Hey, look! I finally got my meds right!
Well, mostly. The sinus meds are making my heart rate skyrocket, so they need some adjustment. But the rest of it is finally A-OK. Hurray!
Hey, look! I finally got my meds right!
Well, mostly. The sinus meds are making my heart rate skyrocket, so they need some adjustment. But the rest of it is finally A-OK. Hurray!
The final module in DBT, Emotion Regulation, was the turning point at which I got with the program, because it really worked when I really needed it.
The goals of emotion regulation in DBT are to understand emotions, reduce emotional vulnerability, and decrease emotional suffering. Hands-down, the most valuable parts for me were learning to observe and describe emotions, and also to accept them, because fighting your emotions just makes the hurt worse. Those skills built off the mindfulness components of DBT and gave me the evidence that it was all valuable if I could be brave enough to accept it.
Describing and Understanding Emotions
DBT uses “wave” model for describing emotion:
At first, I didn’t believe that I had any control over any part of my emotions because they had run rampant over me for so long — a very common belief among DBT newbies. It all happened too fast for me to respond deliberately, or so I thought.
I didn’t actually know what emotions I was experiencing… If you’re avoiding your emotions, it’s easy to be clueless about them.
I quickly realized that I didn’t actually know what emotions I was experiencing. They just felt “bad” and I couldn’t differentiate between them very well. Doing the post-hoc analyses helped me learn to associate my physical experience with the emotion I was experiencing, so eventually I recognized that feeling sick to my stomach meant I was afraid. It sounds very basic, but if you’re avoiding your emotions, it’s easy to be clueless about them. Once I was clued in, I could make conscious decisions about how to handle the situation instead of acting on autopilot and regretting it later.
Here’s a rather dramatic example from one of my worksheets, on the second time through the module, which shows that I had actually learned the skills quite well:
It was also really useful to have the huge range of words we use to describe emotions boiled down to a few basics: love, joy, anger, sadness, fear, and shame. By reducing the range of emotions I was trying to understand, I started recognizing that frustration is actually anger, anxiety is fear, etc. That might not sound very profound, but by simplifying things, I could associate the physical experience with the right label and then match it to an appropriate response.
I had no idea that I was so afraid so much of the time until I slowed down and took a closer look.
Most people probably don’t need to process emotions so deliberately, but I really did need help to figure it out. I had no idea that I was so afraid so much of the time until I slowed down and took a closer look. At that point, I could start asking myself what I was so afraid of, what was the worst thing that could happen, and whether I was OK with letting fear control me (yeah, not so much.)
Letting Go of Emotional Suffering
Aside from developing some shockingly basic emotional literacy, the other big win for me was applying mindfulness and acceptance to my emotions. This wasn’t easy — no, actually, it’s very easy — but it was terrifying at first.
This is one of those things where it sounds like voodoo bullshit and you have to initially take it on faith. First, observe the emotion: recognize it’s happening and don’t engage, just observe. Then experience it. Just let it happen; emotion comes and goes like a wave (the analogy really works here) but if you struggle against it, you’ll exhaust yourself getting nowhere. Likewise, if you let yourself get sucked in, amplifying and embracing the emotion, that also makes it worse. You know what I’m talking about — we’ve all done that, especially with “righteous” anger.
It’s hard at first, but you have to stop trying to control and understand the emotion, and just let it be. At the same time, remember that you don’t have to act, and it will get better. Biochemically, your body can only produce freak-out hormones for 45 minutes before the supply is completely depleted, so things will get better in 45 minutes or less. Yes, it might feel like forever, but if you stop resisting and just let yourself experience the emotion, it probably won’t even last that long!
I discovered that when I was extremely upset, if I just laid down and let myself feel miserable, doing nothing else — not feeding it or struggling against it, literally just focusing on being miserable — I’d get bored within about 20 minutes. At which point, I’d mop up my tears and get on with things. After doing that a couple of times, I realized my emotions weren’t going to kill me and it’s really OK to just let them be what they are.
The last part is to “love” your emotion, which basically means this: don’t judge yourself for being emotional, but be willing to experience it — it’s a big part of what it means to be human. Accept the emotion: you feel what you feel, like it or not, and that’s OK. It’s actually much easier than wasting your energy uselessly resisting reality, which will only make you feel worse. Accepting emotions is very powerful because it’s also validating, and it became part of self-compassion for me. When I felt so rotten that I had to just lay down and cry, I’d tell myself, “It’s hard to feel this way, but that’s just how it is right now. Letting yourself experience your emotions is brave and you will be OK.”
And that’s how I handle it today: when I’m overtaken by emotion, I just let it be. I’m self-aware enough to understand what I’m experiencing and I’m strong enough to experience difficult emotions. Sometimes that means excusing myself to the ladies’ room and crying my eyes out in private, but at least I’m not running away from myself anymore.
Pain is a problem of the moment, but suffering is letting the problem cause pain for longer than necessary.
As I learned from another group member, pain is a problem of the moment, but suffering is letting the problem cause pain for longer than necessary. We’re much more in control of our suffering than we’re led to believe. If you can accept your emotions instead of wanting things to be what they aren’t and never will be, you’ll suffer a lot less for it. And if you’re not busy making yourself suffer needlessly, you can be joyful instead — which I highly recommend!
To some approximation, I was mostly right about that. I wouldn’t be good at what I do if I wasn’t good with people. But interpersonal skills can always use a brush-up, no? By the second time around, I took a little less offense to the material and got a bit more out of it, but managed to be absent (for legitimate reasons, no less) a lot during that module.
Interpersonal effectiveness is all acronyms, all the time: DEAR MAN, GIVE FAST. But I’m not doing a review of the content because I covered it already. The take-aways, for me, were in the themes of balancing, and the factors reducing interpersonal effectiveness.
What can I say? Balance has not generally been my forte – whether or not the bipolar diagnosis was accurate, having been given it at all pretty much disqualifies me for the “Miss Balanced” contest, don’t you think? It was useful for me to get non-academic perspectives on balance as well, because other academics have similarly insane notions of balance.
In any case, I came to recognize that my wants deserved attention in addition to the things I feel I should do – and I also learned to question whether I really should be doing the various things that demand my time and attention. Surprisingly often, the answer is “no,” and that’s a good thing to know.
I liked that DBT acknowledged the variety of external and internal factors that can reduce interpersonal effectiveness. The big culprits for me pop up at different times, under different circumstances: worry thoughts, emotions, and indecision.
I occasionally worry way too much about how others perceive me, and when I’m in a low mood, I tend to ruminate to no end about how badly I screwed up every last interaction with anyone ever – which basically leads me to isolate. That can hardly be called effective interpersonal interaction, but it’s not entirely ineffective either – however, it’s also particularly unhealthy for me.
At times my overwhelming emotions overflow into my interactions with others. I kinda can’t help that – I’m trying to observe patterns of behavior that I can detect and nip in the bud, so to speak (like ranting. So much ranting.) Unfortunately, I really lose objectivity when I’m under the influence of hormonal havoc, and I just can’t always tell it’s happening until I’m in the middle of it and can’t readily extract myself. Usually later I want to punch myself for talking or typing too much or too loosely.
At other times, during emotional lows, I suffer from indecision that makes it hard for me to interact effectively because I just don’t know what I want, or to be honest, sometimes I just don’t — and can’t — care. Sometimes I want someone else (ahem, Mr. Chickadee…) to make decisions for me as a way of taking care of me, because sometimes I just can’t handle the stress of one more decision.
While I can’t always do much about these factors, if I recognize that I’m feeling overemotional, indecisive, or particularly anxious, I can give a second thought to any plans for communicating with collaborators, meetings, and social events. Sometimes it might just be best for me to stay home from the party or reschedule a meeting until I can get my head cleared enough. Sometimes I might be able to find ways to compensate – like setting up a process to deliberately delay outgoing email when I’m feeling dysphoric, so that I can review the content and send messages when I’m feeling a little more sane.
Final installment: Emotion regulation
Distress tolerance was the first DBT skills module I encountered (after mindfulness, of course.) I knew I needed help with distress tolerance, which is a set of crisis survival strategies, but my initial reaction to most of it was that it was bullshit, hokey, outdated, and wouldn’t work.
I was wrong.
Distress tolerance skills are about how to get through those tough moments that you can’t change, but simply have to find a way to accept and tolerate. Acceptance doesn’t signal agreement – accepting a crappy situation is not the same as approving of it, it’s just acknowledging that you don’t have control over it. For the purposes of DBT, “crisis” is anything emotionally upsetting – including spilling the milk – because distress is distress, regardless of scale, seriousness, or cause.
There are four main distress tolerance skill sets: self-soothing, distracting, improving the moment, and analyzing pros/cons. I really, really resisted for three reasons: I didn’t feel that I deserved to be less distressed; I was afraid that actively distracting myself from distress would cause even bigger problems due to ADD; and I didn’t really believe that anything I did would make distressing situations more tolerable. I also didn’t want to accept the distressing situations I found myself in, and that just made it worse.
What I found is that these techniques do work if you actually let them, but you have to experiment to find what works best for you. As expected, I do have to be careful with distracting, but I’ve learned that sometimes it’s exactly what I need to do (e.g., while waiting for Ativan to kick in when I’m in really bad shape). It also takes time and deliberate practice, but some of the skills are now automatic responses to distressing situations, which is how DBT is supposed to work.
One of my first questions about self-soothing was how it differed from self-indulgence. I generally believed that being kind to myself was some kind of superfluous mollycoddling. It’s true that self-soothing is about making yourself feel better, but I didn’t feel I deserved or needed it. DBT held up a mirror that showed me I needed to practice self-compassion.
“Self-soothing with the five senses” is exactly what it sounds like. Using the lotion that smells so good and feels so nice that it makes you feel just a little less upset with the world. Flipping through a coffee-table book of visually-pleasing photos. Mindfully preparing a steaming mug of sipping chocolate (super-deluxe hot cocoa!) and then mindfully sipping it. Going outside somewhere that I can hear moving water – a creek, river, or lake. Baking cookies that make the whole house smell yummy. Hitting “play” on the playlist of songs that always make me feel good. These are little ways to make it easier to get through a bad moment.
All it really takes is realizing that I’m in distress, and asking if there is anything I can do to make the situation easier on myself (which requires some measure of mindfulness in the first place.) I mentally run through the five senses to check if any small, quick interventions will help me feel better right now.
Simple, really – but it took awhile to learn. Some of us forget to include “be nice to yourself” in our coping repertoires. I certainly needed the reminder.
I know I can distract myself from distress; I get distracted from just about everything. The trick is finding a non-destructive distraction when you’re in crisis (i.e., cutting not permitted), and for me, not losing too much time to it. I use distraction strategies sparingly because it’s hard for me to refocus afterward.
The acronym for DBT-approved distraction strategies is “Wise Mind Accepts” – accepting that we can’t change the situation, but can change our reaction to it. These are mostly “right now” strategies for immediate distractions. There are lots of options for ACCEPTS strategies, but here are a few that are effective for me:
Improving the moment is basically about acceptance and doing what we can to buffer ourselves against emotional distress. To me, these techniques help in ongoing bad times, as opposed to in-the-moment interventions.
I wrote about the process of analyzing pros and cons in some detail when I went through it the first time. While I don’t use it all that often, I still keep a filled-in pros/cons 2×2 table in my top desk drawer for “avoidance.” It’s easy for me to remind myself why I need to resist avoidant behavior, and I think of it in moments when I realize I’m avoiding something that I probably should be facing. I found this strategy particularly useful because of its analytic approach, which is compatible with how I like to think about problems.
Next topic: Interpersonal Effectiveness
The blog continues, for now. Thanks to those who weighed in and said there’s value in my learning to tolerate uncertainty. 😉
Back in August, I finally graduated from DBT – Dialectical Behavioral Therapy – after 16 months of weekly group therapy. It was really more like a class on coping skills designed for those of us who can
were forced to admit that we have problems handling emotions.
Somewhere along the line, I drank the Kool-Aid and got on board with DBT. It really started to pay off – but it took me about 9 months to get that far. Yes, I can be pretty resistant to changing my thinking about things… Once I gave the DBT skills a serious try, I found they worked. I also really wanted them to work, because I really needed things to improve. Apparently for therapy to work, you need to give it time and make a real effort. Lesson learned, yo.
Anyway, Mr. Chickadee asked for an update on what I got from DBT. DBT is divided into four modules: Mindfulness, Distress Tolerance, Interpersonal Effectiveness, and Emotion Regulation. Each of those areas is rich enough to merit its own post, so I’ll start my debrief with the core module, Mindfulness, which was repeated in between every other module.
The more I practice mindfulness, the more I benefit from it. Yes, this is super-clichéd and you’ve seen it all over the evening news: mindfulness is extraordinarily beneficial in multiple ways. In group, every session opened and closed with a few minutes of mindfulness practice. We had homework assignments to further practice “one-mindfulness,” like making the coffee while paying full attention to every part of the process and experience with all our senses.
Such mindfulness practice, incorporated into daily living, makes me happier, calmer, and more content. Mindfulness in group sessions was often as simple as breathing exercises, or a slow, focused sensual experience like spending 3 minutes eating a Hershey’s kiss or everyone’s favorite: coloring. Seriously, coloring was one of the best activities for finding that mindful flow state.
At the start, in April 2012, three minutes of focusing on my breathing was terrifying and agonizing. I didn’t think I could do it, categorically, due to my ADD. I just about panicked over one of the first homework assignments, which was to do something one-mindfully. On a good day, I can barely sit still and my thoughts don’t move linearly. How could I possibly focus on just one thing? I was afraid to even try.
But I did it, in part because anything so terrifying has to be challenged. Initially, each second seemed to last a minute. A year later, I found that three minutes of focused breathing felt like 30 seconds, and I’d open my eyes feeling calm and centered.
I’d call it a miracle, but it’s not. It’s just what comes of mindfulness practice.
What I learned to do with mindfulness is to slow down enough to evaluate what is going on around and inside me. I now have more control over how I experience my life – mindfully and fully in the moment, or skimming the surface and lost in the crowded, noisy place that is my suboptimally configured brain.
So I practice living one-mindfully and non-judgmentally as often as I can because it really helps reduce the impacts of ADD and screwy mood episodes. I also think it’s making me a better person. Or at least, a person I like better.
I went to DBT to learn how to deal with explosive mood swings, depression, and anxiety. At first, I didn’t see how mindfulness fit in. But it helped me slow down, which let me better understand my moods and emotions, and that allowed me to start to take more control.
Mindfulness also helped my anxiety – focused breathing is remarkably restorative. These days I rely more on a few deep breaths than on benzodiazepines (not about to give those up just yet, though.) Just learning to breathe, and do nothing more than that – a practice totally foreign to the ADD mind and body – has been beyond valuable for helping relieve symptoms of anxiety and inattention.
Repeatedly practicing non-judgmental stance was surprisingly valuable. We judge a lot, some of that is natural and useful in its own way. But most of us judge too much, feeding negative feelings and basically undermining our own wellness and ability to be compassionate. Judging is also presumptuous in many circumstances – I mean seriously, who do we think we are?
I usually judge myself, and harshly. I don’t know why I’ve chosen to hold myself to ridiculous expectations that I’d never put on anyone else, but I do know that no one should hold herself in such poor regard. In retrospect, I’m almost embarrassed to have been so mean. To myself. This is progress, my friends.
Telling myself, “I’m doing the best that I can under the circumstances” and working on slaying the dragons of perfectionism and imposter syndrome seems to help. Even my therapist, Hippie Dude, has commented recently that I don’t seem to be as anxious about everything as I used to be.
I can now admit that I can’t do everything. I don’t expect myself to do all the things, just right, all the time. I don’t even expect myself to do all the things anymore! I have learned to accept that my body and mind require care, which requires time, effort, and money. And it’s not only worth the investment, but the consequences of neglect are dire.
Mindfulness has been a key tool in unlocking the benefits of the rest of the DBT skills. It has also been good for me in itself, and I plan to keep at it.
Next topic in the series: Distress Tolerance
This blog is clearly in limbo. I haven’t had anything much to say since July. I’ve barely been making a post every two weeks.
I know it doesn’t really matter, but it bugs me. It’s another loose end, another project started and then left hanging, another responsibility neglected, and yet more evidence of my innate flakiness. Less obviously, it bothers me that I haven’t anything to say and even when I do, I can’t seem to make time to say it.
I could be tempted to read these signs as reflecting badly on my character, but a more suitable interpretation is that blogging has lost some of its benefit for me. I’ve learned and grown a lot since starting this blog, and as I’ve gotten healthier, I no longer rely on blogging and the community for support like I once did.
Which is good, because as I’ve refocused on the rest of my life, my lack of attention to the blog shows. I don’t post or participate as much, and my writing evokes fewer likes or comments, particularly if I wander off-topic. I’m not fishing for interaction, just observing that others’ inactivity is in part a reflection of my own.
This is the natural way of things: everything new becomes old; we pass from one stage of life into another; our needs and priorities change over time; we focus on new challenges as we surmount the old ones. All of these things are true. My mental health is more stable and the next big challenges are the completely normal(ish) kind that everyone experiences: finding a new job, relocating, and re-establishing my life somewhere else. I’m not sure where blogging fits in with that, if it does at all.
So I’m considering closing the doors on this blog. I have one or two more posts in mind, but might as well save them for Canvas, because there’s no predicting when I’ll finally feel like writing them up. Pulling the plug sooner rather than later just seems a more graceful way to end things than slowly petering out or vanishing without explanation.
Well, in any case, to those friends who may still be reading – it can’t come as any surprise that the blog is in limbo. Maybe soon it will be time to put it to rest.