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How the DBT 'PLEASE' Skill Helps Me Practice Self-Care With Mental Illness

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Our bodies are complex systems. Because of this, they require our constant care and attention so we can function at our maximum potential. However, for many of us living with mental illnesses like depression, even the most basic forms of self-care go out the window, especially on our most difficult days.

I remember recently walking into my weekly therapy session feeling completely defeated by the few days before the session. As my therapist looked over my diary card and thought records while I spewed out my negative emotions, she interrupted me with this simple question: “Have you been using your PLEASE skill?”

In case you’re not familiar with it, the PLEASE skill is one of the clever acronyms Marsha Linehan developed to make dialectical behavior therapy (DBT) skills easier for patients to remember. Essentially, the thought behind this skill is by taking care of your body’s most basic needs, you can more easily regulate emotions and decrease vulnerability factors that could put you in emotional mind and, ultimately, make less skillful decisions.

Whether or not you actually go through DBT, this skill can prove highly beneficial. Here’s what each letter stands for, why these items are important and how I implement them into my daily life:

PL: treat physical illness.

Research shows a direct link between our physical and mental health. Since they often work in tandem, it’s critical you treat any physical illnesses or conditions as soon as possible so you can avoid those struggles negatively impacting your mental health.

Personally, I battle frequent headaches and sinus issues. While these headaches cause physical pain, nausea and sometimes vision issues, they also put me in a crappy mood. When I take the time to treat my headaches as soon as I start to feel them coming on with medication and other hacks I’ve learned over the years, I find I don’t become as irritable and depressed, and can better cope with my day.

E: balanced eating.

We all know our bodies require proper nourishment to function. When we’re battling depression or anxiety though, eating regular meals tends to go out the window. While we may think skipping meals or eating fast food all the time is acceptable during our depressive states, it ultimately causes even more harm to our mental stability and overall well-being.

I use several hacks to force myself to eat throughout the day, even when my anxiety causes nausea, or my depression leads to a loss of appetite. I also keep my workstation and my pantry well stocked with snacks and easy-prep single serving meals so I have no excuse to not eat even on my worst mental health days.

A: avoid mood-altering drugs.

According to the National Bureau of Economic Research, there is a “definite connection between mental illness and the use of addictive substances.” In fact, nearly 70 percent of people with a diagnosed mental health condition use mood-altering substances like alcohol, drugs or cigarettes to cope with their inner demons at some point in their journey.

Honestly, I fit into that statistic — I frequently turned to alcohol in times of trouble during my youth. Unfortunately, those moments when I reach for the bottle never end well, and I often regret them for days (or even weeks) after. While I don’t live a completely dry life now, I do try to only drink socially and surround myself with friends who can remind me to use other coping skills when needed.

S: balanced sleep.

Between our busy lives and heavy reliance on electronic devices, we’re all getting less sleep these days. In fact, I recently read a study published by Zoma that really resonated with me. According to their research, nearly two-thirds of people spend time on social media before bed, and this causes them to stay up later, receive less nightly sleep, get lower quality sleep and feel less rested in the morning.

I’ve gotten more serious about my sleep recently, and it’s definitely lowering my emotional dysregulation and vulnerability to anxiety attacks and suicidal ideation. I now try to spend 30 minutes before bed reading, silencing my phone when I’m ready to sleep and using another DBT skill called paired muscle relaxation to calm myself back to sleep when sleep disturbances wake me up at night.

E: get exercise.

Most of us know regular physical activity helps our body produces endorphins, which in turn creates positive feelings and reduce our perception of pain. However, many of us who battle depression also struggle to get out of bed in the mornings, let alone go for a run.

For me, the trick to getting in physical activity is finding ways to make it seem like something fun versus exhausting work. A friend of mine encourages me to wear my Fitbit and participate in weekly challenges with her, and another friend and I frequently take our children to a local park with a walking trail that allows us to spot local wildlife and talk while we get some steps in. I look at these opportunities more like mindful moments instead of exercise, and that simple reframe typically makes the challenge seem more enticing.

The most important part of all of this is to focus on progress, not perfection. You won’t always meet all the steps on this list, nor should you constantly beat yourself up when you struggle or experience a bad mental health day. As my therapist stresses though, remembering your PLEASE skill will only enhance your daily life and help make everything just a bit brighter on those dark days.

Unsplash image by Ronaldo Oliveira

Originally published: January 31, 2020
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