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!

Thoughts are not always facts!

Living one day at a time 

Enjoying one moment at a time 

Accepting hardships as the pathway to peace 

Taking this difficult world 

As it is 

Not as I would have it. 

And in this way 

Opening to Grace 

And the Joy and Peace that comes with it.

Thoughts are not facts. They may not always be your friends.....

In the midst of a full blown emotional dysregulation attack I find myself so much estranged from my heart, body, and spirit, relying almost exclusively on the thoughts in my head for guidance, companionship, criticism, and comfort.

To hear “your thoughts are not facts” was scary to me. If I couldn't trust my own thoughts, was there anything trustworthy I could count on?

I slowly began to understand more about thoughts during the summer (and a bit) I spent inpatient at a hospital in Dublin, their nature and purpose, how they arose and where they went after I stopped paying attention to them.

Along the way, I learned that thoughts were not necessarily my enemies either.

They were just my thoughts.

And even the “my” was up for debate, because technically they belonged to no one until one floated by in my mind and intrigued me, at which time I reached up, nabbed it, and claimed it with a triumphant  “Mine!”

Thoughts, one kind occupational therapist explained, are like clouds. Only much closer to the ground. 

We snatch them up as if it they are the last pair of jeans on sale in our size. We are afraid it will get away before we decide if we want it or not.

I feel I know so little about myself that I seem claim anything and everything so that I will not be left with a shell where a personal identity should be.I must be choosier, I have the right to question each and every thought – to turn the tables and become the exclusive commodity that my thoughts want to hang around!

I am the one who is in demand. I am the one that keeps my thoughts keep hanging around. I have limited capacity for thoughts, and only want the cream of the crop.

Therefore, each thought must go through an extensive screening process, much like a job interview. “What can you add to my life?” “What have you come to teach me?” “Are you here to uplift me or drag me down?” “Are you telling me the truth?” If I see a thought float by that looks interesting, I can pause it, circle its perimeter, ask it a few questions, then decide whether to pull it down into my awareness for further scrutiny and conversation, or just motion it along.

I realize now that I have the right to question my thoughts – but my thoughts do not have the right to question ME. WE choose them, and not the other way around.

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.

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?

Objective Self Compassion

So, after spending time in the south of Ireland with my sister (and the baby bump!) and brother-in-law, where my Mother lives with her new husband and his daughter, I am pleasantly relived. I was really worried about spending so much time with my family, as previous comparable experiences have resulted in vexing squabbles and quarrels. I understand now that my sensitive and highly emotive character can be very vulnerable to the criticisms and teasing which occurs within my family unit. Simply OBSERVING this helped me to muddle through the weekend. It also helped me to take a NON JUDGMENTAL STANCE towards myself, something which, until recently I have found incredibly difficult to do. Self compassion just was not something that I was able to accomplish before. A constant record was stuck on self hate in my mind. I believed that I was not deserving of compassion and was not allowed to give it to myself. One of the greatest lessons I am learning in therapy is the gift of self compassion. I am starting to treat myself as I would like to be treated by others, and also how I treat those around me, as I have a great ability to be compassionate to others, but am terrible when it comes to being kind to myself. 

I had so much time to think between the car journeys and early nights with little to do in the countryside. I astounded myself with a realization of how far I have really come in the last year. It hit me that it has been a year since I last attempted to end my life. Which when compared to the year before, is really an achievement. The reason I say this is because the accomplishment lays not just in the absence of suicidal actions, but the ability to now deal with and manage the same feelings and urges (which are still at the same intensity as before) with new, healthier coping mechanisms. I can truly say that I am proud of myself. 

This last week has been a real eye opener for me. I have had huge swings of intense emotions along with some really dangerous action urges. Instead of carrying though with the urge to end my life, I reached out for help, and most importantly; accepted the help I received. Of course it took a while for me to get my head around the acceptance part of this process, as you can tell from the posts on this blog from earlier in the week!!! 

I have an open mind about the upcoming admission. I really think it will help me figure out some of my current problems. I will hopefully have a good team of people around me to keep me regulated. And I also have this wonderful outlet, my own form of personal form of therapy. My blog is another gift I received this past year. Writing is the best way for me to find objectivity during difficult situations, where due to my intense emotions my judgement is often compromised. 

I am so grateful for all my readers too, as you always offer such sound feedback, and often make suggestions which have helped me to act in more efficient ways with more successful outcomes.

Why do we need emotions anyway?

Before fully engaging in therapy, I honestly thought that if I could just 'turn off' my emotions, then all would be fine. This is seemingly a very common request with BPD sufferers according to my group facilitator. Greenberg and Paivio (1997) capture nicely the generally agreed upon functions of emotions, which are that they;

1. Prompt and organize us for action
1. Give us important information about whats going on in a given situation
2. Are for motivating
3. Are for communicating to others
4. Are fundamentally adaptive

So I now realize that my emotions are like a motion-detection or warning system telling me that something is happening that I should know about. Another important lesson I have resonantly grasped is that my emotions never last forever, even though some may last longer than others and I tend to be more sensitive than my peers to emotional stimuli. It also depends on my current level of skillfulness in handling emotion and other factors such as sleep, health, stress, and support.

As Marsha Linehan explains so wonderfully in her book; 

'Emotions are like tides of the ocean, they ebb and flow, they come and go; they're transitory.'

When I forget this simple piece of advise, I am more inclined to act impulsively when in the throws of an intense emotion. But when I can tell myself calmly in the heat of the moment 'This too will pass' I am so much more able to open up a variety of options and not feel so helpless.

When emotions do what they are supposed to do, they are called PRIMARY EMOTION. They are unlearned and fundamental to human functioning. When you hear a loud noise, you jump, you feel afraid. Its a perfectly normal response. They are helpful. 

The problem lies in what are called SECONDARY EMOTIONS. These are complicated, non adaptive patterns of emotions about emotion. You feel shame for jumping and feeling afraid at the loud noise. 

When I learned about the different levels of emotion, I felt relived. It all started to make sense. I had never understood why I felt such random emotions in reaction to a situation. My secondary emotions were very often generated and intensified by judgments I had about how I was supposed to feel rather than how I actually felt.

My 'Judgement' Counter

The best thing I did to help me OBSERVE the judgments which lead to SECONDARY EMOTION was to get a counter. I found one in my local knitting shop, and its actually a stitch/row counter. A tally counter can also be used. I carry it in my pocket and click it every time I realize I am having a judgement. I observed how critical I can be of myself when i catch my reflection and I noticed how cruel I am with my self talk.

Try it out for yourself. I bet you will be surprised at the results of you judgement monitoring.

NON JUDGMENTAL STANCE

Today we finished INTERPERSONAL EFFECTIVENESS and moved onto MINDFULNESS in skills group. Now that I have gained back some motivation to partake in DBT, I feel disappointed that I missed so much of the DEARMAN, GIVE, and FAST skills. I get now why the modules are repeated at least twice and am slowly coming around to being told I must repeat the skills group again next year. So my guilt, although still there, has dissipated somewhat.

This weeks homework is to focus on being NON JUDGEMENTAL. It’s a toughie for me so, is a good one to re-visit (or should I say visit, as I have yet to master it!) It was suggested that I get a tally counter. Which is one of them clickity yokes to count how many times you notice a judgement and learn to associate the ‘click’ with it. So tomorrow I am going on a city wide hunt for one!

A place where I think I will be able to practise this skill is at the Ball I am going to this Saturday night. I will be getting all dolled up and be in the company of beautiful and highly intelligent people (It’s the annual Medical Ball!), so as you can imagine…. I am shivering with nerves already. My challenge is to go and simply notice all the judgements I have about myself, other people and the environment. 

All-though unless I can find a counter to match my gown, I might leave it at home that night!

Wish me luck!

Black and white thoughts, searching for the grey!

Today I was faced with a stark reality check.  I do not have the objective ability to have a balanced view of situations and am thus ruled my my dichotomous thinking. 

Under extreme stress, I find it can be comforting to oversimplify.

I will eat, or I will not eat.

I will live, or I will die.

This rational streamlining allows a sense of peace in the midst of turbulence. Yes, there are plenty of things that are black an white. Simple things. Is the toaster plugged in? Is the door locked? 

But the reason we have words like maybe, probably, partial, more, less, etc. is the grey is all around us. Everything has details, data, different ways to present and interpret the details and data, these different ways of presentation and interpretation is what causes grey.

When the stakes are not quite so high, perhaps a little room for the middle ground would be advisable. There are more choices than you think.A little "wiggle room" goes a long way when navigating through people, events and circumstances. Very little in my own life has ever been distinctly good/bad or black/white in any way, shape or form. Most things are just a subtle shade of gray when examined closely.

So much of the world is best described in an analog way not a digital way and definitely not in the binary way. So much is best described as a continum: I will not eat, I will eat a tiny bit, Iwill eat a moderate amount, and so on with an infinite variety of amounts.

Either / or is just the easy way out. I must leave a little room for humanity to breathe. If the middle ground is removed, how many of us still stand? My life is too complex to be able to discount gray areas in order to accommodate absolutes built on foundations that aren't solid simply because I am are either too fixed in my ideologies to be able to critically assess a situation or too intellectually lazy to do the heavy lifting, so to speak, when it comes to handling difficult ethical dilemmas, I simply use a catch all.

BEING MINDFULLY WILLFUL

 Today I spent the day with myself. I was alone, but not lonely. I made a choice to live and partake in life.

I grabbed my camera and gear in a hurry when I noticed a niggle of a destructive urge raising to the surface, and went to soak up the atmosphere in the city. I tried to notice things that I would not ordinarily notice if I were not being mindful.

I observed the light fading within the space of the 50mins I was shooting. I realized that there were so many tourists enjoying the Christmas lights. I chuckled at the wonderment of a group of Americans and the emotion of a gaggle of Spanish girls arguing. I really listened to the soundscape of Grafton Street in December. 

I  often stopped and was awed by the decorations, of the music, the smells and the people. I observed my own emotions as people got in my way or bumped into me, then I 'realized' I was realizing and had a giggle at myself.

I was NON-JUDGMENTAL. I allowed myself to shoot what ever took my fancy rather than wait for a perfect opportunity. I tried not to care what the picture turned out to be.

 Here are the results of my MINDFUL efforts. I hope you enjoy them as much as I enjoyed taking them. xxx