Happy Emotional Independence Day: Let's start today!

How to gain emotional independence – 3 simple ways to start today OR Happy Emotional Independence: Let's start today!

Do you feel like you’re consistently putting out fires for your loved ones? Or maybe you’re on the other side, and your loved ones seem like they’re always putting out your fires. When we don’t know how to regulate our own emotions it can seem like we are unintentional arsonists in need of a firefighter (supportive loved one) to redeem us. When our firefighters come to our rescue, we may feel reassured or validated. They make us feel like we aren’t crazy, and our emotions are valid. They cool us down and might even do damage control for us while we bask in their comfort.

Now, you might be reading this and think, “Yes! [insert loved one’s name] is my firefighter, and I’m so happy I have them in my life.” And I’d agree with you; it’s helpful to have supportive firefighters when we are going through life stressors. However, if you are an "unintentional arsonist" who feels like they consistently set fires, your firefighters may become burnt out if we do not know how to put out our own fires or prevent them from starting. In addition, our firefighters occasionally have their own fires to put out, which may prevent them from putting out yours. When we don’t have the skills to regulate our own emotions, it can lead to various problems in our relationship and possibly exacerbate our fires.

If this sounds like you, it might be time to gain some emotional independence and learn how to be your own firefighter. Emotional independence is the ability to manage your own emotions without the need for others’ approval, attention, or validation. Before you continue reading, it is important to pause and reflect on what emotional independence means to you. Is this important to you? Are you exhausted from not knowing how to put out your fires? We are laying down our matches and picking up our coping tools. Below are three simple ways we can practice emotional independence today:

1. Incorporating mindfulness into your day

What is mindfulness?

Mindfulness is being aware of what is happening inside you, such as your thoughts, emotions, and body sensations, as well as your surroundings.

Why do we care?

Mindfulness allows us to observe our internal and external processes without reacting to them. Have you ever done a behavior and instantly regretted it? You might have even explained yourself to someone saying, “I don’t know what I was thinking.” Often when we feel strong emotions, we might not notice our urge to do a behavior, and we just do it. Mindfulness slows this process down so we can notice our emotions and our action urge, which will help us gain control of our emotions so that we do not do a behavior that we might regret.

How do we do it?

Mindfulness is like a muscle that needs to be strengthened by LOTS of practice. This may look like doing one task at a time, such as watching your favorite TV show and only paying attention to the episode. When a thought arises about a previous episode, you notice it and redirect your attention back to the show. It can also look like noticing your own judgments (both good and bad) while watching the show. You may notice body sensations while watching the show and simply observe them before returning your attention to the show. If you are consistently redirecting your attention back to the activity, you are practicing mindfulness.

2.Challenge your thoughts

What is a thought?

Our thoughts are simply sensations bouncing around in our minds. They are not facts, no matter how loud they sound, how long they stay, or how frequently they come. I like to think of our thoughts as guests. You get to choose how long they stay and how you interact with them.

Why do we care?

When we treat our thoughts as facts, it can lead to emotional suffering and possibly regrettable behavior. Agreeing with our thoughts can often lead to a self-fulfilling prophecy. Have you ever thought that someone did not like you, so then you acted disinterested in them? And because you acted disinterested, they probably started to not like you. That is a self-fulfilling prophecy. Maybe they didn’t like you to begin with, or maybe your thoughts just led you to believe that, so you made it come true with your behaviors.

How do we do it?

When we challenge our thoughts, we counteract them by formulating our own thoughts. This may include logically arguing against your thought, checking the facts on your thought by looking at the evidence for/against it, doing the exact opposite of what your thought wants you to do to see if it’s true (i.e., thinking that if you don’t wear makeup, then your crush won’t like you anymore so you don’t wear makeup), or coping ahead with the imagined negative consequence (i.e., afraid to get fired from your job so you imagine what you would do to cope with getting fired).

3.Practice self-validation

What is self-validation?

Self-validation is when you find the kernel of truth in the situation you face and tell yourself that your emotions, thoughts, or behaviors make sense. It is NOT giving approval, encouragement, or compliments.

Why do we care?

When we self-validate, it lowers our emotional arousal so that problem-solving is possible. It also alleviates some pressure on our firefighters for needing them to validate us when we are upset.

How do we do it?

When you self-validate, make sure that you are only validating the valid and not the invalid. For example, if I yelled at my friend for forgetting to pick me up, I might validate my frustration, disappointment, or urge to yell. I would not validate the behavior of yelling. Self-validation may also look like acknowledging your emotions in the present without trying to avoid or push them away. For example, if I am frustrated about my friend forgetting to pick me up, then I would say, “I’m really frustrated right now” and sit in that frustration rather than telling myself “I shouldn’t be upset.”

Linehan, M., M., (2015). DBT Training Manual. New York, NY: The Guilford Press.

How to Achieve More Balanced Sleep

Many people struggle with sleep. Whether it’s falling asleep, staying asleep, or getting enough sleep it is extremely frustrating since it is partly out of your control. Good news- there actually is a lot in your control to improve your sleep.

 

  1. Stick to a bedtime and wake-up routine. While it’s understandable to want to stay up late and sleep in on weekends, try not to get too far off schedule. It’s a myth that we can “catch up” on sleep the next night. To get better sleep we need to have a better routine. It’s easy to get distracted by the activities we are doing and accidentally stay up later than we intended. To help with this, try setting an alarm on your phone 60 minutes before you want to sleep. This will be a cue to stop and start getting ready for bed as intended. Your bedtime routine can include a relaxing activity to help wind down for the night. This can be a mindfulness activity, reading, light stretching, taking a warm bath, or drawing. If you’re consistently going to sleep around the same time, it will be easier to wake up at the same time.

 

  1. If you wake up at a certain time in the middle of the night consistently, set an alarm for a few minutes beforehand and then see if there is a particular noise that is waking you up. I’ve been woken up to printers and robot vacuums turning on and then learned they were accidentally preprogrammed to turn on in the middle of the night! Once we know what it is we can problem-solve and reset those devices!

 

  1. If you wake up frequently in the middle of the night make sure you aren’t being productive- avoid work, laundry, meal preparations, etc. Although this may be tempting, it can accidentally train you to get up to tackle your to-do list!

 

  1. What to avoid right before bed: Heavy meals, drinking too many liquids, caffeine, nicotine, exercising, TV, or other screens. Note: Phones and smaller devices are even worse than TV because the screen is closer to your face. Also, it’s a myth that alcohol helps with sleep. While some people may report it helps them fall asleep, alcohol will decrease the quality of your sleep and prompt you to wake up earlier.

 

  1. More things to avoid:

 

  1. If you struggle to stop worrying and can’t fall asleep, it is recommended to leave your bed. Remember we are trying to only associate bed with sleep, not worrying. When you get up, assess if you’re hungry, and if so, have a light snack. Otherwise, try a relaxing activity, such as having a cup of decaffeinated tea, reading a book, listening to a podcast or music, or drawing. These are similar activities to help wind down before bed. Do the activity for about 30-60 minutes and then try falling asleep. Keep doing this until you can fall asleep.

 

  1. Lastly, avoid worrying about how bad the next day will be! We tend to think about how terrible the next day will be if we get poor sleep. We imagine doing horribly at our job or on a test or being so incapable of doing what we need to do. Unbalanced sleep increases our vulnerability ANDyou’ve survived every “next day.” We may not be performing at our best, we may need to be more compassionate with ourselves, and we will likely do just fine the next day.

 

Sleep difficulties can be very frustrating. I hope these tips help you get more restful sleep. For additional help, contact a mental health professional who specializes in insomnia.

 

Sources:

Cognitive behavioral therapy for insomnia (CBTI). Stanford Health Care. (2017, September 12). https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia.html

Rathus, J. H., & Miller, A. L. (2015). DBT®skills manual for adolescents. Guilford Press.

 

How to Self Validate

how to self validate infographic

What is validation?

Validation is the recognition that another person’s experience (or our own) makes sense, is logical, fits the facts, and is reasonable. We can validate actions or internal experiences like feelings, thoughts, opinions, desires, and beliefs. Validation makes us feel heard and understood, which not only can provide us with reassurance, but also helps to regulate our emotions. A validating statement could be as simple as someone saying, “It makes sense that you feel that way”, or “I would have totally reacted in the same manner”. It’s someone offering us a blanket when we are shivering cold and it’s also someone listening attentively when sharing a personal story.

What is invalidation?

Invalidation is just the opposite. It is the dismissal, rejection, disapproval, or disbelief of another person’s experience. It is when someone communicates either directly or indirectly that our actions or internal experiences do not make sense. Invalidation can be communicated through someone’s words (e.g. “You’re overreacting! You don’t need to worry so much.”); through body language (e.g. eye rolling, scoffing); or through actions (e.g. interrupting or changing the subject).

Whereas validation provides us with a sense of safety and helps to regulate our emotional responses, invalidation can have the opposite effect. Validation makes our experience seem acceptable and therefore makes US seem acceptable. Similarly, when feeling invalidated, we can sometimes generalize the invalidating experience to mean that we as people, not just the pieces of us being invalidated, are not acceptable. In response, we could feel a host of unpleasant emotions and negative self-judgments (or judgments towards the person who invalidated us). Both put us at risk for unskillful behavior.

Coping with Invalidation through the Power of Self-Validation

Self-validation is necessary for everyone and is of utmost importance for those of us that have been subject to invalidating experiences repeatedly. It is a helpful coping strategy to combat the effects of invalidation, but also an extremely useful tool in response to general life stressors and challenging emotions. If the invalidating person in your life is yourself, listen carefully😉

Before getting into the steps of how to self-validate, first let’s talk about the why. Studies have demonstrated that validation produces the following benefits: Lowered emotional arousal, improved emotion regulation and increases in positive affect. Additionally, applying self-validation (and reducing self-invalidation) will result in increases in positive self image.

Ways to Self Validate

  1. Pay Attention to YOU

When experiencing invalidation, take pause. Give your emotions your full attention. Notice what you are feeling even if you don’t know what it is and even if it is unpleasant. Being validated by someone else often starts with them giving us their full attention. When we are ignored, we feel worse. The same applies to the self. Ignoring your own experience or minimizing it as unimportant is going to do the same. Paying attention is simply taking stalk of what is going on for you. It is giving yourself the time of day. It is approaching your experience with openness and interest.

  1. Describe your experience without judging it

This involves putting words to your experience. Remember, by “experience” we mean emotions, thoughts, physical sensations, and actions. This could be saying to yourself, “I am feeling sad” or, “I am having the thought that I didn’t do so well on that presentation”, or “I am experiencing tightness in my chest and an urge to cry”. We don’t need to know what we are feeling or even have a clear articulation of our thoughts to do this. It can also look like “I don’t know what I am feeling right now but I am know it is a lot”. What’s really neat about this step is that the simple act of observing and describing our feelings can actually serve to regulate our emotions! It provides with just enough distance from our experience to help regulate our responses as well.

  1. Tune in

Ask yourself, “What might my emotions be trying to communicate to me?” Get curious about what your emotions might be trying to tell you about what you need. If you were feeling sad, perhaps crying, and someone offered you a hug, that would be validating right? This step is similar. Your tears communicated to someone that you were sad and in need of soothing. What can you do to honor your emotions that would have a similar effect? Self-validation could look like drawing yourself a warm bath or tucking yourself into your favorite blanket. And it could also include offering yourself a kind, encouraging statement.

  1. Acknowledge the causes

Ask yourself, “What makes sense about my emotions, thoughts, or actions based on what I know about myself and my history?” It is important to consider our experience within the context of our entire life and our learning history. For example, if as a child I struggled with homework tasks and was frequently punished because of it, it would make sense that I feel a surge of emotions when my therapist assigns me “homework” at the end of a session. Perhaps I feel a strong urge to avoid the task due to this negative association. I can acknowledge that fear makes sense given my negative experiences attached to homework (while also recognizing how the current situation is different).

  1. Normalize your experience

Highlight for yourself that any person in your situation would think or feel or behave similarly. You are not alone in your responses. Stand up for yourself and the validity of your experience, even in the face of invalidation. For example, let’s say you had a vacation booked for April 2nd, 2020. You are planning on going to a place you have always dreamed of. You saved your money, you banked your vacation time, you spent weeks, maybe even months, planning this trip. But, uh oh, COVID happened. Naturally, you are incredibly disappointed that your vacation plans have been cancelled. You may have the thought, “I don’t deserve to feel sad or angry about this [invalidation] because there are people going through worse things in the world”. Yes, there are people suffering AND, yes, you are entitled to feel disappointed. Both can be true. Any person would feel disappointed if they were looking forward to something so intensely and that something was taken away from them.

  1. Treat yourself with respect

Talk to yourself the way you would a loved one. Treat yourself the way you would treat anyone else going through a similar experience. In this step, you are validating the person as whole, not just your experience. As mentioned, invalidation can make us as a person feel invalid. The inverse is true of validation: Validating our experience is going to increase our own sense of personal validity. This might be in direct contrast to how you feel or have been treated by others who consistently invalidated you, which is also why this last step is essential towards healing. If you are feeling stuck, consider what you might tell a loved one going through something similar and then send that message right back to you. The rules are not different for you – you are just as deserving as this validating message.

Disclaimer: Self-validation takes patience, practice and may involve acting opposite of your emotion urges. If it feels uncomfortable to do, perhaps you can start by simply validating what makes sense about your discomfort around self validation! (E.g. “It makes sense that I would feel uncomfortable with self-validation as I’m not used to doing it”.)

 

Fruzzetti, A., & Ruork, A. (2018). Validation Principles and Practices in Dialectical Behavior Therapy of a single chapter of a title in Oxford Handbooks Online for personal use (for details see Privacy Policy). Validation Principles and Practices in Dialectical Behavior Therapy Oxford Handbooks Online. https://doi.org/10.1093/oxfordhb/9780198758723.013.50

Linehan, M. M. (2015). Dbt skills training manual. Guilford Publications.

‌Linehan, M. (2015). DBT Skills Training Handouts and Worksheets (2nd ed.). The Guilford Press.

 

Opposite Action

Be honest - have you ever felt overwhelmed with a task, so much so that you put it off for days, or weeks, or even months? Lately, I have been thinking about avoidance and its effect on people.

When we avoid something, such as doing our laundry, cleaning the dishes, or generally taking care of ourselves and our commitments, we give ourselves temporary relief. And when I say temporary, I mean it. Later on, the task feels even more overwhelming than it did when we first noticed it. What's the common denominator here? Emotions. 


In DBT we teach a skill called Opposite Action as part of our Emotion Regulation module. Opposite Action is a skill that helps us to make effective changes by activating the opposite of our current mood-dependent urges. I love using this skill when I “feel stuck.” One example is when the emotion name is anxiety and the ineffective urge is to avoid. 

Opposite Action asks us to face avoidance by identify it as an action urge in response to fear and/or anxiety. It then asks us to question, “Is my urge to avoid going to help me reach my long-term goal and be effective?” If the answer is “no,” we do the opposite and we approach instead of avoid. Our bodies and minds may be sending us the message that we should keep away from the thing we are putting off. This is why DBT teaches us to act opposite fully, meaning all the way! This means applying the skill using your mind, body and soul, such as the statement “fake it till you make it.” This will interrupt the pattern of mood-dependent behavior and make room for new neural pathways to develop.

For some it may be more difficult to use Opposite Action with emotions like sadness and fear. Sadness and fear are two emotions that often urge us to act in ways that keep us feeling stuck. When we feel depressed, we may have urges to isolate, hide, stay still and essentially do nothing. 

In this case, we can use Opposite Action to break down our task into small, bite-sized pieces, which will make it easier to start. The first step is always the hardest. Imagine getting out of bed as your task: Opening your eyes, sitting up, taking the covers off of you, shifting your body to the side of the bed, dangling your feet off the side of the bed, putting your feet on the ground, and standing up! Sometimes we may notice judgmental thoughts trying to sabotage us from using Opposite Action, such as “This is stupid” or “This should be easy.” Remind yourself that little steps lead to big steps. 

Using Opposite Action can make a big difference in our daily lives. Remember to thoroughly identify what emotion you are experiencing, what it is urging you to do, and if that action will be effective. If it is not effective, whole-heartedly throw yourself in the other direction! I highly recommend trying this in the face of ineffective urges.  As one of my therapist friends says to me, “Something is better than nothing! You can do it!”

2024 calls for more Willing hands + Half-smiling

We often think about what we might change when considering our New Years Resolutions. How can I improve? What can I work harder on? How can I further myself? What do I need to change about myself so that I can then accept myself?

While change is important, and while we can always “do better, try harder, and be more motivated to change,” per Marsha Linehan’s DBT assumptions, for some of us a far more underdeveloped skill set is that of acceptance.

If you have found yourself geared towards change-based resolutions in past years, I encourage you to bulk up on your acceptance-based practices in 2024.

Accepting what is out of our control, accepting what “is,” and accepting what we cannot change in this moment are valuable tools, that when practiced can improve our quality of life tremendously by reducing our suffering.

We can practice acceptance with our mind, body, and soul. To jump start your practice, I will offer two DBT reality acceptance skills that begin with the body.

Have you ever noticed that when you are fighting your reality, your body is tight, tense, and unrelaxed? You may feel like you are bracing yourself for some threat that may never come.

We can reduce our suffering by communicating to our mind that our body is safe through two simple exercises: Willing hands and half-smiling.

Willing hands is a practice that involves uncrossing our arms, unclenching our fists, and opening our palms. We can even face our palms up to the sky in a relaxed way. This posture is the opposite of a defensive, cross-armed, or clenched posture and communicates that we are receiving whatever may come. We resist resisting and open ourselves up to our reality. This skill can be adapted to sitting, standing, and seated postures. Prompting events for this skill might include feeling anxious on the subway, feeling angered at the dinner table, or when receiving a disturbing message from a friend.

The second skill is called Half-smiling. Similar in theme, this change in body involves first relaxing the muscles of the face and then slightly curving the corners of the lips upward into a “half smile.” This communicates to our brain that we are calm and relaxed. Prompting events for this skill might include when feeling frustrated completing a task for work, while holding a difficult yoga posture, or when you notice you are ruminating while walking down the street.

To watch Marsha Linehan herself teach Willing Hands check out her demonstration.

 

Understanding DBT and its Trauma Adaptations

Dialectical Behavioral Therapy (DBT) was originally created by Dr. Marsha Linehan to treat Borderline Personality Disorder. In recent years, DBT has increasingly been found to be effective for any person struggling with up and down, difficult to manage emotions (what’s formally been called emotion dysregulation). Those experiencing such emotional tumult can often struggle with lashing out at loved ones, making impulsive decisions, substance abuse, suicide and/or self-harm behaviors.

Research has shown that many of these kinds of clients who seek DBT likely also have trauma histories and may meet criteria for a PTSD diagnosis (66% of those with PTSD have two or more additional mental health disorders, and 30% attempt suicide (1, 2)). There are growing theories that emotion dysregulation is often fueled by previous traumas. What’s more likely to inspire painful feelings and high distress than traumatic triggers? DBT is greatly beneficial for those learning new ways to manage their emotions and engage with the world; however, the standard protocol does not target trauma, and in fact discussing trauma is explicitly avoided in Stage One of the treatment (when clients are struggling with severe, life-threatening behaviors).

Two major treatments have been developed to address PTSD within the DBT framework: DBT-PE and DBT-PTSD. To help understand the differences between the two treatments (with such similar acronyms), here is a brief guide:

DBT-Prolonged Exposure (PE)

Stabilization has been a necessary precursor to beginning trauma work in the field of mental health treatment. Essentially, this means that clients must be able to experience emotional difficulty without engaging in destructive behaviors before diving into past traumas. DBT-PE, instead, attempts to rework that timeline by requiring a shorter period of stabilization (two-months of no self-harm or suicidal behaviors), and then allows clients to begin trauma work. This puts clients on the fast track towards reducing the impact of trauma, while still spending time honing their DBT skills.

Developed by Dr. Melanie Harned, the DBT-PE protocol follows much of the same aspects of comprehensive DBT (individual sessions with diary cards and behavioral chain analyses, skills group, skills-based phone coaching, and consultation team). The addition of Prolonged Exposure (PE), originally created by Dr. Edna Foa, aims to reduce symptoms of PTSD by repeatedly revisiting traumatic memories and experiences related to past traumas (such as visiting certain places or performing certain acts) over and over again until they no longer cause high distress. Think of watching a scary movie once as compared to watching it a thousand times.

DBT-PE has drawbacks for those who cannot achieve the stabilization requirements or for those who cannot afford potentially three therapy sessions a week. Additionally, this treatment has exclusions for clients who have severe dissociation (the experience of life seeming off, distant or unreal as distress rises), current psychosis, or active substance dependence. Additionally, a decent amount of outside homework is required for clients enrolling in DBT-PE treatment.

That being said, for those who can receive the treatment, research has found that DBT-PE is highly effective. It doesn’t increase safety risks, clients in DBT-PE are found to have more than double the reduction in self-harm and suicide as compared to those in standard DBT, and 60% of clients no longer meet criteria for PTSD upon completion of the treatment. Additionally, clients also benefit from getting the entire gamut of DBT skills by attending skills group and focusing on skills application for at least part of their individual sessions.

DBT-PTSD

DBT-PTSD, created by Dr. Martin Bohus, was specifically designed for adult clients with Complex PTSD (C-PTSD) who are victims of childhood sexual and/or physical abuse. (C-PTSD is a diagnosis currently only recognized in the ICD 10 and is for people who struggle with all the features of PTSD, while also endorsing symptoms of emotion dysregulation, disturbed relationships and a negative self-concept.) There is current debate in the field about the difference between C-PTSD and BPD, or whether they’re one in the same. The rationale for the treatment is that a client’s dysfunctional behaviors in DBT are functionally related to post traumatic stress, as clients may self-harm, become suicidal, dissociate, or abuse substances in order to temporarily reduce the distress tied to traumatic triggers (like someone cutting to calm down after remembering a previous assault). Essentially, the theory behind DBT-PTSD is that in order to truly reduce such severe behaviors, one must target the trauma as quickly as possible.

The old school rule of stabilization gets thrown out the window in DBT-PTSD. Dr. Bohus’s research found that exposure-based treatment to trauma can be administered to clients currently struggling with suicidal and self-injurious behaviors, substance use, disordered eating, and highly dissociative features, without increasing their risk (3, 4). This research is core to the treatment, as it does not follow the typical protocol of comprehensive DBT and instead adds features of DBT (as well as elements of ACT and cognitive therapy) into exposure-based trauma work. Skills group is not required in the treatment and instead, clients are asked to engage in daily skills practice and homework completion. Additionally, phone coaching only is used for severe behaviors, while the DBT consultation team remains the same as in standard DBT.

Because this approach focuses on targeting trauma, one potential drawback is that clients’ skills acquisition and generalization possibly lag behind those who commit to standard DBT or DBT-PE.

A major trial found that DBT-PTSD, as compared to Cognitive Processing Therapy (another evidence-based treatment for trauma), resulted in a remission from PTSD in 80% of clients who completed the treatment. This was found to be a success rate 15% higher than clients who received CPT in the same study. With such high effectiveness, such minimal exclusion criteria, and the requirement of only one weekly session, DBT-PTSD is a potentially highly accessible treatment for clients struggling with pervasive emotion dysregulation (3).

Research is currently being conducted on DBT-PSTD’s efficacy for teens (reports from a recent training I attended are that initial findings show the treatment to be even more effective for adolescents than adults) as well as for those who have trauma histories outside of physical or sexual abuse.

Works Cited

  1. Harned, M. S., Korslund, K. E., Foa, E. B., & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: Development and preliminary evaluation of a Dialectical Behavior Therapy Prolonged Exposure protocol.
    Behaviour Research and Therapy, 50, 381-386.
  2. Harned, M. S., Korslund, K. E., & Linehan, M. M. (2014). A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy, 55, 7-17.
  3. Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, Ludäscher P, Steil R, Fydrich T, Kuehner C, Resick PA, Stiglmayr C, Schmahl C, Priebe K. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial. JAMA Psychiatry. 2020 Dec 1;77(12):1235-1245. doi: 10.1001/jamapsychiatry.2020.2148. PMID: 32697288; PMCID: PMC7376475.
  4. Bohus M, Dyer AS, Priebe K, Krüger A, Kleindienst N, Schmahl C, Niedtfeld I, Steil R. Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: a randomised controlled trial. Psychother Psychosom. 2013;82(4):221-33. doi: 10.1159/000348451. Epub 2013 May 22. PMID: 23712109.

 

Reduce Anxiety with Gratitude this Holiday Season

a little gratitude goes a long way

Reduce Anxiety with Gratitude this Holiday Season

Have you ever had a thought that you could not get out of your head? Maybe you had one thought that led to hundreds of other thoughts. You might have tried to tell yourself a variation of, “ok, I need to stop thinking about this” which made those thoughts even louder. These ruminating thoughts are a symptom of anxiety. Anxiety can be thought of as the fear of a perceived threat and then underestimating our ability to handle that threat. When we keep on thinking of these worries by either spiraling or trying to suppress them, it can exacerbate our anxiety. Now, if thinking about your worries solves your problems then go for it and don’t let me stop you; however, if ruminating only causes you more suffering then bear with me. Ironically, sometimes when you stop worrying you might have a better shot at solving your problem and reducing anxiety.

So, let’s try to replace our worries with gratitude! Research suggests that our brain cannot hold anxiety and gratitude at the same time. This is because gratitude affects the same area of the brain, the limbic system, that regulates our emotions, so instead of being overwhelmed by anxiety, your limbic system becomes flooded with thankfulness. In doing this, you're not only preventing rumination, but you're also lowering your blood pressure, improving your immune system, promoting more efficient sleep, and creating a positive lens through which you see your life, which then makes you feel better.

Below are four, simple and easy ways to integrate gratitude into your day:

1. Mentally give thanks

a. If you don’t have time to write down what you’re grateful for or maybe you just don’t feel like it, mentally giving thanks is a great way to take your brain's attention away from your worry thoughts. You can utilize this practice when your mind starts to ruminate or as an everyday practice to promote positive thinking.

2. Writing thank you notes

a. Build your self-compassion and relationships by writing thank you notes to your loved ones and/or yourself. There is nothing too small or too big to say thank you for. Simply waking up this morning is something you can thank yourself for. To begin, try writing a thank you note once a month and gradually increasing your frequency.

3. Mindfulness

a. Mindfulness of breath involves intentional focus on the present moment, steering away from past and future moments, while taking a nonjudgmental stance. You can use mindfulness to focus on something you’re grateful for (i.e., Your friends, partner, family, car…etc.). It can be as short as a minute or as long as you’d like. I’d recommend you start off by doing it for a few minutes if you are not used to practicing mindfulness. Your mind will wander and once you are aware of this, remember to bring it back to gratitude.

4. Gratitude Journal

a. Set aside a regular time each day for writing down the things you're grateful for. This can also be done at night to reflect on things you're grateful for during the day. Studies have shown that writing one thing you’re grateful for and expanding the list from there enhances gratitude and positive thinking more so than creating a list of unrelated items.

 

Juneja, J.K. (2022). Gratitude and it's importance. International Journal of Health Sciences, 6(S2), 9721-9728. https://media.neliti.com/media/publications/430566-gratitude-and-its-importance-b249fae4.pdf

 

Reducing Your Emotional Vulnerability So You Can Fight Your Monsters This Halloween

Fight your monsters with abc please

Who are your monsters?

We all have our monsters and they don’t just come out on Halloween. Our monsters are our unwanted emotions that disrupt our lives sometimes. I don’t know about you all, but my spookiest monster’s fear and anger love to come out when I am tired or hungry. When I accidentally unleash them without regulating them, they can wreak havoc on my self-esteem, self-respect, and relationships while simultaneously summoning monsters out of my loved ones. Some of us experiencing chronic anxiety or depression, may feel like our monster is always out or maybe you even start to feel like you have become the monster. If that sounds like you, then it is even more important that you equip yourself with our kick-ass monster weapons also known as our ABC PLEASE skills, used for reducing emotional vulnerability. When you maintain these skills, it allows you to have a fighting chance against your monsters!

Before we start…yes you can do this and yes this will take hard work! Below are our ABC PLEASE skills broken down and explained:

SKILL 1: Accumulating Positive Emotions (in the short-term)

Think of this like you are building an emotional wall between you and your monsters through positive experiences, events, and valued behavior patterns. The reason that you want to build this wall is because we know that positive experiences in life summon our inner fairies (positive emotions) to come out. Without our fairies, our monsters get louder and hungrier which might resemble an emotional explosion like yelling or some of us just explode covertly, which might look like not expressing anything and instead “shutting down.”

How to build positive emotions NOW:

1. Do at least ONE pleasant thing a day that evokes your fairies (i.e., enjoyment, pleasure, serenity, calmness, love, joy, pride, or self-confidence).

a. Note: You can start off by making a list of activities that elicit positive emotions (ex. Cooking, listening to music, hanging out with friends…etc)

2. Use problem-solving skills when you have an inflexible schedule, financial strain, or many demands that might get in the way of you integrating positive experiences in your everyday life.

a. Note: Planning positive experiences in your schedule ahead of time can help make this less stressful in the moment.

3. Stick to your plan even when your monsters are out and you don’t feel like doing it.

a. Note: It can be really hard to summon your fairies when your monsters are creeping out and we know that summoning those fairies in those moments are that much more important.

SKILL 2: Build Mastery

When we are building mastery, we are strengthening our sense of competence and confidence so that we are less impacted by unwanted emotions when they try to creep in. The goal is to engage in activities that are difficult AND possible to achieve. If you engage in activities that are too easy or too difficult then you’ll give your monsters confidence rather than yourself.

How to build mastery NOW:

1. Do at least ONE activity a day to build a sense of accomplishment.

a. Note: This will look different for everyone. For me, cooking a new recipe makes me feel like I’m unstoppable.

2. Plan for Success, NOT failure.

a. Note: This is not a competition. It always feels better to raise your expectations because you aimed too low than to lower your expectations. For example, if exercising gives you a sense of accomplishment, then you might start off by walking on a treadmill for 30 minutes with an incline rather than running 5 miles.

3. Gradually Increase difficulty over time.

SKILL 3: Cope Ahead

Although we might be shocked when we accidentally summon our monsters, sometimes we can anticipate them coming before the situation even occurs. When we are “coping ahead,” we are figuring out what situations are likely to summon our unwanted emotions or cause a problem and then planning ahead for how to effectively cope with expected difficulties.

How to cope ahead:

1. Describe a problem situation that you are worried about coping with well (emotions? urges?)

a. Example: Talking with your partner about saving money - emotions that come up might be fear and anger; urges might be yelling or shutting down.

2. Decide what coping or problem-solving skills you want to use in the situation. Be specific.

a. Note: You can google “DBT skills” or look at past blog posts for ideas on what you might need. Reminder: DBT skills are divided into mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness skills.

3. Imagine yourself in the situation in your mind; in the present NOT in the future. Our brain does not know the difference when we imagine it in our brain versus when we do it in real life.

4. Rehearse in your mind what you would do to cope effectively (including thoughts, actions, and phrasing words with how will say it).

5. Practice relaxation after rehearsing.

6. REPEAT steps 3-5 until you feel comfortable to enter the situation in real life.

SKILL 4: PLEASE

Just like your body is an armor to protect all your organs inside of you, PLEASE skills protect you and your loved ones from your monsters. Therefore, when we don’t take care of our body, our monsters become hungrier and scarier with little protection to contain them. These skills help us maintain our body’s health so that our monsters don’t grow stronger than us. Let’s set ourselves up for success! Below are the different factors our body needs us to maintain, so that we are less prone to distress and more prone to success:

1. Treating PhysicaL illness

a. Note: When we are sick, it is harder to contain our monsters so the healthier you are the better you can control your emotions.

2. Balance Eating

a. Note: The snickers commercial is right…well kinda. Eating foods that make us feel good as well as not eating too much or too little can give us more control over our monsters.

3. Avoid mood-Altering substances

a. Note: Alcohol and drugs can lower our resistance to unwanted emotions. Yes, that means caffeine too…however we are not perfect so let’s at least aim for moderation!

4. Balance Sleep

a. Note: Everyone’s sleep schedule is different; however, we want to aim for 7-9 hours a night and be consistent! No, you are NOT ok with less than 7 hours of sleep a night even if you think you are.

5. Get Exercise

a. Note: As much as it hurts me to say this….we have to exercise. When consistently done, aerobic exercise can serve as an antidepressant. Also, you can kill two birds with one stone as exercising may build mastery for you too. For those who feel triggered by the word “exercise,” consider the word “movement” instead and try stretching or a neighborhood walk.

 

Don’t let your monsters control you this Halloween and every day!

 

Debunking Sleep Myths Part II

debunking sleep myths part 2

How to Optimize Your Sleep

As promised, we could not leave you dark from our last blog post on sleep myths, and we are back with some tips and tricks to optimize sleep!

Thankfully, a significant amount of research has taken place to develop methods to enhance our ability to fall asleep and get the most out of catching some Z’s! This research is known as CBT-I or Cognitive Behavioral Therapy-Insomnia.

CBT-I is the most effective nonpharmacological treatment for chronic insomnia. In just a few sessions, it can produce lasting results that are equivalent to sleep medication, without the side effects and with less chance for relapse (Rossman, 2019).

There are five key components to CBT-I: Sleep Consolidation, Stimulus Control, Cognitive Restructuring, Sleep Hygiene, and Relaxation Techniques.

Sleep Consolidation

Sleep consolidation, also known as sleep restriction, brings us back to the first myth that we addressed, "If you’re having trouble falling asleep, stay in bed until you can." Oftentimes when people are having a hard time falling asleep, they lay awake waiting to get tired. This leaves them spending more time in bed awake than asleep, which can be counterproductive and super frustrating! Instead, it’s recommended that you don’t get into bed until you are feeling tired, so that by the time that you get into bed you can fall asleep and stay asleep. In short, the suggestion is don’t crawl in bed until you’re good and tired!

Stimulus Control

The next component of CBT-I is stimulus control. Experts stress that the bed should specifically be a place for sleep, and not used for reading, watching TV, talking on the phone, eating, drinking, or working. While it can be tempting to spend all day cozy in our beds, in order to get a great night’s sleep, it is important that our bed is not associated with anxiety and wakefulness or anything but rest!

Cognitive Restructuring

When we are having a hard time falling asleep, our minds can tend to spiral. You might think, "I should have fallen asleep two hours ago! If I don’t fall asleep soon, I’ll be a wreck tomorrow and never pass my exam." In order to change our sleep patterns, it’s important to change these thoughts into more positive ones, such as, "Even if it takes me longer to fall asleep tonight, I will still get through tomorrow."

Sleep Hygiene

Sleep hygiene refers to a set of guidelines that promote healthy sleep. These are often the guidelines that we hear about but might be more hesitant to enforce. These include: Go to bed at the same time each night and wake up at the same time each day; refrain from eating and drinking alcohol 2 to 3 hours before bed; avoid exposure to bright light 2 hours before bedtime; avoid caffeine in the afternoon and evening; decrease exposure to screens 1 to 2 hours before bed. While you might be reading through this list thinking, "what a pain! Do I have to?" you aren’t alone. However, changing these habits have been proven to be worth it when it comes to improving our sleep.

Relaxation Techniques

The last component is relaxation techniques that can be done before bed. These techniques include, but are not limited to, breathing exercises, mindfulness, meditation and more. Box breathing is a personal favorite. This involves repeating the pattern of breathing in for 4 seconds, holding for 4 seconds, breathing out for 4 seconds, and holding for 4 seconds.

Hopefully CBT-I has restored your faith in your future quality of sleep and has debunked the sleep myths we discussed in our prior post.

 

Source:

Robbins, R., Grandner, M. A., Buxton, O. M., Hale, L., Buysse, D. J., Knutson, K. L.,
Patel, S. R., Troxel, W. M., Youngstedt, S. D., Czeisler, C. A., & Jean-Louis, G. (2019). Sleep myths: an expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices. Sleep health, 5(4), 409–417. https://doi.org/10.1016/j.sleh.2019.02.002

Rossman J. (2019). Cognitive-Behavioral Therapy for Insomnia: An Effective and
Underutilized Treatment for Insomnia. American journal of lifestyle medicine, 13(6), 544–547. https://doi.org/10.1177/1559827619867677

 

Debunking Myths about Sleep!

Picture this: It’s an important night! You’ve got a big presentation tomorrow! You’re about to meet your in-laws for the first time! You’re traveling first thing in the morning! Whatever the scenario, all you want is to get a good night's sleep, but you’re wide-awake staring at the ceiling, counting sheep. Sound familiar?

It’s likely we’ve all gone through this demoralizing experience of lying in bed and listening to the clock tick, tick, tick at some point in our lives. 

Today we’re going to go over some strategies to improve our sleep, but before we dive into those, let’s address a few sleep myths first. 

Myth 1: If you’re having trouble falling asleep, stay in bed until you can 

While it can feel counterintuitive to get out of bed when you are trying to fall asleep, experts actually recommend it. This is because it’s important to associate your bed with sleep and lying in your bed all restless can do the exact opposite. Instead of lying in bed, twiddling your thumbs, and worrying about when the sand man will come to collect you, after about 20 minutes of trying to fall asleep, get out of bed and do something relaxing like read a book (Robbins et al., 2019). 

Myth 2: Your body gets used to lack of sleep

Maybe this happens to you on a regular basis, and you tell yourself it’s fine because your body gets used to the lack of sleep. As much as we may want this to be true, this is, in fact, also a myth. Persistent lack of sleep takes a toll on you and can hinder decision-making, memory, focus, and creativity. If you’re reading this thinking, “eh, it really doesn’t seem to be catching up with me,” you may be accumulating more serious health problems that you aren’t aware of (Robbins et al., 2019). 

Myth 3: Napping makes up for lack of nighttime sleep

 Now you might be thinking, “okay fine, my sleep isn’t great at night, but I can always just take a nap the next day to get that energy boost I need!” Sadly, this is another myth. This is because during a nap, you typically won’t go through all the stages of sleep to make up for quality sleep at night. Instead, napping can throw off your sleep schedule even more, and make it harder to fall asleep later (Robbins et al., 2019).  

Myth 4: Alcohol before bed improves sleep

Okay, so naps are a no go, but what about the glass or two of wine? Another myth! While alcohol might make us feel more relaxed and drowsy, it throws off our sleep cycles which worsens the quality of our sleep and makes it harder to get into REM. It can also worsen snoring and sleep apnea. Experts also warn against caffeine in the afternoon and evening (Robbins et al., 2019). 

Myth 5: How long you sleep is all that matters

 “But as long as I’m getting enough hours of sleep, I’ll be well-rested right?” Myth. It’s not actually all about the duration of sleep. Sleep quality is also critical. It’s important that our sleep is as continuous and uninterrupted as possible in order to hit all of the stages in the sleep cycle and get optimal rest and recovery (Robbins et al., 2019). 

 If you’re now feeling discouraged from all of these sleep myths, there is some positive news…Check out our upcoming post to learn tips and tricks for optimizing sleep!

 Source:

Robbins, R., Grandner, M. A., Buxton, O. M., Hale, L., Buysse, D. J., Knutson, K. L., 

Patel, S. R., Troxel, W. M., Youngstedt, S. D., Czeisler, C. A., & Jean-Louis, G. (2019). Sleep myths: an expert-led study to identify false beliefs about sleep that impinge upon population sleep health practices. Sleep health, 5(4), 409–417. https://doi.org/10.1016/j.sleh.2019.02.002