You’re lying in bed about to fall asleep when you suddenly remember you forgot to make your car payment. Your body tenses as you worry where you will get the money for your mortgage next week. Maybe if you take a cash advance on your credit card, but then the interest will be outrageous. How will you ever send your kids to college? Or retire? Now you’re awake with little hope of getting back to sleep.
Pain, both physical and emotional, is part of life. At some point, everyone experiences it. As Longfellow wrote, “Into each life some rain must fall.” Still, you don’t have to stand out in the rain and get wet. You can use an umbrella or go inside. Similarly, there are things you can do to manage painful situations. The following Crisis Survival Skills help you get through these situations.
Recently, when I informed my 11 year old that he had to set aside his afterschool plans for fun with friends to attend his acting class his mouth tightened and tears filled his brown eyes. I was shocked to see this from a boy who loves this class and has never wanted to skip it. When I questioned his unusual reaction he said “I just have too much to think about. I can’t handle one more thing.” His mind was filled with the current happenings in his life, field day and other end of school celebrations, but his thoughts also went to future events. Day camp in a few weeks, his first time at sleep away camp, and the start of middle school were among the topics occupying his brain and increasing his stress. He described endless thoughts swirling in his head making it difficult to concentrate.
It occurred to me that learning about mindfulness might help him to better manage his thoughts and reduce his stress.
It’s funny, in my work as a therapist, I’m constantly teaching clients to use mindfulness skills, but I’ve never taught my own son. I broached to subject and he loved the idea.
First, what is mindfulness? It’s one of those words that’s thrown around, but many people don’t know what it means.
Mindfulness is paying attention to the present moment with acceptance of the feelings, thoughts and physical sensations that may arise.
The opposite of mindfulness is MINDLESSNESS. When you go through life mindlessly, intense emotions, powerful sensations and agitating thoughts build up to the point where you can’t ignore them. It may feels as if they come out of nowhere, overwhelming you and leading you to do anything to get a moment of relief…have that cookie, smoke that cigarette, check that text. On the other hand, with mindfulness, you notice experiences in your body and mind bit by bit as they happen so you can better tolerate them.
The question is how do you practice mindfulness? In his Ted Talk, Dr. Judson Brewer, psychiatrist and mindfulness researcher, describes practicing mindfulness in three simple steps notice, get curious, let go and repeat:
- Notice: Become aware of thoughts, feelings and sensations as they happen. When you do this you will realize there is a constant stream of thoughts and sensations going on at all times. Don’t try to stop the flow. Just notice.
- Be Curious: Curiosity allows you to take a step back and observe what is happening in your mind and body just as a scientist would collect data during an experiment. The goal here to neither analyze nor avoid what occurs. Just be open to whatever comes up.
- Let go: Thoughts, feelings and sensations naturally enter our awareness, peak and dissipate. You have never had a thought, feeling or sensation that didn’t eventually go away. The key is to let it go. When you try to avoid, suppress or otherwise ignore it will keep coming back again and again.
When my son practiced being mindful of his thoughts he saw that he was worrying about many things he had no control over. As he continued to practice he was able to let the thoughts go, and he’s starting to feel much better.
“Mindfulness is paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment." Jon Kabat-Zinn When I first heard the word mindfulness it sounded like new age nonsense. I couldn’t understand how it could help with everything from decreasing depression to increasing concentration to effectively manage pain. But when I began to practice mindfulness, it became very clear how beneficial it could be. The fact is that the benefits of practicing mindfulness are endless. But you can’t just read about it. You have to try it. In this on-going series about improving your life with DBT Skills, this week’s topic is mindfulness.
Here are a few ways mindfulness is helpful:
Mindfulness gets us out of our heads and into our lives. So many of us have a tape playing in our heads that is chockfull of criticisms, judgments and worries. (I’m stupid, I don’t deserve happiness, nothing will every get better). Mindfulness helps us stop believing the negative messages in our heads, stop comparing this moment to any other, stop thinking about what should be and just be present in this moment. This is particularly important for those who struggle with depression because those negative messages can spiral into an episode of depression.
Mindfulness helps us focus on one thing at a time. I know multi-tasking is all the rage. We are texting while listening to music while watching TV while talking on the phone. Our attention is so divided and superficial that we are not really experiencing our life. When we focus on one thing in the moment we are much more engaged, much less distracted and much more effective.
Mindfulness helps us accept reality as it. When we fight again reality we are fighting a losing battle and ultimately creating more suffering for ourselves. Mindfulness teaches us to stop fighting that which we cannot change.
So the question is how to you practice mindfulness? Like any other skill we learn in life, mindfulness is best learned step by step. Observing and describing are the teaching steps that get us to the goal of participating.
1. Observe: The first step is observing, just noticing your experiences right now...notice sensations in your body. Notice smells, tastes, textures, sights, thoughts, feelings, anything that may be part of you current experience. Just notice without judgment.
2. Describe: Now put words to your experiences. The idea is to clarify what you have noticed to yourself and to others. Stick to the observable facts, and stay away from judgments.
3. Participate: Once you have practiced observing and describing your experiences its time to participate. Throw yourself fully into the moment. Participate completely and unselfconsciously, if you’re eating just eat, if you’re dancing just dance. If you watch children at play they are always participating. They are not worried about how they look, or what they are doing later they are completely engaged in the moment.
Try the simple mindfulness exercises:
Taste something mindfully (a mint, gum, a cup of tea).
Play with play dough or silly putty mindfully
Notice your thoughts mindfully (watch them float by like clouds, don’t become attached to any of them). Remember thoughts aren’t necessarily truths.
Do you want to increase you ability to survive a crisis, have more control over your emotions, improve your relationships, be more present and less judgmental? Dialectical Behavioral Therapy is for you.
Dialectical Behavioral Therapy (DBT) is a model of therapy created by Marsha Linehan specifically to treat her clients who were struggling with chronic suicidal ideation and engaging in self-injury. The therapy is very effective at decreasing suffering and ending problematic behaviors. But DBT skills can be helpful, even if your pain is not life threatening.
I've been teaching DBT skills for many years to many different types of people from those who were overwhelmed with work stress to people struggling with parenthood to women trying to manage the symptoms of menopause. They were all able to benefit from the skills. During one group session, a woman participating said that she thought everyone should learn DBT skills. She said she and the other group members were more emotionally competent then any other people she knew. The fact is that DBT skills are good life skills from which anyone can benefit.
- Distress Tolerance Skills: Everyone has distress, trauma, pain...some kind of discomfort at one time or another. When you ignore, fight against, deny or otherwise avoid the pain it only grows causing suffering. These skills teach you accept reality and get through crisis without making the situation worse
- Emotion Regulation Skills: In this emotion phobic society, many of us have difficulty expressing our emotions. These skills teach you to understand and experience emotions more comfortably. The ultimate goal is to give you more control over your emotions rather than feeling like your emotions have control over you.
- Interpersonal Effectiveness Skills: Whether it’s the boss, the kids, the parents or the partner, we all need to improve our communication with someone. With these skills you learn to communicate more effectively so you can get your needs met without damaging your relationships.
- Mindfulness Skills (Skills for Paying Attention): Mindfulness is often associated with meditation where in a structured setting you practice paying attention to the moment, noticing your thoughts and feelings without judgment. These skills teach you to bring the practice of meditation into the activity of life. Mindfulness has enormous benefits including: decreasing depression and anxiety, improving sleep, increasing pain tolerance and strengthening relationships.
So the question is who couldn't benefit from DBT Skills? Stay tuned. Next week, I'll go into more depth about how to practice mindfulness, and the benefits of incorporating it into your life.
Starting this Fall, I will be running a DBT Skills Group for adults. For information on the group email firstname.lastname@example.org or call 917-721-2251.
Today I've been thinking about the concept of Radical Acceptance mostly because I'm having a difficult time with it right now. I have a medical condition that causes a great deal of pain, has no known cause, and treatment options that don't work well. So my doctor can neither help me prevent the symptoms or effectively treat the pain. Now I realize that many people are dealing with far worse situations. This is not a life-threatening problem or even a major life changing problem, but its really uncomfortable and unlikely to end.
So I have two choices. I can get really upset and wallow in the pain, tell myself that it's unfair, why did this have to happen to me, etc. Or I can figure out a way to accept it. This has been going on for months, and for months I've been going with plan A. I've been whining, complaining, getting worked-up and spending hours on-line trying to find a website or a blogger or someone who can tell the opposite of what my doctors have said over and over again. There is no known way to prevent or treat this condition. Plan A is not working. It's only making my feel worse when I'm trying to find a way to feel better.
USING RADICAL ACCEPTANCE TO EASE PAIN
Moving on to Plan B, Radical Acceptance. Radical Acceptance occurs when we accept what we cannot change without fighting it, without judging it and without trying to control the experience. Keep in mind that accepting a situation is much different than approving of it. You do not have to like something to radically accept it. In addition, radical acceptance does not mean accepting everything without questions. It means accepting what cannot be changed, and being open to making the changes that are possible and necessary.
Usually, when we perceive pain, whether physical or emotional, we tense up our muscles turning them into an armor against the enemy pain. Next, our minds start to spin wondering why this pain is happening and how can I stop it...now. These instinctive actions were necessary when we where hunters and gatherers and the enemy was a wild animal bent on killing. Our world has evolved past that threat, but our minds and bodies have not. The problem is when we tense-up and try to think our way out of pain, the pain doesn't go away it intensifies.
PRACTICING RADICAL ACCEPTANCE
When we radically accept pain, we open ourselves up to the experience. We relax our bodies, slow our breathing and experience each moment as it unfolds. We stop trying to figure out what we did wrong to bring on the pain. Instead, we tell ourselves it won't last forever, and it won't destroy us.
We all have to accept pain at some point in our lives. Whether you are waiting for an OTC medication to kick in to quell a migraine or you are fuming with anger after an argument or you have a chronic condition that you must tolerate on a daily basis practicing radical acceptance can help. I am not suggesting that it is a miracle cure, but it will decrease your suffering.
Start today. What do you need to radically accept?
“A child born today will live to be about 80 years old, on average. But the challenge is getting them through 16, 17, 18, 19 – the most hazardous time of their lives. A kid with a car, a kid with a gun, a kid with a bottle – any one of these combinations is much more of a risk than a terror attack or a flu from [overseas].”Timothy Egan, NY Times, 6/09/14 OpEd, P. A15
FACTS ABOUT ADOLESCENT SUICIDE Annually: - 19% of high school students seriously consider suicide (1 in 5). - 8.8% attempt suicide. This adds up to 1 million teens, of whom 700,000 require medical attention. - Up to 11% of teen suicide attempters will eventually die by suicide. (Diekstra, 1989; Shaffer et at., 1988) - In a typical US high school classroom, two girls and one boy will make a suicide attempt this year. - Between 31-50% of all adolescent suicide attempters re-attempts suicide (Shaffer & Piacentini, 1994) - 27% (males) and 21% (females) of adolescent suicide attempters re-attempt within 3 months of their first attempt (Lewinsohn et al., 1996). - The risk of suicide increases significantly as an adolescent accumulates more problem behaviors (violent behavior, substance use/abuse, self-injury, risky sex, etc.)
WHAT IS THE ANSWER? Dialectical Behavioral Therapy (DBT) is designed to treat patients who are struggling with multiple problem behaviors that make them at high risk for suicide.
In initial studies DBT with Adolescents is more effective than treatment as usual at the following: - Decreasing inpatient hospitalizations - Increasing treatment retention (many teens drop out in the early stages of most other treatment programs). - Reducing suicidal ideation, depression, anger, anxiety and emotional sensitivity - Reducing symptoms common in a borderline personality disorder (confusion about self, interpersonal chaos, emotional dysregulation, impulsivity). Rathus & Miller, 2002