DBT Skills: Vulnerability Factors

This week in my DBT class we went over an emotion regulation worksheet that had us list something that had never occurred to me before and I think something many of us may not think about: vulnerability factors. I feel that many of us (and I include myself) get wrapped up in potential flawed chemistry and brain structure when we experience emotion regulation which means we are ignoring very important factors that can make us vulnerable to feeling negative emotions and becoming dysregulated. Vulnerability factors can include,

  • physical illness
  • poor sleeping
  • poor eating
  • use of drugs or alcohol
  • stressful events in our environment

I have noticed within myself that around the time I am getting my period (about 1 week before) I become angered more easily and my ability to use DBT skills goes down a little bit. During this time, my body is going through physical changes associated with my period. Now, experiencing vulnerability factors is not an excuse to be unskillful. As in most cases, awareness of these vulnerability factors means that we can prepare ourselves for these moments to be more skillful. Now that I have observed this increase emotional dysregulation about a week before my period starts for a few months now (I needed to establish a pattern) I can now think of DBT skills to use next time to decrease my dysregulation. One thing I did for myself this time was treat myself to my favourite cake (self-care is important :p). I think it may also be helpful to create a self-soothing box and put in things that involve the 5 senses.

I am a little stuck on this one but I do have plenty of worksheets, books and peers to reach out to for ideas :)

Asking Why

My friend/colleague, Mhairi, sent me a reflective piece to post on the Young Ones website (the organization we have both helped run for the past 4 years). She is making great progress in her CBT treatment and in her reflective piece she asks herself why she thinks such negative thoughts about herself. This is a huge step for her because she identifies that she had, up until now, accepted these negative thoughts as apart of her life. Mhairi says, “…for those of you that are reading this and have been treating yourself in the same horrendous ways, I implore you…..start asking yourself, why?…Question everything you’ve accepted as fact.

Since beginning DBT, and especially in the current emotion regulation module, I have been asking myself why I feel certain emotions. In the past I accepted these emotions as facts. The extremity I experienced was “proof” that I was out of control and a horrible person. I never asked myself why I was experiencing these emotions, instead I asked myself why do I have to feel them. It was never about the cause, just about getting rid of them.

I am becoming fairly effective at taking the time to STOP, PAUSE and BE CURIOUS when I start to feel overwhelming emotions. I am better at giving my emotions names and weeding through the numerous other emotions to find the one that has been causing all my issues. I have learned something that is quickly changing how I cope and interact. Why do I feel emotions so strongly and why do I behave and think the way I do? Because I am afraid. I am afraid of being hurt, of being a victim and of losing everything/everyone that I care about. I live with this every day and respond based on what I feel will make the fear go away (ie: yelling, cutting, name calling etc.).

Now that I have identified that I am afraid I can find the causes and the solutions. For example, a few days ago I came home to find that B had put the clean laundry on the bed and not in the basket for me to fold. I immediately became angry and proceed to tell B that he needed to take responsibility for the laundry. I had not been able to catch myself so I was being aggressive with him. After a bit though I did catch myself and began to explain to B why the laundry had made me upset. In my past relationship, laundry on the bed meant that I had taken to long to fold it and if I wanted to go to bed I either had to fold the laundry or put it on the floor which demonstrated my “lack of commitment, motivation and character”. I told B that I was afraid he would think the same of me if I did not fold the laundry. I cried out my fear as he told me that he would never think those things of me if I didn’t want to fold the laundry. Cause: past experience where I was harshly criticized by someone I cared about. Solution: Explain to B why I am afraid to get his support in dismissing the feeling as just a feeling and not a current fact. 

Ask yourself why and see how you can start making changes.

 

Sloppy Psychiatric Diagnosis

Many of you know that I am not a fan of psychiatry and struggle very much to see the benefit the profession brings as it currently is. I was pleased to come across an article today in the Toronto Star that spoke to something I noticed as a teenager and recently, again, as an adult and demonstrates how far psychiatry still has to go in order to serve us better. The article, “Be wary of sloppy psychiatric diagnoses” by Jowita Bydlowska, speaks to the countless diagnostic errors given to people by psychiatrists. There are multiple reasons for this, but I feel it simply comes down to the fact that there is very little science in the diagnostic process.

But, let me organize myself a little bit to explain my thoughts on this article.

Since being diagnosed with Dysthymia (chronic depression) at age 16, I also had psychiatrists toss around Bipolar and Post Traumatic Stress Disorder. My Borderline Personality has been labeled as a disorder and then as traits. While only two of these diagnoses stuck with me I am bothered at how different psychiatrists can come up with different diagnoses (as seen in the research paper, Being Sane in Insane Places) based off of what I feel is nothing. While I greatly value anecdotal evidence and a person’s unique narrative, when it comes to providing myself with a label that can greatly alter the course of my life I would like more to be done than an hour long chat.

I often find myself becoming upset when I read research on Borderline Personality Disorder that says when the brain scans of someone with BPD and someone without BPD are compared it can be seen that the BPD brain is more Brain imagery helped Assistant Professor Anthony Ruocco untangle the neural circuitry underlying bordeline personality disorderemotionally on and has difficulty shutting off than the non-BPD brain (as seen, in research done by the Univrsity of Toronto). If we have seen this then why is brain imagery don’t a part of the diagnostic process?! I know this probably has something to do with “needing more research” but psychiatrists have already made so many diagnoses not based on these scans that I think adding it to the process wouldn’t hurt much. I’m sure cost comes into play as well, if not being one of the largest motivating factors for not providing it as an option. I WANT THE SCAN! I trust that.

The other part that I found interesting in the article is that the author talks about how certain diagnoses seem to be “in”. I noticed this when I was newly diagnosed. Many of my classmates seem to be getting diagnosed with some for of depression or bipolar disorder. I have a distinct memory of thinking, “How can everyone have depression?” Then, as the author mentioned, I noticed a few years ago that a lot of my friends were being diagnosed with PTSD or trauma language was being used a lot to describe their experiences. This past year, in the house that I live in, various occupants wondering, “Do I have ADHD?” and asking me for resources to receive a diagnosis (child and adult). As for 2015, I have noticed a great surge in BPD diagnoses. “BPD is so hot right now,” as I commonly say. It baffles me that these trends can exist. What is going on?

My final point is based off a comment in the article made by Dr. Andrew Lustig from the Centre of Addiction and Mental Health (CAMH, Toronto). He says, “the clinical picture of diagnosis can change over time as person develops in their illness, so sometimes a diagnosis that a person gets at one point (early) isn’t accurate at another point as the condition progresses.” This is cited as a reason for misdiagnosis and it is valid, but, I feel it is a tad weak. Aside from still coming from a patient-blaming perspective that ceases to acknowledge the systemic flaws of psychiatric, it ignores the fact that some diagnoses are not given out for certain reasons (age, gender, potential stigma etc.) or that a diagnosis is usually made after a 1 time visit that usually lasts an hour. Let me use myself as an example.

By the time I was 14 years old, I believed I had BPD. I displayed 8 or the 9 criteria (5 criteria are required at the minimum) but because I was still a teenager I could not receive the diagnosis and was given dysthymia instead. This meant that I was treated for depression which as I see now as an adult was very ineffective. If psychiatrists had looked at BPD as a potential option, seen that I had the traits, regardless of my age, then maybe I could have received treatment that actually helped me. My diagnosis of depression and BPD traits were made after a 1, 1-hour session with a psychiatrist. I was also prescribed medication during this session. I would think there is a lot of room for error if you are going off of your very first (and sometimes only) meeting with someone.

As always, my message is to be your own advocate. If you do not feel like you can step into that role yet or your doctor/psychiatrist will not listen to you, then find someone you trust to support you in having a conversation with your professional. You have to live your life and be comfortable in it.

DBT Skills: The Physical Side of Emotions

Tonight in my DBT class, we discussed in more detail the process in which emotions occur. It starts with an event that triggers an emotion/emotions and goes all the way to the result based off of what we did in between. I wanted to focus on the physical sensations and ques that we all experience when we experience emotions because they are often our first clues that something is happening to us (positive or negative).

We can actually see the heat distribution of each emotion!

For many years, I was oblivious to what was physically happening to my body when I would become emotional. It wasn’t until one night, I became so angry, that I felt like my heart was going to explode. It was extremely painful to experience and scary that I could become so angry that I could physically feel the stress on my body. This moment brought to my attention that when I experience negative emotions I experience chest pain.

Physical Sensations for Negative Emotions

  • Chest pain (always the first thing I notice)
  • Slowing or speeding up of breathing (depends if anger or sadness is most prominent)
  • Restlessness in my limbs (I feel the need to flex my muscles, this usually brings on self-harm urges)

Physical Ques for Negative Emotions

  • Touching my neck (or face area, I can’t explain why, I just do)
  • Making myself bigger or smaller, posture (depends if anger or sadness is prominent)
  • Big or small facial expressions (depends if anger or sadness is prominent)

Positive emotions also manifest physically and it is good to know what we physically feel when we feel good!

Physical Sensations for Positive Emotions

  • Warm feeling throughout my body
  • Fast or even breathing
  • Lightheadedness (when I’m really excited)
  • Feelings of being content

Physical Ques for Positive Emotions

  • Smiling
  • Open body/posture
  • Clear mind/focused

Knowing your physical sensations and ques can help you identify when you need to use a skill (for negative feelings) or continue doing something (for positive feelings). When I start feeling my best pain I do my best to remember skills such as urge surfing or ACCEPTS.

Listen to your emotions and your body and you will learn a lot about yourself.

Are you aware of your physical sensations/ques? What are they? How do you respond to them?

 

DBT Skills: Impulsive Email

I swear I am not one to write impulsive emails, especially to acquaintances, but I just did and I am now filled with deep shame. I am holding back tears because I feel embarrassed and hoping that I did not hurt the other person and make myself look bad. I tried to come off as standing up for myself and although I did not write anything that could get me in trouble (ie: name calling or accusatory remarks), it was just a very emotional sounding email. I did include in the email that I was upset and therefore probably not saying things properly and that how upset I was, was not the person’s fault. I then followed up this email with another email apologizing and trying to be more appropriately assertive and then also sent them a text message apologizing.

I seriously want to cry. I am still emotional so now probably isn’t the right time to be reflective on the experience, but I do feel the need to write about what happened. This links to DBT because in this moment I was not skillful. I did not regulate and I did not use any distress tolerance. I tried to use some interpersonal effectiveness by expressing what I needed, what I was displeased about and tried to stand my ground but when that is mixed with being emotional I know it comes off as being very aggressive.

Try and add a little humour here.

I am reminded of an article that one of the peer facilitators at DBT Path, Debbie, wrote about sending emotionally charged emails and texts and how to cope. Debbie includes a PDF of an emotionally charged email/text prevention worksheet in her post which would have come in handy tonight (please do check it out!). This was a blip and I am glad that the person who I sent the email to is a kind person who knows that I am a good person.

So, what do I do? I will try some distress tolerance and emotionally wade through this moment tomorrow when I am more capable. Writing about this has been helpful. I am already calmer than when I first started writing. I am going to settle into bed, do some deep breathing and read. What’s done is done. I will learn from it and move on (radical acceptance?!).

 

DBT Skills: Self-Compassion

I’m not good at showing myself compassion. I am a people pleaser and have a long history of hating myself. While I do not hate myself now I still place high expectations on myself. I am the hidden perfectionist that stops trying if they can’t do something right the first time. I know that using DBT skills is an act of self-compassion but when it comes to specifically addressing self-deprecating thoughts I really struggle to call upon skills because those thoughts are harder to make go away when I feel like I deserve them.

My emotional episodes are when I can, 8 times out of 10, show myself compassion. I am beginning to understand why I feel certain ways and that I deserve to not feel guilty when the emotional response to related to trauma. Where the struggle to show myself compassion comes in is when I do not feel like I deserve it. This is where I find myself this morning.

I have a headache. I do not like taking medication for headaches and they usually don’t work if I do. I told work I couldn’t come in today and I feel huge amounts of guilt. I apologised to my employer for not feeling well and have now been telling myself for an hour that I am letting my team down and that I am a horrible person. I tell myself that I should be able to suck it up and go to work. These thoughts are causing physical anxiety which is uncomfortable to sit with.

I am trying to not focus on the emotional thoughts and keep telling myself that it is best that I take care of myself and do other productive things with my day such as send some emails, begin packing for my move and visit my family. I need to replace my negative broken record (“You’re worthless”) with a positive one (“You deserve self-care”).

DBT Skills: Listening to Emotions

In my online DBT class, we talked about a few purposes of emotions and one of them was that emotions are our body’s way of communicating with us. In order to hear what our emotions are saying though we need to be open to listening and that is something I have only recently started doing and I didn’t even know it. If I want to skillfully regulate my emotions I need to know what they are and why they’re there. This tells me what to do next.

When I first started taking DBT we were learning the interpersonal effectiveness module. During this module, I challenged myself to wait a bit before I spoke when I became upset with someone or about something. By waiting a bit, I was able to think about what I wanted to say (DEAR MAN, GIVE, FAST) instead of immediately blurting out the first anger filled words to pop into my head. I have become better at this but until this past class I found myself just sitting with the feeling and wait until I calmed down to speak instead of looking at what feelings were making me feel like I wanted to say or do something nasty in the first place.

A few days ago I utilized this skill to investigate what emotions were behind some urges I was feeling. I uncovered that I wasn’t really angry (primary emotion) but that I was afraid, sad and felt hopeless (secondary emotions).  Listening to these secondary emotions helped decrease the anger, allowed me formulate a better method of communication and gave me an opportunity for self-compassion (which I really need to work at).

I do suggest using a feeling wheel (which I have written about in the past) because sometimes, especially in the moment, we do not have the words to describe what we are feeling. By using this feeling wheel, I have found out that my anger is actually fear, sadness, resentment and frustration (depending on the situation) which changes my course of action when dealing with a situation.