STOP

STOP

My psychologist handed me a few of these cards yesterday because I need them. There are times when I don’t think, I just react and then I end up making the situation worse whether that be because I’ve shouted back in an argument or because I’ve hurt myself or spent money I don’t have.

I’ve stuck these in a few places where I am likely to see them at a time when I need them. They are in my self-soothe box and next to my computer and I’m going to save the image onto my phone too.

I think STOP skills can help everyone but I feel it is important to put this on my blog because I think both people with mental health conditions and those caring for people with mental health conditions could benefit from this. Don’t just read it, write it down and put it where you will see it. If you struggle with binge eating stick it on the fridge, if you struggle with spending then put it in your purse. Put it somewhere that suits you.

Self-Soothe Boxes: Self-Harm Recovery

Something I really struggle with is self-harming and self-destructive behaviours. There are times where I feel really upset either because something has happened or because mental illness is dragging me down and I don’t know what to do with myself. I can’t concentrate on television as a distraction. Going for a walk feels like too much because I want to hide away from the world and not feel exposed and then I end up feeling kind of stuck because I don’t know how to deal with how horrible I am feeling and I don’t know what to do with myself. This is where the self-soothe box comes in.

My self-soothe box is all about the five senses which are touch, taste, smell, sound and vision. The behaviours I engage in are strong behaviours and so the self-soothe box needs to contain things that have a strong impact on my senses. It isn’t about what you like or dislike or what is deemed cool or uncool. A self-soothe box is simply about what will help YOU when you are struggling.

So what have I got in my self-soothe box?

  • A scented candle
  • A stress ball
  • Bubbles
  • Play-doh
  • Lip balm
  • Balloons
  • A colouring book
  • Word-searches
  • Photographs of people who mean a lot to me
  • A notebook
  • Chalk and chalkboards
  • Wool to make bracelets

Taste was a difficult one to include because having an eating disorder means that I don’t find taste very self-soothing but you could include mints or chewing gum. An extreme taste is pretty good to get the senses going so minty, sour or spicy food can be helpful but self-soothe is about what soothes you and if a bar of chocolate soothes you then put it in the box. Remember this is about YOU.

This is my self-soothe box:
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DBT: What Is It And How Has It Helped Me?

Recently I have had many people asking me on Twitter about DBT and it is really hard to describe it in 140 characters. My DBT folder is a good few inches thick and I’m not even half way through the treatment, there is a lot of information and so I decided to write a blog post about what it is and how it has helped me and could potentially help others.

DBT stands for dialectical behaviour therapy. I started DBT last December and my treatment involves attending a skills group every Monday for two and a half hours and then an individual session each week with my psychologist. I remember when I started DBT I just thought that it would be another treatment that would fail or that I would become too unwell and have to leave the treatment which has often been the case with me. I thought it was nonsense and it wouldn’t help me. Recently I have noticed that DBT is actually changing my life. I am still poorly and I still struggle but life is very different to how it used to be and I finally feel hopeful about the future. Everything has clicked into place, DBT has clicked into place and I’ve gone from thinking it was a waste of time to wishing that everybody had the chance to learn the skills that I am learning because they aren’t just life saving, they are life changing.

There are three modules in DBT, these are distress tolerance, emotion regulation and interpersonal effectiveness. There is also a strong focus on mindfulness with it being the foundation for all three modules.

What Is A Skills Group?

A DBT skills group is different to group therapy because behaviours should only be mentioned if it is to say that skills were used. The focus is on the positives, the times where skills were used and the skills there are to learn rather than focusing on the illness and behaviours. Many DBT groups are for those with personality disorders but I am extremely lucky that my Tier 3 eating disorder service offer a DBT group specifically for those with eating disorders.

At the beginning of every session we have skills feedback where each member of the group is given up to 5 minutes to talk about their effective skills use over the course of the previous week. For example coping with a stressful situation such as going out for a meal. We are supposed to have folders but being stubborn and hopeless I didn’t have one up until this weekend when I realised that actually DBT is doing something and the information I am being given is important.

The goals of skills training are to decrease relationship difficulties, intense and unstable emotions, acting on impulse and confusion about self and troubling thoughts whilst increasing interpersonal effectiveness, emotion regulation and distress tolerance as well as using mindfulness.

This is my DBT folder:

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Mindfulness

Mindfulness is all about being in the present moment. It’s about being aware of what is happening and what you are doing as well as observing what is going on internally and externally.

Mindfulness is not about your mind never wandering, mindfulness is about recoginsing that it is.

Mindfulness includes two sets of core skills. These are the ‘what’ and ‘how’ skills. ‘What’ skills are all about observing, describing and participating. ‘How’ skills are all about doing things effectively, non-judgementally and doing one thing at a time.

You can do almost anything mindfully including driving, eating, brushing your teeth, colouring and cleaning.

States Of Mind

The three states of mind that DBT focuses on are emotional mind, reasonable mind and wise mind.

Emotional mind is probably where most of us spend our time. In emotional mind our thoughts and behaviours are controlled by our emotions and therefore we can get thoughts that are unhelpful and distressing. It can be difficult to think logically and rationally when in emotional mind and facts are often distorted to fit with the current distress. In Harry Potter terms emotional mind would be Ron Weasley.

Reasonable mind is intellectual and scientific as it includes logical and rational thinking. Thoughts are based on facts and evidence and the person is able to plan how to respond. In Harry Potter terms reasonable mind would be Hermione Granger.

Wise mind combines both emotional and reasonable mind, it is the calm which follows the storm. Wise mind grasps the bigger picture rather than just parts. It ensures emotional mind is soothed whilst knowing that reasonable mind is correct. In Harry Potter terms wise mind would be Harry Potter.

The aims of DBT are to recognise emotional and reasonable mind and find wise mind to then appropriately address problems. Finding wise mind is not an easy thing to do and can take a long time to achieve. It is possible though. 100%.

Distress Tolerance

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Distress tolerance was the first module I did. It is all about getting through a difficult moment when you cannot make it better but without making it worse. For example if I am feeling upset about a situation in my life then I might restrict my intake in order to cope but that doesn’t get rid of the problem. In fact if we look at the bigger picture it has made the situation worse because not only am I upset about that situation but I now have to deal with the impact anorexia has on my life. Distress tolerance skills are crisis survival skills aiming to reduce suffering, not to get rid of the pain.

Wise mind ACCEPTS was the first skill we were taught. It’s all about distraction which is excellent but should only be used in the short-term. Wise mind ACCEPTS can be helpful to divert your attention from distressing thoughts. Choose things that grab your attention and keep you absorbed.

Activities: Such as baking, writing, journaling, nail painting, making an amazon wishlist, dancing, playing a game, collaging, colouring, reading etc.

Contibuting: For example blogging, tweeting, volunteering, making something for someone, look after a pet, smiling at someone etc

Comparisons: Be careful with this one, don’t make unhelpful comparisons. Perhaps compare yourself to a worse time and look at how far you have come.

Emotions (opposite): Create a different emotion by watching a comedy or fails on YouTube. Look at cute animals or baby photos. Find positive quotes.

Pushing away: Leave the situation behind for a while. Put it in a box and decide not to think about it.

Thoughts (changing): Change your thoughts by playing word games, doing a puzzle book, counting in 3s backwards, speaking another language or learning song lyrics.

Sensations: Focus on the five senses (taste, smell, touch, sound and sight) by using a stress ball, having a bath, using hand cream, listening to loud music etc.

Distress tolerance has a huge focus on pros and cons. What are the pros and cons of tolerating the distress? What are the pros and cons of not tolerating the distress? So basically what is good and what is bad about using skills compared to using behaviours?

Other distress tolerance skills include radical acceptance which is accepting what is happening at the time without making it worse or doing anything. There is also turning the mind which is all about turning your mind towards acceptance and willingness rather than willfulness.

I think for me the key parts I got from distress tolerance were self-soothing and distraction when distressed rather than getting angry or upset with people or harming myself.

Emotion Regulation

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Emotion regulation helped me to understand and name my emotions. Emotion regulation also decreases unwanted emotions and emotional vulnerability. These skills are important because they quieten the body, quieten behaviour, help to find wise mind and improve self-respect.

Emotion regulation takes a healthy perspective on emotions. We need to accept that we are emotional beings and that emotions are neither good or bad. It isn’t helpful to judge your emotions. Whilst it is okay to have an emotion, there is a difference between having an emotion and acting on an emotion. For example, it is okay to feel angry with your partner for lying to you but it is not okay to punch your partner in the face repeatedly because of it. Emotions are pretty good at convincing us they are permanent but they are not. Emotions come and go and get replaced by another emotion regularly. Emotions may feel like the truth but feelings are not facts.

Emotion regulation taught us to describe emotions. It gave us words that related to the emotion for example other words for anger are fury, rage, wrath and frustration. It also gave us prompting events for the emotion, for example seeing blood may make you feel disgust. It also focused on the biological changes relating to the emotion as well as expressions and actions and the after affect of the emotion.

Emotion regulation focuses on changing the emotion. Firstly it is important to check the facts. To notice and observe the emotion you are feeling and want to change, what event prompted the emotion, what your interpretations, thoughts and assumptions are. You should also ask yourself whether you are assuming a threat and/or a catastrophe and then think about whether your emotion fits the facts. If it doesn’t or if acting on the emotion is not effective then opposite action can be helpful.

Opposite action is acting opposite to your action urge. For example, the other day I had my sunglasses on because I wanted to hide from the world but realised this was coming from a place of emotional mind so then I took the sunglasses off. If the urge is to avoid then don’t avoid. If the urge is to attack then avoid or be nice.

Certain things in life can make us more vulnerable to emotional mind but there are ways to reduce vulnerability. The acronym ABC PLEASE can be used to remember these skills.

Accumalate positive emotions: In the short-term do pleasant activities that are possible in the moment. In the long-term make changes to your life so that positive events will happen in the future. Build a life worth living.

Build mastery: Do things that make you feel competent and effective to combat any helplessness or hopelessness you may be feeling.

Cope ahead of time with emotional situations: Rehearse a plan and prepare to cope skillfully with emotional situations.

PLEASE: Treat PhysicaL illness. Balance Eating. Avoid mood-Altering substances. Balance Sleep. Get Exercise.

Interpersonal Effectiveness

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I am only beginning the interpersonal effectiveness module now so I don’t have a huge amount of information on it. The aims of interpersonal effectiveness are to be skillful in getting what you want and need from others, for example getting others to take your opinions seriously or being able to say no to unwanted requests. Interpersonal effectiveness also aims to build relationships that are healthy, strengthen current relationships whilst also ending any destructive ones.

The three parts of interpersonal effectiveness are objective effectiveness which is about being effective in asserting your rights and wishes, relationship effectiveness which is about acting in a way that you maintain positive relationships and finally self-respect effectiveness which is about acting in a way that keeps your self-respect.

Myths can get in the way of interpersonal effectiveness, for example feeling like I don’t deserve to get what I want or need might make me not bother asking but interpersonal effectiveness gives challenges to these such as, ‘we are all equal and we all have the right to ask for what we want and need’. It is okay to ask for what you want and need and it is also okay for that person to say no but the person saying no doesn’t mean that you shouldn’t have asked in the first place.

Diary Sheets

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Everyday I have to fill in several diary sheets. I started off just filling in the standard DBT diary sheet which gets you to rate emotions, urges and behaviours from 0-5. However this has now been tailored to me so as well as filling in that sheet I fill in a mood and food diary and write down how much time I spend on myself in that day and what I have been avoiding that day. It is a lot to do every day and I spend the majority of my time thinking about it or recording things but that is a good thing because DBT is not one of those therapies where you only have to do it in the session, it can be applied to everything and should be used every day.

I understand that DBT may not work for everyone, the same as any other therapy or medication but I can honestly say with my hand on my heart that after a very lengthy battle with no signs of recovery or improvement I am on the road to recovery. DBT is changing my life.

Recovery: The Definition

I think recovery means different things to different people but something I felt compelled to write about was the idealistic view of recovery. I’m not sure where it came from but there tends to be this idea of recovery floating around that is unrealistic. I find that especially in the eating disorder world recovery is viewed as the sufferer returning to who they were before the eating disorder. As though the sufferer would wake up one morning and none of it would’ve ever happened.

Recovery from a mental health problem is similar to recovery from a physical health problem. If someone breaks their leg then that fracture will have always happened, the patient may get pain in that leg and perhaps in later life arthritis will develop. The patient has worn the cast and gone through treatment but that bone will always have broken. If someone has cancer and they go through chemotherapy and have the tumor removed and thankfully get given the all clear then they are in remission. They still had cancer, they still had to go through the physical and emotional hell that they went through and the patient will probably always have the fear in the back of their mind that the cancer could come back. They are not the same person. This is the same with mental health problems. A patient with bipolar may be stable but they probably have the fear in the back of their mind that they could have another manic episode. I’ve heard the questions and comments such as, “Are you back to normal then?” as though recovery blanks out everything that happened during times of illness.

My illness will have always happened to me. I am better in some ways but I am still really unwell. My illness has changed me because being sectioned for two months, spending a night in a cell and battling anorexia and bulimia for a very long time does change a person. I am not actively suicidal at the moment but I still have to look away when I see a train approaching the platform because I don’t trust myself not to jump in front of it. Whenever I hear a police officer’s beeping walkie-talkie it reminds me of being in a mental health crisis. These memories will always be a part of my life.

I don’t think recovery is about having a perfect, idealistic life where you smile and laugh and the sun shines and mental illness doesn’t exist. I think recovery is about stability and managing symptoms. It’s about living and feeling joy and excitement but also feeling sadness and sorrow when bad things happen because life is always going to throw sad things at us simply because nothing is permanent. Recovery is about living life the way YOU want to rather than your illness dictating to you constantly. Recovery is about looking after yourself and managing distress rather than hurting yourself. Recovery is about managing and not about having a perfect life.

Building A Life Worth Living

A huge part of getting better for me is about building a life worth living. I used to be pretty much house bound. I would spend days on end inside my home and being outside in the fresh air was a novelty. I had no friends, no hobbies, there really was nothing to my life other than my illness and for that reason I had no motivation to be alive let alone commit to getting better. Having a mere existence was not a small chunk of my life, it was years and years of loneliness, isolation and nothingness. It was not something I ever envisaged changing but it did.

I can honestly say that this year I have lived more than I ever have before. I am still unwell but I am building a life worth living and it all happened on the day I appeared on BBC Breakfast and fell back in love with life again. That day I realised that I was more than an illness and that I do have talents. I began to participate in life more and grasp the opportunities I wanted rather than allowing my illness to make excuses and keep me locked away in my home.

For a very long time I wanted to die and I truly believed that was all that was left for me but I cannot explain how grateful I am now for those people that saved my life when I didn’t have the capacity to save myself. I found myself writing my life plan the other day. I used to be so scared of growing up but now it is written in black and white. I know where I want to live, the type of house I want, the career I am aiming for and I want children and a dog called Toast.

Building a life worth living used to be a difficult concept because I tried to live my life to please certain people but it wasn’t through love, it was through fear. We are given one life and a lesson I have learnt recently is that life is about what you make it and it is not selfish to do the things that you want to do, that is healthy. I know that a life worth living does not mean that mental illness magically disappears because unfortunately the two do not correlate. However, mental illness tends to steal a lot of things from it’s victim and acts like a blindfold so whilst building a life worth living is not a cure, it can certainly help to take those parts of your life back that the illness stole. Building a life worth living gives me hope, excitement and enjoyment and it builds up positive experiences that I never imagined that I would have, even just going to a nail bar with a friend. Now I have a reason to fight the suicidal thoughts my illness throws at me because I know who I am and I know that I want to be alive.

The Importance of Early Intervention

I often wonder what my life would be like now if I’d received the help straight away…maybe I would be recovered and free.

Imagine this: For months you’ve felt horrendous, strugged to get through the day and engaged in self-destructive behaviours in order to cope. You are hopeless and inches away from throwing the towel in and so you make an appointment with your GP and it’s a small glimmer of hope even though it is weeks away. You feel sick with nerves on the morning of the appointment but you need help and you are prepared to tolerate the anxiety around the appointment. You walk up to the surgery and sit in the waiting room silently. Part of you wants to walk straight out the door but you don’t. Your name is called and you walk into the doctor’s room and explain what it wrong whilst your hands shake and your eyes sting as you hold back the tears. You leave the surgery with an appointment card in your hand to see the same doctor in 4 weeks time. That is all he gave you.

This is a scenario that is happening far too often in the UK. Early intervention for mental health problems is not always possible because some individuals may not seek help. However there are circumstances where people do seek help in the first weeks, months or year of their illness and are turned away. This should not be happening. The longer a problem goes on then the harder it is to fix and the longer it takes. It’s the same with physical illness, if cancer is found and treated early then the chances of survival are much higher. I think that when it comes to mental illness sometimes severity can be due to the length of the illness. Say if someone who may be considered to have a mild to moderate mental health condition is left for two years with no treatment then it is likely that mental health condition could become severe.

Something more important than money is human life. If we were to have early intervention for mental health problems it would save lives. I dread to think how many people have taken their lives after asking for help and not getting it. I know lack of support and no hope in mental health services contributed to me attempting to take my life. These lives aren’t just people with mental health problems, they are people who are capable of writing the next bestseller, becoming surgeons and saving your life, paramedics, scientists finding cures for cancer. A person with suicidal thoughts may think that their life has no hope but that is because they are unwell. Their lives have so much potential and who knows what difference they could make to your life if they were given the life saving help that they asked for.

Financially it would be a good investment to provide prompt early intervention to those that present with mental health problems. If early intervention does not happen then hospital admissions, crisis services, emergency services, mental health act assessments, medication and long term treatment are often needed and that’s just for one individual. For a fraction of that cost early intervention could’ve been provided.

Early intervention is incredibly important. We are talking about human beings here. I often wonder what my life would be like now if it hadn’t taken over a decade to get the help I needed. I might have graduated university or be in a theatre company. I might still be teaching 5-8 year old children how to bake cakes and dance. Maybe I would have my own home and be in full time employment. I was always a dreamer, I always aimed high and worked to get where I wanted to be in life but mental illness stole that all away and mental health services watched me slip through the net until I had to be detained under the mental health act and required a lot of treatment. I am not a one off, I am one of thousands of people that have reached out for help and been turned away.

Early intervention saves lives, saves money and changes lives.