Dialectic Behavior Therapy (DBT) provides us with many excellent concepts and skills to practice and incorporate with various areas of distress and dysregulation, including the current uncertain times of living with COVID-19. The way in which this pandemic illness is spreading all over the world and is the focus of most any current conversation requires that we find a way to cope effectively. Marsha Linehan, the founder and developer of DBT, provides us with several excellent ideas about how best to manage stressful times.
Many of us Americans struggled to radically accept that this virus was in our midst and needed prompt attention. I noticed that I was initially thinking that this couldn’t be as dire as was being portrayed in the media, and I was hoping we could just continue on with primarily focusing on ways to reduce anxiety. I wanted to help my clients limit exposure to panic being promulgated on various social media sites and to focus on using good common sense (like practicing proper hygiene and staying home if sick). And I was rather willful at first about not wanting to cancel my vacation that had been carefully planned and scheduled for over a year.
However, I have had to embrace willingness to recognize that I need to do what is needed and participate fully in the process of changing the way I mange my daily life. I need to fully and whole-heartedly offer teletherapy options to all of my clients (including finding a way to run DBT group on-line), cancel the social gatherings that are a critical part of my self-care, and put adventuresome travel on hold indefinitely. As Linehan astutely points out: rejecting reality does not change reality.
Linehan has an elegant model which provides a solution to any problem, and this is focused on four primary ways that we respond to a serious problem in life:
- Figure out how to solve the problem.
- Change how you feel about the problem.
- Tolerate and accept it.
- Stay miserable or possibly make it worse (by using no skills).
The coronavirus pandemic provides opportunity to practice all four of these responses, though clearly focusing on options 1, 2, and 3 would be more ideal. Option 1 forces us to consider how we maybe can’t solve the problem of the virus being here, but we can keep practicing ways to limit spread of the virus and to be smart about how we proceed in the weeks to come. Option 2 references the fact that we can focus on ways to use skills of emotional regulation, part of which might be to simply be mindful of our current emotions (which, in of itself, often actually reduces the intensity of emotion). Option 3 might be the one that is potentially most applicable in this circumstance, which is focusing on acceptance as a way to reduce suffering. This latter option is especially helpful when other options don’t seem to be working, such as when one can’t solve the problem or is struggling to change emotions about the problem.
Various reputable sources of information (including CDC and WHO) and illness mitigation models currently in place show us that we need to accept the facts that this pandemic is upon us and that social distancing really seems to be scientifically based. These are the facts about social distancing being needed and appropriate:
Source: “Coronavirus: Why You Must Act Now” by Tom Pueyo on Medium
“The earlier you impose heavy measures, the less time you need to keep them, the easier it is to identify brewing cases, and the fewer people get infected,” Pueyo writes. This is similar to the DBT approach of how addressing a painful or problematic issue in our life sooner rather than later can mean that there is less overall distress. The longer we ignore or refuse to face the facts, the more long term unhappiness and suffering there is overall.
The reasons for facing the facts immediately in this COVID-19 outbreak are not only for our mental health but also strongly correlated with better outcome for physical health for thousands. It has become clear that our healthcare system would be much better equipped to manage cases more slowly over a longer period of time. This would also allow scientists to continue their work on developing the vaccine. We are striving for the flattening effect:
Source: “Flattening A Pandemic’s Curve: Why Staying Home Now Can Save Lives” by Maria Godoy on NPR
“It’s all part of an effort to do what epidemiologists call flattening the curve of the pandemic,” Godoy writes. “The idea is to increase social distancing in order to slow the spread of the virus, so that you don’t get a huge spike in the number of people getting sick all at once.” This provides an interesting approach where the goal is not currently to eliminate coronavirus contagions but rather to postpone them until a time when science has advanced enough that the risk can be eliminated completely.
Engaging in the recommended social distancing and quarantining for some will mean that interpersonal skills are tested in a new way. Family members or roommates who haven’t generally spent as much time together will now suddenly be thrown into more constant contact. Validation skills may be taxed as each person approaches this pandemic in different ways and may be protective about their view of how best to cope. There may be more need for those Interpersonal Effectiveness skills on a more regular basis, with individuals who are able to use assertiveness, respect and communication effectiveness likely finding important relationships more positively maintained.
One seminal interpersonal skill acronym, DEARMAN, very craftily guides individuals to obtaining objectives effectively by using steps to Describe, Express, Assert, Reinforce while staying Mindful, Appearing confident and Negotiating as needed. Some household, romantic, neighborhood or work relationships might need more positive focus for improvement (using GIVE skills) while other might need focus on self-respect (using FAST skills). We are also likely to see a sharp rise in loneliness factors potentially given the natural reduction in social connections, and this will require us to be more creative as the usual skills of seeking proximity with others and joining community groups might be put on hold for some time.
There may be many things we can’t do, but there are also actually many things we can do in the weeks to come. We can continue to find the dialectical balance of bringing in wise mind focus, being mindful to aim for the middle path of not staying stuck in overly emotional or the overly rational mind. Continuing to attend to the basic of self-care will be critical. Linehan outlines these with one of her clever acronyms, PLEASE, which stands for the reminder to treat PhysicaL illness, balance Eating, avoid mood-Altering substances, balance Sleep, and get Exercise. All of these foundational behaviors are shown to be highly helpful with both mental and physical health.
We can also strive to use the ABCs of reducing vulnerability to emotion mind, namely Accumulating positive emotions, Building mastery, and Coping ahead. We can use the many Distress Tolerance skills relating to distract, soothe and improve (each with DBT-famed accompanying acronyms), ideas focused on actions and mindsets which can assist in staying skillful when emotions are threatening to overwhelm.
Many things will likely continue to be canceled and many things might be changed in the upcoming weeks. Our flexibility muscles are going to be tested. But it is also breaking news there are also many things that are not canceled, and there is wisdom in keeping some perspective on these as well:
Pueyo, T. (2020 Mar 10). Coronavirus: Why You Must Act Now. Medium. https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
Godoy, M. (2020 Mar 13). Flattening A Pandemic’s Curve: Why Staying Home Now Can Save Lives. NPR. https://www.npr.org/sections/health-shots/2020/03/13/815502262/flattening-a-pandemics-curve-why-staying-home-now-can-save-lives
More About Coronavirus: Psych Central Coronavirus Resource