Examples of Emotions that Fit the Facts

Module: Emotion Regulation

Handout:
Emotion Regulation Handout 8A – Examples of Emotions that Fit the Facts

When checking the facts, it can be hard to determine if what you’re feeling is justified or not. I know for myself, sometimes what I’m feeling is so strong that I think I’m already working the facts. I believe they are justified. So I wonder what do I need to do this step for?

Obviously you need to be honest with yourself when checking the facts because without it you’ll end up in the same spot as you started with nothing to work with to change or resolve the emotion or situation.

I can personally attest to this because at first I wasn’t that honest. Not because I wanted to lie about it but because I felt the fear of people not liking me so far that it was a fact. The truth is though I have no evidence to support this belief. I mean, maybe everyone might not like me, but frankly I don’t really care about everyone. I’m worried enough if the people I like, and my friends like me. I just wanted to believe that the people I liked, and my friends liked me. When I checked the facts, and was honest about it, it turns out I didn’t have much to fear in terms of rejection. My friends, they liked me.

One thing that helped me to determine what the facts were, and if they fit was reading the Emotions Handout 6, their prompting events, and interpretations that made me realize I was feeling a lot of unjustified fear and shame.

Since it would take up a lot to list each of the emotions from Handout 6, their respective prompting events, and interpretations etc., is first of all a copyright issue, but also it’s a lot to paraphrase, and I’m not sure I can do it.

It’s much easier to use examples of emotions that fit the facts, to see if it’s justified or not, and then whether to do Opposite Action, or Problem Solve.

The following are examples of emotions that fit the facts:
Fear:
There is a threat to you or someone you care about.
There is a threat to your body, health, well-being, or property.
There is a threat to the body, health, well-being, or property of someone you care about.

Anger:
A goal is being blocked, or prevented from being attained.
Something you enjoy doing, or pursuing is blocked or prevented from being attained.
There is a threat of attack to you or someone you care about.
You or someone you care about is insulted.
You or someone you care about is offended.
Your integrity, status, or well-being is attacked or threatened.

Disgust:
You come into contact with something that can make you sick.
You listen or witness an opinion or behavior that goes against your own moral code.
Someone you dislike speaks to you or touches you.
Someone you dislike speaks or touches someone you care about.

Envy:
Someone has things or privileges that you want.

Jealousy:
Someone or something you care about is being pursued by someone else.
Someone or something you value is in danger of being taken away.

Love:
You cherish, adore, or connect significantly to another person, or animal.

Sadness:
You have lost something or someone you care about.
An expectation of a person or situation has fallen short, or has not been met.

Shame:
You or something about you (personality, behavior, values, opinions, etc.) is rejected, insulted, or offended by another.

Guilt:
You do or say something that goes against your own moral code.

It helps a lot to have these to refer to when figuring out if an emotion fits the fact. A number of times now I’ve referred to these examples and realized I was kind off the mark.

Bye for now!

Skills, Handouts, and Worksheets from DBT Skills Training Manual, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

 

DBT Group: Week Five – Opposite Action to Change Emotions

Module: Emotion Regulation
List of Handouts and Worksheets covered in group and assigned as homework will be listed at the end of this post.

Homework Take-Up:
Handout:
Emotion Regulation Handout 10 – Opposite Action
Handout Reference:
Emotion Regulation Handout 11 – Figuring Out Opposite Actions (9 pgs)
Worksheet:
Emotion Regulation Worksheet 7 – Opposite Action to Change Emotions

Emotion Regulation Handout 7 – Overview: Changing Emotional Responses
– Checking the Facts
– Doing Action Opposite to Emotion
– Working to Solve the Problem

Starting with:
Emotion Regulation Handout 7 – Overview: Changing Emotional Responses
Second Box (Overview): Opposite Action
Moving to:
Emotion Regulation Handout 10 – Opposite Action

Every emotion that we feel comes with an action urge.
For example:
When we feel the emotion: fear
Our action urge tends to be: To hide, avoid, or run away
The Opposite Action for Fear might be: To approach the situation, or person, not avoid the situation or person

It can be tough to do opposite action because it is directly counter to the natural urge we feel with an emotion. However, when our emotion doesn’t quite fit the facts of a situation, or if it isn’t effective to act on the emotion, then we would do Opposite Action.

When I did the homework for this, surprise, surprise, I picked fear. I wanted to give a gift to someone that I made but I was afraid to do it. I was afraid that they would reject the gift, and thereby reject me.

This isn’t the first time I’ve been afraid to give someone a gift, whether I made it or not, and was terrified to follow through with it, and that I would be rejected. I’m not too sure how I developed this fear because I don’t recall ever making something for someone, or giving someone a gift and had them reject it.

When I went through the emotion, and I checked the facts, my emotion of fear wasn’t really justified. I’m always terrified of people not liking me, and then rejecting me. To an extent I don’t really have the evidence to support that. I mean I’m sure there are people who don’t like me, for whatever reason, but I’m actually not thinking of them. I’m thinking of people I do like, or even friends, that I get it into my head, they have some reason not to like me. I worry slash believe that these people, even if they tell me they like me, they actually don’t. They are either lying, or pretending, and they do it either because they don’t want to hurt my feelings, or they feel obligated to like me. I have no idea where I really got this belief from but its there, and it’s quite deeply ingrained.

So since my emotion didn’t fit the facts, it was time to do Opposite Action.

My urge was to hide the gift, possibly bury it at the back of a closet somewhere, and never ever mention it, ever again. I have drawers and storage space filled with gifts or gestures that I wanted to give someone, from birthday gifts, to Christmas gifts, to gifts for just whatever, that I decided would be rejected, and so they were all boxed and stored away, never to see the light of day again.

Doing Opposite Action for this was a big chance for me I was taking. I actually felt light-headed as I gave the gift. I was terrified.

When you do Opposite Action, you’re supposed to do it all the way, with open posture, firm voice, and make eye contact. But honestly I was too afraid to do it all the way. I did not have the eye contact, the firm voice, or the open posture. I brought the gift with the intention of giving it to the person, but also holding reservation that if it looked too scary, or even a hint of rejection was in the air, I would bag that gift right to the bottom, and it would never be known that I had it

Right up until the last minute I was on the fence about giving the gift. I was terrified and prayed I wouldn’t pass out. If I could have given it to her anonymously, and found out first if she liked it, I would have preferred it that way.

Regardless of my fear, I did the opposite Action, and guess what, she liked it. She really was pleased, and I was so glad it worked out. It made Opposite Action a little easier to consider for the next time I felt afraid to do something. It’s certainly not foolproof, because it’s only a matter of time that a situation doesn’t work out well, and then I’ll probably start to second guess the effectiveness of Opposite Action. Even though it is worth a try.

Because I do think it is worth trying. And it turns out I do Opposite Action more than I thought I did. Every time I’m afraid to text someone and ask them out for coffee, or a movie and I do it, I’m doing Opposite Action. It’s not always easy but for some things it does get easier with time. I encourage anyone to give it a shot. You can always start small and work your way up to bigger or more scary situations.

Lesson Taught: Second Half of Group:
The lesson for the second hour was about Problem-Solving.
Emotion Regulation Handout 12 – Problem Solving.

I was very keen to learn about how to problem solve some of my emotions. In part because I wasn’t very keen on the Opposite Action, but mostly because I thought actually being able to troubleshoot and solve a problem with an emotion or situation made me feel hopeful. So there was a chance I could actually figure out how to manage this myself?

Alright then, bring it on.

Homework Assigned:
Handout (Reading):
Emotion Regulation Handout 13 – Reviewing Opposite Action and Problem Solving
Worksheet:
Emotion Regulation Worksheet 8 – Problem Solving to Change Emotions

Bye for now!

Skills, Handouts, and Worksheets from DBT Skills Training Manual, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

 

A Word About Vulnerability Factors

Something that comes up a lot in DBT, is the term “vulnerability factors”. This is typically in reference to dealing with emotions and when applying the skills.

What vulnerability factors present in any given situation can vary from person to person, and even day to day. They are factors that can be significant enough that they determine what emotion you feel in response to a situation, and they can inhibit how you handle an emotion, and what, if any, skills you try to use.

Some examples of vulnerability factors include, but not limited to:

  • Poor, or not enough sleep
  • Unbalanced diet, or missing meals
  • Mood-altering substances
  • Medications
  • A distressing situation occurring prior to the current event or emotion
  • Stress
  • Anxiety

Any of these on their own can be a vulnerability factor affecting your mood, emotions, capability, sensitivity, or even the desire to apply the skills.

The more vulnerability factors that are present the more your emotions and mood can be subject to sensitivity or susceptibility to feeling emotions that don’t seem to fit the situation, or feeling the emotion stronger than had there not been any vulnerability factors present.

For example:
You have trouble falling asleep one night, and end up waking up late. You don’t have time to eat breakfast, or make your lunch because you’re running too late, and you end up being late for work.
In the morning, you attend a meeting and realize you’ve forgotten your notes for the presentation and now the meeting has to be rescheduled.
You go for lunch and since you woke up late, and didn’t have time to make your lunch, you have to buy your lunch today instead, except you’ve forgotten your bank card at home. So now you’re forced to eat a small apple and granola bar that you keep in your desk.
At the end of the day as you’re leaving work, you see that it’s raining, and you don’t have your umbrella with you.
As you enter the subway, someone accidentally bumps into you, and before you can stop and think, you turn and your response is to freak out on the person, yelling at them, calling them an idiot for bumping into you, and they should be paying attention to where they are going.

So as you can see, this would be a crap day for pretty much anybody.

Now let’s consider the situation and the emotion and the vulnerability factors present.

The Situation: Someone accidentally bumped into you.
The Emotion: Anger, specifically hostility or even rage.

Considering the situation and the emotion, is hostility or rage towards the other person justified?

The emotion of anger as frustration or irritation may be justified but the intensity spiked up at rage or hostile doesn’t quite fit. And the reason why lies in the vulnerability factors that were present at the time that the situation occurred.

The vulnerability factors for this situation started the night before when you didn’t get to sleep on time, and woke up late the next morning. Then not having the time to eat breakfast or make your lunch has added on to the first two factors. Then you got to work late, and forgot the notes for the presentation, so now you’ve added more factors, and slowly your mood is becoming more and more sensitive. Next we have forgetting your bank card, and missing eating a proper lunch, adding another significant factor since by now all you’ve had to eat all day is an apple and a granola bar. Then we have leaving work, and not having an umbrella to use in the downpour has compounded onto an already hefty pile of factors, so that when the person in the subway accidentally bumps into you it has caused an intense reaction that is disproportionate to the situation.

Think about if you had gotten a good night’s sleep, and woken up on time, had breakfast, had time to make your lunch, and gotten to work on time. You were prepared for the meeting and then had a proper lunch, and leaving work you had your umbrella with you. When the person in the subway accidentally bumped into you, you most likely either wouldn’t have been as hostile to the person, or more likely, you probably wouldn’t have even noticed the bump in the first place.

Vulnerability factors can make a significant impact on your emotions whether it’s one factor or twenty, so as part of DBT, but really for anyone, having an awareness of your vulnerability factors when trying to manage emotions can help to understand why the emotion that did came up, how intense the emotion may feel, and how we handle it with skill, or not.

Some vulnerability factors can’t be helped sometimes, no matter how much we try to keep things balance. The key is to first do what you can to take care of yourself and minimize your vulnerability factor low, but also when they are present, to be aware of them and take them into consideration when dealing with situations that spark a heightened reaction.

There are several Handouts and Worksheets covered in Emotion Regulation that include how to reduce vulnerability factors, so there will be more info on this to follow in a later post or two.

Good luck!

Bye for now!

DBT Skill: How to Check the Facts

Module: Emotion Regulation

DBT Worksheet:
Emotion Regulation Worksheet 5 – How to Check the Facts

In order to learn how to check the facts, covered in DBT Group: Week Four. I thought it might help to give some guidelines, based on the Worksheet, for those who don’t have access to the Worksheets.

Since the copyright of the content belongs to Marsha M. Linehan, and cannot be reprinted without permission, I’ll be paraphrasing what’s on the Worksheet.

To actually see and use the Worksheet you will need the DBT Skills Training Handouts and Worksheets book.

I’ll do my best to give as close a guideline to the Worksheet as possible.

  1. Name the Emotion
    What emotion are you looking to change or problem solve?
  2. What happened that brought up the emotion?
    Describe the situation that brought up the emotion. What is it about the situation that troubles you?

Stop…and Check the Facts
Here’s the first point where you’re going to check the facts. When describing the situation are there any interpretations, assumptions, or judgments in the description? Are you using the words ‘always’ or ‘never’?
Rewrite the description without the extremes and just the facts.

3. If there are any interpretations and assumptions, what are they?

Stop…and Check the Facts
Is it possible there are other interpretations to the situation?
Rewrite your interpretation again with the facts that there could be other reason or interpretations of the situation.

4. Are there any threats concerning you regarding the outcome of this situation?

Stop…and Check the Facts.
Is it possible there could be other outcomes to this situation? Do you have certain expectations to the outcome?
Rewrite the other probable outcomes to the situation. Are your expectations realistic?

5. What is the worst case scenario you can think of?

Stop…and Check the Facts.
Describe your worst case scenario for this situation, and what can you do to prepare for this.

Finally, go over all the facts, and check, does the emotion fit the situation? Does the intensity?

Whatever the situation and emotion, you can stop and check the facts as often as you need to. Stripping away the assumptions, interpretations, and expectations, and working with just the facts allows the emotion to be stripped of all the additional baggage to manage the situation and the emotion more effectively.

That’s it for checking the facts!

Bye for now!

DBT Group: Week Four – Checking the Facts

Module: Emotion Regulation
List of Handouts and Worksheets covered in group and assigned as homework will be listed at the end of this post.

Homework Take-Up:
Handout:
Emotion Regulation Handout 8 – Check the Facts
Worksheet:
Emotion Regulation Worksheet 5 – Check the Facts

Emotion Regulation Handout 7 – Overview: Changing Emotional Responses
– Checking the Facts
– Doing Action Opposite to Emotion
– Working to Solve the Problem

Starting with:
Emotion Regulation Handout 7 – Overview: Changing Emotional Responses
First Box (Overview): Check the Facts
Moving to:
Emotion Regulation Handout 8 – Check the Facts

When dealing with an emotion it can be difficult to move through the problem, or past it when our minds are clouded with interpretations or judgments, and if we are actually dealing with the situation and its primary emotion, or if we are dealing with the secondary emotion.

It can take some effort to pull it apart and see what we’re really dealing with, and checking the facts helps us to do this.

When I first started this homework I didn’t think this would really work or help me. This was in part because I thought I was already dealing with facts (hello, Emotion Myth, when did you get here?). As I started the Worksheet and the prompt was to rewrite the facts I was stumped.

I chose the emotion fear, and what caused the feeling of fear was that I didn’t think I was good enough to enter a contest. I was afraid that I would fail, that I would suck, and that I just wasn’t good enough. Not just good enough to win, but good enough period. To me, these were facts. But when I stepped back and considered the statements, I had to ask, were they really facts?

My first fear was that I would fail. As in I wouldn’t win the contest, and that would make me a failure. Now, is this a fact?

No, actually it isn’t. It’s an assumption, and pretty big assumption considering the situation. Yes, there is a possibility that I might not win the contest, but did that make me a failure? The fact would be that I didn’t win. That’s it. Even if I don’t win that doesn’t automatically translate to being a failure. I might feel like a failure but that doesn’t make it true, nor does it make it a fact.

My second fear was that that I would suck. This was basically a thought between being a failure and my third fear of not being good enough. It too is also not a fact. By not winning, that doesn’t mean I would suck. Again, it just means I didn’t win. So, me sucking? Not a fact.

My third and biggest fear was that I wasn’t good enough. This is a belief I have had about myself for a long time, years, decades actually, and I apply it to a number of things, from whether people like me, to being capable of starting, or completing a project, to just believing that me as a person is just not good enough. So, to me, this is a fact. A big one.

When I checked the facts on this one, I thought ‘yep, there’s a big ol’ fact.’ But when I checked Emotion Regulation Handout 6, Fear, this thought fell under “Interpretations”. Hmm. Really? This is an interpretation? So not a fact? I was sure that this didn’t apply to me, but then, what if it did? What if this was an interpretation? What if this was not a fact at all? Did that mean that I was good enough? Somehow that didn’t sound right. I was good enough even if I didn’t win the contest? Interesting.

The Worksheet really makes you break it down to just the facts. Every time I wrote down that I wasn’t good enough, the Worksheet would tell me, “Check the facts!” Are there any other outcomes to this situation? Aside from being not good enough? Oh, sorry, just that facts. Well, I suppose an outcome could be that there’s a chance I could win. A long shot I’d say but if you’re looking for facts then yeah, I could win.

Let’s say the worst case scenario is that I don’t win, what would that mean? Well, I hate to sound like a broken record but I believe it would mean I’m not good enough. “Oh really?” – says the Worksheet…did you Check the Facts? Hmm. Okay so I was forced to admit that whatever happened with this situation, I was good enough. I may not win but that didn’t make me a total failure or that I wasn’t good enough.

Breaking down my fear, which initially felt like it was because of a major personality flaw I have, it was actually not true. The emotion of fear itself was warranted because submitting to a contest can absolutely feel scary, especially when it’s judging something subjective like an opinion or a piece of art. I might not win but having not winning mean I was a total failure, or not good enough, was not warranted.

This was quite an eye opener for me.

I found out that checking the facts kind of poked holes in my reasons for not trying, and being too afraid to enter the contest.

Touche Worksheet 5.

For the record, I have yet to enter the contest because I’m still working on believing the facts, but I am much closer to going through with it because of checking the facts.

For a guideline on how to check the facts, click here.

Lesson Taught: Second Half of Group:
The lesson for the second half of group we discussed Emotion Regulation Handout 10 – Opposite Action.

Opposite Action is for when the emotion doesn’t fit the facts, or if acting on the emotion won’t help or change anything.

More on Opposite Action in the next post.

Bye for now!

Skills, Handouts, and Worksheets from DBT Skills Training Manual, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

 

A Dedication to CAMH

 

The first couple of experiences I had with CAMH were not ones I care to experience again.

I had gone to my family doctor for help, and after several weeks, and medications to see if I improved, she decided to refer me to CAMH for an assessment. This would be my first visit to CAMH and I was relieved I was going to get an appointment there. It was like I was going to the mothership of mental health. If anyone could help me CAMH could. I did have to wait about two months for an appointment but I didn’t mind because I figured it was going to be so worth it because I would go for my appointment, meet a CAMH professional, they would assess me, and I would be onto bigger and better things from there. But it didn’t quite go the way I had imagined it.

I went to the appointment, and I saw the CAMH professional who then “assessed” me, and an hour later I left with a list of books to check out that the professional thought might help, a list of some therapists in Toronto I could contact (none covered by OHIP), and a disappointed spirit. That was it? Shouldn’t there be more? Had I missed something? That couldn’t be it, could it? Shouldn’t I have been welcomed into the CAMH family with open arms? Shouldn’t they have done more? Had I been wrong? Was this all that they did?

I started to doubt that maybe CAMH wasn’t what I thought it was. Well, that’s disappointing. Now what?

So for the next two years, I lived, and functioned, and worked, and whatnot, but slowly I started to decline again. The emotions that overwhelmed me to the point of tears, the crushing depression that put in bed for days, and the feeling that living is looking less and less like a good idea. So again I reached out to my doctor for help. She again prescribed some meds, and after several appointments with no improvement she again said she was going to send me to CAMH for assessment.

This time I was not as relieved. Would I be brushed aside again with a couple of lists and suggestions and then left to walk out and fend for myself? Would this time be different?

I am sorry to say that it wasn’t. Again I waited weeks for the appointment, and again I was assessed, again given a new lists of therapists (still not covered by OHIP), and now this new sense of defeat that made me feel like crying as I left the building.

What was happening? Why was that it? How could that be it? While in the waiting room, I saw a number of people emerge from the offices, and greet the waiting patients with familiarity. As if they’d known them for weeks or months.

So they did see patients more than once? How? How did they get that? Did they know someone? Or was it me? Was I not sick enough? Was I not in a desperate enough state to warrant my own familiar greeting? Was I okay enough to be sent on my way? Maybe I needed to be really bad off. Maybe these people got special referrals. I wondered how in the labyrinth of hallways and offices there wasn’t one person there who thought I was worthy to be familiar too.

I stood outside the building after that second appointment and stared at it. There was something about this place that made me feel like they could help me? But so far, after two appointments, I was still standing on the outside alone. How could I get in? Was there a password? How could I crack the code to become a familiar? Who did I have to know? What did I have to do? There must be a way. There must be. Because twice now I had witnessed people being called by first names and patients who were obviously regulars. And twice now I had just been “assessed”, listed and sent on my way.

I felt so desperate, and rejected, and alone. I was in a bad way. I needed help and I felt like I was running out of options, and the will to carry on. And I was starting to think that whatever it took to get into the CAMH family, I didn’t have it.

I couldn’t figure it out. And so again I made way back to reality and life, and tried to keep things functioning. But it didn’t last. I declined again. Much more rapidly this time. A string of months filled with extreme stress, crippling anxiety, and deep grief finally pushed me over the edge. I couldn’t do it anymore. I didn’t want to do it anymore. I was done. I was tired of this cycle that whipped my emotions around, and left me feeling worthless, and hopeless. I needed help, now, or it would all be over. I knew it, and I felt it.

Because I had nowhere else to go, I saw my doctor again. And I prayed she had answers and that this time would be different. But no, the same things happened, new meds, weekly monitoring, and yet another referral to CAMH. I was so tempted to tell her to forget the referral because I obviously wasn’t worthy of whatever CAMH had locked behind their doors. I couldn’t handle another assessment, or new lists of therapists I couldn’t afford, but especially I couldn’t handle the rejection. Not again.

And then one night, last summer, during the period of weekly monitoring, I reached a breaking point. This was it. I was done. I couldn’t stop crying. I felt raw, vulnerable and ready to snap. And when I snapped that would be it. I would be gone. I was moments away and for whatever reason I instead went online and looked up the nearest hospital. Because without it, it would be over.

And despite the fact that I live nowhere near it, Google gave me CAMH on College as the first option on the page. I sighed. I hadn’t cracked CAMH’s code so that was a no-go, until the words “24 hr emergency” caught my eye. Say what? CAMH has an emergency department? Really? Was this new? I don’t know what inside me pushed me out the door and in the direction of College St. but I sprung for a cab and went, ending up on College St not long after midnight, staring at the emergency entrance at the side of the building. I felt a sense of terror creep over me. What if they rejected me? What if they sent me back out into the night? What if I was left alone and rejected by them again? But instead I took a deep breath and walked through the door. What have I got to lose at this point? I hoped that if anything, maybe they’ll at least keep me safe and alive for tonight. That’s all I needed. Somewhere to keep safe. Just for tonight. They could do that for me right?

I imagined walking in and again being assessed but this time I wasn’t doing that. This time I was just asking, keep safe for tonight please? Because I’m scared. I’m scared I will do something bad that I won’t be able to take back. I’m scared that this is it for me. And I’m desperate. Can you help me?

As I walked in the door at around 1am, I tearfully told the woman that. I told her that I needed help. Was there someone I could talk to? And that folks, was the code breaker for me.

I sat in their waiting room, alone, crying, hoping that at least tonight I’d be safe and make it through to see tomorrow. And when I spoke to the doctor on call that night she gave me a lifeline. Not only did she say she didn’t want me to go home, she suggested I stay for a few days, maybe even a week. She gave me a choice to stay and I took it. And it saved my life.  I ended up staying six weeks.

The support team in my unit, from the nurses to the nutritionist to the physician to the creative director to the psychiatrist to the social worker, they were all behind me. At first they left me as I was, wrapped in blankets, keeping to myself, and periodically checking in on me to see if I was okay. But then, they helped me stand, and they told me it would be okay. And even though I didn’t quite believe them, I stood. And then they got me moving forward. One by one, day by day, I met my team. I met my village. They all supported me, and listened, and encouraged me. They guided me to finally face forward so I could move forward.

I not only got a diagnosis that finally fit while I was admitted but I also got several referrals, and after care, that lasted well beyond my stay on the unit. I learned skills, got situated with medicine that worked for me, and what’s more is, I met some truly amazing, wonderful people, some of which I am still in contact with.

So even though my first (and second) impressions with CAMH hadn’t been so great. Maybe that wasn’t their fault. Maybe it was the timing of things, maybe it was because in my earlier assessments at CAMH I hadn’t asked for help then. Who knows? But I can’t blame them. I can’t say that I didn’t get help because of them because I hadn’t taken the initiative for myself either. I hadn’t spoken up and told them what I needed. I hadn’t pushed for more. I didn’t let on that I was desperate. I waited for them to figure it out. I expected that their assessment of one hour would reveal all of my pain and desperation. I expected that they would guess how broken I was and how much I needed help. And when they didn’t read my mind, I felt rejected and alone. For that I extend a heartfelt apology to CAMH. For underestimating them and assuming that because they understood mental illness they would be able to just know right away that I needed help. That was unfair of me because it’s a two-way street. And they can’t know what I don’t tell them.

I would like to suggest to them however that maybe there be more than one assessment done, like a follow up, and maybe whoever does the assessment can ask the assessee what kind of help they are looking for? So that maybe they can speak up and maybe they can be told about some of the wonderful programs CAMH has. Or even directed to some of the other great programs the city has to offer, like CMHA, Mood Disorders of Ontario, Toronto General Eating Disorder Program, to name a few.

I sometimes wish I could go back and ask for what I needed then, when I had my first and second assessment. I wish that I had spoken up because maybe that would have made the difference. But regardless of how long it took, and what finally brought me to the emergency room doors, with the nice doctor, and the bed that kept me alive that night, I will forever be grateful that CAMH was there when I needed them. No passwords. No codes. No referrals. No lists.

They took me in, and brought me back. They say it takes a village to raise a child. I think it also takes a village to help a child too (or an adult, since I am far removed from being a child lol). And at CAMH I had my own village.

For the following I will not mention any names for privacy sake.

To all the nurses who took care of me every day I was admitted I thank them for asking me every day how was I doing? And for sitting with me when I felt my world closing in and they talked to me and soothed me. When I felt anxious and scared they stayed with me. Day or night. They were there.

To the social worker, who helped me handle my insurance with my work and who spent countless hours researching and listing several things we had discussed about treatment as well as school and more. The effort she put in and the time she gave me made me feel like I was the only one on the ward she had to take care of and I know I wasn’t. She remembered things I had only mentioned despite looking after at least a dozen other patients. And her efforts getting me referred are what got me where I am today. So I thank her deeply for everything she did.

To the physician, nutritionist and creative director that rounded out the team, I thank all of them for listening to me, addressing my concerns, supporting me, helping me, teaching me and giving me the tools and tips and even some fun (with the creative director) that I still use today.

To the facilitator who ran the After Care Program when I got discharged I truly cannot say enough about her. She is an inspiration, an absolute master at what she does, and a wonderful listener. She has knowledge that absolutely astounds me. There wasn’t a moment with her that I didn’t feel heard, understood, and validated by, even with other people in the room. She has shown a kindness and understanding that is obviously part of her core, and I hope one day to work with her again. She is a CAMH treasure. And she will always be someone I think of fondly and I credit with helping me to move forward.

Last, but certainly not least, I want to thank my psychiatrist. The first day I was admitted was a holiday and when they told me I couldn’t talk to her until the next day, and word on the ward was she was new, I felt a panic grip me because no one could tell me if she was nice, or understanding, or was she one of those psychiatrists who just prescribes drugs and moves on with her day, or was she my worst fear, mean. Would she hear me? Would she invalidate me? I had no idea what to expect of her. I prayed I would like her and that she would like me, but especially I prayed that she wouldn’t be mean. And the next day when I did finally meet her I knew it would be okay.

Not only was she kind and understanding but it felt like right off the bat she saw that I was really struggling and that I needed help. And even better, she could help me get to a better place.

Not one time did she dismiss something I said, no matter how much I thought it sounded crazy, no matter how much I thought she would think I was an awful, weird, abnormal person who had these weird thoughts and emotions she had never heard of before. She never once told me I was weird or abnormal.

In fact, she often reassured me that what I was feeling was okay, and that there was nothing wrong with how I felt, and most importantly that there was nothing fundamentally wrong with me, as in I wasn’t damaged goods. I was a worthy person who needed help. She was the first person I truly believed that I was worthy. And that whatever emotion I was feeling was okay because that’s how emotions are. They don’t always make sense, and sometimes they can be completely irrational. For the first time, I wasn’t afraid to tell someone about what I was feeling. Because when I spoke to her, I felt like she was actually hearing me, and taking my thoughts and feelings into consideration.

She has told me by now so many times that I’m not crazy that I’m actually starting to believe her. I thank her for every day making me feel like I was the most important person in the world, no matter how many other patients she had to see, and working with me on how did I want to proceed with treatment or meds. She talked to me not down to me and it made me feel like I wasn’t just some nutcase she needed to dope up and send on my way. She made me feel like a person. A person who has suffered trauma, and a person who has had years of disordered, dysregulated thinking and emotions.

She still sometimes has to remind me that I need time and patience to get through it. She is also the saviour that finally diagnosed by BPD and suddenly brought my world into a clearer picture, where a lot of stuff started to make sense.

I think of her as kind of the leader in my CAMH Village, and I feel safe because of that.

So to CAMH, and all in my village, I thank you profusely from the bottom of my heart, for saving my life, and for helping me save my own life.

For anyone who struggles with a disorder, diagnosed or not, or anyone just struggling, wondering why your days feel dark, not feeling like anyone cares, not caring or wanting to get out of bed, wondering why the tears won’t stop, or why they started in the first place, CAMH may not be where you’ll find yourself again, but it is a great place to start, and is an amazing resource worth exploring. There are some amazing people they’re just waiting to help. And you want to know the secret?

All you have to do is ask.

DBT Skill: How to Observe and Describe Emotions

Module: Emotion Regulation

DBT Worksheet:
Emotion Regulation Worksheet 4A – Observing and Describing Emotions

In order to learn how to observe and describe emotions, covered in DBT Group: Week Three. I thought it might help to give some guidelines, based on the Worksheet, for those who don’t have access to the Worksheets.

Since the copyright of the content belongs to Marsha M. Linehan, and cannot be reprinted without permission, I’ll be paraphrasing what’s on the Worksheet.

To actually see and use the Worksheet you will need the DBT Skills Training Handouts and Worksheets book.

If you do have access to the Handouts and Worksheets, I highly suggest using the 10 pages of Ways to Describe Emotions to help you the first few times you observe and describe emotions.

I’ll do my best to give as close a guideline to the Worksheet as possible.

  1. Name the Emotion
    First, choose the emotion you want to dig further into. It could be an emotion you felt recently, or one you are currently experiencing.
  1. Rate the emotion’s intensity.
    Next is to rate the intensity of the emotion. On the Worksheet it’s from 0-100, but you can do 0-10, or whatever works for you. The key is to determine how great are you, or were you feeling the emotion in the moment.
  1. What happened that brought up the emotion?
    Describe the situation, you don’t need to go into great detail, of what happened that brought up the emotion for you.
  1. Is there anything that could be contributing to why this emotion came up, or why it was so intense?
    These are called “Vulnerability Factors”. I’ll be doing a short post to go into detail of vulnerability factors because it comes up a lot in DBT.
    For example: If Anger is the emotion, then a ‘vulnerability factor’ could be that you didn’t sleep well the night before and are feeling grumpy, or agitated; or it could be that the relationship is tense to begin with leading to a predisposition of agitation even before the situation, and exacerbating it after; or it could be anything that may directly or indirectly affect the emotion that came up, and its intensity.
  1. How are you interpreting the situation?
    Are you making assumptions about the situation? Are there any beliefs about yourself, the situation, or the other person, that might colour or cloud how you’re interpreting the situation?
  1. What are you feeling in your body?
    Are you feeling tense? Tightness in the chest? Throat achy? Is your jaw clenched? Are you holding your breath, or breathing rapidly?
  1. What urge are you feeling?
    Are you feeling like physically responding to the situation and emotion? If you’re angry, do you want to yell? Or do you want to punch something? If you’re sad, do you want to cry?
  1. How is, or was you posture, or your expression?
    If someone were looking at you as you experienced the emotion, could they tell by your face, or posture what emotion you were feeling?
  1. What did you say in the situation?
  1. What did you do in the situation?
  1. How did you feel after the situation?
    Did it affect the rest of your day? Did it affect how you spoke or treated others? Did you think of it for a short while, or for the rest of the day?

That’s it. Those are the guidelines.

By going through what you thought, how you saw the situation, what you felt physically, what you wanted to do, if anything, and how it did or didn’t affect the rest of your day or mood, can help break down the emotion and situation into digestible steps. This allows you to see where you might be able to change the situation, or how you respond to it the next time it occurs. It can show you where maybe you assumed something that wasn’t actually happening or relevant to the situation.

It can also help to figure out if you’re dealing with a primary or secondary emotion.

Learning how you respond to any given situation is key to becoming more aware of your emotions as they happen, and gives you better opportunity to either change the situation, or the emotion.

Bye for now!

Skills, Handouts, and Worksheets from DBT Skills Training Manual, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.