Lin asked me to do an outline on the cope ahead skill from DBT. I am not an outline sort of person. I prefer to free flow, stream of consciousness sort of thing. So, here goes, by request…sort of. [Sue’s written about cope ahead before. I wanted her to review it again and give us an example of its use.]
Dialectic Behavior Therapy (DBT) is a skills-based approach. That means DBT therapists directly teach skills of living. One of these skills is how to cope ahead to effectively get through a situation. [Lin/Linda: to read more about DBT, read Sue’s page Teacher, Teach Thyself.]
Effectiveness is doing what works to get to your goal. It assumes you know what your goal is. Most people have an idea of what their goals might be but they describe them in the negative. “I won’t mess up” for example.
Now those of us who have ever had anything to do with small children can tell us all something about the use of negatives. You tell a kid not to do something and that is the first thing he does. Hate to break it to you, but you do the same thing. Tell yourself not to do something and that is exactly what you do, too.
People don’t end up with an eye on the prize. They end up with an eye on the booby prize and that is exactly what they get!
Ergo, first rule: be positive! Your goal is to succeed. It is not to avoid failure. The scenario you want to construct for cope ahead is positive, positive, positive.
The second rule is include details. You want to make it as true to life as possible. Your imagination can construct very vivid images. Let it go. The more vivid and lifelike you make your cope ahead image, the more real it will seem.
Last but not least is practice. Imagine yourself just breezing through the situation. Look at me! I am doing everything right! Imagine yourself being collected, skillful and brilliant. Imagine doing everything right until it becomes second nature.
Then take it into the real world and try it out.
Ta da! There you have it, ladies and gentlemen, I give you the cope ahead skill.
Lin/Linda here: I also asked Sue to help me come up with an example of a cope ahead visualization. One of the experiences that causes some people anxiety is that of going for an anti-VEGF injection for wet AMD. Try this:
Think of driving to the office on a beautiful day noticing everything around you.
Enjoying the day.
Going in to the waiting room and sitting calmly, distracting yourself with beautiful photos or a funny story in a magazine.
Think about getting up easily and walking into the examination room.
See yourself joking with a technician and then sitting comfortably.
Feel the numbing drops and know that they’re working.
Greet the doctor with a smile and look in the direction that he told you.
Breath calmly.
Feel the pressure of the shot.
Think of having the doctor tell you how well you have done and see him smile.
Sit there calmly while the technician checks you out. Get up, walk out the door . Wave at everyone.
Feel free to embellish this basic outline with as many, very positive details as possible. The idea is to really feel as if you are skillfully practicing it for real. If there is a glitch, don’t be tempted to give up or start imagining horrible things. Calm yourself and start again.
PS Those of you who had Intro to Psych may recognize something else in the visualization exercise of cope ahead. Did you see it? It’s desensitization! Three bonus points on your quiz if you got it right! Desensitization is exposing yourself to the feared stimulus without the feared consequences. The connection between the stimulus and the fear is lessened. And you thought you would never use any of that stuff in the real world!
Written August 17th, 2019