Dbt Skill - Tumblr Posts

This post is to elaborate more on my experience in the DBT group and some of the reading and tools I found most helpful to me.

The DBT group I was able to take part in was a remote group that met once a week for 16 weeks via Webex. I was very lucky to get a spot and that my Medicaid covered any cost. It was run by two social workers as part of NYU Langone's Psychiatric Center at Sunset Terrace.

The weeks were broken down based on the 4 Modules (core skill groups) of DBT: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness.

Mindfulness: This is the base of any DBT practice, and what I always had trouble with in the past. Mindfulness is a kind of self-awareness that you can use to break down your experiences and give yourself a kind of reality check. Being mindful is being present and aware of your emotions, your body, and your thought process.

There are 3 states of mind with which we experience and react to the world: Emotion Mind (acting based on emotions alone), Reasonable Mind (acting based on facts alone), and Wise Mind (a combination of the first 2 and the goal of mindfulness).

Distress Tolerence: This module focuses on short term solutions for big emotions. The skills involved in this module are called Distraction skills because their goal is to just get you through the wave of emotion, resist any harmful urges, and survive your distress long enough to talk to someone or get to other skills.

There are quite a few skills in this module I found helpful, and I'll go into more detail on them in another post. The skill I think can do the most in the moment is called ACCEPTS, an acronym used to remember what you can do to distract yourself when feelings get too intense.

Emotion Regulation: This 3rd module focuses on learning to identify your emotions, understand where they come from and what they are trying to tell you, and processing them in a healthy way.

The purpose of all emotions is evolutionary survival. Emotions spur us into action to meet our needs (when you get hangry, you know you need to eat), and communicate danger to ourselves and others. Body language and voice tone can also often communicate emotions before words do.

*Use a feeling wheel to identify your emotions and dig deeper. If you can't process them right away, use a distress tolerance skill until you are able to sit with them.

*The best skill for emotion regulation is ABC PLEASE, an acronym used to help you recognize vulnerability factors in your life and minimize them.

Interpersonal Effectiveness: This last module focuses on skills that help us communicate with others. There are skills like GIVE, which can be used to maintain good relationships with others, and FAST, which can be used to help maintain your self-respect when making a request of someone.

*There are others that I will make graphics for, stay tuned!

Attending the group and learning the skills was only part of what I found helpful on my journey toward stability. I found a book, Mindfulness for Borderline Personality Disorder, that helped break mindfulness down in great detail and very easy to follow language. The book is written specifically for BPD-havers so it's really an excellent resource. The other tool I found helpful is something my therapist suggested I get, The Game of Real Life, which is a game that you can play to learn DBT skills in an interactive and fun way. It comes with a little book that breaks every skill and practice down, Skill cards which I find to be a great go-to for recalling a skill in a moment you need it (after all, it's a whole lot of acronyms to remember), and Conflict cards that give you examples of situations you might experience, and you have to pick a skill card to practice (can be done alone but better with someone you trust to really dive into the communication and regulation skills). I've actually been carrying a few of the skill cards in my purse wherever I go, just in case I need a quick reference in a moment of distress.

I have so much more to share with anyone who's interested. I'll keep posting, making graphics, and if anyone has a specific question about any of the modules, I'll do my best to answer or help you find the information online. DBT groups are super hard to find, in extremely high demand so it's hard to get in, and usually grossly expensive due to this country's horrible healthcare system. I consider myself extremely privileged to have been able to find a great hospital when I needed it and a great group that my insurance covered. I'm here for anyone who isn't as lucky. Let's make DBT accessible and break the stigma of the BPD diagnosis!

*More DBT guides here*

I need to feel productive and like I can accomplish something so I’m giving myself the goal of finally finishing my guides for the STOP and TIPP skills by next Friday, October 27th. And then diving into 1989 TV will be my “reward.”

I’m a girl with a desperate need for a gold-star feeling and pretty much no opportunities for moments like that. So I have to create them myself and reward and love myself…no one else is going out of their way to do it for me.

STOP

Use this skill when you are fully in your Emotion Mind to stop yourself from reacting impulsively to a distressful situation.

S - Stop: When distress is high, don’t react. Just freeze!

T - Take a step back: Remove yourself from the situation. Take 15-30 seconds to focus on your breathing and slow down your heart rate.

O - Observe the situation: Take in what’s going on around you and in your body. Remember to stick to the facts.

P - Proceed Mindfully: What’s your goal in this situation? Consider your thoughts and feelings, and those of others.

*More DBT guides here*

TIPP

Use this skill when you are overwhelmed by intense emotions or are feeling the urge to self-injure.

*If you’re in crisis and are having suicidal thoughts please call a Crisis Hotline! (Call 988 in the US)

T - Temperature: To relax fast or distract your mind with sensation, hold an ice pack to your cheeks or eyes or dunk your face in a bowl of ice water for at least 30 seconds to activate your Diver Reflex*.

*If you have high blood pressure, talk to your doctor before trying.

I - Intense Exercise: Doing a few minutes of vigorous exercise will release Endorphins. Try a few minutes of Jumping Jacks or running in place (or around the block). Play your favorite fast paced song and dance it out.

P - Paced Breathing: Breathe deeply into your belly, expanding your lungs as much as you can. Pace your inhales and exhales to 5-6 per minute. Then make your exhales longer than your inhales (5 seconds in, 7 seconds out).

*Try a 60 bpm Metronome track from your music streaming app or YouTube for pacing.

P - Paired Muscle Relaxation: Breathing deeply, tense your muscles (not so much that you cramp up) section by section, move your focus from your feet up your body. Tense up with every inhale, relaxing and melting with every exhale.

*More DBT guides here*

My DBT skill graphics organized by module🩷

Please feel free to save them, share, print and submit requests if there’s any skills you’d like sooner than others (as I make more, I’ll add them to this post for easy access).

Mindfulness: FLAME

Emotion Regulation: ABC PLEASE

Interpersonal Effectiveness: GIVE, FAST, DEAR MAN

Distress Tolerance: STOP, TIPP, ACCEPTS, ACCEPTS Worksheet

Misc: Wise Mind, Box Breathing

DEAR MAN

A DBT Skill for Interpersonal Effectiveness

Use this skill to help you get what you need without damaging relationships or compromising your integrity.

Describe: State the facts of the situation.

Express: Use I-statements to express your feelings and take responsibility for them. I-statements prevent the other person from getting defensive.

Assert: Assert yourself by asking for what you need or by saying no firmly. Speak simply and clearly.

Reinforce: Make sure the other person knows what they will gain by granting your request. It’s important to reinforce that the relationship is a two-way street.

(Stay) Mindful: Stay focused on the conversion. If the person starts getting defensive, keep the conversation on track.

Appear Confident: Regardless of how you feel on the inside, project confidence with your body language; stand or sit up straight with your head held high, voice clear and strong, and make eye contact.

Negotiate: If the person isn’t on board with your request, remember that you are asking for something, not making demands. Modify your request to make it more appealing to them, and/or try asking them their thoughts on solving the problem together.

*More DBT guides here*

Wise Mind

This diagram breaks down the states of mind that we experience.

Please note that neither side is “good” or “bad”; the aim of practicing mindfulness is to combine both and act in your own best interest.

Emotion Mind

Feelings control actions

Can disregard the facts of a situation

Impulsivity based on emotions in the moment

Self-injurious behavior 

Reasonable Mind

Logic controls actions

Detached from emotions

Can invalidate your emotional experience

Wise mind

Combines the facts of a situation with the emotional experience

Helps you process a situation before acting

Mindfulness will help get you here

*More DBT guides here*

Box Breathing

This breathing exercise is great for de-stressing and grounding yourself for meditation.

To start, get into a comfortable seated position, straighten your spine, keep your hands relaxed by your sides or on your lap, and legs relaxed with your feet on the ground.

Inhale deeply, counting 4 beats.

Continue by holding that breath and counting another 4 beats.

Exhale slowly for another 4 beats.

Hold for another 4 beats.

Repeat 3 or 4 times.

*For help pacing, you can use a 60 bpm metronome, which can be found on any music streaming platform or Youtube.

*DBT guides here*

ACCEPTS

A DBT skill for Distress Tolerance

Use this skill to help you get through moments of crisis

*The best way to utilize this skill is, when you're calm and not feeling any distress, make yourself a list of specific things you can do that correspond with each of these steps. Thinking of something to distract you when you're in the midst of an emotional storm is incredibly hard, so preparing a reference guide for yourself ahead of time is a way to show up for yourself.

*Corresponding worksheet to help you plan ahead*

A - Activities: Watch a comforting tv show or movie, clean, do a puzzle, any task that requires most of your attention so you can focus mindfully on it rather than your emotional spiral.

C - Contributing: Talk to a friend or family member, help someone with a task like cooking or cleaning.The goal being to focus on being with someone rather than being alone in your thoughts.*This obviously would not be a go-to if the person would further trigger you.

C - Comparisons: Compare this emotional storm to a past, worse experience as a way to remind yourself that you've survived before, and you can do it again. *Again, the point of this is not to further trigger yourself, but to prove to yourself that you're strong enough to get through this moment of distress.

E - Emotions: Activate opposite emotions by watching a funny video or recalling a happy memory.

P - Push Away: Mentally push away the triggering thoughts or situation until you are calmer and more regulated and able to deal with the emotions. Commit, for a few minutes, to picturing your problems going into a small box, closing them in it, shoving the box deep in the back of a closet and closing the door. This exercise is a very short term way to remove the weight from your shoulders.

T - Thoughts: Actively think about something completely unrelated to your triggers. Sing your favorite song from memory, do a crossword puzzle or a math problem.

S - Sensations: Interact with your 5 senses mindfully; hug a stuffed animal or a pet, hold ice in your hand and feel it melt, lay flat on the floor and feel your body pressing into the hard surface.

*The best way to utilize this skill is, when you're calm and not feeling any distress, make yourself a list of specific things you can do that correspond with each of these steps. Thinking of something to distract you when you're in the midst of an emotional storm is incredibly hard, so preparing a reference guide for yourself ahead of time is a way to show up for yourself.

*More DBT Skills Here*

ACCEPTS DBT Worksheet

*Corresponding DBT Skill*

This worksheet is a way for you to plan ahead and show up for yourself when you're in distress.

Print this out, fill it in and have it as a tangible list of things to take your focus off the emotional storm and avoid harmful coping mechanisms. 

List activities that will take your focus in the moment (for example draw, play a video game, put together a small puzzle)

List things you can do with someone who calms you (for example help with washing dishes, fold laundry, cook a meal)

List 2 times before when you were struggling emotionally and got through it (to remind yourself that you have before and can survive again)

List things you can do to activate opposite emotions (for example watch some funny videos to counteract sadness with laughter)

List numbers you can call for help (For example a crisis hotline, therapist, or loved one)

Bonus Project: Self-Soothing Tool Box 

Fill a small box with anything that you can grab in a moment of stress to occupy your 5 senses.

This can include things like fidget toys, stress balls, mini plushies, small puzzles (25 pieces or so), a laundry sheet or perfume that calms you, a print out of the lyrics to one of your favorite songs, photos of loved ones, a Box Breathing guide, post-it notes with helpful affirmations, and even sour candies or mints.

The goal here is to have a go-to collection of self-soothing assistants so you're not searching and struggling in the midst of your distress.

*More DBT Skill guides here*