What a Dialectical Behavior Therapy (DBT) Session Looks Like

Summary

In this insightful session, Dr. Judy Hope demonstrates Dialectical Behavior Therapy (DBT) with a patient named Kyle, who struggles with depression and feelings of hopelessness. The session focuses on managing depressive symptoms and preventing future episodes through self-soothing techniques and the concept of 'wise mind,' which balances emotional and logical responses. Dr. Hope introduces practical strategies like engaging in pleasant activities daily and accepting the current experience to foster resilience and navigate through depressive episodes.

Takeaways

• 😀 The session demonstrates an example of Dialectical Behavior Therapy (DBT) with Dr. Judy Hope and a patient named Kyle.
• 🤔 Kyle is dealing with depression, feelings of hopelessness and helplessness, and is seeking help to manage these symptoms using DBT.
• 💊 Kyle is on antidepressants and has a history of depressive episodes but has stopped therapy due to a move and is looking for a new therapist.
• 🔄 Kyle discusses the cyclical nature of his depressive symptoms and the impact of his work and pride on his mental state.
• 🧘 Kyle has tried various methods to cope with his feelings, including overeating, exercising, and focusing on a clean, organized environment.
• 🌱 Dr. Hope introduces the concept of self-soothing using the five senses as a quick method to manage distress and prevent escalation into a depressive episode.
• 💡 The importance of not rushing to prevent depressive episodes but accepting their occurrence and having the skills to handle them is emphasized.
• 🧘‍♂️ Kyle is encouraged to engage his 'wise mind,' a state of mind that combines emotional and logical thinking to make balanced decisions.
• 📝 Dr. Hope provides a list of pleasant activities as a preventive measure and for building an emergency toolkit for Kyle to use when feeling hopeless.
• 🔑 The session highlights the DBT principle of finding balance and not being overly rigid in thinking, which is key to managing depressive symptoms.
• 🌟 Kyle's biggest takeaway is the realization that he needs to work with both his emotional and logical sides, rather than fighting or negotiating with them.

Q & A

What is the main purpose of the session between Dr. Judy Hope and Kyle?

The main purpose of the session is to explore how Dialectical Behavior Therapy (DBT) can help Kyle manage his depressive symptoms and develop strategies to prevent or cope with depressive episodes.

What is Kyle's current mental health status according to the transcript?

Kyle mentions that he is currently not experiencing severe symptoms, but he still has feelings of hopelessness, helplessness, and self-doubt about his worth and impact, especially in relation to his work.

What does Kyle believe about the origin of his feelings of hopelessness and helplessness?

Kyle believes that these feelings are hardwired in his brain, possibly due to heredity, similar to how he has Crohn's disease, and not due to lifestyle factors or lack of social interaction.

What strategies has Kyle tried in the past to combat his depressive symptoms?

Kyle has tried overeating, exercising, and sleeping as subconscious methods to mask his feelings. He also mentioned using medication and therapy as part of his coping mechanisms.

What is the concept of 'wise mind' in DBT as discussed in the session?

The 'wise mind' in DBT refers to a state of mind that integrates both the emotional and logical aspects of a person, transcending them to make better decisions and find deeper meaning in experiences.

What is the significance of the 'roller coaster' and 'play' analogies used by Dr. Judy Hope?

The analogies are used to illustrate the different levels of self-awareness and emotional distance one can have from their experiences. It helps to understand that there is a part of oneself that remains intact and can observe and survive even the most painful episodes.

What is the role of 'radical acceptance' in managing depressive episodes as per DBT?

Radical acceptance is a technique used in DBT to accept the current experience without judgment or resistance, acknowledging that there is a part of oneself that will always survive the episode, which can help in reducing fear and distress.

What is the 'pleasant activities list' and how is it supposed to help Kyle?

The 'pleasant activities list' contains 250 activities designed to improve positive emotions. Kyle is encouraged to pick one activity from the list to do every day as a preventive measure and to manage depressive symptoms when they arise.

How does Dr. Judy Hope suggest Kyle should approach the inevitable feelings of hopelessness and helplessness?

Dr. Judy Hope suggests that Kyle should not rush to prevent these feelings but instead practice acceptance and use strategies like self-soothing with the five senses, engaging the wise mind, and doing pleasant activities to manage the moments when these feelings arise.

What is the homework assignment given by Dr. Judy Hope to Kyle at the end of the session?

The homework assignment is for Kyle to look at the pleasant activities list, pick one activity to practice every day, and circle the ones that work best for him as he experiments with them, with the goal of building an emergency tool kit for when he starts to feel hopeless and helpless again.

Outlines

00:00

😔 Introduction to DBT Session

In this introductory paragraph, Kyle, a patient diagnosed with depression since childhood, begins a DBT (Dialectical Behavior Therapy) session with Dr. Judy Hope. Kyle explains his history with depression, including multiple depressive episodes and his current struggle with feelings of hopelessness and helplessness, despite being on antidepressants and having a generally good life situation. He expresses his need for a new therapist and his interest in DBT as a method to manage depressive symptoms. Dr. Hope engages with Kyle's concerns, focusing on his current symptoms and the impact of his depressive episodes on his daily life.

05:00

🤔 Exploring Coping Mechanisms

This paragraph delves into Kyle's attempts to manage his depressive symptoms. He discusses various coping mechanisms he has tried, such as overeating, exercising, and sleeping, which he acknowledges may have been subconscious efforts to mask his feelings. Kyle also mentions the importance of medication and staying busy in his life, suggesting that these activities help keep his depressive symptoms at bay. However, he expresses that these methods do not address the root of his feelings of hopelessness and helplessness, which Dr. Hope identifies as a key area to focus on in the therapy session.

10:03

🌿 Discussing Self-Soothing Techniques

In this paragraph, Dr. Hope introduces the concept of self-soothing using the five senses as a method to manage immediate feelings of hopelessness and helplessness. She emphasizes the importance of finding quick ways to self-soothe that can be implemented in under a minute. Kyle and Dr. Hope explore different sensory experiences that could potentially soothe Kyle, such as visual images of his dog, looking at real-estate magazines, and the scent of a clean, organized house. This approach aims to provide immediate relief and prevent the escalation of distressing emotions.

15:03

💪 Acceptance and Wise Mind Strategies

The focus of this paragraph is on the acceptance of depressive episodes and the introduction of wise mind strategies. Kyle discusses his difficulty in accepting the inevitability of depressive episodes and the intense pain they bring. Dr. Hope uses the analogy of watching a play to illustrate the different levels of self-awareness and separation from the immediate emotional experience. She encourages Kyle to understand that there is a part of him that remains whole and intact, even during the worst episodes, and to use this understanding to foster acceptance and resilience.

20:05

🛠 Developing Wise Mind Decisions

Dr. Hope continues to guide Kyle towards developing wise mind decisions during moments of hopelessness and helplessness. She explains that the wise mind is a state where both the emotional and logical aspects of oneself work together to make better decisions. Kyle is encouraged to consider what his wise mind would do in the face of his depressive feelings, rather than letting his emotions or logic dominate his actions. Dr. Hope emphasizes the importance of improving the moment, finding meaning, and making decisions that are not based on immediate emotions or strict logic alone.

25:05

📝 Implementing Pleasant Activities

In the final paragraph, Dr. Hope assigns Kyle the task of engaging in pleasant activities as a form of daily practice and prevention. She provides a list of 250 activities and asks Kyle to select one to do each day, with the goal of improving positive emotions and building an emergency toolkit for moments of crisis. The activities range from simple tasks like coloring or taking a bath to more involved actions like reading for fun or spending time with others. The purpose is to help Kyle break down his experience into manageable moments and to practice not seeking a grand solution but instead finding ways to improve the current moment.

Keywords

💡Dialectical Behavior Therapy (DBT)

DBT is a form of cognitive-behavioral therapy that focuses on the concept of dialectics, the balance of opposing forces or ideas. In the video, DBT is used to help the patient manage depressive symptoms and improve emotional regulation. The theme revolves around applying DBT principles to understand and cope with feelings of hopelessness and helplessness.

💡Depression

Depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. The patient in the script discusses their diagnosis and experiences with depression, which is a central issue being addressed through DBT.

💡Hopelessness

Hopelessness refers to a feeling of despair about the future, often associated with depression. The script frequently mentions the patient's struggle with feelings of hopelessness, which is a key symptom they are trying to manage with DBT.

💡Helplessness

Helplessness is the feeling of being unable to change or control a situation. The patient describes feeling helpless, particularly during depressive episodes, and this concept is a focus of the DBT session to develop coping strategies.

💡Self-soothing

Self-soothing is a technique used to calm oneself during moments of distress. In the script, the therapist introduces the idea of using the five senses for self-soothing as a way to manage feelings of hopelessness and helplessness.

💡Fight-or-flight

The fight-or-flight response is a physiological reaction to a perceived harmful event, leading to a decision to either confront or escape the threat. The therapist in the script discusses the importance of not being in a state of fight-or-flight to make effective decisions and to process deeper issues.

💡Wise Mind

Wise Mind is a concept in DBT that refers to a balanced state of mind that integrates emotional and logical thinking. The therapist explains the importance of engaging the Wise Mind to make decisions that are more effective in managing depressive symptoms.

💡Radical Acceptance

Radical Acceptance is a DBT technique that involves fully embracing the reality of a situation, even if it is uncomfortable or distressing. The therapist suggests using radical acceptance to accept the current experience and the knowledge that a part of the self will always survive.

💡Pleasant Activities

Pleasant activities are tasks or actions that bring joy or satisfaction. The therapist provides a list of pleasant activities as a preventive measure to improve positive emotions and as part of the patient's emergency toolkit.

💡Emotion Mind and Logical Mind

Emotion Mind and Logical Mind are terms used in DBT to describe the emotional and rational aspects of an individual's thinking. The therapist discusses the importance of not forcing these aspects to compete but to work together harmoniously in the Wise Mind.

Highlights

Introduction to a Dialectical Behavior Therapy (DBT) session with Dr. Judy Hope.

Patient Kyle discusses his struggle with depression and depressive episodes.

Kyle shares his experience with antidepressants and the discontinuation of therapy due to relocation.

Dr. Hope inquires about current depressive symptoms and their impact on Kyle's life.

Kyle expresses feelings of hopelessness and helplessness despite his current life circumstances.

The discussion of the impact of work and personal life on Kyle's feelings of self-worth.

Kyle's experience with intense depressive episodes and their debilitating effects.

Strategies Kyle has used to cope with depression, including therapy and medication.

Dr. Hope introduces the concept of distress tolerance in DBT.

The importance of self-soothing with the five senses to manage immediate distress.

Kyle's exploration of self-soothing activities that appeal to his senses.

The concept of acceptance in DBT and its role in dealing with depressive episodes.

Kyle's realization of the separation between his true self and depressive feelings.

Dr. Hope explains the principle of wise mind in DBT and its application.

The introduction of a pleasant activities list as a preventive strategy in DBT.

Kyle's assignment to practice a pleasant activity daily and build an emergency toolkit.

The session concludes with Kyle's understanding of the importance of integrating emotion and logic.

Transcripts

[Music]

now that you understand each principle

of DBT it's time to see them in action

in this episode dr. judy hope performs

an example dialectical behavior therapy

session dr. ho I've got no questions

here all right my glasses are real I'll

let you take it away okay well thank you

so much for coming to see me Kyle what

can I help you with today

well my I was diagnosed with depression

at nine years old I have had three major

depressive episodes in my life after

that maybe after the age of 10 or so and

I do take an antidepressant every day

but I stopped going to therapy maybe

three months ago because of a move so I

just need to find a new therapist so I

heard you were really good night circle

I'm really just looking to see how DBT

can help me manage some of my depressive

symptoms and depressive episodes okay so

what types of symptoms are you still

struggling with right now

well it's actually pretty good right now

and it's easy not to have symptoms come

up I think when everything in your life

is pretty good and everything in my life

is pretty good right now so that makes

it easier but there is still feelings of

hopelessness and helplessness that

reoccur

there's also feelings of just not being

enough like I take a lot of pride in my

job at Med circle and what we're doing

and what we're doing for people and and

you know that in other parts of my life

as well I work a lot with animals and

people with animals and that that has a

lot of pride for me attached to it

because I want to help people that way

and I but I still have those ones where

like is this is this am i doing enough

am i making a big enough impact am I am

I really helping or am I just telling

myself

I'm helping and yeah and I think that's

kind of in general yeah so sometimes you

still struggle with for example thinking

whether or not you're valuable

worthwhile enough you connect that

sometimes to the work that you're doing

so obviously when you're doing great and

you feel great about it

everything's awesome but then you make a

mistake or something like that you might

take it harder than the average person

perhaps I don't know if I take mistakes

harder than the average person

I pretty much all make mistakes so for

me to make a mistake that's okay mm-hmm

I just I always want to be putting out

the best that I can do and that's that

is not always possible and so when when

I kind of feel those times are occurring

that's hard for me and on a more

significant scale while it hasn't

happened recently I'd say you know in

the last six months

there are times where it I'm so

depressed you can't you can't get me out

of bed I cannot function it doesn't

matter how much I'm hearing you or

understanding what you're saying it

doesn't change my inability to take care

of myself like I can't take care of

myself I don't eat or I eat too much I

mean my life it just becomes a a

splatter of mess you know until I can

finally dig out of it how do you usually

dig out of it well I go to my therapist

a lot and then you know sometimes we

change medications yeah sometimes it's

just a realization right there though

I've had those times in my life through

therapy I have a realization oh my gosh

that's why and then as soon as I know

that's why I'm like ah well now that

makes sense now you can move on right

yeah that makes sense

um tell me a little bit about the

hopelessness or helplessness that you

feel sometimes well I believe that those

feelings are hardwired in my brain

mm-hmm and I don't I feel like I was

born with that and it sucks mm like I

have Crohn's disease I I didn't

come in contact with some rare bug and

get Crohn's disease

I just got it they think I it was

hereditary right and that's how I relate

it to depression I it's not because I

like don't exercise enough or I don't

believe it's because of these reasons in

order that I'm not social or whatever it

is it's just my brain is wired

differently and its default is to be

helpless and hopeless hmm and I have to

work against the way my brain is set on

a default mm-hmm to not fall in to that

category and so if when that happens

there's no that we I would have canceled

today there's no there's no room for

anything in my life

hmm when that's full okay so I think for

today we're gonna focus on two things I

think one is to try to manage this

hopelessness helplessness that's kind of

long-standing as you mentioned and

clearly when you're having problems

managing your activities of daily living

when you're super depressed that

certainly amplifies the hopelessness and

helplessness because that just kind of

starts to percolate even more like I

can't do anything right so I want to

focus on that a little bit and I think

the other piece I want to focus on is

just developing a prevention plans

because right now you're doing great yep

so it's really about okay how do I sort

of reduce my vulnerability to having

another significant episode and how do I

manage it when I start to see some of

those things creep in mm-hmm so we can

sort of make sure that we get back to

the baseline that I feel more

comfortable at okay so the first thing I

want to talk about is the hopelessness

and helplessness aspect because it is so

long-standing and it's something that

you were saying that you always have to

fight and what have you tried so far to

try to fight that like do you just try

to try to tell yourself to be positive

like what are the things that you've

tried in the in my past I have tried

overeating I've tried exercising

I've tried sleeping and these are all

things that I was probably doing on more

subconscious level to try to mask

whatever I was feeling there even was a

period where I'm like am i grabbing that

wine bottle because I want a glass of

wine or because I'm feeling this way and

that was very alarming to come to a

conclusion of things that have been

successful is there

good old tell me about your father there

from a psychiatrist or a therapist

medication has been wonderful I don't

believe I could live the life I'm living

without it and being busy mm-hmm

is in getting enough sleep are probably

the two biggest things that help me keep

it at bay

I don't feel like I'm addressing it

right right I feel like it's a bay right

yeah cuz you know we drove up here to

film this today and then we're supposed

to get on a plane tomorrow morning and

be gone for 40 we're just constantly

busy busy busy yeah and so that when

you're so busy

you don't have time to be helpless and

hopeless because you're busy right Yeah

right exactly so sometimes maybe that

distraction is keeping it at bay yes but

you don't feel like you've addressed the

root right so I think one of the things

about hopelessness and helplessness that

people find interesting is of course

that we are all preferably agents of our

lives like we want to be able to be

masters of our universe to some degree

and when things feel like they're

starting to slip out of control that can

come up a little bit more often than

other times as you said you know

sometimes things are hardwired you feel

like maybe you are prone to that but I

think it still comes from a very human

need to want to be masters of our

universe in some way none you don't want

to have something happen to you that you

didn't foresee and therefore don't have

an action plan and when there are

challenges that come up when you are

prone to hopelessness and helplessness

that could be your first default is oh

I'm not gonna be able to manage this

sort of like a message that you tell

yourself it's not gonna get better or

here we go again

and even though cognitive behavioral

therapy does work on some of the

modifications of these thoughts what I'd

like to focus more on is your tolerance

of those stressful moments in that time

and using that as a route to get to some

of the underlying issues I get that we

really can't deal with the underlying

issues if we can't get to a baseline in

the moment and what I mean by that is if

you are in fight-or-flight the part of

your brain that actually gets activated

is the primordial parts of your brain so

that's not the frontal lobe that makes

good decisions and manages your mo

effectively that's the part that's just

trying to survive that moment so we have

to find a way to get you out of that

fight-or-flight activation and bring you

back to a baseline where you feel like

you know what there's nothing wrong with

this moment right now therefore I don't

have to activate that fight-or-flight

and that leaves you more room to then

process the deeper issues if that makes

sense it does so with the distress

tolerance there's a couple of ways that

we can work on this one thing when

you're are feeling hopeless and helpless

is to try to improve that moment at that

very time and so a very simple way is

just to self-soothe with your five

senses and this just involves you

ticking off for each of your senses

something that is pleasant for that

sense and being able to commit to using

those in under one minute and I think

that that's really important part of

this which is that when you are starting

to have that hopelessness or

helplessness well up that there's

something that you can do to self-soothe

in under one minute that's simple so

what are something that you can think of

for example that would appeal to you

visually that would make you feel calm

or relaxed what does that involve

something visually yeah like for some

people some people they like to look at

a picture yeah so I really like

aquascaping okay it's underwater

gardening okay so I watched these video

they're more than a minute though I

don't know if that would work because I

these videos are logged but it is very

peaceful and soothing and calming to

watch somebody garden underwater

essentially but that's not that's not

less than it's not a minute it's much

more than that so I would just say

images of my dog yeah great

I've never thought about looking at an

image to handle depression so I don't

know right yeah and I think it really

does show again how simple it can be

yeah just in that moment just to improve

your moment by looking at something

that's happy you know what I love

looking at is um real-estate magazines

yeah and I was looking at one last night

on my coffee table and I thought why

don't I look at this more this is so

yeah

so I could do that for a minute awesome

yeah I've had people tell me things like

they want to look at a clothing catalog

I'm yeah no judgment whatever works for

you right yeah so whatever brings you

that sense of peace let's try it one

more sense like what about like all

factory like things that bring you

senses of relaxation and calm like when

you smell a particular fragrance or any

other kind of thing that would you know

what calms me down so fast uh-huh a

clean organized house if I walk into my

house and it's clean and organized oh

nice yes if it is chaotic and there's

dirty laundry I'm gonna go home too

today

can I go so all factory it's an

environment that's clean organized and

not stressed yeah because if my

environment look stressed then I get

stressed yeah so a sense of cleanliness

anything that would evoke that for you

yeah

sometimes people enjoy like smelling

their

dryer sheett yeah yeah cuz it like

reminds them of a clean house yeah I

would that I would just go why am i

smelling a dryer if I do that I do have

a new detergent called yeah fray I think

that's the best not sponsored by fray

always only by freight detergent so that

scent does call me down okay

what about something that appeals to

your tastes and people like to you know

eat a mint like to a piece of gum like

it tends to calm down a bit like is

there anything like that for you certain

foods no sushi I like sushi

I do love a Pellegrino water yeah

that to me is a when I was broke when I

had no money but I was like I need

something to just make me something

other than pasta and butter yeah I would

buy a bottle of Pellegrino water cuz

it's you know a dollar 20 but yeah the

joy is like ten dollars or 20 cents yeah

I think it's so good absolutely I like

that okay great

so these are just you know examples you

can think some more about it but really

it's all about self soothing with your

five senses for under a minute and

usually people will find that even

utilizing one or two of these things

it'll change their experience in the mo

enough so that they're not engaging

their fight-or-flight and they can take

a little bit more time to be more

concerted about their next step so I

have a question about that because in

most of my experiences with these major

episodes I have been aware that they

were coming on mm-hmm

and so I've actively made decisions to

try to not have them happen mm-hmm and

it never worked

mm-hmm I would go to go see a movie I

would call a friend I would clean my

house I would do all these things and it

it it seemed inevitable yeah

and now if they were to come on again I

would believe that it was inevitable

right I wouldn't believe that those

things would keep it from coming it

might delay it yeah but not keep it from

coming that's what I believe right and I

think part of this is also not rushing

to have to prevent it from coming it's a

weird idea but DBT is really about

accepting the current experience I I

don't think I could ever be in a

position to accept that type of episode

occurring because it is it is the worst

thing that's happened to me and it's I

could start crying right now thinking

about and it's happening three times

it's and my mom died when I was 16 those

depressive episodes are worse than that

day it is it's like being shot with a

gun but you're alive

yeah you're and you have to live right

while you have bullet holes in your body

right and no one sees you bleeding yeah

why do you what are you talking about

there's no bullet holes in you but you

feel like you've been shot yeah so I

don't I I can't I don't understand how I

can write be like well that's gonna

happen right it's not about giving up

though on being able to change the

experience it's just about not being

afraid of it coming because you know you

have the skills you need to deal with it

and it's hard to do that because

obviously they've been so incredibly

painful for you but you are still

sitting here and you survived them yeah

and it's sort of like even in the worst

occurrence I know that I'm gonna emerge

on the other side that is the kind of

acceptance

that would be helpful for us to delve

into a little bit doesn't mean that you

like it nobody's saying that you should

like it or want it to happen or not want

to change the experience once it's here

or once you anticipate it being here

right but it's about understanding that

on the other side you've emerged that

there is a part of you that remains

intact even after these horrible

episodes I do understand that yeah yeah

perhaps my hopelessness is exaggerated a

little bit because even in the worst

moment I understood what it was yes I

knew it was almost like I was separated

like the true version of me was here

yeah and we were on this ride that we

didn't want to be on with the fake

version of me

right so I recognized that it wasn't me

I recognized that it wasn't who I was

and I recognized it was something that I

felt like at the time was happening and

I couldn't control it

but I knew that it would eventually go

away right because I wasn't going to die

yeah I was leave it there I like to use

the analogy - I like your analogy of the

roller coaster and I often use the

analogy of people watching a play and

there's the actors in the play and

sometimes there's horrible things going

on in the storyline and then there's a

narrator who is talking about what's

going on even the bad storylines but

they're a little bit removed because

they're narrating the entire story and

they kind of know the beginning in the

end and then there's the audience

members who are even on another step

more removed because they're watching

all of this unfold but they don't

necessarily have a personal stake in it

mm-hmm and I think that there's all of

these different levels of who we are

there's a level of us that's like

actually the characters experiencing the

pain in the turmoil because the

storyline is horrible and then there's a

narrator who can take a step back and

say okay I'm mindfully observing what's

happening and yeah this is a really sad

story

but I'm not emotionally steeped in it to

the same level of

the pain that the actors themselves

might be experiencing and then if you

back up another level they're sort of

the audience which is the audience will

always be there there's different

audience members for different plays

they're interchangeable but in the end

they've always been a group that will be

there at any show and that particular

piece is the self that has seen you

through all of your pain and all of your

happy times and remains intact and

nothing happens to it that part of you

is whole and understanding that

sometimes can help with distressful

moments that there will be a part of me

that emerges whole and there's a part of

me that feels broken right now but like

you were saying there's these different

aspects of yourself and being able to

separate out sometimes preserves the

part of you that needs to be preserved

at a time I so get that that metaphor

makes perfect sense to me yeah that's

how I feel yeah and it's great because

you've already made that connection and

of course it's like what do you do with

that now and so sometimes we resist

these horrible things from happening

because we know how horrible it is and

there's one thing - until actually say I

can stand it but then there's also what

do you do in the moment when it's

happening right and I think in the

moment when you find yourself struggling

with hopelessness or helplessness the

first thing to do is to spend a little

bit of time under a minute just writing

your mind again okay we're not in the

state of emergency I'm able to handle

this whatever I need to do to reengage

out whether it's ten deep breaths or

self-soothing with the five senses or

whatever I need to do to make sure that

I can put my mind at a state that is not

in fight-or-flight because we don't make

it decisions then and it's hard for us

to engage our wise mind mm-hmm then

after that once you realize that you've

sufficiently gotten to a place of calm

then it's about introducing some of the

deeper level strategies to try to manage

the situation so the first one is wise

mind it's this principle of engaging

both the emotional and logical sides of

you to a wise mind that actually can

sort of transcend all of that is sort of

the 1+1 doesn't equal to it's it's more

than that it's more than the sum of its

parts it's not just logical and emotion

mind together it's

something even better where you can

actually take a step back and say here's

what my emotion mine wants to do here's

what my logical mind wants to do but

when I gather everything together and

also experience that there is a deeper

meaning to all of this and what we're

going through what would that part of my

mind want to do next so when you feel

hopeless or helpless I'm imagining that

your emotion mind is like screaming for

you to run back into bed or do whatever

you need to do know and then maybe

there's your logical mind that's

thinking okay what are the things that

have worked in the past mmm can I apply

any of them now I should apply them now

I should get better why am I not better

why is this coming back maybe it's also

the part that yells at you and your self

criticizes yep so then what would your

wise mind do in that experience

you're asking me huh yes I I don't I

don't know I've never thought about it

that way yeah I've I've only tried to

ignore my emotions and act on my logic

that is truly what I've tried to do yes

when my emotions like just get back in

bed I'm like I don't really I really

shouldn't do that I should do this but I

don't want to do that and I probably

just end up getting in bed anyway yep

because that's the emotion part is so

strong in those moments I've never I

don't know I don't know how to answer

that question yeah and so emotion and

logical might often fight each other

it's that dialectic that you're talking

about the emotion might say I want to

get back into bed and your logical mind

say you lazy bum you're not getting back

into bed you know that's gonna make it

worse why don't you do something

different for a change right to try to

motivate yourself to get out of this and

it doesn't work because you're forcing

them to compete for it for the next step

and it's really about bringing them

together acknowledging that they'll do

that yeah well and I think that's really

where DBT comes in is by teaching you

the specific strategies to engage your

wise mind so we talked about one of them

already which is sort of this idea of

radical acceptance how do we accept that

moment knowing that there's a part of

you that's always going to survive it

that is one of the techniques that I

think I can do that is one of the

techniques that your wise mind can use

another technique is to try to improve

your positive emotions in that moment so

I'm gonna give you at the end of our

session today a pleasant activities list

there's 250 activities on this list and

all I want you to commit to is to pick

one of those to do every single day as a

means of prevention but also circling

the ones that tend to work the best for

you as you start to experiment with them

that you know can give you a more

positive experience in that particular

moment and some of these activities are

so quick you can do them in like two

minutes and that is another wise mind

decision so it's not about I can't go to

bed or if I go to bed that means I'm

lazy beating yourself up but it's more

about what if I get in bed for half an

hour but while I'm in bed I can do one

of these pleasant activities and that is

a wise mind decision for that moment and

then after the 30-minute passes you do

the next thing and the next thing so

that you're really encountering each

moment as it's happening as opposed to I

need a grand way to solve this problem

yeah it's worse I'm always looking for

the grand way yeah yeah and I think that

is the logical mind the logical mind is

saying you need the grand way you need

to do something right now to fix this

once and for all

mm-hm and the wise mind would say let's

improve the moment let's find meaning in

what's going on and you'll find that

over time the more that you're able to

sort of break down your experience in

those pieces the less the hopelessness

and helplessness will scare you yeah and

that's really yes sort of the core I get

that all of that I sososo understand

that yeah can you give an example of one

of these activities yeah they're like

coloring for example yeah or taking a

bath yeah or cleaning your room yeah

folding your laundry yeah I mean it's

it's things that are so so simple

there's some you know bigger ones as

well but a lot of them you can do on

your own and kind of at any time and

some of them will also involve other

people it might be reading a magazine

reading a book for fun all these

different types of things that maybe you

haven't done just considerably for that

purpose once in a while I'm seen in a

self

yeah but it is a wise mine strategy to

not be so black-and-white in your

thinking in those hopeless and

helplessness moments it's not about if I

go to bed then I've just wrecked

everything it's like how about you go to

bed for 30 minutes and then after that

first 30 minute passes let's see what to

do next

it's that loosening of you have to have

a solution yeah I need to practice

Oh time yes I know we're just kind of

like starting to you know peel back the

layers obviously but I think my homework

assignment for you first and foremost is

to take a look at these pleasant

activities and to pick one to practice

every day and then as you start to

experiment with them to circle the ones

that work the best for you and we're

gonna start to build your emergency tool

kit well let me start feeling hopeless

and help us again this is good awesome

you delivered knowing that I stepped

into this without any preparation it was

great it was great that it made sense

and my biggest takeaway is for sure I've

spent my life fighting my emotional side

yeah and negotiating with my logical

side right when I really need to be

making them work together yeah to have

the what it's both valuable yeah I love

it

alright well we'll in there and go to

our next episode

Yeah right now

[Music]

you