Finding the Words

'Shall I compare thee to a summer's day?' (W Shakespeare, Sonnet 18) or how on earth do I describe you? Finding the right words is an essential skill in trying to identify for ourselves and articulate to others, the deepest hidden feelings, experiences and thoughts. Too often when it is a problem, we find ourselves inside the 'belljar'. Locked away. One of my often repeated phrases when I was most in distress and struggling to get help, was 'I am inside my own head, screaming. No one can hear'.

That is why I found the Emotion Regulation module of DBT (Dialectical Behaviour Therapy) so helpful. I started to learn how to first identify the individual feelings from the morass of turbulent, violent waves of panic, anger, fear and self-hatred that used to tumble incessantly through my head. This step was the crucial first one towards learning how to manage the power and frequency of such self destructive and exhausting experiences. That's where having the time and safety to find and express what is going on inside is so important to begin to manage the fast cycling moods I so often experienced.

There has been a constant debate since I was first diagnosed - given the label 'Borderline Personality Disorder' (BPD) - in 2011 about what to call the clusters of symptoms and behaviour patterns which I exhibit. In one sense I don't care, my bigger battle is to find a sense of who I am among the shifting sands of invalidating parenting, my own confused sense of the world and the relationship difficulties this led to. However there are times when I am jealous of other sufferers who have a vernacular with an agreed understanding of their diagnoses: Chronic Fatigue Syndrome, Generalised Anxiety Disorder, Depression. There are always disagreements caused by stereotypes/stigma. Getting passed the minimising attitudes which get in the way of educating people about the real impact of Mental Illness is an ongoing struggle to get beyond the surface meaning of the diagnosis.

For those of us who have the complex roots both biologically and socially of emotional dysregulation, our diagnosis rarely, if at all offers any real language of understanding our experiences. We have gone through a number of versions: Emotionally Sensitive PD, Emotionally Unstable PD. Today I read of the World Health Organisation latest attempt to give us a workable diagnosis: Mild, Moderate, Severe Personality Disorder, with sub classes related to things such as experience of complex trauma, obsessive compulsivity, detachment, dissociation and disinhibition. This to me is a more positive move forward in giving a shared language between sufferer and professional to help explain the main areas where I have problems in life.

However, as with all diagnoses there is the problem of individualised responses to words and language: where I impose on them judgements and assumptions based on my personal experience and history. So, for some people being told that their condition is 'mild' may create some problems which makes them feel 'less than'. Whether we like it or not, there is a reality born of experience which tells me that words, like 'severe', 'acute', 'urgent' bring with them the resources I may feel I am in desperate need of.

I don't care in my moment of crisis where I sit in terms of others who may be more 'severe' than me. My fear becomes, if you give me the label 'mild' or 'moderate' then it follows that will not be given the help I feel I need until I prove to you I am 'severe'. In many ways this has always been an issue with perceived PD 'problem behaviour'. In reality if every team working with people like me is adequately and appropriately trained and resourced to provide the right level of intervention for me, then I can be reassured and given the right level of intervention for my needs - in theory.

It is good to work towards clarity of diagnosis, but, for me, the priority must be the reassurance that if I am given this diagnosis then it follows that I will then receive the appropriate level of help I need to learn to manage my condition.

"Personality disorders will no longer be classified categorically, but rather using dimensions of severity—mild, moderate, or severe.1 An additional category of personality difficulty will be demarcated not as a disorder, but as the equivalent of a z-code in ICD-10—ie, a non-disease factor that affects health status and encounters with health services. Following assessment of severity, clinicians will then have the option of specifying one or more of five domain trait qualifiers: negative affectivity, anankastia, detachment, dissociality, and disinhibition. ICD-11 will include new guidance for personality disorders to be diagnosed during childhood, albeit with caution, as they had previously been “inappropriately set at late adolescence or early life adult life”.1 Additionally, the revision will include a borderline pattern qualifier that is not dissimilar to the symptom profiles outlined in ICD-10 and the Diagnostic and Statistical Manual of Mental Disorder, 5th edition." (From the Lancet - Problems with the ICD-11 classification of Personality Disorders - Jay Watts - June 2019)

On Superheroes, Mindreading and BPD

I have just completed a week in which I transformed myself into a superhero. The hardest part was to come up with my 'superpower' - in the end I opted for the title 'SuperConfused' with my super power being the ability to sow confusion wherever I went. It was quite a wheeze! In case you're wondering, it wasn't an experimental therapy option being trialled near me, it was in pursuit of entertaining 30 odd (sometimes in both meanings of the word) children aged 5-11 for a week of the summer holidays. Yes, I know volunteering is a funny old world!

I'm a reflective soul. Some may call it navel gazing, but occasionally, it yields positive fruit. This time my reflection led me to the realisation that I have been living a double life as myself and my alter ego, the Amazing Mind Reading Woman. This came out most clearly during an overseas holiday in the company of my family and some friends in July.

I have written a previous blog about some aspects of this alongside the phenomenon known as 'Apparent Competence': http://bpdlifeinthemoment.blogspot.co.uk/2014/07/caught-between-two-minds-problem-of.html

Mind Reading as a feature of the symptoms of BPD (Borderline Personality Disorder) will be familiar to anyone living with or seeking to support someone who is emotionally sensitive. There are a number of aspects to this superpower of mine.

1) I know exactly what everyone is thinking about me. Especially when I am feeling stressed and/or emotionally vulnerable this 'superpower' is at its most potent. You see, I know that everyone around me is judging me and at times, loathing me, because that is what I am feeling and thinking about myself, and, my reasoning (confused by the power of emotional waves crashing over me) is that in that moment everyone around me can see right into my rotten core. It is a feeling of emotional and mental nakedness and can appear like paranoia, but in that moment I can have such belief in my mind reading 'abilities' that reassurances will seem to be 'flannel' and so much nonsense, as no one can possibly not recognise what I recognise about myself in those moments. Of course you have to be thinking that. If you struggle to understand the power of this 'ability' think about the number of times you have attributed motives and emotions to inanimate objects as well as total strangers: 'That lamp-post deliberately jumped out of nowhere and hit me smack in the face.' Or 'That driver in the fast lane thinks he's so much better than me, I'll show him.' Ok, so much nonsense which can be easily reasoned away. What if that level of conviction about the ability to see into others motives and thoughts is coupled with the most powerful of negative emotions?

How do we make sense of the world?

It is my understanding that we begin with our physical senses, sight, hearing, touch, taste, smell. We build up an understanding of the world around us through these physical experiences. So far, so simple. Through time we build up a bank of sights, smells, tastes, sounds as our experiences widen. What if we couple these experiences with emotions. For example, sights (a beach), tastes (ice cream, chips) coupled with a feeling (happiness) means that I can evoke a visual memory of happiness just by walking by a chip shop. What if our sense of what we perceive around us is affected by negative emotions? It follows that our emotions lead and overwhelm our physical senses of what is going on in the present moment, so whilst others around us may be oblivious to our internal meltdown, we are living the equivalent emotional response of a disaster movie. While most people may experience the same stressful situation as me, both their immediate response and the length of time it takes to recover from the feelings of anxiety and stress will not be as powerful nor last as long. So, within a couple of hours of missing a flight all my travel companions can be asleep, while I remain wide awake while adrenaline courses round my body, reignited by catastrophising thoughts and heightened emotions. Paranoia about the different experiences between me and my friends, triggers my mind reading tendencies which may continue for several days as I perceive judgement and disapproval - an echo of my own thoughts about myself.

2) All the Bad things in the World are centred on Me One of the paradoxes of low self esteem is that I can convince myself that everything bad that happens is because of something I have thought or done. How's that for a superpower? This sometimes links into my ability to read minds in that I assume everyone will be blaming me. I have apologised for a stormy day before now. Either this is faulty thinking deeply affected by overwhelming feelings of unwarranted guilt, or I am suffering from some as yet undiagnosed form of megalomania!

3) If YOU cared for Me/Were any Good at YOUR Job, you would be able to read my mind! This is the part of my superhero persona which, I think, provokes fear and loathing in others. I will sit at home, or in your office, A&E, wherever, in abject distress and expect you to work out a) how far down I am feeling b) if you should intervene c) how you can help me. Most of the time I am so overwhelmed with distress that all I want to happen is for it to stop. This I know is daunting to anyone dealing with me in these moments. How much of a risk am I to myself/others/you? For me, that answer is, just help me feel safe until the feelings pass.

I've written before of how challenging my behaviour could become in the past with mental health professionals who I had a habit of 'testing'. This resulted in me presenting as functioning on all evident levels, but expecting those trying to help me to be able to read what was going on, under the surface. 'Failure' would result in me going away and pressing self destruct in some more 'obvious' way. Deeply unfair, and likely to perpetuate the feeling of being manipulated by me. For me, those who managed to get past this stage were those who were able to take time to listen, who were allowed to assess me over a period of time and, above all, those who were honest about their limits. 'No one can change your past hurts.', 'I can't stop you feeling this bad about life', 'life sucks'. Reality and honesty have been the best tools used in helping me build therapeutic relationships.

In friendships and relationships I am challenging to love to say the least. My silence can be a gauntlet thrown down to challenge you to demonstrate a) how much patience you have b) how much you really love me, especially when I am not communicating c) Whether all the failed and failing relationships of the past, are really in the past, or if I can push you to reject me too. As with the professionals who have had to work with me, I can expect you to be able to read my mind. In the end, sticking to boundaries and being consistently straight and practical is better than joining me in my emotional morass.

Thankfully, I have not lost any friends for a number of years, either I've changed or people are more accepting of me. Another, thing that has changed is that I no longer tolerate 'bad' friendships or relationships which are not good for me or my emotional health. I don't have to invest in damaging relationships for fear they will be the only people who could care for me.... recognising that any level of abusive behaviour, does not constitute love. Actions do speak louder than words where this is concerned!

How do I get myself out of the Mind Reading loop?

1) Stop the physical symptoms of anxiety/anger. There are a number of techniques which have helped. The one tool I carry with me all the time is my breathing. If I can slow myself down by practising mindful breathing, this helps me regain control of my emotional responses. Another technique which is more of an immediate shock to bring my heartrate down is to plunge the whole of my face (right to the edge of my ears) into freezing cold water. If there isn't the means to do this, it helps to carry a freeze pack in my handbag which when held to my eyes for up to two minutes (or as long as I can stand it), has the same immediate effect.

2) Use my Senses to focus on my immediate surroundings. It helps to maybe suck a sweet and focus on the sensations, taste etc.

3) Identify the feelings. If I can name them, I have a number of DBT strategies I can use to manage them, until they subside.

4) If I have a relationship of trust, check out the reality of my beliefs about what others are thinking.

The times when I find myself mind reading have lessened over the past few years. However, life has unexpected twists and turns and sudden changes/crises may result in me assuming the superhero in me must be right about what is going on in your head. Every now and then I need to be remember that superheroes are for comic books and that I am not the Centre of the Universe, nor am I the Carbuncle of the Cosmos around which everyone and everything revolves - which means I am not personally responsible for tornadoes in Oklahoma, or the dodgy schedules of international airlines!

Bridging the Gulf

I was in a crowded room. I knew a large number of people there. I had managed some conversations and got myself a cup of tea. Suddenly, I was overwhelmed by an all pervading sense of alienation and aloneness. I have experienced such floods of negative emotions nearly all my life. The sense of being an alien, of being locked inside a glass prison unable to make myself heard or understood, is one that is familiar to me. As I sat there, I had a choice to stay and front it out, as I have done so many times before, or to make what I consider a 'tactical retreat'. Although leaving difficult situations in panic has been a response I have often used in the past, this time was different.

Last week I was having a conversation with someone about the sense of isolation and overwhelming sense of emptiness experienced by people with my diagnosis and symptoms. She too has experienced these feelings, but would make herself get involved in groups of people and 'do' things. I think there is a right time to do that, for me. But yesterday was different. I have had a week of giving out to a lot of people in different contexts. In order for me to be able to regulate my emotions I need to be able to identify them. When I am tired I find my ability to feel anything is impaired because it takes so much energy to manage any emotions. Numbness is easier to manage, but clearly, makes it difficult to function at any social level. Over the past couple of weeks I have recognised that I was lapsing into numbness, because, for me I had had too much general human contact with a wide range of people, some of whom I struggled to connect with. I retreat into numbness when I am in a group of people and I am beginning to feel overwhelmed by my emotions.

Essentially, in the past couple of weeks I have not experienced negative emotions, but around people I am deeply uncertain about my ability to read other people and my acceptance in their groups - fear of rejection is an emotion often in the background, particularly when I am feeling uncertain or vulnerable.

I work hard at recognising and responding to emotional signals. Something most people take for granted. The development of my emotional abilities was fractured due to my experiences in childhood, this coupled with the emotional amplifier in my brain which means that all of my emotional responses are in dolby-surround-sound and full glorious HD technicolour, means I do need respite from being around people. I am happiest when I am on my own. That may come as a surprise to many who know me, because I have learned throughout my life, and from many embarrassing mistakes, how to behave around people. Again, it is not something which came easily to me, I would describe myself as a quiet, almost shy child. The sense of being an alien was ever present. One of my family nicknames was 'Moon-man'. Another was 'Droopy' after the little depressed dog, who when he got mad, he got 'real mad' - my angry outbursts were epic!

Emotions are exhausting for me, even with the DBT (Dialectical Behaviour Therapy) Emotion Regulation skills which help me maintain equilibrium most of the time. Today, I am back on an even keel. Here's what I did.

1. I gave myself a break. Yesterday was not a day to challenge myself to stay in a difficult situation. It takes self compassion to know when I need to accept things as they are and when I need to push myself to change the way I react. I needed some groceries so I went shopping before going home. This meant it didn't feel like I was running away. In the spirit of self kindness I bought some treats.

2. I watched some comedy on catch-up until I felt myself relax.

3. I breathed mindfully until I was able to identify the emotions I was feeling. Having named them, I accepted that, given the week I've had these emotions were understandable.

4. I listened to my 'belters' playlist which has some summery, upbeat songs on it. I spent time in the sun, colouring mindfully. Eventually I enjoyed and fully participated in the music and ended up dancing in my back yard. I enjoyed the warmth of the sun.

The process of bringing myself back from numbness used to take weeks or even days. Looking back on yesterday I realise it is progress that I was able to use skills to look after myself and bring myself back to equilibrium in an afternoon. It is now four years on since I started using DBT skills and it has and is taking time. Good to remind myself that I had over 40 years without using them. Rather than feeling unable to reach people across the gulf caused by my emotional dysregulation I am becoming my own bridge builder.

Sometimes I feel Sad - and that's OK

Most of my life was spent avoiding painful emotions, any dip in mood was met with a frantic increase in activity, avoidance and, frankly physically and emotionally draining 'coping mechanisms'which, if I'm honest, weren't particularly effective. At the time those coping skills, poor as they were in the long term, actually helped me to 'function'. The problem came as the cumulative effect of using my 'coping skills' became self destructive. I felt I had to keep using them because I was so in fear of the huge torrent of grief that had been dammed up for decades, that I believed my very life depended on me stopping myself from feeling, ANYTHING.

As I have described elsewhere in this blog, the use of those coping skills resulted in me being unable to feel anything. I had reached the point where not only was I lacking in any energy to keep going, but as my GP told me, if we looked under the 'bonnet' I would find that I had long been trying to function without 'any engine at all'.

Over the past five years since that point, I have slowly built up different sets of skills and found out that the huge emotional breakers I have feared for so long didn't kill me. It has not been an easy process, developing skills takes time, effort and determination. One of the first set of skills essential for me to learn and practice were the distress tolerance skills. If I know I am equipped to cope with the feelings I fear so much, then my very existence no longer depends on preventing myself from feeling.

As time has gone on, the importance of Distress Tolerance has reduced in proportion to the number of times I find myself in crisis. The second set of skills which dovetailed into the first was the Emotion Regulation Skills. In practice, the ability to identify and name the feelings I feared so much was one of the most important points in turning the corner from the way I had lived for so long. Rather than sitting frozen in fear of a fog of indefinable feelings, I can name my 'demons' and once named the sting is taken from them.

The sets of DBT skills along with the routine practice of Mindfulness have helped me to stop the constant rise and fall of difficult emotions, to give myself time experience them, without living in constant fear of being overwhelmed by them, so that I am able to effectively manage relationships which for so long were damaged and broken by the uncontrolled impact of my emotions.

The most vital fact I have needed to face up to is that I cannot escape emotions. Simply because they are part and parcel of being human, and I am in fact a human being, contrary to how alienated my emotional responses have made me feel. Emotions are an important part of the way I am built. All emotions have a function and actually are beneficial.

I have had to adjust my thinking about emotions from seeing them as some internal monster, ready at any point to wreak havoc on my life. As someone who, due to biological and social, environmental factors, is more emotionally sensitive than average, emotions have always loomed large. Due to the experience of trauma in childhood, there has been a significant amount of grief to manage. In the past that grief has been unresolved because most of my energy was focused on avoiding feeling it. If I cannot identify the grief, and name it, it can connect in an endless stream with any difficulties, or sadness I am feeling in the present. My baseline emotion is at a higher level than average, that means that I have always struggled with a high degree of underlying grief and sadness. So, it is understandable that even the most seemingly insignificant trigger to grief in the present may well lead to overwhelming waves of grief.

It has taken me three years of working on DBT skills to understand this about myself. If I struggle to understand why my responses are so extreme, how hard then, must it be for those around me? I think sometimes, this is what makes me feel like an alien, even when in the most supportive of company. I am only just beginning to be able to articulate this process for myself.

As I have moved along the path of recovery, I am learning to recognise sadness as an emotion in its own right. Rather than try to avoid feeling it, for fear of it connecting with the overwhelming grief of the past, I am learning to accept it for what it is in the here and now. The past and its experiences are done with. Sometimes I may still feel an echo of the grief of the past, but I no longer need to fear it as massive, rolling breaker, rising threatening above my head. The waves of sadness are more manageable as a result. Not only do I now possess the skills to manage my emotions, but I have learned to accept even sadness as an important part of being a human being. It's okay to feel sad, because sometimes there are things in the here and now to be sad about, and that's okay.

There are Still 'Bad' Days

The thing is, outside of my emotion fogged vision of 'how life should be', it's actually not easy for anyone. That little realisation has taken me so long to get to, it's not funny. We're all guilty of it; that conviction that 'everyone else' somehow is living a gilded, perfect life. The belief that 'if only...', my life would be problem free and perfect. As I have learned to deal with the nuclear emotional fallout from the combination of my biological predisposition and impact of social environments, I have learned to be less focused on my own storms and able to see more clearly the world and people around me. The grass is always greener...? Only if I am entirely focused on my internal struggles.

The impact of mindfulness is often described as suddenly feeling 'awake' to life in the here and now. For me, practising mindfulness and DBT skills is not about distancing myself from my experience of 'real' life. Rather, it is to replace coping mechanisms which cushioned me and separated me from both the environments and relationships I was living through. In a sense those skills which helped me survive trauma and the symptoms of mental illness, actually built a wall of 'bubble wrap' around me which became so deep that my emotional experience eventually became total 'numbness'. Recovery has meant that I am able to feel and experience life as it is. I do feel more aware and more awake to life more clearly. It is not distorted by either emotional responses which cause me to be terrified of my life experience, or those emotional responses which are so maniacally 'happy' that they deny the impact of real day to day difficulties which are part of life.

As I have moved from clinging on by my fingertips in the most terrible emotional storms, to a mix of calm and 'choppy' emotional experiences (ie 'normal' life), I have the energy to recognise more clearly life as it is in the here and now and, more importantly the emotional energy to cope with everyday ups and downs.

The picture I have in mind is the difference between the scenes from 'The Perfect Storm' where a small vessel is tossed about mercilessly and hopelessly on huge waves, beyond which it is impossible to see, to the kind of 'swell' which is more common, where waves can be felt and seen, but where the ultimate destination can be seen beyond. That is the difference between, 'before' and 'after' skills and learning how to use them to manage my emotions.

So, here I am at a time of year that is not the most uplifting, recognising that I am having a few 'bad' days. The difference for me now is that I can see beyond these days, that I am certain, 'this too will pass'. The other thing is that any fears I have that 'bad' days mean I am relapsing back to the previous 'Perfect Storm' days are unfounded. I have moved from merely surviving and existing, to a life which is meaningful and worthwhile. As long as I continue to build on the skills I have learned and use the helpful techniques that help me manage aspects of life that other people may take for granted, then my internal as well as external life will more closely reflect the life experience of most people.

The Feeling is on the tip of my Tongue

I've been revisiting the DBT Skills in a more structured way recently. It has brought unexpected challenges to my day to day practice. It has been some time since I have found myself noticing and, therefore recognising the distinction between primary and secondary emotions. Coming back to DBT skills after a time when I had become accustomed to a narrow range of skills which suited me and with which I had become comfortable, has reminded me that continuing to manage my emotions effectively starts with being able to notice and name the feelings I may be grappling with.

One day I found myself feeling unutterably irritable, angry even at the world in general, other people, but (an echo from the past) most of all at myself. It was an uncomfortable feeling as I have managed to achieve a reasonable level of equilibrium. However, I am embarking on a number of new projects which I find challenging.

In the past I would have been tempted to wallow in the discomfort, allowing it to grow into the impulse to self harm. The Poison Tree by William Blake, has always summed up the dangers of nurturing bitterness, anger and hatred, particularly when it is turned inward. 'I was angry with my friend, I told my wrath, my wrath did end, I was angry with my foe, I told it not, my wrath did grow...'

As someone who is emotionally sensitive, I find it easier to forgive others than to forgive myself. Self directed anger needs a range of skills to manage, particularly so it does not become a spur to self harm. Naming it is vital. Spiky was how I would describe my general sense of how I was feeling, but it took me a long time to name 'anger' as the surface emotion. The problem then became, angry at what?

Rather than sit and ruminate, nurturing and feeding the destructive emotion, I decided to 'stomp' it out. So, along with my dog, I embarked on a two hour brisk walk. One hour in, the feeling of anger moved and changed into another feeling. I realised then that I was feeling sad, I was missing some key relationships from my time in Mental Health Services. I have moved forward to a point where I can use my skills, I have learned to self reflect. However, there will be times when I need coaching and encouragement. I am moving into a phase where that needs to be something I do for myself, having previously relied on my Care Co-ordinator and DBT Therapist to guide my reflections.

It is good to reflect that the storm of irritability lasted around three hours from when I first felt angry to resolving the feeling into sadness and allowing myself to feel sad about good relationships that have past. It is ok, it is understandable. In the past most of my emotional life was dominated either by a feeling of numbness when I was engulfed in an amorphous cloud of numerous emotions, or outright irritability and anger at myself which periodically exploded against those closest to me, but primarily at myself.

'Telling' my feelings allows me to look the challenger in the face. I was able to move forward when I acknowledged that I was angry, used opposite action to deal with that feeling until the main emotion, sadness was ready to be named.

I am learning that when I can't immediately tell you what I am really feeling, I know it is just on the tip of my tongue... I am learning to make space and give myself time until I am ready to tell my feelings and stop them from becoming an all devouring monster.

Making Use of All the Senses in Mindfulness

The longer I go on with mindfulness practice the more I recognise that I can become stuck in ruts. We like habits and sometimes it's a relief to have stability in something in contrast to the turbulent emotional and internal lives many of us battle against. There is a need though, to 'mix it up' and rediscover the fresh in our experience of the everyday. I find that I focus a lot of my mindfulness practise on hearing and sight, I tend to ignore taste, smell and touch. Yet, I know when I do try something out that focuses on these senses I tend to enjoy the change and what it gives to me in opening up a sense of moving forward and experiencing new things in the every day.

To help structure my ideas around my senses I have put together a worksheet, with a view to including it in a day course I'm running in October. Let me know what you think - any feedback (kindly meant) is gratefully received!

Making Sense of Mindfulness

You have been practising Mindfulness for some time now. These questions are designed to help you decide what works best for you, and to help you try out fresh ideas to use all five senses in your mindfulness practice.

1. When I take time to be mindful I usually use exercises which use my
Hearing /Sight/Taste/Smell/Touch *

2. I have never or rarely tried exercises which use my Hearing/Sight/Taste/Smell/Touch *

*Circle the answer

3. List your top three favourites sounds:
_____________________________________
_____________________________________
_____________________________________
4. List your top three favourite sights:
________________________________________
________________________________________
________________________________________
5. List your top three favourite tastes:
________________________________________
________________________________________
________________________________________
6. List your top three favourite smells:
________________________________________
________________________________________
________________________________________
7. List your top three favourite sensations (Touch)
___________________________________________
___________________________________________
___________________________________________
 
Now from these lists, note the experiences which you find help you to feel:
 Calmer
 Pleasure
 Enjoyable anticipation
 Warmth
 Nurtured
 Relaxed
Exercise:
Sit as you usually do when practising Mindful exercises. Notice your breathing and allow your mind to focus on the rise and fall of your stomach/rib cage. Focus on the sensation of your breath in your nose, then as it travels into your lungs and out again. Allow distractions from thoughts, memories, to pass through.
Now choose one of your senses to focus on. (touch or taste or smell make sure you have any props set up within easy reach). As you use your senses become aware of initial thoughts/judgements? Notice them, then let them go.
Spend some time simply experiencing your activity. Notice feelings about what you are experiencing. If it is pleasurable do not push it away, but allow yourself to sit with it. If it is negative, notice it and let it pass. Change your focus back to your breathing and away from what you are experiencing, then return return to the focus on your sense. Repeat twice more, then when you are ready, return your focus to the room.

I Can't Cope with 'Disney' Films

There I am, a sodden heap on the sofa, sobbing uncontrollably. To any casual observer I must have received some devastating news about a loved one or something that devastates my life, but no, the trigger to my outburst of uncontrollable grief was a small sequence in the 30th anniversary programme made for Neighbours. The subject of the sequence was not even any of the human characters, but Bouncer, the Ramsay Street dog.



I tend to enjoy highly taut thrillers, crime drama with proper adult themes. I am unaffected by the most psychological of thrillers, particularly if there is intrigue to be worked through. However, present me with the highs and lows of family drama and I am reduced to incapability by virtue of the extreme emotional reactions evoked. I am sure there will be some professionals who might recognise the 'whys' of this situation, I am aware of the cathartic nature of some tv programmes and films.

The problem for me and those around me when watching anything is that I am fully immersed in the programme in front of me. As someone who is emotionally sensitive this means that if the main focus of a film is to evoke emotion, then my emotional response will be evoked - in buckets. One of the biggest challenges facing me due to my BPD (Borderline Personality Disorder) is that I go to the heights or depths of emotion exceptionally quickly, but then it can take me hours or even days to come down.

Two weeks after watching the 30th anniversary Neighbours programme I am still experiencing echoes of the depths of grief I felt when contemplating the death of a pet I never knew personally who died well over 15 years ago. That is how powerfully my emotions can affect me.

I cannot watch 'Chitty Chitty Bang Bang' because of the panic evoked by the child catcher. I may laugh about it with friends, but I can experience the fear as if I were still a child watching it or as if the threat is real and immediate - yet I have managed to follow and be unaffected by series such as The Fall, and Hannibal. Perhaps, it is because I have survived real trauma and threat throughout my formative years, so constructed fear is nothing compared to what I have actually experienced. Or perhaps I naturally dissociate myself from these kind of threats as this is what protected me in the past?

Perhaps, my struggles with family focused stories is the identification with the pain and danger of animals or innocent children and an unacknowledged recognition of myself as a victim or as someone for whom sympathy or empathy is warranted. It is easier for me to feel pity or sympathy for the children or animals in 'Marley and Me', or 'Hachi', or 'My Girl', or 'The Bridge to Terrabitha' than it is for me to recognise the unshed tears for my own life.

I've studied the art of story arcs and such in film - I can divorce myself from most genres of film and focus on either the themes or intellectual properties of them. Even Beaches doesn't affect me in the same way that 'Homeward Bound' affected me. I can recognise the tricks which are designed to evoke the required amount of grief over the death of a friend. Today, however, I was unable to manage my emotional response to the story of a dog who waited outside a train station for over ten years for his deceased owner to return to him.

At Christmas I baffled my friends' children by becoming excessively distressed about the death of the lead character's father in 'How to Train your Dragon 2' and an injustice done to the 'lead' dragon. Actually, it was the fact that the little dragon was blamed unfairly which upset me more than the death of the father. An eleven year old assured me it would be okay.

Whatever the reasons behind my emotional responses, I need to either stop watching things which trigger uncontrollable emotions or practice the DBT Self Soothe skills I need to short circuit them. I guess the trick becomes being able to recognise when I need to be careful with my emotions and when I am able to emote along to a family film or programme without it interfering with the rest of my day or, even week.

If I can't love myself, where do I begin with self care?

Being able to feel secure in my place in the world is vital to my ability to engage with the world around me. I cannot contribute to the communities I may want to be part of if I don't feel that I am accepted or, more accurately, acceptable to those around me. I will not be able to sustain relationships if I do not believe that I am worthy of that most basic of human needs - human contact and interaction. For most who suffer from BPD (Borderline Personality Disorder) a lack of basic self esteem underlies most self destructive behaviour. I will not care for myself, because I don't believe 'I'm worth it'.

One of the hardest things I was asked to do in DBT was to say 'I love myself so much'. It still hurts to even write that. I cannot say that I've reached a point where I'm able to say it with any level of belief. A lack of self love in the past evidenced itself in behaviours which often resulted in crisis in one or other area of my life. I would spend until my debts were so overwhelming they affected my physical and mental health. I neglected my physical health - I rarely went to the doctor, what was the point? I reasoned, it would be a waste of resources - because it's me.

No therapy in the here and now can undo the experiences and relationships in the past which have stolen any sense of self worth. Even the most loving relationship in the here and now cannot hope to permeate the depths of my sense of self loathing. A friend of mine who has gone through the adoption process told me about some of the training they received on expectations of the children's ability to absorb the effects of a loving home. During training they were told that the child is like a cup with a layer of cling film wrapped over the top. Pouring love into the child is like trying to pour liquid into the cup. It cannot get through. There is a certain acceptance of the reality of the impact of invalidating early environments.

I can relate to that image. I have been unable to understand or feel that I am loved, despite having some very high quality friendships. It is true that the hurtful, rejecting relationships have been the ones that I have gravitated towards over and over again. Again I return to the core belief that 'I am not worth' any better treatment. People wouldn't ask questions about why abused women and children don't seek help, if they truly understood the cumulative impact of experiences which reinforce again and again, that I am less than, that I am someone whose needs don't matter, that I am someone who can be used and abused at will and no one feels is worthy of rescue.

So, given that has been my experience of life, where do I begin with self compassion and self care?

1) Start with the simple things. I began to regulate my sleep. As I practised mindfulness I found that I was able to fall asleep and stay asleep easier. Under the DBT Emotional Regulation skills module, the PLEASE* skills give me a guide to what to do. Sleep is the S of the skill. I don't need to worry 'HOW' practising these skills affects my sense of self worth. I just have to try something different and see if that helps me feel better. P means take care of my physical ailments - so get myself to the doctor when I need to. I started by doing that, getting help with oft recurring migraines - they used to last 3-4 days, happen 1-2 times a month and resulted in me vomiting for at least 48 hours. Getting help with medication which prevents attacks as well as practising DBT skills means that I have only had 2 attacks in the last six months. It doesn't take a brain surgeon to work out that the impact on my emotional health of getting these under control has been immense.

2) Give it a go anyway. Even if I don't think I deserve it - by practising the non-judgemental aspect of mindfulness all I have to do is experience a bath, a walk in the sunshine, massaging hand cream into my hands, putting together an ace playlist for my ipod, watching a favourite TV series in the middle of the afternoon. It took me a long time to lose the guilt, but I kept 'acting' on my plans to treat myself. After nearly two years I am able to take stock of my needs and decide how to care for those needs in any given day. This of course needs to be balanced with using other times to care for others.

One of the difficulties of being introduced to DBT Skills in a group is that not every exercise or suggestion suits every member of the group. Having said that, if I am to find what works for me, I need to get over myself and give things a go. This is one aspect of DBT Willingness, which I understand better as a willingness to engage fully with the world and people around me. My therapist asked me to try saying 'I love myself so much' using Miss Piggy's voice (remember I enjoy drama - it was tailored for me as an exercise!). This made me less fearful of the emotional power of the words and has allowed me to keep trying to say it for real - as I have said earlier - still working at it.

3) Do what you can. Initially I found it difficult to look after my health by way of my diet. So much emotion was carried in my relationship with food. I have been obese for some time, but it was only when I had been out of therapy a number of months that I decided I was ready to do something about it. I needed to build up my ability in using other core skills such as mindfulness, long before I was ready to deal with my weight. Be realistic about what you can do. Care for yourself in basic ways such as sleep, enough water and regular meals before you try to tackle things you have used in the past to help you cope with your emotions, like smoking, overeating etc.

4) Accept any help on offer. Lack of self care results in avoiding asking for help from others OR it results in me becoming so ill that I have no option but to rely totally on others for my care. There is nothing more strengthening that being able to ask for help, knowing that I have made the decision and I know how such help fits in with my own plan of self care. Having decided that I needed to feel fitter I asked the GP about help with diet and exercise. I am so glad I did because I need additional support to keep going - in our area there is a Fit Squad which means that if you are suffering from Mental Health issues you can access three months individual support to improve fitness as well as a Food for Thought programme. I've lost over three stone and have ground to a halt - so I need to go back to my advisers and ask another boost of motivation to complete the transformation. Overall, by caring for myself I feel so much better physically and am able to enjoy activities a lot more. In addition because I am practising mindfulness, I am able to enjoy the changes.

The most important thing to remember when embarking on this journey of self care is not to blame yourself or mistaking self care for selfishness. It is not selfish to care for yourself and just because your parents or others have discounted you in the past, you do deserve to be able to enjoy good things. If you keep going with looking after your physical needs, then you will find your emotional needs easier to meet too.

* DBT PLEASE Skills can be remembered as follows:

"P L E A S E M A S T E R."

treat Physical illness
balance Eating
avoid mood-Altering drugs
balance Sleep
get Exercise
build M A S T E R y

I have downloaded the Loving Kindness meditation from the UCLA website (http://marc.ucla.edu/body.cfm?id=22) This again is something which will feel painful if you are starting to work on self care, but over time allow yourself to keep going - non-judgement will be your friend.

I have found these tools on American website and have pinned them on my DBT Pinterest account. They are a good graphic representation giving some ideas about how to begin with self care:

The Morning After the Day Before

Yesterday I did something I don't often do, I started to write this blog post while I was still 'coming down' from an emotional storm. Partly because I wanted to be able to articulate what was going on in my head and emotions, and partly because it is a helpful way for me to make sense of the emotions that were crashing in on me for nearly four hours.

The trigger? I tried to get home on the bus using the Day Rider ticket I had bought in the morning, on my way to a Nativity Rehearsal (I know, that's a whole different story!). Normally, it's a matter of showing the ticket and walking straight on, but this time the driver asked for a closer look before pointing out that the ticket only allowed me to get to a stop at least two miles back from the one where I was trying to get on. It was also another three miles from the correct stop to my home. I had paid the right money, but the ticket was for less than I'd paid, apart from not remotely resembling where I got on the bus and where I needed to go - so my outward journey had been technically without a valid ticket too. Not my fault, not the fault of the current driver either. The only option? Walk the five miles home... so I got off the bus, shame faced.

Suddenly, the relatively benign set of emotions with which I had started my day, neither good nor bad, disappeared in a flood of...what feelings were they exactly? It felt like anger, but towards whom? I know I was frustrated - it is a nuisance - not sure I am the only person who has been missold a bus or train ticket and had to walk home as a result. Behind these (primary emotions) I also detected shame and an overwhelming sense of injustice. Extreme, right? Not if you know me or anything about BPD (Borderline Personality Disorder).

Some days, simple things are difficult. Going to any new place is a trial. I need to know exact routes - my favourite internet tool has to be Google Maps Street View, because this means I can actually do the journey in a safe, virtual world, before I venture out. I have learned to be this prepared for new journeys and modes of transport because the uncertainties of journeys often trigger negative emotions in me. Since having to get rid of my car, I have realised that public transport is a minefield of stressful situations for me. Even on my routine journeys, I rehearse each part of the journey in my mind, and constantly use self soothe music and/or mindful breathing while travelling. I find it difficult that I have absolutely no control over how well the journey goes, how timely it is, or even who or how many I travel with. My bus out from home yesterday actually arrived nearly twenty minutes late. So I guess, if I were to do a Chain Analysis on the triggering events, the meltdown began in that moment of anxiety as I raced to make my meeting up time. The disappointment of finding that a driver had taken all my money and not given me the correct ticket then resulted in an enormous break in my plan to manage myself and my journey.

You see, the sense of frustration would be shared among most people in the same situation. So far, so average. Frustration though wasn't my overwhelming emotion. As I walked away from the bus stop, all idea of 'being in the moment' and 'mindful' of my surroundings (which were stunning in the winter sunshine - something I normally really enjoy) were lost. Instead, I was overwhelmed with a sense of total failure, of thoughts of 'why me?', of a sense of grave injustice, of helplessness and weariness. I am certain that I was feeling despair in there - why does MY life have to be so hard?

In the middle of my 'feeling fog', I managed to think of a friend who sometimes works from home. I phoned. At first, she couldn't make sense of me because she couldn't hear me clearly, nor was I saying what it was that I needed her to do to help me. 'Breathe' she said. I did and for the first time since the incident on the bus, the whirling thoughts and emotions paused.

Together we managed to come up with a plan. My immediate practical problem was solved with the offer of a lift. The emotional fallout, however, has taken so much longer to dissipate.

It took over three hours and lunch with my friend to bring an end to the whirling emotions, initially. I finally arrived home feeling exhausted and wrung out but still battling shame and a sense of injustice.

Shame is probably the most familiar of all my secondary emotions, but what part did it play in a simple mix up over a bus ticket?

Since completing my DBT therapy, I have learned to recognise when I am vulnerable and need to be gentle with myself. However, yesterday the rush of negative emotions took me by surprise. There are a number of reasons why such a minor incident could evoke such a reaction in me. I ended up being agitated and disturbed. What baffles is me is how relatively little the primary emotion (frustration) factored in my resulting distress.

It is now over 36 hours since the incident. I am beginning to make some sense of what was happening with my emotions:

1) Over the past couple of weeks my emotional 'skin' has been thinner. I have been extra sensitive to mood changes. I have limited myself in terms of TV programmes I can 'cope' with. I have also been misreading people's words and actions, interpreting them negatively. During these times I need to be kind to myself. Not to push my limits, particularly on things where my emotions are involved. Small as it was the bus incident felt an enormous disruption to my attempts to protect myself from a flood of unmanageable feelings.

2) Although I forget it at times I am so much better at managing my life and BPD than even a year ago. What this means, though, is that I lull myself into a false sense of security and fail to maintain a weather eye on my moods. There were warning signs last week, that I was more emotionally sensitive and despite using my emotion regulation skills the underlying difficult emotions were not being fully resolved. I didn't totally ignore all of the warning signs, but I did overestimate my current levels of resilience. This has meant that I have tried to do a lot more than my normal routine. Fine if I still had my car, I am realising that the additional time and effort needed to travel by bus actually needs to be factored in by me to my emotional management. As does the fact that most people find day to day life tiring at this time of year.

3) Subliminally I have been absorbing the overwhelming political message about 'people on benefits'. My aim is to be well enough to be able to provide for myself. To be able to buy presents for loved ones without putting myself under financial pressure. To 'feel' like a productive member of society. Problem is, by even allowing that pressure to push me beyond my emotional and mental capacity to cope at the moment is to buy into the lie that I do not contribute. I wish that we as a nation would value people for being human beings, rather than for the size of their income, how hard they work, what they do, what they are, what their status is. Any one of us could suffer from mental illness in the same way that any one of us can succumb to physical illness. I can suffer from BPD and a Flu bug at one and the same time, as the same person. Perhaps, recent noises from some Health thinkers about integrated physical and mental health services is finally acknowledging that reality! As I looked at the bus driver yesterday my shame came from the fact that I couldn't even rustle up the £1.20 to make up the shortfall on the ticket. That and the fact that a full bus looked askance at my lack of funds. I felt as if I had 'BENEFIT SCUM' written in red letters across my forehead.

4) Shame is an all pervasive emotion for me. It is most damaging when it gets out of control and connects with the shame I felt as a child survivor of abuse. The bus situation MUST have been my fault. Like the song in the Sound of Music, my negative voice tells me 'somewhere in my youth or childhood, I must have done something BAD!' The shame I felt in not being able to pay an extra £1.20 (although I had actually already paid for the ticket I wanted!) opened the floodgates to a wave of shame from all the moments when I felt I was to blame for all the pain being inflicted on me.

Secondary emotions are the most problematic of the feelings to manage. This is because, they are often unconnected with the triggering incident. They are so powerful because they are ingrained on our minds, and our emotional responses. A positive emotion such as Joy is the secondary emotion to Happy. It goes deeper, it lasts longer, it has a more profound effect. A joke can make me happy. The love of a child gives me joy. That, I think is how I make sense of the difference between primary and secondary emotions. Both can be triggered by the same event and link into one another. Secondary emotions are rooted in past events and memories, with all their associations. Primary emotions are an immediate response to the present trigger, but they are reignited and fuelled by the power of the secondary emotions.

So, how do I manage shame? The short answer is I only manage it when I recognise it! So I:

a) RECOGNISE and NAME the underlying, more powerful emotion. This means taking time to be mindful and allowing myself to become aware of the feelings flitting across my mind, along with the negative thoughts which keep the triggers to the secondary emotions stoked.

b) If the emotion is SHAME or GUILT. I ASK if they belong to me ie have I done something that I need to remedy in a relationship, work situation, public interaction etc. If so, ASK 'is there anything I can do to remedy the action which caused the guilt/shame? Guilt can be useful if it reminds us to think of the needs of others. If either SHAME or GUILT rightly belongs in the past with someone who has done me harm and who has shifted their guilt onto me, then I try OPPOSITE EMOTION or give myself permission to continue doing the thing that has brought shame - this is a kind of reverse exposure. Why should I feel shame about having a long bath in the middle of the day? Why should I feel guilty if friends do something nice for me?

Yesterday my friend encouraged me to consider with RATIONAL MIND, how much shame belongs to me for being on benefits. We then listed the positive things I am doing to help others when I feel able.

Today, I am exhausted. I can accept that I am not up to great feats of intellect or action. It's ok to give my emotions, as well as my headachy brain time and space to recover. I can also be encouraged by the fact that the after effects of emotional storms are no longer measured in days or weeks, but hours and days.

And....breathe.....I've survived another one. If you need me, you'll find me self soothing and being kind to myself.


(dbtselfhelp.com has useful advice and DBT worksheets to use: http://www.dbtselfhelp.com/html/opposite_action.html)

In the Lion's Den

There are many lions to face in life. The challenges and difficulties that, if left unchecked, could devour me. The most fearsome of these for me and many with Borderline Personality Disorder (BPD) is the one called 'rejection' or, more accurately, 'fear of rejection'. Given that as a child my parents could ignore my needs and, my very presence, it is logical that, as an adult, I will have an almost unshakeable belief that there is something in me which causes people to ignore or reject me - out of hand, automatically, simply because I am me.

So, for me the very process of job hunting and applying for jobs feels like launching myself, bowed and bloody, into the den of the biggest, fiercest of all my lions.

Along with Simba, in the Lion King I proudly shouted 'Hah, I laugh in the face of rejection' as I recently launched myself into the once familiar process of CV writing and application letter preparation. I seem to do this well as I manage to get myself to interview stage quite often, and this is where I meet another of my lions. Hope. If job hunting ends at the application stage, then this smaller, possibly more sinister lion remains sleeping peacefully in the background. However, the period leading up to interview always results in him awaking and growing in stature.

A little something about me. My stuggles with depression and BPD aside, I am an eternal optimist. Hence, year after year, I would put all my efforts into constructing the perfect Christmas, overspending wildly in an effort to reconstruct my dysfunctional family into my version of the 'The Waltons'. So when it comes to any little shred of encouragement ie an invitation to attend interview for a hoped for job, I will become my optimistic twin sister, who has absolute self belief. Sham. All this does is build me up for a fall. Then again, I need to be able to summon from somewhere the wherewithal to keep job hunting and moving forward somehow. I guess this may be one of my flawed coping mechanisms, although I suspect I am not altogether different from most people. I mean if you can't see yourself in the role you're applying for, then how can you possibly sell it to any prospective employer?

So far, so average. The problem for me lies not in this side of the application process, but in the emotional fall out from such investment when I am unsuccessful. Apart from natural disappointment, the million and one hurts from all the rejections of my life add up to make for one massive cold, wet, Trout in the kisser! Along with mental tiredness and disappointment following the delivery of the bad news, the rejection lion roars out his 'told you so's'. I am reduced to a quivering wreck before him. Of course he's right, every time I try to move forward, I am bound to fail simply because that's what has always happened. I mean who would want to employ me, I am after all 'unemployable'. Along with this crushing sense of self defeat, I am also assailed by the roars of derision from Rejection and his pal, Hope, 'ha, fooled you into believing that you could be valued.' Again, the overwhelming realisation that of course there's no point in my ever trying to get a job, because no one wants to have me around them, full stop, let alone working for them.

There I am on the floor of the lions' den, with Rejection and Hope (or as he has now become), his alter ego, Despair, circling me, licking their lips. I have a choice at this point, I can either allow all the missiles coming from the ghosts of my past looking on with glee to keep me down, or I can stand up and face the lions.

It's either this or give up on ever finding an occupation which can provide me with an adequate income. There are enough obstacles to my satisfying any prospective employer, given my history of mental health, without me having to overcome my own emotional and historical 'lions'as well.

This is where my reasonably newly acquired DBT Skills need to be used in earnest. I need to manage my emotional distress, because it is not nice, after all when someone doesn't choose me for a job I obviously had thought I wanted. I need to acknowledge the disappointment and hurt, that's natural and understandable. I need to make myself control the negative thoughts that are my natural default - thought diffusion exercises help with this (Mindfulness). This is where my determination and fight need to begin, otherwise I have no hope of ever re-entering the workplace. I need to learn to validate myself, unlike other rejections a work rejection is not personal - hard when I am in the thick of it to grasp hold of, but I need to remind myself that my skills were not what they wanted. It is not me as a human being who has been rejected. This, again is hard for me, as most of my sense of validation in the past came from being a high achiever in work environments. I could manage my emotions when my mind was allowed to focus on the task in hand. At the moment in my life, I don't need to be validated as a person - I have people who love me who do that. So far so very DBT, reality is that I have to repeat the use of my skills over and over as waves of self condemnation wash over me, followed closely by cycles of anxiety about my future and my ability to provide for myself.

Right now, in between the crash of the waves, I am aware that I'm no longer in the lion's den. I have begun to stumble from the grasp of my lions. The emotional waves that are crashing on me, resemble the sound waves from their roars of derision. I need to grab hold of my bottle of lemonade, and prepare myself for the next time. There is no point in me feeling sorry for myself. Yes, I've had a lot to overcome, yes it feels as if I am due some good fortune, but that's not life as it is. For me to constantly expect that life should be fair, is the real definition of insanity. After all, I just wasn't right for THIS job.

Unlike Burping, Thinking is NOT always 'better out than in'!

You know the moment, that one when the belcher states with satisfaction to the belchee 'oooh, that was better out than in!' Etiquette aside, I think we can all agree there are few things that are more irksome than trapped wind. Enough said. What about 'trapped thinking'? Impulse control has always been an issue for me, particularly when I have been emotionally overwhelmed.

In the past I had a reputation for lobbing conversational 'grenades' into social gatherings. It has been damaging to me and damaging to those on the receiving end. Much of this has centred on two things that I have always struggled with. 1) My inability to read social situations appropriately and 2) My need to find a way of managing the crescendos of difficult emotions. I've come to think of these moments as my BPD having a verbal 'burp'. As with other impulsive behaviour associated with BPD such behaviour was ultimately self defeating and actively prevented me from building sustainable relationships. I mean if your opening gambit is 'Hi my name's Alma, I was abused as a child, how are you?' it's hardly surprising that most friendships ended before they began, with potential good friends stuttering away from me as they headed to the hills.

Such impulses I see as the 'burps' that have arisen from my emotional turmoil inside. Along with my expectation that others should be able to read my mind and that I, in turn, could tell what other people were thinking about me, such outbursts were a way of de-cluttering the mess of thoughts that were running around in my head. I have had to learn to filter myself a lot more, I'm still tactless at times and often say what everyone else is thinking, because I don't always follow the rules of social restrictions, which is not necessarily a bad thing.

The skills that have helped me to do this start with mindfulness. If I take a moment to breathe before I speak, especially when meeting new people, then that allows me time to notice what I am thinking, before I 'burp' it to the outside world, unfiltered.

Other methods I use, especially when I notice difficult memories and thoughts is to use thought diffusion exercises - such as turning the thoughts into leaves or clouds and watching them pass me by without having to articulate or cling onto them. In times when I have needed clear space to do this, I have made my excuses and retreated, literally from the room. Ultimately, if I can remember to ask myself, 'would this thought help me or the others around me if it was on my lips instead of in my mind?' this can act as a useful net to catch any damaging thoughts before they cause any harm. In Northern Ireland there is a saying 'catch yerself on' which basically means, 'would you have some sense, please?' This needs to be a reminder to myself to keep thoughts that are best kept in - in, until I can deal with them appropriately.

A helpful way of bringing this process out of my mind is to draw or create a head with a large circle for the mind and a large mouth. If I can write down examples of thoughts on pieces of paper and place them in either the mind or the mouth, as appropriate, I can teach myself to recognise which thoughts are 'better in than out'. This picture is one example of how someone has used this method to practice filtering their thoughts.

Recovery is not a Straight Line

I've had an interesting couple of weeks. I am facing a lot of change in my life, positive change. The problem is that, in the past, I have struggled with new situations and people simply because my trust in the relationships around me were shaky. It is now nearly six months since I completed the DBT programme and nearly three months since I was fully discharged from mental health services entirely. As with any routines and structures, the skills which have replaced my previous coping mechanisms have bedded in and become habit.

The problem for me comes when I find myself lapsing into old familiar patterns of coping and thinking, and allow myself to go back to the familiar rather than the helpful. After all, I am in the process of replacing over 30 years of self destructive behaviour with skills I have only been practicing for just a couple of years.

As ever, the problems for me have lain not in practical problems. I am currently organising and running a public event, I am more than capable of doing so. However, relationships and my emotional response to them remain a major challenge to me.

One working relationship has been particularly problematic to me. I am used to dealing with difficult people. I guess some would say I am a bit of a challenge myself! I have found myself shocked at how destabilising I have found this working relationship. My concerns grew when I found myself becoming disruptive in a training session. The result was that I have decided not to attend that particular group and to withdraw from that team for the time being. Initially I felt this as a failure - it has been a default response to many situations for me for so long. However, after a couple of days beating myself up about letting the world down, I actually took a step back and was able to reflect on positive steps forward.

1) I recognised that my response to the training was not helpful to my recovery.
2) I took action to look after myself in the situation.
3) I recognised my emotional limits had been reached before I exploded in frustration.
4) I managed to withdraw from the team by using the DBT FAST (be Fair, don't Apologise for being alive, Stick to your values, and stick to the Truth) interpersonal effectiveness skills.
5) I have found a way to continue with my work without putting myself under this emotional stress
6) I have managed not to damage any of the working relationships involved

(This sheet from DBT Self Help website explains in detail: http://www.dbtselfhelp.com/html/ie_handout_10.html)

In the past such interpersonal issues have resulted in me 'behaving badly', often making myself feel really bad about behaving like a stroppy teenager. In the past my self respect has taken a battering as a result of my out of control responses to professional situations.

For a number of days I grappled with conflicting emotions, I forgot to use my mindfulness skills to enable myself to be able to identify and manage the problem emotions in the situation. I was in danger of spiralling downwards. At certain points, I even found myself trying to resist self harming urges. The good news is, with some effort, I was able to use my DBT skills to avoid relapse. More than that, I have been able to manage both myself and a difficult situation. Most of all, I have not been left feeling that I have destroyed working relationships and I am able to reflect on where the difficulties have arisen within that particular relationship.

Incidents like this would have caused crises for me in the past and would have had a detrimental impact on my ability to even be in the same room as people involved. Not good for team cohesion! Although I was tempted to despair of my progress on recovery, I am pleased that this situation has been manageable for me. This is vital, because I am currently in the middle of applying for jobs after more than two years of redundancy. If I am to successfully move back into working life, I need to be able to build up my confidence in using the skills which have been helping me in my personal life.

Life is not a drift through a glassy calm mill pond. At least, my life hasn't been. Having learned skills to manage distress, emotions and relationships, it follows that there will inevitably be situations where I will need to use those skills. I think one of my mistakes which led to me feeling shock at how quickly I felt destabilised was that I had deluded myself into thinking that acquiring the skills in itself would protect me from life's problems. D'oh - I'm with Homer Simpson - when I see it in black and white, of course that is daft. Any skill takes practice - when I was a competitive swimmer there were times when I was training for six days a week. Perfecting the stroke technique, building up my physical fitness, practicing starts, turns, finishes. I didn't really make use of those skills and that fitness until I raced. So it is with managing my condition. There are routine practises which are designed to keep my stability: I need to keep taking my medication, I need to maintain my physical health, my sleep patterns, my eating, mindfulness should be part of my day to day emotional life. However, I will not really know how effective my DBT skills are until I use them in situations which in the past I would have avoided or I would have responded badly to.

Recovery is not a procession, it is part of my life journey. There will be ups, downs, twists and turns along the way. My challenge is not to put my energy into looking back at the things I fear creeping up on me, but to keep my focus and energy facing forward.

An Image for Emotion Regulation and Mindful Breathing

Here is another picture that I use when dealing with difficult emotions like anger, or anxiety.

I use the picture to focus while bringing my breathing under control. I imagine myself in a small boat on the river. I allow it to carry me forward carried along on the river, as I lie in the bottom of the boat watching the sky above with its clouds and beautiful sunset. As I am carried forward on the water I change my focus from my breathing in and out to notice negative thoughts and feelings as they arise, I then change my focus to the clouds floating by above, returning to focus on my breath until it has slowed and become regular. As I notice the thoughts and feelings, I notice as they float up from the boat to the clouds above. I give them the form of words, often with characteristic size, shape and colour, so Anger cna be spiky, red, and large when I first notice it. I then watch the negative feelings grow smaller as they drift upwards away from me towards the clouds until they dissolve completely. As each thought or feeling arises and floats away I watch, then return my focus to my breathing, until I feel completely calm.

It works for me because it helps me to balance control of my breaths along with identifying and controlling the emotions as they arise. Managing to identify and manage the emotion until it grows less intense takes time and practice. Concentrating on slowing down your breathing is a good first step.

Learning to Ride the Emotional Waves

Emotions for most people naturally seem to come and go. Most people experience either euphoria, grief or anger as passing extremes. For me, I get stuck with damaging emotions, experiencing the emotional pain as a groove I cannot break out from. Hyper emotions are similar I find it hard to manage myself in social situations when I am 'up'. I have been known to follow urges to self destruct in an effort to short circuit emotional distress. After these periods of extreme emotion I am exhausted and vulnerable. Unlike other conditions which can cycle between extremes of emotion over longer periods, I can experience the extremes of the swing from extreme grief and distress to euphoria several times in a day. These periods of swinging emotions can last for hours or can last up to two or three days. It is like constantly riding a roller coaster, without any hope of being able to escape from the constant rise and fall of feelings. Feeling sick (a lot of the time physically) over and over with the constant, sudden changes in mood. My overall experience of life has been lack of control.

It was a revelation to me when I was told during DBT skills group that my moods were not constantly either up or down, that they actually come and go, more swiftly than I thought. For anyone who struggles with emotional dysfunction this seems to contradict the day to day experience. For me, the distress I felt was so overwhelming that it felt as if I was experiencing my feelings as emotional 'white noise'. I cycled constantly through distress, relief, exhaustion so rapidly I was unaware of any distinctly identifiable feelings.

I worked for some time with people who struggled with addiction to Class A drugs. I learned a lot from them about the extremes of cravings and the need to give in to the urge to use their drug of choice. One of the skills they learned was to 'surf the urge'. I could not imagine at that time the extremes of the pain of their cravings. However, as they developed the urge surfing skills a number of them would talk about the moment they realised that the height of their cravings was relatively short lived. Of course managing Class A drug addiction takes a lot more than the realisation that cravings are not actually constant even if it feels like it. But it was a small step in helping those who were ready to regain control from the ravages of their addictions.

It is not an exact parallel but for those of us with a diagnosis of Borderline Personality Disorder (BPD) the realisation that the extremes of our emotions do not have to be out of our control, is also a key moment in recovery. In DBT the Emotion Regulation Module includes the skill of 'surfing the emotion wave'. For me this skill has been all about first recognising that the fast cycling of emotions can be slowed down. I no longer see myself under a constant cloud of unidentified emotional mists.

There are a number of steps towards 'surfing the emotion'. Here is how I see them:

1. I press the 'pause' button. Using Mindfulness I focus on what is certain around me. 'This is a cup of coffee, I can smell, it, I can notice the warmth spreading to my hands from the mug, I can enjoy the sensations and taste as I drink it'. I allow myself to use my senses, I take the time to experience what I am doing in that moment, noticing my feelings, but not allowing myself to get stuck with them. I also slow myself down by using breathing skills. Either deep breathing focusing on my lungs, the rise and fall of my tummy. In these ways I take my mind away from trying to analyse feelings which cannot be rationalised and simply focus on what is certain. Grounding myself in my surroundings.

2. Once I am able to focus on my breathing or on my surroundings, I try to name the feelings. Often the most immediate feeling is not the problem. My main problem is when my immediate emotional response to the present trigger connects with feelings about and from my past. Often these historic feelings are painful and linked to past traumas. I need to be able to separate present feelings from those from the past. If I can name my 'enemy' I have a better chance of winning.

3. Accept that 'this too will pass'. No matter how I feel about the intensity and life of my feelings, they don't last forever. And there is a rise and fall in the intensity. Again, using mindfulness exercises which allow me to observe my feelings without losing control, helps me to notice and observe the rise and fall of the feelings. They do come in waves. If I can survive the 'crest of the wave' for a time, it will ease. This is a safe place visualisation I use when I need to calm myself and cope with waves of intense emotions: It's a You Tube video, https://www.youtube.com/watch?v=pPBxNLpOLNU

4. Sitting with the emotion. If I recognise that the feelings are not permanent, or that they don't have to remain as painful all the time, I can then allow myself to learn that no matter how painful, they cannot kill me. Sitting with the emotion has so often been the last thing I have wanted to do. However, DBT acceptance skills tell me that trying to avoid or push away the emotions will not help in the long run. In a sense I need to allow the wave to wash over me, in the knowledge that I will be safe and once the wave has receded I will still be standing. Again, the ability to allow myself to feel the emotion is a mindfulness skill. I use a mindfulness visualisation which identifies the feeling, then gives the feeling a visual form in my mind. As I breathe through the waves of emotion, I return to my image of the feeling and observe it. I continue to switch focus between my surroundings and my image of the emotion until finally I can observe it grow smaller and disappear. There is a version of this in The Dialectical Behaviour Therapy Skills Workbook (2007, McKay, Wood and Brantley - New Harbinger Publications, Inc).

5. Another way of managing the wave of emotion is to listen to classical music. Popular music is not complex enough, I feel, to be able to help ride the emotion wave, although I do listen to pop music as Opposite Emotion exercises. However, movements from the classics have shades of emotion. They rise and fall, the orchestra builds to crescendo then dies away. Allowing myself to focus on the rise and fall of the music, allows me to naturally fall into the concept of waves. Once I am comfortable I can connect my emotions in a similar way and allow them to rise and fall along with the emotions. I have explained a bit more about how this works for me in this blog: http://bpdlifeinthemoment.blogspot.co.uk/2014/07/my-dbt-classical-music-playlist.html

I have found these explanation of the DBT Emotion Wave helpful too: