No matter what is thrown at you, you have to be ready with a DBT skill or response, in the moment. You cannot hesitate and you cannot give up.

Make an acceptance-acknowledgement declaration

-for you and your loved one this declaration often opens the door to healing and change

-repeat it over and over if necessary

-remind your loved one that you never intended to do any harm

-apologize

Take your loved one’s emotional temperature

-try to sense what emotion they are feeling

-observe body language, gestures, and facial expressions

Mind-read

-imagine being your loved one by looking at the current situation from their perspective, given their dysregulation and past experiences

-validate and normalize their response

Describe

-describe what you see, what you feel, and what your intuition tells you

Validate

-have courage and validate the emotion you sense your loved one is feeling

-keep your own emotion out of it

-validate their inner capabilities and wisdom

-validation is the key to improving communication

Be fully present in the moment

-during the interaction, stop doing whatever you were doing and focus all your attention on your loved one

-make eye contact

Identify and prevent triggers

-it is time to practice predicting your loved one’s reactions by identifying possible behavioral triggers

-this requires you to mind-read so as to identify possible behavioral triggers in various situations and try to prevent emotional escalations by validating emotions and suggesting alternative behaviors

Script a DEAR CCC

-when you want to ask for something or explain why you cannot do something, plan what you will say in advance by writing out a structured, clear, and concise script using the DEAR CCC format

-this will help you to reduce misinterpretations of simple, uncomplicated situations or neutral statements

-using DEAR CCC as a guide can prevent triggering maladaptive BPD responses and decrease the possibility of misinterpretations, thereby averting stressful, aversive interactions and improving communication

Email

-it is sometimes easier for your loved one to “hear you” when what you are saying is written rather than said face to face

-reading decreases the potential misinterpretations of voice tones and facial expressions

Cheerlead

– encourage your loved one by reminding them that they can do hard things, that they have done hard things in the past, and that they are capable of tolerating distress

-communicate that you believe in your loved one

Develop a scale

-help your loved one to evaluate their experiences, to rate their own emotional intensity or difficulty of their problem

-remind them of how they overcame problems in the past

-WOW stands for wait, observe, and wing it

Be a magnifying glass

-people with BPD do not see the world the way you do because their thinking has a strong negative bias

-call attention to the positive aspects of situations

-by pointing out the overlooked positive in their life you are being their magnifying glass, helping them see the world and their own accomplishments in a more positive life

Find the nugget of truth

-find the truth in whatever it is that your loved one says or feels

-there is usually something valid at the bottom of their feelings or actions, it is your job to find and validate it

-accept that they feel what they feel

Do not encourage fragility

-do not treat your loved one in a patronizing or condescending manner

-that contributes to their feelings of shame

Build competency and self-respect

-to feel competent, a person must succeed at doing something, even if it’s just a small thing

-competency is feeling proud of yourself because you have achieved something you wanted to do

-point out that your loved one deserves to feel really good about themselves because they have achieved a goal they did not think they could achieve

-achieving competency means developing self-esteem

-people with BPD need to feel they have control of their lives, can stand up for themselves, express their own opinions, and say no to demands
-try asking your loved one for advice, say ‘what advice would you give your best friend in this situation?’

Be irreverent

-use humor or make challenging statements, or say things that are irreverent

-it is important to keep your tone of voice light and validating

Learn to live with failure

-if you protect your loved one from experiencing failure, how will they ever learn to overcome it?

-failure is as much a part of life as success

Accentuate the positive

-glass half full or half empty, people with BPD tend to see it as half empty

-persistence is often more important than innate talent, it takes courage to keep going

-courage is not the absence of fear but the ability to keep going in spite of it

Be your loved one’s memory

-when a person with BPD is in emotion mind, they will hold themselves up to the impossible, unrealistic standards, compare themselves to others, and feel as if the world has conspired to cast them as a failure

-because people with BPD seem to have difficulty accessing their own happy memories, provide your loved one with concrete, physical evidence of their positive experiences

Manage contingencies

-anticipate how your loved one might react or feel in a certain situation

-try asking questions about potentially difficult situations that are sure to arise and help them find ways to deal with them ahead of time

Empower your loved one

-almost any new situation in which your loved one feels out of control, judged, compared to others, criticized, incompetent, or embarassed will produce anxiety

-remind them of past achievements in similar difficult situations

Reconcile and synthesize

-both you and the person with BPD must radically accept that each one of you did the best you could and never realized or understood the effect your behaviors and responses had on the other person

-to achieve a synthesis between acceptance and change it is essential that you forgive one another

Accept the premises of BPD

-progress in DBT is a slow, ongoing process

-it requires setting realistic goals and readjusting expectations

-BPD is a chronic disorder, progress is a decrease in the severity of episodes and an increase in the length of time between episodes

-focus on changing yourself so that you can be willing, open, radically genuine, authentic, and compassionate

-a term used in psychiatry to describe the inability to hold opposing thoughts, feelings, or beliefs

-some might say that a person who splits sees the world in terms of black and white, all or nothing

-it’s a distorted way of thinking in which the positive or negative attributes of a person or event are neither weighed nor cohesive

-splitting is a defense mechanism, by which people with BPD can view people, events, or even themselves in all or nothing terms

-splitting allows them to readily discard things they have assigned as “bad” and to embrace things they consider “good”, even if those things are harmful or bad

-splitting can interfere with relationships and lead to intense and self-destructive behaviors

-a person who splits will typically frame people or events in terms that are absolute with no middle ground for discussion

-things are either “always” or “never”

-people can be either “evil” and “crooked” or “angels” and “perfect”

-opportunities can either have “no risk” or a “complete con”

-science, history, or news is either a “complete fact” or a “complete lie”

-when things go wrong, a person will feel “cheated”, “ruined”, or “screwed”

-what makes splitting even more confusing is that the belief can sometimes be iron-clad or shift back-and-forth from one moment to the next

-people who split are often seem to be overly dramatic or overwrought, especially when declaring things have either “completely fallen apart” or “completely turned around”

-acting out, without consideration or consequences

-denial, consciously ignoring a fact of reality

-passive-aggression-an indirect expression of hostility

-projection, assigning an undesirable emotion to someone else

-omnipotence, the belief that you possess superiority in intelligence or power

-emotional hypochondriasis, trying to get others to understand how severe your emotional pain is

-projective identification, denying your own feelings, projecting them onto someone else, and then behaving toward that person in a way that forces them to respond to you with the feelings you projected onto them

-“mirroring”

-the constant, unconscious change in the person’s ‘self’ as they struggle to fit into their environment, or the people around them

-it is, essentially, a fluctuating identity

-it is the manifestation of a basic inability or difficulty in establishing a stable sense of self

-without diagnosis and treatment, most people are unaware of the chameleon, and it is only through awareness that the chameleon can be managed

-people with BPD instinctively ‘mirror’ to fit in, because without that behavior, we have no idea what will happen

-we have little or no sense of our own identity, so we can’t know if that will be acceptable to others

-and, without acceptance by others, we risk abandonment, which is an intense fear

-the fear of abandonment is a fear of being alone. it is terrifying to be left alone with yourself when you don’t know who you are

-those with a chameleon personality conceive relationships in an unequal way, they believe one partner gives orders while the other submits

-they always adapt to their partner’s lifestyle and their tastes

-the advantages to this are that you get a partner you can share everything with, and since you leave the decision making up to your partner, you always get along great

-the disadvantage is that they will always show a tendency to please and submit to the other person, they’ll never show initiation and will simply agree with their partner on everything

-but being yourself and having a healthy self-esteem is very important on a personal and relationship level

-they pay careful attention to social cues, scrutinizing others with keenness so as to know what is expected of them before making a response

-they try to be as others expect them to be, in order to get along and be liked

-they use their social abilities to mold their appearance as disparate situations demand, so that, as some people put it, “with different people i act like a very different person”

Chameleon meanings

-insight

-change

-stability

-patience

-curiosity

-sensitivity

-perception

-resourcefulness

-each emotion you’ve ever felt exists to serve a purpose

-emotion regulation is used to increase positive feelings over time, and as you practice these skills, you will feel more resilient when you experience a negative emotion

-the purpose of emotions is to communicate what we’re experiencing to those around us, both verbal and nonverbal communication of emotions can help us connect with others and build stronger relationships

-another purpose of emotions is to influence others, an intense emotion is able to influence the feelings, thoughts, and opinions of others

-many emotions are self-productive, they encourage us to react or respond in difficult situations, responsible for our fight, flight, or freeze reactions

-each human emotion is equally valuable, each one has a purpose and something to communicate

-but…emotions aren’t always right

Examples of emotions and their functions

-main types of emotions-

-joy

-trust

-fear

-surprise

-sadness

-disgust

-anger

-anticipation

Love-lets us know that something is going right, arises from a feeling of profound oneness, it can be platonic, romantic, religious, or familial

Joy/Happiness-signal that something is going right, sense of well-being, inner peace, love, safety, and contentment

Guilt-could be a sign that we’ve done wrong and we can work to correct it

Anger-lets us know that we’ve been wronged

Fear-a response to impending danger, a survival mechanism

Shame-gives us information about our faulty core beliefs

Anxiety-there are two types, productive and non-productive

Sadness/Grief-having support from those we love makes it easier to get through the grieving process

Fear>nervousness>anxiety, apprehension, distress, dread, tenseness, uneasiness, worry

Fear>horror>alarm, fright, hysteria, mortification, panic, shock, terror

Joy>cheerfulness>amusement, ecstasy, gaiety, euphoria, bliss, elation, delight, happiness, jubilation

Joy>zest>enthusiasm, excitement, exhilaration, thrill

-it simply means you are acknowledging reality

-you are acknowledging what happened or what’s currently happening, because fighting reality only intensifies our emotional reaction

-fighting reality only creates suffering; while pain is inevitable, suffering is optional

-practicing acceptance actually leads the way to problem solving

-it is about saying yes to life, just as it is

-it is difficult to accept what you don’t want to be true, and it’s more difficult to not accept, not accepting pain brings suffering

Components of radical acceptance-

-accept what is

-realize what we can and can’t control

-look at the situation from a non-judgemental perspective

-acknowledge the facts of the situation

-stop fighting reality

-learn how to live in the present moment despite our pain

Questions to ask yourself to understand your pain-

-what were the events that lead to the painful situation?

-what part did you and others play in causing this situation?

-what control did you have over these precipitating events and what did you not control?

-how did you respond when the situation happened?

-how did your response change the way you and others thought and felt?

-what could you have done differently to reduce the suffering you feel or the suffering of others?

-what about the situation would have been different if you had practiced radical acceptance?

Reality Acceptance Skills-

-mindfulness-observing, describing, and participating in your physical sensations, and doing it non-judgementally and effectively

-crisis survival-learning to contribute, occupy yourself with activities, make comparisons, use opposite emotions, push away from non-reality, and examine thoughts and emotions

-self-soothing using your five senses

-improving the moment by using imagery, meaning, prayerm relaxation, doing one thing at a time, vacationing, and encouraging

-identifying pros and cons

-mentally and physically accepting your reality

-having the willingness to accept things as they are

-turning your mind towards reality

-reducing vulnerability by treating physical illness, eating, sleeping, and exercising properly

-building mastery

-building positive experiences

-being mindful of present emotions

-avoiding acting out of emotion

-acceptance skills like half-smiling, an expression that brings the reality from your body to your mind

-interpersonal efffectiveness-a means of interacting with others in positive, productive ways, using techniques like objectiveness effectiveness, relationship effectiveness, and self-respect effectiveness

Benefits of Radical Acceptance-

-accepting yourself completely gives you the ability to care for yourself in a strong, realistic way

-helps regulate your emotions so that you can stop bouncing between positivity and despair, but rather maintain a clear, calm focus on your unique identity and needs

when you learn to accept yourself realistically, you give yourself the power to change and become more like who you want to be

-the changes you make can lead to better relationships, more work success, and a more peaceful outlook on life

(Dialectical Behavior Therapy)

-a type of cognitive behavioral therapy that focuses on the psychosocial aspects of therapy, emphasizing the importance of a collaborative relationship, and the development of skills for dealing with highly emotional situations

-DBT was created by Marsha Linehan, for the treatment of individuals struggling with suicidal thoughts, and has now become the gold standard treatment for Borderline Personality Disorder (BPD)

-covers four areas-

1 interpersonal effectiveness

2 distress tolerance

3 emotion regulation

4 mindfulness

1 interpersonal effectiveness-

-skills are related to interacting with others, especially in difficult situations

-objective effectiveness

“DEARMAN” skills

D escribe

E xpress

A ssert

R einforce

M indful

A ppear confident

N egotiable

-relationship effectiveness

“GIVE” skills

G entle

I interested

V alidate

E asy manner

self-respect effectiveness

“FAST” skills

F air

A pologies/no apologies

S tick to value

T ruthful

2 Distress tolerance

-skills relating to accepting, tolerating, and learning from suffering

-distracting

-self-soothing

-improve the moment

-pros and cons

-also radical acceptance and willingness vs willfulness

crisis survival

“ACCEPTS” skills

A ctivities

C ontributing

C omparisons

E motions

P ushing away

T houghts

S ensations

self-soothing skills

-taste

-smell

-see

-hear

-touch

improve the moment

“IMPROVE” skills

I magery

M eaning

P rayer

R elaxation

O ne thing at a time

V acation

E ncouragement

pros and cons/accepting reality skills

-willingness

-turning your mind

-radical acceptance

3 Emotion Regulation

-identifying and labeling emotions

-identifying obstacles to changing emotions

-reduce vulnerability to “emotion mind”

-increasing positive emotional events

-increasing mindfulness to current emotions

-taking the opposite action

-applying distress tolerance techniques

reducing vulnerability skills

-treat physical illness

-eating

-altering drugs

-sleep]

-exercise

build mastery skills

-build positive experiences

-be mindful of current emotion

-opposite to emotion action

4 Mindfulness

-skills include “what” skills, like observing, describing, and participating, and “how”skills, like non-judgement, and practicing “one-mindfully” effectively

mindfulness skills

-“what”skills

-observe

-describe

-participate

-“how”skills

-non-judgementally

-one-mindfully

-effectively

Reality Acceptance

-accepting reality is an effective antidote for a common problem in our society: struggling against the pain and suffering that is inherent to life as a human

-observe that you are fighting the reality of your situation, acknowledge that you are reacting to something that you cannot change

-remind yourself what the reality is, even if it’s difficult

-consider the causes of your current reality and incorporate the skill of non-judgement to remind yourself that this is a random occurence set in motion by a million other factors that are outside of your control

-accept this reality with your whole being, or your mind, body, and spirit

Radical Acceptance

-simply acknowledging the reality of your circumstances instead of fighting it by thinking “this isn’t fair”

-it can be difficult to accept pain, but fighting the reality of your pain only creates more pain, and this pain is optional

-radical acceptance helps us accept the reality of things that we cannot change, it can also help us to realize what can be changed

Non-judgemental stance

-you avoid assigning value to events and feelings

-instead of facing a difficult situation and thinking “this is awful”, practicing non-judgement allows us to take a step back and realize that the value judgements we make are based on facts and the emotions we are feeling in reaction

-when you break a judgement down into a fact and your emotional reaction, you not only reduce the emotions you are feeling, you can also be empowered to think about ways to solve the problem and make healthy decisions

Bitterness-shows you where you need to heal, where you’re still holding judgements on others and yourself

Resentment-shows you where you’re living in the past and not following the present to be as it is

Discomfort-shows you that you need to pay attention right now to what is happening, because you’re being given the opportunity to change, to do something differently than you typically do it

Anger-shows what you’re passionate about, where your boundaries are, and what you believe needs to change about the world

Disappointment-shows that you tried for something, that you did not give in to apathy, that you still care

Guilt-shows that you’re still living life in other people’s expectations of what you should do

Shame-shows that you’re internalizing other people’s beliefs about who you should be (or who you are) and that you need to reconnect with yourself

Anxiety-shows that you need to wake up, right now, and that you need to be present, that you’re stuck in the past and living in fear of the future

Sadness-shows you the depth of your feeling, the depth of your care for others and this world

-instability in interpersonal relationships, self-image, and affects

-severe instability can be seen in their fluctuating views and feelings about themselves, they often feel really good about themselves, their progress, and their futures, to only have a seemingly minor experience turn their world upside-down with plunging self-esteem and depressing hopelessness

-marked impulsivity that begins by early adulthood and is present in a variety of contexts

-will often give up on something just before the goal is attained

-it is often difficult to maintain relationships, jobs, or educational goals since their basic instability extends to work and school

-psychotic-like symptoms may occur when they are under stress, symptoms include hallucinations, body-image distortions, ideas of reference, and hypnagogic phenomena

-typically don’t do well in personal relationships and may feel more comfortable with pets or inanimate objects, relationships are unstable

-risk of suicidal, self-mutilating, and/or brief psychotic states increases when they are experiencing an emotional state they cannot handle

-risk for suicide increases when the individual also has a co-occuring mood or substance-related disorder

-10% of adults with BPD commit suicide

-a person with BPD has a suicide rate 400 times greater than the general public

-patients suspected of BPD also exhibit symptoms of depressive mood disorders, addictions to various things, and anti-social behavior, other comorbid disorders include mood, substance related, eating, ptsd, adhd, and other personality disorders

-to the sufferer, BPD is about deep feelings, such as:

-if others really get to know me, they will find me rejectable and will not be able to love me and will leave me

-I need to have complete control of my feelings otherwise things will go completely wrong

-I have to adapt my needs to other people’s wishes otherwise they will leave me or attack me

-I am an evil person and I need to be punished

-if someone fails to keep a promise, that person can no longer be trusted

-if I trust someone, I run a great risk of getting hurt or disappointed

-if I comply with someone’s request, I run the risk of losing myself

-if you refuse someone’s request, you run the risk of losing that person

-I will always be alone

-I can’t manage by myself, I need someone to fall back on

-there is no one who really cares about me

-I don’t really know what I want

-I will never get what I want

-I’m powerless and vulnerable and I can’t protect myself

-I have no control of myself

-I can’t discipline myself

-my feelings and opinions are unfounded

-other people are not willing or helpful

BPD Triggers-

-perceived or real abandonment

-rejection of any kind

-loss of a job

-locations that invoke negative memories

-reminders of tragic events

-ending a relationship

-some people with BPD have low self-esteem, we were not taught how to value ourselves and celebrate the things we are good at

-we may grow up thinking that we suck at everything we do, these kind of thoughts can translate to our feelings

-our low self-esteem can impact every decision we make in our lives

-learn to have better self-esteem-write a list of things you like to do, then do something new related to your interests, start learning and putting into practice, slow process but you can master it and build your self-esteem along the way, make a list of your strengths and what you have achieved in your lifetime, spend time on personal hygiene, set challenges for yourself, practice gratitude

-take a self-esteem inventory-strengths and weaknesses, lets you know all the things you already tell yourself about how much you suck, as well as showing there are just as many things you don’t suck at

-set realistic expectations-no unrealistic expectations, stop the cycle of negative thinking about yourself that reinforce our negative self-esteem

-set aside perfection, grab hold of accomplishments and mistakes-perfection is unattainable for any of us, write down your accomplishments as you achieve them, set small goals, take something away from the mistakes you make, mistakes are opportunities for learning and growth

-explore yourself-self-exploration, open yourself up to new opportunities, new thoughts, trying out new things, new viewpoints, new friendships

1 Understanding and Labeling Emotions-simply identifying and naming the emotions you feel, to manage an emotion you must first know what it is

2 Mindfulness-can be described as living your life in the moment instead of being stuck in the past or future, practicing mindfulness helps us become more aware of our thought patterns, our emotions, and how our thoughts and feelings affect our reactions to events

3 Letting go of Painful Emotions-the most important regulation skill, learning to let go of painful emotions can be very difficult but it is worth the effort you invest, humans have a tendency to become stuck when attempting to process negative emotions, the act of accepting that we are feeling negative emotions can be key to letting them go, 1-observe your emotion, 2-try to experience your emotion as a wave, coming and going, 3-recognize that you are not your emotion, 4-do not necessarily act on your emotion, 5-practice loving your emotions

4 Take Care of your Body-eat well, exercise regularly, get enough sleep, avoid toxic substances, treat any illnesses that require treatment

5 Increasing Positive Emotions-find ways to have fun-give yourself permission to enjoy yourself, work on relationships, repair and restart relationships, forge new friendships, commit to maintaining and strengthening your current relationships, be present to and mindful of the positive-focus on good things, even if bad things happen, there’s bound to be at least one or two positive things to savor, be unmindful of worries-focus on positives, put worries and insecurities aside, STOPP-stop, take a breath, observe, put into perspective, practice what works

6 Differentiating between healthy and unhealthy regulation activities-talking with friends, exercise, write in journal, meditation therapy, get adequate sleep, pay attention to negative thoughts, notice when you need a break