Best Breathing Technique For Panic, Anxiety and Distress

When we’re having a panic attack, or feeling anxious or in distress, our breathing generally speeds up. This elevates our heart rates, making things feel more intense, and creating even more panic, anxiety and distress. The advice in these situations is often to take deep breaths. But deep breathing can actually make things worse.

If we start breathing deeper without slowing down out breathing, we can end up panting or hyperventilating. And this can feel like we’re having trouble breathing or starting to suffocate, which leads to more panic, anxiety and distress. So instead of trying to breathe deeper, we want to breathe slower. The video below describes the best breathing exercise to slow down our breathing, deescalate panic attacks, and reduce anxiety and distress.

Best Breathing Technique for Panic Attacks and Anxiety

Breathing Technique for Panic and Anxiety Longer Version

Someone requested a longer version of this breathing exercise, so the video below is the same as above, but looped a few times.

The actual best way to learn how to breathe during a panic attack is with Capnometry-Assisted Respiratory Training (CART), but this requires a portable capnometer device. If you’re interested, you can read about CART (along with a video demonstration), or read the the academic study. But if you’re like me, and don’t have your own capnometer, the breathing technique in this video is a simple and effective way to slow down your breathing during a panic attack.

If you have any questions or comments, please leave them on the YouTube video page.

5-4-3-2-1 Grounding Exercise

The 5-4-3-2-1 grounding exercise is a grounding technique that helps us connect with the outside world through our senses. We can use this coping skill whenever we’re feeling anxious or overwhelmed, our minds are racing, or we’re stuck in our heads dwelling or ruminating. The 5-4-3-2-1 exercise can also help if we’re dissociating or experiencing depersonalization.

The 5-4-3-2-1 grounding technique brings us back into the present moment as we identify and name:

  • 5 things we can see
  • 4 things we can touch
  • 3 things we can hear
  • 2 things we can smell
  • 1 thing we can taste

5-4-3-2-1 Grounding Technique

If you have any questions or comments, please leave them on the YouTube video page.

Cognitive Fusion and Defusion

Another way to be mindful of our thoughts is with cognitive defusion. Cognitive defusion is a technique from Acceptance and Commitment Therapy (ACT). Cognitive fusion refers to a state of mind in which we get so stuck in our heads and caught up in our thoughts that we become fused with them. Our thoughts become our entire reality. We often enter a state of cognitive fusion when we’re anxious and worrying, or depressed or angry and dwelling and ruminating on things.

Cognitive defusion is the opposite of cognitive fusion. Cognitive defusion is a way of letting go of our thoughts before we become fused with them. Or if we’re already in a state of cognitive fusion, cognitive defusion allows us to get out of our heads and de-fuse ourselves from our thoughts.

Cognitive Defusion

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

There’s a type of mindfulness based therapy called acceptance and commitment therapy. And an important concept in acceptance and commitment therapy is the idea of cognitive fusion and defusion.

Cognitive fusion describes those times when we’re so tightly stuck to our thoughts that we become fused with them. We can’t separate ourselves from our thoughts and so our thoughts become our reality. And when we’re in a state of cognitive fusion we can feel removed from the world outside our thoughts, and from what we’re doing, and from the people around us, and it can be hard to pay attention to anything outside our head.

The opposite of cognitive fusion is cognitive defusion. Cognitive defusion involves taking a step back from what’s going on inside our minds, and detaching ourselves from our thoughts. In this state of defusion we can observe our thoughts without getting caught up in or lost in them. And we can just allow them in and accept them and let them be and let go of them if we want.

One way we can practice cognitive defusion is to label your thoughts. Anytime you notice that you’re starting to become fused with your thoughts, you can simply take a step back from your thoughts by labeling them as thinking, or daydreaming, or worrying, or ruminating or planning—just labeling whatever type of thought you’re having with a one or two word description.

And doing this helps you take a step back from the thought and focus less on the content of your thought and more on just the fact that you’re thinking, or worrying, or daydreaming, or whatever the nature of your thought is. And this makes it less likely that you’ll get sucked in by those thoughts, or carried away by them, or become fused with them.

Or you can say to yourself: I’m just thinking, just worrying. And putting the qualifier just in front of the thought helps take away some of the power of that thought and makes it easier to let go. Or you can label the content of your thought as being “just a thought.” So if you’re thinking, “i can’t do anything right,” you can reframe this as “I’m just having the thought i can’t do anything right.”

Or if you’re thinking “this is going to be terrible” you can reframe that as “I’m just having the thought that this is going to be terrible.” Instead of “,nothing ever goes my way,” “I’m just having the thought that nothing ever goes my way.” And by prefacing our thoughts with the disclaimer that this is just a thought, we reinforce the idea that our thoughts are not facts. And every time we remind ourselves of this we take away some of the power that our thoughts have over us.

Or if you’re having trouble letting go of your thoughts you can imagine yourself writing down each thought on a balloon, and then releasing that balloon up into the air and just allowing that thought to float from your mind as the balloon floats away.

Now sometimes instead of just letting go of our thoughts, it can be helpful to look at the content of our thoughts, and just get a sense of how accurate or how biased that thought may be, and see if there may be a different way of looking at things and thinking about them that’s more helpful to you, which is something we’ll explore in the next video about reframing your thoughts and cognitive restructuring.

If you have any questions or comments, please leave them on the YouTube video page.

Watching Our Thoughts

Mindfulness of current thoughts is one of the DBT distress tolerance skills. I put my video about Mindfulness of Thoughts in the mindfulness skills section. But I have a couple of videos about specific mindfulness of thoughts techniques that I’ll include here under distress tolerance skills.

When we’re feeling distressed, we often get stuck in our heads, thinking in circles with our minds racing, completely detached from anything outside of our thoughts. This is the opposite of being mindful. It’s very stressful, and can leave us feeling even more distressed. When we’re able to get out of our heads, and simply observe our thoughts mindfully, we reduce our levels of distress. In the video below we’ll learn how to be mindful of our thoughts by just watching them and letting them go.

Watching Thoughts and Letting Them Go

If you have any questions or comments, please leave them on the YouTube video page.

DBT Distress Tolerance and Reality Acceptance

This video on reality acceptance follows up on the radical acceptance video in the previous post. When we allow in our unpleasant experience, accept them, and let them be, we take away their power. Reality acceptance doesn’t make distressing experiences go away, but it makes them more tolerable.

Reality Acceptance, Allowing and Letting Be

If you have any questions or comments, please leave them on the YouTube video page.

Problem Solving and Action Plans in CBT

In CBT we focus on changing our thoughts and behaviour in order to change the way we feel. But sometimes we experience a difficult or unpleasant emotion and our thoughts about our situation are accurate, and we’re behaving in a reasonable manner. When that’s the case, changing our thoughts or behaviour may not have much of an effect on our emotions. Or maybe we’re just finding it too difficult to modify our thoughts or behavior.

But there’s another option. Instead of changing how we’re thinking or acting, we can try to change the actual problem situation or event that’s responsible for how we’re feeling. And we do this by problem solving and coming up with an action plan to implement our solution.

Problem Solving and Action Plans in CBT

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

One of the main premises of both cognitive behavioral therapy and dialectical behavior therapy is that our emotional reactions start with a situation or event, that leads to certain thoughts and behavior, and it’s these thoughts and behaviors that are responsible for the emotion we feel. And we focus on changing these thoughts and behaviors in order to change the way we feel.

But if our thoughts are accurate and reflect reality, and our behavior is appropriate for the situation we find ourselves in, then there may not be much we can do to change our thoughts and behavior in order to help ourselves feel better. Or maybe our thoughts about a situation aren’t that accurate and we haven’t been acting in the most effective way to try to cope with things, but we’ve tried changing our thoughts and behavior and just haven’t had much success. So instead we focus on changing the situation that triggered these thoughts and behaviors in the first place. And we do this by problem solving and then coming up with an action plan.

So the first step in problem solving is to identify and then define or describe the problem or the situation that’s causing the problem. So for example, we’re feeling lonely or sad because we’ve just moved to a new city and we don’t really know anyone here yet. Now being lonely or sad in this situation is a natural way to feel, and so trying to change our thoughts about the situation probably isn’t going to be that successful or help that much.

And assuming our behavior isn’t contributing to the way we feel—for example we’re not just isolating ourselves and lying around on the couch when we’re not at work, we’re actually doing some activities and trying to meet people, we’re just not having much success—there may not be much about our behavior we can change that’s going to have an effect either.

So instead we need to engage in problem solving, and figure out a way to change the situation so we’re no longer feeling so lonely and sad. So the next step is to identify our goal in solving the problem and what needs to happen in order for us to start to feel better. And we want to keep the goal simple and realistic, and choose a short-term goal, because we want something that can start giving us some results right away.

Now if we think the solution is make lots of new friends here so I don’t feel so lonely all the time, well that’s a great goal, but it’s not something that’s going to happen right away. So instead, something like meet one or two new people here I can spend some time with. Then we come up with possible solutions or options to help us reach our goal. And we just brainstorm these, writing down as many things as we can think of without worrying about evaluating them yet.

And then we read over our entire list and select the best solution we’ve come up with. And if it’s not clear which option is the best solution, we can choose two or three and compare them with each other using a pros and cons list. So let’s say the solution we choose is to get involved with a group of people here with similar interests to our own and try to make some friends among them. So once we’ve chosen a solution to help us reach our goal we need to come up with a plan to implement that solution.

The key to creating a good action plan is to break it down into as many small steps as possible, so that each individual step is manageable. The biggest reason an action plan fails is that at some point, one of the steps creates a barrier we just can’t get around. And often it’s the first step that’s the biggest barrier, so make sure the initial step is really, really simple and manageable, because if this first step seems at all overwhelming, we can end up procrastinating and never get around to even trying to start on our plan. And just initiating this first step, no matter how small, often brings with it a sense of relief, because now we feel like we’re finally starting to do something about our problem, and we no longer feel so stuck or hopeless.

And when we come up with a plan we need to be specific about what each step entails and when we’re going to do it. We also want to anticipate possible problems or barriers that might come up, and have strategies ready to overcome them if they do arise. Otherwise it’s easy to get stuck and then just not know what to do next, or become so discouraged that we set aside our plan and stop working towards our goal altogether.

So let’s create an action plan to meet one or two new people where we’ve just moved who we can hang out with sometimes. So the option we evaluated as being the best solution is to get involved with a group of people with similar interests. So maybe we like playing board games and would like to get into a games night group. Or maybe we like sports and want to join a soccer or softball league. So step one is choose an activity.

And step two is to do some research and see what’s out there. Tonight when I get home from work, I’m going to spend an hour looking at the various options available to me. And then step three might be, tomorrow I’m going to evaluate the different options I found and select the one that looks most promising, as well as two others I can use as backup in case the first one doesn’t work out—so anticipating solutions to possible barriers we might face.

And then the next step might be this weekend I’m going to get in touch with a contact person or organizer and find out information about what I need to do to sign up and participate. And then after I hear back from the contact person. I’m going to write out the additional steps I need to take based on what i’ve learned from them. Leading up to the step where we show up at the first games night or practice.

And maybe we have a couple of other steps about strategies to connect with people once we’re there, or if for some reason it turns out our first choice isn’t an option. But we anticipated this barrier so we already have two backup options ready to go so we choose one of these and go back to the step where we contact the organizer and carry on from there.

Now one challenge with action plans is that they can seem really trivial—like do we really need a plan to figure out how to attend a board games night? But at the same time, in a lot of cases, as simple as the plan seems ,there can be issues like anxiety that get in the way of being able to complete it. If we’re an outgoing charming extrovert and want to meet people, maybe we can just show up to a games night and start talking to people and connecting with them. But if we’re more shy or introverted, when we get to the show up step, that can seem like an impossible hurdle to get over.

So part of doing all of the small steps is that it can help us become comfortable with the idea of doing something we’re a little apprehensive about. Each step gives us some exposure to the thing we fear, which can reduce the anxiety we experience when faced with the steps later on in the plan, which is something I talk more about in my video on systematic desensitization. But often we’ll get to the last step and still find it hard to follow through.

So we need to anticipate this barrier and try to have a solution ready. So maybe we could ask a friend to come visit us the first time and go to the board game night with us, so we don’t have to show up alone and we know at least one person there.

Or if we have a lot of social anxiety, maybe we’ve gotten ahead of ourselves, and before we can implement a plan to meet new people, we need to focus on an action plan to manage our social anxiety better. And maybe this entails working with a therapist for a while to learn strategies to overcome social anxiety, which as part of the therapy, could involve a plan to meet new people with the help of a therapist to support us through the steps.

And finally we evaluate the outcome and results of our action plan. And if it worked, that’s great. But if it didn’t, then we need to go back to step four and evaluate our possible solutions again and choose a new option, and come up with an action plan for that, keeping in mind the barriers we face this time, and trying to anticipate solutions to them so we don’t get stuck in a similar way next time around.

So action plans can seem really straightforward on the surface, but when it comes down to acting on the plan, it’s often not that simple. Let’s look at another example.

So let’s say we hate our current job, and the goal we’ve come up with is to find a new job. So we generate an action plan. What more do we need than step one, look at job listings; and step two, apply for jobs. But that’s a pretty common plan people use that often goes nowhere, because although it looks easy, just the thought of changing jobs can seem overwhelming, so we keep procrastinating. So we need to break it down into smaller more manageable gradual steps.

Step one: update my resume this Monday through Wednesday after work.

Step 2: Thursday and Friday after work find the best sites for job listings in my field.

Step 3: start looking at job listings this weekend and bookmark any that look promising and do the same thing every evening this week looking through any new job postings that come up;

Step 4: next week reach out to personal and professional connections to see if they know of any jobs available. I’m going to contact this person on Monday, and this person on Tuesday, and this person on Wednesday.

Step 5: I’m going to reach out to my references on Thursday and Friday next week.

Step 6: start applying for jobs I identified during the week. Apply for at least two jobs over the weekend, and at least two other jobs over the course of the next week.

And this is often where we hit a barrier. Maybe the idea of switching jobs is creating so much anxiety we can’t even bring ourselves to start applying. So then we need to come up with a strategy to manage our anxiety and realize that just because we apply for a job doesn’t mean we’re going to get it. And even if we do get it, that doesn’t mean we need to take it and leave our current job. And we can make that decision when we get there and we don’t have to worry about that yet.

Or maybe the thought of going to a job interview is too stressful and that’s what’s holding us back. So we need to back up and before we get to the apply for jobs step, we need a practice job interview step. So maybe step six, review potential interview questions, step 7 ask someone to do some mock interviews with us, and then step 8 start applying for new jobs.

And remember that changing problem situations is hard so try not to get discouraged if your plans don’t always work out exactly as planned. And if you ever get stuck always look for a smaller intermediate step you can take, even if this step seems trivial and insignificant, because when we hit a barrier or start to lose momentum, the best way to get going again is with a really small simple and manageable step.

You can download the Problem Solving and Action Plan Worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

The Difference Between Pain and Suffering

One goal of distress tolerance in DBT is to learn to replace suffering with ordinary pain. The video below explains the difference between pain and suffering with the parable of The Two Arrows, and shows us how we can experience pain without it leading us to suffer.

DBT Distress Tolerance Skills: Difference Between Pain and Suffering

When we’re able to accept the fact that we’re experiencing pain, we avoid causing ourselves additional suffering. In the next post, we’ll look at the role of acceptance in DBT. If you have any questions or comments, please leave them on the YouTube video page.

DBT Interpersonal Skills: DEAR MAN Objectives Effectiveness

The first set of interpersonal effectiveness skills in DBT consists of three skills that help us obtain objectives effectively:

  • objectives effectiveness
  • relationships effectiveness
  • self-respect effectiveness

With Objectives Effectiveness we use the acronym DEAR MAN to communicate assertively in order to have our rights and wishes respected. Learn about objective effectiveness and DEAR MAN in the video below.

DEAR MAN: DBT Interpersonal Objectives Effectiveness Skill

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In this video we’re going to learn how to communicate more assertively by using one of the interpersonal skills from dialectical behavior therapy called objectives effectiveness, which refers to getting what we want or need from another person by being assertive. Rather than passive, aggressive or passive aggressive. So first let’s look at these four main communication styles.

Passive communication is often no communication at all. We don’t ask for what we need. We don’t speak up about things that are bothering us. Maybe we’re intimidated or lack confidence or fear conflict or confrontation or all of the above. So we just stay silent, often growing more and more resentful, but keeping our feelings bottled up and not letting people know that we’re upset or what’s bothering us.

Aggressive communication is the opposite of passive. We make demands, give orders, blame or try to control others, raise our voices, or even start yelling and screaming. And sometimes we start off with passive communication, but then once we can’t keep things in anymore we explode and start communicating aggressively.

Passive aggressive communication involves expressing how we’re feeling, but doing it passively rather than directly with some sort of veiled aggression. If we’re mad at our partners we give them the silent treatment or we get really sarcastic. If we’re annoyed with a friend we don’t say anything to them but we show up for coffee half an hour late.

With assertive communication we are direct about what we want while still being respectful to the people we’re communicating with. Assertive communication is key to objectives effectiveness. The more assertive we’re able to be the more likely it is we’ll be able to accomplish our objectives. And the types of objectives we’re trying to achieve are things like: getting someone to do something we’d like them to do; having our rights respected; saying no to things that are unreasonable or that we don’t want to do; resolving interpersonal conflicts; getting our opinions or points of view to be taken seriously.

The assertiveness skills we use to obtain our objectives form the acronym dear man so let’s look at each of these.

Describe: we describe the situation we’re talking about as neutrally and objectively as possible, just sticking to the facts. The goal is to simply let the other person know what we’re talking about without provoking any defensiveness or emotional reaction. So try phrasing things along the lines of, we were supposed to meet at 9 30 and you showed up an hour late without texting me, instead of something like, you’re so disrespectful and irresponsible you never show up on time.

Express: we express how we’re feeling about the situation. We don’t assume the other person knows how we feel or can read our minds, even if we think it should be obvious. We tell them how we feel directly. And if you’ve ever heard about eye messages, that’s what we want to do here: express how we’re feeling with an I message when you do a i feel b. So when you show up late without letting me know, i feel neglected and hurt. Or when you’re not here when you say you’d be, i worry that something happened to you.

When we use I messages, since we’re just speaking about our own experience, it’s easier for others to hear without reacting negatively. If we say, when you show up late you’re being disrespectful, the other person is likely to start arguing with us or get defensive. But if instead we simply say, when you show up late, i feel disrespected, then that’s less likely to provoke an argument since we’re not judging or blaming or criticizing the other person but just stating how we feel.

Assert: then we assert what we’re asking for or want from the other person. And again we don’t expect them to be able to read our minds. We let them know what we want directly. If you’re going to be late, I’d like you to let me know. And again use an I message. I want you to text me and let me know when you’re going to be here, instead of a you message like, you should text me, or you need to let me know when you’ll be here, because i messages are less likely to provoke an argument or defensive reaction, and nobody likes being told what they need to do or should do.

And sometimes asserting involves saying no. We’re asserting that we’re not going to do something that someone requested. So when we are telling someone no we need to be clear about it. I’m sorry but i can’t do that. No beating around the bush. Not, well you know, I’ll do my best to try to be there, but yeah, i really don’t know if i can make it. Be clear with your message. I’m sorry but I’m not going to be able to come.

Reinforce: and then we reinforce the behavior or result we’re looking for. In psychology reinforcement is a reward that encourages desired behavior, so when a dog sits we give them a treat. But here we’re reinforcing in advance and letting someone know what the reward will be if they cooperate. If you can just let me know when you’re going to be late, then i won’t be so moody when you get here.

So the dear part of dear man is the process we use to make a request or to say no. We were supposed to meet up at 9 30 but you got here an hour late. When you don’t let me know you’re going to be late i feel hurt and i worry. So next time I’d like it if you could text me if you’re going to be late. And then i won’t be in such a bad mood when you get here.

Last night you criticized me in front of our friends. When you criticize me in front of other people i feel embarrassed and hurt. If you have a complaint I’d like you to bring it up with me in private. And then I’ll be happy to discuss it with you.

And sometimes that’s all that’s needed, and they respond, i promise I’ll text you next time. Or i shouldn’t have done that in front of our friends, next time I’ll bring it up in private. But sometimes it’s not that simple and dear initiates a discussion or dialogue, at which point the man part of dear man kicks in.

The m stands for stay mindful. We stay mindful of and focused on our objectives. We don’t allow ourselves to get distracted or to let things get off topic before we’ve achieved our objectives. One way we can do this is by using the broken record technique, which involves repeating your message or opinion over and over like a record that keeps skipping back and playing the same passage over and over.

If you’re saying no, then every time they try to convince you to change your mind just repeat, I’m sorry i can’t do that. But you’d really be helping me out. I’m sorry i can’t do that. Come on i don’t know who else to ask. I’m sorry i can’t help you. Just this once. I’m sorry i can’t.

If they attack or insult us or try to change the topic we just keep repeating our point. I’d like you to text me if you’re going to be late. It’s not like i was that late. Please just text me if you’re going to be late. What are you my mother? I’d just like it if you could text me the next time you’re going to be late. You don’t text me when you’re late. Please just text me next time. You’re being stupid right now. I’d still like it if you could text me next time.

Appear confident: speak in a confident voice. Maintain eye contact instead of looking down at the floor or your eyes darting around the room as you talk. Don’t whisper or hem and haw or say things like, I’m not sure, i guess. And if it’s not regarding an issue that’s just come up in the moment, you can try writing out a script of what you want to say in advance and then practice what you want to say beforehand to help you appear more confident and comfortable when you bring it up.

And finally negotiate: just because you’re making a request doesn’t mean the other person has to comply. People are more willing to cooperate if they get something in return, or at least get to participate in coming up with a solution instead of just being told what to do. You can offer other solutions or reduce your request. It’s fine if you’re only going to be 10 or 15 minutes late but anything longer than that I’d really like it if you could text me to let me know. I’m sorry i can’t do that for you, but if i have the time i would be willing to help out with something else.

But only offer alternatives that you’re okay with. Don’t suggest something you don’t really want to do just because you’re feeling uncomfortable and want to end the conversation. Or we can invite their input” do you have any suggestions? Is there something else you’d like to try?

So dear man is a great way to communicate assertively and will often lead to a solution that everyone’s happy with or at least can accept. But there are times where it’s a little more challenging. If you or the person you’re talking to, or both of you are starting to feel angry or frustrated or hurt or reacting emotionally, then it’s a good idea to take a break, set things aside for a while and give yourselves a chance to cool down.

And you can do this with the dear technique. We’ve been going in circles for an hour. I’m feeling tired and annoyed and i don’t think we’re gonna get anywhere if we keep talking about this now. I’d like to take a break and talk about it later once I’m not feeling so emotional.

Or if the other person isn’t being cooperative—i keep saying no to you and you keep asking me again and again. I’m feeling very frustrated right now and I’d like it if we could just drop this. I’m sorry that i can’t help you out—and in this case maybe there is no reinforcement. We just want to say no and be done with it.

And our own views about ourselves and the world can sometimes get in the way of our ability to be assertive. Marsha Lnehan who developed dbt describes a number of myths that can make it challenging to be assertive including things like: i don’t really deserve to get what i want or need. If i ask someone for something it’ll show that I’m weak. I have to know someone is going to say yes before i ask for something. If i ask for something or say no i can’t stand it. If someone gets upset with me if they say no it’ll kill me. Making requests is really pushy and rude saying no to something is selfish. Obviously the problem is just in my head; if i would just think differently i wouldn’t have to bother anyone else. If i don’t have what i want or need it doesn’t make any difference. I don’t really care.

So try not to fall for these myths instead see if you can adopt something like the personal bill of rights from the anxiety and phobia workbook by Edmund Bourne.

With Relationship Effectiveness, we use the acronym GIVE to build and maintain positive relationships, and end destructive ones. GIVE stands for:

(be) Gentle
(act) Interested
(use an) Easy manner

With Self-Respect Effectiveness, we use the acronym FAST to build and maintain positive relationships, and end destructive ones. FAST stands for:

(be) Fair
(no) Apologies (for asking for something, or having an opinion, or disagreeing)
Stick to your values
(be) Truthful

If you have any questions or comments, please leave them on the YouTube video page.

Emotion Regulation and Checking the Facts in DBT

In DBT, there are a number of emotion regulation skills that help us change our emotional responses. The first step in changing these emotional responses is Checking the Facts.

Emotion Regulation and Checking the Facts

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In dialectical behavior therapy there are three main skills that we can use to help us change, or I prefer the term influence, our emotions and how we feel: checking the facts, opposite action, and problem solving. In this video we’re going to learn how to check the facts.

Checking the facts stems from a similar premise to cognitive behavioral therapy, and that is our emotions aren’t the direct results of situations or events we experience. These events trigger beliefs, thoughts, assumptions, and interpretations, that then lead to an emotional consequence. In cbt we call this the ABC model. Checking the facts involves looking at the beliefs, thoughts, assumptions and interpretations we have about things that happen to us or situations we find ourselves in, to see how accurate they. Are we ask ourselves, do these beliefs, thoughts, assumptions and interpretations fit the facts?

And if they don’t we change them so they fit the facts better. And when we do, this since we’ve changed the b in ABC, the consequence the emotion we experience also changes to reflect the change in b, usually by reducing the intensity and duration of the negative emotions we’re experiencing, but we may also begin to experience a different less negative emotion altogether.

So that’s the first reason we check the facts. When our beliefs, thoughts, assumptions and interpretations of events aren’t that accurate, they affect our emotions in a negative way. When we check the facts and make these more accurate, we generally start feeling at least a little bit better right away.

And the second reason we check the facts is when we get to the end of this exercise, if it turns out our emotions don’t fit the facts, there are certain steps we can take to regulate our emotions and help ourselves feel better. And if it turns out that our emotions do fit the facts, there’s a different set of emotion regulation steps to take. And so do my emotions fit the facts is the first question we ask ourselves on the flow chart to figure out how to change our unwanted emotions that we’ll talk about in the next video.

So on the checking the facts worksheet we start by identifying the emotion we want to change or influence. And we just write it down with a one word descriptor like sadness, anxiety, anger and so on. And then we rate the intensity of this emotion on a scale from zero to a hundred.

And then we ask ourselves, what is the prompting or activating event or situation that triggered this emotional reaction: the who, what, where, and when of the situation. Who was I with or who else was involved? What happened? What did I do? What did other people do? Where was i? When did it happen? And we want to make sure we stick to the facts with as neutral a description as possible. We describe the situation as if we were just a bystander watching it, without attaching our own interpretations or emotions.

So after we write down our description we read it over and ask ourselves, does it fit the facts? And if we find any exaggerations or assumptions or judgments or interpretations or emotional statements we rewrite the description to remove these and make it more accurate by sticking only to the facts. And one thing that often creeps up in these descriptions are what we call cognitive distortions, which are exaggerated and negatively biased thoughts that lead us to perceive reality inaccurately. So in other words they don’t fit the facts. So be on the lookout for cognitive distortions and make sure to remove them when rewriting your description.

So if our description is something like, john was supposed to meet me for coffee, and like usual he didn’t show up on time or text me because he’s so selfish and disrespectful, so I gave him the silent treatment because I don’t deserve to be treated that way. Well just writing that down is probably going to make us start feeling angry again, or if we’re still angry it’s going to make us even angrier. So then we check the facts and we remove any exaggerations, assumptions, interpretations, judgments, emotional statements or cognitive distortions. And then we rewrite the description and stick to the facts.

I was meeting up with john for coffee at three o’clock. He showed up at 3 30 without letting me know he was going to be late. I didn’t talk much to him after that and made an excuse to leave early. And when we stick to the facts it’s not going to provoke the same sort of emotional reaction as the original statement we wrote down. So just by keeping our description neutral and making sure we stick to the facts we can already start feeling a little bit better, because by making our description less emotionally charged we start to calm our emotions.

So let’s look at another example and say we’ve written down a description like, I texted my partner about something important and i’ve been waiting all day and I still haven’t heard back from them yet. They never text me back. They’re so inconsiderate. If they cared about me they wouldn’t treat me this way.

When we check the facts we find that there are exaggerations, judgments and assumptions in this description, so it doesn’t actually fit the facts, and we need to rewrite it with something more accurate and neutral: I texted my partner an hour ago about something important and they still haven’t texted me back, and I’m worried they might be upset with me.

And then in step 3 we ask ourselves, what are my beliefs, thoughts, assumptions or interpretations of the situation or event? They’re ignoring me. They’re sick of hearing from me. They must be mad at me. If they cared about me they would answer my texts.

Now we check the facts by listing all of the other interpretations of the situation we can come up with. Maybe they’re just really busy and haven’t had time to text back. Or maybe they’re in a meeting and their phone is off. Maybe they didn’t even realize I was expecting a reply right away.

So now we reframe our interpretation of the event taking into account all of the various different interpretations we’ve come up with, and write out an interpretation that’s more accurate and balanced and better fits the facts than our original ones, which might be something like: I’m not sure why they haven’t texted me back yet. They’re probably just busy and haven’t had a chance.

So that’s the first part of the check the facts worksheet, which is all pretty similar to a thought record in cbt. And once you’ve completed this first part you’ll probably feel at least a little bit better, because your emotions will usually be a little less intense, because now your beliefs, assumptions and interpretations of the event or situation fit the facts better and aren’t as emotionally charged.

So then in step four we start off by asking ourselves am I assuming a threat and if so what is the threat what is it about this situation or event that’s threatening to me what am I worried or expecting will happen what outcome am I afraid of so maybe the threat is I’m worried they’re upset with me and they’re not going to want to talk to me again or they just don’t care about me anymore

And then once again we check the facts, and we list other possible outcomes. Often the threat we’re worried about is the worst possible outcome. So we want to ask ourselves, what are some other possible outcomes, including what is the best possible outcome. So the best possible outcome might be, they’ll text me back as soon as they’re not busy anymore. And other possible outcomes would be things like, they’re annoyed because I text them so much when they’re at work so they’re just going to wait a while before they respond. Or they’re mad about the argument we had this morning and they don’t want to argue over text so we’ll talk about it when they get home.

And then we check the facts and assess the accuracy of the threat we’re worried will happen and see if there isn’t a more probable outcome that fits the facts better, in which case we write down the most probable outcome, which might be: they’ll text me back as soon as they’re not busy anymore. Or if we’re not sure what the most probable outcome, is we write down a more likely, less catastrophic outcome than the one we originally wrote down. And again this helps calm our emotions because now the threat that we’re worried about isn’t so severe and may not even be much of a threat at all.

And then in step five we ask, what’s the catastrophe if the outcome I’m worrying about does occur? And we describe in detail the worst possible outcome we can reasonably expect. And so it’s probably not that they don’t like us anymore and they’re never going to talk to us again, because while that might be the most catastrophic outcome, it’s not very likely. So in this case maybe the worst outcome we can reasonably expect is they are mad at me and they’re not going to want to talk to me all day, and I’m going to be anxious and worried and have to wait till they get home to find out what’s going on, and maybe we’ll end up in a big fight or argument tonight.

So then we ask ourselves, if this catastrophe did happen, what could we do? And we describe ways that we could cope if the worst case does occur. So maybe these are things like: if I start to worry too much about what’s going on, instead of texting them over and over looking for reassurance, I could do something to distract myself. Or call a friend or meet up with someone for coffee. Or go for a walk or get some exercise or use any of my distress tolerance skills.

And then when they do get home if there is an argument, I can do my best to listen to what they’re upset about without reacting emotionally. And then use my objectives effectiveness skills to let them know how I feel about the situation and what I’d like from them. And this helps calm our emotions because we know that even if the worst case scenario does occur there are things we can do to help ourselves cope.

And then finally in step six we ask ourselves does my emotion fit the facts so first we go back to part one where we wrote down our emotion and rated its intensity. And now we re-rate the intensity of that emotion based on how we feel now. And then we ask ourselves, does my emotion fit the facts? And does its intensity and duration fit the facts? And we rate how much it fits the facts on a scale from zero to five, where zero is no not at all it doesn’t fit the facts, and five is yes it absolutely fits the facts.

Now how do we determine whether or not our emotions fit the facts? Well Marsha Linehan gives us some examples of emotions that fit the facts, and this isn’t a complete list and there could be other reasons you feel an emotion and it does fit the facts.

So sadness fits the facts if you’ve lost something or someone important to you, or if things aren’t the way you wanted or expected or hoped them to be. And anxiety or fear fit the facts if there’s a threat to your life or health or well-being, or that of someone you care about. And anger fits the facts if an important goal is blocked, or a desired activity is interrupted or prevented, or if you or someone you care about is attacked or hurt or insulted or threatened by others, or if the integrity or status of your social group is offended or threatened.

And then we can judge how well the intensity and duration of an emotion fits the facts by asking ourselves, how likely is it the expected outcome will occur, how important the outcomes are, and how effective the emotion is in my life right now. Is the emotion helping me or is it getting in the way? So once we’ve determined whether or not our emotions fit the facts, there’s a flow chart we can use to help us decide what to do next and I’ll talk about this emotion regulation flow chart in my next video.

This Check the Fact worksheet is adapted from from DBT Skills Training Handouts and Worksheets by Marsha M. Linehan. You can download the Check the Facts worksheet in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.

Opposite Action and Emotion Regulation in DBT

Opposite Action is a DBT emotion regulation skill that helps us change unwanted emotions. Our emotions have a strong effect on our actions and behavior. We tend to act in line with how we’re feeling. But when we do this, our behavior feeds back into our existing emotions, making them even stronger.

Opposite action teaches us to act opposite to how our emotions are telling us to act. When we use opposite action, we reduce the intensity and duration of our emotions, and may sometimes even change the way we feel altogether.

DBT Skills: Opposite Action and Emotion Regulation

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Just like when we’re feeling a certain way we tend to have thoughts that are congruent with the way that we’re feeling, and then those thoughts feed back into how we’re feeling, making those feelings even stronger, the same sort of relationship exists between how we’re feeling and our behavior and how we act.

For example if we’re feeling sad or depressed we tend not to want to do much of anything. We can find it hard to get out of bed, or drag ourselves to work, or make plans with our friends, and we can want to withdraw from the world and just avoid doing things. Maybe just lie in bed all day, or on the couch, or sit in front of the TV doing nothing. And although when we’re feeling sad this can be exactly what we want to do or feel like we need to do, acting in this way he doesn’t do anything to help our mood, or make us feel any less sad, and tends to actually intensify the way that we’re already feeling, creating one of those vicious cycles that we’ve talked about so much.

One way we can combat this tendency is called opposite action: the idea that when we feel a certain way we tend to act in ways that are congruent with how we’re feeling, and this has the effect of intensifying those feelings. But if instead we take opposite action, and act opposite to how our feelings are telling us to act, this helps moderate our emotions, slows down any vicious cycles, and allows our feelings to subside.

And so by changing the way we act we can change the way we feel, just like how changing the way we think can change the way we feel. And so that was an example of using opposite action to help manage sadness or depression.

Now we’re gonna look at how you can use opposite action to help with anxiety, stress and anger. When we’re feeling anxious our tendency is to want to act in ways that allow us to avoid whatever it is we’re anxious about. But this doesn’t work because the more we avoid something, the more anxiety it tends to cause us. So instead we need to take opposite action, act opposite to the way our feelings are telling us to act in this situation. And rather than avoid what’s making us anxious, find a way to face our fears and expose ourselves, at least gradually, to whatever it is that’s causing our anxiety. And when we do this we start to feel more comfortable with whatever was making us anxious and as a result our anxiety starts to decrease.

And if we’re feeling stressed, what we tend to want to do is to work harder, rush around, multitask, and keep going and going until we get everything done so we can finally relax. But acting in this way only makes us more stressed. But if instead of acting based on what our stress is telling us to do we take opposite action, slow down a bit, be more mindful, take some breaks and give ourselves some time to relax and unwind, not only will our level of stress decrease; but we’ll be more productive in the long run and get things done quicker and be more efficient.

And when we’re feeling angry usually what we want to do is attack and fight back. But that only escalates situations and tends to leave us even more angry. Or we withdraw into ourselves and avoid talking about things, which just leaves us ruminating and stewing in our heads and getting angrier by the minute, often until we can’t take it anymore and explode.

But if instead of acting based on what our anger is telling us to do, and instead of attacking we take opposite action, take a step back and remove ourselves from the situation, we can we’re usually able to calm ourselves and our anger starts to dissipate. Or if instead of staying silent and stewing about something, we take opposite action and find a way to express what’s bothering us assertively rather than angrily, we’re often able to resolve situations and let go of our anger.

And so if instead of acting based on what our emotions are telling us to do, which tends to feed back into how we’re feeling and making those feelings even stronger, we take opposite action, act opposite to the urge so that we’re having at the time, and take a moment to plan what we’re going to do, we can start to reverse any vicious cycles or downward spirals, calm our emotions, and our mood will start to improve. And in the next video we’ll learn an effective way to use opposite action to help manage depression called behavioral activation.

If you have any questions or comments, please leave them on the YouTube video page.