Dr. B's Blog

Mindfulness in Plain English

When teaching mindfulness as a DBT skill as often as I do - up to 10 times per month - I have to come up with new material to keep my classes, and myself, interested. Often, group members have heard the typical DBT core “what” mindfulness skills of:

  • Observe
  • Describe
  • Participate

And the “how” skills of:

  • Non-judgementally
  • One-mindfully
  • Effectively

But rarely have they been exposed to the actual origins of the DBT skill of mindfulness. In my studies, I’ve found that it’s a very deep and complex topic. I’ve not even been able to scratch the surface and I wish I had the time to understand it better.

To that end, I’ve been Mindfulness In Plain English to help guide my reading and discussion points. Yes, that’s the full book as a .pdf. Unbelievably, the publisher has allowed us to post it for free as long as I don’t charge you for it. Quite amazing. Please feel free to re-distribute it far and wide.

Helping Kids be resilient

This is something we psychologists have known for a while, but here’s a story from NPR on a program at U Penn about teaching kids to be emotionally resilient.

The academic schedule is tight, and the students’ days are packed with rigorous academics, but Tom Brunzell, the dean of students, says it’s important for these fifth-, sixth- and seventh-graders to take time out for “Emotional Health 101.”

Read more at NPR.org.

Mental Health Parity

Wellstone-Domenici Parity Act. Back in 2008 the mental health parity act was passed. It didn't come into effect until this year and is still not in place for all policies. It makes insurance companies offer the same level of care for mental health treatment that they offer for medical conditions on their policies. It requires that they not limit access to therapy because you're out of sessions or you've reached a yearly or lifetime maximum.

It's not perfect because it only applies to poliicies at large (greater than 50 employees) organizations whose current policies already offer mental health and substance use disorder treatment. It's not perfect because an insurance company can get out of the requirement if they can show that their costs will increase 2% due to the change (1% in later years). It's not perfect because it only applies to a handful of diagnoses. And it's mostly not perfect because we have to rely on insurance companies to "believe" our diagnoses when filing.

That said, it's a huge step forward in care for patients who need mental health coverage. It'd be nice if all conditions could be treated within the 20 or so sessions offered by some policies but that's not how it works. At least for these conditions we should be able to get the time we need to start living a life work living.

DEAR MAN

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.

Ψ Yerkes-Dodson Law

On multiple occasions throughout my week, I talk about the Yerkes-Dodson Law 1. It occurs to me that I should probably write up a post on this subject so that others can get a sense of what it means to have functional anxiety and when anxiety can be helpful or harmful. The “law” is not complicated, but understanding it can go a long way towards helping people who suffer from things like performance anxiety or social phobia.

Generally speaking, conventional wisdom suggests that there’s an inverse relationship between anxiety and performance. That is, the more anxiety you have, the worse your performance. That’s partly true, but only half of the story. The other half is that there is a point at which too little anxiety can affect performance as well. So, there’s a direct, as opposed to inverse, relationship between anxiety and performance. There’s a point in the middle, between the two relationships, direct and inverse, where anxiety and performance are at optimal levels.

Think of an inverted “U”, with the point in the middle being that optimal level of anxiety for peak performance. In non-psychology terms, it means that you need to feel some anxiety to do well. Think of it like this: If you are never anxious prior to taking a test, are you really going to study? Probably not. But if you’re too anxious prior to taking a test, can you study effectively? Probably not. The key is to maintain an optimal level of anxiety without going too far in one direction or another.

How does one do this? Well, there are a number of ways, but I prefer to have people practice some mindfulness meditation. In addition, working on identifying thoughts that are causing them to become more anxious than is called for by the situation (e.g., it’s perfectly understandable to worry about failing a class if you don’t do well on your final, but it’s a bit much to imagine the end of your earning potential if you fail). We call this “cognitive restructuring” in the CBT/DBT areas of psychotherapy.


Footnotes:

  1. A note about wikipedia links: I like Wikipedia.org for information on various subjects, with the caveat that Wikipedia can change from the time I link to the page. As of 01/22/09, the information on Wikipedia about Yerkes-Dodson is accurate. I can’t speak to how long it will remain so, but you can always go back through the revision history and see what it said today.