Levels of Action

In the previous blog, we talked about five stages of acceptance.  Now we are going to talk about five stages of action. Do you remember why we talked about acceptance first?  Because we can’t change reality until we first accept it! But now that we know how to recognize—and overcome—the obstacles to acceptance, we can next focus on taking action.

In the previous lesson, we talked about the importance of accepting the original trauma, as well as the affects of the trauma.  As you recall, trauma affects us in many ways: our emotions, our thoughts, our relationships, and our behaviors. Sometimes one of the most difficult things to accept is that our own behaviors, as a result of the trauma, have not always been the healthiest.  Well, as it turns, our own behaviors are not just difficult to accept—they can be even more difficult to change!

In this blog, we are going to focus on the five stages of changing our behaviors:  Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance (Connors, DiClemente, Velasquez, & Donovan, 2015).

 

  1.  Pre-Contemplation:

     To contemplate means to think about something.  Therefore, pre-contemplation refers to a time before you are even thinking about how your behavior might be a problem.  Notice that pre-contemplation resembles denial. Just like acceptance starts with overcoming denial, change also starts with overcoming pre-contemplation.  Pre-contemplation is another example of a blind spot: Other people often notice what needs to change before we do!

 

  • Example:  Not sure why the wife is always on my case.  Joe drinks way more than I do, and his wife never complains about it!

 

  1.  Contemplation:  

    Remember, contemplation is the act of thinking about something.  Therefore, contemplation refers to a time when you start thinking about your behavior.  Contemplation does not mean that you are necessarily convinced the behavior is a problem, just that you start to think more about the behavior, and how it may or may not be problematic.  Have you ever heard the phrase “paralysis through analysis”? The problem with too much contemplation is that it resembles constipation: There’s no movement!

 

  • Example:  You know, I’ve called in “sick” 5 times this month.  Now my boss AND my wife are on my case. I can’t pack down my liquor like the good ol’ days.  Must be getting older!  

 

  1.  Preparation:  

    This stage is all about getting ready to potentially deal with the behavior.  This stage implies that you have already thought long and hard about the behavior, and you have decided that something needs to give.  You would finally like to change something. At the very least, you start to make some internal or mental changes. Or maybe you have even taken some small baby steps to help change at least some aspects of the problem behavior.

 

  • Example:  I have got to find a way to get everyone off my back.  That’s it: No more drinking till Friday night. I am not going to stop at the bar on my way home from work.  And that hidden stash of booze in the closet has gotta go…

 

  1.  Action:  

    This stage is all about finally making a decisive change in your behavior that other people can actually observe.  At first blush, it seems like you have arrived at your destination. After all, you have finally changed your problem behavior.  Congratulations! Everyone should celebrate…right? Not yet. The action stage is still full of landmines. Many people let down their guard when they reach the action stage.  They think they have the problem licked. They start to take “harmless” risks as they allow themselves more and more freedom. That’s why people with too much over-confidence tend to experience relapse at this stage.   

 

  • Example:  Okay, so only drinking on Fridays still didn’t work.  I think I just need to bid farewell to my long and storied drinking career.  Out with the Old Me. In with the new Upgrade: Clean and Sober! Now I will be attending AA meetings on Friday evenings!  Fast forward:  Now that I have a month of sobriety under my belt, surely my sponsor won’t mind if I head over to Joe’s apartment for his birthday bash.  Maybe I can even brag about how sober I’ve been…

 

  1.  Maintenance:  

    The last stage of change is when you have not only made the decisive change, but you have found ways to successfully maintain that change over time.  Regression back to old habits is still always possible, but now you realize that. Therefore, you have found ways to avoid relapse—and get back on track right away if you do slip up!

    Example:  After a few painful relapses back in my early days of sobriety, I have now been abstinent for five years.  I have learned the key to maintaining my sobriety is to avoid certain people, places, and things—and never to miss an AA meeting!

 

Working through the stages of change is a lot like working through the stages of acceptance:  Nobody goes through the stages perfectly; not everyone goes through these stages in this exact order; it is possible to go through different stages at the same time; and it is also possible to regress in the stages.

Here’s one analogy that has always helped me to understand the stages of change—and especially the importance of making it all the way to maintenance.  Let’s assume that someday you would like to have a garden full of vegetables. However, right now it’s February, and you are not even thinking about the garden yet.  That’s pre-contemplation.  How many vegetables will you have if you stay in this stage?  

Now let’s assume it’s March, and you finally start to think about the garden.  You think about what kind of tools you will need, what kind of soil you will need, and what kind of seeds you will need.  That’s contemplation.  But how many vegetables will you have if you stay in this stage?  

Now let’s assume it’s April, and you start to get everything ready for the garden:  You buy the tools, you buy the soil, you buy the seeds. You even rototill a little plot of ground.  That’s preparation.  But how many vegetables will you have if you stay in this stage?

Now let’s assume it’s May. You finally plant the garden! That’s the action stage.  Congratulations!  But now let’s assume you do absolutely nothing to maintain this garden for the rest of the summer.  You don’t water. You don’t weed. You don’t fertilize. How many vegetables should you expect by the end of August if you stay in this stage?

Now do you see the importance of making it all the way to maintenance?  Lifelong changes are not one-time deals:  They need to be maintained!

For practical exercises to learn more about the stages of acceptance, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder…coming soon in 2019!  

 

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Levels of Acceptance

Levels of Acceptance

 

All of us struggle at times to accept the reality we have been dealt.  Sometimes reality is so painful we would rather pretend that some things do not exist or never happened.  However, there are many reasons why it is a good idea to accept reality—just as it is. First, it is just not possible to avoid all forms of pain; pain is simply an inevitable aspect of life.  In fact, rejecting reality can sometimes make the situation even worse. In addition, denying reality does not change reality. On the contrary, we can’t change reality until we first accept it!  Finally, acceptance of reality may indeed increase our sadness at first, but eventually it leads to peace and freedom (Linehan, 2015).

 

Trauma survivors have even harsher realities to accept than most people.  Just accepting the trauma itself is hard enough! But that’s not all. You also have to accept how the trauma has affected all aspects of your life:  your thoughts, your emotions, your behaviors, and your relationships. Healing from trauma requires you to accept (NOT agree with—but accept) not only the trauma itself, but all the ways that the trauma has affected your life now.  

 

Sometimes reality is so harsh that we simply cannot accept all of it at once.  That’s when we gradually process reality in stages. Sometimes we pass through several phases of non-acceptance before we finally reach a place of acceptance.  This is perfectly normal and healthy—as long as we are progressing towards full acceptance. Unfortunately, life only gets much more difficult when we get stuck for too long on any of the forms of non-acceptance.  Nobody that I know is going to tell you that acceptance is easy. But one thing I can assure you: Non-acceptance is even harder!

 

There are five well-known stages many of us go through as we attempt to process reality (Kübler-Ross, 2014).

1. Denial

Sometimes traumatic events are so horrendous and so unexpected that our first reaction is shock and disbelief.  In other words, denial!  What happens when you have a surgery and the pain of the operation is too difficult to bear?  The medical staff will administer some sort of numbing agent. The numbing agent doesn’t remove the source of the pain; it just temporarily blocks the pain.  Denial is like a drug that numbs out reality when it is too painful for us to deal with. Denial is actually our mind’s way of protecting us when we can’t handle a full dose of reality yet.  While we sometimes need this “mental anesthesia” (at least initially), too much denial can obviously create additional issues of its own. Trauma survivors sometimes engage in activities or consume substances that further numb the pain.

 

  • Example:  My boyfriend beats me because he loves me.  This is how he shows me that I am his woman.

 

  • Connections:  Remember the Thinking Mind, Feeling Mind, and Balanced Mind?  When an individual is in Denial Mode, all three minds are de-activated.  While this complete shutdown may be temporarily appropriate, it is not a good long-term solution!  Do you also remember our previous discussion on blind spots? Denial is a great example of not seeing information about ourselves that other people do.  

 

  • Reality Check:  What sorts of problems can happen when you are in Denial Mode?

 2. Anger

What happens when the anesthesia wears off after a surgery?  Now you feel the pain, don’t you? The same exact principle applies once our denial or “mental anesthesia” wears off.  Now we feel the emotional pain triggered by the situation. In other words, we feel anger!  Anger is like another drug which also has an important function, within limits.  For example, anger provides us with the impulse and energy to change the traumatic situation.

But what if the original situation can no longer be changed? Now what’s going to happen to all that anger?  Not surprisingly, too much anger also can create additional issues of its own. Trauma survivors tend to have lots of anger simmering just beneath the surface—a simmer which quickly turns to boil when triggered.

 

  • Example:  The next time my boyfriend lays a hand on me, I am going to cut myself to show him how ticked I am!  (This would be an example of turning anger towards yourself, which can be common among trauma survivors).

 

  • Connections:  Remember the Thinking Mind, Feeling Mind, and Balanced Mind?  When an individual is in Anger Mode, the Thinking Mind and Balanced Mind are both deactivated, but the Feeling Mind is in full throttle.  While this arrangement may be temporarily appropriate, it is not a good long-term solution!

 

  • Reality Check:  What sorts of problems can happen when you are in Anger Mode?

 

3. Bargaining

Once both of these “drugs” wear off (anger and denial), we become slightly more rational.

Bargaining is when we try to scheme, negotiate, compromise, or manipulate our way out of the situation.

While this may sometimes be a good strategy, what if no amount of scheming, negotiating, compromising, or manipulating will change the original trauma?  The problem with too much bargaining is that it is full of unrealistic, ineffective, and wishful thinking or plans. That’s why too much bargaining can also create additional issues as well.

 

  • Example:  Maybe I just need to be a better girlfriend.  Maybe I just need to learn to not tick him off so much.  Maybe if I can make it up to him, this won’t happen again.  Maybe…

 

  • Connections:  Remember the Thinking Mind, Feeling Mind, and Balanced Mind?  When an individual is in Bargain Mode, the Feeling Mind and Balanced Mind are both deactivated, but the Thinking Mind is in full throttle.  While this arrangement may be temporarily necessary, it is not a good long-term solution!

 

  • Reality Check:  What sorts of problems can happen when you are in Bargain Mode?

 

4.  Depression

Once our attempts to bargain have failed, we feel helpless and hopeless.  We feel we are stuck, with no way out. We feel like things will never ever get better.  We even start to feel worthless, like we somehow deserve to be in this situation. In other words, we feel depressed!  Depression feels the worst but is also the closest to acceptance, because we finally start to see just how bad the circumstances really are.

Remember, “it’s always darkest before dawn.” Of course, too much depression can create further issues as well. One problem with depression is that the situation that we’re in, as awful as it might be, can now seem even worse.  For example, depression tends to make things seem more personal, permanent, and pervasive than they really are.  Personal means that bad things happen to me because I am a bad person. Permanent means the bad things will never go away.  And pervasive means everything is now dark and bleak—not just the trauma!  Another problem with depression is that we lose the ability and energy to deal with the rest of life.  

 

 

  • Example:  This is just how he is.  He will always be abusive.  I will never be good enough for him.  But of course, I was never good enough for him in the first place.  I guess I should just be thankful that at least some guy wants me. This is all I deserve anyway…   

 

  • Connections:  Remember the Thinking Mind, Feeling Mind, and Balanced Mind?  When an individual is in Depression Mode, the Feeling Mind and Thinking Mind are both activated, but the Balanced Mind is not!  And since the Balanced Mind is not active, negative thoughts and negative emotions continue to feed off each other, resulting in a dark, gloomy cyclical cloud of depression.  While this arrangement may be temporarily appropriate, it is not a good long-term solution!

 

  • Reality Check:  What sorts of problems can happen when you are in Depression Mode?

 

5. Acceptance

Acceptance happens when we fully acknowledge and embrace the circumstances just as they really are (no better and no worse).  It has been said, “acceptance…is the only way out of hell” (Linehan, 2015, p. 420).  When we finally face reality as it is, we can actually do something about it!  

 

  • Example:  My boyfriend is abusive.  This is an abusive relationship.  I have options. I deserve better than this!

 

  • Connections:  Remember the three minds?  When an individual is in Acceptance Mode, now all three minds are active:  Thinking Mind, Feeling Mind, and Balanced Mind! Since we have access to the Feeling Mind, we still feel that pain of the trauma, but it is no longer so overwhelming.  And since we have access to the Thinking Mind, we see the facts a little more clearly and rationally. But most importantly, since we have access to the Balanced Mind, we know how to accept the trauma, deal with the trauma, heal from the trauma, and move on with the rest of our life!       

 

  • Reality Check:  Life is never perfect, even when we have mastered the art of acceptance.  What sorts of problems can still happen even when you are Acceptance Mode?

Conclusion

Of course, nobody progresses through the five stages perfectly.  Sometimes we do not go through these stages in this exact order. Sometimes we experience more than one stage at the same time.  For example, you might experience anger and bargaining at the same time; even denial and depression can overlap. Sometimes we regress in the stages.  And sometimes one of these stages is our default response to any life trigger.

 

Learning acceptance does not mean you will never experience any of the roadblocks of denial, anger, bargaining, or depression.  Rather, the key to acceptance is learning what your particular roadblocks are, and learning how to overcome those roadblocks. Remember, each of these forms of non-acceptance is normal and has its place—but none of these roadblocks are healthy places to camp out long-term.

So the next time you experience denial, anger, bargaining, or depression, ask yourself: Is this a roadblock keeping me stuck—or is this a stepping stone leading me towards acceptance?

 

For practical exercises to learn more about the stages of acceptance, please refer to my new workbook: DBT Skills Workbook for PTSD: Practical Exercises for Overcoming Trauma and Post-Traumatic Stress Disorder…coming soon in 2019!  

 

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Intro to Mindfulness:  Part III

In the previous blog, we discussed the first three components of mindfulness:

  1. To be aware
  2. On purpose
  3. In the present

However, there is one more component of mindfulness:  “Without judging.”  Now mindfulness just got a lot harder!  How so?  Well, what happens to us when we increase our intentional awareness of the present?  We start to notice a whole lot of things that we wish we didn’t see!  In a sense, learning to become more mindful (more intentionally aware of the present) means letting go of our denial or other defense mechanisms.  It means exposing ourselves to all the dirty laundry that we shoved under the bed.  It means turning on the lights and seeing that the room is mess.  And what happens when we increase our awareness of things we would rather not see?  We trigger our judgments!

Judgment versus Acceptance

Judgments are basically the negative messages that go through our minds.  Most of these negative messages probably came straight from people who were or are important to us.  Over time, when we hear the same negative messages over and over again, they become internalized.  In other words, they become our own negative messages, rattling through our heads.

The opposite of judgment is acceptance.  A judgment basically screams:  “Things should not be this way!”  However, acceptance simply acknowledges:  “But regardless, this is simply how things are right now.”  Now here’s another great irony of life:  Contrary to what seems logical, judgments do not actually make anything better.  Even if a judgment correctly diagnoses a problem, it only makes the problem worse!  Think about it.  When did judging yourself or someone else make anything better?  However, accepting a problem for what it is will actually put you in a better place to deal with the problem.

Therefore, mindfulness is not just about awareness.  It is also about acceptance!  The tricky part is increasing both awareness and acceptance at the same time.

Mindfulness = Awareness + Acceptance

So why is mindfulness so important?  Why are awareness and acceptance such a big deal?

The answer is simple.  Under the best of conditions, life is full of problems!  And what happens when we either ignore the problems or fail to accept them?  Do they just go away?  Do they get better all on their own?  No, of course not!  Awareness and acceptance are not just random exercises with no purpose.  Rather, they are the tools we need to deal with life.  Once we become aware of our problems AND accept our problems, we are now in a much better position to deal with them.  In other words, once we are fully aware and fully accepting of a problem, now we are finally in a position to decide if, when, and how to take action.  But without awareness and acceptance, we continue to fumble through life, just making problems even worse than they were.

Applied Mindfulness

So what does applied mindfulness look like?  So glad you asked!  Based on everything we have learned in this lesson, we can now define applied mindfulness in three simple steps:

  1. Awareness
  2. Acceptance
  3. Action

Now, the beauty of this formula is that awareness and acceptance are already action.  In fact, just implementing awareness and acceptance is already more action than most people take in their daily lives!  Therefore, sometimes awareness and acceptance is the only action you need to apply to a situation.  Sometimes situations really do get better just by becoming more aware of and more accepting of them.  However, some times increased awareness and increase acceptance allow you to understand that further action is required.  But either way, you are now in better position to make better decisions moving forward.

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Intro to Mindfulness:  Part II

When people hear the word mindfulness, sometimes they think of meditation or great mystical experiences.  However, the concept of mindfulness is actually quite simple and ordinary.  In this blog, I would like to demystify the concept of mindfulness.  I want to make sure you understand that mindfulness is a concept that is readily accessible to everyone.  While mindfulness does require patience and practice (just like anything good in life), it does not require decades of discipleship under a famous guru.

In the previous blog, we defined mindfulness with the following four components:

  1. To be aware
  2. On purpose
  3. In the present
  4. Without judging

Let’s take a look at each of those definitions in a little more detail.  “To be aware” of something simply means to notice something, to observe something, or pay attention to something.

“On purpose” simply means to do something intentionally or deliberately, as opposed to randomly or accidentally.  We all notice things when it’s too late or when we have no other choice.  However, many times we fail to notice something when we do have a choice.  And that’s precisely why minor issues continue to built up over time—and we never even bother to notice them, until they become out of control.

“In the present” means learning to focus on what’s going on in the here and how.  That does not mean that the past or future are not important.  They are!  However, here is one of the great ironies of life:  You cannot effectively heal from the past by obsessing about the past, nor can you effectively plan for the future by worrying about the future.  Rather, by learning to become more grounded in the present, we are actually in a much better place to then heal from the past as well as plan for the future.  If we are not paying attention to what’s going on in the in here and now, we simply fumble from one crisis to the next, constantly reacting to skeletons from the past or phantoms of the future, without having a firm grasp on the reality that is right before our eyes.  Perhaps you have heard the old adage:

Yesterday is history and tomorrow is a mystery, but today is a gift: And that’s why it’s called the present!”

So to summarize so far, the first three components of mindfulness are all about awareness, and more specifically, intentional awareness of the moment:  Learning to deliberately notice, observe, and pay attention to events in the here and now.  That’s where mindfulness starts.

Please refer to Dr. Dan Siegel’s website for more information on mindfulness.

 

 

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Intro to Mindfulness: Part I

Perhaps you have heard the term “mindful.” “Mindfulness” seems to be the latest buzzword in treatment circles, not to mention society in general. But actually, the concept of mindfulness has been around for thousands of years. What does the term mindfulness mean? And what does it mean to be mindful?

Not surprisingly, there are many definitions out there. But here is my favorite definition of mindfulness: “To be aware, intentionally, in the present, with judging.” You might have noticed this definition has four distinct parts. We will discuss each of these parts in more detail later.

1. To be aware
2. On purpose
3. In the present
4. Without judging

Mindlessness

The opposite of mindfulness is mindlessness. To be mindless means to be unaware. Here are four examples of mindlessness: reactivity, dissociation, automaticity, and multi-tasking. Reactivity means to respond with our instincts or emotions, without thinking first. Trauma survivors tend to be very reactive to anything that reminds them (even subconsciously) of a previous trauma. Dissociation literally means to disconnect from your own experiences; in other words, to “space out” for long periods of time. Dissociation is much more severe than just daydreaming. Trauma survivors tend to be quite good a dissociating as well, since disconnecting or “spacing out” is precisely what helped you survive much of your trauma when it was occurring. Automaticity means to do something automatically, without having to think about it. If you know how to ride a bike without thinking about every single muscle movement required to stay balanced and moving forward, then you know what this concept well. Finally, multi-tasking refers to performing two or more tasks at the same time, such as changing a diaper while answering the phone.

Now notice that there is nothing wrong with mindlessness in and of itself. In fact, we would never have survived as a species if part of our brain did not know how to react without thinking, space out, learn to do something automatically, or perform multiple tasks at once. For example, what if your house was on fire, and no part of brain knew how to react impulsively? What if you had to relearn how to ride a bike, every single time you tried to ride one? Or what if you could only do thing at a time? As you can see, we wouldn’t do so well, would we? Indeed, it is a great gift that our brain can do so many things without even thinking about it.

Mindfulness versus Mindlessness

Therefore, mindlessness is a gift (even though you won’t hear too many therapists tell you that). However, mindlessness alone is also a rotten way to go through life. What if you were always reactive—to everything? What if you were always spacing out, even during your most cherished moments? What if you could only do things you already knew how to do automatically—and therefore, you could not learn new behaviors? As you can see, we still wouldn’t be doing so well, would we? That’s why mindfulness is also a gift. We need both!

DBT is all about the dialectics: The process of finding balance by bringing together opposites. Therefore, one of the first opposites we need to balance is mindlessness versus mindfulness. While mindlessness is a gift to the brain, so is mindfulness. The only problem is that mindfulness is a gift that we have to learn! Unlike mindlessness, mindfulness does come to us naturally.

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