Painful feelings such as anger, are often associated with worries about negative consequences — perhaps that an important goal will be blocked or that you will fail, be criticized, hurt or abandoned.  The intensity of your feelings and worries can leave you stuck in a cycle of angry feelings, with resentment and rage fueled by worry, spiteful thoughts and memories of hurtful experiences.

Emotions, even those that are painful, serve an important purpose in our lives. Anger can motivate us to fight for an important cause or overcome obstacles.

But sometimes we can get stuck.  We become annoyed and remember every past irritation.  Or we feel resentful and begin to think only of how we’ve been wronged.  When angry, we’re more likely to lash out, have a short fuse or act in other ways that perpetuate hostile and tense interactions.  Once the cycle begins, anger can stick around, damage our relationships and keep us from positive life experiences.

Sometimes the only way to change painful emotions is by changing how you act.  The key word here is sometimes.  In the case of anger, it is not important whether you have a legitimate reason to feel angry.  Anger often is justified, but not helpful.  When angry, ask yourself “is the anger doing me any good?”  If it is helping you, say by motivating you to stand up for yourself or causing you to right a wrong, than acting differently will not decrease your anger.  But if anger is damaging relationships or making problems worse, changing your actions can have an impact on how you feel.

Changing how you act will only change how you feel if you change both your actions and your thoughts.  Acting kindly towards someone with whom you are angry, instead of lashing out, will not reduce your angry feelings if you are thinking “what a hypocrite” or “I can’t stand this person” during the encounter.  You have to change your thinking, as well as your behavior.  This could mean “I can understand why this person acts as they do, even if I don’t agree with it.”

Steps to Change Angry Feelings

1. Figure out your emotion. Emotions can be complicated and confusing.  Figuring out what you are feeling, for example anger, annoyance or frustration, is an important first step.  Are underlying feelings of guilt or fear influencing your anger?
2. Ask yourself what action goes with that emotion. Aggression usually goes with anger.  Aggression can be physical, verbal or indirect and passive.
3. Ask yourself ‘do I want to reduce my anger?’  It only makes sense to try to change those feelings you want to change.
4. Figure out what the opposite action is.  The opposite of aggression is kindness or at the very least, decency.  Putting yourself in someone else’s shoes and imaging their perspective is an effective way to change angry and aggressive thoughts into something kind or at least understanding.
5. Do the opposite action all the way.  Throw yourself in to acting differently in both your actions and your thoughts.  Acting differently, without thinking differently won’t work.  You have to do both.

The ability to solve life’s problems and live the life you want to live sometimes means acting in opposition to your feelings.  You may need to gently leave a situation that makes you angry or be fair-minded in thoughts about someone who has hurt you.  Doing so can release you from anger that has become destructive in your life.

Angry man photo available from Shutterstock.

I can accept the idea of constant change and see it in the world all around me.  Seasons change, children grow, friendships strengthen or grow more distant.  We move, get older, experience health problems, fall in love, recover from sickness, lose loved ones, graduate from school and so on.

But sometimes those things we most wish to change, seem to stay the same.

I recently listened to a radio program about people who desperately wanted someone in their life to change and who were faced with the reality that this person was not going to change.  In one example, a woman, who identified herself as a lesbian, desperately wanted her brother to change his view of her.  He had become a born-again Christian and because of his religious beliefs, was unable to accept her lifestyle as valid.

After years of estrangement, feeling rejected, invalidated and wishing he would change his beliefs so they could regain the close relationship they’d had as children, she accepted that her brother was never going to change.

Many people struggle with strained or conflicted relationships in which they wish the other person would change.  We can spend years suffering as we try to encourage, force, teach, foster, persuade, inspire or otherwise urge this change.  We might want someone to change for any number of reasons, for example, we may see the disastrous consequences when a loved one drinks or gambles too much, feel alienated by someone who has a different style of communication or see that someone struggling could feel better if they would simply see the world differently.

Which brings us to another concept central to DBT: that of acceptance.

When the woman in the story above accepted that her brother was never going to change his religious beliefs, something did change.  Although she was still hurt by his views of her, when she accepted him as he was, she was able to have a relationship with him again.  They were not close, as they had been growing up, but they were also not estranged.

She also no longer spent energy feeling anger towards him.  Instead of trying to make him see her point-of-view, she focused on trying to understand him.  In listening to and accepting him, as he was, she reconnected with him in simple everyday interactions.  And aside from the fragile reconnection, she found that she no longer had to struggle with her own emotional response to his view of her.  Instead she was able to focus on her own life and living in a way that was best for her.

Have you had to accept that something or someone you desperately want to change is not going to?  Do you think that acceptance can lead to change? Do you agree with these two basic concepts in DBT, that of Acceptance and Change?

Businessman photo available from Shutterstock.

Mindfulness Based Stress Reduction training can help breast cancer survivors in their struggle with depression.

The number of women who survive breast cancer has increased in recent years.  However, side-effects of breast cancer treatment, including sleep problems and depression, can disrupt people’s lives and interfere with their treatment. According to a study conducted by Mary Jane Massie (2004), depression may impact as many as 50% of women with breast cancer.

In a recent study at the University of Missouri Jane Armer and other researchers found that breast cancer survivors’ health improved after they completed mindfulness-based stress reduction training that incorporates meditation, yoga and physical awareness.

What is Mindfulness-based stress reduction?

Mindfulness Based Stress Reduction involves learning to focus attention, on purpose.  Attention is focused on the present moment with an openness to experience.  The quality of this attention is a gentle, non-judgmental acceptance of whatever arises into awareness.

Mindfulness is often seen as a way of counteracting emotional reactivity that can leave us stressed, anxious and depressed.  Instead of simply reacting to feelings, thoughts and events in life, with mindfulness you learn to become aware of your reactions and to respond to your experience out of awareness and consciousness.

At his mindfulness based stress reduction program in Worcester, Massachusetts, Jon Kabat-Zinn teaches participants this increased awareness through meditation, yoga and dialogue in day-to-day awareness of life.  Participants attend groups and complete homework assignments that include daily meditations.

This training is aimed at teaching people to use their innate abilities to respond effectively to stress, pain and illness.  Surviving breast cancer is certainly stressful.

Studies have found that breast cancer survivors who have finished treatment experienced more depression and far higher levels of fatigue, sleep problems, and difficulty working and concentrating than healthy subjects.  Mindfulness-based stress reduction is a treatment that may be a fit for many in their recovery.

Breast cancer ribbon photo available from Shutterstock.

Most often behaviors such as self-destructiveness, aggression, substance use problems and other impulse behaviors happen at times of high stress and intense emotions.  And stress and emotion both have a significant impact on memory.  They interfere our ability to accurately remember events and skew what we do remember.

Diary cards, in DBT, are central to investigating and understanding problems that are being targeted in individual therapy.  They are completed during the course of the week–as emotions, events and problematic behaviors occur—with the intent of improving memory. If targeted behaviors have occurred, they are discussed in therapy.  If patterns emerge, they are investigated in therapy.

But diary cards can be difficult to complete.  It’s easy to forget to carry them, can be stigmatizing to pull them out and complete them when you’re on the go and they can be complicated.

Now, Sammy Banawan, PhD, a clinical psychologist in private practice who has trained in DBT, has developed an app for diary cards to address some of these problems and enhance the use of diary cards.  I had the pleasure of talking to Dr. Banawan about the app he developed.

Christy: Why an app for DBT diary cards?

Dr. Banawan: In my practice, I’ve found that a couple things really stand out about DBT and diary cards:

• First, they’re very helpful to structure sessions and provide a clear idea of treatment targets and where to focus our work. They provide a lot of insight into particular patterns of emotion and behavior and can be extremely informative for both me and my clients.
• Second, they often get forgotten. Either my clients forget to do them in the moment or forget to bring them in. The DBT Diary Card app was designed to help alleviate this problem. It also allows the user to have quick access to descriptions of the items on the diary card and add their own skills and targets for treatment.

Christy: How can this app enhance treatment?

Dr. Banawan: There’s a lot of research supporting the idea that self-monitoring can help change behavior. This is just one step closer to keeping people on top of what they’re thinking, feeling and doing. It also frees us from having to fit the skills and treatment targets on one sheet of paper which can be extremely problematic and counter-productive.

Christy: Is it possible to personalize targets and preferred skills on the app?

Dr. Banawan: The app was designed to be completely flexible. I always start a diary card with a set of skills and targets and then customize them as appropriate. This app gives the user the ability to do that without a second thought. It’s really the app’s best feature.

Christy: Can you explain the “coaching” portion of the app?

Dr. Banawan: The Coaching part of the app doesn’t get nearly the attention it deserves and many of my users tell me it’s the most valuable part of it! In individual DBT treatment, we have “Coaching calls” where a client can call to get some skills coaching on the phone between sessions. This is a part of any comprehensive DBT program and helps get therapy outside of the therapy office. These coaching calls are designed to generalize skillful behavior. The Coaching part of the app is there to put some problem-solving skills at one’s finger tips. This part of the app will walk users through their particular situation and give them some suggestions about how to handle it and which DBT skill to use. It’s not a replacement for an actual DBT therapist, but it can go a long way towards making problem-solving easier.

Christy: Can you send a diary card created on the app to your therapist?

Dr. Banawan: The app will generate a PDF of your skills and treatment targets to your therapist automatically if you choose, remind you to send it or let you do it manually.

Christy: What other features of the app might compel someone to use it, rather than the paper and pencil version used in most DBT treatment.

Dr. Banawan: Accessibility and availability. Having the diary card with you at all times, in an inconspicuous way, can be extremely helpful. You also have access to essentially every skill you’ve ever learned right at your fingertips and you can add them as you learn new ones. This, combined with the coaching section can really make a big difference in both tracking your week and generalizing your skills.

How to find the app:

The app can be found on the iTunes store here:

http://itunes.apple.com/us/app/dbt-diary-card/id479013889?mt=8 or you can learn more about it at www.diarycard.net .

More about Sammy Banawan, PhD.

Sammy Banawan completed his Ph.D. in clinical psychology in 2004 from the University of Georgia where he was trained in the use of empirically supported treatments for a variety of psychological conditions. His dissertation examined the effectiveness of a self-paced online intervention for marital discord using a modified version of Behavioral Marital Therapy. He completed his internship and post-doc at the Duke University Medical Center where he focused on Dialectical Behavior Therapy in both clinical and research settings. He worked directly with Dr. Marsha Linehan and her group at the BRTC at the University of Washington to adapt DBT for substance use disorder. As part of this NIH-funded multi-site randomized clinical trial, Dr. Banawan worked with Dr. Thomas Lynch (PI) and other faculty at Duke to deliver DBT in a modified format. He also completed a two-week intensive training in DBT as well as had several training sessions directly with Dr. Linehan herself.

Clinically, Dr. Banawan has been interested in the use of DBT for a variety of conditions including depression, eating disorders and anxiety. After his post-doc, Dr. Banawan began his private practice, Durham DBT, with a focus on delivering comprehensive DBT to the Triangle region of North Carolina. He also worked as the DBT therapist for the Carolina House, a residential facility for women with eating disorders. He has long had an interest in the use of technology to assist in the delivery of empirically supported treatments and to aid in treatment outcomes. DBT Diary Card is the first app to make that interest a clinical reality.

Smartphone photo available from Shutterstock.

These are all valuable things to do and many of them may be essential to the people that you care about in your life.  Some may bring you pleasure and satisfaction, while others are chores that suck away precious time and leave you off of your own list of things to do.

Women are especially prone to putting everyone else’s needs before their own, but with today’s pressures, men often find themselves in the same predicament– caring for others, while neglecting themselves. In the midst of daily demands it’s easy to lose ourselves.

Thoughts that indicate you may be too far down your own priority list include telling yourself that “other people’s problems are more important than your own” or that “I can’t stand it if someone gets upset with me.”

Routinely putting other people’s needs first means your needs often get bumped to the bottom of the list.  Once they’re on the bottom, they frequently fall right off.  At the same time, excessive worries about other people getting upset with you makes it extremely difficult to assert your own wants and needs.

If you suspect that your sacrificing your own well-being to accommodate other people’s needs and demands, it may be time to make a change.

To begin:

• Make a list of your own priorities.  These are the things that are important to you, deserve your attention and make life meaningful and fulfilling.  They can include your spiritual needs, your need for intellectual growth or your health and wellness needs.  Once you’ve made your list, identify your top three priorities.
• Make a similar list, but this time, focus on those needs and demands of others that you find take up your time and energy and take you away from focusing on your own priorities.  You may want to jot down items as you go through a typical day.  Notice demands, such as washing dishes, mundane tasks at work, volunteer work, responding to email and preparing meals.
• Once you’ve made your list, identify three or more tasks that you can simply not do (sometimes we get stuck doing things because we feel we “should” but no real harm will come from skipping them).  If you’re a neat nick, you may be able to skip some of your regular cleaning, if you respond immediately to every email, call and social contact, you may be able to simply give up some less important interactions.  What you simply skip is dependent on your own personality and your assessment of what, in your life, you can loosen up on.
• Now identify three or more tasks that you can give to someone else, train someone else to do or negotiate to offload
• Giving unwanted tasks to someone else can be difficult, but it is possible.  Initially you may get some flack.  You may need to counter worries about disappointing or frustrating other people with thoughts such as “I can respond to other people better if I take care of myself” or “my needs are just as important as other people’s needs.”
• Once you have given up some of those demands from others, be sure to replace them with your own priorities from the first list that you made.

Making a new habit takes time.  Pay close attention for several weeks, to ensure that new demands from others don’t creep up on you.  Once you’ve made a habit of including yourself on your priority list, you’ll be better able to say ‘no’ to other people’s demands that interfere with your ability to take care of yourself.

To do list photo available from Shutterstock.

As I considered the past year, I looked back over posts I had written and found 5 that captured some of the struggles and strategies people identified with and found helpful.

In Can What You Eat Impact How You Feel? I discuss a review of over 160 studies that suggested that diet and nutrition impact mental health. These studies found that principles of eating, such as eating a wide variety of colorful vegetables, can have a positive impact on your mental well-being. They also found that deficiencies in our diets, such as a deficiency in vitamin D (a widespread problem in the US) can impact mental health.

The focus of Why Can’t I Get Off the Couch?  Is our continual struggle to incorporate exercise into our lives.  Although most of us know we should exercise regularly,  we often still don’t make it a habit. In this post I offer 4 tips to help you begin and stick to an exercise routine.

Have you ever wanted to avoid thinking about a particular experience or topic only to find that it continually intrudes into your thoughts and activities?  In How You Can Overcome Intrusive Thoughts I review techniques identified by social psychologist Daniel Wegner in this month’s edition of Monitor on Psychology to suppress intrusive thinking.

Extreme Emotion, Problem Behaviors and BPD discusses the Biosocial Theory and how the interaction between an invalidating environment and a biological vulnerability to extreme emotions can result in the impulsive and risky behaviors characteristic of people diagnosed with Borderline Personality Disorder.

Our body’s response is an important component of an emotional reaction to any event. In Exposed:  What Does Your Body Language Communicate, I review common examples of body language and the emotion that is often connected with a particular stance.

What are you continuing to struggle with?  What do you need strategies to handle?  In this new year, what would help you to feel better and improve your life?

Woman eating salad photo available from Shutterstock.

I am an anxious flyer.  I don’t avoid trips, but I think twice before booking one.  I have all sorts of techniques to take my mind off the flight, particularly during take off and landing, which always feel like the most vulnerable parts of the flight.

I wasn’t always frightened of flying.  As a child, flying was an adventure.  Sudden dips that made my stomach flip were fun.  But in my teens, the physics of flying simply seemed impossible.  Then, as a young adult, I got a VW bug.  The car was older than me, cute, fun to drive and constantly breaking down.  When I learned that many of the planes in use at the time were the same age as my car, my anxiety increased.  If my 20 year old car constantly broke down, why wouldn’t a plane of the same age, I wondered.  Add in a flight with real mechanical difficulties that were quite scary and my anxiety stuck.  For me, flying has come to represent a complete lack of control and during times of stress I have nightmares about plane crashes.

Logic, reciting to myself that “flying is safer than driving,” distraction and deep breathing all help me get on a plane.  But once on, I am always anxious.

All of this is why I have looked forward to the release of Elisha Goldstein’s Mindfulness Meditations for the Anxious Traveler: Quick Exercises to Calm Your Mind. In his book, Dr. Goldstein offers simple and practical mindfulness exercises specifically targeting anxiety while traveling.  It includes 3 video-led mindfulness exercises to practice with in relationship to anxiety around traveling.

At this time, I have not had the opportunity to fly while using these techniques.  However, I plan to practice them now and put them to use on my next trip.

To date, my top methods of dealing with the anxiety of traveling include:

• Deep breathing,
• Distracting myself with books, music or in-flight programs,
• Repeating like a mantra “flying is safer than driving”
• Pushing away fears about flying by creating a mental wall between my fears and my current thinking

Are you an anxious traveler?  How do you keep your anxiety from limiting your life?  What techniques or strategies do you use to get you through a flight, long car ride or other type of travel?

Plane and magnifying glass photo available from Shutterstock.

We might love the holidays, but find ourselves trapped in a recurrent family drama year after year.  A romanticized version of family life promoted in holiday songs, television ads, magazines and stores throughout the country would have us believe that “home for the holidays” involves crackling fires, roasting chestnuts, warm embraces and comfort.

But, in reality, during this season of family gatherings many experience tension, conflict, shame, embarrassment, irritation and disagreement. And, for better or wore, what we remember about holidays is usually more about family, gathering together and spending time with loved ones, than about any one particular gift that we receive.

But, because our families are comprised of human beings, rather than characters from a television advertisement, holiday gatherings are often as full of reminders or our past embarrassments and family shortcomings as they are with warmth and increased intimacy.

I often provide tips on getting through difficult moments, but today I’m interested in hearing tips from you.  What is your holiday story and how did you deal with a holiday that might have been far from picture perfect?  How do you handle it when your sister brings up an ex in front of your new partner or when uncle Joe pours himself another glass and starts in on a diatribe about gay marriage.

Did you embrace it?  Take it outside?  Soldier on with a stiff upper lip?  Grit your teeth and endure it? Jump into the fray?

But greater happiness is not closely correlated with getting things.  It’s our experiences that increase our happiness over time.  And many experiences are free.  Below are suggestions for giving this season that don’t cost anything and just may be the gifts that are remembered long after the hustle and bustle of the holidays has passed.

Give the gift of your time

Soup kitchens and charities can always use spare hands, but so can people in our day to day lives.

• Offer to watch a busy mother’s children, so she can wrap presents or go to the grocery store unencumbered.
• Pick up dry cleaning or groceries for a friend working long hours
• Help an elderly neighbor put up decorations or clear their walkway of snow

Give the gift of tradition

When you think back to your childhood, it is likely that you remember specific traditions, more than a particular gift and that it is these traditions that make the holidays seems special.  Sharing customs and traditions with others will make the holidays memorable and special in a way that no store bought gift can.

• Spend time with children telling stories or passing on traditions from your family
• Create new rituals—for instance giving thanks at meal times, remembering loved ones who aren’t present, singing holiday songs, baking together, making special decorations or reading a particular story.
• Put on holiday music that connects you to your past
• Participate in local activities, such a tree lighting ceremonies, sing-alongs or social gatherings
• Reconnect with customs from your heritage—for example, some Polish Americans on Christmas Eve spread hay on their kitchen floor and under the tablecloth to remind them of a stable and a manger. In Alaska, boys and girls with lanterns on poles carry a large figure of a star from door to door.  Advent calendars and the use of tinsel first originated in Germany.

Give the gift of kindness and generosity

Although we all feel we should be happy and joyful during this season, many are stressed, overloaded with demands and expectations and feeling frazzled.  An act of kindness or generosity can lift someone’s spirits during a difficult day and make you feel good for contributing to their happiness.

• Say a kind word to someone
• Start the day off with positive remarks
• Think about and communicate to others how they enrich your life
• Listen to someone else’s troubles, without needing to share your own experiences or difficulties.

These are just a few suggestions for making this time of year meaningful and joyful without the need to spend money.  Please share any ways that you give to others, without spending, in the comments section.

Senior and friend photo available from Shutterstock.

We’ve all seen how failure to admit wrong-doing and mistakes can impact public figures.  Martha Stewart, for example, went to jail, not for her original actions, but for trying to cover them up.  On the news this morning, I heard another case of public figures who had mishandled allegations of sexual abuse. They are now the subject of a grand jury investigation—not for their mishandling of the allegations, but for their attempts to cover up (with lies and by perjuring themselves) their original mismanagement.

We’ve all made mistakes and blunders, have forgotten or failed to act at important moments or unintentionally or callously hurt others at some point or another.  Sometimes our errors in judgment are small and relatively inconsequential, while at other times, such as in the mishandling of sexual abuse allegations, there are considerable consequences.

Shame and embarrassment can cause us to try to hide our mistakes and errors.  But hiding doesn’t solve problems and often makes them worse.  It also doesn’t result in forgiveness or a sense of peace that comes from having confronted and rectified past mistakes.

Whether big or small, facing wrong-doing is the key to moving on.

1. If you’ve acted poorly and are embarrassed or ashamed about your conduct, rather than hide, approach the situation.
2. When you approach, you’ve got to do it all the way.  This means facing anyone you’ve wronged and sincerely apologizing.
3.  Make efforts to repair any damage you’ve done. Ask yourself what you can do to improve the situation and do it.  It’s not always possible to fix problems when we’ve made mistakes and done wrong, but making a real and significant effort to do what you can to make amends, fix problems and be a part of solutions is part of the process.

Make no mistake: this process is painful, especially when your action was egregious and you’re unable to truly fix the problems that resulted.  But, going through the pain and acting with sincerity and dignity is the path to self-forgiveness, moving on and maybe the forgiveness of others.

Young couple photo available from Shutterstock.