Don't Give Up - DBT for Distressing Self-Harm Thoughts

It has been a long while since I have had the types of thoughts I'll be writing about today. If you're feeling particularly sensitive around self-harm thoughts or issues, please be advised that this post comes with a trigger warning.

*Trigger Warning Starts*

I felt alarmed today.  I experienced thoughts I haven't had in a couple of years.  The thoughts were around existential questions.  I had seen some recent tweets where people were asking "What's the point if I keep suffering?" and "Why should I go on?"  When I am feeling strong and stable (as I have been for the  most part the past two years), I can scan over these tweets, first feeling compassion for the person suffering and second even replying sometimes, and then I am able to let them go. I noticed that I actually felt triggered by such tweets yesterday and today.

I don't want to avoid Twitter, as it is a large source of support for me, and I offer quite a bit of support to others through it as well, so I need to figure something else out.

I'm keeping in mind that everything has cause.  This means that nothing is completely random. Even if we don't know the reason for something, we can rest assured that something happened before it to cause it. I take comfort in this. It means that my thoughts and feelings and reactions are in response to something. Whether or not I can sort it out as to what the cause is, applying DBT (Dialectical Therapy Skills) can be effective in helping to reduce my resulting suffering and help me from making matters worse.

Instead of completely freaking out over these unwanted, intrusive, and scary thoughts, I am instead looking at them mindfully, with curiosity, and looking through my DBT skills to determine what will be the best course of self-care action. Which skills will I use to cope with the distress of these thoughts?

In just asking these questions, I became aware that I do not WANT to have self-harm or suicidal thoughts, and this is a good sign.  If the thoughts felt good or I wanted to pursue them, I'd be in the type of crisis that would require professional intervention. I know that. I've been there before and have needed to seek that help. I am confident in my ability to discern between that type of feeling and feeling distressed because I'm having unwanted, distressing thoughts.

In addition to my diagnosis of Borderline Personality Disorder, I also have Obsessive Compulsive Disorder, and the intrusive thoughts feel like they are coming more from that place than BPD (where I would actually think about or consider acting on the thoughts), however, due to the complexities of the mingled diagnoses, I believe that DBT will be more effective than CBT (Cognitive Behavioral Therapy) for these particular thoughts. I could be wrong. If they continue, I'll discuss it with my therapist at my appointment on Thursday.

I think I can identify the cause in this case.  Yesterday, I was interviewed for an investigation from 9:45 in the morning until 3:00 pm with just a half an hour break.  It turns out that we didn't have enough time to finish the interview, so I have to go back on Tuesday morning to complete it.

The topic was difficult.  Someone had violated me in very inappropriate ways, and it triggered wounds from the past.  I had to retell what happened, in details, and I became very emotional during those times. I managed to remain strong and calm throughout the other segments. 

I have been very stressed leading up to yesterday, knowing it was coming.  At 3:00 pm yesterday, when I headed home, I felt overcome with exhaustion. I went home, connected on Twitter, and then fell asleep on the couch.  I was out.

I got up to eat and watch one TV show, but by 9:30 pm, I could barely keep my eyes open. I decided not to fight it and that resting was in my best interest. So, I managed to take a hot shower, and then I went to bed.

I slept quite a bit, and when I woke up, I felt depressed and groggy.  I got ready to meet my boyfriend for lunch. We did that, and after that, we went for a walk. It was on this walk that he began to discuss his plans to eventually move back overseas.  This is when I started having the thoughts.

It's making sense.  I've often noted that when I have had suicidal thoughts, it was NOT because I really wanted to die.   I actually wanted to feel ANYTHING other than what I was feeling.  In that moment, overwhelmed with replays of the troubling moments of the investigation yesterday and then hearing these words from my significant other, it became too much.  

Other times, I could have these thoughts pass through like a cloud in the sky and not latch on to them.  I could see people tweeting existential-type questions and not become wrapped up in them or freaked out by them. But, I think I have been under so much stress and pressure that I was emotionally vulnerable to the point where the thoughts became a trigger. 

When I'm not under so much pressure, if a thought like this crosses my mind, I literally think, "Who cares? I'm enjoying life."  So, I told myself this even though it didn't feel completely true.  I liken this to doing the "half smile" exercise, which I also practiced today.

*Trigger Warning Ends*

I felt the sun on my skin, opened my arms up, turned my head up to the sky, and said "Yes!" to life. (This is a Radical Acceptance exercise.) 

I decided that although I am justified in feeling sad, the thoughts that have followed are not in proportion to what I am dealing with,  so I will use Opposite Action skills to cope.  With opposite action, you identify the emotion you want to change. The closest emotion I can come up with is sadness.
According to Skills Training Manual for Disordered Emotion Regulation by Dr. Marsha Linehan, (c) in press Guilford, in order to practice opposite action for sadness, one should:

"1. Get Active: approach, don't avoid.
     I'm writing out what's happening. I told my boyfriend how I'm feeling. I'm taking action
    to cope skillfully.
 2. Do things that make you FEEL COMPETENT and self-confident.
    I did my makeup and hair nicely today. I also helped boyfriend clean laundry room and take
    recyclables to the recycling facility. I am also blogging.

 3. Do the OPPOSITE of other action (or inaction) urges.
    Instead of sleeping all day and focusing on the thoughts, I got out of the house.

ALL-THE WAY Opposite Action for Sadness:
4. Pay attention to the PRESENT MOMENT.
    As I was walking, I told myself, "It's Saturday, September 8th at 1:45 pm..." and I described
    what I saw around me.  I let me self be in the moment, reminding myself, "Just this moment,
     just this breath."
    Be mindful of your environment, each detail as it unfolds.
    Experience new or positive activities you are engaging in.
    I was mindful of this and adjusted accordingly, including doing the "Yes to Life" radical
    acceptance exercise.
     Increase physical movement, e.g. run, jog, walk, or do other active movement exercise"
     I walked for about two miles and helped clean up around the house.
     (Linehan, 56).

I can also use Distress Tolerance skills.  I plan to:
  • Distract with my favorite TV shows
  • Push away emotions - I think it's perfectly fine to put these thoughts "on the shelf," as they serve me no good.
  • Think new thoughts based on experiences (i.e. from funny TV show).
  • Use self-soothing by wrapping up in my favorite blanket on the couch with my cats
  • Listen to upbeat songs that improve the moment, including:
    • Move (about trusting things will get better, and until then, I can dance in the rainstorm.)

    • Don't Give Up (the title says it all)

I have DBT group on Tuesday and Thursday and an individual session with my therapist on Thursday as well.  I have the skills to cope through this distress, and I will.

How might you apply some of these skills when you are feeling this way?

Thanks for reading.
More Soon.


  1. Thank you so much for this post. I have been dealing with the same, horrible thoughts the past few weeks and it came to a head this weekend. I am staying at a friends for the weekend to stay safe. The songs and the DBT skills you put in your post are such a great reminder to me of some of the tools I have to stay strong. Thank you for being so open and honest. Keep yourself safe and are amazing!

    1. You're very welcome, Charisee. We are NOT alone, and this, too, shall truly pass. ♥

  2. Thank you so much for this post. So very helpful for where I am at right now.

    1. So glad to hear that, Christelle. You are very welcome! ♥

  3. My temptation is to react to BPD behaviors. But I must focus on responding, which puts me in line with my long term goals. Thanks for your post. It is helping me to stick to my response and push aside my reaction.

    1. That's a pretty common initial reaction Scot. So glad this was helpful! ♥



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