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I finally got my DBT homework finished. If you’ll recall from my post about week 5 of DBT, this homework was a bit harder than prior assignments. Luckily we had two weeks to do it, as a session was cancelled for Memorial Day.

This assignment was about crisis survival skills. It required coming up with a crisis, destructive behavior, and the pros and cons for both doing and not doing the destructive behavior. I had a hard time getting started because I didn’t know what to use as a “crisis” and destructive behavior. It also took awhile to finish up because I was having a hard time thinking about pros for tolerating distress. So here’s a summary of what I put together for my assignment.

Crisis I was faced with: starting new job
Destructive behavior I did/wanted to do: smoke pot

Pros of destructive behavior:

  • relaxing, reduces anxiety
  • easier to get into tasks
  • more creative
  • better mood
  • feel good

Cons of destructive behavior:

  • self-medicating (which I don’t want to do)
  • lower overall motivation
  • mindless eating
  • illegal
  • makes me sleepy, fuzzy-headed

Pros of tolerating distress:

  • legal
  • less mindless eating
  • not self-medicating
  • no medication interactions
  • easier to get up in the morning

Cons of tolerating distress:

  • still anxious
  • panic attacks
  • paralysis
  • irritability
  • frustration
  • less productive

The instructions say to weigh out which side is heavier and act accordingly. Honestly, it’s the cons of tolerating distress and the counterbalancing pros of smoking pot that are winning this battle. The cons of smoking pot that bother me most are the mindless eating and the pot hangover that makes me fuzzy-headed and slow in the morning. But it doesn’t come anywhere near the cons of tolerating distress and pros of smoking pot.

Trying to keep Pandora’s box of freak-out tightly closed.

Neither approach solves the real problem. It doesn’t matter what the crisis actually is, nor the destructive behavior. Anxiety is the persistent issue, but my docs haven’t considered it much of a concern.

As far as I can tell, my anxiety issues are not diagnosable as separate from bipolar because there are relatively few/infrequent autonomic responses, although I have some of the other symptoms and it interferes with normal functioning at times. More often than I’d like to admit, quite frankly. Mood stabilizers have made it better (overall) but anxiety is nearly always riding shotgun. So I’m trying to manage as well as possible with the means at hand. Marijuana has always been an effective anxiolytic with relatively mild side effects. But the whole point of doing DBT is to get better at handling this stuff without resorting to self-medication.

Using the DBT skills for distress tolerance isn’t really helping much right now. I can’t afford to spend all my time self-soothing and distracting myself when the distress is pervasive and ongoing. Most of the skills are designed for managing difficult situations, cases where something nasty is happening for the moment, not something that spreads throughout the whole day, day in and day out. I can try to use the DBT skills for this kind of thing, but the second I stop distracting or self-soothing or whatever, I’m right back where I started. And then I just feel worse for not having accomplished whatever it was I ought to have been doing. Maybe when we get to emotion regulation I’ll find something more helpful.