Teaching Psychological Flexibility

Foreign. Hey there, everybody, and welcome to today's presentation on teaching psychological flexibility. This is another one of those presentations that we're doing as a part of Mental Health Month in order to help people learn different techniques that they can use in order to cope with life on life's terms, and this one in particular. Psychological flexibility has its foundations in a lot of things. You're going to find a lot of discussion about it in acceptance and commitment therapy, but it also weaves in concepts of hardiness and dialectical behavior therapy. So let's go ahead and start learning about that. We're going to start out by defining psychological flexibility, exploring how to apply it to. To your life, and finally identify a shortcut question. So if you don't have time to go through the whole activity, you can just ask yourself this one simple question. Right before you make a decision about a choice in your behavior or when you make a decision about how you're going to react to something, you can ask yourself this one simple question. What is psychological flexibility? Well, it's really simple. It is the willingness to accept things as they are in the moment. It is what it is. Some people hate hearing that. Some people embrace that term. If you can come to embrace it, or a term like it that in a way that you can remember that the present is the present and you can't change it. You can't make what has just happened not happen. All you can do is figure out your best choice to improve the next moment. This moment is done. What can you do to improve the next moment? Which brings us to the second part in psychological flexibility. You accept things are as they are in the moment. Then you make a conscious choice to act purposefully in ways that are going to move you toward your goals in life. Making that conscious choice instead of just reacting on autopilot to go with your first urge. If you get angry punching the wall, maybe your first urge. But is that a behavior? Is that a response that's actually going to help you get closer to. To those things that are important in your life? And I would guess probably not, because punching walls is not good for your decor, nor is it good for relationships or your hands, for that matter. The first step is to define what a rich and meaningful life looks like for you. And you can do this with adults and with children. Anybody who is, you know, elementary age and older can participate in this activity or can do this activity to identify what's important to them. Obviously, it's going to be more granular with adults than it is with an elementary School child. But this is a fun activity that you can do. It's sort of an art activity that you can do in order to help people learn goal setting and set goals yourself, in order to make sure that you are doing the things you need to do to move toward that rich and meaningful life, to move towards your goals. You can wish and hope all day long that you are going to have good health, for example. But if you don't actively do things in order to protect your health and even improve your health, then that may not come to fruition. You can hope for amazing relationships with your friends, with your kids, with your spouse, and that's wonderful. But unless you actually do things to nurture those relationships, guess what? You're probably not going to have that amazing relationship. Because relationships take work. Our health takes work. Anything in life that we want generally takes work. We can't just sit there and hope that it will happen. And as my son would have said when he was little, expect it to just poof. Be there. Start out this activity with a poster board, or you can use a great big cork board, whatever it is that you want to use. I'd like to use something that's durable because this is something you're going to be referring to for a while. The first thing you want to start out with, or where I start is relationships. And what you're going to do is make this collage on the cork board or the poster board. Make this collage that has pictures of the things that are important in your life. So we're starting out with relationships. Which people are most important in your life? You may have a picture of your entire family and that represents your extended family. Then you may have another picture of your children or, and each individual child or them together, however you want to do it. And then one of your partner and maybe one of your best friend. Because your activities, what you do in order to nurture the relationships with each one of those groups of people is probably going to be a little bit different. Put their pictures there so you can see those people that you really want to spend your energy on. You only have so much energy, just like you only have so much energy in, in a battery, in your cell phone battery, for example. And you have to decide how you're going to use that energy and how you're going to use that time. You only have so many hours in the day. Identify the people that are most important to you. Put their pictures on that collage, whether it's a poster board or, or a cork board or whatever. Underneath the picture, use an index card or post it notes or something and identify 10 ways that you can realistically work to create or maybe five ways that you can realistically work to create the kind of relationship with that person that you want. These are five to 10 things that you're going to do to nurture that relationship. And then under that card, so the pictures on top, the first thing underneath it is an index card or a post it Note that identifies five things that you are going to do or 10 to nurture that relationship and realistically achieve that goal. And then underneath that card, you're going to identify anything about that person or that relationship that causes you distress or unnecessarily drains your energy and what you can do about it. For example, maybe you have someone in your family that you really want to have a good relationship with, but that person is super critical and they don't mean to be, you know, that is, they think they are doing it from a place of love, but it feels very critical of you and it causes you distress. When, when you get together, there are options. So that is one aspect of your relationship with that person that adds distress. What can you do to deal with it? You choose to let it go. You can assertively have a discussion with that person about how it makes you feel. There are a lot of options. It is important to recognize that sometimes relationships, even the ones that we really love, bring a little bit of stress with life. So how are you going to deal with that if you have a teenager at home who you'll love to pieces? But there are a couple of things that that child does that drive you a little bit bonkers. Okay, that's going to be on that list of. This is something in this relationship that causes a little bit of friction. What can I do to address it? The next thing you're going to work on is identifying things, events and experiences which are meaningful to you. So it's your relationships and then pretty much everything else. What else is important in your life? When you think about having a great life, I'm not saying perfect, but a great life. What is going on? What is work like? What are your relationships like? What are you doing for your health? Are you exercising? Maybe that's not for you. Maybe it is. Are. What hobbies do you have? What are you doing? What is important in terms of activities in your life? Again, under each one of those pictures, identify what aspects of it are important to you. So if work, for example, is important to you, what aspects of work make it important to you? Why is this important to you? Because it provides you accomplishment, money, camaraderie, the ability to help others, mental stimulation and creativity, for example. Those might be some of the reasons that work is important to you, and you want to be able to remember that. So if you're feeling stuck or stifled at work, you can look back over that list and ask yourself, is my current position still providing these benefits to me? And if not, what can I do to change that situation? And it may not be changing jobs. It may be taking a different approach to work than you're currently taking. Under that particular index card, you're going to put another one that identifies aspects of your work. Health, things, experiences that cause you distress or unnecessarily drain your energy and how you can have. How you can better use your energy to address it again, letting it go, accepting it, having compassion, addressing the issue. There are a lot of things. For example, if you're at work and you know it provides you a lot of stuff, you love your job, you love what you do, and it is really important to you to be in the career that you're in. However, you have a boss that is super micromanaging and helicoptery all over the place that can feel very oppressive at times. That would be one of those things that goes on the very bottom index card. There are great things about your job that you want to remember, and it's fulfilling a lot of those needs for you. However, what parts of that job are adding distress and what can you do about them? What you're trying to do is identify the benefits of things. You're trying to also identify steps that you can take not only to remove distress, but also to enhance the ability for those things to provide you with the feelings and experiences that will lead you to that rich and meaningful life. The next thing you're going to have people do is clarify their values. We want them to ask, ask themselves, what values do I want to embody? Choose four and write them on the top, bottom and sides of the collage. So it sort of frames what they're doing, just like our values frame the way we view and interact with the world. The values you can, you can go online and Google any of the values that, like top 200 values or something and print out a worksheet. If you're doing this as a group, sometimes you can have people narrow it down, start with the top 10 and then tell them they've got to narrow it down to five or, you know, cut it down a little bit, and you can have people in Your group explain why they narrowed their values down to the values that they chose, why those particular values are so important to them. Step two. Step one was visualizing what a rich and meaningful life looks like. Step two is figuring out how you're going to use your energy. You only have so much energy every day. Like a cell phone battery. I get up at 4am most mornings. I live on a farm. I go to bed early. So, you know, 4:00am is reasonable. Just like a my phone at 4:00am I have 100% charge. My personal energy battery needs to last all day long. Just like my phone battery needs to last from 4am until 6pm and allow me to monitor my heart rate, listen to music at the gym, make calls, get directions if needed, and receive text messages from my kids. So those are the things that I know I, I have to conserve energy for. Those are the things that are really important for me during the day. If I'm trying to conserve my cell phone battery, we want people to do the same thing with their real life and think at the beginning of every day, what things do I have to get done today? So what things do I really need to purposefully use my energy for? What can I do to conserve energy for those things? When it comes to the cell phone, you can lower your brightness. That makes a big difference on your how much your battery uses. When I listen to my music, I don't have to have the screen on. You know, sometimes I like to have the screen on to look at the lyrics, but I don't always have to do that. You don't when you watch videos on your phone, it has a huge battery drain. That's another thing I don't necessarily have to do. That's not in my list of things that need to be accomplished with my battery every day. And then I can look for other apps that are running in the background that I may be able to turn off so they don't suck energy throughout the day. People can do that. I want them to think about what things can you do to turn down your intensity, turn down your brightness? What things can you do to conserve energy? What things do you have going on in the background that are sucking your energy and you don't even realize it? Our little dog broke her leg last night and you. I can tell you that I've had thoughts about that. I'm worried about her. That's going on in the back of my head. That's going on in the background right now. And using psychological flexibility tools is really important for me to conserve Energy. And I'm going to be using that a lot as a example. But a lot of people, most people have cell phones, even little kids now are very caut cognizant of that battery level. So that is an analogy that a lot of people do get. Psychological flexibility is on a continuum. In the middle is mindfulness, noticing and choosing. You're aware of what's going on, you're aware of. You know, for me, I became aware when I was driving into work today that I was fretting about what was going on with Raina. I noticed it, I didn't get upset, I noticed it non judgmentally. And then I chose, you know, I thought, well, what are my options? Is this a good use of my energy right now? To be, you know, all worked up and worried and fretting about it when there's nothing I can do at this point? And my answer was no. So, you know, distraction, going to work, getting into things, that was a better use of my energy because that helped me get closer to some of those things that are important in my life other than my dog. Mindfulness. Noticing and choosing is just being aware. When you start to feel distress of any sort, physical, mental, interpersonal noticing, and then looking at how can I use my energy to cope with this situation? Not to suppress it, but to cope with this situation in order to help keep moving towards that rich and meaningful life. Sometimes it'll be letting it go. If you have someone in your life who is exceptionally critical for some reason, most of us have encountered someone like that. If you notice that you're dwelling on what that person says or you're getting yourself all worked up over it, you can ask yourself, is using this energy to. To dwell on it, to perseverate on this person's negativity, is that helping me move towards my goals of happy relationships with other people, of, you know, having energy to do things after work, of having, you know, not having high blood pressure and having good health is using that energy to perseverate and get, keep myself stirred up. Is that what I want to do? And it's really important. It is way easier said than done to say, okay, I'm going to choose to let it go. No doubt. I'm not saying that that's easy at all. But once we recognize where we're spending a lot of our energy, then we can start noticing and start trying to take take steps to not perseverate as much and eventually hopefully get down to being able to let it go. When you are working on the Psychological, Psychological flexibility matrix. I call it destination happiness because I think of it sort of like a directions that you're using. You're trying to get to this destination. The wizard of Oz, you know, at the end of the yellow brick road, whatever, where it's just, you know, all light and sunshine and, you know, a rich and meaningful life. Have people identify things in the four quadrants, and I keep saying five. The four quadrants. On the right hand side or on my right hand side are the things that you do that other people can see. The actions, the behaviors that help you move towards those things that are important to you. If good health is important, for example, then good nutrition, exercise, sunlight, adequate sleep, pain management, all those things are going to be important. On the other side are behaviors that you do that move you away from what is important in your life. So for example, binge drinking alcohol or, or smoking crack cocaine to deal with stress. That's probably not going to help you move toward good relationships and physical health. Is it a behavioral response option? For some people it is. We're not saying anything is off the table. We're just saying what are your typical response, typical responses and response options. And then you can start making a conscious choice to choose what response to have versus just reacting and going on autopilot. Below the arrows. You have again, moving toward and moving away. These are the things that people can't see. They're your thoughts and your feelings to move you toward what's important. And in a rich and meaningful life, you want to have empowering and positive thoughts and positive feelings. Making a list of mantras, making a list of examples of how you've been courageous in the past, doing things to enhance your positive feelings, or even meditating on things that make you happy. That one can go sort of in behaviors too. There's no super clear demarcation. But we do want to look at thoughts, feelings and behaviors, which takes us back to cognitive behavioral therapy. 101. Thoughts, feelings and behaviors that move us toward our goals and thoughts, feelings and behaviors that move us away from what's important to us. Remember that all feelings are normal. It's what you do with those feelings that can be harmful. The first thing we're going to talk about is what I call away thoughts and feelings. Those are thoughts and feelings that we have that move us away from what's important and responding to those thoughts and feelings in ways that move us away. When you have a thought or a feeling, it is like a. Your brain's fire alarm, smoke alarm, warning system, whatever you want to call it feelings are awesome because they send us a message. It's what we do with those feelings. Think of feelings, emotions. Thoughts like dog poop. And if you've got dogs, you know what I'm saying? If you've got children, you know, think of it like baby poop. When you smell it, you get up and check if the dog crapped in the house or if the baby's diaper is dirty. The smell is akin to our emotions. We smell poop. It's like, that can't be good. That doesn't mean that anybody necessarily actually pooped. You know, it's just a warning sign that a diaper may need to be changed or you may need to clean something up. So you get up and you look around. Imagine that instead of jumping to conclusions, you get up and go, is there a problem? We need to do the same thing with our feelings when we feel angry. Okay, I notice that I'm feeling angry. Let me check the facts and see if there is something that is worth my energy to continue to be angry about or if I need to explore some of my alternate response options. If you find poop, you don't just get angry and leave it there either. You know, you get up, you're like, oh, crap. So if you do realize that there is a problem, then you take care of it. Same thing with your emotions. You get angry and you check it out. You go, is there any reason for me to feel angry or threatened right now? If you realize that, yeah, I deserve to feel angry about this, it's. It's okay, all right? But you don't just leave it there. You don't just sit there and say, okay, I'm going to be angry now. You're supposed to do something about it. You want to clean it up. You don't want to just leave it there. If you don't pick up the poop or you don't do something about your anger, it's just going to make the whole house stink. And think about with. When you hold on to your anger, it. You know, it makes your mood grumpy. You know, it kind of makes you unpleasant to be around. Negative emotions are what I call the dog poop of the soul. If you don't address them, they're going to permeate your whole being and repel other people. So that is a rather unique analogy, but I think most people have either been around dogs or babies enough that a lot of people can kind of wrap their heads around that issue. And, you know, poop in and of itself. If you've had kids, you've probably read the book. Everybody poops. Poop in and of itself is not a bad thing. Poop is something we all do, but, you know, you don't just leave it there away. Thoughts and feelings. Questions that people can ask themselves. What thoughts do you regularly have that keep you from being happy? People can make a list or keep a journal so they can start addressing them. I encourage people to, you know, just kind of keep a running log of negative self talk and stressful thoughts that they have and then look for patterns in them. You can do this as a group. You can say, just think about today. Over the past four hours, what thoughts have you had that have increased your unhappiness, that have made you feel angry or anxious or something for a minute by doing that? And you write them all up on the whiteboard and then you can start talking about ways to address those thoughts. When you get angry, what thoughts do you have that keep you stuck in the quicksand of anger? Quicksand. When you struggle to get out of the quicksand, you actually sink deeper into it. Now, I don't know a lot about quicksand. I know more about getting my car stuck in the mud. So I usually use that energy analogy a little bit more. But when you get angry, what thoughts do you have that keep you spinning your wheels and getting further entrenched in that mud? Remember that resentment, jealousy, envy, and guilt are all different forms of anger. You can put grief in there too, but I usually don't. Anger is a part of the grief process, but guilt is anger at ourselves. Envy is anger at somebody else for having something we want. And resentment, you know, that's easy enough. When you're sad or grieving, what thoughts do you have that keep you stuck? That hopeless. Hopelessness and helplessness. I want people to start identifying those when they get into that depressed mode. Have them start identifying those thoughts. When you're lonely, what thoughts do you have that keep you stuck? I. I'm going to be alone forever. Nobody likes me. There's a lot of negative self talk that can happen when you are sad. We already talked about that one. Remember that you only have so much energy. It's either used to help you move forward or wasted. Spinning in circles or even going backwards. I want people to recognize that everything they do, and there's another activity for that in just a minute, everything they do uses their energy, right? Breathing uses their energy. Going to work uses their energy. Calling their best friend on the phone. Uses their energy. It's important to recognize, you know, what things they're doing that are helpful and what things are, you know, wasting their energy. Now we talked about emotion focused coping in the away behaviors. Now there are different definitions of that. What I'm really talking about is coping. That does nothing to change the situation. It's just designed to eliminate the unpleasant feeling, aggression. Alcohol, drugs, gaming, sex, shopping, sleeping, smoking, things people do that don't address the situation. It's basically used to self medicate, if you will. So when that medication goes away, when you wake up, when you quit shopping, that problem is still there. What can you do instead? Have clients identify all of the things they do when they get upset, reasons why they do that, and what they could do instead. So if I get upset and I decide that I'm just, I'm going to go back to bed, forget it, I'm going to start over tomorrow. Okay, why am I going back to bed? Because I feel overwhelmed. I, I feel hopeless and helpless. Therefore my response is to withdraw. What could I do instead? And that's where you really want to challenge people to make a list. Because it's hard to think when you really want to climb back under those covers. It's hard to think about what your options are. You know, go outside on a walk, that's usually the last thing people want to do. Call a friend, okay, maybe that's getting a little bit better. Make a cup of coffee. You know, I discourage people from turning to food too much for trying to deal with stress because that can become a problem. But a drink of water or a cup of coffee is probably the least, especially decaf coffee is probably the least harmful. Have clients identify all the things they do when they're acting purposelessly, which prevents them from moving toward their happiness. If you don't like your job playing hooky, okay, well, that may get you fired, so ultimately it may serve your purpose. But a lot of times if you play hooky from, from your job, you take a mental health day and another one and another one. It's probably not resolving the issue, such as being overburdened, having too much paperwork, whatever it is. So when you go back to work, that problem is still going to be there. We need to help people figure out, how do I cope with whatever is burning me out. Cognitive distortions are often unhelpful thoughts, all or nothing and overgeneralization. Ask people when they start using those all or nothing words to notice them. Have them spend one day, you know, they get up in the morning, they can flip a coin, coin tosses, a, a common one that I use in my, in my practice. If it lands on heads, they need to be mindful of something all day long. If it lands on tails, they don't need to do it. So about half the time they can flip that coin. And they're going to have to be mindful in this particular case of their all or nothing language. Throughout the day. It really surprises a lot of us how many times we say things like every time or you never. Throughout the day, encouraging people to notice, start becoming aware of their all or nothing thinking and when they notice it, to change it and use more general terms. So a lot of the time that, that works a little bit better and to look for exceptions. If I say you never do this, then I am going to challenge myself to think back to a time when the person did do that, because they probably did at one point or another. Like you never cleaned the litter box. Well, let's think back to a time when maybe that person did. So never doesn't really work. Mental filtering can either be magnification of the negative, you know, the sky is falling, or minimization of the positive. I did something great, but you know, it wasn't that great. It wasn't really that big of a deal. Well, yes it was. And if it were anybody else, you would be giving them all kinds of kudos. But for yourself, you're minimizing the positive. That's another one of those coin flip things. I generally have people attack one cognitive distortion per week because attacking all of these at one time can get overwhelming and difficult to really focus on. But yes, you can do journaling and if you want to throughout the day or at the beginning of the day as well, exaggerate. When you're working with mental filtering, if somebody is magnifying the negative or minimizing the positive, encourage them to look for the facts. You know, what are the facts that the sky is falling? What are the facts that anybody could have done this? What are, you know, what are the facts supporting your minimization or your magnification? Exaggeration kind of falls in the same place. Making a mountain out of a molehill, you know, thinking that it is going to be the worst possible thing, you know, that's going to happen. And you know, I got fired from my job, so that must mean that I'm going to lose my house, which means I am going to end up living on skid row and shooting up heroin. That that was an actual train of thought that a Client of mine had. And so we talked about it and he's. As soon as it came out of his mouth, he's like, yeah, I realize how improbable that is and how unlikely it is, but that's where my mind keeps going. Okay, well you recognize it? It's ego dystonic. That's a good thing. Let's look at the probability that that's going to happen. So then every time he started having that thought, he would counter it with a statement to himself about how probable or improbable as it was that that would actually happen and all of the things that he had as a safety net to prevent him from falling that far and ending up on, on skid row. Personalization, Taking things too personally. Encourage people when, if they tend to personalize a lot, encourage them when they personalize something to think about. What are three other explanations that have nothing to do with me, why this might be happening? The availability heuristic means that we are judging something's goodness or badness or dangerousness based on the most recent data. What is most prominent in our minds or. Or what's most prominent in our minds, like plane crashes. And that is probably the textbook definition of the availability heuristic. When a plane crashes, it is all over the news. So we think, oh my gosh, that's horrible. Flying in a plane must be so dangerous. Do we ever hear about the 20, 30,000 flights per day that take off and land successfully and that doesn't even include the private pilots that are flying? What is available in our mind is that prominent story that the media fed us about the plane that crashed. And yes, it is devastating when you lose 156 souls or something. Don't. I'm not trying to minimize that, but I'm trying to put it into perspective. How dangerous is flying? The same thing when you are disciplining your children or doing the evaluations on your employees. A lot of times, if you haven't been keeping good records, you think about the most recent, you know, month, six weeks, maybe three months. What. What's been going on proximally, you're not thinking back to last July and thinking, okay, you know, things were going great and then, you know, your spouse went into the hospital and things have been a little dicey since then. A lot of times you're just thinking about what you remember most recently that's going on. Same thing with your kids. Be cognizant of that. Jumping to conclusions without having all the facts. This goes back to get all the Facts. Try to figure out what are alternate explanations. If your partner comes home and smells like a perfume that's not yours, what are other explanations for why that might have happened? You know, maybe they were on a business meeting with another person and they hugged each other. Maybe they were. He walked through the, the mall and got spritzed. You know, there are possible explanations, but without having the information, don't jump to conclusions. Which takes us to mind reading. Encourage people to realize and recognize how often that they are assuming they know what somebody else is thinking or wanting. Blaming shoulds, the fallacy of fairness, the fallacy of having control over everything and emotional reasoning. Believing something is dangerous just because you feel afraid of it. All of those are different cognitive distortions that can SAP people's energy if they nurture those distorted thoughts. It's important to recognize now sometimes you're going to have something negative that happens and you look at all the facts and you go, no, this still sucks. All right, well then it's not a distortion, it's reality. But the times that we have these all or nothing or extreme realities is much more infrequent than the times that we use the number of times that we use. Cognitive distortions, Distress, intolerant thoughts. When people tell themselves, I can't stand this, it's unbearable. I hate this feeling, I'm going to go crazy, I can't, it's wrong to feel this way. I'm feeling stupid or I'm being unacceptable. All of those things contribute to distress because they are either saying that it's going to kill them, which reinforces that feeling of threat and keeps their HPA axis stirred up, or they're criticizing themselves and they are basically verbally lashing themselves. And neither one of those responses is going to use their energy to help them move towards what's important in their life. Dirty discomfort. If you've ever watched some of the old, oh, who's it, what's his name? I can't even think of it right now. Even Chuck Norris. That's not the word I'm thinking, not the one I'm thinking of right now, but any of those movies. When you have someone fighting one on one, you know it's usually a fair fight. Assuming they're roughly the same size. When you are dealing with an emotion, anger, depression, anxiety, that is almost a fair fight. When you start dealing with multiple aggressors, you feel depressed. Well, then you feel guilty about feeling depressed and then you get angry with yourself for feeling depressed. So now you've got depression, guilt, and anger that you're trying to fight and that gets overwhelming. I mean even if you are a fourth dawn black belt, you may not win that fight. It is really important. And in acceptance and commitment therapy, Hayes talks about dirty discomfort and what he's talking about is emotions that layer upon emotions and you get just get stuck further and further down into this quagmire of ickiness toward activities. This is the good stuff. Sleep, nutrition, exercise, ergonomics, pain management is super important for good health and good sleep. Social support, recreation, relaxation and positive triggers. There are a lot of bio social things that we can do that can help us have the energy and the health needed in order to accomplish the rest of our goals. If I am sick and I am exhausted, I'm not going to have the energy to nurture my relationships or to try to get that promotion at work. It's important to have people recognize and I usually give them a handout about the Maslow hierarchy. It's important for them to recognize that to achieve their goals of actualization they first have to start with biological needs and safety, then love and belonging and hello self esteem. Those are things that they need to incorporate in order to help them move towards that rich and meaningful life. Remember back to that collage the you had under the pictures. The first note is five to ten things that you can do to nurture that aspect of your rich and meaningful life. Encourage people to set a goal to do at least one thing each day to move them closer to a rich and meaningful life in each of the following areas. Health, people, work, personal growth and perspective and attitude. Those are the ones that I like but you know, they can choose however they want. Obviously when you have them do this then they are regularly reviewing that collage. They're regularly envisioning this. They're regularly seeing what where they want to be and it helps them continue to move forward. We want these goals to be small, like nurturing a relationship with your children. One of the things that I try to do every day is provide positive feedback about something because I noticed that, you know, I was real quick to notice what hadn't been done and to be critical and take for granted the positive. So I recognized that that was a problem and one of the things that I took an active step toward was trying to identify something positive that each of them did every day. That doesn't take a long time. It's not a huge thing that I've got to do can knock that one out for my health. Exercising for work, you know, staying focused, personal Growth. And depending on what I'm working on at that point, right now I'm crocheting some sofa covers, so making sure that I spend 30 minutes doing that each day. These don't have to be huge things, but encouraging people to feel like they are moving forward. Problem focused coping involves changing the situation, you know, fixing it. If you have working, are interacting with somebody who is super critical, maybe that means being assertive and having a talk with them about how what they're saying is not helpful and what they could say instead. I worked with one client who was losing a lot of weight. She had already lost like 75 pounds and she still had some weight to lose. And she was terrified to go to dinner with her family because instead of congratulating her on the progress that she'd made every time they went out to dinner and in, in her mind and, and at this point approximately, it was literally every time they went out to dinner, her parents were criticizing what she ordered, how fast she ate, what she ate, how much she ate, instead of focusing on how much progress that she had made. So she worked on developing skills for assertiveness to have that conversation with them. So meal times would not be so adversarial. If you can't change the situation, which sometimes you can't, like COVID 19 change how we think about the situation through exception, through acceptance, compassion, and evaluating old beliefs, we are accepting that we are on lockdown. It is what it is. There is nothing I can do to change that. At this point. I'm having compassion with myself. Even on those days that I get irritated and frustrated, like for Raina's leg. They decided that, you know, repairing the ruptured tendon was not a. They. They decided that that was a elective surgery because it was not life saving. So they're not going to even look at doing surgery on it for several weeks. And yeah, okay, so I started getting really angry and frustrated about that, but there was nothing I could do. I'm compassionate with myself. I'm like, okay, you know, mama bear came out, I get it. But I also had to accept that, well, I can't force the doctor to do surgery. And then sometimes it means evaluating old beliefs about the situation, about the person to see, you know, if this person situation is really still important in your life or what is causing you to react the way you are reacting. The third way you can respond is choosing to let it go. And that is an active choice. It's not suppressing it, it is making an active decision to go, you know, What? That is not worth my energy. And I will even sometimes, and this is in dbt, in the Accepts and Improve acronyms. Pushing away. When you push away thoughts. My children have seen me do it before and I will actively use my hand and say, no, not going to think about that right now. Not anybody else around. Talking to myself. You know, I'll admit I talk to myself, but I'm choosing to let it go and I'm saying no, not worth my energy. The final one is getting social support or help. Sometimes there are things that we just can't do on our own and problem focused coping may mean calling up your mom or a friend or a contractor and saying, I got this problem. That tornadic storm that went through on Sunday tore up our roof. So that is a problem. I am frustrated about it. I'm accepting it, being compassionate. But I also know that there's nothing I can do to fix it because I'm afraid of height. So there's no way in heck that I'm getting up on the roof, get social support and help. So I'm going to be calling roofers over the next couple of days to get people to come out to give us bids. Nothing wrong with that. It is active steps towards resolving my problem toward thoughts and feelings. Have people keep a list with them of empowering thoughts such as, I've got this, I've been through worse. This too shall pass. Or just even. Today is going to be a great day. Starting out with positive mantras that they can tell themselves. They wake up in the morning, they're like, all right, you know, I'm gonna grab this one by the tail. Make a list of compassionate thoughts that they can have for themselves when they're having a stressful moment. It's okay to feel depressed, anxious, angry, whatever it is, it's okay to feel blank. Just don't unpack and stay there. It's okay to feel that way. All of our feelings are normal and okay. If you're working with other people and they are, you know, really stressing you out or grinding on your last nerve or whatever it is, thinking to yourself, wow, it must be a really dark place in that person's head for them to be that angry or, you know, to be that miserable, I wonder what might be causing that person to feel so unsafe if that. If you're working with somebody, you're interacting with somebody who's lashing out or blaming or doing some other things that indicate that they feel threatened in some way. You know, I wonder what might be causing that person to feel so unsafe. And finally, keeping a daily gratitude list is another activity for toward thoughts and feelings. Identify something. And I have my clients do this henceforth and forevermore every single day. I want you to add something to that list that you're grateful for. And after a couple of months, it starts getting a little bit more difficult. But it's important for people to keep trying and adding to it Another thing that you can do that's more creative and in a family or in a group or in residential, you get a big old vase, vase, whatever you want to call it, and get some sticks from outside, not with leaves on them, just plain sticks that have the little branches on them. And then you can get the luggage tags or the package tags that are little paper package tag that has a string through it. And on each package tag you write what you're grateful for. And then you hang it on the little sticks that are in the vase to make your own flower tree sort of collage. You can get different colors for it, and it can be very pretty to look at. And it can remind people about how much stuff they have going on in their world that is actually positive, maybe not just for them. If you're doing it in a family or in a residential, they start seeing all these notes of gratitude and recognizing that there is good in the world. Add triggers for positive emotions to your room, your car, your office, and your common areas. That includes like the bathroom. I love walking into the bathroom of a lot of the universities now and that even the restaurants around here and they always have flyers on the back of the bathroom stalls. And a lot of times they're just advertisements. But every once in a while, somebody will put a. A funny meme or a joke or something on there and it just catches you off guard. So there are a lot of interesting places that you can put things that can trigger happiness in people. I will share with you one of the worst jokes that I've ever heard, but it's also one of my favorite. Why was Piglet looking in the toilet? Because he was trying to find poo dun dun, dun. Sorry. But you're gonna think about that the next time you go to the bathroom. I tell you that you can add aromatherapy or anything for smells. It can be you. Can I put a dryer sheet in my car? You know, I don't get super fancy with essential oils. I just want it to smell decent sites, including pictures, books, the coloring of your decor, things you have like flowers, people and pets. What do you see that makes you Happy sounds that make you happy can be music, comedians, birds, wind chimes, silence. If you've got a lot of children or dogs at home, silence actually can be very breathtaking. Touch what temperature, texture are most pleasant to you? And ergonomics, you know, and sometimes it's not just what you're wearing, but what you're feeling if you're wearing clothes that are too tight. I know when I have to wear business suits and stuff, I never feel as comfortable. Having things that you feel comfortable in is important. But even if you can't get out of that, you know, stiff old business suit, maybe having something that you can hold that is soft and fuzzy or that reminds you of something happy and taste. Good food is awesome. And it can be healthy food. It doesn't have to be junk food. It can be junk food. But good thing, good food is a trigger that you can add to your day. Just because you're eating healthy doesn't mean you've got to eat rabbit food. 24 7, 365. You know, you can have things that you really really enjoy. Unless you really really enjoy rabbit food, then by all means. But recognizing that it's okay to have treats and pleasures in your life throughout the day, we need them because it helps balance out our brain chemicals. You know, I've used that analogy before with making a. Making a bath. Anxiety, anger, your stress emotions. That's hot water. So if you've got that turned way up, you're going to burn yourself unless you add some cold and ideally turn down the hot. So turning down the hot is like dealing with the stressors. But adding the cold also helps balance it out. Step 3. Become mindful. Becoming aware of thoughts, feelings and urges in the present moment. Like a fly on the wall, just noticing non judgmentally how you feel, what your thoughts, wants and urges are, and any physical sensations that you're experiencing, such as palpitations or flushing or feelings of nervousness and then recognizing that you don't have to react. I can feel this way. I can feel like I want to punch the wall without actually having to do it. It's okay, I can notice that I have that feeling. That's okay, you know, I don't have to act on it. Once you've observed, accepted and unhooked, then you're able to sort through thoughts and feelings and start to see the options. Now once you've observed, accepted and unhooked from your feelings, it is you're more into your wise mind. As Linehan would say, unhooking means putting the phrase I'm having the thought that before whatever that thought is, I'm having the thought that, you know, this is the worst thing in the world. I'm having the thought that I can't tolerate this. I'm unhooking because, you know, I'm not, I'm not attached to thoughts. If I say I can't deal with this, you know, that feels overwhelming. That's on me, that's part of me. If I'm saying I have the thought thought, I'm having the thought that I can't deal with this. Okay, well, is my thought correct or incorrect and why? Implementation Clients need to learn how to apply what they've put into their matrix, what they've put into their collage. In summary, you know, basically you notice and choose. You notice how you're feeling, you notice what your options are, and then you choose the best response option for you at the moment, recognizing that. Autopilot your away behaviors and your way thought away thoughts and feelings are often things that help you feel better right now, feel better in the moment, make it go away now, which you know, feels good, but a lot of times it doesn't solve the problem, it just numbs the problem or avoids it. Your toward behaviors are things that are more actively focused on addressing the situation. It's an adventure, and this is one that older kids and adults, you know, can wrap their heads around. Younger kids, the math is too much for them. You may be able to modify it, I'm not sure. Have clients imagine that they're going to create a utopian world in which they feel happy, healthy and loved most of the time. You know, we're not going to feel loved all the time. They get $200 per day to create this world using monopoly money, of course, in the little 10 bills, just because it makes it easier not to have to make change. This money represents their energy. So they're going to have twenty $10 bills. Each time something happens and they make a choice about how to handle it, they spend $10. This isn't 100% accurate because some things take more energy than others, but that was more than I could work into this activity. Have keep a cl. Have clients keep a log of their days for a week, writing down the 20 things that they do each day. So for me, this one particular day, I kept this log 16 steps forward towards my goals, towards my rich and meaningful life. Four backwards. I got up, that was ten. Woohoo. Picked berries from the garden, went to the gym, you know, so I've got 30 there. Then I got irritated on the way home at a motorcyclist who was driving erratically. And yeah, I mean, I got myself all fired up about, you know, about it and that, what good did that do, you know, that was one that I could have let go. I ate a good breakfast, talked with my kids, went to work, worked on a presentation, skipped lunch to work on something else. That was a bad choice for me. After lunch, worked on another presentation, answered emails, paid bills, drove home, listened to comedy, made dinner, spent time with the kids. Then I got frustrated with my daughter and then I got frustrated with both kids. So, you know, 10 more for those. I did my chores, emailed my stepdad and two friends, mowed the lawn, did some weeding, watched television, and went to bed at a reasonable hour. Those were the 20 major things that I did that day. I mean, yeah, I, I'm sure I did other little things in there, but as far as spending my energy, that's how I spent it that day. So I was able to look back and go, okay, the majority of the day I was moving forward. There were a couple back steps. It was a little bit of a cha cha. There rarely am I going to be going full bore ahead 100% of the time. But it helps people recognize how that, how that plays out throughout the day. For prevention, encourage clients to do this for. What's the word I'm looking for? For prevention, for relapse prevention as well. Noticing and choosing. I want them to focus on this every single day. Make a list over here in their toward behaviors of things that they need to do interpersonally, physically, cognitively and emotionally to help them work towards their goals and values. And I have a lot of them listed right here. And then on the other side, have them list the things that they do that help them move towards. They either are neutral or don't help them move towards their goals and values, such as sleeping too much, being a couch potato, lashing out, working too much, and getting burned out. There are a lot of things that we may do that actually work against us. Becoming aware of those is the point. Not being judgmental, but becoming aware so we can address them. Shortcut question, are my current thoughts, feelings and actions moving me closer to or further away from my goals and values? You don't have to map out everything every single time. But just stopping before you say, yes, I'm gonna, yes, John, I'll help you move on Saturday. Thinking to yourself, is this helping me move toward what's important in my life or is it going to take away energy from other things that I need to do to work towards those goals. When I was recovering from surgery a few years ago, my daughter was 11 or 12 and I got all upset about something on social media and it was stupid. It was something that was not consequential in the big scheme of things and I was frustrated about it. And I'll never forget 11 or 12 years old, she looks at me and she goes, knowing that I was supposed to be resting and recovering, she looks at me and she goes, mommy is getting upset over this moving you closer to or further away from your goals. At that moment I wanted to turn to her and go, oh, just shut up. But that's not an appropriate response. And I knew she was right and I had to laugh and I said and I had to say, you know what, you're right baby girl. And that changed my attitude right there. I was like, if my 11 year old can see it, you know, I think I need to cut through my own bs. Every event is an opportunity to choose thoughts and behaviors that help will help you use your energy to move toward your goals and values. Acceptance means accepting without judgment how you feel and the situation as it is instead of fighting against it. Commitment and purposeful action mean that you choose to use your energy on thoughts and behaviors that move you closer to your goals instead of throwing it out like a leaf. Like a leak in the in the plumbing. Are there any questions? I know I skipped over a couple of slides. I wanted to make sure to get you guys out by one o', clock, but I am happy to answer any questions that you may have. Between writing notes, filing insurance claims and scheduling with clients, it can be hard to stay organized. That's why I recommend TherapyNotes. Their easy to use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of therapy notes by just using the promo code CEU. When you sign up for a free trial at therapynotes.com it.