[content warning: this post contains advice to exercise and eat more healthily.]
These skills used to be called PLEASE MASTER, but then someone took Marsha Linehan aside and explained to her what BDSM is, and now they’re called ABC PLEASE instead. This is terrible and I suggest we all write letters to our congresspeople.
A lot of the skills talked about in DBT so far have been in-the-moment skills. Distress tolerance skills are skills you use when you’re upset and can’t handle it; naming emotions, opposite action, and problem-solving are used when you have a distressing emotion. These skills are completely different! They’re about the basic self-care you do to create a life such that you aren’t goddamn miserable all the fucking time. As such, most of these are things you do every day.
A: Accumulate positive experiences. This falls into two categories: short-term and long-term.
In the short term, you should do at least one pleasant thing every day. You might read a book you enjoy, or spend time with a friend, or pet your dog, or knit. It’s important that this be something you enjoy, and not something that you think you’re supposed to enjoy, or that other people enjoy. It’s okay to do something you like, even if it’s silly or stupid. If you have a hard time thinking of things you like, looking at a pleasant activities list may help you.
Many people may have a hard time with this because it doesn’t fit in with their lives: they might think, “I’m a depressed person! I don’t do fun things!” Other people may have trouble with it because they feel like it’s frivolous, or they don’t deserve it. Still others may have difficulty because they’re so sluggish that they can’t do much of anything over the course of a day, and it feels selfish to use up their limited energy on something fun. But the thing is: you cannot be a happy, functional person unless you have fun sometimes. It doesn’t work. Don’t just think of it as something you enjoy: think of it as an investment in your future. When you’re lonely and not very active, you’re setting yourself up for misery.
Pleasant activities do not count unless you actually pay attention to them. If you read a book, that’s fun, but if you’re half-reading a book while mostly concentrating on how much you hate yourself, it doesn’t actually do a lot of good. Focus your attention on positive things. Don’t multitask. Participate and engage fully. Don’t worry about when the positive experience will end, whether you deserve it, whether people will expect more of you, or whether you should be doing something else. Whenever you find your mind wandering to those thoughts, refocus on the pleasant activity. It’s okay if you have to draw your mind back many times– even if you have to do it many times a minute. Just keep trying, it will get easier.
In the long term, you cannot have a life worth living unless you take steps to achieve it. It will not happen by magic.
Some people know what they have to do to have a life worth living: they know that they would be much happier if they spent time with their kids, or wrote their novel, or found a romantic partner. Their problem is that they’re avoiding it. Avoidance can be really sneaky. You can think “oh, I need to take care of myself! I need to relax! I can’t work on that now.” Or “well, I should probably clear my calendar and make sure I have some time to focus on it.” Or “Well, I don’t really want that.” If this is your problem, think about some concrete steps you can take towards your goal and actually take them. Even twenty minutes of progress is invaluable.
Other people might have no idea what they need to do to create a life worth living. One way to figure it out is to identify your values. These are things like “having lots of pleasure and enjoyment”, “experiencing exciting adventures”, “obeying authority and tradition”, “having autonomy”, “loving God”, or “being safe”– the principles that are important to you. It’s important that these be yours, not other people’s. It doesn’t matter whether your mom, friends, or boyfriend think that respecting the environment is the most important value– if you couldn’t give a shit about the environment, but really care about challenging yourself and self-improvement, that’s okay. People are unsure of their values for lots of reasons: other people have taught them not to have values; they feel like they can’t live according to them and feel guilty; they feel like it’s wrong to have values in the first place.
Most people have lots of values, but it’s best to identify one to work on at a time. For instance, you might decide that you value being honest. If you are already pretty honest, then there’s not much to worry about there, and you should probably pick a different value to work on. But you might find that you haven’t been living in accordance with your value: your job involves lying to clients, you haven’t been very open with your wife, and you cheated on your taxes. In that case, no wonder you feel like shit! If you’re in that situation, think of goals to set yourself: for instance, you might want to find a new job, or communicate better with your spouse. Choose one goal to work on– you don’t want to be overwhelmed. Then identify some small action steps that will help you reach your goal: for instance, you might want to buy and read a book about better marital communication, or write your resume.
B: Build mastery. Many people are depressed because they feel worthless, or like failures, or like they’ve never achieved anything in their lives. One solution to this problem is to make a commitment, every day, to do something that gives you a sense of accomplishment: that makes you feel competent, confident, in control, and able to master things. You should try something that’s challenging, but possible. If you succeed easily, it won’t feel like a triumph; but if you always fail at it, you’re right back to feeling like a failure.
You don’t have to do something big, or something that you like, or something that’s related to your long-term goals. In fact, activities to build mastery can be quite small. Maybe you spend twenty minutes tidying your apartment. Maybe you cook dinner. All it has to be is something where you can look at it and go “hey! I did not do literally nothing today! That bedroom used to be dirty as fuck, and now it’s clean!” For many people, learning an instrument or a language can be a great source of mastery: you used to not be able to do the thing, and now you can do it!
C: Cope ahead. One problem a lot of people face when they’re learning emotion regulation and distress tolerance skills is that it’s hard to remember to do them. You can read the blog post about opposite action and think “yes! Opposite action! What an excellent idea! I should definitely do that!”… but that doesn’t mean that in the moment, when you’re feeling sad, you’re going to do it. In fact, a lot of the time, it won’t even occur to you that this is an option.
Fortunately, a lot of our problems are predictable. Either we’ve faced them in the past– every day, around 10 am, it occurs to you that instead of doing your work you could read Tumblr for the rest of your life– or we can anticipate that they’re going to happen– you have a job interview coming up, and you have no idea what you’re going to do. So what you can do is cope ahead.
It can help to do this with a pen and a piece of paper first. Describe exactly the situation you’re in, avoiding black-and-white statements, judgments, and your opinions about what’s going on. For instance, you might say “I’m going to have a job interview. I am going to be frightened.”, but not “I’m going to a terrifying job interview and they are never going to hire me.” Next, think about what skills you would want to use. Describe how you use them. You might write: “I’m going to use paced breathing if I notice myself getting overwhelmed. I will practice opposite action by deliberately adopting unafraid body language. If I get a question I can’t answer, I will radically accept that I don’t know how to answer it.” Now, imagine yourself in the situation. Don’t visualize yourself from outside: think about yourself as if you were in the situation. Imagine yourself using the skills: for instance, noticing your fright, and then taking one or two slow, deep breaths and throwing your shoulders back. Once you’ve finished imagining, you may want to use some relaxation techniques, such as paced breathing or progressive muscle relaxation– particularly if the situation is one you’re worried about.
Coping ahead is a great skill for worrywarts, because you’re already most of the way there! When you find yourself dwelling on the situation that makes you anxious, it’s an opportunity to imagine yourself coping with it well– and increase your chances of actually coping with it well in the future.
PL: Physical illness and the treating thereof. (No, I don’t think anyone has a clear idea about why the L is there.) There are people who manage to be calm, peaceful, and full of love of self and others when they have an earache. However, if you have found yourself deeply interested in a series about emotion regulation techniques, you probably aren’t one of them. If you have access to health care, and you have some sort of niggling health problem, go see a doctor and get it treated. Take your prescribed medication. If you’re in pain, consider taking painkillers instead of toughing it out.
E: Eat right. Now, everyone probably has an idea of what is meant by “eat right”, and it involves counting your calories and not having any ice cream for dessert. But it’s important that we think about diets in the context of a person’s life.
Calories are the most important nutrient. While this isn’t something most people in the US have a problem with, some people do. If you have an eating disorder, the most important aspect of your diet is that you avoid restricting and binging; whatever you do to make that happen is okay. If you’re broke or someone with a disability that makes food hard, it is much more important that you get enough calories than it is that you eat “good” food.
If you’ve gotten eating the right amount of food sorted, the next step is to work on the rest of your diet. I am not a nutritionist, but most sources of information on the topic seem to agree that eating more fruits and vegetables and fewer Pop Tarts and Skittles is a good idea, so I would advise that. Many people notice that certain ways of eating make them feel like shit: for instance, they might have really unstable moods after they have a meal that’s low in protein. If you suspect this might be the case for you, it can help to write down what you’re eating and see if you can notice trends. While most people get enough vitamins, if your diet is restricted in some way (for instance, because you’re gluten-intolerant, vegan, a person with sensory sensitivities, or just picky), it can be important to see if you’re deficient in anything and supplement or eat more foods rich in that thing.
A: Avoid mind-altering substances. Now, DBT is primarily advice for borderlines, chronically suicidal people, and others with emotion regulation problems. For us, “don’t take any drugs other than alcohol, and seriously consider whether alcohol is a good idea” is sensible advice. However, most of the population is not at nearly as high a risk of dysfunctional use of substances as borderlines are. So just be aware that mind-altering substances do, well, alter your mind, and emotional regulation is significantly more difficult if you’re intoxicated. Practice sensible harm reduction techniques, such as starting with a small dose when you’re using an unfamiliar substance, researching substances ahead of time, and not mixing substances.
S: Sleep. You should sleep an amount that makes you feel good; for most people, that’s between seven and nine hours a night. Many people, particularly depressed people, are prone to hypersomnia; hypersomnia can be just as bad for your moods as insomnia.
To increase your chance of falling asleep: follow a consistent sleep schedule, even on weekends. Avoid any naps longer than ten minutes. Avoid caffeine, alcohol, nicotine, exercise, and heavy meals late in the day. Try to avoid using your bed for anything other than sleep or sex. When prepared to sleep, turn off the light and keep the room quiet and the temperature comfortable and relatively cool. Things that might help: an electric blanket, a fan, a sleeping mask, earplugs, a white noise machine, a weighted blanket.
Aim for reverie and dreaminess; while falling asleep is the best, even just resting your brain is tremendously good for you. If you’re feeling sort of vague and floaty, your job is done. Don’t decide to give up on sleeping for the night and get up for the “day”. If after about half an hour to an hour you are still wide awake, evaluate whether you’re calm or anxious (even if it’s just “background anxiety”). If you’re calm, get up, eat a light snack like an apple, and do some sort of quiet activity that won’t wake you up further until you feel tired. (My therapist suggested reading a book, but I think she underestimates how engrossed people can get in books.)
If you are anxious, there are many techniques that can work. Splash some cold water on your face, then get right back in bed and breathe long, slow, gentle breaths; this lowers arousal. You may want to practice some form of meditation; even something as simple as counting your breaths can help. Reassure yourself that these worries will seem much more solvable in the morning. Focus on the bodily sensations associated with rumination. Read a few pages of an interesting novel, and then try to continue it in your head. Listen to public radio at low volume with your eyes closed. If your problem is quickly solvable, it may help to get up and solve it. If you can’t do anything to help with your problem right now, think about the very worst outcome, and then practice coping ahead.
Many people have trouble sleeping because of nightmares. If you want to work on changing a nightmare, start when you’re calm; if you’re not calm, you may want to practice pleasant imagery, relaxation exercises, or distraction until you feel better. Choose a recurring nightmare you want to work on, one that you can manage. Write down your target nightmare, including sensory descriptions, thoughts, feelings, and assumptions about yourself. (If the nightmare is a trauma nightmare, skip writing it down.) Then, think of a way to change the nightmare. The change should prevent anything bad, scary, or traumatic from happening and give you a sense of peace. Your changes can include changed thoughts, feelings, or assumptions about yourself; they can be physics-defying changes, like you being a superhero. Throughout the day, visualize the entire dream with the change and practice relaxation techniques that work for you; at night, before going to sleep, rehearse the changed nightmare and then practice relaxation techniques.
E: Exercise. Exercise can be tremendously important in helping people to manage their moods. It does not matter what sort of exercise you do: yoga, lifting weights, playing sports, or even just doing a couple of pushups. In fact, even doing a ten-minute walk once a day is a lot better than being sedentary. The important thing is that it’s exercise that you can do and that you do it consistently. It’s much better to do less exercise regularly than it is to get overambitious and commit yourself to something that you can’t follow through on. Once you’ve gotten into the habit of exercising, then you can get ambitious.