I was done trying to live…

At a major crossroads in my life, I had a complete mental breakdown that ended up being the best thing to ever happen to me. I suddenly, and impulsively, left a relationship I wasn’t sure I was happy in or not, quit my job and opportunity at yet another promising career for the same reason, and proceeded to lay in bed in a deep bout of depression without eating for two weeks. I had been suffering intense splitting where I loved and hated my relationship and my job constantly, and I was confused to say the least. I didn’t realize I was suffering “splitting” or what that even meant, so for me I just felt confused as hell. I felt I was going to completely lose it. And I pretty much did. I lost 20 lbs off my already slender physique. I wasn’t going to kill myself, but I was done trying to live. My family intervened and found a DBT (Dialectical Behavior Therapy) program that is our last hope of me ever getting better. A year prior to this, we had strongly considered the idea of me having BPD (Borderline Personality Disorder) after stringing together some patterns of behavior I’ve had almost my entire life. The therapy seemed to be hard to come by; it was not offered anywhere in my area, so I relocated to a city six hours from my hometown. We wanted a program that had been certified by the Marsha Linehan Institute, otherwise it couldn’t really be considered DBT. Marsha Linehan is the founder and developer of this lifesaving treatment, and my personal hero so far! Having had a long history of depression, anxiety, panic, substance abuse, self-harm, rocky relationships, fear of abandonment, disproportionate anger, and identity issues… I met most of the criteria for a diagnosis of BPD and was eventually diagnosed with the disorder by a psychiatrist shortly after starting the DBT program. (**After more evaluation, my diagnosis has changed to CPTSD or “Complex Post-Traumatic Stress Disorder,” —an anxiety disorder commonly misdiagnosed as BPD because they share many of the same traits.) In the later stages of the development of my mental illness, I had frequent suicidal ideation, no will to live, paranoid delusions regarding my job and relationship, and started dissociating while under severe stress, which was becoming more and more frequent.

I had a sliver of hope upon arriving to the city where my DBT began. It took two more weeks to get settled into the new living situation after the plan had been set, and in that two weeks I lost 10 more lbs and continued to have severe emotional dysregulation ranging from panic to rage to uncontrollable crying, sometimes within a few hours. I had done a good amount of research on the therapy prior to leaving (I had a lot of time in bed to do so!). It seemed promising. It seemed different than anything else I had tried before, and this gave me hope that maybe it could work. I tried everything else. It had to work. Because nothing else had. DBT was my last hope at ever having “a life worth living”, as Marsha Linehan puts it.

I had gotten my substance abuse issues under control, for the most part, with diligent efforts in AA (Alcoholics Anonymous) in the several years prior to starting this treatment, however, the AA program does “not have any opinion on outside issues” such as coexisting mental illnesses and outside solutions such as therapy. Mental illness other than alcoholism is basically not talked about in the rooms of AA. I do understand the reasoning for this, but it nonetheless is hard for me to talk about my struggles in meetings, as they are always considered to be due to “untreated alcoholism”. The solution I found through trusting in a Higher Power in AA proved to be the bedrock and foundation of my continued recovery from drugs and alcohol, but I have sometimes been pegged a “chronic relapser” when my extreme emotional dysregulation continued to send me “back out”. I actually have AA to thank for my final discovery of my underlying (or coexisting) mental illness! Without putting together some length of sobriety, I would have never realized my behavior patterns were more than just a side effect of drug and alcohol abuse. It also became clear, as I worked the steps, they were more than untreated alcoholism. I can honestly say that I was working the program to the best of my ability, and I was still at a loss. I have continued to be an active member of AA, and will always know that my sobriety comes before ANYTHING else, because without it I will lose everything, including the progress I have made in therapy.

This blog is for anyone struggling with alcohol or other related substance abuse issues, emotional dysregulation, suicidal ideation, self-harm, toxic relationships, and all of the other debilitating manifestations that come along with a diagnosis of depression, anxiety, BPD, CPTSD, PTSD, (Post-Traumatic Stress Disorder), Panic Disorder, Dissociative Disorder…you name it… if you’ve got a mental health condition, I can almost guarantee DBT skills can help! After only a month and a half into treatment, I have already made leaps and bounds in the right direction. I plan to blog every week (sometimes more often) going over the skills I have learned. I want to share everything I can with you so that you can join me on this path to a life worth living!

I can say without a doubt, the skills I have learned in DBT can be extremely helpful for anyone suffering from the aforementioned conditions, however, I must note that there is not much research on the effectiveness of just applying these skills without going through the very structured therapy as set forth by Marsha Linehan. Not everyone can afford or can even access DBT therapy, and everyone deserves to have a life worth living, so regardless of the lack of research on the effectiveness of teaching these skills outside of therapy, I intend to share what I can of what has freely been given to me by my parents, who had so desperately wanted me to get better for over two decades.

I look forward to sharing my experience so that it might help someone else, even if only one person. This has taken a lot of courage to bare my soul online to the world, but I’m guessing if you made it to this blog, you are a trusted friend or family member of someone just trying to survive like me.

Join me as I continue learn and share my experience, strength, and hope. –A little line I stole from AA 🙂

With love,

Natalie Johnell

Thank you for visiting my blog!

The “R” in “DEAR MAN GIVE FAST”

The skill, “Reinforce”, is a part of the interpersonal skills section of our workbook.  Reinforcing is part of a set of skills termed “DEAR MAN”. It’s the “R” in DEAR MAN, and it involves reinforcing behavior in ourselves and others that we want to have continue or decrease. It sounds manipulative in a way, however, it is actually something people normally do… that maybe we just hadn’t practiced enough as children, so it never carried over into our adult lives and interactions with ourselves and others. So, in that sense it is not manipulation, rather learning to communicate effectively so that we get what we need and others get the acknowledgement they need and deserve. 

On the worksheet, we had to list a behavior we want to increase in ourselves and a behavior we want to increase in others and the corresponding “reinforcers” we used to encourage the behavior to continue. 

Positive reinforcement for myself could be, for example, a sticky note on the bathroom mirror that says something like “You feel amazing the next day when you go to bed early.” I am more likely to go to bed early when I am reminded that I end up benefiting from the behavior.

Positive reinforcement for others could be as simple as acknowledging when you appreciate a behavior. I used positive reinforcement today (without even realizing it until now!) when a friend in AA called to check in and chat with me. I had been having some negative thinking because it seemed like (to my BPD mind) this friend would sort of fall off the map unless I continued to reach out to her, and I had the negative thought that she didn’t really like me and was only being nice and cordial when I called or texted her. So, when she called today, I was happy and I said during our conversation “I am so glad you called and are keeping in touch with me. For some reason, I thought we might lose touch.” 

Investigating our feelings and saying to others the real feeling behind the reaction is something else that was mentioned in group. How many conflicts do you think we could nip in the bud if we stopped, took a step back, investigated our emotion (this literally takes a few seconds), and returned to the interaction saying something like “You know, I guess I’m just feeling a little fear underneath this anger.”… and go on to explain what we are really feeling. The person is more likely to give us what we need in the conversation when we identify and relay our real feelings. For example, if the underlying feeling is fear that the person or significant other was losing interest because he or she is seeming to have less interaction with us, directly telling them that (instead of recoiling into our own negative thinking patterns or reacting with anger) is much more effective. 

Wow, just writing this has brought to light a few things for myself! I hope it did for you, too!

❤ Nat 

Dialectical Approach: Two Opposite Things Can Be True At The Same Time

Ruminating on emotion makes the emotion escalate. For example, in sadness,
when I ruminate on negative thoughts it makes me exponentially more and more sad…like a bad downward spiral! It is important to be able to validate what I am feeling in the moment AND CHECK THE FACTS that are true at the same time. If I keep telling myself, “I’m worthless,” I’m going to start believing that thought, (and pretty soon I will be in complete self-loathing at that rate) but our thoughts are not reality a lot of the time. It is very hard to stop ruminating and believing our thoughts (essentially impossible without using skills) when you are highly emotionally sensitive as is the case with PTSD, CPTSD, or BPD. That’s where DBT skills can really help. A dialectic approach, for example, is merging “Emotion Mind” and “Logic Mind” to come to “Wise Mind”, by changing the way you speak to yourself. Instead of saying, “I’m a complete failure.” You could use the “Check The Facts” skill and say, “Right now I feel like a complete failure AND I succeed a lot of the time too.” Another example is to change, “I’m always going to feel this way,” to “Right now I feel this way AND a lot of the time I don’t, and this feeling will pass”. I emphasize the word “and” to show that two opposite things can be true at one time which is the basic idea in dialectical thinking from what I understand so far in therapy! I hope this helps!!

TIPP Skills — Quick Relief From Escalated Emotions

***Some of these skills have a direct impact on heart rate and blood pressure. If you have a heart or blood pressure condition, consult your Dr. before trying these skills.

T — Tip the temperature of your face. Put your face in a bowl of cold water, or keep some cold bags of water in the fridge to press onto your cheeks and eyes. This will tip your body temperature and thus lower your heart rate. (Linehan, 2015) This skill has been especially useful for me in deep bouts of sadness with uncontrollable crying and ruminating or a panic attack with the same type of ruminating on negative thoughts and emotions.

— Intense Exercise. (Linehan, 2015) Even if only a short sprint down the street and back, or a short but intense weight lifting session. This will get out all that pent-up emotion or energy. If you have it in you to do a full 30-45 minute workout at a slower steady pace, go for it! I have found the heavy short lived exertion to be the most beneficial for escalated anger.

P — Paced breathing! (Linehan, 2015) This is my favorite skill to reduce panic, especially when I am confined to a place such as in my car while driving, at work, or in a meeting. It is a skill you can do literally under your breath 🙂 The key is to slower your breathing, while taking long deep breaths in and breathing out at a much slower pace than breathing in. The biochemistry behind this is that your heart rate increases a bit upon breathing in and decreases when exhaling.

P — Paired muscle relaxation. (Linehan, 2015) When you tighten your muscles strongly and then release the tension, they are more relaxed than before. While using the paced breathing skill, you can tighten all of the muscles in your body while taking the deep breath in (pretty strongly, but not so much that it causes a cramp), and then slowly releasing the breath and the tension on your muscles at the same time. This is something that can also be done in confined situations where you may not be able to break away to deal with your emotion dysregulation with the other TIPP skills. Using the combined paced breathing and paired muscle relaxation technique has been a miracle worker for me in times of extreme panic or lengthy periods of anxiety and tension.

Watch This Useful Video!!

Agreeing to Abide by Basic Assumptions

Sources Cited: “DBT Skills Training Handouts and Worksheets” Second Edition, Marsha M. Linehan, 2015

The first skills I want to share with you are basic dialectical thinking skills that sort of lay the foundation so to speak.

I am not copying these skills trainings verbatim. That would be a disservice to the individuals that worked so hard to develop them. Rather, I am relaying what I personally learned or took from the lessons from one friend to another.

This particular skills training was so similar to some of the fundamentals I have learned in my experience in Alcoholics Anonymous, that I would like to start it with the “serenity prayer”. If you do not believe in a God of your understanding, that’s ok, just speak to the Universe or your own inner True Self. Just intuitively say to yourself:

“Grant me the serenity, to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

In this skills training, we learned to abide by basic beliefs or assumptions about ourselves and others whether or not we think they are true. We just agree to abide by them. Period. (Linehan, 2015)

These assumptions make it easier to accept the things we CANNOT CHANGE ie. other people’s behavior or our own current circumstances.

These assumptions also make it easier to see the things that we CAN CHANGE, and what we are RESPONSIBLE for changing, even if we did not create the problem in the first place.

Some basic assumptions to abide by that will give you more ability to accept the things you cannot change, and change the things you can are:

1. People are doing the best they can at all times. (Linehan, 2015)

2. Everyone wants to improve their lives; everyone wants to be happy. (Linehan, 2015)

3. The reality that people are doing the best they can, and want to improve, does not mean that this is sufficient enough to change their circumstances. (Linehan, 2015)

4. As much a we might not like it, we have to solve our own problems, even if they were not of our own making. (Linehan, 2015)

5. Since we want to do better, and are doing the best we can, we MUST learn new skills and behaviors. (Linehan, 2015)

6. All behaviors ie. what we do, think, and feel are caused by internal or external stimuli. This is true even if we cannot pinpoint the trigger. (Linehan, 2015)

7. Finding the root cause of our actions, thoughts, and feelings is more productive than blaming or criticizing ourselves or others. (Linehan, 2015)

8. There exists no benign view. Everyone sees things through their own perspective.

9. There exists no absolute truth. No one is right or wrong.

Interpersonal Effectiveness — Validation of Self and Others

From what I understand, emotional invalidation is a repeated way of dismissing someone’s emotions, thoughts, and feelings as irrational, invalid, and unimportant. Although we who suffer mental illness may have irrational thoughts and feelings at times, that does not mean we don’t still have those thoughts and feelings. Validating someone’s emotions does not mean that you necessarily agree with them. You can say something like “It makes total sense that you would feel this way.” and follow up with a nudge in the right direction of suggesting a more “wise minded” approach if the thought or emotion doesn’t seem to fit. Some mental illnesses are said to have biological components that make us inherently sensitive by nature. It’s simply how our minds are wired. It has been said that emotionally sensitive children are sometimes told over and over again that their emotions are inappropriate, wrong, and even forbidden. I believe many prominent role models in the emotionally sensitive child’s life (including parents, siblings, teachers, peers etc.) are unaware of the affect “emotional invalidation” can have on a developing child’s psyche. This isn’t about blaming anyone, although some have defined it, in severe cases, as “traumatic invalidation”. If we are biologically prone to emotional sensitivity, we are literally built to have these thoughts and feelings about ourselves, others and the world around us. It’s perfectly ok to have our emotions, but as adults, we are responsible for how they impact our lives and the lives of others. When emotions arise, we need to acknowledge the emotion, realize it’s there, and “check the facts”. Is the emotion proportionate to the trigger, or are we reacting without using both emotional and logical mind? We may have been invalidated in our emotions as children, but it is up to us now to both validate our own emotions and thoughts, (say to ourselves it is ok that we have them, and it makes sense that we would have them) and ask ourselves if the emotion “fits the facts.” If we have just lost a loved one or suffered a major disaster in our lives, the intense emotion would be proportionate to the cause… it would fit the facts. However, if we descend on a downward spiral of sadness or anxiety about something like fear of abandonment, the emotion does not really fit the facts, especially if the fear is imagined abandonment or some other imagined catastrophe. We can have a way of ruminating over the worst case scenarios, and these emotions can drive us into all sorts of unwanted problems and behaviors. When we start to get escalated, we need to accept our emotion, acknowledge it, and investigate by asking ourselves if it fits the facts. We can also start to practice validating others as well using the same skills. The worksheets in this section of the workbook ask questions like “How did I validate myself this week?” and “How did I invalidate myself or others?” We invalidate ourselves all the time when we say, “I’m stupid for having this emotion,” Etc. Hope this helps!!