Mindfulness of Current Emotion and the Gym

I have really bad generalized anxiety and panic attacks.  I’m just generally on `hyperarousal’ mode most of the time, but there are some things that are almost certain to bring on a panic attack.  Of course, knowing that, I have anticipatory anxiety too.  Suhweet! ; )  One of the places that’s worst for me is the gym.  First of all, the gym is just not where I want to be.  Secondly, I’m super-sensitive to what’s going on in my body, so the physiological changes exercise bring on are fodder for my freaking out.

Tonight I went to a Nia class at the gym.  Part of me wanted to get some `exposure’ to panic, so I knew I’d have to do some major `mindfulness of current emotion’ (among other things) to get through the class.  Thankfully, the music was great, so I was able to Distract myself a bit – but still I had a lot, A Lot of anxiety.  I moved at my own pace, and tried to stay really conscious of staying generally mindful and in-the-moment, but particularly tried to be aware of physical sensations related to anxiety/panic.  I did about 10 seconds of Distract with the music, and then 10 seconds of just noticing my discomfort and trying to be a little bit curious or even friendly with it.  Not fun.  But, really Effective.  The stomach-rolling-butterflies-throat-constriction-legs-trembling feeling really mellowed out when I just kept looking at it, Non-Judgmentally.  I don’t know if I could have kept that up for more than a short period of time, so it was great that there was a distraction there.  So, no full-blown panic attacks.

I did avoid a bit by leaving the class a few times.  I actually was pretty sure that I was leaving for legitimate reasons, but looking back on it, I was so desperate to leave the room and my discomfort that I was probably finding reasons.

Still, it was some Mastery.  I’m thinking about going back to the gym right now, and really feel like crying.  If I wasn’t so exhausted, I could use more skills – but really, sleep is probably a better option.

What’s interesting, is that in writing this blog I’ve noticed that so many things we do actually fit into a dbt `skill-box’.  Sleep is a PLEASE skill.  If we fill out our diary cards regularly and honestly, we may find that we’re actually pretty damn skillful – without even trying.  Which is encouraging.  And *ahem*, Encouragement is a skill.  How ’bout that!

My `anxious tummy and I wish you a G’night.

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My different DBT programs

Just as an overview: DBT intensive programs are set up so that clients attend 3 hours of `skills training’ per week, and have a one hour individual session with a DBT-trained therapist.  It’s pretty rigid, and it’s really important to show up.  Not just show up, but be ready and willing to do the work.  Trust me, there will be times you’ll have to search for a kernel of Willingness while you’re brain screams at you alll the reasons you don’t want to go.  “The program sucks, my therapist sucks, mindfulness sucks, I’m not getting better, this is too hard, blah blah blah blah blah”.  It’s just your brain doing what it does, aaand you can ignore it.  I ended up naming this `yelling, bitchy, negative, self-critical thought-machine’ Amy, after Amy Winehouse.  The part of me that found the kernel of Willingness, and Wise Mind in all of this, I called Charlie.  Charles was a professor of mine at University who adored me, and whom I loved unconditionally.  But I wanted a gender-neutral name, so I chose Charlie.  Geeez, how did I get there?  Well, ya know, whatever works. ; )  The bottom line is: if you don’t go to therapy, you can’t get better.  Sucks, I know.  I’d rather take a pill too.

The first time I tried DBT I could only go to the group.  Insurance paid for the group, but not the individual session.  So, I wasn’t doing an `intensive DBT’ program at all.  The therapists who lead the skills group were really lax about how we acted in group, and how engaged we were, which lead to people just saying whatever the hell they wanted, whenever they wanted.  It was chaos.  Negative chaos.  Group is for learning skills, not for bitching.  But most of the time people just bitched.  It was so weird, because I knew that the therapists were actually good one-on-one.  They just didn’t know how to lead groups.  The worst part about all this is that most people ended up leaving the group having given up on DBT.  The truth is that it wasn’t DBT that didn’t work – it was this particular group. Sad.

A year later I went to a group run by a couple of interns.  Once again, I just went to group.  I paid a sliding scale fee for the group, but couldn’t afford the individual therapy. Wow, the difference between this group and the last was immediate and amazing.

First of all, the clients were really engaged.  We had been told that if we didn’t participate we’d have to `problem solve’ with the therapists until we did.  If we were late, we had to `problem solve’ also.  Basically, we had made a commitment to the therapists and to ourselves that we would be fully involved with the group.  If we showed that we weren’t honoring our commitment, why not?  Holding us accountable when we did things that were counter-productive was so, so important.

Also, for some reason, the people were `vital’.  We were really alive, and excited, and were trying so, so hard.  We were rooting for each other to practice the skills and do well.  There were people with various diagnoses in the group – and still it felt really cohesive.

One of the agreements you are asked to make when you join a dbt group is that you won’t form outside relationships with other members.  We changed that to `won’t form relationships that we can’t talk about in group’.  In other words, we were careful not to form relationships that might put our engagement with the group in jeopardy. No flirting, sex, forming cliques etc.  A couple of us became friends and `skill buddies’.  We’d go on walks and keep each other updated about how our skill practice and homework was going.  Having friendship in this group was really helpful – but the only reason it worked was because we were all very careful.  Certain topics were off-bounds.  No talk of self-harm, suicidal ideation, or anything we thought might trigger the other person.  If we asked for advice, we had to take it.  We couldn’t say, `yes, but…’.  Anything about self-harm or Suicidal Ideation went straight to the therapists.  Immediately.  The therapists were available, and wanted to help.  For the first few months we were all so dysregulated, most of the therapist calls were about holding our hands through using the TIPS skills.  I spent quite a few phone calls with my head dunked in ice water to get the `dive reflex’ simulated.  Held my breath under ice-cold water for 30 seconds, cried into the phone for 10, repeat, and again.  This became my go-to TIPS skill.  Not every skill will work for everyone.

I stayed in the group for about 9 months, and really was noticing some changes.  Unfortunately, I had to move.  Fortunately, the place I moved to had an intensive DBT program that I qualified for.  Yaaay!

Finally I was in a program that provided me with both a skills group And individual therapy.  Again, this group was run really tightly.  If you didn’t show up more than a couple of times you were out.  If you were late, why?  I didn’t `gel’ with the people as much, and didn’t become friends with any – but man, did we work the skills!  Well, I should say, “maan, did some of us work the skills”.  Some people were just too dysregulated to stick with the program.  Others had logistical problems.  One was wasted.  Everyone was encouraged and given multiple chances, as long as they didn’t do anything that triggered other group members.  I think about one third left pretty quickly.

I was lucky to have had DBT previously, and to have had experience with zen meditation.  I came into the program knowing that it *could* work.  Many times I wanted to quit.  Or maybe “Amy” wanted to quit.; )  But, I felt like this was my last chance – and actually, a gift.  Thankfully, the therapists stuck with me during my pissiness, anger, self-hatred and self-defeating urges.  I’m sure I wasn’t the most pleasant person to be around.  I’m not a religious person at all….but as many times have I wanted to quit the program, I thanked ‘something’ for giving me the opportunity to participate in it.

Some people call DBT `diabolical behavioral therapy’.  You love it, you hate it.  You love to hate it, and hate to love it.  Part of you wants to leave, but somehow you stay.  The skills might feel weird, and `fake’.  It’s not exciting enough.  It might be the healthiest thing you’ve ever done for yourself, which in itself can feel completely foreign and uncomfortable.  You’ll want to stir shit up.  You’ll get stirred up.  Finally, if you stick with it, your `wise mind’ will kick in, and you’ll just work.  I hope.

To everyone just now starting a program, I hope you always remember why you started it, and keep on going toward whatever goal you and your therapist set for yourself.  A lot of the time your emotions will be so ‘loud’ you won’t be able to see that you’re actually moving toward that goal, but your therapist will.  S/he will drag you back on the path if you fall off.  But you have to be Willing.  Just a little bit.

I’d love to hear from you!  Please leave comments about what aspects of dbt you’d like me to write about, K?  I may be invisible, but I’m rooting for you!


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Radical Acceptance: the bad, the ugly…


Once upon a time….

I was in a `partial-hospitalization’ program at UCSF, after having admitted myself for extreme anxiety, panic, and insomnia.  I was in the program because I was `too good’ for county services, and had nowhere else to go.

I hated, hated Mark, the therapist assigned to me.  He was the worst version of New York, brash in-your-face obnoxiousness.  He insulted me, telling me during group that he was wasting his time with us.  He was generally disgusted with us.  And I was disgusted with myself…and everyone else.  I was especially disgusted with my family, who really only paid attention to me when I was in a crisis/in the hospital.  During group, I told Mark I was going to send my brother an email telling him what an ass he was for ignoring me until I was practically flinging myself off a bridge.

What do you want? What do you want?  Mark kept yelling at me.

“I want him to love me.  I want him to show that he loves me”, I yelled back.

“Well, do you think sending him an email telling him that he’s an ass will make him show you any more love?”

Oooohhhh, lightbulb moment, and first real `dbt moment’.  Holy crap!  I was the one creating the drama???  Reallllly?????

I had, until this point, felt like I didn’t have control over letting my emotions, feelings and thoughts just pour out of me.  In fact, because I studied philosophy, I was encouraged to just `let it all out’.  I got A’s for doing just that.

But my personal life was a mess.  Everyone left.  And honestly, this isn’t a ‘yay, dbt made my entire life great blog’.  My family still doesn’t talk to me.  But at least I send emails saying that I love them and wish we could have a relationship.  I don’t, unfortunately, have control over their responses.  I feel everything from rage to abandonment about the situation – but I don’t say it.  The one time per year that we speak I concentrate on showing them that I am gentle and kind.  I try to sound upbeat even if I’m feeling like crap.  Does it feel fake?  Yes.  And that’s what it will feel…until I do it enough times that it doesn’t feel fake anymore.  I’m still me – but I am a me who is doing what is effective vs. letting my emotions rule and ruin my life.

As far as not having a relationship with my family goes, I go from wallowing in self-pity to practicing Radical Acceptance.  Things are as they are.  And I’m Radically Accepting that some things are awful.  And I need to Radically Accept that some things are actually okay.  Even good.  And I need to Radically Accept that sometimes it is actually harder to acknowledge the good things than the bad…because I’m not used to it, and it is new and scary to have anything but blips of contentment, joy, peace, gratitude….

Radical Acceptance includes acceptance of what is good.  I keep forgetting that.  Hopefully now that I’ve written it down, I’ll remember.  Maybe you’ll remind me.



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Thinking and mold

Hi there. So, it’s taken me a few days to actually get started because WordPress apparently doesn’t like Firefox, and I don’t understand computers.

Al right. So, last thursday.

Last thursday I went to pick up my car, that had been sitting unused in an outside lot for a few months. During that time the window had been broken and replaced, and the car had (supposedly) been cleaned up. Everything *should* have been fine. Ha! Well, I have no idea what happened to the car exactly, and have no way of finding out. All I know is that when I got into the car it stank of wet-clothes-left-in-a-bag-for-too-long, and literally had hundreds and hundreds of tufts of bile-colored mold over all the fabric surfaces. The seats, of course, were covered, as was the floor. Even the seatbelts had become biology experiments. I felt angry, but a bit numb, as the parking lot owner said “yes, he had seen the mold”, and offered nothing else. What to do? I didn’t know what to do, but was feeling so dysregulated that getting my SUDS down seemed like the most important thing to do. If I wanted to use other skills later, to try to get money back, or an apology…well, I could do that later.

First I needed to do ‘mindfulness of current emotion’. I was panicking, pissed off, and feeling victimized. My SUDS were around 70, so I did some deep breathing exercises. In for 4, hold for 8, out for 10. 5 times. What was I feeling then? My eyes were stinging from being teary, my stomach had a heavy log in it that was rolling, rolling. My arms and legs were tingling, my throat felt constricted, and my face felt numb. Okay, time to look outside myself and get grounded in reality. Sight: Blue car, red car, tow truck, cement, gravel, rock. Describe rock: Dark grey with light grey lines. Smooth. Cold. What do I hear? Rumbling, honking, barking. What do I feel? Wetness of raindrops, constriction of jeans around belly, cold and hard where my body connects with the ground. Smelling coffee.

Okay, that took 30 seconds. Now how am I feeling? Stomach is still rolling, but I feel `present’. I feel generally okay.

What am I going to do? I could go and talk to the guy who owns the lot. He’s drinking beer and smoking. What do I want from him? Well, an apology would be nice, and money to get the car cleaned would be nicer. Do I think I’ll get either? Of course, I don’t know unless I try. I have no control over what he’ll do. However, I really don’t want to try to reason with someone who’s been drinking. Maybe I’ll do it another time. Right now, I’m gonna get back in my car and leave. This takes some Radical Acceptance, because I am pretty hung up on wanting things to be `fair’. It’s helpful for me to remember that things often aren’t fair. If I can’t make this situation turn out in a way that seems `fair’ (to me), then I need to accept it. So, Radical Acceptance is next in line. How to practice Radical Acceptance when I’m driving? For me, practicing Willing Hands is the quickest way for my brain and body to `get’ that I need to `accept things as they are’. I don’t have to like them. And I don’t. I think the situation sucks, And at the same time I need to accept it. So, while I’m driving I visualize Willing Hands. It might sound weird, but it works for me.

In the next hour, I find out that the blinkers and headlights no longer work. I’m on a bridge, and notice the thought, “)(*Y% this! I’m going to drive off this (*#$^-ing bridge”….followed quickly by, “Oh, that’s just a thought. I don’t have to believe it.” I’m both frustrated that I still have thoughts of self-injury, And I am grateful that I can just notice them.

It wasn’t a great day. But I did okay. I handled it much, much more gracefully than I would have a couple of years ago. If I had more energy, I might even be grateful for the opportunity to practice so many skills. But I’m exhausted, so I take a hot bath and get my `Self-Soothe’ on.

Wherever I go, the skills follow. I don’t really trust it yet…but maybe if I keep writing the blog, I’ll be able to check-the-facts and start having some confidence!

PS: I don’t have time to edit the entry, so I apologize for all the inconsistent grammar, and the rambling. Please let me know if you get something out of it at all. Thanks!

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