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#37: Level Up Your Skill Use

This episode is in response to a listener question about combining DBT skill use for difficult situations. We thought it was a great question to tackle in an episode.

As your knowledge of DBT skills increases, you will likely find that using several different skills is often the most effective way to respond to challenging life situations. Another way of thinking about this is layering skills – using skills to reduce distress first and then using skills to solve problems or change situations. Marielle and Ed discuss the following scenarios where layered skill use can be helpful:

  • You’re in an intense conflict with someone important to you.
  • You’ve experienced loss and sadness is overtaking you. 
  • You have a strong desire to avoid doing something that needs to get done.

Show Highlights

  • STOP skill is a good place to start as a way to pause
  • Once you use STOP, the next step might be TIP skills
  • TIP is a great way to slow down your body’s system so you can think more clearly
  • Distraction skills, such as Wise Mind ACCEPTS are useful when you find yourself ruminating
  • Distraction works because it gives your mind a break from the thing that is upsetting you
  • Moving away from the urgency to figure out problems immediately 
  • Making a plan ahead of time with significant others about how to calm down during moments of conflict
  • Addressing the shame that may come when you don’t use skills
  • The importance of patience and self-validation when working towards behavior change. 
  • Recognizing that there can be more than one truth in a situation
  • Retreating is the natural response to loss
  • Doing Opposite Action all the way
  • Toggling between acceptance skills and change skills
  • Asking yourself what you’re scared of
  • Using self-encouragement
  • Self-soothing as you start a challenging task
  • Thinking about how to reward yourself at the end of doing the hard thing

DBT Skills Discussed

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.


#37: Level Up Your Skill Use 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 

Hi, Ed. Welcome.

Ed Fowler 

Hi Marielle. It’s good to be back in the virtual booth, as it were.

Marielle Berg 

Today, we’re gonna focus on answering one listener question that came in that we thought was really interesting, and we have a lot of things to say about it. And just our standard disclaimer that the answers we give here are not a substitute for mental health treatment, and do not constitute a provider client relationship. So if you want and need therapy, please pursue that. But we’re hoping that the things we talk about today can be helpful in some way.

Marielle Berg 

I also just want to note that we get emails periodically from listeners, which we love, we appreciate them. And thank you also for the kind words in the reviews that you leave us it is motivating and keeps us going. And we’re not able to respond individually to emails that come in about the podcast, but we do take note of them, and are doing our best to answer the questions as we can.

Ed Fowler 

Yeah, that actually, the questions are so helpful, because it does give us a sense of like the questions people have on their minds as they’re listening to the podcast and ideas for topics that we can talk about. So we’re always welcome to have those, right.

Ed Fowler 

So the question that we received from a listener, I’m going to read it, and then we’re going to spend some time, because it’s a really nice question about, I think, a common thing that people deal with in trying to apply DBT skills. So the question is:

Ed Fowler 

Can you talk about skills that frequently come up together, and work well as a pair, or a group of skills that address different aspects of the same problem? Like I often have to practice STOP, just to keep myself from completely missing an opportunity to practice the skill that is really needed in the situation, ultimately making the bad situation even worse. So basically, the question is like, what are combinations of skills that can help for really stressful difficult situations, or situations that you’re not sure which skill to use? Are there combos that work together?

Marielle Berg 

And I really like this question, because I think it speaks to a certain sophistication with DBT, or deeper knowledge of it, because usually, people first learn the skills and they’re practiced sort of one at a time. You kind of get your, your bearing with each skill individually. But ideally, as you become more comfortable with the skills, and they really become integrated in your life, using them in conjunction with each other, or pulling on a combination of different skills is often the most effective way to respond to difficult situations.

Ed Fowler 

And I think for most skills in most situations, one skill isn’t enough, there’s usually a combo that we’re using in order to be as effective as possible. So I think this is a really helpful question to recognize the reality that usually one skill isn’t going to cover it, not always, but a lot of times we need, you know, a combo. And so what are some ways to think about combining skills?

Marielle Berg 

And so we came up with some general examples that we hear our clients talk about, and that we experience ourselves because these are human situations that I think can get a lot of people a little bit flustered about how to respond.

Marielle Berg 

So the first example we were thinking of, is one where you’re in conflict, maybe very intense conflict with someone you’re close with. It could be a significant other or a different family member, or a good friend. And in that moment, you’re feeling perhaps really misunderstood, or angry or hurt or whatever it might be, and you have an urgency to respond right away.

Marielle Berg 

So for some people that looks like lashing out, saying something mean or hurtful, or threatening to end the relationship. For other people that might be retreating or running away, in a in a kind of an intense way where you slam the door and don’t tell the other person where you’re going. For other people it might be more like a real shutdown and sort of a silent treatment kind of thing. So different people respond in different ways and in different situations.

Marielle Berg 

But the overall example we’re working with here is a high conflict situation with someone who is important to you. And so what are the different skills that we can use in that kind of situation?

Ed Fowler 

So as the listener who wrote in with the question, usually the STOP skill is a really, really valuable starting point, especially when our distress level is really high, we really do want to just stop and take note of what’s happening and figure out what to do.

Ed Fowler 

So a reminder that the STOP skill is an acronym for Stopping. The T stands for Taking a step back. The O stands for Observing the situation that you’re in, what’s going on around you, what’s going on within you. And then the P stands for Proceeding mindfully. So the STOP skill is really a helpful reminder of like, if, if I’m feeling in a lot of distress, so any conflict with another person is going to bring that up, just stopping and taking a step back and noticing what’s happening here? What am I feeling? What am I thinking? What do I need to do? And very often in these situations, the Proceed mindfully is to use another skill.

Marielle Berg 

Yes, yes, the STOP skill, and in this one, the the listener who wrote in talked about practicing, STOP which might actually make the situation they’re in worse. And I can see that. So the STOP is, is really an a way of pausing. And getting yourself to not do the thing that you feel like doing, which will likely make things worse. But once once you stop, once you have, you know, put down the phone, you’re not going to call that person for the 10th time or you have bit your tongue so to speak, you’re not going to say the thing you want to say, then what? And you’re absolutely right, Ed, with the Proceed mindfully. Once we get to that point, then we need to pull on other skills to help us access our Wise Mind and to even know what is the wise response in this situation? And if our SUDs, our subjective units of distress are really high, it’s going to be almost impossible to know that. And that’s where we need to bring in other skills.

Ed Fowler 

So another really helpful skill that’s a good starting point in stressful situations is the TIP skill set, which is part of Distress Tolerance. Again, an acronym. This is DBT, it’s just going to be a lot of acronyms.

Ed Fowler 

TIP stands for, is a set of skills that are using our body chemistry to bring down distress, so that we can think more clearly we can access our Wise Mind. The TIP skill set is Temperature, so changing the temperature on your face. So that’s the ice dive, where you’re putting cold around your eyes to simulate diving into cold water, which kind of shocks us out of the moment. The I stands for Intense exercise. So just doing a couple of minutes, a burst of really intense exercise, that gets your heart rate up, so that your body has to work a little bit to bring your heart rate down, which is inherently more calming and slows us down a bit. And then the P stands for Paced breathing. So breathing in and out at a steady pace, emphasizing the exhale, which is inherently more relaxing. So that we’re slowing our breathing down, especially if we’re stressed, we tend to, like our breath is shallow. So slowing our breathing down pacing it paying attention to our breathing. One of those three approaches, and sometimes more than one, will stop the physical reaction to the stress and start to get us back to a position where we can think more clearly.

Marielle Berg 

Yes, and these skills can be incredibly effective. I think different people are drawn to different ones in the TIP list of skills. And so we know lots of people who are just really into the cold water, and or even just an ice pack, can be so helpful. It’s interesting. I saw a family recently and I have a niece who got very agitated during a board game. So I have learned not to play board games with my nieces. It doesn’t end well, very often. She got super, super upset and I wasn’t sure if I should attend to her or continue playing and I’m thinking in DBT terms, do I want to reward this behavior.

Marielle Berg 

And my mother who knows nothing about CBT sort of went to her and tried to talk to her and gave her an ice cube. And had her kind of hold it and rub it on her forehead and it really calmed her down. And then they started laughing about the ice cube because she dropped it. So you know, I just felt like there’s real knowing I think that a lot of us already have, even without knowing about DBT. So you have probably already have the experience if you’ve been really upset, and you go for a jog or a brisk walk around the block that you feel a little bit differently after. It doesn’t solve everything, it doesn’t necessarily bring your distress, if it was at a 10 down to a one, but it will definitely shift things. So working with her body chemistry is really powerful. And when emotions are super high, after you do STOP, think about the TIP skills.

Ed Fowler 

Yeah, so STOP is the starting point that says, Hold on, I am struggling, I need to take a step back. TIP is when we recognize like, Okay, I am really stressed, I’m really agitated, or I’m really shut down, like I’m totally numbed out and dissociated, I need to physically kind of come out of this space. So you use one of the TIP or more than one of the TIP skills. And then you’re still in a position of having to figure out, okay, what do I do now?

Ed Fowler 

Because, for instance, in the example we’re using, if you’re in a conflict with someone, and you step back and go put some cold water on around your eyes, you’re not done with the conflict. And so this is how we stop ourselves from reacting. So I really want to lash out, I want to run away, I want to shut down, I have the urge to just totally shut down, I’m going to stop, I’m going to take a step back, I’m going to maybe use some TIP, and then ask myself, okay, what to do now?

Marielle Berg 

And that’s where, depending on, again, your distress level, if it still feels kind of high, sometimes the best thing to do is to continue to use Distress Tolerance skills. And of course, it depends on the situation. Sometimes you really do need to respond, if it’s perhaps a work situation that you can’t take a lot of time to Distract. But if you have some time thinking about doing something that moves your attention away from the upsetting thing.

Marielle Berg 

And so oftentimes, when our emotions get high and we get really upset or angry or hurt in a conflict with someone that’s important to us, that’s all we can think about. And perhaps you’re ruminating, or you’re replaying the conversation in your mind, and then they said this, and how dare they and whatever else might go on. So finding something to focus your attention on, that is not the upsetting conflict. And that’s where our Wise Mind ACCEPTS, which are basically our distraction skills, and again, that’s an acronym. That’s where that comes in.

Marielle Berg 

And so you can think really broadly about that, and get creative. Because for different people, different things will work. Maybe that’s working on a puzzle, or watching a really engaging movie, or listening to music or a podcast or gardening. I mean, the list could be endless, but focusing intentionally, for a period of time on something else, to give your mind a little bit of break from the thing that is upsetting you.

Ed Fowler 

I think that the series of skills that we’re recommending so far, so STOP, TIP, and then Distract, to get to the listeners question, I hear a lot of times people saying, oh, my gosh, I’m having this conflict with someone, like I should be figuring the conflict out. It’s not right, it’s not appropriate for me to say I need space, and to go and watch TV for a while or to go for a walk and listen to a podcast. Like I should be figuring this out in the moment.

Ed Fowler 

And so this is where again, coming back to the skill of Effectiveness, which we apply to mindfulness, as well as to other situations, to think about what’s effective. So oftentimes, where we struggle is, I should be figuring this conflict out. So I’m going to maybe I’ll stop and do a little paced breathing and go back, but my stress level shoots right back up, and I want to react again, maybe the effective thing is to take more time to distract, or use self soothing or something like that, until the emotion really does come down, so that we can access our Wise Mind again.

Ed Fowler 

So that we can recognize, okay, how do I engage this conflict in a way that I’m not going to be quite so reactive? So having permission to do whatever it takes to be able to engage the conflict wisely. And if that means taking the afternoon or the rest of the day to distract, so be it. If that’s what’s going to be effective, being able to be again in Radical Acceptance, this is what’s needed. I’m going to do what’s needed, I’m going to be effective.

Marielle Berg 

Absolutely. And when you do this, if you do this, and especially if there’s another person kind of there or waiting for a response, there are different ways to do it. So there’s a way to take that afternoon or the rest of the day, that can exacerbate the conflict. And there’s a way to do it where it can hopefully mitigate some of the intense emotions.

Marielle Berg 

So if you’re able to let the other person know, like, I’m not in my Wise Mind right now, I’m really upset, I need some time. And because we’re using an example here, of a conflict with someone who’s important to you, ideally, when things are calm you two have some kind of agreement, where and they might need this for themselves too, that when things get too heated, or emotions get really heightened that, especially if you know that you need time, and some people need a lot of time, and I know other people can kind of bounce back pretty quickly. But if you’re someone who does really well with a significant amount of time, letting that person know.

Marielle Berg 

You know, I’m not doing this to shut you out or to stonewall in any kind of way. I’m doing this because I care about the relationship, and I’m not thinking clearly right now. So I really need that time. And so that makes a big difference if you can take that space, and that time with that kind of energy around it. As opposed to the storming out, slamming the door, you know, not responding to your phone for hours and hours, which can really, if you do that, will just heighten the intensity of the conflict.

Marielle Berg 

So thinking about that, and then there’s something else you said a moment ago, Ed that I thought was so on point. Effectiveness. Thinking about what’s effective in the situation. And in order to know what’s effective, you have to be in Wise Mind. And if you feel urgency, like really intense urgency, and I know I have certainly felt this, and I bet other people have too, it can feel like that’s Wise Mind. Like, I’m just I just need to tell them off. I am so right in this moment. So let that be a little bit of a red flag, when the urgency to respond is super high and hard to restrain, that’s a somewhat reliable sign that you may not be in Wise Mind.

Ed Fowler 

And then, I do think it takes practice to recognize, okay, I’m not in Wise Mind right now, I need to take some space, how do I communicate that effectively? How do I say I need to take some space without saying I need to take some space because you’re being so ridiculous. No. But being able to like recognize Okay, hold on, I’m I’m really stressed, I’m not in Wise Mind, I need to take space. Being able to like be gentle with ourselves as we practice this stuff. Try our best.

Ed Fowler 

I know, for me, we talk about this in skills group a lot like I’ve been practicing this stuff for a long time, I talk about DBT skills almost every day. I definitely am not always acting in my Wise Mind. There are you know, just as human beings, there are going to be times where we get overwhelmed. Being able to recognize, okay, hold on, I’m overwhelmed, I do need to slow it down.

Ed Fowler 

The more we practice, the quicker we are to get there. I think people sometimes struggle in their DBT skills practice of why didn’t I think of the skills in the moment, I thought of them after the fact, but I had already done the reactive thing? We got to go through the process of reacting in the moment, taking a step back, recognizing what happened, thinking about what might have helped more, and trying again, the next time and doing it again and again, and being gentle in that process.

Marielle Berg 

And I think what you’re saying is speaking to some of the shame that can come up for us when we respond in ways that aren’t skillful, especially when we know skills, but in the moment, maybe we are feeling willful, we don’t want to use them or we, you know, our SUDs are so high that we kind of you know, more or less forget about them. There can be a lot of shame after.

Marielle Berg 

And so this is just the normal human process. I don’t even know if I want to say normal, but I’ll say for people who feel a lot of emotions and who are emotional, this is how it is. And so again, as Ed said, being kind, being gentle with yourself, thinking about what you can learn for the future, to have things go a bit differently then, next time, and having patience. It takes a long time to change behavior.

Ed Fowler 

Exactly. And in this process, another skill to think about is being dialectical in our thinking, recognizing more than one truth in any situation. And so being able to say like, I reacted really strongly, and I was quicker to recognize what skills to use. I think dialectics, when you’re in a conflict, are often the helpful thing once you get to your Wise Mind to be able to see okay, so I have this perspective, they have this other perspective, instead of which one’s right, which one’s wrong, how do we acknowledge both and find a way forward?

Ed Fowler 

So dialectical thinking can be so valuable in bringing down our stress instead of like, was I right, or were they right? Like, okay, we’re both have our opinion and we feel strongly about it. How do we recognize that there’s these two opinions and they both exist? And then also being dialectical about our own process of like, I am really making progress. And I’m trying to use my skills. And I don’t always catch it in the moment. Sometimes it takes a while. Sometimes I’m clumsy with my skill practice.

Marielle Berg 

Yes, yeah. And then the last skill I want to mention before we move on to some of our other examples, is Radical Acceptance, which we might mention for every example we have here. And that means, you know, when your distress comes down, radically accepting yourself, both your more positive traits and your more negative traits.

Marielle Berg 

Or maybe a different way to say that is the things that you your strong points, and the points or your qualities that you’re working on. So radical acceptance of who you are, in this moment, radical acceptance of the situation, especially when it really feels like an impasse that’s hard to get through, and radical acceptance of who the other person is, as well.

Ed Fowler 

And so that is a whole bunch of possible skills to use in one situation of a conflict with someone else, which is a good example, where most situations where we’re having a strong emotional response, we’re going to need multiple skills. And so it’s really thinking about, okay, what are some possibilities? I always think about STOP and TIP at the top of the list, because that’s, you know, start there. And then think about what are some other things you can add in?

Marielle Berg 

Yes. And I feel like we could go like, there’s more Mindfulness of Current Emotion, but like, we’re gonna stop with here, but like, there’s a lot we could bring in.

Ed Fowler 

Right.

Marielle Berg 

And I feel like for folks who’ve been studying DBT for a while, you might have your favorites or the skills that you’re really drawn to, because they, they work well, they’re what you need. So over time, you’ll become more familiar with that. And of course, it can change, too as you continue to deepen into your DBT practice.

Marielle Berg 

So let’s, let’s move on to another example. So we did the one about a conflict with someone you’re close to. And so let’s let’s think about in the example, where you’re feeling really sad, maybe something hasn’t gone your way. Or you’re dealing with loss, or during this past year of COVID, might be cumulative losses with no real kind of end in sight, and you don’t want to do anything. Maybe you’re feeling like you don’t want to get out of bed. Chores, or daily tasks just feel like too much. So low energy, perhaps feeling depressed, and really, in the emotion of sadness, and grief.

Ed Fowler 

So again, I think that Mindfulness is a helpful starting point, to be able to just notice, okay, what’s happening for me, like, not to notice I am feeling like really shut down because I’ve had a big loss or a lot of losses. And, again, when we think about emotional responses, retreating is the natural response to loss, we go within ourselves to deal find ways to grieve and deal with that loss. So starting with just noticing this is where I’m at.

Marielle Berg 

And with what you just said, Ed, I think that there’s a going back and forth between really honoring and accepting the emotion, which I think is, you know, is obviously, super important, and Opposite Action. At different points, different skills are going to be needed. Sometimes what we need is to be mindful of the emotion. And grief is pretty exhausting, and causes us to retreat, and sometimes that’s actually what’s needed. And it can be hard in the moment to know like, is this effective?

Marielle Berg 

And some ways to begin to think about this is: Is it restorative? When I retreat or maybe nap or take time alone? Does that sort of calm my nervous system? Does it feel healing in some way? Or conversely, is there a point where it tips over and it doesn’t feel good? And maybe I feel like I’m getting stuck, or I’m ruminating and that’s when we want to think about some of the more active skills, checking in with our Wise Mind doing Check the Facts, Opposite Action and some other skills that we can unpack a bit more.

Ed Fowler 

So yeah, I think that being able to just notice, and then check in, this is kind of a Wise Mind thing. To check in, like, is this helping me to be in more of a retreat mode? Because sometimes that’s what we need. And sometimes we’re feeling stuck and it’s, it’s not helping. And so when we notice that we are feeling stuck, that retreating or or going inward, being alone, is not helping, then we want to look at okay, what are some options?

Ed Fowler 

And I think that very often Opposite Action is a good place to start there. Again, we use Opposite Action when we have emotions that are really not justified by the facts, that are based in a lot of assumptions or a lot of judgments. We also use Opposite Action when the emotion we have may be justified by the facts, it may be meaningful and valuable. It’s not the right time, or there’s too much or it’s interfering.

Ed Fowler 

And so yeah, if you’ve had a lot of losses, we need to grieve. But sometimes we do need to get out and do things, or the grief becomes too consuming. So some Opposite Action of I’m going to take action, I’m going to do things, I’m going to get out of bed, I’m going to clean, I’m going to go out for a walk. Something to move in the opposite direction of that emotion is feeling like it’s no longer helpful.

Marielle Berg 

Yes, and in our skills book, it says about grief, I think it’s in the Opposite Action skill, but I’m not 100% certain right now, it says something like, visit the grave site, but don’t build your home there. And I just really, really like that. Because it’s acknowledging like, yes, grieve, be with that. If you’ve lost your job, or, you know, people you love, or, you know, the multitude of losses during this time and just losses in general, the grief is absolutely fitting the facts.

Marielle Berg 

And sometimes acting on that or going with it isn’t the most effective thing because we have bills to pay, or we have children to take care of, or we have to do the laundry, things like that. And so Opposite Action, just to do a quick review, the way we start with that is we identify the action urge that our emotion is directing us to do. So with this sadness, very common, as we’re talking about retreating. Maybe not getting up from the couch, not wanting to leave the house, not wanting to do much, being sort of inactive, isolating. So whatever, but but getting specific for yourself, because it might vary, like what is my sadness or grief, directing me to do? What is it wanting me to do? What do I feel like doing right now as a result of the emotion? And then figuring out what the opposite of that is.

Marielle Berg 

If what your sadness is directing you to do is to isolate, and you want to do Opposite Action, then you reach out to people. You make contact in one way or another. If your sadness is making it hard for you to get out of bed, the Opposite Action is to get out of bed, take a shower, change your clothes. You know, when we do Opposite Action, we want to do it all the way. Because if you do it halfway, so maybe you pull yourself out of bed when you really don’t want to, and then like you just drag yourself over to the sofa in your pajamas and you sit there. We would say that’s like a quarter of the way opposite action. It’s not going to change much.

Ed Fowler 

Right. And again, I think the point of Opposite Action is, as a skill, is we use it to change our emotional response. So that if an emotion isn’t working for us, we use Opposite Action as a way to change it. And so if you’re feeling like just staying in bed, getting up putting on clothes, going outside and going for a walk, oftentimes people will say I felt actually more energy afterwards. It changed the emotional response.

Ed Fowler 

So that’s what we’re going for. Instead of going with the emotion when it isn’t working for us. And as we said, if you’re dealing with grief and loss, sometimes you do need to just stay in bed. Sometimes it’s not working in the moment or in general. So do some Opposite Action, whatever that might be, do it all the way until you actually start to feel different.

Marielle Berg 

Yes. And with that, I want to just remind people that this can be so hard.

Ed Fowler 

Yes.

Marielle Berg 

Especially with sadness and depression, it’s like the last thing you want to do generally, is to get active. And so it takes lots of willingness. And I think when you’ve done Opposite Action several times, you can kind of know, your brain might remember like, even though this feels like I am moving boulders to do this thing right now, you you have had the experience before that, you know what, in an hour or two, I’m probably going to feel different.

Marielle Berg 

And so with that, just another skill to throw in there, is Validation, self validation. This is really, really hard. And I’m going to do it anyway.

Ed Fowler 

Exactly. Yeah. And I do think that with the topics that we’re talking about today, again, it’s a helpful reminder that getting to the point where knowing what skill to use, and being able to use it effectively takes a lot of practice. And it’s really hard in that process. And so just doing the best we can.

Ed Fowler 

And again with this skill, starting with mindfulness, noticing what’s happening, trying to check in with your Wise Mind. What do I need right now? What will help, what’s getting in my way? And be willing to try something. Trying it and being really gentle with ourselves and validating, as we try things, that may be really hard, or maybe we aren’t able to do it all the way. Keep checking in, because the information will remind us of our options as we keep trying.

Marielle Berg 

Yes. And maybe the last thing I’ll say about this example is that we actually have a Distress Tolerance skill, which involves taking a vacation from life. So putting, pulling the covers over your head if you need to, for a period of time. That is one of our Distress Tolerance skills. And it sometimes is what we need.

Marielle Berg 

So we’re again, we’re kind of going back and forth between more active skills and more acceptance skills, Emotion Regulation skills, and skills that are more about just tolerating distress. And that’s the I think some of the beauty of DBT is there’s a whole range of different things to draw upon,

Ed Fowler 

Which is, dialectically, is really great. And it’s hard, because how do you know which one to use? Trial and error, trial and error.

Marielle Berg 

Yes.

Ed Fowler 

And you know, just seeing what works, I like Marielle, what you said with this one in particular about noticing is my grieving restorative or not? Because sometimes we do need to take a vacation from life, take a break, just really be alone, grieve, feel, be numb for a bit, whatever it might be. And sometimes we need to do the opposite. And so just noticing, and being gentle in the process.

Marielle Berg 

Yes. And let’s do our third example. So we had the one about conflict with someone you love, then we just talked about feeling really sad or grieving and not having energy to do much of anything.

Marielle Berg 

And then our last one is more or less about procrastination. But you have to do something, something has to get done, and not doing it will create additional problems. And you do not feel like doing the thing.  Maybe you’re too scared, you’re overwhelmed or you don’t know where to begin, or something else is happening. So you need to take some action, and you really don’t want to do it. And if you don’t take action, you will have new problems. So how do we tackle that one with different skills?

Ed Fowler 

So again, I think the starting point is Mindfulness of noticing, right? Noticing, okay, here’s where I am, here’s what’s happening right now. And then, in this case, trying to name the emotion. And Check the Facts, right. So being able to recognize and again, I’ve talked before on the podcast about how procrastination has been a struggle for me most of my life. And I’m aware now that procrastination is an anxiety response. I’m anxious about something that I have to do, and I’m doing what we do when we’re anxious, and I’m avoiding.

Ed Fowler 

And so being able to notice, like, Okay, I have this thing to do, I don’t want to do it. What’s happening? Oh, I’m scared. I’m gonna name it. I’m scared. Instead of you’re procrastinating, you better get to work. I don’t know why you can’t get over this. Like, I’m scared. All right, let me Check the Facts on my fear. I mean, notice the fear, name, the fear and Check the Facts, like what’s contributing to this fear? And so that can be a helpful starting point.

Marielle Berg 

And when we do Check the Facts, sort of the in depth way that we have laid out in our skills workbook, it asks us to think about what’s the threat? Because sometimes or very often, immovable, strong emotions have a component of a threat or something we’re scared of. So when you do your Check the Facts, think about like, what is really scaring me here? What is creating this, this inertia, this kind of real difficulty in getting started?

Marielle Berg 

And so you, you just sort of spoke to that Ed with the anxiety, but you can think more about am I scared of failing? Am I scared of not doing it perfectly? Do I not know where to start? Is it something that’s complicated, and I’m just frightened that I’m not going to be able to tolerate the distress that I need to in order to figure out this hard thing? So kind of naming what the threat is, can be helpful to just sort of bring to consciousness, what is sort of laying there in the background, perhaps influencing what you’re doing or not doing.

Ed Fowler 

So sometimes checking the facts and especially that really thorough checking the facts in and of itself gives us what we need, and it’s like, okay, so I’m nervous about this. Here’s what I understand about it now. Now I’m feeling some energy to do it. Oftentimes, checking the facts is not enough. And so we have the information but we’re still feeling a little bit stuck.

Ed Fowler 

And so that’s where sometimes Opposite Action is what we need. Of like, Yeah, I’m scared, and I don’t want to do this and I need to try to do it. So what are some things that can get me into doing it? So you know, just picking up and doing it, or maybe I need, and this is kind of getting into a bit of Problem Solving, maybe I need to ask for help around it? Maybe I need to talk to somebody and say, Look, I’m struggling with this, can I check in with you, as I do this task, whatever it might be?

Ed Fowler 

Kind of looking at, based on, you know, what, what we’re feeling, do, I need to do some problem solving and figure out things that will help me move it forward? Do I need to focus on I’m doing opposite action, I’m just gonna do it, I’m gonna get into it, I’m gonna go all the way I can do this, I absolutely can do this, I’m going to do a great job, what’s going to help get us moving?

Marielle Berg 

And just now you were pointing to another skill, which is Cheerleading with, I’m gonna do this, I’m gonna do it well, so kind of self cheerleading. I also think about with this, that it’s a Distress Tolerance skill, and, and can be helpful here. But the Self Soothing. Of thinking about, Okay, I have to sit down if, you know, I’m assuming you’re sitting at a computer, doing something complicated, but it might be something totally different. But maybe having like a hot tea next to you, or playing music or letting a candle or whatever the thing that might be soothing for you, that can be a helpful way to get started on challenging tasks.

Marielle Berg 

And this comes from the behavior change portion of DBT, thinking about rewards. So if I do this thing, maybe I set my timer for 45 minutes or I mean, who knows how long it might take, maybe I do that several times, is there a reward at the end of the task? And that can be quite motivating. So when I, when I finish this, I get to do XYZ thing. So setting up a reward system for yourself to help you move through the difficult process or the difficult task.

Ed Fowler 

So yeah, when we’re struggling with something that we want to avoid, usually some Emotion Regulation like checking the facts, opposite action, problem solving, and some Distress Tolerance in the process. So doing some self soothing while we’re doing it, that combo is often going to help us to get moving if we need to.

Marielle Berg 

I think we’re pretty much at the end of going through all our examples. And as we were talking Ed, I was just reflecting on how, like the skills, how they take a while to really get and integrate. And this is why we encourage people to stay in skills group for a while, because the first time around, if you’re in a traditional skills group, and you’ll learn each skill once, it’s often not enough.

Marielle Berg 

And I know not everyone has access to that. But if you do, take advantage of it. Because that’s when you’re going to get some of what we’re talking about here. The sort of skill dexterity. “Okay, I’m going to do this emotion regulation skill, then I’m going to do a distress tolerance. Maybe I’m going to do some radical acceptance, maybe I’ll do some mindfulness.” It takes time. But once you have it integrated, you have such a rich toolbox to draw from.

Ed Fowler 

Right.

Ed Fowler 

And it all takes practice. And so really, I think we’ll we’ll end with emphasizing be gentle with yourself as you figure this stuff out. There’s no one way. There’s, you know, we just notice, and try to assess what we need, and then try to do it and see how that goes and repeat. And as we do it, we do tend to gain confidence and security and our overall ability to manage stuff in our lives increases and that has its own positive reward.

Marielle Berg 

Right, great note to end on. Thank you.

Ed Fowler 

Thanks.

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 you can find us online at bayareadbtcc.com. That’s BayAreaDBTCC.com.