DBT Skill of the Day: Opposite Action to Sadness

In the Emotion Regulation module of DBT there is a skill called Opposite Action. As the name would suggest, it means acting opposite to the way you are being driven to act (by ineffective feelings, thoughts and urges) in order to regulate your emotional state.

For example, the “action urge” of shame is to hide away. In situations where shame isn’t warranted, acting opposite would be exposing yourself and the thing you feel shameful about for everyone to see. The action urge for anger would be to lash out, attack or defend. Opposite action to anger would look like gently avoiding, or even generating kindness towards, the source of that anger.

Today, I have been feeling painfully depressed. Depression for me is apparently sadness, according to my therapist, even when it doesn’t feel like it because I am so apathetic. The emotion of sadness may have been somewhat justified, but the intensity certainly was not. It is not effective to go with my sadness when it’s as high as it has been recently, because all that happens is I avoid life, stay in bed, cry, remain unproductive, and think very hopeless and destructive thoughts. 

Until 4pm I was not being particularly skilful, as I returned to my bed straight after DBT group ended. I really wanted to be effective but was struggling to generate willingness. I felt willing cognitively, but was struggling translating any of that willingness into physical actions. I reached out for skills coaching and got my DBT handbook out, then committed to doing the Opposite Action I agreed with my therapist. 

This is the sheet from Marsha Linehan’s DBT workbook on Opposite Action to Sadness:

  
The first step was to change into an outfit I felt more confident in than pyjamas, and actually put on a bra and deodorant in preparation for…. shock horror!… leaving the house. This was the beginning of implementing numero 2 – avoiding avoiding

To get active (number 1) I agreed to take my dogs for a walk for around an hour. (My therapist is very pro behavioural activation.) This meant I was also avoiding avoiding my responsibility to care for my pets – which is important because I love them and don’t want them to be deprived because of my shitty mental state. I left my phone and did this mindfully in order to increase my awareness of the present moment (number 5). I also inadvertently used points 6 and 7 here.

I didn’t quite build any specific mastery (number 3) although using skills of my own accord and not making the situation worse maybe counts for something there.

Lastly, to increase pleasant events, I watched Impractical Jokers (a shitty but hilarious American reality TV show) in order to influence other emotions

All in all I survived the day without hurting (or killing) myself. (Sorry to be morbid but this is the truth when it comes to living with BPD). Considering how much I’ve been struggling, that certainly stands for something. In the moment it’s easy to hate Opposite Action to sadness because it requires extortionate amournts of effort and can feel pretty invalidating when I’m hurting so bad. But at the same time, when it comes down to it, sometimes it also really does work.

Reminder: Opposite Action is only used when the emotion or emotional intensify does not fit the facts i.e. the emotion or its intensity does not match the situation.

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