DBT tools

I am in the process of writing up some of the DBT worksheets I used. These are taken from this workbook and I have added some words of my own. I did this under the supervison of a trained DBT therapist. They are not a replacement for DBT and I do not claim this to be a subsitute for therapy, but they may be a helping hand.

I am not a DBT therapist, I am a patient. These sheets have an emphasis on problems with restricting type eating disorder behaviours but feel free to use them for whatever is useful to you.

 

DBT worksheet 5, ‘Accepts’

The first of the four distracting skills is ACCEPTS. This is an acronym to help you remember “Wise Mind AC C E P T S
Activities, contributions, comparisons, Opposite Emotions, Pushing away, Thoughts, Sensations
Distract with Activities:

Do hobbies, watch a video, go for a walk, cook, call a friend, go on the internet, read a magazine, draw. It doesn’t matter how ‘big’ or ‘small’ it is – an activity does not need to use loads of energy or mean leaving the house – it does not even need the help of another person if you do not want it to – of course, something like ‘shopping with a friend’ would also be a good Activity but it is no more valid than picking up a pen and drawing or reading a book that was a childhood favourite.

Try not to apply a judgement to the activity you choose but been mindful of the reasons – if you feel very sad and your chosen activity is ‘go and watch a moive’ make sure that the content is appropriate and not triggering – if you are fighting eating disordered thoughts is going for a run an activity chosen by your disorder and not you? Be aware but do not fall into self hate.

What other activities can you think of that you can get involved in and distract yourself from your distress? Make a list of your activities and put it up your mirror, in your purse or journal so you revisit it often.

Distract with Contributing:

Contribute. Doing something for someone else can make you feel good. Try not to judge yourself – it needs not be a grand gesture.

Some ideas – make a cup of tea for your Mum, offer to read a story to a sibling, write an email to a friend, make a craft, quirky card, clean a bathroom, brush a pet On a larger scale you could apply to volunteer or babysit for a friend with small children (or even pets!)

The idea is to take your mind off emotional stimuli and notice the ‘feel good factor’ of interacting but as with activities, a cup of tea is not less worthy or ‘good’ than a volunteer post. Stretch yourself while being mindful of your limits and emotional mind.

 What have you done this week to contribute? What can you do next week to contribute? Plan something in advance. This takes you away from your pain and puts your attention on your concern for someone else.

Distract with Comparisons:

Compare yourself to people coping the same as or less well than you. If you are doing better than you were a year or two or five years ago, make that comparison. The manual suggests that you compare yourself to others’ suffering, watch weepy soap operas, read about disasters. Some people find this helpful, others don’t. Just do what works for you.

The idea with this skill is to make yourself aware of your own strengths, do you do anything now that you could not do before when you were in the grips of your illness?

What do you think about comparisons? If it does not help to make comparisons to other people avoid this but do be willing to congratulate yourself on your own progress – progress can be measured by making your own mindful comparisons.

Distract with Opposite Emotions

Read emotional books, go to emotional movies, listen to emotional music. For this to work, you need to read or watch or listen to things that have an emotion opposite to one you are feeling. If you are sad, watch a comedy. Watch a scary movie. Listen to silly music. I think that the reason this works is that it kind of jars your feelings loose.  If you are sad or angry, watch a silly or funny movie, and end up laughing, you have changed your emotion and put yourself in a different place.

Do you have a comedy clip you could save on you tube? Is there a friend who always, always makes you laugh? Try to make a file of things that make you smile. If you are angry a bath with oils may help or having a long hug with someone willing and able.

Emotions are valid but at times they become overwhelming – if you cannot function as you usually do because you are so sad or so angry or anxious then you need to use Opposite Emotions. In the case of eating disorders the ED often ‘grabs’ your emotions and places one at the forefront (eg: regret for having eaten) this is where it may be a good idea to go and find that file with a funny comedy in it – this emotion needs to be ‘rewired’ so using opposite emotions will help here.

Can you think of emotions or situations where it would help to do the opposite? Do you fall into the same patterns of thought and behaviour again and again?

Distract by Pushing Away 

a distressing situation by leaving it mentally for awhile.

Build an imaginary wall between yourself and the situation.  Imagine yourself pushing it away with all your strength. This is about keeping yourself safe and dealing with emotional stimuli in a safe and appropriate environment. If something upsets you it may be dangerous to you to break down straight way, it is okay to ignore it to make sure old, negative behaviours (restricting food, controlling weight, self harm) do not occur and that the situation is only dealt with in the company of aid.

It is more than okay to not be able to do things alone. It is okay to be emotionally vulnerable. It is okay to push things away, emotions do not need all of your attention all of the time.

Block the situation in your mind. Each time it comes up, tell it to go away, or put some other thoughts in its place, perhaps some more pleasant thoughts. Refuse to think about it. Try putting the pain on a shelf, or in a box, to contain it and get it out of the way. I use the technique of putting my distress in a locked box on a shelf in a closet. I can get it later, but right now I can let it go.

All of these are techniques to give you a break from dealing with the pain all the time. They haven’t resolved the painful situation, but they have put it away for awhile so that you get a break and a chance to live some part of your life without it.

An example could be thinking about past events over and over, replaying a conversation or a situation. Imagine a bin or a box or a wall, whatever works for you – and throw it in, close the lid or brick it up. Imagine a strong hand pushing the situation away, shake free of it and carry on. Do all you can to ignore it until you are in a better place to deal with it. DO bring the situation that is hurting up with a therapist or a close friend/family member but try to push it away until you are in a safe place- only let the bucket tip when there is someone to help you clear up the mess.

Is there one image that connects with you? Would it help you to draw it? Write it? (a wall, a box, a barbed fence) ..or can you close your eye and imagine it well enough?

Distract with other 
Thoughts

Some examples are counting to 10 or counting the tiles in a floor or the panes in a window or the stars in the sky, anything to keep your focus on the counting.  This is a good one to use in a sudden emergency, when you need to pull something out of your bag of tricks really quickly. Other ways of distracting with thoughts are reading, watching videos or movies, doing crossword puzzles or jigsaw puzzles, writing poetry, if you can keep your thoughts away from your pain. 

The simple things are the best here. List the alphabet then do it backwards, then think of a girl’s name for every letter. The internet can help as long as you are busy and occupied, if you feel your thoughts drifting to something that is causing you emotional pain change the ‘thought’ activity.

Can you think of some other ways of distracting with thoughts?


Distract with other Sensations.

You might hold ice in your hand or apply it to the back of your neck (I used to use a bag of frozen peas against the back of my neck – the sensation was kind of shocking, and it shook me out of my tangled up distressing feelings), put a rubber band on your wrist and snap it, listen to loud music, take a hot, hard shower, a cold, hard shower, or swim in very cold water. Any strong physical stimulus like this can kind of jog loose your connection to your pain and distract you from it.

This works if things are becoming very overwhelming and you feel in danger of self harm or a panic attack. It may take a while to experiment and work out what works for you. Use this to stop from engaging in harmful behaviors and attempt to sandwich it with other skills that will help you feel better. 

________________________________________________________________

DBT Skills worksheet 6

IMPOROVE the moment

  • Imagery (e.g. create an imaginary “safe place”)
  • find Meaning in the crisis
  • Prayer
  • Relaxation
  • One thing at a time
  • Vacation (take some time out)
  • Encouragement (talk to yourself in an encouraging way)

 Okay, so..Improve the moment. The ‘moment’ you in right now kind sucky? This is another crisis skill meaning it is meant to help you through a crisis..not deal with day to day life. When you are feeling like a binge/self harming/restricting/acting on a negative impulse use these to calm things down and get back on tract. It isn’t a life skill, because you cannot micromanage your life – but be aware of your triggers and insert ‘improve’ when you need to.

I is for..Imagery

– can you picture a safe place? What helps you? Imagine a fort of duvets, comfy things…hone in on this image, make it real with colours. Pay attention to the imaginary detail. If, right now you are somewhere you do not want to be, picture yourself in your safe place.

A river of running water may calm you – or you may want to be in a room with a loved one, or a party full of friends. It doesn’t matter what it is to you as long as it is safe. Try and use the same imaginary place time and time again. Imagine a shortcut on the desktop in your head, a distress button.

Breathe deeply while you are thinking of this. If it helps, write down a long description in your journal or on a note card you can keep handy in your bag.

It may be useful if you share the details of this place with a loved on or a therapist, someone who can ‘jog’ you into going there when you are in crisis – but do not let them know all the details – keep some parts secret in your mind so that no one else can cross into your fortress of safety. This is just for you, enjoy it.

If you are having flashbacks and want to use imagery but the safe place is just not quite enough….

Imagine yourself encased in a protective bubble. Choose a colour you like and imagine it encasing you.   Imagine yourself shrinking the images and memories that come into your head and then picking them up and putting them in a tiny box & burning it or in a bottle.  Try and alter the memory….a persons face is particullay sharp in the flashbaxk? Try and give them a comedy beard or change the colour of their eyes..make it funny. Play around with the speed of your flashback..make it go superfast.

It isn’t about getting RID of the horrible memory but about altering it so you can cope with it.

Are you scared of the future and thinking about alol the negative things that could happen?

Play the ‘postive what if’ game..escape. What if you won the lottery? What would your dream house look like? What award would you love to win?

It doesn’t matter if it is not practical, it is about making yourself more comfortable with that place in your head. Daydreaming and inventing is a useful skill that does not only belong in childhood. Be kind to yourself.

Imagine you are a superhero – what would you do? What would your powers be? What would you wear?

 M is for…Meaning

Finding meaning in the crisis

Okay, this one can be hard. I can feel the scepticism. Meaning? In bad stuff? Pffffft, er, no!

Remember that by trying to find positive things about our distress, we are not denying that things are bad, or trying to say that distressing things are not distressing. We are trying to Improve the Moment, to find some things that help us feel better in the moment.

What do you believe about suffering?  Does it have a meaning? A purpose?

Here are some day to day examples –  Are you seeing something more clearly? Have you learned something? Has this brought you closer to anyone or finally ended a toxic relationship? Has this encouraged you to use your DBT Skills more?

You can use Historical examples if it helps you too – suffering alters human behaviour and often promotes change, can you think of a historical event where this is true?

Even if you can list twenty thousand negatives to the situation you are currently in try and find one positive.

P..is for prayer

Prayer is not just a tool for religion. If you do believe in a higher power then pray in whichever way is comfortable for you but if not, prayer is not exclusively for those who have a religious faith.

Which kind of prayer brings you an emotional release? A ‘why me’ prayer? A ‘please help me, I need help’ prayer, An ‘acceptance prayer;’ ask for the courage & peace to accept and acknowledge what is.  Try all three – do any create the emotional release you are seeking?

Close your eyes and think about what you ate thankful for or grateful for, it could be relationships, a person, a pet or even thanks for the supermarket selling your favourite brand of ice cream.

List and reflect on things that you want to give thanks for, they can be as big or small as you like. Try and gather strength from the positivity.

If you like send or reflect on a message of help..but see where your mind wonders and then settles on any concrete image of something positive that could help you.

R..is for relax

It is hard to relax, but it is proven that if you do you will be able to focus more clearly on the issues at hand and are less likely to deal with them using a negative coping mechanism.

Breathe. It is an automatic reflex but paying attention to it and breathing deep and slow can really help soothe during an emotional crisis. Count to ten, count your breathing, in and out. Try abdominal breathing

Try some other self soothe ideas, prehaps looking at calming images will help? 

Again, try not to judge yourself – find what works for you. 

O is for… One thing at a time

This is similar to other skills where you look at the ‘present’ and work on mindfulness. Try to slow your thoughts..just focus on now. 

Be present “NOW”.  Being in the “now” allows you to let go of anger, shame, worry…
Use grounding skills when distressed – here are some examples of possible grounding skills that may help you – 

  •  Sing a song & stay with each note & word, do not judge your voice but just let yourself sing and be lost in the process of thinking..use ‘pushing away’ from the ‘accept’ skills to loose any judgement thoughts.
  • Memorize something important to you – song lyrics, a key texts, a  funny poems, it can be anything but try to really focus on it. 
  • Count all the squares, triangles, rectangles, circles within your vision.
  • Count all the red, blue, yellow, green, orange, brown, black, purple items you can see.
  •  Choose a random object, like a paperclip, and try to list 20-30 possible/crazy uses for it.
  •     Sit and listen to “now”. What noises can you hear? List them. 

V is for…Vacation 

I know, horrible and very american isn’t it? But they had to make all the letters fit somehowEver wished you were far, far away or could just jump on a plane?

A vacation is a mini break from responsibilities. Do you have a uni paper you need to write that is really stressing you out? A deadline to meet? Something you really need to do but can’t face? 

Take a vacation from it. 

Set an alarm for ten- fifteen minuites time. 

In that time space do something that will make you feel good – watch a kids cartoon, have a sit down and shut your eyes, paint your nails, read a trashy magazine, do something that helps you ‘get away’ from the immediate stress. 

 

Once the alarm sounds get back to the orginal activity with a calmer mindset. Repeat ‘vacations’ at intervals if needed but do not let them run over 10-15 minuties long. This will lead to you not getting anything done at all – do not let it turn into a negative cycle. Use the vacation to be kind and understanding to yourself. Make a folder on your computer of photos to look at of a place you’d love to visit. Include video clips and sounds..use this folder as a ‘vacation’ from written computer work. 

E is for..Encouragement 

From this moment you are your own cheerleader, stupid outfit and all. 

this hurts my eyes >.<

Think of statements you can say to yourself to encourage yourself. What advice would you give to a friend? Give it to yourself instead; 

I can do this! I will do this! I am okay! I am strong! 

Here is a list of affirmations that may help you..write your own and write them on flashcards in a fancy pen and keep them in a self-care box, in your journal or on your person – 

I’ve already been through many other painful experiences, and I’ve survived.
This too shall pass.
My feelings make me uncomfortable right now, but I can accept them.
I can be anxious and still deal with the situation.
I’m strong enough to handle what’s happening to me right now.
This is an opportunity for me to learn how to cope with my fears.
I can ride this out and not let it get to me.
I can take all the time I need right now to let go and relax.
I’ve survived other situations like this before, and I’ll survive this too.
My anxiety/fear/sadness won’t kill me; it just doesn’t feel good right now.
I have got through this before.
These are just my feelings, and eventually they’ll go away.
It’s okay to feel sad/anxious/afraid sometimes.
My thoughts don’t control my life. I do.
I can thing different thoughts if I want to.
I’m not in danger right now.
So what?!
This situation sucks, but it’s only temporary.
I’m strong and I can deal with this.

There are so, so many more but try to come up with your own. What sounds ‘right’ to you? 

So, that is IMPROVE

This is not a definitive list/definition and if you think it may be useful to you then try writing out your own answers or using a workbook or Google or a talk with your therapist to work out how you could change these to suit you. As I said before, most of these skills have been re-written in my own words with the aid of a DBT therapist to make them applicable to me..they may help you or guide you but I know there may be some bits that differ to the books or to what your DBT Therapist may instruct you to do in a session. This is a guide and example ony. 🙂 I’ll write up some more laters.

 

 

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  1. #1 by Snaffle on January 16, 2012 - 1:50 am

    Thank you for posting this! There’s some really useful stuff here, and now I’m even more certain that DBT is the right way for me to go. Time to start kicking some NHS arse… 😛 Oh, and well done for digging this stuff out to help yourself feel better – a very strong and sensible thing to do, and definitely a win against the Ed! Keep chalking up those wins ❤

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