Emotion Regulation Worksheet 1a: Intense Anxiety Episode



One of the reasons that I am able to write so openly and vividly about the experience of the intense emotion of anxiety is because I, too, experience it. Perhaps not as often as in years past, but that doesn't seem to matter in the heat of the moment when it strikes. It feels just as intense and real as ever. A very recognizable group of sensations and thoughts. Can you relate?

This morning, I woke up feeling anxious. We've recently been prompted by our DBT group therapist to pull out and fill out the DBT Emotion Regulation Worksheet 1a when we experience an intense emotion.   Early on in my journey with DBT, these worksheets were a life saver for me. (If you put "Emotion Regulation Worksheet 1a" in the search box at the upper right of my blog, several posts will come up - one of which includes a blank sheet so you can fill one out, too. Click here to go directly to the blank worksheet.) Taking the time to fill this sheet out helped me on many occasions to slow down my experience and prevent myself from behaving in ways that would only cause me more distress by making the situation worse (allowing the sheet to serve two purposes: emotion regulation and distress tolerance.)

It's been months since I've felt the need to fill out one of these sheets. I've had intense episodes but have processed through them without the sheet.  I don't see the choice to use one today as regression. In fact, I think this sheet will be in my toolbox as a resource for many years to come.  I think I just happened to have been  nudged by the reminder that this sheet is the homework for group this week, so it made sense to use it. Plus, it may help some readers if I share it...so here goes.

Note: I fill out these sheets in the heat of the intense emotion, except for the last question on After Effects, which I fill out as I begin to feel calmer. Also, I try to be blatantly honest and real with myself about my experience, sometimes revealing behaviors I've engaged in that evoke shame, which I then need to deal with separately.  I find that the only way to really get anything out of therapy, DBT, doing these worksheets, etc., is to take the risk to be very honest with ourselves about our experiences -- even if uncomfortable emotions come up in response. Then, we just deal with those and further heal, grow, and move forward on our healing journey.


Emotion Name: Anxiety
Intensity (0-100):  78

Prompting Event for my emotion (who, what, when, where) What triggered the emotion?: 
Woke up with some physical pain, nausea, and muscle tension. Received a mean comment online. Hurt feelings of family member with passive aggressive Facebook post rather than reaching out in compassion, for which I feel guilty and like a jerk and hypocrite. MRI scheduled for today.

Vulnerability Factors - What happened before that made me vulnerable to the prompting event?
Anticipation of loneliness/boredom during the day to come. Had neurological exam yesterday (was fine, but anxiety provoking. Dr. asked upsetting, triggering questions.)  Had MRI scheduled for today but was too anxious to go. Weather, though cozy, is gloomy, and driving would likely be dangerous, so I feel stuck isolated at the house.

Interpretation (beliefs, assumptions, appraisals) of the situation:  
This is anxiety or I could be sick. Another annoying anxiety episode. This could ruin my day. This could pass quickly. I know how to get through this.  I shouldn't have to deal with this again!

Face and Body Changes and Sensing(what am I feeling in my face and body?):
Tension in jaw and face. Hands cold. Stomach making noises, having to go to bathroom. Breathing faster. Muscles really tense.

Action Urges - What do I feel like doing? What do I want to say?:
Freaking out: screaming, running, crying.

Body Language - What is my facial expression? posture? gestures?:
Despair face (eyebrows up, frowning, eyes look scared), rubbing belly. Head in hands.

What I said in the situation (be specific):
This sucks. Not again. Enough already. I know what to do.

What I DID in the situation (be specific):
Tweeted. Told sister how I was feeling (on phone). Rescheduled MRI appointment instead of just being a no-show, sat down to do this worksheet. Started planning for self- care, including a guided meditation and muscle tension and relaxation exercise. Took Tylenol for pain. Rescheduled MRI appointment instead of just doing a no-show.

What AFTER EFFECTS does the emotion have on me (my state of mind, other emotions, behavior, thoughts, memory, body, etc.)?:
So far I've noticed tension. A little bit of sadness. Thinking more clearly about what footwork I need to do to get out of the house more (i.e. part-time job, gym).


Here's the actual sheet I filled out: 




Was this helpful to you in any way? Might you fill out this sheet the next time you are feeling an intense emotion and bring it to DBT group/share it with your therapist?


Thank you for reading.
More Soon.

The Biology of An Emotion | Slowing Down Anxiety, Panic,and Distress


This week, a number of my #BPDfriends on Twitter were suffering from what appeared to me to be intense episodes of emotional dysregulation -- something that I, as a person with Borderline Personality Disorder, am all too familiar with (thought they are far and few between compared with years past).

In each instance that I was honored to be able to provide some peer support, I noticed a few things that you may recognize in yourself when your emotions begin to spiral. I know I sure did. 

Trigger warning - description of intense symptoms during some emotion dysregulation episodes. If you are particularly sensitive to such topics at the moment, you may want to skip down to the END Trigger Warning section. Remember, I am not a doctor or therapist. Seek medical/psychiatric assistance for diagnosis and assistance.

They are:
  • Intense mental reactions, such as:
    • Racing stream of thoughts that overwhelm you. You can't seem to stop thinking, and the thoughts are coming super fast
    • A feeling of being frantic, helpless, and out of control
    • Worries about the past
    • Worries about the future (including "what if" thoughts)
    • Worries that you are going crazy
    • Worries that you will never feel better again
    • Worries that you have or will "lose everything" you have (relationships, jobs, etc.)
  • Intense physical reactions, such as:
    • Issues with breathing, i.e., hyperventilating, feeling like you're not breathing enough, pre-occupation with the breath in a fearful way, tightness in chest or feeling of throat closing which makes it seem like you're not getting enough air
    • Gastrointestinal issues, i.e. stomach upset, nausea, vomiting, diarrhea, stomach pain
    • Headache
    • Muscle tension

END  Trigger Warning

When I saw others in pain and was fortunately available and willing to step up and try to support them as a peer, I kept a few things in mind:

  • I've felt similarly before and made it through. They can too.
  • They have probably felt similarly before and have made it through. They will again.
  • Anxiety and Panic are like a mouse with a microphone, loud and scary, but very often there is no actual danger.
  • When emotions are dysregulated at this level, the person is in Emotion Mind. I know that, for me, anything that can help me back into Wise Mind is a good thing during these episodes.
  • There are things that can be done to potentially help slow down the cycle 
  • I am not a doctor or therapist, so I need to be conscious of this, support as a peer, and be careful of my boundaries

Look At It As a Curious Scientist

With all of that, I kept in mind some things that my DBT therapist has been discussing lately, one of which is the biology of emotions - particularly anxiety.  Thinking of what happens to my state of mind and body - the hardwired human responses when triggered into an anxious or panicky episode - really helps to make it less scary for me. 

For example:
  • Biological changes, including a brain change in neural firing
  • Muscle tension
  • An urge to run away, fight back, or freeze
  • Crying
  • Feeling terrified
These are part of a universal experience when these emotions arise, and if you can remember this the next time you experience it, it may help to slow down any reaction you have to the episode, helping you to not add to your distress.


Breaking Free From The Cycle

The way I helped my friends - and a way you can help yourself the next time you notice you're stuck in the vicious cycle of biological changes and ruminating on the situation that triggered the emotion - is to make a move by responding to the biological changes. 

Start by:
  • Noticing what's happening in your mind and body
  • Describe, non-judgmentally, what you notice. For example: Breathing is faster. Heart is racing. Feeling like I'm not grounded.
  • Figure out what desired emotion or behaviors you want, and act accordingly

One of the most effective DBT skills I've found in this situation, both when helping my peers and myself is Distraction.  Once I've noticed, described, and figured out that I want to feel better, whether that means safe vs. fearful, happy vs. sad, calm vs., angry, etc., I want to distract my mind with thoughts that interrupt the pattern of unwanted thoughts that continue to race through my brain.

If helping someone else, I may ask random questions, such as their favorite movie, singer, color, or cuisine. If I get one word answers, I ask for elaboration.

During the time that the person is responding to these distracting questions, messages are being sent back to the brain and nervous system that there is no danger and that all systems can return to normal, so to speak. If you're alone and wanting to do this for yourself, you can turn a television program that requires close attention to follow the story, get online and find some YouTube videos that are detailed, such as makeup tutorials, or fill out a crossword puzzle or word game -- yes -- in the midst of feeling like you are...distraction can (and often does) help.

Remember and tell yourself, "I don't have to suffer."

Remember that your interpretations of what is happening during an episode of emotional dysregulation do not always reflect reality. Be open to the possibility that your Emotion Mind is doing a lot of the talking and that you will have more rational, reasonable assessments of your situation once your nervous system has finally calmed down.

And, about that, I've often noticed that while my mind may logically get that I am not in danger and that I am safe, my body may take extra long to catch up. My heart may still race for a while. I may still randomly sob even though I've stopped crying. I may still feel uncomfortable with muscle tension or stomach upset.  Don't let this distress you further.  

In my experience, it takes longer for the physiological/biological ramifications of the distress to dissolve and stop.  I find that the more effort you put into self-care, soothing, and distraction, the sooner you feel better on all levels, including physical. Just be patient. Your equilibrium will be restored, and you can help facilitate this by remaining as calm as you can in the meantime.

Other skills that can help during this time are deep,meditative breathing and half-smiling, which has been scientifically proven to help positively affect mood.


I hope this was helpful for you or someone you love and that it took some out of the "scary" out of emotional episodes.


Thanks for reading.
More Soon.

NEW DBT Book: Stop Sabotaging: A 31 Day Challenge to Change Your Life by Debbie Corso

Now Available! Click HERE to purchase!


Stop Sabotaging: A 31 Day DBT Challenge to Change Your Life
by Debbie Corso, author of Healing From Borderline Personality Disorder: My Journey Out of Hell Through Dialectical Behavior Therapy


Here's what the book covers:
  • what sabotaging is
  • why, as emotionally dysregulated individuals, we tend to do it, and 
  • strategies for shifting out of this destructive pattern and radically changing your life
The book includes a 31 day practice of DBT (Dialectical Behavior Therapy) skills, and keeping a journal as you read (whether old school pen and paper or a memo app on your smart phone) is essential.
The book contains skills and challenges that help you learn to:
  • know and love yourself more
  • connect more appropriately and closely with others
  • change how you view and value your life so that you reduce or virtually eliminate self-sabotaging from the options you choose from on a daily basis.  
If you're ready to Stop Sabotaging your life, join me on the journey of Creating a Life Worth Living!

Introduction by Alicia Paz, M.A., LLPC
Afterword by Amanda Smith, founder of My Dialectical Life



Start Reading Now:

Download and start reading the book on your e-readers for only $2.99 from Smashwords by clicking HERE from Smashwords.

This book is also available on:

Kindle (Amazon)
Nook (Barnes & Noble)

and your other favorite ebook retailers!

Enjoy, and thank you for reading my books and blog! 


Click here to watch a video review of the book by "Atypical Aeshe," a transgender woman who chronicled her journey and progress with the book for the full 31 days on Youtube:






Click here to HERE psychologist Dr. Ginger Peterson recommend my books on "The Mental Health Happiness Hour" podcast with Paul Gilmartin.  (Please note that this podcast by Paul Gilmartin contains vulgarities.) Segment starts at 36:48.


In kindness,
Debbie 

Shopped At The Serotonin Store Today: Serotonin & BPD


Many of us who have Borderline Personality Disorder experience an array of emotions on any given day. Our experience of these emotions tends to be much more intense than that of someone who is not diagnosed with BPD. 

Included in the mood swings we experience are often deep levels of sadness and depression.  Because I suffered for many years, feeling at the mercy of these particular (yet just just as transient as any other) emotions, I sought out ways to support my mind and body in feeling well.


We don't have to be powerless over this situation.

For me, in addition to Dialectical Behavior Therapy (DBT), my action plan turned out to include a combination of things revolving around something called serotonin.


What is Serotonin?


We hear a lot these days about serotonin - a naturally occurring chemical in the human brain that promotes feelings of well-being. Scientists say that people with low levels of serotonin suffer from depression.  A class of drugs called SSRIs (selective serotonin re-uptake inhibitors), such as Zoloft and Celexa, work by lengthening the amount of time that serotonin is in contact with certain brain receptors.

In addition to taking an SSRI, I've learned that there are other ways to increase my serotonin levels and feel good, and in my experience -- they work!


A Visit to the "Serotonin Store"


This weekend, I went to the "Serotonin Store." This place can look different from person to person on any given day. For me on Friday, it was the beach. Yes, instead of Black Friday, I celebrated Beach Friday, and it did me some good. 



My view the other day

Sunshine

According to WebMD

"A new study shows that the brain produces more of the mood-lifting chemical serotonin on sunny days than on darker days....Researchers found that regardless of the season, the turnover of serotonin in the brain was affected by the amount of sunlight on any given day. And the levels of serotonin were higher on bright days than on overcast or cloudy ones. In fact, the rate of serotonin production in the brain was directly related to the duration of bright sunlight."


Yesterday was a sunny, warm day at the coast here in California, with temperatures ranging from the 60s to the 70s and not a cloud in sight. I felt the warmth of the heat of the sun on my skin and felt enveloped and comforted it by it.  I knew that not only was my body absorbing vitamin D from the sun, but it was also creating more serotonin. 


Movement

Whether the effects were technically immediate or not, I felt better during my walk and outing of over six miles. In addition to sunlight helping with the production of serotonin, exercise is also shown to do the same, so I surely picked up some more while engaging in my brisk walk.


An article on how to increase serotonin in the brain by the National Institute of Health states that a strategy 
 "that may raise brain serotonin is exercise. A comprehensive review of the relation between exercise and mood concluded that antidepressant and anxiolytic effects have been clearly demonstrated...Several lines of research suggest that exercise increases brain serotonin function in the human brain." 

I find it helpful and empowering to know that there are things that I can do to potentially increase serotonin production in my brain and feel better.  


DBT Skills In Action

I practiced several DBT skills, including:


  • Creating a Life Worth Living:  I enjoy being out in the sun and going to the beach. While there, I collected a bunch of beautiful seashells and stones to take home and admire. I also intend to pick out one that I will carry as a "grounding" tool. I will have that part of the ocean with me to remind me of its vastness and beauty. While there, I felt an immense amount of gratitude and thankfulness for all of the good in my life.
    These are some of the shells and stones I found at the beach.
    I suppose they were my "currency" at the  Serotonin Store. :)

  • Distracting: I got my mind off of my problems by engaging in walking and observing the beach while collecting keepsakes.
  • Self-Soothing: I observed that nearly all of my senses were soothed during this outing:
    • Through sight: I, of course, looked at and enjoyed the beautiful scenery all around me. 
    • Through sound: I listened to the waves coming in and going out and crashing on the shore and rocks.
    • Through touch: I felt the sand  with my hands and noticed how it felt as I walked on it. 
    • Through smell: I smelled the salty sea air.
  • PLEASE: Through exercising and staying hydrated (I took my trusty bottle of bubbly water with me), I took care of my physical well-being.

Did you ever shop at the Serotonin Store? What does it look like for you?

Thank you for reading.
More Soon.

Paying Forward The Compassion You've Received - Empathy and BPD



If I can save one person, perhaps you, from unnecessary suffering because you are able to gleam some insight into similarities in your own life and behavior, this post will be worth it. I am going to trust that someone, somewhere will stumble across this post, see themselves in my story, and find hope.

I've been reflecting on something for the past couple of days, and what I've found, I believe, is a revelation that if treated without judgment and with willingness and compassion could be a huge step in my recovery. Content may be triggering for some.

To be frank, as a person who was victimized quite a bit as a child and young woman, as a young adult, I became someone who was a bit cynical, naive, and reckless, all rolled into one.

In my early twenties, I had sides of me that seem so foreign now. I thought sex would make someone love me and make me feel loved. I could get so angry that I was vicious, and my careless words could hurt more than any weapon possibly could. I was incredibly impulsive, and satisfying immediate urges overpowered any desire I had to live a "normal" life. I didn't think much about consequences until it was too late and I was suffering them.

How could I have behaved that way? The answer is, believe it or not, I was doing the best that I could at that time, given my life experience and the resources and tools that I'd learned and integrated up until that point. As much as I want to harshly judge that girl in her 20s and ask "How could that have possibly been 'your best' ?", I have found a way to have compassion for her.

In reality, at that time in my life, I was a scared (even terrified) young girl who was desperate for love, approval, stability, and safety, but I didn't know how to find it. I acted out in desperate ways and manipulated others to try to have these things for myself. It was all I knew. In the midst of that, I felt slighted by most people, was incredibly emotionally sensitive, and had tons of anger that came out in inappropriate outburst, mostly to the people closest to me.

I hadn't even heard of DBT at that time in my life. I lived my life in survival mode, always feeling like I had to outsmart prey.

I remember one of my inpatient psychiatric hospitalizations at around age twenty when I was kept in a locked ward for three weeks. We went on walks with staff and had cigarette breaks outside (I smoked heavily at the time), but other than that, I lived within the walls of the third floor. There was this one nurse who I felt was out to get me. I remember trying to convince her that I was ready to leave about two weeks into the stay. I told her that my self harm threats were for attention and that I wasn't suicidal. She recommended I continue to be observed.

When I found this out, I felt betrayed and angry. I became so cruel to her, saying insulting things, slamming things, and glamorizing the slight buzz I got off of the benzos in front of other patients. In short, I tried to annoy her and make her shifts difficult and unpleasant. I am sorry that I treated her and others that way at that time of my life. I didn't know how to be assertive, so I was very passive aggressive and sometimes aggressive.

I remember on my discharge papers that the notes said, "Rule out Borderline Personality Disorder." I never followed up, and it wasn't until about eleven years later that I was officially diagnosed with BPD.

So, what was the revelation? I recently found myself "the victim" of some cyber abuse, and I was incredibly hurt. Individuals who I came to see as friends and who I'd wholeheartedly supported many times had essentially and suddenly completely turned on me when I announced a boundary I had and chose to "unfollow" a person on Twitter temporarily.

I felt completely victimized and wasn't able to see that I may have played a small role in setting myself up for criticism - not that I am justifying the attack that occurred. I tend to be a Mother Hen type, trying to protect others and nudging others to conform to my ideas around creating a safe community, but you know what? No one asked me to do it. It's not my job. I can speak what's on my mind, create a boundary for myself, and even make suggestions, but it's not my place to expect that others will see things as I do and conform accordingly. And, it wasn't fair for me to expect this.

The cruelty I experienced in response to what was an intention to protect my boundary and those of other vulnerable people was not, in my mind, justified, and I cried, shook, and felt rejected and alienated, but I also began to remember the girl I used to be.

I held compassion in my heart and in my hurt for the women who were attacking me. The woman I was in my early 20s came to mind. I honestly feel that it was okay for me to set the boundary like I did, but I've since realized that there were more sensitive ways to go about it.

I also remembered an important component of the Toltec Four Agreements, which is that nothing anyone does is about you -- it's about them. How people react to you and treat you reflects where they are on their path right now.

I release judgment against those involved and myself. I release the need to be right. I wish nothing more but for peace in the hearts, minds, and spirits of all those involved. When I meditated on this, I saw the young me in my mind's eye and wondered how many times others, further on the path perhaps, held me and my behaviors in that same regard.

We are all healing from our own hurts. We are all growing. We all need compassion.


Thank you for reading.
More soon.

What does "TW" Mean, and Why Should You Use It?




You may have come across tweets on Twitter or posts on Facebook that start out with the letters "TW." What does this stand for, and why should you consider using it?



What does "TW" mean?

TW means "trigger warning." It is a courtesy extended to others who may view your content on social media when your post is potentially an emotional trigger.

Geek Feminism Wiki describes trigger warnings as:

"Trigger warnings are...designed to prevent people who have an extremely strong and damaging emotional response (for example, post-traumatic flashbacks or urges to harm themselves) to certain subjects from encountering them unaware. Having these responses is called "being triggered."

The Urban Dictionary describes it as:

"Used to alert people when an internet post, book, article, picture, video, audio clip, or some other media could potentially cause extremely negative reactions (such as post-traumatic flashbacks or self-harm) due to its content. Sometimes abbreviated as "TW."


Psychotherapist Alicia Paz, M.A., LLC mentions the use of TW in tweets in this way:

"Although the DSM IV-r criteria for Borderline Personality Disorder does not include trauma, it is often a common thread in those with the disorder.  Often on Twitter I see a tweet started with "TW" (trigger warning) before something that may be triggering, it's a safety boundary for many in the BPD community.  In DBT we strictly enforce the rules about saying things that can be triggers, sometimes those who don't have BPD don't realize how harmful what they say can be, sometimes people try to stir up some drama and some are so disconnected from their trauma they don't understand how someone could be hurt by what they are saying."    

The Challenges of Using TW:

We've all come across that tweet that made us feel a sudden flood of anxiety or disbelief. We wish we had never read it, as we now feel emotionally affected by it. Wouldn't it be nice if there were a code for warning others that our post may be upsetting so that they have the choice to read on or pass it over if they are feeling particularly vulnerable? There is.

By putting the letters TW at the beginning of your tweet or post and spreading awareness as to what this means, we help create a safer, more courteous space to connect with others who may be suffering. 

There are some challenges around using TW, of course, and they include but are not limited to:

  • Forgetting to use the label when in the heat of Emotion Mind
  • Being willful and deciding that it's not important to extend this courtesy in a community setting
  • Not caring about how your words might affect others
  • The fact that triggers are very subjective. You may tweet something about how you are angry with your mother, not thinking this is a triggering tweet, but someone else who is going through something with their Mom may find it very triggering.

    It's just impossible to be aware of and sensitive to every possible trigger that any person may be vulnerable to at a given moment in time, nor should you be burdened with that responsibility or have your freedom of expression squandered due to this. What we can do is come up with and agree on certain topics that should always be treated with caution and be preceded with a TW. Here are my suggestions:
    • Tweets or posts about:
      • suicide
      • self harm
      • specifics about abuse (mental, physical, sexual, etc.)
      • glorification or support for eating disorder (ed) behaviors
What to do if you consistently see posts/tweets without TW that trigger you:

Many people on Twitter and Facebook, like us,  have mental illness and go through periods of suffering. They may sometimes post things on the above list without a TW. If it becomes too much for me, I unfollow them (usually not permanently -- I just take a break. I've recently been particularly sensitive and vulnerable due to strong PTSD symptoms).

I also let the person know why I've unfollowed. It's a matter of self-care. It's nothing personal or done to hurt or upset anyone else.  Sometimes I just step away from social media for a while to soothe and then return later. 

It's up to you how you handle these situations. We can't control anyone else's behavior. I tend to be a Mother Hen, and with the best of intentions try to nudge people into considering using TW, but this is not always well received. I have to accept that.  Nothing anyone does is about us. It is about them, and each person as at their own point on their particular journey.  We can't force people to understand or compromise. It's up to them to decide how they will behave in a community setting.


Your Thoughts?

What are your thoughts? Do you agree with my list of suggested TW topics? What would you add or take way from the list, and why? What do you do when you come across a triggering tweet or post? What do you do to warn others when your content may be triggering?


Thank you for reading.
More Soon.

The Four Agreements: Toltec Wisdom for the Emotionally Wounded


Years ago, in a mystical new age bookstore, I stumbled upon a book and accompanying deck of cards called "The Four Agreements." I remember my intrigue when I read the back cover and learned that there was a system of beliefs, delivered down from the Toltec culture, that boiled down to four, simple principles. I was also not naive enough to believe that practicing them would be easy, but I was compelled to learn more.

I bought the book, The Four Agreements by don Miguel Ruiz, and the deck of cards.

The book
  
Deck of cards

I'm revisiting the book and cards again, because as simplistic as the messages they contain may be, much like DBT (Dialectical Behavior Therapy) skills, they work beautifully when applied wholeheartedly and consistently.

(I've learned that a fifth agreement has been revealed, but I am not yet familiar with it. I will read the book and report back, but for this post, we'll focus on the four I am familiar with).

The Four Agreements are:

"1. Be Impeccable with your Word: Speak with integrity. Say only what you mean. Avoid using the Word to speak against yourself or to gossip about others. Use the power of your Word in the direction of truth and love.

2. Don’t Take Anything Personally
Nothing others do is because of you. What others say and do is a projection of their own reality, their own dream. When you are immune to the opinions and actions of others, you won’t be the victim of needless suffering.

3. Don’t Make Assumptions
Find the courage to ask questions and to express what you really want. Communicate with others as clearly as you can to avoid misunderstandings, sadness and drama. With just this one agreement, you can completely transform your life.

4. Always Do Your Best
Your best is going to change from moment to moment; it will be different when you are healthy as opposed to sick. Under any circumstance, simply do your best, and you will avoid self-judgment, self-abuse, and regret" (Ruiz, 1997).


Yesterday, during a personal challenge, all four of these agreements (that we consciously and voluntarily make with ourselves) came rushing back to memory.  The situation served as a reminder to brush up on these skills and to re-implement them into my daily life.

I can't undo the past, but I can choose to move forward in integrity while practicing not only my DBT skills but also The Four Agreements.


Which of the agreements speaks to you? How do you think your relationships, career, and life can be transformed if you are willing and able to apply them?



Thanks for reading.
More Soon.



Reference:


Reinventing Ourselves: Identity Issues & Borderline Personality Disorder


When I was a little girl I witnessed one of my idols, Madonna, from album to album, undergo metamorphosis. She would change her entire look and vibe, and the press would say she had yet again "reinvented" herself. This thought always appealed to me, and as someone with Borderline Personality Disorder who has dealt with an elusive sense of self-image and identity, I've tried to do this many times -- to reinvent myself.

For example, in my twenties, I changed my name. I've gone by so many different first names over the years because I never felt like I identified with "Debbie." (Sometimes I still don't.) I'd pick names that felt good at the moment. Names that I thought others would think we're cool or pretty. I'd eventually either bore of the new name or become distressed and distraught, feeling like I'd only further separated myself from the possibility of connecting with the truth of who I really was. So, I'd rather reluctantly go back to being called Debbie.

I've radically changed my hairstyles over the years only to eventually find that a short pixie is what truly makes me feel like "me," whoever she may be. At least that's a start.

I've tried different styles of clothing only discover that while there's a part of me that is desperate to be perceived as cool and edgy, I'm more of a classic Ann Taylor Loft girl on my dress-up days and an Old Navy sweats and hoodie girl most others. There's another part of me where I've managed to find a piece of authenticity: the way I dress. I'll occasionally stray, but if I stray too far, it feels uncomfortable and awkward. I suppose this is normal for most people.

I used to fantasize that I would just move to a place where nobody knew me. I'd show up and be whoever I wanted. The girl with no past and a fresh slate. I could have them call me whatever I chose and create any image I wanted to project. I actually tried this a couple of times prior to being diagnosed as BPD.

I eventually learned that no matter how we dress, style our hair, where we live, or what we ask people to call us, we'll keep repeating the same dysfunctional and destructive behaviors we always have until we are willing to make a deep and honest attempt to find out who we really are in light of, despite of, and because of the lives we've lived up until this point in time.

I've been in DBT for almost two and a half years now. One of my major concerns that I had when I entered the program was whether it could be a help in me figure out who I was. It certainly has helped me get off to a good start. I've learned that I am not my emotions, nor am I at the mercy of them or a victim of them.

I've learned more effective ways to cope with distress so that I don't sabotage the progress I've made so far. I've learned ways of connecting and communicating with others that takes their perspective and needs into account rather than just my own. I have a long way to go in the area of relationships -- especially maintaining friendships, but it no longer seems impossible. It turns out that who I am at the core is someone who is pretty likable. I need to continue to believe that, to discover her, and let her emerge. I also need to create safety for so that I can learn to maintain those relationships despite having failed miserably at doing so in the past.

I continue to work on connecting with my own evolving identity. After all, how can we be in healthy relationships with others until we have a sense of who we are as individuals?

Perhaps I am undergoing or undertaking a self reinvention of sorts at present, but I'm proud to say, it's a conscious one. It's not about trying to figure out who I need to be in order to please someone else or to create an image that isn't really me to attract attention or change my life on a superficial level. It's about discovering, accepting, and loving who I really am and letting that woman shine, one day at a time.


Thanks for reading.
More soon.

It's All In Your Head: Mirror Neurons and Borderline Personality Disorder


I am always fascinated when my DBT group therapist goes into the science of psychology, human development, and the wonders of the mind. Yesterday, when I mentioned that I have have an over-empathetic mind, often taking on the emotions of others who express burdens, she explained that this is not pathological. 

While having Borderline Personality Disorder, of course, adds to this with the complication of identity and boundary issues, it turns out that humans, primates, and many other animals naturally mimic others' behaviors through something called "mirror neurons."

(I've been sitting on the edge of my seat each time our therapist gets into these discussions with us -- so much so that I've felt inspired to apply to a masters program that focuses on psychology and writing. I'll keep you posted on that process. I'm in the school research stages and may be applying to a particular university soon!)

What are Mirror Neurons?


Mirror neurons are impulse-conduction cells of the brain, spinal column, and nerves that react when a person (also present in many other animals) sees another person perform an action or experience an emotion (Wikipedia, 2012). The mirror neuron of the person observing reacts as if it, itself, were the one doing the action.

Scientist debate over the intended function of these mirror neurons. Some think they are designed to help us learn empathy, others to learn to mimic survival behaviors, some think it's for animals to understand the behaviors of other animals species, and still others are not sure.

I remember seeing an image like this in my undergraduate studies of the subject. It is of a human being sticking out his tongue at a tiny little monkey. In response, after a bit of observing, the monkey stuck his tongue out at the human. I actually tried this with a very young newborn baby in my Early Childhood Development practicum and was so delighted when the newborn baby also responded by sticking out her tongue.


(Gross, 2006)

Empathy and Mirror Neurons


The concern that I brought up in DBT group was my intense empathy for others when they talk about their problems and are visually distressed. Two people in a new processing group I'm in discussed issues around terminally ill loved ones. I noticed after a few moments that my expression was so sympathetic, and my mind went to the years when my father was in hospice.

When another group member talked about her struggle with food, I became very empathetic with her and connected her experience to my own with disordered eating.

According to researchers at Social Brain Lab, people who experience higher levels of empathy show more activity in the part of their brains responsible for mirroring (Jabbi, Swart, & Keysers, 2007). This might explain a lot!


What are your thoughts on mirror neurons?  Can you relate to being highly empathetic to others? How do you feel your diagnosis of BPD contributes to this?


Thanks for reading.
More soon.

References:

Gross, L. (Photographer). (2006). Evolution of neonatal imitation. [Web Photo]. Retrieved from http://en.wikipedia.org/wiki/File:Makak_neonatal_imitation.png

Jabbi, Mbemba; Swart, Marte; Keysers, Christian (2007). "Empathy for positive and negative emotions in the gustatory cortex". NeuroImage 34 (4): 1744–53. doi:10.1016/j.neuroimage.2006.10.032

Wikipedia. (2012). Mirror neuron. Retrieved from http://en.wikipedia.org/wiki/Mirror_neuron 

Acknowledging Your Mental Health Truth And Progress


I recently posted about feeling in so much emotional distress that my psychiatrist and therapist agreed that a return to IOP (Intensive Outpatient Program) was in order. This discussion happened last Friday, and I agreed to be skillful over the weekend and go in for an intake evaluation on Monday.  My therapist reminded me that I may not feel as badly in three days and that I may not need IOP at that point. Although I felt incredibly distressed and skeptical, I remained open to the possibility.

Amped Up the Self-Care

The weekend involved lots of self-care. There were times when I challenged negative, anxiety provoking thoughts and other times when I had to radically accept that they would keep coming. It was frustrating and tiring, but I stayed hopeful and pushed through. The moments free of these stressors were pretty darn good, so it was worth it.

Practiced DBT "PLEASE" Skills

On Saturday, my SO and I went to our favorite Indian restaurant. Although my appetite was not completely there, I ended up enjoying a little bit of this and a little bit of that of my favorite items from the buffet. We enjoyed some conversation and spent some time at the restaurant. Afterward, we went for a 4.25 mile walk. It was a brisk walk on a crisp Northern California autumn day. I was surprised at how refreshed and good I felt afterward. 

I slept well Saturday night. I'm sure that eating enough, walking, spending quality time with a loved one, and staying optimistic all helped.

I woke up on Sunday feeling refreshed. I took care of some errands that I had been putting off because they felt too overwhelming, and I felt a sense of accomplishment and mastery once I completed them. They were to my advantage, as they helped me save money while helping a family member. So glad I pushed through in this!

Sunday Night Anxiety & Realizing My Truth
When Sunday night approached, as is common for me on Sunday nights (see my post "Sundays Can Be Difficult for the Borderline Chameleon"), I noticed my anxiety begin to rise. I doubted myself and whether I felt stable emotionally. I also noticed some irritability. 

The weekend was coming to an end. I was really enjoying my SO's company, and he'd be returning to work in the morning. I'd be going in for an IOP evaluation. The truth was, overall, I didn't believe I was IOP material at this point. The program is intensive and designed for people coming out of psychiatric hospitalization as a transition program or to help prevent someone who is at risk for psychiatric hospitalization from needing to go inpatient in the first place.

I felt much more stable than I did last week. I was getting sleep. My appetite was a little bit better, and I was eating more regularly. The mood swings were more stable. But, there was a part of me, honestly, that wanted to go into IOP anyway. I've been a bit lonely and isolated. I don't have a huge social network right now outside of my online communities on Facebook and Twitter. Part of me just wanted to be in IOP to be around other people and to have structure.

I discussed this honestly with my DBT therapist, who also happened to be assigned to do my intake. She was proud of me. She told me what I already knew, which is that IOP is not designed to replace a social life. I smiled.

I am so fortunate to have access to a resource like this if needed, but I have made some personal growth, evidently, because I was unwilling to use the system to meet my need in a manipulative way. I felt safe. I have three groups a week to attend and work on my issues. I didn't need IOP, and I was honest about it, even though it left me with the anxiety over the lack of structure in my life.  I knew I had to take responsibility for that time and find ways to fill it with meaningful things and in a healthy way.

That part of the journey begins.

Do you have a lot of free time? How do you choose to structure it?

Thanks for reading.
More soon.

Mood Swings and Unstable Emotions with BPD



Things were getting pretty scary for me yesterday.  I'd had two nights of hardly any sleep.  I kept waking up every 1.5-2 hours with a racing heart and racing, nonsensical thoughts. It was extreme anxiety in response to some nightmares stemming from PTSD. It wasn't fun.

I tried so many of my skills. I listened to three meditation CDs. I used self-talk. I took my anxiety medication. It became clear that this episode would be a doozy and not as responsive to previous self-care measures as other episodes had been.  I needed to radically accept that this episode would, evidently, need to ride out its course.

I left messages for my psychiatrist and therapist at the clinic. After some discussion, we decided that going back to IOP (Intensive Outpatient Program) for a little while would be a good idea. I had a couple of good days after I graduated from the program on Monday, but then my symptoms flared up with a vengeance, even strong than before I'd first entered the program.  It became clear that I need additional support right now, and that's okay.

Part of the issue -- the way my symptoms are manifesting -- is through mood swings and instability of emotions. I go from feeling fine to very tearful over little things. I go from feeling confident and in control to meek and childlike.  It's mostly PTSD induced, but having Borderline Personality Disorder is also hugely contributing.

Over the past couple of years, I have become very skillful in using DBT (Dialectical Behavior Therapy) to help with issues of moodiness and emotional instability. On rare occasions, such as this, when I've exhausted the skills that I know to be helpful and still find myself in great distress, I know it's time to reach out for additional help from the outside.

I'll be honest. I was feeling very angry and frustrated yesterday. I was crying and getting upset about having a mental illness to begin with. I was angry that I was having a repeat episode of suffering that I had so recently thought I'd conquered. 

Mental illness is so complex that we can't always explain why our nervous systems and minds react and respond in the way that they do. We can know that, even if we can't identify a cause, there always is one, be it psychological or physiological.  I do find some comfort in knowing that in some quirky way, there is a method to my nervous system's seemingly mad way of sorting things out.

One suggestion that my therapist had was to get out of the house. I hadn't in a few days, and according to her, your mind can start playing tricks on you when you're cooped up, isolated, and focusing on the symptoms your experiencing and recalling details of nightmares.

I took her up on the challenge and took a drive out to the ocean.

I snapped this pic to share with you. It's of happy California cows. Through my tired eyes and hazy, moody mind, I smiled at them. I wondered what it would be like to be a dairy cow that gets to live free outside and graze on the grass while looking out at the ocean (that's the beautiful Pacific Ocean out in the distance.)



I also went and picked up some food and walked around in a couple of stores. I bought really inexpensive things, mostly to justify my long lingering up and down the isles. (I know I didn't have to, but I felt more comfortable doing so.)

Did any of this help with my moods and emotions? YES.

Just getting out of the house and breathing some fresh air helped. The drive helped. My mind was racing on anxious thoughts on the way out there, but I noticed it was a lot calmer on the way back.

When I was in the stores, I initiated friendly conversations and engaged with others. I felt less lonely and isolated.  

When I saw the cows and the ocean, I remembered that my situation is part of a much bigger system of life, that it would pass, and that I can tolerate the distress. It may not be fun, and I certainly wouldn't choose it for myself, but I know brighter days are coming, so I'm doing everything I can to soothe in the meantime.

If you're feeling moody or unstable, please take extra good care of yourself, and reach out for help from the outside.


What do you do to help when feeling moody or emotionally unstable?


Thanks for reading. 
More Soon.


Anxiety: A Mouse With A Microphone


I woke up this morning not feeling the best physically. I'll spare you the unnecessary details and just tell you that the particular symptoms I experienced are strongly associated with a childhood trigger.

I was really proud of myself this morning as I was able to, though I didn't feel well and continued to experience the symptoms, stay overall calm, emotionally balanced, and at ease.

I reminded myself:
  • to watch my breathing and slow it down, because our minds and bodies are intricately connected. I wanted to generate peaceful thoughts to keep both my mind and body calm
  • to stay in Wise Mind by thinking of other times that I've felt similarly and made it through
  • that I am here, in the present. I don't have to worry about what might happen tomorrow or even later today. I can be here now. I don't have to worry about what happened in the past. In this moment, I am safe.
  • anxiety is often just a mouse with a microphone. The message that we receive when anxious, the way our body reacts, can be so scary and overwhelming, but most often we are in no imminent danger. We are okay in the present moment.
For self care, I also:
  • called advice nurse for an opinion and a little reassurance
  • took care of my physical needs using DBT PLEASE skills, as best as possible 
  • got on Twitter and shared my experience 
  • worked on a writing project to distract and engage my thoughts elsewhere
  • took a short nap with my cats
To further stay skillful, I: 

  • Did the dishes, even though I didn't want to. This Opposite Action helped make my space look a little nicer for myself and significant other.
  • Made pizza. Thursday night is pizza night in my house. Even though I don't feel  up to eating it, I was able to make it so that my significant other isn't disappointed coming home after a long day and expecting this ritual treat.

I've had one major anxiety attack during the day, despite all of these efforts, but I am okay with it and am on the rebound. When I closely examine the possible cause, I know that I've been feeling anxious for a friend who went inpatient. She is in no way responsible for my anxiety. I just care about her and want her to feel better and am honored that she would share her strength by getting hope and letting me know about it.

I am also anxious that my significant other is getting closer to purchasing his ticket to go back home to his family. (This is the biggie, as are emotions coming up around some other personal issues.)

I do believe that this morning's symptoms were based in a physical illness that came and hopefully went, rather than anxiety, but perhaps it could have been a mix. I continue to care for myself, body mind and spirit.

With each thing I do to self-care, I turn down the volume on the mouse's amplifier. I eventually take the microphone away, and I hold him close and let him know that there really is no danger. All is well, little mouse. All is well, me. This too shall pass.


If you're not feeling well physically and/or mentally today, I send you a huge hug and reminder that you will feel better soon too. Huge love and hugs.


Thanks for reading.
More Soon.

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