Sometimes I have to be intentional and deliberate with the use of DBT skills. Yesterday my day turned from ‘Improve the moment’ and self care plans, to crisis mode, and I had to go with Distress Tolerance.
After graduating from a Dialectical Behaviour Therapy (DBT) course, I find coping with life a little easier but I can become complacent with using the skills I learnt. I zealously applied them to overcoming Borderline Personality Disorder (BPD), but this form of treatment is showing such promising success in the areas of eating disorders too! My ED recovery is based in DBT.
Yesterday I was not complacent. I was aware fairly early that I was in ‘crisis mode’. My definition of crisis used to be around events or circumstances. The word crisis I would use to describe something traumatic happening, like a death or traumatic injury. My crisis is now defined around how I feel about any event. If my reaction is with turbulent emotion then I am in ‘crisis mode’. It validates my reality instead of dictating how I ‘should’ feel about something.
Something happened yesterday that was highly stressful and triggering. I can accept that I feel very strongly about this issue and dealing with it required me to 1) be aware of how I was feeling
2) apply the skills that were most appropriate
I could hear one of my therapist’s voices in my head (wise mind) linking a similar distress and it allowed me to acknowledge and accept the reality of the moment.
Distress tolerance (DT) is what I needed. DT involves skills to get through this moment, to tolerate it, without making things worse. It’s not about changing how you feel (though that can happen), it’s aim lies in making it through this initial period, doing things that will not bring harm.
It’s skill is based in wise mind ACCEPTS.
This ACCEPTS acronym stands for the distraction techniques you can draw from in ‘crisis mode’. Being in crisis mode it’s highly unlikely you can come up with ideas right then. The emotion is too high, so I recommend you personalize your own list at a time when you are sailing, or at least not in the firing zone on the battle field. Make it portable. Your phone is ideal to hold your weaponry of skills. It was the thing I turned to when I needed some ideas.
Things you can DO to distract you. I used eating the meal I had yet to start. Face booking and housework. This one is easy to use. Surely anyone can find a game app they could get lost in!! EXERCISE is my biggest go to, but I have to be careful not to overuse it.
This is something you can do that gives to something or someone else. Could be charitable or encouraging a friend, making something for someone else,… Something that you can input that has a positive affect on others. I contribute to a Facebook group, sharing experiences or hope and encouragement… so I worked on that which inevitably helped me to focus on employing my skills.
When I originally heard this one, I cringed. I’m trying to steer away from comparing myself to others… Isn’t this going against my goals? However it is more directed at comparing for sake of gratitude, perhaps seeing the silver lining. So I become grateful for what I have, where I live, and who I have in my world to share that with. I compare my ability to cope in a positive way to how I would have coped a year ago.
EMOTIONS (opposite or different ones)
When I’m really sad, a good one for this is reading Damn You Auto Correct entries I have not been able to read these without tear spitting laughter!!
Music is always good as long as it isn’t perpetuating the emotion you are feeling.
This is about pushing thoughts away to think about at a more appropriate time when you have more wise mind to draw from. I visualize putting those thoughts in a box and putting them on a shelf. Aware they are still there to deal with later and not to let that box collect dust. Just postponing for looking at when I am not highly emotional.
Replacing negative or harming thoughts with others. I pick encouraging myself. ‘I can’t do this’ with ‘You can do this, you have done it before’. ‘This will never get better’ or ‘I can’t stand this’ to ‘it does get better, I have ridden this urge out before’
Using your senses to get an intense and/or physical reaction that is not self harming.
I didn’t need to call on this one yesterday as the urges weren’t intense and after scrolling through my list and doing all the above, my distress had lessened and could move on to use other skills. One of my favorites in this category when my distress is at its highest is pushing a full sized ice pack in my face. It’s like putting your face in a bucket of ice! Induces a divers reflex and an icy pain that won’t leave a mark or have permanence. Shocks me that much that it’s impossible to think of the distress and it’s causes. Other ones I use on the less intense scale are gentle touches on the arm or tickling feathers across my skin.
It takes time, but it works. It’s frustrating that I have to clear out the day to use these, like I am not coping, but in fact this is coping. Just coping in a more skillful and positive way than alternatives I have used in the past.
The practice was worth it. The distress has lessened.