DBT, mental health

Thoughts, Feelings, Behaviors


Thoughts, feelings, behaviors. They are all connected and the relationship is transactional.  This means that while one influences another, that change will in turn influence another factor.  None of the three can exist without the other two.

This begs the question, where do we make the change in our lives if we have suffering?  Do you change what thoughts you have, do you change your actions before or after the thoughts, or do you change how you feel about the situation?  The answer is ANY of the three will elicit change; however, I will tell you that I believe that it is easier to BEHAVE your way into thinking differently than it is to THINK your way into behaving differently.  Feelings will happen.

Think about it: You wake up to your alarm.  You are very tired as you didn’t sleep well.   You were up late crying, emotional about something that had happened.  Is it easier to get yourself to think “gee, I am so glad to be awake early! The fact that I have a headache from crying is no problem! I look forward to seeing people today who may ask me how I’m doing!” OR is it easier to get out of bed, turn on the radio to some upbeat music, and pour a bowl of fruity pebbles?  I imagine that if you try to change your thoughts, you may end up with anxiety, dread, sadness (and you may never get out of bed, at least not on time!)…whereas if you try to change your behavior, you may actually feel pride, competence and contentment.

We know it is one of the HARDEST things to do, to act differently than we may feel.  Think back to the last time you were feeling depressed, I bet it would have been REALLY hard to get you to go exercise!  The last time you were really anxious, I bet it would have been REALLY hard to convince you to go lay down and listen to a meditation.  And the last time you were fuming mad, I bet it would have been difficult to get you to go for a walk…and yet this is what I suggest! Why would I suggest something so radically difficult? Mainly because if you do, you will see how quickly it remedies the intensity of the emotion and thoughts.  I propose that if you do it a few times in a row, you will begin to trust the process…this is pretty much what all people with good habits say about how they stick to their routines!

So work on doing the opposite of your (ineffective) urge and see if the thoughts and feelings come along in a helpful way!


Self Care

As a mental health professional, self care is paramount to my well being and ability to do my job well.  I often say that I won’t preach what I don’t practice, so I wanted to share with you five of my self care rituals.

1. Sleep.  My sleep is mandatory and highly schedule! I typically allow for 10 hours of sleep each night, knowing that sometimes it takes 15-20 minutes to unwind and fall asleep.  The longer block of time also allows for me to wake on my own (BEFORE the alarm startles me awake).  If my body happens to need more sleep, it is not difficult to get it with a 10 hour block.

2. Skin. I use a lot of lotion! I have a large bottle at every sink in my house, on my dresser, on my nightstand, in my purse and work bag, at my desk, etc.  I find putting on lotion to be a kind gesture to my body; whether it’s hands, elbows or feet.  It also allows me to pause for a moment several times a day just to reflect on the sensation.

3. Scents. I am an avid candle burner.  One of the first things I do when I get home is light a bunch of candles all over the house.  The warmth, flickering light, and scents are all very relaxing to me.  I also choose my body wash wisely, using a citrus in the morning and lavender in the evening.

4. Music. I always have music on. Records, playlists, Spotify, Pandora, radio, etc. Music to me is very soothing, both listening to it, searching for it, etc.

5. Me time. To me, this means scheduling time to explore.  From new stores, the library, trails, taking the scenic route or walking around the block.  I love to spend time exploring and learning about new places, people, and parts of the city I live in.

What do you do for self care?


Recommended Reading

It’s been quite a while since I wrote a recommended reading blog! I am going to dig into the depths of my mind (and my bookshelves) to provide you with a more current list of mental health books that I suggest.

  1. Calming Your Anxious Mind: How Mindfulness and Compassion Can Free You from Anxiety, Fear, and Panic by Jeffrey Brantley – If you or someone you love struggles with anxiety, this book is an excellent read. It does not proscribe medication; rather suggests regular, daily and holistic changes you can make in both thinking patterns and behaviors.   I do recommend this book to loved ones as it explains anxiety in a beautiful way.
  2. Overcoming Depression One Step at a Time: A New Behavioral Activation Approach to Getting Your Life Back by Michael Addis and Christopher Martell PhD – This is both a book and workbook focusing on what behavioral changes you can make that will help pull you out of depression, stay out of depression, and keep it from returning (or staying as long when it does return).  A very practical guide
  3. Mindfulness Based Cognitive Therapy for Depression by Zindel V. Sega and J. Mark G. Williams – What a gift this book is! If you’ve wondered about this whole mindfulness craze and why you should give it a try…this book answers all questions and beyond!
  4. I Love You Rituals by Becky Bailey – A great book for parents of any aged child. Helps you to understand healthy development and attachment, what actions you can take to optimize your relationship with your child and their self esteem.
  5. Don’t Sweat the Small Stuff by Richard Carlson – What a great reminder on a daily basis to step back and stop catastrophizing!
  6. God Found Us You by Lisa Tawn Bergren – A heartwarming children’s book for kids who are adopted.
  7. The ADHD Book of Lists: A Practical Guide for Helping Children and Teens with Attention Deficit Disorders by Sandra F. Rief – Pretty self explanatory but this author thought of EVERYTHING! A great resource for those who tend to make “careless” mistakes or are “forgetful”.  Also helps others understand just how hard it is to have ADHD.

Ok, there you have it: 7 suggested reads that should keep you busy for a few months!


Stop the Stigma

Many of my clients have lived with chronic invalidation of their experiences.  Afterall, there is no “test” for depression or anxiety.  We can’t do blood work to confirm stage two depression or take an x-ray or MRI to confirm anxiety of the brain. We have to rely on self report by clients about the symptoms they are having, their intensity and duration.  This is difficult for “outsiders” to understand as most conditions require objective testing to confirm their existence prior to treatment.

So what can we do?  If you are the one with the mental health condition, practice being very descriptive of your symptoms so that they are easier to understand, record and measure.  For example: “I have had more difficulty getting out of bed since Tuesday.  I typically turn on my radio and get up after 2 songs; now it takes on average an hour.  During that hour I am trying to convince myself to get up, it seems that my body is heavier and my energy is lower.  As a result I have been skipping my showers and I am not wearing makeup.” This description allows you and your providers to measure progress or decompensation more clearly than “I can’t get up in the morning”.  Our example allows us to measure by how many songs it takes to get up, whether you get a shower and whether you put on your makeup.

What can you do as a family member or friend?  Believe the person! For the most part, I sincerely believe that people are telling the truth about their symptoms.  When in an acute episode, cognitive distortions are common and may cause you to think the person is exaggerating, lying, or being manipulative; however it is their PERCEPTION of the symptoms that is important.  They do not need to prove anything to you.  Just listen and validate.  Only offer problem solving if they ask for it.  Throwing out random solutions or overgeneralized/oversimplified solutions is typically perceived as invalidating and unhelpful.  For example: “just get out of bed, you’ll feel better”.  Now while this may be true, and your friend likely knows that, just getting out of bed isn’t always as easy as it seems.  Saying “I can see you are feeling low energy today.  Let me know if I can do anything to help” is much more understanding and patient, allowing the person to talk to you rather than get defensive.



What is Mindfulness?

Mindfulness is not only a hot topic in our culture today; it is a fantastic tool that anyone can utilize to gain immeasurable benefits.  Many people equate mindfulness to meditation.  This is accurate and inaccurate at the same time.  Mindfulness is a large umbrella concept, meditation does fall under the umbrella; however so do many other techniques.  Mindfulness is merely choosing to focus all of your attention on one thing, one task, or one thought.

Under the mindfulness umbrella, there are two main techniques:

  1. Focusing your attention ON something or some task.
  2. Clearing your mind

Frequent feedback that I get is that the first type of mindfulness is easier.  In our culture, focusing on something is much more acceptable than focusing on nothing.  There is a judgment that focusing on something is still accomplishing something, while clearing your mind is a “waste of time”.

Focusing on SOMETHIING can take almost any form:  purposeful conversations with eye contact and no cell phones, choosing to read a book with limited distractions, painting, doing a puzzle, breathing techniques, body scan, yoga, fully throwing yourself into a sport or exercise etc.  The goal is that you control your attention as opposed to blowing through the breeze at its mercy.  When being mindful, you may notice distracting thoughts or urges; however you choose to let them pass.

Clearing your mind may indeed be more difficult; however the benefits are life changing.  What I hear most often is that it’s weird or the people don’t “know how” to do it.  Clearing you mind can happen in many forms.  Zen mindfulness suggests sitting upright and comfortable in a meditation position.  The only goal is to sit upright and still.  Thoughts will rise and fall, we don’t judge or cling to them if possible.  Sitting periods can be anywhere from 60 seconds to hours at a time.  There are of course other ways to meditate: prayer, reciting mantras, contemplating an issue, chanting, listening to classical or calming music etc.

So why should you buy into this? Because it works!  I will admit I was a skeptic at first.  I thought people would make fun of me or judge me (and perhaps they do…). I didn’t think I could “make time”…I was too busy!  I began practicing as to not be a hypocrite.  The benefits I experienced are right in line with the numerous studies out there and include: boosted mood, mental clarity, improved ability to problem solve, increased feeling of connection, increased wisdom, improved productivity, optimism, and confidence to name a few.

I urge you to give it a try.  Start with stopping several times per day to intentionally focus your attention on the task at hand.  If you are walking, walk.  Feel the knee swing through, the weight transfer from foot to foot, and stop ruminating.  If you are working, work.  Stop multi-tasking, pay attention to the ink on the paper, to your fingers on the keyboard, to the voice on the phone.  If you are watching TV, watch TV.  Stop eating, stop folding laundry, put your phone down and just watch TV.

Once you feel confident in your ability to control your attention in those ways, begin several times per day to stop and breathe.  Just stop what you are doing and take 10 deep, slow breaths.  Center yourself, and then carry on with the task at hand.

Finally, intentionally choose to block out time in your day to practice a formal sitting meditation practice.  Whether 5 minutes or 50 minutes, just take time to sit and be still.  What have you got to lose?