#bpd therapy

[fraeuleinrabenschwarz]

The fact that I can't remember like 90% of my childhood sometimes makes me wonder if I've ever even been a child. Maybe I haven't and the blurry 10% I believe to remember are just random pictures and szenarios I made up to convince myself that I once was a child.

[bpdclub]

In DBT (dialectical behavioral therapy), the mind is seen as having three states: emotional, rational, and wise. Our wise mind is the ideal state that we strive to act from when making decisions, but simply getting to know the three is a great introduction to internal awareness. Above is a graphic explaining the three minds, alongside a journaling exercise. ✨

You can read more about Wise Mind here and here.

[beating-bpd]

EMDR is an amazing therapy, and if I start talking about it at length I’m sure I’ll sound like a cult member, but I will just say I recommend it wholeheartedly if you have PTSD or BPD or both.

That said, I am exhausted. It’s definitely draining. I had my 3rd session today, and I’m already seeing great changes - but it’s 7:30pm and I’m about to knock out for the night. Therapy days leave me feeling so fatigued. But good. 

[womanism]

Wise mind

[brunchbitch]

DBT part 2 - Distress Tolerance

Distress Tolerance involves using skills to bring down your emotional “baseline” in order to be more effective in your thinking and actions. Distress Tolerance includes a few sets of strategies: distractions, self-soothe, IMPROVE the moment, pros and cons, and crisis survival skills.

Wise Mind ACCEPTS:

Activities - engage in hobbies, watch a movie, or go for a walk.

Contributions - volunteer, make a card for a friend, or call a relative.

Comparisons - compare your experience to people who have it worse than you. 

Side note: Personally I’m not a fan of this one as a way to compare to other people because it always makes me feel guilty that I’m struggling as much as I am when other people have it worse. The way I use this skill is to do comparisons to where I have been in the past. For example, if I’m feeling really depressed and want to self-harm but am working to try to get through the moment, I think about times in the past where I wouldn’t have even stopped to think about it - I would’ve just self-harmed.

(opposite) Emotions - after identifying what emotion you’re feeling, expose yourself to things that will increase the opposite emotion. For example, if you’re feeling really sad, look up funny cat videos or stand-up comedians. If you’re angry, look at pictures of or call people you love, do an activity you love, etc.

Push away - give yourself permission to push away the difficult experience mentally. Imagine putting the experience or emotion in a box, lock it, put it high up on a shelf, walk out of the room, shut the door, and walk away.

Thoughts - count backwards from 300 by 7′s, read, write, or watch a movie. The idea is to distract your thoughts from the painful experience or emotion.

Sensations - squeeze ice in your hand as it melts, listen to loud music, or take a cold shower. Engage in something physically intense (but not self-harming) to take your mind off the painful experience or emotion.

NOTE: These distraction skills should be used short-term in order to get you through the distressing moment. Distractions should not be used long-term because they can encourage avoidance. 

Self-soothe - includes using your five senses to decrease distress:

Sound - listen to calming music, babies laughing, your favorite TV show, or nature sounds.

Vision - look at pretty pictures, watch a movie, color, or watch the sunrise.

Smell - light a scented candle, use essential oils, smell your favorite lotion, or bake something and notice the smells.

Taste - suck on a hard candy, drink your favorite tea, or eat a piece of chocolate.

Touch - put on your favorite lotion, give yourself or get a massage, take a warm bath, or put on fuzzy socks and wrap yourself up in a cozy blanket.

IMPROVE the moment:

Imagery - imagine a pleasant and safe scene and focus on each aspect of it - what do you hear, smell, see, touch, taste? Use an app or YouTube to find a guided imagery meditation such as this one, this one, or this one.

Meaning - find meaning from your pain by imagining helping someone in the future who is struggling with similar issues or thinking about how strong and self-aware you are becoming through these struggles. For example, when I’m struggling in school, I think about how much more meaningful it will be when I finally do graduate because my path has been so difficult.

Prayer - pray to a Higher Power or God to give you strength or offer your struggles up to the universe, a supreme being, or Mother Nature.

Relaxation - listen to relaxing music, take a short nap, give yourself a massage, take a bubble bath, or use deep breathing or other breathing exercises.

One thing in the moment -  focus your entire attention on what you are doing in the moment. Try putting one hand on your abdomen and one hand over your heart and focus your attention on the feeling of your breathing and your heart beating.

Vacation - take a short vacation from the painful experience or emotions; imagine sitting on beach in a tropical location and watching the waves crash in, or take a short nap.

Encouragement - use cheerleading statements such as “I can do this,” “I am capable,” or “I am strong.”

Pros and Cons:

Make a list of the pros and cons of using a behavior and the pros and cons of resisting the action urge.

Mark whether each pro or con is short-term or long-term.

Make a list of the pros and cons in order of importance to you (i.e. a long-term goal of recovering and feeling better about life is more important than the short-term relief of using a behavior in the moment).

Crisis Survival Skills - used to bring your Subjective Units of Distress (SUD’s) down a few notches. Crisis survival skills would be used when you are at an 8 or higher (on a scale of 0-10) of distress. The aim is to bring your distress down to a 6, 5, or lower where you are calm enough to use other skills. Two crisis survival skills are TIPP and STOP.

TIPP:

Temperature - take a freezing cold shower, put an ice pack across your cheeks or your upper chest, or ice dive. 

To ice dive: fill a bowl with ice water and dunk your face into it, holding it submerged for as long as you can, then come up for air and do it again until you feel your heart rate/physical distress decreasing. This is a great skill to use for dissociation because you won’t feel the cold at first but, as you keep dunking, eventually you will realize how cold it is and it will bring you into the present moment. This skill works because the cold stimulates the Vagus nerve that runs under your eyes which decreases your physiological distress, i.e. it lowers your blood pressure/heart rate. DO NOT use this skill if you have a heart condition.

Intense exercise - engage in a SHORT (especially if you have an ED) burst of exercise; do 20 jumping jacks, run up and down a flight of stairs 1-2 times, do burpees, etc. You will be physically tired which can bring your distress down.

Paced breathing - use your abdomen to breathe fully (rather than breathing in your chest); breathe in for 5 seconds, and out for 7 seconds.

Progressive muscle relaxation - scan your body, starting at your toes and going up to your face; tense the muscles in each section of your body for a few seconds (not to the point of cramping), and then release the muscles and focus on the relaxing sensation. There are many guided “body scan” or “muscle relaxation” meditations online such as this one or this one.

STOP:

Stop - stop what you are doing and freeze.

Take a step back - take a deep breath, pause in your interaction, and look at your thoughts/actions from a distance.

Observe - look at what your thoughts are doing, look at the situation, and notice your body sensations (Are you tense? Are you making fists or clenching your teeth?).

Proceed mindfully - make effective decisions, consider all sides of the situation, and do one thing in the moment.

Sources (X, X)

(You can find Part 1 here, Part 3 here, and Part 4 here)

[brunchbitch]

DBT part 1 - overview and Mindfulness

Dialectical Behavior Therapy, or DBT, was founded by Dr. Marsha Linehan in the 1980′s. She is a researcher at the University of Washington and has her own psychiatric past, including being diagnosed with BPD. Part of the reason why she developed DBT is because she felt very hopeless with the treatment that was available to her when she was younger - which was essentially to lock her up in seclusion in a long-term psych unit (she spent over two years at the Institute of Living in CT). 

DBT was originally founded specifically to treat BPD and chronically suicidal individuals but it has been used for other diagnoses as well (including PTSD, substance abuse, and eating disorders, among others). 

DBT treatment is generally offered on an outpatient basis: it consists of weekly individual therapy sessions with a DBT-trained therapist addressing a hierarchy of behaviors, weekly group therapy in which group members learn specific “skills” and offer support to each other (and homework is usually assigned), phone skills coaching which provides the client with access to the therapist outside of session hours in predetermined agreements (i.e. only during daytime hours, 24/7, texting, paging, calling, or emailing), and a consultation team for the therapist which helps prevent “burnout” and is a place where the therapist can get support from other clinicians about how to best approach the client’s treatment.

The general principle of DBT is to discourage “black and white thinking” (i.e. thinking only in extremes) by helping the client understand that two seemingly opposing ideas can exist at the same time (i.e. dialectics). The main dialectic of DBT is a balance between Acceptance and Change - that the client is doing the best they can in that moment AND that they can do better. Pre-DBT when Dr. Linehan focused mostly on change with her clients, she found that the clients felt invalidated and pushed too hard - many clients would drop out of the treatment. When she shifted to focusing primarily on acceptance, the clients felt validated, but they weren’t getting better. So Dr. Linehan fused the two ideas.

Acceptance and Change each have two modules associated with them - Acceptance encompasses Mindfulness (which is, in some ways, the very foundation of DBT) and Distress Tolerance, while Change involves Emotion Regulation and Interpersonal Effectiveness.

Mindfulness involves the What and the How skills for how to stay present in the current moment. The aim of Mindfulness is for the client to stay in Wise Mind which is the synthesis of two “mind states” - Emotion Mind (when your thinking is influenced by your emotions, often leading to impulsive decisions/behaviors) and Rational Mind (when your thinking is influenced by logic and reasoning with very little attention to emotions). Mindfulness is the core of DBT because all the other skills modules work best if the client is in Wise Mind.

What you do:

Observe - observe your environment non-judgmentally, using “teflon” mind, i.e. allowing thoughts, feelings, and reactions to come into your mind and letting them go. An example would be to imagine watching clouds pass by with a thought/feeling on each cloud, letting them drift out of view without holding onto any part of it.

Describe - describe what you have seen in the environment without judgment or criticism. Stick to the facts, either to yourself or to someone else. For example, “my friend has raised her voice and is making gestures with her hands” instead of “my friend is angry”.

Participate - participate fully in the experience. Throw yourself into the activity or experience and keep bringing your mind back to what is happening when it drifts away. When we learn anything new, we fully participate in the experience of it. When we have done something over and over, like brushing our teeth, we tend not to participate in it. How many times does your mind wander when brushing your teeth? Instead, try brushing your teeth with your non-dominant hand and pay attention to all the sensations in your mouth. Keep bringing your mind back to that sensation when it wanders.

How you do it:

Non-judgmentally - when you describe the facts or any aspect of the situation, try not to think in terms of things being “good” or “bad”, “right” or “wrong”. This will take practice because we are conditioned to make judgments about everything, so don’t be hard on yourself. Similar to a meditation, it will take practice to not have your brain go straight to judgment to make sense of a situation.

One-mindfully - when your mind wanders to other things (which it will!), bring it back to the thing you are focusing on in the moment, again and again and again. And don’t judge your brain for wandering; this will also require practice! You can say something like “oh there my brain goes again to what I’m having for dinner. What is happening right in front of me? What do I hear right now?” etc. For example, when you are talking to a friend, notice when your mind wanders and keep bringing it back to the sound of your friend talking, the expression on her face, etc.

Effectively - do what is most effective in the situation rather than what seems “right” or “fair”. Is there a situation in which you are holding onto anger and it is not helpful to the relationship? Practice letting go of what doesn’t work.

Sources: (x, x)

(You can find Part 2 here, Part 3 here, and Part 4 here)

[fuckbpd23]

My therapist is trying to put a little hope inside of me