The “PLEASE” skill in Dialectic Behavioral Therapy is one that is near and dear to my heart. PLEASE is an acronym and it’s the emotion regulation pillar of DBT.
The acronym is as follows:
P – Treat Physical
L – Illness (treat physical illness)
E – Balanced Eating
A – Avoid Mood-Altering Drugs
S – Balanced Sleep
E – Get Exercise
In my personal experience with Bipolar Disorder, I truly believe that the PLEASE skill is the core of my well-being. When I have all of those under control (so hard, but doable) I am rocking this illness and doing life to the fullest.
So, I’m going to give a little background, I was a college athlete at a large Big Ten school out in the Midwest. I was recruited to swim and beforehand, my entire life revolved around swimming. Growing up, I was a moody, precocious and impulsive kid. It scares me to think where I would have been without swimming in my life to ground me.
With being so committed to a sport, you have to take care of yourself. I went to bed at 9 p.m. every single night from 11 years old until I turned 22 years-old. I planned out my meals. I had oatmeal for before morning practice, eggs after morning practice, lunch was a toss-up and dinner was salmon with quinoa. I was never sick, I never had physical illnesses to treat. I mastered the PLEASE skill when I was a swimmer.
However, once my bipolar symptoms developed, things changed. I no longer can glide through the acronym as I used to. I struggle with most of the letters, to be completely honest. But, when I am able to use each letter to my benefit, my world goes round again. So, I will never stop trying to master the PLEASE skill.
So let’s go through the phrase, PLEASE.
Treating physical illness – while I actually do have a great immune system, I currently have a fractured foot. I fractured my foot as I was mastering “E – Get Exercise”. I overdid my training for running, training twice a day, and being very hard on my body that ultimately leads to a third metatarsal fracture. So for now, I have been treating my physical illness. I went to my podiatrist, I’m wearing a walking boot and I have crutches. Do I love the fact that I can’t do what I want? No. But I’m taking care of me so that in the future, I can crush those half marathons and sprint to personal records in 5ks.
Balanced Eating – This is another tough one. I am recovered/recovering from an eating disorder and therefore, it’s hard for me to rationally be around food. I never know what to cook. I will get take out. I hate eating dinner. I have multiple scales that I hide around my apartment because I know I shouldn’t be weighing myself. But balanced eating is so tough. I wish I had someone to give me a meal plan and tell me what to buy at the grocery store because even though I’ve restored my weight, I still have no clue what balanced eating looks like for me. This is especially going to be something I need to work on as I can’t work out as much.
A – Avoid Mood Altering Substances is a funny thing. For most of my life, I was never able to interact with mood-altering substances unless it was a Saturday night or a break. And when I did, I did it hard. My whole team did it hard. It’s actually a statistic that for college athletes, when you are unable to drink/go out during the week, you bank it all for one night and it can turn into a disaster. I’m still learning that I don’t need to cash out and go all out for a night with friends. This is something that scares me and this is something I talk to my therapist with regularly.
S – Balanced Sleep is like oh if we could all drink sleepy time tea, put on a nice aromatherapy diffuser and fall fast asleep. I remember being in a group at a Partial Hospitalization program and it was about sleeping. I remember telling myself, I take drugs for that, that’s not my issue. And as I’ve become more aware of the importance of sleep, I’m realizing that taking drugs doesn’t guarantee to give you good sleep. You need to, honestly, do the rest of the PLEASE skill, eat well, exercise, avoid alcohol and drugs and treat your physical illnesses. I’m still trying to finagle my way through my sleep so I am only waking up once or twice instead of four to six times a night. Sleep is so so so so so important to bipolar. It’s something that’s trial and error. Maybe you need to watch TV beforehand, maybe you need to drink herbal tea, maybe you need a facemask and a bath or maybe you just have to read a really great book.
Last, but certainly, not least is getting exercise. This one is my favorites. This is the foundation of my life, the core of my being. I am so passionate about being athletic. I’m so passionate about it that it scares me that I made myself so weak at one point that I couldn’t exercise or that after my last hospitalization, I couldn’t get myself to exercise. My current therapist gave me the best advice; she wanted me to pick up running. Running is similar to swimming in that they are both individuals, have similar pace-like workouts and are lifelong sports. However, I was AWFUL at running. My therapist told me, run tree to tree. So I tried, but I didn’t do it. I just ran. And a few days later I run 5 miles without stopping, I couldn’t believe it. It was liberating. And then I ran half marathon and placed 4th in my age group after 3 months of training. Unfortunately, my training is on hiatus as my foot is fractured, but I will keep on going.
The PLEASE skill is amazing. It’s all the things that are so basic to just living a human life, eating, sleeping, exercising, etc. Yet, they are things that we can ignore, abuse or avoid. So my hope to you is that you can find the way to make the PLEASE skill work in your life and once you find it, work it!