PLEASE SKILL

Session Online Version

Theme Song: Watch “These Are Days” video.

MINDFULNESS “NOTICING SENSATIONS” EXERCISE

Focusing on body sensations can bring you back into the present.

Step 1: Rate your current level of distress or SUDs (Subjective Units of Distress) from 0 to 10, 0 being no stress 10 is lots of stress.

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Step 2: Listen to each question and notice what occurs after each question. There are no right or wrong responses. Just notice your reaction to the question.

“Can you feel your hair touching your head?” __________________________________________________________________________________________________________

“Can you feel your chest rising and falling as you breathe?” __________________________________________________________________________________________________________

“Can you feel the space between your eyes?” __________________________________________________________________________________________________________

“Can you feel the distance between your ears?” __________________________________________________________________________________________________________

“Can you notice your arms touching your body?” __________________________________________________________________________________________________________

“Can you feel the bottoms of your feet?”

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“Can you notice the space within your mouth?” __________________________________________________________________________________________________________

“Can you notice the position of your tongue in your mouth?” __________________________________________________________________________________________________________

“Can you feel a breeze against your cheek?” __________________________________________________________________________________________________________

“Can you feel a heaviness in your legs?”

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“Can you notice your body hanging on your bones?” __________________________________________________________________________________________________________

Step 3: Rate you level of distress now. One a scale of 0 to 10 did your SUDS or distress level go down, stay the same, or go up?

Review your commitments from the ABC – DBT skill session:

·      Plan and do one Shared Pleasant Activity with a loved one.

·      Complete the “My Values Worksheet”

·      Complete the Weekly DBT Diary.

·      Come prepared to the next session to share your experience using DBT skills.

1. Do you ever notice people around you who seem to be more energetic and joyful? One of the reasons they may have more energy and are overall happier is the good habits they have formed over time. Sometimes we fall into traps of bad habits or neglect daily rituals that directly affect our physical health. When we form and observe healthy habits, our bodies and our minds naturally respond positively, and we feel overall healthier and happier. DBT’s PLEASE skill helps us take care of our mind by purposely taking care of our body. If we are feeling emotionally vulnerable even small differences in these lifestyle choices can make a major difference in reducing that vulnerability.

Watch: “Rocky” video.

2. Other than an iconic music cue, the difference between Rocky’s first and second training montage is his use of the PLEASE skills. How we sleep, eat, whether we drink or use drugs, if we exercise, how we take care of our physical health—all affect how we feel emotionally, our overarching mental health, and our physical well-being. As we read through each letter of the PLEASE skills acronyms rate how you are doing on a scale of 0 to 5, with 0 doing poorly or little effort and 5 doing great. (Your maximum score is 25.)

3. Treat PhysicaL Illness. Take care of your body. See a doctor when necessary. Take medications as prescribed. Your rating: _____.  As we learn more about the nature of our bodies, we begin to recognize the importance of caring for our physical health. Although our bodies suffer from natural limitations there are important ways to care for our bodies so we have the strength and stamina to maneuver through life’s challenges. Sometimes we neglect taking care of our physical bodies, and don’t recognize that our physical health directly affects our mental health and well-being. 

Discuss: Why is it important to understand the connection between our physical health practices and our emotions?   ____________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Some people find the “Activities of Daily Living (ADL) Worksheet” accompanying this session helpful in taking care of their body. Maintaining good personal hygiene includes bathing regularly, washing your hands, brushing your teeth and wearing clean clothing. It also includes making safe and healthy decisions when interacting with others. Implementing good personal hygiene practices has both health and social reasons and benefits.

Watch: “The Breakfast Club” video.

5. Balance Eating. Don’t eat too much or too little. Stay away from foods that make you overly emotional. Your rating: _____. “For adults a healthy diet includes the following: Fruit, vegetables, legumes (e.g. lentils and beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat and brown rice). At least 400 g (i.e. five portions) of fruit and vegetables per day excluding potatoes, sweet potatoes, cassava and other starchy roots.” World Health Organization (WHO), 2018.

6. Decide which day of the coming week to keep a food diary using the “Balance Eating Worksheet” included with this session. On that day make a list of everything you ate or drank by main food category.  Identify foods that negatively affected your mood. Use “Other” for anything that doesn’t fit into a category. (Do not include water.)

·      Fruits

·      Vegetables

·      Grains

·      Protein[1]

·      Dairy

7. Unhealthy diet and lack of physical activity are leading global risks to health. If you become so preoccupied with food and weight issues that you find it harder and harder to focus on other aspects of your life, it may be an early sign of an eating disorder. Check with medical professionals about your eating habits, behaviors and beliefs (NAMI, 2020). These three food groups can cause many health problems so need to be eaten ‘sparingly’. Medical experts recommend keeping intake of added sugars to about 200 calories per day, but the average intake in some age groups is almost twice that amount. The leading sources of added sugars are soda pop, cakes, cookies, candy, and ice cream. Sodium, usually consumed as salt, can increase blood pressure and risks for heart attacks and strokes. Most of our salt comes in processed foods. Fats in our foods can add to obesity and heart disease. Fried foods and processed foods are usually high in fats.

As you review your food diary, what are some practical ways you can lower sugars, salt and fat in your daily diet?__________________________________________________________________________________________________________

8. Avoid Mood Altering Drugs. Your rating _____. Stay off non-prescribed drugs such as marijuana, other street drugs, and alcohol.

Watch: “Your Mind on Drugs” video.

9. Balance Sleep. Try to get the amount of sleep that helps you feel rested. Stay on a regular schedule in order to develop and maintain good sleep habits. Your rating: ______. How much sleep do you need? Everyone is unique so there are no official guidelines about how much sleep you should get each night. On average, a normal amount of sleep for an adult is considered to be around seven to eight hours a night. Children and babies may sleep for much longer than this, older adults may sleep for less. What is important is whether you feel you get enough sleep, and whether your sleep is of good quality. You are probably not getting enough good quality sleep if you constantly feel tired throughout the day and it’s affecting the normal functioning of everyday life. Improving your sleep habits may be helped by understanding how much sleep you are currently getting. Use the “Balance Sleep Worksheet” accompanying this session to chart your own sleep patterns for the next seven nights.

Watch: “Invasion of the Body Snatchers” video.

Discuss: For Kevin McCarthy’s “Invasion of the Body Snatchers” film character, fatigue was a matter of life and death. How can fatigue affect our ability to make decisions, solve problems, control our emotions or behavior and handled change?__________________________________________________________________________________________________________

10. What can you do if you can’t sleep?

·    Keep to a regular sleep schedule as much as possible

·       Try a short “power” nap if it’s difficult to stay awake during the day

·       Relax and reduce distractions in your bedroom, particularly screens

·       Exercise daily

·       Avoid going to bed hungry or overeating at dinner

·       Don’t try to force yourself to sleep

·       Seek profession medical help (e.g. medication) if needed to help you sleep

Discuss: What other ideas have worked for you? How do you think these ideas could help you better manage your sleep habits? ____________________________________________________________________________________________________________________________________________________________________________________________________________________

GET MOVING ACTIVITY

Step 1: Stand up for one minute and do something to move like stretch, walk around, or do jumping jacks. (If you need to stay seated, try and move your arms, legs, toes, and so forth.)

Discuss: How did this short activity make you feel? What blessings come from using our physical bodies?____________________________________________________________________________________________________________________________________________________________________________________________________________________

11. Get Exercise. Do some sort of exercise every day, including walking. Start small and build on it. Have you ever felt that your life is like a “rubber band”, stretched to its maximum, ready to snap? Your rating: ______. The health benefits of regular exercise and physical activity are hard to ignore. Regular exercise, which can be useful for anyone at any age or fitness level, is a healthy and highly effective approach of releasing the rubber band. Your exercise options are endless; walking, jogging, swimming, cycling, gardening, dancing – even household chores.

12. Exercise improves mental health by helping to reduce anxiety, depression, and negative mood and increase self-esteem and cognitive functioning. Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal. This is because physical activity stimulates various brain chemicals that may leave you feeling happier, more relaxed and less anxious. Use the “Get Exercising Worksheet” to help you begin to develop a regular an exercise plan.

NOTE: IF YOU HAVEN'T EXERCISED FOR A LONG TIME, HAVE CHRONIC HEALTH PROBLEMS (HEART DISEASE, DIABETES, ARTHRITIS) OR OTHER CONCERNS, CHECK WITH A MEDICAL PROFESSIONAL BEFORE STARTING A NEW EXERCISE PLAN.  

Watch: “PLEASE End Credits” video.

13. As we roll the PLEASE – DBT Skill end credits think about what is the most important thing you learned in this session and what will you do differently because of what you learned. Write your thoughts below.

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Our Session Commitments include:

·      Record a week of Activities of Daily Living (ADLs)

·      Keep a food diary for a week.

·      Analyze my sleep patterns for a week.

·      Develop an exercise plan and follow it for a week.

·      Complete the Weekly DBT Diary Card.

·      Come prepared to the next session to share your experience using DBT principles and skills.

[1] FDA (2018) Protein is found in a variety of foods including beans and peas, dairy products, eggs, grains and vegetables (these generally provide less protein than is found in other sources), meats and poultry, nuts and seeds, seafood (fish and shellfish) and soy products.