Category Archives: Substance Abuse

Track Your Emotional Level Using “The Levels of Emotion Chart” from the DBT-CBT Workbook (with Estimates of Emotional Mind and Rational Mind)

Posted on August 26, 2011 | Leave a comment

The Levels of Emotion Chart provides descriptions of how we FEEL and FUNCTION when we’re experiencing different levels of negative emotion. The levels range from 0-10. At Level 0, we are at peace. At Level 10, we are desperately overwhelmed with negative emotion. Notice the far right columns.  They show how active Emotional Mind and Rational Mind are at each level (this is just a guess though!) This chart helps to gauge or measure our emotional intensity and to better understand the effect our emotional levels have on our ability to participate effectively in our life.

Use the link below to check out the chart and to read the text from the workbook related to the chart.  I don’t know why, but you’ll go to a page view that doesn’t open the file…BUT, if you click the link again when you get to that page…it’ll come up like it’s supposed to!  

The Levels of Emotion Chart – from the DBT-CBT Therapy Workbook by Melanie Gordon Sheets, Ph.D.

Review the levels of emotion in the chart and answer the following questions.

What level are you currently at?

What has been you lowest and highest level today?

What is the level of your best functioning over the past week? the last month?

At what level were you at when “Something Happened” and you ended up having to go into treatment?

At what level should you seek help so you can prevent going into treatment?

Most group members believe we should call our support person, sponsor, counselor, or crisis worker at level 5 or 6. Knowing what they know now, they want to get help BEFORE things begin to get out-of-control. At levels 5 and 6, we still have a fair amount of Rational Mind going on. This helps us to seek support…and to accept the Rational Mind and Wise Mind understandings and suggestions offered to us!

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Posted in 1 - The DBT-CBT Workbook, 2 - From a DBT-CBT Therapy Perspective, Depression and Suicidality, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Relapse - Recovery Dynamics, Self-Destructive Behavior, Self-Injurious Behavior - Cutting, Substance Abuse, Suicide and Suicidal Behavior, Thinking - Destructive

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The Dynamics of Emotional Mind and It’s Role in Driving Destructive Coping Behavior: When Emotional Mind Drives…We Wreck Out…and Our Lives Become a Total Wreck

Posted on August 18, 2011 | 6 comments

The Dynamics of Emotional Mind - hand-out 092010b

View the pdf file for a readable image – click the link below

The Dynamics of Emotional Mind – DBT-CBT Conference Handout – 072411

This hand-out addresses the dynamics of Emotional Mind and its role in driving destructive emotion-driven coping behaviors (e.g., substance abuse, aggression, eating disorders, etc.)

The “Cycle of Suffering”- when we respond to emotional pain and life problems in destructive, emotion-driven ways, we end up with new problems and increasingly severe old problems…and we feel worse than before.  If we respond to this new level of pain and problems in destructive ways, our pain and problems will continue to intensify and multiply.  Because we’re not working through our pain or resolving our problems, our emotional baggage piles up.  The trauma from the past weighs us down in the present and intensifies present misery.  What could have been temporary pain and problems has turned into long-term pain and suffering.  The only way to get the cycle of suffering to stop…is to stop it.  We can stop our suffering by stopping our destructive coping behavior.  We must turn on Rational Mind to “think through before we do” and we must “follow through” with Wise Mind problem-solving and life-enhancing coping behaviors.

Based on:  “Out-of-Control:  A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” copyright © 2010 by Melanie Gordon Sheets, Ph.D.   (www.dbt-cbt-workbook.com)

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Posted in 1 - The DBT-CBT Workbook, Aggression - Physical - Verbal, DBT - CBT Workshops and Trainings, Depression and Suicidality, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Pain and Suffering, Relapse - Recovery Dynamics, Self-Destructive Behavior, Substance Abuse, Thinking - Destructive

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Why We Relapse: Desperate for Peace in a World of Emotional Turmoil

Posted on August 7, 2011 | 1 comment

I responded today to a LinkedIn discussion started by Elisabeth Davies, MC of Bright Alternatives, Inc.  and the author of “Good Things, Emotional Healing Journal: Addiction.”  The discussion topic was, “Is relapsing with unhealthy substances an attempt to get more peace of mind? Being so passionate about this recovery topic, here’s my long-winded response!

“For many, yes. Many use substances as a coping behavior to help bring their emotional level to a more tolerable or comfortable level. Also, returning to such a behavior reduces the extreme tension of wanting to do it and not allowing ourselves to…thus, the experience of immediate relief or peace in-the-moment. To help us to feel better about relapsing, we’ve probably come up with all types of reasons (emotion-driven lies) as to why it is okay to do and would help us…and how we can also quit again when life settles down, etc…unless of course, it is a major emotional reflex to an immediate stressor and we do it VERY impulsively…without giving it much thought.

Relapsing on substances is little different than wolfing down a big bag of cookies or scoops n’ scoops of ice cream, or starting to smoke again, a “forbidden” sexual encounter….whatever. I think these types of behaviors have to do with attempts to bring an “out-of-control” emotional mind into control…so that we feel better and more comfortable in the emotional moment. It is all about being desperate for relief and doing what brings us relief, often immediate relief. It’s a desperate way to experience a sense of emotional, psychological, and physical peace IN-THE-MOMENT…although we’ll have hell to pay when we come to (when the emotional moment passes and rational mind picks up strength).

When we come to and realize what just happened and are faced with the consequences of our behavior…and the unresolved problem…we feel bad again…and then we may continue destructive coping….chasing “peace in the moment”…When we use destructive coping behaviors to deal with our pain and problems, we enter the Cycle of Suffering. Our problems multiply and intensity and we go through a period of increased pain and suffering as a result.

I believe most people use destructive coping behaviors to some degree (e.g., overworking, oversleeping, physical aggression, yelling, throwing fits, being rude and ugly, ‘always speaking our mind”, lying, gambling, obsessive exercise, cheating, sleeping around, codependency, procrastination, smoking, prescription meds, alcohol, overeating or eating the desired “poison foods” for us, being hyperreligious, narcissistic….and the list goes on and on.) I actually tell my patients that it’s “normal” to be “abnormal” and entirely abnormal to be so perfectly normal and in control of ourselves. We all do some destructive coping behaviors and the healthier or more in recovery we are…the less we do these things…and the more we work VERY hard to stay in control of our emotions, behaviors, and our addictions of choice….and the more we choose life-enhancing coping behaviors instead.

I’m obviously very passionate about this…it’s one of those, “been there, done that, still doing that…having to fight for recovery at times to stay in control…and not to get too far out of control” type of things for me. I believe that when we are in recovery…we remain “works in progress.” Sometimes it’s a daily battle and sometimes, an occasional battle. We’re emotional critters and creatures of habit…and when we hurt or are feeling desperate and “out-of-control”…we tend to fall back into old patterns of relief-seeking behaviors…or to certainly think about doing them!

We’re emotional critters and creatures of habit…and when we hurt or are feeling desperate and “out-of-control”…we tend to fall back into old patterns of relief-seeking behavior…or to certainly think about doing them!”

And you know the more we think about doing them…the more likely we are to finally do them. That’s because the tension is building…we want…and we won’t allow ourselves to have…and we want…we tell ourselves “NO”…and we want…and we’re tired of the pain, problems, tension, and frustration…and we become desperate for relief and peace…that we finally do what we keep trying not to do…and we relapse. Have you “been there, done that?” Have you been through this struggle? It’s a battle of the minds, Emotional Mind vs. Rational Mind and Wise Mind. It’s a battle of wills…willingness vs. willfulness. Which recovery skills do you use to get through the “fixing to relapse” moment? Do you still have these moments?

I believe that one of our major recovery tasks is to learn ways to keep our Emotional Mind in control and to tame our Emotional Mind when it is getting out-of-control. That’s my biggest recovery task…and it’s always a battle of the mind states and a battle of will. Sometimes, I grow tired of the battle and dealing with my emotional, willful self. At those tired, weak moments, I remind myself….”Mel, what do you want…peace and stability or chaos and pain?” Isn’t it horrible that you have to parent yourself even when you’re a grown-up!?

Link to the LinkedIn discussion

Link to Elisabeth’s book:  “Good Things, Emotional Healing Journal: Addiction on Amazon

Link to Elisabeth’s blog

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Posted in Aggression - Physical - Verbal, Eating Disorders and Weight Issues, Emotional Mind, Rational Mind, and Wise Mind, Pain and Suffering, Relapse - Recovery Dynamics, Self-Destructive Behavior, Substance Abuse, Willingness - Willfulness

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Radical Acceptance: Accepting the Unacceptable – Coming to Terms With Our Destructive Behavior to Heal the Emotional Pain of Shame, Guilt, and Regret

Posted on March 27, 2010 | Leave a comment

I recently responded to a LinkedIn discussion regarding the negative consequences of an individual being found “Not Guilty by Reason of Insanity.”  It was spurred by a Wall Street Journal article entitled, “The Trouble With the Insanity Defense” written by D. J. Jaffe, a co-founder of the Treatment Advocacy Center.  It was printed in the 3-26-10 edition.

http://online.wsj.com/article/SB20001424052748704896104575139801575696436.html

The writer notes, “Not guilty by reason of insanity is an inadequate remedy to violence by individuals with mental illness.” He raised some valid points.

As I work for a state mental health institution which provides treatment for NGRI patients, I responded with the following comment.

“Pros and cons. Time in a psychiatric hospital is generally “easier” time than in prison – so that is a definite benefit to the NGRI population. Further, many of our NGRI patients have stabilized to a degree that they are among the highest functioning patients in the hospital and have the highest level of privileges. Those are benefits.

In terms of cons, in general the NGRI population spends more time in a psychiatric facility than they would if they served Guilty sentences in prison. Also, like the article notes, they are often held in a psychiatric hospital long after stabilization and likely safe release to the community. In Texas, the superintendent (CEO) of the hospital has to approve the potential release before petitioning the court for placing the patient on an outpatient commitment. Both the judge and the hospital CEO are risking their careers and reputation if the released patient recommits a significantly violent crime.

The headline test – ‘Judge ordered release of criminally insane man who kills again‘

In addition, the community mental health officials also have to ‘sign off’ on the release and attest that they can ensure adequate monitoring and treatment to prevent reoffending. It’s a risky business. However, many of the NGRI individuals are truly honorable, caring, competent individuals who regret their actions and strive for a productive life. It is a great shame for patients and victims. Our facility works very hard on behalf of these patients, the courts, and the community to carefully evaluate individuals who appear ready for an outpatient commitment and to ensure a sound outpatient treatment program / support plan is in place for these individuals. It is a risky situation however as a state psychiatric facility, we are charged with providing this service and level of care.”

Marilyn Miller, MS., LPC., a psychotherapist in private practice in San Antonio, Texas, comments in this discussion that she works with individuals with bipolar disorder to help them “resolve enormous shame for their actions during manic phases (pre-medication and -treatment).”  She notes that even though their acts did not involve violence against others, their behavior was so “devastatingly self-destructive” and “so counter to their own ‘real’ values that the hurdle of getting over that shame is quite high.”  She states that she “can not imagine the further horror” for NGRI individuals “knowing that they have taken lives (or attempted to do so).” http://www.marilynmillerpsychotherapy.com/

My follow-up response using the vernacular and understandings of the DBT-CBT “Out-of-Control” Workbook I wrote…includes,

“As you say Marilyn, it is horribly sad to work with the NGRI’s (or other patients) who are non-psychopathic…and in a period of being out of touch with reality or otherwise ‘Big Time in Emotional Mind’…enacted state dependent destructive behavior…and when they ‘come to’ reality (Rational Mind) and recognize what they have done and the impact on others and their lives…they are in great emotional pain and are devastated by their behavior.  Just this week in group at the state hospital, this came up as we were discussing the consequences of ‘Emotion-Driven Behavior.’  A cloud of great remorse and sadness came over the group in that moment of insight and understanding relating to why things are the way they are in their lives…why their people are so upset with them….and why they have lost so many of the things that they value and cherish.

I teach them that it’s not WHAT happened (like a relationship break-up, conflict on the job, abuse, etc) that has led to such life losses…that it is HOW they responded to the life situation (drugs, alcohol, suicide attempts, physical violence, saying ugly things to people, etc) that has led to the deterioration of their life and the widespread losses of all the people, things, and activities they love and cherish.  This is a painful truth that leads to a major moment of reckoning.  From there, we talk about what we can do to prevent getting ‘Big-Time in Emotional Mind’…and learning ways to respond through Wise Mind when we do experience out-of-control emotional moments.

This past week, this moment in group was so heavy in sadness that I told them that this is exactly why I wrote the workbook and why I am so passionate about helping them in group…that it pains me greatly to be among such neat, wonderful individuals who truly care about their lives and their people…and how it is so sad to live, eat, breathe Emotional Mind…and to be stuck in a ‘Cycle of Suffering’…a cycle of being upset, enacting destructive Emotion-Driven Coping Mechanisms, suffering more losses, feeling worse, continuing destructive copings, consequences worsen, feeling even worse….and on and on and on.

The depth of their pain is what drives me to work so hard to help them to understand Emotional Mind dynamics and to find new ways to respond to life stressors, problems, situations, losses, etc., to STOP the cycle of suffering, and to live a recovery lifestyle so they can reap all the rewards of doing so…to end their pain and suffering and to live a life that provides meaning and satisfaction.

For many, this involves understanding why they have done the things they’ve done, self-acceptance and forgiveness, being committed to change the way they respond to life, developing a Game Plan for recovery, and FOLLOWING THROUGH with their recovery plan.  This process also involves understanding why others have acted in certain ways towards them, acceptance and forgiveness of others, etc.

Another major point I teach them is that their destructive behavior is not a product of WHO THEY ARE as a person…not their character, personality, or true self…but a product of HOW THEY ARE (or were) when they are ‘Big Time in Emotional Mind’…as a result of psychosis, mania, intoxication, great anger or upset, the result of an altered state of consciousness, the one in which they are Big Time in Emotional Mind without any significant levels of Rational Mind going on.  It is not WHO THEY ARE….because most of these individuals are good-hearted people who care about others…and truly care about living a productive life and being kind, loving, and helpful to others.”

For this blog, I’d like to add the following text from Chapter 12:  “ACCEPTANCE” from the DBT-CBT Workbook.  This is an example of applying “Radical Acceptance” to our lives.  Radical Acceptance is about “accepting the unacceptable”….and boy, when we’re in recovery…we’re going to have to do a lot of that!

ACCEPTANCE OF THE BAD, HORRIBLE, ROTTEN THINGS WE’VE DONE

We’re human.  We ALL make mistakes.  When we’ve LIVED IN Emotional Mind, we’ve made MANY mistakes.  We’ve acted impulsively and have made MANY regrettable decisions.  We’re NOT bad, horrible, rotten people.  We’ve just done some bad, horrible, rotten things.  These things happen when people are drinking, drugging, in a manic or psychotic state, or are desperately overwhelmed with painful emotion.  When we’re CLEAN N’ SOBER, on our MEDS, making HEALTHY LIFESTYLE CHOICES, and ACTING IN WAYS to Mindfully Protect Our Peace and Stability, we’re GOOD-HEARTED PEOPLE with good morals and values…and WE CARE ABOUT PEOPLE.

Think of the REALLY NEAT people we’ve met in rehabs, AA, support groups, and hospitals.  They’ve lived a past JUST LIKE US.  They’ve done hurtful things to the people they love WHEN they were in the middle of their addictions and Destructive Coping Behavior.  They’re NOT bad people.  They’re the WALKING WOUNDED and IN THEIR DAYS of PAIN and IMPULSIVITY, they did some painful and impulsive things.  TAKE AWAY the drugs, alcohol, mania, depression, pain, anger, and bitterness…and what’s left are some PRETTY NEAT PEOPLE!

We’re the walking wounded.
We’ve experienced a lot of pain.
Being desperate for relief,
we’ve done a lot of painful things
that have hurt ourselves and others.

Think of two people YOU KNOW that fit that description.  What sort of bad things did they do when they were in the middle of their addictions and destructive coping behavior?  Also describe their character when they’re living a Recovery Lifestyle.  _________________________________________________ _________________________________________________

Our Recovery Task is to ACCEPT whatever we’ve done.  Then, we must WISELY decide which things we CAN DO SOMETHING ABOUT and which ones we CAN’T.  We need to focus our efforts on the things we CAN do something about that are a PRIORITY in our life.  We need to DO WHATEVER WE NEED TO DO to improve these things.  The things we can change that AREN’T A PRIORITY…
we need to LET THOSE GO… FOR NOW.

The things we CAN’T CHANGE…
we MUST let them go.
Letting go is a CHOICE.
It’s a choice for FREEDOM from burden
and a choice for PEACE and SERENITY.
Remember, “God grant me the serenity
to ACCEPT the things I cannot change.”
ACCEPTANCE is what gives us serenity
EVEN WHEN our lives are in turmoil.
It’s how we CHOOSE to THINK about things
and RESPOND to things
that ultimately affects HOW WE FEEL about things.
We can CHOOSE to be AT PEACE with our situations
or we can CHOOSE to be in turmoil.
We CANNOT LIVE NEW LIFE if we live in the PAST.
CHOOSE to let some things go
so you can GO ON with life…
and LIVE NEW LIFE!

Extra margin text from this section of Chapter 12:

We weren’t born this way.
We became this way
because of an Out-of-Control lifestyle.

Our people want us ALIVE and WELL,
so we need to bury the guilt and pain that’s killing us.
We cannot be the person we were meant to be
or live the life we were meant to live
if we are carrying around what makes us wish we were dead.

The only way to start over
is to START OVER.
We do that by accepting

what needs to be acceptedand by moving on down the Recovery Path.

This text was adapted 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. – copyright 2009 – Recovery Works Publications –

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Posted in 1 - The DBT-CBT Workbook, 2 - From a DBT-CBT Therapy Perspective, Acceptance - Non-Acceptance, Aggression - Physical - Verbal, Depression and Suicidality, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Grief and Loss, Pain and Suffering, Relapse - Recovery Dynamics, Self-Destructive Behavior, Substance Abuse

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

Posted on December 12, 2009 | 1 comment

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.

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Posted in About the Workbook, Aggression - Physical - Verbal, Anger, Avoidance - Denial, Eating Disorders and Weight Issues, Emotional Mind, Rational Mind, and Wise Mind, Pain and Suffering, Relationship Dynamics, Self-Destructive Behavior, Self-Injurious Behavior - Cutting, Substance Abuse

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A List of Common Self-Destructive Coping Behaviors

Posted on December 11, 2009 | Leave a comment

“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.

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Posted in About the Workbook, Aggression - Physical - Verbal, Anger, Avoidance - Denial, Eating Disorders and Weight Issues, Excerpts, Relationship Dynamics, Self-Destructive Behavior, Self-Injurious Behavior - Cutting, Substance Abuse

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A Partial Relapse or a Full Relapse – Using Rational Mind and Wise Mind to Tame an Out-of-Control Emotional Mind (A DBT-CBT Workbook Perspective)

Posted on December 5, 2009 | Leave a comment

The following is “Pete’s Story” – an excerpt from the DBT-CBT Out-of-Control Workbook which highlights a “real life” relapse experience.  This relapse is processed using principles and concepts from the DBT-CBT Recovery Program, especially the three mind states of DBT.  It’s an example of DBT-CBT “In Action.”  The content for this post is the opening for Chapter 7, the “Rational Mind” chapter of the workbook.  As it is from Chapter 7, it refers to things discussed in Chapters 1-6.  So, if you feel a little lost reading it…that’s why!

Chapter 7 – RATIONAL MIND

We’ve been working with Rational Mind (1) throughout this book, so you’re somewhat familiar with this mind state. Rational Mind is the part of us that processes life in a logical, legalistic, fact-driven, reality-oriented, and cut n’ dry manner. In other words, Rational Mind uses reasoning, it respects rules, it’s guided by truth, it deals with how things really are, and it’s the calm, cool, intellectual, and unemotional part of us!

Emotional Mind is driven by how WE SEE AND EXPERIENCE the world while Rational Mind is driven by how THE WORLD REALLY IS!

The Purpose of Rational Mind

A Recovery Goal is PREVENTION of Destructive Emotion-Driven Behavior. We need to STOP OURSELVES before we do what we really feel like doing!
Rational Mind helps us to gain control before things get Out-of-Control.

When we’re in a troubling Emotional Mind state, the first step for gaining control is Mindfulness. We need to be aware of what’s going on in Emotional Mind. We need to be Mindful of our Raw Emotions, Emotion-Driven Thoughts, and our desired Emotion-Driven Behavior. This includes awareness of our feelings, the thoughts racing through our mind, and what we’re thinking about doing! Once we become aware of what’s going on in Emotional Mind, we need to TURN ON RATIONAL MIND to look at our situation logically and realistically.

Rational Mind helps us to know what is true and factual.
It helps us to perceive the reality of our situations and our life.
The reality of Rational Mind is generally quite different from the picture Emotional Mind paints!

Rational Mind helps us to understand THE BIG PICTURE OF THE SITUATION and the TRUTH about what’s going on. This helps us to challenge our Emotion-Driven Thoughts and to get our emotions MORE IN LINE with the REALITY of the situation. This REDUCES our emotional distress because we FOCUS on the HERE-AND-NOW situation RATHER THAN EVERYTHING that has EVER HAPPENED to us.

Rational Mind also considers the Big Picture of Our Life and REMINDS us of the CONSEQUENCES we’ll SUFFER if we ACT ON destructive Emotion-Driven impulses. WHEN we’re USING Rational Mind to deal with what’s going on in Emotional Mind, WISE MIND TURNS ON and BRINGS US to a GAME PLAN for effectively dealing with our situation. Our Recovery Goal is to PARTICIPATE EFFECTIVELY in our life… so we’re MANAGING and DEALING WITH our problems RATHER THAN CAUSING OURSELVES MORE PROBLEMS!

APPLICATION: The Meeting of the Minds

The following story, “Pete’s Story,” is a good example of how the three Mind States work together in real life.

Pete’s Story

Pete has a lot of stress and family conflict caused by his responses to life. His family has allowed him to stay in their garage apartment “for the last time.” His probation requires him to be employed. He doesn’t have a good work history so it took a while to find a job. He just bought a used car and now has visitation with his kids because he’s paying child support. Things are pretty good in his life… though not the greatest. His boss accused him of doing something he didn’t do. He blew up and walked off the job. He went to an old hangout and started drinking again and snorted some coke. Thoughts began churning in his mind. He is very worried and is thinking the worst, “My family is going to kick me out and I’ll be homeless again. I’ll lose my car without income and I’ll lose visits with my kids. If I get called for a UA (2), it’ll be dirty and my probation will get revoked (3)…especially since I’m now unemployed. Then I won’t see my kids for a long time.” He’s very upset with himself and thinks, “I am such a failure. I screw everything up. My family will NEVER let me hear the end of this. I should just kill myself. I can’t handle all this crap again.” Thoughts are racing through his mind. His emotions intensify and he becomes more and more upset. He begins to panic. He is desperate for a way out and considers going back to live with his ex-girlfriend. He’s afraid of doing that because she still uses drugs. He panics even more and all he can think about is killing himself. He ruminates about this stuff for hours and hours. It’s now 3AM and he’s worried about going home…so late…so upset…and so messed up.

Does Pete’s story seem like Real Life or does it seem like an exaggeration to make a good story? _____________________________________________________________________________________
_____________________________________________________________________________________

Have you been in a state like this before about a lost job or some other major problem? If so, describe how your experience is similar to his. ________________________________________________________________ ______________________________________________________________________________________

The quality of our life comes down to two choices.
We can LIVE IN Emotional Mind and ALLOW our life to fall apart
OR we can TURN ON Rational Mind and Wise Mind
to get a Game Plan for dealing with our problems.
The choice is to stay on the life-enhancing Recovery Path
or to go the way of Relapse Route.

SKILL BUILDER: Pete’s State of Mind

Re-read Pete’s story and UNDERLINE the parts that describe what’s going on in his Emotional Mind. Put a BOX around the parts that are driven by Rational Mind.

You probably had no trouble identifying what was going on in Emotional Mind. You may have had some trouble deciding if his statements about getting kicked out of his apartment, being homeless…and losing his car, probation, and visits with his kids were Rational Mind or Emotional Mind.

What did you decide? Explain what you based your decision on? ________________________________________________________________________________________
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When he went to the bar, he was upset.
then he began drinking and drugging,
then he became hopeless, desperate, and PANICKED.

Mindfulness of the consequences suggests he was in Rational Mind. Some think he was in Emotional Mind because it seemed like he was catastrophizing4 how bad things could get. However, given his life situation, his worries WERE based on truth and reality!

A reason to suspect he was Big-Time in Emotional Mind is…WISE MIND DIDN’T TURN ON and OFFER LIFE-ENHANCING SOLUTIONS. All he did was ruminate for hours about consequences and finding a way out…NOT A WAY THROUGH. He was panicking! All the COCAINE and ALCOHOL did was PUSH HIM DEEPER and DEEPER into Emotional Mind…and farther and farther away from Rational Mind and Wise Mind. He couldn’t think straight. The MORE he ruminated, drank, and snorted, the MORE DEPRESSED, ANXIOUS, WORRIED, and PARANOID he became.

In order to think straight,
we’ve got to be straight!

The Big Picture of Pete’s Story suggests he was Big-Time in Emotional Mind. He had SOME Rational Mind going on…but, not much. He was AWARE of the consequences of losing his job, he KNEW he should not return to his ex, and he KNEW his behavior would cause family problems. He was probably 80%-20% Emotional Mind – Rational Mind. Wise Mind flickered on and encouraged him NOT to call his ex. Not having that option…and having more time to drink and snort, he panicked even more…and came to believe that suicide was his best option.

Isn’t it odd how we can go from bad to worse…
and we begin to think the worst option is the best?

Given Pete’s story IS Real Life, how do you think this part of his story ends? _______________________________________________________________________________________
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He’ll either do something MORE DESTRUCTIVE, like a suicide attempt, driving drunk, or a full-blown relapse OR he’ll do something LIFE-ENHANCING like staying safe and sleeping it off in the car and TURNING ON Rational Mind WHEN HE COMES TO…TO GET HIS LIFE BACK IN ORDER.

Pete’s story tells about the “Something That Happens” on the Recovery Path and the two choices we have. Pete CHOSE the RELAPSE ROUTE in the Heat-of-the-Moment. HOWEVER, he DOESN’T HAVE TO stay on that path. He can call for help at 3AM or crawl into his car and sleep it off.

SKILL BUILDER: How to Get Control Once We’ve Lost Control

Let’s suppose he chose the Recovery Path at 3AM.  When he comes to and is able to shake off the cobwebs later that day, what might Rational Mind say to him? ____________________________________________________________________________
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Rational Mind might lead him to think,

“I blew up and walked off the job and I drank and used coke last night. I was scared. I freaked out…but this DOESN’T HAVE TO BE the end of the world. It’s time for DAMAGE CONTROL. MY PRIORITY RIGHT NOW is to get a job. Whether it’s my old job back or a new one…I need to act fast! No doubt my folks know Something Happened because I didn’t come home last night and I’m home now when I’m supposed to be at work. I need a plan for dealing with them, too, so I don’t lose housing.”

At this point, Emotional Mind will probably rear up with all kinds of self-defeating thoughts and feelings. Pete MUST TURN ON Rational Mind to Fight for his peace and stability.  He cannot ALLOW Emotional Mind to control the course of his life.   When a destructive thought comes up, Pete needs to remind himself that HIS NUMBER ONE PRIORITY is to STAY ON the RECOVERY PATH and that HE CAN AND WILL HANDLE this situation. He needs to tell himself that he STRUCK OUT last night, but there’s still MORE INNINGS in the game. He’ll have to challenge the destructive Emotion-Driven Thoughts AS THEY COME UP and REMAIN FOCUSED on TRUTH, REALITY, DAMAGE CONTROL, and PROBLEM-SOLVING.

At this point, Wise Mind will kick in to help him with a plan of action. What might Wise Mind suggest? ______________________________________________________________________
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Wise Mind might suggest he visit his boss to apologize for blowing up and to ask for his job back. Wise Mind might suggest he TRY to assure his boss he didn’t do what he was accused of doing. Wise Mind would likely remind him if “Plan A” doesn’t work, he could apply for dozens of other jobs until he gets one…and that IT’S NO TIME TO BE PICKY! Wise Mind might encourage him to explain the situation to his parents…to let them know HE SLIPPED…but was BACK ON the RECOVERY PATH. If needed, he could tell them he’ll have a job quickly, REGARDLESS OF WHAT HE HAD TO DO. Wise Mind would likely inform him that it’s unlikely he’ll get called for a UA over the next few days and to pray on that! If he did get called for one, Wise Mind might suggest telling his probation officer what happened and the POSITIVE WAY HE’S DEALING WITH IT. Wise Mind would have MANY DAMAGE CONTROL and PROBLEM-SOLVING IDEAS for GETTING RECOVERY BACK ON TRACK!

When we mess up, we don’t give up.
We STAY IN the game even if it’s our toughest inning ever.

If at the end of the next day, he didn’t get his job back and he didn’t get a new one, Emotional Mind could easily start the self-defeating rumination and worry process. What could he do to help himself if this starts up? ________________________________________________________________________________________
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Rather than spending days worrying about a catastrophe happening, Wise Mind would inform him that he’d be BETTER OFF PREVENTING ONE by focusing on a Game Plan! Wise Mind would strongly encourage him to chill-out and focus on Damage Control, problem-solving, and the use of Life-Enhancing Coping Behaviors (5) to avoid destructive worry.

Through Rational Mind, he could TAKE NOTE of the PRODUCTIVE things he’s done the last two days INCLUDING his MAJOR SUCCESS with QUICKLY GETTING BACK ON THE RECOVERY PATH and preventing a full-blown relapse. He could LIST HIS GOALS for the next day and a PLAN OF ACTION for the rest of the week. Since money is tight, he could WORK OUT A PLAN for paying what HAS TO BE paid. He could DISTRACT himself with POSITIVE ACTIVITIES (support group meetings like AA, helping his family prepare a meal, visiting with a recovery friend, etc.). He could SEEK TEMPORARY WORK cleaning yards, painting his parents home, and whatever else he can come up with to earn money and to KEEP HIS MIND BUSY. He could even talk with businesses about hiring him for a day or two to do “odd jobs.”

This WORK-UP of Pete’s story shows how RATIONAL MIND helps to CONTROL the INTENSITY and NEGATIVITY of an UPSET EMOTIONAL MIND! Rational Mind DOESN’T BUY INTO a “I’m a total screw-up. This is going to ruin everything. I can’t deal with it. I should kill myself.” mentality. Rational Mind CHALLENGES panic and negativity by looking at the situation in a calm, NON-EMOTIONAL, realistic, logical, and truthful manner. In the upcoming sections, we’ll look at some common Emotional Mind experiences from the viewpoint of Rational Mind. We’ll see how Rational Mind TAKES the POWER and NEGATIVITY OUT OF a destructive emotional experience.

Rational Mind tames what comes out of Emotional Mind.
Rational Mind pulls on the reins and helps to get control
of what is going Out-of-Control.

Footnotes

1- Dr. Linehan calls this mind state “Reasonable Mind.” On page 65 of her Skills Training Manual, she states, “This is your rational, thinking, logical mind. It is the part of you that plans and evaluates things logically. It is your cool part.”
2- UA – urinalysis – a urine test to check for drugs or alcohol.
3- Probation revoked – to lose the privilege of being on probation. Folks have to serve their sentence in jail if their probation is revoked.
4- Catastrophizing – (cuh-tah-stro-fi-zing) –when we’re focusing on the very worst things that could happen. It’s a form of the word, catastrophe – (cuh-tah-stro-fee).
5- Being busy with problem-solving…and working towards the solution is a powerful coping tool. Getting a newspaper and a phone book and making a list of jobs to apply for and businesses to call and visit is solution-focused. Visiting the employment agency and ironing a decent set of clothes for job hunting is very constructive, too!

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Posted in Anger, Anxiety and Panic Attacks, Depression and Suicidality, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Mindfulness, Relapse - Recovery Dynamics, Self-Destructive Behavior, Substance Abuse, Suicide and Suicidal Behavior, Thinking - Destructive

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How to Motivate People to Change – Some Keys to Recovery from a DBT (Dialectical Behavior Therapy) and CBT (Cognitive-Behavioral Therapy) Recovery Program

Posted on December 5, 2009 | Leave a comment

From the perspective of a psychologist in a state hospital treatment setting and a population of individuals who have struggled with recovery over time, I believe insight and understanding is a key to creating a desire to change. I believe it greatly helps people to see the big picture of their life and come to an understanding of why their life is like it is…that is, why they have lost “everything” or most everything they’ve ever loved or cherished…or why things always end up so bad…or why anything good never lasts. I believe folks need to grasp that this life outcome is a product of how they have tried to cope with upsetting life events over time…and the way their life is today…is because of the progressive and worsening consequences of their self-destructive coping mechanisms (drugs, alcohol, verbal and physical aggression, suicide threats and attempts, rebound relationships, and other emotion-driven coping choices). I believe that once they grasp that the quality of their life is based on how they attempt to cope with daily life and major life stressors…once they realize that how they cope with life is responsible for the current state of their life….once they really get this…motivation for behavioral change often follows. In the group I do, they are also taught that part of being wise (use of DBT’s Wise Mind) is not only knowing what to do (Wise Mind Game Plan), but it is about “following through with what we know to do”…because there is nothing wise about knowing what to do…and then not doing it! I believe insight and understanding is an initial part of behavioral change. I also believe that knowledge that change is possible is essential. I believe they need to really get it that other people have done it and have made it through. They have to have this knowledge…which breeds hope that the recovery process actually works…that people do recover and live satisfying and meaningful lives. I also believe personal empowerment is a key ingredient. They have to believe that they can do it…that they have the skills and understandings necessary to pull it off.

Thus, they have to understand why things are as they are..(insight and understanding), they have to recognize that change is attainable (knowledge and hope)…and they have to think they can do it (personal empowerment). Of course, they also need the knowledge, skills, and resources for getting through the tough times that are part of making and undergoing major life changes (life-enhancing coping skills, support system, hobbies and activities, busy-ness). They have to understand the concept of Distress Tolerance…that things will be hard, but they must Get Through It…that recovery is not easy…and in fact, it will be one of the hardest things they’ll ever do. They are also taught that change typically does not occur until we are sick n’ tired of being sick n’ tired…that we have to soooo hate the way things are…that we’re willing to do whatever we’ve got to do to change things…that we refuse to live like this any longer. I believe that people need to be filled with recovery attitudes…or rehab-itudes…and they need to be prepared for the fight of their life…which for many is the fight FOR a life (a decent life) and for others, it is a fight for life itself…because the severity of their consequences has escalated into things being so bad…that it comes down to “life or death”…

When the pain of living like we’re living is greater than the pain of change…that’s when most people decide to change…and the question for the rest of us is…how bad do we have to let things get before we’re willing to make changes! It’s a shame that we’re such stubborn creatures, that we have to let things get so bad…before we’re willing to make changes! If only we knew then…what we know now…how we could have spared ourselves of such long-term pain and suffering.

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Posted in Acceptance - Non-Acceptance, Aggression - Physical - Verbal, Emotional Mind, Rational Mind, and Wise Mind, Pain and Suffering, Relapse - Recovery Dynamics, Relationship Dynamics, Self-Destructive Behavior, Substance Abuse, Suicide and Suicidal Behavior, Willingness - Willfulness

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