DBT and Aging

When I took part in a 10 week course on Dialectical Behavioral Therapy (DBT) six years ago, I blogged extensively about the experience. (You can still read these posts on this site to discover the basics of DBT and how to use the skills.) 

At the completion of the program, I synthesized and integrated the skills--along with my strong faith in God--into my daily life.  Overall, I navigated the ups and downs of life pretty well since then. What brings me back to blogging about DBT is a new and unwanted reality with which to deal: I am getting old. 

Old age has brought physical pain including arthritis requiring seemingly endless spinal procedures, injections, and medications. 

It has brought a chronic bladder condition resulting in the deterioration of my bladder lining, enabling painful urine substances to reach the bladder's nerve endings.  

It has inflicted its usual bag of tricks on my physical appearance which often leave me looking in the mirror and not seeing "me," but some elderly stranger. 

It is beginning to rob me of friends and relatives as they deteriorate and die.

Some days, aging feels like impending death no matter how much I use "Radical Acceptance" or "Distract" or try to avoid the unavoidable by living in the present with "Mindfulness.' 

Recently, as I tried to put makeup on my face, I watched it crack and crease into wrinkles upon wrinkles. I thought, what are you doing, collagen? Where are you going? You used to hold me together but now you just remind me of my old gardening jacket. Every autumn, I think, it’s time for that jacket to go. It's falling apart. Its zipper is broken. People are staring at the safety pins and duct tape, reminiscent of too many layers of makeup concealer and bad hairpieces.

In my youth, collagen wound itself into tight triple helices and zipped me all together: skin, bones, muscles. It was my trampoline. No matter the circumstances life brought my way, at least my appearance bounced back. It put the spring into my step, teased the dimples back into my cheeks, swung my arms back open to embrace the world one more time.

Now collagen and I are both unraveling in identity, stretching out of shape beyond our capacity to rebound, and coming apart at the seams. My hands are blue. My scalp through my thin hair looks as though it’s scribbled on with a pen. My cheeks look like wet tissue paper. I hardly recognize us.

By unfolding the layers of my skin, aging has rent the curtain on my inner being, bringing glimpses of blood vessels, tendons, bones to the surface. It is an unwanted xray-- a visual reminder of increasing physical deterioration, pain and limitations. It makes it hard to get my eyes off of myself and focus, instead, on building a life worth living.

But I know I can do it. After all, isn't this relationship with my physical body also in danger of becoming yet another "co-dependency," i.e., if "you're okay, I'm okay." Clearly, things are not "okay" with my body as I continue to age, experience pain and sickness, and move toward the end of life. I can't pretend that they are. However, I can challenge my "storytelling" left brain's "doom and gloom" narrative every day to find acceptance and, yes, even joy.

My "go-to" for words to confront distorted narratives my brain tries to tell me most often come from scripture, such as, "Do not be anxious about anything, but in every situation, by prayer and petition, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus." (Philippians 4:6-7)

And so, collagen, I forgive you. Even though your molecules no longer zip, you and I still have much to do regardless of how this worn old jacket looks. It is spring again. God is warming the earth and knitting us together with Him and in love. It’s an unbreakable bond, this love for Him, for others, for myself. So, let’s link up with Him and step outside into April. Will you come with me? There are bluebirds on the lawn and peace to be found.

Self-Care

"I wish I had a remote control to make him or her stop doing _________."  But, of course, no such thing exists. Still, that hasn't stopped me from trying to rescue, fix, or please someone to the point of personal neglect, exhaustion, or mental anguish.

 

So this week, I added participation in a 10-week co-dependency group therapy program to some of the steps I’m taking to create a more positive life. The stated goals of the class seem to fit well with many DBT skills I practice every day—especially self-care and interpersonal effectiveness skills such as assertiveness, asking for what I need, saying no, and coping with interpersonal conflict.

 

I don’t think I’m alone in having people in my life—past and present—who blame, manipulate, control, use, and abuse.  I’m sure you know what I mean. It could be a boss, relative, co-worker, church leader, spouse, or friend.

Where I differ from many people, however, is that I often forego healthy personal boundaries and self-care to please others, control circumstances and outcomes for others, fix problems, and think about others and their problems obsessively. That is, until I get completely burnt out and exhausted. Then I just say “I don’t care anymore!” But, of course, I do.

I’m trusting that somewhere in the "wise mind" middle—neither living to fix, please, or control people in order to "make everything okay" nor being completely self-centered—is a life worth living. Since this site is dedicated to Dialectical Behavioral Therapy, my posts over the next 10 weeks will focus on those DBT skills which I find most helpful and complementary to decreasing co-dependency behaviors.

Be Prepared

 

 

I haven’t been a Girl Scout for more than 45 years. The badges are long gone. I forget the handshake and the name of my troop leader. But the motto still regularly comes to mind. “Be prepared.”

A few posts back, I wrote about the benefits of not trying to manage depression, panic, and PTSD on my own. My wellness plan includes regular practice of coping skills, medication, lifestyle changes, and weekly therapy. And, yesterday, when I wrecked my car on a telephone pole, I was reminded of just how important is to have a full spectrum of support systems in place.

I used mindful breathing and wise mind when it first happened to call the police, complete the police report, text Fred to have him call my therapist, and contact the insurance company. I heard myself talking too fast to the police and observed that I was beginning to panic, so I began to silently count as I was breathing. Counting engaged a different part of my brain, enabling me to stop “crisis” thinking and slow down.

When I arrived home, however, I began shaking and became tearful. My sympathetic nervous system was highly aroused. My head hurt. And I was suddenly overwhelmed with fearful feelings and judgmental thoughts. I tried to get myself back to “base line.” I self-soothed with a cup of cocoa. I walked around the block to use up some adrenalin. I talked to Fred for encouraging, comforting words. It was a beautiful day so I went outside and mindfully looked at all the flowers coming up. Over the next hour, it seemed that I used every DBT skill in the book and I was still right at the edge of a full blown panic attack.

That’s when my therapist called. Making coaching phone calls are part of a trained DBT therapist’s tool box. She was encouraging, validating, and comforting which helped a lot. She also said something that finally helped me “turn” my mind. “Just give it some time,” she said. “As time passes, this will get resolved and you’ll move on. You’ll be okay.” Those gentle and positive words were just what I needed to help me get unstuck and put things into perspective.

I don’t know why I couldn’t find those words within my own mind and calm myself down. Hopefully, someday I will. But for today, I’m grateful that I have people, plans, and procedures in place to help me when I start to unravel. “Be prepared.” Still a good motto even after all these years.

 

 

Palm Sunday

Today is Palm Sunday, a Christian holy day marking the entry of Jesus Christ riding on the back of a donkey into the city of Jerusalem. Churches hand out palm fronds to remind congregants of the praise of first century onlookers who stood alongside the road and waved palm branches as a symbol of triumph. I’ve always felt connected to my Judeo-Christian ancestors when I hold a palm in my hand. And today is no different.

However, my mind is also someplace else this Palm Sunday. My journey over the past year has gotten me thinking about donkeys today, in spite of the abundance of chocolate rabbits and marshmallow chicks I’ve seen filling store shelves in the weeks leading up to Easter. I recall that in Biblical times, the donkey was an animal which represented peace, unlike the horse which was an animal used in wars.

The significance of that is not lost on me. Jesus was seen by many to be the “King of the Jews.” People showed reverence with branches representing victory. But if anyone thought Jesus’ achievement was going to be a military defeat, the donkey seems to have put a pin in that notion.

The jubilation of Palm Sunday fills me with a feeling of happiness every year. However, today the image of Jesus on the donkey and its message of peace seems important, too. It is a powerful reminder to stay the course (no matter how I am feeling) to continue to put aside who is right and who is wrong. To judge less and forgive more. To choose peace over arguing.   It’s a different type of victory, I suppose, but one that’s just right for me.

Princesses Aren't What They Used to Be

 

"Let it Go" from "Frozen

 

One of the DBT skills I use a lot is “letting it go,” which involves accepting that “things are the way they are” at any given moment. So, lately, I’ve been humming the Oscar-winning song, “Let it Go” from the Disney movie “Frozen” as a reminder to myself.
 

The character Elsa belts out what many have called a song of empowerment and choosing to be who you are. Taking a look at the lyrics, though, I don’t think the meaning is that simple. I see other themes, too—all of which are highly relatable to me and bring the song even closer to home.

The song begins with Elsa experiencing isolation, fear of the loss of self-control, and anger. “The snow blows white on the mountain tonight. Not a footprint to be seen. A kingdom of isolation and it looks like I’m the queen. The wind is howling like the swirling storm inside. Couldn’t keep it in. Heaven knows I try.”
 

I get it, Elsa. I, too, cannot number the times I’ve struggled with wanting to bottle up my anger or just run away and hide somewhere until things “blow over.”
 

Then there are the deeply entrenched beliefs taught to her by her father.  “Don’t let them in, don’t let them see. Conceal, don’t feel, don’t let them know.” It's called internal conflict and I believe we all have it--much of it, as it was for Elsa, the result of deeply held childhood beliefs and distorted views.
 

And in her foot-stamping declaration of "I don't care what people say" and “the cold never bothered me anyway,” I hear echoes of myself saying “I don’t care” and “you’ll never see me cry” when I really do care, I am bothered, and I feel like crying. To numb it or deny it is simply bravado on my part. In other words, I'm kidding myself.  Lately, what I'm doing instead is to allow myself to be present in the moment. If that means I care, cry, or am bothered, so be it. It rises, it falls, it dissipates... and I can handle it.  


From my perspective, I think the songwriters produced lyrics which depict a balanced, realistic view of human nature—powerful and frightened, sad and joyful, strong and vulnerable. The result is that by the time Elsa gets to the chorus’ crescendo, I understand that “letting go” comes from a flawed state of being human and “letting go” is not a perfect process. With that in mind, her declaration of “I’m free!” is all the more powerful to me.
 

I have to say, even as a little girl, I’ve never wished to be a princess living in a beautiful castle with a handsome prince. But Elsa? Now that’s a girl I understand.

 

 

 

 

 

Driving




Here's what I got for 1,200 bucks in 1987

Years ago, as a newly-single mom as well as a full time college student with a low-paying, part-time job, I found myself suddenly needing a replacement for my clunker of a car. My friend Wanda helped me make phone calls and, eventually, we found a $1,200 car—the exact amount in my bank account.

It seemed like a small miracle except for one thing. It was manual drive and I’d only ever driven automatic. Oh, well, I’d cross that bridge when I got to it, I thought. It was the only half-decent car in three counties for that price. I bought it.

The day I went to pick it up, my young sons came along for the ride from Lebanon to Berks County. As they will tell you to this day, they lived to regret it. I insouciantly hopped behind the wheel, studied the stick in the center console and the three pedals—gas, brake, clutch—and told the kids, “Don’t worry. I’ll figure it out.” Twenty minutes later, still in the parking lot, wildly stamping on this pedal and that one, and jerking the car back and forth while regularly stalling it out, I felt the first wave of doubt.

A 25 minute drive home lasted nearly three hours. At one point, the boys lay down on the back seat so the other drivers who were cursing at me couldn’t see them. The youngest begged me to call someone. Somehow, I got us all back home, but my new car was moaning and whining by the time I pulled into the driveway. And so were we.


I thought about that day yesterday when I read an article by Milton Z. Brown, Ph.D. (www.dbtsandiego.com) on the importance of slow, deep, and regular breathing. Brown explained two complementary body systems that help regulate my reactions to the world. The sympathetic nervous system revs me up to react to stressful events, emergencies, and threats by cranking up my heart rate, blood pressure, and breathing. The parasympathetic applies the brakes to return my body functions to normal when the threat has passed.

Heart rates vary with emotional states

Sometimes the system that is intended to speed me up and the one intended to slow me down do not work smoothly, timely, and efficiently. Brown says this is “just like driving a car with one foot on the gas pedal (the sympathetic system) and the other on the brake (the parasympathetic system) at the same time, which creates a jerky ride, uses more fuel, and harms the car.”

However, he goes on to explain that the rate and way in which I breathe helps regulate my “gas” and “brake” systems. Practicing slow, deep, relaxed breathing for at least 20 minutes a day strengthens my body’s brakes and slows down my body’s acceleration—all adding up to a smoother ride through my day with increased tranquility and a greater sense of well-being.

My sons are grown up now with kids of their own. In fact, two of the kids turned 16 recently and are going to be learning to drive. I know the driver education teacher and their parents will do a good job of teaching them to navigate the roads—but I plan to add some grandmotherly words of wisdom about deep breathing to help them navigate their way through life.

Doing it By Yourself

When German Anabaptists and Swiss Mennonites escaped religious persecution by sailing to America hundreds of years ago, most of them settled in the south central Pennsylvania region where there was plenty of good farmland. While I’m not Mennonite, several of my ancestors were, including those from Switzerland and Germany. So I grew up in a culture rich in Pennsylvania Deutsch/German ethics and values.

Here, people close their shops on Sundays because it’s the Christian Sabbath, eschew materialism, put God and family first, and, ironically, hang their laundry outside on clotheslines to dry—even in winter. I say ironically because this culture also prizes grit, backbone, and self-reliance. In other words, people are rarely willing, as this idiomatic phrase figuratively describes, to “air their laundry in public.”

That means, around here, the phrase “I can do it myself” reflects more than plucky self-confidence. It’s also a statement that perpetuates a commonly held belief that not only can you do it yourself, but you indeed should. And that includes “getting a grip,” “holding it together,” and “getting over it” during times of emotional distress.

However, as I’ve learned in DBT, this type of thinking often goes hand-in-hand with judging my emotions, which, in turn, leads to shame/hiding, attempting to alter my mood with substances (caffeine, alcohol, or sugar), fight or flight behavior, or withdrawing/shutting down. On the other hand, you can see by this chart, a DBT alternative is to allow my emotions to ebb, flow, and dissipate while acknowledging, noticing, and accepting the fact that I am experiencing them.

The key difference is that instead of “getting a grip” on myself, I am “loosening my hold” on my emotions as they come and go in my mind. I’m learning that without judging myself for feeling one way or another, I stand a much better chance of staying grounded, breathing mindfully while those feelings follow the “90 second rule” (see previous posts), and tolerating the distress instead of running from it or fighting with it.

Can I do this myself? Well, ultimately, how I respond to emotional distress is my choice. Be that as it may, I also rely on others, including  weekly encouragement, validation, and instruction from my DBT therapist. I also know I can call her for a “coaching” session over the phone. I reach out to others who are using these skills to heal from abuse and trauma. And I share my experiences on this blog, in person, and in a DBT-based social media group. So, no. I’m not growing and learning all by myself. But I believe even my Mennonite great-grandma would approve. After all, even “Pennsylvania Dutch” communities come together for collective practices such as “barn raising”—because some jobs are just too big to do alone. To me, that also includes tolerating emotional distress.