wellness& resilience
TT24
Lesson_14_Resilience_in_your_life_Summing_it_all_up_ONLINE-_chugani.pptxThis is the end!
We have loved being your teachers
We love hearing from students
We will miss you (a lot)!!
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Questions
Mindfulness Activity
Observe Exercise
Instructions: Get into a mindful position, feet flat on the floor, back straight, and eyes softly gazing in front of you. Begin to bring your attention to your breath as it goes in…and out….in…and out. Don’t try to change your breathing or slow it down, just be present to it, fully observing your breath with each inhale and exhale. As you continue to breath, silently say the word “wise” on your inhale….and “mind” on your exhale, focusing your attention entirely on these words as you breathe, settling yourself deeper and deeper into a place of calmness and wisdom. (allow students to practice silently for 2 min and then invite a few to share observations)
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Resilience in Your Life
Lesson 14
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Learning Objectives
The overarching objective of this lesson is to review all previous content covered in the 13 previous lessons in this course:
Foundations of Resilience
Mindfulness
Values and Goals
Distress Tolerance and Willpower
Reality Acceptance Skills
Choosing Attention and Gratitude
Model of Emotions and Cultivating Positive Emotions
Recognizing Negative Thoughts and Changing Them to Positive Thoughts
Managing Negative Emotions
Developing Interpersonal Effectiveness Skills
Relationship and Self-Respect Effectiveness
Healthy Relationships and Interpersonal Effectiveness
REFRESHERs
Today we are going to be reviewing content from all 13 of our previous lessons in preparation for our final exam!
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Participation Week 14
Share one way you are intentionally building a skill for resilience now that you weren’t doing at the start of the semester.
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Why We Need to Manage Stress
On our body:
Headache
Muscle tension or pain
Cardiovascular
Fatigue
Change in sex drive
Stomach upset
Sleep problems
On our mind:
Anxiety
Restlessness
Lack of motivation
Memory problems
Irritability or anger
Sadness or depression
On our behavior:
Angry outbursts
Avoidance of important activities
Overeating or undereating
Social withdrawal
Drug or alcohol abuse
One of the major themes in this course is that there are unavoidable stressors that come along in all of our lives. These stressors can cause frustration and suffering and impair our ability to think clearly and behave most effectively. Stress, as we have learned, has many more negative effects--particularly when we don’t develop the resiliency to withstand and overcome the stressors.
Recall that a stressor is anything that knocks us out of homeostatic balance and triggers the sympathetic response—the “fight or flight” response--in the autonomic nervous system. Unlike other animals, humans have the capacity to let stress linger with them by ruminating on a past stressor or projecting into the future about stress that hasn’t even occurred. When we don’t develop the skills to effectively manage stress it can produce significant wear and tear on our body, mind, and behavior.
Remember the concept “allostatic load.” Stress accumulates in the body and can become toxic to a person’s mental and physical well-being. When allostatic load is high, our bodies, minds, and behaviors can be negatively affected. Experience stress regularly enough and you’re going to damage your cardiovascular system. Moreover, you are more at risk for chronic fatigue, sleep problems, headaches, gastrointestinal problems, muscle loss, and most significantly, adult-onset diabetes.
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Not All Stress is Bad
It’s all about how you perceive stress and what skills and habits you develop to manage it as you pursue a meaningful and fulfilling life both professionally and privately
You’ll also recall that we learned early on that not all stress is bad! Research has shown that a moderate amount of stress actually improves our performance – whereas too little or too much stress can hurt our performance. With stress, the key thing to remember is that it’s all about how you respond to stress – because stress is inevitable and it will happen!
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DUAL FACTOR MODEL OF MENTAL HEALTH
Symptoms of Psychopathology
(Suldo & Shaffer, 2008; Suldo, Thalji-Raitano, Kiefer, & Ferron, 2016)
Subjective Well-Being
Symptomatic but content:
Person has significant amount of distress but also high amounts of quality of life. (11-13%)
Complete mental health:
Low distress and high amounts of well-being and quality of life
(57-62%)
Troubled:
Person has significant amounts of distress and low well-being and quality of life
(15-17%)
Vulnerable:
Low distress and low amounts of well-being and quality of life
(11-13%)
Low - Subjective well-being
Many
symptoms
None or few symptoms
High - Subjective well-being
What you're seeing here is a graphic representing a simple breakdown of the dual continua of mental health and where people can fall on these dimensions. The horizontal arrow represents the distress/illness/suffering continuum and it can range from high to low. The vertical arrow represents the wellbeing-quality of life continuum and it too can range from high to low. Where someone lands on these two continua determine what quality of mental health you have. This model also emphasizes the importance of improving one’s overall mental health by working to minimize distress and/or maximize well-being. Let’s briefly touch on each of these quadrants.
First, I want you to draw your attention to the lower left quadrant. This represents languishing because people who fall in this quadrant experience high distress and low well-being. There are two essential pinpoints for intervention. One is to minimize distress and the other is to promote well-being and quality of life.
Now focus on the upper left quadrant. This one represents high distress and high well-being. People who fall in this quadrant have a mixed bag with regard to mental health, given that they experience times of high distress, as well as have many aspects in their life that enhance well-being and quality of life.
Next, take a look at the lower right quadrant. People who land here are often referred to as complacent or ambivalent, meaning, they don’t have a lot of distress in their life, but they do not have optimal well-being. They may not have tons of happiness going on and are not thriving at the level they could be. The aim for these folks is to optimize well-being to live a richer and fuller life.
Last, bring your attention to the upper right quadrant. People here have what we call complete mental health. Complete mental health means one experiences low distress, but has high amounts of well-being and quality of life. For these people, the goal is to maintain this level of mental health through purposeful life style choices and methods of managing stress.
As you can see, when you understand where you fall within this model, it can help you figure out what areas you might need to improve in to develop better overall mental health.
You don’t need to be experiencing problems to maximize well-being though, you can still learn skills to regulate the intensity of the stress we all face.
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Resilience Defined
Resilience: the ability to survive and thrive in despite life’s daily ups and downs, curve balls, and stressors.
Survive:
Navigate stressful situations successfully
Bounce back after a challenging, adverse situation
Minimize life suffering
Thrive:
Ability to flourish in life
Optimize well-being and life satisfaction
Be as effective as possible in everything you do
What is resilience?
Although the concept of resilience was originally derived from research on children who grew up in adverse circumstances, the concept has evolved and is now seen as applicable to everyone. Why is this so? Well, life possesses adversity and challenges for everyone. Nobody is immune to life stress and suffering--everyone will experience the death of a loved one, have a relationship problem at some point, worry about finances, and experience a range of other difficult situations. Moreover, nobody has perfect well-being and quality of life, so we all can strive to further improve our personal well-being and life satisfaction.
From this perspective, resilience is the ability to survive and thrive. Resiliency is not only about your ability to positively adapt in the face of adverse or challenging circumstances (that is, survive), but it is also about learning the positive skills, strategies, and routines that enable you to live a happy, fulfilling, and successful life (in other words, thrive). In essence, resilience represents the dual continua of mental health in action. Basically, resilient people do what is necessary to minimize distress and maximize their well-being.
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Ingredients for a Healthy, Happy, Resilience-filled Life:
Developing helpful and optimistic thinking
Seeking “good” social support
Good sleep
Clarifying values and doing what matters most
Emotion Regulation
Regular exercise
Role models
Mindfulness-based practices
Problem-solving skills
Purposefully practicing gratitude
Grit and perseverance
Scheduling time for recreation and relaxation
Receiving mentoring
Cultivating positive emotions
Healthy, balanced diet
These are things you can do to put money in the bank so that when those inevitable stressors come, you have reserves and skills to use. Remember that resilience can absolutely be cultivated by engaging in specific skills and practices, and that’s what this class is all about. A useful recipe for resilience is that you want to have a ratio of at least 3 positive emotions for every 1 negative emotion.
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Acceptance vs. Change
Acceptance
Validation
Emotion Regulation Skills
Interpersonal Effectiveness Skills
Change
Problem-Solving
Dialectic or Balance of Life
Mindfulness Skills
Distress Tolerance Skills
We also learned about the fundamental dialectic in DBT, which is the balance between acceptance and change. Dialectical thinking is when we are able to see the value in opposing viewpoints – in this case, acceptance and change are fundamentally at odds with one another, and yet both are needed to achieve wellness and resilience. Mindfulness and distress tolerance skills fall on the side of acceptance because these are about being present with our current moments or reality. Emotion regulation and interpersonal effectiveness skills fall on the change side of the dialectic because these are skills that help us change our current moments or reality. You may be asked on the exam to identify which specific skills learned in this class are change skills and which are acceptance skills. We suggest using your diary card to easily see all of the names of the mindfulness and distress tolerance skills which are acceptance skills, and, all of the names of the emotion regulation and interpersonal effectiveness skills, which are change skills.
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Neuroplasticity
Neuroplasticity is defined as the ability to change the brain’s structure and function in response to enriching experience that consist of:
Learning new skills
Continual or increased use of skills
Enhancing overall performance in areas that initially viewed as weaknesses
For decades, the prevailing dogma in neuroscience was that the adult human brain is essentially immutable, hardwired, and fixed in form and function, so that by the time we reach adulthood we are pretty much stuck with what we have. But research over the last decade has overthrown the dogma. In its place has come the realization that the adult brain retains impressive powers of neuroplasticity--the ability to change the brain’s structure and function in response to experiences, to learn new skills and improve overall performance in areas initially viewed as weaknesses.
Those who pursue developing new skills and attributes capitalize on neuroplascticity and are significantly less likely to develop neurodegenerative disorders such as Parkinson’s and Alzheimer’s. Our brain loves to learn. In fact, it thrives on acquiring new skills such as playing a musical instrument or learning a new dance, a new language, or different evidence-based educational practice. Our brain also thrives in the context of mentoring relationships in which we feel connected to someone else and are in the process of learning new skills and increasing our development in a particular area.
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The direct opposite of mindlessness
Mindfulness is “the awareness that emerges through payin attention on purpose, in the present moment, with an element of openness to the unfolding of experiences moment-by-moment.”
--Kabat-Zinn, 2003
Mindfulness Defined
Also refers to intentional exercises and practices of mindfulness
Lesson 2 was about developing greater awareness and empowerment through the intentional use of mindfulness practices. As we discussed, our natural inclination is to go through most of life mindlessly. Mindlessness is like having our head in the clouds. We behave on autopilot without thinking, which causes us to miss out on what is right in front of our faces. We also have a tendency to react emotionally to situations rather than respond calmly and rationally, which means we are likely to behave less effectively and do things we later regret. We also tend to spend a lot of time bemoaning the past or projecting into the future. In other words, we spend very little time mindful of the present moment, which is actually what living is all about. There is only one way to live: in the here and now—not stuck somewhere else in past and future.
According to John Kabat-Zinn, mindfulness is defined as “awareness that emerges through paying attention on purpose, in the present moment, nonjudgmentally.” Mindfulness practices represent formal and informal strategies that focus on training attention and awareness to bring mental processes and behavior under greater control and thereby foster calmness, and better decision making and behaviors during both routine and challenging situations.
When people are able to practice mindfulness and build greater awareness of self, others, and the environment, then they are more empowered. They are liberated from uncomfortable or distressing thoughts or feelings, are able to interact more effectively with others, and live a more enriched and satisfying life. The purpose of mindfulness is to help see things/situations in our lives more clearly and intentionally position ourselves differently in relation to them. Research has shown that engaging in conscious and intentional mindfulness practices can change both structure and function of the brain.
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3 States of Mind
Our reasonable mind is the part of our minds that is responsible for planning and organizing – there are many advantages to reasonable mind – we can build bridges, solve incredibly complex problems. But what would happen if someone was in reasonable mind all of the time, do you think you would like them? (No, it would be like talking to a robot).
Emotion mind is the part of our minds that is controlled by feelings – we probably all know what it’s like to feel really lousy, and, emotion mind can be great, for example, the feeling of falling in love for the first time! There are times we want to make decisions in reasonable mind (surgeons) and emotional mind (when the person who love proposes to us). Usually, though, we want to be making our decisions in wise mind.
Wisemind is the synthesis of reasonable mind and emotion mind – it’s when you think something and feel it. Often times people describe this as knowing in their gut. Being in wisemind is a calm and centered experience. If you are feeling intensely, you are probably not in wisemind – this can be tricky because sometimes when we feel things very intensely they feel very true in that moment.
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How Mindfulness Practices Work
Increased Awareness Through Mindfulness
Practices
What Skills
+
How Skills
Better Decision-Making and Coping Strategies
The “WHAT” Skills:
1. Observe: - wordless watching, paying attention without reacting
2. Describe: - putting what you observed into words
3. Participate: - throwing yourself completely in
Within our mindfulness skills, we are the WHAT skills (what we do when we practice mindfulness), which are Observe, Describe, and Participate. Observe – wordless watching, Describe – putting words onto your observation, and Participate – throwing yourself completely into the moment. One of the participate exercises we did where you first got to begin wrestling with how to fully participate and throw yourselves into the moment was called, “sound ball.”
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How Mindfulness Practices Work
Increased Awareness Through Mindfulness
Practices
What Skills
+
How Skills
Better Decision-Making and Coping Strategies
The “HOW” Skills:
1. Nonjudgmentally: see but don’t evaluate, just the facts
2. One Mindfully: being completely present
3. Effectively: focus on what works
How Mindfulness Practices Work
We are learned mindfulness HOW skills (how we practice mindfulness): Nonjudgementally, onemindfully, and effectively.
Being nonjudgmental means that we stick to just the facts of a situation without layering on our opinions or beliefs about whether something is good or bad. A big issue with judgment is that a lot of the time, it can really impact our emotional health because we are sending messages to ourselves that aren’t really accurate.
Being one-mindful means paying attention on purpose in a certain way to be aware of what is going on moment-by-moment. Purposefully aware, not just vaguely aware. Purposeful awareness is the act of deliberately directing attention to aspects of the present moment. We can develop and refine this skill by purposefully paying attention and noticing even the littlest things moment-by-moment. Connecting to the here and now on purpose to what is happening with regard to your five senses rather than being somewhere else is the essence of purposeful awareness.
Effectiveness (also called intentionality) is about developing the personal agency to choose what to do next in the moment even when confronted with challenging, frustrating, or stressful situations. It’s is also about having the confidence that certain unwanted situations and internal experiences can arise and we can still intentionally make certain choices that are more effective than other possible choices that actually create more problems and make the situation worse. Effectiveness means being able to choose to do hard things on purpose – it’s chosing to do what works or just what is needed in the moment rather than holding onto anger, spite, and other negative emotions that only make things worse. Example: not wanting to go to class or work – overriding thoughts and feelings to do the effective thing.
Remember that the mindfulness WHAT skills are done sequentially (that is, they can only be done one at a time), whereas the HOW skills can all be done simultaneously.
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Clarifying Values & Goals
Values
Represent chosen life paths that motivate us, enrich our lives, and give us a sense of purpose and meaning
Are like a life compass or roadmap that points us in the direction that matters most
Are about figuring out what matters most in different aspects of our lives
Are about what we care about and want to be known by our family, friends, work colleagues, and community members
Can never be attained
Goals
Are the steps that can help lead us towards our values
Help to align us with our values
Are achievable
In Lesson 3, we discussed the importance of values clarification and commitment. Acting in the service of our values despite stress, challenging situations, or unwanted thoughts and feelings is is at the heart of being resilient. We’ve all engaged in behaviors or made decisions we later regretted or weren’t proud of, or that made situations worse for ourselves or others. That is, we’ve engaged in behaviors that are inconsistent with the person who want to be.
Values-based behaviors are the direct opposite of this –Values are what you want your life to be about, deep in your heart--what you want to stand for--what you want to do with your time on this planet--what ultimately matters to you in the big picture of things--what you would like to be remembered for by the people you love.
Values are distinguished from goals. Goals are achievable ends that we can cross off; they should be intimately tied to our values. That is, goals are directed by values. Unlike goals, values cannot be completed or achieved in an absolute sense. Rather, values reflect a pattern or ongoing stream of meaningful behaviors and actions. For example, if I value being a loving, caring, and thoughtful oartner, then even though I clean the house or help care for my husband’s parents once, that doesn’t mean I’m done. Rather, I must be committed to doing this over time, to live consistent with my values. When our behaviors or actions are directed by stress or unwanted thoughts and emotions, we are less likely to act in a way that is consistent with our values. As a result, it is critical to clarify values and determine which ongoing actions and behaviors are consistent with the person who you want to be, and to stay committed to them even when faced with stress or unwanted thoughts and feelings.
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Values-Directed Behavior
Choosing purposefully to engage in actions that are consistent with chosen values
Letting values guide and dictate our behaviors rather than efforts to avoid stressful situations or unwanted thoughts and feelings
If you recall, values are leading principles that can guide and motivate us as we move through life. The aim of values clarification is to give our life a sense of meaning or purpose, and allow us to use our values as a compass for our actions. Take the example of valuing being honest in your life. If you see someone drop a $20 bill on the ground, your value of honesty will move you to pick up the money and give it to the person. If you value your health, you will limit your junk food intake and factor in time to get regular exercise.
Values-directed behavior consists of purposefully choosing to engage in actions that are consistent with chosen values. Rather than letting random life circumstances or stressful situations guide our behavior. Values-directed behavior consists of letting letting values guide our decisions and actions. The point is to do what it takes to live by our values. Values-directed behavior should happen every day. Getting up and going to work is values-directed behavior. Exercising patience and care with a friend who is going through a rough time is values-directed behavior. Values-based behavior is when you allow your values to dictate your behavior rather than simply acting in whatever way is going to help you avoid stress or discomfort.
To be resilient means being committed to engaging in values-directed behavior despite facing difficult, challenging, or stressful situations.
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The Difference Between Values and Goals
| Values | Goals |
| A value is a chosen life path | A goal is a specific outcome we want to attain or achieve |
| Values involve a direction we keep moving toward--we never stop | Goals are specific things we achieve along the way |
| Values are ongoing actions or decisions that never end | Goals can be crossed off and completed |
| Values add meaning and purpose should inform our goals and decisions | Goals reinforce our values by telling us that we are on the right track |
Remember that values and goals are related but they are not the same thing. A value is a chosen life path whereas a goal is a specific outcome we want to achieve. For example, one of my values is to help people, and one of my goals right now is to do research on this wellness course. My goal is a specific and achievable outcome that is directly in line with my overall value of helping people. Goals can be achieved or obtained, whereas values are ongoing.
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Values, Goals, and Behaviors
Goals
Goals
Goals
Goals
This graphic illustrates the relationship between our overarching personal value system, domain-specific values, and values-directed behaviors and actions. It is important to consider the connection between the things we say and do on a routine basis and whether they are connected to our values--meaning the person you want to be. You may find that you’ve steered aware from your values. That’s no big deal, as at any point we have the ability to recognize and notice we’ve veered off our values-base path and then take specific actions to live more consistent with your values and being the person you want to be. Living more like the person you want to be can take willpower, which is important because it is how we build up the ability to resist our impulses.
With regard to our goals and behaviors, we also learned about WOOP, which is a useful way of identifying our goals, the intended outcomes, the internal and external obstacles that might get in our way, and a plan to overcome these. When you make a plan in WOOP, you should use the If/Then format which focuses on the following – if the obstacle happens, then here is what I will do to overcome it, eg., if I get nervous about the exam, then I will remind myself that my grade is not a reflection of who I am as a person. If I have a hard time studying, then I will minimize distractions and ask a classmate to study with me for accountability.
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The Amygdala Hijack
Amygdala Hijack : a term coined to describe the process of losing rational, logical thinking when becoming emotionally upset
The amygdala takes over dominates thinking and behavior and essentially interferes with prefrontal cortex functioning (e.g., self-regulation, weighing consequences, thinking clearly)
In lesson 4, we began learning about willpower and the stuff that gets in the way. The reason we don’t tend to cope well with intense, negative emotions is that our amygdala gets hijacked. The amygdala hijack is a term that refers to the process of losing our rational, logical thinking when we become upset. During this process, our amygdala takes over our thinking and behavior, and essentially interferes with our prefrontal cortex functioning. Recall that the prefrontal cortex is the part of our brain that is responsible for our self-regulation, impulse control, and rational, logical thinking.
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What if it’s too late? Strategies to Manage Intense Negative Emotions: Distress Tolerance Skills
TIPP
Distraction with ACCEPTS
IMPROVE the moment
Pros & Cons
Crisis Survival Skills
*** These are not problem-solving skills – they are - don’t make it worse skills
The purpose of the Distress Tolerance skills are to help reduce the intensity of the emotion enough to get you back into a place where you can reconnect with your wise mind to make a better choice. It’s important to remember that these are NOT problem solving skills – that’s why we don’t use these to solve all of our life’s problems. It’s important though, that we learn to cope with painful feelings that the impulsive urges that often come with these feelings because pain is a natural part of life – it cannot be avoided. The best we can do when we have pain is to cope as effectively as possible. Crisis survival skills are all about helping you get through a crisis in the moment without making things worse for yourself. A crisis occurs when you believe that the demands of a situation exceed your ability to cope effectively.
We learned four sets of skills for crisis survival: distracting ourselves with (ACCEPTS), skills for improving the moment (IMPROVE), skills for managing extreme emotions by changing our body chemistry (TIPP), and skills for considering the positive and negative aspects of tolerating distress (PROS AND CONS).
When we are in a crisis, we often have urges to engage in problematic behavior – we have certain action urges that come up. All of the crisis survival skills are useful for resisting giving into these action urges. When your goal is just to avoid making things worse or you are clearly panicking or in crisis, you should use crisis survival skills first.
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Accepting Reality Skills: Turning the Mind
Accepting reality means Turning the Mind to acceptance:
Willfulness does not equal Acceptance
a. fuels emotion
dysregulation
Willingness = Acceptance
a. acceptance is not approval
b. it limits emotional fuel
Accepting reality doesn’t mean we’re ignoring or agreeing with what is happening or how we’re feeling. Rather we’re ACCEPTING that it is real in this moment and we can’t change it! When we turn our minds toward willingness, we are choosing to accept, but this is not the same thing as approval. When we are willful, it makes us MORE emotionally dysregulated whereas when we are willing, it limits the amount of fuel we throw on that emotional fire.
Willfulness is when we refuse to tolerate a situation or just give up. So we either take the stance of “I can’t stand it” or “I’m helpless, I give up, it’s useless.” Willfulness is also when we try to change something that can’t be changed or refuse to accept something that must be changed. Willfulness is the opposite of doing what works in the moment – it’s the opposite of being effective.
Willingness is responding to what happens in life voluntarily without complaints or bitterness – it is accepting what “is” and participating in it fully. Willingness is doing just what is needed in the moment, no more and no less, it is being effective. We all have willful moments. When our alarm goes off in the morning, most of us want to hit snooze, right? And, we eventually find the willingness to get out of bed and start our day because that’s what is needed. Willingness is about responding appropriately and effectively to the current situation.
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We are vulnerable to paying more attention to bad emotions, bad interactions, negative aspects of others and upsetting aspects of our experiences.
What is our natural tendency? Pay More Attention to the Negative than Positive
We’ve also learned that our natural tendency is to have a negative confirmation bias, which is the human tendency to pay attention to the negative aspects of our lives while discounting the positives. Research has demonstrated that we are vulnerable to have our attention being devoted more to bad than good. We are more likely to pay attention to pain emotions, negative interactions with other people, harsh feedback, and bad impressions than good ones. It’s in human nature, and there are even signs of it in animals. People who are friends actually have "stress contests" with one another, each trying to outdo the other in lamenting about spouses, children, and work. The end result is that people feel more riled up than soothed and develop an even more negative outlook on their marriage, being a parent, and their job.
Evolutionarily, paying attention to the negative has proven to be an adaptive characteristic. Throughout our evolutionary history, species that were better attuned to negative things would have been more likely to survive threats and, consequently, would have an increased probability of passing along their genes. Survival requires urgent attention to possible bad outcomes, but it is less urgent with regard to good ones. Hence, it was once adaptive for us to be psychologically designed to respond to bad more strongly than good. The trouble now is that most of our daily life encounters and events do not involve life or death situations. Thus, we must gain an upper hand on our natural tendency to pay attention to the negative because it ultimately impacts how we feel and the behaviors we engage in.
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Taking Control of Our Attention
Paying Attention to the Positive
Searching for the silver lining
Choosing to see the positive in others
Developing positive go-to staples
Practicing Gratitude
Weekly gratitude journaling
Thank you notes
Gratitude letter
Gratitude visit
Awe in the present moment
The good news is that in any given moment, we have the ability to choose what we pay attention to. This means if we find ourselves focusing on a negative, stressful situation, we can intentionally re-focus our attention to something more positive. Focusing our attention on the negatives is likely to start a cycle of negativity, whereas focusing on the positives will allow us to establish a state of positivity. Choosing to pay attention to the positive and practicing gratitude consistently are easy and effective ways to practice channeling our attention on aspects of our daily life that tap into the positive emotions of fulfillment, enjoyment, and happiness. The result of intentionally focusing on the positive aspect of ourselves, others, and our surroundings is that we feel and behave better.
Thinking positively takes practice in order to offset our natural tendency to pay attention to negative, bad, and stressful aspects of life more than to positive ones. We can actually help rewire our brains through the process of Attention Training. This is an intentional process, like shooting free throws or developing a backstroke, that can be strengthened by purposefully paying attention to the positive aspects of ourselves, others, and our surrounding that enrich our lives rather than shrink and narrow them. This process can also be called selective attention, which is defined as concentrating on one aspect of your experience or environment, while ignoring other aspects.
Two major areas we discussed in developing a more positive outlook are paying attention to positives, including searching for the silver linking, choosing to see the positives in others, and developing positive go-to staples. We also discussed many different ways to engage in gratitude practice.
Gratitude is defined as a felt sense of wonder, thankfulness, and appreciation for the small and big things that come along with life. Gratitude is acknowledging the goodness in our lives and recognizing that the source of this goodness lies outside of the self. Gratitude requires mental discipline and effort because it is not natural to most people. People who intentionally practice gratitude experience greater satisfaction with life, greater happiness, fewer illness, more sleep, and greater ability to think clearly.
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We Are Meaning Making Machines
The meaning we make of situations is what makes us feel good, bad, or neutral—not the situation itself.
We can become fused with our thoughts, which means our thoughts are inseparable from and dominate our feelings and behavior
We also learned the resilience skill of identifying unhelpful thoughts and altering them to be more helpful. We learned that as humans we are meaning-making machines; that is, we experience situations and then attempt to interpret and making meaning out of the situations. For most situations, the meaning we make is what makes us feel good, bad, or indifferent--not the actual situation or event itself. In this way, the meaning or interpretation we attach to situations or events is what causes us to suffer or experience happiness. The first step in developing more helpful thoughts is recognizing that we are not our thoughts. Thoughts are not facts. Just because you think something, does not make it true or helpful!
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Cognitive Fusion: The Power of Thoughts
Fusion is the idea that thoughts are inseparable from emotions and behavior
Thoughts dominate how you feel and act
Goal of this lesson is to learn how to separate from your thoughts (defusion)
Even though we are not our thoughts, our thoughts have tremendous power to dictate how we feel and act if we do not see them for precisely what they are--that is, just thoughts. We can develop the skill of watching them appear and disappear just as if we are watching clouds appear, float across the sky, and disappear.
What makes this difficult? Cognitive fusion is when our thoughts become inseparable from our emotions and behavior. Cognitive fusion is the state of mind in which we are so enmeshed/fused/joined with our thoughts that they appear to be the literal truth and we must act upon them. It is so easy to get caught up and tangled with our thoughts. In a state of cognitive fusion, we're inseparable from our thoughts: we're welded to them, bonded to them, so caught up in them that we aren't even aware that we are thinking.
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Cognitive Distancing and Defusion
Cognitive distancing consists of detecting or noticing thoughts, and seeing them as hypotheses rather than objective facts about the world
Defusion is being able to stand away from thoughts in order to take effective action in spite of them
Looking AT thoughts rather than FROM them
The opposite of fusion is defusion, which means learning how to take a "step back" and separate or detach from our thoughts, images, and memories. Instead of getting caught up in our thoughts or being pushed around by them, we let them come and go as if they were just cars driving past outside our house. We step back and observe our thinking instead of getting tangled up in it. We see our thoughts for what they are—nothing more or less than words or pictures running through our mind. We hold them lightly instead of clutching them tightly.
Turn and Talk: Does cognitive distancing and defusion seem hard to you or achievable? What skills have we taught you that might make this easier?
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What is Cognitive Behavioral Theory?
Unhelpful thoughts and beliefs result in unwanted/ feelings that ultimately lead to less effective or problematic behaviors
In a nutshell, cognitive behavior theory teaches people how to evaluate their thinking in a more realistic and adaptive way so they can experience improvement in their emotional state and in their behavior. The foundation of CBT theory is that our thoughts, feelings, and behaviors are all interrelated and impact one another in a bidirectional manner.
For lasting improvements, CBT therapists also work at a deeper level of cognition, which are the beliefs people have about themselves, their world, and other people. A person's belief system potentially undermines their effectiveness as a person. For example, if you constantly underestimate your abilities to be a successful student, you might have an underlying belief of incompetence. Modifying this general belief of incompetence--that is, seeing yourself in a more realistic light as having strengths and weaknesses--can alter your perceptions of your ability to be effective. Instead of "I can't do this," you might think "I'm good at this task, and not as good at this other task; but I can learn how to be better." The latter belief is a more resilient belief that will result in greater well-being and effectiveness.
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Define the Situation
Identifying Unhelpful Thoughts
What was going through your mind just then?
How did you interpret or making meaning out of the situation?
Evaluate the Unhelpful Thought
Detective thinking
Evidence: For and against this thought?
Alternatives: Any other potential thoughts to the situation?
Implications: So what?
Alter, change or re-frame thought to be more helpful
Self-helping thought results in most effective response to the situation?
Steps to Cognitive Restructuring
Cognitive restructuring involves a four-step process. Basically, cognitive restructuring is the process of noticing unhelpful automatic thoughts and core beliefs, and challenging, disputing, or reframing them to be more helpful.
1. The first step is always recognition of the situation, which involves becoming aware of the situations that provoke unhelpful automatic thoughts.
2. The next step is to identify the unhelpful thoughts we are having in response to the situation. This involves some awareness and self-reflection to pause and notice the thoughts, images, and/or memories one is having in response to a situation.
3. Step three involves actually evaluating or taking a close look at the unhelpful thought. We can investigate our thoughts using detective thinking - where we are going to approach our thoughts as if we were investigating a crime. We are going to take a step back, look at them and examine evidence for or against the thought. This piece is basically the skill of checking the facts.
4. Step four is the part that involves altering, changing or reframing the thought to be more helpful and accurate to reality.
We also learned that when our emotions don’t fit the facts of a situation, an additional skill we can use is opposite action.
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EMOTION RESPONSE ROAD MAP
EMOTION
Emotion Intensity <65
EMOTION INTENSITY >65
SOLVABLE SITUATION
UNSOLVABLE SITUATION
Problem Solving
Wave, Radical Acceptance & Willingness
OPPOSITE ACTION
TIPP
EMOTIONS COOL DOWN <65
ACCEPTS
IMPROVE
Pros + Cons
CRISIS SURVIVAL SKILLS
Emotion + Intensity
Fit the Facts
Emotion + Intensity
DON’T
Fit the Facts
Do not reproduce or distribute without written permission from DBT in Schools, LLC © 2019
(Ferrick, 2018)
Here is the last time we will revisit our emotional response roadmap. Recall that our first step is to take our emotional temperature. If we are at or above a 65 on a scale of 0-100, then we are going to start with crisis survival skills. As we cool down, we can begin to use emotion regulation skills and ultimately decide whether we are able to problem solve or whether reality acceptance is needed.
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Do not reproduce or distribute without written permission from James J. Mazza © Mazza Consulting, 2017
REFRESHER
P
We are learned that an emotion is a full-system response that includes our thoughts, the sensations in our bodies, and our actions. Emotions have several benefits including energizing and motivating us to perform, supporting our learning and memory, and giving us feedback about our environment. This model helps walk us through all of the different components that make up an emotion. You’ll notice that the first box is vulnerability factors, which comes even before the prompting event occurs. Vulnerability factors are things that can make your emotions more intense, like not getting enough food or sleep, or being sick. Vulnerability factors typically increase our emotions, for example being “Hangry= Hungry + Angry”.
When we have an emotion:
First, an event happens (a prompting event) that causes us to have some type of thoughts about the event. Thoughts about the event are our interpretations of the event. For example, say we are walking down the street and pass by a friend, but they don’t say hi to us. One interpretation is that they are mad at us. Another is that they didn’t see us. Our thoughts are not always accurate, and, it’s easy to see from this example how our thoughts can have a big impact on the subsequent emotional response we have to the situation. Vulnerability factors can also play a big role here.
Next, we have a reaction inside our bodies – this can be things like increased heart rate (physical responses to the event), as well as urges to engage in certain behaviors, like punching someone who made you mad. We also have reaction that occur externally or outside of our bodies – this is the only part of our reaction that others can observe. These are things like our facial expressions, body language, and any behaviors we choose to do in that moment.
This whole process happens in 60-90 seconds, then we either emotionally move on our we have further thoughts that retrigger the same emotion
Sometimes we engage in a behavior as a result of our emotion, and then there will be consequences for this action – either positive or negative. This can also lead to a second prompting event. For example, if we are angry at someone and have the action urge to punch them, and we choose to do it. The consequences might be that they get hurt, and the new prompting event is that we get arrested for assault.
Also note that we learned skills for every part of this model during the course of the semester!
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When the emotion doesn’t fit the facts, we use opposite action. When the facts and the emotion actually fit, we use the wave skill – another name for this skill is mindfulness of current emotion. With this skill, we will learn how to allow ourselves to experience emotions like a wave, being mindful of how they begin, build to a peak, and then go down, without trying to shut off or control them. In this skill, we are learning to just sit with the emotion because the emotion is justified and makes sense in the moment. With the wave skill, we are simply tolerating our current emotion knowing that emotions have a short duration of just 60-90 seconds unless we do something to set them off again. We use the wave skill when the emotion is valid.
Being able to actually feel, experience and tolerate emotions is key to having healthy coping and decision-making skills – feeling your feelings is a necessary component of coping and decision making.
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Cultivating Positive Emotions
Focus on the small positive things
Kindness counts
Engage in activities where you experience flow
Connect with others
Intentionally practice gratitude
When it comes to developing resilience, we need to work on both reducing painful emotions as well as cultivating more positive emotions. Five things we learned we can do to purposefully increase the amount of positive emotions we experience are:
Finding ways to focus on the small positive things, like cuddling with a pet or laughing with friends
Engaging in acts of kindness toward others, no matter how small, such as holding the door for someone or smiling at someone
Engaging in activities where you experience flow. Flow is a state of complete immersion in a task, this is also sometimes called “being in the zone”
Connecting with others in fun and meaningful ways
And finally, intentionally practicing gratitude
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Well-Being Derived from Relationships
| INCREASES | DECREASES |
| Connectedness and belonging | Sense of isolation & loneliness |
| Life Satisfaction (purpose & meaning) | Stress |
| Problem-solving in response to life challenges | Burnout |
| Prevention of mental health problems | Incidence of diseases |
| Successful life transitions (strongest predictor**) | Impact of chronic illnesses |
| Better Recovery from Illness* | |
| Longer life |
Relationships are the underpinning of our happiness. They’re also one of the most important predictors of our resilience. You might say it’s the key that makes the other two keys. We pay less attention to our relationship health than our physical health, but having good relationships has a huge impact on our physical health as well. On this slide, we have a review of some of the major areas in which our wellbeing increases when we have good quality social support, and the areas where our wellbeing decreases when we don’t have quality social support.
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Connecting With Others in Meaningful Ways
MEANINGFUL CONNECTIONS
CONTRIBUTE TO OTHERS
SOCIAL SUPPORT
MENTORING
ROLE MODELS
Seek & provide
volunteer & acts of kindness
mentor & mentee
Identify & strive
Relationships are threaded through every aspect of our lives, at home, at work, and in the community. They are the foundation of our greatest happiness, but can also be the cause of our deepest despair. To be healthy and perform well, the brain actually requires relationships with others. Researchers across the globe have demonstrated that relationships are at the core of quality of life and represent social indicators of the well-being of the inhabitants of a country. Essentially, we can look at the quality of relationships among people within a country to infer the extent to which its citizens are prospering and satisfied with life.
Given the critical role of relationships, it is important to reflect on our relationships and purposefully pursue relationships with others that promote our resilience and well-being. Despite how crucial relationships are, we may not give much thought to the types of relationships that lead to resilience. There are four types of relationships or ways of meaningfully connecting with others that have been shown to promote resilience and enable people to increase their well-being. These relationships are social support, mentoring, doing good deeds for others, and role models. We will discuss each of these and make specific recommendations for how to establish these meaningful connections.
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SOCIAL SUPPORT
FUNCTIONAL VIEW OF SOCIAL SUPPORT
EMOTIONAL SOCIAL SUPPORT
Being cared for
INSTRUMENTAL SOCIAL SUPPORT
Specific task or activities
INFORMATIONAL SOCIAL SUPPORT
Problem solving
What purpose or function* does the social support serve?
Structure vs. Functional
We also learned that there is a distinction between structure of social relationships and the functions they provide. So the structure is how many friends, colleagues, family relationships you have. The functional aspect is what these relationships actually do for you. Research has found that the function of social support is more important than the structure. In this way, it is critical to consider the different functions of social support and attempt to gain support from others for specific purposes or reasons.
The three types of support are emotional, informational, and practical. Emotional support refers to the feeling of being loved, cared for, esteemed and/or comforted by others during times of stress; practical (or instrumental) support refers to help with performing tasks or specific activities,. Last, informational social support is about receiving advice or suggestions about how to solve particular problems or respond to situations in effective ways.
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EMR Model of Relationships
The EMR model is a basic model for building relationships. EMR stands for Establish, Maintain, Restore – in the model, we learned that we first have to establish new relationships by doing things such as spending individual time and showing interest in the other person. Next, we need to develop authenticity in our relationships by having the courage to be vulnerable and show our real selves. We need to maintain our relationships over time using guidelines such as the 5:1 ratio of positive to negative interactions. Last, when conflicts inevitably occur, we need to intentionally restore relationships by making time to reconnect, genuinely apologizing, offering forgiveness, and working to rebuild trust and relationship strength.
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Establish
Restore
Maintain
Authentic Relationship
Interpersonal Effectiveness
| Skill | DEAR MAN | GIVE | FAST |
| Purpose | Objective Effectiveness | Relationship Effectiveness | Self Respect Effectiveness |
| Steps | D – Describe E – Express A – Assert R – Reinforce M – Mindfully A – Appear confident N – Negotiate | G – be Gentle I – act Interested V – Validate E – Easy manner | F – be Fair A – no Apologies S – Stick to values T – be Truthful |
We also learned three key skills for being more effective in our relationships with others. We won’t go over each of these in detail now, but does anyone have any questions about DEAR MAN, GIVE, or FAST?
Remember that we use DEAR MAN when getting our objective (e.g., asking for a raise) is more important. We use GIVE skills when our top priority is keeping or maintaining the relationship with the other person. And we use FAST skills when maintaining our self-respect is most important.
The core goals or objectives for the interpersonal effectiveness skills we learned are: objectives effectiveness, relationship effectiveness, and self-respect effectiveness. While these skills can absolutely help with communication skills – having better communication is not actually a core objective of these skills.
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REFRESHER
R – Relationships
E – Exercise
F – Fun; Recreation Enjoyable Activities
R – Relaxation & Stress Management
E – Eat Well – Nutrition & Diet
S – Sufficient Sleep
H – Helping others
E – Earth – Time in Nature
R – Reason – Sense of Purpose (Religiosity & Spirituality)
We also recently learned about REFRESHER skills which are key to reducing our vulnerability factors for having intense emotions. We won’t review these in detail here because we just recently learned them, but does anyone have any questions about these skills? Remember that the refresher skills are therapeutic lifestyle changes or TLCs that research has found are very effective ways to support good physical and mental health for free or very cheaply.
One of the things that can be particularly important to practice during finals week is good sleep hygiene – which refers to all of the different habits we have, factors in our environment, and practices that might influence the length and quality of our sleep. We suggest memorizing all of the names of the skills included in REFRESHER.
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So What’s the Difference?
| Distress Tolerance (TIPP, ACCEPTS, IMPROVE) | REFRESHERs |
| Use when you’re already in “crisis”; when you’re experiencing an amygdala hijack Shorter term to prevent you from acting impulsively on an intense emotion Helps return you to wise mind | Use preventatively or to give yourself grace when you feel like you were “wasting time” Can be done for any length of time and should be done regularly to keep you in a good mental space Helps to keep you in wise mind |
REFRESHER skills are also different from distress tolerance skills in that they are used preventatively and should be done on a regular basis to help keep us in wise mind. Our crisis survival skills from distress tolerance are used when we are already in crisis mode (at a 65 or higher on our emotional thermometer). The basic thing to keep in mind is that you use distress tolerance skills in moments of crisis to calm yourself down, whereas you use REFRESHER skills to minimize vulnerability factors and prevent crises from occurring.
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(DeCano & Cook, 2015)
Finally, the framework for remembering all the areas of skills we learned in this class is the APT model of Resilience. The APT model organizes all the areas research has shown support resilience. The keys to resilience are the corners: Experiencing positive emotions, having a sense of purpose that is tied to our values and goals, and Healthy attachments and connections to others. We build these through using the sides of the triangle: APT reasoning, APT resources, and APT routines. We benefit most from all of these things through building our awareness of ourselves, others, and our environment, which is represented by the outside circle.
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Tips for the Final
Study the content:
In the week 14 review PowerPoint and your diary card the most
Then the content in the other PowerPoints (especially the glossary slides!) and your notes on them
Then our comments on your assignments
Then the readings and videos
Tips for the Final
Get a good night’s sleep the night before and eat a good meal before you come in
Engage in a REFRESHER during the day to help put yourself in a good place to succeed on the test
Questions
Test Q&A –
Notes to Share with Class about the Exam:
-Final is 50 multiple choice questions. There is extra credit available on the exam. Some of the exam questions involve scenarios where you need to figure out what skill the person should use given the situation, so you need to know when to use each skill to be able to answer these types of questions. For example, a test question in this format could be something like, “Carla is taking a hard class this semester and she’s doing a lot more homework than usual. Which of the skills can she use to take care of herself and prevent vulnerability to negative emotions: DEAR MAN, PROS and CONS, REFRESHER skills, or Values Directed Behavior? (Answer: REFRESHER skills are used preventatively as part of an ongoing self-care routine – these skills help us stay well and reduce vulnerability to intense emotions).
-Students may NOT use notes or other study materials during the test. They may NOT communicate with one another during the test, but they will be allowed to ask questions as needed to the class instructors.
-It is okay to share the notes you took during this class with your classmates – just not to use during the test.
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Participation Week 14
Which skill for resilience is going to be the most helpful for you during final exam week? How are you going to make sure you engage in that skill over the next week?
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Mindfulness Activity
Observe
Today’s Mindfulness activity is an observe practice.
QUIZ students – what are three WHAT skills? What are our three HOW skills?
Right! When you notice your mind wandering, bring yourself back to the affirmation activity effectively, nonjudgmentally, one-mindfully.
Cell phones put away.
Feel flat on the floor.
Now take a deep breath in…..and out….. and let’s begin.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
INSTUCTOR NOTE: Make sure that as you read each affirmation, you give students enough time to repeat each statement to themselves before moving to the next one. You cannot just read through this list the way you would read through a script. You need to give a PAUSE after every affirmation to allow students to silently participate in the practice.
I’m going to read a series of affirmations. Imagine that all of the following affirmations are true for you, right now in this moment. Repeat each affirmation in your mind, with conviction.
I am at peace with myself.
I appreciate who I am.
I value myself as a person.
All people have value, and I am a valuable human being.
I deserve to be happy.
I imagine and believe that all of these affirmations are true for me, right now in this moment.
I look forward to the future, and I enjoy the present.
I look fondly upon many memories from my past.
I forgive myself for my mistakes. All people make mistakes. I am still a good person and I release the feelings of regret because I have learned and moved on.
I imagine and believe that all of these affirmations are true for me, right now in this moment.
I feel good about who I am today.
I accept the person that I am. I accept my flaws, and accept my strengths.
I approach challenges with strength.
I do the best that I can at the time. I accept my imperfections and the imperfections in what I do. My efforts are good enough, and they're okay.
I do not have to be perfect to be okay as a person.
I am a human being with flaws. I enjoy being who I am, and love myself as I am.
I feel secure in who I am.
I imagine and believe that all of these affirmations are true for me, right now in this moment.
I accept myself.
I care about myself.
I take time for myself. I deserve time for myself.
I handle difficulties with grace.
I allow myself to experience and express emotions, both negative and positive.
I accept myself.
I am perfectly alright just the way I am.
I accept myself.
I am a valuable human being.
I accept myself.
In a moment I will count to 3. At the end you will become fully awake and increase your alertness and become energized.
One... take a deep, cleansing breath in... and exhale slowly.
Two... take another deep breath.... and exhale...
Three.... you are feeling calm, confident, and refreshed.
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Group Discussion
Which skill and/or content area do you feel most confident about?
Which one is still hardest for you?
Small group discussion
Instructor note – Make sure you review instructions for the APT toolbox activity as well before sending students off to small group work online.
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Now we’re going to do another activity to help you practice for your final exam. You each have a blank version of the APT framework and you’re going to fill in with your own examples and where the skills work for you.
MAKE YOUR OWN MODEL!
Instructor Note: Blank copies of this model should be printed for the class or emailed to students ahead of time. This worksheet is available in the “Class Activities Materials” folder in dropbox, and is labeled as “Week 14 – Group Activity APT Toolbox. This sheet provides instructions that students should work on the own model for about 10 minutes, and then discuss with their groups for the last 20 minutes.
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Group Activity
Making your toolbox
Look at notes, diary cards, etc.
Fill out the APT model on the back
At least one skill/practice/strategy per area
Discuss with your group
You’ll reflect on this as part of your last Homework Post
Instructors: Put this slide up during the final activity. Note that instructions for the activity are also on the worksheets you have provided to all students. (see instructions on slide 51).
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Instructors: Feel free to bring students back into the full class to say goodbye and wish them well before adjourning.
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Emotion Name Describe Emotions
And rate (0-5)
Vulnerability Factors PLEASE
Prompting Event #1 Problem Solving
Thoughts about the Event
Check the Facts Mindfulness of
Current Thoughts
Sensations, or Urges
Wave Skill Crisis Survival
Skills
Body Changes
TIP
Expression Face/Body
Action Behavior
Opposite Action
Consequences of Action Distress
Tolerance Skills
Model of Emotions
Inside the Body
Outside the Body
Prompting Event #2
ABC
Emotion
Name
Describe
Emotions
And rate (0-5)
Vulnerability
Factors
PLEASE
Prompting
Event #1
Problem
Solving
Thoughts
about the
Event
Check the Facts
Mindfulness of
Current Thoughts
Sensations, or
Urges
Wave Skill
Crisis Survival
Skills
Body
Changes
TIP
Expression
Face/Body
Action
Behavior
Opposite Action
Consequences
of Action
Distress
Tolerance Skills
Model of Emotions
Inside
the
Body
Outside
the
Body
Prompting
Event #2
ABC
