Hi, everyone. Here is a video post on the Dialectical Behavior Therapy Distress Tolerance skill of “Distracting.”
Racing thoughts. Obsessive compulsive behaviors, such as cleaning, organizing, exercising. Increased negative coping behaviors, such as overeating, smoking, and drinking. Physical pains, such as upset stomach, migraines, muscle aches and fatigue. Early morning waking. Increased irritability. Forgetfulness. Tightening chest. Racing heart rate – literally hearing my heart pounding in my ears. Shallow, rapid breaths. Dissociation or feelings of having an “out-of-body” experience.
These are common occurrences for those of us with anxiety disorders. This week, I experienced all of them (except for the drinking.) Only after forcing myself to sit down long enough to do some journaling was I able to identify the source of my anxiety…
There is always a cause for anxiety. Did you know that? It just doesn’t come because “we are crazy.” There is always a root cause, and it serves me well to sit down and face the fear of finding out what it is, because once I realize what is causing it, I can deal with it, and the symptoms will subside.
Sometimes finding the cause isn’t as simple as it can be with straight-forward Post Traumatic Stress Disorder symptoms, which are caused by specific events such as accidents and natural disasters. Sometimes the events are actually an accumulation of events occurring over a period of months or years, where the person is subject to long-term, repeated trauma as in the case of child abuse. In such cases, the term “Complex PTSD” is often used even though it is not officially a diagnosis included in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
This week my three-day anxiety attack which culminated into a full-blown panic attack was triggered by a few things. First of all, I posted my BPD story last weekend, which set my anxiety level higher than normal, but in and of itself didn’t cause me too much stress. However, add that to the fact that on two different occasions last week I unexpectedly ran into different individuals with whom I went to high school, and then the kicker was an unplanned evening of looking through my high school yearbooks (at my daughter’s request.) She wanted to see what her dad and I were like back in the day, and I didn’t think twice about taking a trip down memory lane. Next time I will.
High school was a very traumatic time for me. My parents’ alcoholism was at its peak; dysfunction and emotional abuse and neglect were at an all time high in our home. Memories of those years are clouded with my own drunken states filled with self-harm behaviors and untreated bipolar and borderline personality disorder symptoms, which I talk about in great detail in this video post.
Before going to bed that evening, I made a passing comment to my husband about feeling a little anxious after looking through those yearbook, and then I thought nothing more of it.
Three days later, I had my first panic attack in many, many months.
After quickly figuring out the cause of my anxiety (due only to writing about my feelings, which is why “Write into the Light” is my mantra) I began to ask myself many questions:
- Is knowing the cause of my anxiety enough to make it go away?
- Do I need to worry that these memories triggered me the way they did?
- Is this a sign that I need to work out some more stuff in therapy with my counselor, who I haven’t needed to see in six months now?
- Does this mean I am not healed all the way like I thought I was?
Healthy Coping Skills
I was a mess at this point. But, here are the skills I used to cope with my state of mind at the time. My hope in sharing these is that it will give you some ideas to try when you find yourself experiencing extreme anxiety.
First, I left messages for two friends who I knew would understand, and I also left a message for my therapist.
Next, I tried sitting with and observing my feelings, thoughts, and body sensations without judgment; trying not to push anything away nor hang onto anything. Just noticing and observing as if I was an outsider looking in.
I tried soothing myself by rubbing scented lotion on my arms and hands, which didn’t help much.
Then I decided to call my doctor to get an emergency refill of my PRN anti-anxiety medication. Luckily, the pharmacy filled it in ten minutes and also luckily, my husband was due home for his lunch break and was able to pick it up on his way.
While waiting, I wrapped myself in a warm blanket and sat in a fetal position on the couch in a quiet room. This helped calm me immensely.
I also said some simple prayers.
I took my medication at the same time my therapist called back. After telling her what happened, she said that I might need to try some “exposure therapy” meaning that I look at the yearbooks when I am in a good place emotionally and mentally, and even then only for a short time, and maybe not with my young daughters.
I made the comment to her that I thought I had gotten past this part of my life, that my negative feelings about it were gone. She said they are always going to be there; that the goal is not to get rid of the bad memories, which is impossible, but to instead integrate them. Integration is the goal. (Integration: The organization of the psychological traits and tendencies of a personality into a harmonious whole.)
She also said that I should try to dig up a few good memories from that time. She said they are probably there, but are just overshadowed by the bad ones. At first I didn’t think she was right, but then I made a conscious effort to get out of my black and white/all or nothing thinking, and started thinking dialectically – where good and bad memories can co-exist. And guess what? She was right!
When you’re anxious do you dig deep to find out what the root cause is? It may be something more than what it appears to be on the surface.
What physical symptoms do you have when you are feeling anxious? Do you take the time to sit and notice your body’s sensations and your mind’s thoughts during these times? Why or why not?
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Until next time…
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“Sometimes we just can’t, and that’s ok. Sometimes we kind of can, but the energy trade-off just isn’t worth it. Society demands that we keep overcoming, overcoming, overcoming. But we don’t have to. Nowhere is it written that to be a really real human you have to brute force your way through your limits. Nowhere is it written that not doing so makes you less worthy.” ~ Author, unknown
It is Easter Sunday and I am experiencing guilt for not being able to take my kids to church (and not getting myself there as well.) The crowds, parking, and stress of it all is more than I can bear, I know from experience. Plus, my husband is working which makes it all the more difficult to handle since I am on my own.
On top of that, we will be with family later on this afternoon…loud, excited kids, my siblings and their kids, my parents, all cramped into a tiny house for the evening…need I say more?!
Here’s another kicker – a mess up with my medication refill leaves me with no anti-anxiety pills this weekend. Kind of a WTF? moment…
Thinking about it all makes me want to shut down OR fall into a panic attack. I feel like my body doesn’t know which one to choose.
What I am choosing however, is to try and sit back and observe all of these thoughts and feelings as I would if I was watching another person go through them.
Acknowledging them, not fighting them, but also not making them who I really am…separating my thoughts and my feelings from my true self (who is simply a consciousness/higher self comprised solely of peace and love) seems to really help.
Maybe some would call this a form of detachment, and in a real sense I suppose that is what it is. Reminds me of that saying “Go to your happy place” – the place in your mind where no one or nothing can hurt you. Only this place isn’t in my mind. It is outside of my mind.
I picture it floating directly above my mind. Although, it is not a place but more of a presence, an aura so to speak.
And in this entity I am not escaping from reality but rather engaging in it as an observer…not a fighter or a victim or any kind of participant, but simply as an observer that knows – believes – deep down that all is ok, that I am ok no matter what thoughts and feelings are happening inside my mind.
It truly is a peaceful phenomenon on this joyous Easter morn. I do hope you are having positive thoughts and feelings today. And if not, I pray you can access your higher self – that space outside of your mind but still within you that can sit back and observe and know that it is safe, it is happy, and it is pure love.
Thank you for taking the time to read my thoughts today. I would love to hear yours. Feel free to leave a comment if you are so compelled. Until next time…
Guess what? My life is awesome! I have a great husband, supportive family, sweet although moody pre-teens, cute little dogs, financial security, spirituality, good health, friends, great doctors, good medical care, and outside of the normal stresses of motherhood, nothing to complain about.
So what’s the problem you ask? I am going crazy in mind and body! Panic attacks in the form of heart palpitations have played guerilla warfare on me all day.
For the past five weeks my moods having been swinging back and forth, progressively reaching further toward each extreme.
For the past three weeks I’ve been crying, sad, irritable, losing my temper, and anxious.
Over the past two weeks, my mind’s eye has jumped from one self-harm thought to another with increasing frequency and severity. These are not thoughts I consciously think of nor do I dwell on them when they occur. They pop up out of the blue, usually during extreme stress-states.
I say “stress-states” instead of “stressful times” because my external surroundings are not extremely stressful, but my internal states are. Short of kicking everyone out of the house so that I can be alone in complete silence, these are the symptoms I am currently having to cope with.
The suicidal thoughts concern me. I become especially scared when they start to feel as if they control me rather than the other way around. So, I told my husband about them – all of them – in detail. I feel relieved. They have less power over me now. I will be calling my doctor and therapist on Monday as well.
It is important for us and others to know that mental illness is a disease, like cancer and diabetes. Yes, there are external factors that influence the disease state – smoking habits, diet, exercise, stress, etc. – but, sometimes cancer comes back, and blood-sugar levels fall despite our best efforts.
And sometimes, even though life is going good, people get depressed. And it is not their fault. It is no one’s fault. It just is. And that is ok, if it is dealt with in healthy ways.
Talk to someone. Call your doctor. Be completely honest. Go easy on yourself. It is not your fault.
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I found this helpful article on causes and solutions of having dual diagnoses (substance abuse AND mental illness.) I wanted to bring to you some interesting facts and highlights. To view the handout in its entirety click here to download the Hazelden Foundation’s pdf.
Factors involved in the development of psychiatric disorders:
1. Vulnerability (determined by genetics and early life experiences)
2. Stress (challenges faced in life)
Factors that can help reduce symptoms and relapses:
1. Abstaining from alcohol and drug use
“Avoiding alcohol and drug use can reduce biological vulnerability in two ways. First, because substances affect the brain, using alcohol or drugs can directly worsen those vulnerable parts of the brain associated with psychiatric disorders. Second, using substances can interfere with the corrective effects of medication on vulnerability. This means that somebody who is using alcohol or drugs will not get the full benefit of any prescribed medications for his or her disorder, leading to worse symptoms and a greater chance of relapses.”
2. Take prescription medications according to your doctor’s orders
3. Learn to use positive coping skills
4. Develop social support systems
5. Engage in meaningful activities
Which factors are you incorporating into your life to help reduce symptoms and prevent relapses? Which factors do you need to add?
“Doing” versus “Being”
I’ve been feeling extremely uneasy this past week unless I’m engaged in busy work – cleaning, writing, reading, taking care of the kids, or watching TV with my husband. (I can’t seem to watch it by myself); uneasy like something bad is about to happen.
During times of non-activity, when I am feeling called to just “be”, which is how I often find peace, I am extremely uncomfortable and I don’t know why. I suppose I could go back to therapy to see if there is a root cause or if it is just because – for no other reason than I’m human and we all go through emotional ups and downs regardless of mental illness.
UpS and DoWnS
My motivation to get out of the house is low. Even to run a simple errand or take my daughter some where or pick her up without having to leave the car is a chore. I want to sleep by afternoon and not wake up until the next morning, for it is in the morning that I feel most productive, happiest, and most alive.
After lunch my mood starts to plummet as I feel like I have given all I can for the day and it is only 1 o’clock in the afternoon. I believe I need more therapy, but I keep putting off doing anything about it, ignoring it, hoping the urge will go away. It’s been lingering for a month or two now, so I suppose it’s time to pay heed to my inner voice which is telling me I need therapy.
Counseling or No Counseling
It is hard to talk about the things going on inside of me. I’d rather figure them out on my own, but I know from past experience, and more recently from the last two months, that this is not possible. I can write about it, I can pray about it, I can talk to my husband or friends about it, but all of that is like putting a band-aid on a gusher of a wound. For me, healing doesn’t come unless I see a professional.
I suppose those other things work for people who do not have mental illness, specifically complex PTSD (which is common in adults who were abused and/or neglected as children). Personally, I need the structure and the accountability of seeing a professional. I also need the expertise of a trained therapist, not simply a shoulder to cry on or an ear to complain to (not that those things aren’t important as well :).)
So, tomorrow I will call and make an appointment with someone, and hopefully, this uneasiness will pass soon. Has anyone out there ever found that they needed professional counseling? Do you listen to that inner voice that tells you to get help or do you ignore it, hoping it will go away even though it never does?
Doing the same thing over and over again and expecting different results is the definition of insanity. I don’t want to be insane; I just want to be at peace. I want to live, and love me.
“Doing” for Now
In the meantime, I’m going to take a bath, listen to some relaxing music, put on some scented lotion, and then see what you all have been up to. I know these distractions will help me to get my mind off of myself and my stresses. I will then deal with the stresses when I have the support of a professional to get me going in the safest and healthiest direction. Otherwise, I feel like I am prescribing my own medicine, and that is a dangerous thing to do.
While thinking about what I just wrote in this post, I realized that blogging in this way is a blessing. For one, it gives me the opportunity to help others to know they are not alone in the way they feel. It creates an atmosphere where we can share with one another what works for us – positive coping ideas.
Secondly, it makes me accountable. I have been telling myself that I need to call a therapist for months and still haven’t done it. But I think since I have now written about it, and publically made the committment to do it, I will be more likely to follow through. Thank you for that.
Now, tell me how you are doing (or “being”)…
how I despise thee
except when you save me
from hitting a tree
with my car in the throes
of a storm in my sea.
Oh, hateful anxiety
how I despise thee!
Just a quick follow-up to yesterday’s post…I regret to say that my day got worse instead of better. I believe I spent too much time in mindfulness and turned my attention to my emotions into an obsession. All or nothing thinking – another classic symptom of borderline personality disorder.
Couple, no triple, that with the fact that we had major thunderstorms and tornado activity in the area last night along with the fact that I came across the story and then the video of Amanda Todd, the Canadian teen who committed suicide last week as a result of years of bullying by her peers.
I told myself not to watch her you tube video, but like when driving by an accident one can’t help but look, I clicked play. I cried and cried as I watched her tell her story through flash cards. The incorrect grammar and misspellings made it all the more endearing and real, for that is how anyone her age would have written it out.
Even though teen suicide is nothing new, when I was young (pre-internet days) we just didn’t hear about it like we do today. I suppose it is good for advocacy and awareness that we do now, but in many ways it is also bad, especially for maintaining hope and faith in the good of humanity.
People are still writing horrible things about her and she’s dead! Bullying the deceased…unbelievable! If you are a sensitive, hyper-emotional person such as myself, I strongly recommend you do not go near this story or any like it. This is why I don’t watch even the local news anymore. Heck, I could barely watch the recent presidential debates here in the U.S. merely because of the aggressive ways in which the candidates treat one another.
Not only do I not cope with conflict well, as it often ignites explosive anger in me, I am even worse in some cases at coping with witnessing conflict, because it often upsets me to the point of hysterical crying, despair, and panic attacks. It’s a family thing. Growing up in a home with two alcoholic parents can have that kind of effect on you. That being said…I’m off to visit my parents. Hope you have a good day. Me? I plan to keep on keeping on.
How do you deal with conflict? Are you hyper-sensitive to it? Does witnessing conflict among others affect you as much as when the conflict directly involves you?
Quick follow-up to my last written entry:
I am weaning off one of my anti-depressant medications and starting an anti-psychotic one that is supposed to decrease my anxiety while NOT triggering bipolar mania and rapid cycling.
My discontinuation symptoms aren’t too bad – some dizziness and flu-like discomforts. Have you ever experienced “discontinuation symptoms” when coming off of a medication? What were they like? How bad or not-so-bad were they? Were they worth it?
My mental illness largely stems from childhood stresses that formed me into a caregiver, peacemaker, and people pleaser – dysfunctional, unhealthy roles which I continued to play to my own demise in adulthood.
There is most likely a genetic component to my mental illness as well, because studies on serotonin and studies on dopamine show that these neurotransmitters have major effects on our emotional brain centers such as the amygdala and hippocampus.
Although, since individuals with no mental illness have also been found to have abnormalities in neurotransmitter levels, researchers speculate that these abnormalities “may represent a classic susceptibility factor for affective disorders by biasing the functional reactivity of the human amygdala in the context of stressful life experiences and/or deficient cortical regulatory input.”
So, back to the environmental stressors… Yes, I most likely have the neurophysiological susceptibility to depression and bipolar, but would these illnesses have manifested if my childhood was one of validation, and unconditional love and support?
Or let’s assume I don’t have the neurophysiological susceptibility, but still grew up in the same abusive environment. Would the environment alone have caused my mental illness?
The answers to these questions I will never know for sure. What I do know is that as a child, the aforementioned roles, or coping skills if you will, helped me survive. However, as an adult they were killing me. You see, if no one validates or takes care of a child in ways that facilitate healthy emotional development then that child is less likely to know how to do these things for her adult-self. And obviously, no one else is going to (or should have to) do this for her because she is an adult…on the outside, that is.
On the inside, I was still that little child, who felt helpless, threatened, scared, and vulnerable. I was still operating in survival mode – “fight or flight” – hence, the PTSD symptoms.
Most therapists I have worked with use CBT (cognitive behavior therapy) techniques (i.e., self-talk, re-directing and grounding.) These techniques didn’t do anything for me, even after years of CBT treatment. In fact, I think they actually perpetuated my childhood coping skills which, as I previously stated, were no longer working for me as an adult.
CBT by its own definition “challenges an individual’s way of thinking and the way that he or she reacts to certain habits or behaviors.” Where is the emotional component to that? Everyone knows that trauma produces an emotional response which ingrains itself so far deep into our brainstem, physical, body, fight-or-flight memory that no amount of cognitive restructuring can truly change it until the emotions are first processed. I am talking limbic system, caveman-instinct stuff here, where as CBT addresses frontal cortex areas (higher brain centers than the limbic system.)
Only speaking from my experience, there are a few things that have made the biggest difference in my healing journey, and these things have to do with emotions which, remember, are recorded in the limbic system.
1. learning how to validate my own feelings
2. learning how to not judge myself for having negative feelings
3. learning how to radically accept myself and my feelings
I learned all of these skills in DBT (dialectical behavioral therapy.) A therapist has to been specially certified in this therapy, not just anyone can do it.
Only after I learned how to recognize and then experience my emotions in a validating, non-judgmental way was I able to learn how to accept and tolerate them long enough to change my thoughts and behaviors (which gets into CBT stuff.) But, the emotional processing had to come first for me, and I will explain why further on in this post.
I have been working with a DBT counselor for less than a year and have completely changed. I still have a lot of work to do, but at my last visit, I was shocked to realize I had nothing to talk to her about because my emotions, thoughts, and behaviors were all balanced; in a state of homeostasis, which is an absolute miracle for me; now on to the scientific aspects of my transformation.
Implicit or “Physical” Memory
Explicit or “Narrative” Memory
When a person is negatively affected by trauma, information experienced during the traumatic event such as tightening muscles, rapid breathing, increased heart rate, sweating, and increased blood pressure is quickly stored as “physical” memory via the amygdala while information such as where the event happened, when it happened, and whom you were with at the time is slowly stored as “narrative” memory via the hippocampus.
Narrative memory is stored more slowly because excessive catecholamines (epinephrine and norepinephrine) and endogenous opioids that are released during “fight or flight” episodes inhibit narrative memory storage. In other words, your brain says to you, “No time to process, just get the hell out of here!”
Childhood traumas are even more complicated because “the hippocampus is still immature, while the amygdala is already able to record unconscious memories.” Therefore, “early childhood traumas can disturb the mental and behavioural functions of adults by mechanisms that they cannot access consciously.”
To summarize, it is safe to say that we are more apt to retain the negative emotions and physical sensations of the original event (i.e., physical memory), and less likely to have acquired the type of memory needed to verbally and logically recall and analyze our experience of the event (i.e., narrative memory.)
Researchers believe that the amygdala’s general function is for “biologically relevant learning”. It does this by signaling a “baseline level of arousal,” whereas “other parts of the brain such as the prefrontal cortex use that information and elaborate that information in a way that’s relevant for the specific experience of positive or negative emotion.”
In order for the prefrontal cortex to do this, however, it must have a strong connection to the temporal lobe which is where the amygdala resides. This connection is made via a nerve-fiber bundle known as the uncinate fasciculus (UF.) The figure below is from a study entitled, “Volumetric associations between uncinate fasciculus, amygdala, and trait anxiety,” by Baur et al which was published in BMC Neuroscience in January of this year.
A 2009 study in the Journal of Neuroscience reports that higher amygdala activity corresponds to lower prefrontal activity, and vice versa. Researchers, Justin Kim and Paul Whalen explain, “The prefrontal cortex is supposed to keep areas like the amygdala in check, and instruct them that, for example, ‘I know that’s a snake, but it’s behind a piece of plexiglass, so we’re good.’” Whalen says, “It’s much like a parent and child. Children are less flexible in their responses to situations than parents, whose job is to instruct them and help them regulate.”
So, as a child in constant fight or flight mode, I believe it is possible that my amygdala was over-stimulated, and because my parents did not “instruct me” or “help me regulate” my responses to stressful situations (mainly because they were the cause of the stressful situations) I hypothesize that this left me with a underdeveloped prefrontal cortex-temporal lobe/amygdala connection via the UF.
My hypothesis is strengthened by a 2006 research study of 10 year-old children who had suffered from socioemotional deprivation. Researchers found that the left uncinate fasciculus showed “reduced fractional anisotropy compared to that in other children, and that this might underlie their cognitive, socioemotional, and behavioral difficulties.” Why they didn’t just say, “their mental illnesses,” instead is beyond me.
In my experience, when I processed the emotional and physical information of my PTSD symptoms stored by the amygdala (namely, fear, panic, and anxiety) via DBT, I believe this information was then transferred to my narrative memory which allowed it to finally be used to strengthen the prefrontal cortex-temporal lobe connection causing the body sensations and negative feelings associated with it to disappear. (Abracadabra!)
Here’s a fun fact for all of us with mental illnesses related to lack of serotonin in our brains: A recent nuerogenetics study concluded that people with a genetic variation affecting the serotonin neurotransmitter system tend to have a thinner UF (remember, that is the nerve fiber that connects the prefrontal cortex to the temporal lobe where the amygdala lives.) These same individuals show “increased amygdala reactivity and decreased coupling between the amygdala and medial prefrontal cortex,” according to researchers.
What do you guys think of all of this? Do you think that your mental illness has more of a genetic component, an environmental component, or both?
Do you think that if people who don’t understand mental illness had this information they would be less likely to tell us to, “Snap out of it” or any number of other ludicrous pieces of advice they think are helpful?