Tag Archives: self-destructive behavior

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 –

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

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!

How Could Someone Try to Kill Themselves: Suicide Attempts and Doing the Unthinkable – from a DBT-CBT Therapy Perspective

When Emotional Mind drives and Rational Mind is left on the side of the road…

When folks are moderately, even severely depressed (say up to an 8 or an 8.5 on a scale of 1-10), they are “Big-Time in Emotional Mind” but they still have some Rational Mind going on (say 85% Emotional Mind and 15% Rational Mind).  Through the small degree of Rational Mind, they maintain some contact with reality and have some mindfulness of the big picture of their life. For instance, they still recognize they have something to live for…they still have some holds on life…and although their grip is loosening and they may be barely holding on…with at least some Rational Mind going on, they recognize the basics…like they have kids to live for…or pets…or their dying parent (examples).  However, as the depression worsens, Emotional Mind intensifies, and Rational Mind further fades…and they lose awareness of these reasons to live.

Patients in various ways have explained how this happens.  They relate that when they made that final decision to kill themselves…to enact that near fatal behavior…they weren’t  thinking…that previously they thought about their kids, their spouse, or other holds on life and they struggled to stay alive…but then, something happened and they no longer thought about these things.

One patient so well described this to me, I haven’t forgotten it.  She said that as her depression deepened, it was like she was going further and further down a well…and the deeper she went, the less she could see out.  She related that she got so far down, she was surrounded by darkness…she could no longer see nor feel…and she lost touch with the love she had for her kids and concern about what would happen to them.  She cried intensely and said that when she did what she did, thoughts of her kids did not cross her mind.  It was utterly heartbreaking, and yes, as a therapist and despite trying to hold my tears back, they rolled out of my eyes.  I stood up and hugged her as she wept and gently rocked her to help soothe her through the pain. It was one of those heart-wrenching therapy moments when I had no words to comfort her and could only pray for her self-forgiveness and healing.  She so loved her babies and could not understand how she could have tried to end her life.  With Rational Mind going on, she realized she did the unthinkable.

I believe that she became 100% (or near 100%) Emotional Mind…and Rational Mind was essentially turned off.   Without Rational Mind, she was not connected or in contact with the reality of her life and what really mattered to her.  It was like a Rational Mind black-out.   She was no longer mindful of the big picture of her life and the reasons to continue the fight.  And we always ask, “God, how could she have done that, she has kids” or “How could he have done that knowing his family would find him.”  They weren’t thinking…that part of their brain was turned off.

Based on the recovery workbook by Melanie Gordon Sheets, Ph.D. -<span
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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

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

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

A List of Common Self-Destructive Coping Behaviors

“A List of Common Self-Destructive Coping Behaviors”

Avoidance Strategies

Denial  •  Oversleeping  •  Procrastination  •  Stuffing Our Emotions

Walking Off – Leaving   •   Withdrawal – Isolation

Flight into Activity (staying too busy to think about our troubles)

Eating Disorders

Anorexia   •    Bulimia    •   Overeating   •   Comfort Eating

Passive-Aggressive Behavior

“Harmless” Jokes   •   “Forgetting” (forgetting on purpose!)

“Accidents” (accidently doing something on purpose!)  •  Sarcasm

Procrastination   •    Talking Behind Someone’s Back    •     Gossiping

Physical Aggression

Towards People, Animals, and Property

Self-Harmful Behavior

Suicide Attempts – Gestures

Self-Mutilation (cutting, burning, scratching, hair pulling,

and other forms of self-inflicted body damage).

Substance Abuse / Dependence / Self-Medicating

Alcohol   •    Illegal Drugs    • Prescription Drugs

Over-the-Counter Drugs

Vengeful Acts

Taking Revenge (getting even…or ahead!)

Verbal Aggression

Saying Hurtful Things to Others   •   Hostile – Threatening Remarks

Screaming Fits – Temper Tantrums • Threats to Harm/ Kill Ourself

Telling People Off    •   Bluntness – Speaking Our Mind

Other

Gambling    •    Habitual Lying    •   Codependency – Enabling

Rebound Relationships    •    Promiscuity (sleeping around) – Affairs

Overshopping   •   Being the Drama King or Queen

Getting Involved in Other People’s Problems

Criminal Acts (stealing, property damage, setting fires, etc.)

High Risk – Reckless Behavior (driving too fast, “playing chicken,”

road rage, “taking chances for the fun of it,” etc.)

How many of these things do you do?

Most of us do MANY of these things…and we end up with a lot more problems to deal with!

This list is excerpted from the DBT-CBT “Out-of-Control” Therapy Workbook by Melanie Gordon Sheets, Ph.D.

DBT is Dialectical Behavior Therapy  and  CBT is Cognitive-Behavioral Therapy.

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)

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!

How to Motivate People to Change – Some Keys to Recovery from a DBT (Dialectical Behavior Therapy) and CBT (Cognitive-Behavioral Therapy) Recovery Program

From the perspective of a psychologist in a state hospital treatment setting and a population of individuals who have struggled with recovery over time, I believe insight and understanding is a key to creating a desire to change. I believe it greatly helps people to see the big picture of their life and come to an understanding of why their life is like it is…that is, why they have lost “everything” or most everything they’ve ever loved or cherished…or why things always end up so bad…or why anything good never lasts. I believe folks need to grasp that this life outcome is a product of how they have tried to cope with upsetting life events over time…and the way their life is today…is because of the progressive and worsening consequences of their self-destructive coping mechanisms (drugs, alcohol, verbal and physical aggression, suicide threats and attempts, rebound relationships, and other emotion-driven coping choices). I believe that once they grasp that the quality of their life is based on how they attempt to cope with daily life and major life stressors…once they realize that how they cope with life is responsible for the current state of their life….once they really get this…motivation for behavioral change often follows. In the group I do, they are also taught that part of being wise (use of DBT’s Wise Mind) is not only knowing what to do (Wise Mind Game Plan), but it is about “following through with what we know to do”…because there is nothing wise about knowing what to do…and then not doing it! I believe insight and understanding is an initial part of behavioral change. I also believe that knowledge that change is possible is essential. I believe they need to really get it that other people have done it and have made it through. They have to have this knowledge…which breeds hope that the recovery process actually works…that people do recover and live satisfying and meaningful lives. I also believe personal empowerment is a key ingredient. They have to believe that they can do it…that they have the skills and understandings necessary to pull it off.

Thus, they have to understand why things are as they are..(insight and understanding), they have to recognize that change is attainable (knowledge and hope)…and they have to think they can do it (personal empowerment). Of course, they also need the knowledge, skills, and resources for getting through the tough times that are part of making and undergoing major life changes (life-enhancing coping skills, support system, hobbies and activities, busy-ness). They have to understand the concept of Distress Tolerance…that things will be hard, but they must Get Through It…that recovery is not easy…and in fact, it will be one of the hardest things they’ll ever do. They are also taught that change typically does not occur until we are sick n’ tired of being sick n’ tired…that we have to soooo hate the way things are…that we’re willing to do whatever we’ve got to do to change things…that we refuse to live like this any longer. I believe that people need to be filled with recovery attitudes…or rehab-itudes…and they need to be prepared for the fight of their life…which for many is the fight FOR a life (a decent life) and for others, it is a fight for life itself…because the severity of their consequences has escalated into things being so bad…that it comes down to “life or death”…

When the pain of living like we’re living is greater than the pain of change…that’s when most people decide to change…and the question for the rest of us is…how bad do we have to let things get before we’re willing to make changes! It’s a shame that we’re such stubborn creatures, that we have to let things get so bad…before we’re willing to make changes! If only we knew then…what we know now…how we could have spared ourselves of such long-term pain and suffering.

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

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.

How to Get Control of the Quit Smoking Bloat, Weight Gain, and Constipation! Must DBT my way through it!

I teach DBT (Dialectical Behavior Therapy)…in fact I wrote the DBT-CBT Recovery Workbook, “Out of Control.” I have the skills and understandings for behavioral change…I’ve recovered from many things…and I’ve kicked many habits…but this one is kicking my butt this time. This is a follow-up to two previous “I’M TRYING TO STOP SMOKING” WordPress blogs. It’s been about two weeks since my last blog on trying to quit smoking and the bloating and weight gain that compels me to resume smoking. So, I’ve been smoking again for the last two weeks. It’s really a love-hate relationship with smoking…I love to smoke, I hate to smoke. I hate it more than I love it and I’m determined to quit. My plan continues to be to get a Game Plan for quitting. I am going to a conference tomorrow in California on risk assessment, the Reid Meloy PCL-R one. I didn’t want to suffer the agony of being three sizes bigger and “feeling fat,” so I’ve allowed myself to smoke for this period…two weeks plus the conference.

Folks in my DBT Group would say I am just sabotaging myself and falling into the trap of Emotional Mind by coming up with Emotion-Driven Lies and Excuses to continue smoking…that my excuse to smoke is nothing but an excuse to smoke. Alike many people who sabotage themselves this way, I would say, “I’ve got a plan to quit and this is part of my plan. If you knew me, you’d know I was going to quit…and this is part of my quitting plan.” And everyone else would say…”Bull Sheets…that’s just bull, Sheets!” And I would say…”Just sit back and watch. I’ve quit many things in my life and I will quit this…come hail or high water…I’ll find an umbrella to make it through this storm.” And, I will. I’m determined to quit and I’ll find a way. If I knew that smoking two more weeks and through the conference would cause me lung cancer, I’d put this cigarette out right here, right now, and call it quits. Glad I don’t know that! I do think about it though and I’ve asked God to see me through this…and keep me safe while I get ‘er done.

I sent an email out to the Docs and nurse practitioners at the hospital yesterday and was just about desperate enough to send an email out across campus. I explained this bloating – constipation – weight gain problem and I asked if they knew of a medication or patch that would minimize this. I read a bit about Chantix and stopped at the side effects of constipation and gas! I haven’t studied any more…so, I don’t know if Nicorette gum or other nicotine replacement therapies will help. I’m hoping some readers will share their experiences and we can figure out what to do. Many people are reading this blog, so many are struggling with the same thing. Please leave some comments and let us know what works and what doesn’t. I’d really like a magic pill or patch so I can easily quit smoking. I’ve quit 5-6 times this year and I’m fine mentally, emotionally, and psychologically after the first couple days…until this bloat thing happens and my weight soars…and my pant size increases by 2. So, if I can get this bloat thing figured out, I’d be quit again in no time. I seek the “No pain…big gain” method of recovery!

So, if I don’t know of anything else to do when I return from the conference, I’ll set another quit date, try Nicorette gum or something similar and go at it again. I understand that the gum is expensive…and I did try to sabotage myself with that excuse…but, my Rational Mind isn’t going to put up with that crap and quickly reminded me that smoking is more expensive. Ended that. I do have a doctor appointment set up in early July and I can get some information from my PCP at that time if Nicorettes doesn’t work. I’ve also become Mindful that my current diet is very high in fiber and protein and that may be why I am having this new problem with quitting smoking. I’ve always been able to quit for long periods of time and have never had this problem…until this year. Maybe I have to change my diet and eat more roughage rather than soft protein bars. Maybe I have to exercise more often. Do you know that riding a horse burns about 200 calories an hour? All I have to do is to go outside, sit on a horse for an hour, and let it take me for a walk! That’s sure a lazy woman’s way to exercise. If I can hold on while the horse gallops, I can burn about 500 an hour! I thought about putting a sign on my horse’s butt and trotting past power-walkers on the road or galloping past a jogger that says “I’m burning more calories than you!” FUN-NY! Yes, I know I’m not getting the same cardio benefits…nor pulmonary…but the mental picture is quite amusing!

Long blog short…I’m still smoking and I’m not done quitting! I’ll keep folks posted on this journey and what I learn as I go…and what I have to do to get there! Hope there’s a magic pill!

Quit Smoking and Bloating, Constipation, Reduced Metabolism, and Weight Gain!

The same thing happened again…I got bloated, constipated, and my weight went up. I gained 6 pounds and 2 pant sizes. Not a happy moment. Good-bye slim fit Wrangler size 9 and hello size 11 regular fit! That’s going from a size 7 to a size 11 with just 6 pounds…6 pounds in my stomach and waist area that is! If you read the other blog post I wrote recently about my struggles to quit smoking, you’ll know that I’ve quit smoking 5-6 times this year…and each time I got bloated, gained a bunch of weight REAL FAST…returned to smoking…and lost it all real fast.

One time I was eating a lot of nuts and blamed it on the nuts. Another time I blamed it on starting birth control pills. This time, I didn’t change anything in my life…but, the same thing happened. As is typical, I talk to my friends when I’m in distress. Today, I spoke with a friend…and he said the same thing happens to him…the bloat, the constipation, and the weight gain when he quits smoking. I told him another friend told me that smoking increases metabolism…so I assumed not smoking results in decreased metabolism. Well, knowing he’s had the same experience, I googled and read about what happens when you quit smoking. This pattern is typical. It’s not just about eating more, it’s about the GI tract slowing down, constipation and bloating! So, I learned something new today.

Well, I started smoking again this morning…because now I have gained 6 pounds and I went up two pant sizes. My plan…get a Game Plan, just like I teach in the DBT-CBT class. Obviously, recovery from smoking is more than just stopping smoking…it’s going to involve some major life changes…some of which I have no interest in changing. I have to decide what to do. I already drink quite a bit of water and I eat a LOT of fiber each day. I guess I have to add regular exercise…URGH! I am also going to visit with the doctor and see if there is a magic pill or patch that will help me transition from smoking to non-smoking without all this bloating, constipation, and weight gain. I can deal with a little weight gain…but not something that makes me feel totally Out-of-Control.

So, my plan for now is to smoke for a couple weeks, let my body readjust to all the toxins and poisons in the cigarettes, and…enjoy it as my weight goes back down and I get to smoke again. Then, with increased knowledge and a different plan, I will try again…and I will keep trying until I make it. I sure hope cigarettes don’t kill me in the meantime.

One thing I have to think about is that when I stop smoking, my caloric needs will go down by about 150 calories a day because my heart won’t be pumping so fast. My metabolism will go down because I won’t be smoking and causing my heart rate to unnaturally increase. If I’m eating 300-400 extra calories per day because I’m not smoking…then that’s about 500 extra per day…and one extra pound of true fat per week. I am going to have to do something to offset that! It will be hard to reduce caloric intake by 150 calories a day because I normally eat about 1200 calories per day! So, I have a definite problem.

Another thing I have to keep in mind is that I lost the first 100 pounds without smoking and I have been slender before without smoking. Somehow I did it then, and I have to do it again.

Copyright Statement: Material contained within this blog is copyrighted protected with all rights reserved © Melanie Gordon Sheets commencing in 2009 and through the present age. Please request permission to quote or otherwise use material obtained from this blog by emailing: service@dbt-cbt-workbook.com

Please visit the website http://www.dbt-cbt-workbook.com for more information about the DBT-CBT Workbook – full title “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior.

Trying to DBT-CBT My Way Through Quitting Smoking – The Battle Between Emotional Mind and Rational Mind

This is my 5th or 6th time to quit smoking this year. This is something I’ve always been really good at. I’ve successfully quit smoking over a dozen times in my life. No joke…I really mean it! I’ve quit for long periods of time, like years at a time…and then, I pick up a cigarette…and here I go again!

I have most often quit when I’ve gotten sick. It was always a “planned quit”…”I’ll quit next time I get sick and cigarettes taste horrible.” That was a very effective plan. The problem this time…is that I haven’t gotten sick enough to quit and I’ve had to find other reasons to quit. No, please don’t pray for me to get so sick that I quit! Don’t want to go there on purpose…especially in this age of swine flu!

I’ve also quit several times due to pregnancy. I’ve also quit before when I dated someone who didn’t smoke…I knew what it was like for a non-smoker to kiss a smoker…been on the receiving end of such a kiss…and it’s plumb nasty! All in all, I’ve smoked and have quit many times over my 40 year smoking career.

Because I didn’t get sick over the last 18 months…well, not sick enough to quit smoking…I’ve been smoking for 18 months now…with the exception of some short periods of not smoking over the last 4-1/2 months. I did a planned quit on Jan. 5th – the day I went back to work after the holidays. I did fine for about 5 days…my weight had been going crazy and I gained about 13 pounds REAL FAST…like over a two-week period when I was eating 1200-1300 calories a day. Being a professional dieter (like I am a professional smoking quitter!)…My Rational Mind knew that weight wasn’t REAL weight…that it was water, poop, whatever…but, it wasn’t FAT. However, given I’ve lost a ton of weight over the last several years and the last thing I want to do is to gain all my weight back…my Emotional Mind was going crazy…and I was freakin’ out…

I was telling a friend about the weight gain…the bloating…and all the concomitant gas. I told her I shouldn’t be gaining weight because I wasn’t eating that much. She asked what I was eating…and I bragged on eating a very healthy diet of nuts. Well, thank goodness she knew a little something about nuts. She told me that nuts cause bloating…and can cause all that extra gas! I told her I sure wanted to get rid of all the bloating but I was rather enjoying having the ammunition to get even with my gassy family. Well, I did a bunch of googling and found out she was right! So, I got off the nuts and took up smoking AGAIN. My weight dropped as quickly as it came on…and I was RELIEVED!

My Dad was hospitalized for a stroke on Feb 1st…about 3 weeks into my most recent smoking indulgence period. Baylor Heart Hospital in Dallas is NO SMOKING all over the campus…there are NO smoking places…inside or out…imagine that…a heart hospital that does not support smoking. So, given we were living at the hospital for a week, and given my father was a long time smoker and obviously just had to quit cold turkey, I had to give up smoking AGAIN.

That went just fine for a few weeks…and since I wasn’t smoking, I figured it was a good time to start the birth control pills my doctor has prescribed for pre-menopausal hormone replacement. I tried them about two years ago…but my weight went crazy and I quit. Well, this time wasn’t any different…my weight went crazy again. I was gaining 1-2 pounds a day…and about 8 days, 12 pounds, and two sizes later, I quit the pills three days early and started smoking AGAIN!

As expected, my weight went right back down…and I lost a few more pounds. YEA! Well, after about two weeks of enjoying this most recent smoking binge, I set a date to quit smoking AGAIN…on my next “return to work” day. I did just fine for about five days. I quit at the wrong time of the month…the part of the month for me that my weight goes up about 5 pounds…regardless of caloric intake. My Rational Mind knows it’s just water…maybe some extra poop…but, I’m bloated and I have to wear a larger size…and that’s NOT okay. It was also Easter time and my child brought a large bag of some VERY FRESH chocolate covered raisins home and of course, she had to show me what she had. Okay, those were consumed the first night, but I skipped dinner to offset the increased calories. The next day, my friend visits and brings over Easter candy that she found on sale…of course, it’s chocolate stuff…and of course, I consume that…however, because I missed nutrition the night before, I ate real food, too.

Okay, we’re doing “the weight done gone crazy” thing again. My Emotional Mind was freakin’ out…so I asked my husband to bring me some smokes on his way home. I told my family and my friend that I would quit smoking AGAIN once my weight was under control and to NOT BRING SWEETS INTO THE HOUSE if they wanted me to stay off smoking. Our recovery has to be a family affair…our support people need to support us and to help keep our environment as temptation free as possible. Very few people will recover if they live in an environment filled with temptation. That’s why we’re told that we have to change people, places, and things.

Okay…a few weeks went by and I quit again. I quit for five days and I started smoking again because I was stressed out at work…and just because I wanted to. It wasn’t about weight…it was about MY WANTS. I WANTED to smoke.

So, now here we are at Saturday, May 23rd, 2009. I’ve quit AGAIN. I’ve been off cigarettes since Tuesday, May 19th when I went back to work after a long weekend. The week went well, though Tuesday at 4pm when it was getting close to quitting time (at work), I was thinking about the 23 minute drive home and how I could stop off and pick up some smokes…and how nice that would be. I thought about how much I REALLY WANTED a cigarette…and how I was really “Jones-ing” to smoke.

As I sat on the pot at work…my Emotional Mind and Rational Mind was battling it out. My Emotional Mind desire was to smoke. My Rational Mind was fighting hard to talk me out of it and my Wise Mind was telling me to GET THROUGH THE MOMENT…go straight home…you’ll be alright…you’ve done great all day. My Emotional Mind was coming up with all these schemes to smoke, like “I could just smoke at night…and not smoke during the day.” and, “Remember, I don’t want to live ‘til I’m 90 and have to live in a nursing home…if I smoke, I’ll die in my 70’s and not have to deal with that misery…and it’ll be better for my family that way.”

Well, Rational Mind fought back and told me, “It’s an Emotion-Driven Lie to think that you’ll just smoke in the evenings…that may work one day and then you’ll be back to smoking full-time AGAIN…that’s bull Sheets.” Finally, after conducting this fierce battle over the porcelain pot, my Rational Mind spoke again in my sister’s tone of voice…and said, “Think about what you’re doing to your lungs.” – oh thanks a lot for that Rational Mind…spoil my fun. Then, my own voice kicked in with Rational Mind and asked, “What do you desire more…to be a smoker…or a non-smoker?”

Well, that was a defining moment for me…and I said in a strong voice (inside my head)…”I most desire to be a non-smoker.” and…that was it…I sighed deeply, flushed, and went on with my evening. I drove right home and it was wild…while I waited at the Walmart light, it occurred to me that I hadn’t thought about cigarettes until just that moment when I thought about not thinking about cigarettes. That was pretty cool!

I’ve done great until today, Saturday…the 23rd as referenced above. I’ve gained three pounds because it’s that time of the month. At the beginning of this most recent non-smoking attempt, Wise Mind suggested that I wouldn’t start freakin’ out until I gained 8 pounds…to give myself a larger window before taking action! I weighed one more pound on Wedn morning, one more on Thurs…and one more on Friday. I was the same weight this morning.

That should be exciting because maybe the monthly weight gain is slowing down…and the eating an extra 100-200 calories a day not smoking isn’t adding up too fast. My Emotional Mind was a bit disappointed…because if I would have gained another pound or two, I could have smoked again. I was actually disappointed. I even weighed a second time just to be sure. Aren’t we sick?! I say “we”…because we folks who struggle with recovery do all sorts of things to sabotage ourselves…so we can return to our habits and addictions.

Of course, I was Mindful of my mind games and reminded myself that I want MORE to be a non-smoker, save the money, breathe better, it’s more professional, I don’t want to be burdened with the habit and the NEED to smoke when it’s inconvenient and I’m going to be late for a meeting, I’m smoking up my book profits, God’s been good to me and look how I’m taking care of his blessing….etc. I also reminded myself that I told my Group on Wednesday about what helped me to win the relapse battle on Tuesday (what do I desire more)…and how awful it would be…to have to let my Group down by telling them that I’m smoking again. What a horrible example that is. What a hypocrite I would be. I’m encouraging them to change everything in their lives as they try to quit life-encompassing habits like drugs and alcohol…and I can’t overcome smoking. All these Rational Mind thoughts attacked that sick Emotional Mind Game…but, I did think that I could just not smoke in the mornings…that I wouldn’t smell like smoke during Group…and if they asked, I could lie. The faces, the stories, and the hearts of some of my Group Members flashed through my mind…and the guilt trumped my desire to smoke.

Today is Saturday and it’s a time when I spend long hours on the computer. It’s a time when I really enjoy smoking…one cigarette after another. It’s a very convenient and relaxing time to smoke. So, today has been tough. I’m glad I have no smokes at home, I’m glad the store is about 10 minutes and a major hassle away…and that I hate leaving my home on my day off…and my husband hasn’t said, “I’m going to the store, want anything?” I did hear my boy ask his Dad if he was going to “Buffalo Fina” after he drove to a friend’s home to feed their horses. Thank goodness, my husband said, “No, I haven’t thought about it.” Thank goodness I didn’t say, “Hey, could you pick me up a pack of smokes.” I’ve had to remind myself so many times today what it is that I really want…and it’s to be a non-smoker.

I ate fine today…but a part of me wishes I will have gained an extra pound in the morning. I did pray this time around for God to help me through this. I told him that unlike in the past, I may not be able to do this on my own this time…that it was getting harder. I’m off work tomorrow and Monday…Memorial Day weekend. Lord, keep me focused…keep me Mindful of what my goals are…help me through the rough moments…and help me to be bursting with pride and excitement on Tuesday when my Group asks, “Did ya’ smoke?”…and I can say “Came close…came real close, but worked through the moment…for hours and hours over that long weekend!” See me through this Lord, Amen. This makes me smile and gives me hope that I’ll make it through. I don’t want to be a disappointment to others…I want to be an inspiration.

UPDATE: 5-26-09 (Tuesday)
I think I made it through! Got through the long weekend WITHOUT smoking. Had several tough moments each day…really desired to smoke…but used all my Rational Mind – Wise Mind – Talking Myself Through the Moments skills to make it through. Been off cigarettes 8 days now…guess I saved about $40. Almost enough to purchase another pair of boots off Ebay! I’ve probably made it through the toughest point…the long weekend. I bet I can be done with cigarettes…if I choose to be.

Something my patients taught me is that we don’t just relapse when bad things happen…we also relapse when positive things happen…that fun, excitement, good news, and similar positive experiences are also a relapse trigger. I’ve twice experienced this during my 5-6 attempts at not smoking this year. About 2 weeks ago, I relapsed into smoking following an exciting event (good news) and great news this weekend just about sent me to the store to buy some smokes. Celebrating, partying, drinking….and smoking all go together. Add to that the memories of the best times as a kid…often involved smoking, too…and drinking…and partying! It’s just Emotional Mind experience that we have to talk ourselves through. Some Rational Mind statements for me include…”That was then, this is now…those WERE some fun, carefree times. Life is different now. Smoking is a bad thing for me now.” “I MOST DESIRE not to smoke. I want to be a non-smoker more than I want to smoke.” “This moment will pass…I’ll get my mind involved in my work in a few minutes…and I’ll be okay for awhile.” “I want to be an inspiration to people, not a disappointment.”

By the way, my weight is good…have only gained 1 pound during “this time of the month.” I worked harder on my eating this weekend so I wouldn’t have an excuse to start smoking! I was very Mindful of my Mind Games! I made a point of putting up food my family left on the counter so I wouldn’t snack on it all day! I also ate a bunch of sunflower seeds. Sunflower seeds SEEM to reduce my appetite. They’re also good cuz they give my mouth and hands something to do…a fine replacement for cigarettes. You know what else I might try…pomegranate seeds. They make for quite a bit of hand and mouth work!!! I haven’t eaten those since I was a kid! Oh Lord, I cannot cycle back to fond memories as a kid and smoking! Man, our Emotional Mind is relentless!

Copyright Statement: Material contained within this blog is copyrighted protected with all rights reserved © Melanie Gordon Sheets commencing in 2009 and extending through the present age. Please request permission to quote or otherwise use material obtained from this blog by emailing: service@dbt-cbt-workbook.com

Please visit the website www.dbt-cbt-workbook.com for more information about the DBT-CBT Workbook. The full title is “Out-of-Control: A Dialectical Behavior Therapy (DBT) – Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior” – Recovery Works Publications, 2009.