Dr. B's Blog

Can Shame Be Useful? - The New York Times

How can emotions be helpful?

1) Motivating one's action: emotions make you do stuff.
2) Communication to others: they convey important information to others without having to actually tell them directly. 
3) Communication to yourself: they tell us important information about ourselves; what is important and meaningful.


Read More

Sleep and health

When a client first gets started in therapy, we often try to “go back to basics.” That is, recalibrating those things that tend to get off center when things get hard:

  • sleep
  • exercise
  • eating
  • medication use

Specifically referred to as the “ABC Please” skills in DBT, we try to do what we can to reduce negative emotion[1], we try to re-implement those things that don’t take a lot time to do and provide a great deal of benefit over the near term. Sleep is one of those:

There’s a syndrome called sleep inertia which is the cognitive impairment, disorientation, and groggy feeling we experience when we first awake from sleep. Sleep inertia can negatively impact the brain’s ability to think clearly and our ability to function effectively in performing tasks right after we wake up (Donatelle, 2009). Just think about the challenge it takes to brush your teeth when you wake up after only four or five hours of sleep.

I’ve never heard of “sleep inertia” but I’m not a sleep guy. I just know that it’s important. The term makes conceptual sense, even if it’s just a fancy name for begin groggy.

The stages of sleep include: wakefulness, drowsiness, light sleep, and deeper sleep. It is in the deeper sleep phase where rapid eye movement (REM) sleep occurs. REM sleep is absolutely essential. In fact, missing REM sleep is responsible for our feeling groggy and sleep deprived (Donatelle, 2009).

I recommend that my patients get through at least 2 REM cycles of sleep/night in order to feel well rested. At the very least, make sure you get through at least one REM cycle. For most people, that’s about 4 hours or so.

There are so many little things that you can do to adjust your life to make it a bit better. None of them may be earth-shattering changes, but taken together, they can make a big difference.


[1]: This is the "ABC Please" skill in the emotion regulation module. In the currently published manual (Linehan, 1993), the skill is referred to as "PLEASE MASTER" but it's going to be changed in the next version.

More on rain

  • How do you predict the rain?
  • How do you predict emotion?
  • Why do we still get caught in the rain?

Answer these questions and I think you’ll have a nice understanding of how one might look at emotions in a different light.

We know how to predict when it’ll rain. We understand the science behind it, but we can’t make it rain or make it stop once it’s started. Sometimes all we can do is prepare ourselves.

Similarly, we understand what creates an emotion. We can pretty well predict what might make someone emotional but we have little control over emotions.

We do have control over how we respond to them.

Progressive Muscle Relaxation

The topic of PMR came up today in one of my groups and I encouraged them to do a google search on progressive muscle relaxation. I figured I’d do the same and post my results here.

I found a site at Arizona State University that has audio of someone reading a PMR script. I haven't heard the audio but the transcript looks good. Have a listen.

Jon Kabat Zinn Teaches Mindfulness

In yet another example of how many resources there are on the web, I found Jon Kabat-Zinn teaching mindfulness. Dr. Kabat-Zinn is the author of many mindfulness tomes and one of the creators of Mindfulness Based Stress Reduction. Needless to say, he’s an expert on mindfulness and psychotherapy. Here he is teaching mindfulness.


I used to blog my DBT-U class and this is an entry that I have heard is particularly helpful to people. I thought I’d repost it here just to give people more exposure to it.

For homework we reviewed some of the myths and challenges to those myths as well as cheerleading statements in the Interpersonal Effectiveness section. These worksheets were on pages 118 and 119. We again went through some of the challenges and while we were in class, we had several people help one another out with some convincing challenges.

After the break, we covered a lot of material. The new material started on page 121 and went through 126. First we talked about factors to help you determine the intensity of your response to a situation (either asking for something or saying no to a request). The thing to remember with this is that you need to vary your intensity based on a number of factors:

  1. Priorities: What are my priorities in this situation?
    • Are my objectives very important (increase intensity)?
    • Is my relationship weak? (reduce intensity)
    • Is my self-respect on the line (increase intensity)?
  2. Capability:
    • Is the person capable of giving me what I want? If yes, ask more strongly.
    • Do I have what the person wants? If no, say “no” more strongly.
  3. Timeliness: Is this a good time to ask?
  4. Homework: Have I done my homework? Do I know all the facts to support my request?
  5. Authority: Am I responsible for this situation? Does the person have authority over me?
  6. Rights: Is the person required by law or morality to give me what I want? Am I required to give them what they want?
  7. Relationship: Is the request appropriate to our relationship?
  8. Reciprocity: What have you done for me lately? What have I done for you?
  9. Long versus short-term: Will being assertive or acquiescing to the request help or hurt my long term goals? What about my short-term ones?
  10. Respect: Do I usually do things for myself? Am I careful to avoid asking for help or seeming helpless when I can?

These are things to consider when trying to weigh the intensity of asking for things or saying no. You can find more complete examples and explanation on page 121-122.

We then went into some suggestions for practice (this was also the homework). You can find these examples on page 123 in your book. The homework was to try to do one “easy” thing on the list and one “hard” thing to do. It might help to rank order each item 1-3, with 1 being easy and 3 being hard.

Finally, we talked about DEAR MAN. This is the first of many acronyms we’ll use to help you remember what we talked about in class. You use DEAR MAN when you’re making a request or trying to say no. It’s a nice framework to help you remember an effective way to do this. Remember that you don’t always have to use each thing in every situation, but it helps to do them all if you’re not sure.

D: Describe the situation.
E: Express how you feel about it.
A: Assert your request.
R: Reinforce the other person for giving you what you want.

M: Stay mindful.

  • Be a broken record
  • Ignore attacks

A: Appear confident.
N: Negotiate if needed.

It was a very full class, as you could see. We’ll continue talking about Interpersonal Effectiveness next week.