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 for grief

I am worried what to say to her, but I am sure everyone worries about what to say to a grieving person. But what I really feel is that knowing how to listen is much more important. Oftentimes, well-meaning people avoid talking about the death or mentioning the deceased person, I felt I should bring her Dad up, but when I was grieving for my friends that died a few years ago, I really needed to feel that my loss was acknowledged, I wanted to talk about it.

I wanted to let her know that she had my approval to talk about her dad’s death, even if it had only happened a few hours ago, yet I tried not to force her to open up. I just let her talk when the subject of her dad came up.

I brought food and made pots of tea. It’s what I do. I want to ‘mother smother’ her. That’s my term for looking after a person in time of crisis. I did it for my sister when her baby boy came early and was sick in the hospital. I got some healthy salads and soups, and also some comfort food like pizza and soda bread and giant cookies and coca-cola.

I am going out to her again tomorrow, I would like to make her some food for the freezer, but I am very low on money and can’t afford to buy the meat this weekend. From what I could see, she has enough food in the house for a few days, so can hold off for a while.

Okay… so the point of this post is to figure out what DBT skills to use to stay regulated so I can be the shoulder to lean on my friend needs right now.

MINDFULNESS

I need to be aware of which emotion I am experiencing. I will do this with OBSERVE, by checking in regularly with myself, and through my meditation practise. Then I will DESCRIBE the emotion and how it is affecting my body, thoughts and behaviours. I will be NON-JUDGEMENTAL towards my thoughts, my emotions and the feelings and emotions of those who are grieving. I will do this by putting myself in their shoes. I will let my friend know that t’s ok to feel whatever way they feel, let her express her feelings without judgement, argument or criticism.

INTERPERSONAL EFFECTIVNESS

This is a time to use the relationship effectiveness skill GIVE

·         Be gentle

·         Be interested

·         Validate

·         Have an easy manner

I will smile at my friend and her family and be MINDFUL in my conversation.

EMOTION REGULATION

I really need to reduce my vulnerability with PLEASE, take my medication, go to yoga (even though this friend normally comes with me). Absolutely no drink or prescribed drugs…! I must endeavour to get the right amount of sleep. I will continue with my healthy diet and stick to my meal plans.

I will try to INCREASE POSITIVE EMOTIONS by going to my meditation group tonight. I will notice how I feel in my body, what’s passing through my mind, what I am doing, how I am behaving.

DISTRESS TOLERANCE

DISTRACTION is my best bet here, in particular focusing on others, in particular my friend. I will focus on her and concentrate on her needs. This will help direct my thoughts away from the difficult emotions which accompany death

I am AWAKING OPPOSITE EMOTION by listening to my favourite music, calming and soothing music.

PRAYER is helping me too to not make the situation worse. I am also bringing my friend and her family into my meditation.

I self-soothed by taking a really long hot shower this morning which gave me the strength to go see my friend after.

Finally RADICAL ACCEPTANCE is greatly needed. Death is the ultimate test for this skill. I hate that he is dead, yet I must accept it. 

Is life about seeking happiness or embracing life's inevitable challenges?

Without a doubt, my life has procured an innumerable amount happy times. Times filled with smiles and giggles and the excited squeals of childhood birthday parties.  Times filled with warmth and nurture and the encouragement of educators and mentors. Times I lock away as if  precious jewels, in my vault of memory, so as never to lose them. Yet it is often very hard to find the key to this vault, and to the positive times I describe, when your mind is polluted by a haze of mental illness.

I earnestly try to recreate these happy times each and every day, only to become compounded with distress as my life fails to reproduce them, fails to provide the embrace of contentment they produce, leaving in their place an empty, hopeless void of distress.

Have I got it all wrong though? Am I chasing the wrong thing? Am I casting shadows on my immense intrinsic power by seeking to recreate happy times?

Tonight I am lying in my bed eating frozen blueberries to tolerate the distress I am experiencing. Savoring the bitter coldness in an attempt to survive the moment. I am not enjoying the warmth of those happier times. I am frozen in the chill of distress. I can't see where my life is leading or fathom as to why I should keep trying.  Something is not right about my pursuit of happiness, and I think I am beginning to understand why.

Implicit in the phrase of 'overcoming an adversity' such as mental illness is; that success or happiness is about emerging on the other side of a challenging experience unscathed, unmarked by the experience. As if successes in life have come about because of an ability to side step, or circumnavigate presumed pitfalls of a life with mental illness.

But I am marked, I am changed, of course, by a challenge. I am starting to think that adversity needn't be an obstacle I need to get over in order to resume living a happy life. It's part of our life, part of who I am as a holistic being. I tend to think of it as a shadow, sometimes I see a lot of it, sometimes there is very little, but it is always with us. 

Now, in no way am I trying to diminish the impact, the weight of a persons struggle. What I am trying to say is that there is always going to be adversity and challenge in life. Its very real and relative to every single person. The question is not whether you are going to meet adversity, but HOW you are going to meet it. 

So the responsibility is not simply to be shielded from the adversities and challenges we face, but to prepare us to meet it well. We do a disservice to each other when we make others feel like they are not equipped to adapt. There is an important difference and distinction between the objective medical fact of psychiatry and the subjective societal opinion of whether or not we are are mentally unwell. But in reality the only real and consistent adversity I face is the world ever thinking that I can be described as disabled or unable to contribute to society.

In our desire to protect those we care about by giving them the cold hard truth about their medical prognosis, or indeed the prognosis of the excepted quality of their life, we have to make sure we don't put the first brick in a wall that will actually disable someone. Perhaps the existing model of 'what is wrong with you and how do we fix it!' serves to be more disabling to the individual than the pathology itself. By not treating the wholeness of a person, by not acknowledging their potency, we are creating another 'illness' on top whatever natural struggle they might have. We are affectingly grading someones worth to our community. We need to see through the pathology and into the range of human capability. And most importantly, there is a partnership between those perceived deficiencies and the great human creative ability. 

So its not about devaluing or negating these trying times we want to avoid or sweep under the carpet, but instead to find those opportunities wrapped in the adversity. The idea I want to put out there is not so much overcoming adversity as it is opening ourselfs up to it, embracing it, grappling with it as Katie Taylor would do in the boxing ring, maybe even dancing with it. And perhaps if we see adversity as natural, consistent and useful, we are less burdened by the presence of it. 

In my own experience, adversity is simply change, to which I have not yet adapted, and the greatest adversity we have created for ourselfs is the idea of normalcy. I mean, who here believes them self to be normal? There is no normal. There is 'common' and typical, there is no normal.would you want to meet that poor beige person if they existed? I dont think so.

If we can change this para-dime of achieving normalcy, to one of possibility or potency, we can release the power of so many people and invite them to engage their rare and valuable assists with the community.   

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 

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.
re

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!

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?

HALF SMILE your way to acceptance

Two elegant yet, sheepishly impatient women are making rapid glances around Starbucks, hoping to nab a free space to sprawl out and natter after an afternoon of window shopping. You can tell they are the leisurely type. I overhear them giving out about the lack of seats, and can’t help giggle as the hand approaches the first single digit on my watch, signifying my third hour sat in the comfortable chair by the window which seems to have moulded to my frame by now. I am not moving. I even turn my chair to get a better view out the panoramic glass wall.

People-watching is a not a new hobby of mine, but observing the finer details of said people is. I recently acquired a very helpful possession for this pursuit; eyesight! For some reason or another, cost and hassle being the most likely, I had not replaced my broken specs when the arm unhinged its self from the frame last year. I had grown used to the blur, and liked not living in focus. But when I passed my own father on the street, I thought ‘enough is enough’ and got them fixed.

There are two categories of people who meander up and down Grafton Street in winter. The fast paced snakes who weave their path in plaits around the care-free traffic blockers, who are much more easily distracted as they gather in large semicircular groups around each of the buskers dotted on the side of the street.

The girls compete in the small city style wars, and the guys compete for the most stealthily glances and puffed up chests. The dramatic outfits somehow seem to conspicuously blend in a contradictory fashion with all the rest and it’s the plain and ordinary which stand out. The frizzy haired student, the make-upless lady and the elderly man with a walking stick all seem out of place in this world of perfection and antagonism.

Once, a woman smiled at me as I walked by in a daze. It shocked me, and my initial reaction was to wonder if I had food or bicycle grease on my face. Why it was that something so pleasant made me react in such a capricious manner? I was a suspicious mess, and was almost angry at the woman for evoking such an unstable feeing in me. But of course it was not her error; it was my own lack of self confidence which made me react that way. Then I realised that it was not just anger stirring up in the pit of my stomach, it was jealousy. I wanted to be that woman, who could smile at the world and warm the hearts of others. 

So I guess that the point of this post is that the DBT skill of HALF SMILE is a valuable one. The idea with this one is that there’s a biofeedback mechanism between the face and the brain. If your face is tense, the brain gears up for trouble. If on the other hand your face is relaxed, it tells your brain that everything is fine.

I’m not sure yet how this ties in with accepting reality, but then there’s a lot I don’t understand about accepting reality generally. The book says ‘Half smiling is accepting and tolerating with your body’. DBT seems to ease you gently into ‘accepting reality’ before finally hitting you with Radical Acceptance. I’m hoping that after we’ve covered radical acceptance I’ll understand more where these breathing, smiling and awareness exercises fit in.

I’ve used this skill several times since I learnt it. On the bus when I saw my reflection and realised just how anxious and cramped my face looked. In a crowded market today when I felt overwhelmed and my face was agreeing with me. Both times I consciously changed my face to an ‘I can cope’ expression. And cope I did… Coincidence perhaps; I need to experiment more but I’m definitely prepared to try it out.

'I Shall Go To The Ball' OPPOSITE ACTION To Fear

 I am sitting here waiting, wishing for the moments to pass more slowly. Dreaded time has caught me by surprise this morning, dragging me into a place I would rather run and hide from. Yes tonight is the night that I have been both looking forward to yet silently wishing would never come. I admittedly have not been listening to my emotions about this event. If I am honest, I have not observed the suffocating sensation in my neck, or how hard it has been to catch my breath between the shallow gasps.

I am in full blown distress mode this morning. I feel titteringly close to losing control once again. So I must turn to DBT skills to quell my EMOTION MIND and find the calm which accompanies WISE MIND.

Firstly I can recognize that my fear is disproportionate to the situation. Yes OK, I acknowledge that it is out of my safe place. A formal ball with hundreds of new unfamiliar people is not going to be comfortable, but it will not harm me in anyway. With this in mind, the obvious skill to use is OPPOSITE TO EMOTION ACTION. For it to work, I must go ALL THE WAY with this skill to distinguish the fear and snuff out the flame of panic

Sometimes in order to change how we feel we have to act opposite to how our emotions are telling us to act.  With anxiety, instead of running from the feared circumstance, we need to approach and engage in it.

Acting opposite to how you’re feeling only works when:

• The fear is not justified.  Fear is justified when a situation is a threat to your life, health, or well being.
• You do opposite action all the way. Not just by acting opposite to how you’re feeling, but also by thinking opposite to how you’re feeling.

PROCESS OF OPPOSITE ACTION

Figure out your emotion

Figure out what action goes with that emotion.

Ask yourself ‘do I want to reduce this emotion?’

Figure out what the opposite action is.

Do the opposite action all the way.

So I will firstly decide to go and follow through with that plan. I will fix my tan, go to the hairdressers and get my make-up done. I will dress up and make sure I feel as confident as I can before I go. Once I get there it is really important that I continue to be present, and stay in the skills mindset. I will use HALF SMILE to center my nerves and help accept that it is a difficult night for me. I must make sure that both my body and mind are at the party, so no hiding in the bathroom or keeping quite. I will make small talk and remember to breath!

Wish me luck!

.