4/5/19 - AIMS Centeraims.uw.edu/nyscc/training/sites/default/files/Ursula Whiteside_DBT... · Slide...

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Ursula Whiteside ©2019 All Rights ReservedUrsula Whiteside ©2019 All Rights Reserved

Part 1: Using DBT Skills to Put Out, Manage, and Prevent Emotional Fires

Presented by: Ursula Whiteside, Ph.D.

Ursula Whiteside ©2019 All Rights ReservedSlide 2

Trainer Background


Language Matters


Reference Materials

• See Amazon.com

• DBT Skills Training Handouts & Worksheets. Marsha M. Linehan

• DBT Skills Training Manual. Marsha M. Linehan

• NowMattersNow.org website


Topics for Today

• Ice-Water (Distress Tolerance)

• Paced Breathing (Distress Tolerance)

• Opposite Action (Emotion Regulation)


Each year, approximately 10 million American adults think seriously about killing themselves, 3 million make suicide plans, and 1 million make a suicide attempt.

Substance Abuse and Mental Health Services Administration.HHS Publication No. (SMA) 13-4795 2013

Suicidal Experiences Are Not Uncommon

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% supported friend or family member who was suicidal

% had lost someone

% had experienced suicidal thoughts

Suicidal Experiences are Not Uncommon


Dialectical Behavior

Therapy Works

What Works?

Also have support: Collaborative Assessment and Management of Suicidality (CAMS), Cognitive Therapy for Suicide Prevention (CBT-SP). There is little to no support for medication-only or hospitalization


1. Weekly individual (one-to-one) therapy

2. Weekly skills-training group

3. As-needed coaching with client outside of

sessions

4. Weekly therapist consultation meeting

(therapists meet to discuss their DBT cases)

DBT Components


DBT Skills with

support work too!

(without all the other stuff)

DBT SKILLS

Linehan, M. M., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: a randomized clinical trial and component analysis.JAMA Psychiatry, 72(5), 475-482.

Ursula Whiteside ©2019 All Rights Reserved

Emotion Regulation

Interpersonal Effectiveness

Distress Tolerance

Mindfulness

DBT Group Skills

Modules


Linehan’s Theory of Emotion Dysregulation

Stress Model

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Some of us have biology and history that makes us

more responsive to stressful events.

Stress ModelLinehan’s Theory of Emotion Dysregulation (Stress Model)


Some of us have biology and history that makes us

more responsive to stressful events.

Micro-Interventions

Validate/Accept: This may mean that we aren’t understood by others. But this doesn’t make us bad or wrong.

Hope/Change: Learning skills allows us to keep best parts so that you choose what happens, instead of emotions choosing for you.

Linehan’s Theory of Emotion Dysregulation (Stress Model)


Stre

ss Le

vel

Time

EVENT


Micro-Intervention


1. Suicidal thoughts are a way the brain gets relief from pain.

2. The more used for relief, less the brain uses other methods of relief.

3. Biology and history (including childhood, adulthood and recent

events) affect our emotional baseline and also reactivity.

4. Some of us have higher baselines, physiology that responds more

quick and strong, stays there for longer, and takes longer to come

down. Suicidal thoughts are one way our brains “manage” this.

5. With skills, people can learn how to control how they react to and

manage emotions – this can lead to fewer suicidal thoughts.

6. With skills, people can bring down their emotional level baseline –

this can lead to fewer suicidal thoughts.

Micro-Intervention



Distress Tolerance

Skills for being “On Fire” Emotionally


Do you know what to do in an emotional emergency? How do you

survive a full on crisis?

Being “On Fire” Emotionally

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▪ What is a is an emotional emergency? What is a crisis?

▪ A situation that is highly stressful and short-term

▪ It creates intense pressure to end the crisis now

▪ Use Ice-Water and Paced Breathing skills when…

▪ Acting on your emotions will only make things worse

▪ You are overwhelmed but you need to be skillful

▪ Strong that you can’t solve your problem right away



The Ice-Water and Paced Breathing skills are what to use when tolerating painful events, urges, and emotions

when you cannot make things better right away.



These skills help REDUCE EXTREME EMOTION MIND fast



Ice Water

Like restarting a computer that’s been on

the fritz


Important concepts

▪ Mammalian Dive Response

▪ Vagal or Vagus Nerve

▪ “Cycle the Power”

Ice-Water (pg 329)


When and what to do

▪ Use this to to calm down fast.

▪ Hold your breath, put your face in a bowl of cold water, or hold a cold pack (or zip-lock bag of cold water) on your eyes and cheeks.

▪ Hold for 30 seconds. Keep water above 50 degrees.

Ice-Water (pg 329)

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Describing Using Cold Water to Patients

▪ Full face into cold water, or zip-lock bag with cold water on eyes and upper cheeks.

▪ Describe the “dive response”.

▪ Heart rate slows down, blood flow is directed to brain and heart.

▪ Use when you want to act on dangerous urges or are about to panic.

Ice-Water (pg 330)


Paced Breathing

Making your exhale longer than your

inhale


▪ Pace your breathing by slowing it down.

▪ Breathe deeply into your belly.

▪ Slow your pace of inhaling and exhaling way down (on

average, five to six breaths per minute).

▪ Breathe out more slowly than you breathe in (for example, 5

seconds in and 7 seconds out).

▪ For clients who feel panicky, you can start with shorter

breaths and build up to longer ones.

Paced Breathing (pg 329)


What situations have you been in where Ice-Water and Paced

Breathing would have been called for?



Emotion Regulation

Skills for being “In a Fire” Emotionally


Opposition Action

Doing the opposite of what you want to do, and doing it all the way

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First question you should ask yourself:Do you want to change your emotion?

Opposite Action (pg 231)


What is Opposite Action?Doing the Opposite of what your emotion wants (urge)

Why do Opposite Action?You don’t want to feel the way you do

Does it work?Yes! But you have to do it all the way!

Opposite Action


Every emotion wants you to do something

▪ Sadness wants you to pull away from the world because the world is painful

▪ Fear wants you to run or stay away from what you are scared of

▪ Anger wants you attack

▪ Shame wants you hide from others



Step by Step


Describe what your emotions want you to do

Ask Wise Mind if that is a good idea

What would be opposite action

Repeat over and over

Do Opposite Action all the way

Notice something is going on (an

emotion)

Name the Emotion

Change your

Emotion


Example:

▪ I wanted to study in peace and my boyfriend keeps asking me questions, turning up the tv volume, and talking loud on the phone

▪ I’m angry

▪ I want to yell at him to leave me alone

▪ Opposite action would be to act a little nice “Hi honey, I’m really tired and need to study. I know you want to relax too. I’m going to go work in the bedroom. Do you mind turning down the TV while I do that?

Opposite Action (pg 232-240)


Teaching Patients, some discussion ideas:▪ How powerful are your emotions?

▪ Give some times when an emotion has run your life and it has been a positive thing.

▪ Give some times when an emotion has run your life and it has caused negative problems.

▪ What are some situations that you see coming up where you already know you would like to feel differently.

Opposite Action

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How would your life be different if you started doing Opposite Action

all the way?


NowMattersNow.org


NowMattersNow.org


NowMattersNow.org Works

Website visits are associated with decreased intensity of suicidal thoughts

(and negative emotions).

This includes people whose rated their thoughts as “completely overwhelming”

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