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

Compassion for my Past Self

What if we looked at emotional sensitivity as simply another way to experience life? I would like to live in a world where there is more than one way to be social. 

The expected way to relate to others comes through external channels, such as other people, home, school, work and the general public. These come with a prescribed way of acting and being. 

But what happens if it’s impossible for you to swallow an approved social remedy? We feel like we are missing out on life because there seems to be a piece missing. We compensate for the overtly stimulating world with coping strategies. I turned to food, study and avoidance. They became the rules by which I could function for a time. They were my compensatory methods for living in a world full of difficulties. In a world which is overwhelming, emotionally over-stimulating, and just too demanding, this was a smart strategy; I had to establish a way I could live amidst a world of social encounters I couldn't relate to. 

Food was my numbing essence, it was comparable to a resolved hug from a caring parent, full of comfort and compassion and unconditional love. I ate until my world made sense again, until I felt the familiar pain and stretch in my stomach that reminded me that I was a living, breathing human being. The food passed my lips like smooth caramel that cascades from high up off a wooden spoon as it’s ladled from a hot sauce pan and falls back into the sweet sticky mass.. I ate to fill the missing piece I lacked in life. I ate until I felt like a full person. 

The release after overeating came like the shutter release on an old manual camera. All it took was one finger gently pressing down on the right spot. The picture of the inside of that toilet bowl will be burned into the back of my mind forever. 

I wasn't a natural academic. I worked hard to find the peace and control good grades offered me. It was a steady focus I could control. It also gave me an excuse to practice my third coping method; avoidance. I arrived to school early most days, and rarely went home before 8 pm  The library and study rooms became my best friends. I loved the stillness; I loved the silence they offered. Finally I found a place that didn't overwhelm me. I had my own small place which I inhabited. Yet due to dyslexia, I couldn't always concentrate on school work for long periods of time, so often I would read or day dream about the stories I read. I became aware through literature how the characters in the books dealt with life. I was drawn into the safety of the stories and the friends I gained by scanning each line. I learnt how to be from those books.

Even when it came to sport, I avoided team games and opted for swimming. It was a solitary exercise. When I put my head under the water, the world became still and quite. The gentle echoes were comforting and safe for me. And this way less people asked questions as to why I came into school so early. I could cry easy in the pool and nobody knew. 

As I look back at my teenage years I can see clearly that I have always been a very sensitive person, easily overwhelmed and highly emotional. I didn't know that then though. I just thought that my general ‘being’ was wrong and non-functional. 

Okay, these coping methods were never going to useful forever, but in a way I am sort of proud of my little adolescent self. She found a way to survive, to live and to get by in a scary lonely world. So now I don’t look back with scorn at my past behaviors  I look back with compassion for a girl who didn't know any other way to stay alive. And in twenty years I will look back on what I will have learnt and see that right now I am doing the best I can do right at this moment. I will always face difficulties, I don't like to think I will be this way for ever, but the harsh reality is that

Mindful Moments

The time of your life?

How do you experience time in this season?

Are you in control of your time? time as a whole?

or does time control you?

How do you relate to time?

When I don't want to deal with something I seem not to experience time accurately. I block time out, dissociate from it, try to run away from it. Days or weeks can slip by without me taking stock, and I find it hard to recall memories with much detail. 

Now, after almost two years of therapy, I try (but don't always succeed) to take in each moment for what it is, not run away from time, but experience it.

This is the essence of what I have come to know today as mindfulness. Learning to let go and be without thought, without judgment, without mind, to really be present with each and every moment.

This is easier said than done. Instead, I waste my time either ruminating over past mistakes or worrying about future catastrophes. But I have learned that I can’t change the past. So why live in it? There are no guarantees for the future. So why jump to conclusions? Of course it is intelligent to plan for the future. It is also smart to learn from my past mistakes. However, it is irrational to worry about that over which I have no control – e.g., the past and the future.

Living in the “now” allows me to be present, mindful, and experience the passing of time. Whatever emotion or thought I am experiencing, whether positive or negative, over time, has to pass. The moment I wrote these words has just passed. Try to hold onto it… I can’t. The moment I write THESE words has passed again. And so on and so forth. This is what is meant by “This too shall pass.” Every moment is moving toward the next moment. Being present in THIS moment as it occurs leads to mindfulness.

The only time we have control over is this very moment. So If I live each moment as it is, life seems less overwhelming. I can always manage what the next 60 seconds will bring, and then I move on the the next moment and so on.

Scared Shitless

Today started out with scary thoughts, insidious negative thoughts which infested my mind. I have a social welfare inspection tomorrow morning. I am so unbelievably scared. I have canceled this appointment so many times already. I even let her turn up to an empty house on Tuesday as I chickened out last minute and fled, pretending that I didn't know about the meeting.

Why I am so terrified? I have no idea. I cannot for the life of me figure out a plausible reason. I did a chain analysis on the event on Tuesday. I am stilled at a lose. So all I can conclude is that my fear does not fit the facts. But this annoys me, this fear is so real to me. I can't just will it away by standing up straight and acting as if nothing is wrong. 

I am confused as to what skill to use for tomorrow. I have tried COPE AHEAD by getting as much documentation gather as I can.I have a letter from my landlady, a letter from the bank and asked for a letter from my therapist.

Other than that I just don't know what else to do! I think I will go hide in my nest of a bed until the time comes that I have to leave its safety!

Impermanence - Finding the Dialectic of Emotion

Nothing is permanent. The goodness in life passes in the same way the bad periods slithers by or sticks to our awareness. Positive emotions and experiences leaves a good taste long lingering in my mouth, but it can be rudely interrupted and all too quickly be contaminated by the next onslaught of pessimism. 

I swing widely between the poles of ‘good’ and ‘bad’ judgement, rarely receiving the respite which a balanced, middle ground provides. Take for example the last 24 hours. This time yesterday I was curled up in bed, steeped in self pity. I felt so ashamed and selfish wasting a whole day doing nothing to help make me feel better. I knew I needed to do the housework, go food shopping, have a shower, go for a walk, meet some friends, go to mass, send emails ….. the list went on and on. I was feeding my negative emotion and allowing it to gain nourishment from each moment spent lying in that bed. I was down in the depths of my emotional rating, and I honestly thought that I was the biggest failure on the planet that I should just give up on life and that nobody would care if I was gone. 

Then I wake up today, still feeling the hangover of negativity surround my aura. I dragged myself to an interview for some potential writing experience with a local newsletter. It took every morsel of energy to find the motivation. It was raining, ‘typical’ I thought. I missed the Bus; I was convinced it was a sign. I didn’t have the full address; I should just give up, it’s not going to work out anyway. It really was a miracle I got there in the end. I hadn’t even researched the organisation, certain that it would be a waste of time as I would never get the job. 

If I look back and evaluate the emotion I was experiencing, I was really nervous. Fear wanted me to run home and hide away, to avoid, sabotaging any chance at a life worth living. But being the suborn mule that I can be sometimes, and because I had told some people about the interview, I felt I must go, even if to say I went. 

I actually found the place with relative ease, and was greeted by two lovely ladies who seemed interested in me and appreciative of what I could potentially bring to the organisation. We brainstormed ideas and I felt excitement build up in my tummy. The more I talked to the two lovely ladies there, the more confident I felt in my abilities. I could really do this. They really do like my ideas. To my delight, they asked me to contribute to the June issue and gave me a deadline for submission next week. 

Walking towards the bus stop I felt elated with happiness. I felt like I had overcome the fear which stops me from doing so much in my life, like I had climbed a personal mountain. I was propelled into a heightened state of positive emotion, a world away from the foul mood I had been in only hours before. I grinned childless to the bus driver and sent a barrage of texts and emails to friends and family bombarding them with my good news. 

Now that the initial exhilaration of this morning’s achievement had subsided slightly, and I am not so ruled by my emotional instability, I can see how exhausting this yo-yoing of emotion is to my emotional stamina. If I try hard to be dialectical in my thinking about today’s events, taking into account the importance of living in the moment, I guess the middle ground might be as follows; 

I spent the day resting in bed yesterday, even though I had a lot to do. By doing this I was reminded that staying in bed all day negatively affects my mood. I do need to lie in sometimes, but next time I might only rest for the morning, and get some tasks done in the afternoon. I allowed my bad mood to continue into today. Each day is a new page in my life. I can start afresh if I do not hold onto the past. It was a great achievement to obtain the job this morning. Congratulate yourself. Now move on to concentrating on the rest of today’s tasks. 

I aim for this balanced way of thinking in all my endeavours. When I read it back I don’t feel any overwhelming emotion either positive or negative. I just want to move onto this afternoon. I have a focus group to attend which has nothing to do with the newsletter. 

Have you ever had a similar experience? How do you stay centred?

Distraction. ACCEPTS, Distress Tolerance

Everyone loves progression right? Well I know I do in any case. Today in group we finally moved onto the next module: DISTRESS TOERANCE. Again, this is a nice inoffensive, non triggering topic. This time round anyway. Last time I found it hard to accept that these skills won’t solve all my problems straight away, as in right now! But rather they are designed to help you to bear pain skilfully without making the situation any worse. (Marsha Linehan 1993)

This set of skills is for when in the throes of an emotional crisis. When the problem can’t be solved, or if it can, maybe it is simply not the right time to solve it in that moment. It may not be the right environment to try to solve the problem either; for example, I am not skilled enough yet to stay emotionally regulated around my family during disagreements, so for now, using the DISTRESS TOLERANCE skills is the best solution for me. When I am in a food crisis, where I am trying really hard not to binge or purge, then being at home or around food is most defiantly the worst environment to be in, so some skills might not be as effective. And parallel to that, sometimes I can’t get away from situations involving food; this is when I find DISTRESS TOLERANCE skills really help. I like to think that my cue to use the distress tolerance is when I reach my complex skill breakdown point. It is also a way for me to find wise mind and calm the moment so I can try a solution focused skill like OPPOSITE ACTION, because it’s really important to not spend all my time self soothing or distracting! I would never get anything done!

What I picked up from today’s group is that PREPERATION is the key for these skills to REALLY work, and to allow myself to gain maximum benefit from them. We are always being told to practise the skills in less emotionally intensive situations so as we are familiar with them when we really need them when deregulated. So that is the aim of this post. To put together a list of distraction ideas based on the skill WISE MIND ACCEPTS.

DISTRACTION for CRISES SURVIAL is not the same as ‘zoning off’ when a problem CAN be solved, like staying in bed watching Disney films and avoiding the real world for days on end. That will just make it worse! WISE MIND ACCEPTS is for when you have to tolerate the situation in a way that is not harmful to yourself or others.

WISE MIND ACCEPTS stands for:

A – Activities

C – Contributing

C – Comparisons

E – Emotions

P – Push Away

S – Sensations

These are some of my own ideas; things which I know will help me during a crisis. Again, it is a work in progress and as always I would love to hear all your suggestions.

Activities Throw self into the moment.

·         Reading books – Silly novels, short stories about unimportant topics, Sci-Fi, Harry Potter. NO non-fiction. Magazines, trashy or glossy! Read recovery Blogs, Karyn Hall, Audio Books

·         Exercise - Get active, something intensive which demands focus and attention. Zumba class, Yoga.

·         Hobbies – Music, learn a new song on the guitar. Art and crafts. Writing, blogging. 

·         Mental activities – Memrise.com. Word games, scrabble on phone, Memorize a poem or prayer. Write a poem or short story.

·         Cleaning – Bedroom, Kitchen, Bathroom, Make-up, Wardrobe, Cooking, Washing

·         Events – Go see a movie, a play, a show, a lecture. The Silent Room, Meditation class. Google entertainment.ie, Hospital lectures.

·         Friends – Meet up, text, call, chat, email….. But DO NOT talk about crisis.
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Contributing - Focus on something/someone other than yourself.

·         Volunteer time, Hospital, Church,

·         Do something nice for another person. Bake, cook, send letter/card

·         Surprise someone, pay for coffee, buy something

·         Send nice text, Email, facebook

·          Smile at shop assistant, people on the street.

·         Give money to charity, buy food for homeless person

·         Visit Nana, Granny, Someone who is sick

·         Say prayers for the well – being of others

Comparison – Remember, it could always be worse

·         Compare myself to myself this time last year, a few months ago, even a few weeks ago!

·         Compare myself to others in my situations who are coping worse than me.

·         Compare myself to the rest of my family who have the same condition who are not accepting and coping with the disorder.

·         Be thankful for what I have

Emotions – Create opposite emotions to the one you are experiencing.

·         Music – create ‘happy’ playlist, ‘upbeat’ playlist, ‘relaxing’ playlist

·         Movies – Disney, Comedies, Period Dramas, Scary films

·         Comedy show

·         Read romantic books, thrillers

·         Read inspirational stories or poems

Push Away – Allow yourself a break from the emotion/thought

·         Mentally leave the situation, go to another ‘room’ in your mind

·         Give it to God box

·         Do a guided visualisation on Youtube

Thoughts – Focus mind on thoughts, Take a mental ‘Time-Out’

·         Count to ten

·         Count your breath

·         Visualise STOP! Sign

·         Look around, observe the things around you, and name them.

·         Say the same thing over and over in your mind. Breathe in WISE breathe out MIND. Over and over

Sensations – Interrupt physiological action urges with something intense which will not harm

·         Have a very hot or cold shower. Alternate between the two

·         Hold ice, eat frozen fruit

·         Go swimming, use the steam room

·         Suck on a lemon/lime

·         Snap a rubber band on your wrist

I cannot stress the importance of being prepared ahead of a crisis, and also it’s so important to find what works for you. It took me a really long time to figure out that these things work for me.

Hot Cross Bun (CBT) Model of Thinking/Feeling/Behaving

Today we were asked in group to write down how an emotional crisis looks like and feels like to ‘us’. The worksheet was based on the well known CBT (Cognitive Behaviour Therapy) ‘Hot Cross Bun’ Model. Even though I have seen it a million and one times before, it really helped to revise it, and use it in relation to DBT skills. This is the model in a picture format.

I find retrospective thinking hard to do, as I find it difficult to sense any emotion other than the one I am experiencing at any one particular time, no doubt it’s a BPD thing. None-the-less I tried hard to imagine a scenario where I was overwhelmed by an unpleasant emotion. Here is some of the dialogue which helped me to complete the worksheet. I really found this particular therapist very helpful today, I guess it’s nice to have a change in health professionals every now and again to gain new perspective

.

My Reflection of Myself in a Crisis

Example: Getting letter to say that a course I have been waiting to attend for many months has lost its funding and has been cancelled.

·         How do I feel?

Me; “I feel as if everything is overwhelming.”

Therapist (T);”Can you identify the emotion behind this statement?”

Me; “Well, it’s like I become paralyzed by fear and anxiety or worry.”

T; “So, is it fair to say that anxiety related emotions would be your initial or strongest feeling?”

Me; “Yes, anxiety, fear and worry.”

·         What bodily sensations do you notice

Me; “My body can become very tense; I fold my arms and cross my legs and clench my jaw”

T; “Is this when you would notice you are in an emotional crisis?”

Me; “No, probably not to be honest, it’s more when I feel like I can’t catch my breath, am shaking or have a migraine. Sometimes I become very tearful.”

T; “Ok, it’s really skilful that you can realize that. It gives you scope to work at leaning to catch the anxiety at the earlier stages, rather than it escalating to a higher intensity.”

·         What Thoughts Come to your Mind?

Me; “This feeling will never go away.” “I can’t manage.” “I should be able to manage/cope better” “I need to do something to change/stop how I am feeling RIGHT now”

T; “Well done on identifying these thoughts. The way to help change them is to weigh up the evidence for and against them and challenge them by asking; ‘Are these thoughts rational?’ Can you come up with a fairer, more tangible thought which will be more solution focused?"

·         How Do You Act?

Me; “Well because I can’t think straight, I tend to resort to behaviours which, when in wise mind, I know are harmful in the long run”

T; “What kind of things?”

Me; “I have a list!, I will avoid any situation which feels overwhelming, even if I know it needs to be dealt with and will even avoid doing things I enjoy. I stay in bed, and isolate myself by not contacting anyone. This time I didn’t open any other letters, couldn’t respond to emails or texts.”

T; “That makes perfect sense to me, but as you said, it doesn’t really help solve the crisis at hand.

Me; “No it doesn’t help, even makes it worse. I become very emotionally deregulated and resort to old destructive behaviours such as binge eating/drinking, which leads to secondary emotions of shame and guilt  and then I feel I must punish myself by self-harming to make up for it. Then it basically starts the whole cycle off again doesn’t it!

T; “Exactly! Here is where you can intersect the cycle to change the emotional and behavioural outcome by noticing initial bodily sensations before the thoughts and behaviours take over.

We then went on to cover all the ACCPECTS and SELF SOOTHE skills which can be useful to change the intense emotion. I will be making a separate post about the ACCEPTS skills as I am still putting together what works for me.

I guess I just wanted to go over this exercise, and always find that here, on my blog, is a great way to reflect. The biggest lesson I learned today is that I can always learn something new, even if I think I know it all! It feels good to have bashed this out again. I hope it helped you to read it too.

I would love to hear if this model has ever helped you.

Panicked and afraid

I came out of my one to one therapy session yesterday feeling utterly ashamed of myself. I am a fraud, a fake, an undistinguished manipulator, who's sole aim is to gain attention and pity from those who are only trying to help me. I can't cope with life. My miserable and  shameful life. I have no clue who I am, and the scary thing is that don't think I want to find out. I am terrified that when I find out who I am, I won't like the real me.

It's better to be unwell, and use that excuse to explain my horrible personality than to accept that ultimately this may be who I am and that I choose to behave the way I do. I am so afraid of myself.

I found myself calling a suicide hotline last night and wondering if I would ever have the courage to go through with it, but I am too weak. That is the conclusion I came to, that my drive is there, but I am to scared to really go through with it. Its like a marathon runner who has trained for their entire life for a big race. The have the ability and the drive to run, but the day before they break their foot and can't go through with it because they physically can't.

Today I panicked again. I need answers to the hazy questions circulating in my mind. I didn't go to work and instead festered in bed with my unwashed thoughts.  I don't care about anything. I didn't even pick up my social welfare payment this week. I am back to thinking about starvation and attention seeking.

I called my Doctors office not to long ago knowing full well that my therapist was out of the office today and couldn't call me back. Now I am waiting for a call back from some randomer and I have no clue what to tell them about why I called. All I know is that my insides are screaming in silent agony with confusion and guilt and that I am terrified of myself.

Why did I call? It was an instinctual reaction to the emotional pain. My head wants me to be devious and secretive yet also wants to let others know when I am hurting too. As if by sharing the hurt that it will somehow soften it and justify its reality. But the instant I open my mouth it won't let me explain it in a way that gets me any help.

Oh I am not making much sense I know, and I am also well aware that this blog has taken a radical turn from recovery to something much more dark and disturbing and I really am sorry about that.

Just off the phone with the on-call doctor there. He was nice, but detached and was reading my notes as we spoke. We agreed that I must put in place my distress tolerance skills and reminded me that these feelings rarely last... so in the words of Marsha.... I must ride the wave of the emotion.... I fucking hate surfing. Could never stand up on the board and always got thrown off into the white thunderous water. But she tends to be more wise than me when I am feeling like this so I'm off to self soothe in a hot shower and wash away the dirt of my anxiety, then I will paint my nails and paint a half smile on my face in order to ride out this period. 

'Participation' Is Torture

This week we have been set the goal of in incorporating the 'What' Skill (from the Mindfulness module) PARTICIPATION into our everyday lives. Thing is, with every good intention of being a diligent member of DBT group therapy, I made a plan. But annoyingly, I keep forgetting to fully participate in a task in order to be mindful to my experiences. 

"I used to think mindfulness is some form of passive observation… it is NOT passive.  In fact, mindfulness requires you to be both the participant and the observer simultaneously.  In this way, you are the observer of your experience at the same time as you are the experience itself.  As thoughts, feelings, and sensations naturally arise, they arise with the same vessel that observes them.Mindfulness is not a denial of your experience and a retreat into nothing but detached observation.  It is a type of open observation that is experiencing that which it is observing." Laura Schenck MA

Some skills from DBT are like little treats for the soul, while others are more akin to TORTURE! This is one of them. When you are fully awake to an experience you have actively spent a good proportion of your life trying to avoid, it is not a nice experience to then have to be aware of all the unpleasantness.

Does that make sense? I can't seem to explain what I mean in the way I want to. For example, a way I have tried to incorporate participation into my life this week, is to fully engage in eating. I really tried hard to experience every morsel of food. To taste the differences between sweet, bitter and salt. I noticed the variances in temperature and texture. Then I switched from external stimuli to the internal. To my thoughts, judgments and emotions.

Here is where the problem with this skill arose for me. No matter how hard I concentrated on noticing my thoughts, there was a strong resistance to participate in the task any longer. It was too hard to observe, then describe, then participate with eating when my head was screaming floods of guilt. 'Fat cow' 'You have no self control' 'You will be alone forever' 'This is what you deserve, fatness and unhappiness' .... 

This skill needs practice I think. And its not what I want to do. Its hard and annoying, but I guess if I was to pull from another skill, and weighed up the pros and cons, is it harder to live with an eating disorder or to just practice this skill?