DBT For Managing Pain

I have been dealing with severe pain in my leg for about two months now. I had a clot in my right leg which has thankfully resolved itself but the pain is still there if I walk for more than 15 mins at a time. I also get horrible PMT pain around my time of the month. Pain management can be a tricky business, drugs are great in the short term, but not a viable long term solution (the side effects are icky) so I have had to find alternate ways to deal with the pain. Mindfulness has had great success with pain management, so when I read the studies (which claim that mindfulness actually changes the way the mind perceives pain so that it’s more bearable), I thought 'If mindfulness is good for pain, and DBT is based on mindfulness... then why not try using the skills for my pain!'

Living with pain is not only a physical strain—be it merely uncomfortable to outright debilitating – but is also an emotional strain as well. Throw in an emotional vulnerability and you get a bubbling, hot pot of dysregulation spitting and spewing over into our relationships and lives. Feelings of frustration, anger, depression or even despair can deeply impact my quality of life maybe even more so than someone without an emotion dysregulation disorder.

Okay.. enough waffle... let me get straight to the point. Here is how I use the skills to manage my pain.

1. OBSERVE

The idea of being mindful of pain and observing it as it is may seem counter-intuitive. Most people want to forget about their pain, I know I do. I want to escape it, run away from it, I wish I could ignore it or get rid of it somehow. My mind typically launches into a litany of judgements and negative thoughts. I start ruminating about how much I hate the pain and want to wish it away. Then I judge the pain, and that only makes it worse. My negative thoughts and judgements not only exacerbate the pain, they also fuel anxiety and depression. The problem is, ironically, that by fighting and struggling against it, and even by trying to ignore it, I create within myself a state of ‘resistance to what is’ and that means stress, and ultimately more suffering.

The mindfulness skill of OBSERVE teaches us to have a 'Teflon mind'. Don't let your thoughts or experiences 'stick' in your mind. Take a step back and look at the situation with fresh eyes. The ability to step back from what is happening in the moment creates a psychological space. This separation allows you to not get caught in or react to your experience. Without the psychological space, your reactions are automatic. Shame, guilt, anxiety, and depression often collapse your ability to create psychological space and cause automatic reactions (acting the way you feel). Experiencing the moment without getting caught or reacting is a way to extinguish automatic responses. Psychological space creates room for mental flexibility and freedom of choice.

2. Being EFFECTIVE

Sometimes if I spend time simply observing and giving the pain my awareness, just doing that can bring the intensity of it down to a manageable level, if not, it prompts me to stop what I am doing long enough to realise I need to change something. 

For example; I was going to catch a bus yesterday. The stop is about a five minute walk away. I was nearly at the bus stop when I saw a bus coming. I started to jog so I wouldn't miss it, but was instantly hit with a siring pain in my leg. Rather than push through the pain and ignore it, I stopped, OBSERVED it and realised that the most EFFECTIVE thing to do was walk slowly, let the bus go and wait for the next one. There was no use in damaging my leg further for the sake of waiting 10 mins for another bus.

Another example is cancelling plans and getting extra rest, your friends and family will understand, and going out out despite the pain is only going to hinder your recovery and create extra suffering. Your pain might decrease your ability to be interpersonally effective and could lead to bickering or you saying something you might regret. 

Sometimes being EFFECTIVE is as simple as recognising that the pain is more than you can handle and getting help from a health professional. In these cases the next skill can be really helpful.

3. SELF SOOTHE 

One of favourite things to do, especially when dealing with bad pain days is to SELF SOOTHE. It's great for when I am feeling down and need a pick me up. But the thing is, when I am feeling down, or low is not the time I tend to think to myself, “you know what would really make me feel better? Painting my nails, or calling a friend". So, for this reason, the real key to this skill is to have a SELF SOOTHING kit pre-made for those particularly hard days.

I have written as post about different SELF SOOTHING ideas, so check out the link below, make your kit and then let me know how you got on. I adore hearing about others experiences and ideas.

SELF SOOTHING ideas

Stay mindful. xxx

DBT Skills for Romantic Relationships

For a very long time I thought I wouldn't ever be able to be part of a healthy romantic relationship. It's often seen a huge trigger for those of us with an emotional vulnerability, and it very often can be. But I soon learnt that having a mental illness does not have to be a reason to avoid being in a relationship. A mental illness may cause more stress and require more work, but having a successful relationship is not impossible. There are few things I had to really work on so my current relationship (of over a year!) could work.

Before I could be in a relationship and worry about another person, I had to prioritize my own health. My current boyfriend actually asked me out a year before we officially started dating, but I was still in DBT and quite unwell. So I decided to wait until I was finished formal therapy and had learnt the DBT skills to help me manage my emotions before I agreed to be in a relationship with him. Luckily he was still around when I finally was in the right place. I'm only going to mention a few DBT skills here to demonstrate how I manage my emotions in relation to how we make things work in our relationship, but there are lots and lots more!

Number 1. PLEASE

Staying on top of any medication I've been prescribed and taking care of my physical health -- exercising, eating well and avoiding alcohol or drugs, is the best thing I can do to regulate my emotions; and therefore the best thing I can do for our relationship. Avoiding alcohol has been a great way of staying present in stressful situations like nights out or large gatherings, where I have had emotional outbursts in the past due to feeling out of control, leading to arguments and behaviours I am not proud of.

Sleep is a difficult one as it can be difficult to get quality sleep for me at the best of times and when he stays over it's even more challenging. I only have a small bed so we inevitably end up elbowing each other in face! If we were to move in with each other, a big bed would be a must!

Number 2. NON JUDGEMENTALLY

Staying non judgemental is *sooooo* important to keeping our relationship healthy. Being non judgemental helps to get my point across in an effective manner without adding a judgement that my partner might disagree with. When I practice this skill, I can look at the weaknesses of others with compassion, not accusation which allows me to respond to them effectively and not lash out in an emotional way.

Believe me, there are plenty of times I am still judgemental. It's a constant effort. We all live with preconceived notions of what's right and wrong, and the minute someone or something doesn't fit our bill of perfection we become judgemental and that affects the way we say things and the things we do.

I practice non-judgementally by OBSERVING my thought patterns. Like all of DBT, this skill requires a few others to make it really work. This might seem hard to do at first, but once you get used to catching your thoughts in ‘judgemental mode’ you can then start to stop them.

I try to develop an understanding of my partner by thinking about why he acts, talks, dresses or just is a certain way. I put myself in his shoes and wonder why his behaviour has emerged. If I want further understanding, I strike a polite (I emphasize polite) conversation using the skills GIVE or DEARMAN.

Once an understanding has been created in my mind of my partners action, acceptance of him just as he is becomes easier. I can accept that this is the way he will react, cause its the way he is made up. There will most certainly always be things we don't agree with, but that doesn't mean I cant accept his presence in the world. When you accept, frustration that leads to judgement takes an automatic back-seat.

On a final note, relationships are hard! They are difficult whether you have an emotional vulnerability or not and require lots of hard work to make them last, and there are so many more things that we need to work on in our relationship, but I have to say that, it's so worth it and really contributes to my life worth living!

Increasing Positive Experiences

Things are most certainly looking up. Whether it's due to some shift in the universe where by it's finally my turn for which nice things are to happen to me, or whether it's down to the increased motivation this recent elevation in mood has brought and therefore a self stimulation of sort of pleasant experiences. Either way, its quite lovely having the positive emotions to balance out not so lovely ones on the 'feelings' scales. I guess the more aware you are of the nice things in your life then the more positivity you attract. Also, on the other hand, I have too experienced the flip side of this with avoidance and negativity. As much as a depression can be a downward spiral into despair and hopelessness, I feel being aware of more positive feelings and emotions breeds more happiness in my life and thoughts.

I got a really big phone bill last month, and needed to try find a way to pay it off. So I signed up to a child-minding/nanny agency in the hopes of finding a small job. Although I still haven't found a job which will pay off the bill...... I WAS offered a six week Au Pair position in the south of Spain for this coming summer!

I am so excited and happy with the job. The family seem to be really nice and, as far as one can tell from a wee, short skype call, I think I can safely say I will settle into the family unit well. I lived in Spain as a child, and can speak Spanish quite well, although it is a bit rusty! I am familiar with the culture and the way of life too from living there. So I really feel I will get on well .

Next thing is a bit abstract, I'm pretty sure it may just be a 'borderline' thing. For the last three and a bit years, ever since I was first admitted to inpatient actually and experienced that intense fuzzy feeling of 'being cared for', and having my family be worried about me, telling me they love me, dropping everything in a heartbeat to be by my side... the feeling of people caring if I lived or died, has consumed me. I kept trying to chase that feeling again, but, like a class 'A' drug, it has been harder and harder to find the same initial hit . Like a classic addict, I would do anything to get the attention I wanted, saying I was sicker than I was, that I was doing worse than I may have been. I didn't comply to treatment plans, I lied to my team..... Then I actually DID get sicker, but by then I had exhausted my family's ability to care for me. 

I guess what I am getting at is that although the urge to want to be cared for is still there, I feel like I don't need to chase the feeling with so much fervour at the moment. It's incredibly liberating to be freed from the shackles of relying on others for the validation that... I matter... that I am worth something. I sort of feel that I am just fine on my own right now and it's really nice. Every so often I catch myself thinking up ways to end my life, but rather than spending hours planning it to the minute detail, like I have done many times before, I can come up with a list of reasons not to go through with it. I push the thoughts aside and simply get on with life. I see the destructive thoughts like a side effect of my emotional sensitivity, a residue that might always be there, but doesn't have to be the main focus.

Self-validation is wonderful. It's allowed me to feel like I am worth it. like the ad says! I went and got my hair done today, not because I needed to, but just because I wanted to. I bought a lovely pair of shoes, and I spent a few hours at a coffee shop, relaxing and being kind to myself. I am eating better and not mindlessly binging (as much), I have had a few incidents where I have over eaten, but I made a conscience decision to and didn't have any urge to get rid of it after.

This all comes under the EMOTION REGULATION skill of BUILDING POSITIVE EMOTIONS. I should actually pull out the list of 176 pleasurable activities and have a gander at it.

Hope you are keeping well dear friends.

Stay mindful. xxx