Well with Arielle Lorre - 229: How to Deal with Big Emotions, Change Behavior, and Reframe Happiness with Dr. Maddy Ellberger

Episode Date: February 15, 2023

Dr. Maddy Ellberger is a CBT and DBT therapist and professor at Columbia University. She joins the show to discuss DBT (dialectical behavioral therapy) and how to use its principles to change emotions via changing behaviors. She has actionable tips on how to interrupt thoughts and behaviors, take opposite actions, and explains the usefulness of having a Distress Tolerance List. She also tells us why we should reevaluate our expectations in both therapy and in life, what mindfulness really looks like, how to process trauma, and what happiness really is.   Right now, Sakara is offering our listeners 20% off their first order when they go to Sakara.com/Blondeor enter code BLONDE at checkout.   Ritual is offering my listeners 10% off during your first 3 months. Visit ritual.com/BLONDE to start Ritual or add Essential for Women 18+ to your subscription today.   Discover how Shuteye Chai can revolutionize your sleep and get 15% off with code BLONDE. Go to helloned.com/BLONDE or enter code BLONDE at checkout.     Produced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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is a dear media production. Welcome to the Blondefiles podcast. I'm your host, Ariel Lori, and I'm here to talk all things wellness. From how to achieve optimal health and well-being to the best beauty tips and everything in between, no topic is off limits. I know there's so much information out there, so I'm bringing on expert guests and sharing my own experiences to help you sift through all the wellness stuff without the BS. Enjoy the show. Hi, everybody. Welcome to the show. I just woke up before I recorded this, so I might have have kind of like a sleepy voice. But I am really excited for this episode. I say that before every

episode, but I'm going to have to say that this one is in my new top three. And that's nothing against any of my other guests. I really do love every single one. But sometimes I'm sitting there recording with somebody and I'm just like, holy shit, wow. Like I resonate so much with what they're saying and I just feel like they are going to reach so many people. And that's exactly how I felt when I recorded this episode with Dr. Maddie Elberger. So I'm going to give you a little background on how we met and how we came to record this episode. I went on Eileen Kelly's podcast called Going Mental and that episode came out maybe like a month ago. And I got an email after from Maddie just saying that she listened, she loved it, and she would love the opportunity

to come on the show. I get a lot of pitches, whether it's from a person themselves or from their PR or whatever. And not all of them are great fits. And I really try to like curate the show to be what you guys would want to hear, what I think provides the most value. And I loved what she had to say and just her energy and her passion for what she does is infectious. So you're probably like, okay, what does she do? Who is this person? I will tell you a little bit about Dr. Maddie Lberger. So she received her undergraduate degree in psychology from Yeshiva University and her master's and doctoral training in clinical social work from Columbia University and New York University. She completed her pre-doctoral internship at Morgan Stanley Children's Hospital and

Columbia Presbyterian Hospital and her postgraduate training at the Center for Cognitive and Dialectical Behavior Therapy. Maddie has received extensive training in cognitive behavioral therapy, dialectical behavioral therapy, DBT, which we talk a lot about today, mindfulness-based stress reduction, and prolonged exposure and cognitive processing therapy for trauma. She has provided treatment to children, adolescents, adults, and families with anxiety, mood behavioral, and personality disorders in a variety of settings, including schools, community mental health clinics, private group practice, and hospitals. She has her own practice, and she's also a professor at Columbia, all in her early 30s.

So in this episode, we talk about DBT, but we talk about it in a way that you guys are going to learn how to apply it in your own lives and learn how to change kind of unwanted behaviors and move through big emotions. Her whole thing is like, yeah, it's great that's kind of watered down self-care that we see all over social media from, you know, the green juice to the meditation, to the journaling. But when somebody is struggling with something really hard and you see that and those things don't work for you, it can be really discouraging. So she has real, tangible, actionable things that we can do to get through those things. So we talk about how changing behavior changes emotions instead of vice versa. We talk a lot about taking opposite actions, how to not take the action

you don't want to take, whether that's texting the X or drinking or whatever it is. We talk. We talk about a distress tolerance list, something that we can all have in our lives, how to interrupt thoughts and behaviors. We talk about what happiness actually looks like. What she said about happiness is so powerful. It's towards the end of the episode. You guys all need to hear this. We talk about mindfulness. We talk about accepting emotions and circumstances versus invalidating emotions and circumstances. We talk about trauma. she talks about wellness tips that actually work like cold plunge but not like cold plunge getting in a bath. We talk about dunking your face in freezing cold water and how it activates a dive reflex. And she just is so passionate like I said. Her energy is really infectious. And what I love most about her is that she's super relatable. So she's really smart, super intelligent and obviously knows her shit. But she talks like one of us. if that makes sense. And she does not make these things seem unattainable or, you know, super academic.

And that's what I really love about this episode. So I think by the end of it, you are going to want Maddie to be your best friend. I know that's definitely how I felt. So with that, please enjoy Dr. Maddie Lberger. So welcome to the show. Thanks. I'm glad to be here. That will just be our entryway into it. So how we met is you reached out to me after hearing me on Eileen's podcast, I think. And you told me about what you do. And I just immediately was like, yes, you need to come on the show. Because I think that you just have the credentials to talk about so many of the topics that are prevalent on social media today that are maybe talked about by people who really have no background and no knowledge of how to really deal with. things like emotions and all of that. So why don't you just start by introducing yourself to the audience?

Sure. So my name is Maddie Lberger. I'm a doctorally trained therapist and a professor at Columbia. I have my own private practice, Madeline Elberger clinical services, but no one calls me Madeline. So except for my mom. I have been doing therapy, treating people for about 10 years, and I specialize specifically in dialectical behavior therapy. And so dialectical behavior therapy, in short, is a cognitive behaviorally based treatment for people with really, really big emotions. And the way that generally plays out in people's lives are, you know, really ineffective communication, poor boundaries, suicidality, self-injurious behavior.

So people who really, really feel lost, and I help people find their way back. And it's really, it's like the best thing ever. So that's what I do, day in and day out, and I love it. And I just started a professional Instagram where I give their like 90-second videos about, you know, therapy. Shout yourself out. Shout out your Instagram because it's great. Thank you.

It's millennial mindfulness doc. And fun fact, I spelled millennial wrong the first time I started it. And the amount of messages I got was like, are you kidding? I'm like, okay. Amazing. Yeah. Okay. So I'm really familiar with cognitive behavioral therapy.

And I think that a lot of people are. I feel like that might be the more. common modality when it comes to therapy. So can you differentiate between CBT and DBT for us? Just explain like the main differences. Absolutely. So CBT is really a catch-all. There's many, many branches of like protocols within CBT, but it's really what we like to call a big C little B treatment. So a lot of cognitive behavioral therapies, whether they be for anxiety, depression, PTSD, are focused on changing thoughts, challenging thoughts, and the idea that thoughts, emotions, and behaviors are all connected. And so if we come in through thought, everything else will change, okay? Like challenging your beliefs, et cetera. So that's

CBT. Dialectical behavior therapy on the other side of that coin is a big B, little C treatment. And so in dialectical behavior therapy, because we are really targeted towards people who are really, really, really suffering, like people who are in the hospital, have made a suicide attempt, have like lost everything, we lead with behavior change because it's really, really hard to change your thoughts. If you are a person who's been living a certain way for a really, really long time, it is actually, believe it or not, easier to change behavior. And when you change behavior, you actually will more quickly change your emotions and your thoughts will follow. So that's like the bread and butter. DBT is more intensive. It's geared towards personality disorders. It has been

like normalized by our research for like everything now. But that's basically the difference. I truly believe that sleep is the foundation of my wellness. Not only do I feel so much better when I get adequate quality sleep, but so many important processes in the body happen when we are sleeping. And unfortunately, a lot of people are not getting good sleep. And I think the tendency so often is to look at the things that we're doing during the day, like exercise and what we're eating, and those things obviously can affect sleep as well. But if we aren't paying attention to that, then a lot of the other things can tend to unravel. 70 million Americans actually have chronic sleep issues, and 50% of Americans deal with sleep deprivation. So these numbers are not good. And I know

everybody can relate because we've all had sleep issues at some point. And of course, life happens. But something that really helped me a couple years ago was adding magnesium at night. So I have a really good nighttime routine. I'm off my phone a couple hours before bed. I like to read using my amber light. So I'm not on like a blue light screen. I'm not watching TV usually. I will do my skincare. So I really have this wind down routine that helps. But sometimes I have trouble falling asleep or staying asleep. So I started taking Ned's mellow magnesium. And I've said it on the podcast before. It really like a missing puzzle piece. I don't think any one ingredient is a panacea for anybody, but if you are deficient in something, especially like magnesium, which so many of us are deficient in, supplementing with that can really make you feel a big difference. And Ned came out with their new product, Shudai Chai, which has taken my routine to a whole other level. Okay. I'm usually a dessert person, but I was starting to feel like even my usual dessert, like dates with chocolate or sometimes I have these vegan ice cream bites or whatever it is,

was kind of disrupting my sleep, even if I ate it a couple hours early. So when I took inventory of what I was doing and how it was making me feel, I realized like dessert was just not working for me anymore. So I have my dessert earlier in the day. I'll eat something sweet after lunch. But after dinner, I like to have a little something and this is where should I, chai, comes in. So it is a mellow super blend latte for sleep that combines adaptogens, aminos, functional mushrooms, and magnesium. So seriously the best ingredients out there wrapped in this heavenly masala chai inspired spiced body. So think cinnamon, clove, ginger, all that good stuff. And it doesn't just set you up for amazing sleep. It has ingredients like chaga, Rishi, and Ashwaganda that

are deeply nourishing to your body, so you're getting a ton of additional benefits. And I'll have this with some macadamia milk. I'll put a little bit of honey in there. And it's just this amazing treat that I look forward to every night as much as I look forward to my matcha in the morning. And you guys know that that is a lot. So discover how Shudai Chi can revolutionize your sleep and get 15% off with the code blonde. Go to hello ned.com slash blonde or enter the code blonde at checkout. That's H-E-L-L-L-O. NED.com slash blonde to get 15% off sweet dreams. Hi friends. I'm Cameron Rogers, host of Frecklet Foodie and Friends podcast, which is now on Dear Media. Are you wondering what just happened to your life after having a baby or struggling

with your mental health during postpartum? That was made just a few months ago. Are you working on healing your relationship with yourself, your body, and or food? Same. We are all on a journey to self-love and acceptance, and I'm right there with you. That's what Freckle Foodian friends is all about. Remind you that no matter, what, you are not alone. Make sure to tune in for season five launching with Dear Media on November 9th and subscribe to listen to new episodes every Wednesday morning. You know this because you heard me on Eileen's podcast, but I've been sober for nine years now. And that was the first thing that I learned when I got sober was I am not going to be able to

think myself into feeling better. And I think that so much of the advice that we see today is kind of centered around that and maybe centered around journaling and being aware of your thoughts and your feelings and just change that. And for me, I have to take action, usually contrary action to what I feel like doing in order to change. And that's been the entire foundation of my sobriety and my life and my life right now as a result of taking action, not of thinking, although I do therapy and I do all of the other things as well. And, you know, I thankfully haven't suffered with something like intense depression or, you know, suicidal ideation or anything like the people that you probably work with have. But even just getting out of the depths of addiction, you know, it wasn't from thinking.

It was from action. Yeah. So just a couple of things on what you just said. And there's nothing that brings like me as a therapist. And I really am like, I breathe and sleep this stuff for better or for work. there's something that brings me more joy than hearing somebody talk about, like, really honestly, what works for them? And I really, it's one of the things that drew me to you is that I just appreciate they're like, I need to do this. I do this thing. I usually have to do it this way. And so I just

want to say, like, that just fills me with so much joy that like it works for you and you're, and you're making it work. So that's number one. Thank you. And number two is that you're actually doing a DBT scale that you don't even realize. It's called opposite action. And it's when we want to change or lower the intensity of emotion. We do the thing that's opposite to the urge. right? So if we're really anxious and we want to like avoid something, we do it as long as it's safe, like stuff like that. So you actually don't even realize that you're being skillful in a DVT way and you are, DVT in the wild. How exciting. I feel like it's so hard to do though. It's easy to hear and go, okay, next time I feel this, I'm going to do this. But then when that happens,

I know for myself, I'll just speak for myself right here. I want to revert to the comfortable thing, not the uncomfortable thing. And I know that you've talked about this on your new Instagram. where, you know, I think it had a name to it, distress something, distress tolerance, where we are more prone to continue doing the coping mechanism or whatever it is that we know isn't serving us instead of doing the different action or whatever that we know might serve us. But it's just so hard to go from the place of being in that uncomfortable feeling to taking that action, right? It's the hardest thing ever. Behavior change and emotion regulation are the hardest things ever. We can all speak to that from different areas of our life, you know. But your point of saying, like, yes, the idea of just kind of learning to shift the way you react to an emotion, you don't have to like the emotion. You just have to shift, practice small shifts in the way you react to the emotion. And that will change things for you. And yeah, it's really, really hard. If it wasn't hard, I would be useless. But aside from that, like, you know, we're shaped behaviorally, right?

I'm a behaviorist. So I believe that everything is learned, which means basically anything could be unlearned, right? So we're shaped to believe that when we're in an uncomfortable situation, this means bad. This means danger. Our amygdala, which controls our emotions is like, ah! Like, it's like literally freaking out, okay? And so we do the thing that's comfortable. We do the thing that makes the discomfort go away.

And that could be ineffective coping or effective coping, right? Like, name your poison. Fine. And being able to learn that that's actually not unsafe, that like being anxious is not unsafe. Our reaction to anxiety is actually what makes us unsafe. Being sad is not unsafe. Our reaction to sadness is what makes us unsafe. And being able to actually practice doing that and acting in that way is what makes it a little bit easier each time. But I will also say, one more thing on this, is that behavior change takes about two to three weeks of consistency. Nobody is a machine. So you're not going to be consistent for two to three weeks of like doing something.

Like that just doesn't happen. Who does that? I don't know. AI maybe. But like I don't know. So the biggest challenge that we use human beings face when we want to do something differently and feel differently is giving up too soon, right? It's that this is so hard.

Why isn't this easier for me yet? And that's the value of really good treatment is that you have somebody like my patients call me all the time, 24 hours today I'm available and they know. And it doesn't have to be for suicidal crisis. It's like, I really want to text this guy. And I'm like, you will not fucking text this guy. You will not. Here's what we're going to do instead.

Call me back in an hour. That's tolerating distress. Interesting. I'm just, again, comparing it to my experience in sobriety. And I think that the reason that it's been so successful so far in my case is because that's kind of the model. I mean, I don't talk about it really publicly, but of like a program where you have that person who's guiding you, where you have that person or people that you call when you're

about to do something or when you're feeling a certain. way and you're taking that separate action. So I'm curious, like, if you are starting to work with a new patient and they're dealing with something really big and they're in a really bad place, what are the most common steps that you might take when you're working with them to try to start to get them out of that? Sure. So I'll just caveat this with this is not treatment, but I can talk a little bit about like what early treatment and what we call coaching calls and DBT looks like, right? So whatever someone is dealing with, the idea is that we want folks to practice in the moment being mindful. That means knowing I feel this way and my body is pulling me to react

in a way that I know isn't going to be helpful for me in the long term. So I really, like, encourage my patients. It doesn't matter what you think it is, call me. So the first step is, please call. And if someone's not calling, then we first have to address that, right? But let's assume someone's like used to calling me, right? So what we do in those crisis moments is we really want to, we want to clamp down the crisis. We want to make sure that it doesn't turn into an actionable thing, right? Because like you said, thinking isn't doing. And if you can actually catch the urge, fabulous. So what we do in that moment is it's like a five to 10 minute phone call. Hi, what's going on. Hi, Dr. Elberger. Here's what's up. I, this thing happened. This triggering

event happened. I want to do X, Y, and Z. Trigger warning. Like so about that might be harm, that might be drink, that might be, you know, impulsively have sex. It could be literally, it could just be like, I want to, you know, like go on a run. It's, it's 3 a.m. Like, no, like, maybe not, right? So, so what I'll do in that moment is I want to give this person very specific distress tolerance skills, which is basically a replacement behavior to help them elongate the time that they don't act on an urge. So I'll almost always use the cold plunge. which we can talk about. There's a really good science behind that. And I love that's being popularized in an effective way. And then what I'll do is I, on a first session with every single patient,

regardless of their level of severity, I make 10 things to do instead of acting on an urge list with them, individualized. They keep it in their phone. So I say, open that up. I have a copy of every single person. So that's, I think I'm seeing 38 people now. So I have 38 distress tolerance plans of my phone. and I'll say, okay, first you're going to do the tip scale, which is the cold plunge. Go do that with me on the phone, right? Remember, so I'm supporting someone along the way. And then I'll say, okay, let's look at your distress tolerance situation. Let's say it's like 4 p.m.

So it's not an unreasonable time to do stuff. I'll say, okay, choose one. They might say phone a friend. And I'll talk about that because venting is actually not effective, but phoning a friend and being distracted is really effective. I said, okay. So you're going to do that for at least five minutes. How about you also bake something and you bring it into the next session for me?

That's going to take you 30 minutes. You better not do anything until you finish that 30 minute thing, right? And then let's add one more thing in there for good luck, right? And I want you, after you do all those things, to call me or text me and let me know how strongly you want to do the urge. And so it's really individualized that it's about being able to mindfully place your attention somewhere else while still knowing that you don't feel good. So for people listening, if they are doing something that they don't want to be doing, going back to an ex or drinking or self-reliable. harm. Wherever they are on the spectrum, if they are not in therapy, they're not seeing a professional, which obviously proponents of seeing professionals if you can. But are there things

that the listeners can do at home for themselves? I mean, you mentioned cold plunge. Can they make a list for themselves of these things that they can do, phoning a friend? Absolutely. So I would say, I actually love that for bringing this up because I like want everyone to have a distress tolerance list. So no, everyone is. I'm going to make one after this. I'm like obsessive. I'm so excited. Okay. So basically you want to think about 10 things that you can literally be anything as long as they're not going to be more triggering, obviously, that you're going to do in what we call like really like in the zone. So you're going to spend like you're really going to focus. And if you notice your mind getting pulled away to the thing that you really want to do,

you do your best to bring it back. So that's half the battle is like practicing, refocusing. And it could like again, it could be anything. I like things that are easier to pay attention to. So like if one of my patients is into baking or cooking, I'm like, go on Pinterest, create a recipe list. That's one activity. Now go make something. Then send me a picture, right? Because it's all about accountability. And my patients know because I'm on their team. I'm like, I love, I live for my patients. Like they want, they want, they want to give that back and forth to me. So you can cook, you can bake. You can scroll through TikTok. That is actually mine now. My TikTok makeup thing is my new distress tolerance. I'm obsessed with it. But,

Again, be mindful. If it's, if it's triggering to you, don't do that. You can read a book if you can focus on the book. You can watch a TV show. You can phone a friend. Please don't vent. When you vent, when you're in a high emotion, you actually, you increase the emotion or you maintain the emotion. Emotions only last 20 to 30 seconds. When we talk about them, we think about them, and thinking impacts our emotions. I can attest to this because I have a few friends who get what we call the friendship podcast, the voice notes of everything. everything happening and whatever situation I'm venting about. I was actually doing it this morning with a friend. And I was like, I am so fired up now. Like she asked me, oh, how's such and such? And I was like, well, let me tell you. And then I'm, you know, 10 voice texts into it after 10 minutes. And I'm like, holy shit. Like now this, it wasn't even bothering me before. Now it's bothering me a little bit. I mean, and for what it's worth, like this is why we have good friends and we tell them, don't ask me what's wrong. If I want to talk about it, don't let me. And my best friend who's in the room with us, Ashley, like, knows. Because I can sometimes be like, oh, my God, I need to talk about this thing. And she's like, stop. Like, this is not helpful. And it's not helpful. And it's true. You'll burn people out like that. So that's also what ruins relationships when you're not mindful. So phone of friends, but please ask them to talk at you and really pay attention. Work out if that's effective for you. Do yoga. Meditate anything. Put down 10 things. My general go-to is, or my mattyism, as I like to say, is spend at least

five minutes each each each. Some of them will take longer. So five minutes each, 10 things, that's 50 minutes that you're not acting on an urge. And if you still feel the urge really strongly, you still want to engage in that ineffective behavior, do the list again. Just keep doing the list until you have found a way to be present enough, not feel good, to be present enough to not engage in the ineffective behavior. Okay, so just playing devil's advocate here, what if you're like, okay, I'm going to go on TikTok and then you're on TikTok and you're off to the races. I know that you said if it's not triggering for you do it. But what happens when that fails, when those behaviors fail or they

lead you down another kind of distressing road? Sure. Well, that's why everything and this is a, this is a DBT thing and it's interesting the way it's talked about now in like pop culture, but like everything comes down to mindfulness. What is mindfulness? It's really focused awareness. It's really focused awareness. It's the moment in time where you can turn inward and say, I think, I feel, my body feels, and I want to do. And then it's the practice of being able to refocus your attention. Okay. And so if there's no mindfulness, there's no skillfulness. So let's say you're like, okay, I'm like, okay, cool. Like I'm doing my makeup thing on TikTok. And all of a sudden, something comes up that's really upsetting to me. Like maybe it's a body image thing or like, I don't

know, whatever, you know, again, pick your poison. You have to know yourself. I could stay with that unless I'm, but if I'm being mindful, I won't because I know it's going to make me worse. And I need, and so it's a choice. We're not always going to make the right choice. We're not always going to make the effective choice. It's a choice. You could do X, you could do Y. There's no one right way. It's just what, what's your goal? And so if my goal is to not text my X or, you know, whatever my thing might be, if, you know, self-harm or drink or whatever it is, then I'm not going to do that TikTok video right now because I don't want to screw up my long-term goals. And if I do go into that TikTok video, that's okay. Great. Once you start feeling really bad, ask yourself, what can I do now instead?

There's no wrong time. There's no, there's no too late for mindfulness. Yeah, I guess I'm just thinking about, like, what is the incentive for having the discipline to do the uncomfortable thing versus the comfortable thing. And I get that. Like, I guess it's how much, how badly do you want to reach your goal? How important is that to you? How badly do you not want to be uncomfortable? Like, I know for me, I have to, I only learn by getting in enough pain and getting really uncomfortable. That's why I was a rock bottom addict and alcoholic. I had to be shit out of luck. I had no other options. I was either going to die or get sober. That was the point at which I was like, okay, I'm willing to do something different.

And I've gotten to that place with other things. I've gotten to that place with dieting, you know, where I'm like, I cannot live this way anymore. Now I have to find a different way with exercise. You know, with things that are actually can be helpful to us as well. Like, I'm an extreme person and I have to get in enough pain and discomfort that then I'm going to be willing to try a different way and try that contrary action. So how do you navigate that with your patience? Sure. So you're actually just talking about, like, bottom line, the human experience.

So humans are dogs or rats or whatever. We all learn, literally learn in the same way. No one is going to change if something is hard if there's no consequence, right? So the consequence has to be aversive enough for you to be like, shit, I'm done with this. Like, I just can't, I can't take another goddamn minute of this, right? For you, it was literally life or death. And that makes a lot of sense for addiction. But by the way, it was still a choice. You still actually responded to that consequence. And it's important to remember that. And so with my patients, you know, with any of any of us, with myself included, right? I'm working on things always.

I have to be. I want to be because I want to feel better. I want to feel different. It's about coming in. Like, you know, so someone brings something in and they're like, okay, I did this thing. And we actually keep a record. We keep something called a diary cards. so people are tracking their emotions, they're tracking their urges, they're tracking when they act on their urges, right? So that people are getting an idea of what's the pattern here? And they're like, okay, I did this thing.

And I look at it and I'm like, okay, let's talk about what got you there. Link by link by link. Okay. So like this thought happened that led to this behavior, et cetera, et cetera, et cetera, okay, how did you feel after? How is this getting in the way of your goals? What can we do? It's like, okay, fine, you're changing your behavior.

Like I said, two to three weeks of absolute consistency is what robots do. We're not robots. This is what's going to happen. This is not an all or nothing thing. So we're not just going to give up on treatment. Sorry. What can we do differently next time? Where do we need to intervene in that whole chain of events?

Where do we need to intervene so that we can get you to do something a little bit differently? Because actually just doing one thing differently will change the chain. It doesn't have to be that complicated. I feel my absolute best when I am cooking my food. I know exactly what's going in my body. But you may have noticed. lately that I have not been posting many meals or recipes on my Instagram and that's because I have been on the go and so busy and I know that so many of you guys are in the same situation. So if you are

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why I've been taking it for years and it just takes the guesswork out of what you should be taking. So instead of striving for perfect health, aim for supporting foundational health. Ritual is offering my listeners 10% off during your first three months. All you have to do is visit ritual.com slash blonde to start ritual or add essential for women 18 plus to your subscription today. Again, ritual.com slash blonde. What do you see that precedes the action? Is it, as I remember hearing like, it's the thought, which leads to the feeling, which leads to the action, which is your behavior, which determines your character and your life, ultimately. But how do you see that originating?

What precedes your actions, which then determine your life? Sure. So, once again, behaviorist, everything is learned, which means everything is reinforced or consequenced. And so we do a thing, like we live our life and something happens. Like, okay, we feel an emotion, something happens, and the anxiety goes away or the shame goes away. So we're going to keep doing that thing because it made us feel better.

alternatively, we do a thing and it increases the shame. It increases the anxiety. It increases the anger. We're not doing it again, most likely, because it, unless it, I'll get to that. We're not going to do it again because it doesn't, it doesn't, it's not working for us. And so then you're like, okay, well, people have behaviors that aren't working for them all the time. So the thing is it has, the consequence has to be aversive enough, right? So for you dying was aversive enough, right? For some of my patients, nothing feels immersive enough, and that's why they attempt suicide. But it's the idea that it's actually not that bad unless it's really emotional rock bottom. And it takes some time to get there. But we're not going to change something that's like, even if it's not working for us, because it's giving us something in that moment. Even if it's five seconds, it's reinforcing. And that like rush to your brain of like dopamine, that reinforcement rush is really,

really strong. So basically consequence yourself. Interesting. When I got sober, I worked with this group of consultants. They were therapists and they would work with the entire family of the afflicted individual. So the family would get therapy while the individual was getting therapy, but oftentimes the addict or alcoholic or some of them were not addicts or alcoholics. They just had mental issues and they didn't feel like they were at their emotional rock bottom. They didn't feel like they wanted to change. They weren't willing to go to rehab. They weren't willing to get help. And so the therapist would work with the family to try to help bring the bottom up a little bit and get the family, you know, for months ahead of time to the point where they could say,

if you don't do X, Y, Z, we are leaving, you know, and they would try to bring the consequences. to the person who maybe wasn't experiencing enough dire consequences to the point where they were willing to make a change. You're so on the money. You should go back to school. For real, right? We say in DBT you can get behavior change without motivation. And that's exactly what you're talking about.

The environment shapes us, right? And so if our environment becomes unlivable, as in our family stops giving us money, the locks on the doors change, whatever it might be, we can't keep doing the things that we're doing. We actually have no choice. So like you said, we bring that bottom up so that it, like, they're there. You have to get there. And like, yes, ideally, we don't want to have to get to that place. And sometimes we do. Sometimes people, sometimes you just, we all can't get out of our own way. And that's okay. Like, because when you get to the other side of it, you're like, holy shit, that saved my life. So, yes, we shape, we shape everything around us. And we need people to sometimes

force us into behavior. Right. Okay. Let's talk about some of the kind of wellnessy things. Absolutely. But let's start with the ice plunge, ice bath, because that was one that we talked about a little bit earlier. How is this useful with anybody who's struggling? Okay. This is literally a thing that I'm not kidding. Everyone needs to try at least once in their life.

Like, please do it. Okay. So I'll just like briefly be a nerd and like explain the mechanisms. Okay. So basically what happens is we have this. this reflex that we're born with called the dive reflex that sends a message to our brain. We're immersed in really, really cold water, like immersed. It sends a message to our brain that we're drowning.

And then it forces our brain to conserve oxygen, turning on the parasympathetic nervous system, which is our rest and digest. Okay. So that calms us down. That's actually how it works. And so this is the skill where you don't have to think and you can reduce panic. You can reduce rage. Like anything where you feel it so strong in your body,

This is the skill for you. In DBT, we call it the tip skill. You can call it a cold plunge. You can call it an ice bath. I don't care. But the idea here is if you are feeling something extremely strongly, like in your body, you can slow your heart rate out down without having to do anything. Fill up a bowl with really, really cold water. You actually don't have to add ice, but you can. Fill up a sink. I don't care where you are. There's always a sink, even if it's nasty. Fill up a sink, okay? Hold your breath and then put your face in. You literally do not need to wash your hair. Like it is not, you know, like a dive, but put your face in for as long as you can. You're holding your breath. Do not blow bubbles. Come back up. Do that several times. My usual rule is like at least 10. You will actually notice a shift in your heart rate.

There is like really good data behind this. And so you could start your day like this, right? Like it's cute that people are doing that. Great. It's really you want to use it when you're at a width end. And you need to sort of give yourself a window to be able to then refocus on something else because your body is so out of control that it needs a reset. And it's literally, it's an actual reset button. It's fabulous. Is it the face only or can it be like a cold shower, cold bath? Great question.

So the face will, the face only will activate this dive reflex and actually more specifically like your sinuses. Like got it. Like your acunized if you wear sunglasses on your tanning, okay, and holding your breath. So that will give you the dive reflex. However, taking a cold or hot shower or squeezing ice, it's a thing I have patients do all the time, that will also, like, turn, turn your mind towards something else. Those are great distress tolerance tips. They're just not going to do the physiological thing, but they are distractions. They will force you to focus somewhere else outside of your mind. If you're holding ice, it hurts like an MRFR. Like, it is the worst, okay? And especially for people who utilize physiological coping mechanisms, like cutting,

burning, et cetera, like being able to get that like sensation of like the body sensations in a way that's safe is incredibly useful. But even if you don't struggle with self-harm, like try to hold ice in your hands. You will not be able to think about anything else. How long do you do that for just until you can't anymore? Obviously don't give yourself like any kind of frostbite or like like disclaimer. Like obviously please do not take this to the extreme. Listen to your body. But yeah, basically, like, for as long as you can. And again, it gives you that moment to, like, switch.

Then you can say, like, okay, like, I need to call someone for them to talk at me right now. But sometimes we need that physiological thing, different from the ice bath with a similar flare. Are there any other kind of wellness-y things out there that actually are effective? Yeah. So let's, like, talk about that a little bit because this is like the hill that I will die on. This is why I love you. is why I created my Instagram. I think the way, I think it is incredible and fabulous that there is so much available now

and there's so much acceptance around mental health and therapy and all these things. Like, that's great. And so people talking about what has worked for them, fabulous. It is just so wildly oversimplified and it's so troubling to me. So, yes, exercise is great. Having a consistent routine is fabulous. You like to drink a green juice in the morning because that's part of your wake-up routine. Fucking do it.

That's amazing. But not just one of these things is going to make you feel better. And if you do all these things and you still don't feel better, that's okay because they're parts of the puzzle. And that's, I think, the most important thing to think about. Like, yes, exercise has a lot of benefits. Yes. Eating healthy has a lot of benefits. Yes, having an effective nighttime routine, as you see from my Instagram, incredible benefits, right?

These are all things that support your ability to manage your emotions. They are not catch-alls. And what worries me a lot and what I really feel passionate about is that people look at this stuff and they're like, well, I'm doing all of this. What's wrong with me? And it just like makes me sad. And so it's like you have to understand the holistic picture. And I think for folks out there who are talking about their experiences, talk a little bit more about the messy part. Talk a little bit more about what you're talking about in therapy.

You know, like suggests that somebody go to therapy if they're feeling. anxiety, not just go on a run. Because that's actually how you figure out how to take all those pieces from the internet and make them work for you so that you can have a life worth living, build a life. Yeah, I think it's very reductive. Even I've been in a space where I've been like, okay, I'm doing the things that have always worked for me or I'm doing the things that I think I should be doing and it's not working and like why. And it can be very discouraging, I think. And especially if you're like struggling with something big and I know that everybody is is dealing with something, you know, and we look to other people for inspiration. But I think when it comes to really getting help

and changing, like it's so individual. Like you have to find what works for you. Like, and you have to find the person to help you with that. And it's like, you know, finding the right therapist is, yeah, I'm a research nerd. Like research shows that that's the single most important thing is a therapeutic relationship. You have to really believe that your therapist is here to help you and that you trust them, right? Otherwise, you're not going to, it doesn't matter like, if I'm like the Dalai Lama, you're not going to practice mindfulness, if you think I'm an idiot, you know? And so it's, it's really just about like, yes, I'm doing all the right things and I still don't feel well. Why is this happening to me? And bringing that up in treatment.

I did all the interventions you told me to do this week. Why is this not? Why is this not? Why? do I still feel like hell? Why is it still so hard for me to get out of bed? And talking about what it means for something to work or not work, really understanding what beliefs are coming into your purview and how that's impacting the way in which you're seeing your life be built. My favorite thing to say, this is another Maddieism and it's kind of like something that I think about a lot for myself as well. You're laughing at me. No, I love it. I love the Maddieism. Yeah. It's like it's a bit, if you will, but sorry me, is you come to therapy not to be more happy. Don't ever come to treatment with me because you want to be happier. That's bullshit. Come to treatment with me. Come to therapy.

If you want to be able to deal with life better, if you want to feel like you have control. Because ultimately, happiness, the way that we view it in society is like, it's not a thing. The way that what we call happiness is actually joy. Life is punctuated with joy. Have your cup of coffee in the morning. You mean like, hell yeah, I love this coffee. Like having sex, joy, going out to dinner, joy, going on vacation, joy. That is not a prolonged state of being. A prolonged state of being, like, if you want to talk about happiness, what I think about is really content. It's the ability to know that you can handle the shit that comes your way. That's what being happy is. Being happy is being in control. Being happy is knowing how to handle your stuff. And then you want to be able to hold on to

joy, but you cannot hold on to joy if you have, if you do not feel competent in your ability to manage your life. I love that. And I think to your point about being able to handle things, I think it's also like the ability to be to adapt and to be flexible and to be an acceptance. I know that you talk about this as well. Like those are all things that I think lead to being content. And it's not this feeling of like, oh boy, like all day, every day. Yeah. I mean, that's cool. Like, Honestly, though, like, there are some mental illnesses that are punctuated by that grandiose feeling. I mean, like, you know, that's mania. So it's not real.

You can't live like that. And you, like, and there are shifts that we can make in our everyday life to help us be more okay with the idea that, like, actually what we're trying to do is just, like, get by and, like, be okay. And there's certain language you can use. And so, as you were saying, you're talking about flexibility. And so there are two things that in DBT we talk about that, like, literally my sister is, like, we're putting on your. your tombstone, Maddie Lelberger, and, because you can speak yourself into being more flexible. So rather than saying, but, like, oh, like, I really appreciate that, but, like, nope, I don't like it. You say and, because it actually allows both things to be true.

Because ultimately, there really is no one right thing. You don't want to negate everything you just said. And so it's like, okay, I really appreciate this gift. That was really kind. And at the same time, like, this is totally not my styles. I just want to let you know I'm going to return it, right? Not, oh my God, I love this gift, but like, you know, but it's not for me because then someone's looking at you and they're like, well, did you like it? Because you literally just said you fucking

hated it. So using and instead of but and using should instead of could is so important. And that's why I said before you could do X, you could do I, you could do Z because any of those options are choices. It's what's the choice that's going to get you closest to your goal? Should implies one right way. And that's not real. It's just not a thing. And so it's either it works out the way it is or failure. And like, that's not the vibe. Failure is not so bad. I'm going to have to change my closing question on my podcast when I ask the guests, one thing we should stop doing and one thing we should start doing. Sometimes I actually do, like, it depends who my guest is, but sometimes I do say could because I'm like, oh.

Right. Great. We love the mindfulness. I'm learning. Amazing. Do you think that everybody struggles with mindfulness today? Yes. Like, yes. The bottom line is, we're not programmed as humans to like think about the way we're thinking. And if you're doing that all day, like not, again, not the vibe. Unless you're like a monk. You're a monk or like you're ruminating like crazy and like you're miserable. Right. So it's about this idea of like you just need to know what you're doing and why you're doing it in any given moment because that gives you options. Mindfulness gives you options. We have eight million distractions that we can choose. to engage in or not. But this idea that like, you know, mindfulness is zen, not true. And the idea

that, like, you know, you have to meditate every day, also not true. You can. But it's just about asking yourself, like, once a day, okay, like, where am I right now? What do I want to do? Is that effective or not? Am I going to do it anyway? At least when you make ineffective choices, then you're, doing it with awareness. And so, yes, we all struggle with being able to be able to understand where we are and to refocus, especially when there's so many distractions, phone, this, that. and the other thing. And again, it doesn't need to be as complicated as it looks online. It's just asking yourself questions and making decisions. How can we accept our feelings, kind of what we were talking about before, without invalidating them?

Where is the line there? This is an amazing question, right? Because it comes up. When we think about distress tolerance, it's like, okay, I'm not engaging in those emotions. I'm distracting. But you can't distress tolerance your life away. you have to feel stuff. Yeah, you said it way better than that. I mean. She's a professional, everybody. L-O-L.

If I wasn't saying it right, I probably wouldn't be here. So, I mean, here's how you do it. And this is the idea of how do you validate. And so it's a dialectic. Everything ultimately is a dialectic, which means there's at least two sides. And so saying I shouldn't feel sad because someone broke up with me a year ago doesn't actually make you less sad. It's like when someone says to you, like, calm day. and you're like in a rage.

Like I literally will be like, I will end you if you fucking tell me to calm down. Like, and so it's the same idea that you're doing to yourself. I shouldn't feel sad. Doesn't make you feel less sad. It actually just adds shame in there because you're like, what's wrong with me for feeling this way? And so then you end up feeling worse and it compacts it and then it reinforces it. Right.

So you have to be able to say, I feel sad because I feel sad because my breakup is really hard on me. I feel sad because I'm still feeling like I don't understand. I feel sad because I'm still sad. I'm sad about being sad and I'm done with that. I'm tired of it, right? And at the same time, I don't want to feel this way. I can and will feel different. So you actually literally, yes, have to label your emotion and understand where it's coming from before you can change it. You're not going to change it by being mean to yourself. It's just not going to happen. And that doesn't mean you have to like it. Acceptance is not happiness. You can hate something and accept it. It just means you're not trying to. It just means you're not trying to. to make it not be real. Does that make sense? Yeah. So you can accept it and still try to change it. Absolutely. Okay. That's our dialectic in DBT. We're always kind of like oscillating between acceptance and change. There are some things that we have to accept and some things that we have to change. And sometimes when we accept something, it allows us to change it. Amazing. Okay. Trauma. We haven't really touched on this one.

Sure. But I did a Q&A on Instagram about mental health and a lot of people were asking about trauma. I've had my own trauma, which you heard on Eileen's podcast. And it's something that I've done a lot of therapy around, but I feel like it still does come up. I tend to like hold things in my body. And I'll think that I'll have dealt with it. I did brain spotting and like lots of different therapy things around it. And then sometimes it will just come up. Something will kind of trigger it.

And I'm like, oh, it's still there. And I think a lot of people deal with trauma, whether it's big T, little T, like there's a whole spectrum. How do you guide people through trauma? So it depends where they are in their experience, right? And I first of all appreciate you talking about the difference between big T and little T. Because another Mattieism that I talk about in treatment is it doesn't matter what happened to you. If it's staying with you and it's impacting the way you live your life and the way you view yourself, then it's trauma. And so, yeah, anything can be traumatic if it plays out in your life over and over and over again.

shapes the way you exist. And so if someone's first coming in, I'm going to do a really thorough assessment of what that looks like for them. I want to understand every single symptom in the, in the DSM that has to do with PTSD because I want to understand what's the worst part and what we need to attack first. Is it your sleep? Is it your hypervigilance? Is it intrusive thoughts? What's going on for you? What are you avoiding? Right. And so this is like somebody walking in who's never dealt with their trauma, right? And then I'm going to choose an effective evidence-based treatment because that's what works, guys, to literally help them process that trauma. The way that I like to think about trauma also is it's like a, like when you have a traumatic experience, your,

your brain, like imagine it like a puzzle. The trauma like smashes it. And so the puzzle is all over the place. And then the experience, like the acute traumatic experience, the healing afterwards, where you're actually not healing, but you're just functioning is your brain's like putting back the puzzle pieces together, but they're not in the right spot. Like you have a corner piece and it's in the middle and it's like, what the fuck am I doing here? Right. And so good trauma treatment helps you move the pieces back around, not again so that you feel good about your trauma. That's never the goal.

In fact, you don't want to make someone feel good about their trauma because you're then habituating to something potentially dangerous. It's about being able to integrate it so it's a chapter in your life and not like the punctuation mark. And so when people go so let's, okay, so we do a whole protocol. We've had three months, six months, EMDR, PE, all the different things, right? And so, yes, to your point, like I also said, it's going to come up in other times in your life. And this is where you tap into the, like, you've gone through this. What do you know works for you? You've done so many harder things.

And I'm sorry that this still freaks you out. It's going to freak you out forever, acceptance. There are going to be times where you're hit by a PTSD trigger and you're like, what in the goddamn hell just happened to me? And in that moment, you say, okay, this happened to me. A bad moment isn't a bad life. How do I want to handle it next time? Again, to take the keys to your life convertible and hold them. You have the keys, right? And it's about being able to say, okay, I know this is going to keep happening. I don't like it and I know I can handle it. I think it's back to that point, again, also about managing expectations. And I think that there is a misconception around so much of this, but around trauma. Like, you have to get to the point where you're good with it. And to your point, you can be habituating yourself to dangerous situations in the future. And I think it's just so refreshing to hear like, no, it's not about getting good with it. You know, it's about learning. how to move forward with all of this and experience all of this and be okay. And be okay. Right. Like to how do I, like I said, like how do I live with this as a chapter of my life? Not like the back cover explanation.

You know, it's not the entire, it's not my entire story. And that's really hard. And yeah, like it's not fair. It would be nice to be good with something. But and at the same time, and enough but. And at the same time, like, if that's the goal, you're never going to get there. And then you're going to be perpetually miserable. And that's the same with like any mental health, wellness, whatever thing. You know, it's got to be less all or nothing. I'm super all or nothing. Sometimes it's got to be less all or nothing. I was going to ask you like, what do you do in your own life? I'm sure that you've dealt with really difficult situations, at least in your professional life. I would imagine, like having patients who are suicidal. I don't know if you've had any patients that you've lost.

You know, I can't even imagine being in this field and being there to be a lot. to help people day and day out and be available and be witness to other people struggling, how do you process all of that in your own life and have boundaries and make it so that you're okay? Yeah. So I very much so identify and relate to the idea that I'm a very big emotion person. Like everyone in my life knows that. My patients know that. Everyone knows that. That's why I think this treatment that I do, DBT is so beautiful because when you're a DBT therapist, like the first thing you learn is like you live the treatment, right? Okay. So that's, that's number one. I, yes, and I've gone through some shit professionally and personally I'm

divorced. I've moved to Israel, back from Israel, all right, you know? And yes, my job is sometimes really, really hard. So what I'll say is professionally, I lean on the fact that I am very well trained and I have a group of colleagues around me who I can call at any time if I'm on consult. I am not infallible. I am not, you know, I don't know everything about everything. And if I'm in a situation that's, you know, making my hair stand up professionally. Like, I'm calling someone and checking because I don't care about my ego in that moment. I care about somebody making it out alive. So that's kind of professionally.

It's actually easier for me to regulate because I know, like, I just know that it works, you know, and I know how to trust myself. I would say personally, sometimes, you know, emotion regulation is harder. Like, it's harder to not send that text. It's hard to, you know, not do those things. I have an incredible therapist, CBT, she's. amazing. I don't listen to everything she says, but I know that. You know what I mean? I know it. And I really try to punctuate my life with things that work for me. I know I'm a person that needs

to look forward to stuff. So even if it's a, you know, doing dinner with someone next week or, you know, I'm going to Thailand with my sister in March. And I'm like, hell yeah. Like that's going to be amazing, right? So like, I know. I know what works for me. It's about being mindful about what works. And also knowing when to ask for health and knowing when you're not okay. You know, like I know. I can call Ashley. She's in the corner. I can call my sister or I can call my friend Sydney and say, I need you to talk to me about something because my mind is doing things that we all know, ain't going to help me. Okay? And so it's not really about this like, ooh, I journal thing. Like, oh, that's nice. You can journal. And like, I just recently started journaling,

actually. Just kind of funny. But I'm like, I don't, okay, whatever, I'm going to try this. This thing that everyone says works so well. It's about just knowing, being able to know what you need or asking somebody to help you figure that out. And also knowing that like you're going to, you're going to feel bad sometimes. There are times that I can't get out of bed. There are times that I send an impulsive text. There are times that I feel really, really bad about myself. And again, a bad moment isn't a bad life. It's just about including things that bring me joy and being mindful of that joy when I have it. I love that. I also recently started journaling again. I mean, sometimes it's great. And sometimes I'm like, mm, doesn't really. I think that's also

important. Like, don't put all your eggs in one basket expecting something to like completely change your life. And I do that too. Like sometimes I'm like, if only I journaled every single day, like then this, you know, whatever the situation is. That was me with my lip filler. I'm like, oh my God, when I get lip filler, I'm going to be Haley Bieber. This is sick. I mean, I'm not. In a shocking turn to events, it did not turn to me in Haley Bieber. However, I love my lip filler. It looks amazing. I wouldn't even know that it was filler. Like it looks very, very natural. Yeah. I can see it. It will not ruminate. We're going to do another podcast. Everybody on beauty. Yeah.

Beauty tips and all the aging things. Amazing. Well, I could keep going, but we're out of time. So now I got to ask, one thing we could stop doing today. And one thing we could start doing today to enhance our lives. Sure. So one thing we could staff doing today is doing that whole whole. self-judgment thing of like, I shouldn't feel sad. I shouldn't care about this. I shouldn't like this guy. That's shit and you're making yourself the worst. Please do not choose to do that. One thing you can do is find literally one thing in your day that you like. It does not matter if it's putting on a new highlighter or, you know, getting into your bed. But in that moment, really being mindful of the positive, taking that 30 seconds to push out the worry thoughts. That's how we bank our joy and that's actually how we build our baseline. And you'll start

feeling better. Amazing. We'll tell everybody where they can find you. You can find me on Instagram at millennial, what's my Instagram? Millennial Mindfulness Doc. I think that's what it is. Millennial mindfulness doc. That's my professional Instagram. You'll find kind of just different tips and skills and like Maddieisms, if you will. And you can check out my website, www.com.com. You can email me there. And if anyone needs any referrals, please, reach out. Thank you so much for coming on. I'm so glad I'm here. Thank you. I hope you enjoyed that episode. And if you liked it, and if you like the show in general, please take a second to rate, review, and subscribe. It goes a long way, and it's actually the best

way to support the show. Also, if you want to see more about each episode, you can head over to the Blonde Files podcast on Instagram. You can go to areallori.com. And I'm always posting about each episode over on my personal page at Ariel Lori. Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.