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

Healthy Weight Loss After an Eating Disorder - Week Two

I was dreading today. I mean what a bloody embarrassment it would have been if I didn't lose anything in my first week, the seemingly easiest week to lose weight according to the literature. It was small but at least it was a loss! Yippee! 

I had a wobbly week regarding sticking to the programme. I had two major slip ups where I binged. The first was after a night out last Saturday, the second, I'll get to.... I had a fair few tipples on Saturday and soon lost track of how many points I had consumed, actually I stopped even caring about my weight loss plan. I have the best boyfriend ever, as he picked me up from town in the wee hours and 'saved' me from that late night chipper. but as soon as I got home, I actually remember thinking 'Feck it' I'll be good tomorrow, which is saying something... because I remember very little else.

I stumbled into the house and into the kitchen and all of a sudden I was ravenous! I tore open the fridge and turned my nose up at the glossy green apples and colourful selection of veggies I had stocked it with earlier that day. No way was that going to satisfy the roaring hungry lion in my tummy. Within minutes I had the laptop out and I had ordered a pizza from Domino's. Damn the convenience of late night delivery!!!

Despite that set back, I picked up the broken pieces of my programme and tried to glue them back together. I got back to tracking and working out my points, home cooked hearthy, filling and healthy beef meatballs (needed the iron) packed full of zero point veggies and a small portion of wholegrain pasta. Total of 12 points for great sized yummy dinner, and there was enough left over to freeze a portion too.

Great, I am feeling wonderful and it's now bank holiday Monday.... I go to a spinning class and get my weekly dose of torture.. those seats are so painful! Then me and my better half went to my family home where my Mum cooked a beautiful roast chicken and ham dinner with all the works! yum! Points were through the roof... but kept within my 31 daily points and snacked on zero point food for the rest of the day.

I re-started the mindfulness class on Tuesday and have sort of mixed feelings about it. I came home and binged again on pizza after, and it took me a few days to reflect upon why it happened. It was differently emotional eating in response to the new group.

It's very different to the Mindfulness-Based Stressed Reduction group I did last year. It's easier to fit in and actually do the practises as the tracks are only 8 - 15 mins long! No more 45 mins mega sessions. Yay! This course is based on Mindfulness-Based Cognitive Therapy (MBCT).  MBCT has been clinically proven to be at least as effective as drugs for depression and it is recommended by the UK's National Institute of Clinical Excellence - in other words, it works. More importantly it also works for people who are not depressed but who are struggling to keep up with the constant demands of the modern world. This programme focuses on promoting joy and peace rather than banishing unhappiness. It's precisely focused to help ordinary people boost their happiness and confidence levels whilst also reducing anxiety, stress and irritability. All sounds good so far.

This new style of mindfulness suits me to the ground as I am an expert in postponing my practice and in finding reasons why it doesn't matter if I don't practice each day. In addition, sometimes I am afraid to meditate. I'm scared of what I might feel if I am are not busy distracting myself. I'm fearful of being bored or of feeling intense emotions. Looking back to when I first started mindfulness I remember not being ready yet to experience the intense fear or memories of abuse by myself, alone in my own head. I feared that if I meditated, or let go of my usual strategies of numbing or being mindless, I would feel overwhelmed by the intensity of those memories or emotions.

I remember having "an epiphany", I was just so unused to being in the present moment that that was what was making me anxious. This isn't uncommon seemingly - especially for people with anxiety disorders, who frequently live in the future rather than the present. I was not used to looking at what's happening in this moment, never mind trying to bring acceptance to it! So I came home and ate, ate, ate to numb all those emotions that I being trying so hard to escape from.

What I learnt back then and consequently forgot in the last few months is that often what we find in the present is scary, and that's one reason we've been living in the past or the future. In reflection, I learnt or should I say I re-learnt a very valuable lesson this week: negative emotions are shit, really shit, but running away from them just makes you eat more pizza, put on weight and make said emotions even worse.

Anyway here's a shiny new graph charting my loss this week.

Stay mindful friends

Healthy Weight Loss After an Eating Disorder.

****TRIGGER WARNING**** Weight, BMI and ED behaviours mentioned.

As some of you may know, I have been purge free for the last year now (can I get a whoop whoop!) which is a HUGE personal achievement after years of bulimia ruling my every waking hour. The only thing is, I unfortunately am still not 100% ED behaviour free. I am still over eating and sometime binging, although nowhere near as frequently as before now I don't have a 'release', a way to 'get rid' of that post binge, horrible full feeling. None-the-less all that chomping on cream cakes and late night pizza parties have taken a toll on my body, my health and on my emotional well-being.

I knew my clothes size had gone up but I had gotten used to it going up after re-feeding. So I was NOT prepared to be told my BMI was in the overweight section during a recent Dr visit. I was shocked. She recommended cutting back on the sweet stuff and taking up exercise. 

In the last two years I have gone from being under weight for my height; bringing with it all the negative health risks that go along with that, to being over weight for my height, which has brought about some unexpected twists to my long list of maladies. My blood pressure is now high for the first time ever, I have nasty stretch marks on my legs and boobs. My iron levels are all over the place and cant make it up a flight of stairs without feeling like my heart is going to explode. 

Now I must say that I am not obese or anywhere near that category on the BMI scale (not a reliable scale I know, but I use it from time to time) I am just tipping into the overweight category. I'm super tall (5''11) so I tend to carry weight easily without knowing it, especially if I am not weighing myself, which I haven't as it used to be a major trigger in the past.

My Dr and I came up with a plan. Go to weekly weight watcher meetings, do one fitness class a week and get back running twice a week also. And also check in with her monthly to discuss any returning ED thoughts or behaviours. She also singed me up to an 8 week mindfulness programme to re-assert myself with awareness skills which will allow me to notice any negative thoughts creeping back in. A solid plan I think. My team believe in letting me make my own choices, including how I life my life. I love how they don't coddle me or insult my intelligence. I told them that I felt I could trust myself not to take the weight loss to the extreme and they agreed with me.

So I joined my local weight watchers last Thursday and found it really motivating. I've been cooking healthy home-made meals everyday from scratch, taking into account all the food groups and incorporating knowledge I learned from nutrition sessions over the years. Nothing is off limits, just eating in moderation. My goal weight gets me down into low end of the healthy weight BMI section. 

I'm back to tracking my daily food intake and now add values to everything I eat in the form of weight watcher pro points. The Weight Watchers program is based on a points system. Food items are assigned a point value, and based on your current weight you are given a daily allowance of points to consume. Weight Watchers also encourages a continuing education in nutrition through weekly meetings, which also offer support and accountability. The Weight Watchers program encourages slow and steady weight loss, but like any diet plan it has its dangers....

The main concept in the Weight Watchers diet is portion control and limiting the daily intake of calories. Each food item is given a point value based on the number of calories, fat and fiber it contains. Many vegetables have no points while a piece of pizza will have five or more, depending on the size and toppings. The problem with this system is that it recognizes points instead of the quality of those points. Two points is two points whether is a cookie or a small serving of low-fat cottage cheese with pineapple. The latter is the healthier choice, but the system sees them as equal. It is up to the individual to make healthy choices.

I have some peeves with adding these values to foods but I think I will do a different Blog entry on that though ... I can ramble a bit if you don't know!

Okay, so in the interest of accountability I am going to do a weekly weigh in on here to chart my weight loss. I do like a chart, I'm a numbers geek and proud of it. So here is week one.

I would really love to hear your thoughts on whether weight loss can be achieved in a healthy way when there is a history ED and disordered eating.

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. 

WILLINGNESS to get over this bump and OPPOSITE ACTION TO ENVY

Although I would like to think I am calm, rational and a judicious person when it comes to taking an objective standpoint about transgressions in my own life, simply put, these skills is severely lacking from my toolbox. I find it very hard to push aside the judgements which paralyse me and turn my thoughts into narrow, dichotomous lines which only have two end points.

As I mentioned in the last few posts, my emotions have been amplified to way out of manageable levels this past week.  All this lead to me equating many of these emotions as facts; hence I felt had to act on the emotion. The feelings almost felt like they have a mind of their own, and that I was a vessel for them to carry out their action urges. At the time I felt I had no control, but I am not trying to evade responsibility for how I treated my therapist, as I know I could have been more skilful. I could have used OPPOSITE action to my anger, or even HALF SMILE. In reflection, I see that it could have been a perfect week to also practise DISSTRESS TOLERANCE and RADICAL ACCEPTANCE.

Yesterday morning I received a letter stating that a course I had been waiting to get onto for many months had been cancelled due to lack of funding. When I first saw the letter I was super excited, as I thought it was a start date. I had been advised to hold off going to university by my team for another year until I finished DBT and instead attend this collage as it operates under recovery ethics. It seemed a perfect transitory step for me. I decided to do something creative and less academic, so picked a photography course. I really was looking forward to it. 

Now I am so disappointed that my heart literally hurts. I am so afraid; I feel I have nothing really left to look forward to now.

I went to check in with the community nurse a few hours after getting this terrible news. And I am really so very grateful and abashed to admit that he was not the invalidating type I was expecting. In truth, he sat with me for about 45 mins and listened intently to what I had to say. We came up with a plan in order to help problem solve the solution, and jointly agreed that the best outcome would be for me to attend a crisis resolution based therapy group for 8 – 10 days. It came with a warning that I would have to be willing to work at finding solutions to my problems and not to abandon self responsibility. It seems fair, if like a lot of hard work, but I am up for the challenge. I really am so appreciative for how great that nurse was. I really needed his objectivity in that moment. 

I felt calmer and more in control after the meeting, and was much more willing to stay with my family for the night, I tried not to see it as a suicide watch, but as an opportunity to spend quality time with them. I went to see my sister and her husband who are expecting a baby and are in full blown 'nesting' mode. They are buying my family home off my mother, and have done a beautiful job of renovating it and putting their own stamp on the house. I noticed that I had been avoiding seeing the house as I felt great envy towards my elder sister, who has such a perfect life and gets to have everything I want and more, and on top of that gets to have the house I grew up in, the only place I called home. I am afraid I might never fall pregnant again, so am also reluctant to talk to her about the baby and envious of her ability to carry a child. I (quite skilfully in my opinion) figured out that I was experiencing ENVY which really did not fit the facts of the situation

I put on my DBT SKILLS hat and tried to use OPPOSITE ACTION. I knew that the prompting event to the ENVY was that I was being reminded about all the things I really want but can't have. A stable home, a family, nice things.....

My HOT thoughts where:

• 'I will never have what my sister has'
• 'I am such a failure'
• My sister is more successful than I will ever be'
• 'I am inferior to my sister'
• 'My parents think she is the better sibling'
• 'life has treated my so unfairly

The biological changes and bodily experiences I felt with the envy was a slight pain in the pit of my stomach and I was extremely anxious and noticed I was feeling resentment towards my sister and her husband   I began to ruminate about how unfair I felt the situation was and how much of a failure I felt I was. My attention was very narrow and I could barely even talk to them. I OBSERVED how much I had avoided seeing my sister and the house, which had undergone so much renovation that I nearly didn't recognize it! I hadn't even offered to help with painting or decorating because I had been festering in my envy.

Although it is ok to feel envy when others have what you want, the problem here lies with the intensity of which I felt the emotion. I had checked the facts and become conscious that I had not been there to help my sister due to an out of control emotion.

I mindfully asked myself what my assumptions, belies and thoughts were about my sister buying the house and having a baby. I then tried to challenge the hot thoughts which popped up. Here is how I tried to turn the judgments into facts;

• ‘My sister is 7 years older than me, is married and in a good position to raise a child’
•   My sister and her husband have worked very hard to get everything they have and deserve it all
•    I also have many very wonderfully things. I live in a fantastic location and have so many beautiful things. Someday, with hard work, I will also have a house to live in, but for now, recover and health are my greatest assets.
• It is a very good solution to the present economic recession as my sister would not have been able to buy a house like this without help from the family
•   My sister’s children will get to grow up in the same wonderful house and we did
• I am not a failure because I am not the same as my sister, I have other attributes which make me a successful and competent person

My goal is to have a positive and functioning relationship with my sister and brother-in-law, I love them and love the bump too! So my anger and resentment to them was making me avoid them and not nurture and develop a healthy bond with them. That is the main reason that the envy needed to be challenged.

In the moment I made sure to count all my blessings and avoided exaggerating my deprivations, Marsha states that to go ALL THE WAY I must imagine that it makes sense for my sister to have all this, as she has worked hard and deserved it all.

Finally I changed my emotions by changing by behaviors and posture. I unclenched my hands and relaxed my stomach and used HALF SMILE.

I now feel my envy is more in proportion to the situation. I’m not going to lie, it’s still there, but now I feel motivated to work as hard as my sister so I can have what she has. That means I can’t just throw my hands up in the air and moan about how unfair life is, I have to get off my ass and go get it for myself!

I’m really sorry this is so long and thank you so much for taking the time to read this. 

 

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?

Regular Eating Pattern

I am having a rough time with my BULIMIA this week, but really, I don't want to dwell on negativity and destructive behaviors in this post. You are an intelligent reader and hence I assume you can understand what devastating effects an eating disorder has on anyone unlucky enough to suffer from one, without the need for me to point out the finite and mostly dirty details. 

Instead, I want the spotlight of this late-night post to shine on a combination of resources which can be used to combat the BINGE/PURGE cycle. I am not saying that I have mastered them all, far from it, but I have tried some with great success. And the way I look at it, at least trying some of these suggestions has to be better than continuing to destroy my body and mind with self-inflicted agony.

The first thing I have (tried) to do is introduce a pattern of regular eating. It is the single most important element of overcoming Bulimia in my opinion. Its different for everyone, but for me it means containing my eating to three planned meals a day plus three planned snacks between main meals. By eating this way it displaces the urge to and action to binge. My approx daily plan looks like this:

 8.00 A.M.: Breakfast

10.30 A.M.: Morning Snack

12.30 P.M.: Lunch

 3.00: P.M.: Afternoon Snack

 6.30: P.M.: Dinner

 9.30: P.M.: Evening Snack

I have left no more than 3.5 hours between meals/snacks as I know that that is my limit when trying to curb binges, and also the ideal time frame to  master EMOTION REGULATION. Any longer and I turn into the wicked witch of the west. Fact. Although this is set in stone, and has to be for my recovery, I do change it up a bit a weekends and if I am out and about at a commitment. Sorry therapist, I have a life. I try my hardest, (but don't always succeed) to not skip any meals or snacks though.

Where possible I do make eating my number one priority each day. My food diary and meal plan also take time, but I realize the importance of monitoring my food intake and being mindful to my emotions around food. I try to plan, plan and plan to plan! This includes having ample amounts of my "safe" foods in the house such as oats, fruit, skim-milk and rye bread. I am comfortable with these foods. I tend to plan the night before what I will eat the next day and jot down some ideas on my food diary. For example, tomorrow I am having Salmon, peppers and quiona for dinner.

I also restrict eating to the kitchen table or sitting room. Never my bedroom. Crumby bed sheets are really not attractive. I try to eat at a table which is out of arm's reach of further supplies of food. And while it might be tempting, and I am so guilty of not following this one, It is important to focus on eating and not distract with TV or internet. 

Limiting my amount of "trigger food" by not having any in the house it a safe bet to stop me impulse bingeing  So I plan my shopping, make a list and stick to it. 

The best thing I find to do when that niggle of an urge comes on me is to get out of the house and not take ANY money with me, and stay out until the urge goes away. This really is my 'go-to' STOP method. But everyone will have something different.

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.

ACCEPTING the importance of MINDFULNESS

This has been a good week. I am feeling more 'me' again. Its not that the black cloud has gone away, its just I feel like I am better able to cope with the next storm life throws at me. Almost like I am prepared to fight now, posed and ready with my armor of skills and SELF-COMPASSION.

I returned to a meditation class on Tuesday and Thursday evening and it was simply wonderful. It was inspiring to listen to others stories of how meditation helps them in their daily lives. The inner peace they radiate really is infectious. I truly get the importance of MINDFULNESS in DBT this week.

When emotions wreak havoc, it helps to “get it out” — ranting to a therapist, friend or partner, or writing about your feelings in a diary, or blog like this one. Sitting down on a cushion to meditate is seemingly the polar opposite of this catharsis. But could it be that the two approaches are helpful for similar reasons?

Talking or writing about your feelings forces you to call them something. And one technique taught in mindfulness is naming your emotions. It’s part of noticing and detaching from those emotions vs. letting them hijack your bliss. I like to imagine it as 'the mindfulness wedge.” It’s about developing that pause button,' so you can observe emotions from the outside.

The main focus of DBT for me is gaining control over my emotions and it is now known that simply labeling my emotion promotes detachment, providing a stop-gap and the opportunity to choose of a healthier coping mechanism.

It’s very challenging to bring what you practice on the meditation cushion out in a real-life situation, when you’re actually in that moment — say someone is yelling at you — you have to remember to step back, say, ‘Oh, that’s anger I’m feeling,' and change what you do with that emotion, all in a millisecond. It takes a lot of practice. To help with this, I try to extend my meditation to everyday activities like going for a walk, having a shower, or drinking my morning coffee.

Often when you feel something, you don’t acknowledge it, and by avoiding that feeling, you perpetuate greater pain. Meditation helps me realize that I create my own feelings. If I’m in a state of frustration and I stop and observe it, I realize there’s another way to deal with the pain. Acceptance is key to dealing with distress, and it is without a doubt the hardest part of mt therapy, but each journey starts with a single step right!

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.

PLEASE take care of your body!

We are back to EMOTIONAL REGULATION this week. I like this module, and it is not too triggering for me either. I am a firm believer in returning to basics during a state of emotional deregulation, so it makes perfects sense to me that I must consistently make sure the base of my emotional pyramid is strong and stable.

The PLEASE Skill is about taking care of your mind by taking care of your body.

PL – Treat physical illness. This is about looking after yourself if you are unwell, seeing a doctor and taking meds as prescribed. I find I am grumpy when sick with a headache or flu, so I am more emotionally venerable. I also get very deregulated around my time of the month, but if I validate my pain and take care of myself I can avoid behaviours which I may not be proud of.

E – Balanced Eating. Okay I’m not going to lie here and say that this is something I do…. I have bulimia. But I understand the theory. Balanced glucose levels most certainly even out emotional responses to situations. Someday I might just be able to achieve this one!

A – Avoid Drugs and Alcohol. I was surprised at how much avoiding excessive amounts of alcohol has helped me to stay out of trouble. All of my suicide attempts have been after drinking too much. I simply cannot over drink until I get a handle on my emotional liability. I don’t miss it too much and certainly don’t miss the hangovers!

S – Balanced Sleep. Sleep is just so important in regulating emotional responses. This has some serious research behind it too. Too little and you are leaving yourself open to irrationality and too much has been proven to increase negative emotions. Sleep hygiene is a bitch but it works. Sleep is a big one for me. If I do not get enough sleep on a regular basis, I get irritable, short-tempered, my judgment is less good and I get upset much more easily. I have to work on it all the time.

E - Exercise. This is another no-brainier, if anyone knows the magic motivation skill for this please let me know! I try to walk/cycle everywhere, and love to run and do yoga.

I guess looking after the basics is the main reasons people go inpatient or into residential treatment, It re-sets a base level from which you can really start to therapeutically manage emotions and behaviours. Most of this is common sense, but for me at least its dramatically boosts my mood. 

Early Rising Plan

'yum! Morning worms are far better than late ones'

I’m inspired by the Dalai Lama, who said, ” Everyday, think as you wake up, ‘today I am fortunate to have woken up, I am alive, I have a precious human life, I am not going to waste it. I am going to use all my energies to develop myself, to expand my heart out to others, to achieve enlightenment for the benefit of all beings, I am going to have kind thoughts towards others, I am not going to get angry or think badly about others, I am going to benefit others as much as I can.’ “

Coffee Coffee Coffee

Amazing start. I start my day by jumping out of bed, late as usual, and rushing to get myself ready, never fully feeling present. I sulky walk into work, looking rumpled and barely awake, grumpy and behind everyone else. Not a great start to the day. I am sick of my broken morning routine. Its no wonder that all I feel like doing is crawling back into bed and snoozing for the day.

Quietude is the main reason I want to become an early riser. No neighbours kids yelling, no babies crying, no echoes, no cars, no television noise. The early morning hours are so peaceful, so quiet. It’s my favourite time of day. I truly enjoy that time of peace, that time to myself, when I can think, when I can read, when I can breathe.

Why do I want to subject myself to the wee hours? Simple. Sunrise. People (Me!) who wake late miss one of the greatest feats of nature, repeated in full stereovision each and every day — the rise of the sun. I love how the day slowly gets brighter, when the midnight blue turns to lighter blue, when the brilliant colours start to seep into the sky, when nature is painted in incredible colours. I want to start doing my early morning run during at this time, and I look up at the sky as I run and say to the world, “What a glorious day!”

Rise early and I actually have time for breakfast. I’m told it’s one of the most important meals of the day. Without breakfast, your body is running on fumes until you are so hungry at lunchtime that you eat whatever unhealthy thing you can find. The fattier and sugarier, the betterier. But eat breakfast, and you are sated until later. Plus, eating breakfast while reading my book and drinking my coffee in the quiet of the morning is eminently more enjoyable than scarfing something down on the way to work, or at your desk. It helps to regulate my mood, and sets me up for a more SKILFUL day.

There are other times to exercise besides the early morning, of course, but I’ve found that while exercising right after work is also very enjoyable, it’s also liable to be cancelled because of other things that come up. Morning exercise is virtually never cancelled. And plus not as many people see you all puffy and red faced in jogging tights!

Just 5 more minutes Mom!

Mornings, for me at least (when I get up!), are the most productive time of day. I like to do some writing in the morning, when there are no distractions, before I check my email or blog stats. I get so much more done by starting on my work in the morning. Then, when evening rolls around, I have no work that I need to do, and I can spend it doing other things.

No one likes rush-hour traffic, except for oil and motor companies. Commute early, and the traffic is much lighter, and you get to work faster, and thus save yourself more time. Or better yet, commute by bike. (Or even better yet, work from home. A girl can dream!)

It’s much easier to make those early appointments on time if you get up early. I like making 9am Dr. appointments, to force me to get up early. Showing up late for that appointment is a bad signal to the person you’re meeting. Showing up early will impress them. Plus, you get time to prepare.

I don’t plan to make drastic changes. I will start slowly, by waking just 15-30 minutes earlier than usual, get used to this for a few days, then cut back another 15 minutes. I must also allow myself to sleep earlier. I am used to staying up late, watching TV or surfing the Internet. But if I continue this habit, while trying to get up earlier, sooner or later one is going to give. And if it is the early rising that gives, then inevitably I will crash and sleep late and have to start over. I must go to bed earlier, even if I don’t think I’ll sleep, and read while in bed.

Getting out of the bedroom as soon as I turn off the alarm is the best plan. I mustn’t allow myself to rationalize going back to bed. Just force myself to go out of the room. My plan is to drink lots at night and therefore come morning have to stumble into the bathroom and go pee. By the time I’ve done that, and flushed the toilet and washed my hands and looked at my ugly mug in the mirror, I’m awake enough to face the day. I must not rationalize. If I allow my brain to talk me out of getting up early, I’ll never do it. Getting back in bed is not an option.

I have been trying to set something to do early in the morning that’s important. This reason will motivate me to get up. I like to write in the morning, so that’s my reason. Also, when I’m done with that, I like to read all of your comments!

Opposite Action

I am not in the mood for being social tonight. In fact,  I am damn grouchy. So what does DBT tell us to do? (cue validating and reassuring voice...) OPPOSITE ACTION. If I am to apply a rational mind to this skill, I can see how it can be useful, but at the same time my emotion mind is yelling at me that it is just another 'get on with it' statement disguised as a skill! But hay, I will try try anything once!

First things first. Identify which primary emotion I am actively avoiding. I don't think I am angry, or sad. Both are normally too intense for OPPOSITE ACTION just yet. Yes it must be fear. I am afraid of life today.

OK, so how do I apply OPPOSITE ACTION? Marsha tells us to approach our fear and do things which gives a sense of mastery over the situation. I was asked to the movies tonight, so in the spirit of making myself feel good and practicing DBT, even though I feel like crying, hiding under the covers and not coming out for a week, I smile and accept the invitation. OH NO! NOW I actually HAVE to go.

First things first. I must do something to give myself some control over the situation. So being the girl that I am, I spend an hour washing blow-drying, straightening and preening my hair. I put on my face and feel somewhat more able to deal with the world.

During the movie, I try to go ALL-THE-WAY with the OPPOSITE ACTION. I MINDFULLY PARTICIPATE in the story line of the movie, I OBSERVE the palpitations of fear which are causing me to breakout in waves of nauseating and sweaty tremors. I am in full blown panic at this stage and all I want is to run away, to flee the movie theater and be alone.

Instead I count slowly to ten and concentrate on my breathing, and try to once again bring my attention back to the story. Finally the movie ends, and although it wasn't easy and it was far from enjoyable, at least I went, and I didn't engage in any destructive behaviors!