Have you ever looked at yourself in one of those funny mirrors? Whose image did you see? It was you, of course. After all, it wasn’t George Washington or Michael Jordan staring back in the mirror—it was you! But it wasn’t exactly you. You were either taller or shorter or fatter or skinnier (or all of the above) than you really are in real life. In other words, the image you were seeing was indeed you—but a distorted version of you.

That’s what distorted thoughts are like. Distortions happen when whatever we think about a situation is somehow skewed—it’s kind of accurate but not completely accurate. Or maybe these thoughts used to be accurate for a past situation, but are no longer fully accurate for the current situation. Usually these distortions are completely automatic and tend to be overly negative—and that’s precisely why I call them automatic negative thoughts, or ANT’s for short.

Psychologists have long noticed that we all tend to have what is called a “negativity bias” (Siegel, 2014). One example of the negativity bias is that our brains tend to favor false alarms over no alarms. Think of our ancestors in the jungle. Let’s assume one ancestor sees a stick, but thinks it’s a snake. That ancestor will experience anxiety…but live! Now let’s assume another ancestor sees a snake, but thinks it’s a stick. That ancestor will not experience anxiety…and will probably die! Do you see how the negative bias helps us survive, but at the cost of anxiety?   

Another example of the negativity bias is that our brains learn from negative experiences much more quickly than we learn than from positive experiences. If you don’t believe me, just think about this: How many insults does it take to negate many compliments? Only one! And how many compliments does it take to undue one insult? Many!   

The negativity bias explains why trauma is so traumatizing: Because of how we are hard-wired, really negative experiences (aka trauma) stick in our minds for a really long time. It can be extremely difficult to unlearn what has been learned from traumatic experiences.

Traumatized people have the same negativity bias as everyone else, just more of it! As we have already learned, trauma is an extreme situation that throws us off balance, including our thoughts. Trauma survivors tend to have more extreme thinking in two particular ways: What I call the Three P’s and the Hindsight Bias. The Three P’s are personal, permanent, and pervasive. This means when something bad happens to you, you take it more personally than other people, you think it’s more permanent than it really is, and it you also think it is more pervasive than it really is (in other words, situation affects everything else in your life). The Hindsight Bias means that you beat yourself up with everything that could’ve / should’ve done differently to stop the bad thing from happening.

The Three P’s and the Hindsight Bias are examples of automatic negative thoughts, or ANT’s. Here are some more ANT’s that you might recognize (adapted from Beck, 2011):

• All or Nothing – Whenever you think everything is either black or white, and you do not take into account possible shades of gray. Absolute terms (such as “always” and “never”) are sure signs of this sort of thinking. 
  • Example: “I am never thin enough. I am always so obese.” 


• Over-Generalizing – Whenever you take one small piece of evidence and apply it across the board. Over-generalizing is a great example of making something more permanent or more pervasive than it really is. 
  • Example: “All men are potential predators.”

• Mental Filter – Whenever you fixate on only one negative event, or whenever everything seems dark and negative (sort of like wearing a dark pair of sunglasses). 
  • Example: “Life has been awful ever since the accident. Life will never ever be the same again.”

• Disqualifying the Positives – Whenever you explain away or discount something that is legitimately positive. 
  • Example: “The new girl said I was really nice, but it’s only because she doesn’t know my history yet.”

• Mind-Reading – Whenever you think for sure that you know what someone else is thinking; tends to result in self-fulfilling prophecies. 
  • Example: “She didn’t even wave to me today; I bet she’s mad at me about something. Fine, if that’s how she’s going to be, then I will just ignore her too!”

• Fortune-Telling – Whenever you think for sure that you know how an event in the future will turn out; also tends to result in self-fulfilling prophecies.
  • Example: “There’s no way that I am going to pass my biology test tomorrow...so why even bother studying for it?” 


• Magnifying – Whenever you take a small problem and turn it into a large problem.
  • Example: “I can’t believe I didn’t make the basketball team. This is SO humiliating. Everyone is going to think that I am such a loser!” 


• Catastrophizing – Whenever you take a small problem and turn it into an outright crisis; this is “magnification on steroids.”
  • Example: “I can’t believe I didn’t make the basketball team. I am seriously thinking about killing myself.” 


• Minimizing – Whenever you take a large problem and turn it into a small problem; this is the opposite of magnification.
  • Example: “He hit me, but it doesn’t really hurt. I can cover up the bruise with makeup and no one will know.”

• Denial – Whenever you take a large problem and turn it into no problem at all; this is “minimization on steroids.” This is also the opposite of catastrophizing.
  • Example: “A little bit of physical contact in marriage is not domestic violence. Physical contact shows that we love and care about each other!”

• Emotional Reasoning – Whenever you think with your feelings; in other words, feelings become facts. Or put another way, emotions become the only evidence you need.
  • Example: “I feel really guilty about the miscarriage; I know that it wouldn’t have happened if I never got pregnant in the first place!”

• Over-Shoulding – Whenever you pile up unreasonable / unrealistic expectations for yourself. One example of over-shoulding is the hindsight bias, which we mentioned earlier.
  • Example: “I should have known better than to wear that outfit to the party. Of course I got raped.”

• Under-Shoulding – Whenever you do not take ownership for things that really are your responsibility.
  • Example: “They shouldn’t get all upset when I pop positive on my drug screen, because they don’t know what kind of a life I’ve had.”

• Labeling – Whenever you complete the following sentence in unfavorable terms: “I am _____.” Even labels we consider to be accurate are still distortions, since they only focus on one sliver of information, while ignoring other relevant data points.
  • Example: “I am such a loser; I deserve the poor treatment I get.”

• Personalizing – Whenever you take something personally that has nothing to do with you. Blaming yourself for someone else’s abuse is the harshest form of personalizing.
  • Example: “The only reason he molested me is because I was such a slut.”

• Blame Shifting – Whenever you blame someone else for something that really is your responsibility.
  • Example: “I wouldn’t have punched him if he wasn’t screaming at me first.”

• Rationalizing – Whenever you try to make something seem logically right, even though it was wrong.
  • Example: “Technically he didn’t mean to rape me. He just loved me so much that he couldn’t control himself.”

• Justifying – Whenever you try to make something seem morally right, even though it was wrong.
  • Example: “He didn’t mean to rape me. It was my duty as his girlfriend to make sure he was satisfied.”

All of these automatic negative thoughts are like swarms of ANT’s that can cause lots of harm to self and others. Fortunately, there are three simple questions that can help you identify a potential ANT:

1. Is it logical?

2. Is there evidence?

3. Does it matter?

Each time you answer “no” to one of these questions represents one stomp on the ANT. And remember, you only have to stomp the ANT once to kill it!

Psychologists have long noticed that thoughts, emotions, and actions all influence each other. Since the 1960’s, psychologists have especially focused on how certain thoughts can inspire certain emotions which in turn can instigate certain actions. More recent research, however, has shown that this relationship is not so simple or linear. Rather, emotions affect our thinking just as much as thoughts affect our emotions. In fact, our thinking affects both our emotions and our actions; our emotions affect both our actions and our thoughts; and our behaviors affect both our thoughts and emotions (e.g., Shoda, & LeeTiernan, 2002). So basically, everything affects everything else!

Since thoughts, emotions, and actions all influence each other, what that also means is that if you change one, you can also change the other two! Some aspects of this work focus directly on changing our behaviors (such as the previous chapter). Other aspects of this workbook focus directly on changing our emotions (such as the next chapter). However, this chapter will focus on changing our thinking, for two reasons. First, just because we think something does not mean that it is 100% accurate. Secondly, as we already said, sometimes it becomes easier to change our emotional or behavioral reactions if we can also change how we think about something.  

Although thoughts, emotions, and behaviors all mutually affect each other, in this lesson we are going to specifically focus on the sequence that has received the most attention and research: Thoughts à Emotions à Actions. In fact, this sequence is so well known that I have created the following acronym to help you remember it better: TEA. That’s why in this lesson we are going to learn what’s in your TEA!

Let’s use a simple example to show how this sequence can sometimes play out. Let’s assume you were verbally abused by your father growing up. Now let’s assume that you are terrified every time your boss asks to speak to you, and therefore you try to avoid him at all costs. It seems that your boss is causing you all this distress, right? But is that really the case? Well, let’s find out what’s in your TEA! The reality is that you are probably having thoughts such as: “What does he want now? He’s probably going to just criticize me.” And those thoughts probably cause you to feel scared or intimated of him. And those emotions probably lead you to avoid him whenever possible.     

I want you to notice a few things from this example. First of all, this sequence makes complete sense based on your experiences growing up with a verbally abusive father. Your father really did criticize you. You had good reason to feel scared and intimidated of your father. And you also had good reason to avoid him as much as possible. But does this sequence necessarily apply to your boss? Maybe it does and maybe it doesn’t!

The second thing I want you to notice from this sequence is that it might be your thoughts about your boss—and not necessarily your boss himself—that is driving this sequence. Since you are thinking that he is going to criticize you (like your father used to do), then of course you are going to feel intimated, and of course you will want to avoid him.

The final thing I want you to you to notice about this sequence is that it is self-reinforcing. What does that mean? It simply means that the more sequence plays out, the more it will continue to play out. The more you think your boss will criticize you, the more you will feel intimated of him. The more you feel intimated of him, the more you will avoid him. And the more you avoid him, the more you will fear his criticism. And the cycle just keeps going! This cycle is sometimes called a “self-fulfilling prophecy.”

So, what would happen if you simply changed how you thought about your boss? Instead of constantly dreading potential criticism, what if your thoughts were the following? “My boss has always praised me much more than criticized me. Sometimes he gets a little short and irritable, but that’s only when he’s under lots of stress himself. So when he gets that way, it’s probably more about him than me.” If that’s what you were thinking, how would that change your emotions? You might still feel a little scared or a little intimated, but would it be as intense as before? And would you still feel such a strong need to avoid him at all costs? Do you see how simply shifting your perspective can also make it a little bit easier to change your emotions and actions as well?     

We’ve already learned about the three minds: The Thinking Mind, the Feeling Mind, and the Balanced Mind. Do you remember how both our thoughts and our feelings can get off balance when we are not using our Balanced Mind? Do you also remember that the purpose of the Balanced Mind is to notice, evaluate, regulate, and ultimately balance what we are thinking and feeling?

The entire point of this chapter is to use the Balanced Mind to restore balance to the Thinking Mind. (In the next chapter, we will use the Balanced Mind to restore balance to the Feeling Mind). There is one key concept you will learn in this chapter that will help your Balanced Mind restore balance to the Thinking Mind: Dialectical Thinking.

Some people are just more rigid or “black and white” in how they think. People who have been traumatized are especially prone to thinking in extremes. Why is that? Because trauma survivors really have been in extreme situations. For example, when you are in a life or death situation, there really aren’t too many shades of gray worth contemplating! Unfortunately, sometimes those extreme ways of thinking crystallize into how we see everything else in life—even situations that are not traumatic.

Based on our previous life experiences, we learn to see things in a certain way, and only that way. Even if we learn that what we feel is sometimes misleading, we often still assume that what we think must be gospel truth. However, the reality is that not everything we think is necessarily completely true, accurate, logical, rational, or healthy. Once again, this can especially be true if we have been traumatized in any way. For example, trauma survivors may inappropriately blame themselves for their own abuse. Or they may become overly negative in how they view themselves, other people who are not abusive, or even all of life.  

You might remember from the first chapter that “dialectics” is all about finding balance by bringing together opposites. Dialectical or balanced thinking simply means that we learn to bring our extreme thoughts and beliefs more to the middle. Balanced thinking means we learn to think about things from new and different perspectives—instead of thinking about things in only one way. Balanced thinking also means that we are flexible in how we think, that we can change our thinking if we learn new evidence, and that we can see things from someone else’s perspective. People who learn to develop balanced thought patterns are better problem-solvers, better at getting along with other people, and better at dealing with life in general.

In this chapter, you will learn a variety of concepts related to balanced thinking. First, you will learn the relationship between thoughts, feelings, and behaviors. Then you will learn a variety of ways in which our thinking can sometimes become distorted, or misguided. Next you will learn three simple questions to help stomp out your automatic negative thoughts (ANT’s). Finally, you will learn two very simple methods for changing your most deeply entrenched thought patterns.

Here is a brief preview of what you will learn next:

• Learn the relationship between your thoughts, emotions, and actions (TEA).
• Learn a variety of automatic negative thoughts (ANT’s).
• Learn to challenge your ANT’s with three simple stomps.
• Learn to change your thinking by working the TOM.
• Learn to change your interpretations by playing your DS (Dialectical Synonyms).

A sequence we have seen repeatedly throughout these blogs is this: Awareness, Acceptance, Action. As we have already learned, awareness and acceptance alone can often transform our lives from unbearable to bearable, from unmanageable to manageable. Obviously, however, sometimes life requires additional action beyond awareness and acceptance. But here’s the good news: First, awareness and acceptance are already forms of action. Secondly, awareness and acceptance are precisely the foundation we need in order to respond to life with specific, concrete behaviors. Otherwise, we are just back to our old ineffective habits and impulsive reactions that only make matters worse.

Now that we have laid this foundation of awareness and acceptance, the rest of this blog series will focus on specific, concrete behaviors. In this blog, we will introduce some basic, short-term strategies we can use to cope in the moment and return to our Balanced Mind.

Remember all those ways our minds can get off balance? Sometimes our Thinking Minds are in over-drive, and we can’t stop worrying or obsessing. Sometimes our Thinking Minds aren’t working enough—and we make reactive or impulsive decisions. Sometimes our Feeling Minds are in over-drive, which makes us feel overwhelmed or out of control. And sometime our Feeling Minds aren’t working enough—which makes us feel numb, empty, or even dead.

People do many things when either their Thinking Minds or Feeling Minds are off balance. Some people use drugs. Some people rage. Some people engage in self-harm. Some people keep making the same mistakes over and over again. Perhaps you can relate to some of these patterns! But regardless, they all have the same outcome: Although many of these reactions may help you feel better in the moment—or at the very least provide some sort of temporary relief—they all make things even worse in the long haul. Just think about it: How could drugs, rage, self-harm, or knee-jerk reactions really help you turn your life around? You already know the answer to that!

Therefore, the entire purpose of all the coping skills in this chapter is to get you back into your Balanced Mind as efficiently and effectively as possible—without incurring further collateral damage. In other words, you will be learning alternate behaviors to replace the behaviors you would normally engage in.

As you learn each of these new coping skills, here are a few points to keep in mind: First, practice makes prepared—not perfect. The more you practice these skills, the more prepared you will feel to face your triggers. Don’t worry about perfection…save that for a different lifetime! Second, the time to practice these skills is when you are NOT in crisis. Please do not wait for a crisis situation to try out a new coping skill! Third, you need to integrate as many of these coping skills into your normal daily routine as possible. These coping skills will have both a preventative and rehabilitative effect. In other words, the more your coping skills become part of your normal lifestyle, the less you will feel triggered in the first place—and the better you will deal with those triggers when they do happen. Fourth, it is important to remember that all of these skills work for someone—but none of these skills work for everyone. The key is to figure out which of these coping skills will work for YOU!

So let’s get started already.

Pros & Cons

Pros and Cons is the first coping skill in this list, because this is the skill that helps us realize that we need to cope in the first place! This skill is especially useful when we would much rather do something impulsive (an action urge), as opposed to coping. It is well documented that previous trauma makes us more impulsive. In one study of 412 people with trauma histories, researchers identified the importance of replacing sensation-seeking tendencies, and especially when triggered by negative emotions, with more effective forms of coping (Contractor, Armour, Forbes, Elhai, 2016). So the next time you feel like doing something impulsive, it may be helpful to think through the pros and cons of engaging in your action urge (in other words, what you feel like doing in the moment), and then think through the pros and cons of instead choosing one of the coping strategies described in this book…and then think about which of the two options would be best for you in the long-term. It is especially helpful to ask yourself the following questions: Which option will help me get back into my Balanced Mind as soon as possible? Which options will help me best meet my long-term goals?

Half Smile

Research shows that changing our facial expressions can also change our mood (Linehan, 2015). This works for a variety of negative emotions, including anger, anxiety, and depression. One of the best ways to change your facial expressions (and therefore your mood as well) is simply to smile—even if you don’t feel like it. And if you can’t smile all the way, then don’t—just do a half smile! The goal here is to train your facial muscles to produce a more contented countenance. Research also shows that smiles are the facial expressions people can recognize from the farthest distance (Frank, 2016). In one study (Lynn, 2011), waiters increased their tips by 140 percent—just by smiling! Therefore, not only does smiling improve your own mood, but it is also a great way to contagiously get other people in a better mood as well…which in turn will make your day even better!  

Change the Temperature

Research shows that immersing your face in cold water has an immediate calming effect on the entire body (Neacsiu, Bohus, Linehan, 2015). Research also shows that feeling connected to someone and temperature are strongly linked (Vess, 2012). For example, you will feel more connected to someone if you are holding a hot cup of tea! In short, another way to influence your emotions is to shift your body temperature. So take a cold shower. Or take a hot shower. Or grab an ice cube. Or soak in some rays. Or drink a simmering hot beverage. Or drink an ice-cold beverage. You get the point!

Intense Exercise

Exercise releases natural chemicals in your brain which make you feel better. That’s why another way to quickly shift your mood is through rigorous physical activity. In one study of 81 people with PTSD, all 81 participants received comprehensive trauma treatment, including individual counseling, group counseling, and appropriate medications (Rosenbaum, Sherrington, and Tiedemann, 2015). However, only 39 subjects participated in an exercise program. By the end of the study, the exercise group had less PTSD, less depression…and less waist!

There are many ways to exercise. You don’t have to run marathons, become an Iron Man, get a gym membership, or buy lots of expensive equipment. It’s completely okay to just go for a walk or ride your bike. But if that’s too boring for you, here are some more options: Shoot some hoops. Lift some weights. Do some sit ups, push ups, or chin ups. Cut the grass. Cut the neighbor’s grass. Garden. Do a physical project around the house. There are many options for exercise—besides surfing the web or playing fantasy football!  

Controlled Breathing

Controlled breathing sends oxygen to your brain from your abdomen rather than through from chest. Breathing from your chest is one way to trigger or reinforce the fight, flight, freeze response we discussed earlier. However, breathing from your abdomen sends the signal to your brain that all is well, which in turn has a calming effect on your whole body. The good thing about breathing as a coping strategy is that it doesn’t take any extra time, since it’s something you have to do anyway!

In one study of veterans from Iraq / Afghanistan (Seppälä, Nitschke, Tudorascu, Hayes, Goldstein, Nguyen, Perlman, Davidson, 2014), breathing exercises significantly reduced both PTSD and anxiety symptoms....even one year after the study ended! There are many variations of controlled breathing. Here’s the basic pattern that most forms of controlled breathing follow:

• Place one hand on your stomach.
• Place the other hand on your chest.
• Breathe in through your nose.
• Breathe out through your mouth.
• Exhale for twice as long as you inhale.
• Make sure the hand on your chest remains still.
• Observe the hand on your stomach rise and fall with your breathing cycle.

Muscle Relaxation

There are also many variations of muscle relaxation. However, all of the variations have one basic theme in common: learning to both tighten and relax your muscles. There are two reasons that such a simple exercise can be so helpful. First, it is helpful to simply become more aware of how our muscles feel when they are either tense or relaxed. Our bodies are constantly communicating to us, and often the body talks to us through our muscles. So when our muscles are tight, that usually means we are stressed about something. And secondly, learning to tighten and relax your muscles also teaches you that you have some control over how your muscles feel. For example, if you can deliberately tighten your muscles, that also means you can deliberately relax them—which then helps your entire system to relax. One study examined the effects of muscle relaxation on 80 women who had received hysterectomies. This study found that the 40 patients who practiced muscle relaxation following the operation had lower stress, anxiety, and depression than the 40 patients who only received the normal nursing care (Essa, Ismail, Hassan, 2017). Here are two of my favorite forms of muscle relaxation:

Method A:

• Identify the major muscle groups in your body where you feel the most tension when stressed.
• Tighten that muscle as hard as you can for 3 seconds; then release; then repeat the entire step.
• Repeat Step 2 with the parallel muscle from the other side of your body (if applicable).
• Repeat Steps 2 and 3 with all of the muscle groups identified in Step 1.

Method B:

1.    Tighten all of the major muscle groups in your entire body.

2.    Imagine that a gentle waterfall landing first on your head, and then slowly cascading through your entire body, all the way down to your toes.

3.    Starting with your head, relax each muscle group as the cascade passes through your body. 

Making Comparisons

Sometimes we feel like we are the only one with problems—or maybe not the only one, but our problems certainly seem much worse than everyone else’s! That’s when it is sometimes helpful to make some realistic comparisons to balance out our thinking. In one study of 70 people with spinal cord injuries, those who were able to compare themselves to others who were worse off had more constructive coping than those who did not make these comparisons (Buunk ,Zurriaga, & González, 2007). Here are some examples of comparisons that some people find helpful:

• Think of someone who is worse off than you are.
• Think of how your situation could hypothetically be worse than it is.
• Think of a time in the past when things were even more difficult than they are now.
• Think of all the progress you have made so far.

However, even though Making Comparisons can be very effective for some people, this technique does not work for everyone, for several reasons. For example, some people feel it is too negative to compare some else’s misery to your own. Other people feel this technique sends an invalidating message: “Don’t be such a wimp, when other people have it worse.” In addition, some people are so sensitive that just thinking about someone else’s suffering…makes their own suffering even worse! And still others feel that Making Comparisons can be used as a grounds for justification: “Well at least I wasn’t as drunk as she was!” If any of these scenarios apply to you, stayed tuned for the next coping skill…

Counting Blessings

For people that do not benefit from Making Comparisons, there is a great alternative called Counting Blessings. Instead of coping by reframing the negatives, Counting Blessings works by focusing on the positives: What is going well for me? What can I be thankful for? How have I been blessed? What gifts, strengths, and talents do I have? Who are my best friends and biggest supporters? One group of researchers studied the role of gratitude in 182 college girls with trauma histories. These researchers found that thankful college students had fewer PTSD symptoms, regardless of the severity of the trauma, extent of the previous trauma history, or the amount of time elapsed since the trauma occurred (Vernon, Jacqueline, Dillon, and Steiner, 2008). Another study involving 236 participants found that gratitude was associated with reduced self-blame, denial, and substance abuse…all of which get in the way of healing from trauma (Wood, Joseph, and Linley, 2007). 

Finding Humor

Humor is another great way to quickly shift your mood. Perhaps you have heard the adage that “laughter is the best medicine.” This is a very old concept, going all the way back to the ancient Hebrews. For example, the Hebrew Bible says: “A merry heart does good, like a medicine (Proverbs 17:22). Indeed, modern research supports this claim. For example, one study found that having a good sense of humor was linked to lower burn out and trauma symptoms in 179 firefighters (Sliter, Kale, Yuan, 2014). So it’s worth figuring out: What makes you laugh? What do you think is funny? Think of your favorite comedian. Think of a funny joke. Think of a really funny movie. Think of your funniest memory. Think of a friend that has a great sense of humor. Think of a YouTube video that makes you laugh, no matter how many times you see it. In short, create a “funny bank” that you can draw from, whenever you need to. In addition, try to find the humor in even the worst of situations. If you look hard enough, there’s almost always a funny side to life! 

Thought Stopping

Sometimes we have certain words, worries, images, or memories go through our minds, and we wish they wouldn’t. Sometimes the more we tell ourselves not to think about them, the more we think about them! Did you ever argue with someone about whether or not you were arguing? What happened when you tried to convince the other person that you weren’t arguing? You continued to argue, of course! It’s the same principle with your thoughts: Instead of trying to think about not thinking about something, sometimes you just need to find a way to stop thinking altogether. First example, one study found that thought stopping lessened feelings of anxiety and helplessness in children facing painful medical procedures (Ross, 2009). There are many ways of stopping your thoughts. Some people find a little pinch to be helpful (but please, no self harm!). Some people just shout “STOP!” in their minds. Some people find a private place and say “STOP!” out loud. And some people find the acronym “STOP!” to be helpful: “Stop, Take a step back, Observe your thought, and Proceed with a different thought.” (Adapted from Linehan, 2015). But how do you proceed with a different thought? That’s where the next skill comes in…

Memorization

Disrupting a recurring thought pattern by verbally or mentally telling your thoughts to “STOP!” (or with a little pinch) will at best accomplish that: Disrupt the thought. Now disrupting a disturbing or distressful thought is indeed a great start...but how do you replace that thought with a different one so that you don’t go back to the original one? That’s where memorization comes in handy. Once you have disrupted a problem thought, default to repeating something over and over again that you already know by memory. This could be a favorite song, poem, prayer, quote, expression, saying…or anything that can be turned into what I call a “mantra for the moment.”  

In one study of 182 women, the participants who regularly memorized the Koran demonstrated less anxiety / depression and better sleep / social function than those who did not (Kimiaee, Khademian, Farhadi, 2012).

Helping Others  

The original creators of the 12 Steps learned that helping others maintain sobriety was the best way for them to maintain their own sobriety—and that’s precisely why the twelfth step is all about helping others (Alcoholics Anonymous, 2002). There are many studies suggesting that helping others can be a great way of helping ourselves. In fact, one author reviewed almost 25,000 articles on volunteering. This researcher found that people who volunteer tend to have better mental health, physical health, life satisfaction, social interaction, coping, and even longevity. In one study researchers found that older adults who volunteered to provide support to other older adults seemed to benefit more from the volunteering than the people they helped! (Brown et al., 2003). More and more research shows that volunteering can especially help people heal from trauma symptoms. One study of 356 veterans returning from Iraq / Afghanistan found that participating in a national civic service significantly improved many aspects of physical health, mental health, and social health—including reduction in both depression and PTSD (Matthieu, Lawrence, Robertson-Blackmore, 2017). Think of ways that you could help someone else that would also provide you with a sense of purpose, fulfillment, satisfaction, or relief. This can be as simple as volunteering at a soup kitchen, babysitting someone’s children, or mowing the neighbor’s lawn.

Some people, however, are people pleasers in unhealthy ways, and they already focus too much on helping other people meet their needs—at the expense of their own. In fact, some people tend to help others as an escape from dealing with their own problems, or only feel like they have any worth when they are helping needy people. If you can relate to this description, then helping others may not be the best coping skill for you. But don’t worry—there are plenty of other options here to choose from!

Self-Care

Remember that DBT is all about balance? That’s why we need to balance helping others with taking care of ourselves. Both can be really effective ways of coping—but only with the proper balance! There are many ways of practicing self-care. Sometimes the first step in improving self-care is learning to practice basic habits of health and hygiene: eating well, sleeping enough, grooming ourselves, etc. The next step in self-care is learning to treat, pamper, and nurture ourselves—without feeling guilty! This will be different for everyone. For some people, this might be taking a nice long bubble bath. For others, it might be splurging on a well-deserved cup of gourmet coffee. Ironically, research shows that counselors are often not very good at practicing self-care themselves (Figley, 2002). (Note to self: Practice what you preach, Kirby!)

Looking Back

When we are in a funk, we tend to make things more permanent than they really are. We tend to think our problems were always this bad and will always be this bad. In other words, we take our current situation and project it both backwards and forwards in time. That’s why one way of coping in the present is to remember and reflect on positive memories from the past. Use this opportunity to remind yourself that things have not always been as bad as they seem right now. Recall good times from the past that can give you the strength, encouragement, and motivation to get through the present. In one study of 26 older adults with moderate to severe depression, reminiscing about positive events from the past significantly reduced their depression (Watt and Cappeliez, 2010). In fact, in one of the groups, 100% of the participants continued to demonstrate clinical improvement three months after the experiment ended!

Looking Forward

Life would be unbearable at times without hope. One way to cope in the present is to think ahead to when the current situation will be over or better. Make a list of your goals, plans, dreams, ambitions, and aspirations. Think about how what you are going through now is helping to prepare you for better things down the road. Look for the light at the end of the tunnel. Remind yourself: “This too shall pass!” There is a lot of research on the benefits of hope. In one study of 164 veterans with PTSD, higher levels of hope were associated with less depression and less trauma symptoms (Gilman,Schumm, Chard, 2012).

One Thing at a Time!   

Sometimes life becomes overwhelming because we start to think about all of our problems at once. That’s when it’s helpful to hit the pause button, take a step back, and chose just one thing to focus on. If necessary, make a list of everything you need to get done, rank these tasks in the order of importance—and then focus on one thing at a time.

There are decades of research indicating that learning to pay attention to just one thing at a time—in other words, mindfulness—helps improve just about every human symptom, whether physiological or psychological…including PTSD (e.g., Kearney, McDermott, Malte, Martinez, Simpson, 2011…among hundreds of examples).

Mini Vacation 

Something else we can do when everything starts to pile up is to simply take a temporary break from things—and then return when we are ready. There are many ways to take a “Mini Vacation.” Go for a walk. Take a bath. Go out to eat. Watch a movie. Go for a drive. Take a coffee break. Cook your favorite meal. The goal here is not to avoid your problems, but simply to take the time you need so that you can get back in the game as soon as you are ready. One study found that even people who have experienced major life-altering events (such as spinal cord injuries or chronic illness), improved their coping and made their immediate life circumstances more bearable by learning to take “mini vacations” (Hutchinson, Loy, Kleiber, Dattilo, 2010).

Cheerleading

In a previous chapter, we talked about judgments. As you recall, judgments come from the negative messages we hear from others. When other people say enough negative things to us over enough times, eventually we start to make those messages our own negative self-talk. Sometimes what we desperately need is for someone else to say something nice or positive to counteract those judgments running through our heads. And that’s great when that happens. But what do we do when there is no one around in the moment to be our cheerleader? That’s precisely when we need to be our own cheerleader! This skill is all about learning to provide ourselves with the positive self-talk that we need to compete with our negative self-talk. In this case, cheerleading does not mean putting on a small skirt and jumping up and down with pom-poms…but it does mean giving yourself a pep talk! How effective is cheerleading? Well, research suggests that positive self-talk will even improve your dart-throwing accuracy (Van Raalte, Brewer, Lewis, Linder, 1995). ’Nuff said…

Journaling

Another way of coping is through any sort of written expression—and it doesn’t even have to be words! Some of my clients love to write poetry (and I love to read their poems). And some of my clients love to draw (and I love to see their drawings). But regardless, finding creative ways to express your thoughts and feelings in written form can be very therapeutic. In one study of US veterans who had spent time in Afghanistan / Iraq, expressive writing resulted in less PTSD, anger, and physical complaints compared to veterans who did not write at all. In fact, veterans who wrote expressively even experienced better reintegration and social support than their peers (Sayer, Noorbaloochi, Frazie, Pennebaker, Orazem, Schnurr, Murdoch, Carlson, Gravely, Litz, 2015).

Enjoyable Activities 

What’s something you really enjoy doing that costs very little money—or no money at all? Sipping a cup of coffee? Watching the sunset? Walking your dog? Getting comfy with a good book? Taking a shower? If you want to cope well with life, you need to do at least one enjoyable activity per day! In one study, people who participated in more frequent enjoyable activities reported more positive emotions, life satisfaction, and social support as well as less depression, blood pressure, and stress hormones (Pressman, Matthews, Cohen, Martire, Scheier, Baum, Schulz, 2009). Life is simply too short of be a workaholic all the time. Take time to enjoy life! (Another note to self: Practice what you preach, Kirby!)

Soothing with the Senses

Research shows that mindfully engaging the five senses (sight, sound, smell, taste, touch) can lower symptoms of depression, anxiety, and PTSD. For example, one study found that systematic exposure to certain aromas decreased symptoms of both anxiety and depression (Lemon, 20014). Another study found that massage therapy significantly influenced brain chemistry. For example, massages decreased stress hormones (cortisol) while increasing neurotransmitters associated with positive emotions, such as dopamine and serotonin (Field, Hernandez-Reif, Diego, Schanberg, and Kuhn, 2005). Yet another study found that listening to music helped reduce anxiety in terminally ill patients—and even pain and fatigue (Horne-Thompson and Grocke, 2008). In fact, one study even found that music therapy could be more effective in treating depression than counseling (Castillo-Pérez, Gómez-Pérez, Velasco, Pérez-Campos, Mayoral, 2010)…but please do not tell your therapist that!

That’s why another way to cope in the moment is to mindfully engage at least one of your five senses—and use that sense to focus on something that has a calming effect on you. For example, mindfully gaze at something that is soothing to look at. Mindfully listen to something that calms you down. Mindfully absorb your favorite aroma or fragrance. Mindfully ingest your favorite flavor or ingredient. Mindfully relish a favorite tactile sensation (such as a comfy blanket or warm water streaming down your back). Some people even find it’s helpful to create a Five-Senses Pouch: Some way to have all five senses immediately accessible to you at all times (such as in your purse or pocket). For example, you might have perfume, candy, a small stress ball, and a favorite picture or song on your phone—all within reach.

Ride the Wave / Urge Surfing

This coping skill is all about visualizing your intense emotions as a wave, and then learning to interact with that emotional wave the same way you would deal with a real wave. If you are at the beach and a big wave is coming, you always have a couple of options. One option is to simply get out of the water, if you have enough time.

But if that is not possible, another option is to just ride the wave. Yes, it will feel uncomfortable. Yes, you will feel like you are losing control. But the only other option is to fight the wave, which will only make matters even worse. When people panic at the beach, their first instinct is to control the wave by kicking and thrashing. The only problem: You cannot control a wave, no matter how much you kick and thrash…but a wave can control you! In fact, the more you try to control a wave, the less control you actually have. And if a wave really controls you, you might even be completely knocked off balance…and then get caught in the undertow. Which, trust me, is a really scary experience. Since I grew up in Connecticut, which has awful beaches, I still have childhood memories of getting pulled under and dragged along the rocks and seaweed of the undertow!

All of these concepts apply to emotions. Sometimes if you notice an intense emotional wave coming, you can simply get out of the situation that is causing the wave. But if you cannot, then your next best option is to simply ride out the wave. Yes, you will feel uncomfortable. Yes, you will feel like you are losing some control. But just like a real wave, you cannot control emotions. And just like a real wave, the more you try to control emotions, the more emotions will control you. And just like people try to control a real wave by kicking and thrashing, people try to control their emotions through judgments. “I should not feel this way. This is stupid. I hate depression.” And if you judge your emotions too much, you just might end up in the emotional undertow, which will drag you through all kinds of emotional rocks and seaweed. Think about it: If you are angry, and you judge yourself for being angry, now you will be angry at the anger, which just made your anger problem even worse…not better! That’s why it’s always better to ride the wave than to fight the wave.

The same idea of learning to ride our emotional waves also applies to intense urges (such as craving a certain drug). That’s why this same basic skill is sometimes called “urge surfing.” Recent research suggests that “urge surfing” can be an effective way to overcome strong cravings for alcohol, nicotine, and other drugs (Bowen and Marlatt, 2009; Ostafin and Marlatt).

Imagery

It’s not always possible to cope by doing something specific. That’s when imagery comes in handy. Imagery is all about visualizing something instead of actually doing it. Visualizing is more accessible and more portable than some of these other coping skills, because you can do it anywhere / anytime. Think of some of the other coping skills we’ve been talking about, such as Self-Care, Enjoyable Activities, Mini Vacation, and Soothing with the Senses. In the event that you cannot actually implement these coping skills in the moment, would just visualizing them be helpful? If visualizing a coping skill is just as effective or almost as effective as actually doing it, then imagery is for you. In one study of 130 surgical patients, the participants who received guided imagery before, during, and following the operation experienced significantly less anxiety and pain…and required 50% less narcotic medications! (Tusek, Church, Fazio, 2006).

Finding Purpose

Some situations in life seem so painful that no amount of physical OR virtual coping will provide much relief. That’s when it is necessary to practice Extreme Acceptance. Something that can make Extreme Acceptance a little easier to implement is to think about how your current suffering can be redeemed for a greater purpose. Learn to ask and answer questions such as the following: What can I learn from this suffering that I could not have learned otherwise? How can this suffering prepare me for something that nothing else could have prepared me for? How can this suffering be used for good? If these sorts of deep philosophical questions are difficult for you, consult with a spiritual leader, such as a pastor, priest, or rabbi.  

Viktor Frankl was a Jewish psychiatrist who survived several different Nazi concertation camps during World II, including Auschwitz, where over one million people died from brutal treatment, including starvation. Frankl later wrote a book called Man’s Search for Meaning (1984), in which he described his experiences in the concentration camps. It is clear that Frankl inspired Marsha Linehan, the originator of DBT (2015). Throughout his book, Frankl especially describes the coping skills that both he and others used to survive their hellish experiences. In fact, almost every single paragraph in his book makes reference to skills described in this chapter (as well as other chapters). But as the title of his book implies, the most important coping skill Frankl references is finding meaning (or purpose) in suffering. Knowing that he was probably going to die anyway, Frankl decided against suicide and decided to use whatever time he had left in the camps to serve his fellow prisoners. According to Frankl, people who were able to find purpose in their suffering and maintain hope were much more likely to survive than those who did not.

Practice Makes Prepared

Perhaps two of the most researched coping strategies are controlled breathing and progressive muscle relaxation. There are lots of Internet resources which provide guided, step-by-step instructions on the many variations of these techniques. Once you learn how to do these skills, you need to incorporate them into your daily routine. You will need to figure out which routines work the best for you. One routine that is gaining some recent attention is to make controlled breathing and progressive muscle relaxation even more effective…by combining them! In order to combine these skills, you simply tense your muscles as you inhale, and relax your muscles as you exhale. For example, I love to combine controlled breathing and muscle relaxation when I go for bike rides. Every time I pedal, I both tighten and relax my muscles….while simultaneously inhaling and exhaling.

For practical exercises to learn more about specific coping skills, please refer to my workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder.

Not everything that happens to us in life is something we signed up for. There are some things in the past we desperately wish never happened to us. There are other things in the present we desperately wish we could change. In fact, there are even people we desperately wish we could change.  

Extreme Acceptance means accepting something that you emphatically do not like. Extreme Acceptance does not mean that you approve of or agree with the situation—but it does mean that you will acknowledge and embrace the situation anyway. Extreme Acceptance is the exact opposite of denial. As we learned in a previous blog, denial is adaptive when we are still in shock and the brain needs to protect us from information that we cannot handle yet. But denial is no longer adaptive when we constantly have blinders on that prevent us from seeing realty how it really is. Long-term, ongoing denial is basically when we lie to ourselves—and then believe our own lie! Extreme Acceptance, in contrast, means we see reality exactly how it is—no better, and no worse.

Why should we learn to practice Extreme Acceptance? Well, here are a few reasons to consider. First, just because you deny reality does not mean that problems just go away. In fact, the opposite is true: The more we make an ongoing habit of denying reality, the worse our problems get—not better! Another reason to practice Extreme Acceptance is because pain cannot be avoided anyway. Pain is simply a fact of life. We all have pain. A baby’s first emotional response to life is to cry. Why? Because coming into this world is painful…just ask the mother! And even death is sometimes painful. And then there’s plenty of pain in between. So in short, it’s not possible to avoid all that pain, no matter how hard we try. Another reason to practice Extreme Acceptance is something we have already seen: We must accept reality before we can change it! Accepting reality is indeed painful, since we are becoming more aware of painful things that we would prefer to ignore. But eventually, Extreme Acceptance leads to peace and freedom. Why? Because Extreme Acceptance puts us in a better position to deal with reality (Linehan, 2015).

Since Extreme Acceptance can be such a difficult idea to grasp, here are two formulas that help me understand this concept better:

• Pain + Extreme Acceptance = Healing
• Pain – Extreme Acceptance = Suffering

There are several important lessons we can learn from these two simple formulas. I apologize ahead of time if an example from Algebra will be triggering, but you can think of these two equations this way: Pain is the constant, while acceptance is the variable. As we have already seen, pain is a given: Both of these equations include pain! However, our response to pain is what determines the outcome of this equation. If we demonstrate Extreme Acceptance of the pain, we are now on the path to healing. Of course, as we have already seen, the path to healing can itself be painful…but at the very least, things will eventually start to get better. But when we do not practice Extreme Acceptance, that pain only gets worse! When pain gets worse instead of better, we will experience suffering rather than healing.

Something else we can learn from these two formulas is that pain is required, but suffering is optional. Let me explain what I mean by this statement. First of all, I do not mean that everything you have suffered in your life is your fault. However, now that you are learning new skills and new insights in this blog series, the pain in your life does not have to keep piling up or getting worse. By demonstrating Extreme Acceptance, you really can start to turn the tide on your suffering. You can switch from the path that leads to suffering—to the path that leads to healing. Both paths will still have pain. But the pain on the healing path is bearable, while the pain on the suffering path is not. And that’s an important difference!

Something that helps us to better accept pain is to understand how much we need it. Yes, you heard me correctly! Let’s use a physical example to explain what I mean. Pain is obviously a very uncomfortable experience—and that’s precisely why it is such an important wake up call. Pain is a signal that something is wrong! If our minds did not send us such a loud, clear message, we might not get it. Pain allows us to heal, learn, and grow from our experiences. Think about it: You probably would not have survived childhood without it. There are indeed children who do not physically experience pain, and they actually have really high mortality rates. Why? Because when they are injured, they have no signal from their brain telling them to stop, get help, or pursue a different course of action. I for one would never have survived childhood without pain…in fact, I barely survived with it! The same principles apply to us emotionally: We need emotional pain to heal, learn, and grow. The more we can understand the benefits of pain, the easier it becomes to demonstrate Extreme Acceptance.  

There are three basic scenarios in which we need to practice Extreme Acceptance:

1. Situations from the past that cannot be changed.

2. Situations from the present that cannot be changed.

3. Situations from the present that can be changed.

Perhaps you were raped as a child. That’s an example of a situation from the past that cannot be changed. As much as you wish it did not happen, that does not change the fact that it did happen. Perhaps you have some sort of permanent disability. That is an example of a situation from the present that also cannot be changed. As much as you wish you did not have the handicap, that will not change the fact that you have it. But sometimes there are situations from the present that can be changed. For example, perhaps you are involved in an abusive relationship. Perhaps you have tried to change your abusive partner—and could not. But there’s still another option that perhaps you have ignored: Get out of the relationship!

In all three cases, Extreme Acceptance is not easy (to say the least). However, as we have already seen, failing to demonstrate Extreme Acceptance would not help any of these scenarios. Pain would only become suffering. Extreme Acceptance is precisely what we need in order to deal with each of these scenarios. Therefore, Extreme Acceptance is emphatically not a passive process, although at times it may seem that way. As we have seen, some situations in life can be changed while others cannot. Regardless, Extreme Acceptance always provides you with the opportunity to change what can be changed. For example, you cannot change the fact you were raped—but you can change how you decide to relate to men now. You cannot change the fact that you have a disability, but you can decide to optimize your life regardless of the disability—and perhaps even because of the disability! And maybe you cannot change an abusive partner—but you can decide whether or not you remain in that relationship.

For practical exercises to learn more about Extreme Acceptance, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder!

In the previous blog series, we learned all about mindfulness. In particular, we learned that applied mindfulness involves a three-step sequence: Awareness, Acceptance, Action. First we need to become more aware of what’s happening in the moment. Then we need to become more accepting of what’s happening in the moment. And then, once we are both more aware and more accepting, we are in a much better position to finally take action:

In other words, to deal with the situation.

When we experience trauma, however, we are not using the part of the brain that guides us through awareness, acceptance, and action. We are using a different part of the brain which is more concerned about our immediate survival. We are using the part of the brain that causes us to alter awareness, activate judgments—and jump straight to action as soon as possible.

But there are only three main options for action with this part of the brain: Fight, flight, or freeze.

• The fight response means we become hostile or belligerent (whether physically, emotionally, or verbally).
• The flight response means we either physically leave or emotionally avoid a situation.
• And the freeze response means we just shut down altogether. An extreme example of the freeze response is fainting. 

So what happens when you are in a situation in which it is not safe to fight back and it’s also not possible to escape? That’s precisely why many trauma survivors learn to freeze—and then escape in their own minds. This is a process that psychologists call dissociation. Dissociation is a combination of the freeze and flight response; this happens when you mentally freeze and then mentally escape, even if your body is still fully functioning and fully present in the situation.

All of these responses to danger or crisis are extremely helpful when we are experiencing a traumatic situation. Awareness is altered because you need to focus only on survival. Judgments are activated because you need to make quick snappy decisions about life-and-death matters. And you certainly do not have the luxury of consulting with a panel of experts on the best course of action. That’s why your brain limits your choices to the three options most likely to help you survive: fight, flight, freeze (which, as we saw, includes dissociation).

But here’s the problem.

When we have been traumatized enough, we learn to execute these responses to everything in life—even if we are not in immediate danger or crisis! In other words, our brains over-learn these responses. Do you see the problem with that? Let’s assume your coworker responds to you in a tone that you did not expect. Now let’s assume your awareness is altered (you only notice her stressed tone, not her baggy eyes from not sleeping last night)…and then your judgments are activated instead of acceptance (“I can’t believe I have to work with scum that give me no respect)…and then you jump straight to fight, flight, to freeze. I will let your own imagination take over from there. But here’s my point: Are you off to a good start at work? Did your trauma response just make things better—or a whole lot worse?

Remember that DBT is all about restoring balance? DBT has entire set of skills called Distress Tolerance which are designed to provide temporary “quick fixes” to help us quickly restore balance in the moment, when we are triggered. In other words, the purpose of these skills is to give us alternatives to replace our instinctive fight/flight/freeze reactions, and to get us back into our Balanced Mind as soon as possible.

One of my favorite definitions of Distress Tolerance is “how to survive the moment without making it worse.” In short, Distress Tolerance is all about healthier and more effective ways of coping—as opposed to unhealthy or ineffective coping, in which you hurt yourself, hurt someone else, or somehow make the problem worse than it already was. Another definition of Distress Tolerance that I really like is “turning unbearable pain into bearable pain.” Notice that Distress Tolerance does not take away pain—but it does help you deal with painful situations in ways that do not cause the pain to become even worse.

Ultimately, Distress Tolerance skills will help you with both acceptance and action. That’s why the first Distress Tolerance skill you will learn is called Extreme Acceptance. As you will see, Extreme Acceptance is a special kind of acceptance that we need to apply to both trauma and its consequences. However, after you learn about Extreme Acceptance, you will next learn a series of coping skills that will help you take action; in other words, learn how to react in more effective ways. Notice that effective coping involves both acceptance and action. This is another one of the great balancing acts of DBT! 

For practical exercises to learn more about your fight, flight, freeze response, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder!

So far in this blog series, we have further developed the themes of awareness, acceptance, and action. We have learned that we cannot accept difficult facts or make difficult changes until we first overcome our blind spots (denial and pre-contemplation). By definition, we cannot see our blind spots on our own…we need help from others to kindly, gently point them out. We have also learned other roadblocks for acceptance (anger, bargaining, depression), and have further learned that no action is lasting until we have found ways to maintain that change. And finally, we have also learned that acceptance is often a prerequisite for action. In other words, we won’t be motivated to change a problem if we haven’t first accepted that it is indeed a problem!   

But how do we get from acceptance to action? And how do we accept that something really is a problem? And how do we start to change something once we have agreed that it is problematic? The next exercise will help answer these questions!

Look at the chart below.

First, identify a behavior that you would like to evaluate in more detail. Describe this action in as much detail as you need.

Then move to the next two rows. These boxes will help you accept whether or not this is a problem behavior. First, list all of the positive results that you can think of. Next, list all of the negative results you can think of. Sometimes it is also helpful to distinguish between short-term positives versus long-term positives, as well as between short-term negatives and long-term negatives.

Now take a step back and look at the rows describing the results of your behavior. Are there more positives than negatives? Are there more negatives than positives? Remember that this is not just about numbers. Sometimes just one long-term negative consequence can far outweigh many positive short-term consequences. In the final analysis, are the negative results worth it? Or are there enough negative results to make this a problem behavior?

In short, these boxes have just helped you with acceptance. But now how do you change the problem behavior? Well, let’s take a look at the next two rows. These boxes are all about what preceded the behavior. The first of these two boxes is specifically about external triggers. External triggers answer questions such as: What? When? Who? Where? For example, what were you doing before the behavior happened? When was this going on? Who were you with? Where were you? The next box is about internal triggers. Internal triggers answer questions like: What was going through your mind before the behavior happened? What were you feeling (emotionally)? What were you feeling (physically)?

Guess what? Everything you just identified in these two boxes are called triggers! One of the keys to changing behavior is learning to identify, avoid, eliminate, or manage our triggers. Do you see how this simple exercise helped you with both acceptance and change in one single chart?

Let’s check out a sample exercise first. And then it will be your turn!

For practical exercises to overcome your blindspots, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder.

In the previous blog, we talked about five stages of acceptance. Now we are going to talk about five stages of action. Do you remember why we talked about acceptance first? Because we can’t change reality until we first accept it! But now that we know how to recognize—and overcome—the obstacles to acceptance, we can next focus on taking action.

In the previous lesson, we talked about the importance of accepting the original trauma, as well as the affects of the trauma. As you recall, trauma affects us in many ways: our emotions, our thoughts, our relationships, and our behaviors. Sometimes one of the most difficult things to accept is that our own behaviors, as a result of the trauma, have not always been the healthiest. Well, as it turns, our own behaviors are not just difficult to accept—they can be even more difficult to change!

In this blog, we are going to focus on the five stages of changing our behaviors: Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance (Connors, DiClemente, Velasquez, & Donovan, 2015).

Pre-Contemplation:

To contemplate means to think about something. Therefore, pre-contemplation refers to a time before you are even thinking about how your behavior might be a problem. Notice that pre-contemplation resembles denial. Just like acceptance starts with overcoming denial, change also starts with overcoming pre-contemplation. Pre-contemplation is another example of a blind spot: Other people often notice what needs to change before we do!

Example: Not sure why the wife is always on my case. Joe drinks way more than I do, and his wife never complains about it!

Contemplation:

Remember, contemplation is the act of thinking about something. Therefore, contemplation refers to a time when you start thinking about your behavior. Contemplation does not mean that you are necessarily convinced the behavior is a problem, just that you start to think more about the behavior, and how it may or may not be problematic. Have you ever heard the phrase “paralysis through analysis”? The problem with too much contemplation is that it resembles constipation: There’s no movement!

Example: You know, I’ve called in “sick” 5 times this month. Now my boss AND my wife are on my case. I can’t pack down my liquor like the good ol’ days. Must be getting older! 

Preparation:

This stage is all about getting ready to potentially deal with the behavior. This stage implies that you have already thought long and hard about the behavior, and you have decided that something needs to give. You would finally like to change something. At the very least, you start to make some internal or mental changes. Or maybe you have even taken some small baby steps to help change at least some aspects of the problem behavior.

Example: I have got to find a way to get everyone off my back. That’s it: No more drinking till Friday night. I am not going to stop at the bar on my way home from work. And that hidden stash of booze in the closet has gotta go…

Action:

This stage is all about finally making a decisive change in your behavior that other people can actually observe. At first blush, it seems like you have arrived at your destination. After all, you have finally changed your problem behavior. Congratulations! Everyone should celebrate…right? Not yet. The action stage is still full of landmines. Many people let down their guard when they reach the action stage. They think they have the problem licked. They start to take “harmless” risks as they allow themselves more and more freedom. That’s why people with too much over-confidence tend to experience relapse at this stage.

Example: Okay, so only drinking on Fridays still didn’t work. I think I just need to bid farewell to my long and storied drinking career. Out with the Old Me. In with the new Upgrade: Clean and Sober! Now I will be attending AA meetings on Friday evenings! Fast forward: Now that I have a month of sobriety under my belt, surely my sponsor won’t mind if I head over to Joe’s apartment for his birthday bash. Maybe I can even brag about how sober I’ve been… 

Maintenance:

The last stage of change is when you have not only made the decisive change, but you have found ways to successfully maintain that change over time. Regression back to old habits is still always possible, but now you realize that. Therefore, you have found ways to avoid relapse—and get back on track right away if you do slip up!

Example: After a few painful relapses back in my early days of sobriety, I have now been abstinent for five years. I have learned the key to maintaining my sobriety is to avoid certain people, places, and things—and never to miss an AA meeting! 

Working through the stages of change is a lot like working through the stages of acceptance: Nobody goes through the stages perfectly; not everyone goes through these stages in this exact order; it is possible to go through different stages at the same time; and it is also possible to regress in the stages.

Here’s one analogy that has always helped me to understand the stages of change—and especially the importance of making it all the way to maintenance. Let’s assume that someday you would like to have a garden full of vegetables. However, right now it’s February, and you are not even thinking about the garden yet. That’s pre-contemplation. How many vegetables will you have if you stay in this stage? Now let’s assume it’s March, and you finally start to think about the garden. You think about what kind of tools you will need, what kind of soil you will need, and what kind of seeds you will need. That’s contemplation. But how many vegetables will you have if you stay in this stage? Now let’s assume it’s April, and you start to get everything ready for the garden: You buy the tools, you buy the soil, you buy the seeds. You even rototill a little plot of ground. That’s preparation. But how many vegetables will you have if you stay in this stage? Now let’s assume it’s May. You finally plant the garden! That’s the action stage. Congratulations! But now let’s assume you do absolutely nothing to maintain this garden for the rest of the summer. You don’t water. You don’t weed. You don’t fertilize. How many vegetables should you expect by the end of August if you stay in this stage? Now do you see the importance of making it all the way to maintenance? Lifelong changes are not one-time deals: They need to be maintained!

For practical exercises to learn more about the stages of acceptance, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder!

All of us struggle at times to accept the reality we have been dealt. Sometimes reality is so painful we would rather pretend that some things do not exist or never happened. However, there are many reasons why it is a good idea to accept reality—just as it is. First, it is just not possible to avoid all forms of pain; pain is simply an inevitable aspect of life. In fact, rejecting reality can sometimes make the situation even worse. In addition, denying reality does not change reality. On the contrary, we can’t change reality until we first accept it! Finally, acceptance of reality may indeed increase our sadness at first, but eventually it leads to peace and freedom (Linehan, 2015).

Trauma survivors have even harsher realities to accept than most people. Just accepting the trauma itself is hard enough! But that’s not all. You also have to accept how the trauma has affected all aspects of your life: your thoughts, your emotions, your behaviors, and your relationships. Healing from trauma requires you to accept (NOT agree with—but accept) not only the trauma itself, but all the ways that the trauma has affected your life now.

Sometimes reality is so harsh that we simply cannot accept all of it at once. That’s when we gradually process reality in stages. Sometimes we pass through several phases of non-acceptance before we finally reach a place of acceptance. This is perfectly normal and healthy—as long as we are progressing towards full acceptance. Unfortunately, life only gets much more difficult when we get stuck for too long on any of the forms of non-acceptance. Nobody that I know is going to tell you that acceptance is easy. But one thing I can assure you: Non-acceptance is even harder!

There are five well-known stages many of us go through as we attempt to process reality (Kübler-Ross, 2014).

1. Denial – Sometimes traumatic events are so horrendous and so unexpected that our first reaction is shock and disbelief. In other words, denial! What happens when you have a surgery and the pain of the operation is too difficult to bear? The medical staff will administer some sort of numbing agent. The numbing agent doesn’t remove the source of the pain; it just temporarily blocks the pain. Denial is like a drug that numbs out reality when it is too painful for us to deal with. Denial is actually our mind’s way of protecting us when we can’t handle a full dose of reality yet. While we sometimes need this “mental anesthesia” (at least initially), too much denial can obviously create additional issues of its own. Trauma survivors sometimes engage in activities or consume substances that further numb the pain.

• Example: My boyfriend beats me because he loves me. This is how he shows me that I am his woman.

• Connections: Remember the Thinking Mind, Feeling Mind, and Balanced Mind? When an individual is in Denial Mode, all three minds are de-activated. While this complete shutdown may be temporarily appropriate, it is not a good long-term solution! Do you also remember our previous discussion on blind spots? Denial is a great example of not seeing information about ourselves that other people do.

• Reality Check: What sorts of problems can happen when you are in Denial Mode?

2. Anger – What happens when the anesthesia wears off after a surgery? Now you feel the pain, don’t you? The same exact principle applies once our denial or “mental anesthesia” wears off. Now we feel the emotional pain triggered by the situation. In other words, we feel anger! Anger is like another drug which also has an important function, within limits. For example, anger provides us with the impulse and energy to change the traumatic situation. But what if the original situation can no longer be changed? Now what’s going to happen to all that anger? Not surprisingly, too much anger also can create additional issues of its own. Trauma survivors tend to have lots of anger simmering just beneath the surface—a simmer which quickly turns to boil when triggered.

• Example: The next time my boyfriend lays a hand on me, I am going to cut myself to show him how ticked I am! (This would be an example of turning anger towards yourself, which can be common among trauma survivors).

• Connections: Remember the Thinking Mind, Feeling Mind, and Balanced Mind? When an individual is in Anger Mode, the Thinking Mind and Balanced Mind are both deactivated, but the Feeling Mind is in full throttle. While this arrangement may be temporarily appropriate, it is not a good long-term solution!

• Reality Check: What sorts of problems can happen when you are in Anger Mode?

3. Bargaining – Once both of these “drugs” wear off (anger and denial), we become slightly more rational.

Bargaining is when we try to scheme, negotiate, compromise, or manipulate our way out of the situation.

While this may sometimes be a good strategy, what if no amount of scheming, negotiating, compromising, or manipulating will change the original trauma? The problem with too much bargaining is that it is full of unrealistic, ineffective, and wishful thinking or plans. That’s why too much bargaining can also create additional issues as well.

• Example: Maybe I just need to be a better girlfriend. Maybe I just need to learn to not tick him off so much. Maybe if I can make it up to him, this won’t happen again. Maybe…

• Connections: Remember the Thinking Mind, Feeling Mind, and Balanced Mind? When an individual is in Bargain Mode, the Feeling Mind and Balanced Mind are both deactivated, but the Thinking Mind is in full throttle. While this arrangement may be temporarily necessary, it is not a good long-term solution!

• Reality Check: What sorts of problems can happen when you are in Bargain Mode?

4. Depression – Once our attempts to bargain have failed, we feel helpless and hopeless. We feel we are stuck, with no way out. We feel like things will never ever get better. We even start to feel worthless, like we somehow deserve to be in this situation. In other words, we feel depressed! Depression feels the worst but is also the closest to acceptance, because we finally start to see just how bad the circumstances really are. Remember, “it’s always darkest before dawn.” Of course, too much depression can create further issues as well. One problem with depression is that the situation that we’re in, as awful as it might be, can now seem even worse. For example, depression tends to make things seem more personal, permanent, and pervasive than they really are. Personal means that bad things happen to me because I am a bad person. Permanent means the bad things will never go away. And pervasive means everything is now dark and bleak—not just the trauma! Another problem with depression is that we lose the ability and energy to deal with the rest of life.

• Example: This is just how he is. He will always be abusive. I will never be good enough for him. But of course, I was never good enough for him in the first place. I guess I should just be thankful that at least some guy wants me. This is all I deserve anyway…

• Connections: Remember the Thinking Mind, Feeling Mind, and Balanced Mind? When an individual is in Depression Mode, the Feeling Mind and Thinking Mind are both activated, but the Balanced Mind is not! And since the Balanced Mind is not active, negative thoughts and negative emotions continue to feed off each other, resulting in a dark, gloomy cyclical cloud of depression. While this arrangement may be temporarily appropriate, it is not a good long-term solution!

• Reality Check: What sorts of problems can happen when you are in Depression Mode?

5. Acceptance – Acceptance happens when we fully acknowledge and embrace the circumstances just as they really are (no better and no worse). It has been said, “acceptance…is the only way out of hell” (Linehan, 2015, p. 420). When we finally face reality as it is, we can actually do something about it!

• Example: My boyfriend is abusive. This is an abusive relationship. I have options. I deserve better than this!

• Connections: Remember the three minds? When an individual is in Acceptance Mode, now all three minds are active: Thinking Mind, Feeling Mind, and Balanced Mind! Since we have access to the Feeling Mind, we still feel that pain of the trauma, but it is no longer so overwhelming. And since we have access to the Thinking Mind, we see the facts a little more clearly and rationally. But most importantly, since we have access to the Balanced Mind, we know how to accept the trauma, deal with the trauma, heal from the trauma, and move on with the rest of our life! 

• Reality Check: Life is never perfect, even when we have mastered the art of acceptance. What sorts of problems can still happen even when you are Acceptance Mode?

Of course, nobody progresses through the five stages perfectly. Sometimes we do not go through these stages in this exact order. Sometimes we experience more than one stage at the same time. For example, you might experience anger and bargaining at the same time; even denial and depression can overlap. Sometimes we regress in the stages. And sometimes one of these stages is our default response to any life trigger.

Learning acceptance does not mean you will never experience any of the roadblocks of denial, anger, bargaining, or depression. Rather, the key to acceptance is learning what your particular roadblocks are, and learning how to overcome those roadblocks. Remember, each of these forms of non-acceptance is normal and has its place—but none of these roadblocks are healthy places to camp out long-term. So the next time you experience denial, anger, bargaining, or depression, ask yourself: Is this a roadblock keeping me stuck—or is this a stepping stone leading me towards acceptance?

For practical exercises to learn more about the stages of acceptance, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder!

Have you ever noticed something about someone else before that person did? Maybe that person has a funny tic or says the work “like” way too many times in one sentence. On the flip side, have you ever thought that other people might notice things about you that you don’t even realize about yourself?

In this blog, we are going to talk about four different zones of awareness (Davies, 2014):

Zone 1: Information that others know about me AND information that I know about myself.

Zone 2: Information that others know about me BUT information that I do not know about myself.

Zone 3: Information that I know about myself BUT information that others do not know about me.

Zone 4: Information that others do not know about me AND information I also do not know about myself.

Zone 1 refers to general or public information, since this is information that both you and others know about.

For example, most people within your social circles probably know your name, your job, where you live, how many kids you have, and so forth. Zone 1 is usually the stuff of small talk.

Zone 2 refers to blind spots; this is information that other people know about, but you do not! As uncomfortable as this may seem, everyone has blind spots. We simply cannot observe ourselves from the same perspective as everyone else. Even when we look in a mirror, we still cannot see ourselves to the same extent as someone else looking at us. Therefore, people end up observing details about us that we do not even realize. Blind spots become a major issue in our lives when we have problems that other people see—but we do not. Trauma survivors can have unique blind spots. For example, some of your reactions may seem like over-reactions to other people. Or some of your triggers may seem illogical to other people. Or some of your intense emotions may seem out of proportion to other people. Later on in this series, we will examine two kids of blind spots in greater detail: denial and pre-contemplation.

One goal of this blog series is to help you identify your blind spots!

Zone 3 refers to hidden information, since this is information that you know about, but others do not. Not here’s the tricky part about hidden information: Some information is just personal and we should keep it private, because other people don’t need to know our business. However, some information is toxic when we keep it private, and we should share this information with someone that we can trust. In other words, there is a difference between healthy versus unhealthy secrets. Examples of unhealthy secrets include any past or present abuse, neglect, or trauma. We were not designed as people to carry these burdens alone!

Another goal of this blog series is for you to identify any traumatic experiences (either past or present) that you need to process!

Zone 4 refers to the unknown; this is information that nobody knows about—yet! However, as you continue to journey through this blog series (as well as life), information from this zone will start to transfer to the other zones we have talked about.

The more you practice the skills in this series, the more you will learn about yourself, and the more others will learn about you as well!

For practical exercises to learn more about the stages of acceptance, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder!

In the previous blog, we discussed the first three components of mindfulness:

1. To be aware
2. On purpose
3. In the present

However, there is one more component of mindfulness: “Without judging.” Now mindfulness just got a lot harder! How so? Well, what happens to us when we increase our intentional awareness of the present? We start to notice a whole lot of things that we wish we didn’t see! In a sense, learning to become more mindful (more intentionally aware of the present) means letting go of our denial or other defense mechanisms. It means exposing ourselves to all the dirty laundry that we shoved under the bed. It means turning on the lights and seeing that the room is mess. And what happens when we increase our awareness of things we would rather not see? We trigger our judgments!

Judgment versus Acceptance

Judgments are basically the negative messages that go through our minds. Most of these negative messages probably came straight from people who were or are important to us. Over time, when we hear the same negative messages over and over again, they become internalized. In other words, they become our own negative messages, rattling through our heads.

The opposite of judgment is acceptance. A judgment basically screams: “Things should not be this way!” However, acceptance simply acknowledges: “But regardless, this is simply how things are right now.” Now here’s another great irony of life: Contrary to what seems logical, judgments do not actually make anything better. Even if a judgment correctly diagnoses a problem, it only makes the problem worse! Think about it. When did judging yourself or someone else make anything better? However, accepting a problem for what it is will actually put you in a better place to deal with the problem.

Therefore, mindfulness is not just about awareness. It is also about acceptance! The tricky part is increasing both awareness and acceptance at the same time.

Mindfulness = Awareness + Acceptance

So why is mindfulness so important? Why are awareness and acceptance such a big deal? The answer is simple. Under the best of conditions, life is full of problems! And what happens when we either ignore the problems or fail to accept them? Do they just go away? Do they get better all on their own? No, of course not! Awareness and acceptance are not just random exercises with no purpose. Rather, they are the tools we need to deal with life. Once we become aware of our problems AND accept our problems, we are now in a much better position to deal with them. In other words, once we are fully aware and fully accepting of a problem, now we are finally in a position to decide if, when, and how to take action. But without awareness and acceptance, we continue to fumble through life, just making problems even worse than they were.

Applied Mindfulness
So what does applied mindfulness look like? So glad you asked! Based on everything we have learned in this lesson, we can now define applied mindfulness in three simple steps:

1. Awareness
2. Acceptance
3. Action

Now, the beauty of this formula is that awareness and acceptance are already action. In fact, just implementing awareness and acceptance is already more action than most people take in their daily lives! Therefore, sometimes awareness and acceptance is the only action you need to apply to a situation. Sometimes situations really do get better just by becoming more aware of and more accepting of them. However, sometimes increased awareness and increase acceptance allow you to understand that further action is required. But either way, you are now in better position to make better decisions moving forward.

For practical exercises to learn more mindfulness, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder.

When people hear the word mindfulness, sometimes they think of meditation or great mystical experiences. However, the concept of mindfulness is actually quite simple and ordinary. In this blog, I would like to demystify the concept of mindfulness. I want to make sure you understand that mindfulness is a concept that is readily accessible to everyone. While mindfulness does require patience and practice (just like anything good in life), it does not require decades of discipleship under a famous guru.

In the previous blog, we defined mindfulness with the following four components:

1. To be aware
2. On purpose
3. In the present
4. Without judging

Let’s take a look at each of those definitions in a little more detail. “To be aware” of something simply means to notice something, to observe something, or pay attention to something.

“On purpose” simply means to do something intentionally or deliberately, as opposed to randomly or accidentally. We all notice things when it’s too late or when we have no other choice. However, many times we fail to notice something when we do have a choice. And that’s precisely why minor issues continue to built up over time—and we never even bother to notice them, until they become out of control.

“In the present” means learning to focus on what’s going on in the here and how. That does not mean that the past or future are not important. They are! However, here is one of the great ironies of life: You cannot effectively heal from the past by obsessing about the past, nor can you effectively plan for the future by worrying about the future. Rather, by learning to become more grounded in the present, we are actually in a much better place to then heal from the past as well as plan for the future. If we are not paying attention to what’s going on in the in here and now, we simply fumble from one crisis to the next, constantly reacting to skeletons from the past or phantoms of the future, without having a firm grasp on the reality that is right before our eyes. Perhaps you have heard the old adage: “Yesterday is history and tomorrow is a mystery, but today is a gift: And that’s why it’s called the present!”

So to summarize so far, the first three components of mindfulness are all about awareness, and more specifically, intentional awareness of the moment: Learning to deliberately notice, observe, and pay attention to events in the here and now. That’s where mindfulness starts.

Please refer to Dr. Dan Siegel’s website for more information on mindfulness: http://www.drdansiegel.com.

For practical exercises to learn more mindfulness, please refer to my workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder.

Perhaps you have heard the term “mindful.” “Mindfulness” seems to be the latest buzzword in treatment circles, not to mention society in general. But actually, the concept of mindfulness has been around for thousands of years. What does the term mindfulness mean? And what does it mean to be mindful? 

Not surprisingly, there are many definitions out there. But here is my favorite definition of mindfulness: “To be aware, intentionally, in the present, with judging.” You might have noticed this definition has four distinct parts. We will discuss each of these parts in more detail later.

1. To be aware
2. On purpose
3. In the present
4. Without judging 

Mindlessness 

The opposite of mindfulness is mindlessness. To be mindless means to be unaware. Here are four examples of mindlessness: reactivity, dissociation, automaticity, and multi-tasking. Reactivity means to respond with our instincts or emotions, without thinking first. Trauma survivors tend to be very reactive to anything that reminds them (even subconsciously) of a previous trauma. Dissociation literally means to disconnect from your own experiences; in other words, to “space out” for long periods of time. Dissociation is much more severe than just daydreaming. Trauma survivors tend to be quite good a dissociating as well, since disconnecting or “spacing out” is precisely what helped you survive much of your trauma when it was occurring. Automaticity means to do something automatically, without having to think about it. If you know how to ride a bike without thinking about every single muscle movement required to stay balanced and moving forward, then you know what this concept well. Finally, multi-tasking refers to performing two or more tasks at the same time, such as changing a diaper while answering the phone.

Now notice that there is nothing wrong with mindlessness in and of itself. In fact, we would never have survived as a species if part of our brain did not know how to react without thinking, space out, learn to do something automatically, or perform multiple tasks at once. For example, what if your house was on fire, and no part of brain knew how to react impulsively? What if you had to relearn how to ride a bike, every single time you tried to ride one? Or what if you could only do thing at a time? As you can see, we wouldn’t do so well, would we? Indeed, it is a great gift that our brain can do so many things without even thinking about it.

Mindfulness versus Mindlessness 

Therefore, mindlessness is a gift (even though you won’t hear too many therapists tell you that). However, mindlessness alone is also a rotten way to go through life. What if you were always reactive—to everything? What if you were always spacing out, even during your most cherished moments? What if you could only do things you already knew how to do automatically—and therefore, you could not learn new behaviors? As you can see, we still wouldn’t be doing so well, would we? That’s why mindfulness is also a gift. We need both!

DBT is all about the dialectics: The process of finding balance by bringing together opposites. Therefore, one of the first opposites we need to balance is mindlessness versus mindfulness. While mindlessness is a gift to the brain, so is mindfulness. The only problem is that mindfulness is a gift that we have to learn! Unlike mindlessness, mindfulness does come to us naturally.

For practical exercises to learn more mindfulness, please refer to my workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder.

As previously mentioned, trauma has a way of throwing our lives out of sync in many different ways and directions. In this blog, we will focus on how trauma affects two mental processes: awareness and acceptance. 

When awareness and acceptance are altered enough, we enter into a mindless state. Two examples of mindlessness especially experienced by trauma survivors include reactivity and dissociation. These alterations to our mental processes are adaptive—and necessary—during periods of danger. But, unfortunately, these adaptions outlive the trauma itself—and, therefore, they also outlive their usefulness. That’s why you will soon learn a skill called mindfulness, which helps us restore both awareness and acceptance to our daily lives.

Imbalanced Awareness 

In the introduction, we discussed how trauma has a way of throwing us off balance by forcing our normal way of doing things to the extremes. One of the first things that trauma knocks off balance is our awareness.

When we experience trauma, we are forced to pay attention to things we wouldn’t normally pay attention to. In particular, trauma causes us to focus on information that is directly related to our survival, while focusing less on everything else. For instance, if you are walking through the park and there is no reason to suspect any danger, you are likely to notice—and appreciate—the flowers, the birds, people walking their dogs, and children playing. But if you are walking through the park and you suddenly hear multiple gunshots, you will notice a completely different set of details—the sound of the gunfire, the direction of the shots, the closest place to duck for safety—and ignore everything that doesn’t serve your safety.

Of course, our brain’s ability to shift our awareness during periods of danger makes complete sense and is highly adaptive; without this ability, we would not be able to survive the trauma. However, our brain also seems to overlearn this tendency. Even after the trauma has long ended, our overall awareness remains altered, and we continue to over-focus on some details while under-focusing on others—even though our survival is no longer at stake. This ongoing altered awareness ends up causing lots of additional problems in our lives. We may even become obsessed with minor details while completely ignoring major problems.

Extreme Judgments 

Not only does trauma force our awareness to the extremes, it also forces something else to the extremes: our judgments. When we experience trauma, everything becomes a matter of life and death, and we don’t have a ton of time to distinguish between the two. Therefore, our brain makes quick, snappy judgments: good or bad, safe or unsafe, friend or foe. 

Once again, the brain’s ability to make rapid, simple judgments in times of danger is highly adaptive and allows us to survive the trauma. But the brain also seems to overlearn this tendency as well, which likewise causes even more ongoing problems down the road. With our extreme judgments overactivated, it is much more difficult to accept other perspectives, gray areas, or the middle ground. In other words, trauma does not just affect our awareness; it also affects our acceptance.

Mindlessness 

To be mindless means to be unaware: of yourself, of others, of your thoughts and feelings, of your triggers and urges, of your reactions, and even of your judgments. And since you are unaware of your own judgments, you lack both awareness and acceptance whenever you are in a state of mindlessness. 

Not surprisingly, there are many forms of mindlessness. However, people who have been traumatized tend to adopt two forms in particular: reactivity and dissociation.

“Reactivity” means to respond with our instincts or emotions without thinking first. Once again, this tendency is highly adaptive during periods of danger. We need to be reactive in order to survive a crisis. When we are in a life-or-death situation, we would be foolish to call all of our friends and ask for their opinions. However, this reactivity continues long after the trauma has stopped. In particular, trauma survivors tend to be very reactive to anything that reminds them (even remotely, indirectly, or subconsciously) of a previous trauma—which, not surprisingly, causes even more ongoing problems.

Dissociation literally means to disconnect from your own experiences. In other words, it means to “space out” for long periods of time. Dissociation is much more severe than simply daydreaming, which we all do at times. And you probably already know what I am going to say next: “Once again, this tendency is highly adaptive during periods of danger.” In fact, the ability to mentally and emotionally disconnect from our own experiences during times of trauma is precisely what helps many people survive the trauma itself. But by now you already know this familiar tune: Asset then, liability now. Chronically disconnecting from our daily experiences is simply not an effective, long-term strategy for a happy, productive life. 

But let’s be clear: Since some states of mindlessness help us survive trauma, mindlessness truly is a gift of the mind (you won’t hear too many DBT therapists tell you that!). However, mindlessness alone is also a rotten way to go through life. What if you were always reactive—to everything? What if you were always spacing out, even during your most cherished moments? What if you were always making quick, snappy, and sometimes very inaccurate judgments? That’s why we also need the opposite of mindlessness, which is mindfulness.

WHAT IS MINDFULNESS? 

Wouldn’t it be amazing if there was something that could restore both awareness and acceptance back to their normal balance? Wouldn’t it be amazing if you could notice—and even appreciate—flowers and birds and dogs and children in the park again, instead of focusing on every person you come across as the next armed attacker? Well, I have great news for you: There actually is a skill that teaches both awareness and acceptance at the same time! It’s called mindfulness.

Trauma affects different people in different ways. But there’s one thing trauma always does: It throws you off balance. In fact, the effects of trauma can you leave you feeling so out of sync that you may wonder if anyone understands you—including yourself!

But you are not alone. Every year millions of people experience the effects of trauma. They feel as if their lives have been shattered. But here’s the good news: Both modern science and ancient wisdom can help us not only restore our balance but also create a beautiful new mosaic out of the shattered pieces. 

Trauma, by definition, is an extreme situation that forces us to react in extreme ways. Trauma drives us to respond in ways that are different from our normal way of doing things. And that’s precisely why we feel so “off” during and following a traumatic event.

Sometimes the symptoms of trauma last long after the traumatic situation has ended. This is what psychologists call post-traumatic stress disorder—in other words, the “trauma after the trauma.” This happens when the aftermath of the trauma ends up causing even more ongoing problems than the original trauma itself.

If you have been traumatized, then you know what it’s like to live at the extremes, to feel out of sync with others, and even to feel at war with yourself. Sometimes you completely space on details...and sometimes you obsess over minutia. Sometimes you overreact...and sometimes you feel completely paralyzed. Sometimes you experience a million contradictory emotions at once...and sometimes you just feel numb. Sometimes you overthink with constant worries...and sometimes you make impulsive decisions by not thinking enough. Sometimes you over-rely on other people by acting too needy and clingy...and sometimes you burn bridges that you cannot afford to burn.

In short, not only do you feel like your entire life is off balance and out of whack, you also feel like a complete walking contradiction. With just about everything in your life, you experience either one extreme or the other—and sometimes both extremes at once!

In fact, trauma has a way of throwing people off balance in five key areas: awareness, reactions, emotions, thoughts, and relationships. So it’s no wonder that sometimes you feel “crazy.”

Summary (Part 10 of 10)

Ongoing trauma results in overstimulation of both the sympathetic and parasympathetic nervous systems (accelerator and brake), resulting in a variety of responses that are either “too much” or “too little.” The five skill sets taught in DBT help restore the balance between these extremes by providing a middle path, which includes reactivation of the social engagement system. That’s why when I am explaining DBT to my clients, I usually dispense with clinical jargon and simply refer to this model as “developing balance therapy.” In this article, I have briefly introduced five skills (among legion) as examples of these middle paths: RAIN dance as a form of mindfulness; TIP the balance as a form of distress tolerance; sow your SEEDS as a form of emotion regulation; work the TOM as a form of dialectical thinking; and DEAR Adult as a form of interpersonal effectiveness. 

To be clear, DBT was not designed to resolve the original trauma. Myriad models have been developed for trauma processing. Some models focus more on verbal processing and are generally referred to as “top-down models.” Other models focus more on somatic processing and are generally referred to as “bottom-up models.” Some clients prefer verbal forms of processing, some clients prefer somatic forms of processing, and most clients can benefit from both, so it is not necessary (in my opinion) to engage in endless debate or pointless turf wars on this point. My recommendation is simple: Be trained in at least one form of trauma processing that is mostly top-down and at least one form of trauma processing that is mostly bottom-up — and become proficient in both. (Another dialectical dilemma resolved.) 

However, no form of trauma processing can be completely effective when the individual is actively in crisis, experiencing ongoing danger or constantly dysregulated. That’s where DBT comes in. DBT (which I like to call “developing balance therapy”) provides the necessary skill set to help individuals sufficiently stabilize or self-regulate in order to then proceed with deeper trauma work.

This blog post is an excerpt from Trauma stabilization through polyvagal theory and DBT, an article published by the American Counseling Association on September 14, 2021 by Kirby Reutter.

 If you would like to learn more about how to use trauma-focused DBT with a variety of trauma-based disorders, I recommend the following resources to get started:

• The Dialectical Behavior Therapy Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder by Kirby Reutter, 2019
• “DBT for Trauma and PTSD” (DBT Expert Interview series at psychotherapyacademy.org/dbt-interviews)
• Survival Packet: Treatment Guide for Individual, Group, and Family Counseling by Kirby Reutter, 2019
• “The Journey From Mars: Brain Development and Trauma” webinar (youtube.com/watch?v=WSFqHS_axOc)