DBT (Dialectical Behavior Therapy) for Serious Issues (beyond daily distress & emotional crisis)



So we know that DBT helped me overcome BPD.  Dialectical Behavior Therapy can be used to cope with every day, daily distress as well as an emotional crisis.  With time, practicing DBT allows us to apply the skills to even larger life challenges -- those serious situations that pop up in life that can be derailing for the emotionally dysregulated.
 
In my latest vlogcast, I share how I am using the skills to cope with a serious issue.  I hope it helps you or someone you love in some way.
 
 
 



Thank you for reading and watching.
 
More soon.
 
 
In kindness,
Debbie

Top 10 DBT Skills for Overcoming Alexithymia & Depression (#8 is my Favorite right now!)


 
 
Please welcome Rachel Cooper and her very first guest blog piece at Healing From BPD! 
From Rachel:
 
 
I often get asked what skills I have learned during my time in recovery from depression, and how I cope on a day-to-day basis.
 
TW - Trigger Warning
 
Though I have been in psychotherapy since before I was an adolescent, it was only in the last 2 years that I learned behavioral tools to help me manage my often overwhelming emotions and my impulses to self-harm.
 
End Trigger Warning
 
I first learned about the idea of coping skills during a stint in long-term residential treatment. The particular treatment center I attended placed great emphasis on teaching individuals in early recovery to learn and utilize DBT skills as a means of building a foundation of coping. One of the highlights of learning DBT in this setting was during the Summer Olympics, when the therapist brought in examples of skills that Olympic level athletes could and did use in their training and performance.
 
Learning that Olympians utilize DBT skills made me feel much more normal about utilizing the skills, and made me excited at the prospect of having something in common with these highly successful people.
 
Over the course of 6 months, I sat through each module at least twice and eventually found myself teaching my peers about the concepts and skills I liked the most, particularly Wise Mind and Radical Acceptance. But even before I was able to teach the skills, there were some I found more resonant then others.  Further participation in DBT groups closer to home bolstered my ability to put the skills into practice on good days and on days that I struggled.  I continue to use these skills daily as a means of building and preserving my resilience and also empowering myself to live a life that’s meaningful and worthwhile.
 
Here are just a few of my favorite skills and some examples of how I effectively incorporate them into my life:
 
When I first learned Mindfulness, I really struggled because I couldn’t rein in my racing thoughts during meditation.  When I finally recognized that employing mindfulness didn’t require 30 minutes of sitting still, I was relieved. During treatment, I would often go to the beach and focus on the sight of the waves crashing over and over and the sound of the water and the birds. These brief periods of mindfulness focused my attention in a way that made me better able to do so when I wasn’t in the presence of such beauty. 

2. Observe, Describe, Participate:
 
Learning to observe, describe and participate in experiences has been very helpful. My ability to be present in an experience has enabled me to move away from the racing anxious thoughts I would experience and remain grounded and more open to being in the situation. These skills have proven particularly helpful in the context of my current psychotherapy, whereby I don’t feel afraid of walking into a session because of fear of the unknown. Rather, I can be a part of the conversation in a deliberate and meaningful way – which is the way I wish to engage in my therapy.
 
 
The Emotion Regulation skills have provided me with a new vocabulary to identify and understand my emotions.  Once diagnosed as having alexithymia, an inability to identify and describe my emotions, I am now capable of recognizing and analyzing my emotions by understanding my verbal, non-verbal and physical body cues in response to a situation. I identify myself as being angry when I feel my blood boiling in response to a perceived or real injustice, and I understand fear when my heartbeat suddenly increases substantially.
 
My ability to recognize positive emotions such as joy and pride has also become sharpened. My participation in DBT Path’s online Emotion Regulation courses have made me more capable of employing problem solving skills when I experience negative emotions. Utilizing opposite action to move away from anger, fear or sadness and toward contentment, pride and joy has come from having private dance parties in my bathroom, watching videos of baby sloths on YouTube, and reading inspiring stories of other people in recovery who utilize coping skills regularly.
 
4. PLEASE MasterY:
 
The PLEASE MasterY skills have also been really useful. In particular, eating regular, balanced meals and getting sufficient (but not too much) sleep makes me feel better equipped to handle the emotions that I experience and lessens the emotional dysregulation that does occur from time to time.
 
 

While not my favorite set of skills, the Interpersonal Effectiveness skills have been useful in both my working and personal life. Identifying whether I want to achieve my objective, maintain the interpersonal relationship, or preserve my self-respect has been crucial to being effective in every relationship I find myself in.


6. GIVE:

When dealing with my work clients, I use GIVE skills all the time, remembering to be gentle, interested and validating while using an easy manner to communicate. My clients seem to appreciate this style of communication – and they don’t even know it’s a DBT skill!


7. DEAR MAN

I’ve also used DEARMAN many times. Taking the time to outline how I am going to describe, express, assert and reinforce my position while being mindful, appearing confident and negotiating for my needs has enabled me to hone the skill in an assertive, rather than an aggressive way, which has served me time and again.
 
 
Finally, there’s the Distress Tolerance skills that seem to be present nearly everyday. When I feel anxious, fearful, sad, angry or otherwise dysregulated, distracting myself from the acute feelings helps temper the situation, even if only temporarily.

My iPhone has served as a great source of distraction – I keep pictures of my loved ones, my cat, sunsets, and the beach in my photo collection. I play Words with Friends when I need a break from my emotions, and I turn to Candy Crush when my feelings are so overwhelming that I feel like I’m engulfed. When I’m sad I watch Parks & Recreation, and Amy Poehler cheers me up in 22 minutes.

9. Self-Soothing
 
I also do a lot of self-soothing. I like to light candles in my bedroom, eat homemade soup, chew cinnamon gum and listen to music that makes me feel good. I keep emergency playlists on my iPod for when I’m sad, angry and scared, and I listen to them when needed. I also have favorite pants and shirts that make me feel comfortable in my own skin, especially on those days when it doesn’t feel amazing to be me.
 
 
10. IMPROVE:
 
The IMPROVE skills have also been really helpful. Beach imagery settles me nearly every time. Blogging and tweeting about mental health, recovery and coping brings me meaning and simultaneously makes me feel like I’m contributing to a community in a meaningful way. I have post-it notes posted on my mirrors with cheerleading statements and I have, on many occasions, had a conversation with my higher power.
 
 
Bonus: Radical Acceptance:
 
Radical acceptance is by far my favorite skill, and the skill that I most frequently teach to others. Learning to let go of my need to fight against the situation I find myself in and instead embrace it with open arms means that I can sit in traffic without becoming enraged. I can now accept disappointing news without having my day ruined and most importantly, I can maintain a sense of okay-ness in the face of trial, tribulation and adversity.
 
 

Being in recovery from depression is not easy. There are some days that I wish would end because the emotions I experience are so overwhelming.  Two years ago, experiencing emotion dysregulation meant that I couldn’t function in the world and that I needed help to keep myself safe. Now, because of the DBT skills I’ve learned, not only am I able to survive in the world, but I’m able to thrive and one day at a time, I continue to build a life that’s worth living.
 
Thanks for reading,
Rachel
 
-------------
Rachel Cooper is a passionate advocate for mental health. She has participated in discussions with the Canadian Broadcasting Corporation (CBC) and at the University of Toronto. In recovery from depression, Rachel strives to live a meaningful and balanced life. She believes that everyone is capable of learning and using coping skills to create a life worth living.   Rachel tweets @rachbcooper.

There Will Be An Answer, Let it Be



There is a recurring theme that I have picked up in Dialectical Behavior Therapy (DBT) over the years: If you can reduce your worrying, you can reduce your suffering.  It's a very appealing concept to me, and I have to say, it works.

Whether you have borderline personality disorder, are an emotionally sensitive person, suffer from anxiety, or you are someone who is going through a difficult time with a lot of anxiety provoking unknowns, chances are, you are worrying... a lot.  
 
Many of us have heard the expression by Erma Brombeck that "Worrying is like a rocking chair. It gives you something to do but never gets you anywhere."   It's so true.
 
Right now, as some of you know after reading my recent post, "Coping Effectively with Medical Limbo and Severe Anxiety" and my Facebook and Twitter updates, I am dealing with a very scary medical issue that currently has a lot of unknowns.  Rather than get into the details of it here, I will talk more about the skills I am using to cope effectively -- both an elaboration and additional details on the skills I've recently shared, and some new ones that I am implementing.
 
This post will focus more on what we can do to reduce our worrying and how this in turn reduces our experience of suffering.
  
 
1.)  More Fact Checking

Often times when we are worried, our very vivid imaginations get the better of us.  We start to create what-if scenarios.  One of the few Borderline Personality Disorder symptoms that I still suffer from is black or white thinking.  While I have a heightened level of consciousness around much of my mental health experience, I almost always am unconscious of this pattern until someone points it out to me.   For example, today I was with a friend. I had a sensation and went into panic, imaging the worst possible scenario. She asked, "Is there a way you could not jump from the initial thought to that extreme?"  Things are rarely black or white, clear cut and dry, and having only two possibilities.  Fact checking involves exploring the shades of grey.  If you're like me and need it pointed out from the outside when you're in this type of thinking, it can be very challenging, but it is possible.

The other fact checking that I did was to send an email to my doctor with detailed questions about which I needed clarity.  He called me, and I wrote out his answers.  I better understood what I am facing and felt a sense of relief at knowing a little bit more.  If someone outside of you (i.e. a doctor) has knowledge of your particular situation, consider inquiring to get more peace of mind.
 
2.)  Building Up Support System

I've been calling, emailing, facebooking, and texting friends.  When we are going through a hard time and are in pain of any sort, there is sometimes a tendency to isolate.  I am trying to avoid this.  Today I went out to lunch with a friend.  While I became symptomatic and anxious during our visit, it was so nice to be with her and to not be alone.   I've also booked an appointment with my hypnotherapist in order to get some support around managing the anxiety (including the anticipatory anxiety connected to my upcoming medical procedure.)  Think about who you can reach out to in order to feel less alone and to empower yourself to feel stronger during this difficult time.  I'm finding this to be very helpful.
 

3.) ♫♪  There will be an answer... let it be ♫♪

In DBT, there is a concept called Radical Acceptance.  When we practice this Mindfulness skill, we consciously choose to take back our sanity by, instead of living in denial, accepting the truth of our situation, no matter how uncomfortable or scary it might be.  Radical Acceptance means facing the truth and accepting that things are what they are -- not what we wish them to be or how we think they should be.  This is not about resigning and not caring about outcomes or effecting change in our lives.  It is simply the first step of the paradox that in order to change something, we must first be willing to accept it just as it is.

The chorus of this song, "Let it Be," by the Beatles, reminds me of the concept of Radical Acceptance.



In what ways can you reduce your suffering by reducing your worrying?


Thank you for reading.
More Soon.


In kindness,
Debbie

Coping Effectively With Medical Limbo and Severe Anxiety


 
Yes, that's me looking very anxious, but don't worry -- this is not a gloom and doom post, and by the time you finish reading it, you may feel better and more encouraged.. I know I'm not the only one out there who has been feeling this way. If you or someone you know is suffering from ongoing medical issues (or is in anxious limbo with getting a diangosis and needing to do all kinds of tests and treatments), or if you suffer from intense anxiety on it's own, I really hope that my posts over the next few days (and cumulative blog posts to come) will be helpful to you and your loved ones in some way. 
 
DBT can help us manage extreme emotions and distress (which often come with medical issues and anxiety), and this is true whether someone has BPD, is in recovery, or doesn't have it at all.  So, as I said, I hope that I can create meaning in my current experiences by bringing hope and encouragement to others while also directing some of that to myself and enjoying your comments and posts.  I will be sure to use the letters "TW," meaning Trigger Warning at the beginning of any posts that I think may be especially difficult for those who are emotionally sensitive.  If you're feeling really dysregulated on a given day, please have compassion for yourself and use discretion with any content you read on FB.  If you see TW and you know you're feeling that way, just keep scrolling.
 
Some of the things that have helped me to deal with ENORMOUS anxiety and scary thoughts today have been (and please know that I am in no way giving medical advice. I am a layman peer sharing only MY experience and what's working and not working. ALWAYS, and I mean ALWAYS consult a qualified healthy professional for any health issues and to get a proper diagnosis and treatment for you personally. That being said, click here to read on about what I've been doing. May it truly help you and your loved ones.
 
1.) Fact checking

I am remembering a thought is just a thought, and just because I think it and it's accompanied by strong anxiety doesn't mean it's true or that I'm in danger.)  I can calm down and discern thoughts from emotions from facts.
 
2.)  4 Square Breathing
This is helping when I start to hyperventiliate. I picture a square and I imagine tracing each line of the square in my mind's eye as I do the counts. I breathe in, hold for count of four, hold breath, hold for count of four, breath out for count of four, then exhale for a count of four. Then I hold for a count of four and start over.)  This helps slow down severe anxiety symptoms by reassuring the nervous system.
 
3.) Distracting
Not denying suppressing or wishing away.  I am well aware that I am dealing with some scary you know what.  But #DBT distress tolerance teaches us that when you are in a crisis and are reacting strongly to something you cannot change in this moment (i.e. not knowing your dx, knowing you have to go back for more IV shots, etc.)  Getting yourself worried sick does NOT help.  There is a skill you can use called "putting it on the shelf."  Being fully conscious that the issue does exist, we choose to put it on an imaginary piece of paper, put it in a little imaginary locked box, and then we envision putting that box on the shelf until we're feeling strong enough to deal with it and when we actually have more information to do so.  This alone has helped me calm down quite a bit. Although it uses a lot of imagination, in the end, it makes a great deal of sense, because there is no sense in worrying about things you cannot control and over things that you don't have all the facts in about yet.

4.) Distracting  (again)

I love turning on talk radio. Try to find a channel that is in alignment with your principles and values so you don't get worked up over those sorts of things lol.   I was listening to NPR (KQED Public radio) about the drought and heard that there is a segment on eagles (yes birds) who went to college.  Maybe it's the steroids talking, but that's what I swear I heard LOL.   Whenever I begin to feel anxious or my mind wanders, I turn my attention back to what they are talking about.  AM radio has a lot of excellent stations, as does I Heart Radio.  Another thing is that I have not finished watching Thursday night's episode of American Idol and have some episodes of Big Bang Theory backlogged. It's OKAY to distract ourselves in a skillful way.

5.)  DBT PLEASE: Attending to physical health. 

Took anxiety medication.  Here's the ironic thing: (TW) I went to my psychiatrist on Wednesday to begin weaning off of the anti-anxiety medication Ativan.  While there, I told her some symptoms I was having (unrelated to meds). She said that I needed to see someone in neurology promptly, so I immediately went over.  It was a good thing.  I had an MRI and have an infection and other issues, so I had to go to the ER to get an IV infusion of steroids. I must go back tomorrow and Monday, then I'll be on a heavy does of them in pill form for a few weeks.  Then I need to have a lumbar puncture/spinal tap.  If I hadn't gone to that appointment with my psychiatrist and had she not urged me to go to neurology, who knows?  She giggled and said now might not be the time to get off of the Ativan but she'd leave it up to me.  On Wednesday, I still wanted to, but now I am reluctant.  The ER doctor actually recommended that I take MORE of it to manage the common side effect of the steroid of being amped up and nervous/anxious.  Fine, I will radically accept this (another DBT skill).
 
 
I apologize in advance for any typos or incoherence. I am on quite a bit of medication right now.  I've found this incredibly therapeutic to write and will continue sharing my experience with you and how I am using DBT (Dialectical Behavior Therapy) to cope with the emotional aspects of the situation.  It is my great hope that it will help and encourage you or a loved one.
 
 
Thank you for reading.
More soon.
 
 
In kindness,
Debbie

You're not freaking out about THAT, are you? | BPD & Overreactions

Although I technically no longer meet the criteria for a diagnosis of Borderline Personality Disorder, I still meet some of the criteria and remain (and probably always will be) an emotionally sensitive person.
And, like any other human being, whether you have any type of mental health diagnosis or not, I from time to time become emotionally dysregulated.   For the past week or so, it has been brought to my attention that I've been overreacting to relatively minor things.  I hadn't really noticed.  I knew I had felt more stressed than usual, but I hadn't connected this with anything in particular and scape-goated my emotional sensitivity.
What I came to realize upon reflecting is that, in this case and most others when we overreact to seemingly miniscule or not-so-important-in-the-grand-scheme-of-life things, is that SOMETHING else is going on, and this issue (or combination of issues) is the true source of our emotional dysregulation.
If something that matters to us is put on the back burner for too long, not given validation, and not attended to, we can become emotionally vulnerable in the sense that our resilience and ability to cope effectively and skillfully to minor stresses throughout the day can be compromised.
Sometimes it's very difficult for me to admit (to myself or others) that I still struggle now and then with things like this.  I tell myself that I need to be some type of Mindfulness guru, since I teach online DBT classes.   I should have my act completely together.  (Yeah right!)
If anything, my reflections this past week will give me stories to connect with and relate to my peers who are also working hard on their own recovery.  If opportunities allow, I'll talk openly about how I cried over my cell phone needing to be exchanged and how I snapped at a loved one because I misheard what he said and then snapped at him based on what I thought I heard (and then felt quite humbled afterward). 
I'll talk about how I began to escalate into anxiety, worrying that my lack of consciousness around my irritability meant that I was going crazy or that I was backsliding.  I'll also talk about how I began to shift, using Mindfulness and other DBT Skills, into becoming compassionate, did damage control by sincerely apologizing to those who I had treated less than kindly this past week, and how I realized that there are some issues in my life that need attention.
Next, I commit to addressing each of those.  My goal is to work on these and to create manageable goals that I can achieve to get the overwhelming items in order.
If you find yourself repeatedly freaking out and getting irritated over things that you might otherwise be able to handle in stride, and/or if a loved on points out that they've noticed this change, please consider what you can do to reflect while taking care of yourself.  At first, I was offended and wanted to fly off the handle at such an "accusation."  I took a few deep breaths and used DBT Opposite Action, a DBT Distress Tolerance skill to use a kind, slow, soft voice to, rather than yell and tell the person he was an a-hole, and how dare he?! ... I said, "You know, I'm going to take that into consideration and really reflect on that.  Thank you for telling me, and I'm really sorry if I've mistreated you."
I hope this post helped you in some way.
Thank you for reading.
More Soon.
In kindness,
Debbie

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