Friday, December 10, 2010

Readers questions and DBT answers!

"Thanks for this, MJ. The link to the chain handout is really useful, especially the filled in example! Some really helpful prompts to make sure I've covered everything. I've never really brought body sensations into chains, but will start this as I think it will be helpful.

Something I'd like to hear your opinion on MJ is whether you fine tune your target behaviours, or even change them altogether, over time. The 'big' risky ones seem to have died out for me, so I'm filling in a diary card each week which is mainly 0 urges and no behaviour. Should I be starting to think of more specific things I'd like to work on e.g. specific patterns in IP relationships?"


-Improving


Yes! Yes! and more Yeses! We will be constantly assessing our target behaviors. This is part of recovery. What we set out to change, we will eventually meet that goal and then we move on. We stay mindful of course and re-address those target behaviors in the event that we backslide. Be kind to yourself if this happens! Backsliding is part of our recovery as well. In fact - 





Part of relapse prevention is understanding the relapse cycle:



  1. Skillful maintenance (or green light skills) this is something that we will be doing on a regular basis in our everyday life. This is one of the main reasons borderlines get "tired"; we don't get to take a break from green light skills. It is on-going, forever. Which is not necessarily a bad thing. I am not trying to sound all doom-and-gloom over how tiring it is. It keeps us healthy, mind and body. But yes, it can be daunting at times. 
  2. Environmental stressors - everyone will have these. It is part of the human experience. We cannot shield ourselves from it short of putting ourselves in a bubble. Of course, the irony of that would be that the stress of being secluded is in fact an environmental stressor! Knowing and expecting this about life will make it necessary for us to fine-tune our yellow light skills, what skills can we use to lessen the impact of these inevitable stressors? 
  3. Fantasizing - When the relapse cycle is gaining momentum we start to fantasize about our life. Either in a way of talking ourselves into how a particular situation won't be "that bad" for us to put ourselves into or constantly thinking about how we "wished" we were better. So-on and so-forth, this fantasizing can be troublesome in that we are focusing on all the wrong things. Or rather, ineffective things. What is real, what can we control, what are the facts? Going back to the detective's approach, we get facts about our environment, so what skills can we use here? What can we do to refocus our attention and challenge that fantasy? The skills to use here would also be yellow light skills but certainly ones that are more intense because the next three steps are where we would want to use red light skills.
  4. Building urges - if we have not checked our fantasies we will be setting ourselves up for this one. It is inevitable that our ineffective urges will start to build. Be kind to yourself and don't be alarmed, when this happens it does not mean we are failing in the sense that we are doomed to eternal failure. Rather, it is just part of this cycle that will happen to us all at one time or another. We are not perfect nor would we want to be, that stress would be more than we could bear. So here is where we would want to use a red light skill, what skill can we use to stop these urges right in their tracks? What do we observe about these urges? How would we describe the experience and how do we intend to move forward with the experience? 
  5. Thinking errors - the slope is getting more slippery by the moment. These thinking errors will slide us right into the next step so fast it could make our head spin, it is very important to understand this about the cycle and be ready for red light skills, know them. Become familiar with them before we need them, this is no time to be "practicing" skills. If we start to haphazardly grabbing at skills, they won't work. Sorry to say, but they won't. The goal here is to challenge these thinking errors. 
  6. The set-up - here we are sliding down that slope and our only hope is to use a red light skill that will give us some sort of "toe-hold" What works for you personally? What skill will give you a moment before you engage? Just a moment to use a skill and change the path we are on. 
  7. Lapse/relapse - This may seem like a failure at this point, but believe it or not it isn't. We may have begun to relapse, but we can still lesson the impact at this point. Don't give up on those red light skills just because we are here, at this point!
  8. Positive relief - usually comes in the short term consequences when we are relapsing. Although it feels positive now, it will only reinforce those target behaviors and we all know what that means. It means:
  9. Guilt and shame - the longer term consequence is always negative. So what skills can we use to first, reduce #8's enforcers? and, what can we do to lesson the impact of the shame? 
  10. Fail-well - vow to never do it again, and go back at it. Start over, give ourselves a clean slate and move on. It sounds simple when I type it, but of course as with anything else, it really isn't all that simple. Check-out the failing-well diagram
Notice if you will that steps 1, 2, and 3 move some-what slowly. They take time to move to the next step and we have more time to decide what skill to use. Where-as 4, 5 and 6 tend to snap, one right after the other and then; 7, 8 and 9 slide right into the others, as a rather large blur of events. 10, however is something that won't happen at all unless we force it. Then, we dust ourselves off and return to #1. 


OK, so I have talked in-depth about the cycle and how important it is to understand the process. I have also asked a lot of questions about what skills to use. So, what skills right? What are the answers? This is where I get to be mysterious and elusive! OK, really this is where it is so important to work the program, because what skills will work in those scenarios all depends on you. What works in your circumstances. Know the skills, practice the skills when you are in green light mode. Have them listed for when you need red light skills so we don't have to "think about it" when we do need them. Be ready, set up antecedents to avoid the next step in the future. If you want to discuss specifics skills now, before I get them covered in the weekly posts please visit our forum and share ideas and experiences and let the group participate with you. Of course your experiences will help the others as well! 


Thank-you, Improving for your great question! I hope this helps!


MJ