DBT Skills for Covid-19

Coping with uncertainty, the unknown, constantly changing information, physical social isolation, and the threats to health, economy and our way of life

The current COVID-19 pandemic situation presents many challenges for everyone on many levels.  In terms of managing the emotional response to this crisis, it seems that people need support in managing distress in the form of intense anxiety, panic, PTSD reactions, OCD symptoms, as well as anger management and tolerating irritability.   In addition, help controlling impulsive urges to act on destructive behaviors such as increased substance abuse and urges to act on angry and violent impulses.  And interpersonal challenges and conflicts that arise with social distancing and being home alone, or together 24/7.

There are some ways to think about coping using DBT skills.

• Expert Voices: Dealing With Uncertainty

• Expert Voices: Coming Up With A Plan

• Expert Voices: So Many Feelings

• Expert Voices: What Happens Next 

MINDFULNESS – Being in the Moment

·      Work on being in the moment.

·      Bring the mind back from speculations regarding the unknown and worst case scenarios of what might be in the future. 

·      Focus on what you do know right now and what you can do right now.  If that means productive planning for the immediate future, such as stocking up on food or medicines, that’s fine. If it means involving yourself in a distracting and/or meaningful activity in the moment, great.

·      Much of the uncertainty is around health, finances, availability of resources. It can be helpful to read literature on Buddhist perspectives on impermanence:

Read Buddhist perspectives – Pema Chodron, Jon Kabat-Zinn, Thich Nhat Hanh, Tara Brach, etc. 

Practice mindfulness: Mindfulness apps:  Headspace, Calm, Insight Timer

DISTRESS TOLERANCE

IMPROVE the moment.

·      Ask yourself what can I do right now to improve the moment I’m in? Am I fighting being in this moment and dwelling on wishing I weren’t in it? 

·      Acknowledge, accept and validate that you don’t want to be in this moment, and then decide to turn your mind toward accepting that you ARE in the moment

·      Find one of the IMPROVE (Imagery, Meaning, Prayer, Relaxation, One thing in the moment, skillful Vacation, Encouragement) activities to help get through it, one moment at a time. 

Radical Acceptance

·      Accept that you’re in this moment, that the world is in this moment, that so much is uncertain and we cannot know what will happen, that we have very little control over what will happen.

·      Imagine what you would do if you fully accepted the situation you are in, and then try to do these things.

Distraction skills

·      In addition to the usual distractions, thing about:

·      Contributing – by social distancing and doing your part for the common good, sewing masks, helping others. 

·      Stay well informed, but LIMIT YOUR EXPOSURE TO THE NEWS .  Take time outs if possible.

Some distracting activities:

Reading, cleaning, watching TV, doing a hobby or artistic pursuit, cooking, baking, contributing, self-soothing, listening to music, podcasts, baths, showers, facials, self mani/pedi.  Napping. Playing with and taking care of children, pets. Virtual socializing.

Don’t guilt trip yourself for engaging in “meaningless activities”, as long as they help you get through the moment or the day and you are not avoiding something you really need to be doing.

It may help to balance distraction with building mastery (see below).

EMOTION REGULATION

Use ABC Please skills

·      Reduce your vulnerability to negative emotions.

·      Try to stay on a sleep/wake/eating schedule, exercise and eat healthily

·      Choose at least one activity that gives a sense of mastery and productivity.

Opposite Action to Anxiety

Focus on what you CAN do or control, not what you CANNOT do or control.

Make a list of everything you CAN do and then do the first thing on the list.

Opposite Action to Guilt

A lot of people are blaming themselves for making mistakes, possibly exposing themselves or others.

Take stock of what your wise mind tells you is a real mistake, make repairs, accept the consequences gracefully, make a commitment to not make the same mistake in the future, let go.

Remember that this virus, and this impossible situation we are all in, is not your fault.

Self-Validation

·      Much of the uncertainty is around health, finances, availability of resources.

·      It is okay to be anxious, angry, and sad. There would be something wrong with you if you weren’t.  

·      Accept the normal ebb and flow of your feelings.

·      Try the skills above – opposite action, distraction, mindfulness, IMPROVE, radical acceptance, opposite action, and staying on a schedule. 

·      Also use emotion regulation skills below.

Wise Mind and the Function of Emotion

·      Your emotions are a source of wisdom if you can regulate them and not become paralyzed or overwhelmed.

·      Try to understand what your emotions are trying to tell you about what you need and then try to use them to act skillfully. 

·      Using the emotion regulation observe and describe worksheet can help you identify the trigger of your emotion, the interpretation of that trigger, the internal body sensations and action urges, and the external expressions of your emotion.

Some examples:

Anger.  What is the function of anger? To let you know that something is happening that you don’t like and to motivate you to take action to stop it.  It can be easy to get angry about this situation, or to get angry at a loved one who is behaving in a way that adds to your anxiety or makes it harder for you to cope.  Don’t try to not be angry.  Rather, use your anger to make an effective communication. If the anger becomes overwhelming and leads to a strong urge to be verbally or even physically abusive, take a time out, do some intense exercise or deep breathing, take a hot or cold shower, allow yourself to calm down, and then think of a way to use interpersonal skills to express your feelings directly.

Anxiety.  What is the function of anxiety? Anxiety is a variant of fear. Fear signals that there is danger. In this situation that makes perfect sense. Fear motivates the “flight” response, to try to remove yourself from the danger. If it doesn’t get too overwhelming or paralyzing, it can become a useful tool in motivating positive action to keep yourself as safe as possible.

INTERPERSONAL EFFECTIVENESS

Skills for asking for help effectively, saying no effectively, using skills for relationship enhancement. 

·      Find the right time to approach someone that you would like to speak with

·      Practice validation  - understand that the people around you are just as anxious as you are and may have different ways of expressing their anxiety.

·      Self- validate that your needs are just as important as the needs of others

·      Find the balance between wants tos and shoulds.

It is hard enough to manage one’s own anxiety without being overly affected by the anxiety by those around us.

·      Take time outs

·      Limit exposure to people who are overly anxious, including social media chats.

·      Build in as much positive social interaction as possible

·      Reach out virtually for positive social gatherings – having dinner together over skype or zoom or facetime, watch movies together, even have virtual dance parties or other “gatherings”.

Important to validate the anxiety, anger, sadness of children.

·      Let them have their feelings and reassure them that it’s okay to feel the way they do. Communicate that you will all get through this together.

·      Parents are sometimes feeling guilty or a sense of failure when their kids are not engaging in healthy activities or are having temper outbursts or being oppositional.  

·      There is additional pressure of not having usual structure of school/interaction with peers

·      It is normal for children to not be perfectly behaved even in the best of circumstances.

·      Better not to try to “make them feel better” by trying to talk them out of their anger, fear or sadness.

Recovering from invalidation. 

Being in close quarters with the same people all day long, or having remote, virtual contact with people, all of whom are experiencing this extremely stressful situation and having a lot of feelings about it, can place a lot of extra stress on relationships.  It is inevitable that you will feel misunderstood and/or emotionally invalidated at times.  Review the skills for recovering from invalidation. You can get over it – it won’t kill you.

DEALING WITH INDECISION IN AN EVERCHANGING SITUATION WITH CHANGING INFORMATION

1.     Make a plan and stick with it for the day, reassess when new information comes in. Plan should include distraction, building mastery, being healthy (keeping to a schedule), mindfulness practice, and having steps you will take if you or someone starts to feel sick.

2.     If you or someone you love has symptoms, these are the steps you should be taking:

a.     Call your doctor to find out if you need to be tested

b.     Find out where the nearest testing site is and what the criteria are for going and getting tested (these criteria are changing daily)

c.     Take Tylenol and stay home and rest, stay away from others – you will mostly have mild symptoms and will get over the illness. Much more preferable to stay away from others and from the medical system.

d.     Only if you are having severe symptoms, go to the appropriate medical facility.

Remind yourself of the facts as they become available: (according to Governor Cuomo as of April 13):

·      You are highly likely to survive this virus if you contract it.

·      Food and supplies are and will be available.

·      Although we don’t know when, this situation will end.

·      The only control we have is to do our part and understand that life is going on

·      We have a choice  - to make this period of time the best it can be given the circumstances. 

·      We won’t always be able to hold onto these reassurances but we can try to keep coming back to them.