Courageous Conversations in Evidence Based Treatment

At this point, everyone of us has been touched in some way by the COVID-19 pandemic. We are likely having many emotions: Fear, frustration, disappointment and boredom might just be a few. This leads me to wonder: What can we glean from DBT skills, and how can they help us gracefully get through this current crisis?

When we think about coping with something difficult, we should first consider if we are more emotionally vulnerable than usual. When we are vulnerable, we tend to respond more quickly and strongly than usual, and it may take our emotions longer than usual to get back to normal.

We reduce our vulnerability to emotion by taking care of both our emotional and physical health. We do this by using our ABC PLEASE skills. I recently became aware of a resource written by a colleague who very generously is allowing people to share it. I share it below and hope you can use your skills to help make a difficult situation more manageable.

DBT Skills for the Pandemic

by Julie Matsen, Ph.D.
Medical College of Georgia at Augusta University

We are in the midst of a global health crisis none of us have ever faced before. It is normal that we are all feeling more anxious. It makes sense that our threat systems are activated as we face a lot of uncertainty about the future and hear stories from around the globe of illness and death.

We are all being asked to stay home as much as possible, and this may mean that some of us will be much more alone and isolated than usual. For others, it might mean we are spending more time with family with whom we find ourselves in conflict.

DBT skills help us to be more mindful, more effective in our relationships, regulate our emotions, tolerate our distress, and accept reality as it is. What follows are specific ways you can use DBT skills to help you face this current crisis.

1. Most Important: Treat Physical Illness

• Call your doctor: If you think you have been exposed to COVID-19 and develop a fever, cough or difficulty breathing, call your healthcare provider for medical advice.
• People at higher risk for serious illness from COVID-19 should contact their healthcare provider early, even if their illness is mild.
• Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.

2. Other ABC PLEASE Skills

Reducing vulnerability to emotion is very important in uncertain or highly stressful situations. Take care of your emotional health as well as your physical health with these skills:

• Accumulate Positive Experiences
  • Find one enjoyable thing to do each day, even if you are at home.
• Build Mastery
  • Do something each day that brings a sense of accomplishment. What about deciding to clean out one drawer each day? Is there a hobby or artistic talent you’ve been ignoring? Maybe now is a good time to dust off the guitar and practice. Or find some drawing lessons on YouTube and improve your art skills.
• Cope Ahead
  • Plan ahead in case you have to stay home for two weeks. Make sure you have food and medicines that you need. Think about what activities might need to be canceled or postponed. Plan to have games, books or other activities available. Think about who you will want to stay in touch with.
  • Coping ahead may also mean problem-solving difficult situations such as finding childcare when schools are closed. Remember the steps of problem-solving. Brainstorm solutions. Ask others for help being creative with solutions for difficult problems.
• Ensure you are eating a balanced diet; avoid overeating and undereating.
• Avoid drugs and alcohol.
• Make sure you are getting adequate sleep and stick to a regular sleep schedule. Ideas for improving your sleep:
  • If you are struggling to fall asleep, try to limit exposure to screens (e.g., TV, computer, phone) for AT LEAST 30 minutes before bedtime.
  • Add some white noise to your bedroom.
  • Get up at the same time in the morning and only use your bed for sleeping and sexual activity.
• Get some exercise.
  • If you are stuck indoors, consider accessing home workout videos on YouTube.

3. Check the Facts

Make sure you’re responding to the facts of the situation. There can be a lot of rumors and misinformation on social media regarding COVID-19. Find reputable sources for checking facts. Check out the organizations below for credible information.

World Health Organization
WHO on Facebook
Twitter: @WHO

Centers for Disease Control
CDC on Facbook
Twitter: @CDCgov

4. Radical Acceptance

This is a time of uncertainty for everyone. There is a lot about this situation that you cannot control and cannot change. Radical acceptance means to completely and totally accept the situation as it is, acknowledging that your feelings about it are what they are.

• If you notice you’re fighting reality, acknowledge that with self-compassion. Then see if you can turn your mind toward willingness to do just what is needed.

5. Mindfulness of Emotion

You may notice many emotions arise over the next few weeks. You may experience anxiety, sadness, disappointment, fear and frustration. You may also experience hope, comfort and gratitude. Notice each emotion as it arises and as it falls. Allow it to be as it is. Practice observing and describing each emotion without judgment. Notice urges to act on emotion without necessarily acting.

6. Interpersonal Effectiveness Skills

If you’re spending a lot of time at home with your family, conflicts may arise. Remember to balance your wants and needs with the wants and needs of others in your family. Negotiate.

• Ask others for what you need in this uncertain time.
• Tell others if you need to limit your consumption of COVID 19 related information.
• Practice kindness.

7. Contribute

Crises like this offer us opportunities to be our best selves. Staying home and practicing social distancing is one way we can actually care for each other in our community by slowing the spread of the virus and protecting the most vulnerable.

Consider how else you can contribute to those in your social network. Consider contacting older people to ask how they are doing or if they need anything delivered. Reach out to people you know who might not have others around them. Be extra kind to the grocery checkout clerk and the pizza delivery driver.