Author: Kari Kagan, Psy.D.
Learning how to effectively communicate with others can be one of the most challenging and rewarding skills a person can learn in their lifetime. Even people who consider themselves “easy to get along with” or a “people person,” are at risk for getting caught up in the heat of a moment and not being able to communicate effectively and clearly. For this reason, it could be useful to have a “go-to” skill that can help to provide some guidance during interpersonal interactions that could easily go awry. Dialectical Behavior Therapy (DBT) offers a few different skills to help increase interpersonal effectiveness, but this article will focus on one that can be particularly useful for navigating conflicts, refusing a request by someone, and making a request of someone. The skill is called “DEAR MAN,” and I will go through the acronym and examples of how to use the skill below.
Example: Betty and Joe have been married for five years. They are trying to spend more quality time together so make plans to go on a dinner date on a Friday night. Betty arrives at the restaurant on time and Joe is not there. She waits at the table without ever hearing from Joe. He eventually shows up 30 minutes late. They proceed with dinner but Betty is distracted. She decides to talk to him about it later that night…
Joe, I would like to talk to you about when you were 30 minutes late to dinner tonight.
When you show up late, I feel sad and unimportant. Quality time is important to maintaining relationships and I feel worried that if we don’t prioritize it, we will grow distant.
I would like you to commit to showing up on time to future dates. If you can’t make it on time, please call me with advanced notice to let me know when you plan to get there.
Doing your best to show up on time and to prioritize quality time with me would mean a lot to me and make me feel closer to you. I think it will also improve our relationship in the long-term.
In our example, if Joe starts to point out times that Betty has been late or when he felt deprioritized for some other reason, we want Betty to stay focused on the current situation instead of getting locked into a battle of who has done what to whom. For example, Betty could say, “I understand that I am not perfect either and would be happy to discuss that another time. For now, I am still asking that you try your best to be on time or inform me if you will be running late.”
In our example, Betty should make direct eye contact with Joe, sit up straight, and have a firm tone in her voice that lets him know that she is confident in what she is asking for and that it is a reasonable request.
In our example, Joe does not feel he can commit to calling with advance notice if he is running late as he has a job that requires him to be in meetings that prohibit him from calling. In this situation, Betty might ask Joe, “What do you think we should do here? How can we solve this problem?” In the end, they come up with a solution that works for both of them, which is for Joe to send a text if he is unable to call.
The DEAR MAN skill is a great strategy to help you navigate difficult interpersonal interactions and to help get your needs met. If you would like to learn more skills for communicating effectively, please reach out to us for a free phone consultation.
Author: Diana Gordon, Psy.D.
In parts one and two of our crisis survival series, we introduced the ACCEPTS, self-soothing, and TIPPs skills. Today we will review one more Dialectical Behavioral Therapy (DBT) skill, IMPROVE the moment, that can be helpful when you are experiencing powerful emotions.
When you are in a moment of crisis, it can be really difficult to problem solve or to think rationally. Sometimes when we are experiencing powerful emotions, we need to first calm down and get through the moment before we can move into problem solving. IMPROVE the moment is an acronym you can use to think about ways to make yourself feel better quickly. You might not be able to do much about the thing that is causing you to feel distressed, but you can change your emotional response to it and start to feel better. Once you are feeling calmer and more grounded, you can then apply your other skills.
Author: Katie Leoni, Psy.D.
DBT presents three basic states of mind: Reasonable Mind, Emotion Mind, and Wise Mind. In this post, we will look at the idea of Wise Mind and ways to practice Wise Mind in your daily life.
Reasonable Mind is logical, rational, and task-focused. Facts and reason are the foundation of Reasonable Mind, emotions and values do not live here. When in Reasonable Mind you are able to plan and evaluate things pragmatically and engage in such behaviors like figuring out Muni, creating a budget, or building a house. This is helpful as it allows you to learn and synthesize information to complete tasks and helps in your ability to call forth said information when needed. It is much easier to access Reasonable Mind when you are not emotionally triggered or experiencing acute emotional distress. However, it can become a problem to solely be in Reasonable Mind because it does not account for emotions, needs, or desires. It can feel cold and almost robotic to be in Reasonable Mind.
Emotion Mind is reactive, mood-dependent, and emotion-focused. When in Emotion Mind you are likely to act impulsively based on intense feelings and a strong sense of urgency and engage in such behaviors like using drugs or saying something hurtful to someone you love. Your mood dictates your actions, logical and reasonable thinking are hard to engage in while in Emotion Mind. Experiencing intense emotions allows for passion, intense love, and an ability for a person to strongly connect to various interests. On the flip side, it can make a person feel out of control, flooded by their emotions (anger, anxiety), have a lack of energy (sadness, hopelessness), and create a failure to look at a situation clearly.
Wise Mind is the the integration of Reasonable Mind and Emotion Mind. As you can see in the picture, it is the overlapping region of a venn diagram that has Reasonable Mind and Emotion Mind existing together. It allows a person to tune into and see the value of both logic and emotion in order to form a balanced view of the world, our approach to living in it, and our capacity to cope. Wise Mind has a certain calmness about it and is similar to intuition, which makes it advantageous to experience and live in. It should be noted that the majority of people do not live in Wise Mind as depending on the situation and person, emotion or rationality can reign supreme. It takes continuous deliberate practice to be in Wise Mind. Below are some helpful ways to practice Wise Mind.
If you are interested in learning more about Wise Mind and ways to access it, please reach out to schedule a free phone consultation.
It's the beginning of a new year, which for millions of Americans, means it is time to make resolutions that will hopefully result in an improvement in their life in some way. From exercising more, to cutting back on social media/TV, to going to bed earlier, this New York Times article points out that at the root of most resolutions are habits. This article reviews evidence-based strategies that could help you break away from "bad" habits and replace them with healthy ones that will hopefully result in the change you are looking for this year.
The holiday season can be a challenging time for a lot of people. USA Today explores ways of preventing depression during this season. If you've had a tough time during the holidays, reach out to us for a free phone consultation to help you get your mental health back on track in the New Year.
Author: Diana Gordon, Psy.D.
In Part 1 of our crisis survival series, we introduced the ACCEPTS acronym, which highlights 7 skills you can use to cope with challenging emotions. Today we will review two other Dialectical Behavioral Therapy (DBT) skills that can be helpful when you are experiencing powerful emotions.
One skill we teach a lot of our clients is self-soothing. We can draw on our senses to soothe ourselves during difficult moments. The great thing about these skills is that we can often draw on them quickly in the moment, with minimal preparation. You can use them anyplace and anytime you need to calm down. You can draw on your sense of vision, hearing, smell, taste, touch, or movement to evoke positive emotions.
Another tool we often recommend for self-soothing is a DBT skill called TIPP the scale. The acronym TIPP stands for 4 ways that you can experience intense physical sensations that may help you feel more in control of your emotional state.
Both of these sets of skills can be helpful when you’re feeling overwhelmed by strong emotions. By shifting your focus away from the immediate crisis, you give yourself a chance to calm down before engaging in problem solving or determining your next steps. If you would like to learn more skills for managing intense emotions, please reach out to us for a free phone consultation. And stay tuned for Part 3 of this series, which will introduce a few more crisis survival skills.
Author: Katie Leoni, Psy.D.
Do you view uncertainty and lack of control as an unpleasant experience and something that should be avoided? If so, you are not alone and you may perceive worrying to be productive and useful. People who worry excessively tend to regularly overestimate risk. You may think that if you worry enough then you have more perceived control over the situation. For instance, if you are able to predict every worst-case scenario then you will be fully prepared for that situation and there will be no surprises. You feel in control. Then, when the worst-case scenario does not happen, you attribute it to the fact that you worried about it beforehand and thus, the worry is reinforced. It’s kind of like, “Oh it didn’t happen because I worried about it” when in reality, if something catastrophic is going to happen, it is going to happen regardless of whether you worry or not. The fear is if you stop worrying, the bad thing that you’re worrying about will happen/is likely to happen because now you are not prepared for it.
Let’s look at an example of unproductive worry. Say you are on an airplane and for a majority of the flight you are in your seat worrying about how much training the pilot has, has long the pilot has been flying that day, and stating to yourself “please don’t crash” over and over etc. You spend your time thinking about the plane not crashing and going over reasons why. As a result, you feel anxious and unsettled the entire flight and once you land, you feel a sense of relief. You make a direct link between your worrying and the plane landing safely. What is the effect of this worry on you during this flight? You feel anxious, worried, possibly scared, and you’re spending the whole flight worrying as opposed to being in the present moment.
On the other hand, if you think the opposite during the flight, that the plane will crash, then once the plane lands you realize that just because you were thinking about the plane crashing doesn’t mean that it certainly will.
Worry is not an all or nothing concept. Of course, sometimes worry can be helpful and productive. It’s a natural response to your anticipation of future problems. For example, if you have a flight to catch, it makes sense that you’d be worried a little bit about traffic and making it on time to the airport. You may check the traffic in real time and this results in real change because you might have to leave earlier to get there on time. What is the effect of this worry on you? You problem solve effectively and are not late.
You can worry all the time and ask questions but we just don’t have that kind of control over situations or events. Naturally the question then becomes, what can I do to change this? Here are some suggestions:
If you feel like your worry has been negatively impacting your life and/or you’d like to learn more ways to help manage your anxiety and to tolerate uncertainty, please contact us for a free phone consultation.
Author: Kari Kagan, Psy.D.
In this blog series, we will introduce a variety of skills that you can use to recover from intense emotional experiences.
The acronym ACCEPTS represents a skill from Dialectical Behavior Therapy (DBT) that is designed to help people manage intense emotions until they are able to productively address the situation that is causing the emotions. This skill is particularly useful for coping with situations that cause acute emotional suffering. These tools will help to tolerate intense uncomfortable emotions and once they start to subside, many people feel more equipped to deal with the original cause of distress.
ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Push Away, Thoughts, Sensations. Below I will review each coping strategy in more detail. Not all of these tools will work for everyone, but I encourage you to try as many as possible to figure out which work best for you.
Activities: Engage in any healthy activity that takes your mind off of the distressing situation. For example, reading a book, going for a walk, or talking to a friend could be alternative activities that give you a break for a short period of time. An ideal activity would be one that requires your full attention, such as cooking a new recipe.
Contributing: Try doing something nice for someone else. For example, spend part of your weekend volunteering at an animal shelter, cook for a friend, or send a thoughtful letter to someone in need. Doing something for others takes us away from our own suffering by shifting our focus to someone else.
Comparisons: The goal of making comparisons is to put your current situation in perspective. You could start by comparing yourself to you at a different time in your life. For example, if you can recall a time when when you weren’t doing as well or when you dealt with something more intense than what you are currently going through, this could serve as a reminder of how far you’ve come. You could also try comparing your situation to someone who might be experiencing more suffering than you are, such as someone who is in need of food or shelter. This is not to make you feel bad, but to help get perspective. This might not work for everyone, but it does work for some people and might be worth trying to see if it could work for you.
Emotions: Try doing something that generates the opposite emotion of the one you are currently experiencing. For example, if you are feeling sad, watch funny videos; if you are feeling anxious, try taking a few deep breaths. Doing something that gives you the opposite emotion can help to reduce the intensity of the distressing emotion.
Pushing away: When you can’t address a distressing problem right away, it’s ok to temporarily put it aside in order to give yourself a break from it. For example, you can try invoking the image of putting it on a shelf in a closet where it is out of sight but you can go back to it when you want. It is important to remember that pushing away is a useful strategy for taking a break from acute distress, but if a problem is avoided for a prolonged period of time, it could make it worse. It is important to return to the problem once you feel you’ve had enough of a break and are better equipped to deal with it.
Thoughts: When your thoughts are consumed by a distressing situation, try distracting your mind with other thoughts, such as reciting the alphabet backwards or trying to name all the states. Temporarily occupying your mind with other thoughts can prevent someone from getting stuck in a negative thought spiral that could lead to destructive consequences.
Sensations: Try activating your five senses as a way of snapping out of a distressing emotion or of soothing yourself during a time of distress. For example, try holding ice cubes, taking a hot shower, lighting a scented candle, listening to pleasing music, or eating your favorite food. Using the senses to distract from acute suffering can be very grounding and can help to stop the distress from continuing to spiral.
The ACCEPTS tool provides useful strategies for dealing with acute and overwhelming emotional suffering that could potentially lead to destructive consequences if not dealt with in the immediate moment. Try using these tools to give yourself a break from the distress with the goal of returning to the situation once emotions are more manageable and you can be more effective in dealing with it. If you would like more help in learning how to cope with intense emotions, feel free to contact us or another professional who can provide useful strategies for dealing with acute distress. Stay tuned for Parts 2 and 3 of the series for additional tips.
Author: Diana Gordon, Psy.D.
As CBT therapists, we often have clients come to us to get relief from symptoms that are making it difficult for them to achieve their goals. For example, clients might notice that because of their depression or anxiety, they are having a hard time advancing at work, making friends, or being successful in their romantic relationships. Sometimes when these symptoms have been present for a long time, clients are unsure of what needs to change in their lives in order for them to feel better. Or they may know what types of changes they’d like to see in their lives, but may understandably have difficulty mustering the motivation to make behavioral changes that are difficult and uncomfortable.
One technique that we use often with our clients is values clarification. Values clarification is a process by which we work together to identify what values are most important to the client, and we rank them in a hierarchical fashion. In doing so, we identify the 5-10 most important values that a client holds, and we help them set clear goals that allow them to live more in alignment with these values. When one is living in alignment with their most deeply held values, they tend to experience greater happiness, contentment, and clarity when confronting difficult decisions and experiences. Being aware of one’s values can also help people develop motivation to make difficult changes in their lives. When our goals are linked to deeply held values, we can more easily tolerate the discomfort and difficult work that sometimes comes along with achieving our goals.
Often our deeply held values are not things that we can name off the top of our heads. Some of them certainly are, but others might be things that we are afraid to admit out loud to ourselves or to another person. We may hold judgements about what “should” be important to us, and those judgments may influence the values we identify. As CBT therapists, we have several techniques we use to help people identify their deeply held values. Often clients report that some of the values we come up with are ones they would have named on their own, and some of them are ones that they are surprised to see make it to the top of their list.
If you’d like to start thinking about some of your own values, you can check out this free worksheet which lists common values and helps you rank order them. You might also try asking yourself some of the following questions:
If you’re interested in learning more about values clarification and how this intervention might be helpful for you, feel free to contact us for a free phone consultation. In Part 2 of this blog post (coming soon!), we will explore the difference between values and goals, and will discuss how to use your values to set goals to improve your life.
Author: Katie Leoni, Psy.D.
Therapy session frequency is often a once a week occurrence, however this can vary depending on several factors. Regardless, the time in between sessions is extremely important in order to practice skills, gain confidence in one's ability to cope, and to hone in on what is helpful and unhelpful. Growth and progress happen both in and outside the therapy room. This article looks at the effects of intensive sessions over a short period of time (month or less) on several types of anxiety disorders. The pros and cons of such treatment are discussed and explored.
Diana Gordon, Psy.D., Kari Kagan Psy.D., and Katie Leoni, Psy.D.
Drs. Gordon, Kagan, and Leoni practice psychotherapy in downtown San Francisco and Oakland. Their areas of expertise include anxiety, sleep, stress, depression, and addiction. They blog about these topics to provide research-based information about common problems and strategies to help manage them.