Tag Archives: DBT

DBT Distress Tolerance Skills

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What is DBT?

Dialectical Behavior Therapy’s (DBT) premise is that two seemingly opposite things can be true at the same time. For example, my parents did the best they knew how when raising me and they negatively affected my emotional development.  

DBT trains the mind to think with a good balance between reason and emotion, calling this the “wise mind.” It also can keep you out of all or nothing or black and white thinking. There are many shades of grey with everything in life. 

There are four main tenets of DBT. They are Distress Tolerance, Mindfulness, Emotional Regulation, and Interpersonal Skills. 

Distress Tolerance and Radical Acceptance

Distress Tolerance includes an idea called “Radical Acceptance” where you fully acknowledge the present moment reality. This does not equal condonement. Radical acceptance places you in a position of being able to make a plan to elicit changes in your life because you cannot change anything if you aren’t fully engaged in the acceptance of what currently is. 

Distress Tolerance skills include distraction and self-soothing. Distract by engaging in pleasurable, non-destructive activities, focusing on helping others, doing chores, counting breaths or anything you can see, or distract by removing yourself from the situation.

Self-soothe any of your senses: smell, sight, sound, taste and touch. Use any input that makes you feel good that is non-destructive and not harmful to you or anyone else. 

R.E.S.T.

Above all, make sure to use the “Rest” technique in any situation that is upsetting to you at the start. Relax (R), Evaluate the facts (E), Set an intention (S), Take action (T).  The intention and take action steps could include some ideas from the distress tolerance skills.

More to come on DBT skills…

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Can Being Too Busy Cause Anxiety?

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The short answer to this question is yes, for sure. All it took was four doctors’ appointments in the span of two weeks and planning a birthday party for my mom on top of my normal daily tasks of running the kids to school and activities and keeping up on housework to bring me to DEFCON 1 anxiety.

My anxiety tends to present itself as irritability towards anyone whom I hold near and dear to me, most notably my beloved husband, poor guy.  I not only become dissatisfied with everything that is going on in the house, but I also can’t stand the way anyone is doing anything around me. 

It is usually best if I retreat to a quiet room on my own to chill out with something to read, watch or listen to. Sometimes it does help to talk it out with my husband as well. 

Also here is a great list of dos and don’ts when I find myself too busy and filled with anxiety. 

  1. Don’t over commit.  For example, I rescheduled some of my doctor’s appointments for a time when I wasn’t so busy. 
  2. Do prioritize.  I found that I could let laundry pile up a little that week and catch up on it the following week when I wasn’t so busy so I could make it to my appointments.
  3. Do delegate so you don’t have to push yourself so hard.  I asked for help in driving the kids to some of their activities that week to give myself a break. 
  4. Don’t forget to treat yourself for working so hard.  Mocha lattes every other afternoon for two weeks!

So, as you can see being too busy can cause anxiety especially in someone who already has an anxiety disorder.  However, there are ways to cope with it and decrease it if you take the time to make the appropriate adjustments to your schedule and approach. 

Keep an eye on your busyness before anxiety has its eye on you. 

Dealing with Agoraphobia

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agoraphobia

Agoraphobia is a type of anxiety disorder in which one feels and often avoids situations that may cause them to feel panicky, trapped, helpless, or embarrassed. Using public transportation, being in a crowd, and standing in line are a few examples. According to the Mayo Clinic,

You may feel that you need a companion, such as a relative or friend, to go with you to public places. The fears can be so overwhelming that you may feel unable to leave your home.

I definitely identify with this as I only feel safe leaving my house if my husband is with me. It is especially hard for me to drive myself anywhere. He has to be the one to drive. I believe my fears have to do with previous anxieties experienced in crowded situations. The noise and unpredictable stimuli of people merely moving around me is anxiety-producing for me. I don’t know why and I don’t know how to stop it, but I do know that I am tired of it controlling my life!

I take a PRN anti-anxiety med before going to any social event, which helps a great deal. However, I have to ration them because my doctor only prescribes me five of these pills a month per our agreement due to my addiction history. Thus, I am left with no medication assistance when I have to go to places like the store or to some of my kids’ activities.

So, what’s been happening over the past three weeks is I have been working myself up into an anxious state before leaving the house to do anything by telling myself how awful it is going to be and how much I DON’T want to go. I now realize this type of thinking has to stop if I am to find any relief.

Therefore, I have dug out my DBT (Dialectic Behavioral Therapy) binder to review some skills to help me regulate my emotions. I am starting with “Wise Mind” which is the part of our mind where “Emotional Mind” (our thoughts based on distressing feelings) and “Reasonable Mind” (rational thoughts) merge together (what I want to do vs. what I should do.) Wise Mind says, Yes, our Reasonable Mind is right, but Emotional Mind is important and needs to be validated, too. It is all about having compassion for yourself while still pushing yourself to do what is out of your comfort zone.

Last month, I overextended myself by doing way too much out of my comfort zone without checking in with my feelings and wants. I completely ignored Emotional Mind and blindly succumbed to Reasonable Mind, which over time lead to a state of depression and extreme anxiety – throwing me full force into Emotional Mind. Hopefully, with my new-found awareness I can now start using my Wise Mind to get back on track to emotional well-being and productive living!

What type of “Mind” do you tend to have – Wise, Emotional, or Reasonable? How does this affect your emotional health?

Motherhood and Borderline Bipolar

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bipolar bpd and motherhood

I am a mother, and I have bipolar disorder and borderline personality disorder (BPD) traits, meaning I have some but not all of the criteria needed to meet the diagnosis for BPD. Two years ago, my life was changed due to learning the skills taught through Dialectical Behavior Therapy (DBT). Below is part of my story which was originally published at Healing from BPD.org.

What it used to Be Like

I bee lined down the hall into the bathroom, and shut and locked the door behind me before falling to my knees. Covering my face with my hands, I sobbed. Outside, my two and six-year-old girls banged on the door. “Moooommy! Moooommmyyy!” I thought, “Oh, my God! Why can’t they just leave me alone?”

I dialed a friend’s number and when she answered I cried, “I can’t do this. I can’t be a mom. I don’t know what I am doing. It’s too much. I can’t do this!” She calmly asked me what was wrong. I babbled through snot and tears, “One won’t eat her dinner, the other one always needs her diaper changed, they are fighting over toys, the Disney channel is driving me insane, and of course my husband is working all night again!” I was spiraling out of emotional control…over every day, typical motherhood stuff.

That was six years ago – four years before I would be diagnosed with Borderline Personality Disorder (BPD.) On many occasions, my husband would have to come home from work to calm me down during times like this. Feelings of inadequacy, fear of harming my children or myself, anger, self-pity, gripping anxiety, immobilizing depression and loneliness were my constant companions.

The unpredictability of the children’s behaviors and moods, and my inability to set boundaries and provide structure in my own life, let alone theirs, only heightened my anxiety. I was permanently in fight or flight mode – instincts gone haywire. I was filled with self-doubt and self-hatred. I felt like a caged animal ready to chew off its own foot to escape the chains shackling it to the cold and filthy floor.

Then I learned (in Dialectic Behavioral Therapy – DBT) that this chaotic environment, in which I felt like a prisoner, was imitative of my own childhood home. Sure, I wasn’t walking around drunk all of the time like my parents, but the moodiness, anger, and self-absorption that consumed me were not much different from theirs. Also like them, I had no real sense of how to be a parent.

Everyday interactions with my children baffled me and left me reeling in emotional binges filled with terror like when I was a child. I felt as if I lived in a carnival fun house filled with mirrors that distorted my view of the entire world while everyone else had regular old mirrors to look at. In hindsight, this was closer to the truth than I realized at the time.

The Turning Point

I was already being treated for alcoholism and bipolar and anxiety disorders when my psychiatrist suggested that I might have BPD as well. My first response was, “Great, another fricking diagnosis!” What I didn’t know, however, is that being diagnosed with BPD would be the best thing to ever happen to me and for my mental health recovery. For if I was never diagnosed with BPD, I may have never sought out DBT, which did for me in one year what years and years of individual and group therapies based on other psychological theories could never begin to do.

What it is Like Now

In DBT I learned how to be mindful of and radically accept my limitations as a highly emotionally sensitive person and mother. For example, this past spring I was beating myself up over not being emotionally balanced enough to take my children to church on Easter. The old me would have ignored my high anxiety levels and begrudgingly gotten them ready while screaming at them to, “Hurry up. Do this. Don’t do that!”

Then I would have suffered through the service feeling like a martyr while becoming angrier by the minute. Or I would have had a panic attack and then drove us all back home in a dangerous state of mind. Then I would have spent the rest of the day in bed, completely abandoning the kids to the television and their own devices. And let’s not forget the verbal hell my husband would have received for having to go to work, thereby leaving me to deal with the children alone, and on a holiday at that!

Instead I sat back and observed my thoughts and feelings as if I was watching another person go through them. I acknowledged the guilt and anxiety rather than fighting them. I also consciously did not make them who I was, but chose to view them as an experience of something separate within me. I chose to believe that deep down all was ok – that I was ok – no matter what thoughts and feelings occurred in my mind. I also made special care not to judge my thoughts and feelings as good or bad. The just were there or they were not…period.

Later that morning, I found an Easter service streaming live online, and my girls and I worshiped along with them from the comforts of our family room. It was a blessed day in which I owed no apologies at the end, neither to my kids or my husband, and most importantly, to myself.

What is it like for you as a mother with BPD? Or if you are the child of a mother with BPD, what is that like? What are some positive aspects of being a highly emotionally sensitive mother?

Borderline Personality Disorder and Motherhood

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I bee lined down the hall into the bathroom, and shut and locked the door behind me before falling to my knees. Covering my face with my hands, I sobbed. Outside, my two and six year old girls banged on the door. “Moooommy! Moooommmyyy!” I thought, “Oh, my God! Why can’t they just leave me alone?”…

Read more of my guest post today at Healing from BPD’s website.

River of Emotions

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river

When I am feeling sad or depressed, or anxious and afraid, my first instinct is to get rid of these emotions either by doing something unhealthy like smoking or overeating, or something productive like cleaning the house or exercising. The goal in both cases is to block out the emotion; to ignore it; to purge it from my system; to eradicate it.

What if rather than trying to kill the emotion, I sat with it; let it flow through and around me, believing all the while I am safe, because it is my actions, not my emotions, that have the potential to harm me.

I find that when I do this, the emotion tends to dissipate on its own. It’s as if giving it recognition somehow facilitates its disappearance.

Today, I will acknowledge the emotions within me. I will validate their existence, keeping in mind that feelings are not facts. They cannot harm me. Like a river they will flow towards me, through me and then out of me, and I will know peace.

How to Deal With Complex PTSD Triggers

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Dealing with PTSD Triggers

Current Symptoms

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…

Triggers

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) (at the time of this writing.)

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 shared 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.

Past Trauma

High school was a very traumatic time for me. My parents’ alcoholism was at its peak; dysfunction and emotional 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.

Before going to bed that evening, I made a passing comment to my husband about feeling a little anxious after looking through those yearbooks, 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.

Integration

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!

Discussion Questions:

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…

The Sucky Part of Dual Diagnoses

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juggle

Like many of you, I have multiple mental illness diagnoses…ones in which symptoms overlap to the extent that I don’t know what I am experiencing sometimes.

Is it anxiety or hypomania? I tend to go into cleaning frenzies during both states. Is it depression or hypomania? I tend to neglect my self-care during both states? Is it bipolar or borderline personality disorder symptoms? Frequent mood swings and anger outburst appear upon exacerbations of both of these illnesses for me.

How do you distinguish between different diagnoses? Does making the distinction really matter?

For me it does…anxiety means a change in that med while mania means a change in another one. My doctor increased my antidepressant at one point in order to treat (what we thought was) my anxiety, and the change threw me into rapid cycling bipolar symptoms (a very scary place to be.)

Cycling mood swings calls for a look at my mood stabilizer OR maybe I just need to refocus my efforts on using DBT skills (Dialectical Behavioral Therapy skills are clinically effective for treating Borderline Personality Disorder.)

Depression and self-pity…is it clinical – meaning do I need a med adjustment or is it something that a few extra counseling sessions or sobriety support group meetings would alleviate?

I am grateful there are so many avenues of support and treatment for all of my disorders – counseling, support groups, skills, medications (both traditional and alternative.) However, knowing which one needs to be tweaked here and there can be quite frustrating.

Have you ever experience the frustration of having two or more diagnoses whose symptoms overlap? How do you distinguish between them or how do you cope with it? Please share. I really could use your insight.

Thanks.

hugs,
Wil

Is Mental Illness Popular?

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micro soft image

Is mental illness a hot topic? I am not sure, but you all have been doing an awesome job at reading and sharing my posts because according to blog industry experts, the more popular your blog becomes the more s-p-a-m it is likely to get. Thank God for Akismet!

Next month is Write into the Light’s 2-year blogiversary!

another micro soft image

…which has me reflecting on my current goals for this blog as well as for Turtle Way’s blog (Turtle Way is a compilation of works submitted by artists and writers who have mental illness or have been affected by others with mental illness.)

Current Goals (in no particular order:)

  • I toyed with the idea of stopping Turtle Way’s publication until I reviewed the recent stats and saw that the issue released back in January is still receiving a great number of views. Yay! I love that people continue to (hopefully) gain strength and support from the artists and writers published there.
  • This brings me to Write into the Light’s original and primary purpose which is to offer understanding, strength and hope to all persons sufferring from mental illness.
  • In that light (no pun intended 🙂 ), I am going to place a lot of time and effort this year into finding a publisher for my daily meditation book. The daily reflections are written specifically for persons who have mental illness.
  • The newest and final goal I have to share with you, thus far, is to assemble a list of subscribers who would like to be part of a pilot audience for my book. This would involve receiving sneak-peeks of my daily reflections and providing feedback as necessary on how they affect you…if they help you cope with your illness or not…if they make sense to you or not…etc.

I have yet to finalize the logistics on this, but I am thinking of doing it either by email or password protected posts.

If you are interested in being a part of this pilot study and are willing to provide honest feedback (like serious critique) on how helpful or not-working-for-you-at-all these writings are, please email me at writeintothelight@live.com or leave a comment below.