Sunday, April 25, 2010

April 25th - May 2nd, 2010

A summary for the past few weeks, emotions have a legitimate use, they are very potent, and they love one another. They churn up like emotions based on your focus. This can be a good thing, or it can be a difficult thing; depending on you. Emotions Punctuate - they imprint or embed experiences into your being or make "lasting impressions". Emotions Exaggerate - they can amplify details or distort/twist facts. Emotions Communicate - we use them as signals that send & receive useful information quickly without words to & from others. Emotional expressions are hard wired and quick, they do influence others, whether we intend to or not. When they communicate to ourselves, they can give us useful information on something that may need our attention or perhaps as a warning or alarm. Emotions Motivate - they energize our behavior and prepare us for action, help us to overcome obstacles and they can save time in that they do not require thought. Just to name a few.

So what about emotion overload? What do you do when there is just too much flying around your head? I am careful to label this as distress tolerance, because you aren't necessarily in distress all the time when emotions are running high. Sometimes, life has emotions. Sometimes, life has a lot of emotions. We have to learn how to digest them, not just distract from them. As with anything else, we need to digest (and distract when necessary) in an effective way. What is my intention here? What do I need? Let's say you are preparing for a family reunion, you will be seeing relatives that bring a host of different triggers. For the most part you are well aware of the larger triggers and you are prepared for them. You have decided to go and have been very mindful about what all it will entail. Because you are human you will have quite a bit of emotions. These emotions will range from intense to a passing thought. Some may be wise mind justified and others will not be. As the day approaches, what have you chosen to do to "tolerate" these emotions, is the key. In this case it is more effective for you to find a healthy way to digest them, rather than tolerating them until they pass. I say this because if you tolerate until they pass, you run the risk of them popping up at the reunion and expressing to others things that you may not really wish to be expressing. However, if you digest them, you will have a clearer perspective when you are at the reunion. I know this sounds similar to distracting, but there are subtle differences, in some cases though, you may even use the same technique in both, distracting and digesting. Your aim is different though.

Distracting, usually involves gently pushing away what emotions and feelings are pulsing through your body for any given situation, usually when dealing with triggers. You are waiting for the moment to pass so that you can address the trigger and identify what can be done in the future, etc. Whereas, digesting, involves gently absorbing emotions and feelings that are pulsing through your body for any given reason, usually when dealing with triggers. You are allowing yourself to be a participant in your own life.

For survival we need to be able to distract, hunker down so-to-speak. It serves it purpose, after a time however, we need to expose ourselves to those experiences that have in the past been so strong and overwhelming that all we could do was distract. Live in your life. . . that is what recovery is all about right? So now is the time to digest. . .

What have you found to work? Here are a few ideas from others:

Mindfulness Exercises: take your time with them, perhaps linger in one for an hour or so, take a spa time for your mind.

Positive self talk: Eleanor Roosevelt once said, "No one can make you feel inferior without your consent" Write down positive affirmations and keep them in a handy place that you will frequently see. (no SNL puns intended :))

Gratitude Journal: jot something down that you are grateful for, either when the mood provokes or daily, it is that simple.

Charting: literally chart what your mind and body need to be doing in order for you to have the proper level of emotion, or comfortable level.

Let us know your ideas. Next week I will start publishing something what some find to be helpful, not only writing down what it is that they are feeling, but writing in poems and the like. If you have any, please send them my way. I look forward to hearing from you!


Monday, April 19, 2010

April 18th - 25th, 2010

Well people, thank you for your comments, we have had some good suggestions! If I am delayed in publishing comments, I apologize. My filter catches some of them as spam, and I sometimes overlook those, I will try and make a better attempt and looking through those as well.

So, we have discussed in detail some of the finer points of how emotions may manifest themselves, especially anger. Which, judging from the response I have received on this topic, it is something a lot of us struggle with.

There is a phrase I learned along the way, "Feelings Follow Focus" this term was used in ADEPT classes that I was thankfully able to take through Community Services Northwest. The concept to that phrase though, is heavy. It truly has a lot of power behind them. Notice it doesn't say, Focus follows feelings, which in a milder term is also true, but the idea that our feelings come secondary to our focus, or attention. Not the other way around. Although I give you, it feels like our emotion comes first, then our focus or attention, like in the case of rumination. - It is very important to remember, those of you who suffer the pesky ghost of rumination, it is a by-product or symptom of mental illness. In fact, it is a learned behavior. But rumination is not something that is part of our processing of events, rather it is a behavior, one that is ineffective and would likely be targeted as something you are attempting to be rid of. Being a behavior, not a processing tool, it does not classify as "focus" or attention. -

How can we benefit from understanding the principle of Feelings follow Focus? Well, that leads me to another term that I picked up at the Portland DBT Clinic, the Emotion Mill. The idea here is that we have an event, say you are out getting your mail at the curb, you have a box that you share with your neighbors, and a certain neighbor that you have had an awkward time getting along with is also getting her mail. She arrives at the box exactly at the same time you do, she says to you, "By all means, you first" OK, so here is your event. Now, the way you interpret this event will set in motion your feelings. From your feelings you will then set your attention.

It goes like this:

Interpretation of the event, leads to an awareness of your surroundings, what chemical changes occurred in your brain? Physical body sensations, facial expressions... in this case, you no doubt will immediately start to have these body sensations and hopefully you will be getting better at recognizing what those are. Your muscles may tense, heart accelerates, maybe your body temperature increases. What do you want to do? Do you want to smile nicely back at your neighbor and thank her for her politeness? Or did you interpret her comment to be snide, and you want to lash something snotty back at her? No doubt, whether you took her comment to be kindly or back biting, did she say "Hey I want to offer a peace offering, so please go first" or did she say, "Hey you jerk, you are pushy anyways, so you may as well go first" all depends on how you interpreted the event. Either way, you probably had your body sensations as mentioned above simply out of learned response, automatic due to your interactions with her in the past. The tricky thing here is, you two have not had any formal disagreement or incident, it is just an awkwardness about your interactions. So, the question that begs to be asked is this, is your interpretations off? Or are you rightfully picking up on some "issue" between you and her?  So, NEXT:

Your mind names the emotion you are having, your conscience may not be able to put a word to it, but your sub-conscience has and is set in motion to tell the brain what action is required. NEXT:

Your action leads to event #2, this is immediate, or considered to be the aftereffects of your interpretation of event #1, your meeting her at the mailbox.  Then of course you interpret that second event.

This is the natural processing we as humans have. When you break it down this way, you can clearly see the dangers of a faulty interpretation. The only way to get off of the emotion mill, is to have an effective series of events, leading into the next thing that you are doing, something else entirely. Even in this event, the next thing that you do, you will either be filled with satisfaction or frustration, depending on how well you navigated that emotion mill. You can see the variety of outcomes.

Say, you  took her comment to rude and insinuating that you wanted to be first, then of course your emotion is close to anger, frustration, and you responded rudely, what happens next? Now, she is involved in her own emotion mill, how will she interpret your response? What if she didn't mean her comment rude at all, now she senses your rudeness, and in her case her interpretation is dead on, what happens then? See the mess that can be made? Of course we do, we have all been there. Too many times before, right? There is nothing more that negative emotions like more than more negative emotions. Enter: Rumination.

Alright, how to get off? We talked already about one skill to use, identify your body sensations. It will give you insight onto what your habits are, are you feeling something that you usually do when you are being ineffective? This should clue you into whether you are interpreting wrong or not. Another skill is to take note of your expression of words, but as most of us are painfully aware of, we cannot take note of those words unless we have learned how to give us a moment, a split second between event and interpretation. All you need is a split second, then you can learn new skills to gain more time, to open up more options. In that moment, take note of what you are saying, ask yourself is it wise mind justified. If you determine it is not, you still have the ability to save the interaction, by kind words, back tracking or apologizing. Of course a lot of what I am talking about are skills that take hard work, but the most effective skill is to CHALLENGE your interpretation. This skill takes humility foremost.  A prideful person will not be willing to really challenge that interpretation.They will often times, justify their interpretation whether it is accurate or not.

Whereas a humble person will make sure to take care in really analyzing the event, and seriously challenge their interpretation. Again, there can be many outcomes of this, and once again, this challenge of  interpretation won't happen right in the moment, at least not without a lot of practice anyways. The good thing to remember is, anything is fixable. If you have totally fouled up an event and you recognize you were totally off base, you can revisit the situation and make it better, it just takes mindfulness, practice and a lot of humility to FAIL WELL!!

Your neighbor very well might have reservations about contact with you and you falsely interpreting her comment to be a snide remark has only increased her tension or reservations of you, when in reality she wants to get to know you, she really was attempting a peace offering by asking for you to go first.

Next week, we will discuss some distress tolerance skills. We have touched on how helpful a journal is, and some of us out there find it very healing to write in more formal ways. I have a submission of a letter that one of our readers wrote, and I want to share it with everyone next week. I ask that if anyone else  finds this form of distraction and healing to be useful and would like to share, please send your piece to us.


Sunday, April 11, 2010

April 11th - 18th, 2010

Last week we talked about anger as a secondary emotion. What about the primary emotion?

Well, if we practiced last week and we made lists of what our bodies go through with anger, and what we literally do when we are expressing the anger, and let's say at least once this last week we were able to have a success and we were able to curb our anger, what then? First of all, good for you if you were successful at this, at least good for you for taking the time to make the lists. :) OK, so now the primary emotion will lay bare. In anger situations, likely once you have eliminated the anger, you can clearly see what went wrong. The classic cases of relationship anger, your mate doesn't come home on time and you become angry, once you have stripped that away, in reality you can identify that you were perhaps scared that something may have happened, or maybe you were sad, because he/she was insensitive to you having cooked a meal that was cold upon their arrival, or what have you. Of course, I stress that is a classic case, because there are times when betrayal is the driving force in that case scenario.

The idea is the same here though, if Susan gets angry because her and her husband are discussing the finances and he walks away in the middle of her sentence and chuckles at her as he is leaving, chances are she isn't angry because the insensitivity of her husband. Rather, if she can skillfully handle the uprise of her anger, she will, overtime, recognize that it isn't anger at all. For borderline personality disorder, her husband walking out on her has no doubt triggered her deep fear of being abandoned. Once that fear has been triggered, there seems no reign that could possibly hold in the raging sea of emotions that come afterward. His scanty chuckle will no doubt trigger a sense of dismissal, perhaps worthlessness. This is the emotion that will drive that anger, which will erupt and all these other illness related symptoms will be overlooked. If they are overlooked, then how can this couple possibly begin to know what Susan goes through with Borderline Personality Disorder, and what her husband goes through with being the closest person to a person suffering from Borderline Personality Disorder?

Other common secondary emotion is shame. You see quilt comes when we have done something that compromises our values or as hurt others close to us. This guilt motivates us to make it up to the person we have hurt and not do it again. Where as if our guilt goes unchecked, if we allow it to fester, it will soon morph into shame. This secondary emotion carries all sorts of baggage like anger does. Shame will send you back to bed, never addressing what the root of it was. For the purposes of progress, if shame is a major issue for you, re-read last weeks post about anger and educate yourself in a similar manner.

When we have a clear idea as to the primary emotion is, then we can make all sorts of choices. We have cleared our minds and are prepared to really do some investigation. Shame for example, Susan is in another argument with her husband. He is upset with her for spending more money than he had alloted and is asking her where she spent so much. She fights back with a list of reasons why he spends too much money too and that she is an adult, and that she shouldn't have to answer an accounting of every dime she spent.  But what is really going on, is Susan knows that she bought a few clothing items that she knows she didn't really need, and she also knows that she bought some alcohol that she is hiding from her husband. She reasons she hides the alcohol, because she knows she will use it only for relaxation, and that he is too critical of her drinking anyways. She knows she bought the clothing items and that she really doesn't "need" them, but they didn't really cost that much. However, what we can see is that first of all, Susan's resentment towards her husband is driven by her lack of self-control. No doubt, by this time this is not the first time her and her husband have had this conversation and no doubt this is not the first time she has hid her purchases from her husband. Her values tell her that hiding things from her husband is not healthy. She betrayed her values and instead of allowing the guilt to motivate her to act differently, overtime, deep resentment and shame have taken over. Susan is in no place to make effective decisions from her wise mind. Possibly, if this is has happened for months or even years, Susan may not even know herself all of the underlying issues. Quite possibly, if she has tuned out her guilt for a long time, she really believes the argument is about her husbands lack of trust. What she is seriously missing is that her behavior is right in line with symptoms of her illness and without her educating herself on her destructive secondary emotion, she will never be able to help herself or her marriage.

Now, I know it seems minor, an argument over money, or hiding alcohol in and of itself are not going to destroy someone. But, with mental illness, these what may appear to be minor events are happening more often than we may realize, and to top it off, with each passing event like these we are training ourselves even deeper to ignore our body. Ignore our emotions and ignore our illness.

Once we have dedicated to ourselves that we are going to approach our lives with this inquisitive attitude, sort of like a detective does to a mystery, then we will be motivated to take events like Susan's and pick it apart, analyzing it until we can make sense of it. What this does not mean is that we force our mate to sit through us repeating the event over and over and over. This does not mean that re-tell the event to ourselves and blame or criticize our actions or that of our mates. A detective does not walk into a crime scene and immediately start yelling at the victim of a robbery that they weren't careful enough. He doesn't ask the victim what happened and then keep repeating himself over and over, no, not at all. He asks questions, out of curiosity pieces together what events took place and then refrains from allowing natural emotions that will crop up from clouding his ability to determine what took place and what can be done about it. In the case of the robbery, it may very well be sad or hard to emotionally deal with to see a young child that was struck by the thief before he fled. But no amount of sobbing or ranting about how the thief shouldn't have  hit an innocent child will catch the thief. The detective knows that although it is normal and natural to feel those emotions, that if he let them take the driver seat he would not get his job done effectively. Same holds true for us. A crime has been committed, we have a mental illness. It is not easy, if things were to be fair, then we would not have a mental illness, but the reality is that we are the way we are, fair or unfair, that the crime is not easily solvable and that we need to take the position of a detective in our own lives. This concept is the key to regulating our emotions.

This approach becomes successful the very day we start to use it. We may not be able to peel away the layers hiding the root cause in that very day, but we will start to have successes because the power to attack our illness is given us, by ourself in the moment we say, "OK, that hurt, why did that happen I wonder? Why did I respond that way? Why did he respond that way?" AND we honestly listen to the answers we find. When Judgment has been removed, the answers become clear.


Sunday, April 4, 2010

April 4th - 11th, 2010

I read something the other day, anger and anger expression. It struck me, because they really are two different things. Being angry is one thing, and how we express that anger is something else entirely.

Anger is a secondary emotion, it may be frustration amplified. Sometimes it is fear masked. Unfortunately though whatever emotion it is hiding doesn't have much of a chance to surface and be handled appropriately. In fact the primary emotion loses all effectiveness when anger surfaces. Despite beliefs that "getting the anger out" releases the flood gates and the real emotion is then ready to be addressed, expressing anger or suppressing anger have the same eventuality. A total mental corruption. Yes, anger can be that devastating. Keeping things into perspective will help out a lot.

First, let's explore anger a bit. Anger can be driven from a deep feeling of disgust, some resentment, contempt, hatred or hostility. It may even be the product of a lot of torment. Often times anger is preceded by a the loss of power or authority. Loss of respect or status. Perhaps you've been insulted. Another prompt for anger, which is very likely for most of you out there, is the experience or the threat of an experience of emotional pain.

Once anger is on board, we keep cooking it, stirring the pot so-to-speak. The mere expectation of pain is keeping the anger alive, feelings of unfair treatment, believing that things "SHOULD" be this way or that. Here is one, this one is my best friend, rumination. Ruminating about past events or the current event that is striking the hot iron of anger.

But what exactly does anger feel like? In DBT the skill of identifying body sensations is very important. What we can do to be more skilled at identifying body sensations is mindfulness. Our mindfulness exercises that we should all be practicing daily, will help you to start to recognize what your body really is going through. What helps to strip away the confusion that usually ensues when anger is provoked inside, some have found it helpful to make a list of what you think might be happening inside. Add to your list what others say they have felt, ask around what your friends and family notice about themselves. Because honestly, no one is perfect and every one of us has felt anger from time to time. Once you have a completed list, post it somewhere you will be able to look at it when you next experience anger. Read down the list and see if you can identify with any of the body sensations. Like, feeling your face flush or get hot, maybe clenching your teeth, a tightness or rigidity to your body. Maybe tingling in your arms or hands. Reading through this list of what you think might be going on will help you, A) delay in acting upon your anger and B) you will be able to definitively say what it is that your body goes through when anger begins to boil.

Once you have a better idea of the body sensations that will likely occur while anger is building, you will be able to have alarm bells going off in advance to your total out-of-control anger enveloping you.

While you are working on the body sensations there is much work to be done by analyzing the way in which you express your anger. Yes, an expression of anger is withdrawing or "stuffing".  Take note of what you physically do, outwardly, when you are expressing your anger, make a list of this as well. Do you grit your teeth, verbally attack or criticize, curse, scream, yell, clench your hands, make threatening gestures, stomp, slam doors, or physically attack? Write the ones down that you personally do, if you feel you have a safe support system and that you can ask them what they notice when you are angry. Be cautioned however, if this inquiry is not done with care, you run the risk of triggering yourself. So if you plan on asking loved ones what they notice, be sure you are in a pleasant mood, all of your vulnerabilities that you are aware of have been met, and remind your loved one that you are working hard at making changes so for them to be honest and brief would be helpful. Ask them to gently answer your question, don't sugar coat it, but certainly ask them to weigh their words. And remember, you are asking for the information, not to remind yourself of how "bad" you are, but rather because you want to get better. When that is complete, next to each expression of anger write down why this expression needs to change.

This list will come in handy in two places, 1- when you start to notice your body sensations, or your body amping up to anger, you can review these actions that you see when you are expressing that anger, and it may help to reduce the climbing emotion, because you can see the negative results in advance to you acting on your anger and 2- once you have acted on your anger, and you are picking up the pieces, making apologies where you need to, repairing what you can; take this list out and review it. Make a note of the ones you used again, but also make note of the ones that you know you use and didn't this time. Praise yourself for that.

Education is our most valuable tool. This tool can work wonders if we learn how to use it. Educate ourselves, not only in view of what mental illness we have or the impact of that illness on our lives, but also educate yourself on your own patterns. Without knowing what you experience how can you possible change it? How will you know what to do differently and when to do it?

So make these lists, review them. Incorporate them into your mindfulness exercise. If you know that your hands start to get numb when anger is setting in, then let that be your que to do a mindfulness exercise. Talk your body down, take a 5 minute break, close your eyes. Breath deeply 5 times, then start regular breaths. In your mind tell your body parts to slow down, calm down, and eventually to go to sleep, start with the opposite side of your body that you are noticing the sensations start in. In the case of the tingling hands, start at your toes. Tell your toes that it is quiet time, that they are to slow down and rest. "toes, it is time now to sleep." go onto your ankles, knees, thighs, stomach, heart, arms, neck, hands. . . you get the idea. Once you are done, chances are you have staved off the rapidly approaching anger. Which is a success! Now you will be ready to face whatever distressing situation you were having and this time with a clear mind. Review your list of body sensations so that you will be keenly aware if anger starts its way back up, review your list of anger expressions and why they are harmful. This will give you fresh ammunition to fight against the rising anger.

Just getting through a situation that anger usually takes over will be gratifying for you and give you a huge sense of accomplishment, don't be afraid to agree to disagree with the situation, you do not have to solve it in that moment. Relish the moment of pulling away from anger. If your anger is being triggered by something in your environment that is not another person, ask yourself if you can walk away. Take a "time-out" from it. Give enough time since you were able to push the anger away, not down, before you revisit it. If the anger was triggered with another person involved, use an exit graceful line, tell that person that you care about them, that it is important to you to handle the situation with effectiveness and that you would like to revisit the situation in "place a specific time frame on when you will revisit it" .  Seriously challenge your interpretation if you feel that whatever is triggering your anger has to be dealt with right now. Chances are you only feel that way because the emotion is in the driver seat and you are not.  In these rare occasions however, that something does need to be handled in that moment, say out loud, that you are struggling with anger emotions, you do not want to express them in this way (be specific as to how you do not want them to be expressed) and then proceed. Keep repeating yourself as many times as you need whenever you feel the anger surfacing again.

The aftereffects of anger will be overturn by analyzing your pattern of behavior. Instead of attending to only the situation that made you angry, you will be able to explore the communication break down that you had with an individual. The ruminating thoughts will be turned into pleasant validation. The common dread, shame, fear and hopelessness that follows will not be. There will be room for praise, satisfaction, problem solving and successes!