersonal Effectiveness is where we begin to learn how reducing this type of behavior can help us to better enter into and maintain healthy relationships with others.


Do you struggle with boundaries?  Do you find it difficult to hold back when tempted to share your story with those who may not appreciate it, respect it, or be able to hold the space that you hope they will?  What are some ways you have found help you when feeling this way?

If you'd like to learn more about creating and enforcing healthy boundaries, check out our online Interpersonal Effectiveness course, which starts soon.

DBT Pros & Cons Worksheet Explained

This morning in one of our online DBT classes, one of our students shared how she used a DBT Pros and Cons worksheet to help her decide whether or not to go on a certain medication.

Coping with a physical ailment and having taken the prescription before, the student was aware of the potential benefits and side effects of taking it.  She rated her anxiety as 80 on a scale of 0-100 before filling out this sheet:
The most obvious distinction between the Pros and Cons list that many of us have made outside of DBT is that instead of having just two columns labeled "Pros" and Cons," there are two additional sections.

When you do this particular worksheet, you want to look at all of the following to help you make an informed decision.  This can be about any issue which has you feeling stuck and unable to decide:

1. The Pros of going with this decision (upper left square)
2. The Cons of going with this decision  (upper right square)
3. The pros of not going with this decision  (lower right square)
4. The cons of not going with the decision  (lower left square)

Initially, it may seem that 1 & 4 and 2 & 3 are similar -- and they are, but we find that when students list reasons from each of these perspectives, they come up with more insights to help them make a more well-rounded, Wise Mind decision.

The student in our example listed many pros of taking the prescription, such as how she knows it has worked in the past, it can help prevent her condition from progressing, and how it can prevent the need to take other, additional types of medications.

She also noted some side effects that she is aware of, including difficulty sleeping, heightened anxiety and mood swings, and weight gain.

After completing the Pros and Cons worksheet, she made the decision to take the medication.  Keeping all of the information in mind, she decided that the benefits outweighed the potential negatives, and she came up with self-empowering solutions to address her concerns, including: integrating more movement in her day, talking to her doctor about help with potential temporary insomnia, and reminding herself when she feels mood swings and anxiety that it is "just an effect of the medication" and nothing she needs to be alarmed about.

Upon completion of the sheet, she felt her anxiety level had reduced to a score of 30.  We think that's quite effective!


Have you ever used a pros and cons worksheet to weigh a decision?  Did you use the old fashioned two column version or one like this?  How might you use the DBT version to help you make a skillful decision?

Well all that was just a plot twist... (Letter to former self)

A woman erroneously diagnosed with Bipolar 1 and then, much later, accurately diagnosed with Borderline Personality Disorder (BPD) writes a compassionate letter to her "former self."

This letter contains content that you may consider triggering.  It therefore comes with a "Trigger Warning (TW)."  If you do not know what a Trigger Warning is or what we mean by triggers, please first take a moment to read the article. "What does Trigger Warning TW Mean?" before proceeding with reading this letter.

Dear Iris,

Okay, take a deep breath. As Bob Dylan said, "The times they are a-changin'." You've got a new diagnosis. BPD, not Bipolar 1. That's huge. I know it's scary. Remember how frustrating it was, when you thought you had Bipolar and you spent so many years suffering, taking all those expensive pills and never seeing any results? Other people you knew who had Bipolar took pills too, but they didn't have the same behavior issues that you did, well, for the most part still do. They took pills and led normal lives. Not you. That was confusing. Those people were confused along with you by the fact that you always took your meds, always ate right and slept regularly. You did everything you were told to do (and didn't do anything you were told not to do) to get relief from your symptoms, but nothing worked. Well, now you know why.

Treating BPD with meds for Bipolar 1 was never going to help you recover from BPD. Those behaviors that your friends and family, and friends who have Bipolar Disorder, all found so confusing turned out to all be BPD symptoms. Isn't it comforting to know that all those behaviors were happening for a reason? Symptoms. Your BPD symptoms weren't being treated with those meds for Bipolar Disorder.

You're going to start DBT classes. Those classes are the treatment for BPD. Just think, education as treatment instead of pills! After you take DBT classes you might not need to take pills at all, eventually. Wouldn't that be grand?

Just last year you and your brother were sitting around one day talking about mental illness. Remember that conversation? He asked you, "Iris, wouldn't you like it if it turned out that there was a way you could get better and not have to take pills for the rest of your life?" He was speaking hypothetically. You still had a diagnosis of Bipolar Disorder then. You both had accepted that. It's happened now though. That diagnosis you lived with since 1998 was wrong. You've got BPD and the really great news about that diagnosis is that you can make a full recovery from BPD.

I'm not saying that recovery from BPD will be easy or quick. It's going to take time, and it's going to be hard. The emotional work involved won't always be pleasant. As a matter of fact a lot of the time it won't be. But what worth doing in life isn't challenging? You like challenges. You don't always like yourself, but when you do like yourself, you like yourself enough to wish that you could like yourself a lot more of the time. With the help of DBT you'll get to a point, in time, where you do like yourself. You'll get to a point where you even love yourself. These are big changes you'll be making.

You're strong. You've lived through a lot of tough stuff. Once you recover from BPD you'll look back on all those years with that Bipolar diagnosis and just say, as the writer and performer you are, "Well all that was just a plot twist!"

Study DBT. Write in the BPD recovery blog you've started, and keep singing for the elderly. That's music therapy, it's not just therapy for them. It's music therapy for you too. When you get around to it, write those plays and novels you want to write. DBT will change you. You'll write very different plays and novels after DBT than you did before. You'll BE different. You'll finally be the Iris you've always wanted to be. You're signing up for DBT classes. This is a new, and exciting chapter in the story of you. Turn the page. Read on. You'll be glad you did.

Love you, Iris. No really. I do,

Iris







We are so proud to have Iris in our worldwide, online DBT classes at DBT Path.  Well done, Iris!

Delphine's Search for DBT in Belgium (in English & French)

Delphine shares how she sought help for Borderline Personality Disorder (BPD) in Belgium but could not find what she was looking for: Dialectical Behavior Therapy (DBT), a treatment found to be very effective and what helped our co-facilitator, Debbie Corso, overcome the disorder.

First in English and then in French, Delphine shares her experience of searching, ultimately finding DBT Path's online courses, and her experiences with the program so far.

We are so pleased to have Delphine joining us from Belgium!  Our students span the globe, and we are so excited to be bringing DBT to places where it is otherwise unavailable.

Enjoy Delphine's video:




For more information on our online DBT courses and to enroll, visit www.DBTpath.net.

Coping with OPP Triggers (Other People's Problems) Using DBT

Today in one of our online DBT groups, two students bravely shared how they skillfully and effectively coped with being triggered by "OPP": Other People's Problems. We cannot live in a protective bubble all of the time. There will be times, including those that are very unexpected, where we may overhear or see something we find terribly upsetting, leaving us feeling emotionally distressed and dysregulated.

There are times when we become triggered by things that other people say or the way that they behave.  In our first student's example, she was triggered by another student's (unknowing) pushing of boundaries by sharing explicit information regarding self-harm.

In our second student's example, she was triggered to find out that some dynamics of her personality triggered another student, which then triggered her.  Let's look at each of these.

In our first example, our student was attending class when a classmate, new to DBT Path and DBT in general, began sharing information that she (and even our facilitators) found upsetting and triggering.  As quickly as possible, the student was gently redirected, and a Trigger Warning (TW) was placed on the screen for students so that students who were feeling sensitive to the topic could take a break away from the screen and take off their headsets.  Of course, unfortunately, they may have already been exposed to the triggering emotion and now had to choose how to cope.

This particular student took care of herself in the following ways:

• Immediately, as the Trigger Warning was being loaded onto the screen, also requested that the TW go up for all to see
• Removed her headphones and stepped away from the screen to take care of herself
• Checked in via email with facilitators after group about her concern 
• Utilized her weekly DBT Skills Coaching benefit, included in her class tuition, to work in being triggered with our DBT therapist
• Showed up to her next group ready and willing to discuss the incident while going through an Emotion Regulation 1a worksheet to process through her feelings and reactions in a skillful way.

In our second student's example, she became aware that another group member disliked her and felt the need to leave the private Facebook group/social aspect of DBT Path.  Initially, she felt very sad, hurt, and distraught.  Through a DBT Chain Analysis worksheet, which she brought to class to discuss, she was able to deeply process the events that led to what she described as a "breakdown" that she further described as a crying spell, during which she continuously judged herself and spoke to herself harshly, saying things like, "No one likes me," "This happens everywhere I go -- what's wrong with me?!"  She herself had been triggered to remember elementary school, where she remembers not having friends and being picked upon.  She was in a very emotionally vulnerable place at this point.

This particular student is a sensitive, very caring, empathetic, encouraging individual who is proactive and outgoing in group activities and is often a leader who initiates conversations and cheerleads others.  Another student admitted to feeling threatened by this student's personality.  When our student in this example learned of this, she initially thought she had done something wrong and needed to change the way she was approaching things in class to accommodate the upset student.

This student took care of herself in the following ways:

• Fact checking: She emailed and checked in with our group facilitators and received reassurance that had not done anything "wrong."  The student also ran the scenario by her supportive husband who also pointed out that the student had done nothing wrong, and that sometimes people's reactions are THEIR problems related to issues that THEY need to work on.
• Filled out a DBT Chain Analysis sheet and brought to class to work on in the group
• Changed her self-talk, which shifted her perception.  She now believes that should something similar occur in the future, she will have the confidence and experience to not have a "breakdown" or feel the need to shift her (non-problem, healthy) behaviors.  She will remind herself that these are OPP: Other People's Problems.

How do you cope when triggered by other's actions or behaviors?   How might you approach being triggered differently in the future?

If you're interested in learning more about using DBT skills to cope effectively like these two students, check out our online DBT Distress Tolerance course.

Reducing Over Identification With Our Emotions

Do you tend to over or closely identify with the emotions (or even the physical sensations) that you experience?  It is so easy to get caught up in our emotions, to let them carry us away, and to get confused and believe we ARE our emotions.  This can lead to us feeling emotionally distressed and dysregulated.  There is a strategy that may help reduce this issue.

Today in our DBT Mindfulness 1 class, one of our students talked about a skill she practiced over the past week to reduce this behavior to allow herself to also reduce her suffering and as well as increase her overall sense of well-being.

When she noticed a strong emotion arise, instead of saying, "I'm overwhelmed!!!", she shifted her language to "I am feeling overwhelmed right now."  The psychological impact of this shift include acknowledging that:

• Overwhelm is a feeling.
• You are not your feelings.
• Feelings are temporary/transient states that will pass.

Another example of practicing this technique would be if you feel sad.  Instead of saying, "I am sad," (which, translated literally would mean "I am sadness,") consider tweaking your language to, "I am feeling sad right now," or "Sadness is passing through me," or "I am sad in this moment, but this, too, shall pass."

The same student who practiced this technique with emotions this week also practiced it during the mindfulness meditation that we did at the beginning of class.   During the meditation, she noticed that her hands and feet were cold.  Instead of saying, "I am cold," she noticed that she had the sensation of cold in those specific parts of her body.

The more we can re-train our brain by changing up the messages we send to it with the words we choose, the more emotionally resilient we can become.  Mindfulness practices like this can help greatly with getting into the habit of shifting this way and reminding us to look for opportunities to shift our thinking throughout our day.

For more information on skills and techniques that help us take hold of our mind and emotions, check out our online DBT Mindfulness class, and consider joining us to learn more.

Do you tend to closely or over identify with your emotions?  What language do you normally use with yourself when feeling intensely?  The challenge this week is to notice.  Please comment below with your thoughts.

Role Playing for Assertiveness Training

Last Friday in our Interpersonal Effectiveness 2 group at DBT Path, we had an impromptu session of role playing with our students.

Using the following scale, we did a scenario of one person asking another to help them move:

Both the students and our co-facilitators got into our roles and practiced being on the side of asking and on the side of being able to say no, even when factors like the fear of rejection, being abandoned, or being disliked were present.

We talked about how realistic such fears are in the context of our current relationships and how much we really need to value a relationship with someone who might reject or abandon us if we need to say no to a request now and then to put our own self-care first.

A few days after the class, one of our students told us that her boss called her and said that he needed her to come into work on her day off.  Using the skills she learned in class on Friday, she told him she actually would not be able to do so because she really needed to use that day to study for finals.  The result?  Her boss was fine with it, and he asked someone else to cover that shift.

Our student was pleasantly delighted that her assertive response yielded the result she desired and with no negative consequences.

We have the right to say no when we do not want to comply with a request, especially an unreasonable one.  For those who are insecure or emotionally sensitive, this can be a challenge but can be learned with courage and practice.

For more information on skills that help in interactions with others, check out our online Interpersonal Effectiveness class, and consider joining us to learn more.


How do you feel you do with being able to say "no"?  What about being assertive in asking for your needs to be met?  Let us know in the comments section below.

Welcome to the DBT Path Blog!

Welcome to the DBT Path blog!  DBT is an online health education company that provides entirely online Dialectical Behavior Therapy classes to students around the world.

Our classes are facilitated by Peer Eductor, Debbie Corso, the voice behind the blog Healing From BPD, based in San Francisco, CA.



Live classes are held for 60-90 minutes a week (depending on the course chosen), and each class runs for four consecutive weeks.

What you can expect to find here (coming soon!):

• DBT Videos
  Videos with practical application of DBT skills for typical difficult situations that we may encounter that cause us to feel emotionally dysregulated


• Student's Viewpoint
  Blog posts from our students on their experiences with applying the lessons they learn in our online classes to their lives as they build lives worth living and see REAL change


• Recommended Materials
  Reblogging of materials we find on the net regarding DBT that we feel are helpful as well as reviews of other sites, books, and DBT related materials


• More!

 Be sure to visit our official website, www.DBTpath.net to learn about and sign up for our classes.

 We look forward to sharing with you in our next post.