Thursday, April 22, 2010

Distress Tolerance (Vickie- purple)

I've been spending a lot of time thinking about coping strategies lately. i'm sorry that this post is kind of long. Its actually 3 posts that I've been trying to compose in my head for a few weeks.

The past week I have been trying to observe all the little things I do and the big ones too. Its funny how we don't always do what is good for us. This Distress Tolerance program that I went through in DBT has really gotten me thinking. There are two parts to Distress Tolerance. First, Crisis Survival. Second, Acceptance. I've been disturbed to find that the further we have gotten into the program, the more I've realized my coping skills are unhealthy and preventing me from healthy coping mechanisms.

The basic outline is

Crisis Survival
- Distracting mechanisms
- Self-soothing mechanisms
- Improving the moment
- Pros & cons
- Breathing exercises
- Half-Smiling
- Awareness
- Radical Acceptance
- Turning the Mind
- Willingness vs Willfullness

I am pretty good at distracting myself, first of all, in my opinion. At least for better or for worse. Here is the distracting skills when dealing with a "crisis" (or anything that goes wrong)


Activities - hobbies, cleaning, events, ppl, chores, games, go outside, exercise

Thoughts – count, watch something (out window, TV), puzzles, read

Contributions - to someone, volunteer work, surprises, thoughtful things

Comparisons – soap operas, biographies, disasters & suffering, relate to others

Emotions – create different emotions w/stories, old letters, movies, music

Pushing Away – leave situation, block it out, censor ruminating, put away temp

Sensations – hold ice, hot shower, loud music, sex, strong smells, touch things

In an extreme form distraction can be abused to become a form of denial or the starting point of many addictions to deal with unsettling feelings. Beyond distracting mechanisms, "self soothing mechanisms" help bring you back to reality after you have distracted yourself from the initial unsettling event. Using these "self soothing" mechanisms help you reconnect with reality so that you can move on into the next stage of coping. If you don't, your body is forced to express your emotions with your body. This usually means that something malfunctions (digestion--> diarrhea) or starts to hurt (headache) or you become vulnerable to subconsciously hurting yourself (run into a table, twist an ankle, not being as careful to screen allergens in food, etc) or worse, permanent damage/malfunctions of the body or disease because some people are chronic "stuffers", always "stuffing" their emotions down to deal with something. Usually, it is easier to see someone else doing this then realizing you are doing this yourself.

As I have been exploring these coping strategies, it has been overwhelming to see how things in my life have been redefined and I understand why people do the things they do. For example, when my recent boyfriend was upset he would distract himself by working. He loved his work and I loved the fact that he loved his work. I even didn't mind him working long hours for the cause because I believed in the work that he was doing. What was disturbing (and he couldn't see this) was that he would work well beyond his limits as a way to distract himself form something that upset him. Even worse, overworking himself and constantly "stuffing" and distracting himself led him to subconsciously punish himself when he felt guilty, for example, and vulnerable to hurting himself (ie: accident prone or purposely eating things that would make him sick). He couldn't stop working, even when he recognized that he was doing this and wanted to stop. Often I couldn't tell the difference between him just working hard and abusing himself until he was already out of touch with reality and his body.

One of the most difficult things I have been dealing with the last few weeks is realizing that I was enabling him to be this way. I was co-dependent. He was vulnerable when he was like this and he would need me to take care of him because the "distraction" and "stuffing down" of his emotions would make his body finally translate those emotions into getting very sick. This Distress Tolerance program has made me understand why he was doing what he was doing, and also helping me understand how I was dealing with it. I know that I too don't cope well and I react in similar ways to Adam, but with different methods and results, which is part of the journey of healing: learning about yourself. My way of dealing/coping was to spiral out of control with my own ways of denial, stuffing, and addictions.

Not only that though, I realized that I have a history of this with past relationships, but in different manifestations. And even further, I realized that I learned how to be this way from my family. I had my place in my family that made me both witness to co-dependence, a co-dependent myself, and extremely vulnerable to becoming the dependent individual. I know this because I learned that being sick gives a person the "right" for attention and to expect others will make everything better for you.

Two and half years ago I moved to San Diego because I was so sick that I couldn't go to school anymore. I began my healing journey and have put everything second to health (and often sacrificing a lot). The past 2 years I have been focusing mostly on the second stage, "self-soothing".

Self Soothing

Vision – flowers, candles/flame, decorations, art, nature, stars, museums, downtown, pictures, dance performance

Hearing – music, sounds of nature, sing or play instrument

Smell – perfume/lotion, spray fragrance, aromatherapy, clean sheets or bathroom, potpourri, flowers, bake or cook, nature

Taste – good meal, tea/hot chocolate, dessert, candy, new spices

Touch- bubble bath, clean sheets, pets, massage, lotions, hot/cold, comfortable chairs, unique clothing & accessories, head/hair, hugs

Like I said before, self-soothing is in essence, using your senses to reconnect to your body so that you can move on to the next stages of coping (ie: surviving the "crisis" and accepting it). I started pulling myself out of the deep depression and sickness in my body when I moved to San Diego by seeing a therapist specializing in "complimentary therapy" which means mostly taking advantage of mind-body connections in therapy instead of just talking. I started using music therapy on my own to supplement and to start the process of reconnecting to my body (My body actually was numb and I had lost feeling in parts of it. It was the way my body was dealing with "stuffed" emotions.). Via exploring music therapy, I found that different types of western music induced different changes within the body. I came to this conclusion after working my way through the lecture series of Robert Greenberg from the Teaching Company ( and reading the Mozart Effect by Don Campbell ( I now know its all music, but I'll focus on a few examples. I also know that signing actually produces what is equivalent to an "internal massage" to your body that is helpful, but that is too much to talk about now.

What amazed me what that the evolution of music over the last 1000 years in Europe, roughly followed the same process that a person goes through in growing up, or being "reborn" through an awakening of consciousness (via trauma, religion, etc. ) I learned that Plainchant, popularly known as Gregorian chant, is the primary and nearly the only form of music during the Middle Ages. Its is known for fostering rhythms of natural breathing, relaxation, and induces spaciousness. It is good for quiet study and meditation and will reduce stress. Most importantly, it can create a "sanctuary" of sorts acoustically and a safe space for those in a panic attack or experiencing fear to find a safe space to calm down. It is the time when someone is in their distraction/denial/addiction stage OR quiet growth stage before exploring emotions, like a child before puberty.

After the Middle Ages, the Renaissance created new music unlike anything that had ever been produced in Europe before. Music (and all culture at this time) was starting to explore the boundaries for what is possible and experimenting with expressing emotion. Renaissance music is still quite structured like that of the Middle Ages, but it can be seen as a safety net, or framework in which these emotions could be explored in. This genre is wonderful for individuals recovering from trauma or any negative experience because it creates a safe environment to come out of the "sanctuary" and explore emotion. This type of music is also useful in contemplation.

I found myself going back and forth between these two genres often. I started adding in aromatherapy; using different sents to support or soothe, stimulate and calm. Then I started explore with cooking and new spices and going to art museums and taking walks in nature, thus stimulating all five senses.

Then, I found calm music over-layed with a heartbeat. This was an important turning point for me. When I was in Vienna, Austria, I visited a music museum and there was a large exhibit about the physiological effects of the womb-environment on individuals. The book the Mozart Effect also talked about how recreating the womb was sometimes be therapeutic for some people. I remembered the feeling I had in the recreated womb environment at the museum so I tried this on my own with music containing a heartbeat. I incorporated it into my "bag of tricks" I had, in conjunction with my plainchant and renaissance music. The heartbeat was extremely calming in a way that felt like a rope being thrown to me when I'm drowning in water. Today, when I use the heartbeats (I have a little machine that I can overlay heartbeats over any music now) it usually feels like a rope being thrown to me in the water when I don't need it and is in my way, but I guess that only shows how far I've come! YAY!

I've been working in more self-soothing tricks, such as yoga, acupuncture, exercise, colors, soft sheets and pillows, and meditation. These all help me connect with my body. Today, I have feeling in my body again! Not all places are 100% there, but I can now connect with my body enough to fight dissociation instead of being pulled own into a dissociated state, and thus vulnerable to re-traumatizing myself. This is huge for me!

My biggest challenge that I have started on since the beginning of the year is, and ironically, the next stage in Distress Tolerance is "Improving the Moment".

Improving the moment

Imagery – relaxing scene, secret space, alt reality, hurt draining away, protection

Meaning – find/create purpose, meaning or value, spiritualism, positive aspects

Prayer – conversation w/creator, meditate

Relaxation – massage, exercise hard, hot bath/sauna, hot milk/tea, breathe smile

1-thing in the moment – stay focused w/awareness at the task at hand

Vacation – in bed, motel room, in nature, at the park, breakfast in bed, indulge in chocolate or a magazine/newspaper, unplug phone, 1-hour break

Encouragement – cheerlead yourself

It was hard at first to realize that for many of these Improving the Moment skills, I have been dependent on Adam to do for me. It really hit me hard that not only was I co-dependent on him, but now that I am on my own, I'm recovering from co-dependency (which is nothing more than an addiction to stopping an addiction in someone you care about), my own addictions that were reactivated from trying to cope with the co-dependency, AND recovering from being dependent on Adam (him being co-dependent on me). For whatever reason, I don't know how yet, I would end up in a situation where I was trying to cope with something but I couldn't pull myself far enough into reality with my senses (and thus I would loose my connection with my body) and away from my distracting methods and Adam would talk my through or even do for me something that would improve the moment. By him doing that, I lost control of my ability to cope and was instead dependent on him to do it for me and nothing got fully resolved.

Its been exciting to explore this. A huge step is this massage school. It has opened a lot of doors for me not only professionally but in learning about myself. This blog is a HUGE part of improving the moment as well in finding meaning and cheerleading myself. I want to explore hyponotherapy/imagary, which is a new program at Mueller. And I've been practicing taking "vacations".

I don't think anyone really "masters" everything in this program. But it is a learning process and way to be a healthier person. Its been the topic on my mind for weeks, about how my coping skills are faring. Honestly, I think I have stronger skills than most of the people in my DBT group. But I constantly feel that I don't have good coping skills because I feel that if I keep using unhealthy skills it must be because I am too weak. I feel like I'm sabotaging myself. All I can do, I guess, is keep being myself. Keep learning how to love myself. Yesterday I found my inspiration to get over my unhealthy coping skills.

"Love is a passion for life shared with another person. You fall in love with a person you think is wonderful. It's your deepest appreciation of the value of that individual, and that individual is a reflection of what you value most in life. When you love someone else, you love them with all the joy in your life. When you hate or despise yourself and wallow in misery, how can you love another? Love is not to be ashamed of or embarrassed. It can be one of life's greatest rewards." -Terry Goodkind.

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