GIVE to Yourself

Dialectical Behavior Therapy’s (DBT) GIVE is a powerful therapeutic tool I find myself returning to over and over again in my work with clients, particularly in strengthening interpersonal communication skills. Recently, when preparing for a session, I was thinking of new ways to treat negative self-talk; realizing there is great potential in applying GIVE not only to communication with others, but also toward one’s self!  Today I would like to introduce you to Marsha Linehan’s GIVE and how it can be used for positive self-talk.

What GIVEs?

GIVE stand for Gentle, Interested, Validate, Easy Manner. Gentle can mean many things, I often tend towards tender or non-judging in my approach. Interested means to be listening, if you are listening you can summarize what the speaker said and they would agree with it. Validate means to acknowledge what is being said, this does not mean agreeance. Easy Manner means light-hearted, at ease or humorous.

How can I GIVE to myself?

When I talk with strangers or friends I use GIVE as a guideline to monitor if it is a healthy conversation. The same holds true with my self-talk. If I cannot be gentle with myself, I must be hurt. It’s important that I talk to myself gently if I wish to feel heard, much like I require of myself and those I associate with. If my internal dialogue is abrasive and rapid (cutting myself off) - it is time to implement a coping skill to center myself so that I can fully listen to myself. If conflicting parts of me cannot acknowledge that I have differing roles   that can conflict (being a therapist is different than that of a brother, son or partner) then it is no wonder that I am hurting. Even in ambivalence I have to create space to acknowledge  inner conflicting ideas, thoughts, and emotions. I admit that Easy Manner is an odd and deeply personal approach when it comes to self-talk. I am not particularly humorous, but I can be at ease. My role as a therapist should be at ease with my role as a son, even though they conflict from time to time. GIVE is a great way to support healthy internal communication, which can lead to improvements in other aspects of life including emotional well-being, interpersonal communication, and self-esteem.

What do I do when GIVE doesn’t work?

This is where coping skills come in. What can you do that will ground  yourself so that you can practice GIVE? Use your creativity! You know yourself best. For some inspiration here are a few ways I have seen clients successfully ground themselves in this situation: (1) Just breathe. Find an easy rhythm that keeps your attention on your breathing. (2) Music. Let the tone or lyrics speak to you in a positive way to balance the negativity. (3) Reach out to a close friend, or family member, and talk about mutual interests that you enjoy. Once you feel relaxed, centered, and grounded try to focus on one of the principles of GIVE and see how you feel on the second try. 

Self-talk is one of the hardest parts about communication. If you are trying to communicate with others and it is difficult, you can take a break. When it comes to yourself, you can never quite leave yourself. This is where using GIVE can help, because it is about respecting you, and all your parts, when you use it for self-talk.

--

Linehan, M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. The Guilford Press.

The 3-minute exercise to manage anxiety while under quarantine

Anxiety has the capacity to be both incredibly helpful and harmful. In the event of finding yourself face to face with a cougar, down to the wire on a final project, or gearing up for a big race, anxiety gives us the "juice" to dig deep, focus, and function at a high level. There are consequences of course to these bouts with anxiety, including adrenaline and its counterpart cortisol - which, studies have shown, can be very harmful in high doses. Similarly prolonged states of anxiety can lead to fatigue, GI issues, heart problems, and memory problems. For brief periods of time, this anxiety can be functional and help us overcome challenges.

 Unfortunately, anxiety isn't always helpful. Often the evolutionary anxiety that would help us in the event of a battle against a wild animal is constantly "ON" as we fight internal fears surrounding things that haven't actually happened yet. In fact, I often find that when anxiety is over functioning it leads us to look to the future and build dozens of different possible outcomes, then mount problem solving against them all. This is overwhelming, often unhelpful, and multiplies distress by focusing on situations that do not yet exist!

 The beauty of practicing mindfulness as an anxiety management technique is that it helps us to stay focused on the present moment. Much of our psychological distress exists when we ruminate about the past or catastrophize the future - both are out of our control and are not happening in the present moment. You do not have to hold the distress of the past, present, and future simultaneously - it is too much!

 My favorite quick trick to bring anxiety down to a more manageable level is a grounding technique that engages your senses. This helps take you out of your mind and into the physical space around you. Here you can remind yourself of what is actually happening - relieving your mind of the burden of holding so many possible realities at once. This has been increasingly helpful to folks as they are stuck in self-isolation due to the growing impact of COVID-19 on our world (a veritable powder keg for anxiety and catastrophic thought).

 Before starting, I encourage you to take a few deep, full breaths - holding at the top of the inhale briefly and slowly exhaling. Then I invite you to turn to your senses and work through the following list. Repeat at least once (more if needed):

 *Name 5 things that you see

 *Name 4 things that you physically feel

 *Name 3 things that you hear

 *Name 2 things that you smell

 *Name 1 thing that you taste

 *REPEAT*

 Extra notes: it is normal to still feel your mind racing and to experience internal dialogue (even critiquing the exercise). Allow those thoughts to come and go and continue to focus in on the exercise - the anxious voice will start to subside as you draw more and more attention to the world around you. Also, I encourage you to try to slow down with each item you name, trying to avoid rattling things off as quickly as possible "PILLOW - COUCH - LAMP - CHAIR"; instead try to also include one detail or adjective along with the item "the faded chair" or the "patterned rug". 

If you are interested in more mindfulness activities, I highly recommend checking out meditation apps such as Calm, Simple Habit, and more. If you prefer a hands-on resource I encourage you to check out A Mindfulness-Based Stress Reduction Workbook by Stahl & Goldstein.

Types of Grief

By Kellie Calderon, MA, LPC

"Grief I've learned is just love. It's all the love you want to give but cannot. All of that unspent love gathers up in the corners of your eyes, the lump in your throat, and in that hollow part of your chest. Grief is just love with no place to go."- Anonymous

As if grief weren’t complicated enough to deal with, there are a few different types of grief to be aware of. The importance of knowing these different types of grief is that you or a loved one can understand what you or they are going through to better process the grief and manage the emotions that go along with it. If you would like to get a recap on symptoms of grief, head over to the previous blog here!

Anticipatory Grief

This type of grief occurs when there is either a terminal or progressive illness that causes you to anticipate the grief that will occur when the individual passes away.

What you may experience:

• Anger

• Loss of emotional control

• Helplessness

• Loss of other things, such as dreams, future or family structures

How to help:

In situations where you may be anticipating the loss, it is important to use the time to process the loss with that person. It can be difficult to accept the fact that a loved one is going to pass away, but it gives an opportunity to spend time with them to find meaning in your relationship with that person and gain closure and peace for when they actually pass.

Complicated Grief

This type of grief lasts longer than “normal” grief (I put normal in quotes because there really is not a normal way to grieve, so use this term lightly), and may affect your daily living if you are not receiving help. If someone has an underlying mental health diagnoses such as depression or anxiety, it can also make the grief feel more intense. Someone who has depression or anxiety may have a harder time finding coping skills that are effective without additional help from a therapist.

What you may experience:

• Grief lasting a long period of time with no improvement

• Delayed grief (experiencing grief long after someone passes)

• Extreme or intense reactions to the loss (self-destruction, changes in behavior)

How to help

Since complicated grief is just how it sounds, complicated, the best route to process it would be to speak with a counselor. It may also be beneficial to set up an appointment with a psychiatrist if you feel you may have an underlying mental health condition as well.

Disenfranchised Grief

This type of grief occurs when a society, family member, friend or community invalidates the grief. This could be if the death is a suicide, overdose or something similar. This may also be if the death is someone that was not necessarily a close part of their life such as a coworker. These can be tough because although you may not be a close friend or family member, you still can feel the loss. Friends or family may wonder why you are experiencing grief, but it is important to remember that grief can manifest itself in different ways within different people. It could also be a trigger of a another time someone felt grief.

What you may experience:

• Feeling isolated

• No validation of your grief/feelings

• Feeling shameful or guilty for grieving

• Suppressing the grief

How to help

It can be helpful to find others who may have experienced that type of grief to help normalize the feelings (support groups, etc.). It may also be a good idea to talk to a counselor to find support and an outlet for your feelings of grief. Remember that everyone experiences grief differently, and just because others do not validate your grief, does not mean what you are feeling is not real.

Other types of grief

Along with the types of grief mentioned above, there are other types that may not be as common but still should be discussed.

Traumatic Grief - When a loved one dies in a traumatic and/or violent nature. This could cause nightmares, flashbacks (if witnessed), etc.

Cumulative Grief - Experiencing a loss while still grieving a different loss

Masked Grief - Experiencing grief that affects daily functioning but is not recognized by the person grieving. This person may be masking the symptoms with other behaviors (overeating, physical symptoms, self-sabotaging, etc.)

Collective Grief - Refers to grief experienced by a group. This is becoming more common with school shootings, natural disasters or if there is a death in a close knit community.

Absent grief - When the person is not showing any signs of grieving and is in denial of the loss. This might look like someone who goes about their normal life as if the person had not passed away. This person may be in complete shock and unable to recognize the loss.

There is no “right” way to process grief. However, if you notice that the grieving process is affecting your daily life and functioning, we encourage you to seek out counseling. This will help with processing the grief as well as learning how to manage the emotions that come along with it.

Types of Grief. (2017, March 28). Retrieved from https://whatsyourgrief.com/types-of-grief/

Understanding Grief: Symptoms and Ways to Cope

By Kellie Calderon, MA, LPC

Everyone experiences grief at some point in their lives. This can be through the death of a close loved one, or through other losses such as the loss of a job, the loss of a pet, or even the loss of a lifelong dream or goal. When a loss occurs, there are many different emotions someone can experience. Reactions can range from crying and sadness, to anger and disbelief. The difficult part about experiencing a loss is that there is not a one-stop-shop solution. Grief is not linear. There is not a specific set of things you can do to make it better, and what works for one person may not work for another.

The first part of this series is going to be covering the symptoms of grief as well as a few ways to cope. It is important to be able to identify these symptoms when you may be grieving yourself, or when someone you know may be grieving. By identifying the symptoms, you can begin the healing process, or help guide someone going through it.

There are many different symptoms that can manifest when someone is grieving. They can be separated into feelings, cognitions, physical symptoms and behaviors, and many of them are listed below. (Freeman, 2005; Worden, 2005). 

-Feelings:

- Sadness

- Numbness

- Anger

- Guilt

- Anxiety

-Cognitions:

- Obsessive Thinking

- Intrusive Thoughts

-Physical Symptoms:

- Tight Chest

- Lack of Energy

- Muscle Weakness

- Dry Mouth

-Behaviors:

- Sleep Issues

- Changes in Appetite

- Social Withdrawal

- Absent Mindedness

Many of these symptoms are very normal when it comes to the grieving process. However, one thing to be aware of are symptoms of depression versus grief. There are some similarities between the two but they are also very different experiences, and if left untreated, depression can become very serious. Below are some symptoms of major depression:

- Worthlessness

- Exaggerated guilt

- Suicidal thoughts

- Low self-esteem

- Powerlessness

- Helplessness

- Agitation

- Loss of interest in pleasurable activities

- Exaggerated fatigue

 Coping with Grief

 As mentioned earlier, grief is not linear. This is very important to remember because someone’s grieving process may take a few weeks, while others may take a few years. It is essential to be sensitive to someone who is grieving and to not force them through the grieving process. Below are a few strategies that may help when going through the process of grief (Note: many of these reference death; however, as we have stated loss can take many different forms).

 -Talk about the death. Many people deny the death which can cause isolation and may make it more difficult to accept the death and move on with life.

-Experience and accept feelings. It is important to remember that feelings of sadness, anger, numbness, etc. are all normal. In order to process the loss you must accept these feelings and try to experience them.

-Prioritize Self-Care. Many people neglect themselves while grieving. There is a lot happening and it can be distracting. Make sure you focus on your eating habits, exercise and sleep. Try Mindful Meditation to help as well. Apps such as “calm” or “headspace” can help with this.

-Accept support and help from others. It can be easy to feel like a burden to people when you are grieving, but the people around you are there for you to lean on. Surround yourself with your support people and accept the help they offer.

-Remember your loved ones in a positive light. It can be difficult to think about the positives in a time where everything seems so negative. Celebrate the life of the deceased and remember them in ways that make you feel good. Sometimes it can help to memorialize them in ways such as planting a tree, creating a memory book or advocating for a certain charity that is in their name.

 If you or someone you know is experiencing grief and is having a difficult time, please seek out professional help from a mental health counselor.

Sources:

Freeman, S (2005). Grief and Loss. Understanding the Journey. Belmont, CA: Thompson Brooks/ Cole

Grief: Coping with the loss of your loved one. (n.d.). Retrieved from   

        https://www.apa.org/helpcenter/grief

Schwartz, A., LCSW, PhD. (n.d.). The Difference Between Grief and Depression, The DSM V. Retrieved

      from https://www.mentalhelp.net/blogs/the-difference-between-grief-and-depression-the-dsm-v/

Worden, J.W. (2005). Grief Counseling and Grief Therapy: Handbook for Mental Practitioners (3rd ed.).

      New York, NY: Springer Publishing Company

Using Dialectical Behavior Therapy as part of Holistic Wellness

Owner Danielle Zawadzki, LMFT talks about using DBT in therapy and its role in holistic wellness with Dr. Serena Wadhwa. Episode recorded on July 23, 2017.