*TW* Trying to Return to DBT

So the last several weeks have been hard for me. Last couple of months? Hmm. So more time has passed than I previously thought. I don’t really know if it’s my BPD, depression, or anxiety…actually that’s not true, I do know, it’s all of it. The whole mess of chaos and confusion that lives in my head and in my body, pinning me to the floor, or pushing me into a dark hole. One just egging the other on until I am a puddle on the floor.

The good news is, during this time I have been continuing to attend all of my weekly DBT Groups, and all of my weekly DBT Individual appointments. So I have a wealth of DBT information on backlog. I’ve wanted to start posting those again but I just didn’t have it in me. I thought I could squeeze them in but it didn’t work out that way.

Despite the backlog of posting any DBT skills, there were a few days the DBT stuff helped me with my stress, anxiety, and distress. Some days, I admit, DBT didn’t even enter my brain let alone my practice. And there were a few days I did think of it and it didn’t do squat. But there have been a few moments when it did help, a lot, and I think a lot of it can help others too. Especially the Distress Tolerance, which is unfortunately the most recent module taught, so it will be the last ones to be posted.

Either way, if it can help me, then it has a chance to help others too.

My goal is to now get back on track with posting the DBT stuff again, and in the midst of that, I am going to still try and climb my way back to my normal. “My normal”, for those of you wondering, is a place where I don’t wake up every day wanting to sink into a deep, dark place and be left completely alone. *TW* Maybe or maybe not, considering if I’ll wait for death, or if I’ll walk right towards it. And where every day feels like moving through tar, in body and mind.

I hope to get back on track within the next few days. Wish me luck 🙂

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How Can I DBT My Way Out of This?

Today is a really hard day for me. I feel sad and somewhat defeated and very much like I want to cocoon myself in a blanket and stay there for the duration of the day. I’m not sure if I’ll want to come out by the end of the day. I’d have to let you know then.

As I felt the sadness envelope me I immediately felt uncomfortable. I didn’t want to feel sad. I didnt want to feel sad symptoms. I didn’t want to cry. I didn’t want to feel the ache in my throat and my chest. I didn’t want any of it. I wanted to avoid it all. My first response is to suppress it and avoid it. I wanted to avoid it in my cocoon. But I knew that would probably lead to further rumination and potentially turning to my destructive behaviours when the sadness got to be too much and the cocoon wasn’t providing the suppression I had hoped for. I felt a little lost and unsure. What should I do?

Should I lay here and wallow in the sadness and just let whatever happens, happen, no matter how bad it could get? Should I lay here and wait for the thoughts to get worse and worse until the feelings become so unbearable that I will do whatever it takes to not feel the sadness, or anything else?

As I stared up at the ceiling feeling like nothing really mattered and that I would somehow end up screwed in the end regardless. I thought of DBT. It passed through my thoughts for a brief moment as if to remind me that it was there, but I almost immediately thought I don’t know if I want to “skill” myself out of this. I’m not entirely certain that I don’t want to just lie here and wallow in my sadness.

But it was starting to get hard. Really hard. It was starting to grip my body and my mind. And I wasn’t feeling so cool about this. Despite not being certain I wanted to “feel better”, I didn’t want to feel this either. The sadness was gripping me tightly, and I don’t like it. I feel stuck.

The DBT crept back in, and poked me again. “You have skills you can use.” But which one. Which skill could I use?

The truth is, when I first thought of using a DBT skill, I didn’t think of what skill I could use to help me work through this. I thought of what skill could help me suppress and avoid this emotion. I asked myself, how I could DBT my way out of this emotion?

So then I immediately thought of Opposite Action. Yes. Opposite Action would be good right? I want to hide so I should go out. I did actually want to go out but the pull to the cocoon was winning the tug of war. So this could work. Perfect. Problem solved.

Except…my problem wasn’t solved. Something about what I was doing felt wrong. It almost felt too easy. I sat up on the couch and thought of going out but then minutes later I laid back down again. No, I didn’t want to go out, I feel too sad.

I sat up again, but Opposite Action will help. Yes, do it, go out, be opposite. I will be skillful and do Opposite Action. But then I laid back down again. I didn’t want to do Opposite Action. I didn’t want to go out. I wanted to lay here. Didn’t I? I didn’t know. I didn’t know what I wanted.

I wondered if this was a good time to call my DBT coach/therapist for some help. Maybe she would know what skill I could use to help me avoid this unpleasant feeling of not knowing what I wanted to do, and maybe she could offer me some advice on how to DBT my way out of this.

So I texted her, and she was available to talk. I told her I felt sad. And I had no idea why. And that I wanted to go out but I also wanted to cocoon on the couch. I told her how I had considered Opposite Action but that something felt wrong using it. And that’s when she pointed out that it probably felt a misfit because Opposite Action is used when the emotion doesn’t fit the facts, or when acting on the emotion will be ineffective.

Hmm. Interesting.

She told me that another skill I could try is “Self-Soothing”. Just let myself sit with the emotion, and maybe have a hot cup of tea, or another “self-soothing” tip that would be taking care of myself. When she said that I immediately felt resistance. I didn’t want to sit with the emotion. It was already making me feel uncomfortable. I didn’t want to sit and have a cup of tea with it. But she did make a good point. I hadn’t realized until she said it that I was actually mis-using the skills. I was using them to avoid feeling anything.

When she told me that there were a few skills I could mix and match with to get through this, I felt relieved. She told me I could try self-soothing for a bit, and then maybe do Opposite Action, and come back and do self-soothing, or distraction, or the TIP skills. I suddenly felt like maybe I could do this.

I was honest with her that I didn’t want to sit with the emotion because I was afraid it would take me over and take me down. She understood, and that was why she suggested maybe just trying the self-soothe and see how it goes. And then maybe try a different skill like Distraction or even Opposite Action after. I felt a little more in control by the time we said good bye.

And when I got off the phone, I felt afraid. I was still concerned that self-soothing would turn bad, and without another thought, before I could do anything else, I started crying. My throat ached and my chest tightened and the tears fell. I almost tried to stop it but instead I decided to just see what happens. I felt comforted knowing I could call her back if i needed to, and so I just let the tears fall.

I don’t know how long I cried for, it felt like only 5 or 10 minutes but then the tears slowly stopped and the ache in my throat eased. I don’t know why I cried. I tried to think of what was making me sad but it didn’t come to me. It felt just out of reach but whatever it was it made me cry. How it didn’t occur to me that it really didn’t matter what the cause was, I don’t know. Because all that I know is that I was sad, and so I cried.

And I hadn’t even had the chance to plug in the kettle.

But you know what? I felt a little better. Don’t get me wrong, I still felt sad, and I still felt a little low, but I also felt like I would be okay for now. I felt like now I could go out. Now I wanted to go out, not as Opposite Action but because I wanted to go out. I don’t know if when I get out I may want to turn around and come back home. I may come back home and have the sadness still sitting there waiting for me, but in those few minutes of crying I had at least released some of the pressure.

When I had asked my DBT coach/therapist about picking apart the sadness to see why I was feeling the way I did, I thought it would help. She said that even if I picked it apart I would still feel sad. And sometimes it’s not about the why, sometimes it’s about what is right in front of you that needs to be addressed. Instead of trying to sort out the why, why not try just dealing with the tears pooling in my eyes, and making my throat hurt. Why not let the moment just do what it needs to, and then we’ll see about picking it apart.

It was a surprising moment. I’m not used to this. I’m not used to letting the moment be and not picking everything apart to understand why. I’m not used to just letting myself cry without knowing why. I needed a reason to cry, didn’t I? I needed a reason to justify my tears, didn’t I?

Apparently not. Because I did cry, and I don’t know why, and for the moment, I feel better.

I guess sometimes it’s better to not know why. Sometimes the sadness just needs a release, and the only thing to do is release it. I hope I remember that the next time.

Thank you to my DBT coach/therapist, for being there, and for showing me that I actually already knew what I needed to do.

DBT Group: Week Eight – Part III – Taking Care of Your Mind by Taking Care of Your Body

Module: Emotion Regulation

This is the third of three parts for Week Eight.
Covering the P.L.E.A.S.E. Skills (Treating PhysicaL illness, Balanced Eating, Avoid Mood-Altering Substances, Balanced Sleep, and Get Exercise.

The first two parts of Week Eight covered the ABC Skills, (B) Building Mastery (click here for post), and (C) Coping Ahead (click here for post).
Week Seven was split into two parts as well for (A) Accumulating Positive Emotions – Short Term (click here for post) & (A) Accumulating Positive Emotions – Long Term (click here for post).
I think each of these skills deserves its own post in order to more fully explore how important these skills are towards managing our emotions, helping us to reduce vulnerability, and towards living a more fulfilled, positive life 

Homework Take-Up:
Handout:
Emotion Regulation Handout 20 – Taking Care of Your Mind by Taking Care of Your Body
Worksheet:
Emotion Regulation Worksheet 14 – Practicing PLEASE Skills

Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
(A) – Accumulating Positive Emotions
– Short Term
– Long Term
(B) – Building Mastery and a sense of competence
(C) – Coping Ahead to better manage emotional situations
(P.L.E.A.S.E. – Treating PhysicaL Illness, Avoid Mood-Altering Substances, Balanced Eating, Balanced Sleep, Get Exercise) – Taking care of your health and well-being physically deserves as much attention as taking care of your mental health and well-being

Starting with:
Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
Fourth Box (Overview): (P.L.E.A.S.E. – Treating PhysicaL Illness, Balanced Eating, Avoid Mood-Altering Substances, Balanced Sleep, and Get Exercise)
Moving to:
Emotion Regulation Handout 20 – Taking Care of Your Mind by Taking Care of Your Body

When taking care of your mind and emotions it can become all-consuming, and we often forget or neglect taking care of our bodies. We don’t realize how important taking care of our physical health is just as important as taking care of our mental and emotional health.

It might seem like a no-brainer to some, but I can personally attest to not realizing how much gets affected mentally and emotionally when I falter on taking care of myself physically.

For me, I get so lost in my mental health and trying to get my emotions in control, that my physical well-being often is almost completely neglected, or I do a half-ass job. One thing greatly affects the other; my lack of physical self-care brings down my mental and emotional health, and my trying to take care of things mentally and emotionally means my physical self-care takes a backseat.

For example, it was a long time before I realized that when I don’t sleep well, it has a significant impact on my anxiety, and I am much more susceptible to panic attacks.

The P.L.E.A.S.E. Skills cover the basics of taking care of your physical well-being.

PL – Treating PhysicaL Illness
If you are unwell, and are not taking care of yourself, your moods can be greatly affected. Whether you’re suffering with a cold, or managing a chronic condition like diabetes or arthritis, if you don’t take care this can lead to a higher susceptibility to having extreme emotions, or a faster breakdown in not being able to properly use your skills.

E – Balanced Eating
It’s extremely important to watch what you eat, when you eat, and even how you eat, particularly if food is a sensitive issue for you due to disorder, or if food is linked to other conditions like diabetes or IBS, or even inflammation in the body. When we skip meals and don’t eat regularly we can become moody, grumpy, more likely to snap at other people, and have much less patience with ourselves.

A – Avoid Mood-Altering Substances
Avoiding illicit drugs, and alcohol is especially important in being able to keep our emotions more manageable and our ability to cope with them. Mood-Altering Substances can keep us in Emotion Mind, it can lead to poor choices, and lower our inhibitions that can keep us safe.

S – Balanced Sleep
Getting enough rest is extremely important as well. Not sleeping well or enough can lead to a further reduction in maintaining any of the other areas of physicality that help us stay healthy in our bodies as well as our minds. It’s best to go to sleep at the same time every night, and wake up at the same time every day, getting however many number of hours that you personally require. Even one night of restless sleep can negatively impact us and lead to a snowball effect where our bodies then have difficulty with eating balanced meals, if at all, whether we turn to mood-altering substances to compensate for our lack of proper sleep, whether we manage any chronic conditions we may have, and ultimately lead to our emotions and mental capabilities suffering as well.

E – Get Exercise
Exercise is important because when our bodies are in good health this can help us with any chronic conditions we need to manage, but also exercise, when our heart rates are increased, releases endorphins. Which can help with our moods, and even help alleviate some of the symptoms of depression.

Any of these things on their own is important to take care of when we take care of ourselves but altogether taking care of our physical well-being allows us to be at our optimum level to tackling the day before us, up to and including, how we handle our emotions, or not.

Take care everyone!

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 Eight – Part II – Coping Ahead

Module: Emotion Regulation

This is the second of three parts for Week Eight. Covering the ABC Skills, (B) Building Mastery, and (C) Coping Ahead.
This post covers (C) Coping Ahead.
The first one, (A) Accumulating Positive Emotions: Short Term (click here for post) and Long Term (click here for post). The second one (B) Building Mastery, click here.
And the third post will be the P.L.E.A.S.E. Skills (Treating PhysicaL illness, Balanced Eating, Avoid Mood-Altering Substances, Balanced Sleep, and Get Exercise.

I think each of these skills deserves its own post in order to more fully explore how important these skills are towards managing our emotions, helping us to reduce vulnerability, and towards living a more fulfilled, positive life.

Homework Take-Up:
Handout:
Emotion Regulation Handout 19 – Build Mastery and Cope Ahead
Worksheet:
Emotion Regulation Worksheet 12 – Build Mastery and Cope Ahead

Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
(A) – Accumulating Positive Emotions
– Short Term
– Long Term
(B) – Building Mastery and a sense of competence
(C) – Coping Ahead to better manage emotional situations
(P.L.E.A.S.E. – Treating PhysicaL Illness, Avoid Mood-Altering Substances, Balanced Eating, Balanced Sleep, Get Exercise) – Taking care of your health and well-being physically deserves as much attention as taking care of your mental health and well-being

Starting with:
Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
Third Box (Overview): (C) Coping Ahead
Moving to:
Emotion Regulation Handout 16 – Build Mastery and Cope Ahead

This piece is important because we often find ourselves in highly emotional situations and we get overwhelmed, and we either don’t know how to handle it, or we turn to our tried and true ways of coping. Which is usually negative, destructive ways.

Doing what we can to cope ahead gives us space and time to breathe, and find a more effective way to cope and handle the situation.

Obviously, there is no way for us to see the future and know exactly what situation will come our way and exactly what emotion we’ll respond with.

Coping ahead isn’t about trying to guess the future. It’s about knowing ourselves, and the typical ways in which we have been triggered in the past. It’s about recognizing and recalling certain situations that have led us to feeling hopeless or helpless, or what has led us to our destructive coping mechanisms.

There are patterns to our behaviours and reactions, that we can use to our advantage. We can use the patterns from our past to try and cope ahead for when we encounter the same situation again at a later date. It is by no means foolproof, and what may work one time may not work for another time, but there are times when it can help us, and when it does, it can feel like a lifesaver.

For example: For a long time I was having panic attacks whenever I was in a store. It didn’t matter which store, or whether it was day or night, or if it was busy or quiet (although busier stores did make it worse), and it didn’t matter if I was shopping alone or with someone, I would have a panic attack.

Inevitably, within 15 minutes of being in the store, sometimes less, I would suddenly feel a rush of panic through my body. And I always knew what it meant. The moment it hit me. My heart would race, my hands would get cold, I would hold my breath, and I would feel lightheaded. I was certain I would pass out. I would have to stop in my tracks, wherever I was, and either place a hand on a shelf or a rack or a post, something that would give me a sense of grounding. Something that would help me to feel more stable, and less like the world was tilted.

I would suddenly have tunnel vision, and I would need to focus on something fixed ahead of me. It didn’t matter what it was, a product on a shelf, a tile on the floor, as long as it didn’t move I would zone in on it. Between holding my breath, holding a shelf (or post, or rack), and focusing on one spot before me I felt that this would ground me. I believed that as long as I wasn’t moving, and what I focused on wasn’t moving, then I was stable, and I was safe. I believed this would make the panic subside and I would feel okay. It was almost like staying still meant that nothing bad could happen.

Unfortunately, this was not true. In fact, just the opposite would happen. From holding my breath, I would exacerbate the feeling of lightheadedness, and my urge to run and hide grew stronger by the second. Because I was too afraid to move it wouldn’t be long before it would inevitably turn into a full blown panic attack. I feel like I am going to die, and somehow I need to inch my way out of the store to safety, which would mean a quiet corner or some quiet, secluded spot where I could gather my thoughts and calm down. I would often leave the store without purchasing anything. And it would take me longer than normal to get home as well because I would still feel a sense of tunnel vision.

This became quite debilitating for me because it was so indiscriminate for when it would happen, or if it would happen at all, and how intense it would be. I never knew what store I could go into a be okay, and which stores would set me off. I was relegated to try and get what I needed as fast as I could, or I ended up not going out at all. The idea of going out started to become a terrifying thought, and eventually I would start to feel the panic attack just at the thought of going out. It took a fair amount of time, and progressive exposure with my psychiatrist, that I was finally able to reduce the panic attacks I had in stores. Now I feel a lot more confident going out. I still sometimes have panic attacks but I also have ways to cope with it now too.

This is where the coping ahead comes in.

I would like to say that I am able to breathe or visualize my way through going out and having a panic attack but unfortunately I often need more than just mind control to help me through. I need to find other ways to cope ahead. What I use to help me is a distress tolerance kit I put together for myself. Those of you who have been to BPD support groups, or DBT support groups, will be familiar with the distress tolerance tools. They are usually baskets or buckets that include ice packs, toys like slinkys or squeeze balls, rocks, or blocks, scented hand lotions, puzzle toys, and even Play-Doh. It’s a wide variety of textures and distractions. These toys and tools are used to help reduce anxiety when it starts to feel overwhelming. They can either distract, soothe, or otherwise reduce the feeling of anxiety.

What you may take from the basket or bucket is entirely up to you and whatever can help you reduce your anxiety. It could be the ice pack that works to distract you as you focus on the cold, and when used at the right time can even shock your system into stopping a panic attack from happening in the first place. Or you may want to fidget with the slinky or a rubik’s cube, or a squishy ball, sometimes it takes a few tries with different textures or toys to learn what helps you calm down, or feel less anxious.

Knowing what works for me, I built my own distress tolerance kit. I hit a dollar store and got a small pouch and filled it with a few toys, like a slinky and a puzzle block, and a rubik’s cube, and I carry my distress tolerance pouch with me in my backpack so it’s there whenever I start to feel anxious. Ice packs and walking are the most effective ways for me to ease a panic attack but having an ice pack handy, or cold water to splash on my face, or going for a walk, are not always options I can use. Like when I’m on the bus or subway. So I have my little distress kit I can turn to. I’ll admit that sometimes it doesn’t help, and I end up having a panic attack, but it helps more than it doesn’t.

This is one strategy I use to cope ahead.

Another way that use to cope ahead is when I know I’m going to be in a situation that has previously triggered me, for example, sometimes when I’m with my brother, and he gets angry at something, I know that there is a possibility that will trigger me. It doesn’t always happen, and when he gets angry, it doesn’t even have to be directed at me, but I know that if it happens, it will trigger me into an emotional state of fear. It’s happened to me enough in the past that I know what signs to look for in my brother, as well as in myself.

By going through the situation in my mind, and considering how I will most likely respond, I can plan ahead to either minimize my response, cope with whatever does come up, or maybe even avoid the emotional response altogether.

First, I need to imagine the situation in as much detail as I can, and what my most likely response will be. I need to consider of there might be obstacles or factors that may interfere with being able to use my skills. For example, if we are out when his anger triggers me, I’ll most likely respond differently than if we were at my place or his. If we are out then I can walk away and let him cool down, or I can go home. If he’s at my place, I can leave the room, but it might be harder to really remove myself from the situation.

I’ll need to adapt or adjust as the situation calls for it, depending on where I am, and how I get triggered, and how intense the triggering becomes for me.

For example, if I’m already feeling vulnerable because of my own mood, and there are some vulnerability factors, like I didn’t sleep well, or I’m not feeling well, I will most likely respond with much more sensitivity than if I didn’t have the vulnerability factors or other obstacles preventing me from being as skillful as I could be.

By imagining how I might respond I can also think ahead of other ways I can cope. I can prepare myself however I need to so that I can handle the situation and minimize how much I am affected. I can plan what I could maybe say to him, let him know that his anger is affecting me, or I could try to say or do something that reduces his anger, although the focus should be on myself and reducing my heightened emotional state. Another way I could handle if I am feeling fear because of his anger is to just walk away, and completely remove myself from the situation. This would give him an opportunity to cool down but it also allows me to ease my own heightened emotional state.

Finding ways to cope ahead for situations that we have been in before, and most likely will be in again, can be a lot of trial and error in finding what works. I highly suggest thinking of as many way as possible to cope ahead with a situation you may be triggered by because it’s hard to say what will work when, and having as many options as possible allows for a much better chance to have some control over the situation and your emotions.

This is the chance to use our past to our advantage. By being familiar with what triggers us, we can prepare for what may happen, and reduce our emotional responses, and actually stand a chance of dealing with the situation and moving past it.

Good luck!

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 Eight – Part I – Building Mastery

Module: Emotion Regulation

I’m going to split Week Eight into three parts because what we covered was the remaining two of the ABC Skills, (B) Building Mastery, and (C) Coping Ahead. The first one, (A) Accumulating Positive Emotions: Short Term (click here for post) and Long Term (click here for post). And the P.L.E.A.S.E. Skills (Treating PhysicaL illness, Balanced Eating, Avoid Mood-Altering Substances, Balanced Sleep, and Get Exercise.

I think each of these skills deserves its own post in order to more fully explore how important these skills are towards managing our emotions, helping us to reduce vulnerability, and towards living a more fulfilled, positive life.

Homework Take-Up:
Handout:
Emotion Regulation Handout 19 – Build Mastery and Cope Ahead
Worksheet:
Emotion Regulation Worksheet 12 – Build Mastery and Cope Ahead

Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
(A) – Accumulating Positive Emotions
– Short Term
– Long Term
(B) – Building Mastery and a sense of competence
(C) – Coping Ahead to better manage emotional situations
(P.L.E.A.S.E. – Treating PhysicaL Illness, Avoid Mood-Altering Substances, Balanced Eating, Balanced Sleep, Get Exercise) – Taking care of your health and well-being physically deserves as much attention as taking care of your mental health and well-being

Starting with:
Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
Second Box (Overview): (B) Build Mastery
Moving to:
Emotion Regulation Handout 16 – Build Mastery and Cope Ahead

Building Mastery is something that at first I didn’t quite understand what it meant, or how it would apply to DBT. I had equated mastering something to a skill like learning how to play the piano, or learning a language, but with DBT Skills, how do you “build mastery”?

As it turns out, when learning DBT, you are learning skills, and as a skill they require mastering just as much as any other skill would. Some of the things you may work towards building mastery could be easier things in your life, like flossing every time you brush your teeth, or building mastery to a eating more balanced meals, or it could be something a little more complex like how you handle relationships, or how you can work towards a goal.

Regardless of what you choose, building mastery means doing something every day that helps you move towards mastery. It’s probably best to start with something small, if anything, to get into the habit of building mastery.

I actually did choose, as a small one that was realistic, flossing when I brush my teeth every day, because it’s something I know I need to do, and it’s something that is relatively easy to track and work towards. I know it seems odd to work towards “mastering” flossing, but sometimes even the small stuff can be hard to keep up when you’re depressed or struggling with a disorder.

I personally drop the ball on everything from sleep, to food, to medicine, to flossing, to the bigger stuff, like bills, and the house. It’s all stuff that falls to the side when I’m in the midst of a depression, or when my BPD is particularly prominent.

I am getting much better at the few things I’ve now started to work on mastering, like flossing, eating more balanced meals, and my sleep, but then I wanted to work on something internal, like the accepting myself and others as they are. And I got confused again, how do you “master” something you can’t really see or touch? I can track if I’m flossing, but how do I track becoming more accepting?

I was so confused with how to start this that I enlisted my DBT coach/therapist for some help. This also finally helped me get a head start on the goal in my Values and Priorities.

Here’s how she helped me break it down.

I am going to start with the acceptance of myself, and then work on extending that to others. What she first asked me was when I think of accepting myself, what thoughts, judgments, or assumptions come to mind?

What expectations do I have of myself?

In no particular order, here are some of my personal expectations:
– I expect myself not to make mistakes
– I expect that on any given task, that I am to do it correctly the first time
– I expect myself to understand and new skills or instructions completely on the first try, without having to ask for clarification or help
– I expect that any task I am given, if I cannot complete it successfully on the first try, then I won’t start it to begin with, or I will procrastinate until I can figure it out
– I expect that people expect me to do things right the first time
– I expect people will see my failings and will not understand or accept me because of them
– I expect people to not like me because I am not worthy
– I expect to be picked last, if I am picked it all
– I expect to fail at any task I am given because I believe I am not good enough

These are just a few of the expectations that I have of myself.

When I see them written down like that it really hits home to me how unrealistic they are. It’s no wonder I don’t even meet my own expectations. They are astronomically rigid. I don’t allow myself any room for learning or making mistakes, or that’s even okay to make mistakes. Yikes.

From these expectations, are the judgments and assumptions that follow:
– I am not good enough
– I am a failure
– No one likes me
– I can’t do this
– I’m not good enough to do this
– I am unworthy
– I am unlikable
– I am unlovable

And I feel for myself, that when I fall short of my expectations that is is “unacceptable”. That I am “unacceptable. I need to do better, and be better, no exceptions. Anything less is totally unacceptable.

What my DBT coach/therapist then said to me was to challenge those judgments and assumptions, and to challenge the expectations I have of myself.

Part of challenging the judgments and assumptions goes back to a favourite of mine, and “checking the facts”.

Judgment/Assumption: I am not good enough.
Challenge: This is a blanket statement that I use when I am unsure of myself or when I feel that I am failing.
Further Challenge: When I feel that I am failing, is that an accurate statement? Am I actually failing or am I struggling to learn or achieve something? Does trying to learn something, does this automatically mean that I have failed?
Reframing Judgment/Assumption:
– It’s okay to make mistakes
– I’m okay to make mistakes
– It’s okay to not know everything, no one does
– It’s okay to ask for help
– Not everything has to be perfect
– Accept the dialectical truth that I am doing the best that I can and I can do better

All of this is working towards building mastery at being more accepting.

The steps to building mastery are not always easy to define or see. When I was working on building mastery to more balanced eating, I started by working out the stuff that was okay for me to have, then I started to plan meals, write out grocery lists, and even did some prep work for my meals and snacks so that I couldn’t use the excuse that I didn’t have time to make something. It still takes me time to get myself organized, and some weeks I am way more successful than others. I try not to consider myself a failure on the weeks that it doesn’t go so well but it’s hard. Some weeks I just go one meal at a time so I don’t get too overwhelmed and think I’m just a failure and should just give up. That’s hard too.

When you’re trying to master something, like being more accepting that’s not tangible or something I can track. It can be difficult to figure out how to do it. For those of you in DBT, I suggest enlisting support from your DBT coach or therapist. If you’re learning DBT on your own and have a psychiatrist or therapist then ask them for some help. You can always search online too, there are some good BPD sites and blogs that can help you challenge some of your own judgments and assumptions.

Theoretically you could be trying to build mastery on a number of things at once but I would suggest starting with just one or two things that are smaller and more realistic. It helps to work towards bigger stuff when you’ve got smaller stuff working for you. I suggest starting with things you can track too because it works as a great motivator to moving forward, and then building mastery on stuff that isn’t able to be tracked.

The purpose of building mastery is to have a sense of control over your life, and to also have some ground beneath you that helps to reduce your vulnerabilities, allowing you to better manage your emotions and situations where high emotions are triggered.

It seems so simple and almost too easy but it’s actually somewhat difficult to do. It’s simple but not easy. It might feel like a no-brainer that you should eat right, get a good night’s sleep, or be patient with yourself, but when most of your life those things have been chaos personified where food, sleep, emotions, etc have been all over the place, with one thing contributing to the next pulling it all down into a vicious cycle where nothing is regulated and you end up stuck in a bundle of emotions. It can be hard to reign all that stuff in and actually start paying attention as well as taking care.

I am starting to build mastery with a few things:
– regulating my sleep
– regulating my eating
– trying to be more accepting of myself and others

It’s hard work, believe it or not, to build mastery for almost anything that isn’t already a part of your day, or rather I should say a part of my day. But I’m working on it.

Wish me luck!

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 Seven – Part II – Accumulating Positive Emotions – Long Term

Module: Emotion Regulation

I’m going to split Week Seven into two parts because what we covered was the ABC Skills, and the first one, (A) Accumulating Positive Emotions: Short Term and Long Term, and I think each of these deserves its own post in order to more fully explore how important short term positive emotions and long term positive emotions are in helping us to reduce vulnerability, and towards living a more fulfilled, positive life.

Homework Take-Up:
Handout:
Emotion Regulation Handout 15 – Accumulating Positive Emotions: Long Term
Handout Reference:
Emotion Regulation Handout 18 – Values and Priorities List (3 pgs)
Worksheet:
Emotion Regulation Worksheet 11A – Getting from Values to Specific Action Steps

Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
(A) – Accumulating Positive Emotions
– Short Term
– Long Term
(B) – Building Mastery and a sense of competence
(C) – Coping Ahead to better manage emotional situations
(P.L.E.A.S.E. – Treating Physical Illness, Avoid Mood-Altering Substances, Balanced Eating, Balanced Sleep, Get Exercise) – Taking care of your health and well-being physically deserves as much attention as taking care of your mental health and well-being

Starting with:
Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
First Box (Overview): (A) Accumulate Positive Emotions – Long Term
Moving to:
Emotion Regulation Handout 17 – Accumulating Positive Emotions: Long Term
Emotion Regulation Handout 16 – Values and Priorities List (3 pgs)

In addition to doing what I can to accumulate positive emotions in my day-to-day life, I also need to consider long-term positivity, and building a life that I can be proud of, and feel good about.

I would have to figure out what are my goals? What are my values? What are my priorities? What do I want out of life? What do I want from life? What kind of person do I want to be? What kind of life do I want?

Starting with figuring out what is important to me? What are my values and priorities?

I was actually surprised to find out that I actually didn’t know what my values are, or my priorities. I have a pretty good idea of what my morals are but to actually name them, and identify values and priorities having the list helped.

Emotion Regulation Handout 18 – Values and Priorities List (3 pgs)
This list covers a wide variety of values and priorities, some may apply to you, some may not. There are 14 man Values/Priorities with either a few or several goals within each of the Values/Priorities.

These are goals that you would strive for in living a fulfilling and balanced life based on what is important to you. Some of these you may already be practicing, some may need work, and some may require lifelong effort.

Of the 14, there was something in each of them that I connected with. The one that stuck out for me the most was the last one on the list – Have Integrity.

Have Integrity
– be honest, acknowledge and stand up for my personal belief
– be a responsible person, keep my word to others
– be courageous in facing and living life
– be a person who pays debts to others and repair damage I have caused
– be accepting of myself, and others, and life as it is; live without resentment

This one really resonates with me for several reasons; being honest with myself and others is hard for me. Not because I like or prefer to lie, but I am not always honest about how I feel or what I want. I tell myself that no one wants to hear about my problems. I tell myself that people won’t understand, or want to. I worry that they might reject me if I show them who I really am.

Standing up for my personal beliefs is something I struggle with, and have for a long time. I worry that my opinion won’t matter, or might be mocked, or rejected. I stay silent and figure that is the safest thing to do. I need to learn that my opinion matters just as much as anyone else’s. I just don’t believe that. yet.

I am pretty responsible and for the most part I keep my word. Generally the only one I let down, when it comes to keeping my word, is me.

Being courageous in facing and living life; I am terrified of this one. That’s how I know it’s important to me. I am not very courageous. I actually used to believe that I was fearless but the truth is, I’m not. I’m not even close. I’m not sure where I ever got the idea that I was fearless because life has scared me in so many ways for so long that I am fearful. I want to be courageous.

I want to be brave and do the things that I want to do, even if I’m afraid, I want to try anyway. I want to try, so badly, but I am afraid. I am always afraid. Terrified, actually. Life scares the crap out of me. I know that’s no way to live but I can’t help it. I am so terrified of rejection and failure that it paralyzes me from doing a lot of things, most things, in fact. No matter what it is, I imagine a spectacular failure and rejection that only proves what I already believe of myself and then I’ll wonder why the hell I even tried in the first place. Whether it’s new things I want to try, tasks or project ideas I have, or things I would like to be a part of, I imagine the failure and rejection, and instead I just stay right where I am.
I need to work on this one a lot.

I pay my debts, and will do what I can to repair any damage I have done. My BPD sees to that, thank you very much.

The last one, accepting myself, and others as they are; to live without resentment. This is a BIG one for me too. I don’t accept myself as I am. I forever believe that who I am is fundamentally flawed and broken. I feel that I need to do more, and be more. I feel that I need to do better, and be better, and until I do, I am unacceptable.

I have no idea what the precedent is that I must meet, I just know that I have to meet it, and until I do, I am unworthy, and unable to accept myself as I am.

As much as I hate to admit this, I also don’t accept others as they are. I have a standard or expectation of others, to be honest they are ridiculously arbitrary expectations, of which I have no idea where they came from. But I hold people to a certain standard, that they are never made aware of, and I fully expect them to meet this standard. If they happen to fall short, I not only hold it against them, but I also let it affect how I perceive the, how I treat them, even to the point of questioning whether I stay in a friendship, or relationship with them. When they fall short of the standard I have for them, I am deeply critical of their shortcomings, it doesn’t matter if it’s a big or a small one, and the friendship or relationship is tainted until the equilibrium has been reinstated. The equilibrium is also an arbitrary point. And what might be okay for one to do to “make it up” to me, may not be the same for others. Every single friend and relationship I’ve had has been subject to this, and I have lost friends because of it.

I know that part of this is due to my BPD, but not all of it. The rest of it is my twisted, skewed perception of reality and other people. Either way, it’s a problem that I need to work on. I don’t want to hold anyone, including myself, to some arbitrary expectations, of how they, or I should be.

The homework was to pick one of the values, and one of the goals within it to work on. I had a hard time picking one goal I really wanted to be honest, acknowledge and stand up for my personal beliefs, but I also really wanted to be courageous in facing life, but then I also really wanted to be accepting myself, and others. How do I choose? They all felt important. I needed to work on each of them but I knew it would have to be one at a time.

If I’m honest (see? I need to work on it.) the one that I knew I should start with was the one I hated the most about myself, and would probably be the hardest – be accepting of myself, and others as they are.

So that’s the one I chose.

In order to work on this I needed to identify ‘ACTION STEPS’ that would move me closer to my goal. The only problem I had was how to go about it. How, pray tell, do I take “action” to accept myself, or others? I had no idea how to do this. How does one become more accepting? What actions could I take to be more accepting?

I asked the group for help with this one, and it was suggested to me that I take it up in my individual therapy. I had nothing, and it seemed so did they. I have yet to fully explore this one in individual therapy yet because we’ve been working on other things.

I’d like to tell you I was able to figure this one out on my own but to date I haven’t been able to.

If anyone out there has any suggestions, please feel free to share.

This was the first time I was unable to complete my homework, and in true BPD form of all or nothing, I felt like I had failed. I still do because I haven’t figured it out yet.

That was the first of the last two steps, the first was to identify the “ACTION STEP”, and then the second was to act on it, and describe what you did.

This Worksheet can and should be used when working towards any of the goals that you may check off, one at a time, of course.

I am tempted to move to another goal that I can take action towards but my stubbornness and a little of my BPD won’t let me leave this undone, and move onto something else.

Moving on here though…for the sake of ending the post and getting to the next one, this one will have to wait to be resolved.

The second half of the group, the lesson was about the (B) and (C) of the ABC Skills, and the P.L.E.A.S.E. Skills.
(B) – Building Mastery
(C) – Coping Ahead
(P.L.E.A.S.E.) – Treating PhysicaL Illness, Balanced Eating, Avoid Mood-Altering Substances, Balanced Sleep, and Get Exercise

The P.L.E.A.S.E. acronym feels like a stretch, but it actually does work in helping to remember.

This is what I like to call Marsha Linehan’s Alphabet Soup. As anyone who knows DBT is aware of what a HUGE fan Ms. Linehan is of the acronym.

That’s it for now!

See ya next time!

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

 

DBT Group: Week Seven – Part I – Accumulating Positive Emotions – Short Term

Module: Emotion Regulation

I’m going to split Week Seven into two parts because what we covered was the ABC Skills, and the first one, (A) Accumulating Positive Emotions: Short Term and Long Term, and I think each of these deserves its own post in order to more fully explore how important short term positive emotions and long term positive emotions are in helping us to reduce vulnerability, and towards living a more fulfilled, positive life.

Homework Take-Up:
Handout:
Emotion Regulation Handout 15 – Accumulating Positive Emotions: Short Term
Handout Reference:
Emotion Regulation Handout 16 – Pleasant Events List (3 pgs)
Worksheet:
Emotion Regulation Worksheet 10 – Pleasant Events Diary

Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
(A) – Accumulating Positive Emotions
          – Short Term
           – Long Term
(B) – Building Mastery and a sense of competence
(C) – Coping Ahead to better manage emotional situations
(P.L.E.A.S.E. – Treating Physical Illness, Avoid Mood-Altering Substances, Balanced Eating, Balanced Sleep, Get Exercise) – Taking care of your health and well-being physically deserves as much attention as taking care of your mental health and well-being

Starting with:
Emotion Regulation Handout 14 – Overview: Reducing Vulnerability to Emotion Mind – Building a Life Worth Living
First Box (Overview): (A) Accumulate Positive Emotions – Short Term
Moving to:
Emotion Regulation Handout 15 – Accumulating Positive Emotions: Short Term
Emotion Regulation Handout 16 – Pleasant Events List (3 
pgs)

As someone suffering with a personality disorder, among other issues, I am exceptionally familiar with negative emotions and negative experiences. Even some things that others might not find negative or overwhelming, including positive emotions and experiences, I can quickly become overwhelmed, frustrated, and suddenly it’s no longer a positive emotion or experience.

I’m sure my fellow Borderliners will understand what I mean.

Despite the struggles that any emotion can give me, or almost anyone suffering with a disorder, it is vitally important to make sure the positive emotions and experiences are not lost in the chaos.

Part of learning to manage emotions means creating, recognizing, and appreciating positive ones, and giving them just as much attention as we do to the negative ones.

It’s not an easy thing to do for some with BPD. I personally, tend to gloss over positive emotions a lot. In part because I often just don’t know what to do with them positive emotions or experiences, but also because I’m so used to negatives emotions and experiences, that I fear the positive ones will either be taken away or suppressed by a negative emotion.

An example of this would be when I feel proud of completing a task and instead of letting myself feel the pride, and acknowledge that I did something well. I will almost immediately feel guilt, fear, or shame, or all three. I’ll feel guilty for feeling proud when it was just some simple task. I’ll also feel shame that I was proud over such a simple task, but also because there are so many other tasks I haven’t completed. And then finally there is fear. The fear has two levels, one is the fear that someone will tell me that I am wrong to feel so proud, and the other is that the good feeling won’t last, something, or someone will just take it away. Usually it’s the shame and guilt that crap all over it, take it away. So I do it to myself, but I can’t help it. I feel like if I do it first, it will hurt less if someone else tries to take it away. It’s so ingrained in me that I actually often fear happiness or positive experiences for the reasons I listed above.

Having positive experiences and positive emotions is very important to have though because a life filled with only negativity can take up so much space in our minds and our lives, leading to depression, frustration, hopelessness, and anxiety. And frankly, it’s exhausting, to always be dealing with negativity, and feeling hopeless and helpless, and defeated.

The thing is, in the beginning of working with DBT and trying to heal from BPD, you actually have to work on building positive emotions. I know it seems like an odd thing to do but typically those with BPD, are so focused on negative experiences and negative emotions, that the positive emotions get lost in the chaos, if they even make it to our minds at all.

For me, it was surprisingly hard. I didn’t think having positive experiences would be so hard, but it was. First just choosing what positive experience, or “pleasant event” to do was hard. How do I find something to do that I find pleasant AND I can fit into my day, as naturally as possible? Then once I found ones that seemed doable, actually following through and doing it was an entirely different story.

Emotion Regulation Handout 16 – Pleasant Events List (3 pgs)
There are 225 items on this list, all considered to be pleasant activities or experiences. Of course, it’s all highly subjective, and I doubt there’s anyone that would enjoy all 225 of them. The list covers a wide range of interests, hobbies, and experiences; from hiking and playing team sports, to collecting and shopping, to working on cars or visiting museums. The list is pretty extensive and I think most people would be able to find several things that they would enjoy doing. Plus you can add your own.

I found about 75 things that I enjoy doing or would like to try. My next step was to do them. But every time I went through the list I had created, I found reasons not to do them; I had no money, or I didn’t have the time, or I didn’t want to go alone, or I was too afraid to try it, or it was something I couldn’t do because of where I lived, like being in the city, and wanting to go fishing.

Truthfully, the ideas seemed too small to even matter, or make any kind of difference, like reading a newspaper, or they were too big, like going on a vacation, or too new and difficult, like learning how to play the piano, or too scary, like joining a book club.

But the DBT facilitators insisted that I find at least a few things to do, even if they are all small, and do my best to fit them into my day over the next week.

So what I did was pick seven small, easy things, and schedule them into my week. I scheduled them in so that I would purposely make the time and I wouldn’t forget. It was surprising how easy it was to forget to do something pleasant. That’s how unnatural this was for me.

I ended up doing four of the seven things. I was proud that I at least tried, and out of seven, I did more than half. Taking time out of my day and doing something that I enjoyed, just for me, and doing it wholeheartedly, and mindfully; no multi-tasking, or cutting corners, I did it for me, all the way.

I gotta say, it was nice. It was nice to spend time doing something that I enjoyed for the sole purpose that I enjoyed doing it. I was pleased, and it actually helped my mood. There was, unfortunately, a downside to doing pleasant events, and that was maintaining it. Doing pleasant activities for myself every week, even if it’s only one or two, was actually really, really, hard for me.

It seemed like the negative stuff had no problems showing up and taking over my day, but the positive stuff actually takes work. What’s up with that? That seems unbalanced and unfair. Although, to be fair, I can’t say that if I didn’t plan it, nothing pleasant ever happened, but between the number of negative emotions and experiences and positive emotions and experiences, the positive ones definitely required more work.

I really hadn’t anticipated this being an issue. I thought fitting in positive experiences would be easy as hell, but it wasn’t. It was hard. In fact, it still is hard. Every week since this homework was assigned I’ve had to make an effort to have at least one positive experience at some point during the week. And I am sorry to say that sometimes I have fallen short, and I don’t do it. My biggest is obstacle is me and my mood.

There have been a number of times where I just didn’t feel like it. I don’t feel like doing something positive. I feel blue or disinterested. I try to do it as Opposite Action, and a couple of times it worked but not every time. It’s just so hard. But I know it needs to be done for me to take care of myself.

I think that’s part of my problem actually, sometimes I don’t feel worthy of taking care of myself. Sometimes I think, what’s the point? Does it really matter? The answer to that is, yes it does matter. It does make a difference, and I really need to take care of myself in all aspects of my life, not just when it’s easy or convenient.

I still am working on it…

Next Post will be Week Seven – Part II – Accumulating Positive Emotions – Long Term

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