Monthly Archives: December 2009

How Could Someone Try to Kill Themselves: Suicide Attempts and Doing the Unthinkable – from a DBT-CBT Therapy Perspective

When Emotional Mind drives and Rational Mind is left on the side of the road…

When folks are moderately, even severely depressed (say up to an 8 or an 8.5 on a scale of 1-10), they are “Big-Time in Emotional Mind” but they still have some Rational Mind going on (say 85% Emotional Mind and 15% Rational Mind).  Through the small degree of Rational Mind, they maintain some contact with reality and have some mindfulness of the big picture of their life. For instance, they still recognize they have something to live for…they still have some holds on life…and although their grip is loosening and they may be barely holding on…with at least some Rational Mind going on, they recognize the basics…like they have kids to live for…or pets…or their dying parent (examples).  However, as the depression worsens, Emotional Mind intensifies, and Rational Mind further fades…and they lose awareness of these reasons to live.

Patients in various ways have explained how this happens.  They relate that when they made that final decision to kill themselves…to enact that near fatal behavior…they weren’t  thinking…that previously they thought about their kids, their spouse, or other holds on life and they struggled to stay alive…but then, something happened and they no longer thought about these things.

One patient so well described this to me, I haven’t forgotten it.  She said that as her depression deepened, it was like she was going further and further down a well…and the deeper she went, the less she could see out.  She related that she got so far down, she was surrounded by darkness…she could no longer see nor feel…and she lost touch with the love she had for her kids and concern about what would happen to them.  She cried intensely and said that when she did what she did, thoughts of her kids did not cross her mind.  It was utterly heartbreaking, and yes, as a therapist and despite trying to hold my tears back, they rolled out of my eyes.  I stood up and hugged her as she wept and gently rocked her to help soothe her through the pain. It was one of those heart-wrenching therapy moments when I had no words to comfort her and could only pray for her self-forgiveness and healing.  She so loved her babies and could not understand how she could have tried to end her life.  With Rational Mind going on, she realized she did the unthinkable.

I believe that she became 100% (or near 100%) Emotional Mind…and Rational Mind was essentially turned off.   Without Rational Mind, she was not connected or in contact with the reality of her life and what really mattered to her.  It was like a Rational Mind black-out.   She was no longer mindful of the big picture of her life and the reasons to continue the fight.  And we always ask, “God, how could she have done that, she has kids” or “How could he have done that knowing his family would find him.”  They weren’t thinking…that part of their brain was turned off.

Based on the recovery workbook by Melanie Gordon Sheets, Ph.D. -<span
Continue reading

Advertisements

The DBT-CBT Workbook: Worksheets, Activities, Charts, Questions, Skill Builders, Tracking Sheets, and other Special Features

The Special Features of the DBT-CBT Out-of-Control Workbook

“Statements of Support and Encouragement” –  the first two pages have space for our support people to write statements of support and encouragement for our journey through the pathways of recovery.

“Table of Contents” – a detailed 7-page table of contents not only lists the chapter titles, but also the major topics or sections in each chapter.

“Introduction” – the book opens with a general introduction to the program.

“FAQs and More” – an opening section that answers several “frequently asked questions” about the program and workbook.

“An Overview of the Three Mind States” – a two-page chart describes Emotional Mind, Rational Mind, and Wise Mind so folks have a general idea of what these are before they begin reading the book.  In addition, various emotions are listed with examples of the types of emotional thoughts that go with them. Then, examples of how Rational Mind and Wise Mind might respond to these emotions and thoughts are listed.

“An Overview of the DBT-CBT Process and the Pathways of Recovery and Relapse” – a flowchart shows how we use Emotional Mind, Rational Mind, and Wise Mind to deal with difficult life events and emotions in a healthy, recovery-based way.  The chart also shows what happens when we act on our emotions without using Rational Mind or Wise Mind. A written description of this process is also provided. This also serves as a very good overview of the DBT-CBT program.

“How Bad Do I Really Want Recovery?” – an introductory worksheet to help us gauge our readiness for recovery…before we get started with the workbook.

There are 14 chapters in this workbook:

The Nature of the Problem

The Big Picture of My Life

The Pathways of Recovery

Mindfully Protecting My Peace and Stability

Mindfulness Is a Skill

Emotional Mind

Rational Mind

Challenging Negative Judgments of Me

Wise Mind

The Wise Mind Worksheet

Distress Tolerance

Acceptance

Life-Enhancing Coping Skills

The Game Plan

“Rest Stops” – the 14 chapters are divided into three sections.  After each section is a “Rest Stop” which provides a summary of each chapter in the section, “Where We’ve Been…What Ground We’ve Covered.” The Rest Stops also tell us “Where Do We Go from Here” or what we are getting ready to cover in the next section or sections.

“Applications” – the “general knowledge” information presented in the workbook is applied to situations that are familiar to us. The information is applied to Real Life…and often it’s our life that it’s applied to or the lives of people we know.

“Skill Builders” – these are activities and worksheets that help us to practice and apply the skills and concepts we’re learning.  Several are highly therapeutic and will lead us to major insight, self-understanding, and change.

Workbook Questions – the pages of the workbook are FILLED with “workbook” type questions. These help us to process the material and apply it to our life. “Answers” or comments can be found in the text following most questions.

“Chapter Reviews” – each chapter ends with a set of questions about the material and space for writing responses to these questions.

“For Reflection” – at the end of each chapter is a lined space to “journal” or write.  We’re encouraged to write about whatever comes to mind or heart.  Some ideas for what to write are listed in the margin…such as how the material relates to our life, how it affects us, motivates us, what we have learned, major insights, etc.

“The Concepts and Skills Tracking Sheets” – worksheets at the end of each chapter which list the major concepts, principles, understandings, and skills presented in the chapter. They are a tool to help us learn, practice, and apply the skills and information in each chapter. They help us to remember what we’ve read and they offer a way to TRACK our practice and Real Life use of the recovery skills and understandings.

Margin Text – the left side of each page has a 1-1/2 inch margin that provides the following information and features:

Definitions – easy to understand definitions of words used in the text.

“Phonetic” or “Sound-Out” Spellings – spellings of less common or hard to pronounce words.

“Footnote Style Numbering” – the margin items listed above are numbered and the section in the text that they go with are numbered (footnote style).  This is so we know how the margin information connects to the text…to know when it should be read.

Quotes and Sayings – the margins are also used for quotes and sayings that relate to the text.

“A List of Negative Emotions” – a fairly long list of unpleasant, upsetting emotions.  Similar types of emotions are grouped together.  This helps us to be aware of the emotions we experience and it gives us words to describe our feelings.

“Turning Point Worksheets” – listed below are SOME of the worksheets that have had the greatest impact on Group Members.

“The Cycle of Suffering in My Life Worksheet” – helps us to understand how the problems we’re having in life are greatly worsened by how we are trying to cope with them. It shows that the things we’re doing to try to feel better in-the-moment end up causing us long-term pain and suffering.

“The Big Picture of My Life Worksheet” – helps us to recognize the many things that bring meaning and satisfaction to life…and what happens to these things when we respond to life in self-destructive Emotion-Driven ways.  It helps us to understand the consequences of Emotion-Driven Behavior.  The worksheet provides many insights that help our Rational Mind to rationally challenge many Emotional Mind “desires.”

“The Mindfully Protecting My Peace and Stability Worksheet” – helps us to understand the number of stressors, pressures, demands, and difficult things “Coming Our Way” and the importance of being mindful of these things, maintaining boundaries, prioritizing, and coming up with a Game Plan for managing what’s “Coming at Us.” The purpose is to protect our peace and stability and the quality of our life…to minimize Emotional Mind flare-ups and crises and relapse into self-destructive coping behavior.

“The Challenging Negative Judgments of Me Worksheet” – provides us a structured way to rationally challenge the abusive, hurtful, destructive statements made about us. Members are often shocked at the results of this worksheet because it shows or “proves” how much of a lie those statements were…and how irritational we are to continue to believe.

“The Well Analogy Worksheet” – helps us to talk our way through an Emotional Mind crisis or situation…to go from impulsive coping responses to a Wise Mind response.

“The Wise Mind Worksheet” – walks us through the use of the three mind states so we can come up with a Wise Mind plan for dealing with a major issue or problem.

“The Game Plan” – this worksheet is for the development of a personalized recovery plan. The principles, concepts, skills, and understandings gained throughout this workbook are used to develop this recovery plan. The use of Rational Mind and Wise Mind are built into the plan as is a respect for our Emotional Mind issues and dynamics and who we are and how we are as a person.

“Step-by-Step Instructions” – detailed instructions are provided for the completion of the worksheets and tracking sheets.

“Samples of Completed Worksheets” – one or more completed samples are provided for each worksheet. These aid in understanding how to complete the worksheets. Oftentimes, seeing how a worksheet is done helps to better understand how to complete it!  Many of the completed samples are used for discussion in the workbook, too.

“Real Life Stories” – four stories that describe the life events and situations common to a recovery population are shared. Many Group Members feel as if these stories were written about them…sparing some details.

“Out-of-Control:  A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” by Melanie Gordon Sheets, Ph.D.  –  Copyright 2009  Recovery Works Publications



.

The DBT-CBT Recovery Workbook Focuses On Self-Destructive Behaviors

DBT-CBT is a life-changing recovery program that inspires people
to make the life changes that will change their lives.
This program has turned many defeated hearts into empowered spirits
that are psychologically prepared to take on the challenges of
GETTING ON  and STAYING ON the Recovery Path.

Come join us in our journey.

This is a workbook for recovery from a variety of Self-Destructive Coping Behaviors. The philosophy of DBT-CBT is that “Many of our “abnormal” behaviors are normal given our experiences. They once served as survival skills.  However, their period of usefulness is long over.  We’ve overused these coping behaviors…and now, they’re causing us great pain and they’re destroying our lives.”

This workbook explains why we do the things we do…and why we keep doing these things even though they cause us more pain and problems.  It’s about what we do in the heat-of-the-moment…the emotional moment.  It’s about what happens when EMOTIONAL MIND drives and RATIONAL MIND takes a backseat…and WISE MIND is left on the side of the road.

When we’re filled with upsetting emotions, we often do things for quick relief…like drugs and alcohol; suicide attempts; cutting and other forms of self-mutilation; aggression; temper tantrums; walking off and leaving the situation; withdrawal; overeating or not eating enough; overshopping; “sleeping around”; rebound relationships; gambling; and other risky and reckless behaviors. The Nature of the Problem is…the things we do to feel better end up multiplying and intensifying our problems. Our Destructive Coping Behaviors help us to cope in the Heat-of-the-Moment…but, they have many negative consequences. They make our current problems more severe…and they CREATE many new problems for us to struggle with.   Over time, our lives spiral OUT-OF-CONTROL and into a CYCLE OF SUFFERING.

This workbook provides useful tools, attitudes, and plans for changing how we respond to life.  Our goal is to GET CONTROL of our OUT-OF-CONTROL emotions, behaviors, and thinking. We do this by PARTICIPATING EFFECTIVELY in our lives and by using LIFE-ENHANCING COPING MECHANISMS to deal with our pain and problems.  Our goal is to MINDFULLY PROTECT OUR PEACE AND STABILITY and the BIG PICTURE OF OUR LIFE.  Our goal is to STOP the CYCLE OF SUFFERING.

What Causes People to Change? When It’s Painful To Change But More Painful Not To

Pain and Suffering and the Pain of Change

Pain is a type of distress.  It’s a natural part of life.  Pain is designed to be temporary.  The purpose of pain is to PUSH US TO DO SOMETHING to end the pain…so we can return to a pain-free state.  Pain is a call to action.

Alike most things in life, we have two choices when it comes to pain.  We can either LEAN INTO the painful situation and change things or we can work hard to avoid dealing with it.

If all we do is work to avoid pain…if we don’t Lean Into it…if we don’t deal with it…if we refuse to accept it…if we refuse to do what’s needed to get through it …OUR PAIN WON’T GO AWAY.  It’ll be with us for a long time.

Running from our problems just prolongs our agony and brings us to a chronic state of suffering… a long-term condition of being overwhelmed with despair and stuck in the same place and time… and we don’t move forward.

We want things to get better in our life, but we’re NOT WILLING to do the things that will make our life better.  We want life to change, but we’re not in the mood to change.

We generally DON’T CHOOSE to make major life changes “out of the blue” or on our own.  Change usually happens when we’re FORCED to make changes.  And most often, we make changes when we have NO OTHER CHOICE but to change.  We generally let things get SO BAD that the pain of living like we’re living is MUCH GREATER than the pain of change…and that’s when we begin to change.

If we really want our life to change, we have to make changes…despite the distress of change.  Our life isn’t going to get better unless we do things that make life better.  When people make major life changes, a strong commitment is made, like, “Come hail or high water, this is going to happen.  I’m going to do what I have to do, no matter what.  I’m so tired of living this way.  I refuse to allow myself to live like this any longer.”

Excerpt from Chapter 11 “Distress Tolerance” of the DBT-CBT Therapy Workbook entitled: “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook  for Getting Control of Our Emotions and Emotion-Driven Behavior” (Melanie Gordon Sheets, Ph.D. – 2009 – Recovery Works Publications)

http://www.dbt-cbt-workbook.com

Six Major Problem Areas Addressed by the DBT-CBT Recovery Program

DBT-CBT Addresses Six Major Problem Areas

These six areas are listed below.  Examples of the types of problems
we might have in each area are also noted.

This workbook is designed to meet the needs of people who suffer
from problems in SOME or ALL of the six areas.


1. RELATIONSHIP PROBLEMS

Conflict-Filled or Stormy Relationships   •   Abusive Relationships
Relationship Disappointments or Frequent Ups and Downs
Unfulfilling Relationships   •   Short-Term Relations
Love – Hate Relationships   •   Few or No Close Relations
Fear of Rejection  /  Actual Rejection  /  People Have Pulled Away
Co-Dependency  /  Dependency   •   Attention-Seeking Behavior
Fear of Abandonment  /  Actual Abandonment   •   Mistrust
Mad at Everyone   •   Loneliness  /  Can’t Tolerate Being Alone
Shyness  /  Fear  /   Major Discomfort in Social Situations

2. MOOD SWINGS – DEPRESSION – ANXIETY – ANGER

Moodiness  /  Major Mood Swings   •   Easily Angered   •   Rage
Guilt / Shame   •   Being a “High Drama” Person
Unbearable  /  Intense Emotions   •   Anxiety  /  Panic
Depression  /  Helplessness  /  Hopelessness  /  Worthlessness
Believe Things Won’t Get Better  /  Want to Give Up
Feel Out-of-Control  /  Overwhelmed  /  Suicidal

3. UNHEALTHY THINKING

Worrying  /  Overthinking  /  “Stewing” over Things
Dwelling on the Past   •   Preoccupied with Revenge
Pessimistic Thinking  /  Negative Expectations   •   Irrational Beliefs
Catastrophizing  /  Blowing Things Out of Proportion
Black and White  /  All-or-None Thinking
Putting Ourselves Down  /  Focusing on Our Worst Qualities

4. UNHEALTHY COPING BEHAVIORS

Please see the “List of Common Self-Destructive Coping Behaviors” above.

5. OTHER IMPULSIVE BEHAVIORS – BAD CHOICES

Doing Things on a Whim  /  Making “Snap Judgments”
Not Thinking Things Through and Having Negative Consequences as a Result

6. QUALITY OF LIFE PROBLEMS

Burnt-Out  /  Life Is a Chore   •   Nothing to Live For
Emptiness  /  Meaninglessness  /  Boredom
More Problems Than I Can Bear   •   Must Start Over
Financial Problems  /  Bankruptcy
Job Loss  /  Can’t Keep a Job Loss of Career or Professional License
Demotion  /  Probation at Work
Loss of Relationships   •    Family Pulled Away   •   Can’t See Children
Loss of Trust From Others   •   Reputation Damaged
Loss of Self-Respect and Integrity   •   Loss of Self-Confidence
Problems Getting an Education  /  Not Completing Semesters
Underachievement • Loss of Housing   •   Loss of Transportation
Loss of Possessions • Loss of Pets   •   Loss of Freedom
Legal Problems  /  Probation or Imprisonment
Health Problems  /  New Medical Diagnosis

This list is an excerpt from the DBT-CBT Therapy Workbook – “Out-of-Control:  A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior”  by Melanie Gordon Sheets, Ph.D.  – 2009 – Recovery Works Publications

A List of Common Self-Destructive Coping Behaviors

“A List of Common Self-Destructive Coping Behaviors”

Avoidance Strategies

Denial  •  Oversleeping  •  Procrastination  •  Stuffing Our Emotions

Walking Off – Leaving   •   Withdrawal – Isolation

Flight into Activity (staying too busy to think about our troubles)

Eating Disorders

Anorexia   •    Bulimia    •   Overeating   •   Comfort Eating

Passive-Aggressive Behavior

“Harmless” Jokes   •   “Forgetting” (forgetting on purpose!)

“Accidents” (accidently doing something on purpose!)  •  Sarcasm

Procrastination   •    Talking Behind Someone’s Back    •     Gossiping

Physical Aggression

Towards People, Animals, and Property

Self-Harmful Behavior

Suicide Attempts – Gestures

Self-Mutilation (cutting, burning, scratching, hair pulling,

and other forms of self-inflicted body damage).

Substance Abuse / Dependence / Self-Medicating

Alcohol   •    Illegal Drugs    • Prescription Drugs

Over-the-Counter Drugs

Vengeful Acts

Taking Revenge (getting even…or ahead!)

Verbal Aggression

Saying Hurtful Things to Others   •   Hostile – Threatening Remarks

Screaming Fits – Temper Tantrums • Threats to Harm/ Kill Ourself

Telling People Off    •   Bluntness – Speaking Our Mind

Other

Gambling    •    Habitual Lying    •   Codependency – Enabling

Rebound Relationships    •    Promiscuity (sleeping around) – Affairs

Overshopping   •   Being the Drama King or Queen

Getting Involved in Other People’s Problems

Criminal Acts (stealing, property damage, setting fires, etc.)

High Risk – Reckless Behavior (driving too fast, “playing chicken,”

road rage, “taking chances for the fun of it,” etc.)

How many of these things do you do?

Most of us do MANY of these things…and we end up with a lot more problems to deal with!

This list is excerpted from the DBT-CBT “Out-of-Control” Therapy Workbook by Melanie Gordon Sheets, Ph.D.

DBT is Dialectical Behavior Therapy  and  CBT is Cognitive-Behavioral Therapy.

Radical Acceptance – “Accepting the Unacceptable” – From a DBT-CBT Workbook Perspective

We have a choice to accept difficulties as they come our way…
To lean into them and to get a game plan for dealing with them
AND a choice to Follow Through until we can Get Through…
OR we can choose to avoid, ignore, and numb-out our pain and problems
And stagnate in our pain and suffering.

When we choose to confront things
With an attitude of acceptance
That gives us the serenity to change the things we can
And the wisdom to know our limits.

Acceptance of our life situation and what we need to do about it…is a way of turning suffering we cannot tolerate into pain we can tolerate. It’s a way of turning hopelessness into hope. Most of us have been suffering the pain of our lifestyle and choices for years…and somehow, we remain willing to experience ongoing pain and misery because of them. We’re somehow willing to suffer long-term pain, but we’re not willing to go through the temporary pain of change. We’re somehow willing to dwell in a painful past, to remain in painful situations, and to continue painful addictions and impulsive behavior. We do so because we’re unwilling to accept and undergo the changes that will bring peace and stability.

Radical Acceptance involves accepting what we’d normally consider unacceptable. When we LIVE BY Radical Acceptance, we CAN ACCEPT something whether or not we approve of it and whether or not it’s right or wrong, fair or unfair, or pleasant or unpleasant. Radical Acceptance is about CHOOSING TO ACCEPT whatever is in our best interests to accept.

We MUST ACCEPT whatever we HAVE TO accept because NON-ACCEPTANCE keeps us emotionally troubled and stuck in negativity. To have peace, we must accept many things whether or not they’re acceptable. We must accept things from the past and present. Anything in the past that’s unfixable, we need to LET IT GO. Anything in our current life that we CANNOT CHANGE, we need to accept that it MAY NOT change. Anything we CAN change, we must LEAN INTO…to MAKE THE CHANGES we CAN MAKE. Our Recovery Goal is to live a life that MAXIMIZES peace, stability, meaning, and productivity. To do that, we MUST ACCEPT what has happened HAS HAPPENED, what we’ve done, WE’VE DONE…then, we need to LET IT GO…so we can GO ON with life.

From pages 313 and 316 – Excerpt from “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” by Melanie Gordon Sheets, Ph.D. – 2009 – Recovery Works Publications