DBT Emotion Regulation Worksheet 1a (With Example)

I've found that one of the most effective ways to cope with intense, extreme emotions when they occur is to pull out a DBT Emotion Regulation Worksheet 1a and fill it out - no matter how hard I am crying, how terrified/anxious/panicked I feel, no matter if my hands are beginning to tremble, cramp, and stiffen up due to hyperventilation (which was actually the case this morning).


I had an anxiety/panic attack episode this morning of epic proportions. I worried that I would embarrass myself by going to the emergency room after just announcing that it's been one year since I have used the ER as a resource for an emotional crisis. (Gross warning: When I get severely anxious, I have diarrhea, and that in and of itself probably wouldn't be so bad, but this unfortunately triggers trauma memories from the past when it happens, so I then have that issue compiled onto the existing episode. It's tough!)

I talked myself down, did the sheet and some other activities I'm about to share, and I reminded myself that I have so many more skills and so much more important information to refer to at this time. A year ago, I did not, so that's how I coped. It's time, in the face of such an intense episode, to put the new skills that I've been working so hard on, to work.

I'll share the worksheet with you to start.  My writing is a bit jumbled and messy, as I was shaky and my hands were cramped up as I wrote it.  I will clarify the information in the text below the sheet. If you click on the image, you should be able to see it in full size, which should help. I covered over other peoples' names for their privacy.

I did get quite worked up and, as always, I debated on how much I should share of my personal struggles when they get intense. I find that when I do, many people say they are helped, so that's my rationale for sharing this today.



Emotion Regulation Worksheet 1a with personal example: anxiety. Please note that this sheet is from
the Skills Training Manual for Treating Borderline Personality Disorder by Dr. Marsha Linehan.




I started this sheet at 10:20 am. At this point, I had gotten to the point in the anxiety/panic attack where the typical thoughts come up: "Am I dying? Do I need to go the E.R.? Am I going to be ok? Am I really going crazy this time?"

I knew that I had to intervene with skills that would help me to not make the situation work and that would hopefully make me feel better. Enter the Worksheet 1a.

Emotion Regulation Worksheet 1a: Describing Emotions

Name: Debbie
Date: June 7, 2012 10:20 am
Emotion Name: Anxiety
Intensity (0-100): 92

Prompting Event for my emotion (who, what, when, where): What triggered the emotion?
Headache/muscular pain, appetite issues (and anxiety around eating), gastrointestinal issues, someone I love leaving for three weeks, home from work (broke routine) to care for my cat who had surgery yesterday. Triggered by dehydration fears due to the diarrhea. Fears that I could end up going to the ER.

Vulnerability Factors (What happened before that made me vulnerable to the prompting event?
Stressful event at work this week, stressful event with cat having surgery and then me needing to stay home and miss work, getting closer to loved one's departure (and I don't have much of a social circle right now, except at my job), possibly hormonal (PMS), diet not the greatest this past week. Sleep not the greatest this past week, both due to worry.

Interpretations (beliefs, assumptions, appraisals of the situation)? 

Just a quick note here. I read this the other day, and it is SO true...






The image above was taken from a book one of my DBT group peers brought to class this week. It came to mind, in the midst of all of this inner turmoil, while I was filling out the Interpretations section. It is called The Mindfulness Breakthrough: The Revolutionary Approach to Dealing with Stress, Anxiety and Depression, by Sarah Silverton, with foreword from Jon Kabat-Zinn. I plan on picking it up, as it looks excellent.

A mix of over reactive "emotion mind" (not this again! I'm freaking out! I have diarrhea - what if I become dehydrated or can't eat today? What if I ended up going to the ER and disappointing others and myself since I just announced my one year anniversary of avoiding this behavior?), "reasonable mind" (This is JUST my body's COMPLETELY NORMAL reaction to fear/anxiety/perceived threat, and once I can calm down, these symptoms will subside - the bathroom visits, the lack of appetite, the fearfulness. I have evidence of this from past episodes/experience and because of scientific fact on how the human nervous system responds.)

Face and Body Changes and Sensing (What am I feeling in my face and body?): 
Tightened muscles in neck, shoulders, buttocks. Hands clenching due to hyperventilating, tingling, cold rush of adrenaline throughout my veins, diarrhea, nausea.

Action Urges (What do I feel like doing? What do I want to say?): 
Running, screaming, crying, hitting myself on the head, calling therapist, considered ER, use skills to cope, take Ativan  (a prescription drug for severe anxiety), do some meditation, sleep, distract.

(I notice that the deeper I get into DBT and the longer I've been practicing the skills, the urges tend to be a mix of non-constructive and constructive urges, which I believe is a sign of progress. In the past, the urges might have ALL revolved around self-sabotaging, self-harm, or some other behavior that would only make matters worse. Even though some of those behaviors still show up under urges, I have the power and choice which urges I will act on. Just because I have an urge doesn't mean I succumb to it.)

Body Language (What is my facial expression? posture? gestures?): 
Noticing that I keep hunching over to place my face and head into my hands. Noticing I feel "defeated" in this position/posture, so sitting up.

What I SAID in the situation (be specific):
Sister called - told her I was very anxious afraid I'd go to the ER even though I knew it wasn't an emergency. I felt scared, even terrified, but I wasn't in any actual danger. Told her I needed to hang up phone (anxiety made me feel as if I might vomit at that point, but I sat down and did deep breathing, and  this kept it from happening). 

Called DBT group therapist and left a voice mail doing lots of noticing and describing. 
She never called back. I don't see this as rude. I see it as her TRUSTING that I will work through this using my skills and that I know well enough to reach out further if needed. I actually appreciate this vote of confidence. Glad I got the machine, too. I could just vent and talk myself through it and then release.

What I DID in the situation (be specific):  
Tried to distract with internet. Didn't bring down anxiety, so I turned away from it. Tried the same with talk radio and had the same experience. 

Put some more attention on my cat, took an Ativan, focused on this worksheet (which helped significantly), did a muscle tension and relaxation CD and guided meditation by Catherine Regan, Ph.D. 

It's a CD that I personally highly recommend for coping with stress, anxiety, and panic, as it's helped me time and time again. I hope you can find a copy for yourself.



Time for Healing by Dr. Catherine Regan
I also sipped on sparkling water, cracked my windows open, snuggled with my cats, and drank some warm tea.  I had a breakfast bar.  Used self-talk to soothe and calm.  Took my regular morning medications. Told loved one about episode. He got upset. I had to radically accept that and move into the next moment of self-care.

What AFTER EFFECT does the emotion have on me (my state of mind, other emotions, behavior, thoughts, memory, body, etc.)?
Tired, though this could be a combination of things with the Ativan. Thoughts: Thankful that even when it feels THIS BAD, I can calm down and soothe my nervous system, mind, and heart. There are days that are easy and others that are challenging. I'm just being challenged this morning. In resolving this and getting better, I can share this example and help others. 

Body/nervous system feeling a bit calmer. Mind is definitely calmer - less racing thoughts.  Breathing is still a bit shallow. Hesitant to brush teeth due to nausea, so I'll postpone (I eventually brushed them, lol.) Slight tension headache. Ready for guided meditations. Overall doing better. Proud of myself, as this is hard work.
Finished worksheet at 10:39 am. 


I have since done some handwashing of delicates, which I posted to my "Distraction Ideas" board on Pinterest. I also looked at my Pinterest boards, especially Self-soothing. I've distracted with some minor housework and some actual work from my job that I was able to accomplish from home.

Appetite still not completely back, but I know it's on it's way.

I hope this helped you in some way. Whether you got a better idea of what the Emotion Regulation Worksheet 1a is about and how it can be used, whether you suffer from anxiety and panic or other uncomfortable, intense, emotions and are looking for a helpful tool, or if you just wanted to hear my experience and relate, one human being to another, I appreciate that you took the time to join me here today. Doctors, therapists, social workers, and coaches, I hope this gives you glimpse into what this is like for those of us who suffer.


Thank you for reading.
More Soon.
                                                                                                     

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