Monday, September 14, 2009

DBT Glossary

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Borderline personality disorder (BPD) individuals describe chronic feelings of anger, emptiness, depressions and anxiety. They experience extreme frustration and anger, and occasionally experience brief psychotic episodes. They describe chaotic relationships and "confused identities." Even among those who have not attempted suicide, suicide ideation is common. The quality of life ratings for some of the problems frequently experience by BPD individuals suggest that their quality of life is amongst the lowest.

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Cutting ~ see Self-Injury

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Describe (Mindfulness Skill). Put words on the experience. When a feeling or thought arises, or you do something, acknowledge it. For example, say in your mind, "Sadness has just enveloped me."... or... "My stomach muscles are tightening."... or... "A thought 'I can't do this' has come into my mind"... or... "walking, step, step, step..."Put experiences into words. Describe to yourself what is happening. Put a name on your feelings. Call a thought just a thought, a feeling just a feeling. Don't get caught in content.

Dialectic: In classical philosophy, dialectic (Greek: διαλεκτική) is a form of reasoning based on the exchange of arguments and counter-arguments, advocating propositions (theses) and counter-propositions (antitheses). The outcome of such an exchange might be the refutation of one of the relevant points of view, or a synthesis or combination of the opposing assertions, or at least a qualitative transformation in the direction of the dialogue.

DBT / Dialectical Behavior Therapy: is a therapeutic methodology developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat persons with borderline personality disorder (BPD).

Distract (Distress Tolerance Skill) is the goal of reducing contact with emotional stimuli and is done when Wise Mind ACCEPTS with: Activities, Contributing, Comparisons, (Opposite) Emotions, Pushing Away, (other) Thoughts, and Sensations.

Distress tolerance crisis survival skills have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows individuals to make wise decisions about whether and how to take action, rather than falling into the intense, desperate, and often destructive emotional reactions.

Skills for acceptance include radical acceptance, turning the mind toward acceptance, and distinguishing between "willingness" (acting skillfully, from a realistic understanding of the present situation) and "willfulness" (trying to impose one's will regardless of reality). Participants also learn four crisis survival skills, to help deal with immediate emotional responses that may seem overwhelming: distracting oneself, self-soothing, improving the moment, and thinking of pros and cons.

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Effectively (Mindfulness Skill). Focus on what works. Do what needs to be done in each situation. Stay away from "fair" and "unfair", "right" and "wrong", "should" and "should not".Play by the rules. Don't "cut your nose off to spite your face."Act as skillfully as you can, meeting the needs of the situation you are in. Not the situation you wish you were in; not the one that is "just"; not the one that is "more comfortable"; not the one that...”Keep and eye on your objectives in the situation and do what is necessary toachieve them.Let go of vengeance, useless anger, and righteousness that hurts you and doesn't work.

Emotion Mind. This describes times when your emotions are out of control -- times when emotions are what influence or control your thinking and behavior.Emotional Mind can also be very beneficial.Emotions are what motivate us to action.Emotions are what keep us attached to others and building relationships.Emotion Mind can be aggravated by: Illness, Lack Of Sleep, Tiredness, Drugs, Alcohol, Hungry, Bloating, Overeating, Poor nutrition and/or lack of exercise, Environmental stress and threats

Emotion Regulation is the module in which we learn to understand how our emotions work, and the skills we need to manage our emotions instead of being managed by them, to reduce how vulnerable we are to negative emotions, and to build positive emotional experiences.

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IMPROVE the moment (Distress Tolerance Skill) with: Imagery, Meaning, Prayer, Relaxation, One Thing in the Moment, Vacation and self-Encouragement.

Interpersonal Effectiveness module focuses on situations where the objective is to change something (e.g., requesting that someone do something) or to resist changes someone else is trying to make (e.g., saying no).

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Mindfulness is one of the core concepts behind all elements of DBT. Mindfulness is the capacity to pay attention, nonjudgmentally, to the present moment. Mindfulness is all about living in the moment, experiencing one's emotions and senses fully, yet with perspective. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations.

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Non-judgmentally (Mindfulness Skill). See but don't evaluate. Take a nonjudgmental stance. Just the facts. Focus on the "what", not the "good" or the "bad", the "terrible" or the "wonderful", the "should" or the "should not."Unglue your opinions from the facts, from the "who, what, when and where."Accept each moment, each event as a blanket spread out on the lawn accepts both rain and sun, each leaf that falls upon it. Acknowledge the helpful, the wholesome, but don't judge it. Acknowledge the harmful, the unwholesome, but don't judge it.When you find yourself judging, don't judge your judging.

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Observe (Mindfulness Skill). Just notice the experience. Notice without getting caught in the experience. Experience without reacting to your experience.Have a "Teflon Mind" letting experiences, feelings, and thoughts come into your mind and slip right out.Control your attention, but not what you see. Push away nothing. Cling to nothing. Be like a guard at the palace gate, alert to every thought, feeling, and actions that comes through the gate of your mind.Step inside yourself and observe. Watch your thoughts coming and going, like clouds in the sky. Notice each feeling rising and falling, like waves in the ocean. Notice exactly what you are doing.Notice what comes through your senses: your eyes, ears, nose, skin, tongue, See others' actions and expressions.

One Mindfully (Mindfulness Skill). Do one thing at a time. When you are eating, eat. When you are walking, walk. When you are bathing, bathe. When you are working, work. When you are in a group, or a conversation, focus your attention on the very moment you are in with the other person. When you are thinking, think. When you are worrying, worry. When you are planning, plan. When you are remembering, remember. Do each thing with all of your attention. If other actions, or thoughts, or strong feelings distract you, let go of distractions and go back to what you were doing-- again and again and again. Concentrate your mind. If you find you are doing two things at once, stop and go back to one thing at a time.

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Participate (Mindfulness Skill). Enter into your experience. Let yourself get involved in the moment, letting go of ruminating. Become one with your experience, completely forgetting yourself.Act intuitively from Wise Mind. Do just what is needed in each situation, like a skillful dancer on the dance floor, be one with the music and your partner, neither willful nor sitting on your hands.Actively practice your skills as you learn them until they become a part of you, so that you use them without self-consciousness.

Pros and Cons (Distress Tolerance Skill) Make a list of the pros and cons of tolerating the distress. Make another list of the pros and cons of not tolerating the distress - that is, of coping by hurting yourself, abusing alcohol, or drugs, or doing something else impulsive. Focus on long-term goals, the light at the end of the tunnel. Remember times when pain has ended. Think of the positive consequences of tolerating the distress. Imagine in your mind how good you will feel if you achieve your goals, if you don't act impulsively. Think of all of the negative consequences of not tolerating your current distress. Remember what has happened in the past when you have acted impulsively to escape the moment. Ask yourself, “Will this event that is distressing me going to matter in 5 years?”

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Radical Acceptance. Radical means all the way. Freedom from suffering requires ACCEPTANCE FROM DEEP WITHIN. It is allowing yourself to go completely with whatever the situation is. Let go of fighting reality. ACCEPTANCE IS THE ONLY WAY OUT OF HELL WHICH MUST NOT BE INTERPRETED AS APPROVAL OF THE DISTRESSFUL SITUATION Pain creates suffering only when you refuse to ACCEPT the pain. Deciding to tolerate the moment is ACCEPTANCE. ACCEPTANCE is acknowledging what is. To accept something is not the same as judging it to be good.By stopping your self from fighting, the rage or anger you feel will dissipate as long as you continue to accept your condition or your faulty perceptions to events or interpersonal communications difficulties. You will be amazed at how much better you will feel when you are able to accept.

Reasonable or Rational Mind. This is your rational, thinking, logical mindIt plans and evaluates things logically.It is your "cool" part.Reasonable Mind can be very beneficial.It is easier to be in Reasonable Mind when you feel good.It is much harder to be in Reasonable Mind when you don't feel good.

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Self-injury (SI) is deliberate infliction of tissue damage or alteration to oneself without suicidal intent. These acts may be aimed at relieving otherwise unbearable emotions, and/or sensations of unreality and numbness. Self-harm is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a symptom of borderline personality disorder and depressive disorders. It is sometimes associated with mental illness, a history of trauma and abuse including emotional abuse, sexual abuse, eating disorders, or mental traits such as low self-esteem or perfectionism, but a statistical analysis is difficult, as many self-injurers conceal their injuries.The relationship between self-harm and suicide is a complex one, as self-harm behaviour may be potentially life-threatening, with or without the intent of suicide. However, attributing self harmers as suicidal is, in the majority of cases, inaccurate.

Self-Soothe (Distress Tolerance Skill) is a way to distract from a crisis using each of your five senses: vision, hearing, smell, taste, and touch.

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Turning the Mind. Acceptance of reality requires an act of CHOICE. It is like coming to a fork in the road. You have to turn your mind towards the acceptance road and away form the rejecting reality road. You have to make an inner COMMITMENT to accept. The commitment to accept does not itself equal acceptance. It just turns you toward the path. But it is the first step. You have to turn your mind and commit to acceptance OVER AND OVER AND OVER again. Sometimes, you have to make the commitment many times in the space of a few minutes.

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Willfulness is like sitting on your hands when action is needed, refusing to make changes that are needed.Willfulness causes you to fight any suggestions that will improve the distress and thus make it more tolerable.Willfulness is giving up. It is the opposite of doing what works, of being effective. Willfulness is trying to fix every situation or refusing to tolerate the distressful moment.

Willingness is doing just what is needed in each situation, in an unpretentious way. It is focusing on effectiveness. Willingness is listening very carefully to your WISE MIND, acting from your inner self. Willingness is becoming aware of your connection to the universe - to the earth, to the floor you are standing on, to the chair you are sitting on, to the person you are talking to.Ask yourself, in 5 years from now, will the situation that causes the distress matter?

Wise mind is the integration of emotional and reasonable mind.You cannot overcome or control emotional mind with reasonable mind.You cannot create emotion mind with reason.You must go within and integrate these two states of mind.Wise mind is that part of each person that can know and experience truth.It is where the person knows something to be true or valid.It is where the person knows something in a centered (balanced) way.It is almost always quiet and calm in this part of the mind.
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LINKS
http://www.dbtselfhelp.com/
http://en.wikipedia.org/wiki/Dialectical_behavior_therapy

http://hoodriverdbt.blogspot.com/

Jane Rekas

LCSW, CHt

Jane Rekas is a Licsensed Clinical Social Worker at Turtle Dove Counseling and Hood River DBT, Certified Hypnotist at Hood River Hypnosis, Reiki Master at Rekas Reiki, Astrologer at Astrological Counsel, and Seasonal Color Analyst at Expressing Your Truth.

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