Category Archives: Suicide and Suicidal Behavior

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

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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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
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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)

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? ________________________________________________________________________________________
________________________________________________________________________________________

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? _______________________________________________________________________________________
_______________________________________________________________________________________

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? ____________________________________________________________________________
____________________________________________________________________________

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? ______________________________________________________________________
______________________________________________________________________

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? ________________________________________________________________________________________
________________________________________________________________________________________

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!

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

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.