DBT, Accepting Difficult Feelings, & Creating a Life Worth Living With Avery Hall
- Shannon Jackson
- Oct 8, 2024
- 38 min read
DBT, Accepting Difficult Feelings, & Creating a Life Worth Living With Avery Hall
On this episode of A Healthy Push, we explore a form of therapy that teaches you skills so that you can have a healthier relationship with your emotions, healthier relationships, and all around a more fulfilling life!
I was joined by Avery Hall to chat about Dialectical Behavior Therapy (DBT), an evidence-based therapy that combines cognitive behavioral techniques with mindfulness practices.
Avery is a psychotherapist based in Milwaukee, Wisconsin, who works primarily with DBT, though she also brings in tools from CBT (Cognitive Behavioral Therapy), ERP (Exposure and Response Prevention), and some attachment-based stuff. Basically, Avery's got a big toolbox for helping people work through life’s challenges! One of the things she focuses on is supporting emotionally sensitive people—whether it's helping parents, partners, or individuals themselves understand and embrace emotional sensitivity.
So, What the Heck is DBT Anyway?
If you're thinking, "Wait, what even is DBT?"—don’t worry, you’re in good company! Avery explained it so well. DBT stands for Dialectical Behavior Therapy. It's a type of therapy that emerged from CBT but took a slightly different route. It was specifically designed for people who found traditional CBT (which focuses on changing your thoughts and behaviors) a bit inaccessible. Maybe you've been in that boat: you've tried to "think differently" but it just didn’t work. DBT recognizes that sometimes you need a different approach—especially if you struggle to regulate those big emotions.
DBT is all about finding a balance between two seemingly opposite things: acceptance and change. It teaches you to accept your emotions as they are, while also giving you practical skills to manage them better. It's like finding a middle path, not forcing yourself to always be okay, but also not letting the emotions completely take over.
The Core DBT Skills
Avery walked me through the four core skills that DBT helps you develop. Here’s a quick rundown:
Distress Tolerance: This is all about tolerating difficult feelings without making things worse. Imagine you’re at an "8 out of 10" on the anxiety scale. It’s not about immediately dropping to a zero, but more about bringing that intensity down to a place where you can manage it and make thoughtful decisions. Avery described distress tolerance as learning to be okay in the middle of the storm without adding more chaos to the mix. She shared this powerful analogy: imagine you're being chased down a dark alley, and someone asks you to "think differently." Um, no thanks! You're in full survival mode. DBT acknowledges this and helps bring you out of that panic state so that other skills can kick in.
Emotion Regulation: After learning to tolerate distress, the next step is figuring out how to change those difficult emotions. This means understanding why you feel what you feel and using tools to bring more balance into your emotional experience.
Interpersonal Effectiveness: How do you communicate what you need and maintain healthy relationships? This skill is about being able to express your emotions effectively without pushing people away or shutting down.
Mindfulness: Mindfulness is really the foundation of DBT. It’s about being present and acknowledging what’s happening inside of you and around you—without trying to immediately change it. It’s about understanding what you’re feeling, naming it, and not judging it. Mindfulness helps you slow down enough to identify what’s actually going on, which is huge when everything usually just feels like “anxiety.”
Individual vs. Group DBT
Avery also explained how DBT can be done in both individual therapy and group settings. In a group setting, it's not really about processing personal trauma; instead, it’s a skills class. You’re there to learn. The group format provides a sense of community—you see others trying out these skills, and it’s motivating and encouraging. Plus, knowing you’re not alone in these struggles helps so much with the shame that often accompanies emotional dysregulation.
This conversation with Avery was an incredible reminder that our emotions aren’t something to fight or fix—they're something to understand and work with. If you'd like to hear more of this conversation, be sure to check out the full episode, or connect with Avery on her Instagram linked below!
Feeling like you've tried everything but you're still struggling with lots of anxious thoughts, symptoms, panic attacks, and fears? Take my FREE 60-minute masterclass today and learn 5 shifts that will actually help you to overcome anxiety, panic disorder, and agoraphobia. And I promise, you won't hear any of the usual stuff from me - like doing breathing exercises, grounding practices, cutting out caffeine, and doing more exposures. Let's get you the peace and freedom you deserve without it being so hard!
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TRANSCRIPT
00:01.98
ahealthypush
All right, I am super excited for today's episode. I feel like I haven't done a guest episode in a while. And I have Avery here with me. And we're going to chat about dialectical behavior therapy, which is something that I've been wanting to chat with somebody about for quite some time. And I feel like Avery is going to be the perfect person. So Avery, welcome to a Healthy Fish podcast.
00:24.01
Avery Hall
Thank you, Shannon. So excited to be here.
00:26.49
ahealthypush
Yeah, this is going to be great. So let's just start. Tell us a little bit about you.
00:32.32
Avery Hall
Sure. Yeah. So my name's Avery. um I'm a psychotherapist based in the Milwaukee, Wisconsin area. um And as you said, my my primary way of working is DBT or dialectical behavior therapy. um Though I would consider myself kind of eclectic. I pull in some CVT, I do yeah ERP.
00:50.77
Avery Hall
Um, I like to work on kind of from and like an attachment angle. Um, and I use a couple other modalities here and there as well. Um, so I see teens and adults, um, I work with families, couples on like a wide range of issues, pretty much anything you can think of that would come up in therapy.
01:09.00
Avery Hall
Um, my content on social media, I think reflects I'm pretty eclectic. I talk about a lot of different things, a lot of different interests.
01:15.54
ahealthypush
Yeah.
01:16.71
Avery Hall
Um, I think some of the core themes that I really like to explore most with people, um both in videos and in therapy, are how do we parent emotionally sensitive teens? How do we live with emotionally sensitive partners? How do we kind of navigate the world as emotionally sensitive people? um And how do we kind of reduce the shame and secrecy around our own internal worlds and just kind of put our struggles out in the open to understand them better?
01:46.72
ahealthypush
Oh, I love that. I feel like you're talking to a lot of emotionally sensitive people right now, including myself.
01:52.11
Avery Hall
yep yeah
01:54.19
ahealthypush
So we're in good company. um And I love that. Like, I feel like, right, there's no one approach. I think, you know, when you go to therapy, even if you're like, okay, I'm going to try,
02:04.61
ahealthypush
DBT, like it you know there might be other modalities that are used or different things that you got into and it just depends on right the person and what the the circumstances are and what you're wanting to work through and honestly, what's just helpful for you.
02:16.78
Avery Hall
Yep. Yeah. Sure.
02:17.92
ahealthypush
So yeah, I love that. So let's just start like simply what the heck is DBT if people are like, I've never heard of this before.
02:28.01
Avery Hall
Sure, absolutely. So, DBT is a modality, is what we would call it in therapy. Basically, it's a type of therapy, right? So, you might have heard of other types, CBT, IFS.
02:39.35
Avery Hall
We really love abbreviations in therapy.
02:41.68
ahealthypush
Yeah.
02:42.05
Avery Hall
um But DBT is dialectical behavior therapy. um Most people would consider it an offshoot of cognitive behavior therapy with, I think, some key differences. Um, one being that it was sort of designed to cater to people who maybe find, um, CBT inaccessible. They might struggle to navigate changing their thoughts, changing their behaviors or patterns over time. Um, they want to, they're trying, but they're like, I just, I just can't do it. Um, so DBT takes kind of a different approach.
03:18.57
Avery Hall
working on emotion regulation for people who really struggle with that over their lifetime, um helping kind of teach people to regulate their emotions differently so that those thoughts and behaviors can change over time.
03:32.28
ahealthypush
Yeah. Cause I think it is, I don't know. Maybe that is where I feel like people struggle largely with CBT is like, you know, changing the thoughts, changing, you know, getting into a lot of the like sort of analytical stuff where it's like, whoa, I can't even regulate what's going on internally.
03:46.37
Avery Hall
know
03:50.94
ahealthypush
And that's sort of just taking front and center.
03:51.34
Avery Hall
Yes.
03:53.99
ahealthypush
And so I think for a lot of people, that's why it feels so challenging and sort of why you might hear like CBT just doesn't work for me.
03:58.10
Avery Hall
Yes.
04:02.34
ahealthypush
um Yeah, so I'm glad you talked a little bit about the differences. I think, okay, let's get into because I know there are like, there are things that you're learning, right? When you do DBT and like, what are the main things that you're trying to teach when you work with people?
04:21.01
Avery Hall
Sure, sure. So let me think and now I'm going to think about how to how to summarize this a little bit, because there's so much that we learn in DBT. um
04:32.58
Avery Hall
So I guess the first one of the first key components of sort of initiating someone into DBT therapy is a lot of psychoeducation on why people struggle to change their emotions, thoughts, behaviors. right Maybe they've tried that CBT approach before,
04:47.75
Avery Hall
which to be clear, CBT, super effective, does work if you have a baseline ability to regulate emotions. So a lot of people, when they're coming to DBT, um they're coming with a longer history of, and I'm air quoting failed therapy, right?
05:02.96
Avery Hall
With like, well, I tried, and I'm still doing these behaviors. I'm still having, you know, very volatile relationships. Maybe I'm just bad at this.
05:10.15
ahealthypush
Mm hmm. Hmm.
05:12.05
Avery Hall
So we're providing a lot of education first on what we kind of call like the biosocial theory, which to sort of sum it up, it's the idea of, you know, there's a spectrum of emotional sensitivity.
05:24.31
Avery Hall
You know, we we have some people who maybe aren't very emotionally reactive positively or negatively to anything, right? They just kind of keep a ah cool like 68 degree room temp emotionally, right?
05:35.95
ahealthypush
Yeah.
05:36.17
Avery Hall
um And then there's a lot of us who would identify with being sort of the opposite of that, of our emotions feel very intense, um hard to control, right? And they tend to kind of dictate and influence our behaviors, our relationships in ways that we don't want them to, right?
05:52.37
Avery Hall
um So educating people on the fact that this is biological, right? um And that this isn't something that's wrong with them, right? That this isn't an issue of you're defiant, you're lazy, you're you're willful, you don't want to get better.
06:01.22
ahealthypush
ye
06:07.16
Avery Hall
That's not it. it's you don't have the tools in place to actually regulate emotions like in your body. um And so we have to sort of install that first.
06:14.59
ahealthypush
Yeah.
06:17.66
Avery Hall
And that's why dbt is such a skills based therapy. um There's a wide wide range of skills that we teach in dbt. It is a very like learning oriented therapy. um So we start with that education of here's why things probably haven't been working very well.
06:32.04
Avery Hall
There is hope we can change it. Um, we just have to kind of install those skills to regulate.
06:35.09
ahealthypush
Yeah.
06:39.10
Avery Hall
And then we follow that up with, you know, skills to improve relationships, skills to change our emotions, to accept even experiencing emotions. Right.
06:48.47
ahealthypush
Yeah.
06:48.77
Avery Hall
Um, so one of the things that we really start with, I think heavy in the beginning, especially as distress tolerance, because before I can learn to, you know, navigate my worst fears, um,
07:00.44
Avery Hall
you know, work on the nuances of relationships, I have to be able to even tolerate having emotions without doing things that make the situation worse. And that's kind of the goal of distress tolerance skills is how do I even get through the experience of the emotion without completely coming apart?
07:16.97
ahealthypush
Yeah, i I often use myself as a personal example and then sometimes I'm like, well, why did I do that? Why did I share that?
07:23.43
Avery Hall
yeah And there probably will be there today.
07:25.68
ahealthypush
But yeah, but when I was right, right, but like I remember when I was deeply struggling with panic disorder agoraphobia, I was in a relationship um with my now husband, you know, we've been together for a long time.
07:40.77
ahealthypush
but I remember feeling like nothing was working relating to my anxiety recovery journey and my emotions were like so heightened.
07:42.90
Avery Hall
Mm hmm.
07:52.49
ahealthypush
I felt like I didn't even have control to be able to not, you know, have them all come bubbling out. And I mean, mine mostly came out in anger, um feeling scared, feeling overwhelmed, not knowing what to do with any of it.
08:04.48
Avery Hall
Yes.
08:07.64
ahealthypush
And it just, Yeah, it wasn't it wasn't good. and um But I think That's part of what you're saying, right? It's helpful to understand, to have that education right of what is going on it and taking that that sort of blame and and shame out of it. But this distress tolerance, I remember right coming across this and had like learning this. Can you give an example of like what that can look like? Because I think it is such a... You say distress tolerance. It's like, okay, I kind of get the idea of it, but like what the heck does it actually mean?
08:40.43
Avery Hall
Sure, sure. Um, yes, so I guess one thing I will sort of give an example of sort of how I explain this because I work a lot with teenagers, right, and also, you know, partners, loved ones of people who are struggling.
08:52.22
ahealthypush
Yeah.
08:56.72
Avery Hall
And so a lot of times I'm trying to kind of explain the purpose of this And I think I start with explaining what it is to be in fight or flight, to be flooded, right?
09:03.29
ahealthypush
Oh.
09:06.49
Avery Hall
To be um in DBT, we would call it being past your skills breakdown point, meaning I am so far into fight or flight and the thinking part of my brain is so offline that I don't and don't have a lot of agency to choose what I'm going to do with that.
09:22.01
Avery Hall
So you know I talk to so many well-meaning support people who are like, well, why can't they just think about it differently? you know it's just It's just a presentation. you know It's just a party.
09:32.36
ahealthypush
Yeah.
09:32.44
Avery Hall
There's nothing that's going to go wrong. And I i try to kind of explain, OK, if you were being chased by someone, someone big and scary and dangerous and you're running down a dark alley, right? You can imagine what you'd feel like your heart's pounding, you know, your thoughts are racing, you're just, you're in survival mode. Now, what if someone came up to you during that and said, well, what's another way you could think about the situation?
09:57.29
Avery Hall
Right?
09:58.05
ahealthypush
I might punch you in the face.
09:58.30
Avery Hall
its Right, I might punch you in the face. I might just start screaming. I probably just keep running, right? Because there is nothing that my brain and body are prioritizing in that moment other than survive.
10:06.20
ahealthypush
Yeah. Yeah.
10:13.19
Avery Hall
And I try to explain to these parents, like, while you may or may not know, like, or be having that response in a situation like this, your loved one is, that is their internal experience right now, is just absolute threat.
10:23.65
ahealthypush
yep
10:28.02
Avery Hall
right So there they're at a point where there isn't necessarily an ability to sit down, rationalize. you know Could I think about this differently? What choice do I want to make with this emotion?
10:39.45
Avery Hall
That's not something that they can access. right We're way, way, way past that.
10:42.03
ahealthypush
yeah
10:44.19
Avery Hall
And that's what we call dysregulation in DDT. My emotion is dysregulated. I cannot choose what I want to do with it. And whatever actions I use to try to manage it are probably not going to be super helpful.
10:56.99
Avery Hall
right it might be I avoid the party. I avoid the presentation. um And then sometimes it's actions that have maybe bigger consequences, right? I scream at my partner. um I do something that's harmful.
11:09.09
ahealthypush
Yeah. Okay. That was super helpful. I think that example, right? ah I love examples. It's just so helpful. um Okay.
11:19.38
ahealthypush
So as as the person experiencing it though, I guess like, can we now flip it?
11:19.42
Avery Hall
i just
11:27.44
ahealthypush
Because I think this, you know, distress tolerance, I think is something that people probably have heard if they haven't heard of DBT.
11:28.10
Avery Hall
Mm
11:34.57
ahealthypush
as the person who's struggling, when you're learning this skill, what can that actually look like? Because I think just the term like tolerance in and of itself, when you're struggling with panic disorder, panic attack, like anything of that nature is like, um, no, no, thank you.
11:55.73
Avery Hall
Right, right. Why would I want to tolerate this? Take this away. yeah Exactly.
11:58.36
ahealthypush
Oh, right. Right.
12:01.58
Avery Hall
Yeah, so the idea behind the term tolerance is being able to tolerate an emotion long enough to make choices that will reduce the intensity so that then I can start to use other skills to work through the situation, right?
12:16.95
Avery Hall
Because what happens is that, and this is for all of us, right? When we are at that point, you know, eight, nine, 10 out of 10 anxiety or whatever the intense emotion is, and we're we're in a state of fight or flight, um we usually feel that we cannot tolerate it.
12:32.38
Avery Hall
So we will very quickly start to do things to get out of that zone.
12:32.41
ahealthypush
Yeah.
12:36.03
Avery Hall
Now, those of us who maybe are less emotionally sensitive or we grew up kind of somehow being taught or seeing effective ways to manage that, we might already have some natural distress-tolerant skills.
12:49.27
Avery Hall
Like, OK, this emotion is terrifying. I don't like this. But I'm OK. And I can kind of ride it out and get through it, or here's something I can do. um So when I'm working with people, they generally don't have that.
13:02.20
Avery Hall
And so they resort to these other strategies, right? um Could be avoidance, isolation, lots of like addictive behaviors, right?
13:05.37
ahealthypush
Yep.
13:12.41
Avery Hall
um something to shut down that really intense internal nervous system response to get through it.
13:17.61
ahealthypush
Yeah.
13:17.84
Avery Hall
So we're teaching people, okay, just how to tolerate the fact that you're even having this emotion and distress tolerance skills are kind of our first line defense because they help us just bring the emotion down out of fight or flight.
13:29.46
Avery Hall
Not necessarily going to resolve the emotion entirely, um but they sort of get us out of like the red zone, so to speak. And the way that they do that is generally, especially with the skills that we call tip skills,
13:36.15
ahealthypush
Yeah.
13:41.30
Avery Hall
Um, they're directly targeting the nervous system because that's where that fight or flight response is happening. So instead of saying, I'm going to work with my thoughts, I'm going to think about this differently. Like we can't access that at at this stage of regulation.
13:53.44
ahealthypush
No.
13:55.11
Avery Hall
So we're going to work with our body, right? We're going to do things that actually target that nervous system response, bring that down, reducing heart rate. getting like our breathing to slow down, right? Like basically getting our body to calm down into that parasympathetic nervous response so that then my the cognitive parts of my brain can kind of come back online a little bit.
14:17.04
ahealthypush
Yeah, giving yourself that space, right? I look back and I'm like, gosh, you don't know what you don't know, right? But when you're in it, it's so like, you just want to get rid of it.
14:25.73
Avery Hall
run
14:30.05
ahealthypush
Like you said, like, I don't want to be with these feelings. I want to get rid of this and you'll do anything and everything. And every time panic popped up for me for years, that was my response, right? Like,
14:41.15
ahealthypush
get rid of it. I'll do whatever I can." And it didn't work.
14:47.36
Avery Hall
Yes.
14:47.75
ahealthypush
and It didn't work. And the feelings usually intensified and and came you know came around more often and just the whole thing. But giving yourself that space right to actually be able to say, like, can i can I just be with this instead of trying to look for any and all the things to escape these feelings?
15:07.07
Avery Hall
Sure.
15:08.70
ahealthypush
But I'm glad you said the part because I think this is really important. sort of All your thinking, your logic right goes out the window when you're experiencing the fight or flight response. and so I think people are thinking, right well,
15:21.30
ahealthypush
What can I do? like What can I tell myself? what can i And I'm like, yes, there are supportive things, right but you're not going to think your way out of this and you're not going to do a perfect set of things or like a step-by-step process to get rid of it.
15:33.81
Avery Hall
Right.
15:36.01
ahealthypush
And I think that's one of the hardest pieces of recovery right is sort of accepting. I have to just learn to tolerate these feelings and not try to do my way out of them.
15:47.82
Avery Hall
Yes.
15:48.81
ahealthypush
It's like the the answer that we all don't want.
15:51.58
Avery Hall
Yes. Yes. And one thing I think is funny about DBT is I think it comes with a lot of answers that we don't want because there's so much of this idea of acceptance and change go hand in hand. So do I want my clients or myself to be stuck in a state of panic, right?
16:08.50
Avery Hall
To be like, yeah, it's okay. I'm here. I feel terrible. That's not the goal, right?
16:11.69
ahealthypush
Yep.
16:12.92
Avery Hall
But the idea is that if I cannot accept that this exists, if I cannot accept that, okay, in this moment, I am in distress and I'm going to be in some degree of distress for a bit. if If I can't accept that part of my experience, it completely backfires, right?
16:28.14
Avery Hall
If I'm just fighting with my experience, it's actually going to get worse.
16:28.23
ahealthypush
Yeah.
16:32.31
Avery Hall
So it's accepting like, okay, i I do feel, I am feeling and this is intense and it makes sense, right?
16:32.44
ahealthypush
yeah
16:39.14
Avery Hall
um And I'm going to have to do things to reduce that, but I, you know, I might still have to feel it.
16:45.35
ahealthypush
Mm hmm. I like what you just said. I say this all the time, like, just giving yourself the validation of like, it makes sense. Because I think we often and quickly spiral, right?
16:57.06
ahealthypush
Like, I don't know why I'm panicking. I don't know why this is happening. and Like, it doesn't make any sense. And oftentimes, I mean, it always it makes sense as to why it's happening. It's frustrating as hell.
17:06.56
Avery Hall
Uh-huh.
17:06.91
ahealthypush
But it it makes sense, you know, why your body's responding the way that it is. But yeah, that space. So Of course, distress tolerance is one part of it, ah one of the skills that you learn. I'm probably gonna way oversimplify, but I know there are a few other skills. I feel like DBT is one of those, like, I mean, they all are. There's so much to these different modalities, but I think, you know, some of the other skills, right, are you're learning mindfulness, you're learning that emotional regulation piece, and you're learning interpersonal effectiveness. So can we,
17:43.34
ahealthypush
and i and And tell me like if if you're like Shannon, you're way over simplifying, but can you can we talk about those different skills to that you learn because obviously it's not just just tolerate, right? Like you just have to tolerate it and there's nothing else that's going to help you through these moments.
17:57.64
Avery Hall
Yes, absolutely. Um, would it be helpful if I gave a little bit of background on like sort of how dbt was built the way that it was?
18:05.04
ahealthypush
Yeah, yeah, love it.
18:05.72
Avery Hall
Okay. Okay. So make sure we have kind of time and space for that. But I like to tell the story, um, because Marshall Linahan who created dbt, um, dbt again incorporates a lot of cognitive behavioral therapy, but I think it also sort of emerged in response to it.
18:21.66
Avery Hall
Um, Marshall Linahan has a great story, right?
18:21.66
ahealthypush
Bye.
18:24.60
Avery Hall
She, um, struggled significantly with her mental health to the point of being like long-term hospitalized as a young adult, um, was seen as a patient who couldn't or wouldn't get better, right? Um, and was really struggling acutely. And when she kind of started to come out on the other side of that, she was like, okay, I'm seeing, I think maybe what CBT is missing. Um, and I want, and what I think it is is that people who are,
18:53.55
Avery Hall
more emotionally sensitive or reactive are missing these fundamental skill sets that other people might develop naturally if they regulate naturally, right? Like if you if you're growing up and you sort of have those skills already built in, you're able to have healthy relationships, right?
19:10.40
Avery Hall
You're able to kind of validate yourself, receive validation for what you're feeling and your emotional responses don't seem extreme to people so they can validate you, right?
19:19.80
ahealthypush
Yeah.
19:19.92
Avery Hall
um And you can feel understood. then these things sort of evolve organically. But if you are spending your entire childhood, teenage years into adulthood, constantly internally dysregulated, constantly in fight or flight, you sort of miss out on the chance to develop these really crucial skill sets. And she was like, I'm going to identify what those skill sets are. So of course, there's distress tolerance, right?
19:45.64
Avery Hall
which is the ability to even be in distress without doing things to avoid it or make it worse. So she was like, all right, we're gonna build a set of skills around that.
19:51.48
ahealthypush
Again.
19:54.58
Avery Hall
um And then she identified three others. So emotion regulation, right? Once I've gotten myself out of fight or flight, um what can I do to change my emotion, right?
20:05.36
Avery Hall
Which obviously is the goal for a lot of us. It's like, yes, I would like to not be in fight or flight. I also would like to not be anxious about this anymore. How can I, or shameful or sad, um How can I change my emotion in some situations?
20:19.55
Avery Hall
um There's interpersonal effectiveness, which is how do I communicate what I need, improve relationships, be able to share my emotional experience effectively with other people?
20:33.61
Avery Hall
um And then underlying all of that is mindfulness, right? Mindfulness being um understanding my internal world and what's happening around me and accepting the present moment without judging it,
20:44.73
ahealthypush
Yep.
20:46.08
Avery Hall
without trying to change it and being able to separate my interpretations of a situation from the facts of a situation, right? So mindfulness, I think is kind of core to any of the other skills working. So we also work on it really early, um the ability to identify my emotions accurately, um to sort of observe and describe what's happening in me and around me um without just acting or reacting.
21:13.28
ahealthypush
Yeah. Oh, I'm so glad you said that because I think mindfulness can be this like skill or tool I think that we look at and we see this like, you know, sitting in silence or like, I don't know. I think we just all have the wrong idea or a a lot of us have had the wrong idea of what it is. But just being able, like you said, to be able to describe what I'm feeling. Like, oh, this is the emotion that I'm feeling. Because a lot of times for me, it was like,
21:42.41
ahealthypush
Yeah, anxiety was often at the forefront, but other times it wasn't just anxiety or it or it wasn't anxiety and it was actually other emotions, but I didn't have the skills to be able to say like, oh, I'm actually scared or oh, I'm actually angry or oh, I'm actually, you know,
21:52.31
Avery Hall
Yes.
22:01.82
ahealthypush
feeling vulnerable. But everything sort of for me just immediately translated to anxiety because that's what I was so used to feeling.
22:03.31
Avery Hall
yeah Yes.
22:10.09
ahealthypush
So mindfulness rate as that tool to just be able to so slow down and say, like oh, this is actually what I'm feeling is huge.
22:18.13
Avery Hall
Yes.
22:18.34
ahealthypush
It's like such an underrated skill, I feel like. But all these things that you said, it's so funny how every time I have these conversations, I'm like, gosh, I'm brought all the way back through like my whole journey.
22:31.65
ahealthypush
And I think something important, right, is like all of like this being emotionally reactive, I think for a lot of people, and like you started with saying, right, being an emotionally sensitive person, I feel like a lot of where this comes from is maybe the environment rate that we were raised in, what we saw, like the or just the lack of skills that we saw like displayed for us.
23:00.24
Avery Hall
Yes.
23:00.49
ahealthypush
you know I grew up with a parent who was very like volatile, like didn't have any skills for regulating emotions. And so and then I had you know my other parent on the other hand that was pretty good at it, but like couldn't make up for all the lack and the the dysfunction that I saw. So it was like, I didn't learn a lot of those skills. And then when I really started struggling, all these emotions were coming up. It was like, oh my God. i Like you said, right, you're just trying to survive. You can't even like, I was in years and years of therapy. And I feel like people could have described things to me right until the cows came home. But I like, I didn't have these basic skills. And just knowing some of these, right, understanding them is so important for the healing journey. Because I think, you know, my experience is one that people will say, like, um similar, like I've gone through similar stuff and like, yes, and
23:58.85
ahealthypush
I think a lot of us have that shared experience. If we just weren't taught, we just didn't see it mirrored for us. We have no ka clue how to even be mindful, and especially in today's world. like i just I feel so bad for kids and teenagers now because it's it's hard. So yeah, I feel like learning these skills as a teenager, right?
24:20.85
ahealthypush
So dang tricky. And then you get into your early adult years and it just like, it gets harder to learn this stuff as you get older, but then when you have all the pieces, right, it things are able to actually come together.
24:34.98
Avery Hall
Yes.
24:36.01
ahealthypush
This woman's story, my gosh, like it's so cool and so inspiring that she was like, yeah, like CBT didn't really have it all for me. And like, this is why. I want to talk more about you know honestly all of it, but what what is like the goal truly of all of DBT? like why Why are you doing this work? like Obviously, you're learning these skills. You're learning how to better acknowledge, call out your emotions, getting better at being with them, making space for them, being able to communicate what your needs are. like and All of this is amazing, but it's like what's the whole goal of DBT?
25:15.64
Avery Hall
Yeah, the whole goal of DBT. I think that when we talk about the goals of DBT, it's worth noting that DBT was created by someone whose dysregulation was so intense that she frequently struggled with, I don't wanna live, right?
25:37.63
Avery Hall
Life doesn't feel worth living when I am so consistently in this level of emotional pain.
25:38.05
ahealthypush
Mmm.
25:42.29
Avery Hall
And that was the people that she also wanted to cater DBT to. is you know of course these people struggle with seeing a future for themselves or wanting to move forward because they're like, this is just internal hell all the time. you know My emotions and just have a have me in a chokehold essentially all the time. It feels like I can't even come up for air. um And so she was like, the goal of this is to be able to start with regulation, build back in those skillsets that allow us to have a life worth living. Because if I can regulate my emotions,
26:15.16
Avery Hall
I can hold a job. I can hold a relationship.
26:18.26
ahealthypush
yeah
26:18.30
Avery Hall
right I can not be in constant crisis that's constantly taking me 10 steps back. Once that's in place, now I'm able to move to another level because a lot of times I'm talking to people who they've they've spent their life in and out of crisis and so they don't know what they're passionate about.
26:38.11
Avery Hall
They don't know what their goals are, right? It's not the conversation of like, Oh, what would you like to do with your life? It's like, I, I'm not sure if I'm going to do my life and my life is falling apart 24 seven.
26:45.86
ahealthypush
yep Yeah. yep.
26:49.54
Avery Hall
So it's very hard to have a vision for anything, right? Or a sense of who am I? What do I love? What helps me thrive? It's like, I'm just trying to manage chaos. Right?
27:00.56
Avery Hall
So the goal is we manage the chaos and we teach people to do that so that then they can move forward and have those other things that make life actually worth living, right, reasons to be. um So I think that's that's super relevant, super important when we're talking about the more, I guess, acute side of the spectrum that DVT was designed for, right, what we call borderline personality disorder, people who struggle with suicidality and self-harm, but I think it's really worth noting that these skills
27:32.02
Avery Hall
are for the whole spectrum, right? I think that you they could be taught in schools, right? How do you have better relationships?
27:36.25
ahealthypush
Yeah.
27:37.10
Avery Hall
How do you know what you're feeling in the moment? And instead of ah just acting on that, yelling at someone walking away, how do you communicate? Like, man, i'm I think I'm angry.
27:47.19
Avery Hall
I think I'm feeling shame. I think I'm actually sad, you know, and still stay connected to someone in that moment. um So while it was designed, I think to create with the goal of creating a life worth living for people who could not imagine that, I think it also kind of contributes that, how do I say that?
28:09.28
Avery Hall
um
28:11.93
Avery Hall
I think for anyone, it's it's about you know how do I, I'm trying to phrase this. It's recognizing that
28:25.78
Avery Hall
self-understanding through mindfulness, that emotion regulation, the ability to tolerate and accept pain and work with it instead of running away from it, that those are key for anyone for having a life that's worth living.
28:40.01
ahealthypush
Absolutely. Like, you're so thoughtful. I love, I can see, like, I can see you're like, how can I piece this together in it? What you call it this beautiful, I think.
28:50.35
Avery Hall
Games you can feel so huge, right? So it's like when you try to condense it, it's like, whoa, what is the goal? It's a lot.
28:55.76
ahealthypush
I know, I know, but I think you hit on such big, like, big things, but they are what you're aiming for, right? When you work with people, it's like, how can you make it so that they can better accept feelings because you know when they can, so much of life gets easier because you're never going to get rid of hard feelings. You're never going to get rid of, like I tell people, don't ever sign up to work with me if if you're hoping to get rid of anxiety and never see it again. like That's not realistic, right? But when you learn how to actually have a healthy response to it and create that healthy relationship like you do with all your other emotions,
29:31.89
ahealthypush
life gets a lot easier. um you know And I think, too, the other piece of what you were saying right is just to be able to make positive changes, just to be able to even see that there are things on the horizon, like to even be able to see, like oh, there is so much to this life that I want to live and do, and to be able to have healthy relationships with people. right like I mean, again, you took me back. I was just thinking, like God, and I have no idea how my husband stayed with me through all of that.
30:05.52
ahealthypush
Like I didn't have any of those skills, right? and and i And I remember being in, I mean, my journey started as an early, like a young, young teenager. I remember being in school, right?
30:15.70
ahealthypush
And and talking about going to college and I was like, like I can't even think about that. Like i that is not even a thought in my head. I'm like, how am I just gonna get through the next day?
30:25.68
Avery Hall
Yes.
30:25.73
ahealthypush
Like truly, and and when you're being presented with like, what's the rest of your life gonna look like? I literally had, I went back to college and got my bachelor's when I was 28 because at that point I was in a healthy space with my emotions, with anxiety, like I could actually do that stuff.
30:39.12
Avery Hall
Wow.
30:42.93
ahealthypush
and graduated with highest honors, like stuff that I never imagined would be possible. But when you actually have the skills right to be able to navigate life and also see that, oh, yeah, there is shit that I want to do.
30:49.54
Avery Hall
Yes.
30:59.52
ahealthypush
like There is a beautiful life ahead.
31:00.18
Avery Hall
Hi.
31:02.48
ahealthypush
But I know it can be so hard great for anyone. and And you might be listening to this and thinking, like I'm in that space where I feel like it's not worth it. like i I just don't even like existing is hard enough, you know, truly a hope this gives you some, you know, hope to feel like, okay, there are very real practical things that I can learn that will help me immensely to be able to get that, you know, feeling of, okay, life is worth living. There are things that I want to do.
31:36.31
ahealthypush
And it's not to say, right, I wish it happened quickly or like you could just snap your fingers. It doesn't work that way. But truly, if i like I always say, and people are probably like, Shannon, shut up. But like every day, just taking the tiniest steps to learn these skills and to create that this I feel like honestly a lot of this work is like creating a relationship with yourself.
32:00.36
ahealthypush
Like I always tell people you're going to be learning how to create a healthy relationship with anxiety and in all your other emotions, but it's also creating a relationship with you that helps you honestly more than anything.
32:00.64
Avery Hall
Yes.
32:12.68
ahealthypush
I don't know what you think about that. I can see you're like, there may be something there.
32:14.44
Avery Hall
Oh my gosh. Oh, there are too many thoughts. Um, yeah, I think that most of the time, you know, when I meet my clients, they, they have a relationship with themselves and it is not a nice one.
32:26.47
Avery Hall
Right. Um, it's one that is usually just laid in with a lot of shame.
32:32.33
ahealthypush
Yep.
32:32.36
Avery Hall
Um, from not being able to regulate emotions, seeing the people around them kind of as you describe, right? Oh, I'm going off to college, right? Oh, I'm going to start this job. And it's like, well, this looks so easy for everyone else. Why does this feel absolutely insurmountable for me? right Is there just something wrong with me? And that's usually the kind of beliefs that people end up developing about themselves. you know I think maybe I'm just broken.
32:57.55
ahealthypush
yeah
32:57.79
Avery Hall
um And I think that we do pick up a lot of that from our environment. And a lot of times the people around us, it's not what they want to communicate or trying to, but at the same time, they might not understand the intensity of our emotional experience or what skills we're lacking.
33:14.26
ahealthypush
Yeah.
33:15.28
Avery Hall
So we get a lot of that really well-meaning like, you know, oh, well, it'll be okay. You know, just, you know, have you tried this? Have you done this? like just
33:22.63
ahealthypush
Right.
33:25.19
Avery Hall
We hear that over and over throughou throughout our lives. and It's like, well, none of this feels fine, though. I don't think I am fine. I'm not sure if I'm capable of doing this. And that does lead to a really painful relationship with ourselves. I think the acceptance part of things can't be understated because the other thing I see a lot of is what I what I call, and this is I think a borrowed term, but the happiness trap, right?
33:46.68
ahealthypush
Hmm.
33:47.37
Avery Hall
Where people come in like, I just, I just want to be happy. I just don't want to feel these other emotions, you know? And in DBT, when we're talking about emotion identification, yeah I'm picturing like the wheel of fields and there's like 300, like different emotions named on there, which I always sound a little overwhelming.
34:01.03
ahealthypush
Yeah.
34:04.28
Avery Hall
um In DBT, we kind of boil it down to 10, 10 core emotions that all have a function, right? Like they evolved with us, they exist, for a reason to protect us, right?
34:14.32
Avery Hall
Anger for being able to protect ourselves and the people we love and hold boundaries. um Even shame, right? To keep us from being exiled from our group. um Sadness, right?
34:25.67
Avery Hall
As a way to grieve things that we love and connect with other people through that, right? So what I tell people is like, you know, eight out of our 10 core emotions are actually what we would call negative, right?
34:36.65
ahealthypush
Hmm.
34:37.21
Avery Hall
So the idea of I'm just not gonna feel these, but I wanna feel love and joy.
34:42.39
ahealthypush
Yeah.
34:42.40
Avery Hall
right? It's not a real experience. It would be a very hollow experience. We can't, you know, if we, if we start to shut like shut down all like our negative emotions, we shut down all our emotions.
34:54.33
ahealthypush
Yeah.
34:54.40
Avery Hall
um And so it is like, yes, I want to manage the painful emotions differently, um and have them be less intense and feel like I have some agency in navigating them.
35:04.67
Avery Hall
But I also have to accept them like this is part of the beautiful life, right is i I am also going to feel sad, I'm gonna feel fear, right? This actually means my body, my nervous system is working as it should.
35:16.92
Avery Hall
um But it's hard to accept that if it's always on 10, right?
35:16.92
ahealthypush
Mm.
35:19.36
ahealthypush
Yep.
35:21.32
Avery Hall
So you have a goal of it not always being on 10, because that's that's too painful. um But it is, that's ah just a huge piece of mindfulness and DVT in general is like, I am feeling this, there's a very legitimate reason based on my lived experience, based on my biology that this is coming up and it's okay, I have to coexist with it.
35:39.42
Avery Hall
I have to have a relationship with that.
35:41.82
ahealthypush
Yeah, I love how you called it like the painful emotions because I think it is. Yeah, there are a lot of them that we just like don't want to feel but it is part of all of us, like all these emotions are part of all of us.
35:54.06
ahealthypush
And it is, I know, super tricky, right? And at times you're you're definitely going to have moments where you're like, yeah, that i I knew that wasn't the best. you know I didn't respond in the healthiest way or I could have done that differently.
36:06.37
ahealthypush
that That's literally always going to be the case because we're human.
36:10.63
Avery Hall
Yeah.
36:10.77
ahealthypush
So that's okay too. I do want to talk a little bit about The differences if there are i'm sure rate between individual dbt therapy and group dbt cuz i know you can do it either way or i don't know you could do both can you talk a little bit about that.
36:30.34
Avery Hall
Sure. Yeah. So I think that one thing that's kind of, um, maybe not entirely unique to dbt, but sort of fundamental in dbt is that there is the therapy component and there's like the skills training component.
36:43.57
Avery Hall
Again, if you've ever kind of you know engaged in any kind of dbt, you've probably seen the skills manual. It's like, you know, super thick, heavy manual. There's, there's a ton of learning that happens in dbt, um, to the point where.
36:57.67
Avery Hall
you know, if I have someone come into session, I have to kind of balance like, okay, we're going to process, we're going to go through what you're feeling and what's happening in your life and just do the the talk therapy sort of component. And there's also the skills learning component of now I'm going to teach you the skills that you can apply to that, right? Um, but all of that can't necessarily fit perfectly into individual therapy. So in dbt, it's less of the group,
37:24.07
Avery Hall
sort of element of it is less of like a processing. It's not like a therapy group. It is like skills training, right?
37:30.62
ahealthypush
Oh.
37:31.31
Avery Hall
So you are going to like skills group. This is where you're gonna learn, okay, today we're going through distress tolerance or mindfulness. It tends to run in a cycle. So over like nine months or a year, you cover all four of those skills modules um pretty in depth.
37:47.74
Avery Hall
And then you might go through a rotation again, just to sort of bring them home. um ideally in comprehensive dbt, meaning like the whole dbt package, you would go to skills group, and then you would also go see your individual therapist. So individual therapy, that's where I'm going to process, you know, what's going on with my mom, um, what's happening at school, you know, the, the behaviors that I'm struggling with. And we might incorporate some of the skills I'm learning in skills group, but skills group is more of a psycho educational. Like I'm in here, I'm talking through examples. I may be practicing skills with other people, but but I'm not like processing trauma.
38:23.41
Avery Hall
I'm not getting super into my own personal content. It's more of a learning learning piece.
38:28.99
ahealthypush
Gotcha. With the skills group, I love how you that that's definitely those are very different. But with the skills group, I assume I can have my own assumptions of why it would be really successful. But in your opinion, and in the work that you've done, why do you think that done in a group learning those skills that can be incredibly helpful?
38:52.91
Avery Hall
Hmm, I think there's oh, that's a good question. I haven't thought about that question like, like, give me a sec with that one. Um, yeah, yeah.
39:01.49
ahealthypush
Yeah. yeah
39:03.71
Avery Hall
Um, I think that they're, you know, I'm not sure how much of this actually Marsha Linahan had in mind when she designed this, but I imagine knowing kind of things she said, I think she probably thought about this.
39:17.43
Avery Hall
There is a level of encouragement and reinforcement in being in a group of people, also wanting to learn the same things, also going through struggles that are probably similar in some way to what you're doing. Hearing their examples, hearing like, oh, you know what? I used this skill when I was dealing with this and it worked or it didn't work. And then I kind of did some troubleshooting and this made it work better. Having that group reinforcement, I think really keeps people engaged. It keeps them interested, wanting to learn and it gives them hope.
39:47.65
Avery Hall
right It's like, okay, I'm seeing other people and they're having success with this skill or they were able to navigate this situation.
39:47.85
ahealthypush
yeah
39:54.26
Avery Hall
And so maybe I can too.
39:56.53
ahealthypush
Mm-hmm. I think, yeah, I think there's so much to it. I think with the work that that I do, I've seen just in groups, right, hat holding space. It's sort of, there's so many things that people take away from them and feel like that it really changes their healing. Because I think in a group, you get that sense of we're all here experiencing similar things. So it removes some of that isolation.
40:25.40
ahealthypush
helps you to remove some of the shame. I think hope is a big one, right? You do, you see other people making moves and doing things and you're like, okay. I think just general motivation, right?
40:36.20
ahealthypush
Like I show up and and we're all doing this. And, you know, I think though a huge piece is you have this safe space. You have this space where you can talk about these things and and learn, you know, not so much talk, but learn like the skills and
40:52.23
Avery Hall
Yes.
40:54.57
ahealthypush
i I love when I came across DBT and I learned you know the skills groups. I was like, dang, I can see how that is incredibly powerful and helpful for people. But just DBT in general, I think if you are really struggling with that emotional dysregulation,
41:12.01
ahealthypush
it and Obviously, we've talked about it. It's so incredibly helpful to learn these things and to recognize it's not it's not you. It's not like you're not always going to walk around and be so reactive and be maybe this person who's displaying these certain you know um traits that you don't want to be displaying.
41:23.95
Avery Hall
you
41:35.71
ahealthypush
you know I look back and I cringe. I'm like, my God, Shannon, like the way that you know I treated people. and But honestly, it was just I was so overwhelmed and so dysregulated all the time.
41:49.27
ahealthypush
that it's no wonder. And i you know I give myself that grace, but you can feel pretty bad about yourself when you're like, I am really struggling and everyone is seeing it and everyone's having to sort of bear the brunt of it.
42:04.05
ahealthypush
so But most importantly, right, i gosh, especially for me myself, I say it's it's work that you can do for you that is best done for yourself that will always translate to your outer relationships.
42:14.67
Avery Hall
Yes.
42:16.25
ahealthypush
like I didn't do it for you know, my husband or anyone else, like that work that I did was for myself. And then it translated and I'm not this emotionally reactive, like fly off the handle type of person or the person who's trying to regulate with alcohol or any other tool that, you know, you could throw at me. So is there anything that you feel like, I know there's so much to DBT, so it's like, we can't pack it all in here, but is there anything that we didn't get to that you feel like is really important for people to know about DBT.
42:53.54
Avery Hall
Hmm, oh man.
42:57.17
ahealthypush
I know.
42:58.57
Avery Hall
So, so broad. um I guess one of the things that to me was always cool about DBT, because I really, I stumbled into DBT.
43:12.75
Avery Hall
um It was really like kind of an accident. I land, I picked a therapist job and it ended up being a DBT position and I had like a little familiarity with it, but I sort of had this like super fast learning curve where I had to pick it all up because I was working in a residential program um that was really intensive and it was my first therapist job and I was just like I am new to therapy in general and I and now I had to learn this pretty complex system and it was yeah it was actually a great way to learn but kind of intimidating but one thing you know as I kind of watch people getting better in this intensive environment one of the things that struck me as being so cool about dbt is that it's trans diagnostic meaning that
43:33.62
ahealthypush
Oh god.
43:51.42
Avery Hall
the The philosophy behind this is sort of that when we look at anxiety, eating disorders, family conflict, um you know when we look at at trauma, when we look at all of these different, what we would think of as like unique problems diagnostically, the idea in DBT is like all of this stems back to emotion dysregulation to a very, very, very large degree.
44:11.10
ahealthypush
Hmm.
44:13.13
Avery Hall
And so if we treat emotion dysregulation, a lot of this other stuff either quiets down, becomes manageable, or goes away, right?
44:23.24
ahealthypush
Yeah.
44:23.44
Avery Hall
That our ability to regulate through situations determines, you know, sort of, it, our ability to regulate through situations has a lot to do.
44:37.02
Avery Hall
I'm not sure how to phrase that, actually. Let me back that up.
44:40.17
ahealthypush
yeah
44:40.38
Avery Hall
um I guess, you know, it's fair to say that if we can, regulate emotions, right? We can get through social anxiety.
44:51.15
Avery Hall
um We can manage OCD differently, right? We can, ah conflict looks entirely different. Relationships look different. All of these things, you know, depression, anxiety, we might think of as these kind of like siloed things, but it's so funny how when you see people doing the work in DBT, everything starts to kind of improve simultaneously, right?
45:13.18
ahealthypush
Yep.
45:13.57
Avery Hall
You realize they're all connected.
45:15.38
ahealthypush
Yep.
45:15.81
Avery Hall
So as I love sort of the skills base of it as something that it's not like, oh, we have to do these things for depression. And then we have to do these other things for anxiety and these other things for relationships. Like, no, no, no. If we can become skillful, become effective, all of these things are going to start to improve. So it feels, it feels very efficient. Right. Um, and it feels very hopeful because I think a lot of people coming into therapy, they're like, well, I've got so many problems. Where do we start?
45:41.84
Avery Hall
um probably and And people think that that means I'm unfixable, right? Well, I have depression and anxiety and I have trauma. And so maybe there's just not hope because it's a little too complicated. And so this angle of, well, let's get you working on, you know, why you struggle to regulate what you're feeling and let's improve that. And then we start to see improvements in all of these areas. And I think that's very hopeful for people too.
46:05.26
ahealthypush
Oh, I love that. I'm so glad that that's what you said because I think that is something that an area that a lot of people get kind of caught up in is even with panic disorder, anxiety disorders, agoraphobia, I think there's, you know, people can get really like down on while I'm struggling with panic attacks and health anxiety and I have a bit of a metaphobia and you know the all these different phobias and it truly is once you start working on these key skills
46:36.74
ahealthypush
It really helps with all of it. It's not like you need a set of different skills for each phobia or each different thing that you're struggling with. So that's really cool. I'm so glad that you said that. Okay. If people want to find you and connect with you, which I'm sure they will Avery, where do people find you?
46:54.62
Avery Hall
Yes, I'm gonna pause. I'm gonna make sure I spell my own Instagram handle correctly.
46:58.00
ahealthypush
Yeah. Yeah.
47:00.75
Avery Hall
um
47:10.37
Avery Hall
All right, so all of my content, content about therapy, content about life, is is on Instagram. I primarily kind of work on Instagram right now. and My handle is Avery the therapist. It's Avery the underscore therapist on Instagram.
47:27.35
ahealthypush
I know I love how we all have to get creative with our handles.
47:30.90
Avery Hall
right
47:31.17
ahealthypush
But yeah, we'll include your handle, the link to your website where people can get more information too. And I just so appreciate you coming on and talking about DBT.
47:41.89
ahealthypush
You're clearly very passionate about it. it's This has been is so enlightening for me, and I've loved every second of it. So thank you for coming on, Avery.
47:50.76
Avery Hall
Thank you so much, Shannon. This was a blast. Really love getting to talk to you.
47:54.68
ahealthypush
Yeah.
