DBT chat

Once again, I wasn't able to post a summary from last week's chat right away, and then I got bogged down with work. So, here I am again. I think that I will need to change the day and time for this chat. Hopefully to a time when I can stick around and get a summary posted and not have to rush off. I'm thinking Monday night or Tuesday morning might be my best times. What about either 11 p.m. Monday, or 10:30 a.m. Tuesday? We seem to be pretty chat intensive at the beginning of the week. I think that I will also start a social group for DBT discussion, so if you are interested, look for that too.

On Thursday, we talked about balancing the various DBT skills to find your best option for a situation.

The author of the website, DBTselfhelp.com , feels that we need to have emotion regulation and distress tolerance skills first, before learning interpersonal effectiveness. She does have a point, but I disagree because I'm seeing a tendency for people to lean towards accepting painful and abusive situations, and trying to tolerate them or change their own emotional reaction, without trying to change the situation and/or environment. If you are borderline, you probably grew up being taught that you can't do anything about it anyway, and how you feel about it doesn't matter, so this response makes sense given that kind of upbringing.

Still, we don't have to put up with environments like that, or let people treat us like that anymore. Interpersonal Effectiveness is hard to learn when you haven't learned it before. But you really can do it. Practice it, a lot, especially when you are not too stressed about something and you can take your time to stop and think through the steps to use the skills. I'm not going to repeat DEAR MAN here because it is in an earlier post, so I'll encourage you to go back and look at it and keep practicing it as much as you can. You can add to it with GIVE and FAST. (a few more things to develop and attend to in your interactions).
http://www.dbtselfhelp.com/html/ie_handout_9.html
http://www.dbtselfhelp.com/html/ie_handout_10.html

So, do focus on changing what you can, using these skills. There will still be things that we can't change, crises that we just need to get through, and our emotional reactions to whatever is going on. Sometimes even though we are asking for and working towards change, it just doesn't happen right away. These are the times to use Distress Tolerance and Emotion Regulation.

Just like in the Serenity Prayer. God grant me the serenity to accept the things I can not change, the courage to change the things I can, and the wisdom to know the difference....

When the most important thing, for the time being anyway, is to get through the crisis or morment or discomfort, Distress Tolerance skills are useful.

http://www.dbtselfhelp.com/html/dt_handout_1.html

Going back to Emotion Regulation, the first step is to understand and accept the emotion nonjudgementally. You would focus on the emotion and work through it and then decide if you want to try to change it. We will talk more about that.

Distress Tolerance is more like escaping from whatever is hard to tolarate. You might focus on something else, like your breathing, or whatever you can think of to distract yourself. Or you can focus on how you would like things to be in the future. And we'll talk about this one more too, but if you look at the link, there are some options. This is more of a brief introduction, as in the chat we realized that we still needed to focus more on the other skills first.

I'm sorry to announce I won't be able to do the chat this week, at least not on Thursday. I thought I could make it work, but I have a meeting in the morning I have to get to, and I won't be able to manage both. I can do the chat on Saturday morning, same time (10:30 Eastern) if you like.

I'm not sure if anyone is coming for a Saturday morning DBT chat, but I'll plan to be there and see who shows up. There is a poll in General about the best time for DBT chat. If you haven't seen it, and if you have a preference, please chime in. I'd like you to be able to come if you want to.

I'll show up... if I'm up. I tend to sleep pretty late on weekends... as much as I shouldn't!

Thanks for coming, all who did.

We talked about Emotion Regulation. I presented a model for describing emotions, which I didn't thinik was online, but I did find a good explanation for it:

http://www.dbtselfhelp.com/html/describing1.html

Also, there are probably only about eight primary emotions (anger, sorrow, joy, surprise, fear, disgust, guilt/shame, and interest), but there are many complex emotions which are learned or are combinations of these or maybe emotions plus some kind of action.

Primary and Secondary Emotions


There are primary and secondary emotions. The secondary emotion is the one that follows the primary or first emotion, for example, feeling shame because you got angry. Anger is the primary emotion, and shame is the secondary emotion. A person can get angry for being angry, or depressed for being depressed, or angry for feeling fear. In these three cases, anger, depression and anger are the secondary emotions.

It's really important to be able to tell which emotions are the primary emotions and which are the secondary emotions.

Neither the primary nor the secondary emotions are good or bad, but to get back to the original problem and work on solving it, it is necessary usually to deal with the primary emotions.

Try to think of a situation where you experienced a primary and then a secondary emotion. For example: A close relative died. I first feel grief. That is my primary emotion. Then I feel ashamed because I feel so sad. Shame is the secondary emotion.

This can be hard, because the switch often happens very fast. If you feel an emotion, look at your emotion and see if there is a primary emotion behind it. We will come back to this later.


Exercises


There are two Kinds of emotional experiences
Reactions to events in one's environment
(being criticized, having a loved one call on the phone, losing a game, etc.) Inner reactions, primarily reactions to one's own thoughts
(guilt about feeling angry, shame about not doing well at something, fear about something anticipated or thought about)
How have emotions acted in your lives? Helpful? Hurtful?

Once again, I just can't manage a chat Thursday morning - have to get to work earlier. How about Saturday? 10:30 Eastern Time

Great! looking forward to it. many thanks

I am taking one of these in real life. It's about coping skills. It's a 27 week class. I'm really excited about it, though it just started two weeks ago I believe it will be very beneficial in helping me balancing out the extremes.

=)

We have moved the chat to Tuesday. Sorry for the confusion, but I will be consistent from here on. I'm late today because it was raining and my son needed a ride to school. I'm in the chat room now. I also need to post a summary from Saturday morning.

Ok, I've been promising summaries and getting bogged down with other stuff and not getting a round tuit.

We have continued to talk about emotions, and how complex they are, and how breaking it down into smaller pieces makes it more possible to understand emotions. And you have to understand them and accept them for what they are, before you can change them.

Marsha Linehan says, ""If you don't accept that your tire is flat, you're not going to be able to change it."

There are only about eight or so basic emotions (such as Love, Joy, Surprise, Anger, Sadness, Fear, Guilt/Shame), but there are many variations and combinations that go along with those. I have had people argue with me about anger being a basic, or primary emotion. They have learned that anger is always a secondary emotion. It is true that anger seems to be a reaction to feeling something else first, but in the sense that I'm talking about it is a primary emotion in that it is one that people recognize and understand around the world, and that babies can sense and display without having to learn it. Complex emotions are combinations of emotions, learned emotions, patterns of emotions, etc.

In this model, emotions can become prompting events for new emotions. Such as being mad after feeling afraid, or surprised that you felt happy, etc. To understand all of what you are feeling, you can go through the model of emotions with each separate emotion that you notice, and identify the prompting event for each one, your interpretation, what you can sense, how you express it, how you label the emotion, and the aftereffects.

I think I need to explain a little more about aftereffects. These can be whatever you are left with, or what changes for you as a result of the emotion you experienced. "Intense emotions have powerful aftereffects on memory, thoughts, and even the ability to think, physical function and behavior. In a sense, we can say 'emotions love themselves.' They organize the person in such a way as to continue (or keep firing) the very same emotion." (Linehan, p. 89: Skills Trainng Manual for Treating Borderline Personality Disorder) Emotions tend to keep us feeling them, and we can also go numb and attemt to stop feeling emotions. I'm not sure whether to consider going numb an aftereffect, or simply a behavior. What do you think it is?

I thought I had posted the model of emotions in this thread already, but I can't find it. We've been working with this model. I don't know if I can get it to show up here, or if you will need to click on the link to go and look at it:



http://www.dbtselfhelp.com/html/er_handout_3.html

Cool, it looks like that worked. The box that just says "prompting" should say "prompting event 2." Many times, the first emotion is the prompting event for another emotion. Also, the box that says "Brain Change" lists how emotions are experiences or sensed. Another way that is left out is "action urges." The box that starts with "Face and Body Language" is how we show or express emotions, and should also include actions. I like to point out that these two boxes interact with each other. You might express what you sense or expereince, but what you express also changes what you experience. For example, if you smile a lot, you will probably feel happier, or if you go around frowning, or acting mad, etc., you will feel sad or mad.

Today, we worked though this model for an example of Shame. This isn't on the DBTSelf Help website, but comes from the Skills Training Manual. There is a very long handout in the manual that goes through these details for several basic emotions.

Shame has several words, which have different characteristics, but are generally associated with this emotion. Shame words include:

shame, contrition, culpability, discomposure, embarassment, guilt, humiliation, insult, invalidation, mortification, regret, remorse

Some common Prompting Events for shame include:

• Doing (feeling or thinking) something you (or people you admire) believe is wrong or immoral.
• Being reminded of something wrong, immoral, or "shameful" you did in the past.
• Exposure of a very private aspect of your life.
• Having others find out that you have done something wrong.
• Being laughed at, made fun of.
• Being criticized in public, in front of someone else; remembering a public criticism.
• Others attacking your integrity.
• Being betrayed by a person you love.
• Being rejected by people you care about.
• Failing at something you feel you are (or should be) competent to do.
• Being rejected or criticized for something you expected praise for.
• Having emotions that have been invalidated.

Interpretations that Prompt Feelings of Shame could include:

• Believing your body (or body part) is too big, too small, or not the right size.
• Thinking that you are bad, immoral, or wrong.
• Thinking that you have not lived up to your expectations of yourself.
• Thinking that you have not lived up to others' expectations of you.
• Thinking that your behavior, thoughts, or feelings are silly or stupid.
• Judging yourself to be inferior, not "good enough," not as good as others.
• Comparing yourself to others and thinking that you are a "loser."
• Believing yourself to be unlovable.

Some says that you might Experience or Sense shame are:

• Pain in the pit of the stomach.
• Sense of dread.
• Crying, tears, sobbing.
• Wanting to hide or cover your face.
• Blushing, hot, red face.
• Jitteryness, nervousness.
• Choking sensation, suffocating.

Expressing and Acting on Shame might include:

• Withdrawing, covering the face, hiding.
• Bowing your head, kneeling before the person, groveling.
• Eyes down, darting eyes.
• Avoiding the person you have harmed or the people you know you have done wrong.
• Sinking back, slumped posture.
• Saying you are sorry; apologizing.
• Asking for forgiveness.
• Giving gifts, trying to make up for the transgression.
• Trying to repair the harm, fix up the damage, change the outcome.

Aftereffects of Shame could be:

• Avoiding thinking about your transgression, shutting down, blocking all emotions.
• Engaging in distracting, impulsive behaviors to divert your mind or attention.
• Believing you are defective.
• Making resolutions to change.
• Depersonalization, dissociative experiences, numbness, or shock.
• Intense anger, sadness, fear, or other negative emotions.
• Isolation, feeling alienated.

I'd like to comment on shame and guilt, and the distinction between them. They are closely related. The difference is that guilt means to feel bad about something that you do, while shame is to feel bad about somethign about who you are.

Guilt is productive if you have actually done something that you need to change. It can have a function to motivate you to make amends and change your actions.

Shame is more likely to freeze you in your tracks and keep you trapped in those uncomfortable feelings. Believing that there is something about your nature that is bad, wrong, inadequate, or immoral can lead to discouragement and giving up, even when there really is nothing wrong with you, or at least nothing on the scale that you feel it is. It's hard for me to figure out the function of shame. Do you have any ideas? Maybe to communicate to yourself that you feel hurt?

In the chat, it was asked if it is wrong to do some of these things, like apologizing and trying to make amends, if you really didn't do anything wrong. I don't think it's wrong to try to repair the relationship and get on better grounds where both you and the other person understand each other better and get your needs met. I do think that it needs to be balanced. If they are at fault and not willilng to address their part in it, and you keep apologizing and feeling shamed or guilty, then you stay stuck in a cycle that keeps hurting you and keeps you feeling that way. Interpersonal Effectiveness skills would be appropriate for getting out of a cycle like that.

This handout also goes through the model of emotions for love, joy, anger, sadness, and fear. I'm not going to type all of that right now, but might do specific emotions as they come up either in the chat, or if anyone has an interest in a particular one.

I really appreciate all your hard work - I am not here for the live chat so I am very grateful for the information you post - thankyou

Chat in the morning at 10:30 a.m. Eastern time.

For those who may not be aware, there is also a social group for DBT discussion and support.

http://forums.psychcentral.com/group.php?groupid=52

Anyone who wants to join is welcome. Feel free to discuss skills or information from the chats either in this thread or at the social group.

We talked about two things today. One topic was a review of "Wise Mind."

http://www.dbtselfhelp.com/html/wise_mind.html

http://www.dbtselfhelp.com/html/mf_handout_1.html

Emotional mind and rational mind are both necessary, and both have important messages for you. It is good to be aware of them and know what they are saying. However, neither emotional mind nor rational mind has a balanced perspective.

Wise mind listens to both emotional and rational, and finds what is true in both, and puts them together, and finds what is true. Everyone has wise mind. It is quiet, and peaceful, and is the place in you where you know something is true, or valid, in a centered way.

Wise mind listens to all ways of knowing something: observing, analyzing logically, kinetic and sensory experience (feeling or experiencing something in your body), knowing what we do, and intuition. Wise mind is like intuition, but knows more than reasoning or what you can observe directly. Wise mind is experiencing truth, without having to analyze it intellectually.

"Wise mind is like a deep well in the ground. The water at the bottom of the well, the entire underground ocean is wise mind. But on the way down there are often trap doors that impede progress. Sometimes the trap doors are so cleverly built that you actually believe that there is no water at the bottom of the well. Perhaps it is locked and you need a key. Perhaps it is nailed shut and you need a hammer, or it is glued shut and you need a chisel.

"Wise mind is sometimes experienced in the center of the body (the belly), or in the center of the head, or between the eyes. Sometimes a person can find it by following the breath in and out." (Marsha Linehan: Skills Training Manual for Treating Borderline Personality Disorder)

Wise mind is like riding a bicycle. After learning, and experiencing it, you will know what it feels like, and you don't have to learn it again because your body remembers.

To find wise mind, follow your breath in and out, naturally, and deeply. After some time, let your attention settle to your center. Watch where the breath naturally centers itself. That centered place is wise mind. It can help to wet your finger and dampen the place on your forehead where "the third eye" is.

Some other descriptions of wise mind:

• the calm that follows the storm
• an experience immediately following a crisis or chaos
• suddenly getting to the heart of the matter
• seeing or knowing something directly and clearly
• getting the whole picture
• feeling the right choice in a dilemma (feeling from deep within)

Wise mind can feel like emotional mind. After a heavy rain, water can collect on a trap door in the well, and might be confused with the deep ocean at the bottom of the well. When you feel intense emotion, suspect emotional mind. When you feel calm and secure, that's more likely wise mind.

The other topic from chat today was observing the tendency that people with BPD have to lack adequate nonverbal emotional cues. This is something that Linehan observes in her books, and also something that I see in myself and others. As a result of invalidatinf environments, we learn not to show our emotions most of the time. The flip side that goes along with it is that we react in extreme ways when nobody seems to understand how we feel, and then we explode and others wonder where all of that came from, because they couldn't see it coming, since we don't show signs of what we feel until it gets to that point. Much of the time, we aren't aware of our own emotions and we don't see it coming either. We learn to invalidate and discount our own emotions, hiding them to get by and protect ourselves, and then usually get some results when we finally get out of control, so that gets reinforced too.

It might not be all learned. Marsha Linehan says that it is also possible that people with BPD are born with an emotional system that is less obviously expressive than others, and the inborn tendency to underexpress emotions might set up situations in the environment where others don't get the feedback (emotional cues) from us that they need to monitor their interactions with us appropriately, which sets up the pattern and tends to continue it.

I think that people with BPD tend to also be "highly sensitive" and that our sensitivity contributes to toning down our emotional expression, as well as picking up on other people's emotional cues more readily. A lot of this happens outside of our own awareness, but still is sensed and contributes to feeling overwhelmed or overstimulated, and, ironically, also probably contrubutes to tuning out and dissociating and numbing.

I'm interested in what others think about these ideas. I'm not always sure what to do about it, other than to observe and work on being more aware of these patterns and our emotions and what we sense and what we express, and how. With awareness, maybe we can learn to express emotions more easily.

Another observation is that this may be why online communication is more comfortable or easier for some of us. Since the nonverbal cues don't get transmitted anyway, nobody is seeing them or displaying them and one disadvantage is removed or altered. But it can be a crutch because we can get into a comfort zone here and avoid real life communication and interaction.

Feedback is welcome.