PLEASE Take Care of Your Body...Your Emotions Said So.
When was the last time you ate? No really, when’s the last time you had a meal?
It’s surprising the blank stares or embarrassed facial expressions I get in response to this question. Or how often I reflect on the day and realize that breakfast bar has long since run its course. Enter DBT PLEASE! Not please more DBT, rather, the PLEASE skill from the Emotion Regulation module of Dialectical Behavior Therapy.
Vulnerability to emotion is not always considered. We frequently focus on the emotions that occurred during an event or explore emotions as they are experienced after the fact, which are both fine. However, looking back on vulnerability factors that contributed to emotional states is just as important. The PLEASE skill helps to shine light on those elements of self-care that, if neglected, increase susceptibility to emotional dysregulation.
PLEASE stands for PhysicaL Illness, Balance Eating, Avoid Mood-Altering Substances, Balance Sleep, and Get Exercise. The acronym helps as a reminder of these “basics” when emotional dysregulation gets in the way, although many clients choose to keep an index card handy for reference.
Physical Illness involves taking care of physical problems. These can include making and attending medical appointments, using medications as directed, obtaining treatment when sick, and taking care of your body, overall.
Balance Eating doesn’t mean strict dieting, it can be as simple as remembering to eat in moderation (or just remembering to eat at all). In our busy worlds, an entire day can go by without a solid meal; in contrast, an entire bag of chips or quart of ice-cream can be consumed in one sitting (This is Us made me do it!). Applying mindfulness skills to eating can help increase awareness of unhealthy eating patterns.
Avoid mood altering substances
Avoid Mood-Altering Substances speaks for itself, namely in reference to illicit drugs and alcohol. Degree of abstinence is up to each individual, but if working on mood, taking things that affect the mood may not be the greatest idea. It is also important to consider caffeine here. The effects of caffeine can mimic symptoms of anxiety and this can be difficult to differentiate.
Balance Sleep. How many times have you been told “make sure to get 8 hours,” and followed that up by rolling your eyes? Yea, it can be hard at times, but good sleep hygiene is imperative to emotional health.
Finally, Get Exercise. Like eating, this one is not suggesting you have to be a gym rat or the next big cross-fit star. A good place to start is walking. Sometimes, I have clients start with just putting on their tennis shoes, that’s it, just the shoes as the goal for the week. Almost always, once the shoes are on, they find themselves walking somewhere.
Although some might consider these to be “obvious” or “a given,” not everyone can remember Maslow’s Hierarchy of Needs from PSYC 101 way back when! Actually, even if someone does have an understanding that basic needs are important, these are often the first things to get DE-prioritized on our to-do lists when life gets busy. Further, depression, and many other diagnoses, are notorious for decreasing motivation and causing people to “regress” to a state of not being able to care for basic needs. This can create friction with caregivers and add to overall emotional turmoil.
At PSYCHē, we offer Environmental interventions (EV’s) that allow EV Coaches to assist clients with day-to-day functioning. This can include accountability tasks (term papers, studying, going to the DMV, etc.), time-management, organizational concerns, etc. EV’s are especially helpful to those who are unable to carry out the tasks of the PLEASE skill. EV Coaches can assist client’s with exactly what they are working to manage, such as making those medical appointments or getting those tennis shoes on! EV Coaches can even help client’s trying to manage a new sleep schedule by making house calls when they’re supposed to be waking up! EV’s are a way to bridge therapeutic services with everyday life, which is a common misstep for those diagnosed with depressive or anxiety related disorders.
Now that you have greater familiarity with the PLEASE skill, ask yourself “when was the last time I ate?” Maybe there’s something to being “hangry” or “hanxious.” If that’s the case, how might the moods of your clients be related to an increase in emotional vulnerability that happened well before the onset of emotional dysregulation. And how much of that could have been prevented by having a better understanding of the DBT PLEASE skill?