Note: This blog is a repeat of the one posted 5/1/16, in an effort to keep people in the loop of the current group lesson.
The following is a synopsis of a weekly Dialectical Behavior Therapy (DBT) group lesson, based on the work of Marsha Linehan out of the University of Washington.
The last lesson of the Emotion Regulation module is about changing our emotions through opposite actions. LOVE this lesson, it’s sooooooo helpful and important to practice, which means it’s also hard :-/
FOUR of the most challenging emotions for people to navigate are:
Because of the difficult nature of these emotions, we often react to them poorly, creating vicious cycles that reinforce the emotion. This makes it even MORE difficult to deal with the emotions we often struggle with. Our group brought up some great examples of how we respond to these emotions in unhealthy ways, and the use of opposite action to reverse these cycles.
- Fear: What do you do when you feel afraid? Our usual, often automatic reaction to fear is to retreat, avoiding the thing we are afraid of to make our fear go away. This may seem logical, if I am afraid of snakes, when I go to the Zoo I can ignore the snake exhibits in order to prevent myself from unnecessary distress. The problem with this behavior however, is that slowly, over time, I am actually increasing my fear of snakes, because I have not been exposed to snakes enough to see that there is nothing to fear, or that I can cope with my fear. Opposite action slowly and incrementally reverses our fear so that, our fear doesn’t just get avoided, but our fear gets extinguished! The steps to act opposite to fear are:
- Approach events, places, tasks, activities, and people you are afraid of.
- Do what makes you feel afraid over, and over, and over.
- Do things to give yourself a sense of control and mastery.
- When overwhelmed, make a list of small steps or tasks you can do. Do the first thing on the list.
So…the Opposite action for fear is to face your fears. Duh…..To most of us, this is pretty obvious, but like most coping skills, they may seem very obvious, but they are extremely hard to do. This is simply exposure therapy, the more we do it the more we get used to it and the less fear we will have. Think about anything in your life that you have mastered over time. At first, you were afraid to drive, skate, take the train, go down the slide, etc., but eventually you mastered it. This only happens through challenging ourselves to keep facing our challenges and to keep trying, no matter what.
- Sadness or Depression: What do you do when you feel sad, or when you sink into a depressive episode? Most of the time, when we feel sad we just want to avoid people, places and things. Similarly to our reaction to fear, we want to retreat, avoiding the world. But why would we think that when we feel sadness, we need to wallow in self pity? What other result could there be then except to increase our sadness or depression? Opposite action slowly and incrementally pulls us out of sadness and depression through:
- Getting active; approaching events, places, tasks, activities, and people.
- Doing things that make us feel competent and in control.
So…the Opposite action for sadness/depression is to not lie around and avoid life. Again…..Duh…..BUT don’t expect this to be a walk in the park. I would add to the above list:
- Lower your self expectations to meet your mood.
A LOT of us struggle with perfectionism; where we are so busy judging ourselves as being wrong, bad, or lazy that we create a cycle of shame (see next bullet point!) We cannot be at peak performance every minute of every day, and we must give ourselves permission to do less then we usually do or are normally capable of. During periods of sadness or depression, getting active may mean taking a shower, putting something in the trash bin instead of on the floor, or texting a friend when we really don’t want to engage with others. Whatever the opposite action is, any little bit counts, but we want to do as much opposite action as we can muster up.
- Guilt: What do you do when you feel guilty? This is a trickier one than the rest, because it’s not just about doing the obvious, but there is a whole other step to consider with guilt. Before we can do an opposite action with guilt, we have to first decide, is the guilt justified, or unjustified? This will tell us then what skill to use.
- Unjustified Guilt: This occurs when you didn’t actually do anything to feel regretful, remorseful, or bad about. This ties into a popular Alcoholics Anonymous (AA) slogan, “Feelings Aren’t Facts”. Although it may be a fact that you feel guilt, unjustified guilt is NOT a guilt that is grounded in reality. Rather than feeling guilt about something that we actually did or didn’t do wrong, sometimes we feel guilt in response to someone else’s reactions, someone else’s value system, etc.; or in response to myths and societal pressures that we are letting control us. When someone sends us on a “guilt trip” for example, they are passive-aggressively trying to invoke guilt in us, but this guilt may or may not be justified.
For example, when I was younger my grandfather was starting to lose his memory and reason. It was a ritual in my family that as kids, when we came into a family event we immediately kissed all of our elders hello. One day, my grandfather let us know that he was mad at my sister for not kissing him hello, however we all made our usual rounds that day, kissing everyone hello, including him. He held that resentment against my sister for over a year, despite her insistence that she did, in fact, kiss him hello. The guilt that my sister felt in response to his anger was Unjustified, because she did, in fact kiss him. Unjustified guilt is guilt that is felt in spite of our doing nothing bad or wrong, and even though we feel the emotion of guilt, it is still unjustified. For example, sometime in young adulthood, I got tired of kissing everyone hello and goodbye, mostly because it just took too long to find everyone and say goodbye. By the time I did all of that, it would be a half an hour after I had to leave. The busier I got in life, the less kisses goodbye and hello I bothered to make. I love seeing my extended family, and there is no other motive for not kissing hello and goodbye, but it has become my preference to say hello, to sit and talk, to say goodbye, etc., entering and exiting more quietly and kiss free.
If one of my family members were to become angry or hurt by my not kissing her hello or goodbye, that would be his/her right, and because this is a long standing tradition in my family, I would likely feel guilt, as if I was doing something wrong. However, it is my right to have my own values and morals, and to make my own decisions, and I do NOT have to feel bad about not giving kisses hello or goodbye. THAT then, is unjustified guilt. The opposite of unjustified guilt is not really an opposite, it is:
- Do what makes you feel guilty over, and over, and over.
In other words, tolerate your guilt because it isn’t appropriate, you didn’t do anything wrong, and thereby don’t need to change your behavior. Next time, you will feel a teensy bit less guilt, and the time after even less, and so on and so forth.
- Justified Guilt: This occurs when you DID or DIDN’T do something, and that makes you feel regretful, remorseful, or bad. Justified guilt IS grounded in reality, as it occurs because you go against YOUR OWN value system, beliefs, etc. When guilt is JUSTIFIED, we need to:
- Make amends or offer compensation/restitution
- Commit to not doing it again
- Accept the consequences gracefully
- Forgive yourself
So…the Opposite action for guilt is a 5 step process, EACH STEP BEING CRUCIAL TO FULFILL. For example, imagine I am jealous of my friend’s new job opportunity, but I also feel guilty about not wishing her good luck before she went on the interview. This guilt is justified let’s say, because it goes against MY PERSONAL value of being a kind, supportive friend. In this case, I need to apologize to my friend, explain to her that I feel guilty about what I did and why I did it, and perhaps buy her flowers or just have a nice discussion about it. Next, I need to make an inner commitment, and perhaps a verbal promise to my friend that I will avoid making that mistake in the future. Fourth, I need to accept that my friend may lose some respect for me, may be angry with me for a while, or may even cut me out of her life altogether. This step is really hard for us sometimes because, even in instances where we can see the error of our ways, we often feel that we should be off the hook for consequences if we do so. This is not the case unfortunately, as we still need to pay the price for what we’ve done. Sometimes that’s a very nominal fee (ex. my friend just laughs it off, tells me she understands and has done similar things herself, and we are even better friends then before, living happily ever after). Sometimes, our mistakes come with a very expensive price tag (ex. if my entire group of friends were to drop me for being such an awful friend and a jealous person). Accepting consequences GRACEFULLY means that we did the deed, so we need to rise above our mistakes and take our metaphorical punches, even when we feel the punishment doesn’t fit the crime.
The final step, forgiving one’s self, is a step that cannot be neglected, otherwise a cycle of shame will be perpetuated, which will make this skill entirely useless. Marsha Linehan lumps shame and guilt into the same category with opposite action, but I encourage people to think of this as a skill to be used only for guilt. Guilt is feeling bad about something you did or didn’t do, whereas shame is feeling that you are less then others. So, in reality, shame is NEVER justified, where guilt is either justified or unjustified. Shame is a much deeper concept, with much larger consequences, and shame perpetuates the cycle of relapsing to self-destructive behavior. So if we go against our values, and we apologize, make amends, commit to not repeating our mistake, accept the consequences gracefully, and then shame ourselves for making the mistake, we will never be at peace with our mistakes and we will forever be in a cycle of self destruction and self hate.
- The final emotion of the “Big Four” is Anger. In my work, I find that a tremendous amount of people have poor anger management, and most of the women I meet struggle with mismanagement of anger. Having an anger problem means that you do not express anger in a healthy, balanced way. Individuals with anger problems either repress their anger, act out their anger, or vacillate between those two extremes. Healthy anger management means that we are ASSERTIVELY expressing our anger to others on a REGULAR basis. Assertiveness is direct, honest, open communication that is respectful to both myself, and the persons I am asserting myself to. For women especially, we have been taught that anger is bad, not ladylike, or only for men; and that being assertive means being bossy, mean, or selfish. Men struggle with their own anger management problems, where they sometimes act out aggressively rather than assertively, but expression of anger in general is much safer in our culture for a man then a woman. Similarly to fear, anger is an arousal state, so our fight or flight response kicks in when we get angry. Whether we tend to act out our anger or repress it, both end up being disrespectful towards ourselves, and others, whereas practicing the following opposite action techniques are essential for healthy anger management:
- Do something nice for the person you are angry with.
- Gently avoid the person you are angry with.
- Imagine empathy and/or sympathy for the person you are angry with.
The first opposite action skills, doing something nice for the person, may seem very difficult. But if, instead of skipping over that one, we look for opportunities to do so, we may find it easier than we think. For example, if you really don’t like a work colleague, or even if you’ve recently had a big fight with him, could you still open the door for him when walking down the hallway? How about telling that person that he had a good idea or did a good job on a project, even if he rarely has good ideas or makes a lot of mistakes? Little things count for doing something nice, and sometimes little things are all we can bring ourselves to do, but still it will reverse the increase in anger that we may be experiencing. Someone brought up in group this week that we need to remember that this is not the same as the cliche “Kill them with kindness”, as the intention of doing something nice is for US, not to impose revenge or any ill will on the other person.
Practicing gentle avoidance means that I am focusing on me and my behavior, rather than focusing on what another person did wrong or how angry I am at what they did. In AA, they talk a lot about staying on our own side of the street, rather than crossing the street too much. This image is extremely helpful for keeping me focused on what I am doing, how I am handling myself, and for staying out of my head when obsessive thoughts intrude on my day. Sometimes we need to gently avoid seeing, talking with, or interacting with a person we are angry with. Sometimes we need to avoid letting that person take up space in our head (another AA concept). Sometimes, we just need to mind our own business and gently avoid jumping into other’s conversations, giving the person our opinions, or listening/watching what that person does and judging it. Gentle avoidance helps us feel just a little bit less angry with the person because we are exposing ourself to that person less, and we are avoiding getting caught up in their lives or their world.
The final option for opposite action to reduce anger is to imagine sympathy and empathy for another person. Being a therapist for over 20 years has helped me realize that no matter how perfect someone may seem, every person has challenges, problems, struggles, and weaknesses. Imagine a peer is bullying you at school. When you think things like “That kid is probably bullying me because he has no friends, he is failing all of his classes, and he has never had a date”, you are practicing opposite action, by finding empathy and sympathy for the person you are angry with. Rather than just focusing on YOUR pain, this helps reduce your pain….just a bit….and helps you take a more forgiving stance. A group member brought up a great point this week though, “What if you can’t find empathy in any way for the person?” In this case, you can still do gentle avoidance and doing something nice for the person instead, but it is important to stay open minded to using empathy and sympathy anyway. In these cases, it is likely more our resistance to use the skill then a true lack of things to empathize with.
In cases where we cannot find any fact about the person to empathize with, it is important to IMAGINE empathy and sympathy for the person. An example of this happened to me this week when I went out to dinner with a large group of people. The entire group was unhappy with the waitress, because she seemed very uninterested, annoyed even by our needs and requests. On our way out the door, the waitress announced “Thank you all for your patience, I am deaf in one ear and had trouble understanding some of you sometimes.” After we had more insight into her difficulties, it was easier to empathize with her, but before we were told about it, we all were very angry with how she did her job. Some of us were still angry, but most of us were a little less angry once we had something we could empathize more with. If this waitress never told us this, we could have helped ourselves reduce our frustration and annoyance by IMAGINING any kinds of scenarios that may have made that night’s shift more difficult for that waitress to do her job. Remember that opposite action for anger is not about feeling sorry for the person you are angry at for THEM, it is for US. This skill is about reducing OUR pain and suffering, not about giving the other person permission to act inappropriately or in a hurtful way.
If you find yourself struggling with anger, fear, guilt or sadness on a daily basis, especially if you are stuck in cycles of self destructive behavior, the opposite action skills work so practice them on a regular basis and they will be both subtle AND powerful (a dialectic!).