With all of the new stressors impacting each of us during this time, we now more than ever need to take proactive steps to be mindful and find joy in our days. Although we cannot simply wish the pandemic away, we can add a few simple activities to help us cope with our ever-evolving reality.

Below we are sharing a list of what some of our providers here at Compass Point are doing while working from home proving tele-therapy, a list of what our clinicians have recommended to their clients as well as a general list inspired by Marsha Linehan, professor of psychology at the University of Washington, and the creator of Dialectical Behavioral Therapy (DBT), of activities that can be accomplished in limited time, within ones own home. Many of the items are also friendly for families with young children.

A lot of our clients familiar with DBT will know that our groups use lists like this to help participants identify activities they can use to boost their mood and cope with challenges. While many of us need this in the best of times, most of us need to find what works and how to find balance again in the wake of COVID-19.

Our team at Compass Point have been working remotely from home offering tele-therapy and practicing social distancing for over a month now. I asked them to share the activities and behaviors that have been helping them.

Marcy Rodgers

Since sessions have still been taking place via tele-therapy, clinicians have given quite a few activities they have been recommending to clients to de-stress. I asked them to share a few with us.

The below list is inspired by Marsha Linehans list of distracting, pleasurable activities

As boredom sets in during this COVID-19 crisis, I have noticed the increased need for structure and a schedule.  So, the age-old question becomes even more pertinent: where do I begin?

I really can’t begin to label or quantify the value of good self-care.  Humans are equipped with amazing capabilities to self-regulate…if only we had the energy and desire to use them! In DBT, there is a skill (acronym) called the PLEASE skill, and I believe it is the answer to the question posed above.

I am going to focus on three components of PLEASE: Sleeping, Eating, and Exercising.

Sleep. Just do it, stop fighting it…put your Smartphone away and close your eyes.  Did you know that your brain cannot convert anything into memory until you are asleep? The Disney Pixar movie Inside Out had a lot of great content that helps drive this point home (it was quite factually accurate!).  In the movie, the main character Riley didn’t have her memory balls moved from short-term memory into her long-term memory until she slept! Our bodies are not machines; on a cellular level your body needs sleep to repair itself. Sleep allows time for the immune system to do its job and ward off viruses and bacterial infections.  During this time of illness-anxiety, sleep is a kind gesture you can do for yourself to maximize the immunity in your own body! Sleep will also help you reduce your overall stress level. So next time you want to watch the next episode on Netflix, play the next level on a game, or return one more e-mail, ask yourself what you need more: your health and sanity or screen time…

Eat. A balanced diet helps alleviate mood swings.  We (generalizing for Americans) live on a cycle of sugar highs and sugar lows. We have a habit of eating low quality breakfast (…if we eat any breakfast at all…) which floods the brain with chemicals and overwhelms our neuro-functioning; this results in you feeling hyper, a spike of motivation, and a burst of energy (yay!).  As a result of this flooding however; our bodies secrete insulin to suck up all the sugar like a vacuum leaving us feeling lethargic and moody (not so yay…).  This cycle repeats itself after lunch and dinner as well. Think about it…when do you reach for the candy bar? 10am, 2pm, 9pm…a few hours after each meal! Eating a balanced diet of carbohydrates, proteins, and fats ensures that our food (including a healthy amount of sugar) gets broken down over time and reduces that roller coaster of moodiness. While in quarantine, I want you to focus on mindful eating and try to keep it balanced and healthy!

Exercise.  I feel like this is a mute point in some ways. My goal is not to be preachy; it is to motivate you into action. The science behind working out is limitless and boils down to this: if you move your body your mind will feel better.  Physical exercise can helps your brain secret endorphins, adrenaline, and dopamine…all of which alleviate depressive symptoms.  Consider for a moment the cost of getting those chemicals elsewhere: prescription drugs, theme parks, extramarital affairs… Are those effective or realistic on a regular basis? Exercise also builds mastery. If you become fluent and experienced in a form of movement (yoga, running, lifting weights) it will build your confidence and overall satisfaction in life.  What can you do from home? I have seen a wide variety of online videos being posted on Facebook from different organizations, there are a seemingly limitless supply on YouTube, or you could go for a walk around your neighborhood.

For the full PLEASE skill, please refer to this graphic:

While each therapeutic setting has its own set structure and goals, the following characteristics of DBT are found in group skills training, individual psychotherapy, and phone coaching:

• Support: You'll be encouraged to recognize your positive strengths and attributes and develop and use them.
• Behavioral: You'll learn to analyze any problem or destructive behavior patterns and replace them with healthy and effective ones.
• Cognitive: You'll focus on changing thoughts and beliefs, and behavior, or actions that are not effective or helpful.  
• Skill sets: You’ll learn new skills to enhance your capabilities.
• Acceptance and change: You’ll learn strategies to accept and tolerate your life, emotions, and yourself as well as skills to help you make positive changes in your behaviors and interactions with others.
• Collaboration: You'll learn to communicate effectively and work together as a team (therapist, group therapist, psychiatrist).

Frequency: Once a month for 12 months (in addition to standard weekly DBT groups)
Schedule: Monthly
Location: Anderson

This group is for anyone currently in DBT or recently graduated (within the last year) who would benefit from learning additional DBT skills specific to changing behaviors that they do not feel in control over yet.

These are additional skills that are covered more fully than in standard DBT.   By the end of the group, clients will have learned specific skills to help them to decrease their problem behaviors.

This group would be helpful for anyone currently in DBT who continues to struggle with controlling certain behaviors.

The group would especially be helpful for those with:
Problems over spending/ shopping
Treatment Resistant Depression
Eating Disorder behaviors 
Self-Harm behaviors
Drinking and Drug use
Gambling and other addictions. 

If interested, clients should speak to their Individual Therapist about a referral or discuss this in their DBT intake.  

General diary card instructions:
Each night as you are winding down for the day, take a few moments to reflect on what your daily experiences were. We fill out the diary card left to right, one day at a time.  The first thing you fill out is the day/date! If your session was on a Tuesday and the date was June 3rd, you would write 6/3 in the Tuesday box. Then move across as you would read a book.  There is ample research that shows a strong correlation between tracking and improved outcomes. Whether you want to increase or decrease a behavior, tracking it will help.

The first section asks you to rate your urges for use (drugs/alcohol), self-harm and suicide on an intensity scale from 0-5.  This column does not indicate action, you could have an urge for alcohol at a 5 and not actually drink.  5 is very intense; 0 is non-existent. 

The second section is for emotions.  You are asked to rank the highest intensity of each emotion that day.  5 is very intense; 0 is non-existent. The “P” stands for physical pain (which isn’t an emotion…it just fits there) and the “E” is for emotional pain (which many of my clients like to use as their general stress rating that day.  The goal is NOT all zeros…the goal is not all 3s…the goal is that you are honest. Over time in DBT®, what I tend to see is that a person’s negative emotions will go down first, then their positive emotions will raise up (At about the same time that they start using skills).  Having this sort of proof to look back on can be very helpful when you start to feel jaded or tired from the treatment. I have also found in this section that people tend to block feeling certain emotions; the diary card allows you and your therapist to find this out faster!

The next big section is about drug/alcohol use (including legal prescriptions).  We do need honesty here; your therapist is not going to use this information against you! This section allows us to discover trends much faster. For example, if you have anger outburst every day after a glass of wine…or if you have a depressive slump each time you miss a medication, then we can target that immediately! Some people also find that tracking their medication compliance helps them remember their medications more often.

Next you will find a few blank columns.  This is something for you and your therapist to decide on over time.  Common things to track are: hours slept, bedtime, whether or not you exercised, eating disordered behaviors, etc.

The last section is your actual actions.  This section asks you to indicate (yes or no) whether or not you engaged in self-harm (intentional tissue damage), whether or not you lied (either big lies through the week or lying on the actual diary card) and whether or not you used skills (this is a 0-7 scale indicated on the bottom of the diary card). 

The furthest section to the right and smallest section by far is the reward column. In the column we are asking you to remember that humans rarely learn unless someone rewards a behavioral change; we are asking if you rewarded yourself for a job well done.  This might mean that you had a 5 in anger and you coped well or that you made a choice to go out with friends resulting in a 4 of enjoyment.  A reward could be as simple as positive self-talk/praise or as big as buying yourself a new item (perhaps new workout clothes for going to the gym 3x that week).  A reward doesn’t have to cost anything!

Upon entering session, you are supposed to hand your diary card to your therapist for them to review with you and lay the path for that session. 

The DBT® individual session is structured in the following way:
1. we address any life-threatening behavior (self-harm, suicide attempts)
2. we address any therapy-interfering behavior (not doing diary card, being late to class or session)
3. we address any quality-of-life interfering behavior (substance use, not rewarding self, lying, etc)
 
Other helpful diary card hints:
1. Keep it where you will see it. Inside your planner, the front seat of your car, on your nightstand or where you eat breakfast. We don’t care what condition it’s in when we get it back…just that it’s filled out and that you bring it back!
2. Set a reminder alarm on your phone to complete it
3. Use diary card time as a reminder to do your DBT® homework and/or practice mindfulness
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As of April 2017, the Netflix original series 13 Reasons Why broke a new record: it saw more social media volume than any other Netflix original series.  During it’s first week alone there were over 3.5 MILLION tweets including its title (not to mention Facebook, Instagram, SnapChat, Tumblr etc)! The show was produced by Selena Gomez, who is no stranger to mental health topics.  In an interview from June 2017, Gomez responds to questions about the dark comment by saying “Whether or not you wanted to see it, that’s what’s happening. The content is complicated. It’s dark and it has moments that are honestly very hard to swallow, and I understood that we were doing something that is difficult. But these kids today are so exposed to things that I would never even comprehend when I was 8.”
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As a therapist, I can completely agree with what she is saying.  I hear a lot of parents holding tight to their “not my child” or “not at my kid’s school” mentality…and I talk to enough middle and high schoolers to tell you YES, your kid is exposed to these topics and YES, it happens at your kid’s school (as well as on-line, via texting, on television and at sleepovers).  

The thing I liked the most about 13 Reasons Why was that it exposed the sexualized cultures and chronic sexual harassment that young girls have come to expect in middle and high schools around the country.  It seems to be starting younger and younger too…I have 5th and 6th graders regularly discuss the frequency of sexualized talk, jokes, and requests. 
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The thing I liked least about the show however, was the ease with which the main character killed herself and the graphic nature in which it was shown.  No human being needs exposed to those types of graphic images in any context.  It is unnecessary violence that further perpetuates our culture’s desensitization.  I further dislike that the image is one more thing for people who are depressed and considering suicide to struggle with thinking obsessively about.  They are already fighting so hard to block their own intrusive thoughts and images, I do not believe this horrific scene was necessary in order to get the show’s message across.

 ​In response to 13 Reasons Why, our practice chose to ask our clients why they choose life.  We asked them to write anonymously on post-it notes and put their answers on display in our lobbies on our (More than) 13 Reason’s Why Not posters.  What we found was interesting.  It seems that the majority of our answers fell into five categories: 

​The beauty of this is that we can draw a conclusion that if you continue to work on these categories in your life, then you will decrease your risk of suicidal thoughts and gestures.  If you are struggling with finding reasons to live, I strongly suggest that you reach out to a therapist for guidance.  Therapy is a collaborative experience in which the therapist will work with you to explore your values and help you set goals to achieve your life worth living.  Please feel free to contact Compass Point Counseling Services if you live in the Greater Cincinnati area (www.cpcs.me), we’d love to help.  

DBT Friends and Family is a support group for individuals who have a loved one that is participating in DBT treatment.  We understand that the DBT concepts and skills are foreign to you and that your loved ones behaviors, thoughts, and/or feelings may be confusing.  We believe that you have a desire to help facilitate positive change.

The goal of DBT Friends and Family is two-fold:
1. We seek to support you and connect you with others who understand this stress
2. We seek teach you core DBT skills and concepts so that you can relate and help your loved one

This group is offered in both Anderson + Fairfield on a rotating basis. Ask the front office where the next class will meet

To sign up for the next meeting call the front office at 513-939-0300

​Target Population: Clients who have completed two cycles (one year) of Standard Dialectical
Behavioral Therapy skills class and are still struggling to find their life worth living -or- are seeking a greater understanding or practice of DBT skills and concepts of behavioral change.

Goals of DBT-ACES: Clients will push ahead with new goals to help them create a support network, acquire employment that is in line with their values and needs, experience their emotions and are able to demonstrate mastery of standard DBT skills. At completion of DBT-ACES, the client will be finished with standard weekly therapy or will seek a specific treatment (ie: exposure therapy). It is recognized that continuing with standard weekly therapy keeps the client dependent on the mental health system thus reinforcing their identity of mental illness.

Additional Requirements: The client will need to continue with an individual therapist and continue using a diary card. If the therapist is unfamiliar with the DBT-ACES protocol, an overview will be provided. As mentioned above, a goal is to reduce dependence on the mental health system; as time progresses the standard rules of phone coaching will change and frequency of appointments should decrease. The client must be free of suicidal and self-harming behavior for at least 3 months prior to beginning DBT-ACES.

For more information please contact the facilitator, Charity Chaney, at Compass Point Counseling Center (513) 939-0300

Compass Point is now offering free weekly zen meditation. On Wednesday mornings from 10:00 am to 10:20 am.  We have a brief introduction to the style of meditation followed by a 15-20 minute meditation sitting practice. After, we spend a few minutes discussing the experience. A small amount of time that makes a big impact! Walk ins are welcome, however we recommend coming about 10 minutes before meditation starts.

Below is an article from Alyx Beresford on the benefits of practicing weekly zen meditation shared from her blog,  your mental restoration. 

Formal Zen meditation is the type that I practice and encourage my friends, family, clients, etc to practice also.  Notice I said practice…yes, sitting upright and still requires PRACTICE! The basic components are:
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1. Sit upright and still on meditation cushions (zafu and zabuton) with three points of contact with the floor to stabilize you.  This should be a comfortable position and should not cause straining.  For example, if you cannot get yourself into lotus position, don’t! It is encouraged that you find a position that you can hold for the duration of the meditation without discomfort.  Frequent shifting is discouraged, I recommend that you experiment with different positions in your first few weeks.
2. Clear your mind as best you can and focus on either nothing or your breathing.
3. Practice non-attachment when you notice your mind drifting (as it will) by gently bringing your attention back to your breathing. The reality is that your mind will wander and it will wander more when you are new to meditation and/or when your stress is higher.  We can acknowledge this without judging ourselves or the practice.  It is simple, not easy! Many people complain that they feel MORE anxious when they try to quiet their mind…which may be true because they have removed all of the distractions that they normally put between their feelings and their consciousness.  Ride that wave, calmness will follow. It reminds me of snorkeling in choppy water…the water is only choppy until you put your head under the water to see the reef below!
4. Length of meditation varies, the magic isn’t in the number of minutes; rather it is in the willingness to practice steps 1-3 over and over and over.  Meditation is a muscle that most of us forget we have, thus it is out of shape and needs to be worked consistently over time.
5. The benefits of sitting practice are innumerable.  Science finds that:
   
   

​You can really meditate whenever your want, where-ever you want, with whoever you want. I recommend group meditation in the beginning…think about how much you cognitively know about exercising and eating healthy vs what you actually do in your day-to-day life…? I find that group meditation holds you accountable and achieves better results just as group exercise does! Most major cities have group meditations or a zen center to provide this structure.