reality acceptance

lesson_4_willpower_-_final.pptx

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Sit in Your Groups

While you wait – Share with your table group a goal you have for this semester.

INSTRUCTOR NOTE: Play music of your choice for about 5 minutes before class begins. We typically choose something upbeat and uplifting.

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Questions

Mindfulness Activity

Participate

Happy Birthday to You

Happy Birthday dear STUDENT

Happy Birthday to You

Distress Tolerance and Willpower

Lesson 4

(DeCano & Cook, 2015)

Circled areas are related to the skills for today

Acceptance vs. Change

Acceptance

Validation

Change

Problem-Solving

Fulcrum or Balance of Life

We will learn Acceptance Skills

We will learn Change Skills

Again, a summary of the principle dialectic in DBT Skills: Acceptance and Change

Previous Lesson Summary

Goals are small attainable steps that help keep us moving towards our values. Values are the point at the end of a compass you can never reach, whereas goals are small achievable steps along the way. You can have values and related goals in many areas of your life.

When people live consistent with their values, their mental health is maximized, they report having a more satisfying life, and are more effective in their work and personal lives.

When we are faced with stressful situations, we can make impulsive choices that disconnect us from our values (that’s why clarifying them is so important!)

Highlight dialectics w/ love/hate parents

Previous Lesson Summary

Values also have transformational power to turn everyday routine, tedious, or annoying behaviors into meaningful and rewarding ones.

A dialectic is when two things that seem opposite are both true.

Using WOOP helps you stick to your goals and beat moral licensing.

Highlight dialectics w/ love/hate parents

Learning Objectives

After completing this lesson, you will be able to:

Explain the make up and function of habits

Describe distress tolerance, its importance, and when to use it

Know how to use different distress tolerance skills

Describe the benefits of willpower

Understand the different types of willpower and how to tap into them

Lesson 4: Glossary Terms

Lesson 4 Distress Tolerance and Willpower
Emotion-provoking	stimulate or give rise to emotions, typically a strong or unwelcome one.
Distress Tolerance	Distress intolerance is perceived negative emotions as overwhelming and unbearable.
Amygdala Hijack	It describes the process of losing rational, logical thinking when becoming emotionally upset.
Crisis Survival Skills	The goal of crisis survival skills is to help you get through a short-tem crisis situation without making it worse. Crisis survival skills help us to tolerate our distress so we don’t act on our emotions.
Emotional Dysregulation	It refers to the inability of a person to control or regulate their emotional responses and behavior in response to certain situations.
Willpower	The ability to control our attention, emotions and impulses (desires) in pursuit of something that isn’t immediately attainable.

Participation Week 4 Part 1

What is a bad habit you have?

What is a Habit?

Popcorn call out some habits you have

Ok, so we all have habits, but what actually is a habit? Last week we talked about goals and we’ve talked about mindfulness. The reality is we cannot be mindful and present all the time; our brains don’t have enough capacity/energy for that. And we need that present mindful awareness in order to meet our goals. So habits, when used correctly, allow us to turn some tasks into automatic functions so we don’t need to expend mental energy on them. So how does that happen?

Example (benign) – getting in the car (cue) and putting on my seat belt (habit) and I feel safe (reward)

Cue – something that happens that we automatically do something after; these can be emotions, situations, physical feelings, just about anything

Habit – the thing I do automatically when I experience a cue; this is a behavior

Consequence – the response after that keeps me doing this habit; if I like the consequence (reward), then I do the habit again and again; this is immediately after

Second benign example – your phone notifies you that you have a text or a snapchat (cue), you answer it (habit), you get information and know what’s going on immediately (consequence)  we do this without thinking about it

Another example (more real) – I don’t get a perfect score on an assignment, and I tell myself “I suck,” and I feel bad about myself so I do something to punish myself or make myself feel better

So today’s lecture is all about different habit behaviors we can use when faced wit ha cue if we want to make changes. First, though, we have to talk more about cues.

Cue

(Prompting Event)

Habit

(Behavior/ Action Urge/ Emotional Response)

Reward (Consequence)

Emotions Range from Typical to Impairing

Sad/Bummed Out

Depressed/Suicidal

Angry/Upset

Violent/Property Destruction

Anxiety

Panic/Freaking Out

Happy

Grandiose Happiness

So let’s talk more about emotions as cues.

Does the Emotional Reaction Fit the Situation??????

Note to instructors: When you are in slide show model – animations will allow you to tab through the pictures. Facilitate a discussion with the students. For example, the first pair is an aggressive dog and a child crying (ASK: does the reaction fit the facts? YES). When you change the picture, you’ll see a puppy but the child is still crying (ASK: does the reaction fit the facts? NO).

Emotion-Provoking Buttons

Everyone goes from calm to not calm

There is always a button that gets pushed to cause us to go from calm to not calm

Important to develop an understanding of one’s own emotion-provoking buttons

Awareness of Emotion-Provoking Buttons

We must fully understand our values, thoughts about the past and future, events, and social situations that provoke intense negative emotions in us if we are going to appropriately manage them

Button categories:

Certain people who rub us wrong

Being treated a certain way by others

Unexpected change in routine

Certain event or situation

Thoughts about past experiences

Turn and talk about some other minor buttons you know of

How do WE cope with or Manage INTENSE Negative Emotions?

ANSWER: Generally……NOT WELL

Our habit/automatic response tends to be not in line with our values

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)

The Amygdala Hijack

Fight

Self-Critique

Flight

Freeze

Isolate

Perseverate

We’re not always in places where we actually would fight or run away or freeze though. Sometimes these look different.

Emotional Dysregulation

Emotional dysregulation refers to the inability of a person to control or regulate their emotional responses and behavior in response to certain situations

A crisis is when you experience a serious problem but the solution isn’t readily coming to mind. In a crisis, emotions are high so the problem is distressing, and having high emotions generally makes things worse.

How do you know when you are in a crisis?

EMOTION MIND!!

We talk about crisis level being a 65 on our emotional thermometer. In coming weeks we’ll talk about how you know where your 65 is. You can be at 65 for any emotion, positive or negative. 65 or crisis level just means you’re in emotion mind and would unlikely be able to make a wise minded choice/decision

YOU ARE IN A CRISIS WHEN

the situation is:

Highly stressful

Short term (that is, it won’t last a long time) and

Creating intense pressure to resolve the crisis now

USE CRISIS SURVIVAL SKILLS when

You have intense pain that cannot be helped quickly

You want to act on your emotions but it will only make things worse

Emotion mind threatens to overwhelm you and you need to stay skillful

You are overwhelmed yet demands must be meet

Arousal is extreme but problems cannot be solved immediately

DON’T USE CRISIS SURVIVAL SKILLS for:

Everyday problems

Solving all your life problems

WHEN TO USE CRISIS SURVIVAL SKILLS

Crisis Survival Skills – Short-term

ACCEPTS

IMPROVE

TIPP

Pros and Cons

Distress Tolerance Skills

Accepting Reality Skills – Long-term (we will learn these next week)

Accepting Reality & Radical Acceptance

Turning the Mind & Willingness

Mindfulness of Current Thoughts

Two Types:

The two types of Distress Tolerance Skills

What if it’s too late? Strategies to Manage Intense Negative Emotions: Distress Tolerance Skills

Distraction – with ACCEPTS

IMPROVE

TIPP

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 w/ wise mind to make a better choice

Crisis Survival Skills

Imagery

Meaning

Prayer

Relaxation

One thing in the moment

Vacation

Encouragement

Crisis survival skills – Distract with Wise mind ACEEPTS and IMPROVE the moment

Temperature:

Dipping your head in very cold water (around 50 degrees) kicks in the Dive Reflex – stimulating the parasympathetic nervous system – meaning – your body thinks you have fallen through the ice.

Key components:

1. Cold water (around 50 degrees)

2. Just below the eyes

3. Hold breath for 30 seconds

4. Bending over at the waist

***DO NOT TRY IF YOU HAVE HEART PROBLEMS

The T in TIPP

Intense Exercise:

Intensive exercise for at least 20 minutes. This could be running, biking/spin, paddling, soccer, any high energy exerting activity. When you stop, the body kicks in endorphins – your body’s own chemical feel good drug

Key components:

1. High exerting energy (>20 minutes)

2. Stopping kicks-in endorphins

The I in TIPP

Progressive Muscle Relaxation:

Key components:

1. 15-20 minutes

2. Tensing and relaxing muscles stimulates endorphins

Relaxation is incompatible with being emotionally aroused and upset. We can’t be relaxed and angry/upset/anxious at the same time. Progressive/Guided muscle relaxation has been shown to reduce stress and anxiety.

The first P in TIPP

Paced Breathing:

Key components:

1. Do for at least a minute

2. No key formula/ratio

3. **If you feel like you are going to pass out - STOP

Breathing out longer than breathing in. The idea is to reduce the oxygen level in your body, so everything else shuts down like it is going to sleep. For example, inhale for 4 seconds and exhale for 6 seconds. Stimulating the body’s parasympathetic nervous system

The second P in TIPP

Distress Tolerance: Pros & Cons

	PROS	CONS
Acting on crisis urges	Pros of acting on impulsive urges: __________________________ __________________________ __________________________ __________________________	Cons of acting on impulsive urges: __________________________ __________________________ __________________________ __________________________ __________________________
Resisting Crisis Urges	Pros of resisting impulsive urges: __________________________ __________________________ __________________________ __________________________ __________________________	Cons of resisting on impulsive urges: __________________________ __________________________ __________________________ __________________________ __________________________

Pros and Cons – important to emphasize the four different squares

Distress Tolerance: Pros & Cons

Consider short-term and long-term PROS and CONS

Before an overwhelming urge hits:

Write out your PROS and CONS and carry them with you

When an overwhelming urge hits:

Review your PROS and CONS.

Imagine the positive consequences of resisting the urge.

Imagine (and remember PAST) negative consequences of giving into the urges.

What if it’s not a Crisis?

When its not a crisis – then we use accepting reality skills

What is Willpower

The ability to control our attention, emotions and impulses (desires) in pursuit of something that isn’t immediately attainable

The ability to act in a way that furthers our goals, even when doing something else seems immediately more appealing

The ability to keep our thoughts, feelings, and behaviors in check to achieve a goal that is not right in front of your face.

The Need for Willpower

Everyone struggles in some way with temptation, addiction, distraction, procrastination or avoidance

We eat, drink, smoke, gamble, avoid work too much, max out our credit cards, fall into dangerous or problematic situations, give up on things too easily and become addicted to alcohol, pot, pills and texting/emailing/tweeting.

At day’s end, most people have spent three to four hours attempting to use willpower to squash the urge to do something they shouldn’t, take a nap when there are other important things to do, order another drink, play Candy Crush, check in again on Facebook or Tweet, buy another pair of shoes, skip class, or have an affair.

So where did my willpower go?

We don’t have endless amounts of willpower

Things that deplete our willpower

Stress

Tired

Hungry

Mindlessness

Too many willpower “projects”

But, like a muscle, we can build our willpower because of neuroplasticity!

Developing Willpower

Research suggests that willpower can be developed similar to the way we develop our muscles. Just like a muscle:

To strengthen your willpower, you have to exercise

If you exercise it too much, it will become fatigued

Developing willpower is NOT about pushing yourself harder. It’s about taking small, achievable steps toward the goal over time.

Set realistic goals

Figure out how to reward yourself for each step

The research on willpower suggests that it can be developed very much in the same way we develop our muscles. To build muscle, you need to exercise. And, when you overwork the muscle, it gets tired and needs to recover. The same can be said for willpower. Many people think that developing willpower is about pushing yourself harder and harder and this is a misunderstanding of how developing willpower works. To develop willpower, set small but meaningful goals and take steps toward them every day. It’s important to set realistic goals. For example, I am not going to be successful if I tell myself I am going to exercise for an hour a day – I simply don’t have time for that. However, I might be successful if I start with a goal of 20 minutes of moving my body per day. Next, you need to figure out how to reward yourself for taking each step toward your goal. The reward is important because it will help keep your motivation high. For example, I might tell myself that if I reach my first goal of moving my body in some way for at least 20 minutes per day, I will treat myself to a new pair of shoes. You should pick a reward that is appropriate to your goal – so for example, if my long term goal is to lose weight, then it would not be appropriate to reward myself for exercising with a hot fudge sundae. Giving yourself permission to celebrate the small victories on the way to achieving your long term goals is important for your emotional balance, motivation, and developing your willpower.

Lesson Summary

Habits are the automatic behaviors we exhibit after a cue.

Our emotions are a part of who we are. They range from typical to impairing

Emotional dysregulation – the inability to control or regulate ones emotional responses and behavior in response to certain situations

Amygdala Hijack – when our emotions overtake our decision-making abilities (EMOTION MIND takes over)

Lesson Summary

For Emotional Dysregulation – use Distress Tolerance - Crisis Survival Skills

These are not problem-solving skills – they are don’t make it worse skills

TIPP

Distract with ACCEPTS

IMPROVE the moment

Pros & Cons

Willpower – the ability to control our attention, emotions and impulses (desires) in pursuit of something that isn’t immediately attainable. Or act in a way that furthers our goals, even when doing something else seems immediately more appealing

Three types:

I will

I won’t

I want

Participation Week 4 Part 2

What is an area of your life you’re going to apply willpower to over the next week?

Mindfulness

Observe

Hold arms in the air for 2 minutes. Observe the sensations in your arms, don’t go into describe. Identify the WHAT skills they are using, and then name the HOW skills they are using, and what that means in this case. When you notice your thoughts wander, one-mindfully, nonjudgmentally, and effectively bring your mind back to the present moment.

If you notice the urge to move your body, notice the urge, but notice that you don’t have to do that.

EMOTIONAL THERMOMETER

How intense is my emotion mind?

1-100

Below 65

1-65

Above 65

HIGH ABOVE 65

EMOTION

I strongly feel the emotion AND can still think about solutions

Emotion Regulation Skills

I feel the emotion and the emotion is overwhelming me (I can’t think rationally)

ACCEPTS IMPROVE Pro/Con

I feel the overwhelming emotion + physical sensations (I can’t think + my body is out of control)

TIPP

Thermometer activity in groups – have students (individually) identify their below, above, and high above for anger.

(i.e. below 65 = my professor gave me feedback i felt unfair; above a 65 = my roommate took something of mine and broke it after I had asked her not to borrow it; far above 65 = my partner cheated on me with a friend

Whole class - Read scenarios and have students move along thermometer “on floor” (using 100 scale from back wall to chalk board) to where they would be for the following situations:

My computer crashed and I lost the complete version of my midterm essay

I lost my keys and am locked out of my house

My friend bailed on me last minute

EMOTION RESPONSE ROAD MAP

EMOTION

Emotion Intensity <65

EMOTION INTENSITY >65

SOLVABLE SITUATION

UNSOLVABLE SITUATION

Problem Solving

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

Wise Mind Distracts with ACCEPTS

Distraction is deliberately turning your attention away from the negative emotion-provoking situation

ACTIVITIES	Do something; e.g. call a friend, watch a movie, read a book.
CONTRIBUTING	Contribute to something or someone; e.g. help someone with their homework, give something to someone
COMPARISONS	Compare your situation to something worse; e.g. think about a time you felt worse, compare yourself to those less fortunate
EMOTIONS	Create different emotions; e.g. listen to an upbeat or soothing song, watch something funny.
PUSHING AWAY	Push the painful situation out of your mind temporarily; e.g. put the thought in a box and put it on a shelf.
THOUGHTS	Replace your thoughts; e.g. do a puzzle or a sudoku, read, do a math problem
SENSATIONS	Experience other intense physical sensations; e.g. hold ice, squeeze a stress ball.

-Comparisons: With comparisons, if it makes you feel worse to compare yourself to less fortunate others, then you can compare your situation to a take when you were really struggling, that makes this situation look less bad.

Turn and talk about some examples of things you could use to distract you

Brainstorm a bunch of options per letter with your group and then apply to yourself. Which ones have you used, which ones would be helpful, why? Which seem less helpful, why?

Activity

Keep in mind when and where you might experience a crisis.

Make your crisis survival kit for home, on campus, and to take with you anywhere on your phone.

What skills from distress tolerance feel like they’d be the most helpful to you?

What items do you have accessible at home, on campus, or on your phone with you that allow you to engage in those skills when you need them?

Have students think of situations they identified as being above a 65 on the 0-100 scale – you are now going to identify the strategies you will use from the skills we’ve discussed this week that you could use.

More then ACCEPTS, find examples of each that you can use to help you, put this in your tool box.

What is your survival kit for home, school, and on your phone. The three questions apply to the 3 (home, school). HAVE STUDENTS TAKE A FEW MINUTES TO WRITE THEM DOWN, THEN DISCUSS IN THEIR GROUPS, THEN SHARE OUT TO THE WHOLE CLASS BIG TAKE AWAYS.