Tag Archives: Cognitive-Behavioral Therapy

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

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.


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!


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…

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
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 –


What Frees You To Be Yourself…And To Achieve To Your Potential: Acceptance Of Self And Others From A DBT-CBT Perspective

I came across a discussion item on LinkedIn a little while ago about “What frees you to achieve to your potential.”  The individual posting the question focused on “self-discipline”…well, that was not what I had in mind when I read the discussion headline in my email.  Here’s my response!

“I believe self-discipline is a must, but that hasn’t set me free…it burdens me because I am overly-driven. I believe that my tenacity, perseverance, and ability to stay at a task long after others would have left it is a God-given gift…yet sometimes, I think it is also a curse! I guess I haven’t incorporated the “balance” component yet!However, I also believe that I am able to step out of my comfort zone, put myself “out there” or extend myself, try things…and achieve some pretty awesome things now and then because I do not expect that I will be perfect and I recognize that foibles, errors, and imperfections are very human. I realize that not everyone will like me or my style…and that’s okay…because not everyone will! No matter how great someone is…there’s always critics in every corner!I believe acceptance of my humanity and acceptance of the varied temperments of others helps to free me to be myself…extend myself…and be who I was designed to be…and do what I was designed to do. That sure helps me to work through the neurotic self-doubt and shame that has haunted me over the years.”

As I considered that response, it reminded me of a section in the introduction of the DBT-CBT Workbook I wrote last year.   This section is entitled, “Saving Face: DBT-CBT in Action” and the text from this section is below.

You’ve heard the saying about “stepping in it.”  Well, I sometimes “step in it”…and the work of this book is no exception!  I spoke to a professor at Texas A&M, Dr. Brian Stagner, about reviewing this workbook.  He was my mentor during graduate school and he graciously agreed.  Although I’m proud of this work, at the same time, I’m a little embarrassed by it!  That’s a dialectical problem by the way!  I figured he’d be impressed by the content, but stunned by the language and grammar…so, I never sent it to him!

Part of DBT-CBT is Choosing Our Battles and Taking a Stand and Fighting for what’s MOST IMPORTANT to us…NOT EVERYTHING in life.  It’s also about being prepared for and accepting the consequences of our behavior and choices.  It’s also about being wise…and we’ll see if I made a wise choice!  I expect to take some hits on grammar, like dangling participles, commas instead of semicolons, overuse of contractions, pronoun and antecedent disagreement, Texas slang, and other informal language and grammar.  The truth, I wrote this for the average person and in a language many people speak…except for some southern slang!  It wasn’t written for a professional audience, though I hope many in that audience will read it.  I’m an informal, “down-home girl” and I wrote this for “down-home people.”  I CAN BE formal if I have to be, but I certainly PREFER NOT!

Another criticism I expect is repetition in the workbook.  I tried to write this as I would speak it and teach it in Group.  When I teach important principles and concepts, I often repeat myself by explaining the same thing in different words…one sentence right after another.  Sometimes, hearing something said in different ways helps us to understand and remember it better…and if our minds have wandered, maybe we’ll get it the second or third time around!  I’m very invested in the people I work with…and I’m passionate about doing my part to change lives.  I drill home some points because this is intended to be a learning AND recovery experience.  It’s NOT designed for casual reading or entertainment purposes!

You’ll notice some repetition across chapters. My belief, most people don’t have audiographic memories…like they hear something once and remember it. My goal is for people to understand and remember these life-changing principles, concepts, and skills…so they’ll be equipped to apply them in Real Life. Many of us are hard-headed and need this information drilled into our minds. We may not WANT to hear some things and we may not be ready to look at or process some things. We usually have to be emotionally MOVED before we DECIDE to make difficult life changes. Being MOVED often involves looking at the Big Picture of Reality until our eyes are opened and the truth sinks in. Further, to learn how to carry out these skills and to live these concepts…we need to live, eat, and breathe this information until we know it so well we can repeat it back to ourselves. We LEARN by repetition.

Also, everyone doesn’t read a book cover to cover in a few days.  When time goes by, a review of important principles and concepts helps us to get the most out of what we’re reading.  Further, when we’re stressed out by life, our brain is working full capacity to survive and meet here-and-now demands…and it isn’t always so able to fully process and learn new information.  On top of all this, some of us have used a lot of drugs and alcohol, are aging, on medications, or have had head injuries…and our attention, concentration, and memories aren’t like they used to be!  Also, some folks have had learning problems all their lives.  Others may have symptoms of mental illness which affect their ability to concentrate.  In my mind…REPETITION IS GOOD!

The last point of embarrassment is…there WILL BE errors and typos…and Lord, I hope not…lost lines…where they disappear when the document is printed.  I know I’m obsessive-compulsive…a perfectionist in many ways.  I could review this book for ANOTHER year…and continue to make changes.  However, if I don’t GET ‘ER DONE…it’ll be half of forever before it’s in print and can be helpful to people who are HURTING and SUFFERING.  Getting this in print is much more important than perfection and my ego.

Some folks don’t like how I’ve used CAPITAL LETTERS.  I took some out, but left many.  Again, I’m trying to drill home points.  The capital letters are intended to draw attention to important principles and concepts…things I really want folks TO GET and be aware of!  Sometimes, they’re for emphasis (like to say louder when we’re reading), but most often they’re there to highlight a point.  The capital letters may make reading a little difficult until you get used to the writing style.

So, I resolve my dialectical problem of being both proud of this work and embarrassed by it.  I realize I want to print the PERFECT book to please a professional audience…however, I also recognize this book is for the average person who desperately seeks recovery.  THAT IS its value and purpose.  I ACCEPT that no matter how obsessive-compulsive and perfectionistic I am, I’m not perfect and I’ll make errors despite my best efforts to avoid them.  I also understand that although I’m a highly educated professional, it’s not my spirit to interact with the world in a formal manner.  I’m different, I’m down-to-earth, I am ME…and I’m okay.  Some people will accept and embrace this work…others will criticize it.  I understand some people will find fault no matter what…but, I’ve “stepped in it” and have set myself up for criticism because I haven’t used proper grammar or writing rules.

I’ll take my hits, do Damage Control, fix things as I see appropriate, and I’ll move on down the Recovery Path…and on with life!  Perhaps our paths will cross as we journey through the Pathways of Recovery.  Hope to see you there.

And to that, I say, “AMEN!”

So, what frees you to be yourself…and to be who you were designed to be…and to do what you were designed to do?

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

Using Rational Mind to Challenge the Emotional Mind Lies We Tell Ourselves That Sabotage Our Self-Confidence and Recovery: A View of Addiction Recovery from a DBT-CBT Therapy Perspective

Here’s an “adapted” excerpt from the DBT-CBT “Out-of-Control” therapy workbook.  It’s from Chapter 7, the Rational Mind chapter.  This chapter discusses Rational Mind in detail and offers many Rational Mind challenges for the Emotional Driven Lies we tell ourselves AND WE BELIEVE…ones that often sabotage our self-esteem and our recovery.

The Self-Fulfilling Prophecy of Failure:
“I expect to fail so I don’t try very hard …so, I fail.”

SKILL BUILDER: Failing to Succeed…or Successful Failures

Consider the lies we tell ourselves about success and failure, like,

“I’ll NEVER be  able to do it.”

“Everything I try gets screwed-up somehow.”

What do you say about your failures?  ____________________________

The truth…we MAY HAVE failed at MANY tasks.  If so, we need to rationally understand why.  Quite often, we fail because we DON’T TRY to succeed.  We “KNOW” we can’t do it…so we DON’T TRY, or we DON’T TRY VERY HARD.

Despite USUALLY giving things ONLY A HALF-HEARTED EFFORT, we may recall some times WHEN WE REALLY TRIED, but failed anyway.  BUT, DON’T THINK we’re off the hook because of some FULL EFFORT failures.

WE DON’T GET TO STOP TRYING just because when we’ve REALLY TRIED, we’ve still failed!  Rational Mind would inform us that MOST PEOPLE WHO SUCCEED HAVE FAILED MANY TIMES.  There are many TRUE stories to support this TRUTH.

Which stories have you heard…about people who FINALLY SUCCEED AFTER A LONG STRING OF FAILURES? _____________________________

Abraham Lincoln ran for MANY political positions and lost MANY TIMES before he ever WON an election.  The ONE he won was THE BIG ONE…the PRESIDENTIAL election!  There are MANY stories about business leaders who had MANY failed businesses before they hit it big!  Henry Ford went bankrupt 5-6 times because of failed businesses before he gained success in the automotive industry.  The Heinz company had the same kind of start.  Have you read that Oprah was fired from a reporter’s job because she wasn’t right for TV?  Somebody certainly misjudged her!

Some of our greatest leaders and wealthiest people failed many times
before they achieved great success.

When we fail, we need to SEEK AN UNDERSTANDING of WHY we failed.  We need to LEARN FROM IT and CORRECT WHAT WE’RE DOING.  We need to change or adjust our plan to deal with what went wrong.  Successful “failures” start with PLAN A and go to PLAN B, C, D, E…and so on until things work out!  Despite their failures, THEY KEEP ON KEEPING ON!

It’s also important to be Mindful of our successes and accomplishments and to note WE’VE ALL HAD SOME!  We also need to realize that WHEN WE’VE TRIED…when we’ve REALLY STUCK WITH IT, we’ve overcome challenges…and WE HAVE BEEN SUCCESSFUL. Consider the 8-18 attempts at recovery that it takes people ON AVERAGE to become clean n’ sober.  Through our recovery attempts, we learn about our triggers and relapse patterns.  We learn we REALLY HAVE TO change the things in our life that we DON’T WANT TO CHANGE…things that we’ve refused to change, like friendships, activities, and abusive or conflict-filled relationships.  Because of our repeated failures at recovery, we FINALLY SUCCEED!  That’s because we’ve revised our Recovery Plan SO MANY TIMES that we FINALLY GET ENOUGH OF THE NECESSARY CHANGES made!  We’re hard-headed and we’ve got to learn from OUR experiences…and in the world of recovery…these experiences ARE OFTEN RELAPSES.

Does this information change the way you think about your “failures”?  If so, explain.  ______________________________________________


and UNDERSTAND they’re a NATURAL part
IF we learn from them.

It’s clear that Emotion-Driven Thoughts like, “I can’t do it. Why try?” are lies we tell ourselves. What’s the truth? _______________________________

The truth is, WHEN WE KEEP TRYING, things FINALLY work out.  Sometimes, we don’t succeed because we aren’t going about it the right way.  Therefore, we need to get a NEW PLAN.  Sometimes, we try to do more than is do-able at one time.  We plunge head first when we’d be better off wading in and taking smaller steps!  There are many reasons why we haven’t reached our goals.  Fortunately, most of these problems can be overcome with PERSISTENCE and a REVISED GAME PLAN!

Footnote: This footnote is “margin text” from the workbook alike the dark red inserts in the text above…however, these weren’t so easily woven in!  This first one relates to the 8-18 tries at recovery it takes on average to recover from substance abuse.

“Some say, ‘Been there, done 14, I’ve got to be real close to making it!’ Folks who are new to recovery are discouraged, ‘I don’t want to do this that many times.’ Be Mindful that 8-18 is an average. Some make it on the 1st try (they need to write the book!), others on the 25th. Some make it in 3 tries, others in 20. Bear in mind though…these numbers don’t mean it’s okay to relapse 17 times and then work real hard on the 18th try!”

These are “sayings” in the margin that go along with the text:

“If we don’t put forth a FULL effort,
we’ll never REALLY KNOW if we can succeed.”

“We never fail until we quit trying.
Success comes to those who are determined
to overcome obstacles in their path.”

When we understand that our failures are part of the learning process,
then we can constructively accept our failures and learn from them.

We’re so willful and hard-headed about recovery…
we won’t take someone’s advice or learn from THEIR experiences.
We have to learn from OUR personal experiences…
which is often OUR failures!

A mistake is only a mistake
if we fail to learn from it!
When we learn from our experiences,
our failures become a stepping stone toward success!
Therefore, a recovery goal is to Turn On Rational Mind to challenge our “failure” lies…
and to Turn On Wise Mind to make some adjustments to our Game Plan!
That’s because WE haven’t failed, our plan has!

Hope you enjoyed this blog entry and that it helps to challenge destructive “failure” thoughts.  It took half of forever to format this…the format of the workbook doesn’t cut n’ paste very well…or at least I haven’t learned yet how to do it more efficiently!  Life is one big learning curve and I guess sometimes we’ve just got to hold on…persevere…and enjoy the ride!

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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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


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)