#25: Coping With COVID-19 [Part 2]

Today, Marielle and Ed continue to discuss DBT skills to cope during a pandemic. We are all going through a collective trauma and need extra support. The DBT skill called Check The Facts is explored. We also explore the difficulty in using this skill during a time when things are rapidly changing and uncertain. Using Check the Facts coupled with Mindfulness may be helpful to remind yourself that you are ok right in this moment.

The importance of dialectics is also discussed to avoid getting stuck in either/or thinking and rigidity. Flexibility helps us respond to an ongoing highly stressful situation, rather than react. 

Gentleness with ourselves and others is very important right now. We all need an extra dose of patience and self-compassion. Some people are pressuring themselves to do a lot during this time, not quite realizing what an emotionally exhausting time this is. Continual anxiety is draining. You are not going to be able to do it all and that’s ok. Watch out for berating yourself for not doing more.

Marielle and Ed also review PLEASE skills that help you regulate your emotions and decrease your vulnerability to Emotion Mind by focusing on caring for your physical well-being.

Show Highlights:

• Our nervous systems are activated, this is a collective trauma
• Check the Facts is a skill to use when you have an emotion that you want to change
• Figuring out how much of the emotion is based on facts or on assumptions, judgments, and interpretations
• When the facts of a situation are painful, challenging, and changing day to day, Check the Facts is harder to use
• Asking yourself: “How much fuel am I adding to the fire?”
• People are naturally searching for facts and knowledge to protect ourselves and we are getting conflicting information
• In this moment: “Am I safe? Am I ok? Are my loved ones ok?”
• Noticing how assumptions inflame emotions
• In DBT, the skills are often interwoven. Check the Facts needs to be used with Mindfulness and Radical Acceptance
• Thinking about staying emotionally flexible
• Also ask yourself: Is acting on this emotion right now effective?
• Humor is helpful when trying to do Opposite Action with anger
• Skills that build up emotional resilience: ABC PLEASE skills
• PL: treating physical illness. When we are physically sick, it depletes our energy to manage emotions.
• E: balanced eating. Making sure to regularly nourish yourself.
• A: avoiding mood-alerting substances. For some this means not using them all. If you are drinking or using drugs, be mindful of what works for you and notice if it exacerbates emotionality. 
• S: sleep. Doing what you can to keep regular sleep times
• E: exercise. Finding outlets to release energy and anxiety.

Links & Resources

DBT Skills Training Handouts and Worksheets, Second Edition

The Skillful Podcast Episode #15: Check the Facts

The Skillful Podcast Episode #16: Opposite Action

Ask us a Question

We’d love to hear from you! Where are you getting stuck with your skills application? Ask us a question for the chance to have it answered on the podcast. Submit your question here. 

Please note that questions, and this podcast in general, are not a substitute for individual mental health treatment.

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#25: Coping With COVID-19 [Part 2] Transcript

Marielle Berg 

Hello and welcome to The Skillful Podcast where we explore DBT and RO-DBT skills to help you reduce emotional suffering, improve your relationships, and become more present in your life. I’m your host, Marielle Berg, a psychotherapist at the Bay Area DBT and Couples Counseling Center.

Marielle Berg 

For today’s episode, Ed and I are going to continue talking about skills to help you cope through the current pandemic. And so because we know things are changing rapidly, I just think it’s useful to at least say the date of when we’re recording. So today is Monday, March 30. We’ll we’ll see how things shake out over the next week. But we’re working off the information we have right now, which I believe most of the US is under stay at home orders at this point.

Ed Fowler 

Yeah, I think it’s, you know, still, you know, certain places are doing things differently. But for the most part, I think everyone understands that we do need to stay away from each other in order to slow this thing down. And for those of us in the Bay Area, we’ve been doing this for a couple of weeks now. And I as I talked to people, people are starting to get into a bit of a rhythm with things. And this is all still pretty challenging. So we’re needing to really think about specific skills we want to use to get through all the ups and downs of this time.

Marielle Berg 

And just you know, my heart goes out to the different countries and to New York, where I’m from and have many loved ones, you know, the places that are really struggling right now.

Ed Fowler 

Yeah.

Marielle Berg 

And I know we have a lot of listeners in New York.

Ed Fowler 

Yeah. And I think that that’s one of the challenging things about the COVID 19 virus and what’s going on, and all of the impacts of it, is that for many of us, we’re not experiencing the severe impact that we see other people experiencing. And so there’s a sense of like we, we all are living under the reality that we could get sick, loved ones could get sick, people are losing jobs, things are happening. And for those of us who aren’t experiencing any of that, in the moment, there’s a sense of unease, knowing other people are really struggling, and there’s not much that I can do.

Marielle Berg 

Yes, and that’s really hard. And I think last week, we talked a little bit about this, just this sense of anticipating, or anticipatory grief, which I mentioned, we’re all feeling in one way or another. And for some folks, it’s not about anticipating anymore, they are grieving. Perhaps they’ve gotten sick, or loved ones have gotten sick, they’ve lost jobs. So everyone’s in a in a different place.

Marielle Berg 

But for those of us, especially in the Bay Area where things feel quieter, which isn’t to say that there aren’t more cases, but it’s not sort of an explosion, where it feels like it’s happening in other areas of our country and parts of the world. There’s a bit of, you know, our nervous systems are kind of activated, waiting for the immediate trauma and and it’s, that’s not what’s happening. So there can be a lot of energy coursing through our systems with not a lot of outlets.

Ed Fowler 

So when we talked last week, we went through a lot of Distress Tolerance and Mindfulness skills, which are so helpful when our nervous system is really activated. Things that can calm our nervous system down, calm our Emotion Mind, help us kind of get into a more grounded present space, when things can start to feel are already feel overwhelming. And for many of us, we’re now moving into an adjustment towards a longer term change in the way that we’re living our lives, including having worries that linger.

Ed Fowler 

The virus isn’t going away. Like, we are going to have to continue to deal with this and all the impacts of it for a while. And so today, we thought we might go into some Emotion Regulation skills that are really helpful when we’re already accessing our Wise Mind to a certain amount. Emotional Regulation, Interpersonal Effectiveness skills in DBT, really hard to do when we’re strongly in Emotion Mind, when our nervous system is really engaged, when our distress is high. But when we have our stress level down a bit, and we can think clearly, Emotion Regulation can really help us choose how we want to respond to challenges we face.

Marielle Berg 

Yes, and they can give us a sense of control and that we have, we have a say about how we respond and how will you react, which I think is very empowering. Especially for people who feel a lot of emotions and can feel like they’re just sort of overrun with them, to have tools at your disposal, where you get to have a little more choice about how your emotions impact you, can make a huge difference in your sense of self respect and your self esteem.

Ed Fowler 

And your ability to cope. And I think that’s really important in this time is, there are so many things beyond our control, and so many aspects of our lives that we don’t have choice, or control, and finding the areas where we do have choice and control and trying to exercise that can be really empowering.

Marielle Berg 

So the first skill we want to talk about is Check the Facts, which in quote, unquote, normal times, I love this skill, I find it so useful. And I’ve been challenged myself during this time with how to use that. And so let’s discuss this a little bit. Because Check the Facts is a skill that you use when you are having an emotion that’s really uncomfortable and you want to change.

Ed Fowler 

It’s, it’s kind of the foundational Emotion Regulation skill, where when we notice that we’re having an emotion that we don’t want, we first Check the Facts to see, okay, how much of my emotion is based on the facts of the situation, and how much is based on my own assumptions or interpretations, my judgments about the situation? Which can very much inflame emotion.

Ed Fowler 

So the first thing we want to do when we notice an emotion that we don’t want is to notice how much of this is based in facts. How much am I adding fuel to the fire? And as we’ve discussed, Marielle, when the facts of a situation are really challenging, really painful, really threatening, when the facts of the situation are changing, day to day, moment, moment to moment, it’s an added challenge for how do we practice this foundational Emotion Regulation skill.

Marielle Berg 

One thing that I keep coming back to when I’m not certain of the facts, when I read conflicting things in the newspaper and hear conflicting things about how it’s spread, and how long it can last on surfaces. That’s confusing. And I don’t always know how to sort through that and don’t know what quite to believe. And I think back to I mean, I was young at the time, but I remember, during the AIDS crisis in the 80s, there was a fear, if you drank from the same glass that someone who is infected with HIV had drunk from that you could get AIDS.

Ed Fowler 

Yeah, like I think that, that, for many of us who are old enough, we’re kind of going back to that time in the 80s and 90s, when HIV was like, even more unknown and life threatening. And people were starting to come to terms with what how do I manage this, and a huge part of that was all of these myths about how HIV is transmitted, what it means, what can happen. And I think we’re experiencing something similar, where people are naturally searching for facts and knowledge to protect ourselves, and we’re getting conflicting information. And we’re not sure what to do with that.

Ed Fowler 

So Check the Facts as an Emotion Regulation skill helps us strike some balance by saying what are the facts here, let me bring that more Reasonable Mind side of things into the picture more prominently. But when we’re getting conflicting facts, it can actually be counterproductive to figure out how to manage strong emotion, whether it be fear, or anger, or sadness, or whatever it might be.

Marielle Berg 

Yes, and I imagine and hope that when we are through this, we, it will become much clearer, we’ll have, we really will have the facts about all the different ways that spread and transmission and that will empower us going forward. But right now, things are so uncertain. And so a place I keep coming back to with checking the facts, is the facts of how I’m doing and how my loved ones are doing in just this moment. Because that feels very tangible. And so in this moment, am I safe? Right, in this moment, am I okay? Are the people I care about safe and okay? And you may, you may not know, and, and of course it could change, but right in this moment, most of the time, we are safe and okay.

Ed Fowler 

And I think that this application of checking the facts can help for people who are worried about losing a job or if they’ve lost a job, when will I be able to get back to work? What does all that mean? We don’t know the facts of so many of those things. And so putting in some mindfulness into this and saying what are the facts right in this moment, and start with that.

Ed Fowler 

And I think that you know, where Check the Facts can be most helpful is to acknowledge that our emotions are driven by both facts as well as assumptions and judgments and sorting that out and noticing: what are the facts right now in this moment? And what are my assumptions that I’m adding to it, that may be making this emotion stronger, that I want to acknowledge and also put to the side, and not dive into oh, my God definitely never going to work again. But like know, the facts are I lost my job, I don’t know when I will get a new one. Pulling back to what we do know in the moment.

Marielle Berg 

Right, because sometimes the moment actually can be quite painful. We were talking about if someone is sitting with the fact that they’ve lost a job like that is hard and scary enough in the moment. But when we add on all this kind of fortune telling about the future, it just exacerbates the worry and the stress and the anxiety. And we actually don’t know.

Ed Fowler 

And that’s where pulling in that mindfulness is so helpful. Of, you know, this is what I know. This is what I don’t know. What’s going on right now, in this moment? What do I need right now in this moment?

Marielle Berg 

And when painful emotions are really tenacious, and you try different skills, and you can’t change them, or you’re going through Check the Facts. As we go more deeply into the skill, it asks you to inquire, are you assuming a threat? And also, as the skill also asks you to inquire, what’s the catastrophe? And so those parts of the skill right now can feel a bit daunting to me.

Ed Fowler 

Right? Because, again, if we are having unwanted emotions, sometimes just checking the facts and saying, oh, here are the facts, here are my judgments, that’s enough to bring the emotion down. But when it’s not, we want to say usually, there’s some kind of threat that we’re assuming, that we need to deal with, and perhaps even Cope Ahead with, okay, if this threat happens, how will I cope with it?

Ed Fowler 

And very often, when we’re checking the facts these days, some of those threats are happening. And it is trickier to, to kind of because the whole point of Check the Facts is to pull into Reasonable Mind in order to balance out the emotion. And so for me, that’s where, when I’m trying to Check the Facts, I’m trying to remind myself the point of this is to pull in Reasonable Mind. What do I need to do to pull in Reasonable Mind? And that can help me when I start to, for instance, notice the threat that I’m worried about, and notice, this is a realistic threat, what do I do now? Right? Pull back to: what do I know as a fact, right now? What are the facts I know right now? Snd trying to pull back into that Reasonable Mind side.

Marielle Berg 

And for many folks, I think we’re more resilient, and we can bear more than we often give ourselves credit for. So if you are thinking about the thing that you most fear, what the threat is, or what the catastrophe is, you will figure out a way to cope. Which isn’t to say it isn’t going to be very hard and painful, and that you won’t have to turn to a bunch of other skills to help you get through. But even if what you’re facing potentially, is illness, or death, we will figure out a way to cope

Marielle Berg 

Marsha Linehan talks about in both in her memoir and in the skills training manual for group leaders, how she worked with her fear of an earthquake happening while she was driving through tunnels. And she really went into, and I’m hoping I’m getting the story, right, and please, forgive me, Marsha Linehan, if you’re listening. We should only be so lucky. But this is what I remember, that she had to really work with her fear of death, and that could be a possibility. She lives in a place where there, she lives in Washington where there are earthquakes, she could be driving through a tunnel and earthquake could happen and collapse on her. This, this could happen. And so what she worked on, is Radical Acceptance of her fear of death.

Ed Fowler 

And that’s where I think that just talking about this one Emotion Regulation skill of Check the Facts, is showing how much DBT is interwoven skills. Because Check the Facts by itself is often not enough. We’ve got to pull in some Mindfulness to come into the present moment, oftentimes have to pull in some Radical Acceptance from Distress Tolerance, to be able to just accept that some threats could happen, how will I deal with it and accept that it may be hard, and orient ourselves towards a coping approach? As opposed to oh my god, I’m not going to be able to do anything. Which, which, we then tend to get more paralyzed in shut down, and we don’t know what to do. And that’s where we want to stay flexible. And checking the facts can help us notice all the possibilities in order to stay emotionally flexible in the midst of a lot, that can be challenging.

Marielle Berg 

Yes. And when we’re checking the facts, we want to think about not just does my emotion fit the facts, and fear right now, really does fit the facts. But you also want to think about the intensity of it. How strong is the emotion? Is it terror or panic? You want to think about how long it’s lasting. And so fear or low level fear will probably now last for a long time.

Marielle Berg 

And you also want to ask yourself is acting on this emotion right now effective? So your fear may actually fit the facts, or lower level anxiety certainly would fit the facts. Acting on it may or may not be effective, depending on what you’re doing. Acting on a very strong a very intense level of fear, like a panic, or terror is most likely not going to be effective, because that’s where we see some of the the behaviors, the hoarding behaviors, other kinds of behaviors may be real escape behaviors. This is when people turn to some addictions, or compulsions or other kind of self harming behaviors. These are just nuances to bring into the skill to help you figure out whether your emotion, its intensity, and how long it’s lasting, actually fits the facts.

Ed Fowler 

And that’s why I think that the measurement of, “Is this effective for me, and meeting my goals?” is what we really want to keep in the forefront of our minds no matter what. So I may be feeling really strong emotion. Is, like sticking with this emotion or acting on this emotion when it’s really strong, going to be effective for me, is it going to help me and solve, and is it going to help me to feel better in the long run? We may feel really much better in the short run, but then feel guilt, shame, regret, have more difficulties on actions we take that are effective short term, but not long term.

Ed Fowler 

So checking the facts, noticing, okay, I’m having this emotion, what’s going on? What are the facts of the situation? Does this emotion fit right now? And then if I want to change this emotion, if I noticed that this emotion is not working for me in the moment, and I want to change it, we have two skills that follow up on Check the Facts that give us two possible directions based on how factual that emotion is.

Ed Fowler 

So if our emotion is very much based in facts, and not so much based in our own assumptions, then we need to solve the problem that’s creating those problematic facts. So Problem Solving is the approach that we would use. If our emotion is not really based on the facts of the situation, or the intensity, or the duration of the emotion isn’t really effective for us, then we want to do something to really change that emotion. And that’s where Opposite Action can be helpful, doing the opposite of what our emotion is telling us as a way to shift that emotion.

Marielle Berg 

And so in order to do Opposite Action, you first want to identify and name the emotion you’re feeling. That’s the first step as well with check the facts. You want to put a label on what you’re feeling. And we talked about this last week as well, that sometimes just that act in and of itself can be really settling. To put a name on to what we’re feeling. Oh, I’m feeling sadness, or feeling grief, or fear, or whatever it might be, or irritation. Then you want to Check the Facts, which we just talked about. Then you want to ask yourself, what is my emotion kind of motivating me to do? What are the action urges that are coming along with my emotion?

Ed Fowler 

So for instance, if I’m feeling really angry, which plenty of people who are kind of stuck inside more often are finding anger coming up for lots of different reasons. I’m feeling really angry. And I notice it and I say I’m so angry right now. What’s my urge? Well, my urge is to yell, I want to yell at the person that I’m quarantined with. Or I want to throw something, right. So Opposite Action says okay, instead of throwing something, what would be the opposite? And do that. Because that’s probably going to pull you in a more helpful direction than actually acting on this emotion that’s not working for you, in whatever way.

Marielle Berg 

And if you act on that emotion, you yell at the person you’re quarantined with or the persons, or you throw something, there’s going to be, I mean, it’s a literal mess to clean up if you throw something. There’s going to be an emotional mess, there’s going to be some repair you’re going to have to do to the relationships with the folks around you. And probably some repairs to your own sense of self and your own self respect.

Marielle Berg 

And so Opposite Action, and you can get creative with this, but for something like anger, and somebody that feels more explosive, and you want to lash out, could be a variety of different things. But some that come to mind are, you know, avoiding if you can, avoiding the person or people you’re really angry with, picking up that whatever you had, you had in your hand, that plate, and putting it down gently.

Ed Fowler 

For me, especially with anger, humor is really helpful as a counter. So instead of like, oh my god, this is so serious, I’m so angry about this, being able to say, okay, I’m really upset and try to kind of bring humor into it for myself. For me, personally, that can be really helpful in shifting that emotion. I definitely know other people are like, how can you joke about that. But for me, and for other people that I’ve talked to, it can really help to say, this isn’t so serious. With Opposite Action, we’re trying not to inflame the emotion we have, we’re trying to go the opposite direction. So for anger, it’s like this is really serious, where “This is not so serious, I can actually laugh at this” can be a helpful way to shift that.

Marielle Berg 

Yes, and you’re bringing on a whole different emotion, and changing your state physiologically, which can be so helpful. And I’m thinking about Opposite Action for sadness. You don’t want to get up and get out of bed and take a shower and put clean clothes on because you’re not going anywhere. I think about Opposite Action for that, which means doing the things you don’t want to do, because it will shift how you’re feeling. So acting the way you want to feel, which I know is something you often had talked about when we are teaching the skill in our groups.

Ed Fowler 

Yeah, for me, that’s the shorthand that really works is, act the way you want to feel instead of the way you do feel. And that can be a helpful guide for what to do to act opposite an emotion that you want to change.

Marielle Berg 

And as I said, a moment ago, you’ll have to get creative with this, because some of the things that we advise our group members to do with anger, for example, so avoid or gently avoid, so we might talk about going for a walk or distracting yourself in some other way. But right now, so many of us are really limited. So that walk might not be possible, or really taking a timeout from the folks that you’re closest to might not be possible in any kind of real way. So you’ll have to do it as best you can right now. And while we’re talking about this, I also just want to encourage everyone to be as gentle with themselves as as they can be, or as we can be, because I think we’re all needing an extra dose of love and compassion and, and self compassion.

Ed Fowler 

Which is, I think, a really helpful Opposite Action for putting a lot of pressure on ourselves. And when I’ve talked to people over the past week, when people are struggling, very often, it’s because they’re putting pressure on themselves that like, I have to teach my kids all day long, just as if they were in school, and it’s like, Oh, my God! And do your your job that you usually get a break from those kids from? Like, No, we’re not going to be able to do it all. And so, so many people are finding that they’re having these moments of really strong, overwhelming emotion that are coming out of nowhere, and they don’t know what’s going on, being able to be gentle, and like relieve some pressure and just say, okay, I’m going to do the best I can. What can I do right now, to try? I think that’s a more helpful approach than increasing the pressure of like, you’ve got to get this together, pull it together, get this right.

Marielle Berg 

I’ve also heard people talking about these are folks, I’m guessing mostly without young children at home, so they have more free time on their hands, talking about using this time to you know, finally learn the guitar or that new language or tackle all these work, projects that they’ve been putting off. And that can be a really useful way to distract yourself and make you feel productive and pass the time that can be wonderful. And I can hear folks really sort of beating themselves up for not doing more of that. And I think what can get lost is that this continual level of anxiety, and stress and having our lives upended can actually be pretty tiring, right. And so just to go easy on yourself, if you’re not feeling all this energy to tackle all these things, and clean out all the drawers that you never get to, during this time. This might not be the right time. You might actually need some extra rest right now.

Ed Fowler 

And so with with all of this stuff, it’s noticing what we’re feeling, naming it, and figuring out what what do we need. So sometimes it’s just to be mindfully present in this moment. Sometimes we need some Distress Tolerance to bring that emotion down. Sometimes we need to Check the Facts and say, okay, what are the facts of the situation here? What’s going on with this emotion. And if we really want to change the emotion, we can look at Opposite Action, doing the opposite of what our action urge is, to see if that shifts the emotion in a new direction.

Ed Fowler 

If we notice an emotion, and the facts really are the problem, then we want to do some Problem Solving around that. So Problem Solving is a whole other skill of kind of looking at what’s happening that’s creating this emotion, and what do I need to do to solve the problems around that?

Ed Fowler 

So for instance, I’ve talked to people who notice that they’re feeling like a lot of sadness, and even depression, being at home so much. Especially people living on their own, feeling more isolated. And one of the things that people have noticed is that when we don’t create routines for ourselves, we can kind of sink into these more sad, painful feelings. And I’ve heard people talking about having some progress from, for instance, creating a routine and getting up and taking a shower as if they’re going out to go into work somewhere. And doing some of that kind of stuff as a way to solve the problem of too much time that they’re sinking into.

Marielle Berg 

Yes, and also, again, to acknowledge that this can be hard, because I’ve heard a lot of that create routines, and that’s so helpful. And I think it absolutely is helpful. And it’s so much harder, I think, right now, when we’re under this kind of stress, and our routines have been pulled, like the rug has been pulled out from under us. For many of us, it’s happened so quickly. So there hasn’t been a lot of preparation. And you may have had routines that were really supportive of your self care, and your emotional balance, and it might take some time and some playing with it and trial and error. I know I’m certainly experimenting with that myself, like what routines are going to feel most supportive during this time. And the routines I feel most supportive week one of shelter at home might look really different on week eight of shelter at home, so it will it will shift and we need some flexibility around it.

Ed Fowler 

And such a good reminder that underlying all of this is that for me what’s been most helpful, is trying to be dialectical not getting stuck in either or. So either I have a routine or I am a failure. But like I’m struggling to establish a routine, which again, I everyone I’ve talked to is struggling with that in one way or another. And a routine could be helpful. So how do I kind of balance that not putting pressure on myself not enflaming guilt or shame with a lot of judgments, but also striving towards what’s going to be effective for me? We want to try to be very flexible and trying to balance it all, and for me relieve pressure whenever we can.

Marielle Berg 

Absolutely. And I think about routines that are in place, which are shorthand, often for life. And it saves us time and energy thinking about what we’re going to do next and how we’re going to do things next. So we have routines around work and childcare and the weekends and all of that. And so you’re needed, needing to, we’re all needing to create new routines, sort of at the drop of a hat. And so that takes some time. And I love the reminder of the dialectical piece where we don’t want to swing into rigidity around around any of this really, right.

Ed Fowler 

And so when it comes to creating helpful routines, there’s another set of Emotion Regulation skills that can also be really helpful during this time, which are all about building up our sense of emotional resilience and decreasing our vulnerability to Emotion Mind or strong emotions. And those are the ABC PLEASE skills, which of course is an acronym. A bunch of acronyms, right. But the skill set is all around things that we do on a regular basis to to increase our emotional foundation, strengthen our emotional foundation, so that we can weather the ups and downs a little bit more easily.

Ed Fowler 

So the ABC PLEASE skills are: A is for Accumulating Positive Emotions. B is for Building Mastery. C is for Coping Ahead when we know challenges are coming. And then the PLEASE skills, which I think can be particularly helpful during this time, are all skills around being attentive to our physical health as a support to our emotional health.

Marielle Berg 

Let’s dive into the PLEASE skills more, because I do see them as a real building block for our emotional stability and our we need all the help we can get right now. So the PLEASE skills focus on taking care of your mind by taking care of your body. It’s an acronym. So the P L, which is sort of a a bit stretching to make this acronym work, the P L stands for treating Physical iLlness. So taking medication that’s prescribed, if you are not feeling well getting rest, if you’re feeling the symptoms of COVID 19, contacting your health care provider, if you have one, isolating yourself, taking all the measures that you need to to protect yourself and your loved ones.

Ed Fowler 

It’s a good reminder that when we are physically sick in any way, it is going to deplete our energy or it is going to deplete our energy to manage emotions. And so being attentive and taking care of ourselves when we’re feeling sick. And that can be you know, for some people this time of year is a lot of allergies, which is very poor timing to be kind of stuck inside and not be able to get out as much and to be concerned about oh my gosh, is this COVID-19. So if for instance, you’re suffering from allergies, like really being attentive to what do I need to do to take care of myself in that, whatever it might be?

Marielle Berg 

Yes, and for folks who have chronic illness, this is particularly important to be taking care of yourself taking your medications as prescribed and supporting your immune system in whatever way possible.

Ed Fowler 

And then the in the PLEASE skills, the E, the first E, stands for really being attentive to balanced Eating. So noticing our eating and trying to keep that in balance in whatever way works for us.

Marielle Berg 

And this is another way where our loss of our schedules can make it particularly challenging. And so I again, want to invite listeners to be gentle with yourself if your eating feels off, because your mealtimes and your routines are off, and to give yourself some time and space to figure out what’s going to work for you. And so that’s trying to be mindful of not eating too much or too little and making sure that you are regularly nourishing yourself.

Marielle Berg 

The A is for Avoiding mood altering substances. So staying away from alcohol and illicit drugs, and perhaps not using them at all, especially if you have any kind of addictive tendencies with mood altering substances. Or if you are able to use them in moderation, being really mindful to notice if they’re exacerbating emotionality. So there might be something that’s really helpful about a glass of wine, if that’s something that you can do in moderation, or it might make you extra weepy and more vulnerable to painful emotions. So being honest with and monitoring what what works for you around this.

Ed Fowler 

And then the S in the PLEASE skills stands for Sleep. So being attentive to our sleep, which I know in, in all of these changes, many people are finding their sleep disrupted in one way or another. Especially what’s hard, is I think when sleep is disrupted by anxiety. So having a hard time falling asleep or staying asleep because our minds are more anxious.

Ed Fowler 

So we want to notice that if our sleep is off, we are definitely going to be more vulnerable to strong emotions. So we want to try to do what we can to keep our sleep balanced as well. Again, one of the primary recommended recommendations around sleep hygiene is having regular times for sleep and try not to deviate from that. And so what I appreciate about the PLEASE skills in DBT is they’re a good barometer. If we’re feeling a lot of strong emotions, checking in on the PLEASE skills, there might be something we could focus on and adjust that would help. So for instance, I know a number of people who are finding themselves going to bed waking up at all different times because their schedule is off and trying to get back into a routine around sleep can be one thing you could focus on there may have a strong benefit in the longer term.

Marielle Berg 

Yes, I mean, sleep is so important for all of us. And I know I mean all of the things we’re talking about, but if you’re not sleeping well, if I’m not sleeping, well, that’s a setup for me to have a more challenging day emotionally. And I want to share some tips of things not to do that I have been doing and I’m actively working on. So that’s checking the news before I go to sleep. On my phone, feeling like I have to get the last little bit of the terrible news, Ed. Not helpful, and it’s feeling so hard to break that.

Ed Fowler 

So I want to add to that not checking the news first thing when you wake up, because that’s my thing, that I’ve had to really be conscientious about of like, I’m not going to check this until I’ve had some time to be awake.

Marielle Berg 

Yes.

Marielle Berg 

And so things are changing rapidly, but not that rapidly that we have to be on it constantly. And I think we all want to stay, or many of us want to stay informed. And of course, you figure out what works for you. For some people, you might need to kind of really put that aside for some time if it’s really activating for you. But many of us want to stay informed, and so trying to do that in a way that supports your emotional well being and doesn’t, doesn’t harm you emotionally or make you feel worse.

Marielle Berg 

And another thing that can be helpful, which is not a DBT skill, but I want to share it. So maybe useful for folks is, I will often before I to go to sleep, think of or try to think of three things I’m grateful for. And I’ve been noticing during this time that three is not enough. So I am challenging myself to come up with 10. And so if I spend the time to think of 10 things I’m grateful for, that really kind of sets me up to be in a different mindset as I approach bedtime, one of gratitude, one of appreciation, instead of fear, and weary and panic.

Marielle Berg 

And then the final letter in our acronym of PLEASE is the E which is getting Exercise, which again can be challenging during this time. So here in the Bay Area, we are allowed to go outside, we’re supposed to stay in our neighborhoods, for walks. So if you’re able to do that, and your neighborhood is safe, and you can leave your home, and the weather’s decent, go for it, that is so important. And if you can’t, or even if you can go for walks, you might want to augment it depending on your abilities, and what resources you have at hand and how much space you have with all the online resources for yoga and dance classes and strength training and all of that.

Ed Fowler 

Yeah, and I think that, especially if, as for those of us who are spending more time in our homes, having some outlet for all of that physical energy that we use to automatically expend going through about our day is going to be really important and take a little bit of planning. For other people who may be working during this time, they’re you know, also being attentive to exercise because being at work can create stress during this time. And so thinking about what are the things the little ways that I can do some exercise to burn off some of that stress energy for myself. So for all of us, no matter what our situation is to be conscientious of the ways that some sort of physical activity can be really incredibly valuable in maintaining some balance.

Marielle Berg 

I’m so glad you brought that up, because I realized I was making the assumption, because it’s my experience where I’m stuck at home, that there’s people who are going to work and doing things that we’re all so grateful for, and all the folks in the grocery store and the healthcare workers and all the services that we need, and that those folks are needing extra care and extra attention to their PLEASE skills at this time.

Ed Fowler 

And then I think that, you know, to finish up, it’s helpful to think of some of these other Emotion Regulation skills that really helped building this emotional foundation. So one of them is Accumulating Positive Emotions, making a conscious effort to do things on a daily basis that bring us joy and pleasure. So thinking about the things that you can do each day, that will bring you a sense of of joy and appreciation.

Ed Fowler 

So for instance, for me, like my can of flavored seltzer is a miracle each day. Just like being able to enjoy that. And I was talking to a client this week, who I know also appreciates that and they said I ran out of my seltzer and I was like, I want to go buy you some and leave it on your doorstep. Because that’s critically important. So for each of us, it may be different. But finding those little things that can break it can provide you some pleasure and joy is really helpful.

Marielle Berg 

Yes. I have to ask what’s your flavor?

Ed Fowler 

My flavor right now is key lime.

Marielle Berg 

Ooh, nice.

Ed Fowler 

I, for whatever reason, that’s it. That is my very favorite thing in the world, so.

Marielle Berg 

Let’s hope the grocery stores don’t run out of key lime.

Ed Fowler 

Oh, I’m stocked. That’s part of another one of the skills Coping Ahead, was I knew this was important, so I have stock.

Ed Fowler 

Yeah.

Marielle Berg 

Well, on that note, we’ll end here for today. And our intention is to come back weekly or biweekly, as much as we can to continue to offer support and skills and help during this very stressful time. Thank you, Ed.

Ed Fowler 

Yeah, thank you and keep everybody, all of us we’re going to keep doing what we can to stay on track and feel a sense of accomplishment as we work our way through all of this.

Marielle Berg 

Thanks for listening to today’s episode. To learn more, or if you’re in the Bay Area and want to get started with therapy, ou can find us online at bayareadbtcc.com. That’s bayareadbtcc.com.