Dialectical behavior therapy – or DBT – is a form of therapy created specifically for individuals with borderline personality disorder. DBT is taught in four modules, including distress tolerance. DBT Distress Tolerance Skills Distress tolerance skills refer to a type of intervention in Dialectical Behavioral Therapy (DBT) where clients learn to manage distress in a healthy way. These skills are helpful for situations where a client might not be able to control a situation, but they need to manage their own response. The program relies heavily on Dialectical Behavior Therapy (DBT) techniques, focusing on coping skills, distress tolerance.' Dialectical (DBT) (512) 575-2152. Distress Tolerance: Dialectical Behavioral Therapy emphasizes learning to bear pain skillfully. Distress Tolerance skills constitute a natural development from Core Mindfulness skills. They have to do with the ability to accept, non-judgmentally, both oneself and the current situation.

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• 21 Intro To Distress Tolerancedialectical Behavioral Training Techniques
• 21 Intro To Distress Tolerancedialectical Behavioral Training Programs

Tips to Manage Postpartum Anxiety: A 4-Part Series (Part 3: Mindset)

Part 3: Mindset

Next in this series, we are reviewing how to implement various mindset techniques to support the symptoms of and promote healing from postpartum anxiety. For more information on the symptoms of this disorder, check out Part 1, Part 2, and Part 4 of this series at the bottom of this post.

While anxiety is not a choice, your mindset is. It is a skill that takes constant practice to develop and maintain. A lot of anxiety is rooted in the fear of the future. Will my baby gain enough weight by our next doctor visit? How long will this nap be? Will we be safe in the car if we drive to a baby and me class? When we stay connected to the present, the majority of the time everything is actually okay (more on what to do when the present ISN’T going well later).

Mindfulness practices have been linked with increased emotional regulation, which empowers you to choose which emotions are appropriate for your current experience and which emotions have manifested from implausible worries.(1)Implementing some of the following mindfulness techniques can help you stay connected to the present and can bring your mind back to what is going well now, instead of meandering down the worries of the future:

• Daily Meditation: This doesn’t have to be some overly complicated hour-long practice you have to find time for. Even just 10 minutes in the morning can do wonders to down-regulate your central nervous system and set you up to approach the day from a calm, centered place. The app Expectful has an entire catalog of postpartum meditations to support you during this period, and it is only $9.99 a month. For a wonderful free option, check out One Giant Mind. There is a training course with a full month of guided meditations to help you get the most out of your practice. With 10, 15, 20, and 30-minute options, you have the ability to set up however long a session you have time for.
• 5 Senses Exercise: Meditation is a great preventative tool for anxiety. It is also crucial to have tools for when you are stuck in an anxious period. The 5 Senses Exercise is a great grounding technique to help you regulate your emotions, bring you back into your body, and give your mind an opportunity to focus on something other than the anxious thoughts.
  • Start with 3 diaphragmatic breaths. From there, look around the room and find 5 things to look at – maybe things you hadn’t noticed before, like a crack in the floor, the way a shadow is forming on the wall, etc. Then find 4 things you can touch and notice how they feel underneath your finger-tips and how they differ from one another. Next, tune into 3 different sounds. It could be your own breath, the sound of a car going by, anything near or far. Then, notice 2 different smells. It could be the lotion on your hands or fresh-cut grass. Finally, notice whatever taste you have in your mouth.
  • You can repeat this exercise as many times as you need until you find your anxiety level has lessened. It might not be totally gone, but the goal of the exercise is to bring you back into your body, so that you can feel safe and grounded once again. From here you can address your anxiety from a more productive place.(2)
• Distress Tolerance: Anxiety tends to start slow, build to a peak level of intensity, and then subside. The practice of finding healthy ways to endure heightened moments of anxiety is known as Distress Tolerance and is a core topic of Dialectical Behavioral Therapy (DBT). DBT is a model of therapy in which the main goals are to educate people on how to stay present, how to manage heightened levels of intense stress (anxiety), how to regulate those emotions, and how to improve relationships with others.(3) If you have a practicing DBT therapist in your area, we highly recommend scheduling an appointment, as this model relates very well to the struggles of parenthood.
  • Anxiety Onset: Similar to the exercise above, how can you soothe your five senses during a time of escalating worry. Not only will these techniques help keep you in the present, they will also help elevate your mood and may keep you from reaching peak anxiety levels. It’s really helpful to write yourself a soothing list of what techniques you want to try BEFORE you need these tools. Pick an evening when you’ve had a really great day and write out a few options for each category and put it on your fridge. That way when you feel the anxiety approaching, you don’t have to remember your tools; they are listed out for you. What makes you feel good, calm, and safe?
    • LOOK at photos from an epic vacation
    • TOUCH or wear your favorite cozy sweater
    • LISTEN to some feel-good music
    • SMELL your favorite candle
    • TASTE some good coffee.

• • Peak Anxiety: Anxiety is similar to labor, in that the intense surge of discomfort is temporary, and even though it feels infinite in the moment, it will subside. When you feel you are stuck in a worry spiral and your soothing techniques are no longer effective, distraction is your best tool. It is important to find a HEALTHY way to distract yourself, so try some of the following and take note of what works well for you.
    • Call someone to talk to either about your worries or something totally unrelated to keep your mind occupied.
    • Put on a great TV show you’ve been meaning to catch up on.
    • Find a way to lift someone’s spirits, like writing a letter to a loved one.
    • Listen to music that elicits a feeling that is different from what you are currently feeling. If you are mad, listen to calm music; if you are sad, listen to pump-up music.
    • Visualize yourself fighting the troublesome thoughts. Sit and paint a detailed scenario – the more ridiculous and silly the better. Perhaps it’s of you wrestling the intrusive idea to ground in a boxing ring.
    • Work on a word puzzle or Sudoku. Make your mind work really hard at something, so you have less space to worry.
    • Take a hot or cold shower to shift your current body temperature.
  • Subsiding Anxiety: As your mood begins to level out it is important to nurture yourself – body and mind – to process your experience. The following activities can further encourage your anxiety to subside, hopefully to neutral.
    • Identify the triggering event. Oftentimes we don’t recognize what sets us off, so the more aware we are, the better prepared we can be for those setting off events.
    • Journaling: This is an incredible way to process your feelings and experiences.
    • Movement: Many animals in the wild shake their bodies to release the stress of being chased by a predator once they are safe. These animals don’t embody the stressful event as trauma, because the physical act of shaking off the stress relieves the stress hormones from their body.(5) Find a movement practice that feels good to you – yoga, dancing, or swinging a kettlebell – whatever helps your body move out of the fight or flight response and back into a parasympathetic state. For more details on movement practices to support you when dealing with postpartum anxiety, check out Part 1 of this series.

These mindfulness tools, in conjunction with regular therapy, are the best way to encourage healing and develop the framework to manage your anxiety. Mindset work rewires the brain to choose a different path from that of always anticipating threats and danger to a mind open to receiving calm, positive input from your current surroundings.

Our final segment of this series will focus on how BIRTHFIT’s pillar of Connection can be utilized to support you with postpartum anxiety. Stay tuned!

Free episodes clone wars adventures guide. Tawny Linehan, BIRTHFIT Leader

www.birthfitcoachtawny.com@birthfit_coachtawnyPart 1: Tips to Manage Postpartum Anxiety — FitnessPart 2: Tips to Manage Postpartum Anxiety — NutritionPart 4: Tips to Manage Postpartum Anxiety — Connection

Citations:

1. Whirledge, S., & Cidlowski, J. A. (2010). Glucocorticoids, stress, and fertility. Minerva Endocrinologica, 35(2), 109-125.
2. Sunrise Residential Treatment Center. “DBTDistress Tolerance Skills: Your 6-Skill Guide to Navigate Emotional Crises.” Sunrise Residential Treatment Center, 13 Sept. 2017, www.sunrisertc.com/distress-tolerance-skills/#soothe.
3. “What Is Dialectical Behavior Therapy (DBT)?” Behavioral Tech ICal, behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/.
4. Bray, Suzette. “Distress Tolerance in Dialectical Behavior Therapy.” GoodTherapy.org Therapy Blog, 31 July 2014, www.goodtherapy.org/blog/distress-tolerance-dialectical-behavior-therapy-0117134.
5. “Therapeutic Tremoring – Shake Off Stress And Trauma.” Aces Connection, www.acesconnection.com/blog/therapeutic-tremoring-shake-off-stress-and-trauma.

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By Zainab Fazal, M.ADS, BCBA

bSci21 Contributing Writer

On June 22, 2015, I received a phone call from a staff at a local residential home serving adults with developmental disabilities. With a lot of excitement, she asked if I watched NBC Dateline the night before. Before I could answer, in even more excitement, she said, “that guy did that strategy you were talking about in class!”

Let me give you a little insight into what she was talking about. She was referring to the segment on NBC Dateline called “My kid would never do that: gun safety”, and the guy was Dr. Raymond Miltenberger.You can check out the segment here.

If you teach anyone, anything, behavior analysis has a secret to share with you. It’s the strategy the staff was talking about – Behavior Skills Training (BST). It is a method to teach students, staff, parents, and anyone else you are teaching a new skill. Dr. Miltenberger defines BST as “a procedure consisting of instruction, modeling, behavioral rehearsal, and feedback that is used to teach new behaviors or skills” (2004, p. 558). And that’s exactly what it is, a 4-step teaching strategy that works!

BST teaches a person what to do — that is, what behaviors to engage in under a particular circumstance.It allows for practice within the program so that the person can become fluent with the skills.It is an effective train-the-trainer procedure. And perhaps most importantly, can be individualized to each person. Sounds pretty good, doesn’t it?

Let’s break down each of the steps:

Instruction – Provide a description of the skill, its importance or rationale, and when and when not to use the skill. Repeat this step as necessary.

Modeling – Show your participant how to perform the skill. In-vivo modeling is recommended.

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Rehearsal – Practice, practice, and practice! Allow the participant opportunities to practice the skill. Recent research suggests that participants should be able to practice in-situ. The trainer should record data on correct and incorrect responding during this step.

Feedback – The trainer should provide positive praise for correct responding and some form of corrective feedback for incorrect responses.

Some requirements before you can implement a BST program include: the person receiving the training must have the pre-requisite skills required for the behaviors you are teaching, the skill must include a chain of behaviors (a number of skills), and you must be able to role-play or video model the skills.

In a Registered Behavior Technician training course I was providing, I used BST to teach various skills to participants. Any skill I was teaching that met the afore-mentioned requirements I taught using BST. Based on the feedback forms from eight cohorts, participants reported that they enjoyed and learned the most when they got to practice the skills being taught, and got immediate feedback.

Here’s an example of how it was used in the training. The skill was implementing preference assessments with clients.

Instructions were provided on why preference assessments are done, when and with whom to do them, how to use the data sheet, the materials required, and how to complete the assessment.

I modeled completing a preference assessment, using one of the course participants as my “client.”

Participants paired up and practiced administering the preference assessment with their colleagues.Participants were able to practice the skill as each preference assessment included 30 trials!

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I went to each group and provided feedback on what each person was doing correctly and incorrectly.

What have been your experiences with Behavior Skills Training? Let us know in the comments below. Also, be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox! Tutorials.

Recommended Readings:

Johnson, B.M., Miltenberger, R.G., Egemo-Helm, K., Jostad, C. J., Flessner, C., & Gatheridge, B. (2005). Evaluation of behavioural skills training for teaching abduction-prevention skills to young children. Journal of Applied Behavior Analysis, 38, 67-78.

Miles, N.I., & Wilder, D.A. (2009). The effects of behavioral skills trainingon caregiver implementation of guided compliance. Journal of Applied Behavior Analysis, 42(2), 405-410.

Miltenberger, R. (2004). Behaviour Modification: principals and procedure (3^rd ed.) Belmont, CA. Wadsworth Publishing.

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Miltenberger, R.G., Flessner, C., Batheridge, B., Johnson, B., Satterlund, M., & Egemo, K. (2004). Evaluation of behavioural skills training procedures to prevent gun play in children. Journal of Applied Behavior Analysis, 37, 513-516.

Steward, K.K., Carr, J.E., & LeBlanc, L.A. (2007). Evaluation of family-implemented behavioural skills training for teaching social skills to a child with asperger’s disorder. Clinical Case Studies, 6, 252-262.

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Zainab Fazal, M.ADS, BCBA, began her career in the developmental disabilities field in 2002, and has dedicated her clinical work and research in the area of Applied Behaviour Analysis (ABA). She has worked for many years in assessing and developing comprehensive programs plans for children, youth, and adults with Autism Spectrum Disorders (ASD), learning disabilities, other developmental disabilities, behavioural challenges and mental health issues. Her recent work includes training front-line staff and teachers to use ABA in therapeutic and school settings, and has successfully trained individuals for the Registered Behaviour Technician credential with the Behaviour Analyst Certification Board. She is also an adjunct professor at Seneca College teaching ABA courses in the Behavioural Sciences program. Zainab is the founder and director of Phoenix Behaviour Services, a private practice in Toronto, Canada. You can follow her on twitter @Phoenix_ABA and reach her at zainab@pbxs.ca.