DBT Skills - Distress Tolerance

So week 3 in the DBT Skills Group dealt with distress tolerance. This couldn't come at a better time for me as I am going through some pretty distressing times. But all that will be the content of a separate post. For now, I will let you all in on what I learned - because, well, it also helps me remember it.

Distress tolerance skills teach us to:

• tolerate & survive painful situations when the situation cannot be changed at the moment
• how to survive intense emotions when we feel "triggered"
• decrease the suffering of the moment

PAIN + NON-ACCEPTANCE OF PAIN = SUFFERING

OVERVIEW OF THE DISTRESS TOLERANCE SKILLS

Crisis Survival Skills:

• distracting skills
• self-soothing skills
• improving the moment skills
• thinking of pros & cons of tolerating the moment

Radical Acceptance (accepting reality) Skills:

• learning how to "let go of fighting reality"
• teaches us to turn "intolerable suffering" into "tolerable pain"

CRISIS SURVIVAL SKILL #1: DISTRACTING SKILLS

"ACCEPT" is an acronym to help remember the distracting skills:

Activities: involving yourself in activities that change your focus. Any activity can by used as long as it does not further contribute to your distress or cause other problems. This activity should work to get your mind off the present situation rather than emphasize the current emotion.
Contributing: change your focus away from your emotions toward thinking about what you can do for others.
Comparisons/Count Your Blessings: think about how you successfully solved a problem in the past and utilize those strategies in this moment. Focus on the struggle of other & what they are doing to solve their problems. Focus on what you have or what you are grateful for.
Emotions: (generate opposite emotions) - observe the emotion and then "one-mindedly" involve yourself in an activity that will help you generate the opposite emotion. The opposite emotion produced should be at least the same intensity as the emotion causing the distress.
Pushing away: only used short term - walk away/leave the situation physically or block thoughts triggering the current distress from your mind. This skill allows you to block thoughts that create emotions of distress. You can store the problem away until you are ready to address it. this skill is not a permanent solution: the secret is not to overuse this skill and try using other skills before using trying pushing away.
Thoughts: Fill your head with other thoughts unrelated to the current situation and current distress. Distracting yourself with other thoughts can especially help if you can't get out of the situation.
other Sensations: create an intense physical sensation to focus on rather than a painful emotion or distress. Sensations can interfere with the physiological component of current negative emotion. Remember what you use is not to be harmful to the body or your person. (eg: holding an ice cube or intense exercise).

CRISIS SURVIVAL SKILL #2: SELF-SOOTHING SKILLS

Vision - light a candle & watch the flame; look at nature around you; watch your favourite movie; look at objects that remind us of beauty or that someone loves us

Hearing - listen to beautiful or soothing music; pay attention to sounds of nature; hum a soothing tune; be mindful of any sounds that come your way; letting sounds go in one ear and out the other.

Smell - light a scented candle; smell your favorite perfume or lotion; bake some cookies; carry some potpourri

Taste - have a good meal/ snack; have hot chocolate; have some ice cream; eat something you enjoy (using mindfulness)

Touch - take a bubble bath; pet your dog or cat; have a massage; put a cold compress on your forehead; hug someone; wrap up in a cozy blanket

CRISIS SURVIVAL SKILL #3: IMPROVE THE MOMENT

IMPROVE is an acronym to help remember skills for in the moment

Imagery (visualization) - you can create an experience different from the one you are currently experiencing. You can distract. soothe, bolster courage & confidence, make future rewards seem closer at hand.

Meaning - finding or cresting meaning has been researched and proven to have help people survive crises situations. Often people find it helpful to believe that their suffering has meaning even if they cannot find it in the moment.

Prayer - opening oneself up to the moment. A key point to remember is that praying is not saying "why me, why me?" or bargaining "if you take away this pain, I will do this." This is not accepting the moment. You can pray to God, Buddha, the universe, or whatever works for you. Ask for strength to bear the pain in this moment.

Relaxation - change how your physical body responds to stress and crises. It is your body responding to your mind. Example - a stressed out person often renses their body without consciously knowing they are doing it. it is as if our body is trained to respond to a situation. the goal is to accept reality with your body.

One Thing At A Time - focusing on one thing in the moment can be very helpful in the middle of a crises, it helps the overwhelming mind settle down. The secret of this skill is to remember that we only have to survive "just each moment".

Vacation - A DBT 'vacation' is to stop actively managing your life and either retreat into yourself or allow yourself to be taken care of for the moment. DBT vacations need to be brief, easy to come out of and will not harm yourself, others or make the problem worse.

Encouragement - Cheerleading statements. Speak to yourself as if you are talking to a good friend. Tell yourself what you would like someone else to say to you.

This is all we covered in week 3 of DBT skill group. The remainder of the Distress Tolerance Skills will be the subject of my next post.

Prepping for Highly Stressful Situations

So I got this meeting tomorrow with Child Services. I had an appointment with my DBT therapist this morning. She gave me some really great suggestions to prepare myself for this meeting. I just really hope I can follow through.

The case worker is a horrible, horrible woman that has mocked me and my struggle with BPD. She has caused such extreme emotion in me that I have dissociated.

My ex-husband is going to be at this meeting too. He absolutely hates me to an extreme. He twists the facts of a situation and his interpretations are lies. He feeds this shit to our daughter and she is helpless to his lies.

So I go to this meeting with these 3 people and I'm expected to keep it together. I'm smiling to myself just thinking about it. How the fuck am I supposed to keep it together??? Well this is what my therapist told me to do:

• Mindfulness - practice, practice practice. All day.
• Distraction - unpacking from my move. Be mindful whilst unpacking. Play with my dog, maybe do some training with her.
• Interpersonal effectiveness skills GIVE - be Gentle, act Interested, Validate, Easy manner
• Stick to the facts - avoid interpretations and judgments.
• Practice saying/speaking certain specific sentences/statements. "I would like to respond to that, if I may." "I understand that our previous interaction has been less than amicable but I would like to move forward." "You have to understand as a mother yourself, it is very difficult for myself to have no contact with my daughter. I love her, I'm concerned for her especially when I know she is being told untruths and I am not able to fill in the blanks of these untruths."

So please all pray for me, send me positive energy, or do whatever it is you do to wish someone the best of outcomes.

That is all for now.............

Scared Shitless - Major Anxiety Attack

So I'm at the court centre on Friday, chatting it all up with my lawyer when he informs me that there is a meeting with Child Protective Services on Wednesday the following week (it is in 2 days now). Those to be present are myself, my ex-husband, our 15 year old daughter and the case worker. It was made blatantly clear, in no uncertain terms, that counsel was not to be there. I started to panic. I kept telling my lawyer, Henry, that I could not go to that meeting alone. It would be like being put in front of a firing squad. The more I thought about it, the more I panicked. My body was so tensed up that I started to shake. I could not relax.
Now why would someone have a reaction as extreme as this to something as simple as a meeting with a few people. Well, let me tell you.
Jennifer Duncan, the child and family services case worker, is a heartless ice-queen bitch. Two previous meetings I've had with her ended in a major disaster. When I am in the midst of active distress tolerance skills, she has constantly badgered me to the point that I exploded at her, she mocked me telling me I was playing some stupid little game, she left messages that were so abrupt and heartless that I had a major meltdown episode to the point of depersonalizing and even dissociating. (I even called her back leaving a message calling her "a nigger bitch". Probably not the best way to get on her good side.) That was fucking scary. AND being that she is child services, she holds all the cards in her hands. However, that was all before I started DBT.
My ex-husband - ugh - I'm getting a sick lump in my throat just thinking about how I could describe him. I guess a good way to put it is this - "He loves his daughter but he hates me more." It is not in his DNA for him to be able to keep his mouth shut. He makes shit up - he can't separate fact from interpretation. I think he truly believes that his interpretations are fact. So MY interpretation is that he takes the facts, mixes them all up with his emotional hatred for me and PRESTO!! He now has his own twisted pseudo-facts that are so far out there. BUT it is this shit that he is feeding into our daughter's head. And seeing as I can't have any contact with her, I can't set her straight. She is believing that crap that her dad is shoveling in to her head.

So I am to go to this meeting with a case worker who thinks I'm the reincarnation of Satan, an ex-husband whose hobby it is to make my life a living hell (more than just the BPD hell) and a vulnerable 15 year old daughter who is having garbage, non-truths, blatant lies about me, rammed into her brain.
Make no fucking wonder I'm having a major anxiety attack.

Mindfulness - Week 2 DBT Skills Group

Why does this piss me off - I am sitting there in skills group and we are all doing a check in as to how our week was with practicing the skills that we learned the week before. There was this one girl there who said that there was so much stuff going on in her life that she didn't even think about her "homework". She was making so many excuses for so many things, I'm thinking "what the hell are you even doing here?" I don't think she is in the mind place to have this therapy work. I want to smack her up the side of the head but I, myself, have to practice my skills and remain mindful. (LOL See what I did there :-) )

OK enough venting.
Today we had our second mindfulness lesson. Learned about the What and How skills.

Mindfulness skills help us balance "emotion mind" and "reasonable mind" to achieve "wise mind".
Mindfulness skills help us tolerate intense negative emotions, experience positive emotions, think clearly in order to solve problems and avoid numbing out, zoning out, dissociating and/or acting impulsively in the face of emotional pain.

Mindfulness WHAT TO DO skills
1. Observe - simply sense, notice or experience without describing or labeling the event. Notice what is occurring in the present moment without reacting to it.
2. Describe - use words to represent what has been observed. It is labeling what is observed. Put the experience into words. This can only be applied to observed experiences. You cannot describe what someone else is thinking or feeling, you can only describe what you directly see or experience.
3. Participate - enter wholly into an activity and becoming one with it. Throw yourself into something completely. Lose self-consciousness.

I personally had a slight issue grasping the concept of this participating thing so I'm going to enter an example here. A parent who is tossing a ball back and forth to their child but is also talking to a neighbour is most likely not entering into either activity completely. If that parent stops playing ball for five minutes to talk to the neighbour, s/he has now fully entered into that experience.

Mindfulness HOW TO DO skills
1. One-Mindfully: This is ultimately the opposite of multitasking. It is focusing on one thing at a time, doing one thing at a time and being aware of this experience. It is not being distracted by thoughts and images of the past, worries about the future or focusing on current negative moods.
2. Non-Judgmentally: This is observing and describing things as they are without adding or deleting information, attaching adjectives or colouring with emotion. Labels, such as mean, nice, ugly, fat, good, stupid or perfect, are not used. This is a way to decrease emotions in order to directly solve problems.
3. Effectively: This is behaving in a way that will make a situation work for both you and others.. Do what works for you and the situation without being carried away by your emotions and acting as skillfully as you can.

So that is what we learned and what we had to practice for homework. Not sure how successful I was at the homework thing this week. I was really distracted with moving and unpacking and such. I guess I did get to practice other skills though like radical acceptance and distress tolerance through distraction. Lots of distraction - shampooing carpets, coffee group, unpacking, walking the dog, etc...

That's all for now....

DBT Skills Group Therapy

I started my 8 week DBT Skills group on Thursday. I wasn't sure what to expect but I knew that I needed help.
There were supposed to be 10 people in our group but only 6 showed up. 2 called in saying that the roads were bad and wouldn't be coming.
I met some nice people there. Not all are necessarily Borderline but all have issues with emotion regulation. There's one lady there that I'm not sure of her motivation or commitment but whatever.
We learned about the Bio-social Theory. I understand the concept and it is somewhat of a relief knowing it but I can't really describe it myself so I am going to take an excerpt from Wikipedia.

Biosocial theory in DBT

It is common for therapists using a Dialectical Behavioral Therapy (DBT) model in the treatment of Borderline personality disorder to stress to clients that causes for their condition come both from a biological propensity to their emotional state, and an invalidating environment, that, by its negative reactions, reinforces their dysfunctional behavior. A traumatic event can start the emotional or interpersonal disregulation that spawns a vicious cycle of increased negative behavior as the person continues to react to the environment's invalidation and the environment increasingly devalues them.

"DBT is based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation. The disorder is characterized by heightened sensitivity to emotion, increased emotional in-tensity and a slow return to emotional baseline. Characteristic behaviors and emotional experiences associated with BPD theoretically result from the expression of this biological dysfunction in a social environment experienced as invalidating by the borderline patient."^[3]

The importance of stressing the biosocial theory to the client in therapy is that the information becomes a tool of validation in itself, offering the client the option of seeing their problems as no fault of their own while also offering them the possibility if taking responsibility for future change.

"The biosocial theory suggests that BPD is a disorder of self-regulation, and particularly of emotional regulation, which results from biological irregularities combined with certain dysfunctional environments, as well as from their interaction and transaction over time"^[4]

LOL I hadn't read this entire excerpt through before I posted it. It's kinda funny how I said that it was a relief just knowing it and the excerpt says that it is a tool of validation in itself.

We also started to learn about the first DBT skill - Mindfulness. It is one of the core concepts of DBT and is considered a foundation for the other skills. It helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations. DBT mindfulness is the capacity to pay attention, non-judgmentally, to the present moment; about living in the moment, experiencing one's emotions and senses fully, yet with perspective.

WHAT THE HELL DOES THAT MEAN???

Consider that you are driving home from work taking the same route you always take. You are almost home and you suddenly realize you have no recollection of the last 10-15 minutes or how you got from point A to point B. This would be you NOT being mindful, NOT being in the moment. If you had been mindful, you would remember the entire distance you drove, took notice of all the things around you and all the things you drove past. You would have taken notice of different sounds and different "physical" feelings (such as the feeling of the car seat against your legs or your hands on the steering wheel).

There are different levels of mindfulness - or maybe NOT being mindful would be more appropriate to say.

1. Being Mindful -
2. Zoning/Numbing Out
3. Depersonalization
4. Dissociation

The first 2 are kinda self-explanatory but numbers 3 & 4 - well those are just plain scary. I had a horrible experience with dissociation and numerous depersonalization ones.

Child Protective Services triggered a MAJOR meltdown in me and my emotions raced so extraordinarily high that I lost a short block of time - or at least I think it was short. But during that time I had sent a text message to my daughter giving the impression that I was going to kill myself. For the life of me, I have ZERO recollection of doing that. It was really scary because it makes me wonder what else I did or could have done.

That is all for now.......

Introduction

I have Borderline Personality Disorder. It is horrible. Sometimes I think it was better not knowing what was wrong with me. It was easier being angry than trying to explain to people what is wrong and begging for their forgiveness and understanding.

I only recently discovered that I am BPD. I have been treated for major depression and anxiety for many years but still things didn't seem quite right. Actually, to be honest, I thought everyone was this way and those who didn't feel as strongly as I did simply didn't care.