Ep 6 – improve the moment

Swan Lake by Tchaikovsky

You've got shit. I've got shit. We've all got shit. So let's therapize that shit, with your host, me, Joy Gerhard.

Please note: I am not a therapist. I cannot and do not diagnose anyone, or prescribe anything. This is just me – someone who struggles with my emotions and with intrusive thoughts – sharing what skills I've used and how I've used them. Also, a trigger warning: in this podcast, I talk about sensitive topics including: mental illness, suicidal ideation, self-harm, rape, childhood sexual assault, trauma, and more. I also swear here and there, so listener discretion is advised.

And I'm going to be talking primarily about the Improve the Moment skill, which is a Distress Tolerance skill. So some context here: in my very first episode, you heard me talk about my therapist search. And ultimately I researched and/or reached out to 101 therapists before finally finding the person who is now my regular therapist.

Before finding them, I had a few appointments with another therapist, but had to leave due to financial reasons. And prior to that I had a therapist ghost me and I had to leave another therapist due to insurance. I had another therapist transfer me to a case worker, blah blah blah blah blah.

Long story short, in the last two years I've lost 5 therapists against my will. So, when I started working with my new therapist – about two weeks in is the recording you're about to hear – and this recording was prompted by the awareness that I was dealing with some pretty severe trust issues around therapists. I was having a lot of thoughts, a lot of concerns.

I had the thought that I was consistently abandoned. I was having the fact that I couldn't trust the therapist to actually show up for me. I was having the thought that I was never going to be able to count on a therapist. All of these thoughts.

And this was getting in the way of my new therapist and me doing the work that I actually wanted to be doing. So, we pivoted. And we pivoted to getting me some resources so that I could handle when my therapist needs to cancel unexpectedly, or when they're on vacation.

And on my good days, I get it. I know that people get sick and have family emergencies and car accidents and need to take a pet to the vet and all of this stuff. And I get that people take vacation and that's good and necessary.

And I still have a lot of anxiety when this happens. I keep having the thought that there's no help coming, or that I'm being abandoned. So my therapist gave me the homework to plan out how I can handle that distress when they inevitably cancel on me last minute due to illness.

So the skill I'm going to be talking about in the recording you're about to hear is called Improve the Moment. And it's all about finding ways to reduce acute distress so that I can get my problem solving brain to turn back on and do the work. Work through whatever I need to work through. So that's what you're about to hear.

And a quick note about the sound. We're still playing catch up before we get to the recordings that I actually made with my new microphone. And I'm also going to stick with the sound effect I used on the last episode. I kind of like it – the slight, minor reverberation that I added to whenever I was reading something directly off the page.

Kind of sounds like I was in a bathroom. It's a pretty easy way to let you know that whatever you're hearing is not my original thoughts or commentary. And so I can attribute that to the author of that information. So if you hate it, let me know. Otherwise we're gonna stick with it for the time being. So let's dive in.

Swan Lake Tchaikovsky

OK, so, I am coming back to recording after a couple weeks off. Even though these episodes are being posted weekly, I have been avoiding recording because I am having a lot of thoughts and a lot of judgments and a lot of fear or/and, I guess, anxiety around the idea of posting any of these.

I’m having the thought that... it's not a need for it to be perfect. I think the bigger concern is that I will say the wrong thing, that I will misrepresent myself, that I will say something that I'm like, “oh, that's not the most effective way to communicate that or I missed this part or forgot to add this.”

And so I am doing some exposure right now and recording anyway, even though I'm having all of those thoughts. And today I wanted to talk about something I just talked about with my therapist, which is a Distress Tolerance skill called Improve the Moment. Just to kind of give an overview of Distress Tolerance. And again, this is DBT skill. DBT is Dialectic Behavioral Therapy.

And if you're new to the podcast, you want to know more, there is a link on my website, https://therapize.joygerhard.com. The link is in the description where you can go and find either a PDF of the entire DBT manual, or a link to buy it from a Black-owned bookstore.

So if you're interested in learning more, you can learn more that way. But Distress Tolerance is one of the modules in DBT. The other two – the other three – are Interpersonal Effectiveness, Emotional Regulation and Mindfulness.

Distress Tolerance is basically skills you use when you're so dysregulated, so aroused emotionally, your urges are so high, that you aren't unable to think clearly and think long-term and make effective choices.

Like if your scale from zero to 100, where 100 is like the worst, strongest, negative emotions you've ever experienced, 70 and up usually is the range of distress where it's like you're not going to be able to think clearly. You won't be able to problem solve. You're not going to be able to think in terms of long-term choices.

You need instant relief just to bring your distress down enough so that you can think clearly and problem solve and communicate effectively. There's a bunch of different Distress Tolerance skills that are super, super handy, but today I want to focus on what came up in therapy today.

I have a history, in the last year and a half of losing... I'm just now settling in with my 6th therapist. Six, the number six. And of the five that I have lost or like stopped working with in the last year and a half, only one of those was my choice. And it was based off of a financial need.

But the other four were things I didn't choose and things I... I did not want to lose those therapists. I wanted to stick with them. And for a variety of reasons, didn't get a say in that. And I have a lot of anxiety and concerns and thoughts about...

Well, there's trust issues, for starters, that I have now, and kind of this back burner concern. Like, “don’t get too comfortable, Joy. Like you don't know how long this therapist is going to stick around. You don't know, like any day that they might suddenly be like, ‘sorry, I'm not going to work with you anymore.’”

And those are the thoughts I have. I'm working on validating those thoughts because it makes sense that I have them, given that I had, you know... I lost one therapist because it was a short term thing that, like, “we're going to see you for 15 to 20 weeks.”

They actually saw me for 35 weeks and finally were like, “yeah, you need to move on.” It was a community Health Organization. I lost another therapist because my insurance wouldn't pay for me to have a psychiatrist and a therapist in two different organizations.

They're like, “you need to have them both working for the same organization.” And so when I got a new psychiatrist, I lost my therapist. I lost another one, she disappeared. She just stopped coming to appointments and stopped responding to my emails.

I lost another one because I told her that I was really struggling and feeling worse after every therapy session. So she moved me on to a case worker and that is not therapy. And then I lost the last one because turns out she was too expensive and looking at my financial situation, I couldn't afford to stick with her.

So now I'm on therapist number six. And today we were talking about what will happen if you know if they get sick, if they have a chronic health issue flare up, if they get in the car accident. Like any of a variety of things that can just happen even to really conscientious, consistent people.

Life does happen. And so it's not so much a question of if they will be unable to make an appointment with very little notice, it's more a question of when. And what will I do to survive that. Normally I am not this like, “Oh my God, I'm going to die,” around a missed therapy appointment.

But given the last year and a half, and the loss of control that I have felt around it, and the lack of trust that I'm feeling around it, yeah, I'm feeling very... is “clingy” the right word? Kind of desperate. Attached, like, “you have to show up, you have to show up every day!”

So talked to my therapist. Like, let's come up with a plan of things you can do when this happens so that you can survive the moment and maybe even thrive in the moment. But make it to the next appointment, you know, once we reschedule and we see each other.

How do we get you to bridge that gap? So that's a Distress Tolerance thing because, given my past experience, I'm aware that when the therapy sessions are missed, it’s not like, “oh, that's a bummer. But that's great because I can go to the gym instead.”

It's more like, “oh, my God, I'm going to die” are the kind of thoughts that I have. Well, specifically the thought that I have is, “there's no help coming.” And that is a big trigger for me. So I'm basically coping ahead, preparing, creating kind of like a disaster kit or a first aid kit, if you will, for myself.

So I want to talk about... flipping through my book here. I want to talk about Improving the Moment. Except I need to... I flipped the page and now I cannot find it. Ah, here we go. OK. So again, use Distress Tolerance when you can't change the situation.

I can’t change that my therapist got sick, so I can't magically force them or make it happen that they get on zoom with me and have a therapy session. So given that that is the case, I want to survive the crisis, not make it worse, and bridge the gap until the next time we can talk.

Again, this is this is a DBT skill and DBT was created by Marsha Linehan, who loves acronyms. And oftentimes her acronyms are a bit of a stretch. So we’re going to work with what we've got here. So our way to remember these skills is the word IMPROVE. Fancy that, that Improving the Moment would have the acronym IMPROVE. Shocking, I know.

So the word: I is Imagery, M is Meaning, P is Prayer, R is Relaxing actions, O is One thing in the moment, V is Vacation, and E is Encouragement, self-encouragement and rethinking the situation.

So I want to go through each of these and talk about the examples that she gives, and then how I I'm coming up with my own list of Improve the Moment type things.

So let's start with imagery. This is something that is important to practice. As with all of these skills, you want to practice them when it's not a crisis. So I have practiced Distress Tolerance skills on a lovely sunny day when nothing is wrong.

I'll just sit and practice different things for 5 minutes here and there. What that does is it basically trains your brain to know, “Oh, this is the thing I can use.” In the same way that when you are a toddler, if somebody hands you a screwdriver, you don't know what to do with it.

But if you see a screwdriver being used, you use it yourself enough times, when you need to change a light faceplate, you have the thought, “Oh, I will go get a screwdriver.” And that was a trained thing. That's something you learned how to do. So again, we're going to use these things when I'm not in distress so that they are acceptable – or accessible, rather – when I am in distress. So, Imagery. Some examples here are:

“Imagining a very relaxing scene. Imagine everything going well. Make up a calming fantasy world. Imagine hurtful emotions draining out of you, like water out of a pipe. Remember a happy time, and imagine yourself in it again. Imagine a secret room within yourself; furnish it the way you would like. Close and lock the door on anything that can hurt you.”

So those are examples that are in the Distressed Tolerance, or sorry, the DBT manual. And this is just Distress Tolerance Handout 9, if you would like to read along. And again, all of these things for just Distress Tolerance are intended to be like temporary things. You don't want to use these skills for long-term solutions, for emotional regulation and whatnot.

It's like, “Oh my God, I'm bleeding. I need a Band-Aid,” rather than like I'm going to put a Band-Aid on my bruise. I'm going to put a Band-Aid on this rash. I'm going to put a Band-Aid on my... I don't know, my chicken pox.

There are specific times when using these skills will be effective, and it is again for acute, distressing situations. Those are some awful examples I just gave, by the way. I am having all the judgment around the examples that I gave.

So anyway, one of my favorite things that I use for imagery is some of my favorite places in nature. The Grand Tetons National Park is one of my happy places. I will picture different, very specific viewpoints from that national park. I've also created a happy place that cannot possibly exist, based off of my favorite features of different hikes and national parks that I’ve gone on and been to..

I love the way wind moves tall grass and how it kind of makes it look like a wave. I love being above the tree line on a mountain because you can see super far. I love the sound of running water. I love the feel of the sun when it's kind of late afternoon, the golden hours when the light is really yellow and kind of starting to go down in the sky instead of being directly overhead.

And so I picture myself on a very steep incline, like perched on a rock, that's surrounded by long grass above the tree line. Not tree lion. That's another thing. Tree line. And with rushing water nearby. And the reason those all those things don't tend to exist in the same spot is because once you get above the tree line on mountains, you don't tend to get grass.

You also don't tend to get... Like you can get small trickles and streams and stuff, but you don't get really loud rushing water that high up because there's not enough water to generate that much noise. Yeah, there's a lot of that that's not accurate. So it is my own version of a happy place.

But just like, I can – I'm doing it actually right now, picturing the sun, the golden late afternoon sunlight feels... I can feel it in my chest, almost like a defrosting, if you will. Like it's super, super soothing to me and it's again very specific to me.

All of these ideas are just examples. It's whatever makes you happy. It can be stuff that other people are appalled by. If your happy place is a butcher shop, and you just love the smell of like uncooked chicken or whatever...

The purpose of this is to reduce distress, to basically have your body kind of relax. It's calming. Because when we're in distress, we're hyper-aroused. And I don't mean aroused in the sexual context. I mean, aroused as in all of our systems are running on all cylinders.

And we're in survival mode. And a lot of times, it's like if you have PTSD and you've been triggered like, that's a great example. If you're having a panic attack, an anxiety attack, if you are having a manic episode, if you are having really strong urges towards self-harm, these are examples of when it's like your body is on fire.

It is all you can think about. There's a lot of rumination, like an inability to slow your mind down, to have a single thought. There's a lot of racing thoughts. For me is a lot of it is like the feeling of I need to climb out of my own skin. One of the urges that comes up for me a lot is I want to rip my clothes off. I feel confined.

I have an urge to just like tear out – Hulk style – of my clothes. And doing that actually does nothing for me. It doesn't relieve any of the distress that I'm experiencing. It's just this sense of like I need to climb out of my own body.

So having a really calming image in your head can be super helpful. Other imagery that I really like, there is a park near my house that has a really lovely view. Even that view aside, I will go and sit on a park bench there in the late afternoon with my eyes closed. And the way the light comes through my eyelids, it's kind of an orange tinge. I love that. So picturing that is super, super soothing to me.

If you are not a nature lover or you live in a place where you don't have access to parks or whatnot. If there are moments you can conjure up... like one of my favorites is I'm kind of an honorary aunt to a toddler and one of my favorite things is when I pick him up and he puts his little chubby arm around my shoulder.

There's something about that I'm just like, “Oh! That's nice!” Or like I'll sit down on the couch and he will toddle off and bring a book over to me and crawl into my lap. I have not invited him there. He's just like, “well, this is where I sit when you read me a book. And of course you're going to read me a book.” And that is a lovely moment.

I have a memory of stopping at a fruit stand when I was traveling and getting free sliced mango. And I have a memory of like sitting on the side of the road, eating that mango. And I'm not doing it right now, but just that memory of... It's already cut up for me, it's in a little container. And it's super fresh and super ripe.

So things that you love to eat, even if you're not eating it right this moment, if you can remember, the feeling of your hand wrapping around a warm mug of tea. If you're a parent and you have lovely memories of your kids. If you have friends that you have a favorite, like “oh, remember that night when we all... I don't know, went disco bowling!”

I’m making things up right now, but getting back to the things that I like. It's typically, for me it's mostly view related, but I also really enjoy memories that are more other senses as well. OK, so that's the I in Improve.

M is meaning, and the examples here on Distress Tolerance Handout 9 are:

“Fine purpose or meaning in a painful situation. Focus on whatever positive aspects of a painful situation you can find. Repeat these positive aspects in your mind. Remember, listen to, or read about spiritual values.”

So, this and the next one (which is prayer), doesn't have to be religion specific, by the way. If you do have a faith or spirituality that you practice, this is a good time to whip those out. For me the big ones – and I've actually thought about this a lot since starting this podcast – when I encounter a distressing situation, I have the thought, “oh, this is going to be a great thing to talk about on my podcast.”

Because – I've talked to my sisters about this – if I'm going to go through all the trouble of learning a skill and go through all of the pain, and the distress, and the heartbreak, and the sadness, and the anxiety, and go through all of that and learn skills to address it, it is kind of lovely to be able to share it with other people.

And that's a thing specific... I mean, I'm sure there are the people who have this experience, but it's one of the things that I experienced specifically that can give my experiences meaning. Something that is really important about this: it has to be kind of internally motivated.

I will punch somebody in the face if they come up to me when I'm in distress and say, “God closes the door, he opens a window,” or, “everything happens for a reason.” Because those sorts of phrases can be really invalidating.

What they're not doing is acknowledging where you are. They don't acknowledge your current pain or your current frustration. They’re typically used – I think this is the interpretation that I'm making about when people say these things to me – they want to cheer me up.

It's a comfort mechanism, and it's not even necessarily they want to comfort me. Sometimes they want to comfort themselves. It's hard to sit with somebody who has had a random thing happen.

It's hard to sit with the realization that you can get in a car accident – even if you do everything right and you wear your seat belt, you can get in a car accident. And it can feel really random and randomness is scary.

So I understand it's hard to sit with somebody who had a loved one just die. It's hard to sit with somebody who was just diagnosed with a chronic illness. Those things are scary because it reminds us of our own mortality. It reminds us of how uncertain the world can be sometimes.

So we tend to want to comfort people and also comfort ourselves. And it's a challenge to do those things without invalidation. I think validation actually needs to happen first. That's step 1, and comforting is step 2 only when validation has been completely achieved.

A lot of times I get the sense that people are like, “here, let me slap you with some invalidation so we can run over and get the comfort part done because that's the part I really care about.”

Or, “let's slap you with validation, slap you with comfort, and then get to the part of fixing. Which is what I really want to do.” Validation is key. So with meaning, you know, improve the moment with meaning, when you're doing that for yourself, don't do it in an invalidating way.

Like, “Oh, this is fine because I'll use this on my podcast. Or, “this is fine because I need to learn these skills anyway. Like, it's not a problem, it's fine.” No! It can still be super painful.

Using the example of my therapist, I'm now picturing myself on a morning when I get a text from them and they say, “hey, I'm sick today and I'm unable to make our therapy appointment.”

So all of the thoughts coming up, of like, “oh, my God, there's no help coming. I can't trust them. I can't rely on them. I don't know when our next appointment will be. I'm having all of this distress because I have things I really want to talk about and suddenly I'm not able to talk about them.”

So it’s like, if you've ever had to hold your pee, like you’re in a long car ride and there's no bathroom coming up. It's like, “well, I thought there was a bathroom, and there's not one.” And like, there's that discomfort of an expectation of relief that then doesn't come.

So what meaning would I take from that sort of situation? Yes, I'm having those thoughts. Yes, I'm having concerns. Yes, I'm having anxiety. It makes sense that I'm having all of those things.

They come from somewhere because I just had all of these experiences in the last year and a half with losing therapists. I can understand why my brain will initially jump to distrust and fear about not being able to rely on anybody, and that I would rely on anybody!

Like that's some catastrophizing right there. I'm applying that to everyone, like I don't know who I can trust. Of course I am having all of these thoughts. So what meaning can I take from this experience with all of these thoughts? Not to diminish these thoughts, not to say these thoughts don't come from somewhere.

I think the first thing that jumps to mind – what meaning would I find in that – is: well, this is an opportunity to practice. Because I'm having all of these thoughts and all of these thoughts... It's real that I'm having these thoughts. These emotions are real.

I am having those emotions. I'm experiencing this distress. And it's an opportunity to practice mindfulness. Like, let's name the thoughts I'm having. Let's call them thoughts as opposed to truth. I'm having the thought that I can't count on anybody. I'm having the thought that I can't rely on my therapist. I'm having the thought that I don't know when we'll ever have another therapy appointment.

They’re thoughts. As opposed to being like, “I can't rely on anybody. I can't count on my therapist. I don't know when the next therapy session is going to happen.”

There's a difference when you call it a thought versus treating it as fact. So it's an opportunity to practice that. It's an opportunity to practice my Distress Tolerance, because I mean, fuck...

You know, they talk about there's two things in life that are certain: change and taxes. Well, I would say death and taxes. I would also add distress. Shit’s going to happen.

So, being able to practice it – being able to practice tolerating distressing situations – is actually super, super, super useful. So that's one meaning that I would find. Again, I would punch somebody in the face if they came along and said, “Hey Joy, I know you're really upset right now, but it's an opportunity to practice. And isn't that great?”

No, seriously fuck off. So again, that's one of the meanings that I find.

“Focus on whatever positive aspects of a painful situation you can find.”

I've actually been practicing this quite a bit with my breakup. If you're new to the podcast, my partner of two years broke up with me a couple months ago. Yeah? Yes. No, a month and a half ago. OK.

It’s actually felt incredibly strange because I'm I normally do not have an optimistic bent. I am pretty doom and gloom. It's very easy for my brain to find the negatives and to dwell on those things.

So to focus on the positive of the thing feels very uncharacteristic of me. And it feels like I'm trying on somebody else's clothes who has a completely different aesthetic, you know? I basically live in yoga pants and sweatshirts. So if I tried it on a suit, even if it fits, it's like, “yeah, but this is not normally how I look, and that's weird.”

So practicing finding positives. One of the positives that I found is that my former partner wasn't didn't really have the skill of validation, especially around mental health. And so it's nice now to not be in a relationship with somebody who doesn't know how to validate.

It's nice to not be in a relationship with somebody that I have to explain mental health to. I have had the thought that it opens up the possibility of being with a future partner who is familiar and facile with mental health, either having mental health struggles themselves, or working in the mental health industry.

Yeah, I'm like, “wouldn't that be nice?” Because my closest friends are all people who deal with depression or PTSD or anxiety or other mental health issues. And there's a lovely sense of camaraderie there of like, I don't have to explain myself.

So that's a lovely little bonus, and it doesn't diminish all of the other things that I feel sad about, and all of the other thoughts of like, “fuck, now I have to I have to date again. I have to go on first dates and start from scratch.” That meaning, that positive does not diminish those other things that are bummer.

And I'm just I'm trying it on, having the thought of, “hey, this is a nice thing about this sad thing.” And I've been kind of meditating on those, like repeating them and focusing on them.

And so when I'm having conversations with other people about the breakup, I will practice... In addition to saying all of the things I'm sad about, I will practice saying the things that I'm... Happy's not the right word. Relieved about, I guess. Yeah. And then...

“Remember, listen to, or read about spiritual values.”

This is not one that I use as much, but I think most religions or most spiritual practices involve mindfulness and meditation. So being mindful of: here are the emotions that I'm experiencing; here are the thoughts that I'm having; keeping in mind kind of long-term, this is how I want to grow as a person or where I want to be eventually.

I'm spit-balling cause I don't use this one. These are just thoughts I'm having. Good lord, Joy, focus. Judgment, judgment, judgment. So the next one in Improve is Prayer. And prayer is one that I don’t use. But for those of you who do, the examples given here on Distress Tolerance Handout 9 are:

“Open your heart to a supreme being, God, or your own wise mind. Ask for strength to bear the pain. Turn things over to God, or a higher being.”

Some examples that one of my DBT instructors gave around this: you can ask to be delivered from the painful situation or the distressing situation you're in; you can ask why it's happening; you can ask for strength to bear it.

I am not a fan of the first two. “Ask to be delivered,” I think makes it... this is just my experience here, emphasizing this. I struggle with acceptance when I'm also focusing on trying to get out of it.

So that that one asking to be delivered from a shitty situation makes it harder for me to accept. I like this one asking for strength to bear it, actually. Asking for wisdom in what skill would be effective right now.

Asking for the strength to sit with the mindfulness of your current situation. I actually... one of the – Is it mantra? is that the right word? Or affirmation – that I really like is I can feel this feeling.

Because there really isn't a feeling that we can have that will kill us. It's the behaviors that we do as a result of those feelings that can lead to all manner of harm. And the feeling itself will not kill us. Even if we have the thought that it will.

I have had to sit with feelings, with emotions, and with thoughts that I fully expected to experience such excruciating pain from that I would never recover. And I'm currently not experiencing that pain, which means that at some point it stopped.

So, asking for strength to sit with their distress, to sit with the mindfulness of it can be effective. And you will be hearing my parents moving around the house. So, my apologies for that.

The R in IMPROVE is “with relaxing actions.” Some examples here are:

“Take a hot bath, or sit in a hot bath or a shower.”

Why is that redundant? Take a hot bath or sit in a hot tub or take a hot shower.

“Drink something warm. Massage your neck and scalp. Practice yoga or other stretching. Breathe deeply.”

Or as my mother says, “deethe breeply.”

Change your facial expression.

I actually really like “change your facial expression.” I have really intense resting bitch face. I will notice when I'm driving that I will catch my own reflection in the rear view mirror, and be like, “fuck Joy, you look like you want to murder somebody.”

One of the DBT skills – I'm not going to remember. Oh yeah it is Distress Tolerance. It's Distress Tolerance Handout 14: Half-smiling and Willing hands. Basically, it's a body hack. If you change your posture, it sends a message to your brain. Kind of a, you know, a body hack.

If you find yourself when you're in distress, like curled up in a ball and shaking or rocking, or like folding your arms, or like hugging yourself or whatnot. If you open your body posture... I do this actually quite a bit in the middle of therapy. I will do this even in the middle of a challenging conversation with my sisters.

Willing hands is the act of basically opening up. Imagine if you were like carrying plates like you have a plate in each hand that you're delivering to a table, and you have to go through a very narrow doorway. So you kind of turn sideways and you open each hand up to your side.

Is that kind of posture? It opens up your chest. And it is the opposite of what a lot of us want to do when we're feeling defensive, afraid, sad. We want to close in – you know, have a closed body posture. So opening up your body posture, changing your facial expression like a half smile. You don't have to like Grimace, which is what I'm doing right now.

But like a gentle smile, kind of a relaxing of your brow. If you tend to furrow your brow a lot, this one can be super helpful. Kind of a surprise look can actually send the message to your brain, “we're OK.”

I really like these. They sound so stupid. Judgment, judgment, judgment. Because it's like, “Joy, if I think I'm going to die in the next 30 seconds, how the fuck is having a half smile going to help?” And the answer is: a little bit. And it's one of those things that helps if you believe... if also you're interacting with it as a thing that helps.

If the entire time you're doing it, you’re: “this sucks, this is stupid. I can't understand what the point of any of this is. I resent it. I judge it,” I don't think it's going to be as effective. Breathing deeply, I also really, really, like so picturing again my therapist sending me a text and being like, “Can't make it today.”

Part of it for me, the act of breathing deeply (I keep wanting to say “deething breeply” – that's not right). It creates movement between my ribs. It also creates movement within kind of like behind my collarbone.

So if you're like me and when you get stressed or are anxious, your shoulders creep up towards your ears. Deething... deething breeply! Goddammit! It basically it acts as a reset for your body. And it's like, “hey, remember the tension you're holding here? Here, here, here, here, here, here, here, here. Let's release some of that tension.”

I really, really like box breathing. If you have panic attacks or anxiety attacks and find yourself hyperventilating like I do, regular deep breaths can for me, in those moments, feel like it's too much. Because it's: breathe in for five, breathe out for five, breathe in for five, breathe out for five.

And there's no lag time between the inhales and exhales. Box breathing is basically: breath in for five, hold it for five, breathe out for five, hold it for 5. Or whatever your count is. It can be four, four, four, four. Eight, eight, eight, eight. If you are a free diver and are skilled at holding your breath, you can do twenty, twenty, twenty, twenty.

But it works in a variety of ways. One, it actually... it's something for your brain to focus on, because now you're counting, and it slows your breathing down really slowly. Slower than just taking really slow, deep inhales and exhales. Pausing at either end is like turning it up to 11 in terms of slowing your breathing down.

Other relaxing actions that I like: yoga or other stretching. If you don't have a lot of room, if you're at work, if you're like at the dinner table, if you're in other settings where you cannot... like without a yoga mat or go to a yoga class.

The things that are accessible are the things that I tend to like because you don't have to drive somewhere or set something up or clear out a space. I really enjoy finding a step or a curb and like dangling my heels off of it.

So it’s like a calf stretch. Where your toes are on the curb, your heel is off and down. You can also do it up against a wall. Calf stretching feels really, really nice. I will stretch my hands, cause when I get distressed, I tend to curl in my hands, curl into fists.

So I will basically... imagine like prayer hands where your palms are touching each other. Keep your palms touching each other. Spread your fingers as wide as possible, still with your palms touching each other. And then you're basically bringing your forearms out and moving your palms away so that it's just your fingertips touching.

And you're stretching out the palms of your hands. You can do it against a wall if you only have one hand. It's basically an opposite action. It's like here, my body wants to curl up and be super, super tense and I'm forcing it to not be.

And one of the things I like about relaxing actions is it doesn't have anything to do with your emotions or your thoughts. It's like I'm just going to do this thing with my body. And to me, oftentimes when I'm super, super distressed, choosing a different thought or being mindful to my emotions can feel really distressing.

So I like the body hacks. Also drinking hot tea. I'm a big fan of hot tea. Hot showers too, though they can have other less pleasant side effects. Drying your skin out, can be expensive, and not all of us have access to a hot shower at every moment of the day. Yeah, if you're at home and you have access to do that, that's lovely.

So, moving down on Improving the Moment, we're now in O, which is “one thing in the moment.” And it is:

“Focusing your entire attention on the one thing you're doing right now, keeping yourself in the moment, putting your mind in the present, focus your entire attention on the physical. And listening to sensory awareness.

Like if you like ASMR or you're just going to stand there and say, “OK, what are the things I'm hearing right now?” I can hear my own voice. I can hear the movement of my feet on my bedspread. I can hear a car motor outside it. It focuses everything in just this one moment.

My favorite kind of one mind thing that I like to do, I call it 5-4-3-2-1. That's not the official name, but it's five things you see, five things you hear, five things you feel. And not emotion feel, but like on your skin. Then four of all of those, then three of all of those, then two of all of those, then one.

And sometimes I am in enough distress where I go all the way down 5-4-3-2-1-2-3-4-5-4-3-2-1. Like I'll go back and forth, and it basically refocuses me only on the here and now. So that will be one of the things that I will do when in distress.

You know, if my therapist cancels because they're having an illness or something, a thought that I know I will be likely to have is, “I don't know when I'm going to be able to talk to them next. Oh my God. What do I do?”

And there's a lot of future-based, “See, I can't trust anybody I see. I can't count on them. I won't be able to work with them effectively in the future because I don't know that I can count on them.” All of those are future based conversations. Now, I'm not going to say anything about whether they are right or wrong, whether they are accurate or not.

They’re thoughts that I am having. I don't have the ability to tell the future. So they are hypotheses that I'm making about how their future will go and fortune telling. If you're listening to this podcast, the likelihood that you have churning thoughts and anxiety is pretty high.

So I can ruminate about the disasters that may befall me. “Oh, my God. If I can't work with them anymore, are you fucking kidding me? I have to go back to trying to find a therapist again, and it was so hard the last time, and I don't want to do that.”

Like for me going back into searching for a therapist is infinitely more painful than starting from scratch in dating somebody. There's at least the possibility with starting from scratch, dating somebody that you're doing it under pleasant circumstances.

When you're finding a new therapist, usually like you're not under operating on all cylinders. There's some distress, there's some life situations, vulnerability factors going on. So, of course I would have that thought.

First off – so here I am validating myself – look at the last year and a half, and the... I don't want to say suffering, but there was suffering because there was pain without acceptance. There was suffering around finding new therapist. It was a slog. Like I reached out to and researched 101 therapists before I found my current therapist.

And there were a lot of intake forms, and there were a lot of consultations and a lot of first appointments and all of that. So of course, given how unpleasant that experience was for me, of course I would have the thought, the concern that, “Oh my God, I don't want to have to do that again.”

And in this moment, right now, I do not have to do that. I can be mindful to the fact that I don't know, actually. I don't know when I will see my therapist again. I don't know how long their analysis will last. I don't know when we'll be able to reschedule. I don't know.

And that is the fact that I don't know. So let us focus on the here and now. Oh, and just talking about this, I can feel the anxiety raising in my chest. So the here and now. Five things I see: I can see my pun day calendar that has a picture of a coffee filter on it; I can see my Stormtrooper bobblehead;

I can see my Jurassic Park book; I can see a necklace; I can see my water bottle. Five things I can feel: I feel my feet on my bedspread; I feel my pants on my legs; I feel my hand on my leg; I can feel my headphones in my ears; and I can feel my pillow up against my back.

Five things I'm hearing: I hear my own voice; I hear my feet (and I'm having to move right now cause it's actually super, super quiet in here); I can hear the skin of my feet moving against my bedspread. I can feel the sheet protectors.

Oh they feel so good. Oh, the sheet protectors for my DBT manual feels so lovely. I... am I talking about what I'm hearing or feeling? Let's go with hearing. I think I already did all the feels. So I could hear my hands against the sheet protectors and the pages moving against each other.

I can hear... Oh, there's a bird outside. And I can hear a car engine. Yeah. And sometimes, because I've mentioned that I'll do like 4-3-2-1 of each of them and then go back up again, oftentimes you're repeating, especially the things you're hearing and the things you're feeling.

Because there may be only so many sounds in whatever area you're in. One thing I love about that one is you can do it silently. You don't have to say it out loud, so you can do it if you're on the bus, or if you are at the dining room table, or if you're sitting in class, or in a meeting, or at your job.

It really focuses just on the here and now. The act of having to think of all of those things and pay attention really... It feels to me like going from a wide angle lens to like looking through a pinhole. It's like just the one thing right now. Just this one thing.

So I really like that one. Focus your entire attention just on what you're doing. I've been practicing embroidery lately, so that's an activity that I like. And I'm actually really ineffective at doing that one thing. Because I'll be listening to a podcast or watching a documentary or something while I'm embroidering.

So just focusing on that one thing, like the feeling of the thread pulling through the fabric. The feeling of the needle in my fingers. The sound that the thread makes as it goes through the fabric, and the way the sound changes from the initial... it's like a centimeter in all the way to the kind of little thunk it makes when it's pulled tight.

The feeling of the wooden hoop in my hand. Yeah, there's all sorts of sense, like the sound and the sight and the sensation, the feeling that I can focus one-mindfully on there. So those are some of my favorites there for one thing in the moment.

“With a brief Vacation” is the V in IMPROVE. And I'm going to be iterating again the importance of using this as a Distress Tolerance skill rather than as a... use it every day when you're feeling minor annoyance or minor boredom or minor sadness or whatever.

Because like taking a break constantly, you will not get anything done. So the purpose of using a vacation here is to just bring your distress down to the point where you can be effective. So some examples given here:

Give yourself a brief vacation; get in bed, pull the covers up over your head; go to the beach or the woods for the day; get a magazine and read it with chocolates; turn off your phone for a little bit; take a blanket to the park and sit on it for a whole afternoon; take an hour breather from your hard work; take a brief vacation from responsibility.

So, this is again very case specific. If you are raising a child, if you're doing any sort of caretaking, it can feel like you don't have the option to do this. And even if you're in the middle of work and you're like, “I cannot leave my office or my toll booth or my cockpit or whatever to go and take a vacation,” there are ways to take vacations within it.

So, you know, my friends that have the little boy who I’m the honorary aunt to, if you're trying to get him to eat dinner, and he's not eating, he's not eating, he's not eating. “OK, OK we're going to take a 5 minute break. We're going to get up out of our chairs. We're going to go color.”

For me, when I was in the hospital, I did a lot of Sudoku puzzles. Depending on the day and how I was feeling in a given moment, if I got stuck, I could feel the distress. My brain would initially go to, “I can't do anything right. I don't even know how to do this. I'll never be able to solve it, so we'll never be finished. And I can't live with things that aren't finished.”

Those are all of the thoughts that I was having. And I started practicing something that my 8th grade self would be very proud of. Because my 8th grade self would get stubbornly attached. Like, “No! I will not take a break. I will sit here and I will be miserable and I will be totally ineffective and scream and cry because I refuse to take a break.”

But, me as an adult now, when I would get stuck on a Sudoku puzzle, I would practice getting up and walking, doing just a circuit around the hall and then coming back and not going back to that same Sudoku puzzle. I would start working on another one.

And it was actually annoying – I was having the thought that I was annoyed – at how often I would then go back to the original puzzle 5 minutes later and be like, “Oh! I could put a 5 in that cell. That's obvious!”

And I would have judgment, and I was like, “why couldn't I see that earlier?” Again, when we're in distress, our brains are not fully online. Or rather like our frontal cortex where we're doing all our higher-order thinking, it's not fully online.

In distress, we basically become animals. We are operating from our reptilian brain in survival mode. So fight, fight... I just said that twice. Fight, flight, freeze or fawn. We are acting from our instincts and acting from our urges, not from a place of: this will be most effective in the long term. Or anything like that.

So, don't beat yourself up. It makes sense that you will beat yourself up, but it will be ineffective if you beat yourself up over not being able to do something when you're distressed, and then being able to do it later when you're not distressed. Like, “why couldn't I do that then?!”

You couldn't. It's like if you remove the hard drive from your computer and then yell at your computer for not working. A significant portion of its ability to function is offline right now. Same is true with your brain.

So, when you're in distress – and distress, by the way, doesn't have to be severe trauma actively happening. That's another thing I want to mention, because I have a lot of judgment over the sorts of things that I have experienced distress over. I don't know if I've told this story already, but I remember with my former partner, we were about to go run some stairs together.

And I was like, “oh, I forgot my sunglasses.” And so, I went back inside while he was in the car, and couldn't find my sunglasses. And I had a meltdown.

It was pretty quick, the “Oh, I can't find them. Oh my God! I can't find them,” to “Fuck everything! I quit. I give up on life.” I was throwing my bag around and like dumping my backpack everywhere. And he came back in, and I had torn apart the living room.

And he's like, “what is happening right now?” The thought I had that triggered this was, “I can't control anything.”

And I had other vulnerability factors running at that time, so there's a reason why that's where my brain went, and that when my brain went there, the spiral was very, very fast. And from my partner's perspective, I'm having a meltdown over sunglasses.

And from my judgmental perspective, I also was having a meltdown over sunglasses. And when I had time later to actually sit and think it through, and I was able to then identify that thought – because I wasn't aware of it in the moment – that I was having the thought, “I can't control anything.”

And of course that thought would be scary and infuriating. So, that's an example of a thing that caused me significant distress, and that anybody else would look out and be like, “why are you wigging out?” I also had another meltdown later over a grilled cheese sandwich that I burned one side of.

So, your distress is your own. I understand everybody's going to judge your own distress and think you know you're freaking out over nothing. And here's the thing: all of our triggers make sense.

We are all the byproducts of our wiring, our innate nature, and our nurture, the environment that we're in, the environment we grew up in, all of our prejudices and assumptions and judgments and beliefs and expectations and all of these things.

We're complex humans. And so, you'll have meltdowns over things that anybody else would look at and go, “what the fuck?” And it will make sense. Your meltdown will make sense. So, don't judge your meltdowns. Well, don't judge anything for that matter, but we'll get into non-judgmentalness later.

Yes, so, taking breather, taking a vacation, doing something else for a second, for 5 minutes, getting up and moving around. I remember when I used to work in an office, going to the bathroom. Just get up and move and walk someplace else. Move your body a little bit. Stand up and stretch.

I've had moments in my last job with a small business I was running, where I would take a break and do a Sudoku puzzle on my phone. Or go read something on BuzzFeed or something. Again, you want to make sure that whatever it is you're doing is actually reducing your distress.

If you're distressed by the news, don't go take a vacation by reading the news. But yeah, there's a lot of different creative ways to change that instant and do something else for just a few minutes.

Uh, let's see. And the last one, the E in IMPROVE is encouragement, So with self-encouragement and rethinking the situation. Key point here, these things have to be true. So if... this is a stupid example. I'm judging this example that I haven't even given yet.

If you are trying to fly by jumping off your roof and you keep belly flopping into your front lawn and miraculously not dying, an encouragement of like, “I will be able to fly if I keep trying,” is not an effective encouragement. Human beings cannot fly with our own arms. There are other ways we can fly, but not that way. Some examples here... Marsha Linehan, a delightful human.

“Cheerleader yourself: “You go, girl. You da man.”

It's actually written here on Distress Tolerance Handout 9: you da man. If you are non-binary, you da human!

“I will make it out of this,”

is another one.

“I'm doing the best I can,”

in this moment. So it says on the handout, “I'm doing the best I can.” I added the “in this moment.” And it is not necessarily my universal personal best. Right this second, I am doing the best that I can – that I can do – right this second.

“Repeat over and over: I can stand it.”

So, this is an example of what I mentioned earlier of: I can feel this feeling. Another encouragement example is:

“This too shall pass. This is temporary. I will be OK. It won't last forever.”

And yeah, those things, again, have to be true. I have written on my notes here: humans do more of what they pay attention to. So acknowledging successes, no matter how small, means we reinforce that success.

One of my favorite things for my last DBT group that I went to, the instructor had coasters – like what you put your drink on – that were a picture of Yoda and it said, “do or do not; there is no try.” All rights reserved to George Lucas there.

And in the homework – the diary cards that we do in DBT where you basically track the skills that you use every day – the intention of that is to make sure that it keeps you aware of the skills you're using. Because once we get really super skilled at something, we stop thinking it’s a skill.

If I ask you to list off the things that you're really good at, you will not list tying your shoes or brushing your teeth. Because, I mean, who doesn't know how to tie their shoes? But it is a skill. There was a time in your life when you did not know that. And so if you put on shoes with shoelaces and you tied them today, you were skillful.

And my DBT instructor would say, “did you use that skill even for two seconds? Yes? Then you used that skill.” We have a tendency to diminish our competencies, our skills if we didn't use them all day, every day, all the time, in every situation. And if you use that skill for 30 seconds one day this week, you used that skill.

So that is something that I have been working on focusing on. It's really helpful if you're practicing being non-judgmental towards yourself and towards others, because you know you don't end up saying things like, “oh, I tried it and I did it for about a minute and then I gave up.”

OK. And you did it for a minute! That's great. Do you have a goal of doing it for longer? Awesome. Doing it for a minute is better than doing it not at all. So, you are moving towards that goal. So yeah, self-encouragement, again, needs to be true.

So, things like: my feelings matter; it is OK for me to take a break and do something else for 5 minutes; I can use this skill for 30 seconds and then stop using the skill. That's OK too.

All of this stuff, the amount of judgment. Oh, my god guys, the amount of judgment! We do not treat adults with the same level of compassion as we treat toddlers. I don't know if you've ever been around a baby learning to toddle, learning to walk.

We applaud when they take their first step right, right? That is a big deal. People write that that shit down. People video it, post it to social media. We don't wait until, “hey, my child ran their first marathon today.” No, we applaud the first step.

And then they can sit down and crawl for the rest of their day, and it's still a big deal that they took the first step. And as adults, most of us are not trained in how to use any of these skills: Emotional Regulation, Distress Tolerance, Mindfulness, all of that stuff. So when we use them at all, that’s a big deal.

That's important. You improved that moment. That 30 seconds when you used that skill was 30 seconds when you were skillful. That's great. And you don't get to run a marathon if you skip your first step. Everybody has to start by doing a thing for 30 seconds.

So that's where the encouragement comes from. And if you need to think about yourself as a toddler and be like, “we're going to celebrate every tiny, little win.”

If you're like me, and you have a huge amount of self-judgment, and you have the expectation of perfection, you have the expectation that you'll do it correctly on the first try and you'll beat yourself up if you don't, you have an expectation of being able to deliver at your peak at all times, this can be really challenging.

And the practice of it... words. The difference between how I am now versus when I first started DBT is astronomical in this specific regard. I mean it's astronomical in all areas, but this specific skill is massive. It's huge, because it shifted the judgment that I had for myself, which meant that I was willing to try things and fail.

I mean I have tried skills and failed them. And that's necessary. Toddlers – or babies, again, before they're toddlers – when they try to take their first step, they will try a lot. They will try and fall down many, many times before they take their first step.

There is not a single person who is able to walk who got it on the first try? And I’m being incredibly ableist right now. Really any skill that you have now, you did not have at some point in your life.

None of us came out of the womb being able to play the piano. Even brilliant people, Simone Biles did not come out of the womb being able to do incredible tumbling passes and vaults and balance beam routines. There was a point in her life when she did not have that skill. There was a point in Michael Jordan's life when he couldn't shoot a basket.

Now these people that we revere and we treat like athletic gods may pick it up quicker, and there may be some innate facility there. And there was still their first time. And there were times before their first time of success when they tried it and were not successful.

So, there's some self-encouragement for you. You can feel your feelings. You can sit with those feelings. And you can have the thought, “this feeling is intolerable. I cannot sit with this feeling. You can have the thought, “I will crawl out of my skin.” You can have the thought, “My life will end if I sit with this.” You can have the thought, “I will be miserable forever. If I start crying, I will never stop.” All of those are thoughts you can have. Totally. You can have that thought.

No judgement there. And those thoughts all come from somewhere. And, you can also sit with that feeling. Feel your feelings. Your feelings matter. The whole shebang. So anyway, that's Improve the Moment.

Oh, I should probably say this self-encouragement that I like. I really do like, “my behavior is caused,” “I can feel this feeling.” “I am doing the best I can in this moment,” is a personal favorite.

And again, all of these are designed to move your distress down from... Again, zero to 100, if you're 70 to 100, parts of your brain are offline. Your ability to problem-solve, any executive functioning, they're just not there.

So, these Improve the Moments are designed to move you down back below 70 so that you can problem solve so, you can either use other skills. I mean, I've used these Distress Tolerance skills to lower my distress, and then gone on and used a regular emotional regulation skill.

So, we kind of mix and match and it's all a process. So, those are some of the Improve the Moment things that I am going to be using when my therapist gets sick, or has an emergency, needs to cancel an appointment.

I'm also going to be reaching out to some friends and asking if they would be willing to be part of my Distress Tolerance package. Like, “would you be available to have a quick phone call,” or what have you. But that's going to be for a different day.

That's a Cope Ahead skill, which we will talk about at a later date and time. Anywho, so, that's what I have to say about Improve the Moment. Again, that was Distress Tolerance Handout 9. And the link to where you can find the entire PDF for the DBT manual is on my website: https://therapize.joygerhard.com. Link is in the description.

Swan Lake by Tchaikovsky

Alrighty, now we're back to future Joy, and I don't have much to say that I haven't already said in the past, so I'm just going to end this really abrupt-

Swan Lake by Tchaikovsky

This has been “Let's Therapist That Shit!!!” with your host, me, Joy Gerhard, if you like what you heard, please rate, review, subscribe and tell your friends about it. I'll see you next time.

Intro and outro music is Swan Lake Opus 20 by Pyotr Tchaikovsky, performed by the London Symphony Orchestra, conducted by Anatole Fistoulari, released on LP by Richmond High Fidelity / London Records in nineteen fifty-two.