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.

Where are my VALUES!

I really just need to get the jumbled mess of craziness out of my head. I feel like I am simply existing, not for myself, not for any purpose but simply roller-coasting through life. I feel so empty and scared. Of what? I have no clue. I am just afraid of life in general.

The fear really started after SKILLS GROUP on Tuesday. We are still (read my frustration) doing EMOTION REGULATION. And this week the group focused on CREATING A LIFE WORTH LIVING.   The exercise we were doing is about LONG TERM ACCUMULATING POSITIVE EXPERIENCES. I guess I find it hard to see the point in building a positive life when I have very little hope of ever achieving said life. Its like I am doing it for someone else and not myself, hence why I feel like I am just enduring this prevailing hopelessness. It makes ending my life seem like a really god option right now.

The specific exercise I am talking about which scared me out of my semi functioning state is IDENTIFYING PERSONAL VALUES AND GOALS. I was presented with a horribly long list of equally vague and ambiguous list of values from which to choose from. It was hugely overwhelming. I stared at it for far too long. Which in its self made me uneasy. I mean, who doesn't know what their own personal values are? It compounded my feeling of inundated failure.

After ALLOT of pondering, head scratching, and a whole individual session given over to this exercise, I still had a horrible lump of fear in my throat. I am still so afraid that I have no values. Surely I need to know these. Will they become more apparent as time goes on? How do I know?

Needless to say I had to switch to DISTRESS TOLERANCE MODE all this week, namely the CONTRIBUTE part of ACCEPTs. I have been spending time getting to know my wee cousins again. Its keeping me out of trouble. Stopping me from ending this void and valueless life of mine.

Has anyone else had this experience? How did they get through the emptiness it brings up?

Shameful Emotions

"Please not again!"

Today , being Tuesday, it was once again time for my weekly dose of skills training. I have grown to quite like our little routine of learning, and even though some of the other service users do my head in, I am finding myself more tolerant of their perceived annoyances. I am genuinely interested in how they are getting on with their skill use, even when the unrelenting crisis's overtake our sessions (which happens nearly every week!) I am overcome with empathy and understanding for them rather than intolerance and frustration. I like to take this as a sign of progression on my part, as I am not as wrapped up in my own internal suffering as I have been in the past. 

We are still on EMOTION REGULATION and have finished the first goal of UNDERSTANDING and NAMING EMOTIONS. We got given this massive set of notes on the topic of describing emotions and to be honest I didn't read it all, I've had much too much of a crap week for reading such patronizing handouts. I just flicked through it and stumbled across a very adequate-to-me section on SHAME. Its my primary emotion. My weakness. My downfall.

Shame is recognized as a powerful, painful and potentially dangerous emotion,- especially for those who don’t understand its origins or know how to manage it. Unlike guilt, which is the feeling of doing something wrong, shame is the feeling of being something wrong. When I experiences shame, I feel there is something basically wrong with me. I constantly compare some aspect of myself or behavior to a standard and nearly always feel like I do not live up to that standard. Guilt can be positive, it’s a response of psychologically healthy individuals who realize they have done something wrong. It helps them act more positively, more responsibly, often to correct what they've done. But shame is not productive, shame tends to direct individuals into destructive behaviors. When we focus on what we did wrong, we can correct it; but when we’re convinced that we are wrong as a result of shame, our whole sense of self is eroded.

Shame is the substructure for SELF-INVALIDATION I feel. It feeds the drive to 'pile misery on-top of misery' as Marsha would say! When I feel shame, I believe myself unlovable, that I do not live up to expectation, that I am a failure, unworthy of life. With these thoughts circulating around my head, it becomes a good deal easier to contemplate and justify the destructiveness of self harm. Yes I know I have not referred to my ED as self harm before, but in reality, it is, I need to stop telling myself otherwise.

I actively avoid intimacy with others and have only superficial relationships most of the time, which always deteriorate in times of stress. Isolation and loneliness are serious consequences of my shame. Self-condemning attitudes and negative self-talk reinforce the shame and ultimately lead to self-loathing and self-sabotaging ED behavior.

So much goes into expelling the energy of SHAME. The expressions and actions of my shame control my life most days. It could be hiding the after shocks of a binge, or avoiding others, terrified they know about my Bulimia. I often find myself avoiding myself too, switching off, dissociating from my shame, ignoring my emotion.. This shutting down effects me greatly. I spend hours sitting in front of a screen, looking at moving pictures but not taking anything in, lying for hours, not washing, not eating, not peeing, just fighting to push away the shame. 

It upset me to realize this SHAME hold so much power over me. But some glimmer of hope was illuminated during the teaching part of today session when we learned about challenging negative thoughts with the basic CBT model and also the DBT skill of OPPOSITE ACTION.

The idea of exposing myself to the horrible feeling of shame scares me to my core. But the main thing I must remember is that OPPOSITE ACTION is only for when the emotion does not fit the fact. So my challenge this week is to figure out a transgression for which I feel I could practice this skill, engage in behavior which sets off shame over and over. I must also go ALL THE WAY by not apologizing or trying to make up, and change my body posture to look innocent, maintain eye contact and keep my voice steady and clear.

Some ideas I might try;

• Leave a dirty plate in the kitchen overnight.
• Return an item to a shop.
• Ask for help from a friend or family member.

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!