Tami Simon: You’re listening to Insights at the Edge. Today my guest is Dr. Erin Olivo. Erin is an assistant clinical professor of medical psychology at the Columbia University College of Physicians and Surgeons, and the former director of the Columbia Integrative Medicine program. In addition, she currently maintains a private psychotherapy practice in New York City.

With Sounds True, Erin has published the audio learning program Free Yourself from Anxiety: A Mind-Body Prescription, in which she helps the listener transform their experience of anxiety through a unique approach that combines simple mindfulness practices and break-through insights from cognitive therapy.

In this episode of Insights at the Edge, Erin and I spoke about three skills to help with emotional regulation. We also talked about what to do on the spot when we feel triggered or activated by a situation. We talked about how to become more compassionate towards ourselves when we find ourselves engaging in chronic negative self-talk. And finally, what it might mean to develop a wise mind in relationship to our emotions. Here’s my conversation with Dr. Erin Olivo.

Erin, I know that you have a psychotherapy practice in New York City, and you work helping people with all kinds of different presenting issues: depression, panic attacks, addictions, anxiety. And I know that you work primarily with two different treatment approaches, and I’d love if, right here at the beginning, you could help us understand these different treatment approaches. I’m not familiar, really, with either of them, and I have a feeling that our listeners might not be either. The first is something called Dialectical Behavior Therapy. What’s that?

Erin Olivo: Dialectical Behavior Therapy is the treatment that was developed by a clinical psychologist named Marsha Linehan. And it was specifically developed to address one diagnosis: borderline personality disorder. It’s now being used for a full variety of diagnoses, because it’s been found to be so effective.

But essentially, it was first developed to treat what is considered within the world of psychology a very difficult diagnosis to treat: borderline personality disorder, which is a disorder of emotion disregulation. So at the core of the treatment is helping people to learn skills to regulate emotion. And it’s dialectic in the sense that it is, as a treatment, constantly acknowledging and even teaching patients how to accept the tensions that arise in their emotions, in their life, in the problems that they face—that there are these tensions of opposing opposites and the idea is to try to find a synthesis between these two polarizing positions. So that’s why it’s called Dialectical Behavior Therapy.

And, essentially, the dialectic in the treatment itself is that we’re both, at the same time, trying to help people accept who they are and where they are in their life while also moving towards change. So it seems like that’s kind of the opposite idea, right? So I have to accept myself exactly as a I am; I have to change everything about me and how I’m regulating my emotions right now. So it’s really about finding the synthesis between those and really finding a balance.

So we’re always trying to use some strategies that are about acceptance and validation and acknowledgement of exactly where we are, like mindfulness strategies. And on the other hand, [we’re] using a lot of the stuff that comes from cognitive behavioral therapy that’s very change-oriented: how do I change the relationship I have with my problems [and] the way I’m thinking about them? How do I change what I’m actually doing physically and behaviorally to handle my problems? So it’s really a combination of both of those things.

TS: Now, you’ve already said a lot. I’m going to see if I can unpack some of it here. So emotional regulation, and how that relates to borderline personality disorders—can you help me understand that?

EO: Yes. So physiologically, we all have different set points for the way we experience our emotions, or how emotional we are. And for some people, biologically, they just start out more temperamental. You can see it in young children, that they tend to cry at the drop of a hat and they’re much harder to soothe. They’re just moodier.

And we find that as people develop, this can persist and actually become what we would consider to be a disorder, where the person’s brain is actually built in such a way that they experience emotions more intensely than the average person. Those emotions get triggered more easily, and then once they are triggered, they actually come back down to baseline at a much slower level than the average person. So that’s what I mean when I say that it’s a disorder of emotion disregulation.

TS: OK, and then [there’s] this idea that even if I don’t have a borderline personality disorder but I’m coming to you with complaints about suffering from who knows what—I can’t sleep well at night or I’m anxious—that this emotional regulation would be an important skill. Help me understand a little bit more about that.

EO: Well, I actually think that it’s not even if I’m having a problem with emotions, but I need to learn how to best regulate my emotions. We all experience emotions moment by moment all day long. So we’re all regulating—without having to think about it, hopefully, too much—our emotions on a regular basis.

But unfortunately, I think a lot of us aren’t taught how to do this. In fact, the place we’re taught about how to regulate emotion is usually from our parents when we’re kids. And a lot of times, you hear parents say, “Stop crying, there’s nothing wrong,” or, “What are you complaining about? Why are you complaining? What’s the matter with you? You’re such a pain!”

So we get our emotions invalidated more than we actually get any help in learning how to regulate them. So we might actually be having an emotion that’s not so justified to the situation, or the intensity might be too big, but simply saying to somebody, “Stop feeling it,” isn’t all that helpful. Instead, it could be, “OK, so I know that you’re really disappointed right now about not being able to have the lollipop for breakfast, but let’s figure out what we can do to help you feel better.” That doesn’t happen. Who, as a parent, even has time to do that?

But at any rate, I really think that everyone can benefit from learning some of the tools or skills that have been proven to be really helpful and healthy as a way to regulate emotion, [or] even just general stress that we feel on a regular basis.

So a lot of the skills—I use these skills on a daily basis myself in addition to teaching them to my patients who might actually have anxiety disorders or depression or something that’s diagnosable. And so there are things like learning how to self-soothe, learning how to distract at times when there’s not much I’m going to do about the problem at hand, learning how to evaluate how my thought patterns might be contributing to making the situation feel worse in the moment. Those are some examples of what we might do to regulate emotion.

TS: Well, let’s talk about those skills that you’ve just brought up, because they’re interested to me. The “distract myself” one, that one I think I’m pretty good at, but let’s start there because you must mean something different than what I do most of the time when I feel upset by something—distracting myself by surfing online, or who knows what I do.

EO: Right. No, it’s actually not so different. The one thing I think that is different than what the average person does when they distract is that you would first want to actually acknowledge that you’re feeling something. A lot of times when we feel uncomfortable, we just quickly move to distraction without ever stopping to actually validate for ourselves that we’re feeling any distress. And I think [that] that kind of stuffing your feelings away idea is where problems start to happen.

But distraction in and of itself is not actually problematic. It’s helpful, it’s functional, it’s effective in the moment when you have to be at work doing something and you’re having a strong emotion. You don’t have time to be attending to it, necessarily. So I would say, certainly, it’s about validating it before we go to a distraction, and then addressing it at some other time—not just leaving it and trying to just sweep it under the rug and pretend it doesn’t exist. It’s being a little more mindful about the fact that we’re having these emotions and making an intention to distract as opposed to just simply distracting.

TS: And it’s a positive thing to distract ourselves in what kinds of situations?

EO: I would say first and foremost, any situation where it’s not socially appropriate or effective in the moment, in the context, in the environment you’re in to actually express the emotion or fall apart from the emotion.

If you’re in a big meeting and your boss is breathing down your neck for you to make a big presentation and you’re feeling incredibly anxious, it would be better to acknowledge your anxiety for yourself, take a deep breath, and dive into the content, than it would be to stop and try something else. If you’re already in the moment of sitting in the meeting, I’d say breathe—that would be the other intervention I’d do—but then it’s just, dive in. Distract by fully engaging your attention in what it is that you’re doing in that moment.

But then there are other times when you’re sitting at home by yourself, watching TV, [and] you start ruminating over something that’s been worrying you. Well, great. You have all the time in the world in that moment to stop and actually write down what you’re thinking, make a pros and cons list about the way you’re thinking about a situation, write down the “hot thoughts” and see if you can challenge any of them.

You might be saying things like, “This never goes well for me. I always have this problem.” Any time you hear those really strong statements, you can bet that they’re emotional reasoning and not necessarily the truth of the situation. So you might want to go in and try to challenge some of that thinking to help yourself feel better. It all depends on the context of where you are.

TS: OK, that makes sense to me. Now, you mentioned self-soothing, and I think that’s something that often people find difficult when they’re really upset, they’re really anxious about something, or panicked, even, about something. How to help people learn to soothe themselves?

EO: Well, I think that everyone has to practice and try out things that they might find helpful. It’s amazing to me that people are often—I say, “So what do you do to self-soothe?” And people’s answer is, “I have a glass of wine.” There’s almost always distraction techniques or something like, “I eat something, or I have a glass of wine.” It’s about finding some healthy, nurturing activities that we can engage in on a regular basis or when we’re very distressed that we find to be helpful for us.

For a lot of my patients, I assign homework to them. They have to try out a variety of self-soothing techniques. And if they can’t think up what they might be, if they don’t innately have a sense of, “Hey, this might feel good to me,” then I ask them to ask all their friends what they think is pampering or nurturing themselves.

Then I can also offer some examples for people. Things like, take a warm bath, or take a nice warm shower. Change the sheets on your bed and get in bed and take a 20 minute nap, sort of a mini-vacation from life. Light a candle, buy yourself flowers—little things that in and of themselves are not going to change any big problem you have, but are at least going to make the moment feel a little bit easier to get through. Those would be the kinds of things that I would suggest to people.

I think people often feel silly doing them. They feel like, “I had this really horrible, stressful day, but am I really going to go home and draw a bath for myself and light candles?” That seems almost too indulgent or something, or silly. And I think it’s not. It actually really helps. It sounds simple, but it really can help you in the moment.

TS: Do you have a personal best self-soothing technique? A personal favorite?

EO: For myself?

TS: Yes.

EO: Good question. I guess I would say probably the ones I’ve mentioned are all ones I’ve used, and that’s why they come to my mind first. I would say taking a bath, certainly, is a nice, relaxing thing for me to do. And then the other thing that I think I like to use the best is to play with my son. So I just have fun, easy playtime. That almost always makes me feel better. And so that’s something that I would do. Or pet my dog. That’s another one.

TS: OK, so we’re talking about these three different skills that you mentioned that can help us regulate our emotions. And the third one that you mentioned was evaluating our thoughts when we’re feeling very emotionally activated. That seems quite difficult to me. I wonder if you can unpack that a bit for us.

EO: Right. First, I would say I don’t think that you really want to do too much of it in the beginning when you’re really, really activated. But it’s about starting to unpack what you’re thinking later on, or once you’ve calmed down.

There’s a set of skills we haven’t talked about, which is basic relaxation skills. If we keep in mind that emotion, at its core, is a physiological experience, you want to first treat the physiology before you try doing any higher order-functioning, brain functioning–type activities. I would include the thought challenging idea as one of those. It really takes some brain power and you really have to be thinking somewhat clearly to be able to do this.

And so in the heat of the moment, when your brain is just whirling and your heart is just racing and you’re feeling incredibly tense in all the muscles of your body, the first thing you would want to do is actually calm down your body. Some of the self-soothing [techniques], like taking a bath, for instance, goes along with that, but there are a whole group of relaxation techniques that I teach my patients how to do: progressive muscle relaxation, breathing exercises—that kind of stuff—putting an ice pack on their forehead and lying down for a few minutes. That would come first.

And then, when [you’re] feeling a little bit calmer, or even sometime hours later after you’ve been quite triggered or activated, sitting down and actually writing down a little journal entry about what you’re thinking about the situation. And I ask people to write what, in CBT language—cognitive behavioral therapy language—we call “automatic thought.” So those first things that come to your mind about a problem or a situation.

And then I ask people to go through and look and see if there are any of the most common cognitive distortions that we all tend to use when we’re thinking in a hot way. So those kinds of things include over-generalizing or catastrophizing—making something bigger than it might actually be. The example I gave earlier, of saying “always,” “This always happens,” or, “Nothing ever works out for me.” That’s probably catastrophizing or over-generalizing the situation.

Another example of this kind of distorted thinking would be discounting the positive. So an example of that would be that you had to do some task at work and you handed in a report to your boss and your boss came back with the feedback, “90 percent of this report is just excellent, but this 10 percent really needs work.” And so you go home and beat yourself up about the 10 percent, and you’re not even thinking about the fact that he actually started by saying that 90 percent of it was excellent.

Another example would be name-calling. People do this one a lot. “I’m such a loser. I can’t believe I said that,” or, “I can’t believe I did that.” That [idea] of not being very compassionate with yourself is a sure sign that you’re into a whole different place of thinking that’s not going to be helpful to your emotion. You’re almost adding on something on top of the initial issue.

So those are just some examples, and I give almost all my patients a sheet of paper that describes all the major ways that we might negatively think and thought patterns that we might engage in. And they will go through their journals and look for the tell-tale signs of these kinds of thought patterns. And then sometimes that in and of itself is enough to help us say, “Oh, wait a second, I’m just being too hard on myself here. I’m discounting the positive. Here are the positives, and I can feel a little bit better about this.”

Sometimes that’s not enough. The next step that I ask a lot of my patients to do is to actually go through and challenge the thought by trying to ask yourself, where’s the evidence for this? What would I tell a friend of mine if they were feeling this way? What kind of more balanced viewpoint could I have about this? What’s an alternative way of looking at it? And then write [that] down as well. Then that usually is helpful along the lines of actually helping us change how we feel about a situation.

TS: Now, one of the things I’m curious about is that you mentioned that emotions are physiological. We feel them in our body, and that’s why you start with relaxation. But then here we are, and we’re working with our thought patterns and evaluating and analyzing our thoughts. How do we stay embodied and connected to our body while we do that?

EO: Well, I think it’s about really first being mindful, and first calming your body down and getting in your body before you even start to do this. And then the hope is that you’re going to breathe throughout, and I think a lot of people—especially as they first start doing some of these thought journals that I’m talking about—get very reactivated just in the act of writing them down.

So I ask people to check in with themselves throughout the 15- to 20-minute exercise that they’re doing of writing in their journal, and just notice what’s happening in their body, and if they start to get very activated again.

And everyone starts to identify for themselves what happens in their body as the first red flag that they might be getting somewhat tense or more emotionally activated. And then stop what you’re doing and go back and do another relaxation exercise before proceeding. So that’s about checking in with yourself.

I also ask everyone to do self-soothing or some relaxation after they’ve done this exercise, because even if you didn’t get really reactivated, chances are you are feeling some additional tension in your body at the end of this. So I always tell people to bookend it with relaxation exercises.

TS: So we’ve been talking about these different skills that help with emotional regulation as part of Dialectical Behavior Therapy. And in your introduction of what DBT is—I’m so happy now that I have some new initials I can throw around—you talked about the dialectic being between where we are now and where we want to be. That makes sense to me. But I’m still a little unclear about the behavior therapy part. How are we addressing behavior in this approach?

EO: OK, this is a great question. I think fundamentally DBT is a form of cognitive behavioral therapy. And so in DBT we leave out the C. We change it to a D. But we still are talking about both cognitive—and that’s the thought stuff we were just talking about, the thought records and looking for patterns—and then the behavioral aspect of what we can do.

Let me back up for a second and say that in some ways, the ways we think about things, That is a behavior that we’re engaging in. So that is a behavioral piece in that sense. But in a more concrete way, when we think about behavior, we can think about the things that we do—the activities we engage in, the behaviors we engage in—that we’re probably doing in an attempt to feel better, but often actually make us feel worse, or at the very least, don’t actually help.

And so, I mentioned before, drinking a glass of wine, or you mentioned, surfing the web—doing that to a place where we’re not getting other things done. People smoke, people overeat. So there’s lots of behaviors that we all go to as a default sometimes when we’re feeling emotional that ultimately cause more problems.

And so in DBT, and specifically with borderline personality disorder patients, there are some more severe behaviors as well, [like] addictions or self-injury patients. We really focus in on helping people move away from those behaviors and move to more functional and effective behaviors for them. It’s really about coming up with a behavioral plan for how to stop engaging in destructive behaviors. That’s the other piece of DBT.

TS: Now, this may seem a little naïve or maybe like I don’t understand that much about the process of psychotherapy, so just forgive me. But when I hear something like behavior therapy, what comes up for me is that it sounds a little bit like we’re working on the outside of the problem instead of on the inside of the problem and really getting at the roots.

So I wonder how you look at that in terms of DBT. How are we getting to the roots of what’s happening, that’s driving our anxiety? How do we get to the roots of whatever might be driving us?

EO: Right. There are a lot of different theoretical approaches to psychotherapy. Some of the more psychoanalytic or psychodynamic approaches to therapy really look at, when they hear of question like what you asked, “What are the roots of this anxiety?” they’re thinking back to interpersonal or family dynamics—the person’s interpersonal history, often.

And that’s not ignored in the less dynamic, more CBT- or DBT-oriented treatments, but it’s not focused on in quite the same way, or it’s not the way we would answer the question [about] the roots of someone’s anxiety. So I don’t talk with my patients very often about their childhood, for instance, because we’re not looking for, what is the childhood root to why you feel anxious today as an adult? I actually am more focused on, what is going on in your life today that’s creating a lot anxiety for you?

And if it happens to be that a particular way you view yourself or way you view the world that comes from your family history and your childhood and all that is what’s causing you to feel more anxious or more sad or more shameful today, then we need to really start to pick apart that way of thinking and see if we can challenge it and come up with a new way of thinking about yourself, the world, your family, your life, your relationships.

And so that’s where I might begin to hear some about the origin of where these thought patterns or beliefs—like world beliefs, life beliefs, self-beliefs—come from, but I’m not going to focus there as a CBT or a DBT therapist. I’m going to focus on today and how that impacts you today, and how we can change it, and how you can evolve into a new way of being with yourself in the world. Does that make sense?

TS: It does make sense. Now, I know the other approach that you combine with Dialectical Behavior Therapy is Mindfulness-Based Cognitive Therapy, and you’ve mentioned a little bit about what cognitive therapy is, but what is Mindfulness-Based Cognitive Therapy?

EO: Well, Mindfulness-Based Cognitive Therapy was developed by some CBT clinicians and researchers. Zindel Segal and [John] Teasdale came up with this treatment and studied it specifically related to depression.

So they were cognitive therapists who learned a lot about mindfulness and decided that it sounded very much like mindfulness could be a helpful addition to what they were already doing in cognitive therapy. And they began to study this with their depressed patients. And so in a very strict sense, MBCT has research evidence that supports its use for people who are depressed and have recovered and relapsed. And it’s actually helpful for helping people to not relapse in their depression once they’ve gotten better.

And the idea behind this is that using mindfulness is a helpful way of teaching patients how to look for the red flags of when their thought patterns and behavior patterns might be going back in the direction of the way they think when they’re depressed or [the way they] behave when they’re depressed. They found it wasn’t as effective just starting out with someone who was simply profoundly depressed. That’s not to say it’s not effective with anyone, but the manualized treatment that they created, they found most effective in preventing relapse.

So it looks very similar in many ways to DBT or to any sort of mindfulness-informed kind of psychotherapy, really. And it’s teaching patients how to practice mindfulness meditation and also teaching them a lot of the cognitive techniques that we’ve already discussed today.

TS: So could you give me an example of a patient you’ve worked with using Mindfulness-Based Cognitive Therapy who has recovered from depression and is now in a relapse and how you might work with them in this way?

EO: Hopefully you’re using it with someone before they’ve even relapsed. So they’re in therapy with me, and they still have these ups and downs in their mood. And they’re seeing me to try to prevent another very deep depression. I refer to it a lot of times with my patients [as] “falling back in the hole,” because that’s what it really feels like to them. It’s about noticing when you’re teetering right near that hole, and you could totally jump into it if you jump in and allow yourself to go back to the ways that you’ve been thinking, or these default modes that you have in the way you think and act.

So I’ll give an example of a patient of mine who was a young man. He was about 28 years old and he suffered from depression in various episodes probably his whole life, but first diagnosed in [his] teenage years. And he came to me looking for a way to stop this cycle of constantly having, every year or two, a really deep depression that often [caused] him to have to drop out of his life—either take a leave of absence from work or take a leave of absence from school at various times.

And so we started working on teaching him how to meditate, and how to use mindfulness practice in his life as a life strategy. And then I also began to teach him a lot of the cognitive piece of thought journaling—he keeps a binder filled with his thought records. He also keeps track of his mood for me on a regular, daily basis. [He] rates what his mood is.

And we’ve begun to see that there are some characteristic patterns of the way he thinks about, specifically for him, how he thinks about himself when he’s feeling more depressed. And it’s sort of a chicken-and-egg idea here. He starts thinking negatively about himself and that makes him feel more depressed, or is it that he actually starts feeling a little bit more depressed and then he starts thinking much more negatively about himself? Well, it doesn’t really matter, because the end result is that it’s a cyclical pattern that just spirals him downward into that hole.

And so if he can start to catch himself, [even in] just the things that seem like they might not even be all that important or bad—where he’s doing some work and he’s handing in a piece of work and he thinks to himself as he’s handing it in, “Ugh, that stinks.” And that’s a sign for him. So he’s started to identify these red flags by being mindful of what his emotional state is and what’s happening in his thought patterns on a daily basis. He can catch, really quickly, at the early stage, that little comment that he makes to himself before it gets to, “My life is hopeless, it’s miserable, it’s never going to be better and I can’t get out of bed.”

TS: I think that many people can relate to hearing a critical voice inside [during] different times [of] the day. What do you suggest people do when they when they hear that voice that says, “Oh my God, you’re really a loser. Look what you did. You tripped on the step.” Or who knows, whatever it might be. What should we do right at that moment?

EO: Try to be a little nicer to ourselves, right? I think it’s kind of simple. It’s about setting an intention that we want to catch ourselves in those moments. I think a lot of times we don’t. We don’t even notice that we’ve done it. So first, if we think we might be [doing that], then it’s worth actually doing a little experiment with ourselves, and trying to pay attention for, let’s say, a day. How many times during the day do I beat myself up over something or [how many times] do I say a little nasty comment to myself that I would never say to anybody else but I say to myself?

And if you go through a day and you notice that that’s happening a lot, then I’d say, “OK, for the next day, how about we set an intention that every time you notice yourself doing that, you’re going to stop what you’re doing and try to come up with a nicer, more compassionate thing to say about that same thing.”

An easy way to come up with those so that they’re not just BS or just all Pollyanna positive kind of comments, is to really think of what you would authentically say to your best friend if they were in that same situation, whatever it is. You’re not just going to BS your best friend because they’re going to say, “Thanks, but that’s not helpful, [just] saying everything’s going to be OK when I know it’s not going to be. It’s not helpful.”

So you have to come up with a real compassionate response. Almost all of us have—it’s a little crazy, I think, but it’s true about the way we are, certainly in Western society—an easier time being compassionate with other people than we do with ourselves. So if we take that skill that we have with other people and try to apply it to ourselves, then it can really make a huge impact on our mood.

I often say to my patients, “Imagine if you were teaching a kid how to ride a bike for the first time without training wheels, and you ran alongside the kid and you were saying things like, ‘Oh my gosh, this is really scary! You’re going to fall, you’re going to fall! It’s really going to hurt! I don’t think you’re good enough! I don’t think you can do it! This is going to suck!’ The kid would fall down, right?”

Because that’s not what we do. We actually run alongside the kid saying, “You’re doing it! You’re doing it! This is great! Look at you! This is hard, but you’re trying! You’re being brave! I’m so proud of you! You’re courageous!” And when they fall, you don’t say, “Oh, you suck. That’s horrible.” You say, “It’s OK! Everyone falls when they start. I believe in you, you can get up and do it again. Try again. I’ll be here to support you.”

And so I often say to my patients who report to me that they’re having all this negative self-talk all day long, “You’re running alongside yourself all day long, just willing yourself to fail. It’s going to impact your mood. So how about if we tried having you run alongside yourself all day being a nice, supportive, realistic coach?” And so that’s what I ask my patients to try to do.

TS: Now, before we started recording this conversation, we briefly were talking with each other, and you mentioned to me that you’ve become a mom in the past two years and have been spending a certain amount of your time parenting and raising your child. And I’m curious what you’ve learned about emotional regulation from being a mom.

EO: That’s a good question. I think what I’ve learned is that the emotion regulation system of a two-year-old is wacky. [Laughs] I mean, it’s, wow, there are so many emotions firing at all times. And I’ve seen how important it is to really try to validate [those emotions], but how hard it is, because the quick thing to do is not to validate, it’s just to say, “Come on, shake it off. It’s OK. This is not that big of a deal.”

And so I find myself really trying to be mindful about validating my son’s emotions even when they seem silly to me. So I think that’s the biggest thing I’ve been challenging myself—

TS: Can you give me an example of that, and what it would be like, what behavior you would take a what you would say when you were validating your son’s emotions?

EO: I gave the example a little bit earlier that if he wants something that it’s just possible to give him in the moment—it’s either not safe or it’s not healthy—but he gets really disappointed, it’s easier to just say, “Stop it. You can’t have it. It’s not for now. You just can’t have it.” I feel, as a parent, I do have to set those boundaries, so I have to be firm. But I also want to stop and say, “I know how hard it is. You really want it, don’t you?”

And I have actually found that if I stop and say that first—I’ll say, “I’m sorry, but you can’t have it now. Lollipops are not for breakfast.” This is a common occurrence in my house. He always wants a lollipop for breakfast. “Lollipops are not for breakfast, but I know how really hard it is to not have it right now, right?” He stops and sort of looks at me. He won’t keep screaming about it.

He’ll stop and look at me, and I think—I mean, this is a psychologist as a mom, some people might it’s crazy—but I actually think that he’s actually stopping and being a little surprised by the acknowledgement of his feelings. “Oh, she gets it. Yes. She gets it.” And then I say, “Let’s do something else, and let’s eat something else healthy and maybe later we can have that.”

And so to just try to not just say, “No you can’t, and stop feeling what you’re feeling,” but [say], “Yes, it’s hard to feel what you’re feeling. Let’s do something else right now so that we don’t have to sit here and feel it all the time.”

TS: Yes. So that’s good, that helps me to understand a little bit in terms of how you work with your son. I’m curious how you work with yourself. I have very little experience being around young children, but in the experiences that I have had, I’ve noticed that I’ve gotten more reactive than in other situation in my life. I’m curious what you’ve learned from that.

EO: I’ve definitely learned more about trying to practice acceptance in the moments where I might be triggered by him having a tantrum. You know, we have to run out the door and he doesn’t want to put on his socks. If I allow myself to get really triggered and really aggravated, the whole situation just spirals from there.

But if I can actually take a deep breath and say, “He’s two. I have to let him be two right now. This is OK. I’m going to accept that I hate this right now, but it is what it is. Let’s deal with what we’ve got here.” Then I can stay calmer, and then the whole situation resolves so much faster.

I’m not always successful at that. Obviously there are some times—I’m human, there are times where I just get aggravated and I say, “No, come on, we’ve got to go, just put the socks on.” But it never feels as good to me, and I’m sure it doesn’t feel as good to him. And it never ends as quickly, the tantrum or the emotion.

So I feel like it’s really been about, for me, trying to create space for him to be able to just feel miserable sometimes, and to just allow it and accept it for myself without getting all angry about it or struggling with it.

TS: So I’m very interested in this topic of emotional regulation. I think sometimes perhaps I might feel like one of those one- or two-year-olds, meaning it seems so hard to do it. So I want to get very specific here: What’s your advice to someone who finds themselves in situation—everything’s fine, but suddenly they’re going off the handle. Something has happened, someone has said something, or they’ve gotten an email and they read the first line and they can tell that they’re blowing their fuse inside. What do I do right then?

EO: Stop what you’re doing and don’t act. That’s my first advice. In this world of technology and instantaneous everything, I think that we express our emotions or act on our emotions so quickly in an interpersonal way, like shooting off an email or a text message or something like that way too quickly and in an emotional state of mind.

And so the first thing that I tell all of my patients is, “Shut everything down. Turn off your computer. Turn off your phone. I don’t even mean just put it away, I mean turn it off. Because you don’t want to pick it up impulsively and shoot off a text. And then, give yourself space to actually take care of yourself.”

So after you’ve stopped yourself from acting on anything, you sit down—and, again, I would treat your physiology. There’s got to be something you’re feeling physically. That’s part of how you know that you’re upset in that moment. So you want to calm down your physiology. The basic physiology behind a lot of the most activating emotions [involves] the flight or flight responses. So you’re heart starts pounding, you may be feeling a little hot, you’re feeling tense, maybe you’re stomach is feeling queasy.

So you want to calm down your central nervous system. One of the absolutely quickest and best ways to do that is by breathing, and you want to breathe slowly, because your respiration rate increases when you’re activated. And so the way to breathe slowly is actually to increase the exhale of your breath. It doesn’t really actually matter what you do so much on the inhale.

You don’t want to be hyperventilating, so a lot people think, “I have to take big, deep, cleansing breaths.” I say stay away from that and just focus on the out breath, and really try to extend your exhale a little bit, and see if you can just slowly start to reduce the rate that you’re breathing. And that will help your heart rate come down. Then focus in on your muscles, and the muscle tension that you’re experiencing in your body and try to relax your body.

There is very little in life that is so super life-or-death, “I need an immediate response, I can’t stop and actually calm down my body for three minutes.” It really is very, very rare that we have to act immediately, despite the fact that in the moment it feels like, “I just can’t wait, I have to do this, there’s no time to calm my body down.” But there almost always is.

So that’s the first thing I tell people to do. And then, once you’re calmer, actually stop and try to think through thoughtfully and mindfully, “What do I really want to say in this moment? What am I really feeling? What do I really want to do about this? What are the pros and cons of the various things that I would like to do?” And then make a more, what I would call—this is a term that comes from DBT—a wise-mind decision about how to proceed, as opposed to an emotion-mind decision.

TS: So define a little bit more about what a wise mind is.

EO: Wise mind is exactly what it sounds like. It’s coming from a place of wisdom and not strictly from a place of emotion or impulse. In DBT, we teach all of our patients right in the beginning about the different states of mind that they can exist in, and emotion mind is when emotion is driving the way you’re thinking and feeling and behaving in the world. So emotions [are] driving the train, if you will.

And then on the other side of the coin is reasonable mind, rational mind, where I’m really—I’m sitting, I’m thinking things through, I’m being very logical, and it’s not about emotions. It’s about what’s effective or what’s right or wrong in a situation. Think math problems—I’m sitting down and I’m solving a math problem. It doesn’t matter how I feel about the math problem, it matters what the right answer is. We can think in a logical way.

The overlap of these two states of mind—if you picture the classic Venn diagram—and the two circles are overlapping [in] the center, that is wise mind. So I’m going to both consider the emotional aspects of the situation [and] I’m going to consider the logical, reasonable aspects of the situation, the facts of the situation. And I’m going to make a decision or have a perspective that really combines both. So it’s compassionate and logical all at the same time.

So if you think of someone you think of as very wise, they tend to be the kind of person who really has a logical, problem-solving kind of mind, but they tend to be very compassionate and nurturing and supportive. They don’t just say, “You just have to do it this way because that’s the right way and forget how you feel about it.” So that’s wise mind. And wise mind is a state that I think that mindfulness meditation and mindful living helps us be in more often.

TS: And can you connect that dot? How does that work?

EO: Sure. I think that if we are slowing down and really able to not be on autopilot with our emotions, we can really step back and observe what we’re thinking and feeling. Then we have a much better chance of having a wise stance or a wise mind stance of the world. I can respond, as opposed to react, to what’s happening around me.

And that is what happens when we meditate. We’re really practicing that kind of a stance, of observing and responding with intention as opposed to just reacting.

TS: Now, Erin, with Sounds True, you’ve created a program called Free Yourself from Anxiety: A Mind-Body Prescription. And I’d like to talk a little bit about anxiety itself. Do you think that this is a problem of our time, that more and more people are suffering from anxiety than perhaps at other times?

EO: I would definitely say that I think that people are more stressed out and overwhelmed, and I think that anxiety is one of the things that we feel as a result of how busy we are, how super-connected we all are. And so I would say yes. I think it’s probably a bigger issue. Some people might identify it more as stress than specifically anxiety, but I think that is a bigger issue now.

TS: Can you be specific about how you see the relationship between anxiety and stress?

EO: Yes. I think anxiety is most related to the core emotion of fear, but we think of anxiety as more internally driven than when we think fear. Fear comes from my fear of, let’s say, a snake, or of heights, or something like that. Anxiety is more what I do [then] with that fear internally, and how I might begin to worry, or experience that fear about internal space.

And so that, I think, sounds a lot, to a lot of people, sort of like stress. But I think that a lot of times stress is a bigger phrase. It’s a bigger term. It can also include feeling really shameful about something, or feeling really sad about something can cause me to feel stressed out. So I think it’s important, when someone’s saying, “I feel stressed or overwhelmed,” to stop and really ask them, “What’s contributing to those feelings of stress? And can we really unpack what emotions you [are] feeling?”

And so for some people, that’s anxiety and fear. But for others, it might not be. It might be a lot of anger that they’re holding onto. So that’s, I think, that relationship between anxiety and stress. They have similar symptoms or similar ways that we think about them, but anxiety is a more specific term than stress.

TS: And have you seen that there’s a certain profile of a person who’s prone to a lot of anxiety?

EO: Good question. I don’t know that I think of it as a profile.

TS: Certain personality dispositions, something like that?

EO: I mean, there are theories within psychology that actually divide people into personality types, and one of them is sort of an anxious personality type. There’s [David] Shapiro [who] came up with these neurotic styles, and one of them is the anxious personality, another is the narcissistic personality, yadda yadda yadda. Certainly I think there are theoretical answers to that question. I don’t think about it so much in that way, certainly not in my practice with my patients.

We’re dealing with it more from a solution-focused perspective of, “OK, what do you need my help with?” and, “Let’s really work toward feeling less anxious, and let’s not worry about whether or not you are just have some anxious style that you were born with.” Certainly there’s a physiological component, and then there’s the family history component, as I mentioned before. But I think it’s more about, “How do we help you now?” and less about, “Are you of a type that we need to fix?” Does that make sense?

TS: It does make sense. I’m curious, then, what the DBT approach is to working with anxiety—in a way, how you would put together the different elements of our conversation, and apply them for the anxious person.

EO: From a DBT perspective, it would be not any different than for any other emotion that is creating difficulty for someone. It would be to begin by being more mindful of what we’re feeling, because if we don’t know what we’re feeling, then how are we going to intervene effectively?

So it’s first identifying that: “The thing I am feeling is anxiety or fear.” And then analyzing it from that place of, “OK, I’m feeling anxious and fearful. What are the thoughts that go along with that? What are the interpretations of the situation that go along with that? What’s the physiological experience I’m having of that? What’s happening in my body? What’s my body language looking like? What am I feeling in my body?”

And then, “What is that equating to in terms of my behavior? What do I have an urge to do, or what have I been doing to respond to this anxiety?” And then, depending on where in this diagram you want to intervene—it might be all [of it], or it just might be one or the other. “Where would I first intervene?”

I think you intervene first at the physiological level if that’s really heightened, if that’s really causing you a problem. And then you could look at those cognitive aspects or the behavioral aspects and really intervene at that level. And then there’s all the different strategies. We would use different skills for each of those areas.

TS: Good. You know, finally, Erin, I’m curious to know—in terms of working with the whole area of emotions and all of the different emotions we experience—if you have some sense that some emotions are positive and some are negative, or if you don’t view it that way, if you don’t see the categorization that way.

EO: Right. I don’t. I see it more as that there are emotions that can cause us to stress, and that can just as easily be an emotion that you would think of as a positive emotion. It could be one of the ones we characteristically think of as negative.

So for instance, love is an easy example of this. There are a lot of times where I see patients who are feeling a lot of distress over their feelings of love for someone else. And so you would think that loving someone would just be a very positive thing, but sometimes it’s not, right? We’ve all had that experience, probably. [Laughs]

And even feeling joy or exuberance can sometimes—if we’re really in emotion mind [while we’re] in joy and excitement—we might not be making the most reasonable choices in that moment. And so it’s about trying to feel joy and acknowledge that I feel joy, but be in wise mind about it. So I’m not going to make any ineffective choices in my life because I’m just feeling so excited about something.

So I don’t think of it as positive and negative. I think they all have information for us. All the emotions have something to tell us about our experience and what’s happening around us. And then it’s about how distressed we might feel in those emotions, or how it might be creating behaviorally difficulty for us.

TS: You know, it seems that we’re at an interesting time in the culture, where really being literate in our emotions, being able to regulate in the way that we’re talking about—it seems like this is really becoming clear to people that this is a need that we have in the culture, and that, in general, we haven’t received enough training and we’re not very skillful, in general.

And I’m just curious what you think about that in terms of where we’re at as a society in starting to really become more masterful in working with our emotions—where we are or where we’re not.

EO: Yes. I think we’re not in a great place with it in terms of how masterful people are. I think we see so many stress-related medical issues happening around us. We see an obesity epidemic, which, at its core, isn’t completely about stress or emotion, but that certainly plays a big part in it. We see addiction issue creating huge problems for a huge percentage of people.

Other more chronic issues—I read a study that said two-thirds of all primary care physician visits are for stress-related symptoms. So the patient might not come in saying that they have a stress-related symptom; they come in saying, “I have chronic low back pain,” or, “I have chronic headaches,” or, “I have chronic stomach problems.” But really, they are, at their core, stress problems.

And so I think that it’s really a big issue, and I think we need to start to address it. I think that one of the places that would be best to begin to address it would be to start to teach children how to regulate emotions, to actually have [that lesson] be part of core curriculum of what we teach in schools. Not just, “Can you do math and do you know your history?” and all that, but [also], “Do you also know about yourself and your emotions and the way you think and feel in the world?”And so I think that would be a great way to address it. I know that there are some places that already are, and I think that’s great.

TS: And I just have one final question for you. This is the last one. Our program’s called Insights at the Edge, and I’m always curious to know what people’s current edge is. And what I mean by that is, here we are, we’re talking about emotionally regulation, working with our emotions. And I’m curious, what’s the edge for you in being able to do that?

EO: I think personally my edge right now is probably no different than it’s ever been in my life. If I really stop and think about it, it’s about finding balance. For me, that’s not always easy. I’m a little type A, which is part of why finding mindfulness in my life has been hugely important to me. But it’s about staying balanced, and I mean that both in the macro level of balance for myself between work and family, but also the micro level of just balance spiritually and energetically, for me, day by day, and even moment by moment.

So that, I think, is my edge that I’m always up against, trying to push myself a little further to maintain that balance or be mindful of that balance, I think is really what it is.

TS: Well, thank you so much. I can understand that you’re a little type A. You’re so wicked smart and swift. You have such a fast mind, and you know so much. It’s so wonderful to talk to you.

EO: Thank you!

TS: I’ve been talking to Dr. Erin Olivo. With Sounds True, she has created a learning program called Free Yourself from Anxiety: A Mind-Body Prescription. And she’s also created a mindfulness practice and a relaxation exercise that’s part of a Healthy Heart Kit that Sounds True has published with Dr. Andrew Weil. Erin, thank you so much for being with us.

EO: Thank you so much, Tami. I appreciate it. Thanks.

TS: SoundsTrue.com. Many voices, one journey. Thanks for listening.