DBT05. STOP

SESSION ONLINE VERSION

Theme song: 19th Nervous Breakdown

MINDFULNESS “IMAGERY OF A RECENT EXPERIENCE” EXERCISE ACTIVITY

Step 1: Think of a recent upsetting situation.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Try to conjure up the situation as though it were happening right now—notice your thoughts, feelings, urges, body sensations, and so forth.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Observe yourself in the situation, experience it fully without judging, then silently put words on the experience (e.g., ‘Tears are welling up in my eyes,’ ‘My shoulders feel tense,’ ‘My thoughts are racing’, etc.).

Let at least 15 seconds pass before moving on to the next step.

Step 4: Practice getting into Wise Mind as if you were in the situation right now. Think of a short goal for this situation.

Let at least 15 seconds pass before moving on to the next step.

Step 6: Focus on being effective. Think of one thing you could do or say ‘that works’ in this situation.

Let at least 15 seconds pass before moving on to the next step.

Discuss: What was your experience like? What did you notice?

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Think: Review your commitments from the “TIPP – DBT Skill” session:

·      Use the “TIPP Skill Practice Worksheet” for at least one painful situation.

·      Complete the Weekly DBT Diary. 

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

1. Dialectical Behavioral Therapy (DBT) teaches -- “When nothing you do, don’t seem to work, it only seems to make things worse” -- facing and accepting distress head-on reduces suffering. Tolerance involves putting up with, rather than changing or getting rid of, an unwanted situation. These skills provide short-term solutions that do NOT solve the core problem causing the distress and do not necessarily make people feel better. Instead, they help us bear pain skillfully by not engaging in maladaptive behaviors, including substance use, disordered eating, or self-harm.

Think: During the last week did you make a painful situation, that you couldn’t change, worse by your own behavior? If you had stopped and looked around BEFORE acting, how could you have handled that situation more effectively?

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Watch: “Alive” video.

2. As we review the four steps of the DBT STOP Skill think about how life-long friends ‘Nando’ and ‘Roberto’ responded to the same crisis of surviving a plane crashed. Which one was in their Wise Mind? Like Roberto and Nando you know the skill is working if you survived the crisis without doing something (or not doing something) that made things worse.

S: Stop! when you feel your emotions are about to take control. Don’t react, instead hit the “pause” button. Pausing for a moment helps prevent you from doing what your emotion wants you to do—to act without thinking. Stay in control.

Roberto: Mountains! Nothing but mountains. We've had it! We've completely had it!

Nando: No, we haven't. Going through these mountains somewhere, there's a green valley. See those mountains? There's no snow on them.

Roberto: They must be 50 miles away. You think you can walk 50 miles?

3. T: Take a step back in your mind and/or physically from the situation. Get unstuck, take a deep breath. Continue breathing deeply as long as you need to do this to reduce extreme Emotion Mind quickly until you are back in control.

Nando: If we have to, we will.
Roberto: I can't.
Nando: Yes, you can.
Roberto: I can't. I'm not as strong as you.

4. O: Observe what is happening around you and within you. To make effective choices, it is important not to jump to conclusions. Instead, gather the relevant facts so as to understand what is going on and what the available options are.

Nando: You know what it is that we've lived this long, the way we have? 70 days? That we climbed up here? Know what it is? It's impossible. It's impossible and we did it.
Roberto: I know.

Nando: I'm proud to be a man on a day like this – ALIVE! That I lived to see it, and see it in such a place. Take it in! I love you, man! Look! It's magnificent. It's God. It'll carry us over every stone, I swear! I swear to you.

5. P: Proceed mindfully. What do I want from this situation? What are my goals? What choice might make this situation better or worse?’ Ask your Wise Mind how to deal with this problem. Being mindful is the opposite of being impulsive and acting without thinking.

Nando: We'll get Tintin. We'll send him back to the plane and take his extra food. You see? You see where the sun's going to set? That way's west. And to the west are the green valleys of Chile.
Roberto: We're gonna die, you know?
Nando: Maybe. But if we die, we're gonna die walking.

Watch: “Gravity” video.

6. The STOP skill could come in handy when your space station is being destroyed around you. Did you notice how by the end of the scene Sandra Bullock’s Dr. Stone “Gravity” film character breathing slowed so she was able to more skillfully bear the pain of being lost in space. The STOP skill does not solve the problem, rather it helps keep us alive so that we can problem solve. As we read the following situations examples think about the power of having a short-term goal to help frame the STOP skills use around

8. Situation #1. Your partner tells you they need some space. They are going to stay at a friend’s house for a while to think things over. You’re so upset and scared when you hear this news that you want to yell at them, beg them not to leave, or do both. What to do?

Short term goal: To NOT engage in behavior that you’ll later regret.

S: Stop! Don’t say or do anything.

T: Take a step back. Physically step away from your partner. Notice how you’re breathing. Try to take some deep breaths.

O: Observe what’s going on inside and outside. What are your thoughts and feelings? Are you scared your relationship is going to end? What is your partner doing. Are they waiting expectantly for your response? Notice your surroundings like a camera zooming out to take in the whole scene.

P: Proceed mindfully. Consult your Wise Mind. Does it tell you to start screaming at your partner or beg them not to go? Ask how do you want to feel about yourself tomorrow.

9. Situation #2: You have a deadline for a work project approaching. If you don’t complete the project, it will create major problems. You’re mad at yourself for procrastinating and scared of losing your job. You’re so overwhelmed by your emotions that you can’t think straight and the hours are ticking by. What to do?

Short term goal: To NOT avoid doing something you need to do.

S: Stop in your tracks. Whatever you’re doing, stop immediately. If you’re in front of your computer, put your hands down.

T: Take a step back by getting up and walking away from your desk. Maybe go outside for a moment. Notice how you’re breathing. See if you can take some deep breaths.

O: Observe the situation. What’s going on inside you? Outside you? Notice judgmental or worrying thoughts. Observe your body, too. Are your shoulders hunched? Is your jaw clenched? Notice your surroundings.

P: Proceed mindfully. Ask your Wise Mind what the best course of action is -- spend the next few hours avoiding your project OR getting to work. Ask your Wise Mind what the next right step is for you.

STOP SKILL ACITIVITY

Describe a time when you had a strong urge to act on emotions and when doing that made the situation worse.

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What was your short term goal in that situation?

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S: Stop! How could you have stopped?____________________________________________________________________________________________________________________________________________________________________________________________________________________

T: Take a step back. What could you have done to give yourself some time to calm down and think?____________________________________________________________________________________________________________________________________________________________________________________________________________________

O: Observe. How could you have gathered relevant facts, not jumped to conclusions, so as to understand what is going on and what the available options are? ____________________________________________________________________________________________________________________________________________________________________________________________________________________

P: Proceed mindfully. How could you have dealt with the situation more effectively?____________________________________________________________________________________________________________________________________________________________________________________________________________________

Discuss: Share with the group what you learned from doing this activity.

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Watch: “STOP End Credits” video.

As we roll the STOP – 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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Session Commitments

Use the “STOP Skill Practice Worksheet”

when you need to face and accept distress head on.

Complete the Weekly DBT Diary.

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