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The first Module of DBT-(How to treat intense emotions)

Updated: Feb 6, 2023

Non-urgent footnote:

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There are 4 modules in DBT and the first and longest module we will study is mindfulness. Don't get put off by the black-and-white writing, I've kept the text as simple as I could. They're 7 modules to mindfulness. The first stage is accessing the Wise Mind. The big dangers that come from emotions that we cannot control (known as emotional dysregulation) are emotional avoidance and emotional intensity. I will come to those shortly. First, I will give you a thought experiment to understand the difference between thoughts, feelings and emotions.


If you were on the roof and I gave you a little shove (as a joke), your initial reaction would be fear (you would not have to think about it, you would feel fear). Then you might turn around to me in anger ( again, you are more likely to feel it first before thinking about it). The two emotions demonstrated here ( fear & anger) were reactions without much thought, and they are known as feelings. They make you respond quickly, and there is nothing wrong with experiencing such feelings.


Suppose after the shove on the roof, we go back inside to a safe place. You're probably thinking, "what's wrong with him? He nearly killed me", or "I should not have trusted him". These are thoughts. However, these thoughts give rise to other emotions (Known as manufactured emotions) such as guilt ( for trusting me) or sadness (for not having better judgement). Because the thoughts you had were rapid and not well thought about, they can develop into stuck points, which may change your view of a particular subject. In this example, the next time I go on the roof, you may refuse to join me, be afraid of heights altogether or be very cautious around me. These are examples of how these stuck points may influence our behaviours.


When emotions are powerful and intense, we call this emotional intensity. These emotions may make us act out on our desires the emotion wants us to satisfy. Still, even though satisfying the desire may give temporal or slight ease, we may feel more confused and miserable after acting on the emotion. An example may be an addiction or impulse you need to satisfy.


Emotional avoidance is where we try to resist or avoid our emotions, which provides a "numbed-out sensation". This may work in the short term to grant slight temporal ease from our situation; however, this method can have a damaging effect in the long run. The more we avoid it, the more intrusive it may become in our minds. Here is an analogy, I will give you (the "reader") one task. "DO NOT THINK ABOUT A PINK ELEPHANT FLOATING ABOVE YOUR HEAD for 10 seconds", at the end of this 10-second experiment, you are more likely than not to have thought about it. The avoidance became more intrusive.


A wise mind will allow us to be aware of our mind and give clarity in a situation. It balances reason and emotion. The first step to accessing the wise mind is becoming aware of breathing. Breathing connects our physical life to consciousness; it will also help balance the limbic system of our brain. The exercise prescribed here may be challenging for some, and you may wish to give up, but I promise it's like anything else you can learn, like math. It isn't very easy at the beginning, but easier the more you do it.


Prescribed exercise

  1. Do a 10-minute walk. As you walk for 10 min, count your breaths (both inhalations and exhalation) to 10 and then start from 1 again for the complete 10 minutes. Here is an example, breath in 1 out 2 in 3.... all the way to 10. Start again from the beginning once you complete the 10th breath. If you get distracted by your mind, simply notice it and go back to your breath. (Disclaimer, don't be discouraged if your unable to complete this exercise, with time and practice it will come"

  2. Sit down comfortably and breathe in "just this" and out "moment". This is a method to ground yourself and stimulate your wise mind. You may also replace "just this moment" with "wise" and "mind". Choose out of those mantras which you prefer.

  3. When you wake up, spend 3 minutes noticing things around you without judging anything before getting out of bed.


Observe:

Core mindfulness can be taught like most games, whether it's a console game or an actual sport (for the footballers out there, EA Sports is not a sport). The first aspect of learning a game is first to watch how it's done; you observe the game. Next you would describe to yourself how to play the game, and finally, you would participate in the game. DBT therapy's longest component is mindfulness; mindfulness has 7 modules. You have learned part of the first one already, wise mind breathing. The next stages are like the game analogy mentioned at the top of this paragraph. In fact the next 3 modules to be taught are called observe, describe and participate skills.

Observing is noticing things without allowing concepts of your mind to judge or categorise them. There a 3 parts to practising this, the first being observing externally. Below are observed external exercises:

  1. find a nice place to sit, cast your eyes to the ground and listen to sounds around you. you are not judging the sounds but simply noticing the sounds only. An example may be you hear chirping sounds from birds, just notice the sound without allowing concepts of your mind to judge or describe the sound. If you do judge the sound or you are swept away by your thoughts, simply notice it and go back to listening to the sound. Do this for 5 minutes

  2. take a 20-minute walk and observe things around you just noticing them. If you get swept up in your mind, don't worry; acknowledge you fell into thought and simply go back to observing.

  3. collect a few rocks, pebbles or things with texture and notice what they feel like in your hand. Do this for a couple of minutes

  4. Listen to music that s about 7-10 minutes long. Choose unfamiliar music with longer instrumentation. Try to wear headphones and let go of whether you like the music or not and focus on listening to the instrumentation and tempo of the music without describing it to yourself. Resist the temptation to drift into thoughts; again if you do drift into your thoughts, simply acknowledge this and continue the music exercise.

  5. Observe clouds, spread a blanket on the grass and lay back. Find a cloud and notice it, and watch the cloud for 5 minutes, noticing as it changes shape or disappears. If a cloud disappears, simply find another cloud. If your mind starts describing the clouds or your mind is swept up in thought, don't get disheartened. Your mind may distract you many times but simply return to the exercise and don't judge your efforts.

Observe internally:

Internal observation is where we observe the body and internal sensations specifically. When we have intense emotions, we may get so swept up in our minds that we may struggle to notice the internal physical sensation. Below are ways to practice internal observations:


  1. Take a glass of water and take enough of a sip so that your tongue gets wet, but your cheeks are not starting to bulge. Notice the water's sensations and feelings in your mouth for 5 seconds. Then swallow the water noticing how it feels as it goes down your throat and into your stomach. Take in a deep relaxing breath before breathing out. Repeat this until the entire glass is finished.

  2. Taste fruit. Cut fruit into bitesize pieces before picking a piece of fruit. Examine the fruit noticing its smell, texture etc. Once you have examined the fruit, place it in your mouth, resting it on your tongue. Don't bite it until some saliva covers the fruit. Then slowly bite and fully masticate the fruit before swallowing it. Take a full breath inhaling and exhaling fully after swallowing. This time allow thoughts to arise but do not follow them.











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