Crisis Averted! More Success Using DBT Skills (Dialectical Behavior Therapy)

A few days ago, I had the trigger of all triggers. Deep seated in my psyche are some serious fears and insecurites around abandonment and being alone. My situation is not unique. In fact, according to the DSM (the Diagnostic and Statistical Manual used by psychology and psychiatry professionals), one of the top criteria for diagnosing Borderline Personality Disorder is:
"Frantic efforts to avoid real or imagined abandonment."

Read that again: Frantic efforts to avoid REAL or IMAGINED abandonment.  My significant other recently got on a plane to visit his family and do business in England. For a whole month.  I have known about this planned trip for about a half a year, and I was doing pretty well with it all up until a few days before he actually left.

At that time, I began to notice an increase in my usual frequency of nightmares. I was waking up all hours of the night with panic attacks: heart and mind racing, sweating, feeling cold, having diarreah -- the whole kit and caboodle.

On the afternoon that I took him to the airport, my emotional vulnerabilities showed up. Now, I want to remind myself that anyone who is about to experience a long separation from someone they love will naturally experience sadness and, perhaps, some anxiety, so I know that it is normal that I felt these things.

I also felt more intense emotions that I, luckily, pretty instantly recognized as needing regulation. I felt myself escalating, having some self-harm thoughts, and feeling like I was going "out of control."

Now, this is growth...I saw a cat food can lid on the counter waiting to be recycled. My emotions were so intense that I had an impuslive thought that I wanted to just cut myself with it. Within seconds, my Wise Mind kicked in, and I thought, "No I don't; I just don't want to feel THIS way." That was my cue to start engaging in the DBT skill of opposite action.

Before that, I held an ice cube in each hand (also a DBT skill) to create an intense, but non-harmful physical sensation. As I squeezed the ice cubes in my hands and watched as the water melted down into the sink, I realized that it was helping.

I then thought about the fact that I had a choice.  I was at a fork in the road. (Mind you, this ENTIRE time, and for days afterward, my physiological stress symptoms were at a high -- tense muscles, clenched jaw, having to run to the bathroom, adrenaline rushes, heart racing, etc.)

In the past, I have gone to what I now consider extremes to feel safe and as if someone else were taking care of me (..."Frantic efforts to avoid real or imagined abandonment...").  I would allow my emotions to escalate to the point where I would vomit. Between that and the diarreah, my appetite would be low, so I would be eating and drinking less. I knew that, should I become at all dehydrated, I could go to the ER, and they would HAVE to help me. They would take care of me. They would let me lie down in a sterlile hospital bed with warmed blankets. They would put an IV in me and keep checking in on me to make sure I was ok.  I have done this scenario countless times.

 I was heading in that direction -- the thoughts were there...the physical sensations -- when suddenly,  Wise Mind kicked in: "I have a choice right now.  Yes, I can go to the Emergency Room, but what will this accomplish? Is doing this in alignment with my goals of being well, improving my relationship, and growing as a person?  My SO is gone for 30 days.  I can get as sick as I want, let my emotions get out of control, and cause myself suffering, or I can choose --right now, in this moment -- to take control of my mind and calm down."

I chose the latter, and I have to tell you -- I really am proud. That's progress!

The day after I dropped off my SO, I had DBT group. It went really well. I did my homework (the 1a Worksheet where you describe your emotion in detail), and I presented that in the group. The other group members where very supportive. The doctor said she was proud and that I should be, too: "Crisis averted."

ABC News Article ft. Dr. LeslieBeth Wish on Casey Anthony: Borderline Personality Disorder?

As someone who is diagnosed with Borderline Personality Disorder, who is doing her best to honestly share her experience and help break down negative and inaccurate stigmas about the illness (and mental illness in general), I was alarmed, disappointed, and concerned when, after watching a video by another young mental health advocate and BPD-diagnosed woman, Dani Z, where Dani referred to a recent online article published by ABC News.

Dr. LeslieBethWish  Photo Credit
In the article, a psychologist and licensed social worker in Sarasota, Florida by the name of Dr. LeslieBeth Wish, who has never met with or formally diagnosed Casey Anthony (who was charged and acquitted with killing her infant daughter), proposed the possibility that she may suffer from borderline personality disorder and/or psychopathology, claiming that:

 "[t]he main thing these issues have in common is a total lack of empathy, according to LeslieBeth Wish...'They can turn a person into a non-person,' Wish said. 'Borderline personalities have more emotional regulation problem and often use lying to get away from something and not ever feeling like they're responsible.' Wish explains that for people who suffer from these problems, separate lies can quickly become entire narratives that the teller can even come to believe as true. 'A lie begets a lie and it's easy to get trapped in telling lies to protect other lies,' Wish said. 'Does she believe her lies? She might, but more than likely she believes that she's good enough to make you believe her lies.'"

I have a number of problems with Dr. Wish's comments. To begin with, I haven't met a BPD diagnosed individual, including myself, who doesn't have an incredible amount of empathy.  I cry when I see someone else cry, because I feel so connected to their experiences and pain.  Unlike Dr. Wish, I will not generalize all people with Borderline Personality Disorder as being empathetic, and I feel that her way of presenting us in a generalized way as having "a total lack of empathy" is not only inaccurate, but irresponsible and unprofessional, especially for someone of her education level and title. If I had the opportunity to speak with her directly, I would encourage her to rethink her word choices and request that ABC news update the article.

Dr. Wish's comment that Borderline Personality Disorder "can turn a person into a non-person" is also disturbing and misleading to readers who are not familiar with the disorder. A statement like this creates fear and perpetuates the stigma that people with BPD are dangerous and completely disconnected from reality.

Nowhere in the DSM - the standard Diagnostical Statistical Manual, published by the American Psychiatric Association and used by psychiatric professionals, are Dr. Wish's statement corroborated.

According to the National Institute of Mental Health, (NIMH) in order to be diagnosed with Borderline Personality Disorder, an individual must meet at least five of the following criteria:

  • Frantic efforts to avoid real or imagined abandonment
  • A pattern of unstable and intense interpersonal relationships characterized by extremes between idealization and devaluation (also known as "splitting")
  • Identity disturbance: Markedly or persistently unstable self-image or sense of self
  • Impulsive behavior in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
  • Recurrent suicidal behavior, gestures, or threats, or self-harming behavior
  • Emotional instability in reaction to day-to-day events (e.g., intense episodic sadness, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  • Chronic feelings of emptiness
  • Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  • Transient, stress-related paranoid ideation or severe dissociative symptoms"
Notice that there is no mention in the DSM of a lack of empathy, pathological lying, or a person becoming a non-person.  ABC, please fact-check information given to you about specifically illnesses, even if the source is a doctor, because clearly, they, too, can and do provide inaccurate information that can adversely affect others.

While I am clearly upset about this article, I do understand that Borderline Personality Disorder is still misunderstood by many, including many of those within the psychiatric profession. Strides have been made by professionals in the field, such as Dr. Marsha Linehan, who created and developed Dialectical Behavior Therapy (DBT), a program designed to specifically help those with BPD and other who have difficulty regulating their emotions. I attend DBT groups twice weekly and my doctor and I have noticed a significant improvement in my quality of life and overall well-being.

I hope this post helped you in some way.
More soon.

Making Mistakes! (We all do it.)

I was just challenged immensely on an emotional level just as I was getting ready to celebrate and share my recent success of using some of the DBT (Dialectical Behavior Therapy) skills I have been learning.

This post revolves around my recently noticing an increased ability to cope and deal with the emotions that arise when I realize I've made a mistake.

Typically, these emotions include: embarrassment, anxiety, and anger (toward myself).

The thoughts are typically along the lines of:

"I'm an idiot.
Everyone is going to think I am an idiot.
They are going to see me as incompetent.
I've screwed everything up."

The physical sensations that I tend to experience when I make a mistake are: a feeling that my face is getting hot and turning red, racing heart, clenching jaw and tight muscles (especially in my neck and shoulders).

Photo Credit
I also tend to experience a strong impulse to want to redeem myself in the eyes of the people who witnessed my mistake, sometimes lying to make myself look less incompetent or to make an excuse for why I made the mistake.

Work has been a particular struggle for me, having quit and changed jobs so many times, partly because of the inability to tolerate my perception of what others "must" perceive about me (read: She made a mistake. She's not perfect), which, by the way, is exhausting.

I recently took on a part-time job, and part of my duties are to review documents for the CEO before they are sent out. I basically look them over and correct anything that doesn't sound quite right, that is misspelled, etc.

I have done an excellent job preparing these documents. I give myself credit there. But on one occasion, I sent an email to the CEO (and a couple of other employees) that had a typo and that omitted an important word. Can you IMAGINE the level of my embarrassment, given my role/tasks at the company?

The way that I realized I made the mistake was not because I had carefully reviewed the email before sending it, but because I obsessively re-read messages that I've already sent (at work), and I found the errors at that time.  I felt the blood rush to my face. I was sure he would let me go. Others who were CC'd on the email, I reasoned, were cracking jokes at my expense and suggesting that I be fired, since I must be incompetent if I couldn't take the time to make sure my email was correct before sending it, given my responsibilities at the company.

My anxiety went from a 0-100 in about 30 seconds.  I had to get a hold of my mind. First step: I moved away from the computer. Second step: I thought about how I need to slow down and read my emails through before sending them - always.  I thought about how they may not have even noticed that I made the mistake. I thought about how they might have noticed the mistake and would respond the way I was fearing. I thought about how they might have noticed the mistake and might respond by being concerned that I had made such obvious errors, but they wouldn't take it too seriously because it wasn't something that actually would be seen by anyone else other than those emailed (basically, it caused no harm -- the email didn't go out to the entire staff or to customers, where it might cause some embarrassment to the CEO or the company.)

If you are familiar with a mental disorder called OCD (Obsessive Compulsive Disorder), you may have guessed that, in addition to my diagnosis of BPD (Borderline Personality Disorder), I also have this condition. I have made INCREDIBLE progress over the years (mostly in part to a really good doctor and her CBT - Cognitive Behavioral Therapy Group), but I still have it.

When it comes to perfectionism, the OCD symptom around this, combined with the BPD symptom of black-or-white, all-or-nothing thinking, combine to cause me a great deal of distress.

Third Step: After using my DBT skill of "Describing," I began to practice radical acceptance. I acknowledged that I had NO control over whether other people noticed my mistake, cared about it, thought about it, or how they would respond to it. The mistake was made. There was no undoing it. There was NOTHING I could do about it. 

This, believe it or not, helped me to feel better. I surrendered. What other choice was there, really?

I also extended compassion to myself, reminding myself that everything has cause: from the fact that my wireless keyboard has been sticking, to the fact that I've been rushing my emails and not slowing down to review them before sending them out, to the fact that I was punished, abused, and neglected severely as a child when I made a mistake...there is cause for everything.

I do have to admit that I fell short of behaving in a way that was completely in alignment with my goal of feeling self-respect, because I did tell a "little" lie (I know, a lie is a lie is a lie) to make myself "look better" and less incompetent.

I emailed the people I had sent the original email and made a joke that my phone's auto-correct could be so embarrassing sometimes, and I reiterated what I was trying to communicate in my original email.

I did this again today. I made the same type of mistake, and I blamed it on my phone.  I feel a bit badly about it, but my goal was to look less incompetent, and I hope I achieved this.

My goal now, of course, is to read and re-read my emails BEFORE I send them out.

I love how practicing the skills helped me to keep from making the issue worse. I love how doing so helped me to avoid escalating and continuing the self-abusive thoughts. Most importantly, I love how practicing the skills, in this instance, helped me to avoid self-sabotaging and self-harm and to set a goal to prevent this whole thing in the future.

I hope this helped you in some way.

More soon.

Celebrate Every Bit of Progress - Success with DBT (Dialectical Behavior Therapy)

Those of us with BPD (Borderline Personality Disorder), and those who know and love us, are all too familiar with how we are quick to notice, point out, and dwell upon the things we do "wrong."  As we explore in DBT (Dialectical Behavior Therapy), we learn to be less judgmental and more understanding of ourselves and others. Along the way, we make progress and we backtrack.

Let's not just notice the backtracking. Let's celebrate each and every accomplishment along the way, too!

There is a small group of us on Twitter who correspond with each other, sometimes using the hashtag #BPDFriends.  Today, this group supported me in my joy over some recent accomplishments, both big and small. It felt really good, and I thank each of you - you know who you are.

Today I shared the following tweet:

Last night, I used my #DBT skills immensely. I prevented myself from self-sabotaging and from hurting others with my words. Proud today.

Here's the scenario in a nutshell:

I woke up feeling terrible. I had my period, and oddly, I sometimes get aches and pains all over when it arrives. Yesterday was one of those days. I also had a headache and TMJ pain. It was my second day working from home for a brand new client for my brand new business. (Lots of changes! I decided to go out on a limb and try to start my own little company. So far, so good.)

I had to pull myself together to get some essential work done and submitted to the client, and I had a Starbucks date with a dear friend. I couldn't blow her off (even though I felt like crap). I'd done that too many times and made an agreement with myself that if I could show up. I would show up. I'd canceled on her too many times and didn't want to upset her.

So, I stretched a bit in bed. I let myself sleep in a little bit longer, knowing that I could afford to do so as long as I really focused when I got up.  I gave myself a little "You can do it" pep talk and got out of bed. I started to complain to myself about all the aches and pains, my period, how I didn't feel like doing anything.

Then, DBT skills kicked in - particularly, radical acceptance. All at once, my wise mind kicked into gear, and the mature, rational adult inside spoke up. "What would you tell a friend who was describing this situation to you?"

I've been using this question a lot lately. Somehow, thinking about how I would respond to someone I care about if they came to me with the type of thoughts, feelings, and conclusions I come up with, leads me to treat myself with compassion and a higher wisdom. It's quite neat.

On this occasion, I monitored my thoughts, and then I asked myself: "How would you respond to a friend if she called you up and said, 'I don't feel like doing anything. I'm not sick, but I'm all achy. I have my friggin' period and ALLLL this work to do. I hate everything and just want to go back to sleep."

My response: "I can understand why you would feel SO overwhelmed right now. So much has changed. You've gone from unemployment to job hopping to unemployment again. You'd gotten used to being able to stay at home or roam around without any real structure, expectations, or responsibility, so naturally you are a little bit frazzled right now. Remember what one of the doctors in IOP (Intensive Outpatient Hospitalization program) said: 'Stress is the body's adaptation to change.' You are going through SO many changes right now. Just take some deep breaths, and take everything step-by-step. You'll get through this. This job assignment is a blessing, and you need to use your skills to stay focused, balanced, and to refrain from self-sabotaging. You can do this."

And, I did! :)

I worked all morning and left some time to do my makeup and have a light lunch. I then went to meet with my friend. I was honest and upfront with her about how I was feeling icky and asked her not to take it personally. We had our Starbucks, and I decided to take a couple of Tylenol to help with the pain (which it did, a lot). We went for a little walk and even had time to squeeze in a department store before I had to go to DBT group.  I am so glad that I've matured enough to be able to be an adult, in wise mind, thinking before I act and therefore preserving and growing current relationships (rather than sabotaging them.)  I won't make it sounds like I haven't backtracked or made mistakes. Just the other day I threw a complete fit in a department store because I felt my significant other "wasn't being affectionate enough," but I will not let that incident damper the light of this accomplishment.

Photo Credit


Right after this, I went to group and very actively participated. I enjoyed the guided mindfulness practice on the Marsha Linehan CD for pretty much the first time since I've started DBT.  I refrained from answering every question that the doctor asked, allowing others a chance to speak...and I learned from what they had to say.

By the end of group, the physical pain was gone. The Tylenol had kicked in.  I no longer felt nauseous. (I don't think I'd mentioned before that I had been, but I am one of those people where if the pain is bad enough - including a headache - it turns my stomach.)  I went to the grocery store and picked up a few needed items. Then, I got home, made dinner, and straightened up -- even though I still didn't feel 100%.

That friendly, wise-mind spoke up whenever I wanted to just throw a fit and "not do anything." I can still hear it now: "If we did things based on whether we felt like it or not, most things wouldn't get done." It's not that I am advocating that we don't take care of ourselves. If we are actually sick and need rest, by all means, I think we should lay down. But, I know my body and knew what this was all about.



I took a prescribed muscle relaxer for the TMJ and related/radiated pain. It helped.  I worked some more, completely messed up my computer and printer by tinkering around trying to fix something else, and voilĂ . I had another opportunity to practice DBT.

I know how terrible this is going to sound, and of course I would never act on it literally, but I became so frustrated (infuriated) about my situation, that I felt like tearing out my eyeballs and yelling at my significant other (who was patiently trying to help, by the way).

I began by "just noticing." I started to deep breathe. I then did an opposite action. Instead of screaming, I spoke softly. Instead of lashing out at my significant other, I thanked him for being so patient and trying to help. I told myself I'd work on the issue for 20 more minutes, and if it wasn't resolved, I'd take a break and watch some TV to cool down.

The problem was resolved in 20 minutes. During those 20 minutes, when I would feel myself escalate, I identified the emotion and accompanying thoughts I was having:

Thoughts:

"This thing is broken forever.
I'm an idiot because I f*cked it up.
I'm never going to fix this.
I'm not going to be able to get the project done for the client.
I hate myself.
I hate everything."

Accompanying Emotions:

Fear
Sadness

Hopeless
Hateful
Angry

Mind, you I went from calmly working to having all of those emotions and thoughts...literally in minutes. But, I noticed it and took hold of my mind.  The DBT groups are working!!! :)

I noticed how quickly I went from 0-100.  I noticed that my thoughts were exaggerated and a bit irrational. I was able to identify, from my wise mind, that I was operating primarily in emotional mind. That's when I was able to begin practicing the skills and preventing self-sabotage, self-harm, and hurting my significant other with my words.

This was a long one. I hope it has helped you in some way to understand something about yourself or someone else.

More soon.

Be Like a Baby - DBT Mindfulness Skill

A few weeks ago in my weekly DBT (Dialectical Behavior Therapy) group, the doctor asked us all to place one hand flat on the table and leave it there. About 30 seconds later, she asked us about our experiences - specifically, she asked if we started to describe the experience.
I certainly had. My mind is quick to think, analyze, and describe, pretty much all of the time. I rarely get a break from the constant stream of thoughts.

When I placed my hand on the table, I had the following thoughts:

"My hand is on the table.
The table feels cold.
I feel the pressure of my hand against the table."

When we went around the circle, it turned out that all of the other patients had the same type of experience.  Describing is a good skill for staying grounded and in the moment, but today we were going to learn a new skill: Being in the present moment, or Being Mindful.

The doctor suggested that we think about how a baby experiences the world before he or she has any concept of associating words with things. When a baby feels the table, the baby is fully immersed in feeling the table.

This can be a little bit confusing to "get" at first. In fact, it took me a few weeks of random opportunities to practice touching tables and similiar activities before I began to get it. Now, when I place my hand on a table with the intention of practicing this mindfulness activity, I simply place my hand on the table. If thoughts come in that want to describe, I watch the thoughts float away like clouds in the sky, and I am totally immersed in the experience, just like a baby.

A beautiful baby in the present moment. Photo Credit
The doctor suggested that we "just observe like a baby - with no words - just BE the experience." She also suggested that we keep our eyes open during the practice.

If you practice, you will "get it" too, and, if your experience is anything like mine, you may experience a moment of bliss when you fully connect to the moment without having to put names or descriptions on anything.

Another example that we were given as a potential practice assignment is around mindful eating. The suggestion is to eat a raisin as if you are an alien who just came to this planet and had never seen one before. I have yet to try this, but doesn't it sound fun? If you have done this or something similar, please do share your experience. Others (including me) will find it very interesting.

Mindfully Eating a Raisin   Photo Credit
Some other thoughts from the class:

Mindfulness is the Quality of Awareness or Presence.
Part of being mindful is to do one thing at a time.

What has been your experience with Mindfulness Practices? What are your successess and challenges around this particular DBT skill?

Thank you for sharing.

More soon.

Easily Influenced? A Borderline's Struggle with Identity

I'm not sure if other people with BPD (Borderline Personality Disorder) feel this way or can relate, but I am pretty easily influenced.  I might hear a strong opinion that radically differs from the one I had been holding until that moment and be swayed completely.  I am not trying to say that I am gullible, an idiot, or totally brainless. I do mean to say that my sense of self and identity is not really strong as it is for most other people.

I also mean to say that many of us with BPD have a tendency to shape-shift, if you will, to become like whoever it is that we are talking to at the moment, trying to impress, or who we like and want to like us back.

When I was in high school, if someone asked me what kind of music I liked, (and my musical taste was and is quite eclectic and varied), I think my mind would do a split second assessment of what I though that person must like (based on their clothes, hair, makeup), and I'd respond with the type of music I thought would impress them or give us something in common.

For example, if I met this girl, I'd say I liked goth music. :)


Photo Credit
Have you ever done anything like that?  I have found that sometimes this trait can have positive results.
 
I've been feeling a bit depressed lately, and I reasoned that if I could get myself around some smart, positive people, perhaps their words and actions would influence me in a positive way.  It worked.
 
Yesterday, I went to get a much overdue hair cut.  Due to my budget at the moment, I go to one of those in-and-out quickie hair cut places.  In the past, it's been hit or miss for me in terms of finding someone who is competent and cares enough to cut my hair the way I request. I recently got lucky. 
 
I found a stylist who not only cuts my hair beautifully for $15, but she also shares her bright, positive, encouraging spirit with me every time I sit in her chair.  And, she takes her time. About a month ago, I was very concerned to see that she had stress written all over her face. Her eyes were puffy and red, as she'd obviously been crying. I asked her what was wrong.  She shared with me that she and her husband were losing their house and needed to find an apartment by Sunday (and it was already Tuesday).  I worried for her. In fact, I let my hair grow out all raggedy and didn't go back for a while because I was so sad to see her that way. 
 
The experience made me realize that she is human.  We all experience a wide range of emotions, and just like I can't expect myself to have a constant baseline of "happy," I can't expect others to either.  I can't expect to be all-or-nothing or "completely happy" or "completely depressed."  It's difficult for me to get it sometimes, but there are shades of gray in-between.
 
I finally went to get my hair cut again yesterday.  My stylist seemed happy again. She told me that a huge weight had been lifted off of her and her husband's shoulders and that, although they now live in a tiny apartment, they are very happy and have stopped arguing. She had a brightness in her eyes again. And, this time, she detected my stress.
 
"You seem SO stressed," she said, "It's written all over your face."  I told her I was, indeed, stressed.  I didn't get into all of the details (I had SOME boundaries, lol), but I did tell her that I was having a difficult time holding down a job.  I was on the verge of tears and felt SO DEPRESSED. I even felt a heaviness in my body.
 
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My stylist encouraged me to DISTRACT myself whenever I wasn't doing anything proactive with regards to my goal of securing and keeping a job.  Wow. (She doesn't know, of course, that I have Borderline Personality Disorder, and my hunch is that she probably doesn't know about DBT. So, I wonder, do people who don't have this disorder naturally tend to do the skills we learn in DBT? Any thoughts on this?)
 
Distraction is one of my favorite DBT (Dialectical Behavior Therapy) skills.  The idea is to distract yourself with activities and thoughts that make you feel better and that help prevent you from acting impulsively or destructively when there is nothing more you can do in that moment to change your situation.
 
She also suggested being grateful and speaking positive things about myself and my situation. I started doing it, and it began to work.  Her influence on me was positive.
 
After I left, I got into my car and began speaking positively. Out loud. At first, I still felt really crappy and heavy, but the more I did it, the better I felt. I practiced doing the "half smile" DBT skill (are you familiar with this one by Thich Nhat Hanh?), and I said, aloud:
 
I choose joy.
I choose happiness.
My new job is coming within the next couple of weeks. I will love it. They will love me. I will be happy.
I am happy.
 
It felt kind of fake and phoney at first, but I just kept going with the practice. I kept repeating those four lines all the way home, and, I have to tell you, I felt like a different person when I woke up today. I didn't feel heavy.  I didn't feel deeply depressed as I have been for weeks.
 
It took a perspective change. It took an acknowledgment that I could change my mind and state of being by changing my thoughts and choosing to focus on the positive, and it all began by realizing my highly influenced nature and choosing to be around someone who would positively affect this trait.
 
I hope this helps you in some way.
 
More soon.


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