Today’s the end of the first week of group, and I think it’s gone pretty well. One of my favorite things that I’ve learned this week is about the DBT mindfulness scale, also known as the subjective units of distress scale. Like I mentioned previously, the basic components of DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The idea with the DBT scale is that everything is mindfulness, and depending on where you are on the distress scale, you implement different skills. When you are at a 1-3, you are able to be mindful of others and yourself, and you can use interpersonal effectiveness skills as you interact with others. As you go up on the scale, from 4-7 units of distress, you need to focus a little more on yourself, and you use the emotion regulation skills to help regulate your behavior and calm yourself down. However, once you get to an 8-10 on the distress scale, you’re only able to be mindful of yourself – your mind is entirely involved with your own emotions, and you’re unable to be mindful of others and your interactions with them. At this point, you need to use distress tolerance skills to just survive the moment. This is not the time to try to interact with others, and this is not the time to try to use emotion regulation skills, which may seem counterintuitive. But the key with emotion regulation skills is that you need to be able to think clearly to use those skills, and when you are such extreme distress as with an 8-10 on the distress scale, you’re probably no longer able to think clearly such that you can’t really use the skills. This is the time to just hunker down and try to ride the wave, until you are back to a point that you can think clearly to use your emotion regulation skills.
This scale has been enlightening to me because it has helped me to see what skills are appropriate for different distress situations. Previously, I have tried to make decisions that affect my relationships while in extreme distress, and I’ve also tried to use common emotion regulation tools when at a 10. Obviously, those decisions did not go well for my relationships, and I’ve gotten frustrated and wondered why the emotion regulation tools weren’t working. It has helped me to realize that when I am in that extreme of distress, which, for me, is actually not very uncommon and in fact is relatively frequent, what I need to do is to work on riding it out and learning how to tolerate such extreme distress. Since this is only my first week and we’re on the emotion regulation module right now in the program, I don’t know too much about the distress tolerance skills, but I do know that when in that crisis mode, you can and should only have deeply trusted individuals in your inner-most circle help you through those times. My one concern is for what I should do since my extreme distress/crisis situations can and often do last a lot longer than the average person’s – mine can go for months while the average person’s probably last for a few hours, maybe a day at most. It’s really difficult to “ride the wave” when it’s a tsunami that demolishes everything in its path, but maybe there will be a way and I will find a solution to this problem.
Yesterday I met with my IOP individual therapist. I’m keeping my private psychologist and seeing him once a week while I’m in the program, but I’m also assigned an individual therapist as part of the program, and I met with her yesterday for the first time. She was really sweet but also seemed pretty practical, which I liked, and I think she’ll be able to help me accomplish my goals in the program and that we’ll work really well together, so I’m looking forward to it. I told her a little about my background and some of the struggles I have, particularly when it comes to close relationships and especially in the context of what I like to call my “BPD meltdowns”. We talked about how I often keep people at a distance, but then once I get really close to someone, it’s like I suck onto them like an octopus and end up feeling really dependent and also very easily feel rejected or abandoned by even the slightest thing. I’m so sensitive to everything they do – the slightest positive interaction will leave me soaring, and the slightest negative interaction, or even a neutral interaction, will leave me in the deepest pits. We also discussed how sometimes I end up feeling like I’m in an emotional whirlwind with my mood, and like I’m totally out of control, and that things that seem logical when I’m in that state I look back on weeks later once I’m out of it and realize that the behavior was totally irrational.
This week I also had my regular session with my private psychologist on Wednesday and it went really well. This time, we discussed what factors contribute to me ending up in the emotional hurricane, as well as what factors contribute to me getting out of it. I started off the conversation asking him about that concern I just mentioned – what do I do when my extreme distress can last for such long periods of time? He responded by asking me what happened for that “hurricane” I was in throughout December through February to end, and I think the answer is that I stopped working. I realized that the main problem is that work is so exhausting for me – having to show up consistently no matter how I feel, having to put on a show and act a certain way while I’m at work – that when I get home I just have to spend the rest of my day recovering in order to be able to show up to work the next day. I stop being a person – I can’t cook, I can’t eat, I can’t work out, I can’t do my hobbies, I can’t do chores – all I can do is go to work, recover, rinse and repeat. The weekends are a little better for me, but only by a little, because I mostly spend the weekend resting and preparing myself for the coming week, and it really only leaves me a few hours to do things, which tend to be chores like grocery shopping or laundry, which as my psychologist said, is depressing, in and of itself. In addition to that, I feel like I have to go to work because all of my healthcare is based off my job – I have access to my providers and my medication and my treatments all because of my health insurance, which is provided through my job, and were I to lose my job, I would have to start paying for all of these things, which would end up being thousands of dollars per month, which I couldn’t afford even with an income, much less without one. Because of this, I feel like going to work is something I am forced to do, instead of something I wake up and choose to do each day. And I have to save my PTO days (we don’t get sick days at work) for the days that I am so depressed that I can’t go to work, which is both inconvenient and looks bad from the management perspective, because all of my days off are days that I call in and need coverage unexpectedly, instead of putting in those days off days, weeks, or months before so that they have adequate time to find coverage. All of these things result in me feeling like I have no autonomy in my daily life.
As we spoke, I realized how important autonomy is to me. A few weeks ago, I had come to the realization that the main reason suicide has always been so attractive to me is that it has seemed like the only choice I have when I am in a life that doesn’t feel like my own. I first started having suicidal thoughts when I was around seven years old, maybe eight, and I remained suicidal throughout my childhood and adolescence. I think the main reason this is the case is that I felt trapped in my abusive household, forced to do things that weren’t really my choice, stuck in a life on loop, and the only choice I felt I had was whether or not I lived. Like, maybe I don’t get to choose my parents, maybe I don’t get to choose what happens in my life, maybe I don’t get to choose what I do throughout my day, but at least I get to choose whether I am alive or not for it. It also partially explains why I’ve lived this long, despite feeling suicidal since a young age – sometimes I truly want to die, but a lot of the time I just feel trapped and feel like it’s my only way out, the only choice I get to make, and I’m desperate for even that terminal bit of autonomy. My psychologist says it makes sense why autonomy is so important to me – growing up I didn’t have much of it, and the desperation for autonomy is probably largely a trauma response.
Some of the other things that have been food for thought from IOP are: 1) replacing “but” with the word “and”; 2) we can care about another’s pain without taking on the other person’s pain; 3) secondary emotions tend to happen when we invalidate or judge our primary (initial) emotions, and they often cover or mask our primary emotions; 4) whether we need to be able to empathize with another person, to be able to fully relate to what they feel, in order to connect with and care for them; 5) fighting and not accepting our pain/sadness/negative emotion will only extend the suffering we get from it; 6) maybe it’s okay to feel small, and maybe I need to learn to be okay with feeling small; 7) is the resentment that often builds up in our interpersonal relationships towards others, or maybe is it actually towards ourselves; and 8) being happy, having emotional health and well-being, might be the real goal and accomplishment that we should seek after, not some sort of outward, success.
With replacing the word “but” with “and”, it’s about realizing that often two things are true at once, even when they seem opposing. When we use the word “but”, we are saying that only one of the two things we’re talking about is true, while when we use the word “and”, we are indicating that we realize that both of these things can be true at the same time. This is important and the principle of dialectics, the core concept behind Dialectical Behavioral Therapy. I thought this was really insightful, and it’s something I would like to incorporate more into my daily life. I think it will help me be less judgmental, both towards myself and others, and decrease the amount of emotional turmoil I feel over certain feelings or situations.
2 and 4 are related – we were talking one day about the word sympathy and why it’s important – it emphasizes that we can care about another person’s pain without it becoming our own pain, and that stuck in my mind. One of the struggles in my family’s dynamic is that one family member’s pain often ends up becoming everyone’s burden, and I’ve been learning already that that is really not healthy, and is indicative of relationships that are too enmeshed. I think it’s hard for me to accept that it is okay to care for another person’s pain without it becoming my own burden that I feel like I need to fix or solve. Now that I think about it, maybe it’s the case that seeing other people in pain triggers something in me from my own trauma, and then I take it on as my own and try to fix it. Maybe if I healed my own trauma, I would be less compelled to save other people from their pain.
I was turning this idea of sympathy over in my mind today when I realized that maybe, it’s not always necessary for us to be able to fully empathize with another person. When I think of empathy, I imagine placing myself in the other person’s shoes and imagining how I felt when I was in a similar position. But what happens when I’ve never been in a similar position? What if what they’re describing isn’t something that I can relate to? I realized that maybe that it’s okay when that is the case, and that I don’t have to be able to place myself figuratively into a similar situation in order to be able to connect with them in the moment and care for them. And perhaps the care that I can give isn’t the best care available, and maybe I won’t be able to provide what they need, and I want to learn to be okay with that. I think that this is also a trauma response for me – in the past, not being able to fix the problem or provide the best solution to my parents’ problem meant that I was in danger. But I’m not in that situation anymore, and perhaps as I heal from my trauma, over time, I will stop feeling like it’s so important to be all things to all people. Maybe I will be able to come to terms with the fact that I am a limited human being, with limited capacity and limited experiences, and I cannot solve everyone’s problem or connect with every person in every situation.
For those who don’t know, primary emotions are the emotions we feel in direct response to some sort of stimulus or trigger, whereas secondary emotions are the emotions we feel about those emotions. For example, maybe you feel rejected or abandoned, but then you feel anger about feeling that way. The feelings of rejection and abandonment would be the primary emotions, and the feeling of anger would be the secondary emotion. The important thing with secondary emotions is that they are often problematic, and can exacerbate our pain. Secondary emotions tend to happen when we are judgmental or invalidating towards our initial emotional response, and doing so will tend to extend our pain and make it worse, as I mentioned in point five. Additionally, when we have secondary emotions, they tend to cover up what our true emotions are, and we might even mistake our secondary emotions for being primary, which can cause problems for ourselves and with others. For me, I don’t like feeling small, and in response will become angry and even mean towards other people for making me feel small, which can lead to me making a poor decision or saying something that I will later regret or perhaps don’t really mean. I think it’s important for us to understand this, because it allows us to really be mindful of how we are actually feeling, shorten the amount of time that we suffer through those negative emotions, and prevent us from doing something that we wind up regretting later on.
Speaking of feeling small, today I heard something that I found really interesting, which was that someone said something along the lines of “A lot of people aren’t okay with feeling small”, and it was really enlightening to me because I had never considered that there were people who ARE okay with feeling small. And I realized – maybe it is okay to feel small. We are not supposed to always be the biggest, most powerful, smartest, etc., person in the room, and it is okay to realize that and feel smaller than another person who might be more successful, or smarter, or more famous, or more connected. And if we make peace with feeling small, then maybe this will open the door for better, more meaningful conversations and interactions with the people who feel bigger than us. It would certainly cause less problems for me interpersonally, as I tend to lash out whenever I feel smaller than someone else. And if we’re okay with feeling small, then we are better able to take that opportunity to learn from someone else who might be bigger, more powerful, more successful, more knowledgeable, smarter, etc., than us. If we learn to see being smaller as an opportunity, rather than a threat, and rewire our brain chemistry to realize that we are not necessarily always in danger when we feel small, then perhaps this will set us up to be more successful, both internally and interpersonally, and will allow us to be more confident because we realize that it is okay to be small and feel small, and that our worth is not dependent on how we feel.
This then leads into my last point about what the real goal in life should be. We talked today in group about comparison, and how we often feel like we are not doing as well or are not as successful as our peers. We always feel like we should have done more, accomplished more, whether it’s making more money, being higher on the career ladder, getting married, having kids, buying a house, whatever. But as we were talking about it, I realized that maybe the real accomplishment these days is emotional health and well-being, not some outward accomplishment that you can post about on social media. Because at the end of the day, those outward accomplishments are not going to be what makes you happy. Being married unhappily, being unprepared for children but having them anyways, being depressed but making millions, working 18-20 hours a day after being promoted – none of those things are going to be what contributes to your overall happiness or to a life well-lived. It is our emotional growth, health, and wellness that will actually fulfill us, and maybe if we stopped comparing ourselves based on these external metrics and instead checked in with ourselves internally about where we are in our emotional and spiritual health, then we as a generation and a society would be less depressed and anxious as a whole.