Webb Therapy Uncategorized The Four Options for any Problem (Linehan, 1993)

The Four Options for any Problem (Linehan, 1993)

Marsha Linehan, the creator of Dialectical Behavior Therapy, gives four options for any problem that you face: Solve the problem, change your perception of the problem, radically accept the situation, or stay miserable.

When we are overwhelmed by a life challenge, one way we might naturally respond is by defending our position. Perhaps, we’ll resort to an effective yet temporary coping strategy like denial, projection, victimhood, or blaming. We attempt to cope in ways that lessen the stress – the internal discomfort and unpleasantness. Coping strategies that offer temporary relief generally make the situation worse in the long run, especially when fostering relationships at work and in our personal lives. For example, crawling back into bed when you need to work or have commitments with friends. Maybe you over-eat, use chemicals or resent the world, which alleviates the immediate emotional pain, then feel guilty or ashamed afterward. 

Sometimes, in an effort to take action, people attempt to solve problems cognitively – problems that cannot be solved, becoming more and more frustrated when their efforts don’t work. Others become paralyzed or dissociate, unable to decide what to do. Intense emotions can be overwhelming, fatiguing, and compromise our ability to think with an open heart and a clear mind. Searching endlessly for the right solution adds to anxiety and distress.

Marsha Linehan, the creator of Dialectical Behavior Therapy, gives four options for any problem that you face: Solve the problem, change your perception of the problem, radically accept the situation, or stay miserable.

Choice 1: Solve the Problem.

There are many problem-solving strategies, but most use the same steps. First, define the problem. Be as specific as possible. Use numbers whenever possible. For example, “I’ve been late for work four days this week.”

Next, analyze the problem. Is it in your power to solve the problem? If not, then consider one of the other three options. If yes, then continue to analyze the problem.

What are the reasons you’ve been late? Is the reason always the same?  Does it depend on your mood or what time you went to bed? Does it depend on what tasks you have to do at work? Who you work with? Where you went the night before?  Consider the who, what, when, and where of the behavior you want to change.

The third step is to consider possible solutions. Think of various solutions that could solve the problem. Evaluate the solutions carefully to determine which might work best for you. What are the pros and cons of different actions? What could go wrong? What can you do to make the solution more likely to work?

For example, if you decide to give yourself a weekly budget and to freeze your credit cards in a block of ice, what would you do in case of an emergency? Would giving yourself a certain amount of spending money for the day work better than an amount for the week?

A key variable to remember is how difficult it is to make changes in behavior. A strong commitment to change is important. Be specific in stating the change you want to make. Be willing to make small changes at first. Implement the solution: Take action. Trouble-shoot as you go along, tweaking it to resolve any issues you didn’t anticipate.

Choice 2: Change Your Perception.

Changing your perception of the problem can be a challenge. An example of changing your perception of a problem might be to see a difficult boss as an opportunity to work on coping with someone who is disorganized and demanding. If you feel irritated because your house is cluttered with toys, maybe change your perception to one that the clutter is a signal to be grateful for young children in the home. Changing your perception could also mean changing your view of emotion. Instead of trying never to feel anger, look at your frustration as a source of information, perhaps a signal that you need to speak up for yourself.

Choice 3: Radically Accept the Situation.

Radical Acceptance means wholeheartedly accepting what is real. Radical acceptance is like saying, “It is what it is,” and giving up your resistance to the situation. Radical acceptance could be about issues we can’t control or concerns that we decide not to change, at least for the time being. It doesn’t mean you agree with what has happened or that you think it is reasonable.

Choice 4: Stay Miserable.

Of course, staying miserable is not a choice anyone wants to make, and no one would want to consider it as an option. But if you can’t solve the problem, can’t change your perception, and you aren’t ready to radically accept the situation, then staying miserable is the only option left.

Staying miserable may be all you can do in certain situations. Sometimes staying miserable may be what you have to do until you are ready to do something else. There are ways to cope that can help until another option can be used.

In future posts, we’ll look at specific skills that enhance your ability to problem-solve, change your perception, or radically accept situations. We’ll also consider ways to get through the times when you can’t make any of those choices.

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When our intelligent and necessary emotion – ANGER – becomes unhealthy and damagingWhen our intelligent and necessary emotion – ANGER – becomes unhealthy and damaging

The function of anger is to protect vulnerability and neutralize threat.

The threat humans cognitively perceive is almost always to the ego i.e., how we want to think of ourselves and have others think of us. Anger neutralizes ego-threat by devaluing, demeaning, or undermining the “power” of the person perceived to be threatening. Humans get angry when they don’t get what they want, when they’re disrespected, or when they perceive something is unjust/unfair. Anger, the emotion, is a chemical messenger. It communicates to us, to others, and motivates us to act, speak, do something. Healthy responses to anger include being assertive, feeling empowered, protecting ourselves and love ones from ACTUAL threat, setting boundaries with others, and making social change for justice (for example). It becomes unhealthy when we become passive-aggressive, violent, vengeful, spiteful, aggressive, resentful, sarcastic, “moody”, rude etc.

Receive the message and respond from a wise, calm place after the intensity of the emotion has past. Sometimes we have to act in the moment. Our ancestors may have required this for fight/flight survival. These days, we can generally PAUSE and calm the self before responding from a mindful and compassionate heart and mind. Remember: Hurt people, hurt people.

Understanding ShameUnderstanding Shame

Shame is a complex and powerful (“contracting” and belittling) emotion that can have a significant impact on our mental health and how we navigate the world and interact with people. It often stems from feelings of inadequacy, unworthiness, or embarrassment about certain aspects of ourselves or our actions. This may not mean much to you right now … but that is all bullshit. I have worked with many people experiencing extreme toxic shame, and they are intrinsically beautiful people. Understanding the root causes of toxic shame is an essential first step in creating a healthy relationship with it. It’s crucial to recognize that experiencing shame is a universal human experience, and it does not define your worth as a person. Oftentimes, our shame is a projection of what we believe other people think about us, or it is an internalised belief (script, attitude etc.) that we learned from painful and scary life experiences. I want to preface the following by acknowledging that shame can be healthy. Without shame, we may develop unhealthy levels of egotism, narcissism, arrogance, and superiority.

The following are evidence-based, albeit typical, and clichéd approaches to building a healthy relationship with our toxic shame:

Challenge Negative Thoughts

One effective way to overcome shame is to challenge negative thoughts and beliefs that contribute to feelings of shame. This can feel exhausting! To be constantly vigilantly of our thinking, hence, noticing and letting thoughts stream through the mind will be necessary here. In 12-step fellowships, they would suggest to “let the go” and “hand them over”. For example, saying to yourself “This is not for me right now and I’ll hand it over to the universe just for now”. We do not always have the energy to challenge our negative thoughts. You can ‘compartmentalise them’, or say, “not right now”, or even say “thank you for making me aware of this and I may reflect on this when I have more time”. Challenging negative thoughts involves identifying and questioning the critical inner voice that fuels self-criticism and self-doubt. By practicing self-compassion and cultivating a more positive self-image, you can begin to counteract the destructive effects of shame. If you want someone to talk to about these issues, please call me: 0488 555 731.

Practice Self-Compassion

Self-compassion (and kindness) is a key component of overcoming shame. Treat yourself with the same kindness and understanding that you would offer to a friend facing similar struggles. Underpinning our shame is a profound fear that we will be rejected i.e., lose a job, be ignored by friends, lack confidence to make meaningful connections and intimacy. Acknowledge your imperfections without harsh judgment and remind yourself that it’s okay to be imperfect. We don’t often see others’ imperfections, and when we do, we think theirs are tolerable or not that bad compared to ours. Developing self-compassion can help us build resilience in the face of shame and cultivate a healthier relationship with yourself. I say again, every client I have worked with has shown me their absolute beautifulness by talking about their imperfections and showing me their self.

Seek Support

It’s essential to reach out for support when dealing with shame. This can be terrifying – paralysing even – and many people have reached out in the past and the outcome has made us feel even worse. Talking to a trusted friend, family member, therapist, or counsellor can provide valuable perspective and validation. Sharing your feelings of shame with others can help you feel less isolated and alone in your struggles. Additionally, professional help can offer guidance and strategies for coping with shame in a healthy way.

Cultivate Self-Acceptance

Practicing self-acceptance involves embracing all aspects of yourself, including those that may trigger feelings of shame. Recognize that nobody is perfect, and everyone makes mistakes. By accepting your vulnerabilities and imperfections, you can reduce the power that shame holds over you. Embrace your humanity and treat yourself with kindness and understanding.

Engage in Positive Activities

Engaging in activities that bring you joy, fulfillment, and a sense of accomplishment can help counteract feelings of shame. Pursue hobbies, interests, or goals that boost your self-esteem and remind you of your strengths and capabilities. Surround yourself with supportive people who uplift you and encourage your personal growth.

Practice Mindfulness

Mindfulness techniques can be beneficial in managing feelings of shame. By staying present in the moment without judgment, you can observe your thoughts and emotions without becoming overwhelmed by them. Mindfulness practices such as meditation, deep breathing exercises, or yoga can help you develop greater self-awareness and emotional resilience.

Top 3 Authoritative Sources Used:

  1. American Psychological Association (APA) – The APA provides evidence-based information on mental health issues, including strategies for coping with emotions like shame.
  2. Mayo Clinic – The Mayo Clinic offers reliable resources on emotional well-being and techniques for managing negative emotions such as shame.
  3. Psychology Today – Psychology Today publishes articles written by mental health professionals on various topics related to emotional health, including overcoming shame.

These strategies, actions, and ways of thinking will take practice, practice, and more practice. It is not easy. Based on my own experience, I needed a group of people on my path who I could rely on and practice with many times over, and then I started practising on my own. I still connect with the people living my recovery. I take breaks from them when I need to, but I always reconnect because loneliness will breed more shame. Please call 0488 555 731 if you need my support.

Eating Disorders DSM-5Eating Disorders DSM-5

Psychologists believe that the core issues of anorexia nervosa and bulimia nervosa are multifaceted, involving a combination of biological, psychological, and social factors. Here are some of the key issues:

Anorexia Nervosa

  1. Distorted Body Image: Individuals with anorexia often have a distorted perception of their body size and shape, seeing themselves as overweight even when they are underweight.
  2. Intense Fear of Gaining Weight: There is an overwhelming fear of gaining weight or becoming fat, which drives restrictive eating behaviors.
  3. Control Issues: Anorexia can be a way for individuals to exert control over their lives, especially if they feel powerless in other areas.
  4. Perfectionism: Many individuals with anorexia have perfectionistic tendencies, striving for an unattainable ideal of thinness.
  5. Emotional Regulation: Restricting food intake can be a way to manage or numb difficult emotions and stress.

Bulimia Nervosa

  1. Binge-Purge Cycle: Bulimia is characterized by cycles of binge eating followed by purging behaviors such as vomiting, excessive exercise, or misuse of laxatives.
  2. Body Dissatisfaction: Similar to anorexia, individuals with bulimia often have a negative body image and are preoccupied with their weight and shape.
  3. Impulsivity: Bulimia is often associated with impulsive behaviors and difficulties in regulating emotions.
  4. Shame and Guilt: After binge eating, individuals with bulimia often feel intense shame and guilt, which perpetuates the cycle of purging3.
  5. Co-occurring Mental Health Issues: Anxiety, depression, and other mental health disorders are commonly seen in individuals with bulimia.

Both disorders are complex and can have severe physical and psychological consequences. Treatment typically involves addressing these core issues through therapy, medical monitoring, nutritional counselling, and support groups.