Grounding Skills Effective Psychological and Spiritual coping skills Unity Point Oncology Conference 11.4.16 Heidi Vermeer-Quist, Psy.D. Licensed Clinical Psychologist

Grounding Goals today: Introduction Grounding Goals today: Self-talk, Self-Care, Spirituality, Grounding (DBT - mindfulness & emotion management), and other tangible skills that you can use to help patients and also to deal with your own life struggles. Encouraging patients to talk openly and honestly with family members to enhance good relationships throughout the cancer journey. Q & A

From the book…GROUNDING GROUNDING Your Life From the book…GROUNDING For this Power Point Presentation, the “Grounding” book, or to contact me with any questions, please visit: www. gardeningyourlife.com

Grounding Grieving & Growing in the hands of our Master Gardener GROUNDING Your Life Mental health is a lot like gardening… Grounding Grieving & Growing in the hands of our Master Gardener John 15 – Abiding in the Vine

Grounding Self-Talk Words become Worlds GROUNDING Your Life Grounding Self-Talk Words become Worlds What do you tell yourself? Train your brain to embrace a Healthy Self Concept: For Example: In Christ, I am Accepted I am Secure I am Significant

GROUNDING Your Life Grounding Basics Physical Health! We are organic too, so tend to the BIG THREE: Eat Sleep Exercise

GROUNDING Your Life Grounding Basics PRACTICE Set the tone for application of “Grounding” work throughout the week – Journaling and Using the Grounding Skills Log daily. Use it or lose it…No shame, just lots of encouragement!!!

Grounding – Healthy Limits Put Down Roots for Healthy Boundaries GROUNDING Your Life Grounding – Healthy Limits Put Down Roots for Healthy Boundaries Healthy Boundaries – Good News! You are responsible FOR far less than you think. Learn how to live in and manage your own backyard.

YOU GROUNDING Your Life F – feelings A – attitudes B – behaviors NOW (one moment at a time) RESPONSIBLE FOR Your One Life – Right Now. Managing Your FAByoulous treasures.

GOD YOU GROUNDING Your Life Other Person Source of Love, Life, and Wisdom Prayer Other Person F – feelings A – attitudes B – behaviors NOW Prayer Speak the Truth in Love! YOU F – feelings A – attitudes B – behaviors NOW RESPONSIBLE TO EACH OTHER BY SPEAKING THE TRUTH IN LOVE

Grounding – Healthy Limits GROUNDING Your Life Grounding – Healthy Limits Know Your Limits – Healthy Boundaries CAUTION: You are about to enter the “O” Zone! Getting stuck in the “O Zone” is when you feel responsible for Others, Outcomes and Old Stuff. Just notice: when you feel responsible for the the “O” Zone, you WILL feel stressed. Do you think that perhaps God made you to feel stressed in those times, in order to signal you to slow down and remain responsible just for YOUR part?

Prayer Benefits of Prayer: Feel less alone – aware of being with God GROUNDING Your Life Prayer Benefits of Prayer: Feel less alone – aware of being with God Look at a bigger picture Discern meaning and purpose in the midst of suffering Entrust God with the “O Zone” A prayerful experience can help clients feel less alone, look at a bigger picture than just their own frame of reference and discern meaning/purpose in the midst of their suffering.

Grounding – Living in the Precious Present GROUNDING Your Life Grounding – Living in the Precious Present Be Mindful – live in the precious present. Putting your mind fully on something. Use Your Five Senses Use Your Breath – 4-7-8 Practice Observe, Describe, Participate in the gift of the present moment.

Mindfulness Skills GROUNDING Your Life WHAT Skills: Observe – observe the moment you are in. Turn your mind to WHATEVER is in this present moment. External and internal mindfulness… Describe – describe what you are observing. Attach words to what you are experiencing… Participate – participate in the moment. Be involved in whatever you are doing… Linehan trains Mindfulness from a behavioral approach, teaching both the “what to do” and the “how to do it” skills. For example, if someone just tells you to “smile,” you may or may not enjoy it. However, if someone tells you to “smile” and “imagine your favorite place,” you probably will. Similarly with Mindfulness, the “what” skills tell you what to do, while the “how” skills teach you how to approach the “what” skills. Three Steps… Observe - …Focus on what is external (outside of you) or what is internal (inside yourself). Accept it just as it is (not necessarily as you would have it). Do not judge it; rather look at it as objectively as possible. Describe - …Be like a scientist observing and writing down field notes on an object or experience. Participate - …like a musician who is 100% involved in a piece of music. If you are walking—walk. If you are driving—drive. If you are talking—talk. If you are typing—type….

Mindfulness Skills GROUNDING Your Life HOW skills: Non-Judgmentally – Accept the moment just as it is. Notice what is helpful and harmful but try not to judge. One-Mindfully – Be mindful of each activity, doing one thing at a time. Let go of distractions – use “Teflon mind” – letting unhelpful thoughts slide off your mental frying pan and then return to the present moment. Effectively – Focus on what works effectively for the moment. Use the principles, morals and values you know and trust. Use effective tools: journaling, prayer and social support. Consider your options – what is most effective (not perfect) for the situation. MINDFULNESS…HOW TO DO IT? First, take a non-judgmental stance and accept the moment just as it is. Acknowledging what is helpful and what is harmful is fine, but try not to judge. Second, each activity is approached as one-mindfully, defined as doing one thing at a time. Let go of distractions that keep you from focusing fully on accomplishing this task. Allow yourself to use what Linehan calls, “Teflon mind,” letting unhelpful thoughts slide off your mental frying pan and then return to the present moment and the task at hand. Let go of “O zone” thoughts… Third, focus on what works effectively for the moment. Use the principles, morals and values you know and trust. Use tools like journaling, prayer and social support to identify your helpful options. Consider your options, and choose what is most effective (not perfect) for the situation. In His Sermon on the Mount, Jesus instructs us to trust God and participate in the present moment, just like the birds of air and the flowers in the fields (Matthew 6:25 -30). He also teaches us to let go of judging, especially judging one another.  We are encouraged to constantly communicate with God, trusting Him to guide us, guide others and allow Him to be the judge (Matthew 7:1-5). I love how Jesus tells us to stop our over-controlling and deal with ourselves...right now...effectively addressing the plank in our own eye and depending on Him to help us remove it.

GROUNDING Your Life Mindfulness Exercise External Mindfulness – focus on the breath and then guide yourself (or others) through observing, describing and participating in the five senses. Goal: Calm and External Grounding. Internal Mindfulness – focus on breath and guide yourself (or others) through observing, describing and letting go of thoughts. Notice, name and move on to the next thought. Goal: Calm and Internal Awareness & Grounding. MINDFULNESS EXERCISE Now let’s apply these skills focusing on our five senses. The fist DBT module shows how to use slow, easy breaths throughout this exercise and give yourself time to focus on each sense for a few minutes. First, pay attention to what you are physically touching. Observe and describe in your mind what you are touching (i.e., the chair or another object). Simply observe what you are touching. Describe or put words on it. Now, participate (feel it and allow yourself to enjoy it) for several seconds. Next, pay attention to what you hear. Simply observe, describe and participate with what you are hearing. Then pay attention to what you smell (observing, describing and participating). Now, turn your mind to what you taste in your mouth. Observe, describe, and participate in that taste. Finally, pay attention to what you see. Gently and slowly observe, describe and participate with one or two objects that you see. With practice, clients will feel more grounded and in tune with themselves and their surroundings.

Emotion Management… Whoa, Nelly! GROUNDING Your Life Emotion Management… Whoa, Nelly! Linehan uses a horse and rider analogy when training clients about emotions and how to manage them. Imagine that your emotional mind is your internal horse living inside. It gives you lots of signals and reactions that you depend on. Your horse may react in all kinds of ways: excitement, fright, frustration, joy, sadness, caution, anger, nervousness, suffering and more. Here, we are encouraged to identify and value what our emotional mind (“Nelly,” as I like to call her) is signaling. Rather than reacting to automatic feelings, take time to feel them, become more mindfully aware of them, and understand what they are signaling.

Emotion Management… Whoa, Nelly! GROUNDING Your Life Emotion Management… Whoa, Nelly! The horse – emotional mind – needs the rider The rider – reasonable mind – needs the horse (with all of its strength and ability) Designed to work together to produce “wise mind” realities. Use prayer, paying attention to a loving God, the Ultimate Horse Whisperer! The horse needs the rider and the rider needs the horse, with all of its strength and ability.  Similarly, our rational minds (the rider) and our emotional minds (the horse) are designed by God to work together.  As we train our emotional mind with our rational mind, ever drawing from the life source of God, we will produce “wise mind” realities.  God IS, after all, our Horse Whisperer, training us to reign in our emotions and follow Him.

Emotion Management GROUNDING Your Life Observe Your Emotion – just name it. Experience Your Emotion – as a wave coming and going. Remember You Are Not Your Emotion – Your emotion is just part of you – a signal. Emotions only last 8-15 seconds. The more we accept what we feel and distract our thoughts to neutral or positive experiences, the less we feed the distress and suffering of our emotions. Practice Loving Your Emotion – don’t judge it… practice accepting it. Linehan encourages letting go of emotional suffering by increasing Mindfulness of the current emotion. She uses the following steps: Observe Your Emotion – just name it. Experience Your Emotion – as a wave coming and going. Remember You Are Not Your Emotion – emotions only last eight to 15 seconds. The more we accept what we feel and distract our thoughts to neutral or positive experiences, the less we feed the distress and suffering of our emotions. Practice Loving Your Emotion – don’t judge it… practice accepting it.

FAB Prayer Journaling through Emotions GROUNDING Your Life FAB Prayer Journaling through Emotions Dear God, F - What am I feeling? A - What am I reacting to? the current situation: my interpretation (subjective): the truth (objective – just the facts): B - How did I (or how am I now) respond(ing) to my interpretation of the situation? What is my typical knee jerk response? What other options do I have? (Really listen to yourself, God, what others have taught you….) What do I choose to do?   While the following journaling exercise is not taken directly from DBT, it effectively helps clients work through their emotions, gain self-awareness, and think through their options… moving toward wise mind decisions.  

Distress Tolerance Wise Mind ACCEPTS A – Activities C – Contributing GROUNDING Your Life Distress Tolerance Wise Mind ACCEPTS A – Activities C – Contributing C – Comparisons E – Opposite Emotion P – Push Away T – Other Thoughts S – Five Senses This fourth skill-training module, Distress Tolerance, provides strategies to assist clients with finding purpose in their suffering. Linehan encourages us to radically accept distressful situations, ground ourselves using our five senses, and improve the moment using mindfulness skills, prayer and positive experiences.

Grounding – Radical Acceptance GROUNDING Your Life Grounding – Radical Acceptance ACT (Acceptance-Commitment Therapy) The Serenity Prayer Posture Accept what you cannot change Courage to change what you can (your one life, one moment at a time) Remain Committed to Faith, Principles & Values

Serenity Prayer (for today) GROUNDING Your Life Serenity Prayer (for today) God, grant me the Serenity (tranquility, composure and peace) to ACCEPT (gratefully receive) the things I cannot change (Others, Outcomes and Old stuff), COURAGE to change the things I can (myself in this moment, managing my Feelings, Attitudes, and Behaviors), and WISDOM (understanding) to know the difference… You all have a copy in front of you, for you to easily read This time take note of the may DBT skills – easily integrated in Dr Niebuhr’s prayer Let’s pray together

Continued… GROUNDING Your Life LIVING One Day at a time… ENJOYING One MOMENT at a time (mindfully observing, describing and participating in the precious present) ACCEPTING HARDSHIP as a pathway to PEACE… TAKING, as Jesus did, this sinful (evil, corrupt and broken) world as it IS, not as I would have it… TRUSTING that You are making all things right as I SURRENDER (give in)to YOUR will… So that I am reasonably (sensibly and quite) HAPPY in this life and SUPREMELY HAPPY with You forever in the next. AMEN (So be it!) —Adapted from Reinhold Niebuhr’s Original by Heidi Vermeer-Quist You all have a copy in front of you, for you to easily read This time take note of the may DBT skills – easily integrated in Dr Niebuhr’s prayer Let’s pray together

Encourage Patients to Talk GROUNDING Your Life Encourage Patients to Talk Talk openly and honestly with family to enhance good relationships throughout the cancer journey. Remember Boundaries – Don’t assume anything. Remember loved ones do care, but they don’t fully understand. Receive care and radically accept that others are powerless in controlling the “O zone” too. Focus on walking this journey together - one moment at a time.

Linda Wilson’s 5 C’s (Cancer Survivor) GROUNDING Your Life Linda Wilson’s 5 C’s (Cancer Survivor) Cry out to God. Pray for yourself and ask others to pray with and for you. Count your blessings. Slow down and just notice what is going well. When you count your blessings it changes your outlook and your mood. Claim God’s promises. In the Bible, God promises to provide for you and never leave you. You can read thousands of passages to back up this claim. I encourage you to start with the Psalms and hear songs of both despair and joy.

Linda Wilson’s 5 C’s GROUNDING Your Life Consider your options and opportunities. SLOW DOWN! Don’t make hasty decisions out of your emotions of grief—fear, anger or depression. Tend to those emotions by listing out your options. Perhaps enlist a trusted friend or counselor to help you think through your options and opportunities as your deal with the challenges of cancer. Choose to trust and work toward positives. Accept what is real and choose to squeeze out every ounce of learning you can. Look for meaning/purpose. Positive Psychology.

GROUNDING Your Life Grounding Skills Q & A

From the book…GROUNDING GROUNDING Your Life From the book…GROUNDING For this Power Point Presentation, the “Grounding” book, or to contact me with any questions, please visit: www. gardeningyourlife.com

Gardening Your Life (for groups or individuals): GROUNDING Your Life Gardening Your Life (for groups or individuals): Book One: Grounding Conference Sale: $20 Cash/Check only (VQ Consult) (regular price $25) Book Two: Grieving (pruning) Brand new - $20 Cash/Check only Book Three: Growing (new growth in grateful community) Coming in 2017 Close with Serenity Prayer – out loud together