Category Archives: Pain and Suffering

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The Strength to Love Again

It certainly takes a lot to open our hearts to truly love again. It’s about the willingness to take the risk to love again…to trust that this love will bring us joy and not pain…or that it will bring us much more joy than pain…or that this love will enhance our lives in such a meaningful way that any pain experienced is well worth it and that in the long run, our lives will be much more beautiful and complete because we loved again.

A wise mind knows that when we truly love, we will also truly experience pain.  Pain is often a by-product of love…even the most perfect or true love. The deeper we love…the deeper our pain is likely to be. That’s why some who have been  been deeply hurt by love, have made a conscious decision to never love again. They “refuse” to love again. They guard against lowering their guard…they work very hard to maintain a closed heart, to be detached, and to not care too much. They are not willing to open their lives to love again.

So, in their efforts to protect themselves against future pain, they cause themselves ongoing pain and suffering. Their daily lives are marked with pain…loneliness, anger, resentment, bitterness, unresolved emotional issues and concerns…and the pain of unfulfilled needs for attachment and love.

It takes great strength to open our hearts to love again…because we know that loving someone will also bring pain. It’s the acceptance that nothing is perfect…and the knowing that our lives and the lives of those we love will be much better because we loved again.

Note:  The accompanying photo/poster was copied from a Facebook posting.  It is not an original work! 

The Dynamics of Emotional Mind and It’s Role in Driving Destructive Coping Behavior: When Emotional Mind Drives…We Wreck Out…and Our Lives Become a Total Wreck

The Dynamics of Emotional Mind - hand-out  092010b

View the pdf file for a readable image – click the link below

The Dynamics of Emotional Mind – DBT-CBT Conference Handout – 072411

This hand-out addresses the dynamics of Emotional Mind and its role in driving destructive emotion-driven coping behaviors (e.g., substance abuse, aggression, eating disorders, etc.)

The “Cycle of Suffering”- when we respond to emotional pain and life problems in destructive, emotion-driven ways, we end up with new problems and increasingly severe old problems…and we feel worse than before.  If we respond to this new level of pain and problems in destructive ways, our pain and problems will continue to intensify and multiply.  Because we’re not working through our pain or resolving our problems, our emotional baggage piles up.  The trauma from the past weighs us down in the present and intensifies present misery.  What could have been temporary pain and problems has turned into long-term pain and suffering.  The only way to get the cycle of suffering to stop…is to stop it.  We can stop our suffering by stopping our destructive coping behavior.  We must turn on Rational Mind to “think through before we do” and we must “follow through” with Wise Mind problem-solving and life-enhancing coping behaviors.

Based on:  “Out-of-Control:  A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” copyright © 2010 by Melanie Gordon Sheets, Ph.D.   (www.dbt-cbt-workbook.com)

Why We Relapse: Desperate for Peace in a World of Emotional Turmoil

I responded today to a LinkedIn discussion started by Elisabeth Davies, MC of Bright Alternatives, Inc.  and the author of “Good Things, Emotional Healing Journal: Addiction.”  The discussion topic was, “Is relapsing with unhealthy substances an attempt to get more peace of mind? Being so passionate about this recovery topic, here’s my long-winded response!

“For many, yes. Many use substances as a coping behavior to help bring their emotional level to a more tolerable or comfortable level. Also, returning to such a behavior reduces the extreme tension of wanting to do it and not allowing ourselves to…thus, the experience of immediate relief or peace in-the-moment. To help us to feel better about relapsing, we’ve probably come up with all types of reasons (emotion-driven lies) as to why it is okay to do and would help us…and how we can also quit again when life settles down, etc…unless of course, it is a major emotional reflex to an immediate stressor and we do it VERY impulsively…without giving it much thought.

Relapsing on substances is little different than wolfing down a big bag of cookies or scoops n’ scoops of ice cream, or starting to smoke again, a “forbidden” sexual encounter….whatever. I think these types of behaviors have to do with attempts to bring an “out-of-control” emotional mind into control…so that we feel better and more comfortable in the emotional moment. It is all about being desperate for relief and doing what brings us relief, often immediate relief. It’s a desperate way to experience a sense of emotional, psychological, and physical peace IN-THE-MOMENT…although we’ll have hell to pay when we come to (when the emotional moment passes and rational mind picks up strength).

When we come to and realize what just happened and are faced with the consequences of our behavior…and the unresolved problem…we feel bad again…and then we may continue destructive coping….chasing “peace in the moment”…When we use destructive coping behaviors to deal with our pain and problems, we enter the Cycle of Suffering. Our problems multiply and intensity and we go through a period of increased pain and suffering as a result.

I believe most people use destructive coping behaviors to some degree (e.g., overworking, oversleeping, physical aggression, yelling, throwing fits, being rude and ugly, ‘always speaking our mind”, lying, gambling, obsessive exercise, cheating, sleeping around, codependency, procrastination, smoking, prescription meds, alcohol, overeating or eating the desired “poison foods” for us, being hyperreligious, narcissistic….and the list goes on and on.) I actually tell my patients that it’s “normal” to be “abnormal” and entirely abnormal to be so perfectly normal and in control of ourselves. We all do some destructive coping behaviors and the healthier or more in recovery we are…the less we do these things…and the more we work VERY hard to stay in control of our emotions, behaviors, and our addictions of choice….and the more we choose life-enhancing coping behaviors instead.

I’m obviously very passionate about this…it’s one of those, “been there, done that, still doing that…having to fight for recovery at times to stay in control…and not to get too far out of control” type of things for me. I believe that when we are in recovery…we remain “works in progress.” Sometimes it’s a daily battle and sometimes, an occasional battle. We’re emotional critters and creatures of habit…and when we hurt or are feeling desperate and “out-of-control”…we tend to fall back into old patterns of relief-seeking behaviors…or to certainly think about doing them!

We’re emotional critters and creatures of habit…and when we hurt or are feeling desperate and “out-of-control”…we tend to fall back into old patterns of relief-seeking behavior…or to certainly think about doing them!”

And you know the more we think about doing them…the more likely we are to finally do them. That’s because the tension is building…we want…and we won’t allow ourselves to have…and we want…we tell ourselves “NO”…and we want…and we’re tired of the pain, problems, tension, and frustration…and we become desperate for relief and peace…that we finally do what we keep trying not to do…and we relapse. Have you “been there, done that?” Have you been through this struggle? It’s a battle of the minds, Emotional Mind vs. Rational Mind and Wise Mind. It’s a battle of wills…willingness vs. willfulness. Which recovery skills do you use to get through the “fixing to relapse” moment? Do you still have these moments?

I believe that one of our major recovery tasks is to learn ways to keep our Emotional Mind in control and to tame our Emotional Mind when it is getting out-of-control. That’s my biggest recovery task…and it’s always a battle of the mind states and a battle of will. Sometimes, I grow tired of the battle and dealing with my emotional, willful self. At those tired, weak moments, I remind myself….”Mel, what do you want…peace and stability or chaos and pain?” Isn’t it horrible that you have to parent yourself even when you’re a grown-up!?

Link to the LinkedIn discussion

Link to Elisabeth’s book:  “Good Things, Emotional Healing Journal: Addiction on Amazon

Link to Elisabeth’s blog

Radical Acceptance: Accepting the Unacceptable – Coming to Terms With Our Destructive Behavior to Heal the Emotional Pain of Shame, Guilt, and Regret

I recently responded to a LinkedIn discussion regarding the negative consequences of an individual being found “Not Guilty by Reason of Insanity.”  It was spurred by a Wall Street Journal article entitled, “The Trouble With the Insanity Defense” written by D. J. Jaffe, a co-founder of the Treatment Advocacy Center.  It was printed in the 3-26-10 edition.

http://online.wsj.com/article/SB20001424052748704896104575139801575696436.html

The writer notes, “Not guilty by reason of insanity is an inadequate remedy to violence by individuals with mental illness.” He raised some valid points.

As I work for a state mental health institution which provides treatment for NGRI patients, I responded with the following comment.

Pros and cons. Time in a psychiatric hospital is generally “easier” time than in prison – so that is a definite benefit to the NGRI population. Further, many of our NGRI patients have stabilized to a degree that they are among the highest functioning patients in the hospital and have the highest level of privileges. Those are benefits.

In terms of cons, in general the NGRI population spends more time in a psychiatric facility than they would if they served Guilty sentences in prison. Also, like the article notes, they are often held in a psychiatric hospital long after stabilization and likely safe release to the community. In Texas, the superintendent (CEO) of the hospital has to approve the potential release before petitioning the court for placing the patient on an outpatient commitment. Both the judge and the hospital CEO are risking their careers and reputation if the released patient recommits a significantly violent crime.

The headline test – ‘Judge ordered release of criminally insane man who kills again

In addition, the community mental health officials also have to ‘sign off’ on the release and attest that they can ensure adequate monitoring and treatment to prevent reoffending. It’s a risky business. However, many of the NGRI individuals are truly honorable, caring, competent individuals who regret their actions and strive for a productive life. It is a great shame for patients and victims. Our facility works very hard on behalf of these patients, the courts, and the community to carefully evaluate individuals who appear ready for an outpatient commitment and to ensure a sound outpatient treatment program / support plan is in place for these individuals. It is a risky situation however as a state psychiatric facility, we are charged with providing this service and level of care.”

Marilyn Miller, MS., LPC., a psychotherapist in private practice in San Antonio, Texas, comments in this discussion that she works with individuals with bipolar disorder to help them “resolve enormous shame for their actions during manic phases (pre-medication and -treatment).”  She notes that even though their acts did not involve violence against others, their behavior was so “devastatingly self-destructive” and “so counter to their own ‘real’ values that the hurdle of getting over that shame is quite high.”  She states that she “can not imagine the further horror” for NGRI individuals “knowing that they have taken lives (or attempted to do so).http://www.marilynmillerpsychotherapy.com/

My follow-up response using the vernacular and understandings of the DBT-CBT “Out-of-Control” Workbook I wrote…includes,

As you say Marilyn, it is horribly sad to work with the NGRI’s (or other patients) who are non-psychopathic…and in a period of being out of touch with reality or otherwise ‘Big Time in Emotional Mind’…enacted state dependent destructive behavior…and when they ‘come to’ reality (Rational Mind) and recognize what they have done and the impact on others and their lives…they are in great emotional pain and are devastated by their behavior.  Just this week in group at the state hospital, this came up as we were discussing the consequences of ‘Emotion-Driven Behavior.’  A cloud of great remorse and sadness came over the group in that moment of insight and understanding relating to why things are the way they are in their lives…why their people are so upset with them….and why they have lost so many of the things that they value and cherish.

I teach them that it’s not WHAT happened (like a relationship break-up, conflict on the job, abuse, etc) that has led to such life losses…that it is HOW they responded to the life situation (drugs, alcohol, suicide attempts, physical violence, saying ugly things to people, etc) that has led to the deterioration of their life and the widespread losses of all the people, things, and activities they love and cherish.  This is a painful truth that leads to a major moment of reckoning.  From there, we talk about what we can do to prevent getting ‘Big-Time in Emotional Mind’…and learning ways to respond through Wise Mind when we do experience out-of-control emotional moments.

This past week, this moment in group was so heavy in sadness that I told them that this is exactly why I wrote the workbook and why I am so passionate about helping them in group…that it pains me greatly to be among such neat, wonderful individuals who truly care about their lives and their people…and how it is so sad to live, eat, breathe Emotional Mind…and to be stuck in a ‘Cycle of Suffering’…a cycle of being upset, enacting destructive Emotion-Driven Coping Mechanisms, suffering more losses, feeling worse, continuing destructive copings, consequences worsen, feeling even worse….and on and on and on.

The depth of their pain is what drives me to work so hard to help them to understand Emotional Mind dynamics and to find new ways to respond to life stressors, problems, situations, losses, etc., to STOP the cycle of suffering, and to live a recovery lifestyle so they can reap all the rewards of doing so…to end their pain and suffering and to live a life that provides meaning and satisfaction.

For many, this involves understanding why they have done the things they’ve done, self-acceptance and forgiveness, being committed to change the way they respond to life, developing a Game Plan for recovery, and FOLLOWING THROUGH with their recovery plan.  This process also involves understanding why others have acted in certain ways towards them, acceptance and forgiveness of others, etc.

Another major point I teach them is that their destructive behavior is not a product of WHO THEY ARE as a person…not their character, personality, or true self…but a product of HOW THEY ARE (or were) when they are ‘Big Time in Emotional Mind’…as a result of psychosis, mania, intoxication, great anger or upset, the result of an altered state of consciousness, the one in which they are Big Time in Emotional Mind without any significant levels of Rational Mind going on.  It is not WHO THEY ARE….because most of these individuals are good-hearted people who care about others…and truly care about living a productive life and being kind, loving, and helpful to others.”

For this blog, I’d like to add the following text from Chapter 12:  “ACCEPTANCE” from the DBT-CBT Workbook.  This is an example of applying “Radical Acceptance” to our lives.  Radical Acceptance is about “accepting the unacceptable”….and boy, when we’re in recovery…we’re going to have to do a lot of that!

ACCEPTANCE OF THE BAD, HORRIBLE, ROTTEN THINGS WE’VE DONE

We’re human.  We ALL make mistakes.  When we’ve LIVED IN Emotional Mind, we’ve made MANY mistakes.  We’ve acted impulsively and have made MANY regrettable decisions.  We’re NOT bad, horrible, rotten people.  We’ve just done some bad, horrible, rotten things.  These things happen when people are drinking, drugging, in a manic or psychotic state, or are desperately overwhelmed with painful emotion.  When we’re CLEAN N’ SOBER, on our MEDS, making HEALTHY LIFESTYLE CHOICES, and ACTING IN WAYS to Mindfully Protect Our Peace and Stability, we’re GOOD-HEARTED PEOPLE with good morals and values…and WE CARE ABOUT PEOPLE.

Think of the REALLY NEAT people we’ve met in rehabs, AA, support groups, and hospitals.  They’ve lived a past JUST LIKE US.  They’ve done hurtful things to the people they love WHEN they were in the middle of their addictions and Destructive Coping Behavior.  They’re NOT bad people.  They’re the WALKING WOUNDED and IN THEIR DAYS of PAIN and IMPULSIVITY, they did some painful and impulsive things.  TAKE AWAY the drugs, alcohol, mania, depression, pain, anger, and bitterness…and what’s left are some PRETTY NEAT PEOPLE!

We’re the walking wounded.
We’ve experienced a lot of pain.
Being desperate for relief,
we’ve done a lot of painful things
that have hurt ourselves and others.

Think of two people YOU KNOW that fit that description.  What sort of bad things did they do when they were in the middle of their addictions and destructive coping behavior?  Also describe their character when they’re living a Recovery Lifestyle.  _________________________________________________ _________________________________________________

Our Recovery Task is to ACCEPT whatever we’ve done.  Then, we must WISELY decide which things we CAN DO SOMETHING ABOUT and which ones we CAN’T.  We need to focus our efforts on the things we CAN do something about that are a PRIORITY in our life.  We need to DO WHATEVER WE NEED TO DO to improve these things.  The things we can change that AREN’T A PRIORITY…
we need to LET THOSE GO… FOR NOW.

The things we CAN’T CHANGE…
we MUST let them go.
Letting go is a CHOICE.
It’s a choice for FREEDOM from burden
and a choice for PEACE and SERENITY.
Remember, “God grant me the serenity
to ACCEPT the things I cannot change.”
ACCEPTANCE is what gives us serenity
EVEN WHEN our lives are in turmoil.
It’s how we CHOOSE to THINK about things
and RESPOND to things
that ultimately affects HOW WE FEEL about things.
We can CHOOSE to be AT PEACE with our situations
or we can CHOOSE to be in turmoil.
We CANNOT LIVE NEW LIFE if we live in the PAST.
CHOOSE to let some things go
so you can GO ON with life…
and LIVE NEW LIFE!

Extra margin text from this section of Chapter 12:

We weren’t born this way.
We became this way
because of an Out-of-Control lifestyle.

Our people want us ALIVE and WELL,
so we need to bury the guilt and pain that’s killing us.
We cannot be the person we were meant to be
or live the life we were meant to live
if we are carrying around what makes us wish we were dead.

The only way to start over
is to START OVER.
We do that by accepting

what needs to be acceptedand by moving on down the Recovery Path.

This text was adapted from the DBT-CBT Therapy Workbook – “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” by Melanie Gordon Sheets, Ph.D. – copyright 2009 – Recovery Works Publications –

The DBT-CBT Recovery Workbook Focuses On Self-Destructive Behaviors

DBT-CBT is a life-changing recovery program that inspires people
to make the life changes that will change their lives.
This program has turned many defeated hearts into empowered spirits
that are psychologically prepared to take on the challenges of
GETTING ON  and STAYING ON the Recovery Path.

Come join us in our journey.

This is a workbook for recovery from a variety of Self-Destructive Coping Behaviors. The philosophy of DBT-CBT is that “Many of our “abnormal” behaviors are normal given our experiences. They once served as survival skills.  However, their period of usefulness is long over.  We’ve overused these coping behaviors…and now, they’re causing us great pain and they’re destroying our lives.”

This workbook explains why we do the things we do…and why we keep doing these things even though they cause us more pain and problems.  It’s about what we do in the heat-of-the-moment…the emotional moment.  It’s about what happens when EMOTIONAL MIND drives and RATIONAL MIND takes a backseat…and WISE MIND is left on the side of the road.

When we’re filled with upsetting emotions, we often do things for quick relief…like drugs and alcohol; suicide attempts; cutting and other forms of self-mutilation; aggression; temper tantrums; walking off and leaving the situation; withdrawal; overeating or not eating enough; overshopping; “sleeping around”; rebound relationships; gambling; and other risky and reckless behaviors. The Nature of the Problem is…the things we do to feel better end up multiplying and intensifying our problems. Our Destructive Coping Behaviors help us to cope in the Heat-of-the-Moment…but, they have many negative consequences. They make our current problems more severe…and they CREATE many new problems for us to struggle with.   Over time, our lives spiral OUT-OF-CONTROL and into a CYCLE OF SUFFERING.

This workbook provides useful tools, attitudes, and plans for changing how we respond to life.  Our goal is to GET CONTROL of our OUT-OF-CONTROL emotions, behaviors, and thinking. We do this by PARTICIPATING EFFECTIVELY in our lives and by using LIFE-ENHANCING COPING MECHANISMS to deal with our pain and problems.  Our goal is to MINDFULLY PROTECT OUR PEACE AND STABILITY and the BIG PICTURE OF OUR LIFE.  Our goal is to STOP the CYCLE OF SUFFERING.

What Causes People to Change? When It’s Painful To Change But More Painful Not To

Pain and Suffering and the Pain of Change

Pain is a type of distress.  It’s a natural part of life.  Pain is designed to be temporary.  The purpose of pain is to PUSH US TO DO SOMETHING to end the pain…so we can return to a pain-free state.  Pain is a call to action.

Alike most things in life, we have two choices when it comes to pain.  We can either LEAN INTO the painful situation and change things or we can work hard to avoid dealing with it.

If all we do is work to avoid pain…if we don’t Lean Into it…if we don’t deal with it…if we refuse to accept it…if we refuse to do what’s needed to get through it …OUR PAIN WON’T GO AWAY.  It’ll be with us for a long time.

Running from our problems just prolongs our agony and brings us to a chronic state of suffering… a long-term condition of being overwhelmed with despair and stuck in the same place and time… and we don’t move forward.

We want things to get better in our life, but we’re NOT WILLING to do the things that will make our life better.  We want life to change, but we’re not in the mood to change.

We generally DON’T CHOOSE to make major life changes “out of the blue” or on our own.  Change usually happens when we’re FORCED to make changes.  And most often, we make changes when we have NO OTHER CHOICE but to change.  We generally let things get SO BAD that the pain of living like we’re living is MUCH GREATER than the pain of change…and that’s when we begin to change.

If we really want our life to change, we have to make changes…despite the distress of change.  Our life isn’t going to get better unless we do things that make life better.  When people make major life changes, a strong commitment is made, like, “Come hail or high water, this is going to happen.  I’m going to do what I have to do, no matter what.  I’m so tired of living this way.  I refuse to allow myself to live like this any longer.”

Excerpt from Chapter 11 “Distress Tolerance” of the DBT-CBT Therapy Workbook entitled: “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook  for Getting Control of Our Emotions and Emotion-Driven Behavior” (Melanie Gordon Sheets, Ph.D. – 2009 – Recovery Works Publications)

http://www.dbt-cbt-workbook.com

Radical Acceptance – “Accepting the Unacceptable” – From a DBT-CBT Workbook Perspective

We have a choice to accept difficulties as they come our way…
To lean into them and to get a game plan for dealing with them
AND a choice to Follow Through until we can Get Through…
OR we can choose to avoid, ignore, and numb-out our pain and problems
And stagnate in our pain and suffering.

When we choose to confront things
With an attitude of acceptance
That gives us the serenity to change the things we can
And the wisdom to know our limits.

Acceptance of our life situation and what we need to do about it…is a way of turning suffering we cannot tolerate into pain we can tolerate. It’s a way of turning hopelessness into hope. Most of us have been suffering the pain of our lifestyle and choices for years…and somehow, we remain willing to experience ongoing pain and misery because of them. We’re somehow willing to suffer long-term pain, but we’re not willing to go through the temporary pain of change. We’re somehow willing to dwell in a painful past, to remain in painful situations, and to continue painful addictions and impulsive behavior. We do so because we’re unwilling to accept and undergo the changes that will bring peace and stability.

Radical Acceptance involves accepting what we’d normally consider unacceptable. When we LIVE BY Radical Acceptance, we CAN ACCEPT something whether or not we approve of it and whether or not it’s right or wrong, fair or unfair, or pleasant or unpleasant. Radical Acceptance is about CHOOSING TO ACCEPT whatever is in our best interests to accept.

We MUST ACCEPT whatever we HAVE TO accept because NON-ACCEPTANCE keeps us emotionally troubled and stuck in negativity. To have peace, we must accept many things whether or not they’re acceptable. We must accept things from the past and present. Anything in the past that’s unfixable, we need to LET IT GO. Anything in our current life that we CANNOT CHANGE, we need to accept that it MAY NOT change. Anything we CAN change, we must LEAN INTO…to MAKE THE CHANGES we CAN MAKE. Our Recovery Goal is to live a life that MAXIMIZES peace, stability, meaning, and productivity. To do that, we MUST ACCEPT what has happened HAS HAPPENED, what we’ve done, WE’VE DONE…then, we need to LET IT GO…so we can GO ON with life.

From pages 313 and 316 – Excerpt from “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” by Melanie Gordon Sheets, Ph.D. – 2009 – Recovery Works Publications