Dialectical Behavior Therapy - Tumblr Posts

ABC PLEASE

Use this guide to help you develop emotional resilience and decrease suffering from difficult emotions.

A - Accumulate Positive Emotions:

- Short Term: Be mindful of pleasant events such as listening to music, watching tv, drawing knitting, etc.

-Long Term: Avoid avoiding, identify values, take steps toward goals.

B - Build Mastery:

-Plan on doing something to build a sense of accomplishment.

-Plan for success rather than failure.

-Look for a challenge and gradually increase difficulty over time.

C - Cope Ahead:

-Describe possibly triggering situations.

-Plan coping or problem solving strategies.

-Practice coping effectively.

-Practice relaxation after coping practice.

P - Treat Physical Illness:

-Take care of your body.

-See a doctor when necessary

-Take prescribed medications as directed.

L - List Resources and Barriers:

-List tools and practices that will help with vulnerabilities.

-List issues and situations that will hinder healthy practices.

E - Balanced Eating:

-Don’t eat too much or too little.

-Eat regularly and mindfully throughout the day.

-Stay away from food that makes you feel overly emotional.

A - Avoid Mood-Altering Substances: Stay off drugs and alcohol.

S - Balanced Sleep:

-Try to get 8-9 hours of sleep daily.

-Keep a consistent bedtime and wake time.

E - Regular Exercise:

-Do some sort of exercise daily.

-Aim for 20-30 minutes of physical activity.

-Build flexibility and love your body.

*More DBT guides here*

FLAME

Use this guide to remember how to carry out a task mindfully.

F - Focus and shift your attention to be mindful of the present moment.

L - Let go of distracting thoughts and judgments.

A - Use Radical Acceptance to remain nonjudgmental.

M - Use Wise Mind to make healthy decisions.

E - Do what is Effective to accomplish your goals.

*More DBT guides here*

GIVE

Use this skill to maintain a good relationship and reduce conflict with another person.

G - Gentle: No attacks, threats or judgments.

I - Interested: Listen to the other person.

V - Validate: Acknowledge the person’s feelings, wants, difficulties and opinions.

E - Easy Manner: Use humor and smile.

*More DBT guides here*

FAST

Use this skill to help maintain your self-respect when communicating with others.

F - Be Fair: Avoid judgments and stick to the facts.

A - Don’t Apologize: Assert yourself and ask for what you want. Don’t apologize for making requests, having opinions or disagreeing.

S - Stick to Your Values: Make sure to confidently stick to your truth.

T - Be Truthful: Don’t exaggerate. Don’t lie or act helpless when you aren’t. Dishonesty over time erodes your self-respect.

*More DBT guides here*

If you’re living with BPD like I am you know that stability is hard to achieve and even harder to stick to on a daily basis. DBT skills are a vital part of us getting through the ups, downs, rages and triggers, with as little collateral damage, or damage to ourselves, as possible. After going through DBT group therapy I decided to start making my own guide graphics for the skills because there simply weren’t enough cute visuals available. I often think that something has to be aesthetically pleasing for us to pay attention, and for me that means lots of colors! I make these graphics, using Photoshop and DBT skill print outs that are easily found with a google search. I also think the less clinical language can go a long way💗

*I’m not a licensed clinician or therapist, I’m a woman who’s been battling her BPD for over 16 years. Thankfully, with the help of many professionals, supportive family and friends, and some key reading, I’ve survived past the “average life expectancy” for BPD, which is 27 years of age. I’ve been practicing DBT on and off over the years, at times finding it hard to use and unhelpful in moments of distress. Only this year, after my second hospitalization, did I find the right info to finally understand how it should work and it clicked. I still struggle with the daily triggers, bouts of depression, and the feelings of emptiness, but I do find that I’m able to survive it all because the DBT skills have actually sunk in. I’m also very aware that therapy is a privilege that many can’t access, and sadly even when you can, BPD is a tough thing to diagnose, treat properly, and get the help you need. So now I’m just trying to spread the understanding, help others figure out how DBT can work, and of course, breakdown the stigma associated with BPD.

*More info about my experience with DBT*

This post is to elaborate more on my experience in the DBT group and some of the reading and tools I found most helpful to me.

The DBT group I was able to take part in was a remote group that met once a week for 16 weeks via Webex. I was very lucky to get a spot and that my Medicaid covered any cost. It was run by two social workers as part of NYU Langone's Psychiatric Center at Sunset Terrace.

The weeks were broken down based on the 4 Modules (core skill groups) of DBT: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness.

Mindfulness: This is the base of any DBT practice, and what I always had trouble with in the past. Mindfulness is a kind of self-awareness that you can use to break down your experiences and give yourself a kind of reality check. Being mindful is being present and aware of your emotions, your body, and your thought process.

There are 3 states of mind with which we experience and react to the world: Emotion Mind (acting based on emotions alone), Reasonable Mind (acting based on facts alone), and Wise Mind (a combination of the first 2 and the goal of mindfulness).

Distress Tolerence: This module focuses on short term solutions for big emotions. The skills involved in this module are called Distraction skills because their goal is to just get you through the wave of emotion, resist any harmful urges, and survive your distress long enough to talk to someone or get to other skills.

There are quite a few skills in this module I found helpful, and I'll go into more detail on them in another post. The skill I think can do the most in the moment is called ACCEPTS, an acronym used to remember what you can do to distract yourself when feelings get too intense.

Emotion Regulation: This 3rd module focuses on learning to identify your emotions, understand where they come from and what they are trying to tell you, and processing them in a healthy way.

The purpose of all emotions is evolutionary survival. Emotions spur us into action to meet our needs (when you get hangry, you know you need to eat), and communicate danger to ourselves and others. Body language and voice tone can also often communicate emotions before words do.

*Use a feeling wheel to identify your emotions and dig deeper. If you can't process them right away, use a distress tolerance skill until you are able to sit with them.

*The best skill for emotion regulation is ABC PLEASE, an acronym used to help you recognize vulnerability factors in your life and minimize them.

Interpersonal Effectiveness: This last module focuses on skills that help us communicate with others. There are skills like GIVE, which can be used to maintain good relationships with others, and FAST, which can be used to help maintain your self-respect when making a request of someone.

*There are others that I will make graphics for, stay tuned!

Attending the group and learning the skills was only part of what I found helpful on my journey toward stability. I found a book, Mindfulness for Borderline Personality Disorder, that helped break mindfulness down in great detail and very easy to follow language. The book is written specifically for BPD-havers so it's really an excellent resource. The other tool I found helpful is something my therapist suggested I get, The Game of Real Life, which is a game that you can play to learn DBT skills in an interactive and fun way. It comes with a little book that breaks every skill and practice down, Skill cards which I find to be a great go-to for recalling a skill in a moment you need it (after all, it's a whole lot of acronyms to remember), and Conflict cards that give you examples of situations you might experience, and you have to pick a skill card to practice (can be done alone but better with someone you trust to really dive into the communication and regulation skills). I've actually been carrying a few of the skill cards in my purse wherever I go, just in case I need a quick reference in a moment of distress.

I have so much more to share with anyone who's interested. I'll keep posting, making graphics, and if anyone has a specific question about any of the modules, I'll do my best to answer or help you find the information online. DBT groups are super hard to find, in extremely high demand so it's hard to get in, and usually grossly expensive due to this country's horrible healthcare system. I consider myself extremely privileged to have been able to find a great hospital when I needed it and a great group that my insurance covered. I'm here for anyone who isn't as lucky. Let's make DBT accessible and break the stigma of the BPD diagnosis!

*More DBT guides here*

Trigger warning: su1cidal thoughts

I want to love myself. I want to love my life. I want to enjoy things. I want to be able to let go of what doesn’t serve me. I want to be happy, or at the very least be content. But currently the best I can do is hold onto enough mindfulness to follow my crisis plan when I’m holding a pill bottle in my hand.

As my therapist always says, therapy and treatment can only work if you’re alive, and the skills are there to help you stay that way.

Better buried in self-loathing and shame than in the ground, I guess.

STOP

Use this skill when you are fully in your Emotion Mind to stop yourself from reacting impulsively to a distressful situation.

S - Stop: When distress is high, don’t react. Just freeze!

T - Take a step back: Remove yourself from the situation. Take 15-30 seconds to focus on your breathing and slow down your heart rate.

O - Observe the situation: Take in what’s going on around you and in your body. Remember to stick to the facts.

P - Proceed Mindfully: What’s your goal in this situation? Consider your thoughts and feelings, and those of others.

*More DBT guides here*

TIPP

Use this skill when you are overwhelmed by intense emotions or are feeling the urge to self-injure.

*If you’re in crisis and are having suicidal thoughts please call a Crisis Hotline! (Call 988 in the US)

T - Temperature: To relax fast or distract your mind with sensation, hold an ice pack to your cheeks or eyes or dunk your face in a bowl of ice water for at least 30 seconds to activate your Diver Reflex*.

*If you have high blood pressure, talk to your doctor before trying.

I - Intense Exercise: Doing a few minutes of vigorous exercise will release Endorphins. Try a few minutes of Jumping Jacks or running in place (or around the block). Play your favorite fast paced song and dance it out.

P - Paced Breathing: Breathe deeply into your belly, expanding your lungs as much as you can. Pace your inhales and exhales to 5-6 per minute. Then make your exhales longer than your inhales (5 seconds in, 7 seconds out).

*Try a 60 bpm Metronome track from your music streaming app or YouTube for pacing.

P - Paired Muscle Relaxation: Breathing deeply, tense your muscles (not so much that you cramp up) section by section, move your focus from your feet up your body. Tense up with every inhale, relaxing and melting with every exhale.

*More DBT guides here*

My DBT skill graphics organized by module🩷

Please feel free to save them, share, print and submit requests if there’s any skills you’d like sooner than others (as I make more, I’ll add them to this post for easy access).

Mindfulness: FLAME

Emotion Regulation: ABC PLEASE

Interpersonal Effectiveness: GIVE, FAST, DEAR MAN

Distress Tolerance: STOP, TIPP, ACCEPTS, ACCEPTS Worksheet

Misc: Wise Mind, Box Breathing

DEAR MAN

A DBT Skill for Interpersonal Effectiveness

Use this skill to help you get what you need without damaging relationships or compromising your integrity.

Describe: State the facts of the situation.

Express: Use I-statements to express your feelings and take responsibility for them. I-statements prevent the other person from getting defensive.

Assert: Assert yourself by asking for what you need or by saying no firmly. Speak simply and clearly.

Reinforce: Make sure the other person knows what they will gain by granting your request. It’s important to reinforce that the relationship is a two-way street.

(Stay) Mindful: Stay focused on the conversion. If the person starts getting defensive, keep the conversation on track.

Appear Confident: Regardless of how you feel on the inside, project confidence with your body language; stand or sit up straight with your head held high, voice clear and strong, and make eye contact.

Negotiate: If the person isn’t on board with your request, remember that you are asking for something, not making demands. Modify your request to make it more appealing to them, and/or try asking them their thoughts on solving the problem together.

*More DBT guides here*

Wise Mind

This diagram breaks down the states of mind that we experience.

Please note that neither side is “good” or “bad”; the aim of practicing mindfulness is to combine both and act in your own best interest.

Emotion Mind

Feelings control actions

Can disregard the facts of a situation

Impulsivity based on emotions in the moment

Self-injurious behavior 

Reasonable Mind

Logic controls actions

Detached from emotions

Can invalidate your emotional experience

Wise mind

Combines the facts of a situation with the emotional experience

Helps you process a situation before acting

Mindfulness will help get you here

*More DBT guides here*

Box Breathing

This breathing exercise is great for de-stressing and grounding yourself for meditation.

To start, get into a comfortable seated position, straighten your spine, keep your hands relaxed by your sides or on your lap, and legs relaxed with your feet on the ground.

Inhale deeply, counting 4 beats.

Continue by holding that breath and counting another 4 beats.

Exhale slowly for another 4 beats.

Hold for another 4 beats.

Repeat 3 or 4 times.

*For help pacing, you can use a 60 bpm metronome, which can be found on any music streaming platform or Youtube.

*DBT guides here*

ACCEPTS

A DBT skill for Distress Tolerance

Use this skill to help you get through moments of crisis

*The best way to utilize this skill is, when you're calm and not feeling any distress, make yourself a list of specific things you can do that correspond with each of these steps. Thinking of something to distract you when you're in the midst of an emotional storm is incredibly hard, so preparing a reference guide for yourself ahead of time is a way to show up for yourself.

*Corresponding worksheet to help you plan ahead*

A - Activities: Watch a comforting tv show or movie, clean, do a puzzle, any task that requires most of your attention so you can focus mindfully on it rather than your emotional spiral.

C - Contributing: Talk to a friend or family member, help someone with a task like cooking or cleaning.The goal being to focus on being with someone rather than being alone in your thoughts.*This obviously would not be a go-to if the person would further trigger you.

C - Comparisons: Compare this emotional storm to a past, worse experience as a way to remind yourself that you've survived before, and you can do it again. *Again, the point of this is not to further trigger yourself, but to prove to yourself that you're strong enough to get through this moment of distress.

E - Emotions: Activate opposite emotions by watching a funny video or recalling a happy memory.

P - Push Away: Mentally push away the triggering thoughts or situation until you are calmer and more regulated and able to deal with the emotions. Commit, for a few minutes, to picturing your problems going into a small box, closing them in it, shoving the box deep in the back of a closet and closing the door. This exercise is a very short term way to remove the weight from your shoulders.

T - Thoughts: Actively think about something completely unrelated to your triggers. Sing your favorite song from memory, do a crossword puzzle or a math problem.

S - Sensations: Interact with your 5 senses mindfully; hug a stuffed animal or a pet, hold ice in your hand and feel it melt, lay flat on the floor and feel your body pressing into the hard surface.

*The best way to utilize this skill is, when you're calm and not feeling any distress, make yourself a list of specific things you can do that correspond with each of these steps. Thinking of something to distract you when you're in the midst of an emotional storm is incredibly hard, so preparing a reference guide for yourself ahead of time is a way to show up for yourself.

*More DBT Skills Here*

ACCEPTS DBT Worksheet

*Corresponding DBT Skill*

This worksheet is a way for you to plan ahead and show up for yourself when you're in distress.

Print this out, fill it in and have it as a tangible list of things to take your focus off the emotional storm and avoid harmful coping mechanisms. 

List activities that will take your focus in the moment (for example draw, play a video game, put together a small puzzle)

List things you can do with someone who calms you (for example help with washing dishes, fold laundry, cook a meal)

List 2 times before when you were struggling emotionally and got through it (to remind yourself that you have before and can survive again)

List things you can do to activate opposite emotions (for example watch some funny videos to counteract sadness with laughter)

List numbers you can call for help (For example a crisis hotline, therapist, or loved one)

Bonus Project: Self-Soothing Tool Box 

Fill a small box with anything that you can grab in a moment of stress to occupy your 5 senses.

This can include things like fidget toys, stress balls, mini plushies, small puzzles (25 pieces or so), a laundry sheet or perfume that calms you, a print out of the lyrics to one of your favorite songs, photos of loved ones, a Box Breathing guide, post-it notes with helpful affirmations, and even sour candies or mints.

The goal here is to have a go-to collection of self-soothing assistants so you're not searching and struggling in the midst of your distress.

*More DBT Skill guides here*