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.

Keeping it in the Here and Now

In this blog I've written about the 'time travel' problems caused by dwelling in the past or trying to guess the future.

Core Mindfulness skills are a set of skills designed to bring my thoughts and feelings into the here and now, in order to free me from the pain and distress of the past, and the anxieties and fears for the future. This challenge for the emotionally sensitive person is similar to that of 'mind reading'. I constantly make assumptions about what other people are thinking about me, mostly because I am mixing them up with people who hurt me in the past.

When I am feeling vulnerable I am at risk of slipping back into the past and reliving its hurts or of shifting myself into the future in anticipation of those hurts and injuries being repeated. Any thoughtful examination of our existence in terms of time and space tells me that the only time and space I am capable of occupying is the space around me right now and the present moment, as I am aware of it. When I dwell in the past or future in my thoughts, then I allow the present to slip past me unheeded and unlived. So, I need to use all of my senses to remind me of the good things in the here and now and, slowly, as I heal to begin to enjoy them for what they are.

This picture captures the essence of life in the moment. It was shared on Pinterest by Healing for BPD and I have found it helpful in reminding me to use my mindfulness exercises when memories from the past or fears about the future flood into my mind.

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.

Webs of Care

Since I started treatment I have come across requests from researchers for service users to take part in interviews about different aspects of the treatment received. Recently, I received one such request specifically looking at the discharge process from Dialectical Behaviour Therapy (DBT) and how I experienced it. It has made me reflect on my experience and consider questions such as, was this ending easier than previous endings in my life? How come I have found the removal of formal support easier to navigate than others I have spoken to?

On reflection there are a number of factors that have worked for me:

1) I had become very familiar with the Dialectical Behaviour Therapy model a couple of years before I was even diagnosed with Borderline Personality Disorder (BPD). After my diagnosis Marsha Linehan's theory that my symptoms had developed as a result of the confluence of biological and social factors actually made sense to me when I looked at my life story. This gave me confidence in the therapy when I was finally offered it. Because I had read Marsha Linehan's book behind the practice, I also understood the rationale of the skills training and one to one elements of the treatment.

2) From the beginning the message was consistent within the group and individual sessions that DBT would not and could not offer me a cure for my emotional distress. The first six months involved a process of me learning the skills to 'accept' the fact that I could not change the roots of my symptoms, but I could learn to manage the most damaging behaviours I had developed in an effort to survive my life. In addition I learned that I could also learn skills to help me manage the emotions behind the behaviours, no matter how distressing or painful they may feel.

3) Developing the ability to use DBT skills outside the group and one to one settings is a major objective of the therapy. So homework was central to the success of the therapy for me. I was shocked in talking to others with similar ages and symptoms who had undergone different therapies that their overwhelming feeling when approaching discharge was that of 'losing their family'. I have managed to build up a growing group of friends outside my therapy group so that, at discharge I did not fear that my whole social life was ending too.

4) Most significantly I recognise that throughout my life I have had strong webs of care. There have always been at least two or three significant relationships during periods of extreme crisis which have provided sufficient safety to prevent me from ever being admitted as an inpatient. This meant that I did not have this hurdle to overcome. If my place of safety becomes my default rather than a last resort, then my behaviours will centre frequently around accessing that place.

A Few Things to Consider about Weaving Webs of Care:

A) The isolation caused by mental illness means that at the worst of times we can be hanging by one slender spider thread. However, if you take time to observe spiders in nature, or in my lounge at the moment, that single thread is more than strong enough to hold the spider, no matter how high the ceiling. For me, many times in my life my single spider thread holding me up was a barely perceptible faith that I was held by a God who was capable of coping with my outbursts and emotional pain. In those times I didn't want any complexity to my relationships just a sense that something or someone was holding onto me. For a lot of BPD sufferers that one thread becomes a human relationship, either personal or professional.

B) At some point all therapeutic relationships need to end, if they are to effectively create independent functioning people. That means that the single central thread needs to be woven into a growing network of relationships. I started with two friends, one of whom had known me for over twenty years and, significantly, my pets. I could trust myself to look after my pets without being judged and my friends were close enough geographically to help me build routines - consistency takes time and repetition. In the beginning these relationships were practical and centred on meeting basic needs like walking the dog, making sure I was looking after myself and offering me meals. They didn't overwhelm me, but on more than one occasion they were able to step in when hospital admission might have been the only option and offered me a safe place and a bed for a couple of nights. These friendships were an essential part of my care plan and fitted together with the professional relationships I had.

C) As I developed DBT skills I was encouraged to look outward and to participate in the wider universe. By volunteering on a limited basis I developed a wider web of caring relationships and contributing to the needs of others. Apart from distracting me from my own distress this allowed me to enter relationships gradually rather than me launching myself at people and leaving myself psychological naked having given too much of myself away. By widening this circle of relationships I took pressure off the therapeutic and my central, close relationships. One mistake I had made in the past was putting my 'eggs in one basket' and investing all my emotional energy in one relationship. Inevitably, on both sides these relationships would implode with the pressure I placed on them. It takes a village to support me.

D) Usually, volunteering introduces you to wider communities. I became a part of a local community so there are webs of people who are acquaintances but who bring to me different gifts. Each relationship holds in it potential to either hurt or help, but because I no longer invest in all or nothing single relationships, if someone in the other layers of web hurts me, the stronger more central relationships that I have come to trust have the capacity to hold me, not simply because they are strong, but because I am also capable of using my DBT Interpersonal Skills to manage the normal ups and downs of friendship and caring relationships.

I have searched on-line for a web representation - my drawing is rubbish. This one crystallised for me how far I have come in developing networks of people who form my supportive relationships. It helps me cope with life and those people who would drain or hurt me - they will always be there, but they no longer have to have the power to drag me down. As I've grown stronger and started recovery I'm able to include some renewed friendships and family relationships that I can now manage and vice versa. It's a helpful exercise. Here are some things to consider as you fill it in or create your own web:

Ask yourself: 'Do I have a web of care?'

* If the answer is yes, put people into your web and show their importance and closeness to you by how near they are to you at the centre of the web.
* If the answer is no, ask yourself what is the single relationship that you are holding onto, it may not be human. Then honestly consider friendships that may have slipped - are they lost forever? Or could you get back in touch?

* If people scare you, consider swapping them for pets. My first pet was a hamster given to me by a friend at a time when a lot was going wrong - that wee chap really lifted me and gave me a focus outside of myself - a break from feeling emotional pain.

* If you have a good relationship with your CPN, Support Worker or Therapist talk to them about how you could find other webs of relationships to weave into your life. Taking advantage of the NHS Activity for Life programme has opened up the local leisure centre as a place where I can meet with people without any expectation of me emotionally. If I get to know people better (which takes time), then that's a bonus.

Above all remember, no matter how lucky you think others are with their partners or families and friends; it is still possible to be lonely in a crowd. Building quality rather than quantity takes time and not a little bravery.

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.

Self Compassion and Knickers

Something has changed in me. I am slowly learning to be kind to myself.

Growing up in invalidating environments over time sucks all of the self worth and self compassion from the child until the adult emerges, uncertain of their feelings about themselves, the world around them, and their own intrinsic value as a human being. Rebuilding who I am from the wreckage of my childhood has been a long, slow process. Much of my self destructive behaviour in the past has its roots in feelings of self loathing born of the consistent invalidating messages of my key relationships as I grew up.

Invalidation has many forms, from the simple act of ignoring or discounting the voice of the child to the acts of abuse which say that every part of who I am is so worthless I can be used and abused at the whim of others. The distress and pain of these experiences takes a lifetime to emerge from. Perhaps, if you are in a relationship with someone who has suffered in these ways, you recognise the gaping emotional void, that you feel you are expected to fill.

In rebuilding my life I am in a long term process of learning to validate myself, of valuing who I am, of first of all accepting who I am. In the experience of Borderline Personality Disorder, one major building block of the personality, the sense of self, is damaged. I need to build relationships which patiently reflect back to me the value that others find in me, without me seeking to grab hold and cling to those relationships, or create the self fulfilling prophesy of rejection by my demands.

This means that boundaries, time and trust building are pre-requisites to any level of relationship for me. I used to be a 'hook line and sinker' committer to friendships and relationships. They burned bright and short, and always ended traumatically with major drama and self destruction. Given the emotional void within, this proved overwhelming to most who became involved with me in the past and I have lost many friends, and boyfriends in the process, confirming my lack of worth. 'No one can love me', was my mantra, or 'I am not worthy of love'. And my life was a process of confirming the 'truth' of those beliefs. Given the invalidation I have experienced from so many, including my own mother, over such a long period of time, these kind of thoughts and patterns are understandable.

In the end, having been rejected one time too many in 2000 I gave up on all human relationships. Life was safer that way. As I have gone through treatment and learned DBT interpersonal skills which take account of my invalidating background I have learned to set boundaries for myself. In essence I have learned to protect myself. This again is something which for the invalidated person is not natural. After all, I have to believe that there is something of value in myself to be protected. I have learned to articulate when I am not happy about situations - appropriately. In the past, I have not felt able to voice my needs, so anger at the world has built up until I have exploded at whoever is nearest to me. Not very pretty. It was a revelation to me that people can be interested in listening to me when I speak up about something I feel is wrong. That has taken time.

I realise that, as I keep moving forward and taking small steps, there is one range of skills that are critical in helping me repair and learn to build relationships. Self Compassion is essential to my ongoing recovery. It begins with the simple basics of looking after myself - the DBT PLEASE Skills (treat Physical iLlness, balanced Eating, off mood Altering substances, balanced Sleep and Exercise) and moves on to Mastery of those skills. If I feel I am worth the basics of eating, sleeping etc, then that is the most fundamental way in which I can care for myself.

As I have started to feel better about managing the swings up and down of my moods, I have been building up my mastery of these day to day necessities. This has now extended to my environment and I feel I am on top of my housework and have a reasonable living environment.

So where do my knickers come in? One of my responses to my childhood has been to hide away from who I am at heart. I am a sensitive, creative, articulate person. I love good things. I actually love feeling feminine. However, as a result of people disrupting my sense of my own sexuality and sensuality, I have swamped myself in tomboyish clothes and behaviours, which protect me from others by denying that I might be attractive to others physically. In essence I have tried to express myself as an asexual being. It has been safer that way, or so I thought, although this hasn't stopped perpetrators assaulting me as an adult, so maybe the fault is theirs. This is an essential building block of self compassion: I am not to blame for the wrong behaviour and damage done to me by others. There is nothing that I need to punish myself for. My bad feelings about myself are not accurate or reliable. When I do wrong, I need to do something to make a repair to those I have wronged. But feeling ashamed of myself simply because of what I survived in my past, will not achieve anything and serves to keep me trapped in the pain of the past.

At the risk of being accused of 'too much information', in the past six months, I have started wearing really nice underwear. I enjoy being feminine. I love perfumes, bubble bath, pampering, and the feel of silk against my skin.

I wore a skirt last week for the first time in years along with my favourite perfume and accessorised with jewellery, handbag and boots. 'elegant' was one word used to describe me. With a shock instead of dismissing the compliments, I accepted them, at face value, no critical analysis or suspicious thoughts about the motives of others. It helped that I had had nearly two hours pampering at my hairdressers and he had given me a new sleek haircut which he felt matched what he saw in me - or so he told me. I have a great relationship with him and trust him with my hair! I felt really good about myself and it was not a mask. I've done that too in the past. Because it began from how I felt about myself inside, moved on to my underwear to the outer shell of my clothes.

Learning to love myself is still a new skill in my arsenal. It has had to start with small things like getting help from the GP when I feel ill. The pressure is no longer on me to achieve in my working life, driven to try and find the validation that was missing from my childhood. I don't need to be in a 'successful' relationship to be a person of value. I am enjoying doing the things that give me satisfaction in life. I am able to feel that I have something to offer the community around me and I am free to accept the gifts that they offer me, in return. I think I'm actually ok and I do deserve that really nice lingerie set. Gives me a whole new reason for my 'secret smile'.

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: