Dr. Marsha Linehan, DBT Founder, Comes out as having Borderline Personality Disorder (BPD)

Tomorrow, the weekly DBT (Dialectical Behavior Therapy) group that I attend and that has been helping me signficantly in my walk with Borderline Personality disorder delves into the skills of Interpersonal Effectiveness. I am really excited about this, because I think that my lack of skills in this area have been a stumbling block in my ability to maintain important relationships, including friendships and a long-term job.  The excitement comes from a feeling of readiness to grow in this area and, well, to keep a job.

I look forward to sharing more with you as I learn this particular set of skills. The doctor who leads the group mentioned that there are no accompanying video lessons for this section of the manual.  I have mixed feelings.

The videos we watch in class are by Dr. Marsha Linehan, who, up until last week, was known to me and thousand of others enrolled in DBT classes or therapy, as an incredible doctor who took the time to create a set of skills to help people with Borderline Personality Disorder (and other disorders or mental states of being that interfere with emotion regulation). She named these skills DBT: Dialectical Behavior Therapy.


Photo Credit: Dr. Marsha Linehan
 As of last week, we still knew her as a genius doctor, but we also came to know her as "one of us."  In a New York Times article that came out on June 23, 2011, journalist Benedict Carey reported that Dr. Linehan revealed to a group of her friends and colleages at a presentation at Institute of Living in Hartford, Connecticut, that she was treated as a young adult for severe mental illness and lived in a locked psych ward, primarily in isolation, for about two years.

The signficance of her decision to reveal this personal information cannot be undervalued. Dr. Linehan's disclosure stands to inspire and bring hope to so many of us living with conditions like Borderlie Personality Disorder (and our loved ones), because her disclosure brings us HOPE.  Hope is something that we often are lacking or desperately seeking, so to receive it in such a large dose as we did last week: seeing a successful Ph.D. doctor come as far as she has, be as successful as she has, be as stable as she has -- to have TRULY created a "life worth living" (one of the phrases she repeated encourages us with in her DBT skills), brings incredible hope.

Thank you Dr. Marsha Linehan.  I'll miss your videos during the Interpersonal Effectiveness section of my DBT group, but I'll be making the rounds again to the other sections right after.  All the while, I'll be thinking about how, if you accomplished what you did, there is so much more hope for the rest of us than we had previously imagined.

More soon.

New York Times Article on Dr. Marsha Linehan

DBT Distress Tolerance Skills

Photo Credit: Sarah Cardwell
I am a bit overwhelmed with my own emotions right now.  I have been caught up and in my own internal drama as I work hard to not let it consume me.  Yes, I am working VERY HARD to use my DBT (Dialectical Behavior Therapy) skills to help me through this rough patch.  I am working hard to learn from my past mistakes and overreactions...my tendency to go into black-or-white catastrophic thinking and to fall into a role of feeling/being victimized.

I have been having a lot of anxiety (which affects my appetite and sleep, which causes more anxiety), so I have given in to taking a couple of additional tablets of Ativan.  It is prescribed to me as 0.5 mg at bedtime, but the label says "May take an additional 1-2 tablets on occasion for extreme anxiety." I almost never utilize it, but I would categorize my current state as being in extreme anxiety, and I want to feel better, so I have gone ahead and taken it.

Before doing so, and in the meantime, I have been practicing my skills today. It hasn't been easy. At all.  But now I fully understand why our doctors and therapists recommend practicing the skills when we are doing well and feeling stable. It really does seem to help them to be more effective when used in "crisis mode."

Today I really felt like I needed to focus on skills that would help me take control of my mind, so to speak.

I  used some Distress Tolerance skills, particularly Distracting (during which you do the best you can to allow your Wise Mind to ACCEPT the current situation while you distract yourself.)  According to Dr. Marsha Linehan, the word's respected leader on Borderline Personality Disorder research and treatment, Distress Tolerance skills such as Distracting can be used "for tolerating painful events and emotions when you cannot make things better right away" (Linehan, 1993, Skills Training Manual, 165).

ACCEPTS breaks down to:

Activities (I cleaned the house. Every single room. I also did the laundry.)
Contributing (I consider getting online and posting this as contributing to others out there.)
Comparisons (I compared my current situation to what could be worse and realized I am blessed.)
Emotions (I haven't done this yet. It is when you do things like watch movies or listen to music that evokes the type of emotion you WANT to feel in the moment. I will watch something funny tonight in hopes of feeling the emotion of happiness or joy.)
Pushing Away (As my head started filling with TONS of negative thoughts, I literally stopped in my tracks and repeated the word "NO!" as I envisioned putting the emotions away in a box while I cleaned the house. Funny, but it helped.)
Thoughts (This is where you focus your thoughts on anything. Counting to 10, counting colors in a painting, watching a tv program.  I decided to listen to some talk radio to hear what other people who aren't in crisis are thinking about.)
Sensations (Recently, in DBT class, we practiced holding ice in one hand. The other day, while at the ocean (the Pacific Ocean is VERY COLD), I went in up to my ankles/shins to experience the same thing - a distraction caused by a sudden, intense, non-harmful change of sensation. I haven't practiced this skill today, but I may do the ice cube later.)

I am going to focus on some of the Taking Hold of Your Mind skills that we learned in DBT this past week. These include Observing, Describing, and Participating, as well as being Non-Judgmental, One-Mindful, and Effective.  I hope to share more with you about this soon.

I have an appointment in the morning with my therapist and may be going back into the intensive outpatient (IOP) program again for a little longer.

Thanks for reading. I really hope this helps you on your journey.

More soon.

Anxiety, Lack of Appetite, and Wise Mind

I am writing this so that I can stay in Wise Mind.  Wise Mind is something you learn about in Dialectical Behavior Therapy, or DBT.
Wise Mind Handout Credit: Marsha Linehan

Here's what it's all about:

Suppose we have two states of mind: The Emotional Mind and the Reasonable Mind. If we lived in the Emotional Mind all of the time (and I tend to spend a lot of my time there), we can get into a lot of trouble. If we spend all of our time in the Reasonable Mind, we'd be quite boring and emotionless. (Think of character Data on Star Trek.)

In DBT, we are told that somewhere in the middle is the Wise Mind - a balanced combination of the two minds.

The section of class where we covered this the most was Mindfulness.

I am feeling particularly anxious and fearful. Because of that, my appetite is lacking. Remember, everything has a cause.  Because I have fearful past memories that are being triggered around eating, lack of food, and losing weight, what other people might see as an ordinary lack of appetite after having a stomach bug and going through anxiety - as something that will pass and the appetite will come back, I end up seeing as a very scary, catastrophic experience.

I decided to become mindful and noticed that I was operating almost entirely from the Emotional Mind:

Thoughts include(d):

I am scared. (feeling)
I am afraid. (feeling)
I am anxious. (feeling)
This is very bad. (judgment)
This is dangerous. (thought)
I am in danger. (thought)

The first step into entering Wise Mind was to just notice what was going on in my head: feelings, judgments, and thoughts, and not giving any of them too much credit. This alone started to calm me down. I reminded myself that I am not my feelings and that judgments and thoughts aren't necessarily TRUTH.

I did something that is difficult for us borderlines - I remembered other times when I have been through this and emerged feeling well. I am getting better at doing this. I think it just takes dedicated practice.

I thought about the reasons I might be having those feelings: quitting/losing job next week (with thoughts about loss of structure and income), long-term relationship in peril (with feelings of guilt, remorse, and fears of abandonment and rejection), physical health has been suffering lately (stomach bug, difficulty sleeping, lack of exercise, and now the lack of appetite), and I realized that I had legitimate reasons to have emotional reactions. I also realized that being scared, afraid, and anxious won't help with any of these except to motivate me to continue to get help and stay on track with plans to keep my mood and health stable.

Judging the situation as "bad" isn't helpful either. While I also wouldn't label it as "good," it just is. It is the fact of the matter - the present situation...so I can go ahead and give it a negative label to make myself feel worse, or I can say, "I recognize this situation. It's uncomfortable. I sense I'd rather not be experiencing this right now. But, I am experiencing it. This is not good or bad. This is my present experience."

As far as the thoughts of this being dangerous - sure it would be if I didn't care, made no effort to take care of myself, or wasn't reaching out for help. But, I remind myself that I do care. I am doing the best I can to take care of myself right now with the tools that I have. I have reached out and will be in an intensive therapy program next week to get some in-depth help with getting back on and staying on track.  So, actually, I am not in any real danger.

Do you see how just breaking things down, identifying them, and being reasonable about each item can help you feel better and deal with things more clearly? I feel like this exercise was very therapeutic for me, and I hope you also learned something or got something of value out of my sharing it.

Have you ever heard of the Wise Mind/Emotional Mind model before? Have you used it to help you through a difficult situation?  I'd love to hear your thoughts.

More soon. 

What Gets YOU Through?

It's been a while since I've posted, and I think it's due time. Without getting into the details of what's been going on just yet, I'll give it to you in a nutshell and then focus on what's happening in the now.

Anyone who has Borderline Personality Disorder (BPD) or knows someone who does knows that one of the more common criteria of signs of this disorder is "frequent crises" ("Borderline personality disorder," 2010.)  I can relate to this. About once every 6-7 months, I end up in the emergency room with symptoms such as diarrhea and vomiting that become so intense due to anxiety and dramatization, that I end up needing IV fluids for re-hydration.  Again, I won't get into the details now about my insights as to why this happens, but I will get into it in a future post.

I ended up in the ER yesterday with one of these episodes. I was deeply troubled and very badly triggered by some very unsafe situations going on at work. Not so much on a physical level, but on a mental health level.  I wish I had kept myself together like an adult and made rational choices that I could be accountable for - like quitting and moving on and knowing that I had made the right choice.

I wish I had tried harder with my DBT (Dialectical Behavior Therapy) skills that I have been working so hard to learn and practice. But I ended up going full force into crisis mode, less than 24-hours after my significant other of many years - my first and only real, mostly stable relationship, expressed in a way like he never had before, how his feelings had unfortunately shut down for me. He was tired of seeing me self-sabotage -- one job after another, one relationship after another, financial issues, etc.  He was tired of my crises - my issues with appetite, running to the hospital and getting IVs, etc. He expressed that he cares for me so much but didn't think he could take much more. He had said this many times before, but I had unfortunately not taken it very seriously and sometimes let it go in one ear and out the other, because hearing it and considering he might leave me was just too painful.

But there was something different about this conversation. He asked me to look him in the eyes and know that he really could not take this anymore, and that it is getting close to the point where we might have to go our separate ways. I was and partially still am in denial. I freaked. I panicked. I cried. I felt sick. I begged him to give me another chance, but everything I said in my desperate plea not to be abandoned and to have him know that I do realize where he is coming from and only wanted one more chance to prove that I won't take him for granted -- he said he was tired of hearing it and had heard it so many times. I begged him to let me know if the situation was hopeless or if there was any chance at all, but he didn't want to answer.

I had to put some DBT skills into action PRONTO. Whether the diarrhea and lack of appetite I was experiencing were anxiety or a stomach bug and anxiety combined, I needed to calm down and care for my physical health and condition before I could deal with this incredibly intense, overwhelming, and terrifying emotional situation.

I pulled out a piece of paper that a licensed psychologist at the hospital helped me come up with before I left yesterday.  Here are some of the things that I wrote down to keep in mind, read, and repeat:

  • I don't need to think about this right now.
  • Just this moment, Just this breath.
  • Keep Breathing.
  • I am okay. Look at the evidence.
  • That's too much for me right now.
  • I want to show you I can do this.
  • Listen to a meditation CD.

For the last one, I listened to (and have since listened three more times to) a CD called Time for Healing: Relaxation for Mind and Body, by Catherine Regan, PhD. I am not sure where you can find this CD - a former co-worker gave it to me. But, I highly recommend it. The first track is a progressive muscle relaxation exercise, and the second track is a guided imagery meditation of walking through the countryside.

image credit:: mindbodysmile.com

Other things I am doing to stay on track is to imagine that I am the adult taking care of my inner child while she doesn't feel well.  I came up with a plan where, even though I have no appetite, I have a light snack and a full glass of fluids every 2 hours or so.  It's been going well. What I've had is hardly anywhere near what I'd eat on a normal day, but on a normal day, I don't have stomach problems and a come-and-go fever. So, I need to take it easy on myself, do the best that I can, take good care of my mind-body-spirit, and trust that each day I will feel better and stronger.

Monday I have an appointment with my psychiatrist. We are going to come up with a rational, "Wise Mind" plan on how to proceed with leaving my current job and take a look at the meds I am taking for anxiety. I am looking forward to this appointment. But, until then, I will do my best to live in the moment...to deal with the anxieties and fears as they come up...and to continue to take care of myself.

Thanks for reading. If you have any comments, questions, thoughts, or suggestions, please DO share.

Talk soon.


References/Resources:

Borderline personality disorder.
(2010, November 15). Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/

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