Imagine if I was just doing this for the content. It's probably a bad sign when you tell a friend about a medical procedure you just had and their immediate response is, so are you gonna review it? And a worse sign when the answer is, duh, I started working on it months ago. But here we are, because I knew from the moment that I decided to get a vasectomy that it is something I would talk about on YouTube. And when I started making plans to end the channel and choosing which of my many incomplete scripts to actually finish, I knew that this was going to be one of them. Because I've always been an open book, and I think that transparency is much of why I've gotten any kind of following it all over the past four and a half years. So, certainly not gonna change that now. Unfortunately, despite the fun intro, this is not actually a vlog. I didn't get any dope doctor's office b-roll, nor did I film the surgery. However, I did do little video diaries at various points during the process, which I will be interspersing throughout this broader discussion of why I got a vasectomy and what it does and doesn't mean to me. So, before we get into the heavy shit, let's start with the very first one of those. So, I just got out of the initial consultation with the urologist who will be performing the procedure in about a month and a half because in New York, at least, there is a mandatory minimum 30-day waiting period between the initial meet and greet with your would-be bowl mangler and the actual mangling of your balls, which I think is a good thing, not only because, you know, you shouldn't make this on a whim, but it does feel a little different after talking to him, right? Like, I had wondered if you would try to talk me out of it or at least, like, ask me probing psychological questions about why I was doing it and he didn't do that. He made a joke, like, have you already had so many kids that you just can't deal with any more of them and I was like, is zero too many? And he said, all right. And then he just sort of walked me through the procedure, but he did impress upon me the permanence of it, right? And I know that some vasectomies can be reversed, but he said it's kind of a humpty-dumpty thing, right? Easy to break, hard to fix. And to that point, he gave me the number of a sperm bank, which is not something I'd ever seriously considered before, but now that I'm at this point headed rapidly towards no return, it seemed like, you know, I should do my due diligence, right? Especially because if it's not very expensive, there is no downside and a potentially massive upside. So I think I'm going to call them. So I gave them a call. It's an organization that was specifically recommended by my urologist and I talked to a lovely woman who walked me through the procedure and the prices. She was clear a little put off by the fact that I don't have children but want to do this whole thing, but, you know, she was very nice about it and it's kind of a frustrating amount of money. Like, I live in New York City and so I was expecting prices to be a little bit higher than the $3 to $500 that I was seeing in Google search results. But, you know, so it's like, it's $495 for initial visit and collection plus some lab testing that may or may not be covered by insurance. $325 for any additional collections and then an annual storage fee of $685. So like, realistically, we're looking at $1,500 for the first year and then $700 in perpetuity.  Like, it's not money that I can just throw away without thinking about it. I didn't really expect it to be less but if it had been like $350 a year or something, I would have just said, yeah, sure. And if it had been the $1,000, I'd have said, absolutely fucking, literally not. But $700 is that really frustrating sweet spot. But, you know, if I have to choose between like the Adobe Creative Cloud and the potential for having a child, I'm probably gonna choose Photoshop. That's how I have some thinking to do. I didn't really have to think about it that hard for being honest. A couple of days after filming that, I was sitting right here when a child started screaming in the hallway. She screamed for 30 straight seconds and her clearly exasperated father begged and then yelled at her to stop.  So I never called back. Which gets at the simplest but least interesting reason for all of this. I just don't like children very much and the older I get, the more my definition of child has expanded without changing that fundamental truth. One of the three The Week Air View merch shirts is inspired by my musings about how many kids I could take in a fight. And while that is not something I would really like to try out firsthand, I think I'd rather be in a cage match punching a bunch of other people's kids than a hospital seeing my own for the first time. And yeah, sure, that's a joke. But is it though? My mom once told me that I am narcissistic enough that I would definitely think my child was the best one to ever exist, just like everyone else does. And there is definitely a non-zero chance that that's true. It could be that I just don't like people very much and children are people. So I am projecting my feelings about everyone onto this hypothetical child who could well be one of the handful of people I quite like. But I'm not a betting man and literally someone's life is pretty high stakes. Child rearing is pretty high stakes. Again, this is someone's life that a couple of people have entrusted to them as a result of a biological process as opposed to like anything that would earn them that responsibility. Look, I have a general skepticism towards authority figures.  And yet somehow the latter gives them the right to control someone's life for nearly two decades.  And I'm sure most people agree that this control needs limits and that we should all be glad Jeanette McCartney's mom died and I'm sure that we all think the rehearsal opens some genuinely disturbing questions about the exploitation of children by the entertainment industry. I'm not really of the mind that all child actors are being exploited or that kids shouldn't be allowed to act. But I will never forget being on a student film set with a six-year-old who clearly had no interest in being there but was being pushed by his parents because he looked good on camera and they thought he was their meal ticket. But those are more obviously damaging versions of a pretty common practice, right? There are too many people who look at their children as some attempt at redemption a way to fix their own perceived failings. A new game plus run in the game of life. Or they create absurd expectations for their children, one that often make the kids miserable as they try to make their parents proud or ends up with them being eternal disappointments. A parent saying my kid is a doctor has the same energy as an art collector saying I have a Monet. I don't really see their kids as people but props. How many chefs on Chopped want to win to show their parents that their career choice wasn't a mistake? How many comedians have a set about how disappointed their parents are? Chefs and comedians do a lot more good for the world than anyone with an MBA ever has but pursuing their passions is somehow an affront to their upbringing. And I'm sure at least some of this comes from parents whose dreams resenting the fact that their kids don't want to do the same. Those are the same people who don't want student loan forgiveness because they had to suffer so everyone should have to suffer.  Sucks to be them I guess. I recently had a conversation that really laid bare and disconnected a lot of parents from the humanity of their children. I was talking to an extended relative who lives in Europe. She has a son four or five years old with her best friend who is a gay man. The two of them co-parent each taking care of the kid for half of the week and I asked how she thinks that situation will change as he gets older and she suspects that he will eventually decide he just wants to live with his dad's full time and maybe he'll visit her every so often but who knows we'll see. And she didn't say any of that in a self-pitying way. She wasn't complaining or crying about it. It was a matter of fact thing and she is perfectly okay with it happening as long as he's happy. And I realized that I had never heard of a parent giving their child that level of agency and maybe it's more common elsewhere in the world but it was revelatory to me and a reminder that the way things are isn't the way they must be. There are other better ways of structuring our societies and relationships so it's a shame that we aren't going to give those to the next generation instead they're getting a hell that seems to be getting more hellish by the day which is certainly a factor in a lot of people's decisions to not have kids at this point. To be a parent in 2023 you need to either have a frankly unfounded optimism that things in general will improve a belief that your position in life will insulate you and therefore your offspring from whatever is to come or a general disregard for your kid's future. Whatever the reason if you're wrong the person who will suffer the consequences the most is the one who has the least say. I learned recently that there's a philosophy called antinatalism which is largely centered on the idea that no one chooses to be born and yet here we all are. Antinatalists then conclude that no one should be born kind of like a fun sort of devil's advocate position to take on the whole human experiment but I also agree with Jack Saint that trying to use a word like choice or consent in this context is radically inappropriate because what we're talking about is existentially different than the thing that those words are meant to convey but it is true that some people actively resent that they were born. Fun fact in 2002 France made it illegal to sue your parents for giving birth to you after three separate children born with older disabilities successfully argued that they were owed financial compensation for their parents actual choice to continue a pregnancy and that is all I have to say about that and some of those people do something about it and then the rest of us say they shouldn't have because life is worth living and most of us believe that. I ultimately believe that. Life is pretty cool. It's also all we have because there's no afterlife or God and I think that since most people are glad that they were born abstract idea that we all should have been consulted about our existence is silly. But just because life is worth living now doesn't mean it's going to stay that way. So we return to what you might call pessimism but I'm going to call realism. The only way things stop getting worse is for society to fundamentally change and that isn't going to happen because societies are made of people and people don't like change. The world would be better if fossil fuels that heat the planet in its inhabitants were replaced by clean alternatives. If neighborhoods were built in ways that de-emphasized car ownership and focused on walkability and quality affordable public transit systems. If factory farms were closed and people's diets shifted towards plant-based alternatives these could have transformative effects and would offer myriad benefits to the people who lived within those systems but for many people those would not outweigh the things that they would have to give up in return. There's barely even an appetite for the first thing on that list and at this point all reasonable people agree that the status quo is bad but it can't be a thing that relies on individuals. Like it was gratifying that the 2022 made terms were historically good for Democrats in large part because enough marginal voters decided that openly trying to destroy democracy is probably bad and so generally rejected candidates who did that but voting is literally the least a person can do and 53.1% of eligible adults still didn't do it.  It wasn't about trying to make the planet better. It was about making people question themselves instead of the companies who were and are actually destroying the planet. And I totally get how someone can hear that and just give up. Even the most optimistic view of climate change guarantees more forests will burn and cities will drown. The wealthier countries will survive but poorer countries literally might not. You think refugee crises are bad now? Imagine them after another 10 or 20 years of warming. And then think about the way that authoritarian regimes scapegoat refugees as an incredibly easy other on their road to fascism and how that will further erode environmental protections which is a vicious cycle that is somehow just a part of the impending doom that it feels like we're hurtling towards. And maybe you think I'm wrong. Maybe I am wrong. I would love to be wrong but I've got a 31 year head start on the race to that sweet sweet release and I am not feeling so great about my prospects near the end. So how can I in good conscience put someone at the starting line now? And I am well aware of the societal ramifications of more people not having children. On average every person must have at least one child if not more because unless or until we can figure out genuinely capable robo caregivers produced by companies with genuinely humane incentives under our current economic system the first of those is maybe possible and the second is absolutely not. Countries with sub replacement birth rates are going to have a real rough time as aging populations leave the workforce faster than they enter it. The right wing in the United States is just salivating at their prospect of using that to justify say gutting social security even though it could easily be paid for by taxing all income instead of just the first hundred something thousand. Them doing that is going to be bad for people including me. But just because on average every person should have a kid doesn't mean the average person should have a kid. Plenty of people shouldn't have kids. A lot of them do anyway. And I know that that line of reasoning can go to some dark places especially coming from someone who looks like me. But frankly I don't think all that highly about my own genetic cocktail and let's not forget what this video is about. What's this video about again? Alright let's do it. Let me go get that vestectomy. Alright so it's the day of we're actually like literally 20 minutes away from me getting sterilized. So that's fun. Over the last 48 hours I've been thinking about decisions. I don't make a lot of them in my life. I kind of let life happen to me and I'll make decisions as it comes as opposed to like actively seeking things out. This is the first major decision I've made in a long time. And I'm now feeling the weight of that in a way I haven't really for the past month and a half. It's not changing anything. I still want to go through with it. I still feel good in the decision. But I guess I'm glad I feel something because if I never felt anything that probably would have been a bad sign.  That's onwards and upwards as they say. It literally just happened like a couple minutes ago. I'm still here. I wasn't comfortable. I didn't enjoy it. The needles were the worst part as the doctor said. It's the space occupying liquid within the needles. The needles themselves don't really hurt that much. I don't know smelling your own body burning but not feeling it is a weird sensation. Doctor listened to hot tuna. He didn't have a lab coat on or even wear a mask.  It was fine. It was quick. But yeah it's done. It's happened. I am X amount of days away from fully being sterile. Now that that's out of the way, let's take the gloves off shall we? I'm going to preface all of this by saying out of eugenicist. I don't generally believe that there are specific types of people who shouldn't have kids.  That said I don't think parenting is something that people should just get to do. It's kind of like buying a gun, right? If we're going to let them exist then people should be required to take classes and learn how to take care of them and treat them with respect and not hurt people with them.  I don't get why some people need psychiatric evaluations to have vasectomies, but not to have kids.  They are the obvious exception to my general rule about specific types of people and I really cannot stress how glad I also am that Jeanette McCarty's mom died. Look, I don't think sterility is a choice to take lightly, but the ramifications are pretty minimal. Worst case scenario, I don't have a kid that it turns out I want and that is a much better scenario than having a kid I don't the ripple effects of which can be endless.  And usually they're adults by the time they do it, but the one thing every murderer has in common is that they were all children once. Shonku's 2010 film Beautiful Boy not to be confused with that Timothy Chalamet Steve Carell vehicle of the same name tells the story of parents dealing with the fallout of their son committing a mass shooting at his high school. Everyone turns their anger at the parents, driving them further apart and then ultimately back together as they face this reality that no one can or even tries to imagine. And they're forced to face the question of whether what happened is in fact their fault. And the answer is almost certainly no asterisk. The Carells played heartbreakingly by Michael Sheen and Maria Bello were clearly not great parents distant from each other and their son, but if mild neglect makes you an abusive parent then every parent is an abuser because life gets in the way and it's impossible to be there every single time you're wanted or even needed. Are there signs they missed? Almost certainly. Could they have done something that would have changed what happened? Maybe? Does that mean it's their fault? No. Asterisk. I have no doubt that parenting can be very hard.  I've thought at various points that I would actually probably be an above average dad, but trying to prove a point is an awful reason to do something like that and anyways above average isn't great. I would definitely be a worse dad than my dad who is great. The world would be an objectively better place if he were the bar. And so it genuinely frustrates me how little support parents and more importantly their children get in this country. If children are our future and by definition they must be. Society should be devoting serious resources to making sure they have whatever's needed to make the future better. Right? That seems blindingly obvious and I know the irony that America is pro-birth but anti-child has been discourse to plenty and I've got nothing interesting to add to that, but it's important to keep calling it out because it is frankly disgusting how little we as a country care about whether children can even eat. Politicians can't even agree that children living in abject poverty is a thing that they should maybe stop from happening and it's something they can stop.  And then at the end of 2021 the increase expired. That is unconscionable. There are so many things that we could do to help kids. For example, in schools and teachers offering universal pre-k expanding free meal programs, some states are doing some of these things.  Child rearing is expensive. The USDA estimates that the average cost of a child right now for middle income families over the first 18 years of their life will be around $17,000, approximately $17,000 a year. Now, my household is definitively but not impressively upper middle class. I could afford to have a kid but not to give them a super exciting life doing things and going places. As with all but the wealthiest of people, I would have to choose between having a child and continuing to do many of the things I love. And it's not that hard a choice. And I guess that selfish not wanting to give up the pretty good life I've got for myself but parenting is hardly a selfless act. Even if we ignore the parents who use their children to whatever nefarious ends, it's still an investment. Honestly having a child is kind of like buying a house. They come with a whole bunch of responsibilities that make it harder to move around. Neighbors don't like it when you don't take care of them. Having one is part of the societal contract for those who wish to live the American dream and also offers a kind of long term stability that's probably nice. And they're expensive in ways that are both predictable and not while offering benefits from my tax dollars that I can't actually take advantage of. Subsidies for ownership I don't really love but I would be happy to pay more if it meant fewer children would starve. But they are for dramatically different ends. Yeah, a handful of people give birth to social media stars who then buy them houses but most folks will not get that money back. What they're paying for instead is long term support. My choice to not sacrifice now all but guarantees that I will be lonelier in my old age than my peers who procreate. I imagine a retirement without grandchildren is also more boring than one with. Is all that worth an average of $310,000? It might be. But as with any investment this can fail. Not every parent dies surrounded by loved ones just as not everyone who sells their house gets to break even let a long profit. And while it would be nice if every investment paid off you're not owed anything if it fails. And this I think is the part that younger generations increasingly understand that just because your parents fulfilled their legal obligation to keep you alive and perhaps their moral obligation to do it well they aren't owed a return.   And look it's impossible to not get at least a little messed up by your parents. Even a literally perfect childhood will do some kind of damage. Abuse is not anything a kid doesn't like nor is it anything that is not purely positive for them. And you probably don't need to hear that but like in case I have any chronically online viewers who think I'm completely on their side here. I'm not. It is important that we use words properly. Case in point your children is abuse. Period end of story. Literally every scientific study that has ever been done shows it. To quote the World Health Organization Corporal punishment is linked to a range of negative outcomes for children across countries and cultures including physical and mental ill health impaired cognitive and socio-emotional development poor educational outcomes increased aggression and perpetration of violence.  It's one of those terms that makes me think of George Carlin's classic rant about soft language where we hide harsh realities in vague euphemisms. What we call corporal punishment is better described as sanctioned violence. I will gladly joke about taking on an octagon of infants all day. I would never actually hit a kid nor would I ask another person to hit a kid on my behalf. Not a lot of things in life are simple, but that one's pretty simple. If you are the kind of person who sanctions actual violence against children, you're not a good person. I think it's time to put the gloves back on. So, it's about 24 hours after the procedure and I don't feel great. You know, I've been sitting on peas most of the day you know, took some leave that didn't give me anything stronger I don't know what the difference between pain and severe discomfort is but it doesn't feel good is the thrust of it hopefully tomorrow will be better. It does feel like I have improved over the course of the day I feel like I felt worse 12 hours ago than I do now, but I was expecting three days of pain, so we're still on track for that. Alright, been another 24 hours and I'm feeling better you know, notably better, so that's good I'm not going to keep doing these updates I feel like I'm on the track to just be through this sooner than later and that's good because that's what I was told it would be I'm still sitting on peas but not as much as I needed to yesterday, you know, we're getting there So, it has been two weeks and I just had my follow up and the neurologist said everything is healed very nicely and I can finally sit in the bathtub and dissolve the damn stitches so that is what I'm doing at this point the pain is basically gone very happy about that and now it's just a matter of waiting another couple months before I get tested and then then it's done So, I had a bit of a setback turns out after you get surgery you should not run into a fence with the area that you got surgery on and I did so I developed a retroactive infection in the area and so it's been hurting for the past few days which isn't great it's not like horrible but it's certainly not good and I don't want that for the rest of my life so I went to the neurologist he told me what was up and he gave me an antibiotic so hopefully in a few days I'll be all good we'll see So, it's been about a week I've been on the antibiotic and I'm feeling a whole lot better so thank fuck it's a little worried there but I'm feeling better on with the rest of this What a time that was Speaking of times, did you know that trials for hormonal birth control for men stretch back 50 years and the drugs that they were testing in the 1970s actually existed since the 50s? I see this little tidbit repeated on my 4U page every few months from mostly women who want to point out a radical disparity in the way genders are treated by modern medicine because the reason that the drug never made it past clinical trials was that the side effects which included pain, weight gain acne, mood swings, changes in sex drive, behavioral changes and fatigue were deemed too severe The irony of course is that all of those and more are known side effects of hormonal birth control for women So what's up with that? Modern medicine? To their credit it is conceptually more difficult to stop millions of sperm from doing their thing than it is to stop a handful of eggs from doing theirs but it also seems like the kind of thing that would be done had it really been given the priority it deserves because it's fucked up that women have always had to take responsibility for contraception. Men can wear condoms, of course I've learned over the years that a wild number of them just really don't want to. Very weird to me because TMI but I can count on one hand the number of times I haven't used a condom since I have always run under the assumption that avoiding pregnancy is my problem. Not because I'm a feminist but arguably the opposite. I knew a kid in high school whose life plans were completely derailed when his girlfriend lied about her own use of birth control and got pregnant in an effort to trap him. And whatever fear I had that someone might try that on me was gone by the time I reached my 20s but by that point I was committed to handling it myself especially as it became clear to me that condoms have zero side effects and hormonal birth control as a whole bunch and I know some people prefer the regulation that comes from the pill but for someone who doesn't I'm not going to make them suffer that and I'm not the only one there has been a notable uptick in the number of vasectomies that particularly younger men are having after the overturning of Roe v. Wade. While the timing may imply that the Supreme Court's decision might have had something to do with my procedure I actually decided that this would be my birthday present to myself when I turned 30. It just took me a while to actually get her out to doing it. Which signifies that more men feel like they should be taking on the responsibility and there is a decent chance that if the pill but for men existed, many of those wouldn't be happening. Though birth control may well be on the chopping block next because the Supreme Court is a genuinely bad institution whose only real purpose is blocking societal progress and should be abolished. But even if there has been some encouraging news on the development front in 2022, it doesn't exist yet. For now there is only one real long-term contraceptive for men. It just seems to be the longest term. And as a result I get that it's not the right solution for everyone. But as with abortions, if it's the right solution it should be available without question or interference. Given that I cannot become pregnant and therefore will never be faced with an unwanted pregnancy myself, I've always felt that I had no right to say anything about someone else's choice. But if I ever had any reservations those were wiped out by the 2013 documentary After Tiller which follows the handful of doctors in the U.S. who perform so-called late abortions. It is a powerful film that is largely given over to the patients themselves who discuss what brought them to having abortions in the final trimester. I can't imagine having such little empathy that you could come out of that judging any of those women for what they did. Here's a good rule. You can judge someone's abortion if and only if you're offering to pay for their maternity care and then we'll raise the unwanted child. And that woman says no. It's still her right to terminate the pregnancy but if you find yourself in that exact situation, fair enough you can be mad about it.  You don't matter. Certainly not here and probably not anywhere. It bothers me that three separate U.S. states require a man to get spousal consent in order to have a vasectomy because it is no one's decision but their own. And sure, I think that if someone is in a committed relationship that they should be on the same page with their partner about the whole thing. But if they're not on the same page they probably shouldn't be in a committed relationship. There are plenty of disagreements that you can have with a partner without poisoning the well. That is not one of them. And as such, I never discussed this choice with anyone. I just let people know that it was happening and maybe they asked why but in reality I got a lot more pushback on the fact that I'm ending this YouTube channel than the fact that I can't have kids anymore. And that feels like progress. And on the note of progress, it has been three months since I got the procedure, which means it is finally time to find out if it worked. Got this little jar here that I have to put a sample in, bring it off to the lab and I will know within the next 24 to 72 hours if this was all for nothing or did what it was supposed to do. I am wearing my skull t-shirt to represent all the babies I'm not having. So the next time you see me I will know and we can finish off this whole wild journey we have been on together. See you soon. I don't know what a lot of this means. Like I understand what viscosity is. I know what pH levels are I don't know what it means that mine are high. I don't know what it means that 20 HPF were observed. But I do understand the result, which is the thing that matters, right? No sperm scene post-vesectomy. Those are the words that I've been waiting all of these weeks, months, years to see. It feels like I beat biology a little bit, right? Like life this thing has had a very specific purpose and it no longer has that. I have taken control. It's an incredibly boring version of biohacking, right? But it is official. I will never have children. It's pretty cool. I'm taking a vesectomy. 7.9 out of 10. Thanks so much for watching. Thank you particularly to my patrons. My mom, my cat. Cat Zaraqata, Benjamin Schiff, Anthony Cole, Elliot Fowler, Kojo, Phil Bates, Willow. I am the sword, Taylor Lindy's and everyone else. I have one video left. I am ending on the best movie, everything everywhere, all at once. I'll have that out within the next couple of months. Looking forward to it. I hope you are too. Take care.


Our second presenter is Aditya Chowdhury, whose title is prediction and application of linguistic insights. Okay. Who here has had to learn a new language, say for immigration purposes? Millions of people are learning new languages every single day for job, tourism, immigration. In fact, Deolingo, a popular language learning app, has shown that it can even help refugees to rebuild their lives. So clearly, there is a need for good learning materials and tools which people can have easy access to. And language learning is not only important for people to achieve their own goals, but it's also important for language as a whole to survive. For example, a recent report from UNESCO shows that there are 191 languages on the verge of extinction in India alone. And the reason for that, the primacy given to English as the medium of instruction in schools, which causes many local languages to be ignored. So why not simply add these languages to Deolingo? It's not as easy as one may think, because you need subject experts to come in, sit for days, maybe even months to create the curriculum, find relevant examples, it's time consuming. And by the way, there are 7,000 such languages in the world today. And for some of these languages, the experts are even inaccessible. So in my PhD, I have explored techniques from machine learning, natural language processing, and even linguistics to help automate some of the processes of a curriculum extraction. Existing methods can already take some English sentences and identify basic linguistic information like what is a proper noun, what is a pronoun in that sentence. In my PhD, I have improved upon these methods to identify such basic information for potentially any language. So on the top, I have an example of Marathi, which is my native tongue. Now, this basic information of a proper noun pronoun is useful, but it's not sufficient, because language is complex. You also need to know how to arrange the words appropriately, what if the speaker is of a different gender, how to modify the words. So for each such linguistic question, I formalize it into a machine learning task, I learn an algorithm for it, and then extract rules, which can help illustrate each phenomena. So each component of the curriculum is now automated to some extent. Now rules alone could get overwhelming. So I also extract automatically some illustrative examples to highlight each phenomena. And so each process is now completely automated. And in fact, this curriculum is now being tested in actual North American schools, which teach Indian languages. So if you also give me text in your language, I can create a first pass curriculum for you. It won't be perfect, but it will be a good start. And again, the whole goal is not to replace a teacher, but rather to assist them in their teaching process so that they can focus on the creative aspect of teaching. That's all from my side. Thank you.


This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. Welcome everybody to today's presentation on dialectical behavior therapy. Today we're going to talk about dialectical theory. Over the next hour we're going to explore the basics of dialectical behavior therapy. We're going to talk about the B or the behavior in dialectical behavior therapy and what you need to know about addressing behavior. We're going to briefly address mindfulness, talk about reducing emotional reactivity and distress tolerance skills. We'll explore what clients need to know about emotions regulating the painful ones and increasing the positive ones and helping clients become more effective in relationships. We're going to get a high level overview. Obviously there's going to be an entire presentation on mindfulness and entire presentation on distress tolerance. But what I want you to do is get an overview or sort of a envelope with which to start filing the dbt information that you're going to learn over the next few weeks if you're going to be with us. Emotional vulnerability clients who are emotionally vulnerable tend to react to things others wouldn't react to or wouldn't react to as strongly. And that doesn't mean they're wrong for reacting to that it just means they're more sensitive. I tend to be somebody who's really sensitive, especially when it comes to to critters and children. So if I see an animal on the side of the road, or some dog running around, you know, I'm just like, we've got to do something about it. You know, I say a prayer for every dead animal that I see on the side of the road is just that's the way I am. I react to those sorts of things. Other people probably wouldn't even notice. Now, does that mean I'm emotionally dysregulated? No, it just means I tend to be more sensitive and aware of certain things. Now for a lot of our clients, they are more sensitive and aware, but part of that is because they came from environments that were very unpredictable and unsettling. So they had to be aware all the time. Think about living in a household with someone who has an addiction. So you never know which parent you're going to get and you're always kind of walking on eggshells with a person in addiction. And, you know, ironically or maybe intentionally, one of the first mainstream books about living with somebody with borderline personality disorder is called stop walking on eggshells. Because the living in that environment, you have to be attuned to all the little cues that are going on in order to anticipate what's going to happen next. So you become more aware and you may become more sensitive and reactive to it out of fear and with a desire to protect yourself. Another thing we know about people who are emotionally vulnerable is their recovery time is longer than for other people. Well, you know, think about it. If they are emotionally reactive, they're sensitive, they are reacting and getting emotionally stimulated by stuff constantly. That's tiring. So think about it this way, if you went out and you ran half marathon.  Probably not, you'd require more recovery time because you expended more energy and used more resources. So we want to understand that people need longer time to recover. And when we're talking about recovery here we're talking about de-escalation. But when somebody is on high alert and they're triggered, they sense there's a threat there. It's going to take them a little longer to calm down and say, okay, things are, things are okay again, they're going to be scanning. Think about a soldier in a foxhole. You know, he's waiting, he's on alert. And if something, you know, bomb goes off really close.  So he's going to be on higher alert for quite a while than he was before waiting and paying more attention and being more sensitive and more acutely aware of other things that are going on because that's how he protects himself. So this emotional vulnerability for whatever variety of reasons has evolved as a way of the person's brain trying to protect them. And that's one of the first things I want them to take home is to understand that in a way, and it may not seem like it's helpful right now, but in a way this is your brain trying to protect you. So let's figure out how we can help you tell your brain that it's not as threatening and it's not as scary. So it can turn down the sensitivity and not be as stimulated and as aware and as sensitive to everything all the time as acutely sensitive. People who are emotionally vulnerable have an inability to regulate emotion, partly because they have difficulty identifying and labeling their emotions. They probably grew up or may have grown up in environments that were emotionally invalidating.  So they didn't learn to identify it as an okay feeling, but they may not have even learned to identify what it was they just knew they were feeling out of control or upset. Well upset can mean scared it can mean angry it can mean depressed we need to figure out what it means before we can help the person regulate it. They have difficulty understanding why they feel that way. So they get upset something happens and they all of a sudden are just on full tilt emotional reactivity. And they're like I don't know why I, I get so upset when things like this happen. Okay, helping them understand why giving them the knowledge of why they may react that way is another step in helping them to regulate emotions. And they also may have difficulty expressing the emotion in an effective way. If when they were growing up, and they were scared, and that feeling when they tried to express it that feeling was squished, and their parents said you know suck it up don't worry about it you're making something out of nothing. They still felt scared, you know the child probably didn't feel a whole lot of comfort when they were just told that their feelings were wrong. They just didn't figure out a way to express that feeling in a way to get that need met so they started trying to do different things to get that need met which sometimes is referred to as acting out. But a lot of times when we look to act look at acting out behaviors, we realize that those behaviors are designed to try to get a need met, which wasn't being met before that behavior escalated. People may have developed difficulty expressing expressing themselves before they became out of control they may have developed difficulty asking for help. Everything is interconnected for every action there is a reaction. So let's think about addiction. When somebody uses, they feel really good for a period of time. And then what happens. They feel really bad. Maybe equal and opposite maybe, you know, in balance to the really bad. They sober up or the drug wears off, and they feel really bad. What do they want to do again they want to make the pain stop. So it's this constant yo yo. Anger is another example where something happens and someone gets angry. And generally, when you get angry. You have an effect on everyone around you.  Yeah, whatever. And go about their business. They're either going to try to help you feel better. Or, and more likely, they're going to try to stay out of your way. So you've got to understand that whenever you do something, there is is going to have an effect, kind of like butterfly wings. The, the theory that the current created by a butterfly flapping its wings actually has an effect on everything. So the question, think about how you interact differently with people and how people interact differently with you when you're depressed versus when you're happy versus when you're angry. Remembering that it's not just a one way. So I'm angry. I lash out that person bears the brunt of it and feels bad or goes away. Sometimes they're either going to go away and I may feel guilty then or they may lash back and I may feel angry. So it's important to understand exactly how you interact with others, but also how others impact you. So reality isn't a constant process of change. How you perceive something now may be different than how you perceive it in an hour. So what seems like the end of the world right now, or seems really irritating right now, in an hour is it really going to be all that consequential. So understanding that your reality is not something that has to stay constant. You can change it. You can improve the next moment. The reality in this moment may suck, but that doesn't mean it has to stay sucky. It can improve. And we want clients to understand that that we want to accept what is as it is, but also understand that we have the power to improve the next moment. So we want to look at what helps them change their perceptions. We want to look and ask them, what does their emotional mind say about what's going on right now? What does their logical mind say about what's going on right now? And synthesize the two, because reality comes from synthesizing two different points of view to come to what's considered a truth. The truth is always evolving though. So, you know, think about if you've ever started working out the truth when you started working out, maybe you could curl 15 pounds. And if you kept working out for two months, maybe you could curl 30 pounds. So the truth is different now. Reality is different now. What you can lift is different. It's evolved. What you can handle, quote unquote, emotionally right now is what you can handle right now. But by learning new skills and tools, what you can handle emotionally in six months may be very different than what you can handle right now. Likewise, I mean, things may be going along just ducky right now. Everything's coming up roses and you feel happy. But in six months, you may hit some bumps in the road and your reality may be somewhat different. So understanding that truth is always evolving and we want to try to integrate multiple perspectives and tolerate that two things may coexist so things may suck but be good at the same time. It's important to consider when we're talking about dialectical behavior therapy. When I have people consider opposing truths, sometimes I'll ask them to play devil's advocate. So they have all the reasons not to and all the reasons to do something and then synthesize them and figure out of the reasons not to and of the reasons to what is supportive of the best way to solve the current situation. And still help them move forward towards their goals of being happy and healthy and whatever the rest of their goals are. You can also have people step into someone else's shoes if they're having an argument with someone. You know, not just getting their shoes to try to convince them while they're why they're wrong, you want to get into their shoes to understand kind of their perspective and where they're coming from. So then you can synthesize both people's points of view. When there's a crime scene, the person may the cop that may go to the scene may interview multiple witnesses and he will probably get multiple different accounts of what happened. Does that mean somebody's lying? No, that means everybody has a different truth. Everybody noticed different things and everybody interpreted things slightly differently. So it's up to the criminal justice system to synthesize all of those points of view. And another example, like I said would be an interpersonal disagreement where you have two people and the example that I use I have teenagers at home and they have chores they're supposed to do. And I will go home and I will see that their chores have not been done adequately and I'm like, did you guys even do your chores today? And in their reality, they did their chores. So we need to compare our realities. And is it possible that they could have done their chores and still have it look like they didn't do their chores and combining those two. Realizing that two things may coexist as yeah, they did their chores to what they considered completion, not to what I considered completion. So we needed to discuss what the combined reality is of what it needs to look like for their chores to be done in my reality. Longitudinal. It's also important to understand things different to understand that we will understand things differently as knowledge is gained. When children are little, if a parent goes away. One of the things that they may understand or think they know is mommy had no use for us and that's why she left. As they grow. They may start understanding things a little bit differently maybe mommy had a drug addiction and maybe mommy ended up going to treatment and then relapsing and never ended up coming home. Maybe because she had no use for us, or was that because she was sick. So as knowledge changes, truth or your definition of what happened or your perception may change. So in dbt their skills training groups and some of the things that are being taught include core mindfulness. To make sure that people are aware of their thoughts feelings and urges. This is the first thing and not what they felt yesterday, or what they felt five minutes ago. But what are they feeling right now. What are they thinking right now, and what are their urges, because a response to a situation is a combination of all of those we have a feeling. They have thoughts that are kind of supporting those feelings and generally we have some kind of an urge to either do something to make that feeling stop. Core mindfulness helps us develop an understanding of emotions as things that don't have to be acted upon. So as people become more mindful, they start to understand that I can have an emotion. And it can hurt, but I can tolerate it emotions aren't scary, and I can change the next moment I don't have to immediately react to try to make this unpleasantness go away. I can tolerate it, step back, evaluate my options and choose the best course of action. The next type of skills that people will learn our interpersonal effectiveness to help them develop assertiveness skills and identify the goals of relationships and skills activities needed to achieve those goals. So interpersonal effectiveness is huge because our relationships are some of our greatest buffers against stress. If people are not able to communicate their thoughts feelings needs and urges effectively, they can't get support. And worse yet they may alienate their supports by coming off the wrong way or seeming aggressive or angry at other people. So interpersonal effectiveness helps people figure out how to effectively communicate their needs and wants in situations not only when they're just calm in order to prevent emotional upset, but also in situations when they are experiencing emotional distress, and they're trying to get help or they're trying to create a solution. Emotion regulation skills help people label and effectively communicate their feeling states. So, you know, label them, communicate them and nurture those supportive relationships. It helps people understand the function of their emotions and why we don't want to eliminate them. Emotions are there for a reason. Anger and fear tell you to fight or flee because there's a threat. Emotion results when you feel sadness because something important to you is gone for some reason. And happiness tells you that was good. Do that again. But all four categories if you will have emotions are designed to prompt us to do something or to take some sort of an action. We don't want to eliminate that. What we want to eliminate is our dysfunctional way of continuing to deal with feelings and get stuck in feelings. So we want to find helpful ways of improving the next moment and moving addressing whatever's causing that feeling in a way that helps us move towards our ultimate goals. Test tolerance skills are one of the first skills that I teach my clients because it helps them realize that when they feel a feeling, there are things they can do other than choosing behaviors that would be self or self injurious or harmful, which in many cases clients I'm working with are in early recovery from addiction. So the key is or the goal is to help them develop alternate skills so they can stop before they immediately turn to their drug or addiction of choice. Tolerate the distress and then make a more informed choice about what the next step is that they want to take. Dialectical behavior therapy assumes that clients are doing their best. Clients don't generally get up and say, you know what? I want to be happy, but I think I'm going to half-ass it today. They don't. They get up in the morning and they go, they may go, I want to feel happy, but I don't know if I can. That's a whole world different than I'm not going to try. If clients aren't trying, it means they don't feel like what they're doing is effective. They're starting to feel disempowered and helpless. So clients are doing their best. They're trying. They want to get better. Nobody wants to be in pain. They need to work harder and smarter and be more motivated. And, you know, I don't know that I agree with the harder part because some of my clients work really, really hard. But that's part of DBT assumptions. But they do need to work smarter because sometimes they're trying to address things with tools that aren't super effective. It's kind of like trying to take a Phillips head screw out of the wall with a butter knife. It may work eventually, but it's going to take a whole lot longer than if you actually had a Phillips head screwdriver. I've done both. When they are using ineffective or less than effective intervention tools, they're not going to feel empowered. When you don't feel empowered, you don't feel motivated because it's like, well, what's the point when I try to do this? It doesn't get any better. So we want to help them see that when they use these new tools, when they start working smarter, it will be more effective. That will help keep them motivated. It is true, though, that even if clients didn't create their problems, they have to fix them. They may have grown up in a dysfunctional environment. They may have had all kinds of unfortunate things happen to them. And that's true. But it's up to them to figure out where they're going to go from here. If they want to be happy, they need to figure out how they're going to dig themselves out of the trench that they're in right now. So even if they weren't the ones who created the trench, they got to figure out how to escape from it. Clients need to learn to act skillfully in every area of their life. Remembering that vulnerabilities go back to not taking care of mind and body, go back to chronic stress, go back to lack of support. So if clients are stressed in multiple areas of life, they're also probably experiencing emotional dysregulation in multiple areas of their life. So we need to help them learn how to communicate effectively and set boundaries and take care of themselves and work towards their goals in every area of their life, not just maybe their relationship or being happy. Well, living in isolation on an island out in the Pacific, you could probably be happy. But unfortunately, when you're living wherever you're living, which is probably not there, you've also got to deal with work and family and extended family and neighbors and whatever else. So they need to be able to apply all those skills so they can still be happy even if they've got other influences coming in. And it's also important or finally it's important to remember that clients cannot fail in therapy. Failure is a learning opportunity. If a client starts to backslide, and I don't even like the word relapse because that has so many negative connotations with it. If a client starts to backslide or lose motivation, then I want to look at it and I want to say why? What can we learn from this? Why is the motivation waning? Why is the old behavior becoming more rewarding than these new tools? What do we need to change in order to individualize treatment for this particular client? So it's not about failure, it's about learning. Treatment priorities and dialectical behavior therapy start out with suicidal or self harming behaviors, which in there I include uncontrolled substance use, especially well, any uncontrolled substance use. I consider a self harming behavior because it is easy to overdose and it is really hard to move forward in the process if they are constantly imbalancing their neurochemicals. So suicidal behaviors first obviously self harming behaviors come in a close second, if not tied with first. Then we want to move down to behaviors that interfere with therapy. So let's start out with client behaviors that interfere with therapy like not showing up or showing up late or showing up and trying to divert the therapy session every which way instead of staying on task. So we want to address those and figure out what's the motivation behind it. And how can we address that remembering that behaviors are often self protective they're serving a purpose so we need to look at what is the purpose of those behaviors and how can we address them. Now clinicians behaviors that interfere with therapy. We all have experienced it and, you know, ethically we don't we don't want to say we do. We don't want to think we do but we know we do so being aware of it and addressing it is really important to ethical treatment. Sometimes there are those clients that are just really challenging to work with. Clinician behaviors that can interfere with therapy also include being late canceling sessions, not preparing for the session by reading the notes ahead of time or whatever you do to prepare. All of those things can interfere with therapy because it may make the client feel like they're not important. It may make the client feel that they're again being invalidated. So we want to consider what behaviors we have and in session paying attention to a client. Paying attention and being mindful of our own behaviors any judgmental thoughts that come through we want to model dbt as well as teach dbt address suicidal or self harm ideation and misery. Clients may not be engaging in the behavior but they still may think about it. They may have days where they wish they were dead. They may have a lot of days where they really romanticize using again. So we want to talk about these behaviors and start addressing them. Move on to maintaining treatment gains.  They've made huge gains. So let's work on maintaining those. Let's let them have a plateau and kind of solidify the gains that they've gotten as we start to move towards working on other goals they have identified. So in stage one of treatment, people attain basic capacities. They identify behaviors that pose a direct threat to the client or other safety. We want to know if there's anything we need to do in terms of a safety plan or safety monitoring. Monitor the frequency intensity of an intensity of any self harm behaviors or suicidal behaviors using a behavior tracking form. And you want to start addressing any of these behaviors. Obviously, you're going to take more active and immediate action with suicidal or self harming behaviors than ideation. But making sure that you're tracking how often these happen because you want to see a decrease in the frequency and intensity, not only of the behaviors but of the thoughts about the behaviors. In stage two, you start focusing on reducing traumatic stress. We'll start addressing negative relationship experiences as they relate to emotional dysregulation. When they grew up, they were in invalidating environments. They didn't feel like they got the support they needed from the people who were supposed to be there unconditionally their parents and their caregivers. So you may want to start addressing those experiences and how those relate to the person's inability to regulate their own emotions and the person's emotional sensitivity. Remember how we talked about if they grew up in a situation where there was addiction or domestic violence or uncontrolled mental health issues. This environment may have been very chaotic. So it's important for them to start understanding how all of that has created the situation where they are right now and how their emotional dysregulation is somewhat predictable because they weren't taught the skills. They weren't given the support they needed. And this is also where we start addressing interpersonal skills. Okay, so let's start teaching those skills and start helping you reach out and ask for help from people who can be supportive because it's possible. Those caregivers weren't even able to be supportive at that time. And then at stage three, the clients start working on increasing self-respect and achieving individual goals. So they're no longer having ideation about self-harm. Their life has become at least tolerable where they're not feeling so much emotional distress. They don't know if they can go on. Then you move to addressing traumatic stress, which goes a long way to addressing emotional reactivity. Helping them develop interpersonal skills, helping them develop skills and tools to tolerate distress and change the moment, solve problems. And then in stage three, then they're working on looking back and going, hey, look how far I've come and look at all the good things about me and let's see how far I can go from here. So that B and DBT benefits positive and negative reinforcement. So it's important when we look at the behaviors, whatever behaviors we're looking at, whether they're behaviors we want to eliminate or behaviors we want to add. They're being maintained. So behaviors are being maintained by reinforcement. Positive reinforcement means it brings them something rewarding, such as attention. Negative reinforcement means it takes away something unpleasant, like having to go to school or do chores. So there's something maintaining the behavior and we need to figure out what that is. Punishment is also both positive and negative. So punishment, positive punishment is adding something unpleasant, such as having to write 500 times, I will not hit my sister. And negative punishment is taking away something, such as putting someone in time out or taking away a privilege. In order to increase a behavior, we need to increase the reinforcers. Ideally we do that. Punishment eliminates the behavior, but they've got to have some kind of behavior to put in its place. So if you just punish a behavior, then you're just left with somebody who goes, and that's what happened to the children, leading up to this, which probably created more emotional dysregulation, every time they asked for help, every time they became dysregulated, that was punished. They were told that they were being silly or they shouldn't feel that way. But they weren't told what to do about it. So they were just left with these emotions, not knowing what to do. Consequences of behavior can be negative, harmful, unpleasant, positive, self-explanatory, or neutral. But when I pay my bills, it's not really a positive or a negative experience.  But it's not really, it's not a woohoo moment. It's just, I did what I had to do. So not all behaviors are going to have rewarding consequences. When we apply reinforcement, we want to make sure that we provide intermittent reinforcement. And what that means is you want to make sure the person can't count on the reinforcement always being there. So instead of every single time they do something right, they get lavished with praise, then you're going to back it down. So it's randomly, you know, maybe every third time, maybe every fifth time. And this helps the person keep doing the behavior at a steady state. So intermittent reinforcement produces a longer lasting, more effective behavior change. You can start out with consistent reinforcement, like every time somebody does something, but then you're going to start backing it off a little bit. And then modeling. If you want clients to behave a certain way when they feel a certain way, if you want clients to practice mindfulness, you need to model that. They learn more from what you do than what you tell them to do, just like your kids, unfortunately. So make sure that you're practicing what you preach. You're modeling this.  Perfect time to model and walk through dbt with the client to help them see how you're using those skills.  So I am, you know, taking a step back. This is this is stress tolerance skill I'm using. And I'm trying to improve the next moment so I can be here and present for you, which is my ultimate goal right now. So remember that reinforcers increase the likelihood of a behavior reinforcers are rewards. Punishments reduce the likelihood of a behavior. So you want to reward as much as possible. If you're rewarding the good behavior or the ideal behavior or whatever you helpful behavior. The unhelpful behavior is probably going to go away because it's not getting rewarded anymore. And every time we have a choice between two behaviors, we choose the one that is most rewarding for the amount of effort. So if the new behaviors more rewarding, then they're just going to ignore the old one. Vulnerabilities increase the likelihood of a fight or flight response, because when you're vulnerable, your body feels like you're vulnerable. So it's constantly in this threat response state.   So when you're feeling sick or tired or vulnerable in some way, you're going to be more edgy you're going to be more irritable, which increases the likelihood that when something else comes your way, you're going to be more reactive because you're already spending so much energy trying to wait and protect yourself from that hungry lion that may or may not come. Backward chaining is one tool we use in order to help people identify the reinforcers and vulnerabilities that lead up to some of their dysregulation. So the way I have my clients do it is I have them start out with what happened, you know, had an outburst. Okay, so what caused the outburst co-worker said something insensitive. All right, would that normally get you that upset? No. Okay, so what happened before that? Well, when I woke up this morning, I felt really, really drained and I was just I was ready, already exhausted. I didn't want to go to work. So I was kind of in a funk. Okay, well, what's causing you to feel so drained? What's causing you to feel vulnerable? Well, the day before I had to put my cat down and that took a lot of emotional energy and I was just, I didn't even want to go to work that day. Okay, so now we can see that it wasn't just the co-worker saying something insensitive that led to the outburst. There was a whole cascade of events that wore on this person or built up in this person. So then when the co-worker said something insensitive, that was as they say the straw that broke the camel's back. Helping people see that a lot of times outbursts, relapses, whatever you want to call it, don't come from just out of the blue. If they look back and retrace their steps, they can see how things started to go south, how they started to get exhausted, how they started to feel disempowered, which ultimately led to the unhelpful behavior choice. Remembering that triggers, positive and negative triggers cause a reaction. So remind the person of a prior situation in which a behavior was rewarded. For example, lashing out gave a client control. So in the future, when the client gets upset, they're going to be more likely to lash out. If when the client lashed out, it did no good, then the client will probably be less likely to lash out in the future. But we need to understand what caused the threat. We need to understand that it's important for the person to be able to communicate what is causing their threat. And we want them to put in triggers in their life that prompt feelings of well-being. We always talk about negative triggers, triggers for use, triggers for anger, triggers for anxiety. Why don't we talk about triggers for happiness? What things in your environment look around your office? What things in your environment do you look at and smile? One of the secretaries at one of the places I used to work had a poster of a little kitty cat hanging on a clothesline. And it said, just hang in there. And yes, I'd seen that same poster for 15 years, but it always made me smile. Put in triggers in your environment to prompt feelings of well-being. When somebody gets angry, it's important to help them shape their behaviors. Rewarding successive approximations. So for example, if they get angry, the first step is, you know, we're not going to expect them to never get angry again. Anger is a normal feeling. We're not going to expect them to, you know, not get really angry, but we don't want them to throw things anymore or be physically aggressive. So the first step is not throwing things or being physically aggressive. They can yell. They can, you know, walk around. They can stomp their feet. But if they can get a little bit better and not be physically aggressive, that is a step in the right direction. And we want to reward that. You know, that was that shows progress. So now when you get upset, what can we do to help you disengage or tolerate the distress until the urge to be verbal. Or physically aggressive is gone. So the next step is figuring out how to unhook from that emotional reaction until the person can get in their wise mind. And then level three is being able to calmly discuss the issues or problems without getting overly upset. But each time the person achieves a level of being able to deal with their anger, we want to reward that. And then challenge them to start taking the next step with addiction or self harm. If somebody has gets upset and instead of using they engage in a secondary cope of coping behavior like smoking or eating or drawing. It may not be our ideal solution, but at least they're not using so kudos to them. Once they get the hang of doing that instead of using, then we want to take it to the next level and say, okay. When you get upset, what can you do to remind yourself to take a mindfulness minute to evaluate the situation, then choose a behavior consistent with your goals, instead of just going to another behavior to avoid the feeling. So the first step, not using second step, actually addressing the issue. In mindfulness, we're helping people develop an in the moment awareness of how they're feeling emotionally mentally and physically will help them explore the interconnectedness of their thoughts feelings and physical sensations. So they understand that distressful thoughts are going to lead to distressed emotions which is going to lead to physical distress headaches muscle tension belly aches. But it goes the other way to happy thoughts lead to happy emotions and tend to alleviate a fair amount of pain and somatic stress. Part of doing this we can help them become aware of the emotional wave understanding that feelings come in and feelings will go out. They will peak and then they will start to recede. So helping them identify where they are on the wave. So if they're angry, they can know that they're either almost at the top and they're on the way down, or they can know that yeah, I'm feeling a lot better than I did 30 minutes ago so this feeling will be gone pretty soon. It helps them start tolerating distress and become more mindful of where they are in terms of ability to think in their wise mind versus their emotional mind. So reducing emotional reactivity please is the acronym P and L treat physical illness. Make sure they're eating a nutritious diet. Avoid mood and mind altering drugs. Get adequate quality sleep and try to get some exercise. It doesn't mean going out and running a marathon. It means getting off the couch and moving as much as you are physically capable of doing. We want to help people build positive experiences. Again, you can't be miserable and happy at the same time. So encourage them to actually intentionally engage in positive experiences every day. Encourage them to start becoming mindful of their current emotion so they can intercept it before it becomes a big deal. If they're blue, they can start doing something to feel better before they're clinically depressed. Distress tolerance. The acronym here is accepts. And this is one that I use with my clients a lot. When they have an unpleasant feeling. Sometimes they just need to let that feeling pass for a few minutes while that wave is coming in and out. They can do hobbies, watch a video or go for a walk. They can contribute by doing some kind of volunteer work. They can compare themselves to people that are coping the same or less well than them. They can distract themselves with opposite emotions such as reading a funny book or listening to a comedian. They can actively push away distressing situations by leaving it mentally for a while. They can just check out go I'm not going to pay attention to that for right now. They can think about something else. They can do a puzzle, read a book, start writing a story, whatever it is that can occupy their mind. And they can distract with intense sensations. One of the common things we talk about in dbt is ice holding two pieces of ice in your hand. You're not going to think about much else after two or three minutes except for when can I put this ice down because it is uncomfortable. But you're not thinking about the emotional distress. So sometimes it's helpful just to help people distract from what's going on up here for a few minutes. Clients need to know that it's important to increase positive emotions because when there's positive, the negative is going to go away. In addition to decreasing the negative if you just decrease the negative then again you're left with not much. So what are you going to replace negative emotions with what are you going to replace unpleasant emotions with if you're not angry what are you encourage them to keep a running journal of things that make them happy and positive things that they can do interpersonal effectiveness. We want to help people become assertive be able to state their needs and wants. We want to help them tolerate distress instead of automatically having to act on their urges. Help them identify and communicate their emotions assertively so they can get support from other people. Help them understand their own needs because then they're going to be able to better plan their day and prevent additional vulnerabilities if they're already feeling vulnerable. They don't want to put themselves into a situation that they know is going to cause them emotional turmoil and explore situations with them using dialectical theory. We talked about reality is ever changing and the truth is involved by synthesizing multiple points of view. So helping them walk that middle path. Dear man helps people get what they want and need and this is interpersonal effectiveness skills helps them describe their situation. Express why this is an issue and how they feel about it what what's going on with them helps them assert what they need by sharing clearly what they feel and asking directly for what they want and need instead of just hoping somebody guesses. Reinforce their position by offering a win-win outcome. For example, it would help me to not get nearly as upset when you're late if you would call ahead and let me know that you're running behind that creates a win-win. Mindful focus on what we're requesting not just kind of be all over the place and go well if you knew if you were paying any attention to what was going on you would know what would make me happy. No, be mindful of what is it that you need and communicate it and stay focused on that not go off on six different tangents or a litany of done me wrongs. A peer confident and negotiate because you're not always going to get your way. But if you're confident yourself assured you know what you need and you can be assertive, it will come off a lot better and be more successful. DBT is a great tool to help clients become more aware of their emotions. I identify the thoughts, feelings and urges associated with their emotions in order to figure out the next best step to help them meet their ultimate goal of being happy and healthy. It helps them develop a greater sense of awareness regarding the wise of emotions. Why am I angry? Why am I anxious? Why do I react this way? It helps them develop a self awareness regarding their own vulnerabilities, which are those things that make them more likely to be emotionally reactive or sensitive. I tend to be a lot more emotionally reactive when I'm sleep deprived. Not everybody is, but I know that's a big vulnerability for me. And it provides a framework for teaching skills groups that benefit an array of clients with difficulty with emotionality. So it's not just people with BPD. It's not just people with addictions. It's anybody who has difficulty managing their emotions, depression, anger or anxiety. DBT skills groups can help them become more effective at reducing their reactivity and improving their ability to deal with those feelings. As I said, DBT made simple is one of the go to guides for just getting a general overview of DBT, but there are a lot of other books out there. Marsha Linehan is the one who founded or created DBT. Her books are published through Guilford Press and you can find those on Amazon. Okay, are there any questions? If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceuse.com slash counselor toolbox. This episode has been brought to you in part by allceuse.com providing 24 seven multimedia continuing education and pre certification training to counselors, therapists and nurses since 2006.


What is going on guys, welcome back to the channel and I appreciate you being here. Today I am back with another Fortnite news video and today we're going to be going through a few changes that come with the latest update patch which not long arrived. But before we go any further guys just a reminder that every week I give away 2800 V-Box. To win make sure you're subscribed to this channel and have that bell button ticked. Drop a like on this video and leave a comment down below. Winners are picked at the end of the week and contacted via direct message. So good luck everybody. Ok so with the version 3.6.0 update which is upon us now came some interesting changes for sure and today we're going to go through the picket a bunch. Ok so firstly we are getting a new grenade called the Klinga. A grenade datumined a while back called the sticky grenade and this light suggested will stick to any objects on impact. Here are a few more details on this item taken straight from the patch notes. Rarity is uncommon. Location, floor loot, supply drops, supply llamas and treasure chests. Explosion delay once attached to a target 2.5 seconds. Player damage 100. Structure damage 200. Radius 1 tile. Max stack size 10. Pickup stack size is 3. Stick this grenade to an enemy and wait for it to explode after a short duration. Cannot explode in mid air. Will cling to any surface or player hit. Will detonate early if a structure it is attached to is destroyed. Sounds pretty pretty cool. We then got other weapon changes and adjustments too. Reduce chances of finding more explosives in treasure chests by 40%. Minigun adjustments. Increase accuracy by 10%. Decrease recoil by 10%. Increase damage from 16 slash 17. Epic legendary 2. 18 slash 19. Greatly improved hit registration of long range sniper rifle and crossbow projectiles. Port of thought improvements. Port of thought tires no longer grant falling damage immunity after players bounce off them. Four-port projectile preview now indicates if it will build with stilts and a ramp. Port of thought trajectory now turns red if aim too high. Okay so we're going to move on to something kind of major here and that is a new addition with this update to return bought items. Yes you heard that right. If you have bought items in Battle Royale side of the game for v-box with this update you will be allowed to return three of these items. Here are the details self-service cosmetic returns featured has been added will allow you to return to three cosmetic purchases for v-box lifetime. What can be returned? Emotes, gliders, harvesting tools, back bling and outfits. What cannot be returned? Battle pass, battle pass TS, starter pack, finders pack, finders pack upgrades, loot armor, save the world, event and weekly items save the world. So how do you do this? Well you go to your item shop click on the purchase history indicated in the bottom right corner and basically trade back any three items which are available for you to trade which you have purchased over the past 30 days. If you have items you wish you'd never bought you can trade three back and get something within the future which you will appreciate more. So this is a nice little addition for sure. Good news all of the update changes and all so far you can read through on the screen now if you want to pause in the video might help you though unless you are Barry Allen. Okay so lastly on screen now thanks to two epic buddies on Twitter we can see a few new data mined cosmetics from this latest patch. When more details commonly said items I will cover them in a video for sure. But guys on that note I am out thanks as always for stopping by if you enjoyed the video leaving a like truly helps me out. Subscribe if you're new around here and enjoy daily fortnight videos and hopefully guys I will see you on that next one.