GHH AM-CR Manual

Anger Management/Conflict Resolution Using Dialectical Behavior Therapy

Skills

A 5-Week Course

Prepared by: Lauren A. Shapiro, M.A.May 2014

What is "Dialectical" Thinking?

Dialectical means that 2 ideas are both true at the same time. There is always more than one TRUE way to see a situation and more than one

TRUE opinion, idea, thought, or dream Two things that seem like (or are) opposite can both be true All people have something unique, different, and worthy to teach us A life worth living has both comfortable and uncomfortable aspects (happiness

AND sadness; Anger AND Peace; Hope AND discouragement; Fear AND Ease; etc) All points of view have both TRUE and FALSE within them

You are RIGHT and the other person is RIGHT

You are doing the best that you can AND you need to try harder, do better, and be more motivated to change

You can take care of yourself AND you need help and support from others

Being dialectical means:

Letting go of self-righteous indignation Letting go of black-and-white or all-or-nothing ways of seeing a situation Finding a way to validate the other person's point of view Expanding your way of seeing things Getting 'unstuck' from standoffs and conflicts Being more flexible and approachable Avoiding assumptions and blaming

Practice :

Which is the dialectical statement for each group of sentences?

1. a) It's hopeless. Why do I even bother trying? I give up.b) My problems are gone, this is easy.c) This is hard for me and I'm going to keep working at it.

2. a) I'm totally right about this - it's the truth!b) I'm stupid. everyone else is always right about things.c) I think this is the right way and you can see it that way.

3. a) Everyone is always unfair to me.b) In some situations, I feel that I'm not being treated fairlyc) Everyone is always fair to me.

4. a) People should listen to me whenever I need to talk.b) I should be able to handle my own problems without bothering other people.c) Sometimes I need someone to listen to me. When they can't, it's frustrating.

5. a) Other people always hurt me, so I don't trust anyoneb) I trust some people and I find it very difficult to trust others.c) If I were healthy, I would be able to trust everyone.

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What is Validation?

Validation means telling someone that what they feel, think, believe, and experience is real, logical, and understandable.Self-validation is when you are able to quietly reassure yourself that what you feel inside is real, important, and makes sense.

Emotions, thoughts, and sensations are all experiences that we sometimes doubt in ourself. As a result, we ask ourselves:

Do I really feel this? Should I feel this way? (We question whether we are "right" to feel this way, and whether it's okay to inconveniences someone else)

We may often look around us to guess what other people in the same situation feel, or what others EXPECT us to feel. This happens because we have been told at some point that we should not trust what our inner experience tells us. We actually trust other people MORE than ourselves.

Sometimes when we self-invalidate, we spend a lot of time and energy trying to prove to others and ourselves that our experience is real, and makes sense. This often results in conflict or crisis.

We must learn to validate others because: It helps our relationship with them go better It calms intense situations so that we can problem-solve effectively

We must learn to self-validate because: It quiets defensive/fearful emotions so we can problem-solve effectively It allows us to let go of the pain and exhaustion that constant self-justification and

self-doubt require

Validation does NOT mean that you AGREE or APPROVE of behavior. It is a non-judgmental stance.

1. Focus on the inherent worth of the person: Whether it is yourself or someone else.

2. Observe: Listen carefully to what is said with words, expression, and body language. Intently listen, be mindful in the moment.

For self-validation: Honor your experience by sitting quietly with it, knowing it for at least a few moments.For validating others: Use eye contact, nod, and be mindful of your focus on them.

3. Describe: Non-judgmentally state the facts of the situation.4. State the unstated: Note the presence of feelings and beliefs that have not been

voiced; "You seem to feel angry, but also hurt by what that person said to you"For self-validation: Identify the primary emotions. If anger is obvious, explore your feelings for any shame, hurt, or disappointment that may be hiding beneath.

5. Find what is true/valid about the experience: Without feeling that you have to agree or approve of the experience, find a piece of it that makes sense, and validate that.

For self-validation: Realize that the thoughts you are having are "irrational", however, validate that they exist and are powerful in the moment.

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For validating others: Even if you disagree with their behavior, find something that you can empathize with - "When you get that angry, you want to strike out at someone"

Practice :

After each situation, circle all of the responses that are VALIDATING. Some of the responses may be skillful, but not validating. Remember to focus on reassuring yourself/ others that their experience is real, important, and/or makes sense. Circle all of the validating responses for each question.

1. Janet, one of your roommates, has just thrown a chair down the hallway because, Tina, another roommate refused to let them use the phone. They have received a warning and are both very angry. They are talking to you.

a. You listen, nodding.b. You stay out of it because you don't want to give them attention for bad

behavior.c. You state, "You were really frustrated, weren't you?"d. You say, "You're right! She never lets anyone use the phone!"

2. Harper, your roommate, is having a lot of symptoms lately. She is getting into trouble with staff and you know she is breaking rules. She asks you to lie for her so that she doesn’t get into anymore trouble.

a. You say, "You're really worried about being in trouble, and I can understand that, but I can't lie, and get myself into trouble too."

b. You immediately go tell staff on her.c. You try to avoid her. When she approaches you, you say, "I can't talk right now,

I have to do my laundry"d. You say, "You want me to tell staff that you were with me and that you didn't do

what they say you did."

3. You are feeling a lot of irritation and you don't know why. You snap at Nancy, who has done nothing wrong to you.

a. You tell yourself, "I'm always irritable and drive people away."b. You force yourself to behave more patiently with others than you actually feel

for the rest of the day.c. You talk to a friend and tell them, "I just snapped at someone, and I don't know

why. I'm irritable and confused."d. You ask for an extra dose of your medication.

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Core 1: Mindfulness

Mindfulness: Taking control of your attention and thoughts

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WHAT Skills

What Can You Do To Be Mindful?

1. Observe: Non-judgmentally observe our environment (internal experience and external circumstances). This skill is helpful in understanding our personal truth of what is going on in any situation. Be curious about what you feel. Notice how you feel - do not try to make the feeling stronger or weaker, go away or

last longer. See how long the feeling lasts and if it changes. Notice how the feelings flow in and out of your body. What comes through your senses (Touch, Smell, Sight, Sound, and Taste).

2. Describe: Express what we have observed without judgment. We can either describe our observations to ourselves or to another. Use words to describe your experience. Use "fact" words, call a thought "just a thought", and call a feeling "just a feeling". Use words that everyone would agree with. Don't paint a colorful picture with words. Try to avoid emotional words. Try to let go of being "right" or about someone else being "wrong".

3. Participate: Fully focusing in the moment to what we are doing, feeling, sensing and thinking Get "lost" in an activity. Let go of your sense of time while you are doing something. Allow yourself to be natural in the situation. Practice your skills until they become part of you.

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HOW Skills

How Can You Be Mindful?

1. Non-Judgmental: This is the action of describing the facts, and not thinking about what's good or bad, fair or unfair. These are judgments about what we feel but not factual descriptions. Being non-judgmental helps to get our point across in an effective manner without adding subtle criticism (shame/blame) that will trigger emotional activation, disagreement and/or power struggles in others. See but don't evaluate - Use just the facts. Focus on the "what", not the "good" or

"bad", the "should" or "should not". Unglue your opinions - From the facts, from the "who, what, when, and where". ACCEPT each moment and each event without trying to impose yourself or

anything on it. ACKNOWLEDGE the helpful, the wholesome, but don't judge it. Acknowledge the

harmful, the unwholesome, but don't judge it.

2. One-Mindfully in the Moment: This is used to focus on one thing. One-mindfully is helping in keeping the mind from straying into emotion mind due to a lack of focused and compassionate presence. Do one thing at a time - Do each thing with all of your attention. If you are eating,

just eat. If you are reading, just read. Focus your attention on the very moment you are in with the other person.

Let go of distractions - If other actions, thoughts or strong feelings distract you go back to what you are doing - again and again - do not focus on the distractions.

Concentrate your mind - If you find you are doing two things at once, stop and go back to one thing at a time.

3. Effectively: This is simply doing what works and results in an effective outcome. It is a very broad-ranged skill and can be applied to any other skill to aid in being successful with each skill. Focus on what works - Do what needs to be done in each situation in order to meet

your larger goals. Stay away from thoughts of what is "right" or "wrong", what you "should" or "should not", and what is "fair" or "unfair".

Play by the rules - Do what you need to do in the present situation; not what situation you wish you were in.

Let go - Do not hold onto vengeance, useless anger, and righteousness that hurts you and doesn't work.

Ask and think - Will this way of relating to myself and others result in an effective outcome?

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Core 2: Interpersonal Effectiveness

Interpersonal effectiveness skills: Skills that allow you to get along well in the community.

There are 3 goals of interpersonal effectiveness1. Objective Effectiveness2. Relationship Effectiveness3. Self-Respect Effectiveness

Objective effectiveness - Getting the "thing" I want or one of my needs met Getting what you deserve/have right to or getting another to do something for you Refusing an unwanted or unreasonable request Resolving an interpersonal conflict or getting your opinion/viewpoint taken

seriously

Questions to ask yourself:a. What is the "thing" or need that I want from this interaction?b. What do I have to do to get the results? What will work?

Describe: Describe the current SITUATION. Tell the person exactly what you are reacting to. Stick to the facts.

Express: Express your FEELINGS and OPINIONS about the situation. Assume that your feelings are not obvious to others. Give a brief rationale: Use phrases such as "I want" or "I don't want" instead of "I need", "You should", or "I can't".

Assert: Assert yourself by ASKING for what you want or SAYING NO clearly. Assume that others will not figure it out or do what you want unless you ask. Assume that others cannot read your mind. Don't expect others to know how hard it is for you to ask directly for what you want.

Reinforce: Reinforce or reward the person ahead of time by explaining the CONSEQUENCES. Tell the person the positive effects of getting what you want or need. Tell them the negative effects of your not getting it (if applicable). Help the person feel good ahead of time for doing or accepting what you want. Reward them afterwards.

Mindful: Keep your focus ON YOUR OBJECTIVES. Maintain your position. Do not be distracted. Keep asking, saying no, or expressing your opinion over and over while keeping your voice calm. If you're being attacked, ignore the threats, comments or attempts to divert you. Do not respond to attacks.

Appear confident: Appear EFFECTIVE and competent. Use a confident voice, tone and physical manner while making good eye contact.

Negotiate: Be willing to GIVE to GET. Offer and ask for alternative solutions to the problem. Reduce your request. Maintain no, but offer to do something else or to solve the problem another way. Focus on what will work.

Turn the Table: Turn the problem to the other person. Ask for alternative solutions, "what do you think we should do?" or "I can't say yes and you seem to really want me to. What can we do to resolve this?" or "How can we solve this problem?"

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Relationship effectiveness - Getting and keeping a good relationship Acting in such a way that the other person keeps liking and respecting you Balancing immediate goals with the good of the long-term relationship Remembering why the relationship is important to you now and in the future

Questions to ask yourself:a. How do I want the other person to feel about me after the interaction?b. What do I have to do to get or keep this relationship?

Gentle: Be courteous and temperate in your approach. Do not attack - no verbal or physical attacks and express anger directly. No threats - no "manipulating" statements, no hidden threats, tolerate a no to requests, stay in the discussion even if it gets painful and exit gracefully. No judging - no moralizing (should or shouldn't)

Interested: LISTEN and be interested in the other person. Listen to the other person's point of view, opinion, reasons for saying no, or reasons for making a request of you. Don't interrupt, talk over, etc. Be sensitive to the other person's desire to have the discussion at a later time. Be patient.

Validate: Validate or ACKNOWLEDGE the other person's feelings, wants, difficulties, and opinions about the situation. Be nonjudgmental out loud: "I can understand how you feel, but…" or "I see that you are busy, and…"

Easy Manner: Use a little humor. SMILE. Ease the person along. Be light-hearted. Be political. Use a "soft sell" over a "hard sell"

Self-respect effectiveness - Keeping or improving self-respect and liking yourself Respecting your own values and beliefs: acting in a way that makes you feel moral Acting in a way that makes you feel capable and effective

Questions to ask yourself:a. How do I want to feel about myself after the interaction is over?b. What do I have to do to feel that way about myself? What will work?

Fair: Be fair to YOURSELF and to the OTHER personApologies: No OVERLY apologetic behavior. No apologizing for being alive, for making a

request at all. No apologizing for having an opinion, for disagreeing.Stick to values: Stick to YOUR OWN values. Do not let others dictate them for you and do

not waver from them.Truthful: DON'T LIE, EXAGGERATE OR ACT HELPLESS when you are not. Don't make

excuses.

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Guidelines for Sharing and Listening

Skills for Sharing Emotions:1. State your views as your own feelings and thoughts, not as absolute truths2. When expressing negative emotions or concerns, also include any positive feelings

you have about the person or situation3. Make your statement as specific as possible, both in terms of specific emotions

and thoughts4. Speak in "paragraphs" - that is, express on main idea with some elaboration and

then allow the other person to respond - speaking for a long time without a break makes it hard for someone to listen

5. Express your feelings and thoughts with tact and timing so that the person can listen to what you are saying without becoming defensive

Skills for Listening:1. Show that you understand the person's statements and accept their right to have

those thoughts and feelings - demonstrate this acceptance through your tone of voice, facial expressions and posture

2. Try to put yourself in the other person's place and look at the situation from their perspective in order to determine how the other person feels and thinks about the issue

3. While in the listener role, do not:a. Ask questions, except for clarificationb. Express your own viewpoint or opinionc. Interpret or change the meaning of the individual's statementsd. Offer solutions or attempt to solve a problem if one existse. Make judgments or evaluate what the person has said

Skills for Responding:1. After the person finishes speaking, summarize and restate their most important

feelings, desires, conflicts, and thoughts

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Core 3: Emotion Regulation

What is it important to learn emotion regulation?1. To quiet the body - high emotion leads to high stress2. To quiet behavior - intense emotions leads to intense choices (often regretted)3. To make Wise Mind easier to find - emotion mind blocks out intuitive, creative,

flexible, and value-based thinking4. To be more effective in meeting goals - emotion mind leads us away from our

goals and off on distracting emotional tangents5. To improve self-respect - making calm choices leads to better feelings about

ourselves

Facts about Emotions Emotions are neither good nor bad, right nor wrong. Feelings just ARE. They exist.

It is not helpful or beneficial to judge emotions. There is a difference between having an emotion and acting on the emotion. Emotions don't last forever. No matter what you're feeling, eventually it will shift to

a different emotion When a strong emotion comes, you do not have to act on it. All you need to do is

recognize/acknowledge it and feel it. Emotions are not facts. When emotions are very powerful they feel just like "the

truth" but they aren't necessarily an accurate reflection of reality. You cannot get rid of emotions because they serve important survival functions. Be

willing to radically accept your emotions as they arise.

There are 8 emotions. You are born with these emotions wired into your brain. That wiring causes your body to react in certain ways and for you to have certain urges when the emotion arises. All other emotions are made up by combining the 8 basic emotions. Other times, an emotional reaction is prompted to an emotion. These are called secondary emotions and are learned.

Anger Sorrow Joy FearDisgust Guilt/Shame Interest Surprise

Examples of secondary emotions: Feeling shame when you get angry Feeling angry when your feelings are hurt Feeling fear when you get angry

Emotions have 3 jobs:1. Communication Emotions are communicated most powerfully by our faces, voice tone, volume,

posture and gestures. Often, other people can tell what we are feeling, even when we're trying to hide it and rapidly.

2. Motivation Emotions tell us to ACT NOW and STAY FOCUSED. They give us motivation to

change a situation Emotions save us time in important situations. We don't have to overthink

everything Strong emotions help us overcome obstacles - in our mind and in the environment3. Validation

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Emotions provide information about situations. Emotions are SIGNALS or ALARMSPractice:

Read the items in the left column. For each item, circle the correct category it belongs to.

1. We're going to be late to smoke! Thought Emotion Behavior Event2. This group is a drag. Thought Emotion Behavior Event3. Being afraid of a spider. Thought Emotion Behavior Event4. Throwing a book. Thought Emotion Behavior Event5. Having the urge to scream. Thought Emotion Behavior Event6. Someone calls you a bad name. Thought Emotion Behavior Event7. You pass room check! Thought Emotion Behavior Event8. You are given passes. Thought Emotion Behavior Event9. A peer tells a lie about you. Thought Emotion Behavior Event10. A staff member is harsh. Thought Emotion Behavior Event11. Someone takes your snack. Thought Emotion Behavior Event12. Sad. Thought Emotion Behavior Event13. Crying. Thought Emotion Behavior Event14. Your aunt dies. Thought Emotion Behavior Event15. Irritation with a peer. Thought Emotion Behavior Event16. Worrying about your money. Thought Emotion Behavior Event17. Nervousness about therapy. Thought Emotion Behavior Event18. Your favorite group is cancelled. Thought Emotion Behavior Event19. Rage. Thought Emotion Behavior Event20. I hate this food! Thought Emotion Behavior Event21. You punch a wall. Thought Emotion Behavior Event22. You yell at a peer. Thought Emotion Behavior Event23. A patient is put in time out. Thought Emotion Behavior Event24. You refuse your medications. Thought Emotion Behavior Event25. You take your medications. Thought Emotion Behavior Event

Do the opposite action to counter the emotion/reaction

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Emotion Regulation: Letting Go of Emotional Suffering

1. Observe your emotion Note its presence Step back Get unstuck from the emotion

2. Experience your emotion fully As a wave, coming and going Try not to block the emotion Try not to push the emotion away Don't try to keep the emotion around Don't try to increase the emotion Just be a witness to your emotion

3. Remember that you are not your emotion Do not act on the sensation urgency Remember when you have felt different Describe your emotion by saying, "I have the feeling of ____" rather than, "I am

____" Notice other feelings that you have at the same time that you feel the strong

emotion4. Practice respecting and loving your emotion

Don't judge your emotion Practice willingness with your emotion Radically accept your emotion

Emotion Regulation: Changing Emotions by Acting

How to get over FEAR: Do what you are afraid of doing… over and over and over Approach events, places, tasks, activities, and people you are afraid of Do things to give yourself a sense of control and mastery When overwhelmed, make a list of small steps or tasks you can do and do the first

thing on your listHow to get over (justified) GUILT or SHAME:

Repair the transgressiono Apologize - say you're sorryo Make things better by doing something nice for the person you offended

Commit to avoiding that mistake in the future Accept the consequences gracefully Let it go

How to get over (unjustified) GUILT or SHAME: Do what makes you feel guilt or ashamed… over and over and over Approach, don't avoid

How to get over SADNESS or DEPRESSION: Get active, approach, don't avoid Do things that make you feel competent and self-confident

How to get over ANGER Gently avoid the person you are angry with rather than attacking (also avoid

thoughts about that person, rather than dwelling on them)

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Do something nice rather than mean or attacking Imagine sympathy and empathy for the other person rather than blame

Core 4: Distress Tolerance

Distress Tolerance: Getting through painful situations without making them worse! These are skills that have to do with the ability to accept oneself, others, and the current situation, in a non-evaluative and nonjudgmental fashion. Although this is a non-judgmental stance, this does not mean that it is one of approval or resignation. Distress tolerance allows us to make wise decisions about when and how to take action, rather than falling into the intense, desperate, and often destructive emotional reactions and behaviors that can happen when strong and difficult beliefs and emotions are triggered. The goal is to become capable of calmly recognizing highly charged situations and emotions and their impact, rather than fighting, fleeing, and/or freezing (stress response).

Distract with ACCEPTS: This is a skill used to distract oneself temporarily from unpleasant emotions.Activities: Push the pause button and turn to positive activities that center, ground,

calm, and reconnect you to your strengths and wholeness.Contribute: Acknowledge your strengths and gifts and offer them to othersComparisons: Practice seeing yourself in the greater clan of humankind. We all suffer, we

all feel challenged by our suffering, and we all have the capacity to extinguish our suffering.

Emotions: Shift into humor and lightheartedness with activities that produce positive emotional states. Evoke alternate emotions.

Push away: Put the heated situation on the back-burner for a while. Put something else in the forefront of your mind. This is not suppression; it is pushing the pause button and taking a breather.

Thoughts: Direct your mind to think about something else which brings you to a sense of safety and ease. Evoke alternate thoughts.

Sensations: Do something positive that has an intense feeling other than what you are feeling (i.e. take a cold shower, put on music, scream into a pillow, dance, etc). Evoke alternate sensations.

IMPROVE the Moment: This is a skill that helps you relax in moments of distress.Imagery: Imagine relaxing scenes or other experiences that are pleasing and calming.Meaning: Find or create some purpose, meaning, or value in your pain. Remember,

listen to, or read about spiritual values. Focus on whatever positive aspects of a painful situation you can find.

Parenting oneself: Talk to yourself in a nurturing and comforting way. Come up with a personal mantra or statement that is soothing to you.

Relaxation: Relax muscles, breathe deeply. This is also a self-soothing tool. One thing in the moment: Focus your attention to what you are doing in the moment.

Coach yourself to stay in the present moment (no past or future thinking)Vacation: Another form of pushing the pause button. Take a break from whatever is

happening for a short period of time. Whatever is feeling urgent - is not as urgent as you might think. When you clear a space to pause - you interrupt the momentum of thoughts and feelings that cause a sense of urgency.

Encouragement: Loving self-talk. See yourself as your own cherished and vulnerable child. Be gentle and loving toward yourself. This allows you to offer yourself a

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deep and abiding acceptance and encouragement to get through the difficult moments. Cheerlead yourself. Repeat over and over, "I can stand it" and "it won't last forever".

Self-Soothe: Being comforting, nurturing, kind, and gentle to yourself. You use this skill by doing something that is truly soothing to you. It is used in moments of extreme stress or distress. This is a vital skill and often a hard one to master in the midst of strong emotional activation. Self-compassion is key to mastering this skill. It is helpful to imagine yourself as your own cherished child and offer the soothing that a child would need. Keep in mind all 5 senses and find ways to soothe each one.

Pros and Cons: Think of the positive consequences of tolerating the distress without acting/ reacting emotionally. Imagine the positive outcomes when you achieve your goals of regaining calm and balance when you don't act impulsively. Think of all of the negative consequences of not tolerating your current distress. Remind yourself of what happened in the past when you did not act impulsively or try to escape the moment.

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Radical Acceptance: As you let go of fighting what is, you are able to accept the situation for what it is and bring love and acceptance to the experience. This frees your mind to be creative in responding to the challenges of the situation.

Turning the Mind: Turning the mind towards an acceptance stance

Willingness vs. Willfulness: When you are willing and open to do what is effective it supports you to let go of a willful stance which goes against acceptance. Willingness is a powerful tool for staying focused on the goal of creating inner ease and acceptance.

WILLINGNESS WILLFULNESS Willingness is DOING JUST WHAT IS

NEEDED in each situation, in an unpretentious way. It is focusing on effectiveness

Willingness is listening very carefully to your WISE MIND, acting from your inner self

Willingness is ALLOWING into awareness your connection to the universe

Willfulness is SITTING ON YOUR HANDS when action is needed, refusing to make changes that are needed

Willfulness is GIVING UP Willfulness is the OPPOSITE OF "DOING

WHAT WORKS", being effective Willfulness is trying to FIX every situation Willfulness is REFUSING TO TOLERATE

the moment

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GHH AM-CR Manual

Leadership & Management

Transcript of GHH AM-CR Manual