New Year, Not So New Me

I know, it's been far too long since my last post to even attempt to give an excuse. So rather than say "I've been too busy enjoying my recovery from emotional sensitivity" which to be honest, I wish were the truth, I'll try to explain whats been going on. I haven't posted because I wanted to leave BPD, EUPD, CBT, DBT and anything to do with my 'old self' as far in the past as I could. I threw the baby out with the bathwater insofar as my life seemed to be going OK, so I foolishly thought: "I don't need to look after my emotional sensitivity anymore". But recovery for an emotional sensitive person is not the same as recovery from a broken bone. You cannot only do the prescribed therapy for a few months after the event. You must learn the treatment, remember it, and continue to practise it as a preventative measure against future injuries. 

Christmas and New year have come and the festivities have died down. I'm left wondering why I feel so emotionally delicate. I mean, I had an uneventful Christmas, almost enjoyable actually. It was quiet and there was little to report. 

Perhaps it's the last 8 months finally weighing down on me. I can't shake the crushing feeling of being a total failure. I'm also currently therapist-less, which I find scary. Really scary. I have completed year one of four of an undergraduate Midwifery degree programme in my dream university. My dream course which will lead to my dream job and to my dream life. Seemingly.

But I'm not living the dream. Im on a year out, working 50+ hours a week for just over minimum wage to pay back crazy university fees that I wasn't expecting. Yet I haven't begun to pay my fees back yet because I'm bang in the middle of a emotional meltdown which sees me self destructing using old coping habits I thought I had left in my past.

So seeing as its a 'New Year, New Me' kinda time of year, Ive come back here to this blog, to where I found peace and recovery before, in hopes I may find it again.

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!

Healthy Body, Healthy Mind. Week 3

Wow what a mixed bag this week has been in terms of emotions. There have been some great personal achievements and some difficult moments. The roller-coaster of emotions has been difficult and downright exhausting at times. This lead to huge urges to binge and revert back to that safe coping mechanism which has served me so well in the past. 

I found this weeks mindfulness group really triggering. Others in the group disclosed personal difficulties which I couldn't help but get overly emotional about. It's like I suck up the ambient emotions around me and add them to my already overflowing sensitivity. As if I'm a magnet for others pain. I also didn't complete the homework which triggered guilt, a very difficult emotion for me.

While I was paying attention to the other peoples problems in the group I really wasn't being mindful to my own escalating emotional state. We did a gratitude exercise where each of us listed the things we were most grateful for in the present moment. Some mentioned their houses and family, and rather than being happy about what I do have, all I could do was focus on how jealous I was that I don't have those things. I kept homing in on the things others had that I wanted too.

I see now, in retrospect that I really wasn't using the  DBT skill PARTICIPATE, which is vital when practising mindfulness. It is a 'WHAT' skill which allows you to benefit wholly from the experience and enter into your experiences whole-heartedly. When you participate you let yourself get involved in the moment, letting go of ruminating and self-consciousness. 

Participating is entering wholly into an activity, becoming one with the activity. It is throwing yourself into something completely. It is spontaneous behaviour to a certain extent, although you can also do it mindfully. (dbtselfhelp.com)

This lack of mindfulnesses led to me clinging on to my emotions and carrying them around for the rest of the day. It tainted everything I did that day. I was short and gruff with people who did not deserve that and I was mean and harsh towards myself in my thoughts and behaviours.

I cooked a chicken and broccoli bake that night with the intention of cooking enough for leftovers for the following day, but I let my emotions take control and ended up eating twice as much as I needed. I gorged myself, making myself feel ill as if I was punishing myself. I didn't even enjoy it at all and on top of that didn't have any left overs.

At weigh in today I was expecting a gain. I even cheated by taking my jumper off and wearing really light shoes in the hopes I would at least stay the same. So I was really pleasantly surprised when the scales showed a two pound loss. 

In reflection, it hadn't been that bad a week (except for Tuesday). I had cooked really well all week, had upped my protein intake, had stayed clear of alcohol, only had one takeaway and began walking more in an attempt to prepare myself for an increase in activity. Those are all huge achievements for me. A mere three weeks ago I wasn't doing any of that, eating numerous takeaways a week and  not at all aware of my daily food intake.

I'm in my third week now and am 3.5lbs down, but its not just the number on the scale I am happy about. My energy levels are up and I'm sleeping better. My binges are less and hence I don't feel so bloated. My digestive health has improved drastically too! No more tummy cramps and bunged up sensations (Sorry for the TMI!) I haven't noticed a major difference in my clothes yet, but the reduction in bloating is helping my day to day comfort.

This week in my Weight Watchers meeting the talk topic was 'Exercise and how it affects mood'. I totally agree with this but rarely find the motivation to go get active, yet I KNOW that when I do I ALWAYS feel good after. This is part of the EMOTION REGULATION module in DBT. PLEASE is so important for keeping my emotions in check and exercise is the one particular part I have been neglecting. We talked about finding an activity that we find enjoyable and fun. Those of you who have been here a while know that I used to be an avid dancer, so my mind went straight back to the fun I had in a dance class. Ballet isn't really an option for me right now, but I have tried Zumba before and therefore I made a commitment to my WW leader to go back to it. 

The Gods must be looking after me, money is really really tight and the €10 cost of weekly Weight Watcher meetings is about all I can afford right now on top of the expensive healthy food I'm buying and my rent each week. I can't afford a gym membership or expensive exercise classes. Luckily, I found an online coupon for 6 Zumba classes for €17! And its in the city centre and on my bus route. It's perfect, and I couldn't be happier with such a great deal! I'm starting next Monday evening. Can't wait to tell you how it goes.

Here's this weeks chart, hopefully the green line will keep inching towards my goal weight!

Stay Mindful. xxx

OBSERVE - Listen like a sponge

This very useful skill was taught to me by a extremely talented key worker when I was on the intensive outpatient program last year. She really got through to me and helped me see how little attention I pay to others when they are talking to me.

This is what she told me to try to help improve my relationships by using mindfulness:

"Listen to others as if you are a sponge, soaking up what the other person is saying. Let your mind be quiet, and just take it in. Don't formulate any response in your mind until a response is requested or required."

At first I was quite annoyed, even offended that she thought I didn't listen to people . I became defensive and shut down and guess what... I didn't listen to word she said after that!

Maybe she had a point.

But what I failed to understand is that mindful listening is not common place in our society. It's also known as absorptive listening and really ties in with the DBT skill of OBSERVE. It does not come naturally to most people and most certainly does not come natural to me.

Recently I have started practicing absorptive listening and have become very aware of my inner dialogue;  a mental voice urging the person talking to "hurry up and finish speaking so I can tell you what I think!!!" As you can imagine this voice can interfere with tranquil, attentive listening. I discovered I rarely just allow myself to 'absorb' what the other person is saying without trying to tie it to my own life somehow or come up with a solution to the problem they are telling me about.

I 'but' in to other people's conversations and jump to a new topic before the last has really ended and to be honest I have come across as plain rude in some cases.... not intentionally... but just due to a lack of awareness, a absence of mindfulness.

I know how great it feels to be on the receiving side of absorptive listening, and am blessed to have some fantastically mindful friends who I feel really 'witness' me when I talk, (or write, as I have some great on-line friends). I would love to nurture that talent within myself so that others may feel that total attention from me.

Great Expectations

Blogging for Well-being - Advent Blog - 2nd December

Christmas is a special time of the year for us all. It's especially a time for family gatherings and while it may be wonderful to get together and mark the passing of another year there can be many stresses about it too.

Christmas is also a time for remembering and while for many their memories of past Christmas' are filled with joy for others these memories may not be as happy. If this is the case for you it may influence how you approach planning for Christmas

We human beings are always "expecting." In other words, we are always having expectations. Lots of expectations. Some we are consciously aware of. Many others, we are not.

Expectations are always there, however, in the background of our daily experiences. Whether we are attuned to them or whether we are oblivious to them--which too often is the case--our expectations come into play in a multitude of subtle ways.

Why focus on expectations? The main reason is that expectations are a common source of stress in our lives. They frequently create all sorts of mischief, including emotional distress, relationship conflicts, communication breakdowns, misunderstandings, distrust, and a wide range of other common problems.

Expectations produce stress in two main ways. One is that they are frequently untrue or unrealistic. The other is that most of the time, we are completely unaware of them. Individual expectations are not very complicated. They often consist of simple ideas such as "life should be fair," "people should be honest," etc. It's the fact they are hidden from our view that gives them so much power over us.

Many of my emotionally dysregulated periods have been because I have expected something that may have been unrealistic, and when people or situations don’t live up to my expectations coupled with a less than mindful approach, I become very disappointed and upset, causing my emotions to fluctuate and spiral out of control.

When we consciously or unconsciously harbor expectations that are much too high, we set ourselves up for failure. As a result, we end up feeling frustrated, angry, and personally demoralized.

Once you become aware of an untrue or unrealistic expectation; YOU gain the power to free yourself from it.

It's really just that simple. But "simple" doesn't always mean "easy"--unless, that is, you have the expectation that it does! It's one thing to become aware of your unconscious expectations. It's quite another to know which ones are realistic and which ones aren't. This takes wisdom, yet most people have far more wisdom than they usually give themselves credit for.

Social and personal expectations are a major source of holiday stress. The holiday season is not a happy time for everyone. Yet we all tend to feel compelled to look and feel merry during this time.

The mass media and happy Hollywood movies fuel these expectations. If you are single, alone, or recently divorced or separated, the social pressures at this time of year can be quite stressful. Similarly, we all have expectations of how our friends and family members should behave during the holidays. When these expectations are not met, stress and interpersonal conflicts can easily arise.

All families experience tension to some degree. But there is a DBT skill that may help you; I know last year it really aided me. COPE AHEAD. Part of the reason why Christmas time can be so stressful is the unrealistic expectation of coming together as a happy family on this one day of the year. Suggestions for coping ahead with Christmas include:

1. Keep realistic expectations. If your relatives tend to fight throughout the year, they will most likely fight on Christmas Day as well. 
2. Appreciate that everyone is under stress to a certain degree. For example, one relative may have worked overtime to get everything done before their office closed for Christmas, and may be feeling exhausted and harried. Another may be anxious because they overspent on their credit cards. Be as understanding as you can of people's situations. 
3. Consider breaking up the celebrations to keep 'warring factions' apart. For example, you could see one group of relations on Christmas Eve and another on Christmas Day. 
4. Family members involved in after-lunch activities (such as a walk by the sea) are less likely to get into arguments. Plan for something to do as a group after lunch if necessary. 
5. Use relaxation techniques, distraction and group activities to help steer around stressful situations. 
6. Avoid overindulging in alcohol – the reduced inhibitions could contribute to (or cause) an unnecessary argument. 

Be MINDFUL of your emotions and feelings today and over the next few weeks, and don’t let your expectations rule your enjoyment of what can be a very happy time of year. It's all part of creating a LIFE WORTH LIVING.

New found RADICAL ACCEPTANCE

As the leaves fall and the trees turn bear in anticipation for the ice queen to spread her frosty breath, I have settled down calmly with recognition of the change of the seasons. I do mourn the balmy summer nights where the sun's rays stretch so generously into the evenings giving endless days and shorter dark, scary nights, but as sure as summer must end, winter will also pass in time.

DBT has thought me that rarely are things permanent. The gift of acceptance (when I can practice it) has allowed me to live a life less terrified by despairing thoughts and emotions. They do pass, maybe not quick enough, and maybe not for long enough, but the brief respite between the terrors allows us to reach deep inside ourselves and enjoy the time when we are in control. When the haze of distress lifts, it provides a short period of wisdom where preparation can take place, where gratification can develop and life can be lived.

Recently I have been living in an all too common mist of fear and anxious thoughts. It’s a fear fog which has established itself atop my recovery mountain. It’s holding me back from seeing the view from the top. I am out of breath and exhausted from climbing so high and so hard. Each step developed my emotional muscles and built my tolerance to exposure. I have had to face tough terrain and steep cliffs. Now as I reach the top, I am so so close to achieving the glorious moment of breathtaking beauty, the stunning view from the peak of the mountain. Yet my view is clouded with terror, and I am waiting for it to clear…..

WISEMIND Reflections

                                                                   

Here I am, sat so leisurely, so relaxed, drifting in and along to the smooth background music in a funky hipster vibe café in the south of Ireland. As I nibble at a sweet homemade rhubarb bun, washed down with a silky milky coffee, settled into pretty stratums of caffeine rich liquids of different density, I realise I am happy for the first time in weeks. I am doing everything my heart desires today. I took the 2 hour train ride down here to escape the stress of Dublin, of work, of life, hug my Mother and feel her nurturing impression. A brief respite.

In this veil of contentedness requires me to listen to the WISEMIND voice in my mind that tells me that this internship is just too much for me right now. I am only weeks out of my DBT group; I am still a DBT novice, an apprentice of life. Yet despite all that I am stuffing down my true emotions and all I know is right for me by working 40 hours a week in an internship I am not able for, I can’t manage life and work that much without running myself into the ground. I have no time for writing, my very own creative Prozac. Without my nurturing my creative side, I may as not be taking my medication because, Writing, drawing, taking photos have been an integral part of my recovery.

I have a lot of thinking to do this weekend, but for now I am going back to riding the wave of this emotion of contentedness as I know this too shall pass and the next one might not be so pleasant.

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!

Distress Tolerance IMPROVE Imagery - Safe Place

Jack's Hole Beach, Co. Wicklow, Ireland

The first letter in the anagram IMPROVE stands for IMAGERY. 

I personally like to build a safe place inside my mind, when I am doing well and NOT in distress. This way I have a ready made place to retreat to when I need to escape a crisis or distressing situation, and I do not have to think too much about it.

There is a beach in Co. Wicklow, Ireland where I was brought to as a child during the summertime. It is a private access cove where only residents can gain admittance to its gloriously sandy shore. Luckily a close family friend lived near the entrance and allowed us to park in on their property. I felt so safe there, it was nearly always empty, and the water was clear and clean. There were no scary caves or strange fish. My mother would allow me the day off school if the weather was unseasonably warm and we would drive the hour journey down south towards my coastal heaven. It is where some of my most treasured memories were made. This is my setting for my safe place visualization.

I find this a great way to gain a moments respite from intense emotion. I like that I can do this anywhere, anytime, on the bus, in a busy shop (I find the dressing rooms a good place to practice it). I also like to sit in a quite church  but in reality, this can be used in any situation. Even 3am in the morning!

Try the little script below to help you build a safe place in your own mind.

Allow yourself to create a place of safety and peace that is always yours, always safe…. And breathe in the safety. And breathe out the fear. And breathe in the safety. And breathe out the fear…. As you breathe in, you can even smell the smells of safety…. Perhaps salty air, or the sweet smell of a flower…. Breathe in the smells of your safe place. It’s so safe here that you can even taste it as you lick your lips. Let yourself bask in the safety and the peace…. Allow yourself to walk around, to be in this place, to notice more and more, to create more and more in this place…. Perhaps you would like to build a shelter of some kind, a cottage, a tent, a tree house. And if it’s already there, you may add to it…. Plant flowers, adding a splash of color. Add special places or rooms to your safe place…. Create anything that you would like. [Long pause.] Create special places for special kinds of feelings that need to be healed, special places to wash away fear and pain…. Create a waterfall or a pool of healing water. Stand under the waterfall to wash away the fear…. Let the healing waters wash away what you’d like to be finished with. Each time you come to the waterfall or the healing pool of water, you can wash away more and more of the past…. Each time you come, you are cleansed and rejuvenated, the shame is washed away. Wash away the pain. Wash all of it away, as you are ready. [Long pause.] When you are finished, step out of the water and you will find a robe or a towel to dry and warm yourself.

Now allow yourself to continue walking around your safe place…. You find a place for a healing garden, a place that is just for your healing. You can plant anything you would like…. You can plant wishes and

dreams for the future. You can plant seeds of your healing. And you can weed out what you want to be finished with. Take some time to work with your garden now. [Long pause.]

And now, find your favorite place in all of safety. Walk around until you find just the right place. [Long pause.] Sit down, and get comfortable…. Breathe in the safety and the peace. Breathe out the fear…. Breathe in the safety and peace. Breathe out the fear…. Breathe in the safety and peace. Breathe out the fear…. And just be in this place as you breathe and heal…. Stay in this place as long as you would like…. And when you are ready, simply count yourself out by counting from one to five. When you reach the number five, your eyes will open. And you will be awake and alert, and feeling safe and at peace. One…. Two…. Three. Take a deep breath…. Four…. And five.

Pros & Cons of Tolerating Distress

I will keep this short. I have been putting off doing this for so long. It's fairly self explanatory in it's title, but the problems lies in ACTUALLY doing it. I have been avoiding doing this for my target behaviors for months now, so here it goes! I am only able to do one for the moment, but I have five behaviors I need to do this for!

Target behavior #1 - Binging. 

Resisting binge.

• PROS:

1. Feeling of accomplishment over skill use.
2. Saves money.
3. Healthier body and mind.
4. I eat to give myself MORE energy. When I become too full, I LOSE that energized feeling.
5. I might be able to change my state of mind and continue my life normally without putting on excess weight
6. I will learn to experience the distress and deal with it in time.
7. Feeling of self control.

• CONS:

1. I will feel the emotion I want to avoid. I wouldn't feel the 'food high'
2. I will be irritable.
3. I will feel deprived.

Giving into urge to binge.

• PROS

1. Instant relaxation.
2. Comforted.
3. Get medical attention
4. Escape emotional suffering momentary.

• CONS

1. Will trigger an urge to purge.
2. Waste of food/money.
3. Weight gain.
4. Self hatred
5. Only hurts me, pain, digestive issues.
6. Does not solve problem

Target behavior #2 - Purging


Resisting purge.

• PROS

1. Will keep the nourishment from the food.
2. Will learn to deal and manage 'full' feeling.
3. Will give myself a chance to use DBT skills.

• CONS

1. I will feel very high anxiety.
2. I will feel dirty, lazy, ugly, fat.
3. I will have to sit with the distress, and feel all the food in my stomach.

Giving into urge to purge.

• PROS

1. Get 'rid' of food and not gain weight.
2. It is a quick and easy way to get the food out.
3. I feel in control.
4. I know my stomach is empty.
5. Its a way to punish myself for negative thoughts/behavior.

• CONS

1. Will damage teeth.
2. Does not get rid of all of the calories.
3. Makes me feel week from dehydration.
4. Dizziness and headaches.
5. Heart palpitations.
6. Gives me spots, dry skin and causes my hair to fall out.
7. Sleep issues.
8. After a few days - swelling in legs
9. Constipation.
10. Reduced appetite which will lead to further foody behavior 

Upgraded Armour. Reflection on The Center for Living

I abilities feel stronger, robust even. My suit of armour has been fixed and polished. Inside the suit I am vulnerable, full of emotions and open to triggers, but now that all the chinks and dents have been smoothed out, I am prepared for the onslaught of emotion, armed and ready with more skills. I feel humbled and so glad that the Centre for Living proved me wrong. It’s not easy for me to say that. I like to be right, but I was really mistaken about the programmes ability to help me evolve in my understanding of DBT.

The most valuable morsel of information I am leaving with today is that my life is never all-or-nothing. Just because I had a bad morning, say I eat more than I planned, it does not mean that I need to discredit all the other good things I achieved that day.

One particular therapist was really wonderful. It’s not that she thought me anything new; in fact at first I found it hard to participate in her sessions as I thought I had heard it all before! But the longer I sat there, the more everything just ‘fell’ into place. It’s about using the DBT skills together, in tangent with each other, it’s about weaving the mindfulness skills into everything I do, not just sitting quietly observing my thoughts for 10 minutes a day. It’s about noticing the grumbles of anxiety before the fear takes over and I loss control. It’s about catching the little niggles of frustration and quenching it with self soothing skills, so that intense anger stays at bay. It’s not about the food, or the behaviours. I need to be mindful long before I get to that stage. It’s always about the emotions. This therapist clawed me back to WISE MIND and is a perfect example of the therapy really working, of it making sense.

I found such great validation in the other service users I met over the last 2 weeks. We were all at different stages of our recovery journey. Most were at the beginning of treatment, just becoming accustomed to the structure of DBT, and still exploring the diagnosis. Some had accepted it, others were still fighting it. Some simply didn’t understand it and hence couldn’t make an informed decision either way! We were all sitting in that room because of a common link. We all in some shape or form lacked the ability and skills to deal with our emotions. I found comfort in being reminded that I was not alone, that there are other people out there going through this hell. 

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.

Distress Tolerance SELF SOOTHE Ideas

Distress.  It is impossible to avoid, no matter how charmed your life may be.  Emotional pain and distress are an inevitable part of life. Yeah, I was annoyed when I heard that first too. But even the Duchess of Cambridge has crap to deal with!  The inability to learn how to effectively cope with intense emotion and distress only leads to increased suffering. I found that using my senses to soothe my distress really helped me to tolerate the emotions which were troubling me, without having to use other people as that crutch to stabilize me.

The goal with self-soothing skills is to comfort yourself emotionally by doing things that are sensually pleasant and, most especially, not harmful. At the same time, focusing your full attention on sensory inputs — on what you are physically experiencing in the moment (mindfulness) usually will get people outside of their own heads (and away from troubling thoughts, feelings, and impulses).

Learning to relax and self-soothe is crucial to healthy emotional functioning.  When you are relaxed, your body is not in a constant state of “emergency,” preparing to fight or run away at any given moment.  Most importantly, your brain is much more capable of coming up with healthy ways of coping with distress when physically relaxed.

I find that having a self-soothe ‘box’ is my saving grace, having it ready and stocked with all the things that I know work for me. What works for me also changes depending on the emotion, for example when I am upset, hugging a teddy is a fantastic, yet when I am angry, having a long hot shower nearly always helps me calm down.

Recently I was brainstorming some new ideas for my box, I asked some wonderful friends in a DBT support group on facebook, and found that it was the best thing I could ever have done! Between us we came up with a list which can be used as a reference when trying to think of something to RELAX AND SELF SOOTHE when undergoing extreme distress.

The skills and techniques listed below are a starting point only. Everyone has to find what works for them, and it may even be things that are not on this list at all, but if you are stuck, try some and see if they work. A good way to orientate yourself to self soothe is to really and mindfully focus on your senses while using these. Not all these things fit into my 'box' but that's why I am writing this post, so I can look at it when I am in distress.

RELAX and SELF SOOTHE ideas! (Please feel free to add ideas in the comments, this list is a work in progress!)

• Try something little to begin with, such as using a nice moisturizer on your hands and face after you wash them, also face and hair masks are bliss. I've been trying to do this for the past few weeks and not only does it help me to feel as if I am WORTH looking after, it has also dramatically improved my skin tone etc... (Life worth living!)

• Curl up with a blanket wrapped around you and a teddy bear. This is great for when I'm feeling little and afraid or upset and tearful. I like lavender filled wheat bags, heated in the microwave and placed on my neck.... I do this regularly when I write! 

• Watch a favorite movie (that way you can zone out and don't have to concentrate) Something mindless or funny is even better! My personal choices are; Pride and Prejudice, Shrek, Beauty and the Best, Emma, Actually..... any of the period dramas! I love the dresses!

• When was the last time you took a moment to gaze at the ocean and just watch and listen to the waves hit the shore?  It can be a wonderfully mesmerizing and stress relieving experience.  How about watching an exquisite sunset, or the leaves on a tree blowing in the wind?  These experiences are natural stress relievers and can provide wonderful moments of tranquility.

• Do you have a favorite piece of clothing to wear, something you instantly feel safe and comforted when you put it on? I have a pair of old baggy battered velvet purple pajama bottoms. They are so old and raggity, but I can't get rid of them! And I like to wash them in a nice smelling washing powder that my Mom used to use.

• Candles are relaxing and scented candles are truly a plus.  Most people enjoy the soothing benefits of soft candle light combined with the pleasing scents that aromatherapy candles can provide. I personally love Yankee candles as they are strong and are inexpensive. I have a fireplace in my room which cannot be lit anymore, but I fill it with candles and have a little meditation session when I am stressed, always works a treat!

• The best way to self sooth myself, I find during extremely intense emotional experiences is to retreat to my bedroom, and put on a tried and trusted self compassion relaxation. It was introduced to me by the wonderful Amanda Smith from Hope for DBT.  Here is the link for the 15 min meditation; 

 Self compassion meditation for intense emotions

• I find that art and crafts has a very soothing effect on me, and while I was inpatient I learned about mandalas, which are a form of meditative art, although they have a spiritual aspect to them, I find simply coloring in the patterns so relaxing and creative. Here is a link to a site where you can download and print out some to have ready for when you need them.

Website for Mandalas

• Photography forces me into the present, I have to be mindful to my surroundings and almost get a sense of external perspective through the camera lens. So if I feel the urge to binge.... I grab my ready packed camera pack and head outside and snap away! Even looking at happy memories through old pictures helps me too, like of the time I went traveling, or my 21st party.

• As I suffer from an eating disorder, using my sense of taste can be hard, but I have bought some lollipops to suck when I am angry as for some reason they help! I also find going out for a hot milky drink soothing, I have hot chocolate since I gave up caffeine last month, especially from Starbucks!

• Music is my lifeline, always has been ever since I realized that I can use my voice to express my emotions when words fail me. I love to sing and play guitar. Classical music are art to me, so I have few pieces which always help me calm down, especially during exam stress or when I was grieving a loss. I have made a playlist on youtube, which I am not going to post on here because everyone has different tastes, but I will post a song, which I feel describes how important it is to validate your emotion.

Heathers - Forget Me Knots

• Finally, a good old fashioned hot bath or long hot shower will always bring me back to the present, relax my body and calm my mind

For a very good alternative explanation of SELF SOOTH go to dbtselfhelp.com , This site is my online bible!

Personal Responsibility and Action Plans

For a week filled with extreme emotions and tear stained streaks down my cheeks, I am feeling lighter. Clichéd as it may sound, I feel like a weight has been lifted off my mind, well actually, it’s been yanked off my mind by harsh but powerful words and my own realization that I am the only person who can ‘fix’ me.

If I was to summarize my experience of this last week of intense treatment, it would be in two simple words ‘PERSONAL RESPONSIBILITY’. I have been jolted back into reality being on this programme. No-one is going to do the work for me, no matter how much I want it; it simply is not going to happen. No prince is going to ride in on a shining white horse and save me from the BPD monster, but I can get on my own horse, learn how to ride it and trot away into the sunset myself.  Personal responsibility in my recovery involves taking action and doing what needs to be done to get well and stay well. It involves problem solving, making goals and sticking to them. It involves making promises to myself, not my family, not my team and not my friends. It involves taking ownership of my life and my future. I must remember that am an expert on myself and gain back control of my life.

I have been given a wonderful sense of empowerment, while still validating my emotions. I am so afraid of what my life will bring now that my future is so uncertain. I feel it in the pit of my stomach; I have noticed the inability to catch my breath and the hot sweats I break out in when thinking about what I will do. Yet although these emotions wash over me, and I feel them, they are not going to change or improve my situation.

I have been really trying to use the core skill OPPOSITE ACTION in response to the anxiety. My action urge is to avoid, not thinking about options, not to get advice and not to apply for opportunities. That way I can’t be disappointed again, I can’t be rejected. Yet I am also not helping the problem, I am not giving myself a chance at a LIFE WORTH LIVING, and am pilling more misery on top of misery. More fear on top of more fear.

To go ALL THE WAY with this skill, I have to stop procrastinating and ‘just do it’ as the Nike ad tells us. One of therapists always tells me that ACTIVATION PRECEEDS MOTIVATION, so even if I don’t feel like applying for the internships, jobs, courses or voluntary work I just have to do it, then I will feel the benefits of my labour after.

It’s so hard in real life though, so the way I have tackled it is by making small little steps. The number one reason we put off improving our lives is because big changes feel so scary and unattainable. Which is why breaking goals down into small steps is the secret of success. There’s less fear when you’re just concentrating on what you need to do that day, and as you stick to your good intentions, you’ll be motivated to carry on until your new habits become a way of life. I was told to write your goal down on several pieces of paper.  Hang them up everywhere.  This is my first step to focusing on my commitment. Then make lots of smaller easier to achieve goals for each step of the bigger goal.

 So here it goes; I want to get back to university. I want to do a health science related degree. I either want to study occupational therapy or midwifery. It’s been my dream since I was a teenager, and I was two years into my OT degree when I had to drop out due to BPD.

Step 1: Find out what I need to achieve to get onto course and what university I can study in.

·         I need to have the skills to stay in university for 4 years,

·         Be able to endure 8 hour days of lectures/study.

·         I need to have communication skills to be able to interact with other students.

·         I need to be able to manage stress and have good time management.

·         I need to have the finances in place to support myself for the four years.

·         I need to be physically healthy and emotionally fit.

Step 2: Finish DBT and fully engage in therapy to learn new skills.

·         Attend DBT skills group and individual therapy every week.

·         Complete all homework and be willing to learn new behaviour patterns.

·         Adhere to DBT contract to create a life worth living

Step 3: Attend a less intense course/internship/voluntary work in order to build up skills and confidence.

·         Research opportunities online with voluntary organisations and apply for any that interest me.

·         Talk to and ask others about different opportunities.

·         Update CV and write cover letters.

·         Follow up on all leads and correspondence.

Step 4: Get finances in order

·         Talk to social welfare office

·         Find out about financial aid for going back to university.

·         Continue to babysit and pick up small manageable jobs

·         Set up credit union account.

·         Try to save when I can.

Step 5: Work on personal relationships

·         Stay in touch with friends, and be appreciative of their love and support.

·         Reach out to family; be considerate and patient as they are also learning new skills.

·         Make efforts to create new friendships.

·         End destructive relationships.

·         Be honest

Step 6: Foster and develop creative talents and interests

·         Make regular time to write/attend writing classes

·         Listen to music daily, sing.

·         Keep art supplies stocked and ready to use

·         Make cards/collages/draw/paint

·         Learn new things as often as possible.

This is all I can think of right now, but I know that more steps and action plans will emerge from these rudimentary goals. It feels good to have a plan, something to work towards. i don't feel so empty ans lost.