Therapy

Self harm or self care?

(Please note: This is about self harm and suicidal urges, self-destructive thoughts, and specific ways I try to harm myself (including with food).)

I’ve been struggling recently with basic self care. Anything that I know is good for me or that will help me is hard for me to do.

I used to self harm myself in one specific way. I told my DBT therapist over the summer about it, and I’ve been tracking it on my diary card and using skills like distraction, “riding the wave,” etc. to not engage in the behavior. And, I’ve been successful! I haven’t done that behavior in over three months. Yay!

But… the urges to hurt myself or kill myself haven’t gone away. I have the urges as much as I did when I was still using the behavior. Sometimes I’m successful in using distraction or some sort of positive coping mechanism to manage and resist the urge. However, if the urge is very strong, or I’ve been feeling it constantly for several hours and nothing seems to be helping, or I’m too hopeless to believe skills will work… then I bargain with myself.

I say, “Okay, fine, I won’t kill myself. But, as a compromise, I won’t eat dinner. I know that eating dinner is something that will help me and make me feel better, and that is exactly why I won’t do it.”

I’ll say to my emotion mind, “I know you have the urge to hurt yourself. You can’t do that because it’ll mean you have to stop trauma work. But you still feel intense shame and anger at yourself and want to harm yourself. So, here’s something. I know you feel tired and want to go to sleep. How about you just don’t go to sleep?” And then I stay up until 2 am and don’t get enough sleep and feel more angry and guilty the next day and even more tired.

I’m still harming myself, just in less obvious ways. Not eating enough. Not sleeping enough. Not brushing my teeth. Avoiding friends because I know they’ll make me feel better. Avoiding using skills because I know they’ll make me feel better. Not submitting applications because I’m mad at myself and don’t think I deserve it. Eating chocolate late at night because I know it’ll keep me awake, and I want to prevent myself from taking care of myself and sleeping.

It’s almost easier to self harm in these ways because it’s a smaller decision to make. It often doesn’t require action, just intentional inaction.

Writing this out is helping me realize that self harm is still an issue for me, even if it doesn’t leave visible scars. I’m losing weight, even if it’s not noticeable. I’m hungry all the time. I sometimes have an erratic sleep schedule. My teeth hurt often. My eyesight is getting worse because I refuse to look up from my phone or computer when I start to get a headache. I feel as though I need to feel the pain of the headache because I deserve it.

So, it’s not good. There are negative consequences to doing these things. My “cured” self harm has really just been transformed into different behaviors because I was replacing the behavior, not acting opposite to it.

To be fair to myself, I do sometimes just distract and not do anything harmful. I sometimes reach out to friends or my therapist. I sometimes eat meals because I know it’ll make me feel better. There are just some times that I don’t…

I think the solution is opposite action. Instead of acting on the urge to harm myself, I want to acknowledge that it’s an urge, use the self talk that my therapist and I came up with, and act opposite to the urge.

The self talk is along the lines of,

  • “This is emotion mind talking. It’s strong, but it’s emotion mind.
  • Using skills has helped in the past.
  • Sometimes skills take a while to work.
  • Skills “working” is relative.
  • Distress tolerance is supposed to help get you through the moment, not make you feel better. If you feel better, that’s an added bonus.
  • When you are feeling better, you like feeling better.
  • In the times that you’re not feeling like this, you would want to take care of yourself and help yourself feel better.”

Opposite action to the urge to hurt myself and to the emotions of shame and guilt is to be kind to myself. Some options are: putting lotion on my skin instead of hurting my skin, eating food, hanging out with friends, wearing pretty clothes, watching or reading something funny, etc.

Opposite action to self harm is self care. It’s hard to do because it’s the very thing that the self harm urges are telling me not to do. That’s where the self talk comes in. I have to believe it’ll work and have enough perspective to remember that there’s more than this moment and that self care or skills have helped in the past.

If I’m not thinking clearly enough to do the above, then distraction, calling my therapist, or other skills (if I’m willing to use them) are helpful.

In conclusion… self harm is still a problem for me, and I, Wise Mind Me, want to use the techniques listed above to take care of myself as opposite action to the emotions and urges I sometimes feel. I do deserve to feel better.

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Therapy

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.

IMG_7051
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?