Jackie’s third goal was learning to manage self-judgments and self-abasement that contributed to self-loathing. She found three skills particularly effective. Mindfulness alerted her to engagement in negative or ineffective self-communications. She then used the distress tolerance skills of grounding and distraction to shift her attention away from such thoughts toward her body or environment.
This technique combines the observe, describe, one-mindfulness, and effectiveness skills. Observe and detail five things you see in your environment. Then describe four things you hear, three things you sense or feel, two things you smell, and one thing you taste. Watch when your attention wanders back to judgments, calling it back to observations. Jackie took the initiative to pair this with squared breathing. She breathed in for four seconds then held for four while describing to herself what she observed, then breathed out for four. This added layer forced her to focus on noticing and breathing rather than on thought processes.
- Colors of the rainbow
This is similar to 5-4-3-2-1 as it involves external observation and directs attention away from judgments. You look for every item in your environment that corresponds with a color of the rainbow: red, orange, yellow, green, blue, indigo, violet (ROYGBIV). Jackie started with red then moved through the other colors, though the order of colors isn’t mandated.
- Feet pressure
This exercise is dialectically both easy and tricky. Push your feet into the floor as hard as you can to notice the sensations. Pay attention to different parts of your feet and legs down to individual toes. Though this exercise was effective for her, on days when her knee pain was too intense, Jackie would clench her fists or run her fingernails over her forearms instead.
When grounding didn’t quite work for Jackie, she would employ distracting behaviors pairing mental with physical activity. Going for a short walk, painting, cleaning, or baking allowed her to move her body and get her mind off unhelpful thinking patterns.
Jackie’s fourth treatment plan goal was improving communication with others. It gave her significant distress. Boundary setting and assertiveness were completely foreign to her. She remarked that it was often more comfortable for her to continue being derided by her mother and maintain caretaking patterns than to face the stress of changing those dynamics.
Distress tolerance skills were therefore vital in managing Jackie’s distress and concerns about relationship conflicts. Grounding techniques took her attention away from such rumination and toward finding meaning in the difficulty of changing her patterns.
When Jackie experienced distress after setting a boundary with her mother around weight judgments, she created her own “at-home day spa”, as she called it. She soothed herself by taking a bath, playing relaxing music, dimming the lights, and drinking her favorite tea. She found this so helpful that a lot of time in one session was spent building a list of other ways she could self-soothe to manage distress.
When it came to interpersonal effectiveness and communication, radical acceptance was really important for Jackie to practice while she was changing those dynamics. Other goals could be met by changing what was within her control, but where other people are concerned we must often accept things we cannot change as they are not in our control.
Jackie couldn’t control other people in her life, particularly not her mother. So she had to balance her healthier setting of boundaries and practice of assertiveness against acceptance that she may nonetheless never see altered behavior and judgments from her parent.