The beach

Warm sand that sinks with each step

Squinting in the sun

Smiling in the sun

Wind blowing my hair over my shoulders

Stray hairs across my face

Walking forward against the force of the wind

Sand gradually feels cooler, wetter, denser

A surprise wave laps my toes

Cool clear water

Step forward, cool up to my calves

Little butterfly shells

In purple and orange pastels

Disappear and reappear

As the wave ebbs and flows

White foam comes and disappears

Woosh in, wishh out

Stretching out

To the horizon

We’re here on the edge

Of an immense ocean

And I get to feel the water

And the wind

Using a safety behavior is like cheating on a test

I had an interesting dream last night that made me realize some things.

In the dream, my little sister was caught cheating on a test. Before taking the test, she had to fill out a form with her name, education level, employment, etc. (remember this was a dream, so it was a little weird). She made up a person, Avery Perkins, MD–an older, more educated woman–in order to seem smarter and get a better grade.

She took the test under this persona and got a B+. She had been hoping for an A+, but it was still better than the B- she got last time.

Now, her teacher had looked up this Dr. Avery Perkins my sister claimed to be and found that no doctor existed with that name. She knew that my sister had made up a fake person.

The teacher (who reminded me of my therapist) came over to my sister and told her that Dr. Avery Perkins doesn’t exist. She told my sister she was cheating. She looked at my sister with a serious, sad expression, and asked, “Do you understand why we don’t want you doing this?”

My sister said no, and the teacher continued, “If you cheat on a test or impersonate someone else and get a good grade, you assume that the good grade came because you cheated. You think that in order to get a good grade, you must pretend you are someone else. Getting a good grade when you cheat positively reinforces cheating. So you cheat more.

“The problem with this is that you never learn what happens when you don’t cheat. You don’t learn that you would have gotten the same grade if you had written your own name on the test. You don’t learn that you can take a test and be successful without anyone’s help. You don’t learn that you can do it.

“Cheating is a safety behavior. You use it as a crutch to get through the test. You rely on it. What are you avoiding? What are you afraid of?”

My sister said she didn’t know.

The teacher offered, “Are you afraid of failing? Are you afraid of disappointing your parents? Are you afraid of not being as good as you thought you were?”

My sister again said she didn’t know.

The teacher said, in a manner much like my therapist, “Well, I don’t have all day. I have other students to take care of. I want you to think about this and what cheating is doing for you.

“You’ll only learn that you can do it without cheating when you try it and see what happens. Maybe some things you thought would happen aren’t very likely to happen, or, when other things do happen, they’re not as bad as you thought.”

And she walked away and left me with my sister.

I like this dream because, as good dreams do, my subconscious uses metaphors to explain things to my consciousness. If I only try to face scary situations as Dr. Avery Perkins, using my safety behaviors, how will I ever know that I can face them?

My therapist has been talking to me a lot about exposure to the things I am afraid of and avoid. I’ve been noticing what my safety behaviors are when I do things that scare me.

A safety behavior is something that distances you from something you think would be too scary to face without it. Safety behaviors include avoiding something entirely (e.g. not going to a party out of fear of judgement), escaping from it when you’re confronted with it (e.g. leaving a party early), and avoiding in subtler ways (e.g. attending the party but not talking to anyone because you’re on your phone all the time).

I have a lot of safety behaviors. I carry around survival gear with me. I use google maps even when I know where I’m going. When I’m in the car, I physically brace myself for impact. I announce, “bump,” out loud before we drive over a bump. (I was in a bad car accident.) These are just a few. More obvious behaviors are that I never learned to drive on the highway, and I avoid going on trips with my family (I try to say no or get out of them).

I’ve been trying out mini exposures recently. I wiped up some blood (which was a big deal for me!), but I noticed that when I did it, I was sure to have lots of napkin in between me and the blood, and I washed my hands right away. So, to continue the exposure, next time I would try to do it without those safety behaviors.

I also told a couple friends that I was in a bad car accident, something I definitely avoid talking about. My safety behavior in that situation was that I laughed through the whole thing. I couldn’t keep a straight face, even though I was talking about something serious. I wasn’t fully experiencing the emotions that talking about it brought up. I was also very jumpy and tried to end the conversation as soon as I started it. I’m not sure how much control I have over the laughter, but maybe next time I’ll be more serious.

I’ve also been doing exposures to vulnerability with my parents. I try to share something vulnerable that I would normally avoid, like how I’m really doing. My biggest safety behavior there is avoiding eye contact at all costs. I also avoid eye contact when I’m telling my therapist something I’m uncomfortable with, and she has to remind me, “I’m over here, look over here at me,” and “If you don’t see my face, you won’t know that I’m not judging you or thinking you’re weird.”

My dream made me realize more deeply what I already knew logically, that I have to try the things I’m scared of without my safety behaviors, just as I am and no one else, in order to learn that they are safe and I can do it on my own.

DBT Skills Summary

Here is my summary of DBT skills in mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance!

There’s lots of DBT stuff on this website if you want more! http://www.dbtselfhelp.com

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More on DBT skills:

• Examples of DEARMANs: Asking for what you need
• The Emotions and Opposite Action
• How to be non-judgmental (towards yourself)
• Nightmare Plan (and ice dives)

And other coping skills:

• Coping with justified sadness and grief
• Using Coordinated Movement for Dissociation 
• What to do when things aren’t working
• Alternatives to “Everyone hates me!”
• Getting stuff done when anxious and depressed 

Nightmare Plan (and ice dives)

I have a lot of nightmares and have a hard time getting out of the fear and/or dissociation when I wake up. It is hard to either fall back asleep or to get up and get on with my day. So, this is the plan I came up with after some suggestions from my therapist.

My plan has suggestions of things to try that will probably actually help me. It also has pictures of me doing them, so that it’s easier to figure out how to do them when my brain is slow.

It says:

Nightmare Plan:

• Ice dive
• Drink water
• Play catch
• STUN wave (Sensations, Thoughts, Urges, Name the emotion)
• Listen to music
• Paced breathing (in-2-3-4, hold-2-3-4, out-2-3-4, hold-2-3-4)
• Go for a walk (go to the bathroom, go outside, pace in room, stretch/yoga/ballet)
• Self-validation
• Ground in present (5-4-3-2-1 senses, colors of the rainbow)

Self-validation:

• “All emotions are valid.”
• “It makes sense that I am feeling this way, given my life experiences.”
• “It’s okay to feel strong emotions.”
• “Something scary happened to me, and it makes sense that being reminded of that would be scary, too.”
• “I am feeling ___.” (scared, sad, angry, happy, loving, shameful, guilty, envious, jealous, disgusted)
• “I had a nightmare.”
• “It was intense and very scary.”
• “And, in this moment, I am safe.”

I tried this last night, and the ice dive followed by paced breathing and listening to music or calming sounds seemed to help. Identifying that I was feeling fear also helped.

An ice dive, if you haven’t heard of it, is a way of getting your heart rate to slow down (and therefore making your anxiety come down a bit) pretty quickly by making your face very cold. It’s a way of hacking your evolutionary reflexes. Your body thinks you just fell into an icy river, so it brings down your heart rate.

You can simulate diving into an icy river by sticking your face in a bowl of ice water for 10-20 seconds a few times. Making a bowl of ice water is too much effort and thinking for me when I’m coming out of a nightmare, so I do the ice dive differently.

I keep instant ice packs near my bed and just crack one and hold it over my eyes while lying in bed. It calms me down fairly quickly. A slowed heart rate also helps me to fall asleep! I also keep ice packs with me during the day and try to use them when I am having a flashback, anxiety attack, or am just feeling intense fear and having a hard time calming down.

Ice dives are a part of the “Temperature” component of the TIPP DBT skill. TIPP stands for Temperature, Intense Exercise, Paced breathing, and Progressive muscle relaxation. It’s a Distress Tolerance skill and is intended to change your body chemistry when you are super overwhelmed. I think it’s really cool how well it works. 🙂

More info about ice dives! description of ice dives; description of TIPP skills, including ice dives

This Nightmare Plan is taped to my wall near my pillow so that I can see it while lying in bed.

Yay for things that work!

Things I’ve learned about myself

I’ve done three weeks of my treatment program now. I have at least one more week in the program, maybe more, depending on what I decide to do. I have learned a lot of new skills and ways of behaving, but I have also learned a lot about myself!

I have learned:

• Dissociation: I dissociate a lot. I know I am beginning to dissociate when I lose track of what is going on, ask “what?”, feel like my legs are disappearing, feel confused, have trouble moving, and have trouble focusing my eyes on things.
• Minimizing: I minimize my problems a lot. I say, “Eh, I’m just having a bad day, but it’s okay,” when really I am experiencing intense fear, shame, sadness, and anger and have very strong urges to engage in my target behaviors (self harm, suicidal ideation, etc.). This interferes with asking for help because I think my problems are “not bad enough” to deserve help. But they are.
• Self-validation: It is hard for me to validate myself. I tell myself that I “shouldn’t” be feeling emotions, and I try to block them out. It is hard to be understanding and kind to myself and to acknowledge that there are very valid reasons I feel the way I do. I may be overreacting to a situation, but I am overreacting for reasons that make sense, given my life.
  • Before my therapist left for her vacation, I told her to be safe on her trip and that I was scared that she was going to die. It was hard to say that, and especially hard to say it without prefacing it with, “This is weird, but…” After some talking, I was eventually able to validate myself by saying, “It makes sense that I am scared of this because it has happened before.” My family and I nearly died on a trip once. That doesn’t at all mean that my therapist is going to die when she goes on this trip, but it is valid for me to feel that way.
  • All emotions are valid! The specific emotion, intensity, and duration may not fit the situation, but it is still valid to feel that way.
  • Maybe I look to therapists, friends, and the internet for validation so often because it is hard for me to give myself validation, yet I still need it.
  • Purposefully reminding myself of my trauma (looking at my scars, going through old papers, finding triggering things), even though it upsets me, also serves the function of validating that something bad did happen to me and that it was real.
• Judgements: I judge my feelings and thoughts a lot. Now that I think about it, this could be the reason I minimize and invalidate myself. I say out loud or in my head, “This is stupid,” “This is weird,” “I’m so weird,” “Shut up,” “It doesn’t matter,” “It’s nothing,” “It’s weird; don’t say it,” etc. I am working on being more nonjudgemental and only stating the facts, not my judgements of them. For example, “I notice that I am feeling scared. I notice that I am having an urge to run away. I notice that I feel my heart pounding.”
• Abnormal behavior: I am learning what is normal and not normal behavior for a teenager.
  • Making plans to run away from home is not normal.
  • Staying up to 1 am and sleeping in to 9, or 11 or 12, is normal for a teenager.
  • Staying in bed or in my room for five hours after a nightmare is not normal.
  • Being afraid of going to sleep and as a result doing everything I can to put off going to sleep for hours is not normal.
  • Having feelings of wanting to die every day is not normal.
  • Having panic attacks every day is not normal.
• Avoidance: I avoid a lot of reminders of my trauma, and I have many methods of avoiding them. I have a list of triggers with over 50 items. I avoid looking at said list. I refuse to share it with my current therapist. I don’t look at pictures we have in our house that remind me of the trauma. I tune out of conversations that only indirectly remind me of it. I limit the places I go. I barely watch movies or read books because I’ve been upset so many times by them. I limit the classes I take in school to avoid topics where memories might be brought up. I clamp down on thoughts of the trauma, when I have them, and I very, very rarely talk about what actually happened (even just the basics).
  • I also avoid thinking about how I am feeling. In DBT, I have to fill out a “diary card” every day with my symptoms, emotions, target behaviors, etc. When I show it to my therapist, I flip it over, push it to the side, and try not to talk about it. It is hard for me to think back and explain what was happening when x on my diary card occurred because I bury it so deep.
  • This isn’t something I’ve learned about myself but something I’ve learned in general. Avoidance is okay in the short term but a problem in the long term. Avoidance is okay when it prevents me from engaging in target behaviors. In exposure, I will gradually stop avoiding, but it will be done in safe ways. 
• Relationships: I am scared of pushing people away and losing relationships. I genuinely don’t understand why certain people don’t hate me by now.
  • I had several close friendships end abruptly in my childhood. This could be why I feel like this.
• Self-hatred: I have feelings of self-hatred and worthlessness, and think I don’t deserve kindness, compliments, or good friends.
• Wanting to be a therapist: It is common for people who struggle with mental health issues to want to study psychology and become therapists. I am not weird for secretly wanting to be a therapist or to take psychology courses, even though I’m currently studying a totally different field. It’s okay for my interests to change.
• Diagnoses: I don’t actually know what diagnoses I have, and I’m not sure if I want to ask. I know for sure that I have Post-Traumatic Stress Disorder and that I have had (but maybe don’t at the moment? not sure) Major Depressive Disorder. Other illnesses I think I have or have had at some point (but I could very well be wrong because I am definitely not qualified to diagnose myself) are Social Anxiety Disorder, Obsessive Compulsive Disorder, Hypochondria (health anxiety), Generalized Anxiety Disorder, Seasonal Affective Disorder, Pre-Mentrual Dysphoric Disorder, Borderline Personality Disorder, and Panic Disorder.

I am learning so much! It makes me sad to realize how badly I’m actually doing, but I think that that’s necessary in order to actually address my problems and recover.

What is something you know about yourself?

(here is Things I’ve learned about myself, part 2)

Exposure Therapy!

Today I made the decision to do exposure therapy for my PTSD!

Prolonged Exposure (PE) is offered as an optional part of the DBT treatment program I’m doing (so it’s DBT-PE if you want to be technical). My prior-to-DBT therapist and my DBT therapist have both been talking to me about doing exposure or processing through my trauma in some way for a while. I’ve been very hesitant to try it because it sounds so scary to expose myself to the things I fear most.

There’s a part of me that really wants to do the exposure therapy so that I can finally get over the trauma and leave it behind me. This part of me, my wise mind, knows it will be good to process it through. It knows that the symptoms are taking a toll on my life.

There’s another part of me, my emotion mind, that has an intense gut reaction of “NO!” to the idea of exposure. Exposure sounds terrifying. It sounds dangerous.

Wise mind — a DBT concept

My wise mind argues back that a memory isn’t dangerous. I will not be put in any objectively dangerous situations as part of the exposure. And my reluctance to do the exposure is another form of avoidance, part of what exposure is trying to solve (so meta!).

Still, my emotion mind is strong. I have a lot of fear.

My DBT therapist had me do a pros and cons of continuing to avoid the trauma versus doing the exposure for it. Even after doing the pros and cons and seeing how much of my life I could get back by doing this, I wasn’t sure.

After showing my completed pros and cons chart, discussing it, and getting some more info about DBT-PE, I left therapy feeling kind of sad and hopeless. A lot of hope had been riding on this treatment program and especially the PTSD treatment (the prolonged exposure). I was really hoping this would “cure” me, if not fully, then at least a good amount. I started feeling more depressed than I had been before. I didn’t want to do anything. I saw no future for myself.

I kept thinking about it, and a few hours later, I sat down and wrote my decision below my pros and cons list.

Decision: Do exposure stuff.

Because…

• I’m sick of this!
• It’s been too long
• I could feel better
• It’s worked for other people
• I could be more of myself
• If I don’t, I’ll probably keep being like this, and that makes me sad.
• I can use skills, so it won’t be THAT that bad.
• My therapist can help me. I won’t be doing this alone.
• Wise mind me wants to do this!
• I am doing this because it is safe to do, and I want to feel better, not because I’m being forced into it by anyone. This is my decision.
• Memories aren’t actually dangerous!
• I can always decide not to do something later. I am in control of the exposures and the pace, and I can always say no.

Exposure therapy sounds like the obvious choice when I write it out like this. But I’m writing this from wise mind. It was really hard to think about this and to even consider exposure when I was in emotion mind. And I kept getting drawn into emotion mind every time I tried to think about this.

I don’t know exactly what made me switch into wise mind and finally be able to consider this rationally. Maybe the organized pros and cons list helped. Maybe all the handouts and diagrams and evidence helped make it more empirical. Maybe I needed enough time to think about it. Maybe seeing how sad I felt when I thought about deciding to not do it showed me how essential this treatment is for me right now.

This was a really hard decision, but I feel so much more hopeful now that I’ve made it.

(More info on DBT-PE: https://dbtpe.org/treatment-overview/)

What do you think of choosing to avoid something vs. expose yourself to it?

Random good things

These are some things on the internet I go to when I’m looking for a little pick-me-up.

• Bright drawings of animals with encouraging things: http://thelatestkate.tumblr.com
• Cute gifs of a kitten and a witch saying nice things: http://kittenwitchandthebadvibes.tumblr.com
• Pictures of manatees saying reassuring things: https://calmingmanatee.tumblr.com/tagged/calming-manatee
• Expressive watercolor artwork and nice words, some DBT stuff: https://www.instagram.com/sydneiiii/?hl=en
• A good, long list of grounding techniques: https://www.getselfhelp.co.uk/flashbacks.htm
• The song “I won’t say I’m in love” from Hercules, played on the piano (relaxing): https://www.youtube.com/watch?v=fDmW_CBcMDU
• Parody of Taylor Swift’s song “Blank Space” but with moms (funny, cute): https://www.youtube.com/watch?v=6FrBS2pPcak
• Mouse over the circles to reveal a picture of a koala (satisfying): http://www.koalastothemax.com
• “Every Romantic Movie” — funny, punny, sweet, like watching a full romantic movie but in 6 minutes: https://www.youtube.com/watch?v=-mGeRC6k5Fc
• Playlist of jokes by youtube channel Vlogbrothers (punny): https://www.youtube.com/watch?v=FFym8JwlYxY&list=PLMs_JcuNozJYOfHXHGTtHse4XYvnygc8A

Do you have any go-to’s or favorite videos or websites?

Using Coordinated Movement for Dissociation

This week I learned a new technique to use when I’m dissociating.

I started an intensive outpatient treatment program in DBT last Monday. I think DBT is awesome. 10/10 would recommend. I am learning a ton of new skills and getting answers to every question I ever had. I feel very lucky to be able to participate in this incredible program.

I have learned many new skills, but this is one that I had no idea existed beforehand and that has been really helping me. I’m not sure if this is a DBT skill or just a grounding skill, but it was my DBT therapist that explained it to me and helped me to practice it, so I am crediting the program with this.

Basically the thing is this: Our brains can’t dissociate and coordinate our movements properly at the same time. So, if someone is dissociating, or beginning to dissociate, doing some sort of coordinated movement can help to stop the dissociation and bring their mind back to the present and their surroundings.

What is a “coordinated movement“? It’s something you do that requires you to focus your body on moving. My DBT therapist suggested standing on a balance board, playing catch, and dancing.

I have learned on my own over the past year that dancing can bring me out of a flashback surprisingly quickly. I have a playlist of specific songs that I dance to in order to ground myself. So, it was validating to hear that dancing requires coordination and that that’s probably why it was helping.

If I don’t have a balance board readily available (I can use one while I’m at the program, but not at home), or if it would be too hard to get access to one in the moment, I can just try to balance while standing on one leg for as long as I can. If that’s too easy, I can stand on my tippy toes, too.

Throwing something around is also great. If there’s someone else around, and they’re willing to do this with me, we can play catch. If I’m on my own, I can throw a ball against the wall or bounce it on the floor. If I’m in a group of people, I can simply toss anything from hand to hand without feeling like I’m being weird.

I am going to start carrying around a bouncy ball!

I am also learning that I dissociate a lot. I’ve known for a long time that dissociation is a symptom of PTSD, but I’ve always thought of it as “that one symptom I don’t have.” I don’t think I really understood what the word was describing.

Now I am beginning to pick up on the clues that I am starting to dissociate. I feel dizzy, all thoughts flee my mind, I zone out, I’m not really looking at anything in particular, it’s hard to remember what I was just saying, I ask “whaaat?” in my head or out loud, my muscles feel weak, my legs feel like they’re dropping out from under me and disappearing, I feel like I’m not here, I feel like things aren’t real, I have an urge to run away and hide.

Grabbing something and throwing it up and down or from one hand to the other is hard in the moment. It is hard to remember to do it, it is hard to be willing to do it and trust that it could probably help, and it is physically hard to do it because I am attempting to override the dissociation.

Standing up when I want to freeze and stay still forever because I think that if I don’t, something bad will happen, is hard. Moving any part of me, even just readjusting the position I’m sitting in, is hard because that is not what my body is wired to do.

But I am safe now. In this moment, I am safe. It is okay to move. It is okay to stay present and to experience this moment. I am having a reaction, that is all. I have gotten through this before, and I will get through it again. It’ll be okay.

Had you heard of this skill before? Have you tried it? If you dissociate, what helps you bring yourself out of that?