Anshu Bahanda: Welcome to Wellness Curated. This is your host, Anshu Bahanda, and the aim of this podcast is to help you to lead a healthier, happier, more hopeful life. On the show today, we have Sheri Van Dijk. She’s a highly esteemed expert in the field of mental health and Dialectical Behavior Therapy, or DBT. Sheri is an accomplished author, therapist, and speaker. She’s renowned for her insightful contributions to emotion regulation, mindfulness, and effective coping strategies. With her expertise in DBT and her compassionate approach, Sheri has empowered countless individuals to navigate challenging times in their lives and to lead a more balanced and fulfilling life. So today she’s going to share her expertise in DBT and emotion regulation, and she’s going to help us navigate the complexities of decision making. Welcome to this chat, Sheri, and thank you for making the time to be here with us today.
Sheri Van Dijk: Thank you, Anshu. I appreciate you having me. It’s an honor to be here.
AB: You’re welcome. Now tell us, Sheri, what are some of the common emotional factors that very often cloud our decision making process?
SVD: So I think this really jumps right to the heart of the focus in my career, which is emotion dysregulation, as you mentioned. And this, really, can stem from a lot of different problems, disorders. Emotion dysregulation is a part of depression, anxiety, mood disorders, eating disorders, and often substance abuse problems. And so emotion dysregulation is when we struggle and we don’t have the tools to manage our emotions or to regulate the emotions we’re experiencing in healthy ways. And so individuals often end up turning to some of those problem behaviors that I just mentioned, like disordered eating behaviors, substance use problems, as well as less problematic but still unhealthy means of managing or trying to manage emotions, like lashing out at people or sleeping to avoid emotions, and so on. So emotion dysregulation… I’ll just talk a little bit about where this comes from because I believe that understanding emotional dysregulation is important when we can help our clients or ourselves if we struggle with it. That often helps us bring more acceptance and compassion to ourselves and prepares us to work towards making changes. So the DBT theory as to how emotion dysregulation develops in people is called the biosocial theory. And the idea behind it…
AB: I’m going to interrupt you. I want you to explain DBT to us as well before you carry on.
SVD: Yes, thank you. DBT is Dialectical Behavior Therapy, which was created by Marsha M. Linehan and her team working in Seattle, Washington, back in the early 1980s. And so DBT is a type of cognitive behavior therapy that many people are familiar with. The premise of CBT, or Cognitive Behavior Therapy, is that our thoughts, behaviors, and emotions are all connected, and by changing one of those elements, we will be able to influence the others. So if we change our emotions, we can have an influence on our thoughts, our behaviors, and so on. So, to put it in its most simple terms, when it comes to skills, DBT is CBT on steroids. So it’s kind of the newer, improved CBT where we’re bringing in mindfulness and acceptance strategies. Now, this is just one component, but we’re bringing mindfulness and acceptance strategies to clients to help them accept themselves as they are. So we, as clinicians, accept the client as they are and help them accept themselves in preparation of helping them make changes. Again, the idea that often, when we can have a better understanding, we’ll be in a better position to bring compassion and acceptance to ourselves and to be more ready to make changes. So the DBT biosocial theory proposes that individuals struggle with emotion dysregulation on a regular basis when there are two components that they’ve been faced with. The first component is that we have an individual who is more emotionally vulnerable or more highly sensitive. And this is essentially a temperamental situation, where some people are just born more emotionally vulnerable. What this means is that they react to things that other people aren’t reacting to. So other people can’t understand why there’s an emotional reaction. If others can understand why there’s a reaction, they can’t understand why the reaction is so intense. So this is where we have individuals who might be referred to as overreacting, or they might refer to themselves as overreacting, or the drama queen or drama king kind of idea. So their emotional response is higher than what’s seen as warranted by the situation once they hit that high reactivity level. The third part of this is that it takes them longer to come back to their usual selves or their emotional baseline. And the fourth element of that emotional vulnerability is that, on a regular basis, the individual is walking around with a higher than average level of emotional pain. So this could be sadness, anger, shame, loneliness, anxiety, or a mixture of all of the above. A lot of people experience being highly sensitive or might relate to being more sensitive. But when we combine that with a pervasively invalidating environment, that’s where we kind of have the perfect storm. Invalidation can happen in a lot of ways, and I’ll stick with some examples that many of us can probably relate to. So hearing a parent say to their child, or a child hearing the parent say, “Stop your crying, or I’ll give you something to cry about.” So another example here might be the child hearing the parent say, “You can’t be hungry, you just ate.” So the parent is indicating that there’s something wrong, invalid, or flawed about the experience that the child is verbalising. Now…
AB: Interesting.
SVD: I purposely use these two examples because I remember hearing them from my own parents when I was growing up. So these are not abusive experiences per se, in and of themselves. When we have a non-highly sensitive child, I didn’t relate to being emotionally vulnerable, and I didn’t hear those things from my parents on an ongoing basis. So for me, that wasn’t an issue. For many people, it’s not a problem. But when we have that highly sensitive child growing up in an environment where their experiences are regularly invalidated, that’s when we have that perfect storm. Of course, abuse would be kind of the epitome of what we’re talking about here with the invalidating environment. But it doesn’t have to be abuse, as I’ve shown you, hopefully from these examples. So when we have this individual, this highly sensitive child, growing up in a pervasively invalidating environment, this is when they’re going to be more likely to experience ongoing difficulties managing emotions. They haven’t learned the skills to regulate emotions. They don’t have the skills because they either haven’t been taught as the child grows up in that invalidating environment, or the child is just maybe so sensitive that they haven’t been in a position to learn the skills when they have been taught by the parents or the environment generally. And so regardless, the skills haven’t been developed in the child. And this is when children, teens, and adolescents will start to turn to other means of trying to find ways to regulate themselves. Self-harming, fantasising about suicide, eating disordered behaviors, substance use, video gaming, social media, sleeping to not have to face the world, etc. So I tell my clients, “Fill in the blank with your choice of behavior.” There are lots of different things that we can fill in the blank with here; different problem behaviors. And this is the way that people will attempt to manage the emotions that they’re struggling with and don’t know what to do with it. So this is emotion dysregulation: Not knowing how to manage the emotion, how to distract from the emotion, or what to do when the emotion gets so intense that they turn to problem behaviors instead. Sometimes emotion dysregulation can also come in the form of shutdown dissociation. So there’s a lot of different ways that this can be presented. When we are getting hijacked is how we think of this… If you’ve heard of the amygdala hijack, the amygdala is that alarm center in our brain; it’s part of the brain that is responsible for emotional responses like anxiety, fear, and other emotions— I won’t go too far into that. But when our brain gets hijacked by intense emotions, the thinking part of our brain really shuts down. When we are experiencing intense emotions, depending on the degree of intensity, it’s sometimes almost impossible for us to think straight because our brain is shutting down and our nervous system is activated. So what we want to do then is help people become aware before they get to that point. So this is where skills like mindfulness come in, where as someone starts to become activated, we want to help them learn what the early warning signals are for that individual; because this will be different for different people. What are this particular person’s early warning signs?
AB: In your book, ‘Calming the Emotional Storm’, you explore various emotion regulation techniques, right? So tell me, how can these strategies help us to navigate these intense emotions that may influence our decision making?
SVD: I think one of the most pertinent skills here is the skill of a wise mind. From a DBT perspective, we all have three different states of mind. The first state of mind, I’ll just touch on briefly is the reasoning mind, which is where we’re just using our logical, reasoning, straightforward, matter-of-fact kind of thinking. So this morning, when I was logging on to our Zoom meeting, I was clicking, and following the links to where I needed to go, and that’s my reasoning mind’s step-by-step process. For me, there was no emotion involved in that. I’m well versed in Zoom nowadays. If this was my first Zoom meeting, there might have been some emotion coming up, some anxiety, and so on. That may have taken me into my emotional mind. I won’t go too far into this, but emotion regulation can also show up as a reasoning mind and kind of that more shut-down version that I mentioned briefly earlier. The more common way that I see people emotionally dysregulated is in their minds. So when we’re in an emotional state, we’re being controlled by the emotion that’s there. So emotion in the mind isn’t just when we feel an emotion, it’s when the emotion takes over and is in the driver’s seat, so to speak. So, for instance, when an individual is experiencing feelings of anxiety or intense shame and they turn to self harming to try to manage the emotion, or when we’re feeling really angry and we lash out at somebody close to us, that’s an emotion in our mind with which we’re unable to cope. Or it’s more difficult, at least for us, as we were talking about a minute ago, to access the thinking. And we’re just reacting to that emotion. The wise mind is walking the middle path between those first two states of mind that I’ve just mentioned. A wise mind finds the balance between emotion and reasoning. So we’re able to feel the feelings, and we’re still able to draw on our logic or reasoning. So those are the first two components of a wise mind. The third element of the wise mind, though, is what we refer to in DBT as our intuition. It’s that gut instinct, it’s that internal sense of knowing that we all have, if we’re trying to make a decision from our wise mind. There’s a weighing of the different possible choices that we might make and the possible consequences of those choices. So it’s a more holistic perspective, and we get to that place of just knowing or of this feeling, that internal sense of knowing. For myself, I’ll give an example of a job that I left when I worked at a hospital for the first almost 15 years of my career. And when I started thinking about leaving the hospital, that was a really difficult choice for me. Emotions would come up, and anxiety was certainly there. This is such a big life decision. And so initially, I was emotional about this, and anxiety kept me frozen a little bit for a while. I didn’t feel confident enough to leave. And as time went on, I kept weighing the pros and cons, which is a skill that we’ll probably also talk about today. I was weighing the pros and cons, and I was flip-flopping back and forth. One day I felt: Yeah, this is the right thing; I need to leave. And the next day it was back to: No, I can’t go, what if I don’t succeed? So this is a clear emotion mind, that’s flip- flopping back and forth. But then, at some point, I just got to this place where there was a calmness about it and just a feeling of rightness, of knowing that this was the thing that I needed to do that was in my best interest. So I just got to that place of knowing that this was just the right thing for me to do, and there was that sense of peace and calm about this decision. So that’s how we know that we’re at our wisest. This isn’t to say that we always want to act from our wise mind, because there are times… I’ll give you an example of times when we want to be in our reasoning mind. I don’t need to be in a wise mind to come to a meeting. And emotion in the mind also includes pleasurable emotions. So I don’t want to miss out on opportunities to feel intense excitement, love, or those pleasurable emotions, even when the emotions are painful. Those are what keep us connected to others, what help others see our pain so that they will connect to us. So absolutely, you can see how both of these states of mind are helpful and important. But we want to be able to access that wise minded place more often, when we want to and when we need to. And in decision-making, of course we need to access that wise mind more often.
AB: One of the strategies is to understand that you have three minds: rational, emotional and wise mind, and that we should try and work from the wise mind 80% to 85% of the time, right?
SVD: I don’t think that I can really put a percentage on it and it’s more about just recognizing for ourselves— when is it going to be effective for us to make that decision from our wise mind?
AB: Okay, I get that. So tell me, is it possible for people to cultivate some sort of a sense of self awareness so they can recognize or we can recognize our own patterns and tendencies when it comes to decision making?
SVD: Yeah, so I mentioned mindfulness already, and I’ll come back there to start with because mindfulness is kind of, well, a foundational skill in DBT. And I think in life, mindfulness is, and I’m not going to go too far into teaching about this, but it’s about being aware of what we’re doing in the present moment with acceptance. So being aware and open to our experience, whether outside of us or internally. Then, through cultivating mindfulness practice, we can increase our ability to be self-aware, which would include when emotions start to come up and we get into that hijacked state or before we’re getting into that hijacked state, as I was talking about. So mindfulness would be the starting point there. And then connected to that, of course, would be that wise mind that we were just talking about, practicing, noticing what state of mind we’re in, just identifying, “Yeah, this feels like a wise mind right now, ” or, “Whoa, I’m in an emotional mind right now.” That practice in itself will also help us start to identify when we’re on our way into a problematic state, and then we get to practice. If we notice, for instance, that we’re in an emotion mind or the wise mind and we don’t want to be there, it’s not helpful for us in that moment, then that opens up the opportunity for us to practice skills to get to that wise minded state.
AB: I also want you to address the fact that when we are overcome with emotions, sometimes there’s decision paralysis. So can you give us some strategies and techniques to make making decisions easier at a point like that and making decisions with confidence?
SVD: It’s much harder to get out of that paralysed state than to work towards not letting yourself get to that state in the first place. So ideally, we don’t let it get that far, but that takes practice, and that’s kind of a longer-term goal. In the short term, there are some great skills that I teach clients on a regular basis and that I use myself when I need to. The pandemic was a great time to use those skills, let me tell you. I was grateful for having them. These are actually skills that change our body’s physiology. I’m going to talk about a couple of them that are nice and fast-acting. The first one I call the forward bend. And if you know yoga, you know the forward bend already. But if you don’t know yoga, don’t worry. The forward bend is just bending over as though you’re trying to touch your toes. When we are in a position where our head is below our heart, it actually activates a system in our body called the parasympathetic nervous system. I won’t go down that road either, but it’s part of our autonomic nervous system that helps us put on the brakes. It’s not a quick fix, in terms of getting into a relaxed state or anything like that or making emotions disappear, but it certainly helps us to take a bit of a step back and to feel a little calmer for a short period of time. So it kind of opens up a bit of a window where we’re more able to access that wise-minded state that we were just talking about.
AB: That’s so useful for people to know: that if their head is below, no one’s ever said this to me on numerous podcasts, that if the head is below the heart, it activates the parasympathetic nervous system. Sheri, that’s invaluable. Thank you for that.
SVD: I know, right? And so it really is helpful. As helpful as that one is, there’s actually another skill that’s even more helpful. The problem with this one, though, is that not everyone can do it. And so I’m going to give you a kind of cautionary sign here. First, if someone has anorexia or bulimia in terms of eating disorders, if they have low blood pressure, or if they take a medication that’s called a beta blocker, which is a medication for heart or blood pressure problems, they cannot do this skill. What we want people to do—and this is another strange-sounding one, but believe me, it is so effective— I tell my client to go to the nearest sink and stick a plug in it. Fill the sink up with water as cold as it’ll go. They can also do this if they have a bucket or a big bowl, they fill water in there as cold as it’ll go, and they bend themselves over or tip themselves over. This is called the tipping skill: tipping the temperature of the face with cold water. They stick their faces in the cold water. Ideally, we hang out there for about 30 seconds. Not everyone will be able to do this, of course. If you need to take a breath, come up for a breath, and you might stick your face back in the cold water. And this activates a different system in the body that redirects blood flow. I’ll mention the system, it’s the mammalian dive reflex that gets activated here. And this redirects blood flow in our body, from our extremities to our heart and our head and helps to quickly re-regulate emotions.
AB: Interesting.
SVD: Fast acting. Yeah. Now, again, this opens up a bit of a window, right? So we don’t stay regulated if we’re just still in that situation, still thinking about it or ruminating or whatever, what was going on. But if we can open up that window and get some clarity, get to our wise mind, or at least closer to wise mind, that allows us to think about decision making or allows us to think about what do I need to do next to stay regulated, so that I’ll be in a better position to make a decision in this situation. So those are two of my favorite skills. We can also use breathing practices and all of these skills activate systems in our body. So it’s a nice way of changing the body’s chemistry in order to manage emotions.
AB: So you gave us two very important skills, and you said when we’re not being able to manage our emotions and therefore not make decisions— the first one, you said your head should be below your heart. So do a forward bend. Stand up and do a forward bend. And the second one is to fill your sink or a bowl with as cold water as possible and put your head in it. Right. For how long? Or your face, not your whole head, put your face in it. And how long?
SVD: For 30 seconds. 20 to 30 seconds. But again, if someone can’t hold their breath that long, either because they just can’t or because they’re in a crisis, and so they’re already breathing really shallowly, then they can come up, take a breath and put their face back in the water again if they need to.
AB: Lovely. Thank you for that, Sheri. Now the next thing I want to talk to you about is I want you to explain to me this principle of radical acceptance and how it can help individuals who go through excessive self criticism? How can it help them make decisions based on self compassion and realistic expectations?
SVD: So radical acceptance is another one of my favorite skills. I have a lot of favorites. Radical acceptance is about acknowledging reality as it is. A lot of people get a little confused about the term acceptance. When we’re talking about acceptance from this perspective, we don’t mean that we approve of or that we like the situation as it is, or that we’re even okay with it as it is. We mean simply that we are acknowledging reality as it is. It is what it is.
So there are a couple of ways I think this helps in terms of decision-making. The first way is that it helps us regulate our emotions as well. But this is a longer term skill. It’s not short-term. This isn’t an easy one to practice. This will be a process for most people in the most painful situations. So it helps us to re-regulate emotions because when we are fighting a reality, which is the opposite of accepting a reality, we are essentially triggering more emotional pain for ourselves. So gradually, as we are able to accept that reality, whatever it is, our emotional suffering comes down. And so that allows us to be in a better position to make decisions from that wise minded place we’ve been talking about, let’s say. So I work with people with severe mental health problems, and actually I work a lot with people [living] with bipolar disorder. And there’s still, unfortunately, a lot of stigma around bipolar disorder, a lot of misunderstandings, and so on. And so a lot of people, at least a lot of the clients that I work with, still struggle with a lot of shame and fear about disclosing this to others. And so if they are judging themselves—if the client is judging themselves for having this diagnosis and what that means about them—they’re probably going to feel a lot of shame. So radical acceptance… I’m just giving you a very specific example here to show you how this can help with self-compassion. Radical acceptance would mean accepting that I [live with a] bipolar disorder rather than continuing to fight that reality. And so my suffering is going to come down as I move towards acceptance. And part of the suffering, I would say, was probably the shame. So shame is going to come down on suffering in general. So that might also entail anger, feelings of resentment, bitterness, and those kinds of things. So the suffering gradually comes down as I move closer to acceptance. And the more space there is for self-compassion, the more pleasurable emotions are going to come from living daily life. That’s just one kind of very specific example again. But hopefully people can kind of extrapolate from that as to how radical acceptance can help in their specific situations.
AB: Wonderful. So I want to ask you another very difficult question, actually. You talked about shame, right? So when we’ve made a past mistake or we have some sort of a regret from the past, how can we learn from it so that it affects our future choices, but at the same time we don’t want to be frozen into inaction?
SVD: Yeah, this is a great question, Anshu, and I think it’s a difficult one because I think people often get stuck in that rumination about the situation, the decision, or whatever it is that they’re struggling with. And I think it comes back again to mindfulness. So regret is what will come up when we’re rehashing things that have happened in the past that we’re not happy with, for whatever reason, right? When we’re practicing mindfulness, we’re able to see that our mind is going back to that past situation. And that gives us the option of bringing ourselves back to the present. So mindfulness means bringing ourselves back to the present but also radical acceptance. Again, once I’ve made this decision, I can’t go back and change it. We don’t get that good old do over button in life. So I’m going to practice accepting that it is what it is. I have no opportunity for a do-over. So I’m going to learn from it, maybe as best as I can, as we talked about, and accept it.
When I have clients that I’m working with who are still really stuck on things that they did five or ten years ago, my question to them is, “Do you really think that there’s anything left to learn from that situation?” Especially considering how poor the human memory is. You are not remembering the situation now, as it actually happened at that time. And so this is where I would then be coaching the client to do things like practice radical acceptance, be mindful, bring yourself back to the present, and validate the emotions that are coming up. Because if we’re not accepting the emotions that we’re feeling, like shame, for example: I did this thing, I regret it, and I feel shame about it. Yes, I’m going to learn from that as best I can; but if I’m not validating my shame and the other feelings—anger itself or whatever—if I’m not validating those emotions, that’s going to continue to contribute to emotion dysregulation. Validating the emotion brings down those emotions and helps soothe them, essentially, so that I’ll be in a healthier position to decide what I can do now to help myself. Is radical acceptance mindfulness? What skills are going to be most helpful here?
AB: Okay, thank you for that, Sheri. We do a rapid fire round to summarize our chat at the end. So [what’s the] one important thing that clouds decision making?
SVD: It would be the emotional hijack or that emotion dysregulation that we were talking about.
AB: One practice to help us be more decisive and make better decisions.
SVD: There’s lots of answers I’d like to give, but rapid fire, I will say, mindfulness,
AB : Can people learn to make better decisions at any time in their lives?
SVD: Yes. We can teach old dogs new tricks. Absolutely. Sorry, I’ll make this brief. We do have to consider the history of trauma, previous and current supports that the individual has in their life. So, there’s the contextual piece to this. So, for some people it will be more difficult, but absolutely, it is still possible.
AB: Thank you so much, Sheri, for your time and for the wonderful powerful insights that you’ve given my listeners.
SVD: Thank you again for having me, Anshu.
AB: To my listeners, I hope you learned something new, and I hope we’ve brought you a little closer to leading a healthier, happier, more hopeful life. If you like the session, please press like. Please invite your friends and family to subscribe to my channel and I would love to hear from you. So please email me any questions you might have, any comments, any topic suggestions at: Anshu@wellnesscurated.life. Thanks again and I’ll see you next week.