Let's do Dialectical Behaviour Therapy (DBT)

[CheerBear]

Hey @outlander 🙂 My understanding is that distractions are something that can take your mind off something and self-soothing is something that feels good. In that way perhaps some self-soothing activities could be distractions and distractions could be self-soothing (like listening to music that feels good inside and takes your mind off something while doing it).

Self soothing tries to bring comfort while experiencing something distressing, and distractions shift our focus from distress. In this way they're different skills with different uses probably.

Does that help? Interesting question and I'm wondering whether anyone else has any other interpretation 🙂

[Phoenix_Rising]

Hi @Faith-and-Hope,

I think you make a good point about right and wrong existing within a faith system. Indeed, the idea that there is no right and wrong also exists within a faith system. DBT is very heavily grounded in Buddhist philosophy. This means that some of it simply does not fit with my own beliefs, and I think this idea of there being no good/bad, right/wrong is one of the bits that doesn't fit. It really bugs me when some of these concepts are presented as facts rather than as beliefs. 

Hi @Holly24, welcome to our DBT adventure. I am super excited to hear that you have just started in a DBT group. It would be awesome to hear about the things you learn there - if you want to share. It sounds like meeting people who struggle in ways similar to yourself has been super helpful for you. It is a nice feeling to know you aren't alone in those struggles isn't it. That's what I like about Forum Land. 

@outlander I am super excited to see you are working through a DBT skills workbook. I think the one you have bought is specifically a self-help book isn't it? That would definitely be helpful in terms of explaining things in brief and simple terms (as opposed to the trillion page manual!!!), although as you say, you kind-of trade that brevity for detail. 

In answer to your question, I would say you self-soothe to self-soothe and you distract to distract. Does the workbook give any suggestions about when to self-soothe versus when to distract? 

I really and truly do plan to finish off the mindfulness module within the next few days. I have already written half of the post...but then I got squished by three email buses and an if-you-don't-like-it leave conversation. My brain is just starting to work again now, so assuming no more buses come my way, I really should be able to post the final post soon. Then we'll be onto distress tolerance, as presented by the awesome @CheerBear (pssssst, CheerBear, that's your cue to start preparing your first DT post ). 

[outlander]

Thanks @CheerBear I had similar thoughts to you too, just in my workbook it has a heap of what I would use to bring comfort is listed as a distraction. But then some self soothe things in the book are what I use to distract. So was getting abit off track and not really sure what was the difference

thank you @Phoenix_Rising I was getting confused because somethings can be in both catagories and its asking me to 'create a distraction plan' and then 'create a self-soothe plan for home, and then one for when im not at home.'

and yes this one is a self help book, it is very simple so doesnt go into a huge amount of detail but I find the more the book goes off on a tangent full of examples etc I look focus and forget what it was that I was suppose to be doing

so atm the module thats first up in the book is 'Distress Tolerance' which is where all the distractions etc are coming into it.

I skipped Radical Acceptance cause I dont get it at all! But one thing at a time..

they said the plan is to :Distract, relax and cope.

Ive just copied this part from the book, I think it explains it ok but whe it goes on to list all these things it gets confusing and has brought about the proposed question

“the first distress tolerance skills youll learn in this chapter will help you distract yourself from the situations that are causing you emotional pain. Distraction Skills are important because (1) they can temporarily stop you from thinking about your pain and as a result (2) they give you time to find an appropriate coping response. Distraction can help you let go of the pain by helping you think about something else. Distraction also buys you time so that your emotions can settle down before you take action to deal with a distressing situation. However do not confuse distraction for avoidance. When you avoid a distressing situation, you choose not to deal with it. But when you distract yourself from a distressing situation you still intend to deal with it in the future when your emotions have calmed down to a tolerable level. The second group of distress tolerance skills youll learn in this chapter are self soothing skills. Its often necessary to soothe yourself before you face the cause of your distress because your emotions might be too 'hot'. Many people with overwhelming emotions panic when faced with an argument, rejection, failure, or other painful events. Before you can address these problems with your new emotion regulation skills (chapter 6 and 7) or your new interpersonal effectiveness skills (chapters 8 and 9) its often necessary to soothe yourself to regain your strength. Self soothing is meant to bring you some amount of peave and releif from your pain so that you can figure out what your going to do next. Self soothing skills also serve another purpose. Theyll help you to learn to treat yourself compassionatley. Many people with overwhelming emotions have been abused or neglected as a child and as a result they were taught about how to hurt then to help themselves. The second purpose of self-soothing skills, therefore is to teach you how to treat yourself kindly and lovingly”

it then goes onto the most common used methods to distract from sh urges like holding ice, drawing on yourself with a marker, the elastic band as such then it goes onto distract yourself with pleasurable activities (which is why im confused between distract and self soothe!) and says that doing something that makes you feel good is the best way to distract yourself from painful emotions but you ont have to wait until feeling overwhelmed by painful emotions in order to do one of these activities and lsits things like going for a walk, talking to a friend, artworks, exercise, cooking etc. then is goes onto distract yourself by paying attention to someone else- do something for someone else etc (pretty obvious that one) then is goes onto distract your thoughts (again confusing as i thought that was the aim of distraction?)- dont force youself to forget a memory or thought, try to distract with ther memories or creative thoughs like remembering pleasant events from the past, creating fantasies a few others. distract yourself by leaving- essential leaving the situation, distract with task and chores- giving yourself a job to do like housework, study, distract yourself by count- count anything like breaths, branches on a tree, or subtract.add by certain numbers like, 3, 7 ,9 to challange yourself

so essentially does this mean that i need to figure out way to keep busy but without relaxing in order to distract my thoughts? and then go onto the more relaxing things?

[Adge]

This is excellent stuff, @Phoenix_Rising@outlander@CheerBear

It's helpful to me that you've been having this discussion.

Unfortunately I've had no energy (resolution) or time to work through all of the DBT skills recently.

I have done some work on it before - I watched videos & worked through work-books on Distracting, Self-soothing & maybe Grounding. My psychologist suggested them to me.

Yes, the No right or wrong thing (no values) is an obstacle to me too @Phoenix_Rising For most people there is definitely a right & a wrong (in their Beliefs) for most things.

From a Philosophical view-point I can't accept there being no right & no wrong - because that is a Branch of Philosophy (philosophical thought) called Relativism.

Relativism (in philosophy) always seemed like a cop-out to me - because it says that (basically) anyone can do anything, & it's all the same (it doesn't matter), there is no Truth at all, & no right way or wrong way.

I cannot get my head around the Radical Acceptance idea either @outlander - even though my psychologist mentions it sometimes.

I did a Major in Philosophy, which came in very handy - although I'm very rusty on most of it now.

Adge

[Phoenix_Rising]

Hi @outlander,

It made me smile when I read that you skipped over the radical acceptance bit. That is kind-of an important bit in DBT - that's why it's addressed right at the beginning. 

I agree with about 95% of what Linehan says regarding radical acceptance. It's just the last little 5% where I think the argument falls apart. I am hoping to ask TTT about it sometime soon to hear what she has to say about it. 

I thought of a good example of the whole acceptance thing and I would be interested to hear people's thoughts about this...

Like many of us here in Forum Land, I have had a lot of super bad experiences in the public mental health system. Also like many of us, I have, over the years, questioned whether I matter within this system. I now recognise that I don't. No one in the public mental health system is in the slightest bit interested in whether I live or die - so long as they don't get the blame for it. I believe that most of what happens in that system is about everyone wanting to cover their own a*rse. The many times I have been held as an involuntary patient have not in any way been for my benefit, they have been because no one wanted to take the blame if I suicided. 

To me, this is an example of a situation where I can keep fighting to be heard and to feel like I matter, or I can accept that I don't matter and deal with my muddles in light of this reality. This acceptance does NOT mean that I think it is ok that I don't matter. It does not mean I think it is ok that the system is as it is. What it does mean is that I don't waste precious energy fighting for something that I know I am never going to get. And I can attest to the fact that my world has become calmer since I stopped reaching out to the public mental health system for support. Furthermore, when I've been dragged in there because someone else has called emergency services, this acceptance has helped me to "play the game" more and thereby be less distressed. I no longer try to prove that I don't need to be there. I just go through the process, reminding myself that nothing that's happening is about me, it's all about everyone wanting to cover their own a*rse. 

So you see, even though I don't TOTALLY agree with Linehan's conceptualization of radical acceptance, I do find a lot of it really valuable. Does this example make sense to people? Can anyone think of another example? Oh and as a disclaimer, I know some people find it super helpful seeking support from the public mental health system, so just because it hasn't worked for me, that doesn't mean it won't work for you. 

@outlander I'm not sure what you mean by keeping busy without relaxing. Like @CheerBear said re. self-soothing and distraction, distraction and relaxation aren't necessarily mutually exclusive. For example, I find doing jigsaw puzzles a good distraction technique and I also find them quite relaxing. For me, distraction tools tend to be things that don't require a lot of brain power (because my brain is mushed when my feelings are giant). So, for example, I find playing in the garden or doing housework good distraction techniques.  

[outlander]

Hi @Adge I really sturggle with that concept of radical acceptance.

Im only working on the dbt workbook, without any help except from here. My therapist that ill be seeing doesnt do dbt but honestly I like the book I have and hopefully itll just be a lightbulb and get it.

 @Phoenix_Rising I know Ill get to the acceptance thing but omg I was pulling my hair out trying to understand it! So skipped it.

I kinda think I get it with your explanation, is it accepting things for the way they are even if I dont like them? Is that what you mean?

My mh changes so quickly a lot of the times it confuses me and im the one living with it! One minute I will be fine and then the next Im not. I have learnt quite a lot though and 2 things that stick out to me and im wondering if I partly do some of these strategies just naturally (pr through what ive put together and learnt). Some days I find I am barely functioning, I fumble a lot, cant get words out, cant think straight and dont know whether I coming or going anf those are the days that I dont really do anything about my emotions. I just let them be- like riding the waves- accepting they are there but they cant hurt me so they swirl around on their own. Then other times when im feeling overwhelmed I find I need a job to do- ill use your essay writing for example. When overwhelmed I cant actually write the essay however if I have the question in front of me, I will read my notes, text books, online and take notes of what I think might be useful in the long run and will often try to base it on the PEEL paragraphs that I was talking about a while ago. And then when I feel like its abit too much even if ive just started ill find something easy going and mindless to do.

So after saying all of that is pretty much brings me to what I mean about distractions being keeping busy without relaxing. I dont find essay writing relaxing at all, but it gives me something else to think about- forcing me to think about something else and constructivley, then I find when im tired I do more things like watching a movie, going for a walk, PMR, or something to help me relax.. does that make any sense at all?

Another thing is if I force myself to do something then it makes me worse- kind of defeats the purpose of using my strategies so thats why I have quite a few. I love my art and will use that as bth distraction and relaxation but if im not in the mood and I cant seem to get it right (even if I dont know what I want the picture to look like) things will go flying and then it frustrates me more and more so walk away.

I think that may have been one big ramble but I am hoping that made sense!

[Sans911]

@outlander @Phoenix_Rising

PR has described Radical Acceptance pretty well @outlander. I have used RA in a number of different situations, one of which is to do with my SI/SH issues. Essentially, I have accepted (over and over again-which is the principle of RA) that for me, SI/SH is part of my coping strategies when I'm overwhelmed & feeling hopeless. It doesn't really mean it's ok or acceptable, but it's what I do for now until something more effective comes along and I deal with the issues behind what's driving me to this.

And my understanding of self soothe is this - self soothe is what's used well before you get to crisis point to help you tone down your emotions and feel calmer. So self soothe is using your 5 senses if touch, smell, hearing, sight and taste. Some examples are your drawings @outlander, listening to your favourite songs, eating chocolate, patting your cat/dog, baking, going for a walk like Li1 does and seeing the brumbies, taking a bath. It's about creating comfort and pleasurable sensations to help you relax and also be mindful. It's very different to distraction, but it is still a distress tolerance tool which might make it confusing.

Distraction is what you do when you have intense emotions, feeling overwhelmed and unable to cope and you are reaching crisis point. It's about getting through this difficult time to hopefully alleviate the distress you're experiencing. So distraction involves skills of (Wise Mind) ACCEPTS. That is distract with Activities like taking a walk, doing a puzzle or jigsaw, cooking, watching a show.

C is distracting by Contributing such as volunteering, helping someone out here on the forums who might also be struggling (helps you to feel less alone).

C is distracting by Comparing (I don't agree with this one by the way) - so comparing yourself to others who might be worse off than you either with their mental illness or from a natural disaster. It means perhaps you don't have it so bad!

E is distracting by opposite Emotions. So if you're feeling sad, watch a funny movie, listen to silly songs. I don't know either if I find this skill helpful for me.

P is distracting by Pushing Away the emotion. So it's like your Worry Box @outlander. You are pushing away your emotions so the don't threaten to overwhelm you. You can also do with thoughts. You can push them away by refusing to dwell on them. You can do this by thinking of more pleasant thoughts, or going to a 'safe place' like Nell dies.

T is distraction by using or replacing thoughts. So you can do things like count the tiles in a floor, how many windows in a pane, counting steps. You can also do things like reading, watching TV, writing poetry or journaling or anything else to distract yourself from the thoughts in your head.

S is distraction by Sensations. This is the one that holding ice helps to reset the fight/flight mode. Or using a band on the wrist, having a hot or cold shower, anything that creates a strong sensation to jolt you of what you are feeling.

I hope this helps a little with clarifying a little what some of the DT skills are.

[Phoenix_Rising]

@Sans911 I super like your explanation of self-soothing vs distraction for @outlander. 

I find I'm using the radical acceptance concept more and more, although I'm not sure if this reflects improved skill or a stronger sense of hopelessness around the impossibility of changing the oh-so-many things that are wrong in this world. At the moment I feel utterly broken by mental-health-professional-induced re-traumatization. I simply have nothing left to give or to fight with anymore. I feel utterly utterly hopeless. So yeah, not quite sure whether the acceptance I am moving ever-increasingly towards is a good thing or not. 

@outlander yes, the idea of acceptance is accepting things for the way they are even if you don't like them. It isn't about saying something is ok or right, it's simply acknowledging that it is what it is. I really like the example that @Sans911 gave regarding SH. I have to admit, I've never had any sense of guilt or regret regarding SH. My body, my choice. However, I have noticed that a lot of Forumites seem to compound their struggles by castigating themselves after engaging in SH. I tend to hold the same view that Sans911 seems to be expressing {waves to Sans911}. 

Here's another example for you; I super want to write the final post to finish off the mindfulness module. I've been wanting to do this for weeks and I feel frustrated that I haven't been able to do it due to the giant muddle I'm dealing with. So, I COULD sit here and tell myself, I'm so stupid, I should be able to do this, I'm pathetic for not being able to focus enough to do this one little thing OR I can sit here and tell myself, I feel frustrated that I haven't been able to get this done. Oh well, I can only do what I can do, it is what it is. Which statement do you think is going to make me feel better? Which one is going to make me feel worse? The objective reality is that I can't make my brain work when it simply won't. I can't change that. However, the amount of distress I feel about it, is contingent on what I tell myself. Why make a bad situation worse by heaping a whole lot of judgement on myself. It is what it is...and it's ok. Does that make sense?

[Former-Member]

This article explains how I understand radical acceptance:

https://www.psychologytoday.com/blog/pieces-mind/201207/radical-acceptance?amp

I don't think radical acceptance means we should turn a blind eye to injustice, far from it. It means knowing where to draw the line, what things are worth fighting for, what is just flogging a dead horse so to speak. For me this has also meant learning how to do this in a way that is tackling the problem not the person.

[Sans911]

@Phoenix_Rising thank you, and a lovely post. So we'll be seeing the mindfulness module posted real soon then? BTW, that post from me was at 4:30 my time! That's what living with menopause does to you, and I'm trying to radically accept that for perhaps the next 10 years my life will be uncomfortable, frustrating and unbalanced as my hormones run rampant in their death throes!

Thanks to @Former-Member. Well written post.