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DBT Skills

 

                                                             

 DBT Skill for June: Improve the Moment

Some of the ways we can Improve The Moment Are:

  • Imagery
  • Meaning
  • Prayer
  • Relaxation
  • One thing at a time
  • Vacation
  • Encouragement

When practicing this skill, we are not trying to CHANGE the external circumstance, but rather trying to improve the moment to make it more tolerable (or even more enjoyable) for just this moment.

Here are some examples of putting the skills into action:

  • Imagery: Imagine very relaxing scenes…Imagine everything going well. Imagine coping well…
  • Meaning: Find or create some purpose, meaning, or value in the pain [that’s what I do with this blog, by the way!]. Focus on whatever positive aspects of a painful situation you can find…
  • Prayer: Open your heart to a supreme being, greater wisdom, God, or your own wise mind. Ask for Strength to bear the pain in the moment…
  • Relaxation: Try muscle relaxing and tensing each large muscle group…take a hot bath…breathe deeply; half smile; change facial expression…
  • One thing in the Moment: Focus your entire attention on what you are doing right now. Keep yourself in the very moment you are in; put your mind in the present
  • Take a Brief Vacation: Rent a motel room at the beach or in the woods for a day or two. Ask your roommate to bring you coffee in bed or make you dinner (offer to reciprocate)…Get a  magazine or newspaper at the grocery store, get in bed with chocolates, and read it…
  • Encouragement: Cheerlead yourself. Repeat over and over: ‘I can stand it,’ ‘It won’t last forever.’ ‘I will make it out of this,’ ‘I am doing the best I can do.'”

 

Spirituality and Eating Disorder Recovery: Rediscovering Meaning in Chaos

Eating disorders represent a emotional and cognitive struggle of some kind,  be it trauma, low self-esteem, poor body image, bullying….clients present with many different root causes of their disorder. A client’s spirit is suffering and a person tends to have a breakdown in their spirituality. The one underlying theme is the difficulty in managing the most uncomfortable feelings. The eating disorder and one’s spirituality are often at competing ends. The eating disorder serves as a coping method that presents as a friend, a confidant, a powerful secret, or a god that needs to be obeyed and the eating disorder appears at the time the client needs it most. In a storm of chaos and fear and inconsistency, the eating disorder swoops in and appears to give the feeling of rescue that the client feels temporarily from the distress.

Michelle Lelwica (2010) shares that while the client is focused on creating a “good” body or engaging in eating disorder behaviors like restricting or purging, the inner life is being ignored. No matter how thin the client gets, no matter how filling the binge, there is an eternal sense of emptiness and hunger that is never satisfied. All of the crises that pile up in life, all of the hurts and trauma, drive a wedge through the true self. Big questions like “What is important in my life” and “How do I understand my life’s purpose” cannot be answered when the soul is entrenched in an eating disorder. There is simply no energy left for living. Recovery becomes a spiritual journey as clients attempt to access their pain and face it with the help of a higher power.

Randy Hardman and Michael Berrett (2015) explain that many people with an eating disorder have had some degree of personal spirituality in their lives. Some have participated in religious observations and others may have felt connected to yoga or nature or a meditation practice. Despite this, during the course of the eating disorder these connections were lost. Feelings of unworthiness creep in as the eating disorder, which at one point served a purpose, becomes harder and harder to sustain. Indeed, eating disorders cause sufferers to chase false pursuits that ultimately replace spiritual connection. Hardman and Berrett list these false pursuits:

  • False sense of control
  • False form of communication about pain and suffering
  • False sense of being the exception or exceptional
  • False crusade for evidence against self
  • False pursuit of perfection
  • False form of comfort and safety
  • False identity
  • False compensation for the past
  • False attempt to avoid personal responsibility
  • False pursuit of approval

Eating disorders may represent some or all of these falsehoods for clients. Richards et al (1997) state that eating disorder clients often have difficulty letting go and having faith, despite their spiritual background, leading to a worship of these falsehoods in pursuit of a sense of control and well-being. Along the way the eating disorder gains control of every aspect of their lives, rendering clients powerless when all they were seeking all along was a powerful sense of being good enough.

Not all clinicians work with spirituality in treatment with their clients, but it is a significant aspect of recovery that should not be avoided. Clients who wish to regain their spiritual connections, or foster connections for the very first time, can do so in the safety of the therapeutic alliance. Eating disorders are very hard to give up because it is difficult to remember what life was like beforehand and next to impossible to consider what life might be like in recovery. There is so much unknown and that is often one of the biggest barriers to recovery. Spiritual exploration during treatment can help clients resolve any negative impacts their spiritual pursuits had in the past and move forward with new resolve to take care of their physical, emotional, and spiritual selves.

Lelwica, M. (2010). The Spiritual Dimensions of Recovering from an Eating Disorder. Psychology Today, www.psychologytoday.com

Hardman, R. and Berrett, M. (2015). Eating Disorder Recovery: A Spiritual Perspective. BYU Idaho Counseling Center, www.byui.edu

Richards, P., Hardman, R., Frost, H., Berrett, M., Clark-Sly, J., and Anderson, D.
Spiritual issues and interventions in the treatment of patients with eating disorders. Eating Disorders: Journal of Treatment and Prevention, 5(4), pp. 261-279

The Continuum of Trauma

Trauma is becoming a household concept in the past decade, as we see the many atrocities that are going on around our world and in our own communities. Now many organizations are placing a significant focus on raising awareness of how trauma affects individuals, families, and communities. We hear a lot about trauma and PTSD, they have become buzz words we use to describe war scenarios, domestic violence, and other tragic life events. We hear the word and maybe we have a clear concept of what it is or what we think it isn’t, but the surprising reality is that trauma can be present anywhere at any time. How so? Well, it happens on a continuum.
In the mental health community trauma takes two forms, Big “T” and Little “t”. It’s fairly intuitive, the Big “T” traumas are the classic examples of trauma, it’s the BIG events, like car crashes, sudden death of loved ones, natural disasters that sweep away communities, sexual or domestic violence. Makes sense right? These are the jarring events that leave us questioning, searching, lost, confused, and angry (all at once or in progression). They are the events that are readily recognizable as overwhelming, the events that have awareness groups rallying in line to support survivors of the tragedy. There’s an outcry to help these survivors and an increasing inventory of programs and services available to inform, normalize, and process the aftermath of the Big T.
Little ‘t” traumas are often overlooked. Its death by a thousand cuts… it’s the little inconveniences that send you into a sneaky hate spiral (click here for a hyperbolic explanation of the sneaky hate spiral). It’s all the little jarring things that happen throughout the course of the day, week, or month that progressively add up. Without the necessary skills or supports in place to counter or process these “mini” stressors our systems (mind, body, spirit) get overwhelmed. Little “t” can be things that are recognizably stressful like a new assignment at work or be the minutia that builds and ultimately overcomes us, leading to the same mental chaos as the Big “T”; the problem is that we don’t realize our systems are overwhelmed by all these “small” things until our health or sense of peace suffer.

The beauty of it is that solutions are available. Since this is a therapist writing for a therapy blog, I’ll bet you are thinking I’m going to recommend it as a first line of defense. Surprise, that’s not the case! What I would recommend is slowing down, easier said than done, but give it a try. We spend so much time and place so much emphasis on being perfect and having it all together all the time that we forget to step back and appreciate the little positive moments or don’t take time to process and rebound from the little negative ones.

Try the tips and tricks below to help manage the Little “t’s”; if that isn’t enough, therapy is always an option. There is no shame in asking for help or in seeking new tools and resources to get you over a hump.
• Breathe – use the power of breath to literally breathe life back into yourself
• Body Check – keep an eye on where you hold your tension, the more aware you are the easier it is to see when your body is feeling overwhelmed, even if your mind is telling you to push through it. When you feel it, take a step back and let yourself recover.
• Find an Outlet – everyone’s is different. If you don’t find joy or peace in running don’t run, if yoga isn’t your thing don’t do it. The goal is to find a thing that works for you.
• Put it in Perspective – it takes a little practice but try the rule of 10’s. When you are feeling anxious or overwhelmed ask yourself what impact the outcome of whatever you are focused on will have, really… will this matter in 10 minutes (the guy that cuts in front of you on the freeway), will it matter in 10 days (the balloons you forgot to pick up for the birthday party), will it matter in 10 months (the exam you did poorly on or the job interview that didn’t go so well), will it matter in 10 years (the relationship with your friend or significant other that is in a rocky spot).
o In short, put the level of energy you give something some perspective. Life isn’t perfect and it doesn’t have to be. Some of the best moments are in the mishaps and I am pretty sure no one is on their death bed commiserating over the person that cut them off in traffic 40 years ago. Essentially, let the small things, be the small things.
• Find a Friend – countless studies have been conducted showing how social support mitigates the negative impacts of stress. Meaning the Little “t’s” don’t build as quickly or as uncontrollably when we have healthy social supports to help us process (or vent) our stressful days. Side note: don’t let the venting become the premise of the relationship, that doesn’t do anyone any favors. Allow yourself one cup of coffee and one conversation, then move on.
When you feel like these basic tactics aren’t enough, it might be time to seek professional help. When Little “t’s” overwhelm us we often become anxious or depressed, which can skew our decision making and behaviors, which in turn keeps us in a rut. This is where a professional can help you peel back the proverbial layers and help you reverse or counter the things in your life that aren’t working for you. It’s always OK to ask for help and there is always light at the end of the tunnel.

Be kind to yourself, be kind to others, and keep it moving.

More Information on Trauma:
http://www.prolificliving.com/100-positive-affirmations/
http://www.trauma-pages.com/
http://www.nctsn.org/resources
https://www.psychologytoday.com/basics/trauma
http://www.helpguide.org/articles/ptsd-trauma/emotional-and-psychological-trauma.htm 

 

Written by Ashley Steelman, MSW

Ashley