What are Dialectics and Dialectical Behavior Therapy Skills?

What is Dialectics?

Dialectics is based on the idea that two opposing concepts can both be equally true. One truth does not trump or rule out another, which undercuts the dichotomy of a “I am right you are wrong” type of relationship. A common dialectic is that you are perfect as you are (acceptance), and that in order for things to turn out differently in your life, you need to do things differently (change). One is not more true than the other, and one truth does not rule out the other truth. Sometimes people need acceptance, and sometimes people need to be challenged. Both belonging and growth are an inherent part of being in relationship.

Dialectics challenges the idea that one person is always “right”, because when you take into account diversity of perspective, other truths often arise. Being “right” often fails to take into account effective communication and the value of the relationship. Experience and emotions get ignored. A set agenda of being “right” often gets people stuck in a very rigid, dichotomous, black and white, non-dialectical stance. Dialectics are important in that sometimes you can find the one thing you have in common with your enemy instead of focusing in ways you are different. Relationships exist in context of conflicting truths, yet relationships are the glue that carries us through life.

What are the four Dialectical Behavior Therapy Skills?

DBT is a complex treatment that has confusing origins in terms of how it was developed and who it was for, and has been tailored to a wide range of populations and settings. The DBT skills are universally applicable materials that help people with extreme and painful emotions, intolerable life situations, and relationships. The four skills sets are as follows:

Core Mindfulness: Mindfulness is a skill that helps people focus attention, regulate arousal, calm the brain, quiet the mind, and settle in. Being mindful is a way to steady and anchor oneself in order to observe quietly and not “react” to what is going on. It is inherent in all of the other skills in that it requires a steady, quiet, secure stance in the face of demanding life situations. It takes spaciousness to know what is going in with your body, your self-experience, your wants and desires, and your life. If you don’t pause the moment and check in with yourself, it is easier to get “caught up” in the banging and thrashing of what life throws in your direction. Mindfulness can be a spiritual practice of quiet contemplation, a way to press the pause button, and way to regroup. Core mindfulness skills taught from the DBT material include skills of observing and describing without judgement. Other traditions, spiritual practices, health care services, and therapies teach mindfulness, so it is not “new” nor is it confined to just DBT skills; its roots are actually in Zen Buddhism. There are multiple ways of accessing mindfulness including mindfulness based programs, meditation groups, trainings, and apps. DBT groups are known for implementing a mindful practice or exercise in every group, and like many spiritual traditions are simply considered part of a daily practice.

Emotion Regulation: This is a set of skills that helps people to observe and describe what they feel (you can see the overlap with mindfulness) in order to help regulate arousal, understand what they feel, and know the reasons why they feel the way they feel. Skills cover ways to reduce emotional suffering through mindfulness and opposite action, and ways to reduce vulnerability to emotional suffering. Skills are quite complex and take practice, feedback, and validation. Since emotions can be tricky, elusive, (and just plain unbearable at times) the emotion regulation content is not something you could “quick learn” and be done with it. Sometimes people are not always aware of how or what they feel in general, and there is nothing pathological about this. It is a process! Knowing oneself and knowing one’s emotions is a lifelong task not subjected to any particular type of disorder, and does not end just because you have had a first exposure to all of the skill content. That is why working together on ways to regulate arousal given varying life circumstances can best be done over time in small group settings that promote cohesion and intimacy.

Distress Tolerance: In order to regulate emotional arousal, finding ways to endure the “I-can’t-stand-it-itis” of painful and extreme emotions is critical. Surviving painful life circumstances well means doing so in a way where people do not lose self-respect, forget their values, give up what is important to them, or react in such a way that makes things worse. Sitting in the fire and not reacting is often harder than picking a fight, poking the fire, making others suffer in order to prove a point, exacerbating pain to let others know how bad things are, undermining a person where it hurts, forcing the university to prove its point, perseverating on being “right”, asking “why me”, or engaging in self-defeating or relationship destroying behaviors. Being willing to tolerate the unknown, be zen with the universe, stop fighting reality, and do what works is skillful practice. We all want things to do our way or to turn out for the best. In reality, a lot of people are suffering a great deal and need everything they can to survive well. Distress tolerance skills encompass not only change strategies (if you can do one thing make it better, why wouldn’t you?), but acceptance and willingness skills. Anyone who has successfully undergone any type of exposure treatment for anxiety knows that the benefit to tolerating anxiety is a decrease in overall anxiety. There is an inherent truth that reality is easier to face once you stop fighting it, thus freeing you up to do what is needed to effectively solve problems.

Interpersonal effectiveness: True to the concept of the dialectical philosophy of DBT, it is better to be effective than it is to be right. The interpersonal skill content encourages readers to identify objectives in situations (what exactly it is you want or don’t want), how the relationship may be impacted, and if self-respect is at stake. Balancing the three helps people to look at natural barriers and consequences of interacting, and enables readers to problem solve the cost/ benefit of ignoring each. For instance, you can ask for what you want at the expense of the relationship, or you can give into a relationship but sacrifice self-respect. The balancing act of relationships is an ongoing challenge for everyone, and some give and take is part of how people stick together, find intimacy, and keep people close. Interpersonal skills also include ways to get out of or decrease contact with toxic or unwanted relationships, set limits, say no, and to identify barriers to doing so. Direct rehearsal in terms of “what to say and how to say it” benefits group members in that they can try out and receive feedback in both verbal and non-verbal forms.

A book of all the DBT skills is available for purchase via this link: https://tinyurl.com/y2qad6sk

What Is Mindfulness, What Does It Have To Do With You, And Why Is It So Necessary?

Mindfulness is a particular way of paying attention to 1) expand awareness or 2) focus attention. Below is some brief information on these two applications of mindfulness as it relates to your life and to the practice of psychotherapy.

AWARENESS

What are the benefits of awareness?

  • Increasing awareness increases options (less experiences of feeling or getting “stuck”)
  • Increasing options for how to react to stressors increases a sense of confidence and self control when confronted with life circumstances
  • Increasing awareness helps people understand why they behave the way they do and what controls their behavior
  • Increasing awareness helps people to identify patterns of responding, or repeating themes that may show up again and again, and can be better understood with curiosity and analysis
  • Increasing awareness helps to clarify, understand, and organize behavior in a more meaningful way
  • Increasing awareness (ie, awareness of anger) helps people to be assertive/ proactive, solve problems, and organize action

What problems accompany limited awareness?

  • Repeating patterns of getting stuck
  • Minimizes flexible and adaptive coping
  • Can be likened to zoning out, dissociating, not paying attention, missing out, or failing to show up for one’s life
  • Can increase vulnerability to do, say, or behave in ways that are acquiescent/ compliant; no self-awareness leads to responding/ reacting to environment (reduced autonomy, reduced control, reduced capacity for interpersonal influence/ power)
  • Limited awareness is associated with not knowing oneself, what one likes/ doesn’t like, wants/ doesn’t want
  • If you can’t know yourself (trust experience) how you can you know how to pursue a life that would be fulfilling and rewarding to you

Ways Awareness can bring pain

  • Losses associated with missing out on ones life
  • Grieving times/ time in life when things could have been better (had a person been more aware)
  • Awareness of hope and possibility can feel risky or unfamiliar
  • Familiarity and predictability help people feel consistency/ stability, thus awareness of alternatives can be uncomfortable/ unfamiliar
  • If a past history of problematic responses evoked a particular set of behaviors (escalated conflict results in nurturing/ attentiveness from partner), awareness of alternative ways of behaving may be initially aversive / won’t get immediate desired response

Things to be aware of:

  • Emotions, actions, urges, desires, hurts, want
  • Physical sensations, sensitivities, breath, body awareness, gut feelings, instincts, intuitions
  • Your behavior; how you behave/ change behavior, react in certain situations, which people, in different contexts
  • Your history of behavior; how behavior started, what it means/ meant, how it served a purpose/ had a function or role for you
  • How your behavior impacts others
  • How others’ behavior impacts you

FOCUSED ATTENTION

 Why is obtaining skill to focus one’s attention important?

  • Thoughts, emotions, pain, sensation, restlessness, boredom, etc. can sometimes interfere with a person’s ability to live their life in a valued direction.
  • Thoughts and emotions can create problems, be distracting, and get us derailed
  • Obsessive thoughts, unwanted thoughts, self-defeating thoughts, self-hating thoughts, anxiety thoughts, and non-useful thoughts can threaten to take over attention, control action, and inhibit needed action
  • Staying focused can help a person be less prone to intense, unwanted, or problematic thoughts or beliefs
  • Action urges, emotional reactivity, and other behaviors often happen “automatically”, thus practicing focused attention increases your options for limiting your reactivity (For instance, if you are a person that “flies off the handle” staying focused can help you stay grounded)

Does focusing attention get rid of pain?

No, focusing attention helps a person not get consumed by other things that threaten one’s focus (ie, obsessing, ruminating). Pain is considered a normal part of the human existence; focusing mindfulness activities are not done with the purpose to destroy, get rid of, or inhibit pain.

Focusing on sound exercise. For the next 3 minutes (set a timer if you’d like), try to focus all of your attention on sounds you can hear. Pay all of your attention to the sound, and see if it is possible to do this for 3 minutes. You will likely have multiple other thoughts, sensations, experiences, or distractions that don’t keep you 100% attentive to “just sound.” Likely if you had a painful thought, the thought took you out of the exercise. So, instead of heeding that thought your attention (buying into the thought, thinking the thought, rehashing, problem solving, etc.) you simply be aware of that thought (“oh that thought is showing up again”) and gently return to focusing on sound.

Remember:

  • No one is denying you are in pain
  • You are not denying you are in pain
  • You are not refusing to think about that situation, you are simply redirecting your attention for the time you try mindfulness
  • You are increasing your control of what you pay attention to and when
  • You may need to come back to your pain at some point and solve some problems, but for the three minutes this is not your task
  • Urges, cravings, desires, urges to take action/ do something, urges to eat something, etc. may all come and go
  • You are learning over time to increase control of all of this

Often, if your life is disrupted by intense, extreme, demanding emotions your actions often follow. You may feel as if you are controlled by your emotions and your actions. Focusing attention helps people to be more “aware” of urges, emotions, disruptions, or urgency around fixing or doing something NOW. Learning to control what you pay attention to will help you control yourself; your emotions may DEMAND your attention. Focusing attention exercises can help calm you down, settle you in, and even relax you a bit.

What to do instead of criticize yourself

Try softening your stance, gently relax your face, and allow your muscles to become loose and less tight. Put a hand over your heart with an intention of lovingkindness, and try repeating the following statements with a tone of voice that conveys self-compassion:

May I bear this pain with kindness to myself

May I safely endure this pain

May I accept the circumstances of my life

May I find peace in my heart

May I let go of what I can not control

May I remember that others are also suffering

 

A mindful approach to self-hatred and self-criticism

Often people with self-hatred, shame or self-criticism get “caught up” in a thought process that includes a fair amount of self-attacking. This thought process can include arguments with oneself, reasons a person should not be the way he/ she is, or a rationale for how he/she “should” be feeling. Sometimes this thought process is associated with muscle tension, headaches, the suppression of emotion, the inhibition of interactions, or the shutting down of expression and experience.

People sometimes think that by punishing themselves in a self-hating dialogue is an effect way to change thoughts, feelings, or reality. Almost as if they are somehow being “deserving” of “bad” things someone sets things right. The difficulty is, it typically is not an effective strategy for changing thoughts or feelings! It might temporarily suppress feelings, shut down hurt or sadness, make one feel more empowered or less vulnerable, or even distract from other problems. But the bottom line here is this: Does actually work to reduce suffering? Does it get rid of emotions in the long term?

Being mindful, or starting to observe this process, is really the first step towards making some changes in this process. Being able to notice the thought, step back, practice using a gentle tone of voice, and practice saying “I am noticing the thought that…” is one way to start to just notice thoughts, rather than try to change them.

Next, assess your willingness to “shift gears.” Often people who are stuck in a ruminative process somehow believe that if they keep ruminating, something will change. That’s not to say you have the power to immediately “stop” ruminating, it just starts to get you thinking about an alternative.

If you feel miserable, want to stop hating yourself, and invest a lot of unproductive energy into engaging in self-hating thoughts, the option of doing something different just might be appealing. Once you decide to try something different, you can try softening your facial expression and relaxing your shoulders. Consider being curious about the physical sensations in your body that accompany the thought. What uncomfortable sensations might you be pushing aside in order to invest in the thought? Practice accepting physical discomfort and think about how you might approach or move towards it instead of away from it. If you could be curious about your pain and your emotion, you might be able to work with it a little bit differently. Remember to stay non-judgmental.

Finally, try out the phrase, “May I be at peace.” Try stating this phrase quietly and softly to yourself. Make sure you keep your face and shoulders relaxed, and practice acceptance. Try doing these steps several times throughout particularly difficult days, knowing that practicing new behaviors (and getting “good” at them so they are more automatic) takes effort and rehearsal.

Three mindfulness exercises to use right now to quiet your mind and focus your attention

One of the reasons mindfulness is used is to get yourself calm. If you are a person with a lot of anxiety, your anxiety might get in your way of handling problems, thinking clearly, or addressing something with your full attention.

Mindfulness is one way to lower emotional arousal, center yourself, and help you get back on track. When emotional arousal returns to baseline, accessing the problem solving part of your brain becomes easier.

1)   Inhale to the count of one, exhale to the count of two. Keep going until you get to the bottom of six. Start over. Do this for about three minutes. If you get lost or distracted simply start over. The point is to have something to focus your attention on; which helps cut the distractions of your mind.

2)   Trace your hand. Inhale on the way to the tips of your fingers, exhale on the way to the crevice. This can be done with pen/ pencil on paper or with the finger of the opposite hand. This is a tactile way to “trace” your breath and focus your mind. Keep your attention on your breath.

3)   Pause for three minutes and focus your attention entirely on sound. Try to tune in to every possible nuance of sound. See what you can hear that you typically don’t pay attention to. If your mind drifts, bring it gently back to the experience of hearing.

Four brief ways in which mindfulness can actually be used to help you cope: Practical applications of being mindful.

Here are a few simple ways in which learning and using mindfulness can help people.

Quiet the mind. A simple mindful activity such as focusing on the breath for a few minutes can help people slow down racing thoughts, lower emotional arousal, and feel a bit more settled. If a person can take emotional arousal down a few notches, he or she may feel more prepared to face a situation that evokes anxiety.

Focus attention: When people are wholeheartedly involved in one task (focusing all of their attention on whatever they are doing), their mind is typically not racing, jumping, or scattered. Focusing on one thing can help a person feel less disorganized.

Become grounded, centered, or more connected to ourselves, our environment, or our surroundings. This can be important if you have a hard time relating, enjoying, or benefitting from pleasant experiences. Sometimes the focus of attention is on pain, threat, or impending crisis and it’s hard to absorb the stuff that makes us feel better.

Help you be clear on what you feel: We know what we feel because we sense it in our bodies. Some people spend a lot of time trying to ignore, hide, repress, or inhibit what’s going on inside. Being mindful can help us get back in touch with emotion, discomfort, and even desire.

Want to learn how to be mindful? Click here to try my 30 days of mindfulness program and receive one e-mail a day for 30 days with a mindfulness tip, suggestion, skill, or practical “how to”. If you’ve already done it, click here to do the 30 (more) days of mindfulness- for a total of 60 days of opportunities to learn mindfulness.

6 quick tips on mindfully navigating the holidays when you aren’t “feeling” it

Notice what you feel without judging. Sometimes people believe that if they don’t feel a certain way, they are missing out on some kind of grand, spiritual, or wonderful experience. I am reminded of the Charlie Brown Christmas special in which he doesn’t feel like he “should”.  Not everyone is awed, exhilarated, or spiritually “moved” this time of year.

Accept and acknowledge the mundane, the everyday, or the not-so-wow experiences this season.  Remember that the glue that holds us together in the smaller, everyday nuances of our existence and our relationships also has meaning. Foster the relationships that matter.

If you want to feel more connected and less detached, practice ways to participate willingly, go with the flow, risk being open, and become involved. Volunteer, show up for the holiday parties, attend services, and remain attentive and awake to what is going on around you. Although it is possible that exerting energy takes effort (and may not completely diminish loneliness), it gives you an option to temporarily shift your mood.

Find the stillness within– Crowds, shopping, to do lists, and holiday planning can be overwhelming. Finding stillness within yourself can help you cope adaptively, slow things down, find your wisdom, and stay grounded.  Bear in mind that you have the ability to find inner wisdom, but sometimes emotions and other people can get in your way of finding it. Try the suggestions below:

Find 2-5 minutes once a day from now until Christmas to sit quietly, observe your breath, and gently pay attention to whatever sensations arise within you. After sitting quietly, try writing: I notice… I would like… I feel…I sense…I think…I am aware of…I am most worried about…

If you are out shopping or involved in intense holiday planning, make sure that you don’t skip meals or shop on an empty stomach. Take periodic breaks that include sitting down and being away from loud noises, bright lights, and crowds. Consider what you need and the cost/ benefit of overestimating your energy and pushing yourself too hard.

What does mindfulness have to do with validation?

Mindfulness involves an ability to “get in touch” and be aware of experiences that are both going on inside (ie, feelings) and the outside.

In DBT, the ability to validate means not dismissing or attacking oneself. Self-validating is about paying careful attention to what is present in the moment; true, accurate, and real.  It’s about looking at how you do feel, rather than how you should feel or are supposed to feel. This involves a focus on internal experience and physical sensations. It means figuring out what’s really there- even when it is confusing.

People with extreme emotional reactivity often have difficulty believing that their opinions, attitudes, values, and perspectives count. They may spend a lot of energy worrying, not speaking up, or even attacking themselves for having a different perspective. They may have difficulty when asked about intentions, wants, or desires. In some cases they may be used to not offering input. They may have adapted to not expressing intentions or wants. They may be living most of their lives not really existing, or at least existing on the periphery of what their lives could be.

Are you someone who has a hard time figuring out what’s going on within?

The 30 (more) days of mindfulness program offers many options in finding ways ways to be in touch…to be mindful…and to increase awareness of that which is within and that which is on the outside.

It is just about finished! I hope to have it available by the end of next week. If you want mindful options to arrive in your e-mail inbox for 30 (more!) days, and if you’ve already tried the initial (30) days of mindfulness, you will not be disappointed.

Stay tuned!

Participating mindfully

Often when people are experiencing a high degree of anxiety their attention is pre-occupied. They may walk around in a daze, feel unreal or disconnected, and are unable to pay attention to what is going on around them. Internally they may be ruminating, worrying, or responding to high emotional arousal.

The skill of “participating” as a mindfulness skill is a very difficult skill- especially for people who have lots of emotional stuff going on inside of them lots of the time. The concept of participating is this idea that you throw yourself into the moment. In a way it is like shifting gears, going with the flow, and really working to put your attention to what is going on in the immediate environment. It is one thing to show up in your body, but it is another thing to show up with your mind. It can be effective to show up for the party, movie, meeting, or event even though something really stressful is going on. You can practice shifting gears to show up for the immediate moment or situation- and perhaps shift gears again when you go back to worrying about what is stressful! At the very least, notice how you feel when you are working hard to connect, participate, be part of, and include yourself. Notice how it feels when you are worrying, ruminating, stressed out, and under emotional threat- and possibly shut down to the world around you.

Using the skill of participating means keeping your eyes open to what is going on around you; listening, feeling, and being touched by the things that matter. When you put yourself out there into the world, you risk being vulnerable. Engaging, interacting, and participating in the world helps connect to people in meaningful ways, find people that share similar struggles, and feel more real. When people have extremely stressful situations, they may be able to mitigate the stressors by being present to the things that could be enjoyable despite being stressed out. Sometimes trying to participate doesn’t yield immediate rewards, and therefore takes a lot of effort.

Are there ways in which you are sitting back, playing it safe, and not participating? Consider what it would be like to share with someone how you really, actually feel about something. What would the risk entail?

Really putting yourself out there is hard.

Mindfulness, DBT, extreme emotions, and doing what works:

One of the DBT mindfulness skills includes being effective: Doing what works. Learning how to sit for long periods of time and focus on one thing, such as your breath, can have quite an impact on quieting the mind. However, sitting for long periods of time can be rather difficult for people who are learning how to “be mindful”, and may not be helpful in solving other problems (ie, communicating, reading one’s environment accurately, interpreting behavior).

The persons I tend to treat have difficult with extreme emotion- and sometimes tolerating a single moment can seem like an eternity. The skill of “observing” in mindfulness appears deceptively simple- and yet the actual doing of the observing when it’s needed in real life- as it applies to solving painful problems- is a whole different story.

Observing and describing the cracks on the sidewalk or the ceiling tiles may be a way to be mindful. But here is where it can get tricky:

  • It may be an effective way to be present in the moment, to become grounded and connected to what’s going around you, and prevent you from dissociating, “floating off”, or disconnecting.
  • It may be a way to distract, avoid, inhibit feeling, occupy the mind, and avoid relationships. If you can become overly focused on things and not people, you can avoid taking emotional risks, connections, and opportunities to address conflict. Noticing a tendency to avoid may be a more effective use of mindful activity.

I’ve been working hard on getting together my free 30 days of mindfulness for my mailing list readers. The approach for learning varies and the agenda includes suggestions for trying new and different things. It’s experiential- which means that you get to participate in the exercises. I’m hoping that it will satisfy those who are looking for ways on how to be mindful as it relates to real life.

All you have to do is click on the upper right side of this blog post where it says Get 7 free steps for sailing through emotional storms when you join my mailing list. Sign up!

The 30 days of mindfulness are going to start February 8, so you will have to sign up before then if you want to be included!