Category Archives: Thinking – Destructive

Track Your Emotional Level Using “The Levels of Emotion Chart” from the DBT-CBT Workbook (with Estimates of Emotional Mind and Rational Mind)

Posted on August 26, 2011 | Leave a comment

The Levels of Emotion Chart provides descriptions of how we FEEL and FUNCTION when we’re experiencing different levels of negative emotion. The levels range from 0-10. At Level 0, we are at peace. At Level 10, we are desperately overwhelmed with negative emotion. Notice the far right columns.  They show how active Emotional Mind and Rational Mind are at each level (this is just a guess though!) This chart helps to gauge or measure our emotional intensity and to better understand the effect our emotional levels have on our ability to participate effectively in our life.

Use the link below to check out the chart and to read the text from the workbook related to the chart.  I don’t know why, but you’ll go to a page view that doesn’t open the file…BUT, if you click the link again when you get to that page…it’ll come up like it’s supposed to!  

The Levels of Emotion Chart – from the DBT-CBT Therapy Workbook by Melanie Gordon Sheets, Ph.D.

Review the levels of emotion in the chart and answer the following questions.

What level are you currently at?

What has been you lowest and highest level today?

What is the level of your best functioning over the past week? the last month?

At what level were you at when “Something Happened” and you ended up having to go into treatment?

At what level should you seek help so you can prevent going into treatment?

Most group members believe we should call our support person, sponsor, counselor, or crisis worker at level 5 or 6. Knowing what they know now, they want to get help BEFORE things begin to get out-of-control. At levels 5 and 6, we still have a fair amount of Rational Mind going on. This helps us to seek support…and to accept the Rational Mind and Wise Mind understandings and suggestions offered to us!

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Posted in 1 - The DBT-CBT Workbook, 2 - From a DBT-CBT Therapy Perspective, Depression and Suicidality, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Relapse - Recovery Dynamics, Self-Destructive Behavior, Self-Injurious Behavior - Cutting, Substance Abuse, Suicide and Suicidal Behavior, Thinking - Destructive

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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

Posted on August 18, 2011 | 6 comments

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)

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Posted in 1 - The DBT-CBT Workbook, Aggression - Physical - Verbal, DBT - CBT Workshops and Trainings, Depression and Suicidality, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Pain and Suffering, Relapse - Recovery Dynamics, Self-Destructive Behavior, Substance Abuse, Thinking - Destructive

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Working Through Verbal and Emotional Abuse: Challenging the Lies We’ve Come to Believe Using DBT-CBT Therapy Techniques

Posted on February 21, 2010 | Leave a comment

The following is an amended excerpt from the DBT-CBT Workbook. It is from Chapter 8, “Challenging Extreme Judgments,” which focuses on the negative things we say to ourselves (and believe) and the negative things others have said of us that we come to believe as truths about us.

When we’re mad or hurt, we sometimes say very hurtful things to ourselves and others. This is Emotion-Driven Behavior. Our hurtful words are based on how we’re thinking and feeling in the Heat-of-the-Moment! They’re ANGRY WORDS. We’re not in Rational Mind and we’re not speaking truth. We’re expressing HOW WE FEEL about people and things WHEN WE’RE MAD OR HURT! Words driven by a heated Emotional Mind SHOULD NOT BE TRUSTED!

The purpose of this chapter is to recognize that these statements are borne from Emotional Mind…an angry, depressed, or discouraged state of mind. They are Emotion-Driven Lies…not Rational Mind truths. The worksheet for this chapter, “The Challenging Negative Judgments of Me Worksheet” leads us through the process of challenging these lies through Rational Mind. We identify a particularly hurtful statement that has negatively impacted our self-esteem and self-concept and we identify characteristics of ourselves that prove that we are not that way. Then, we are challenged to answer the question…”What is rational to believe…that statement that came out of the mouth of someone who was upset and irrational in the emotional moment…or all these facts about ourselves that prove otherwise and the hundreds of people that agree we really are this kind of person?”

THESE TRUTHS SHOW HOW MUCH OF A LIE the negative judgment is…and has been. The judgment was NOT based on truth. It was an EMOTION-DRIVEN LIE MADE UP about us…and WE HAVE LIVED SO MUCH OF OUR LIFE BASED ON THIS LIE. We have believed the lie. We have NOTICED EVERYTHING that supported the lie, and discounted, overlooked, and IGNORED ALL THE THINGS that challenged the lie…all the things that prove we’re NOT stupid, worthless, or undesirable. LET THAT SINK IN. What was said about you is A BOLD-FACED LIE. IT IS NOT TRUTH. We know that now because THE FACTS PROVE IT! Anytime those old feelings come up, be ever so Mindful of the facts and the TRUTH. TAKE A STAND and RATIONALLY CHALLENGE THE LIE…right then and there. Don’t EVER let yourself get away with believing that lie again. RATIONALLY CONFRONT IT and DEFEND YOURSELF!

The following is the text that follows this worksheet and discussion directly about it.

APPLICATION: The Origin of the Judgmental Lies

Most of the negative judgments made about us…were first said to us when we were young. They were NOT based on anything about us…not a character trait or a personality feature.

When someone tells a 3 or 4 year old child that they’re worthless, stupid, or will never amount to anything…or they’re too much of this or too little of that…or no one will ever love them…IT’S AN EMOTION-DRIVEN LIE. How in the world can someone know something like that about a very young child? This type of meanness, ugliness, and hurtfulness SPEAKS VOLUMES about the person making the statements…AND SAYS NOTHING ABOUT THE CHARACTER OF THE CHILD.

We know that when WE make ugly and insulting comments to others, we’re being verbally abusive. Oftentimes, we’re mad and we say these things in anger. Likewise, THE PERSON saying ugly things to us is UPSET, too. Often, THEY FEEL stupid, irresponsible, or worthless and THEY TAKE IT OUT ON US. Most of them were emotionally abused…and are just MINDLESSLY PASSING IT ON to the next generation. Also, they may suffer the moodiness and impulsivity that goes with drugs and alcohol, Bipolar Disorder, Borderline Personality Disorder, etc. For whatever reason, they’re BIG-TIME IN EMOTIONAL MIND and they’re being verbally and emotionally ABUSIVE to us. When we’re YOUNG or VULNERABLE, (22) WE TRUST THEIR OPINIONS and come to BELIEVE what they’re saying. However, WE’RE BELIEVING AN EMOTION-DRIVEN LIE.

When we did “The Challenging Negative Judgments About Me Worksheet,” we CHALLENGED the EMOTION-DRIVEN LIE by looking at the Big Picture of Our Life THROUGH THE EYES AND TRUTH OF RATIONAL MIND. When we review this worksheet and consider all the things about us that support we’re capable people with worth and value, we’re functioning in Rational Mind. When we make a DECISION that WE’LL NO LONGER JUDGE OURSELVES in a FALSE and HURTFUL manner, we’re functioning in WISE MIND. When we’re DETERMINED that ANY TIME those old thoughts or labels COME TO MIND, we’ll CHALLENGE THEM and REMIND OURSELVES of all the things about us that PROVE otherwise, then, we’ll be USING WISE MIND TO MINDFULLY PROTECT OUR PEACE AND STABILITY.

ANY TIME, ANY ONE of those NASTY JUDGMENTS comes into our thoughts and begins to hurt us, WE NEED TO CHALLENGE THEM…right then n’ there. (23) We need to STOMP THEM OUT and REFUSE to allow them to CONTROL US any longer. They are lies. WE HAVE BEEN LIVING A LIE. We have perceived ourselves based on a lie. DO NOT ALLOW THESE LIES TO CONTROL YOUR LIFE ANY LONGER! DO NOT ALLOW THEM TO TAKE AWAY your peace and stability! They’re things Coming At Us that have NO PLACE in our Inner Circle.  TAKE A STAND against these lies…and FIGHT FOR YOUR RECOVERY!

APPLICATION: Stupid Is as Stupid Does?

At this point, some folks say, “When they said that, I had done something stupid or irresponsible.” Remember, we’re human. We’re not perfect. Things WILL happen.  That’s our humanity! One stupid behavior or 10 or 12 of them means we did one stupid behavior or 10 or 12 of them. Those things describe our behavior in-the-moment or the month. They DO NOT define WHO WE ARE as a person or WHAT WE’RE CAPABLE OF. They DO NOT define our character or our make-up. THEY DEFINE AN event, action, or a behavior…NOT our WHOLE person. Just because the 8th grade educated shift team leader made a mistake, that doesn’t mean he’s stupid. That means HE MADE A MISTAKE…THAT DAY. That mistake and an 8th grade education DOESN’T describe what he’s capable of. Those things DO NOT define his character or describe everything he has ever accomplished in life. HE IS NOT STUPID. He simply made AN ERROR.(24) Stupid ISN’T as stupid does!

There may be times in our life when we make many errors…even when we totally mess things up for a year or two by making one bad decision after another. DOES THAT MEAN WE’RE STUPID? NOOOOOO. It means we’re DYSREGULATED (25) and LIVING Big-Time in Emotional Mind. It means we’re making a lot of Emotion-Driven decisions which ARE STUPID. That DOESN’T MEAN WE ARE STUPID…you know why?    Explain. _________________________________________________________________________
_________________________________________________________________________

We’re NOT stupid or clueless. In our gut, we usually know our behavior is going to cause problems BEFORE we do it! We have Wise Mind going on, but we’re NOT PAYING ATTENTION TO IT. We’re NOT Following Through With What We Know is in our best interests…because WE’RE BIG-TIME in Emotional Mind! WE’RE  DYSREGULATED… we’re LIVING IN-THE-MOMENT. We’re uncomfortable…we hurt…we’re not worrying about tomorrow. We’re living for TODAY…and if it feels good…we’re going to do it!

Are we STUPID because we do it?  Explain. ___________________________________
____________________________________________________________________

No, we’re NOT STUPID. We’re ACTING in poor judgment. We KNOW better.  We know right from wrong…and good from bad. We DO stupid things because EMOTIONAL MIND IS DRIVING. That’s why we SPIN-OUT and LOSE CONTROL.  That’s why we wreck-out and our life becomes a total wreck.

So, does that mean we have poor judgment?  Explain. __________________________________

____________________________________________________________________________

NO…because WE HAVE GOOD JUDGMENT! We KNEW it was stupid or of poor judgment…but we did it anyway! We KNEW it was going to end poorly, but we DIDN’T CARE AT THE TIME. We just did what we WANTED to do…
and no one or nothing was going to stop us. We were being VERY WILLFUL.

What we did was EMOTION-DRIVEN Behavior. We do all types of MINDLESS and IMPULSIVE things when we’re acting on Emotional Mind…ESPECIALLY WHEN WE’RE IN A DESPERATE STATE, like desperate for relief, desperate for comfort, or desperate to be held and loved on. It’s NOT STUPIDITY. It’s DESPERATION. You’ve heard the saying, “Desperate times call for desperate measures.” Well, desperate measures often involve risky things that are likely to have a bad outcome. So, BECAUSE WE’VE DONE SOMETHING STUPID or two years or ten years worth, that DOESN’T MEAN WE ARE STUPID. That’s because WE KNOW BETTER.

WE JUST DO IT ANYWAY! Gladly, this workbook is about GETTING CONTROL of our BEHAVIOR and our LIFE! And, we do that by Turning On RATIONAL MIND and WISE MIND to REGULATE and CONTROL our dysregulated and Out-of-Control emotions and Emotion-Driven Behavior.

Footnotes:

22- If we’re older when these lies were spoken, they usually came from an abusive spouse or romantic partner.  Over time, we’ll realize these people were angry, mean, harsh, moody, and unfair.  We KNOW their words were Emotion-Driven.  We KNOW they’re abusive, mean, and critical people, but for some reason, we believe their ugly opinions.  We believe they’re right and other people are wrong.  Go figure.  The truth, we were vulnerable and they took advantage of it.  Often, they were mean to “keep us in our place”…in a “downed position” with low self-esteem.  They wanted us to believe we ARE stupid, unworthy, and not capable…so we would never have the strength to leave them.

23- Whenever a negative judgment begins to bother you, either complete “The Challenging Negative Judgments of Me Worksheet” in your mind or on paper.  Use this RECOVERY TOOL to challenge those lies!

24- I’m pretty smart with a Ph.D…that just gives me a license to be  Piled Higher and Deeper in errors!  Lord knows if it’s 10AM and I haven’t made an error yet, I must still be asleep!

25- Dysregulated – (dis-reg-you-lated) – not in control of ourselves… we’re not able to regulate or control our behavior.

Extra margin text below:

No matter how smart we are or how much psychological stuff we know, we can get side-swiped and wrecked-out by a hurtful comment.

When we believe these lies and base our sense of self and identity on these lies, we’re viewing ourselves through Emotional Mind.  We’re not dealing with the facts and the truth.  We’re overlooking, ignoring, and denying all the things which tell us we aren’t that way…and we’re focusing on ALL the things which suggest we may be that way.  We’re ignoring what Rational Mind is telling us and we’re viewing ourselves through the distorted lenses of Emotional Mind.

We have thought poorly of ourselves and have treated ourselves poorly because of a lie.

We ARE going to do some stupid and thoughtless things now and then, but that doesn’t mean we’re a stupid and thoughtless person.  It means we DID SOMETHING that was stupid or thoughtless.

We ACTED in poor judgment.  We went against our good judgment.

“Then how do we describe this stupid, poor judgment behavior?!”   We describe it as DESPERATE behavior.  It’s not an issue of smarts.  It’s an issue of being desperate and dysregulated!  It’s an issue of being OUT-OF-CONTROL! We know better, but we do desperate, self-defeating things anyway.

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

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Posted in 1 - The DBT-CBT Workbook, 2 - From a DBT-CBT Therapy Perspective, 3 - DBT-CBT in action, Aggression - Physical - Verbal, Anger, Emotional Abuse, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Relapse - Recovery Dynamics, Relationship Dynamics, Thinking - Destructive

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Using Rational Mind to Challenge the Emotional Mind Lies We Tell Ourselves That Sabotage Our Self-Confidence and Recovery: A View of Addiction Recovery from a DBT-CBT Therapy Perspective

Posted on January 18, 2010 | 2 comments

Here’s an “adapted” excerpt from the DBT-CBT “Out-of-Control” therapy workbook.  It’s from Chapter 7, the Rational Mind chapter.  This chapter discusses Rational Mind in detail and offers many Rational Mind challenges for the Emotional Driven Lies we tell ourselves AND WE BELIEVE…ones that often sabotage our self-esteem and our recovery.

The Self-Fulfilling Prophecy of Failure:
“I expect to fail so I don’t try very hard …so, I fail.”

SKILL BUILDER: Failing to Succeed…or Successful Failures

Consider the lies we tell ourselves about success and failure, like,

“I’ll NEVER be  able to do it.”

“Everything I try gets screwed-up somehow.”

What do you say about your failures?  ____________________________
________________________________________________________

The truth…we MAY HAVE failed at MANY tasks.  If so, we need to rationally understand why.  Quite often, we fail because we DON’T TRY to succeed.  We “KNOW” we can’t do it…so we DON’T TRY, or we DON’T TRY VERY HARD.

Despite USUALLY giving things ONLY A HALF-HEARTED EFFORT, we may recall some times WHEN WE REALLY TRIED, but failed anyway.  BUT, DON’T THINK we’re off the hook because of some FULL EFFORT failures.

WE DON’T GET TO STOP TRYING just because when we’ve REALLY TRIED, we’ve still failed!  Rational Mind would inform us that MOST PEOPLE WHO SUCCEED HAVE FAILED MANY TIMES.  There are many TRUE stories to support this TRUTH.

Which stories have you heard…about people who FINALLY SUCCEED AFTER A LONG STRING OF FAILURES? _____________________________
_____________________________________________________

Abraham Lincoln ran for MANY political positions and lost MANY TIMES before he ever WON an election.  The ONE he won was THE BIG ONE…the PRESIDENTIAL election!  There are MANY stories about business leaders who had MANY failed businesses before they hit it big!  Henry Ford went bankrupt 5-6 times because of failed businesses before he gained success in the automotive industry.  The Heinz company had the same kind of start.  Have you read that Oprah was fired from a reporter’s job because she wasn’t right for TV?  Somebody certainly misjudged her!

Some of our greatest leaders and wealthiest people failed many times
before they achieved great success.

When we fail, we need to SEEK AN UNDERSTANDING of WHY we failed.  We need to LEARN FROM IT and CORRECT WHAT WE’RE DOING.  We need to change or adjust our plan to deal with what went wrong.  Successful “failures” start with PLAN A and go to PLAN B, C, D, E…and so on until things work out!  Despite their failures, THEY KEEP ON KEEPING ON!

It’s also important to be Mindful of our successes and accomplishments and to note WE’VE ALL HAD SOME!  We also need to realize that WHEN WE’VE TRIED…when we’ve REALLY STUCK WITH IT, we’ve overcome challenges…and WE HAVE BEEN SUCCESSFUL. Consider the 8-18 attempts at recovery that it takes people ON AVERAGE to become clean n’ sober.  Through our recovery attempts, we learn about our triggers and relapse patterns.  We learn we REALLY HAVE TO change the things in our life that we DON’T WANT TO CHANGE…things that we’ve refused to change, like friendships, activities, and abusive or conflict-filled relationships.  Because of our repeated failures at recovery, we FINALLY SUCCEED!  That’s because we’ve revised our Recovery Plan SO MANY TIMES that we FINALLY GET ENOUGH OF THE NECESSARY CHANGES made!  We’re hard-headed and we’ve got to learn from OUR experiences…and in the world of recovery…these experiences ARE OFTEN RELAPSES.

Does this information change the way you think about your “failures”?  If so, explain.  ______________________________________________
___________________________________________________

Changing our LIFESTYLE and our LIFE IS VERY DIFFICULT.
We need to ACCEPT OUR FAILURES
and UNDERSTAND they’re a NATURAL part
of the LEARNING PROCESS…
IF we learn from them.

It’s clear that Emotion-Driven Thoughts like, “I can’t do it. Why try?” are lies we tell ourselves. What’s the truth? _______________________________
______________________________________________________

The truth is, WHEN WE KEEP TRYING, things FINALLY work out.  Sometimes, we don’t succeed because we aren’t going about it the right way.  Therefore, we need to get a NEW PLAN.  Sometimes, we try to do more than is do-able at one time.  We plunge head first when we’d be better off wading in and taking smaller steps!  There are many reasons why we haven’t reached our goals.  Fortunately, most of these problems can be overcome with PERSISTENCE and a REVISED GAME PLAN!

Footnote: This footnote is “margin text” from the workbook alike the dark red inserts in the text above…however, these weren’t so easily woven in!  This first one relates to the 8-18 tries at recovery it takes on average to recover from substance abuse.

“Some say, ‘Been there, done 14, I’ve got to be real close to making it!’ Folks who are new to recovery are discouraged, ‘I don’t want to do this that many times.’ Be Mindful that 8-18 is an average. Some make it on the 1st try (they need to write the book!), others on the 25th. Some make it in 3 tries, others in 20. Bear in mind though…these numbers don’t mean it’s okay to relapse 17 times and then work real hard on the 18th try!”

These are “sayings” in the margin that go along with the text:

“If we don’t put forth a FULL effort,
we’ll never REALLY KNOW if we can succeed.”

“We never fail until we quit trying.
Success comes to those who are determined
to overcome obstacles in their path.”

When we understand that our failures are part of the learning process,
then we can constructively accept our failures and learn from them.

We’re so willful and hard-headed about recovery…
we won’t take someone’s advice or learn from THEIR experiences.
We have to learn from OUR personal experiences…
which is often OUR failures!

A mistake is only a mistake
if we fail to learn from it!
When we learn from our experiences,
our failures become a stepping stone toward success!
Therefore, a recovery goal is to Turn On Rational Mind to challenge our “failure” lies…
and to Turn On Wise Mind to make some adjustments to our Game Plan!
That’s because WE haven’t failed, our plan has!

Hope you enjoyed this blog entry and that it helps to challenge destructive “failure” thoughts.  It took half of forever to format this…the format of the workbook doesn’t cut n’ paste very well…or at least I haven’t learned yet how to do it more efficiently!  Life is one big learning curve and I guess sometimes we’ve just got to hold on…persevere…and enjoy the ride!

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Posted in Acceptance - Non-Acceptance, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Relapse - Recovery Dynamics, Self-Destructive Behavior, Thinking - Destructive, Willingness - Willfulness

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Six Major Problem Areas Addressed by the DBT-CBT Recovery Program

Posted on December 11, 2009 | Leave a comment

DBT-CBT Addresses Six Major Problem Areas

These six areas are listed below.  Examples of the types of problems
we might have in each area are also noted.

This workbook is designed to meet the needs of people who suffer
from problems in SOME or ALL of the six areas.

1. RELATIONSHIP PROBLEMS

Conflict-Filled or Stormy Relationships   •   Abusive Relationships
Relationship Disappointments or Frequent Ups and Downs
Unfulfilling Relationships   •   Short-Term Relations
Love – Hate Relationships   •   Few or No Close Relations
Fear of Rejection  /  Actual Rejection  /  People Have Pulled Away
Co-Dependency  /  Dependency   •   Attention-Seeking Behavior
Fear of Abandonment  /  Actual Abandonment   •   Mistrust
Mad at Everyone   •   Loneliness  /  Can’t Tolerate Being Alone
Shyness  /  Fear  /   Major Discomfort in Social Situations

2. MOOD SWINGS – DEPRESSION – ANXIETY – ANGER

Moodiness  /  Major Mood Swings   •   Easily Angered   •   Rage
Guilt / Shame   •   Being a “High Drama” Person
Unbearable  /  Intense Emotions   •   Anxiety  /  Panic
Depression  /  Helplessness  /  Hopelessness  /  Worthlessness
Believe Things Won’t Get Better  /  Want to Give Up
Feel Out-of-Control  /  Overwhelmed  /  Suicidal

3. UNHEALTHY THINKING

Worrying  /  Overthinking  /  “Stewing” over Things
Dwelling on the Past   •   Preoccupied with Revenge
Pessimistic Thinking  /  Negative Expectations   •   Irrational Beliefs
Catastrophizing  /  Blowing Things Out of Proportion
Black and White  /  All-or-None Thinking
Putting Ourselves Down  /  Focusing on Our Worst Qualities

4. UNHEALTHY COPING BEHAVIORS

Please see the “List of Common Self-Destructive Coping Behaviors” above.

5. OTHER IMPULSIVE BEHAVIORS – BAD CHOICES

Doing Things on a Whim  /  Making “Snap Judgments”
Not Thinking Things Through and Having Negative Consequences as a Result

6. QUALITY OF LIFE PROBLEMS

Burnt-Out  /  Life Is a Chore   •   Nothing to Live For
Emptiness  /  Meaninglessness  /  Boredom
More Problems Than I Can Bear   •   Must Start Over
Financial Problems  /  Bankruptcy
Job Loss  /  Can’t Keep a Job Loss of Career or Professional License
Demotion  /  Probation at Work
Loss of Relationships   •    Family Pulled Away   •   Can’t See Children
Loss of Trust From Others   •   Reputation Damaged
Loss of Self-Respect and Integrity   •   Loss of Self-Confidence
Problems Getting an Education  /  Not Completing Semesters
Underachievement • Loss of Housing   •   Loss of Transportation
Loss of Possessions • Loss of Pets   •   Loss of Freedom
Legal Problems  /  Probation or Imprisonment
Health Problems  /  New Medical Diagnosis

This list is an excerpt 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.  – 2009 – Recovery Works Publications

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Posted in About the Workbook, Aggression - Physical - Verbal, Anger, Anxiety and Panic Attacks, Borderline Personality Disorder, Depression and Suicidality, Excerpts, Grief and Loss, Relationship Dynamics, Thinking - Destructive

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A Partial Relapse or a Full Relapse – Using Rational Mind and Wise Mind to Tame an Out-of-Control Emotional Mind (A DBT-CBT Workbook Perspective)

Posted on December 5, 2009 | Leave a comment

The following is “Pete’s Story” – an excerpt from the DBT-CBT Out-of-Control Workbook which highlights a “real life” relapse experience.  This relapse is processed using principles and concepts from the DBT-CBT Recovery Program, especially the three mind states of DBT.  It’s an example of DBT-CBT “In Action.”  The content for this post is the opening for Chapter 7, the “Rational Mind” chapter of the workbook.  As it is from Chapter 7, it refers to things discussed in Chapters 1-6.  So, if you feel a little lost reading it…that’s why!

Chapter 7 – RATIONAL MIND

We’ve been working with Rational Mind (1) throughout this book, so you’re somewhat familiar with this mind state. Rational Mind is the part of us that processes life in a logical, legalistic, fact-driven, reality-oriented, and cut n’ dry manner. In other words, Rational Mind uses reasoning, it respects rules, it’s guided by truth, it deals with how things really are, and it’s the calm, cool, intellectual, and unemotional part of us!

Emotional Mind is driven by how WE SEE AND EXPERIENCE the world while Rational Mind is driven by how THE WORLD REALLY IS!

The Purpose of Rational Mind

A Recovery Goal is PREVENTION of Destructive Emotion-Driven Behavior. We need to STOP OURSELVES before we do what we really feel like doing!
Rational Mind helps us to gain control before things get Out-of-Control.

When we’re in a troubling Emotional Mind state, the first step for gaining control is Mindfulness. We need to be aware of what’s going on in Emotional Mind. We need to be Mindful of our Raw Emotions, Emotion-Driven Thoughts, and our desired Emotion-Driven Behavior. This includes awareness of our feelings, the thoughts racing through our mind, and what we’re thinking about doing! Once we become aware of what’s going on in Emotional Mind, we need to TURN ON RATIONAL MIND to look at our situation logically and realistically.

Rational Mind helps us to know what is true and factual.
It helps us to perceive the reality of our situations and our life.
The reality of Rational Mind is generally quite different from the picture Emotional Mind paints!

Rational Mind helps us to understand THE BIG PICTURE OF THE SITUATION and the TRUTH about what’s going on. This helps us to challenge our Emotion-Driven Thoughts and to get our emotions MORE IN LINE with the REALITY of the situation. This REDUCES our emotional distress because we FOCUS on the HERE-AND-NOW situation RATHER THAN EVERYTHING that has EVER HAPPENED to us.

Rational Mind also considers the Big Picture of Our Life and REMINDS us of the CONSEQUENCES we’ll SUFFER if we ACT ON destructive Emotion-Driven impulses. WHEN we’re USING Rational Mind to deal with what’s going on in Emotional Mind, WISE MIND TURNS ON and BRINGS US to a GAME PLAN for effectively dealing with our situation. Our Recovery Goal is to PARTICIPATE EFFECTIVELY in our life… so we’re MANAGING and DEALING WITH our problems RATHER THAN CAUSING OURSELVES MORE PROBLEMS!

APPLICATION: The Meeting of the Minds

The following story, “Pete’s Story,” is a good example of how the three Mind States work together in real life.

Pete’s Story

Pete has a lot of stress and family conflict caused by his responses to life. His family has allowed him to stay in their garage apartment “for the last time.” His probation requires him to be employed. He doesn’t have a good work history so it took a while to find a job. He just bought a used car and now has visitation with his kids because he’s paying child support. Things are pretty good in his life… though not the greatest. His boss accused him of doing something he didn’t do. He blew up and walked off the job. He went to an old hangout and started drinking again and snorted some coke. Thoughts began churning in his mind. He is very worried and is thinking the worst, “My family is going to kick me out and I’ll be homeless again. I’ll lose my car without income and I’ll lose visits with my kids. If I get called for a UA (2), it’ll be dirty and my probation will get revoked (3)…especially since I’m now unemployed. Then I won’t see my kids for a long time.” He’s very upset with himself and thinks, “I am such a failure. I screw everything up. My family will NEVER let me hear the end of this. I should just kill myself. I can’t handle all this crap again.” Thoughts are racing through his mind. His emotions intensify and he becomes more and more upset. He begins to panic. He is desperate for a way out and considers going back to live with his ex-girlfriend. He’s afraid of doing that because she still uses drugs. He panics even more and all he can think about is killing himself. He ruminates about this stuff for hours and hours. It’s now 3AM and he’s worried about going home…so late…so upset…and so messed up.

Does Pete’s story seem like Real Life or does it seem like an exaggeration to make a good story? _____________________________________________________________________________________
_____________________________________________________________________________________

Have you been in a state like this before about a lost job or some other major problem? If so, describe how your experience is similar to his. ________________________________________________________________ ______________________________________________________________________________________

The quality of our life comes down to two choices.
We can LIVE IN Emotional Mind and ALLOW our life to fall apart
OR we can TURN ON Rational Mind and Wise Mind
to get a Game Plan for dealing with our problems.
The choice is to stay on the life-enhancing Recovery Path
or to go the way of Relapse Route.

SKILL BUILDER: Pete’s State of Mind

Re-read Pete’s story and UNDERLINE the parts that describe what’s going on in his Emotional Mind. Put a BOX around the parts that are driven by Rational Mind.

You probably had no trouble identifying what was going on in Emotional Mind. You may have had some trouble deciding if his statements about getting kicked out of his apartment, being homeless…and losing his car, probation, and visits with his kids were Rational Mind or Emotional Mind.

What did you decide? Explain what you based your decision on? ________________________________________________________________________________________
________________________________________________________________________________________

When he went to the bar, he was upset.
then he began drinking and drugging,
then he became hopeless, desperate, and PANICKED.

Mindfulness of the consequences suggests he was in Rational Mind. Some think he was in Emotional Mind because it seemed like he was catastrophizing4 how bad things could get. However, given his life situation, his worries WERE based on truth and reality!

A reason to suspect he was Big-Time in Emotional Mind is…WISE MIND DIDN’T TURN ON and OFFER LIFE-ENHANCING SOLUTIONS. All he did was ruminate for hours about consequences and finding a way out…NOT A WAY THROUGH. He was panicking! All the COCAINE and ALCOHOL did was PUSH HIM DEEPER and DEEPER into Emotional Mind…and farther and farther away from Rational Mind and Wise Mind. He couldn’t think straight. The MORE he ruminated, drank, and snorted, the MORE DEPRESSED, ANXIOUS, WORRIED, and PARANOID he became.

In order to think straight,
we’ve got to be straight!

The Big Picture of Pete’s Story suggests he was Big-Time in Emotional Mind. He had SOME Rational Mind going on…but, not much. He was AWARE of the consequences of losing his job, he KNEW he should not return to his ex, and he KNEW his behavior would cause family problems. He was probably 80%-20% Emotional Mind – Rational Mind. Wise Mind flickered on and encouraged him NOT to call his ex. Not having that option…and having more time to drink and snort, he panicked even more…and came to believe that suicide was his best option.

Isn’t it odd how we can go from bad to worse…
and we begin to think the worst option is the best?

Given Pete’s story IS Real Life, how do you think this part of his story ends? _______________________________________________________________________________________
_______________________________________________________________________________________

He’ll either do something MORE DESTRUCTIVE, like a suicide attempt, driving drunk, or a full-blown relapse OR he’ll do something LIFE-ENHANCING like staying safe and sleeping it off in the car and TURNING ON Rational Mind WHEN HE COMES TO…TO GET HIS LIFE BACK IN ORDER.

Pete’s story tells about the “Something That Happens” on the Recovery Path and the two choices we have. Pete CHOSE the RELAPSE ROUTE in the Heat-of-the-Moment. HOWEVER, he DOESN’T HAVE TO stay on that path. He can call for help at 3AM or crawl into his car and sleep it off.

SKILL BUILDER: How to Get Control Once We’ve Lost Control

Let’s suppose he chose the Recovery Path at 3AM.  When he comes to and is able to shake off the cobwebs later that day, what might Rational Mind say to him? ____________________________________________________________________________
____________________________________________________________________________

Rational Mind might lead him to think,

“I blew up and walked off the job and I drank and used coke last night. I was scared. I freaked out…but this DOESN’T HAVE TO BE the end of the world. It’s time for DAMAGE CONTROL. MY PRIORITY RIGHT NOW is to get a job. Whether it’s my old job back or a new one…I need to act fast! No doubt my folks know Something Happened because I didn’t come home last night and I’m home now when I’m supposed to be at work. I need a plan for dealing with them, too, so I don’t lose housing.”

At this point, Emotional Mind will probably rear up with all kinds of self-defeating thoughts and feelings. Pete MUST TURN ON Rational Mind to Fight for his peace and stability.  He cannot ALLOW Emotional Mind to control the course of his life.   When a destructive thought comes up, Pete needs to remind himself that HIS NUMBER ONE PRIORITY is to STAY ON the RECOVERY PATH and that HE CAN AND WILL HANDLE this situation. He needs to tell himself that he STRUCK OUT last night, but there’s still MORE INNINGS in the game. He’ll have to challenge the destructive Emotion-Driven Thoughts AS THEY COME UP and REMAIN FOCUSED on TRUTH, REALITY, DAMAGE CONTROL, and PROBLEM-SOLVING.

At this point, Wise Mind will kick in to help him with a plan of action. What might Wise Mind suggest? ______________________________________________________________________
______________________________________________________________________

Wise Mind might suggest he visit his boss to apologize for blowing up and to ask for his job back. Wise Mind might suggest he TRY to assure his boss he didn’t do what he was accused of doing. Wise Mind would likely remind him if “Plan A” doesn’t work, he could apply for dozens of other jobs until he gets one…and that IT’S NO TIME TO BE PICKY! Wise Mind might encourage him to explain the situation to his parents…to let them know HE SLIPPED…but was BACK ON the RECOVERY PATH. If needed, he could tell them he’ll have a job quickly, REGARDLESS OF WHAT HE HAD TO DO. Wise Mind would likely inform him that it’s unlikely he’ll get called for a UA over the next few days and to pray on that! If he did get called for one, Wise Mind might suggest telling his probation officer what happened and the POSITIVE WAY HE’S DEALING WITH IT. Wise Mind would have MANY DAMAGE CONTROL and PROBLEM-SOLVING IDEAS for GETTING RECOVERY BACK ON TRACK!

When we mess up, we don’t give up.
We STAY IN the game even if it’s our toughest inning ever.

If at the end of the next day, he didn’t get his job back and he didn’t get a new one, Emotional Mind could easily start the self-defeating rumination and worry process. What could he do to help himself if this starts up? ________________________________________________________________________________________
________________________________________________________________________________________

Rather than spending days worrying about a catastrophe happening, Wise Mind would inform him that he’d be BETTER OFF PREVENTING ONE by focusing on a Game Plan! Wise Mind would strongly encourage him to chill-out and focus on Damage Control, problem-solving, and the use of Life-Enhancing Coping Behaviors (5) to avoid destructive worry.

Through Rational Mind, he could TAKE NOTE of the PRODUCTIVE things he’s done the last two days INCLUDING his MAJOR SUCCESS with QUICKLY GETTING BACK ON THE RECOVERY PATH and preventing a full-blown relapse. He could LIST HIS GOALS for the next day and a PLAN OF ACTION for the rest of the week. Since money is tight, he could WORK OUT A PLAN for paying what HAS TO BE paid. He could DISTRACT himself with POSITIVE ACTIVITIES (support group meetings like AA, helping his family prepare a meal, visiting with a recovery friend, etc.). He could SEEK TEMPORARY WORK cleaning yards, painting his parents home, and whatever else he can come up with to earn money and to KEEP HIS MIND BUSY. He could even talk with businesses about hiring him for a day or two to do “odd jobs.”

This WORK-UP of Pete’s story shows how RATIONAL MIND helps to CONTROL the INTENSITY and NEGATIVITY of an UPSET EMOTIONAL MIND! Rational Mind DOESN’T BUY INTO a “I’m a total screw-up. This is going to ruin everything. I can’t deal with it. I should kill myself.” mentality. Rational Mind CHALLENGES panic and negativity by looking at the situation in a calm, NON-EMOTIONAL, realistic, logical, and truthful manner. In the upcoming sections, we’ll look at some common Emotional Mind experiences from the viewpoint of Rational Mind. We’ll see how Rational Mind TAKES the POWER and NEGATIVITY OUT OF a destructive emotional experience.

Rational Mind tames what comes out of Emotional Mind.
Rational Mind pulls on the reins and helps to get control
of what is going Out-of-Control.

Footnotes

1- Dr. Linehan calls this mind state “Reasonable Mind.” On page 65 of her Skills Training Manual, she states, “This is your rational, thinking, logical mind. It is the part of you that plans and evaluates things logically. It is your cool part.”
2- UA – urinalysis – a urine test to check for drugs or alcohol.
3- Probation revoked – to lose the privilege of being on probation. Folks have to serve their sentence in jail if their probation is revoked.
4- Catastrophizing – (cuh-tah-stro-fi-zing) –when we’re focusing on the very worst things that could happen. It’s a form of the word, catastrophe – (cuh-tah-stro-fee).
5- Being busy with problem-solving…and working towards the solution is a powerful coping tool. Getting a newspaper and a phone book and making a list of jobs to apply for and businesses to call and visit is solution-focused. Visiting the employment agency and ironing a decent set of clothes for job hunting is very constructive, too!

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Posted in Anger, Anxiety and Panic Attacks, Depression and Suicidality, Emotional Mind, Rational Mind, and Wise Mind, Excerpts, Mindfulness, Relapse - Recovery Dynamics, Self-Destructive Behavior, Substance Abuse, Suicide and Suicidal Behavior, Thinking - Destructive

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Using DBT and CBT to lose weight

Posted on October 4, 2009 | Leave a comment

I’ve lost 145 pounds and now I have to go on a diet! That’s where I’m at right now. I have steadily lost a ton of weight in 4 years and I find myself in need of going on a diet! September was a VERY bad month for me. I had many more bad days with very high calories than usual (in the 1800-2100 range with one day even higher!) Such high calorie days typically happen just a couple times a month…not many times! Last month (September), I ended up with almost 200 more calories per day than typical. May sound like nothing…but, that adds about 1-1/2 pounds to me over the month…and it kept me from losing any weight.

That may not sound bad…but, the problem is…I really struggled this past month. I was “out-of-control” with eating. I’d pig out some days…and then work hard other days to get my overall monthly calorie count lower…only to have more pig-out days…followed by major attempts to control my eating…which still very often resulted in more calories for me than usual. Overall, I did not have a natural eating pattern this month…it was a time of out-of-control eating.

I recognized that I was in a period of early relapse with my eating disorder (over-eating)…and that if I didn’t gain control, I would lose control, and end up “out-of-control” and back in a cycle of weight gain. I was mindful that I could end up gaining a bunch of weight and perhaps end up fatter than when I started. Scary. Don’t want to go there on purpose.

Because I live, eat, and breathe the teachings of the DBT-CBT “Out-of-Control” Therapy Workbook, I began dealing with this early relapse and my neurotic self. Towards the end of the month when I thought,

“Oh my God, I’m going to gain all my weight back”

and various other statements of an Emotional Mind panic, Rational Mind came to my rescue.

“If I don’t gain control, I will lose control, and gaining weight is certainly likely. I’ve done well with this diet thing for 4 years. I’ve been within ideal body weight for a year now. I’ve been losing weight up until this month. I’ve got the skills, willpower, and know-how to get control of myself. I’ve just gotta tighten up and get a Game Plan for getting through this.”

Wise Mind clicked on and I thought, “I’ll just go back to the early days of my diet and start over. I’ll do things like I did back then. I’ll just start from scratch.”

Emotional Mind clicked on, “I can just not eat much tomorrow and the next day, that’ll cut my calories down a lot for the month…and more in line with a normal month.”

Rational Mind and Wise Mind jumped me, “That’s a bad idea. You know better. You’ll just end up pigging out again. You can’t do that. It’s certainly tempting, but not the way to go. I just need to tighten up and do things like I did in the early days of my dieting.”

Emotional Mind reared up again, “Well, I can just starve myself tomorrow and the next day so my calories won’t be bad for the month and THEN I can start over. I don’t want to have such a bad month…and show a 4-pound weight gain this month. That’s awful”

Rational Mind said, “What’s done is done. It’s just numbers. You’ll show a gain this month, and then next month, you’ll go down again. It’s not real weight, well, just a pound or so. You don’t gain 4 pounds eating an extra 5000 calories a month, that’s just a pound and a half or so…and really instead of losing a pound n’ a half this month, you’re just breaking even. You’re on your period so the extra weight is probably just water.”
Wise Mind said, “Chill, you’ll be okay. This is just temporary. Let’s just get a plan.”

So, I began thinking of how I used to do things. It’s been a long time since I’ve had to be on a diet! I had developed such good eating habits that it became a natural part of living, more a lifestyle than a diet! I actually eat a very healthy diet…I’m just eating more…more yogurt, more fruit, more chocolate protein bars!

Part of my diet basics is to let the people I’m around know about my struggles and to solicit their help. So, I told the family I had a very bad September, that I need to tighten up…and that I don’t want to start the weight gain cycle. I asked them not to offer me food and to put their food up when they’re done. Of course, they’re not perfect in my recovery, so when I notice they’ve left something out that could be tempting to me, I put it up!

I’m also walking past temptation telling myself, “I can’t just eat that, I’m on a diet” instead of having a couple bites, a bowl, or a handful. I’m setting limits because my wants now are much greater than they’ve been for a long time…and I guess I’ve slacked off too much. I find myself eating because I feel like it, rather than eating when I’m hungry.

I’m also setting limits and making choices about when I’m going to eat…not just allowing myself to graze.
I also decided that I would count calories through the day instead of just doing it at night. This will increase my mindfulness of calorie intake throughout the day.

This morning as I was waking up and thinking about my day, I decided what I would eat. Since I slept late, I’d eat two meals and an evening snack.

I’ve also thought about the work week because my calories are higher during the week than on the weekends. I will bring a limited amount of food to work. For instance, instead of a huge bag of grapes that should last a few days, I’ll bring about 100 calories worth. I’m in the process of figuring out what my food day will be like at work and what I’ll have at home in the evening.

So, I’ve gone back to some of the basics, but, I’m not perfect in recovery. I’ve had one “bad day” this first four days of October, but three very good days. My overall calorie count is lower than desirable, but I have faith in myself, I’ll be able to get it up without any problem!

FYI: DBT-CBT (Dialectical Behavior Therapy – Cognitive-Behavioral Therapy)

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Posted in Eating Disorders and Weight Issues, Emotional Mind, Rational Mind, and Wise Mind, I've Lost 100 Pounds!, Relapse - Recovery Dynamics, Thinking - Destructive

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How do I recover from Borderline Personality Disorder: A DBT-CBT perspective

Posted on June 21, 2009 | 1 comment

Recovery from Borderline Personality Disorder (BPD) will be one of the hardest things you’ll ever do. It will require a lot of perseverance and focus…and Mindfulness every waking hour. It will require great effort to gain control of out-of-control emotions, behaviors, and thought processes. Then it will require great control to MAINTAIN control over time. You’ll have to want recovery more than anything else in life. Just like the alcoholic…to recover they have to want recovery more than anything else in life. You’re attitude will have to be “Recovery is my #1 priority” and then you’ll have to act in ways to make it so.

The question of how to recover from BPD was posed to me and I wrote a couple paragraphs to give the person an idea of what it would involve. I did not spell out a comprehensive treatment program, just an overview of some things it would involve. BPD is a severe personality disorder that requires a comprehensive treatment plan and years of therapy…and years of practicing new behaviors and skills to undo and change years of dysfunctional responses. So consider the following information to be an overview of the process and know there’s more to it!

Some aspects of recovery include:

    Therapy
    A support system
    Mindfulness
    Practicing life-enhancing coping skills to replace self-destructive ones…and using these in the heat-of-the-moment…and on a day-to-day basis to keep negative emotional levels as low as possible.
    Challenging self-destructive Emotion-Driven Thoughts with Rational Mind thoughts. Rational Mind thoughts relate to the unchanging TRUTH and facts about a situation, our life, other people, etc. Our Emotional Mind thoughts are based on our “in-the-moment perceptions”…or the way we think about things when we’re in an emotional state. For instance, when we’re upset, we may think and say, “Nobody cares about me.” This will be a habit…so we’ll have to catch ourselves (Mindfulness) and turn on Rational Mind and say, “Many people love me and care about me. I’m just thinking that because I’m upset right now. That’s just stinkin’ thinkin’” If we think, “Cutting would help me to feel better.”…we must catch ourselves and say, “Cutting helps in-the-moment, but it ends up causing me more pain and problems. Calling a support person and working through the moment will help me NOW and in the future. Cutting is relapse for me and will only bring me down and land me back into the Cycle of Suffering. I want recovery and I’ve got to use life-enhancing coping skills.” Wise Mind is already kicking in and will be offering some suggestions for getting through the moment.

Borderline Personality Disorder also involves dysfunctional relationship dynamics and patterns. Part of the recovery process is awareness of our sensitivities and our typical responses in relationships. Mindfulness is essential here. When we catch ourselves responding in old dysfunctional ways, we’ll have to use Rational Mind and Wise Mind to alter our responses. Like when someone hurts our feelings, we might think, “She is such a b—-. She was never my friend. I’m never going to talk to her again. I don’t get mad, I get even.” That’s Emotional Mind thinking…it’s Emotion-Driven Thinking…thoughts that are driven by or are caused by whatever emotions we are experiencing. We’re thinking that way just because we’re Big-Time in Emotional Mind. So, we’ll have to catch ourselves and challenge that thought with Rational Mind. For instance, we might remind ourselves of the truth about her and other people, like “She’s usually nice to me. Maybe something’s going on with her and she’s not in such a nice mood right now. She’s been friendly and she’s been my friend. Everyone has their moods…and I guess she’s in one right now.” Wise Mind would kick on and make some problem-solving suggestions, such as, “I’ll pull myself together and go on with my day and TRY not to worry about this. I’ll check back in with her later and see if she’s okay. If something is troubling her, I’ll offer to talk with her about it. If it seems like she’s upset with me, I’ll let her know I appreciate her friendship and I’m sorry if I did something to upset her…and I’ll encourage her to talk with me about it…and I’ll work real hard not to be defensive! I’ll try to smooth things over with her so I can maintain this relationship.”

There’s a lot to working through and changing a lifetime of experiences, habits, thought processes, reactions, etc. Therapy, support groups, a support system, mindfulness, following through with life-enhancing coping behaviors and problem-solving, and an attitude of “Recovery is my #1 priority” are some key elements to recovery. READ self-help books too…and learn as much as you can about recovery. Know that it took a lifetime to get us to this place and time…and it will take a while to recover. It’s step by step, minute-by-minute, hour-by-hour, day-by-day…month after month..and year after year. I think it is reasonable to expect that even though we get to a point of being “pretty well recovered” things will still come up…things that will bring up old feelings, insecurities, and issues…that we’ll have to deal with. But, by then, we’ll be real practiced at it and it won’t take long to set ourselves straight. Honestly, I am “pretty well recovered” but I still have to deal with myself on a daily basis. I consider myself to be “a work in progress.”

Another thing to think about is that it is normal to be “abnormal.” Most people have issues and concerns that bother them. Some struggle to get better n’ better…and others remain in denial and blame others, avoid their issues…and remain in a Cycle of Suffering.

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Posted in Borderline Personality Disorder, Emotional Mind, Rational Mind, and Wise Mind, Mindfulness, Normal People, Relapse - Recovery Dynamics, Relationship Dynamics, Self-Injurious Behavior - Cutting, Thinking - Destructive

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