Impact of religion and spirituality on health and psychology

Meeting Clients On Their Terms

Michael Changaris, Psy.D.

Religion Health

and Psychotherapy

Freud and Religion

Religion, Freud believed, was an expression of underlying psychological neuroses and distress.Freud believed that religion is a means of giving structure to social groups, wish fulfillment, an infantile delusion, and an attempt to control the outside world."Religion is an illusion and it derives its strength from the fact that it falls in with our instinctual desires." --Sigmund Freud, New Introductory Lectures on Psychoanalysis,1933.

The human psyche is religious by nature.Symptoms come from psycho-spiritual roots.

Had semi-psychotic state after falling out with Freud.

Jung viewed life as an ongoing transformation that is a process of “individuation.” He argued that individuation was the “mystical heart” of all religions. At once it is a meeting of the self and the ultimate.

Jung played an indirect role in the founding of AA and believed in a “spiritual cure for alcoholism.”

Carl Gustav Jung - 26 July 1875 – 6 June 1961“As far as we can discern, the

sole purpose of human existence is to kindle a light in the darkness of mere being…”

Matter of Facts…Two views of the world – “Idealists and Materialists”To idealists, spirit or mind is primary, and created matter secondary. To materialists, matter is primary and mind or spirit is secondary, a product of matter acting upon matter.Logical positivism used formal logic to underpin an empiricist account of our knowledge of the world.We live in a “De-enchanted” world. Mind – Brain – Self (universal mind)

Importance of Religion in US

Religious Importance in Americans of Non-European

DescentAfrican-Americans are among the most likely to report a formal religious affiliation, with fully 87% of African-Americans describing themselves as belonging to one religious group or another.African-Americans (79%) say religion is very important in their lives, compared with 56% among all U.S. adults. African-Americans (53%) report attending religious services at least once a week, more than three-in-four (76%) say they pray on at least a daily basis and nearly nine-in-ten (88%) indicate they are absolutely certain that God exists.

Pew Research Center's Forum on Religion & Public Life.

Religious Importance in Americans of Non-European

Descent

Latino(a)s also report affiliating with a religion at a similarly high rate of 85%; among the public overall, 83% are affiliated with a religion.94% of Filipino Americans Report being highly religious (not Pew Data)87% of Korean Americans Report being highly religious (not Pew Data)

Religious Importance in Elders

Descriptive findings indicate that 96% of elders use prayer to cope with stress based on the Jalowiec Coping Scale.

Women and African American Elders used prayer to cope with stress significantly more often than did men and euroamericans.

The most frequently reported alternative treatment modality for elders was prayer (84%).

Discussion? What role does religion play in therapy?? Have you worked with clients when it

was central to therapy?? How do you work with religious and

spiritual experiences in therapy?? How have you seen religion help clients?? How have you seen religion hinder

clients growth?

William James was the Popularize of American Psychology.

His works form the foundations of the field and are still often quoted.

Co-author of James Lang Theory of Emotions.

Gave a series of lectures compiled in the book,

“The Varieties of Religious Experience”

in University of Edinburgh in Scotland between 1901 and 1902.

William JamesBut such individuals are “geniuses” in the religious line; and like many other geniuses who have brought forth fruits effective enough for commemoration in the pages of biography, such religious geniuses have often shown symptoms of nervous instability.There are moments of sentimental and mystical experience . . . that carry an enormous sense of inner authority and illumination with them when they come.Religion can lead to profound psychological change granting new found passion for life, depth, love and security. Mystical experiences can create profound changes in brief moments. They often feel as if the individual is connected to and expressing a vast intelligence. They are impossible to put into words but transformative to those who experience them.

Aspects of ReligionMoral System: All religions have a system of moral behaviors that help people live a “good” life. Practices: These are the tools, rituals, spiritual technology, skills and habits that the religion offers to help develop either moral habits or spiritual experiences.Beliefs: These are the ideas, thoughts, stories, philosophies and teachings that create the “rasa” of a religion. These include elaborate cosmologies, relationship to “ultimate” and the role of women in liturgical life. Experiential/Mystical: These are the direct contact with the sacred. These can include visions, speaking in tounges, divine union, enlightenment, peace that passes understanding.

Spirituality DefinitionNIHR (National Institute of Health Care Research) Defines Spirituality As: The “feelings, thoughts, experiences that arise in search for the sacred.”

Search: “Are the attempts at identifying, articulating, maintaining, transforming, understanding, knowing and embodying.”

Sacred: Is the divine, higher power, or ultimate reality as understood by the person.

Religion: Operationalized1. Religious/spiritual preference or affiliation. – Affiliation with

specific spiritual or religious group. 2. Religious/spiritual history. – History of participation,

Religious trauma, upbringing, and transformative moments.

3. Religious/spiritual participation. – Frequency and amount of engagement in spiritual or religious activities.

4. Religious/spiritual “private” practices. - Prayer, meditation, rituals, ceremonies, contemplation, dance, movement and work.

5. Religious/spiritual support. – Social support, Spiritual Guidance, Material Support and Imaginable Support.

Religion: Operationalized

6. Religious coping. – Ways individuals participate to cope with life experiences.

7. Religious/spiritual Beliefs and Values. - Morality and belief structures. How the beliefs are held (truth, metaphoric, aspiration etc.).

8. Religious/spiritual Commitment. Level of importance of religion/spirituality and how much it motivates actions.

9. Religious/spiritual Motivation for Regulating and Reconciling Relationships. – Forgiveness, atonement…

10. Religious/spiritual experiences. – Personal experiences with the divine.

A Qualitative Study of Religion in Therapy

Outpatient psychotherapy clients report a desire to discuss religious or spiritual topics in their therapy, and many also indicate that religion and spirituality are of central importance to their healing and growth.Clinicians’ uncertainty may be related as well to the minimal coursework, supervision, and training regarding the place of religion-spirituality in therapy.Furthermore, they may also feel that working with religious or spiritual issues in therapy is outside their area of expertise and may thus refer clients presenting with such concerns to other professionals Clients felt that spirituality was important to discuss in therapy and felt validated and acknowledged by therapists’ explicit and implicit religious or spiritual interventions.

A Qualitative Study of Religion in Therapy

Therapists focused on existential questions or anger at God.These discussions were facilitated by clients’ perception of therapists as open, accepting, and safe. Discussions typically became unhelpful when clients felt that their therapists were passing judgment or imposing their own beliefs on them.

As an example, one client reported that her therapist told the client that she was ‘‘too Catholic,’’ which made the client feel bad.

A third client ‘‘got real mad inside and left therapy’’ because she did not know what the therapist meant by the comment that the client was ‘‘too Catholic.’

Religious or Spiritual Based Therapies

Secular w/ Spiritual Roots

DBT – Dialectical Behavioral Therapy.MBSR – Mindfulness based stress reduction.Jungian analysis.ACT – Acceptance and commitment therapy.Humanistic Therapies

Overtly SpiritualTranspersonal Psychotherapy.American Association of Christian Counselors. Alcoholic Anonymous… (NA, OEA, Alonon, CODA)

Carl Rodgers Transcendent Humanism

An increasingly existential lifestyle – living each moment fully –"To open one's spirit to what is going on now, and discover in that present process whatever structure it appears to have" (Rogers 1961)Increasing organismic trust – they trust their own judgment and their ability to choose behavior that is appropriate for each moment.Holistic approach to human existence through investigations of meaning, values, freedom, tragedy, personal responsibility, human potential, spirituality, and self-actualization.

Focusing: Eugene GildenClearing a space: What I will ask you to do will be silent, just to yourself. Take a moment just to relax . . . All right – now, inside you, I would like you to pay attention inwardly, in your body, perhaps in your stomach or chest. Now see what comes there when you ask, "How is my life going? What is the main thing for me right now?" Sense within your body. Let the answers come slowly from this sensing. Felt Sense: From among what came, select one personal problem to focus on. DO NOT GO INSIDE IT. Stand back from it. Of course, there are many parts to that one thing you are thinking about – too many to think of each one alone. But you can feel all of these things together. Handle: What is the quality of this unclear felt sense? Let a word, a phrase, or an image come up from the felt sense itself. It might be a quality-word, like tight, sticky, scary, stuck, heavy, jumpy or a phrase, or an image. Stay with the quality of the felt sense till something fits it just right.Resonating: Go back and forth between the felt sense and the word (phrase, or image). Check how they resonate with each other. See if there is a little bodily signal that lets you know there is a fit. Asking: Now ask: what is it, about this whole problem, that makes this quality (which you have just named or pictured)? Make sure the quality is sensed again, freshly, vividly (not just remembered from before). When it is here again, tap it, touch it, be with it, asking, "What makes the whole problem so ______?" Or you ask, "What is in this sense?” Be with the felt sense till something comes along with a shift, a slight "give" or release.Receiving: Receive whatever comes with a shift in a friendly way. Stay with it a while, even if it is only a slight release. Whatever comes, this is only one shift; there will be others. http://www.youtube.com/watch?v=j7PEC5Mh5FY&feature=related

Mystical ExperiencesChristian Mysticism: "devotion of ecstasy or rapture," a passive state, in which the consciousness of being in the body disappears .Buddhist Mystical Description of Awakening: Body and mind drops away.Islamic Mystics (Sufism) Hafiz: “And the sun and all lightHave forever fused themselvesInto my heart and uponMy skin.”

AbhidhammaThe earliest Buddhist writings are preserved in the three-part Tipitaka (Pali; Skt. Tripitaka). The third part (or pitaka, literally "basket") is known as the Abhidhamma (Wikipedia)

The Abidharma is a systematic tool and series of teachings designed to lead to liberation. Abhidharma method presents the Buddha's teachings in technical terms that are carefully defined to ensure analytical exactitude.

Ronkin, Noa, "Abhidharma", The Stanford Encyclopedia of Philosophy (Fall 2010 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/fall2010/entries/abhidharma/>.

Stan Grof – Spiritual Emergency

Spiritual Emergence Network - provides individuals that are experiencing difficulties with psychospiritual growth a therapist referral and support service that is staffed by trained graduate students. In a culture which has not understood issues surrounding spiritual development, the gift of being heard and understood by a knowledgeable and supportive listener can be life-altering.

Spiritual Emergency

It is possible to undergo a profound crisis involving non-ordinary experiences and to perceive it as pathological or psychiatric when in fact it may be more accurately and beneficially defined as a spiritual emergency.

-- Stanislav GrofSt. John of the Cross, “Dark night of the soul.” “It is the journey of the soul from its bodily home to her union with God. It happens during the night, which represents the hardships and difficulties she meets in detachment from the world and reaching the light of the union with the Creator.”

Zen - Makyo refers to the hallucinations and perceptual distortions that can arise during the course of meditation and can be mistaken by the practitioner as "seeing the true nature" or kensho.

Kundilini Awakening.

Tingling in the body and brain region, Heat or cold in the system, Fluttering or twitching of muscles, Spontaneous yoga asans or kundalini yoga movements,Sexual desire for partner, Experience of divine light within. Spontaneous bliss, intensely pleasurable, Tremendous vibratory energy.

Discussion? Are there “healthy” non-ordinary

mind states?? How can these states effect

therapy?? How can you tell the difference

between “healthy” non-ordinary mind states and healthy?

Herbert Benson, M.D. founder of the Mind/Body Medical Institute a Massachusetts General Hospital. Harvard

Medical School graduate.

Relaxation SkillTonglen – “The tonglen practice is a method for connecting with suffering —ours and that which is all around us— everywhere we go. It is a method for overcoming fear of suffering and for dissolving the tightness of our heart.” – Pema Chodron

It is also a great skill for building Distress Tolerance…

Basics: Think of a minor slightly frustrating event. Notice how it makes your body and mind feel. Breath as you breath in breath in the frustration. As you breath out breath out compassion.

Health Outcomes and Religion

All cause mortality is reduced by spiritual and religious practice.Depression, anxiety, aggression are all reduced by spirituality/religiousness.Belief in angry or punishing God reduces positive health outcomes.Watching T.V. preachers has negative and not positive health impacts.

Health Outcomes and Religion

Two factors account for Positive Healthoutcomes and religion:

“Religious attendance (RA).” Religious coping

RA also positively impacts all cause mortality to the greatest degree. Religion has a correlation with better recovery from illness and transplants. Religion is correlated with reduced mortality after heart surgery, mortality after heart cancer.Religious practices are correlated with reducing the impact of pain.

Health Outcomes and Religion

Yoga mitigates depression, anxiety and PTSD.Yoga shows changes in stress response and HRV.Yogic breathing is safe for those with COPDA non-placebo controlled study with mall N found “short-term training in yoga is well tolerated and induces favorable respiratory changes in patients with COPD.”Religiousness: No direct effect on observable symptoms in COPD but displayed increased quality of life, reduced depression, anxiety and less reported subjective symptoms.

Negative Health Effects of Religion

Religious medical neglect – Some individuals have gotten sick or died due to the religious beliefs that medical interventions are not helpful. Current birth control controversy.Women’s sterilization in the early 1900’s

Benson Study: Prayer had negative impact on health. Some argue it was due to a nocebo effects.Destructive beliefs: A belief in an angry punishing God leads to negative health impacts.

Prayer and Health

Distant intercessory Prayer: Praying for the health of another. Most studies find no or mixed impact. Some find significant impact on health.Contemplative Prayer: Sitting in the presence of God. No direct studies found.

One study found five types—supplication, devotion, intercession, gratefulness, and contemplative prayer—elicited varying degrees of improvements in heart rate variability and corresponding psychophysiological coherence. (DOI: 10.1111/j.1467-9744.2009.01036.x)

Prayer as copingPrayer - A two-group controlled clinical trial in ICU of Baqiatallah hospital in 2010. Those “Studied with recorded prayer for 3 days used prayer attributed to Prophet Muhammad” Had a highly divergent course of illness for those who prayed and those who did not.

Theoretical Models of Mechanism of Health and Prayer

Prayer may improve health because of the placebo effectPrayer may lead to increase health-related behaviors Prayer may help by distraction from illness or increasing positive emotions.Prayer may increase health act of supernatural being. Prayer may change energy systems: e.g. chi. Prayer may link the consciousness of two individuals an promote healing.

Breslin, J. M., Lewis, A. C. (2008). Theoretical models of the nature of prayer and health: A review. Mental Health, Religion & Culture, Vol. 11, Iss. 1,

Mechanisms of Positive Health Impacts of Religion

Increased positive health behaviors. Some evidence suggests that “strict” conservative religions have healthier participants.

Social Support – Social support has many positive impacts on health. It has biochemical effects on brain health, inflammation, stress levels and purely behaviorally other people to help solve problems and material support. Religions often put a premium on support behaviors.

Coherence Hypothesis: Religion offers meaning and purpose even in suffering. As Victor Frankle said,

“A (wo)man can survive any “what”

if (s)he has a why.”

Coherence HypothesisCoherence has been shown in many studies to be one of the key principles underling the impact of religion on health.

“God would never give you more then you can handle.”

“This is the Buddha appearing before you finding ways to free you from your own attachments, the very attachments that has made you suffer again and again and again.”

DBT – “Any time you feel a difficult emotion or have a stressful event it is a good chance to practice a skill and learn to use the skill more effectively.”

Bruce McEwen Preeminent Stress Researcher and Author of “The End of Stress as We Know It”

Allostatic Load

Inflammatory Response

Cortisol Oxytocin

ANS BalanceAnd HRV

Depression

GAD PTSD Life StressCoping

Style

Adverse Childhood

Events

Personality

Chronic Pain

Social Support

Poor Slee

p

Heart Disease

Suggested Biological Mechanisms of Health Promoting Effects

Stefano, G. B., Fricchione, G. L., Slingsby, B. T., Benson, H. (2001)The placebo effect and relaxation response: neural processes and their coupling to constitutive nitric oxide. Brain Research Reviews

Placebo and Nocebo Effect Mechanism Pain Management

Placebos induced activations of the endogenous Opioid system in these brain structures:

Anterior Cingulate Cortex (ACC), Orbitofrontal (OFC), Insular CorticesNucleus Accumbens (NA) (DA release accounts for 25% of var. in placebo effects). Amygdala (AMY)Periaqueductal Gray Matter (PAG). Dopaminergic activation was observed in the ventral basal ganglia, including the nucleus accumbens. High placebo responses were associated with greater DA and Opioid activity in the nucleus accumbens.

Nocebo responses were associated with a deactivation of DA and

opioid release.

Scott, D.J., Stohler, C.S., Egnatuk, C.M., Wang, H., Koeppe, R.A., Zubieta, J.K., (2008). Placebo and Nocebo Effects Are Defined by Opposite Opioid and Dopaminergic Responses. Arch Gen Psychiatry;65(2):220-231.

Placebo and Nocebo Effect Mechanism Pain Management

Tracey, I. (2010). Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans Nature Medicine 16, 1277–1283 (2010) doi:10.1038/nm.2229

Positive Social

Interactions

Oxytocin Release

Early Childhood

Experiences

Effective Emotiona

l Regulatio

n

Oxytocin Release

Sustained Reduction in

Stress (CORT)

LONG TERM HEALTH

OXYTOCIN MECHANISM for

LONGTERM HEALTH

Telomeres – Health – Life Style

Women with high stress had telomeres shorter (10 years of aging). doi.org/10.1016/S1470-2045(08)70234-1

Telomere shortening cor. w/genetic instability also cor. with shortened life span as well as a reduced wound healing. doi.org/10.1016/S1470-2045(08)70234-1

Telomerase increased after 3 mo intensive life style changes. (doi.org/10.1016/S1470-2045(08)70234-1)

“Telomerase activity was significantly greater in retreat participants than in controls at the end of the retreat (p < 0.05).” (doi.org/10.1016/j.psyneuen.2010.09.010)

God Spot – Temporal Lobe Epilepsehttp://www.youtube.com/watch?v=qIiIsDIkDtg

A link between febrile seizures (seizures coinciding with episodes of fever in young children) and subsequent temporal lobe epilepsy has been suggested, but the exact role remains unclear

Spiritual BrainMeditators and Multiple individuals with extensive religious experience have drastic changes in the brain. One of the key factors is asymmetry in the thalamus.Meditators who practice, “loving kindness” have hyperactivation in the LPFC.In a graded stepwise relationship hours of meditation relate to increased thickness in omPFC.45 minuets of MBSR changed neural structures for “promega” employees.Differences have been shown in shamanistic or devotional practices and meditative states. (changes in prefrontal lobes)In 4 out of 11 participants who had left fronto-temporal lobe inhibited by TMS stimulation there was a dramatic increase in artistic ability (Snyder, et. al., 2003. J Integr Neurosci).

Andrew B. Newberg, A.B., Wintering, N., Waldman, M. R., Amen, D., Khalsa, D. S., Alavi, A. (2010).Cerebral blood flow differences between long-term meditators and non-meditators Consciousness and Cognition, Volume 19, Issue 4, December 2010, Pages 899-905

The Brain on

Meditation

Some might wonder "What is a Buddhist monk doing taking such a deep interest in science?

Although Buddhist contemplative tradition and modern science have evolved from different historical, intellectual and cultural roots, I believe that at heart they share significant commonalities, especially in their basic philosophical outlook and methodology. Dalai Lama at the annual meeting of the Society for Neuroscience on November 12, 2005 in Washington DC

God Helmet

God on the Brain"God helmet". Michael Persinger (University of Ontario), Using a helmet that “entrains” brain states triggered religious experiences. Andrew Newberg (University of Pennsylvania) observed Buddhists as they practice “Śūnyatā, शून्यता” (emptiness) or meditative nirvana.

The parietal lobes as playing a key role during this transcendental state.

This area leads to falling away of body and mind (may also be involved in dissociation) and if damaged the area can lead to the feeling of being “disembodied.”

God on The BrainA study of 40 participants, including Christians, Muslims, Jews and Buddhists, showed  the same areas lit up when they were asked to ponder religious and moral problems.

Experiencing an intimate relationship with God and engaging in religious behavior was associated with increased volume of R middle temporal cortex, BA 21.

Experiencing fear of God was associated with decreased volume of L presumes and L orbitofrontal cortex BA 11.

A cluster of traits related with pragmatism and doubting God's existence was associated with increased volume of the R presumes.

Experiencing fear of God's anger negatively correlated with cortical volume at the L precuneus, BA 7 and the L orbitofrontal cortex, BA

11.Non-religious

pragmatism (the inverse of PC3)

positively correlated with cortical volume at the R precuneus, BA 7

and the R calcarine gyrus, BA 17.

Experiencing an intimate relationship with God (PC1) positively correlated with cortical volume at the R middle temporal gyrus

(MTG), BA 21, extending to the temporal pole.

Kapogiannis D, Barbey AK, Su M, Krueger F, Grafman J (2009) Neuroanatomical Variability of Religiosity. PLoS ONE 4(9): e7180. doi:10.1371/journal.pone.0007180

Die Before you die…Ironic, but one of the most intimate actsof our body isdeath.

So beautiful appeared my death –knowing Who then i would kiss,i died a thousand times before i died.

“Die before you die,” said the ProphetMuhammad.

Have wings that feared evertouched the Sun?

i was born when all I oncefeared - i couldlove.

Rabia Basri, the highly acclaimed woman sufi saint of 8th century (717 - 801)

To Die Before You Die18% of individuals who with Cardiac Arrest experienced NDE.Most NDE’s are filled with joy but some are deeply hellish (about 15%).Most individuals attempt to make sense of the process. There is often a increased religiosity in the after math of both types. Other common response are “reductionism” where the person attributes the experience to a brain state. Still others are asking “why did this happen to me?” This is associated with blank states in the NDE.Clinician explanation fall into three categories: Psychological, Physiological, and Transcendental.

Griffith, L.J., (2009). Near-Death Experiences and Psychotherapy. PsychiatryPMCID: PMC2790400

Near Death Experiences (NDE)

TRANSCENDENTAL ELEMENTS: Another worldEncountered beings, Mystical being, Point of no returnPARANORMAL ELEMENTS: Out of physical bodySenses more vivid than usual, Extra sensory perception (ESP), Visions of the future.AFFECTIVE ELEMENTS: Feeling of peace, Surrounded with light, Feeling joy, Feeling cosmic unity/onenessCOGNITIVE ELEMENTS: Altered sense of timeAccelerated thought processes, Life review and Sudden understanding

Adapted from Zingrone NL, Alvarado CS. Pleasurable Western adult near-death experiences: features, circumstances, and incidence. In Holden JM, Greyson B, James D, eds. The Handbook of Near-Death Experiences. Santa Barbara, CA: Praeger Publishers; 2009:20.

Reactions to NDEPERCEPTION OF SELF: Loss of fear of death, Strengthened belief in life after death, Feeling specially favored by God, New sense of purpose or mission, Heightened self esteemRELATIONSHIP TO OTHERS: Increased compassion and love for others, Lessened concern for material gain, recognition, or status, Greater desire to serve others, Increased ability to express feelings.ATTITUDE TOWARD LIFE: Greater appreciation of and zest for life, Increased focus on the present, Deeper religious faith or heightened spirituality, Search for knowledge, Greater appreciation for nature.PARANORMAL PHENOMENON: Out-of-body experiences, Apparitions, Extrasensory perception, Precognition, Healing, Spiritual, mystical, or transcendent experiences.ALTERATIONS IN PERCEPTION/CONSCIOUSNESS: Heightened sensation, Physiological alterations, Unusual movements, sensations, Unusual stimulation of special senses, Mental changes, Increased energy, decreased need for sleep.Adapted from Zingrone NL, Alvarado CS. Pleasurable Western adult near-death

experiences: features, circumstances, and incidence. In Holden JM, Greyson B, James D, eds. The Handbook of Near-Death Experiences. Santa Barbara, CA: Praeger Publishers; 2009:20.

Guidelines for NDE1. Avoid the assumption that a client’s NDEs are symptomatic of

pathology, but recognize that individuals with mental illness may also experience NDEs.

2. Respect the profound nature of these experiences as well as the individuality of each experiencer.

3. Provide a safe, nonjudgmental environment in which patients can freely discuss their experiences and the emotions surrounding their NDEs.

4. Avoid projecting your own value system. Remember most of these individuals have recently nearly died and encourage them to also express the emotions related to the precipitating events.

5. Normalize the experience for patients without taking away the uniqueness of the NDE.

6. Assist patients with integrating the NDE into their daily lives to maintain best possible functioning.

7. Refer patients to local NDE-focused groups, such as IANDS groupsAdapted from Zingrone NL, Alvarado CS. Pleasurable Western adult near-death experiences: features, circumstances, and incidence. In Holden JM, Greyson B, James D, eds. The Handbook of Near-Death Experiences. Santa Barbara, CA: Praeger Publishers; 2009:20.

DBT – OverviewDialectics – Being able to move between opposites and through holding the tension between opposites “finding a middle path.”

Good and Bad – Human with positive and negitive traitsShort-term and long-term goods – Will spend time on the phone after HW is completed.Humor and Irreverence – Humor requires having a meta-perspective.

Behavioral Chain Analysis – Links that lead to behaviorsTriggering events, Vulnerability Factors, Behaviors and Consequences.Identify each link in the chain like a detective.Links can be thoughts, feelings, sensations, external reactions.

Excellent Video http://www.youtube.com/watch?v=OlYk2nWECpk

DBT – OverviewThree aspects of DBT Treatment.

Individual therapy: Lots of focus on Behavioral Chain Analysis and stopping “therapy interrupting behaviors.”Skills Group Training: rotating 12 week groups.24 hr skills coach.

Four Stages of TreatmentStage 1 – Significant life chaos and emotional dysregulation.Stage 2 – Chaos reduced emotional distress is still significant.Stage 3 – Emotional regulation is with in normal range (aka “ordinary neurotic” like all of us).Stage 4 – Steady, stable equanimity and enlightenment.

DBT – OverviewFour Skill Domains

Mindfulness SkillsHow Skills - Non-Judgmentally, One Mindfully, Effectively.What Skills - Observe, Describe, Participate.

Emotional Regulation Skills – These are the tools an individual uses to learn to regulate emotions.

Interpersonal Effectiveness Skills – Help people learn to be effective in relationships (Assertiveness, Keeping Good Relationships, Negotiation)

Distress Tolerance Skills – Help an individual survive difficult emotions, thoughts, and events.

DBT – Spiritual RootsWise Mind – The combination of emotional mind and rational mind.

Many of the tools in DBT help and individual move from emotional mind to wise-mind…

DBT SkillsMindfulness Skills – Observe and Describe

Observing is seeing a thing as it self. Artists when they view an object see the lines, the color and blank spaces. Observe skill is the ability to see an object just as it is with out mental commentary.

Describe skill is the ability to describe clearly and cleaning with out adding to the top of it. Most of the time emotions happen in an action packet. See – Feel – Judge the Feelings – Respond. This is a tool see our world and reactions simply as they are.

Emotional Regulation - Opposite ActionAll emotions have urges. A times these urges are helpful and times not. Learning this skill helps us have choice with emotional reactions and not act on the destructive urges associated with emotions.

Distress Tolerance - Wise Mind Accepts (see hand out)http://www.dbtselfhelp.com/html/wave_of_emotions.htmlInterpersonal Effectiveness – GIVE (see hand out)

Questions