TABLE OF CONTENTS. The Center for Success and Independence--DBT Handbook

Transcription

1 TABLE OF CONTENTS 1 Module Essentials of DBT What is Dialectical Behavior Therapy? DBT Primary Targets and Skills How does DBT differ from Psychotherapy Group? Biosocial Theory DBT Assumptions Guidelines & Contract for Skills Group Encouraging Affirmations Mindfulness (yellow tab) Taking hold of your mind 3 States of Mind What Skills How Skills Practice Exercise 1-4 Two Simple Skills to Mindfulness Mindfulness Cheat Sheet Distress Tolerance (orange tab) Why Bother? Crisis Survival Skills Wise Mind ACCEPTS Self Soothe IMPROVE Practice Exercise 1-3 Pros & Cons Are you Willful? Are you Willing? Accepting Reality: Willfulness versus Willingness Turning the Mind Accepting Reality: Radical Acceptance & Turning the Mind Practice Exercise 4 Interpersonal Effectiveness (blue tab) Situations for Interpersonal Effectiveness What is your goal? What stops you from achieving your goal Worry Thoughts Questions to Consider when Making a Request Questions to Consider when Saying No to Someone Guidelines for Getting what you want DEAR MAN Guidelines for Relationship Building GIVE Guidelines for Maintaining your Self-Respect FAST Page Number

2 2 Practice Exercises Increasing Effectiveness in the Current Situation 58 Emotion Regulation (clear tab) 59 Middle Path (red tab)

3 Essentials of DBT One of the groups you will be attending is called DBT. In this group, you will be given information about skills you can add to your tool box. These skills can help with relationships; build self esteem; and help you control your mood and impulses. Here is some information about this group. We will follow the routine group rules for the Center. You have this binder that has all group information. You are asked to keep up with this binder and to bring it to each group. As time in group is limited, the focus is on learning new skills. Therefore, personal issues and conflicts will be directed to your individual therapist. You will be asked to do homework and expected to complete it. You will be expected to keep a diary card*** When you start this group, you will be given a contract and asked to make a commitment to the group and to yourself to participate. Groups have incentives for completing diary card and participating in group. ***The Diary Card is a daily record of your feelings, triggers, and relationship struggles. It is designed to make it easy to record your use of skills as you learn and practice them. 3

4 WHAT IS DIALECTICAL BEHAVIOR THERAPY? 4 DBT is an effective treatment for people who have difficulty controlling their emotions and behaviors. DBT aims to reduce problem behaviors and increase skillful behavior. DBT helps people learn how to better understand and value themselves and others. DBT helps people create a life worth living. WHAT DOES DIALECTICAL MEAN? Dialectical=2 opposite ideas can be true at the same time There is always more that one way to see a situation, and more than one opinion, idea, or dream. All people have something unique and different to offer. Considers a life worth living to have both positive and negative aspects (happiness, sadness, anger, and peace) and all of these aspects are necessary and valuable.

5 DBT S PRIMARY TARGETS & SKILLS 5 Problems Skills 1) CONFUSION ABOUT YOURSELF: 1) MINDFULNESS: feelings of emptiness, not knowing awareness to thoughts what you feel or why you get upset; emotions, & urges; w/o trouble making or holding to decisions adding or subtracting 2) IMPULSIVITY: 2) DISTRESS TOLERANCE: acting without thinking it all the way tolerating stress and not through; alcohol or drug use; anger making it worse; accepting reactions; suicidal or self destruction reality as it is 3) EMOTIONAL INSTABILITY: 3) EMOTION REGULATION: fast, intense mood changes with little control of emotions; control; steady, negative emotional state reduce vulnerabilities; extreme mood swings & sensitivity change negative emotions 4) INTERPERSONAL PROBLEMS: 4) INTERPERSONAL difficulty keeping steady relationships, EFFECTIVENESS: getting what you want, or keeping self deal with conflicts; increase respect; efforts to avoid rejection or self respect; get what you feelings of abandonment want; say no assertively 5) ALL OR NOTHING THINKING 5) WALKING THE MIDDLE things are either good or bad, fair or PATH: unfair; polarized thinking, feeling, or be willing to negotiate; see acting; always wanting to be right all perspectives; live in gray

6 How does DBT differ from Psychotherapy Group? DBT Skills Training Therapy Group 1. Group leaders are trainers/teachers. 2. Participants meet in classroom setting and follow a curriculumbased agenda with both handouts and homework to be completed for review. 3. Participants must follow group rules and adhere to the classroom structure by eliminating all behaviors that interfere with learning. 4. Participants are asked not to address therapy issues outside of bounds of curriculum or homework review. Therapy issues and conflicts between members are to be handled outside of group. 5. A primary role of the group leader is to teach the group member DBT skills. Focus in on meeting the guidelines for the curriculum as outlined in the DBT manual. 6. Insight into problems is not the goal. The goal is to learn the skills and to practice them as much as possible. 7. Participant homework is strongly emphasized, and homework review is a main focus of the class 8. Group connectedness is desired as well as useful but not essential to the class. 1. Group leaders are therapists. 2. Structure pertains to therapist s modality of therapy that allows for process and insight. 3. Rules are minimal and pertain to member s safety and confidentiality. Group and participant learning is done in the process of exploring a member s issue or behavior. 4. The goal is for group members to discuss any problems they are having with the group. Addressing interpersonal difficulties between members can be highly valuable and strongly encouraged by the therapist. 5. A primary role of the group leader is to promote change and to help participants translate skills learned into their daily life. 6. Insight into problems is the goal and is expected. 7. Follow up and progress is noted in group members sharing, however emphasis is on members finding a deeper understanding of their selves so they can use the skills. 8. Group cohesiveness is a necessary dynamic for members to build trust needed to share. 6

7 BIO-SOCIAL THEORY BIO: A. There is a biological vulnerability to emotions 7 1) sensitive 2) reactive 3) slow return to baseline PLUS B. An inability to effectively regulate emotions TRANSACTING WITH SOCIAL: An Invalidating Environment: Communicates what you are feeling, thinking, doing is inaccurate, inappropriate, or wrong. Often rejects, punishes, or leaves you feeling less than and then YOU may begin to invalidate yourself. You re so stupid! I don t understand why you re so upset! I am so stupid! OR/AND Sometimes there is a poor fit between the individual and the environment Hyper child quiet parents Active/social family shy child OVER TIME LEADS TO... Multiple Problems Confusion about self Impulsivity Emotional Instability Interpersonal Problems All or Nothing Thinking, Acting, Feeling

8 DBT ASSUMPTIONS 8 1) People are doing the best they can. 2) People want to improve 3) People need to do better, try harder, and be more motivated to change 4) People may not have caused all their own problems, but they have to solve them anyway. 5) The lives of suicidal, depressed, anxious, angry, and/or substance using teenagers are painful as they are currently being lived. 6) All people must learn new behaviors in different situations in their lives (home, school, their neighborhood). 7) There is no absolute truth. 8) People cannot fail in DBT.

9 GUIDELINES & CONTRACT FOR SKILLS TRAINING 9 1. Clients are not to discuss past or current self destructive behaviors or cravings with other clients in or outside of group sessions. 2. Clients who reach out to others for help must be willing to accept help from the person and conversation must be focused on skills. 3. Information about clients must remain confidential 4. No therapy interfering behaviors (sub-grouping, not bringing binder to group, incomplete diary card, not giving feedback, sleeping in group, distracting behavior, refusing group). 5. No therapy destroying behaviors (verbal/physical aggression towards members and/or facilitators, property destruction) I am familiar with the theory, assumptions, and format of DBT. I will come to group on time, with my materials and homework completed, and respect the group guidelines. I understand that if I violate this contract, I risk being asked to leave group and further consequences. (Your Name) (Your Skills Trainer) (Date) (Date)

10 Encouraging Affirmations 10 I accept myself as I AM, always and in all ways. I know and accept that all things presented to me are divine gifts of unconditional love. I accept all others as individual expressions of divine love. I AM perfect in the eyes of my Creator; therefore, I choose to see perfection in all things and all events All life is an expression of divine love. I now choose to accept that all things on Earth are equal and worthy of my love and attention. I AM a perfect expression of love, and I express my love unconditionally to all others and myself. I offer the gifts of love and compassion without asking or expecting anything in return. I AM now able to find the humor in my mistakes, for I see that these are perfect and divine lessons being presented to me. I AM without judgment of others or myself. I unconditionally accept that all things are on expression of divine love. I accept, unconditionally, that I create my reality through my thoughts, words, and actions. I now think only loving thoughts. I now say only loving words. I now act only lovingly toward all others and myself. I choose to love myself, and I see love s perfection reflected in everything and everyone. I love, honor, and accept the perfection of Spirit within myself and within all things. I now choose to recognize the love and perfection in all things and in all events. I now accept that I am only Love in its most divine expression. I AM loving and compassionate toward all others, regardless of any situation. I AM never a victim of circumstance. All lessons presented to me are perfect, and I gratefully accept them as part of my soul s growth. Today, I choose to place love around any fear-based emotions I may have toward another person or situation. I choose to unconditionally accept my family, my friends, my peers, all who I encounter today regardless of the circumstances and myself. Today, I chose to accept the world, its people and its events as they are, without judgment or fear. I AM aware that I create my reality; therefore, I now choose to accept everyone and everything, without conditions attached. In this way, I create a new reality one of love and peace.

11 11 At the core of all things in the universe, there is only divine love. I choose to see only the divine love in everyone. Anything other than love is an illusion. My role as a human being is to recognize my divinity, to unconditionally accept my divinity and to be this divinity at all times. I am aware that I am my own soul mate. My relationship with myself is reflected in all that I experience. By my practicing unconditional acceptance of myself, I AM now able to accept all others as they are. I now choose to invite joy, laughter, peace, and love into my life, and I accept these gifts in whatever form they are presented to me. I show the way to others by choosing unconditional love and acceptance in any situation. My unconditional love and acceptance of who I AM, lights my pathway home. I AM free of judgment and I AM now filled with unconditional love and acceptance for all things. Be like a postage stamp. Stick one things until you get there. Though no one can go back and make a new start, anyone can start from now and make a brand new end. Never give up for that is just the time and place the tide will turn. If I have inside of me the stuff to make cocoons, then maybe the stuff to make butterflies is there, too. To be upset over what I don t have to waste what I do have. I hang onto my humor. I don t ask for permission, I just do it. I make everything fun! Today I will seek out things that are fun to do. I am curious, eager to try new things. I experience and express my emotions freely. I am creative and innovative. I rest when my body tells me to. I learn enthusiastically. This is a new and wonderful day for me; there will never be another day like this. Whenever my attention wanders away from that which is good and constructive, I immediately bring it back to the contemplation of that which is lovely and of good report. I am going to be a wonderful success in all my undertakings today. I am definitely going to be happy all day long! I am not afraid of life. I believe that life is worth living, and my belief helps create the fact. Either I find a way, or I will make one. It doesn t matter what the struggle is. There is always room for hope. I am not going to die one of the statistics.

12 12 The question I ask myself is not if I should heal but how I should heal. I will not wait to have a good day. I will make one. I move beyond my old limitations and allow myself to express freely and creatively. Life is about change, and I adapt easily to the new. I forgive myself and others, release the past and move forward with love in my heart. I love and approve of myself, am at peace with my own feelings and stand tall and free. If I can endure for this minute whatever is happening to me, no matter how heavy my heart is, or how dark the moment might be. If I can but keep on believing what I know in my heart to be true, that darkness will fade with morning and this will pas away, too. Then nothing can ever disturb me or fill me with uncertain fear. For as sure as night brings dawning, my morning is bound to appear. I will persist until I succeed. I can go the extra mile today. I will dwell on the positive affirmations and things in my life, and they will become my aspiration. My free time can be used creatively, inventively, and imaginatively. I do not need to use it for routine habits, which are unimportant and unhealthy. I will be patient in steadily working toward my goal, remembering that all good comes in time. I will hold on. I will be brave. I am almost there. I will never give up. Walking away from something that is bad for me is not quitting! I have learned to treat myself gently because with a few exceptions, I am doing my best. I will not feel guilty for caring for myself. I will not be hard on myself today. I will not be embarrassed by my pain. I will go through it with dignity. It will enhance me. I am grateful for who I am. I will accept my pain when it is present. I will NOT anticipate it. I will be more understanding of the needs of others when I am able to care for my own. I will resist anything that takes me off the chosen path of recovery. Loving life increases my energy and passions. When I am in trouble, dwelling on it doesn t really help. I can feel sad, I can grieve, but eventually I have to move on. Time does heal, and when I am going through a difficult patch I will remember I don t want to make it any worse. When I put force and energy behind something, the results are powerful.

13 13 If I break my habits and shake up my day a bit, I will gain new impressions and understanding. The more things I plan to do, the more energy I will have. I am in charge. I am responsible for the direction of my boat. I will forgive in order to move forward. No one can make me a victim unless I allow them to. Anger hurts more than the person I feel rage toward. I will let go and move on. Life is too valuable to get stuck. I am naturally beautiful when I am myself. All that we are is a result of what we have thought. I will not let others interfere with my steady resolve to live a full, useful, and productive day. Focusing on the present moment will make me less anxious. I am meant to be very different from everyone else. This releases the burden of feeling like I have to be someone other than me. Today is the beginning of the rest of my life. It is a clean slate. I will begin it totally refreshed and just live it. I carry within me all the essentials of a happy existence. My task is to do the best I can which is enough! I gain energy from doing those things I choose to do rather than what I feel I have to do. When I put my time to good use, I value myself and feel good. If I expect recovery to be easy, I will become frustrated. The easy stuff doesn t teach us much what is difficult and challenging enhances my growth. I will be proud of my strengths and nurture them. No one else can blame me and make me feel wrong unless I accept the accusations and choose to feel the guilt. What I do today may have a profound impact on my life tomorrow. I will be the best person I can be today. A quiet and pleased mind absorbs beauty and grace naturally. I will relax, be calm, and therefore be content. When I do a good job in whatever challenges there are, I am living. It is comforting to know I have all the necessary muscles to cope when faced with really difficult times. Whenever I face a hardship, feel anxious, nervous, and sad, I will embrace my pain and agony. I know I can learn from my misery and pain and share the knowledge with others. I will surround myself with people who are affirming and encouraging. I will choose what is really important to me before I run out of time. Remaining optimistic will help me experience joy. I will go about my life doing what I believe is right and hold fast to my beliefs.

14 14 I appreciate and am grateful for all the help I get along the way as I try to stay on course. I choose to make the best of what I have, I am brave, I will survive. I have faith in family friends and myself. I have faith in this world. I have faith in my process of recovery. I will look for the beauty in every problem I have to solve. Thoughts provoke action. I will think healthy thoughts to provide healthier actions. When I am faced with a difficult time, I will get through it better by focusing on what I hope to accomplish. I will be strong, do what I have to do and move forward. I do the very best I know how, the very best I can. Wherever I am I will do my best and that is all I will ever expect of myself. I will live my life in the way I want to be remembered. I will surround myself with trustworthy people and put my trust in them. When I am required to exhibit strength, it comes. Negative thoughts will NEVER help; they will ALWAYS hurt me. I am not in control of others, but I am in control of myself. When I am content to simply be myself and don t compare or compete, everybody will respect me. I will never please everyone and that s okay. I will not listen to anyone who tells me what I can t do. I am proud of myself for all I have accomplished no matter how small or great. I regret nothing, because I am and do the best I can. I will not let the lessons or experiences of the past dampen my enthusiasm for new beginnings. I will go where my heart leads. I will trust my soul it knows the way. I will see myself doing all the things I would like to do. I will take the time to use my creative power of visualization to create the life I would like. Above all I will take the time to see myself being happy. I will trust, honor, and respect the process of change. I can listen to my needs. Taking time to honor the needs of my body is taking time to respect the needs of my soul. I can get out of my rut and discover what interests me. I will do what I need to break through my resistance. See how powerful I am! I will seek out people who empower me. And during those times when they are not around, I will know that I can empower myself.

15 15 When I look back at my past I will look tenderly and gently at all I have been through. I will be proud of my accomplishments and how far I have come. One step at a time. That is how I will get where I am going. I will take the time to honor and express my dreams. I am free to redefine and help create the life I choose. I am free to see life in a new way. I can open myself to the hopes and dreams of today. I am ready to heal my heart. I am deserving of this. I am powerful now and powerfully connected to myself. There is a purpose and value to each day of my life. I will nurture my times of action of creating of doing and value my quieter times of going within. I have all the guidance, energy, ideas, creativity, power, and ability to do all I am meant to do. I will be given the power to enjoy it. I will make each moment count today. Give yourself some relief. Take the pressure off. Today I take time to inhale peace and exhale fear. Facing and feeling my fears will empower me to move on. I am doing better than I think. Reward yourself often. When you accomplish a particular task. When you have gone through a grueling part of your healing process. Reward yourself during the frustrating times just for being patient. Sometimes, reward yourself for just being you. Many things are possible if I accept the fastest way is one step at a time. When I feel too much stress, I will give myself a break and let my body start soaking up some healing energy. I will not let expectations distort my experience. I believe I deserve love. I am not afraid of making mistakes. I can embrace the mystery and magic of myself. I can stop punishing myself with fear. I will not allow the fear of what if to ruin the joy of what is. I can let go of the need to prove myself to others. I will be gentle with myself when I get stuck. I do not need to be paranoid and have to think every event means something. I trust the timing of my lessons. Self-Love is my birthright. Every choice I make will teach me something and whenever I learn something there is success, not failure. I am making the healthiest, most loving choices. I am capable of making at this very moment. I can weather the storms and let them pass. I can let go of shame.

16 16 I can recognize the desire in my heart to recover. I am grateful to the people who are helping me heal, grow, and move along my path. I am free to be all I can be. I deserve to recover. Sometimes I need to spin our wheels. It helps me get unstuck. I can allow myself to heal. I can find new messages that empower me with love, messages that set me free. No matter what I am going through, my soul can be at peace. Maybe I am where I am today for a reason other than I thought. Maybe the first thing to do is cleanse the past and heal my heart. I have the power to create joy by choosing what feels good for me. I will be gentle with myself. I am not alone in my problem, my powerlessness, or my search for solution. I can learn to embrace change. I will let myself receive the healing I need. For now, I will trust and experience what I am going through. I know that this time of change is sacred. I will let my choices come from my heart. I trust that the waiting part of change is necessary. I trust my desire for change is the beginning of change. I trust that each moment I am moving closer to the change I desire. We will be given the power to do all we need to do. Take the simple steps that lie before you. Take one step at a time. You will find the way again. I will not try to complicate things or try to figure it all out. The answer is simple. I will look into my heart. I will reduce as much toxicity in my environment and in myself as I can. I will embrace the changes taking place in me now. They are good. I will be clear and forthright about what I need and want. I have faith that wherever I am going is important and wonderful. I can use the potent, creative power of visualization to create pictures of all the good I would like to see in my life. If I feel an emotion an old, stuck, hardened chunk of emotion or a new one that has arisen along the way I can release it and the belief attached to it. How overwhelmed we feel when we anticipate the future, all that needs doing, all the tasks, the work, the potential problems, the responsibilities. I will stay in the present moment, and the past and future will fall naturally and easily into place. All the wonders I seek are within me. I am the first person who needs to like me. I can become the person I want to be. I make the world more special just by being in it.

17 17 I believe life is worth living. I can sit down in a quiet place and get in touch with myself. I will make an effort everyday to feel good about who I am and what I can be. Today I will work on improving my abilities rather than my disabilities. I run my own life. I am okay. I can live in peace at a time of stress. I cannot climb uphill by thinking downhill thoughts. I can move away from self-defeating beliefs. I have choices. I can choose new responses to old situations. I can learn to recognize my true needs and choose positive ways of satisfying them. Understanding and respecting my limits, I can learn to say no to what might jeopardize my serenity and well being. I need care and attention. I am responsible for seeing that this need is met. I will give myself the care and attention I need. The beginning I make today is never insignificant or unimportant. It is the foundation of my future. I now have the opportunity to pursue my desires until I discover what brings me happiness. Freedom from my addiction clears away the depression and passivity that prevents me from identifying and going after my deepest hearts desire. I am free to do and enjoy the good things that come my way, and I am equipped to deal with inevitable problems. If I begin to get bored with the mechanics of my program, I need to remember what it was like before. I grow by doing what s hard to do. I will accept today s challenges to grow. I no longer need to spend large blocks of time obsessing. I have the wisdom to know how I want to spend my time and energy today. I cannot control or change others, but I can change myself. Today I can take a small risk in the interest of enriching my life. I will determine my priorities today to avoid confusion. I can choose to have a daily reprieve from self-destructive behavior. I will seek progress, not perfection. If I let myself down by slipping back into old habits, I can gently correct my course without feeling that I have failed. Today, I will concentrate on taking one step forward, however small. Today, I will seek renewed supply of serenity, courage, and wisdom. I have much to give. I can be loved and accepted according to how well I give of myself, not for how much.

18 18 Whatever my struggle today, I am a worthwhile person with valuable contributions to make to those around me. I am not finished growing, changing, and evolving. I like myself today. I am aware of possibilities for improvement, but I don t want to be anyone else. I am comfortable and accepting of who I am. I can forgive my mistakes and move on to try again. Today I am glad to be ME! Positive or negative the choice is mine! My actions today will build good memories for tomorrow. I cannot see the outcome of the journey, but I can take the next step. I have the will, strength, and desire to continue working on recovery.

19 MINDFULNESS 19 Taking Hold of Your Mind From: To: Mindfulness is: 1) Paying attention, in a particular way, on purpose, to just this moment, and non-judgmentally. 2) Being awake to the present moment, being in one moment not in the past or future but right in the present, AND also the process of being in control of your own mind more than it controls you, so your are able to be in one moment. 3) Balancing AWARENESS (being aware of all that is in the moment) and ATTENTION (staying focused on one thing at a time).

20 3 STATES OF MIND 20 Logical Mind Blue Cold Logical Practical Intellectual Mr. Spock Police officer just the facts Surgeon Planned Linear Robot Wise Mind Purple Calm Space for a decision Integrated Balance Self respect In control of self Knowing Mental Space Centered Higher Power Gut Feeling Emotional Mind Red Hot Passion Creative Impulsive Sensing Artistic Tidal waves & tornados Feelings Reactive Extremes Motivates

21 MINDFULNESS: 21 3 States of Mind Emotion Mind is: Logical Mind is: Wise Mind When I am in Emotion Mind, I tend to: When I am in Logical Mind, I tend to: Emotion Mind Logical Mind Wise Mind means to me: Examples of being in Wise Mind are:

22 MINDFULNESS 3 STEPS TO ACHIEVE WISE MIND WHAT SKILLS 22 Observe Just notice the experience in the present moment Wordless watching: Watch your thoughts and feelings come and go (like clouds in the sky or as if they are on a conveyor belt) Don t push away your thoughts and feelings, just let them happen, even when they are painful Describe Wordful watching: Label what you observed with words Put words on the experience. For example: o I feel sadness in my heart o My stomach has a knot in it Describe only what you observe (without interpretations or assumptions) Participate Become one with your experience/lose yourself in it Fully experience your feelings without being self-conscious Actively practice. For example: o don t worry about tomorrow or focus on yesterday o just throw yourself into the current moment with all your heart (playing, cleaning, taking a test)

23 MINDFULNESS 3 STEPS TO ACHIEVE WISE MIND HOW SKILLS 23 Non-Judgmental Stance Don t Judge Notice don t evaluate as good/bad Acknowledge the harmful and the helpful without judgment Replace judgments ( You re a jerk ) with descriptions ( I fell mad when you do that Don t judge your judging One Mindfully Stay Focused Do one thing at a time (observe, describe, tasks, activities) Let go of distractions Concentrate your mind Live this moment, just this moment and then the next, and the next Effectively Do what works Focus on what works (don t let your emotions control your behavior) Play by the rules Act as skillfully as you can Do what you need to do to achieve your goals Let go of negative feelings that hurt you and make things worse

24 MINDFULNESS Practice Exercise 1 Getting into Wise Mind 24 Check off 1 What skill and 1 How skill to practice during the week. What Skills Observe Describe Participate How Skills No Judging Stay Focused Do what works Briefly describe your experiences using each skill during the week, including when and where you used them: Briefly describe if the skills affected your thoughts, feelings, or behaviors. If so, how: If you did not complete these practice exercises, please explain why not or what interfered:

25 MINDFULNESS Practice Exercise 2 Getting into Wise Mind 25 Check off 1 What skill and 1 How skill different from last time to practice during the week. What Skills Observe Describe Participate How Skills No Judging Stay Focused Do what works Briefly describe your experiences using each skill during the week, including when and where you used them: Briefly describe if the skills affected your thoughts, feelings, or behaviors. If so, how: If you did not complete these practice exercises, please explain why not or what interfered:

26 MINDFULNESS Practice Exercise 3 Getting into Wise Mind 26 Check off 1 What skill and 1 How skill different from last time to practice during the week. What Skills Observe Describe Participate How Skills No Judging Stay Focused Do what works Briefly describe your experiences using each skill during the week, including when and where you used them: Briefly describe if the skills affected your thoughts, feelings, or behaviors. If so, how: If you did not complete these practice exercises, please explain why not or what interfered:

27 MINDFULNESS Practice Exercise 4 Getting into Wise Mind 27 Check off 1 What skill and 1 How skill different from last time to practice during the week. What Skills Observe Describe Participate How Skills No Judging Stay Focused Do what works Briefly describe your experiences using each skill during the week, including when and where you used them: Briefly describe if the skills affected your thoughts, feelings, or behaviors. If so, how: If you did not complete these practice exercises, please explain why not or what interfered:

28 TWO SIMPLE SKILLS TO MINDFULNESS BREATHING IS GOOD FOR YOU! We often take the most important things for granted. Like breathing. If you re not breathing there s not much else going on! In the most stressful moments a deep breath can help slow everything down and help you gain control. Breathing is often used as a pain management technique. How Take a big breath. Focus on the air going in. Let it fill your lungs completely. Blow out slowly through your lips as if you were blowing up a balloon. 2. YOU RE GROUNDED! - We often go around feeling scattered, our heads disconnected from our bodies. Like breathing, we take our bodies for granted. - Take a moment to notice your body. Are you warm or cold? Notice how you are sitting in your chair. - Tightly clench your fists, and then slowly let go. Open your eyes and your mouth wide. - Take off your socks and shoes. Walk around in your bare fee. Pay attention to how it feels. - Stand up tall and imagine roots growing out of your feet deep into the earth. - Stretch up your arms and imagine that your hands are touching the sky. - Breath deeply. Imagine breathing the pure oxygen through your fingers, drawing the energy down through arms and into your body.

29 Mindfulness Cheat Sheet Choose something to focus on Examples: A favorite picture A burning candle A sound A stone A coin A word, such as relax or chill or peace Or choose an activity to focus on Examples: Breathing Sitting Chewing gum Balancing an egg Brushing your hair Baking cookies Drawing Object in a bag Making a paper airplane Bouncing a ball 2. Bring your attention or thoughts on to the object or activity of your focus. 3. Notice all aspects of the object or activity. The colors, smells, textures, sounds, weight, temperature, taste. Simply describe these qualities without judgment. Notice every detail. 4. Your attention will wander (and we all know it will!). a) Notice that your attention has wandered; perhaps a noise distracted you. Notice your thoughts This is stupid, or I can t do it, or I have to make supper. Notice urges to laugh. b) Gently bring your attention back to the object or activity, again with out judgment. Just notice and return your focus. 5. Start slowly. Focus for 10 seconds. Build up to 30 seconds then 1 minute, then 2 minutes. Practice often. No one will know you are doing it! 6. Use mindfulness to become centered, grounded, calm. Use it as a mental oasis. As a means to become connected to YOU and your wise mind.

30 DISTRESS TOLERANCE 30

31 DISTRESS TOLERANCE: GETTING THROUGH WITHOUT MAKING IT WORSE 31 WHY BOTHER COPING WITH PAINFUL FEELINGS AND URGES? Because 1. PAIN IS PART OF LIFE AND CANNOT ALWAYS BE AVOIDED. 2. IF YOU CAN T DEAL WITH YOUR PAIN, YOU MAY ACT IMPULSIVELY. 3. WHEN YOU ACT IMPULSIVELY, YOU MAY END UP HURTING YOURSELF, HURTING SOMEONE ELSE, OR NOT GETTING WHAT YOU WANT. What are your motivations to learn skills to help cope with painful feelings and urges? What are you hoping to learn?

32 DISTRESS TOLERANCE Crisis Survival Skills Skills for tolerating painful events and emotions when you can t make things better right away and you don t want to make it worse! DISTRACT with Wise Mind ACCEPTS Activities Contributing Comparisons Emotions Pushing Away Thoughts Sensations 32 SELF-SOOTHE with the 6 Senses Vision Hearing Smell Taste Touch Movement IMPROVE the Moment Imagery make Meaning Prayer Relaxation One thing in the moment Vacation Encouragement PROS AND CONS DISTRESS TOLERANCE

33 Crisis Survival Skills: Wise Mind ACCEPTS 33 DISTRACT with... Activities Contributing Comparisons Emotions Pushing Away Thoughts Sensations Do Something. Spend time with a friend; watch a movie or TV; play sports, video game, cards; write in your journal; clean your room. Contribute (do something nice) for someone. Help someone with a project; surprise someone with a card or kind word; do volunteer work; write a letter. Compare yourself to those less fortunate. Compare how you are feeling now to a time when you felt different; consider those who are coping less than you. Create different emotions. Watch a funny show; rent a scary movie; listen to music; read comics; get active; slow down Push the painful situation out of your mind for now. Leave the situation mentally by moving your attention and thoughts away; build an imaginary wall between you and the situation; block it from your mind; put the pain and the situation in a box, on a shelf, in a drawer, and leave it there. Remind yourself you aren t thinking about the situation. Replace your thoughts. Read; do word puzzles; count to 10, 20, 457; notice the colors around you; repeat the words to a song in your mind; go to Logical Mind and stay there for a while Intensify other sensations. Hold or chew ice; listen to loud music; wear a rubber band on your wrist; take a hot or cold shower; squeeze a ball or toy; run fast; exercise hard

34 DISTRESS TOLERANCE Crisis Survival Skills: Self Soothe 34 Self Soothe with... Vision Hearing Smell Taste Touch Movement Vision Hearing Smell Taste Touch Movement Go to your favorite spot and take in all the sights around you; look at a picture or poster that you like; make one part of your room look soothing to you; people watch Listen to soothing music or music you love; play a great song over and over; make a play list/cd; pay attention to sounds in nature (birds, rain, thunder, traffic); play an instrument; listen to silence Put on your favorite lotion or perfume, or try them on in a store; breathe in a candle; make cookies or popcorn; keep some of your favorite scents with you Eat some of your favorite foods; drink your favorite drink like tea or hot chocolate; have your favorite flavor of ice cream; really notice the food you eat (crunchy, creamy); eat one thing mindfully Take a long bath or shower; massage; brush or style your hair; hug someone; put a cold cloth on your face; put clean sheets on your bed; wear comfortable clothes; touch a blanket; pet your animal Move in a soothing way; rock yourself gently; stretch; go for a run; tap yourself gently on your shoulders or knees- Do this mindfully! Dance

35 DISTRESS TOLERANCE Crisis Survival Skills: IMPROVE IMPROVE the moment with Imagery Meaning Prayer Relaxation One thing in the moment Vacation Encouragement Imagine a very relaxing scene; imagine a secret room within yourself, seeing how it is decorated; go into the room whenever you feel threatened; close the door on anything that can hurt you; imagine everything going well; imagine coping well; make up a fantasy world that is calming and beautiful and let your mind go with it; imagine hurtful emotions draining out of you like water out of a pipe Find or create some purpose, meaning, or value in the pain; remember, listen to, or read about spiritual values; focus on whatever positive aspects of a painful situation you can find; repeat them over and over in your mind Open your heart to a supreme being, greater wisdom, God, your own Wise Mind; ask for strength to bear the pain in this moment; turn things over to a higher power Try muscle relaxing by tensing and relaxing each large muscle group, starting with your hands and arms, going to the top of your head, and working down; listen to a relaxation CD; exercise hard; take a hot bath/shower; massage; drink hot milk; breathe deep; half smile; change facial expression Focus your entire attention on just what you are doing right now; keep yourself in this moment; put your mind in the present; focus your attention on physical sensations that accompany non-verbal tasks (walking, cleaning); be aware of how your body moves during each task; do awareness exercises Give yourself a brief vacation; get in bed and pull up the covers for 20 minutes; get lost in a book; lay on a blanket outside; let your phone call go to voic ; take a 1-hour breather from hard work Cheerlead yourself. Repeat over and over your favorite mantras or statements.

36 Distress Tolerance Practice Exercise 1 Distracts Skill: Wise Mind ACCEPTS 36 Check off 2 ACCEPTS Skills to practice during the week when feeling upset: Activities Contributing Comparisons Emotions Pushing Away Thoughts Sensations Briefly describe the stressful situation(s) you were in when you chose to practice your skills: Did using the skills help you to: a. cope with uncomfortable feelings and urges and/or b. avoid conflict of any kind? Circle YES / NO If YES, please describe how it helped: If NO, please describe why you believe it did not help: Write down your level of distress tolerance before and after using your skill: (0=No tolerance, life is a nightmare 10=Lots of tolerance, life is awesome) Before: After: If you did not practice this skill, please explain why:

37 Distress Tolerance Practice Exercise 2 Self-Soothe 37 Check off 2 SELF-SOOTHE Skills to practice during the week when feeling upset: VISION HEARING SMELL TASTE TOUCH MOVEMENT Briefly describe the stressful situation(s) you were in when you chose to practice your skills: Did using the skills help you to: a. cope with uncomfortable feelings and urges and/or b. avoid conflict of any kind? Circle YES / NO If YES, please describe how it helped: If NO, please describe why you believe it did not help: Write down your level of distress tolerance before and after using your skill: (0=No tolerance, life is a nightmare 10=Lots of tolerance, life is awesome) Before: After: If you did not practice this skill, please explain why:

38 Distress Tolerance Practice Exercise 3 IMPROVE the Moment 38 Check off 2 IMPROVE Skills to practice during the week when feeling upset: IMAGERY MEANING PRAYER RELAXATION ONE THING IN THE MOMENT VACATION ENCOURAGEMENT Briefly describe the stressful situation(s) you were in when you chose to practice your skills: Did using the skills help you to: a. cope with uncomfortable feelings and urges and/or b. avoid conflict of any kind? Circle YES / NO If YES, please describe how it helped: If NO, please describe why you believe it did not help: Write down your level of distress tolerance before and after using your skill: (0=No tolerance, life is a nightmare 10=Lots of tolerance, life is awesome) Before: After: If you did not practice this skill, please explain why:

39 DISTRESS TOLERANCE Crisis Survival Skills: PROs and CONs 39 Select one crisis (emotionally upsetting situation) where you found it REALLY hard to tolerate your distress, avoid destructive behavior, and not act impulsively. CRISIS I was faced with: DESTRUCTIVE behavior I did/wanted to do: Remember to consider how the behavior affects you in the SHORT-TERM and LONG-TERM Same Old Way ACTING IMPULSIVELY: PROS ACTING IMPULSIVELY: CONS Building a Life TOLERATING DISTRESS: PROS TOLERATING DISTRESS:CONS Weigh out which side is heavier the pros or cons and act Things to consider? 1. What is my Wise Mind telling me to do now? 2. What would my role model tell me to do? 3. What decision will help me build a life worth living? Can also be used with Yes/No questions.

40 DISTRESS TOLERANCE Accepting Reality 40 Are you Willful? Or are you Willing?

41 DISTRESS TOLERANCE Accepting Reality Acceptance does not mean Approval!!! 41 WILLFULNESS Willfulness is refusing to tolerate a situation Willfulness is trying to change or fix a situation that cannot be changed or fixed Willfulness is refusing to change something that must be changed WILLINGNESS Willingness is responding to reality without trying to change it Willingness is listening carefully to your Wise Mind and deciding what to do Willingness is doing just what is needed, no more, no less. It is being effective. Create within yourself a willing response to each situation!!! How can you feel the difference between when you are Willing and when you are Willful? Check out any extreme thoughts, like No way! Check out your body are your muscles tight, jaw clenched? Describe a situation when you noticed Willingness and Willfulness Where were you Willful? How was your thinking Willful? How could you tell you were Willful? What happened? Where were you Willing?

42 How was your thinking Willing? How could you tell you were Willing? What happened? 42

43 DISTRESS TOLERANCE Turning the Mind: When you are at a fork in the road 43 Five things to do when serious problems come into your life 1. Figure out how to solve the problem a. Do you have what you need? b. Are you wanting/willing? 2. Accept it a. Mindfulness b. Recognize Reality for What Is 3. Change how you feel about the problem a. Mindfulness b. Opposite Action to Emotion 4. Stay Miserable 5. Make it Worse

44 DISTRESS TOLERANCE Accepting Reality 44 Acceptance does not mean Approval!!! Radical Acceptance ACCEPTANCE is when you stop fighting reality. It is letting yourself go with what is happening in the moment, even when you hate what is happening. It is complete and total acceptance. ACCEPTANCE turns suffering you can t cope with into pain you can manage. Freedom from suffering requires ACCEPTANCE from deep within. ACCEPTANCE can be to acknowledge, recognize, endure, to not give up or give in. It is the opposite of Why me? and Things should not be this way. Life can be worth living, even when there is pain. Turning the Mind ACCEPTANCE is a choice. It is like coming to a fork in the road. You may have to turn your mind towards the ACCEPTANCE road and away from the REJECTING reality road over and over again. First notice you are not accepting (anger, bitterness, why me? ) Second, make an inner commitment to ACCEPT. You may have to turn your mind over and over and over again, sometimes several times in a few minutes Three Myths about Acceptance IF YOU REFUSE TO ACCEPT SOMETHING, IT WILL MAGICALLY CHANGE IF YOU ACCEPT YOUR PAINFUL SITUATION, YOU WILL BECOME SOFT AND JUST GIVE UP (OR GIVE IN) IF YOU ACCEPT YOUR PAINFUL SITUATION, YOU ARE ACCEPTING A LIFE OF PAIN

45 Distress Tolerance Practice Exercise 4 Accepting Reality 45 Describe a situation during the week in which you felt you were suffering: Rate your suffering from 1-10 (10 being the worst): If you can t solve the problem right away, what did you choose to do (circle one)? 1. Stay Miserable 2. Accept the situation If you chose to radically accept the situation, what exactly did you do or say to yourself? Did you notice that you had to turn your mind back to radical acceptance? If yes, how? If you chose to stay miserable, what did you do or say to yourself to stay miserable? Rate your suffering now that you ve made your choice (1-10):

46 INTERPERSONAL 46 EFFECTIVENESS Building Positive Interactions

47 INTERPERSONAL EFFECTIVENESS Situations for Interpersonal Effectiveness Attending to Relationships Don t let hurts and problems build up Use relationship skills to head off problems End hopeless relationships Resolve conflicts before they get overwhelming 47 Balancing Priorities and Demands If overwhelmed, reduce or put off low-priority demands Ask others for help. Say No when necessary If not enough to do: try to create structure and responsibilities or offer to do things Balancing Wants and Shoulds Look at what you do because you enjoy doing it and want to do it AND how much you do because it has to be done and you should do it. Try to keep the number of each in balance, even if you have to o Get your opinions taken seriously o Get others to do things o Say No to unwanted requests Building Mastery and Self-Respect Interact in a way that makes you feel competent and effective, NOT helpless and overly dependent Stand up for yourself, your beliefs, and opinions follow your Wise Mind

48 INTERPERSONAL EFFECTIVENESS What is your goal? 48 Relationship: Keeping and maintaining healthy relationships QUESTION: How do I want the other person to feel about me? How do I get the other person to hear what I am saying? Example: If I care about the person or if the person has authority over me, act in a way that keeps the person respecting and liking me. Objective: Get my goals met in any type of situation (to get what I want) QUESTION: What do I want? What do I need? How do I get it? Example: To say no, to ask for something, to resolve a problem, to be listened to. Self-Respect: Keeping or improving how I feel about myself QUESTION: How do I want to feel about myself after the interaction? Example: What are my values and personal beliefs? Act in a way that makes me feel good about myself. PRACTICE: Think about these as PRIORITIES. When they are unclear, you may become indecisive. Describe an interaction (what do I want to say, to whom, why, where): What issues are related to each of the following? OBJECTIVE: RELATIONSHIP: SELF-RESPECT: *Rank them in order of importance to you (1 being the most important)

49 INTERPERSONAL EFFECTIVENESS 49 What stops you from achieving your goals? I. Lack of Skill You actually DON T KNOW what to say or how to act. II. Worry Thoughts You have the skill, but your worry thoughts interfere with doing or saying what you want. WORRIES ABOUT BAD CONSEQUENCES: they won t like me ; she ll think I m stupid WORRIES ABOUT WHETHER YOU DESERVE TO GET WHAT YOU WANT: I am such a bad person, I don t deserve this. WORRIES ABOUT BEING INEFFECTIVE AND CALLING YOURSELF NAMES: I won t do it right ; I m so stupid. III. Emotions You have the skill, but your EMOTIONS (anger, frustration, fear, guilt, sadness) make you unable to do or say what you want. Emotions, instead of skill, control what you say or do. IV. Can t Decide You have the skill, but you CAN T DECIDE what to do or what you want. You can t figure out how to balance: Asking for too much versus not asking for anything Saying no to everything versus giving in to everything V. Environment You have the skill, but the environment gets in the way: Other people are too powerful Other people may have some reason for not liking you if you get what you want Other people won t give you what you need unless you sacrifice your self-respect

50 INTERPERSONAL EFFECTIVENESS 50 Worry Thoughts That May Interfere and Cheerleading Statements (Realistic Thoughts) How can you turn negative thoughts into realistic ones? 1. Why bother asking, it won t make a difference anyway? Challenge Statement: 2. If I ask for something, she ll think I m stupid? Challenge Statement: 3. I m such a bad person that I don t deserve it. Challenge Statement: 4. If I say no, they ll never talk to me again. Challenge Statement: List out your Top 10 Affirming or Cheerleading Statements:

51 INTERPERSONAL EFFECTIVENESS Questions to Consider 51 Capability: Does the other person have what I want? Am I capable of giving the person what they want? Timeliness: Is it a good time for me to ask? Is it a good time for me to say no? Homework: Am I prepared and ready to answer questions regarding request? Am I prepared for the reaction to saying no? Authority: Does this person have power over me? Do I have power over this person? Rights: Do I have the right to what I m asking for? Does saying no violate the person s rights? Relationship: Is request appropriate to the relationship? Is saying no appropriate to the relationship? Reciprocity: Have I done favors for this person in the past? Do I owe this person a favor? Goals: Is asking important to getting my goals me? What does my Wise Mind say? Respect: Am I acting competent and in control? Am I acting confident and assertive?

52 INTERPERSONAL EFFECTIVENESS Cognitive Distortions All-or-nothing thinking: Thinking of things in absolute terms- always, every, or never. 2. Overgeneralization: Taking isolated cases and using them to make wide generalizations 3. Mental Filter: Focusing exclusively on certain, usually negative or upsetting, aspects of something while ignoring the rest. For example, focusing on a tiny imperfection in a piece of otherwise useful clothing 4. Disqualifying the positive: Continually shooting down positive experiences for arbitrary, negative reasons 5. Jumping to conclusions: Assuming something negative when there is no evidence to support it. Two specific subtypes are also identified: Mind reading-assuming the intentions of others Fortune telling-predicting how things will turn before they happen 6. Magnification and Minimization: Inappropriately understanding or exaggerating the individuals or situations. Often the positive characteristic of other people are exaggerated and negative characteristics are understated. There is one subtype of magnification: Catastrophizing-Focusing on the worst possible outcome, however unlikely, or thinking that a situation is unbearable or impossible when it is really just uncomfortable 7. Emotional reasoning: Making decisions and arguments based on how you feel rather than objective reality 8. Making should statements: Concentrating on what you think should or ought to be rather than the actual situation you are faced with, or having rigid rules which you think should always apply no matter the circumstances; musts 9. Labeling and Mislabeling: Explaining behaviors or events, merely by naming them; related to overgeneralization. Rather than describing the specific behavior, you assign a label to someone of yourself that puts them in absolute and unalterable terms. Mislabeling involves describing an event with language that is highly colored and emotionally loaded. 10. Personalization (attribution): Assuming you or others directly caused things when that may not have been the case. When applied to others, blame is an example. What are examples of your most commonly used cognitive distortions?

53 INTERPERSONAL EFFECTIVENESS 53 Guidelines for Getting Your Goals Met Remember DEAR MAN: Describe Express Assert Reinforce Mindful Appear Confident Negotiate WHAT DOES THIS MEAN? Describe: Express: Assert: Reinforce: Mindful: Appear Confident: Describe this situation. State the facts when needed. Express your feelings and opinions using I statements ( I feel, I would like ). Do not assume the other person knows how you feel. Stay away from you should Ask for something or say no clearly. Do not assume the other person knows what you are asking (he/she can t read your mind!) Reward (reinforce) the person ahead of time by explaining the positive effects of following your request or respecting your no. Also, reward him/her afterwards. Keep your focus on what you want, avoiding distractions. Come back to your assertion over and over, like a broken record. Ignore attacks; keep making your point. Make (and maintain) eye contact. Use a confident tone of voice do not whisper, mumble, or give up and say whatever. Negotiate: Be willing to GIVE TO GET and know this ahead of time. Ask for the other person s input. Offer alternative solutions to the problem. Know when to agree to disagree and walk away.

54 INTERPERSONAL EFFECTIVENESS 54 Guidelines for Relationship Building Remember GIVE: (be) Gentle (act) Interested Validate (used an) Easy Manner WHAT DOES THIS MEAN? (be) Gentle: Be nice and respectful! Slow down. Don t attack, use threats, or judgments. Be aware of your tone of voice. (act) Interested: LISTEN and act interested in what the other person is saying. Don t interrupt or talk over them. Don t make faces. Maintain appropriate eye contact. Be patient and sensitive if they have a different point of view. Validate: Show that you understand the other person s feelings or opinions. Be non-judgmental out loud. I can understand how you feel and I realize this is hard I see you are busy, (use) Easy manner: SMILE. Use humor. Be light hearted. Do not use threatening body language or give attitude. Describe how you use each of the following in your interactions? Gentle? Interested? Validate? Easy manner?

55 INTERPERSONAL EFFECTIVENESS 55 Guidelines for Maintaining your Self-Respect Remember FAST: (be) Fair (no) Apologies Stick to values (be) Truthful WHAT DOES THIS MEAN? (be) Fair: (no) Apologies: Stick to values: (be) Truthful: Be fair to both yourself and to the other person. Be aware of judgmental thoughts and assumptions. Don t over apologize. Recognize what amends need to be made, if any, and be aware of what is in yours to take responsibility of and what is in the other person s control. Stick to your own values and opinions. Be aware of how you maintain your morals and principles. Be honest. No lying. Do not act helpless when you are not!! Stay empowered and in your own control. Describe how you use each of the following in your interactions? Fair? (no) Apologies? Stick to values? (be) Truthful?

56 Interpersonal Effectiveness Practice Exercise 1 Getting what you want DEAR MAN 56 Choose one situation during the week in which you used your DEAR MAN skills and describe below. What happened? (Who did what? What led up to what? What is the problem?) What did you want from the other person? DEAR MAN skills used (write down how you used each one): Describe (Describe the situation just the facts): Express (feelings): Assert: Reinforce: Mindful: Appear Confident: Negotiate: What was the result of using your DEAR MAN skills?

57 Interpersonal Effectiveness Practice Exercise 2 Maintaining Relationship GIVE 57 Choose two situation during the week in which you used your GIVE skills and describe below. Remember GIVE: (be) Gentle (act) Interested Validate (used an) Easy Manner Situation 1: With whom are you trying to keep a good relationship? What was the situation in which you chose to use your GIVE skills? What was the outcome? How did you feel after using your skills? Situation 2: With whom are you trying to keep a good relationship? What was the situation in which you chose to use your GIVE skills? What was the outcome? How did you feel after using your skills?

58 Interpersonal Effectiveness Practice Exercise 3 Maintaining Relationship FAST 58 Choose two situation during the week in which you used your FAST skills and describe below. Remember FAST: (be) Fair (no) Apologies Stick to values (be) Truthful Situation 1: In what way are you trying to maintain your self-respect? What was the situation in which you chose to use your FAST skills? What was the outcome? How did you feel after using your skills? Situation 2: In what way are you trying to maintain your self-respect? What was the situation in which you chose to use your FAST skills? What was the outcome? How did you feel after using your skills?

59 INTERPERSONAL EFFECTIVENESS Increasing Effectiveness in the Current Situation Identify the five factors that interfere with being effective 2. Identify the DBT skills that increase effectiveness Skills lacking? helpful? (Identify) What DBT Skills would be Worry thoughts interfering? helpful? (Identify) What DBT Skills would be Emotions interfering? helpful? (Identify) What DBT Skills would be Indecision concerning priorities in situation (conflicts) What DBT Skills would be helpful? Environment makes it impossible helpful? even if skillful? What DBT Skills would be

60 60

61 Emotion Regulation 61 Learning to Experience Emotions like a wave

62 Overview 62 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 emotional experiences. Perhaps more than in the other 3 modules, the skills in Emotion Regulation build on each other. As we learn each little piece, and practice it, we are putting another building block in the structure of our Emotion Regulation, learning little by little how to handle negative emotions and how to build positive ones. The first thing to realize is that no one is telling us our negative emotions are bad, or not important, or to get rid of them. Everyone has negative emotions. It is part of life. Those of us who have been through painful or traumatizing experiences may have very intense emotions. We want to validate these emotions, have them recognized and believed, and accept them as real and meaningful. What the module on Emotion Regulation intends to teach us is how to understand our emotions and how they get that way, how we are or become more vulnerable to those emotions and what we can do about it, and some techniques for building positive emotions into our lives. Our emotions can frequently be very intense and labile (change often). Our emotions can often drive our behavior. A lot of our behavior focuses around finding ways to get our emotions validated or to get rid of the pain in some way. Emotions educate us, if we allow it. We will learn where emotions come from and some techniques about managing our emotions, reducing our vulnerability to negative emotions, learning to experience some positive emotions, and learning to reduce our emotional suffering. There are two kinds of emotional experiences: 1. Reactions to events in the environment 2. Inner reactions, primarily reactions to one s own thoughts/emotions

63 EMOTION REGULATION HANDOUT 1 GOALS OF EMOTION REGULATION 63 I. UNDERSTAND EMOTIONS YOU EXPERIENCE a. Identify (observe and describe) emotions b. Identify (observe and describe) what emotions do for you c. Evaluate whether your own emotional responses are effective II. DECREASE EMOTIONAL SENSITIVITY (STOP UNWANTED EMOTIONS FROM STARTING IN THE FIRST PLACE) a. Change situations that set off painful emotions b. Reduce sensitivity through opposite actions c. Decrease negative vulnerability (vulnerability to emotion mind ) III. DECREASE EMOTIONAL INTENSITY (STOP OR REDUCE THE INTENSITY OF UNWANTED EMOTIONS ONCE THEY START) a. Check the facts so you respond to what is really going on b. Let go of painful emotions through mindfulness c. Manage extreme emotions so you don t make things worse Personal Motivations to Emotionally Regulate

64 EMOTION REGULATION Worksheet 1 (for HO1) Pros and Cons of Changing Emotions 64 Make a list of the Pros and Cons of changing the emotion Make another list of the Pros and Cons of not changing the emotion Check the facts to be sure that you are correct in both Pros/Cons EMOTION NAME: INTENSITY (0-100) Before After Fill this worksheet out when you are experiencing a difficult emotion and at the same time you are: Trying to decide whether to work on changing your current emotion or your general emotional reactions to specific events Having lots of trouble getting yourself to do any work at all to change your emotion Feeling willful, saying NO! to changing your emotion or reducing its intensity Feeling threatened whenever you think of reducing the intensity or letting go of it Not in the mood for putting in time and effort to change your emotion When filling out this worksheet, think about: Are the actions your emotion is motivating effective or ineffective? Will acting on your emotion solve a problem or make a new problem for you? Does expressing your emotion get you closer to or farther away from your own goals? Will expressing your emotion to others influence in ways that will help or hurt you? Is your emotion sending you a message you need to listen to or one you need to let go of? Pros Cons Changing Emotions Changing Emotions Keeping Emotion As Is Keeping Emotion As Is What did you decide to do about your emotions? What is the wise mind decision? Date:

65 65 EMOTION REGULATION HANDOUT 2 WHAT GOOD ARE EMOTIONS? 1. Emotions organize us and get us motivated a. Emotions motivate our behavior, prepare us for action. The action urge connected to specific emotions is often hard-wired. b. Emotions save time in getting us to act in important situations. Emotions can be especially important when we don t have time to think things through. c. Strong emotions help us overcome obstacles in our mind and in the environment 2. Emotions communicate and influence others a. Your facial expression, posture, gestures, words, and voice tone communicate faster than words. They are hard-wired part of emotions. b. When it is important to us to communicate to others, it can be very hard for us to change our emotions. c. Whether you like it or not, how you communicate your emotions influence other people and how they interact with you. 3. Emotions communicate to Ourselves a. Emotional reactions can give us important information about a situation. Emotions can be signals or alarms that something is happening b. Gut feelings can be like intuition a response to something important about the situation. This can be helpful if our emotions get us to check out the facts c. Sometimes we treat emotions as if they are facts about the world. The stronger the emotion, the stronger our belief that the emotion is based on absolute fact. d. If we assume that our emotions represent facts about the world, we may use them to validate our thoughts or our actions. This can be trouble if our emotions get us to ignore the facts.

66 EMOTION REGULATION Worksheet 2 (for HO2) 66 Figuring Out What My Emotions Are Doing For Me Select a current or recent emotional reaction and fill out as much of this sheet as you can. If the prompting event for the emotion you are working on is another emotion that occurred first (for example, feeling afraid prompted getting angry at yourself), then fill out a second worksheet for that first emotion. EMOTION NAME: INTENSITY (0-100) Motivation to Action: What action is my emotion motivating and preparing me to do? (Is there a problem my emotion is getting me to solve, overcome, or avoid?) What function or goal does my emotion serve? Communication to Others: What is my facial expression? Posture? Gestures? Words? Actions? What message does my emotion send to others (even if I don t intend to send the message)? How does my emotion influence others (even if I don t intent to influence them)? What did others do or say as a result of my emotional expression or actions? Communication to Myself What does my emotion say to me? What facts can I check out to be sure the message my emotions send to me is correct? What facts have I checked out?

67 EMOTION REGULATION Worksheet 2a (for HO2) 67 Emotion Diary Record emotions (either the strongest emotion of the day, the longest-lasting one or the one that was the most painful or gave you the most trouble). Analyze that emotion. Fill out a Describing Emotions Worksheet (ER Worksheet 3 or 3a) if necessary, plus this diary sheet. EMOTIONS MOTIVATE COMMUNICATE TO OTHERS COMMUNICATE TO ME EMOTION What did emotion motivate me to do? (goal of emotion) How was emotion expressed to others? (verbal and non-) What message did my emotion express to others? How did message expressed influence others (effect on others)? What was my emotion saying to me? How did I check out the facts? Date:

68 EMOTION REGULATION HANDOUT 3 68 Model for Describing Emotions Recent History Vulnerability Factors Interpretation (Thoughts) Of Event Biological Change Expression Prompting Event 1 (Cue) Inside or Outside Prompting Event 2 (Cue) Inside or Outside Brain Change (neural firing) Nervous System Change (internal body change) i.e., muscles, autonomic system firing, (blood vessels, heart rate, temperature) Face and Body Language i.e. facial expression, posture, skin color) Expression with Words Emotion Name Experience Aftereffects Sensations (feelings) Action Urge Action Doing Something Secondary Emotions

69 EMOTION REGULATION Worksheet 3 (for HO 3-4) 69 Observing and Describing Emotions Select a current or recent emotional reaction and fill out as much of this sheet as you can. If the prompting event for the emotion you are working on is another emotion that occurred first (fear prompted anger at yourself), then fill out a second worksheet for that emotion. Use Emotion Regulation Handout 4 for ideas. Date: Vulnerability Factors: What happened before to make me vulnerable to the prompting event? Interpretation of Event (thoughts, beliefs) Prompting Event: What triggered the emotion? What happened in the few minutes right before emotion fired? Just the facts! Brain Change Face and Body Biological Changes Sensing (feeling in body) Action Urge (what do I feel like doing? what do I want to say?) Face and Body Language (facial expression, posture, gestures) Expression with words (what I SAID) Action (What I DID) Aftereffects: (emotions, behavior, thoughts, etc.)? Emotion Name Intensity (0-100)

70 EMOTION REGULATION Worksheet 3a (for HO 3-4) 70 Observing and Describing Emotions Select a current or recent emotional reaction and fill out as much of this sheet as you can. If the prompting event for the emotion you are working on is another emotion that occurred first (fear prompted anger at yourself), then fill out a second worksheet for that emotion. Use Emotion Regulation Handout 4 for ideas. EMOTION NAME: INTENSITY (0-100) Before After PROMPTING EVENT for my emotion (who, what, when, where): What triggered the emotion? VULNERABILITY FACTORS: What happened before that made me vulnerable to the event? INTERPRETATIONS (beliefs, assumptions, appraisals) of the situation? FACE and BODY CHANGES and SENSING: What am I feeling in my face and body? ACTION URGES: What do I feel like doing? What do I want to say? BODY LANGUAGE: What is my facial expression? Posture? Gestures? What I SAID in the situation (Be Specific) What I DID in the situation (Be Specific) What AFTER EFFECT does the emotion have on me (state of mind, other emotions, behavior, thoughts, memory, body, etc)? Date:

71 71 EMOTION REGULATION HANDOUT 4.1 Ways to Describe Emotions ANGER WORDS anger exasperation grumpiness rage aggravation ferocity hostility vengefulness agitation frustration indignation wrath annoyance fury irritation bitterness grouchiness outrage Other: Prompting Events for Feeling Anger Having an important goal blocked or prevented Losing power Having an important or pleasurable activity interrupted, postponed or stopped Losing status You or someone you care about being attacked or hurt physically or emotionally by others Losing respect You or someone you care about being threatened with physical or emotional pain by someone or something Not having things turn out the way you expected You or someone you care about being insulted Experiencing physical pain Experiencing emotional pain Not obtaining something you want (that another person has) Other: Interpretations of Events That Prompt Feelings of Anger Believing that you have been treated unfairly Believing that important goals are being blocked or that pleasurable activities are being interrupted, postponed or stopped Believing that others are attacking or trying to hurt you or someone you care about Believing someone is insulting or disrespecting you or trying to control you Believing that things should be different than they are Rigidly thinking I m right Judging that the situation is illegitimate, wrong or unfair Ruminating about the event that set off the anger in the first place, or in the past Blaming Other: (Cont.)

72 Biological Changes and Experiences of Anger 72 Muscles tightening Being unable to stop tears Teeth clamping together, mouth tightening Feeling extremely emotional Hands clenching Feeling nervous tension, anxiety or discomfort Feeling your face flush or get hot Wanting to hit, bang the wall, throw something, or blow up Feeling rigidity in your body Feeling like you are going to explode Wanting to hurt someone Feeling incoherent Feeling out of control Other: Expressions and Actions of Anger Physically attacking the cause of your anger Gritting or showing your teeth in an unfriendly manner Clenching your hands or fists Walking out Verbally attacking the cause of Sarcastic or caustic voice tone your anger Using a loud voice, yelling or Frowning, or not smiling screaming Making aggressive or Crying threatening gestures Acting quarrelsome or sarcastic Having a mean or unpleasant Grinning facial expression Using obscenities or swearing Pounding, throwing things, A red or flushed face breaking things Criticizing or complaining Brooding or withdrawing from Talking about how lousy things others are Walking heavily, stomping; slamming doors Other: Aftereffects of Anger Narrowing of attention Attending only to the situation making you angry Ruminating about the situation making you angry and not being able to think of anything else Remembering and ruminating about situations that have made you angry in the past Imagining future situations that will make you angry Depersonalization, dissociative experience, numbness Other: Typical Secondary Emotions of Anger Intense shame or fear Other:

73 EMOTION REGULATION HANDOUT DISGUST WORDS disgust dislike repugnance sickened abhorrence derision repelled spite antipathy disdain repulsion vile aversion distaste resentment condescension hate revolted contempt loathing scorn Prompting Events for Feeling Disgust Seeing or smelling waste products of a human or animal body Being near, seeing or touching something that reviles you, e.g., slimy animals or crawling Observing or hearing about a insects person who behaves without dignity or who strips another person of his or her dignity Being force to watch something that deeply violates your own wise mind values Having a person or an animal that is dirty or unclean come Seeing or being near a dead body close to you Being confronted with someone Observing or hearing about a person acting with extreme who is deeply violating your own wise mind values hypocrisy, fawning Touching items worn or owned Tasting something or being forced to incorporate or swallow by a stranger, dead person, or disliked person something your really don t want Being force to engage in or Observing or hearing about watch unwanted sexual contact betrayal, child abuse, racism or Seeing blood or getting an other types of cruelty injection or blood drawn Other: Interpretations of Events That Prompt Feelings of Disgust Believing that you are swallowing something toxic Believing that your skin is contaminated Believing that your own body or parts are ugly Believing that an object has negative or unwholesome sensory (e.g., smell, feel, taste) characteristics Disapproving of or feeling morally superior to someone, disrespecting someone or their beliefs Extreme disapproval of self or one s own feelings, thoughts or behaviors Believing that a person is disrespecting authority or the ethical norms of the group, or is disloyal to or not honoring of others in the community Judging that a person is deeply immoral or has sinned or violated the natural order of things Judging someone s body as extremely ugly EMOTION REGULATION HANDOUT 4.3

74 Believing that by being around a person you will become contaminated, e.g., by poisonous ideas Believing others are evil or the scum of the earth 74 Other: Biological Changes and Experiences of Disgust Feelings of nausea Sick Feeling Urge to vomit, vomiting Gagging, choking Having a lump in your throat Aversion to drinking or eating Urge to take a shower Fainting Intense urge to get rid of something Wanting to destroy something Urge to run away, or push away Feeling contaminate, dirty, unclean Feeling mentally polluted Other: Expressions and Actions of Disgust Vomiting, spitting out Closing your eyes, looking away Washing, scrubbing, taking a bath Cleaning your clothes Cleaning your apartment Avoiding eating or drinking Pushing or kicking away, running away Treating with disdain or disrespect, disregarding Going first, stepping over, crowding another person out Physically attacking the cause of your disgust Using obscenities or cursing Clenching your hands or fists Frowning, or not smiling Mean of unpleasant facial expression Speaking with a sarcastic voice tone Nose and top lip tightened up Lip curled up on one side, smirking Other: Aftereffects of Disgust Narrowing of attention Closing down senses Feeling ugly Feeling dirty Becoming hypersensitive to dirt Ruminating about the situation making you feel disgusted and not being able to think of anything else Depersonalization, dissociative experience, numbness Other: Other: Typical Secondary Emotions of Disgust EMOTION REGULATION HANDOUT 4.4

75 Intense shame or fear Other: 75 ENVY WORDS envy disgruntled green-eyed bitterness displeased longing covetous dissatisfied pettiness craving down-hearted resentment discontented greed wishful Other: Prompting Events for Feeling Envy Someone has something that you really want or need but don t or can t have Someone gets positive recognition for something you don t Being around people who have more than you have Someone you are competing with is more successful than your in an are important to you Being reminded that your don t have things you want when others do You are not part of the in crowd Someone appears to have everything You are alone while others are having fun Someone else gets credit for what you ve done Other: Interpretations of Events that Prompt Feelings of Envy Thinking you deserve what others have Thinking others have more than you Thinking about how unfair it is that you have such a bad lot in life compared to others Thinking you have been treated unfairly by life Thinking you are inferior, a failure, or mediocre in comparison to others who you want to be like Thinking you are unlucky Comparing yourself to others who have more than you Comparing yourself to people who have characteristics that you wish you had Thinking you are unappreciated Other: EMOTION REGULATION HANDOUT 4.5

76 76 Biological Changes and Experiences of Envy Muscle tightening Teeth clamping together mouth tightening Feeling your face flush or get hot Feeling rigidity in your body Pain in the pit of the stomach Jitteriness, nervousness Feeling nervous tension, anxiety or discomfort Hating the other person Wanting the person or people you envy to lose what they have, to have bad luck or be hurt Feeling pleasure when others experience failure of lose what they have Feeling unhappy if the other person experiences some good luck Wanting to hurt the person or people you envy Having an urge to get even Feeling motivated to improve yourself Other: Expressions and Actions of Envy Doing everything you can to get what the other person has Working a lot harder than you were to get what you want Trying to improve yourself and your situation Taking away or ruining what the other person has Attacking or criticizing the other person Doing something to get even Doing something to make the other person fail or lose what he or she has Saying mean things about the other people or making people look bad to others Avoiding persons who have what you want Other: Narrowing of attention Attending to only what others have that you don t Remembering and ruminating about all the other times that others have had more than you Aftereffects of Envy Ruminating about what you don t have and not being able to think of anything else Making resolutions to change Discounting what you do have; not appreciating things you have or that others do for you Other: Typical Secondary Emotions of Envy Shame about feeling envy, anguish Frustration, anger, or hostility Feeling degraded or humiliated in front of others

77 77 Other: EMOTION REGULATION HANDOUT 4.6 FEAR WORDS fear horror shock amxiety hysteria tenseness apprehension jumpiness terror dread nervousness uneasiness edginess overwhelmed worry fright panic Other: Prompting Event for Feeling Fear Having your life, your health or your well being threatened Being in a similar or the same situation where you have been threatened or gotten hurt in the past, or where painful things have happened Flashbacks Silence Being in situations where you have seen others threatened or hurt Being in a new or unfamiliar situation Being alone (e.g., walking alone, being home alone, living alone) Being in the dark Being in crowds Leaving home Having to perform in front of others (e.g., school, work) Pursuing your dreams Other: Interpretations of Events That Prompt Feelings of Fear Believing that you might die, or that you are going to die Believing that you might be hurt or harmed, or that your might lose something valuable Believing that someone might reject you, criticize, dislike, or disapprove of you Believing that you will embarrass yourself Believing that failure is possible; expecting to fail Believing that you will not get help you want or believe you need Believing that you might lose help and assistance you already have Believing that your might lose someone or something you want Losing a sense of control; believing that you are helpless Losing a sense of mastery or competence Other:

78 78 EMOTION REGULATION HANDOUT 4.7 Biological Changes and Experiences of Fear Breathlessness Fast heartbeat Choking sensation, lump in throat Muscles tensing, cramping Clenching teeth Feeling nauseous Getting cold Feeling clammy Feeling your hairs standing on end Feeling nervous, jittery, or jumpy Wanting to run away or avoid things Wanting to scream or call out Other: Expressions and Actions of Fear Fleeing, running away Running or walking hurriedly Hiding from or avoiding what you fear Engaging in nervous, fearful talk Pleading or crying for help Talking less or becoming speechless Screaming or yelling Darting eyes or quickly looking around Frozen stare Talking yourself out of doing what you fear Freezing, or trying not to move Crying or whimpering Shaking, quivering, or trembling A shaky of trembling voice Sweating or perspiring Breathing fast Diarrhea, vomiting Hair erect Other: Aftereffects of Fear Narrowing of attention Being hyper vigilant to threat Losing your ability to focus or becoming disoriented Being dazed Losing control Imagining the possibility of more loss or failure Isolation Remembering and ruminating about other threatening times, other times when things did not go well Depersonalization, dissociative experiences Numbness or shock Other: \ Typical Secondary Emotions of Fear

79 79 Intense anger, shame or other negative emotions Other: EMOTION REGULATION HANDOUT 4.8 HAPPINESS WORDS happiness enthusiasm jubilation zeal joy jolliness zaniness ecstasy enjoyment thrill delight gladness relief cheerfulness exhilaration pride amusement euphoria optimism elation enthrallment joviality zest glee hope triumph eagerness rapture satisfaction contentment gaiety bliss excitement pleasure Other: Prompting Events for Feeling Happiness Receiving a wonderful surprise Reality exceeding your expectations Getting what you want Getting something you have worked hard for or worried about Things turning out better than you thought they would Being successful at a task Achieving a desirable outcome Receiving esteem, respect, or praise Receiving love, liking, or affection Being accepted by others Belonging somewhere or with someone or a group Being with or in contact with people who love or like you Having very pleasurable sensations Doing things that create or bring to mind pleasurable sensations Other: Interpretations of Events That Prompt Feelings of Happiness Interpreting joyful events just as they are, without adding or subtracting Other: Biological Changes and Experiences of Happiness Feeling excited Feeling physically energetic, active Feeling like giggling or laughing Feeling your face flush Feeling at peace Feeling open or expansive Feeling calm all the way through Other:

80 80 EMOTION REGULATION HANDOUT 4.9 Expressions and Actions of Happiness Smiling Having a bright, glowing face Being bouncy or bubbly Communicating your good feelings Sharing the feeling Silliness Hugging people Jumping up and down Saying positive things Using an enthusiastic or excited voice Being talkative or talking a lot Other: Aftereffects of Happiness Being courteous or friendly to others Doing nice things for other people Having a positive outlook; seeing the bright side Having a high threshold for worry or annoyance Remembering and imagining other times you have felt joyful Expecting to feel joyful in the future Other: Typical Secondary Emotions of Happiness Feelings of love, passion When the joy is not shared, feelings of melancholy, loneliness, shame or guilt; feeling embarrassed or silly Other: JEALOUSY WORDS jealous fear of losing someone suspicious cautious or something self-protective clinging mistrustful wary clutching possessive watchful defensive rivalrous Other:

81 Prompting Events for Feeling Jealous 81 Someone is threatening to take away important things in your life A desired relationship is threatened or in danger of being lost You find your lover is having an affair Someone goes out with the person you like Someone ignores you while talking to a friend of yours A potential competitor pays attention to someone you love Someone is more attractive, outgoing or self-confident than you A person you are romantically involved with looks at someone else EMOTION REGULATION HANDOUT 4.10 Apparently flirtatious behavior of your partner towards someone else Your boy/girl friend tells you that she/he desires more time alone Not being treated with priority Other: Interpretations of Events That Prompt Feelings of Jealousy My partner does not care for me anymore I am nothing to him/her He/she is going to leave me He/she is behaving inappropriately I don t measure up to my peers I deserve more than I am receiving I was cheated No one cares about me My rival is possessive and competitive My rival is insecure My rival is envious Other: Biological Changes and Experiences of Jealousy Breathlessness Fast heartbeat Choking sensation, lump in throat Muscles tensing Clenching teeth Feeling suspicious and mistrustful of others Having injured pride Feelings of rejection Need to be in control Becoming mistrustful Feeling helpless Wanting to grasp or keep hold of what you have Wanting to push away or eliminate your rival Other: Expressions and Actions of Jealousy Violent behavior towards the person threatening you Threatening violence towards the person threatening you Attempting to control the freedom of the person you are afraid of losing Verbal accusations of disloyalty or unfaithfulness

82 Spying on the person Interrogating the person, demanding accounting of time or activities Collecting evidence of wrong doings Clinging, enhanced dependency Increased or excessive demonstrations of love Increased demands of sexual activity Other: Aftereffects of Jealousy 82 Narrowing of attention Being hyper vigilant to threats to your relationship Becoming isolated or withdrawn Changing the interpretation of previous events to suggest that jealousy is reasonable Seeing the worst in others EMOTION REGULATION HANDOUT 4.11 Other: Typical Secondary Emotions of Jealousy Feelings of hatred Becoming anxious of others Feeling of shame or guilt Other: LOVE WORDS love charmed kindness sympathy adoration compassion liking tenderness affection desire longing warm arousal enchantment lust attraction fondness passion caring infatuation sentimentality Other: Prompting Events for Feeling Love A person offers or gives you something you want, need, or desire A person does things you want or need the person to do A person does things you particularly value or admire Feeling physically attracted to someone You spend a lot of time with a person You share a special experience together with a person You have exceptionally good communication with a person Being with someone you have fun with Other: Interpretations of Events That Prompt Feelings of Love Believing that a person loves, needs, or appreciate you Thinking a person is physically attractive Judging a person s personality as wonderful, pleasing, or attractive Believing that a person can be counted on, or will always be there for you

83 83 Other: Biological Changes and Experiences of Love When you are with or thinking about someone: Feeling excited and full or energy Fast Heartbeat Feeling self-confident Feeling invulnerable Feeling happy, joyful, or exuberant Feeling warm, trusting, and secure Feeling relaxed and calm Wanting the best for a person Wanting to give things to a person Wanting to see and spend time with a person Wanting to spend your life with a person Wanting physical closeness or sex Wanting emotional closeness Other: EMOTION REGULATION HANDOUT 4.13 Expressions and Actions of Love Saying I love you Expressing positive feeling to a person Eye contact, mutual gaze Touching, petting, hugging, holding, cuddling Sexual activity Smiling Sharing time and experiences with someone Doing things that the other person wants or need Other: Aftereffects of Love Only being able to see a person s positive side Feeling forgetful or distracted daydreaming Feeling openness and trust Feeling alive, capable Remembering other times and people you have loved Remembering other people who have loved you Remembering and imagining other positive events Believing in yourself, believing you are wonderful, capable, competent Other: Typical Secondary Emotions of Love Exhilarating feelings of joy Ecstasy Contentment SADNESS WORDS When the loved one is not available or doesn t respond, feelings of sadness, grief, anger, hatred or shame Other:

84 84 sadness alienation displeasure gloom despair discontentment insecurity loneliness grief pity sorrow unhappiness misery anguish defeat depression agony dismay distraught glumness disappointment hurt disconnected melancholy homesickness rejection suffering alone neglect crushed dejection woe Other: EMOTION REGULATION HANDOUT 4.14 Prompting Events for Feeling Sadness Losing something or someone that is irretrievable Things are not the way you expect or wanted and hoped for The death of someone you love; thinking about deaths or people you love Losing a relationship; thinking about losses Being separated from someone you care for or value; thinking about how much you miss someone Being rejected or excluded Being disapproved of or disliked; not being valued by people you care about Things turning out badly Getting what you don t want Things being worse than you expected Not getting what you want and believe you need in life; thinking about what you have not gotten that you wanted or needed Discovering that you are powerless or helpless Being with someone else who is sad, hurt or in pain Reading or hearing about other people s problems or troubles in the world Being alone or isolated or an outsider Other: Interpretations of Events That Prompt Feelings of Sadness Believing that a separation from someone will last for a long time or will never end Believing that you will not get what you want or need in life Seeing things or your life as hopeless Believing that you are worthless or not valuable Other: Biological Changes and Experiences of Sadness Feeling tired, run-down, or low in energy Feeling lethargic, listless; wanting to stay in bed all day Feeling as if nothing is pleasurable anymore Feeling a pain or hollowness in your chest or gut

85 Feeling empty Breathlessness Feeling as if you can t stop crying, or feeling that if you ever start crying you will never be able to stop Dizziness Difficulty swallowing Other: Expressions and Actions of Sadness 85 Avoiding things Acting helpless Moping, brooding, or acting moody Making slow, shuffling movements Withdrawing from social contact Avoiding activities that used to bring pleasure Sitting or lying around; being inactive Staying in bed all day Giving up and no longer trying to improve Saying sad things Talking to someone about sadness Talking little or not at all Using a quiet, slow, or monotonous voice Eyes drooping Frowning, not smiling Posture slumping Sobbing, crying, whimpering Other: EMOTION REGULATION HANDOUT 4.15 Aftereffects of Sadness Not being able to remember happy things Feeling irritable, touchy, or grouchy Yearning and searching for the thing lost Having a negative outlook; thinking only about the negative side of things Blaming or criticizing yourself Remembering or imagining other times you were sad and other losses Hopeless attitude Fainting spells Nightmares Insomnia Appetite disturbance, indigestion Depersonalization, dissociative experiences, numbness, or shock Other: Typical Secondary Emotions of Sadness Anger, shame, fear Other: SHAME WORDS shame discomposure mortification contrition embarrassment self-conscious culpability humiliation shyness

86 86 Other: Prompting Events for Feeling Shame Being rejected by people you care about Having others find out that you have done something wrong Doing (feeling or thinking) something that people you admire believe is wrong or immoral Comparing some aspect of yourself or your behavior to a standard and feeling like you do not live up to that standard Being betrayed by a person you love EMOTION REGULATION HANDOUT 4.16 Being laughed at, made fun of Being criticized in public, in front of someone else; remembering public criticism Others attacking your integrity Being reminded of something wrong, immoral, or shameful you did in the past Being rejected or criticized for something you expected praise for Having emotions/experiences that have been invalidated Exposure of a very private aspect of yourself or your life Exposure of a physical characteristic you dislike Failing at something you feel you are (or should be) competent to do Other: Interpretations of Events That Prompt Feelings of Shame Believing that others will reject you (or have rejected you) Judging yourself to be inferior, not good enough, not as good as others; self-invalidation Comparing yourself to others and thinking that you are a loser Believing yourself unlovable Thinking that you are bad, immoral, or wrong Thinking you are defective Thinking that you are a bad person or a failure Believing your body (or body part) is too big, too small, or ugly Thinking that you have not lived up to other s expectations of you Thinking that your behavior, thoughts, or feelings are silly or stupid Other: Biological Changes and Experiences of Shame Pain in the pit of the stomach Sense of dread Wanting to shrink down and/or disappear Wanting to hide or cover your face and body Other: Expressions and Actions of Shame Hiding behavior or characteristic from other people Avoiding the person you have harmed

87 Avoiding persons who have criticized you Avoiding yourself- distracting, ignoring Withdrawing, covering the face Bowing your head, groveling Appeasing; saying you are sorry over and over and over Looking down and away from others Sinking back, slumped and rigid posture 87 Halted speech, lowered volume while talking

88 Other: EMOTION REGULATION HANDOUT 4.17 Aftereffects of Shame Avoiding thinking about your transgression, shutting down, blocking all emotions Engaging in distracting, impulsive behaviors to divert your mind or attention High amount of self-focus ; preoccupation with self Depersonalization, dissociative experiences, numbness, or shock Attacking or blaming others Conflicts with other people. Isolation, feeling alienated Impairment in ability to problem-solve Other: Typical Secondary Emotions of Shame Anger, contempt, disgust, fear Other: GUILT WORDS guilt culpability remorse apologetic regret sorry Other: Prompting Events for Feeling Guilt Doing or thinking something you believe is wrong Doing or thinking something that violates your personal values No doing something you said that you would do Committing a transgression against another person or something you value Causing harm/danger to another person or object Causing harm/damage to yourself Being reminded of something wrong you did in the past Other: Interpretations of Events That Prompt Feelings of Guilt Thinking your actions are to blame for something Thinking you behaved badly Thinking if only you had done something differently Other: Biological Changes and Experiences of Guilt

89 89 EMOTION REGULATION HANDOUT 4.18 Hot, red face Jitteriness, nervousness Suffocating Other: Expressions and Actions of Guilt Trying to repair the harm, make amends for the wrongdoing, fix the damage, change the outcome Asking for forgiveness, apologizing, confessing Giving gifts, making sacrifices trying to make up for the transgression Bowing your head, kneeling before the person Other: Aftereffects of Guilt Making resolutions to change Making changes in behavior Joining self-help programs Other: Typical Secondary Emotions of Guilt Shame, fear Other: OTHER IMPORTANT EMOTION WORDS Weariness, dissatisfaction, disinclination. Distress Shyness, fragility, reserve, bashfulness, coyness, reticence Cautiousness, reluctance, suspiciousness, caginess, wariness Surprise, amazement, astonishment, awe, startle, wonder Boldness, bravery, courage, determination Powerfulness, a sense of competence, capability, mastery Dubiousness, skepticism, doubtfulness Apathy, boredom, dullness, ennui, fidgetiness, impatience, indifference, listlessness Other: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

90 90 EMOTION REGULATION HANDOUT 5 Changing Emotional Responses to Situations CHECK THE FACTS Find out whether your emotional responses and actions are justified by the situation. Check out whether your reactions fit the facts of the situation. Changing beliefs and assumptions to fit the facts can help you change your emotional reactions to situations OPPOSITE ACTION Act opposite to your emotional urges if your emotion is: o not justified by the situation (aka does not fit the facts) o not effective Acting opposite to emotions consistently will change your emotional reactions PROBLEM SOLVE Go to problem solving if your emotion is: o justified by the situation (aka does fit the facts) o is unwanted or ineffective Solving emotional problems consistently will reduce the frequency of negative emotions Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

91 91 EMOTION REGULATION HANDOUT 6 Check the Facts FACT Many emotions and actions are set off by our thoughts and interpretations of events, not by the events themselves EVENT THOUGHTS EMOTION Our emotions can also have a big effect on our thoughts about events EVENT EMOTIONS THOUGHTS Examining our thoughts and checking the facts can change our emotions Changing our mood and emotions can change our thoughts CHECK THE FACTS 1) ASK: What is the event prompting my emotional reactions? a. Challenge judgments, extremes, and absolute black-&-white descriptions b. Describe the facts that you observed through your senses (Mindfulness) 2) ASK: What are my interpretations and thoughts about the event? a. Think of other possible interpretations b. Practice looking at all sides of a situation/all points of view c. Test your interpretations to see if they are correct 3) ASK: Am I assuming a threat? a. Label the threat b. Evaluate the probability that the threatening event will really occur c. Think of many other possible outcomes as you can 4) ASK: Does my emotion and emotional intensity fit the facts? a. Check events that justify each emotion 5) ASK: What s the catastrophe? a. Imagine the catastrophe really occurring; take it to its most extreme ending b. Imagine saying so what? c. Imagine coping well with a catastrophe Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

92 92 EMOTION REGULATION Worksheet 4 (for HO 6) Check the Facts It is hard to problem-solve emotional situations if you don t have your facts straight. It is important to know what the problem is before you can solve it. This worksheet is to help you figure out whether it is the event that occurred hat is causing your emotion, your interpretation of the event, or both. Before you can figure out what to change, you have to figure out what really happened. You have to use you mindfulness skills of observe and describe. You have to Check the Facts and then describe the facts you observed. Date: EMOTION NAME: INTENSITY (0-100) Before After STEP 1 Start by DESCRIBING THE PROMPTING EVENT: Who did what to whom? What led up to what? What is it about this event that is a problem for me? Be very specific in your answers. CHECK THE FACTS: Look for extremes and judgmental describing of the events. REWRITE the facts, if necessary to be more correct FACTS, FACTS, FACTS STEP 2 Next, ask: What are my INTERPRETATIONS and thoughts about the facts? How am I appraising the situation? What thoughts of mine about the event am I adding to the description? CHECK THE FACTS: List as many other possible interpretations of the facts as you can REWRITE the FACTS if needed (if you can, check the accuracy of your interpretations) or, if you can t check out the interpretation for sure, write out a likely but useful (effective) interpretation. Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

93 93 STEP 3 EMOTION REGULATION Worksheet 4 CONT (for HO 6) Check the Facts Next, ask: What is the THREAT? What about this event or situation is threatening to me? What worrisome consequences of this event am I expecting? CHECK THE FACTS: List as many other possible outcomes as you can, given the facts REWRITE the FACTS if needed (if you can, check the accuracy of your expectations) or, if you can t check out probable outcomes for sure, write out a likely non-catastrophic outcome to expect. STEP 4 Ask WHAT S THE CATASTROPHE if the outcome I am worrying about does occur? Describe in detail the worst outcome I can reasonably expect. Describe ways to cope if the worst happens. How much do I believe the worst will really happen? (0=not at all, 100=I am certain) IF OVER 50, go to: Problem Solving (Emotion Regulation Handout 7-8, Worksheet 4) Cope Ahead of Time with Emotional Situations (Emotion Regulation Handout 13, Radical Acceptance (Distress Tolerance Handouts and Worksheets) Worksheet 8) Date: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

94 94 EMOTION REGULATION HANDOUT 7 Opposite Action OPPOSITE ACTION IS ACTING OPPOSITE TO YOUR EMOTIONAL URGE OPPOSITE ACTION WORKS WHEN The emotion or the intensity or the duration of the emotion is NOT JUSTIFIED by the facts of the situation (the emotion does not fit the situation) The emotion or the intensity or the duration of the emotion is NOT EFFECTIVE for the situation. OPPOSITE ACTION STEP-BY-STEP 1. CHECK THE FACTS to be sure your emotional reaction is not justified or is not effective for the situation. 2. IDENTIFY ACTION URGES associated with emotion 3. ACT OPPOSITE to your urges: a. IDENTIFY actions that are opposite to your urges b. Do the OPPOSITE action c. Do it ALL THE WAY (action, posture, facial expression, thinking speech, voice tone) d. Do NOT SUPPRESS emotional experience or feelings; let opposite action do the work for you 4. CONTINUE opposite action until your emotion goes down at least enough for you to notice 5. REPEAT over and over, every chance you get; keep repeating until your emotional sensitivity to that prompting event goes down. Personal Notes: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

95 95 EMOTION REGULATION HANDOUT 8.1 Figuring out Opposite Action FEAR Fear FITS THE FACTS of a situation whenever: There is a THREAT to: Your life or that of someone you care about, OR Your health or that of someone you care about, OR Your well-being or that of someone you care about WHEN FEAR DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Fear 1. Do what you are afraid of doing OVER AND OVER AND OVER 2. APPROACH events, places, tasks, activities, people you are afraid of 3. Do things to give yourself a sense of CONTROL and MASTERY over your fears 4. Do the OPPOSITE of other fearful action urges When OVERWHELMED by fear: 5. MAKE A LIST of small steps or tasks you can do 6. DO THE FIRST THING on the list ALL-THE-WAY Opposite Actions for Fear 7. Keep your EYES AND EARS OPEN and focused on the feared event, a. look around slowly b. explore c. take in the information from the situation 8. Change POSTURE AND KEEP A CONFIDENT VOICE TONE a. keep your head and eyes up, shoulders back but relaxed b. assertive body posture knees apart, hands on hips, heels a bit out 9. Change BODY CHEMISTRY a. breathe deeply, all the way into diaphragm, and slowly b. monitor heart rate Personal Notes: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

96 96 EMOTION REGULATION HANDOUT 8.2 Figuring out Opposite Action ANGER Anger FITS THE FACTS of a situation whenever: An important goal is blocked or a desired activity is interrupted or prevented, You or someone you care about is attacked or hurt by others, OR You or someone you care about is insulted or threatened by others WHEN ANGER DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Anger 1. Gently AVOID the person you are angry with (rather than attacking) 2. Take a TIME-OUT and breath in and out deeply and slowly 3. Do the OPPOSITE of other angry action urges (see ER handout 4) ALL-THE-WAY Opposite Actions for Anger 4. Imagine UNDERSTANDING and EMPATHY for other person a. step into the other person s shoes. Try to see the situation from the other person s point of view. b. imagine really good reasons for what has happened 5. Change POSTURE a. hands unclenched, palms up, fingers relaxed (WILLING HANDS) b. relax chest and stomach muscles c. unclench teeth d. relax face muscles e. drop shoulders f. HALF-SMILE 6. Change BODY CHEMISTRY a. breathe deeply and slowly, counting your breaths if needed b. run or engage in other energetic NON-VIOLENT activity OPPOSITE ACTION for anger is helpful even when emotion is justified!!! Personal Notes: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

97 97 EMOTION REGULATION HANDOUT 8.3 Figuring out Opposite Action DISGUST Disgust FITS THE FACTS of a situation whenever: Something you are in contact with could poison or contaminate you Somebody whom you deeply dislike is touching you or someone cared about, OR You are around a person or group whose behavior or thinking could seriously damage OR harmfully influence you or the group you are part of WHEN DISGUST DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Disgust 1. MOVE CLOSE. Eat, drink, stand near, or embrace what you found disgusting 2. Be KIND to those you feel contempt for; step into the other person s shoes 3. Do the OPPOSITE of other disgusted action urges (See ER handout 4) ALL-THE-WAY Opposite Action for Disgust 4. Imagine UNDERSTANDING and EMPATHY for whom you feel disgust/contempt a. try to see the situation from other person s point of view b. imagine really good reasons for how the other person is behaving or looking 5. Take in what feels repulsive inhaling, looking at, touching, listening 6. Adjust your POSTURE and LOWER YOUR VOICE TONE a. hands unclenched, palms up, fingers relaxed (WILLING HANDS) b. relax chest and stomach muscles c. relax face muscles 7. DISTRACT from irrelevant disgusting thoughts and images Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

98 98 EMOTION REGULATION HANDOUT 8.4 Figuring out Opposite Action ENVY Envy FITS THE FACTS of a situation whenever: Another person or group gets or has things you don t have that you want or need, OR There are as many reasons for you to get or have these things as there are for the other person (just as entitled to benefits) WHEN ENVY DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Envy 1. COUNT YOUR BLESSINGS make a list of the things you are thankful for 2. Practice KINDNESS or appreciation for the person; congratulations 3. Do the OPPOSITE of other envious action urges (See ER handout 4) ALL-THE-WAY Opposite Action for Envy 4. Count ALL your blessings a. avoid discounting some blessings b. avoid exaggerating your deprivations 5. Stop EXAGGERATING others net worth or value check the facts!! 6. Imagine HOW IT MAKES SENSE that the other person has what you do not 7. Change POSTURE a. hands unclenched, palms up, fingers relaxed (WILLING HANDS) b. relax chest and stomach muscles c. relax face muscles d. unclench teeth e. half-smile Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

99 99 EMOTION REGULATION HANDOUT 8.5 Figuring out Opposite Action JEALOUSY Jealousy FITS THE FACTS of a situation whenever: A relationship or thing in your life is very important and desired by you, AND It is in danger of being damaged or lost, OR Someone is threatening to take it away from you WHEN JEALOUSY DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Jealousy 1. LET GO of controlling others actions 2. SHARE what and who you have in your life 3. Do the OPPOSITE of other jealous action urges (See ER handout 4) ALL-THE-WAY Opposite Action for Jealousy 4. STOP SPYING or snooping a. suppress probing questions b. fire the private detective 5. NO AVOIDING, listen to all the details a. keep your eyes open b. take in all the information about the situation 6. Change POSTURE a. hands unclenched, palms up, fingers relaxed (WILLING HANDS) b. relax chest and stomach muscles c. relax face muscles d. unclench teeth e. half-smile 7. Change BODY CHEMISTRY a. breathe deeply and slowly b. count your breaths if needed Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

100 100 EMOTION REGULATION HANDOUT 8.6 Figuring out Opposite Action LOVE Love (other than the universal love for all) FITS THE FACTS of a situation whenever: Who or what is loved does things or has qualities that you value or admire AND Loving that person, animal, or object enhances the quality of your life or of those you care about, OR Loving that person, animal, or object increases your chances of attaining your own personal goals WHEN LOVE DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Love 1. AVOID the person, animal, or object you love 2. DISTRACT from thoughts of the person, animal, or object 3. REMIND yourself of why love is not justified (rehearse the cons of loving) when loving thoughts arise 4. Do the OPPOSITE of other loving action urges (See ER handout 4) ALL-THE-WAY Opposite Action for Love 5. Avoid contact with EVERYTHING that remind you of the person a. letters, pictures, messages, s, belongings, mementos, places you were together, places you planned or wanted to go together, places you know the person has been or will be at, b. no following, waiting, or looking for the person 6. STOP EXPRESSING LOVE for the person, even to friends; be unfriendly towards the person 7. Adjust your POSTURE and EXPRESSIONS if around the person you love a. no leaning toward b. no getting close enough to touch c. no sighing, gazing at the person Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

101 101 EMOTION REGULATION HANDOUT 8.7 Figuring out Opposite Action SADNESS Sadness FITS THE FACTS of a situation whenever: You have lost something or someone irretrievably OR Things are not the way you wanted or expected or hoped them to be WHEN SADNESS DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Sadness 1. Get ACTIVE approach, don t avoid 2. Do things that make you FEEL COMPETENT and self-confident (build Mastery, see ER handout 16) 3. Do the OPPOSITE of other sad action (or inaction) urges (See ER handout 4) ALL-THE-WAY Opposite Action for Sadness 4. Pay attention to the PRESENT MOMENT! a. be mindful of your environment, each detail as it unfolds b. experience new or positive activities you are engaging in 5. Change POSTURE and KEEP AN UPBEAT VOICE TONE a. bright body posture b. head up, eyes open, shoulders back 6. Change BODY CHEMISTRY a. increase physical movement b. run, jog, walk, or do other active movement and exercise Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

102 102 EMOTION REGULATION HANDOUT 8.8 Figuring out Opposite Action SHAME Shame FITS THE FACTS of a situation whenever: You will be rejected from a group you care about if characteristics of yourself or of your behaviors are made public WHEN SHAME DOES NOT FIT THE FACTS: A. OPPOSITE ACTIONS for Shame when your behavior FITS YOUR WISE MIND VALUES 1. Make your personal characteristics or your behavior PUBLIC 2. Engage in behavior that sets of shame OVER AND OVER AND OVER in public 3. Do the OPPOSITE of other shame action urges (See ER handout 4) ALL-THE-WAY Opposite Action for Shame when your behavior FITS YOUR WISE MIND VALUES 4. NO APOLOGIZING 5. Take in ALL THE INFORMATION from the situation 6. Change your BODY POSTURE look INNOCENT and PROUD a. head up, puff out your chest, maintain eye contact b. voice tone steady and clear B. OPPOSITE ACTIONS for Shame when your behavior VIOLATES YOUR WISE MIND VALUES 1. APOLOGIZE publically 2. REPAIR the transgression MAKE THINGS BETTER (or work to prevent pr repair similar harm for others) 3. COMMIT to avoiding that mistake in the future 4. ACCEPT the consequences gracefully ALL-THE-WAY Opposite Action for Shame when your behavior VIOLATES YOUR WISE MIND VALUES 5. FORGIVE yourself 6. LET IT GO Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

103 103 EMOTION REGULATION HANDOUT 8.9 Figuring out Opposite Action GUILT Guilt FITS THE FACTS of a situation whenever: Your own behavior violates your own values or moral code WHEN GUILT DOES NOT FIT THE FACTS: OPPOSITE ACTIONS for Guilt when you will NOT be rejected if found out 1. Make your personal characteristics or your behavior PUBLIC 2. Engage in behavior that sets of shame OVER AND OVER AND OVER in public 3. Do the OPPOSITE of other shame action urges (See ER handout 4) ALL-THE-WAY Opposite Action for Guilt when you will NOT be rejected if found out 4. NO APOLOGIZING 5. Take in ALL THE INFORMATION from the situation 6. Change your BODY POSTURE look INNOCENT and PROUD a. head up, puff out your chest, maintain eye contact b. voice tone steady and clear OPPOSITE ACTIONS for Guilt when it is NOT justified BUT you WILL BE rejected if found out 1. HIDE or, if public, USE SKILLFUL MEANS (if you want to stay in the group) 2. Join a NEW GROUP that fits your values 3. Do what makes you feel guilt OVER AND OVER with your new group. ALL-THE-WAY Opposite Action for Guilt 4. VALIDATE yourself 5. Engage in social action to change public values. Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

104 104 EMOTION REGULATION Worksheet 5 (for HO 7, 8) Opposite Action Select a current or recent emotional reaction that you find painful or want to change. Figure out if the emotion is justified by the situation. If it is not, then notice your action urges, figure out what would be opposite actions, and then do the opposite actions. Remember to practice opposite action all the way. Describe what happened. EMOTION NAME: INTENSITY (0-100) Before After PROMPTING EVENT for my emotion (who, what, when, where): What triggered the emotion? IS MY EMOTION (or its intensity or duration) JUSTIFIED: Does it fit the facts? Is it effective? List out the facts that justify the emotion and those that do not. Justified Not Justified JUSTIFIED: Go to Problem Solving (ER Worksheet 6) NOT JUSTIFIED: Continue ACTION URGES: What do I feel like doing? What do I want to say? OPPOSITE ACTION: What are the actions opposite to my urges? Describe both what and how to act opposite ALL THE WAY in the situation. WHAT I did: Describe in detail. HOW I did it: Describe body language facial expression, posture, gestures, and thoughts. What AFTER EFFECTS did the opposite action have on me (my state of mind, other emotions, behavior, thoughts, memory, body, etc.)? Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

105 105 Date: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

106 106 EMOTION REGULATION HANDOUT 9 Problem Solving 1. OBSERVE and DESCRIBE the problem that is setting off negative emotion 2. CHECK THE FACTS If your facts are correct and the situation is the problem, Continue with Problem Solving If your facts are NOT correct, Observe and Describe the ACTUAL facts 3. Identify your GOAL in solving the problem a. identify what needs to happen or change for you to feel OK b. keep it simple and something you can really achieve 4. BRAINSTORM lots of solutions a. think of as many solutions as you can. Ask for suggestions from people you trust b. do not be critical of any ideas at first 5. CHOOSE a solution that is likely to work a. choose two solutions that look the best b. do PROS and CONS to compare the solution c. choose the best to try FIRST 6. Put the solution into ACTION a. ACT: Try out the solution b. take the first step, and then the second, and then the third It WORKED? YEA! It DIDN T WORK? 7. TRY a new solution Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

107 107 EMOTION REGULATION Worksheet 6 (for HO 9) Problem Solving to Change Emotions Select a prompting event that triggers a painful emotion. Select an event that can be changed. Turn the event into a problem to be solved. Follow the steps below and describe what happened. EMOTION NAME: INTENSITY (0-100) Before After 1. WHAT IS THE PROBLEM? Describe the problem prompting your emotion? What makes the situation a problem? 2. CHECK THE FACTS. Describe what you did to be sure of your facts (ER worksheet 4). REWRITE the problem if needed to stick with the facts. 3. WHAT IS A REALISTIC SHORT-TERM GOAL OF YOUR PROBLEM-SOLVING? What has to happen for you to think you have made progress? 4. BRAINSTORM SOLUTIONS: List as many solutions and coping strategies as you can think of. DON T EVALUATE! Date: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

108 108 EMOTION REGULATION Worksheet 6.1 (for HO 9) Problem Solving to Change Emotions 5. WHICH TWO IDEAS LOOK BEST (most likely will meet your goal, ideas that are possible to do)? Pros Solution 1 Cons Solution 1 Solution 2 Solution 2 6. CHOOSE the solution to try, list the steps needed, check the steps you do, and how well they work Step Describe Done What happened? DID YOU REACH YOUR GOAL? Describe. If not, what can you do next? IS THERE NOW A NEW PROBLEM-TO-BE-SOLVED? If yes, describe and problem solve again. Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

109 109 EMOTION REGULATION HANDOUT 10 Putting Problem Solving and Opposite Action Together Justifying Events Opposite Action Problem Solving Fear A. Your life, OR B. Your health, OR C. Your well-being is threatened 1. Do what you are afraid of doing over and over and over 2. Approach what you are afraid of 3. Do what gives you a sense of control and mastery 1. Gently Avoid 2. Do something a little bit nice 3. Imagine understanding. Step into the other person s shoes. 4. Relaxed posture willing hands, half smile 5. Breathe deeply and slowly 1. Remove the threat 2. Avoid the threat Anger A. An important goal is blocked or a desired activity is interrupted or prevented, OR B. You or someone you care about is attacked or hurt (physically or emotionally) by others, OR C. You or someone you care about is insulted or threatened by others A. Something you are in contact with could poison or contaminate you, OR B. Being close to a person or group whose behavior or thinking could seriously damage or harmfully influence you or the group you are part of A. Another person or group gets or has things you don t have that you want or need, AND B. There are as many reasons for you to get or have these things as there are for other person( just as entitled A. The relationship is important, AND B. It is threatened or in danger of being lost, OR C. Someone is threatening to take away other important things in your life 1. Overcome obstacles to your goals 2. Stop further attacks, insults, and threats 3. Avoid people who are threatening 4. Empathize, get into the shoes of the other person Disgust 1. Move close embrace 2. Be kind step into the other person s shoes 3. Take in what feels repulsive 4. Distract from irrelevant disgusting thoughts and images 1. Remove or clean up revolting items 2. Influence others to stop harmful behaviors 3. Avoid harmful people Envy 1. Count your blessings 2. Imagine how it all makes sense 3. Do the opposite of other envious action urges 1. Improve yourself and your life 2. Get others to be fair 3. Avoid people who have more than you 4. Put on a pair of rose-colored glasses 5. Devalue what others have that you don t need Jealousy 1. Let GO of trying to control others 2. Share what you have with others 1. Protect what you have 2. Work at being more desirable to the person you want to be in relationship with (fight for the relationship) 3. Leave the relationship Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

110 110 EMOTION REGULATION HANDOUT 10.1 Justifying Events Opposite Action Problem Solving Love A. A person does things or has qualities that you particularly value or admire, AND B. Loving the person enhances the quality of your life or that of those you care about, OR C. Loving the person increases your chances of attaining your own personal goals 1. Avoid the person whom you love altogether 2. Distract yourself from thoughts of the person 3. Avoid all reminders of the person 4. Remind yourself of why love is not justified 1. Be with the person, animal, or thing that you love IF THE BELOVED IS LOST, 2. Remind yourself that it is better to have loved and lost than to never have loved at all 3. Fight to get the beloved back (if it may be possible) Sadness A. You have lost something or someone OR B. Things are not the way you expected or wanted or hoped 1. Activate behavior approach, don t avoid 2. Do things that make you feel competent and selfconfident build mastery 3. Pay attention to the present moment 4. Bright posture/body language 1. Accumulate positives: a. Retrieve or replace what is lost where possible b. Increase contact with reinforcing and rewarding people or things in your life 2. Radically accept (grieve) the facts 3. Avoid thinking about what you have lost 4. Put on a pair of rose-colored glasses make up a slightly positive interpretation of events Shame A. You will be rejected from a very important group if characteristics of yourself or of your behavior are made public 1. Make your personal characteristics or behavior PUBLIC (with people who won t reject you) 2. Do what makes you feel shame over and over look innocent & no apologies 1. Change your behavior or personal characteristics to fit in 2. Find a new group that fits your values or that likes your personal characteristics 3. Avoid groups who disapprove of you 4. Work to change public values 1. Repair the harm, make things better or, if not possible, work to prevent or repair similar harm for others 2. Apologize 3. Commit to avoiding that mistake in the future 4. Accept the consequences gracefully Guilt A. Your own behavior violates your own values or moral code 1. Do what means you feel guilty over and over and over 2. Make your behavior PUBLIC (with people who won t reject you) Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

111 111 EMOTION REGULATION Worksheet 7 (for HO 10) Figuring Out How to Change Unwanted Emotions Select a current or recent emotional reaction that you want to change. Write down the name of the emotion and then ask yourself each of the questions below. Circle the correct answer and continue from each correct answer. At the end, practice the skills suggested. Does this emotion fit the facts? See ER handout 6 Check the Facts YES NO Is this an effective emotional response? Is this an unwanted or an ineffective emotional response? YES NO YES NO Act on Emotion Problem Solve ER HO 7 Do Opposite Action ER HO 8 Do Opposite Action ER HO 8 Be Mindful of Current Emotions ER HO 17 Describe what you did to manage emotions Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

112 112 EMOTION REGULATION HANDOUT 11 Reducing Vulnerability to Negative Emotions: Staying Out of Emotion Mind A way to remember these skills is to remember the term ABC PLEASE A 15) ACCUMULATE POSITIVE EMOTIONS Short Term: Do Pleasant things that are possible NOW Long Term: Make changes in your life so that positive will occur more often. Build a life worth living. (ER HO 12- B BUILD MASTERY Do things that make you feel competent and effective as a line of defense against helplessness and hopelessness. (ER HO 16) C COPE AHEAD OF TIME WITH EMOTIONAL SITUATIONS Rehearse a plan ahead of time so that you are prepared to cope skillfully with emotional situations. (ER HO 16) PLEASE TAKE CARE OF YOUR MIND BY TAKING CARE OF YOUR BODY (ER HO 14) Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

113 113 EMOTION REGULATION HANDOUT 12 Accumulating Positive Emotions Short Term BUILD POSITIVE EXPERIENCES NOW INCREASE PLEASANT EVENTS that prompt positive emotions Do ONE THING each day from Pleasant Events Schedule BE MINDFUL OF POSITIVE EXPERIENCES FOCUS attention on positive moments when they are happening REFOCUS your attention when your mind wanders to the negative PARTICIPATE fully in the experience BE UNMINDFUL OF WORRIES Such as When the positive experience WILL END Whether you DESERVE this positive experience How much more might be EXPECTED of you now Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

114 114 EMOTION REGULATION HANDOUT 13 Pleasant Activities List 1. Soaking in the bathtub 2. Thinking about how it will be when I finish school 3. Hanging out with friends 4. Relaxing 5. Going to a movie 6. Going running 7. Listening to music 8. Lying in the sun (with sunscreen) 9. Reading magazines or book 10. Saving money 11. Planning the future 12. Dancing 13. Fixing or cleaning things around the house 14. Having a quiet night 15. Cooking good food 16. Taking care of pets 17. Going swimming 18. Writing 19. Drawing or doodling 20. Playing sports 21. Going to a party 22. Talking with friends 23. Working out 24. Singing 25. Going rollerblading 26. Going to a beach 27. Playing a musical instrument 28. Traveling 29. Making a gift for someone 30. Buying a CD 31. Watching sports 32. Going out to dinner 33. Baking 34. Planning a party for someone Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

115 Working 36. Buying clothes 37. Getting a haircut 38. Enjoying an early cup of hot chocolate, coffee, or tea 39. Kissing 40. Going to hear live music 41. Planning your day at school 42. Spending time with little kids 43. Going for a bike ride 44. Going sledding in a snowstorm 45. Watching MTV, VH1, or BET 46. ing friends who are far away 47. Writing in a diary or journal 48. Looking at photos 49. Dressing up however you like 50. Playing video games 51. Going for a walk 52. Noticing birds, trees, nature 53. Surfing the internet 54. Surprising someone with a favor 55. Completing something you will feel great about 56. Shooting pool 57. Contacting a relative you have been out of touch with 58. Playing video games 59. Thinking about taking lessons (sports, dance, music, martial arts) 60. Bowling 61. Fantasizing about life getting better 62. Saying I love you 63. Writing a poem, song, or rap 64. Thinking about a friend s good qualities 65. Putting on makeup 66. Making a smoothie and drinking it slowly 67. Putting on your favorite piece of clothing 68. Playing a game 69. Planning to make some money and spending it on yourself 70. Instant messaging or text messaging someone 71. Watching re-runs on TV 72. Making a card and giving it to someone you care about Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

116 Figuring out your favorite scent 74. Taking a nap 75. Noticing a storm coming s Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

117 117 EMOTION REGULATION Worksheet 8 (for HO 12, 13) Pleasant Events Diary Accumulating pleasant events can take planning. For each day of the week, write down at least one pleasant activity or event possible for you. In the next column, write down for each day the pleasant event or activity that you actually engage in. Fill out a Describing Emotions Worksheet (ER WS 2,2a) if necessary, plus this diary sheet. Day of the Week Pleasant Event(s) Planned Pleasant Event(s) I actually Did Mindfulness of Pleasant Event (0-5) Unmindfulness of Worries (0-5) Pleasant Experiences (0-100) Comments Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

118 118 EMOTION REGULATION HANDOUT 14 Accumulating Positive Emotions for Life BUILDING A LIFE WORTH LIVING Make changes in your life so that positive events will occur in the future 1 st Pick one important life VALUE 2 ND Identify a few GOALS to work on now 3 rd Pick ONE goal to work on right now 4 th Identify small ACTION STEPS 5 th TAKE ONE STEP Example: VALUE: Better relationship with my caregivers Possible GOALS: Stay sober Stay stable Practice communication skills Practice DBT skills Pick ONE goal to work on right now Practice communication skills Figure out ACTION STEPS that will move me towards my goal Learn interpersonal skills Practice with staff and peers Ask for feedback Be receptive to feedback Put change into action if needed Take in positive feedback TAKE ONE ACTION STEP Learn skills Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

119 119 EMOTION REGULATION HANDOUT 15 Values and Priorities List In my own wise mind, a high priority in my life is to: A. Attend to relationships 1. Repair old relationships 2. Reach out for new relationships 3. Work on current relationships 4. End destructive relationships Other: B. Be part of a group 1. Have close and satisfying relationships with others 2. Feel a sense of belonging 3. Receive affection and love 4. Be involved and intimate with others, have and keep close friends 5. Have a family and stay close and spend time with them 6. Have people to do things Other: C. Be powerful and able to influence others 1. Have the authority to approve or disapprove of what people do to control how resources are used 2. Be a leader 3. Make a great deal of money 4. Be respected by others 5. Be seen by others as successful. To become well known. To obtain recognition and status 6. Complete successfully with others 7. Be popular and accepted Other: D. Achieve things in life 1. Achieve significant goals. Be involved in undertakings I believe are significant. 2. Be productive 3. Work towards goals work hard 4. Be ambitious Other: E. Live a life of pleasure and satisfaction 1. Have a good time 2. Seek fun and things that give pleasure 3. Have free time 4. Enjoy the work I do Other: F. Keep life full of stimulating events, relationships, and activities 1. Try new and different things in life 2. Be daring and seek adventures 3. Have an exciting life Other: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

120 120 G. Behave respectfully 1. Be humble and modest, do not draw attention 2. Follow traditions and customs, behave properly 3. Do what I am told and follow rules Other: H. Be self-directed 1. Follow my own path in life 2. Be innovative, think new ideas, and be creative 3. Makes own decisions and be free 4. Is independent and takes care of myself and those I am responsible for 5. Have freedom of thought and action. Be able to act in terms of my own priorities Other: I. Be a spiritual person 1. Makes room in life for spirituality; live life according to spiritual principles 2. Practice a religion or faith 3. Grow in understanding myself, my personal calling, and life s real purpose 4. Discern and do the will of God (greater power) and find lasting meaning in life Other: J. Be secure 1. Live in secure and safe surroundings 2. Be physically healthy and fit 3. Have a steady income that meets my own and my family s a basic needs Other: K. Recognize the universal good of all things 1. Be fair, treat people equally and provide equal opportunities 2. Understand different people, be open-minded 3. Care for nature and environment Other: L. Contribute to the larger community 1. Help people and those in need; care for others well being; improve society 2. Be loyal to friends and devoted to close people; be committed to a group that shares my beliefs; values and ethical principles 3. Be committed to a cause or to a group that has a larger purpose beyond my own 4. Make sacrifices for others Other: M. Work at self-development 1. Develop a personal philosophy of life 2. Learn and do challenging things that help me grow and mature as a human being Other: N. Have integrity 1. Be honest and acknowledge and stand up for my personal beliefs 2. Be a responsible person, keep my word to others 3. Be courageous in facing and living life 4. Be accepting of myself, others, and life as it is living without resentment Other: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

121 121 EMOTION REGULATION Worksheet 9 (for HO 14,15) Getting from Values to Specific Action Steps Once you have figured out your values, the next step is to get more specific by deciding what your life would look like if you were living according to a certain value; that s a GOAL. Once you have goals, you can figure out what action steps are necessary to achieve the goal. Example: VALUE: Be a part of a group Possible GOALS: Reconnect with old, sober friends Get involved in a social group Join an after school activity Pick one GOAL to work on right now Join an after school activity Figure out a few ACTION STEPS that will move me toward my goal Look into available activities for openings Pick at least 3 that are potentially interesting Attend at least one activity within the next week 1. Pick one of your VALUES: 2. Identify 3 GOALS: 3. Circle one GOAL to work on right now 4. Identify ACTION STEPS you can take right now to move closer to the GOAL Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

122 122 EMOTION REGULATION Worksheet 9a (for HO 14,15) Values and Priorities Worksheet STEP 1: FIGURE OUT AT LEAST ONE IMPORTANT LIFE VALUE Long-term goals depend on wise mind values and priorities. If you could be the person YOU want to be a person you would value, what type of person would you be? What kinds of things would you do? If you could organize your life by your deepest wise mind values, what would they be? Be as specific as you possibly can be. Make a list of 3-4 of the most important values in your life right now. Write down values that are important things for you to work on in your life. (See ER HO 15 if needed) Importance Priority VALUE: VALUE: VALUE: Go back over the list and rate the importance of each value for having a life worth living to you (1 as little important to 5 as very important). Then rate how important it is to work on this value now (1 as low priority to 5 as very high priority). REFINE YOUR CHOICES review your list and ratings above and the value you have chosen to work on now. CHECK THE FACTS. Make sure that what you think are values and priorities are in fact YOUR values and priorities not the values others have, others think you should have, or old internal tapes of values you have learned but no longer really believe in. Rewrite your list if you need to. CHOOSE A VALUE TO WORK ON NOW. Pick the value that is either the most important to you or is your highest priority to work on right now. (If you have more than one value that is high priority to work on right now, fill out another worksheet). VALUE TO WORK ON NOW: STEP 2: IDENTIFY A FEW GOALS that will get you closer to your values List two or three different goals related to this value. Be very specific. What can you do to make this value a part of your life? Think of goals that, when met, will advance your sense of mastery and happiness. GOAL: GOAL: GOAL: STEP 3: DECIDE ON ONE GOAL TO WORK ON NOW Select one goal that is reasonable to work on now. Choose the goal that is most important or most essential to work on now. If one goal has to be accomplished before other important goals can be worked on or accomplished, choose that one as your Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

123 123 working-on-goal. Be specific. If you want to work on more than one goal at a time, fill out two sheets. GOAL TO WORK ON STEP 4: IDENTIFY SMALL ACTIONS TOWARD YOUR GOAL Break down the goal into lots of small steps that you can do. Each small step is a subgoal on the way to your goal. List action steps that will get you closer to your goal. If you can t think of any steps, try brainstorming ideas. Write down whatever comes to mind. If you start to feel overwhelmed because a step looks too big, erase it, and break it down into smaller steps you think you can actually do. Rewrite your list if you need to so that the steps you think you can do are included. Put in the order that you think you should do the,. If you start to feel overwhelmed because there are too many, stop writing new steps and focus on just one step. STEP 1: STEP 1: STEP 2: STEP 2: STEP 3: STEP 3: STEP 4: STEP 4: STEP 5 TAKE THE FIRST STEP: Describe what you did. REMEMBER: ATTEND TO RELATIONSHIPS Attending to relationships and being part of a group are important to just about everyone. If you did not choose a value about relationships, review them to see if one of the first ten values is an important one for you to work on. If you choose one, write it down and then after working on it, fill out the rest of this sheet. Describe the relationship or relationship problem you want to work on. What goal can you work on now? What small action steps will help you reach your goal? STEP 1: STEP 1: STEP 2: STEP 2: STEP 3: STEP 3: STEP 4: STEP 4: TAKE THE FIRST STEP: Describe what you did. Describe what happened next: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

124 124 EMOTION REGULATION Worksheet 9b (for HO 14,15) Daily Actions on Values and Priorities This form is for tracking your progress in reaching your goals and living according to your own values. You can either fill out one page for each value or goal you are working on or you can fill out every day no matter what goal you are working on that day. Remember to be very specific. Check Emotion Regulation Worksheet 8 if needed. DAY VALUE GOAL VALUED & PRIORITY ACTIONS TODAY What value am I working on What is my working-on goal related to this value What action did I do today to achieve this goal and keep this value a priority in my life? (specific) NEXT ACTION What will my next action be to achieve this goal and keep this priority in my life? (specific) Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

125 125 EMOTION REGULATION HANDOUT 16 Building Mastery and Coping Skills for Emotional Situations BUILD MASTERY 1. Plan to do at least one thing each day to build a sense of accomplishment 2. Plan for success, not failure do something difficult AND possible 3. Gradually increase the difficulty over time if the first task is too difficult, do something a little easier next time COPE AHEAD OF TIME WITH EMOTIONAL SITUATIONS 1. Describe a situation that is likely to prompt skills-interfering emotions a. Check the facts be specific in describing the situation b. Name the emotions most likely to interfere with using your skills 2. Decide what coping or problem solving skills you want to use in the situation a. Be specific b. Write it out in detail 3. Imagine the situation in your mind as vividly as possible a. Imagine yourself IN the situation, not watching the situation b. Imagine in the PRESENT TENSE, not the future or the past 4. Rehearse in your mind coping effectively a. Rehearse in your mind exactly what you could do to cope effectively Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

126 126 b. Rehearse your actions, your thoughts, what you say, and how you say it c. Rehearse coping with new problems that come up EMOTION REGULATION Worksheet 10 (for HO 16) Building Mastery and Coping Ahead In the left column, put down the days of the week. Then write in plans for practicing mastery in the next column. At the end of the day, write in what you actually did to increase your sense of mastery. Under Cope Ahead, describe the problem situation and then describe how you imagined coping skillfully. Circle whether it helped. Scheduled activity to build a sense of accomplishment Building Mastery What I actually did Situation that prompts emotion Cope Ahead How I imagined coping effective (describe) Helpful? YES NO Helpful? YES NO Helpful? YES NO Helpful? YES NO Helpful? YES NO Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

127 127 Helpful? YES NO EMOTION REGULATION HANDOUT 17 Helpful? YES NO Taking Care of Your Mind by Taking Care of your Body Remember these as PLEASE skills. P L 1. Treat PhysicaL illness: Take care of your body. See a doctor when necessary. Take prescribed meds E 2. Balance Eating Don t eat too much or too little. Eat regularly and mindfully throughout the day. Stay away from food that make you feel overly emotional, including beverages. A 3. Avoid Mood-Altering Drugs Stay off non-prescribed drugs, including alcohol. Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

128 128 S 4. Balance Sleep Try to get the amount of sleep that helps you feel good. Keep to a sleep program if you are having difficulty. E 5. Get Exercise Do some sort of exercise every day. Try to build up to 20 minutes of daily exercise. Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

129 129 EMOTION REGULATION Worksheet 11 (for HO 17) Taking Care of Your Mind by Taking Care of your Body DAY In the left column, put down the days of the week. Then write down what you did to practice each of the PLEASE skills. At the bottom of each column, check whether practicing this skills was helpful during the week. Describe Treating PhysicaL Illness Describe Balanced Eating Efforts List Mood Altering Substances Used Hours Sleep Time to bed/time up Describe Exercise Type/Time Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

130 130 EMOTION REGULATION Worksheet 12 (for HO 8-17) Steps for Reducing Vulnerability to Emotion Mind A B C For each emotion regulation skill, check whether you used it during the week and describe. BUILD POSITIVE EXPERENCES NOW INCREASED daily pleasant activities (circle): M T W TH F S SUN (describe) BUILD A LIFE WORTH LIVING VALUES considered in deciding what goals to work on (See ER HO 15) LONG TERM GOALS worked on: ATTENDED TO RELATIONSHIPS? (describe) MINDFULNESS OF POSITIVE EXPERIENCES WHEN THEY OCCURRED Focused (and refocused) attention on positive experiences? Distracted from worries if they showed up BUILD MASTERY Scheduled activities to build a sense of accomplishment (circle): M T W TH F S SUN Actually did something difficult AND possible (circle): M T W TH F S SUN (descr) COPE AHEAD OF TIME Situation that prompts emotion (describe, fill out steps 1 and 2 of checking the facts-er WS 5, if needed) Ways that I imagined coping effectively (describe) Way that I imagined coping with new problems that might arise (describe) REDUCED VULNERABILITY TO EMOTION MIND (CIRCE): P L E A S E Describe: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

131 131 EMOTION REGULATION HANDOUT 18 Mindfulness of Current Emotions: Letting Go of Emotional Suffering EXPERIENCE YOUR EMOTION As a WAVE, coming and going Step back, just notice Try not to BLOCK or SUPPRESS emotion Don t try to GET RID of or PUSH away emotion Don t try to KEEP emotion around Don t HOLD ON to it PRACTICE MINDFULNESS OF EMOTIONAL BODY SENSATIONS Notice WHERE in your body you are feeling emotional sensations Experience the SENSATIONS as fully as you can Observe how LONG it takes before the emotion goes down REMEMBER: YOU ARE NOT YOUR EMOTION Do not necessarily ACT on your emotion Remember times when you have felt DIFFERENT PRACTICE LOVING/ACCEPTING YOUR EMOTION RESPECT your emotion Do not JUDGE your emotion Practice WILLINGNESS Radically ACCEPT your emotion Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

132 132 EMOTION REGULATION Worksheet 13 (for HO 18) MINDFULNESS OF CURRENT EMOTIONS EMOTION NAME: INTENSITY (0-100) BEFORE: After: Describe situation that prompts emotion (see steps 1 and 2 on ER WS 5 if needed). When emotional intensity is extreme, go to CRISIS SURVIVAL SKILLS first. With any emotion, high or low, practice radical acceptance with: MINDFULNESS OF CURRENT EMOTIONS Check off any of the following that you did: o Stepped back and just noticed the emotions I was experiencing o Experienced the emotion as waves, coming and going on the beach o Let go of judgments about my emotions o Noticed where in my body I was feeling the emotional sensations o Paid attention to the physical sensations of the emotions as much as I could o Observed how long it took the emotion to go away o Reminded myself that being critical of emotions does not work o Practiced willingness to have unwelcome emotions o Imagined my emotions as clouds in the sky, coming and going o Just noticed the action urge that went with my emotion o Got myself to AVOID ACTING on my emotion o Reminded myself of times when I have felt different o Practiced radically accepting my emotion o Tried to love my emotions o Other: Comments and descriptions of experiences: Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

133 133 EMOTION REGULATION HANDOUT 19 Managing Extreme Emotions When emotional arousal is very HIGH So extreme that your skills break down You are completely caught in emotion mind You are overwhelmed and your brain is not processing information Your mind is shutting down STEP 1 Observe and describe that you are at you SKILLS BREAK-DOWN POINT This is the point where your distress is EXTREME and where you cannot focus your mind on anything but the emotion itself and cannot problem solve or use any complicated skills On a scale of (where 1 is very low and 100 is the highest you can go), mark the number where your emotional arousal and distress is so high write in the number Check the facts do you really fall apart at this level of distress? Change it if needed. This is your personal SKILLS BREAK-DOWN POINT STEP 2 Go to Crisis Survival Skills to bring down your arousal (ER HO 23) TIP your body chemistry DISTRACT from the emotional events SELF-SOOTHE by finding pleasant, soothing things IMPROVE the moment you are in STEP 3 Return to Mindfulness of Current Emotion (ER HO 18) STEP 4 Try other Emotion Regulation Skills (if needed) Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

134 134 EMOTION REGULATION HANDOUT 20 Crisis Survival Skills for Managing Extreme Emotions When emotional arousal is very HIGH So extreme that your SKILLS BREAK-DOWN POINT TIP your body chemistry by Go to Crisis Survival Skills o Changing your body temperature (with ice water) o Intense exercise (20 minutes) o Relaxing your body muscles one by one DISTRACT from the emotional prompting events by o Shifting attention away from what is distressing you o Focusing your mind on something else, anything else o Leaving the situation completely for a while SELF-SOOTHE your senses by finding pleasant, soothing things o Look at o Listen to o Touch o Smell o Eat or drink o Move to IMPROVE moment you are in by o Imagining other moments of something different in this one o Finding some kind of meaning in the present moment o Prayer/Meditation o Finding ways to relax right now o Focusing your entire mind on one thing in the moment o Taking a short vacation by briefly avoiding the situation o Using encouraging sayings or mantras. Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

135 135 EMOTION REGULATION Worksheet 14 (for HO 19) Managing Extreme Emotions Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

136 136 EMOTION REGULATION HANDOUT 21 Factors Interfering with Emotion Regulation Lack of Skill You actually DON T KNOW how to regulate your emotions. You don t know how to use skills. You don t know what will work. Reinforcement of Emotional Behaviors It is extremely difficult to change your emotions when they: Are the only way to COMMUNICATE to others MOTIVATE you to do things you think are important VALIDATE your beliefs or your identity FEEL GOOD MOODINESS You have the ability, and in your current mood, you are unwilling. Problems seem like a threat instead of a challenge. You don t really want to put in the time and effort to solve your current problem or use your skills. Your current mood, not skills, controls what you do. RUMINATING AND WORRYING Worry thoughts and ruminating get in the way of you ability to act effectively. You have the ability, but your worry thoughts interfere with focusing on skills. SECONDARY EMOTIONS You are trying to change a secondary emotion without first figuring out what is the primary emotion. It is very hard to change secondary emotions before you figure out the primary emotions. EMOTION MYTHS Myths about emotions get in the way of your ability to regulate your emotions. Judgmental thoughts about emotions lead to avoiding emotions Beliefs that are extreme emotions are necessary or are part of your being yourself Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

137 137 EMOTION REGULATION HANDOUT 22 Troubleshooting Emotion Regulation: When What You are Doing Isn t Working CHECK YOUR SKILLS REVIEW what you have tried o Did you use a skill likely to be effective? o Did you follow the skill instructions to the letter WORK on your skills o Review and try other skills or o Get coaching o Try again (maybe same skill, different way) CHECK FOR REINFORCERS ASK: Do my emotions: o COMMUNICATE an important message or influence people to do things? o MOTIVATE me to do things I think are important o VALIDATE my beliefs or my identity o FEEL GOOD? IF YES: o Practice Interpersonal Effectiveness skills to communicate o Work to find new reinforcers to motivate yourself o Practice self-validation o Do a PROS and CONS for changing emotions (ER WS 1) CHECK YOUR MOOD ASK: Am I: o Seeing my problem as a threat instead of a challenge? o Unwilling to put in the time and effort to solve my problem? IF YES: o CHECK THE FACTS o Practice RADICAL ACCEPTANCE and WILLINESS skills o Practice Mindfulness PARTICIPATING and EFFECTIVENESS Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

138 138 EMOTION REGULATION HANDOUT 22 (continued) Troubleshooting Emotion Regulation: When What You are Doing Isn t Working CHECK FOR RUMINATING AND WORRYING RATE your level of ruminating and excessive worrying IF HIGH, ASK: Can the problem I am worrying about be solved NOW? o IF YES, do PROBLEM SOLVING (ER HO 9, 10) o IF NO, practice MINDFULNESS of CURRENT SENSATIONS (ER H016) CHECK FOR HIDDEN PRIMARY EMOTION ASK: o Does my current emotion make the most sense given the prompting event? o Is another emotion more reasonable given the prompting events? o What emotion might I be AVOIDING? o Is emotion out of proportion to the facts? IF another primary emotion can be identified: o Focus on the primary emotion o Practice MINDFULNESS of SENSATIONS CHECK FOR EMOTION MYTHS GETTING IN THE WAY Judgmental myths about emotions o Some emotions are stupid. o I can t control my emotion. o There is a right way to feel in this situation. Beliefs that emotions and identity are the same. o My emotions are who I am. o My emotions make me strong. IF YES: o Check the facts o Challenge myths o Practice Non-Judgmental Stance Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

139 139 EMOTION REGULATION Worksheet 15 (for HO 21, 22) Trouble Shooting Emotion Regulation When you just can t get your skills to work, trying doing this worksheet to see if you can figure out what is interfering. Keep going until you find a solution EMOTION NAME: INTENSITY (0-100) BEFORE: After: Describe the skill you were trying to use that did not seem helpful: 1. Did I use the skill correctly? Check out the instructions. o YES: Go to next question. o NOT SURE: Re-read the instructions or get coaching. TRY AGAIN. Did this help (circle)? No (go to next question) Yes (fabulous) Didn t do it 2. Are my emotions being reinforced (and maybe I don t really want to change them)? o NO: Go to next question. o NOT SURE: Review ER HO 2, WS 2, 2a What Good are Emotions? o Yes: Do a PROS and CONS for changing emotions ER WS 1 Did this help (circle)? No (go to next question) Yes (fabulous) Didn t do it 3. Am I seeing the problems as a challenge? Am I willing to put in time and effort to solve it? o YES: Go to next question. o NO: Review ER WS 2, 5 Check the Facts Practice Radical Acceptance and Willingness Practice Participating and Effectiveness Did this help (circle)? No (go to next question) Yes (fabulous) Didn t do it 4. Am I going around in so many circles worrying that I can t focus on skills? o NO: Go to next question. o YES: If possible now, solve the problem (ER HO 9, WS 6). If not possible, review ER HO 18 Attend to Physical Sensations Did this help (circle)? No (go to next question) Yes (fabulous) Didn t do it 5. Am I trying to change the secondary emotion instead of the primary emotion? o NO: Go to next question. o YES: Focus on primary emotion. Practice Mindfulness of Sensations Did this help (circle)? No (go to next question) Yes (fabulous) Didn t do it 6. Are myths about emotions and emotion regulation getting in my way? o NO: Go back through questions. o YES: Practice Non-Judgmental Stance, Check the Facts, and Challenge Myths Did this help (circle)? No (go to next question) Yes (fabulous) Didn t do it Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

140 140 EMOTION REGULATION HANDOUT 23 Myths about Emotions There are a lot of myths about emotions. Here are some potential myths. Rate how much you believe the myth on a scale from 1-10 next to each one. Please identify a few of your own. 1. There is a right way to feel in every situation. 2. Letting others know that I am feeling bad is weakness. 3. Negative feelings are bad and destructive. 4. Being emotional means being out of control. 5. Some emotions are stupid. 6. All painful emotions are a result of a bad attitude. 7. If others don t approve of my feelings, I shouldn t feel the way I do. 8. Other people are the best judge of how I am feeling. 9. Painful emotions are not really important and should be ignored. 10. Extreme emotions get you a lot further than trying to regulate your emotions. 11. Creativity requires intense, often out-of-control emotions. 12. Drama is cool. 13. It is inauthentic to try and change my emotions. 14. People should do whatever they feel like doing. 15. Acting on your emotions is the mark of a truly free individual 16. My emotions are who I am. 17. My emotions are why people love me. 18. Emotions can just happen for no reason. 19. Emotions should always be trusted Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

141 141 EMOTION REGULATION Worksheet 16 (for HO 23) Myths about Emotions For each myth write down a challenge that makes sense to you. An example is given. 1. There is a right way to feel in every situation. Challenge: People respond differently to situations, there is no correct or right way. My Challenge:. 2. Letting others know that I am feeling bad is weakness. My Challenge:. 3. Negative feelings are bad and destructive. My Challenge:. 4. Being emotional means being out of control. My Challenge:. 5. Some emotions are stupid. My Challenge:. 6. All painful emotions are a result of a bad attitude. My Challenge:. 7. If others don t approve of my feelings, I shouldn t feel the way I do. My Challenge:. 8. Other people are the best judge of how I am feeling. My Challenge:. 9. Painful emotions are not really important and should be ignored. My Challenge:. 10. Extreme emotions get you a lot further than trying to regulate your emotions. My Challenge:. 11. Creativity requires intense, often out-of-control emotions. My Challenge:. 12. Drama is cool. My Challenge:. 13. It is inauthentic to try and change my emotions. My Challenge:. 14. People should do whatever they feel like doing. My Challenge:. 15. Acting on your emotions is the mark of a truly free individual My Challenge:. 16. My emotions are who I am. 17. My Challenge:. My emotions are why people love me. 18. Emotions can just happen for no reason. My Challenge:. 19. Emotions should always be trusted. My Challenge: My Challenge:. Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

142 142 EMOTION REGULATION Worksheet 24 Review of Skills for Emotion Regulation REDUCE EMOTIONAL VULNERABILITY 1. Accumulate Positive Emotions 2. Build Mastery 3. Cope Ahead 4. PLEASE Skills REDUCE EXTREME EMOTIONAL REACTIONS & HIGH AROUSAL Crisis Survival Strategies CHANGE EMOTION THOUGHTS AND INTERPRETATIONS Check the Facts! CHANGE EMOTIONAL REACTIONS Opposite Action All-The-Way Opposite Body Language Opposite Words Mindfulness of Current Emotions REDUCE EMOTIONAL PROMPTING EVENTS Problem Solving! MANAGE AFTEREFFECTS NAME EMOTIONS Observe And Describe Emotions Repeat for Secondary Emotions Distress Tolerance Skills Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.

143 143 Middle Path Dialectics: What is it? Dialectics teach us that: There is always more than one way to see a situation, more than one way to solve a problem, and multiple truths. All people have unique qualities and different points of view. It is vital not to see the world in black and white, all or nothing ways. Two thinks that seem like (or are) opposites can be true. Change is the only constant. Meaning and truth evolve over time. Change is transactional. Middle Path is the balancing act of Acceptance and Change Adapted from Miller, Rathus, & Linehan (2007). Dialectical Behavior Therapy with Suicidal Adolescents.