The Diary card: good, bad and even ugly

If you’re like most folks doing some kind of dbt practice, filling out the diary card is…well…a pain the ass!  And you may be experiencing a lot of resistance to filling it out, which (if you’re anything like me), you may be rationalizing so that it doesn’t sound or feel like resistance at all.  Do you forget to fill out the card?  Does it never seem to be around when you actually do remember to fill it out?  *Sigh*.  Damn diary card!  😉

The bad news is that to give your therapist, or yourself, is that filling out the diary card is so crucial that it would really be in your best interest to actually fill it out.  Don’t take too much time thinking about it; it’ll take maybe two minutes.  Are you willing to do some problem-solving re: how you can get yourself to fill it out?  Sticky notes?  Reminder messages on your phone or via email?  Asking someone else to remind you (yeah, peer pressure is verrry effective 😉 ).  Whatever you need to do to fill it out – `just do it’.  If you’re one of those people who negotiates with him/herself, you need to someone get the diary on the `this is not negotiable’ list.  In fact, the less you think about it the better.  Just do it!

There are many reasons why filling out the diary card is in your best interest; here are just a couple that come to mind:

1. You already practice a lot of skills!  Even before you started dbt you were already skillful.  Yay!  You’ll learn that many of your skillful behaviors are on the diary card – just in `dbt-speak’.  I guarantee that even if you think you didn’t use any skills that day, if you woke up and lived another day, there are multiple skills you can check.  So it can be really uplifting and reinforcing to experience the `yay me, I practiced skills!’ moment that filling out your diary card can bring you.  And after you fill out the diary card, you can `pat yourself on the back’…which immediately adds at least one skill you can mark off on your next diary card.  Actually, more than one…wise mind, encouragement, accumulating positives (okay, that may be a stretch), opposite to emotion action (if it was)….and probably more. Oh, mastery.  And willingness.  Damn, you’ve already got a pretty impressive diary card for the next day!  You go Skill Monster!

2.  Just seeing every skill written down, at least once a day, will increase the likelihood that you will both remember the skills later and use them.  Because one of the most important aspects of dbt is that the skills `come out of us’ in the `real world’, it is really important that the myriad of potential skills actually pop into our head when we’re in a situation and wondering what to do.  In fact, I highly recommend that you carry around a diary card with you (or any reminder of all the skills), so that you can pull it out when you’re stumped….or when you’re on the bus, and want the person next to you to stop talking to you.  Or just to study.

We’ll talk at some other point about how some people are `rule-governed’ (they do what they’re told), and others are `contingency-governed’ (they do things because they care about the consequences).  Most people fall into one category or another.  I am definitely contingency-governed.  But, sometimes the consequence/reward/punishment still doesn’t get me to do something I really don’t want to do.  In those cases, I have to shut my mind off as much as I can and just make it a Rule.  Capital ‘R’.  As in ‘Rawr!’.  Two examples of things I need Rules for: showing up at meditation practice, and filling out the diary card.

Honestly, it took me a couple of months before I regularly filled out the diary card.  It took a lot of problem-solving for me to fill it out.  In the end, I simply (yeah, as if `simple=easy’ *snicker) had to take away any choice in the matter.  No thinking allowed.  Just do it.

Sheeesh.  I don’t even like Nike. 😉

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TIP Skills

For some people who come into the program feeling so overwhelmed by their emotions, TIP skills will be a vital area of practice.

TIP is an acronym that stands for:

T-Temperature change:  While many people in dbt use ice (I’ll talk about this later) to get their emotional distress down, others find it more effective to take a warm/hot bath or shower. *DO NOT USE THE ICE TECHNIQUE IF YOU HAVE A HEART CONDITION OR HAVE HAD A HEART ATTACK*.

I-Intense exercise: Running around the block, doing jumping jacks, turning on a song and dancing around for a little while…all of these things can use up some of the energy that is fueling our distress.

Progressive Relaxation:  There are many ways of doing progressive relaxation, but in a nutshell, you are going through your body and mindfully relaxing one area at a time.  If your distress is very high, you may want to squeeze all the muscles in each area very tightly for a few seconds…and then release.  Don’t forget your face!  Scrunch it up tightly, and release.  Some people don’t feel comfortable or capable of doing the relaxation exercises when they are very keyed up.  Some are even `triggered’ by the relaxation response (me!), because it is new and scary.  BUT, if I’m not super keyed up to begin with, the progressive relaxation actually works well for me.  And it may for you too.  Don’t give up on it if it doesn’t work once…try it a few times.  You can find guided progressive relaxation video’s on youtube.  I’ll check some out tonight and get back to you with some good ones.

Please remember that you don’t need to use all the skills.  Some will seems more natural and/or effective for you, and those will likely be your `go-to’ skills.  If you really like the `ice’ technique, it’s perfectly fine to use that one.

If you don’t know what the `ice’ technique is, I’ll give you a little overview.  If you really want to go for it (and this is not a particularly pleasant thought or experience for most people…until they find that it works;) ), fill a sink with cold water and add some ice.  If you don’t have ice, be creative.  Add a pack of cold peas…or something ice-y that will lower the temperature of the water even more.  If you don’t have a sink, fill a big mixing bowl.  Okay, so, you’ve got some frickin’ cold water in a sink, right?  Now, you’re going to hold your breath and dunk your face and head in for as long as you can hold your breath.  Then come up, exhale, inhale and dunk again.  Repeat as many times as you need to until you feel quite a bit calmer. The most I’ve dunked my head is 4 times in one session.  It wasn’t a pleasant experience.  My face and eyes hurt like hell….but I really was a lot calmer.  Now Ice is my go-to TIP skill.  (Fortunately, the longer you practice other dbt skills, the less you’ll need to use the TIP skills…but they’re always good to remember)

The ice-dunk simulates the `dive reflex’, which is what would happen if you actually were in freezing cold water and your body needed to conserve its energy to try to survive.  In such a situation, your body would essentially start to slow or shut down functions that weren’t absolutely vital for survival.  Our anxiety/emotions are not vital, so they get calmed waaaay down.  Honestly, as horrible as this skill might be to practice at first, it became the favored skill of most participants in the two active groups I was involved in.

Some people could not, for various reasons, dunk their entire heads in water.  They would vigorously rub lots and lots of ice over their face and heads for 15-30 seconds.  Others would put ice packs on their heads.  Marsha talks about taking bites out of frozen lemons and oranges.  I’m not sure how that would correlate scientifically with the dive reflex, but if it works, who cares???

I also know of a dbt therapist who use the `ice water’ technique to calm down before going to sleep.

I guess this gives new meaning to the phrase ‘chill out’!

Ha!  On that cheeeezy note, I’ll go and scour youtube for some relaxation cd’s.  Again, Jon Kabat-Zinn has a couple of great progressive relaxation cd’s.  One is about 20 minutes, the other 45 minutes long.  They’re both great, and if you have an MBSR (see last post) teacher near you, call him/her up and see how you might be able to get a copy.

Good luck!

 

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Mindfulness and Meditation, Jon Kabat-Zinn

I’m going to write a little bit about Mindfulness…what it is, and what it isn’t.

Some people equate Mindfulness with meditation; but they’re not necessarily the same thing.   Meditation may be one form of mindfulness – depending on what the `meditator’ is doing?  But, not all forms of meditation practice are mindfulness practices.  Clear as mud?

Mindfulness is simply `being present’.  Simple but difficult.  Our minds and emotions tend to drraaggg us away from the present moment, but with practice we can learn to come back.  You can be mindful: washing dishes, feeling where your body touches whatever it is in contact with, looking at a candle…. When you are doing these things, they are all you are doing.  If judgments or other thoughts come up just watch them float by as if they’re on a cloud, or on a leaf running downstream a river.  Then come back to whatever your mindfulness practice is.

Often, the first mindfulness practice we may learn is to be aware of our breath.  You may want to concentrate on the area just below your nostrils, and experience the in-and-out flow of air.  Or, you may prefer to focus on your abdomen as it rises and falls.

For some people, focusing on the breath can be anxiety-provoking.  If you’re one of these people, you can concentrate on other things.  My favourite is to be aware of my hands.  To just feel them, experience them….not labeling the feeling or experience, but just directly `being my hands’.  Of course, I do put words to my experience, again..and again.  And I’ll drop the words and come back to just being mindful of my hands over…and over…and, well, you get the picture.

You may feel like your brain is screaming at your for attention.  Mine certainly does.  Lol.  It throw little tizzy fits.  I just sit and watch the tizzy fits. Sometimes I can’t resist making a comment to them – but that’s me being dragged into my thoughts again.  So, back to my hands.

Another way of saying all this is that you are being: One-Mindful.  You are only doing one thing at a time.  You are only watching your breath, or your hands, or a candle….

Why is being Mindful important?  Well, of all the really good responses to that question, (and there are many), one stands out for me in relation to dbt skills:

You Can Stand Anything As Long As You Stay Present

There.  You owe me a million dollars. ; )  It’s true though.  If you are thinking that you cannot stand something, and you have to respond right away, or you cannot take the pain you are in anymore…well, I guarantee that you are thinking about the past and the future.

So when crap is hitting the fan (such a visual, huh? ;)), try this: Sit down somewhere quietly and either be mindful of your breath or your hands.  If you notice thoughts, just bring your mind back gently to your breath or your hands.

Could you stand your pain for that breath?  And the next?  As long as you can live in a `series of breaths’, you will be okay.

Practicing at first will be really, really difficult.  I highly, Highly recommend getting some cd’s from Jon Kabat-Zinn to listen to.  He will lead you through mindfulness practices until you feel comfortable enough to practice on your own.

You may find his cd’s at the local library.  Or, you may want to order them.  Here’s a link to his cd’s on amazon:

http://www.amazon.com/Guided-Mindfulness-Meditation-Jon-Kabat-Zinn/dp/1591793599/ref=sr_1_1?ie=UTF8&qid=1297905377&sr=8-1

If you’re going to order his cd, check out his book: Full Catastrophe Living.  It is fabulous!  I keep it on my nightstand.:)  I recommend reading that, so that you can get a grasp on what mindfulness is beyond my undoubtedly confusing little blog post.

Another avenue for getting a grasp on mindfulness would be to join a Mindfulness-Based Stress Reduction (MBSR) class.  Kabat-Zinn is the founder/creator of this program, and it truly rocks!  Some hospitals offer it and offer scholarships.  Google “MBSR” + your town, and hopefully you’ll find something.

FYI:  For Bay Area folks, the Planetree Healing Library is an amazing resource for lucky you.  Go and check it out!  They have lots of mindfulness cd’s, books…and offer MBSR with scholarships available.

‘Night Skill Monsters!

PS: Again, apologies for grammar, spelling, and the random capitalizing of words.  There is a method to the madness; it’s just not consistent. ; ) A dialectic!  Sweet!

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The importance of having a goal

Without Willingness…oh, I already said that somewhere else.  Let’s just say that Willingness is really, really important.  Sometimes you’re going to want to sabotage all kinds of things related to treatment, and you’ll need Willingness to get you through.  It’ll also help tremendously to remember your goal.  Sometimes that can prod you into Willingness.

If you’re in treatment with a therapist, s/he will probably talk about your goals pretty quickly.  What do you want out of treatment?

Here’s what I put on the daily dbt facebook page yesterday:

What is the `goal’ that is going to motivate you to practice, even when you don’t want to? Something specific. Something you’re passionate about. (Even just a hint of passion is fine…just a little kernel). Maybe it’s to have a good thanksgiving dinner with your family next year, or to be able to volunteer one day per week for a `cause’ that is close to your heart. State it in the positive if you can.

My goal at the beginning was to be a more stable partner for my then-boyfriend.  Now this was a little strange because he and I actually weren’t together at the time – but I hadn’t accepted that at all.  So, my goal switched a little bit to: When he’s ready to get back together, I want to be able to be a `better person’ in that relationship.  Still in denial?  Yes.  However, it really got me to work.  Two years later I don’t even speak to the guy, but I’m grateful that I was in enough denial to actually be able to hold onto that goal…until I didn’t need to anymore.  My rockin’ ex-therapist said I was in: functional denial.  That works for my overly analytical brain.  As long as there’s a term for it, that’s cool.  And it was really functional!

I’m definitely not showing my goal as an example of a `good one’ – but as one that got me to work.  And goals can change, of course.  They are long-term, so they don’t change as often as your short-term `targets’ – but as you continue on in treatment they may very well change.  If they change too often though, you might not feel supported or moved by them.  So, choose Wisely.  (Yes, of course,  you’ll most likely find your goal while engaging with Wise Mind).

Speaking of which, it’s valentines day!  *Grimace*.  I just put a yummy tofurkey dinner into the oven for dinner.  Wise Mind and Gratitude have been invited to come over.  And Mindfulness.

(Thanks K. Comtois for the inspiration for this post, and the fb page)

 

 

 

 

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Knives, and thoughts can’t hurt you

Knives scare the crap out of me.  I don’t like having them around, or even seeing them out.  Especially sharp ones.

Most people who are in dbt have experienced quite a bit of horrendous suicidal ideation.  Some people have actually attempted suicide – but if not, there have at least been thoughts, or fantasties of `what’, `where’, `how’, ‘when’?  I have spent probably hundreds of hours both fantasizing about suicide, and actually researching potential `outs’.

Please understand that I did not want to die.  I am, in fact, terrified of death….to the same degree as Woody Allen.  Totally neurotic.  BUT, I was at the point that my primary motivation was to do anything, Anything, to stop the pain/anxiety/panic/overwhelm/dread/terror/add almost any negative emotion.  And, I was afraid of `going crazy’.  I didn’t know exactly what `going crazy’ meant, but it included my not having control over my actions – including actions related to my suicidal ideation.  When I got to the point of `oh my god, I’m afraid of what I’m going to do…’, I would take myself to the ER, and really quite often have to force my way into the psych ward.  I thought it was the only place I would be safe.

That was 2 years ago.  Not a long time, really.  Today, I still have some SI (suicidal ideation).  Not much though.  I have `triggers’, such as knives.  They remind me of my previous thinking, which sometimes leads to, `oh my god, what if that thinking happens again?’, which sometimes even leads to, ‘oh shit, I’m going crazy’……until I remember that I don’t have to believe my thoughts.  My thoughts, in themselves, are not real.  I don’t like them, but they’re not dangerous.  They cannot hurt me.  Believing them, especially when they are happening when I am highly, highly emotionally aroused can be dangerous – but the thoughts themselves are just words.  Blah, blah, blah, blah….blah blah.

It takes time, and taking some risks.  And trusting yourself and that you have actually internalized the skills. And I needed to realize that creating a crisis and ending up in the hospital was absolutely the worst thing that I could do, for my own emotional well-being.  My anxiety, panic and complete overwhelm had only ever become worse in a psych. ward setting.  I was terrified as an inpatient, and was usually discharged, even more demoralized than when I went in, within 24 hours.

When you first start in dbt, you will make a Crisis Survival Plan, and go over Crisis Survival Skills.  If you are someone who has SI, and/or ends up in the hospital when there is a crisis, keep this information with you whenever you can.  Remind yourself over and over again what your plan is and what skills you are going to practice…and they will become automatic.  Honestly, if going into crisis has become a `way of life’ or even `coping mechanism’ for you, this will be really scary at first.  But it doesn’t stay that way.  I promise.  I did it.

So take care of yourself, and do get help if you need it.  If you are in dbt with a dbt therapist, you should be able to call for coaching.  But try the skills on your own first, and in time you will learn that you can do it on your own.

SI may not go away.  Knives still scare me.  But my thoughts related to them don’t scare me as much as they did.  In turn, I have fewer of those scary thoughts.

Oh no, am I becoming positive?  I’m kidding in a way, but I feel like all my posts end on an encouraging note – and I’m not an `encouraging note’ kind of girl.  So, ummmmm, “your mother smells of elderberries”.  Wait.  That sounds wrong.  Okay, time to watch Monty Python and the Holy Grail AGAIN.  Coz as much as I LOVE dbt, Monty Python actually IS the holy grail to me.  Fortunately, I can have both.

Damnit.  Again with the positive endings! *shaking fist in the air*.

Later!

PS:  I’m writing these posts before I go to bed and I’m usually too tired to check them.  So I apologize for all the commas and other crimes of grammar and spelling.

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Change and Acceptance

This is one of the dialectics in Diabolical Behavioral Therapy: change and acceptance.  I’m tempted to write ‘change vs. acceptance’ because there’s so much tension between them at first glance…but both are needed to do dbt successfully.

Some people need to be more change-focused, and others more acceptance-focused.  But both are needed.  As Marsha says, (and I’m loosely paraphrasing here), “you are okay as you are, And your life might be more fulfilling if you made some changes”.  A lot of people have trouble holding that both of those things are true.  And yet I think both things would hold true for almost anyone – whether or not they identify as having a mental illness or not.

I am definitely on the `needing more acceptance’ side.  I am so self-critical it’s hard for me to do anything `good’ for myself, including practicing the dbt skills.  I’m also really critical of other people (although they’re `better’ than I am, because at least they seem to be more functional than me).  I’m really judgmental, again, of myself and others.  When I practice `mindfulness of judgmental thoughts’, nearly every single thought is self-critical/judgmental.  I remember our homework one week in dbt class was to catch a few judgmental thoughts a day.  Damn, are you kidding?  I did 10 minutes at a time.  And I know, `don’t judge your judging’ is a dbt motto…and it is very, very hard to do.  I tried laughing at my ‘judging-judging’, but that just felt fake.  My homework now is to actually sing my `judging-judging’ thoughts. “I’m such an asshole for being so judgmental, what an arrogant bitch” I sing like I’m in a punk band, an opera….to the tune of Old Macdonald had a farm.  Loud and soft, squeaky-voiced and pretty, this exercise does actually take the power out of the words.  They’re just words.  Blah, blah, blah, blah….  I may as well be singing about taking out the trash.  I really, really don’t like this exercise…but I can see its use.  And I’ve committed to this whole process, so I will sing some judgments this week.  In the privacy of my own home.  Under the covers. Embarrassed.  Come on now, try it too.  I know you want to! ; )

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FAST skills, Self-respect and other people

I moved into a new home recently, with a pretty nice roommate, who’s just….I don’t know.  Ugh.  Well, you can decide after you read this.

She has an old, old bike sitting underneath the house, just lying on its side in a puddle.  The seat is torn, and a bunch of components have been taken off it to be used on other bikes.  It has no seat post, no fenders, blah blah.  Having said that, it’s a pretty cute ‘beater bike’.  Since I’m a sucker for all things ‘pretty cute’, especially a beaten up old bike that still manages to fall into that category, I have a little crush on the bike.

I asked my roommie about the bike, and she basically said she didn’t know what she was going to do with it.  She bought it for $75 five years ago, and it was in perfect condition when she bought it, but maybe she’d fix it up for guests.  Well, I know her well enough that she doesn’t have time to fix it up.  And she wouldn’t want to spend the money on buying new components.  She suggested we barter for ‘dog walks’.

We’d had an interraction before during which we `bartered’ for an old jacket of hers.  I felt pretty crappy after the exchange, feeling that the dog walks I was doing were worth way more than her jacket…but I thought it was a one-time-thang, so `whatever’.  But I didn’t want to feel like crap again!  Even though I’m not working, I want my time to  be respected, and valued.  I hate dealing with money stuff, but really want to start standing up for myself, so I decided I was just going to be up front with her about needing my time to be worth something.  If I am going to walk her dog, I want to barter what a dog-walker would charge.  That’s about $15 per walk.  And her bike was worth…ummmm…well, really, not much.  $30 max.  MAX.

After 3 days of waiting for the `right time’ to talk, and realizing it would never come, I just asked if I could talk to her.  I told her that I wanted her to value my time – and that to barter for the equivalent of $4 a walk just felt horrible to me.  When we started `negotiations’, she asked for 8 walks for the bike.  That would have been $3-something per walk.  I just kept repeating that I needed it to work out to more than that.  So, she said 5 walks.  What the hell????  Repeat again that dog-walkers make at least $15 per hour, and I want to make close to that.  In fact, I said, I would rather walk the dog as a favour and receive a `thank you’, than be told my time and commitment is worth so little in her eyes.  I said I would do 3 walks for the bike.  She said that I was too expensive for her, that she would rather that I buy the bike and walk the dog as a favor.  I smiled, said that was fine, and went to my room.

I wanted to throw up.  And cry.  Wow, I was insulted and pissed off.

And I was also really, really proud of myself for not giving in and using the FAST skills to stand up for myself, over and over again.  It was really scary!

Even though the `transaction’ didn’t work out the way I had hoped it would, the most important thing to me going into it had been my self-respect.  Granted, she hadn’t shown that she had respect for me – but I had.  And I once again had to accept that I can’t control what I get back from other people.  I obviously didn’t like what I got back.  But there’s nothing I can do about it.

It’s such a relief to be able to (occasionally) just accept that things often aren’t fair.  ‘Life’ doesn’t have a moral code, shit happens, and being self-righteous about things just makes me miserable. A couple of years ago I would have been angry for days, weeks…about this, trying to figure out a way to make things `right’.  But for some reason I’m pretty okay with what happened.

Follow up: A couple of days after the `bike thang’, my roommie left a bag of clothes by the door for donation to Goodwill.  She left a note saying I could go through and take whatever I wanted.  There wasn’t much that I wanted, but there’s a clothing exchange happening this weekend, so I just took most of the clothes.  I gave her a ‘heads up’ about this later, and she all of a sudden wanted the clothes back so that she could somehow exchange them for other clothes.  I laughed so hard (inwardly). Really???  You’re gonna give the clothes to Goodwill, but not to me?  Reealllly?  Lol.

My god, humans are so weird!!!  I used to think I was the weird one, and everyone else was `normal’.  But the more I use the interpersonal skills really well, the more I think `normal’ is a myth.  And even if I am weird, maybe that’s not such a bad thing.  At least in this case, I’d honestly be my kinda weird than my roommate’s so-called `normal’.

But I still have to walk the dog.  As a favor.  Hey, at least she said ‘thank you!’. 😉

Off to get some poop bags!

G’night.

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