Get Out of Your Head and Into Your LIfe

This morning on television, the news broadcast ended near the top of the hour and two talk show hosts came on the air. The topic of conversation turned to something that had happened in Hollywood overnight. I wasn’t all that interested so I turned the TV off.

How great it would be, I thought, if I could do that with the stream of chatter that frequently runs through my mind.  If only there were a remote control to shut off or at least turn down the volume of repetitive thoughts, my self-critical “inner voice,” and worrying.

Most likely, you can relate. Like the background noise of a radio or TV, streams of thoughts can rattle on and on, especially when you’re doing something you’ve done a thousand times before--driving to work, brushing your teeth, eating at your desk, and so on.

That’s why a skill set in the first DBT module, entitled “Mindfulness,” makes sense to me. They’re as close as I can get to turning the channel, lowering the volume, or simply shutting off unwanted, repetitive thoughts.

By practicing these skills over and over, I’m increasingly able to shift brain activity away from inner “self-talk” and to fill my mind instead with a greater experience of the present moment.

Here are the “Mindfulness” skills which help me be more present and aware of the moment at hand:

·        Observe: notice life experiences without judging them.

·        Describe: put words to those observations and stick to observable facts, not judgments about them.

·        Participate: be fully engaged in each moment.

I’m discovering that the fuller my mind is of what I am presently experiencing with all five senses—hearing, seeing, feeling, smelling, and tasting—the less room there is for negative, critical, repetitive “self-talk.”

I once heard someone say, “Observe, describe, and participate are ways to get out of your head and into your life.” I agree.

A Letter to My Young Facebook Friend

A letter to my young Facebook friend:

I was scrolling down through Facebook posts this morning when seven short words stopped me in my tracks: “numbing is the only way to cope.”

You, the writer, are away at college and my only contact with you lately has been through Facebook, so I don’t know what is causing you such distress.

But here’s what I do know and what I wish someone had told me 40 years ago.

Life events often bring emotional pain so intense that, in my opinion, it’s only natural to want to make it stop. Immediately. In any way possible. At any cost.

At 20, conflicts, stressors, and problems also threatened to undo me at every turn. I didn’t know how to cope. So I also tried to numb, escape, and control. The problem was, the “anesthesia” always wore off and the pain returned.

Decades later and now knowing what I do about the way brains work, I understand that every time I chose to “numb” (in my case, drinking and self-harm) in response to painful events, I was adding another “paver” to that particular neural highway. Life itself often whizzed by me as I drove down that road.

Stuck on the road of habitual numbing behavior, I began to see signs warning me to turn back—such as the consequences of arguments while intoxicated and the suffering of destructive out of control behavior. Fortunately, by the time I accepted that fact that I was completely lost and needed exits, there were several in sight.

But I had to choose. If I kept taking the “numbing” exit, I would always wind up back on the same road. On the other hand, if I steered toward organizations, treatments, and programs that would teach me new skills with which to cope, new horizons would spread out before me. I turned.

Now admittedly, at sixty-years-old, I have a distinct vantage point that comes with age. Life events have reinforced my belief that I will make it. I can stand it. I can let it go. I can forgive. I can move on. I can accept.

But even though you are young, I know you. You’re smart. You’re persistent. You’re destined for something greater than whatever the current circumstances are. You just need a better map to chart new paths for yourself. The future is yours. Turn.

Improving My Ability to Tolerate What Seems Intolerable

Sometimes, I find it difficult to tolerate things I can’t control, much less accept them “as they are” at this very moment. At least without a struggle, that is.

Sometimes people I care about seek to punish rather than reconcile.

Sometimes the consequences of someone else’s harmful choices spill over into my life.

Sometimes the doctor calls with a life-threatening diagnosis.

For those times, there’s a “Distress Tolerance” skill which uses the acronym I.M.P.R.O.V.E. to describe seven practices for emotionally surviving painful circumstances. They include Imagery, Meaning, Prayer, Relaxation, One thing, Vacation, and Encouragement.

In each category, I can engage in virtually unlimited activities to take a break, be my own cheerleader, commit my entire attention to something, and so on. Today, as I often do, I chose to pray. And, as it turned out, my prayer time included all the facets of IMPROVE.

For example, I first imagined a wide, open field full of the beautiful physical world I believe God created—meadow flowers, billowing grasses, and mountains rising in the background, encircling the field with ridges that curved like out-stretched arms to embrace me.

In that place of interaction with God, I became more aware of the bigger picture, more trusting that my life has meaning. I lifted my face to the sky, raised my arms, and kicked off my shoes and, in doing so, assumed a posture of relaxation, serenity, trust.

My Judeo-Christian faith teaches me that God is qadosh, Hebrew for “holy” or “apartness.” To me, God is apart, distinct, “one.” Therefore, I was mindful as I prayed. Interacting with God was my “one focus.”

I recalled words from the Bible’s 23^rd psalm: God “makes me lie down in green pastures, leads me beside still waters, and restores my soul.” In prayer, I let go. I rested. I became still. My body and mind experienced a restorative vacation from circumstances and judgments and my own conclusions.

Finally, I envisioned other points of prayer throughout my life.  And I saw all those times connecting to each other to bring me to where I am today: a wiser, more competent, less judgmental, more loving person who has faced many crises and has overcome them, thank God.

And with that, I was encouraged.

Fireflies and Lint

Why is it that a piece of lint on the floor in my home often compels me to stop what I’m doing and pick it up? Yet, at a friend’s home, floors can be strewn with yesterday’s newspaper, kibble from the dog’s bowl, and candy wrappers that missed landing in the trash can and I am relaxed, comfortable, and compelled to do nothing but sip my tea and enjoy the company of my friend.

The answer, I’ve concluded, is what DBT Mindfulness skills refer to as “observing.”

Here's how it works in my life. When I practice “mindful observing,” I simply notice things without getting caught up in them or compulsively acting upon them. To clarify, “observing” is not the same as denying, repressing, “pushing away,” or largely detaching from thoughts and feelings. It’s more like acknowledging they are there without getting entangled in them.

For example, I usually simply notice things on the floor at my friend’s house without judging or getting stuck on thinking about them. Whereas, in my own home, I might quickly bring self-judgment to that bit of fuzz on the rug and, therefore, not feel relief until I do something about it.

 In other words, depending on the way I experience thoughts throughout the day, they might mentally grow in size, weight, and meaning until they overshadow whatever else is going on at that moment. I might flesh out an observation by padding it with additional thoughts which lead to even more thoughts such as, “That doesn’t belong there.” “There’s a bit of ‘dirt.’” “Rugs must/should/ought to be kept clean.” 

However, "observing" instructs me to take a conscious step or two back such as when I’m at a friend’s house. Allow some distance.  Let it pass. Let it go. It helps me put a little distance between my thoughts, beliefs, and emotions and my actions. I don’t have to act on each one. I don’t have to judge them. I don’t have to cling to them. I can simply notice them like objects on my friend’s floor. Applied to emotions, that means I can observe that I am sad, worried, joyful and not get stuck there for the rest of the day. 

With mindful observing, I recognize that my thoughts and feelings come and go constantly within my consciousness throughout my day. At each point, I can “fixate” (constantly think about something) or I can “notice” (be momentarily aware of something). 

I've found that the more I practice “observing,” the better I get at being aware of unpleasant thoughts and feelings without having to escape or act upon them (usually expressed as trying to change/fix/control things).  In addition, I'm gradually mastering the art of acknowledging and enjoying pleasant experiences without glomming onto them, wishing they could last forever, and being sad when things change (because they do).

Like fireflies, thoughts in the form of electrical activity flit constantly throughout my brain. Blinking here. Twinkling there. Nowadays, I try not to race after a particular thing as I did as a child--catching a firefly, trapping it to the point of death in a glass jar, fixating so intently on one, that I missed the ever-changing experience of the life around me. Fireflies and lint. Pleasant and unpleasant thoughts.  All are part of my life. I notice both and cling to neither.

 

Today Is As Good a Day As Any

A friend of mine is reading When Things Fall Apart: Heart Advice for Difficult Times. Pema Chodron, an American Buddhist nun, wrote the book to present alternatives to chaotic, stressful, restless living. My friend is appreciative of the insights and perspectives the book provides, so she bought and gave a copy to me.

As I was completing a DBT exercise this morning ("Noticing and Managing Thoughts That Are Judgmental and Ineffective") Chodron's text was lying on the coffee table next to my DBT manual. I noticed it incidentally and proceeded with the skill practice. 

The first step in the exercise was to briefly describe the situation in which the judgmental and ineffective thoughts are occurring. I wrote, "Someone I love has cut off contact with us."

Next, I was to identify "emotional mind thoughts" and describe and rate the correlating mood and urges. Thoughts ranged from "I can't stand this anymore" to "I'm never going to see this person again."  Mood? Sad, angry, and fearful all scored a 65 on the 1-to-100 scale. Urges also hit high numbers and included wanting to "fix things" at any cost.

The second-to-last step was to  use rational thinking to re-state beliefs and choices. After writing, "this has happened before and I have coped" and "most likely, he is doing the best he can."

Toward the end of the exercise, I paused and did some mindful breathing. By that time, my mood had altered to peaceful, loving, and accepting.

Now that I was more settled, I noticed Chodron's book again, picked it up, and opened it to my bookmark stuck in between pages 44 and 45. Scanning the pages, I paused at these statements, and read them thoughtfully. 

"We're always trying to deny the fact that it's a natural occurrence that things change, that the sand is slipping through our fingers, time is passing... not resisting the fact that things end, that things pass, that things have no lasting substance, that everything is changing all the time--that is the basic message."

I took the words to heart, recalling my mother at the end of her life. She still had so many things in her "in box" she told me. And to her last days, she tried in vain to put systems into place that would exist in perpetuity and protect those she loved from their individual circumstances and choices. At the time, I'd recognized the futility of trying to control things beyond the grave. Today I asked myself, "But isn't it equally futile to try to control things while I'm still alive? Yep. And with that in mind, I told myself that today is as good a day as any to accept things as they are at this very moment with this person I love. Today is as good a day as any.

A Rising Tide

 

I’ve experience panic attacks for as long as I can remember. An older relative regularly sexually abused from the age of five (that’s my earliest recollection) until I was twelve. By the time I was a teenager, I sank into a state of mind which I now recognize as depression.

At that time, no one I knew participated in, valued, or even understood psychotherapy. However, at the age of 18, when I realized the rage, anxiety, and darkness in my mind were not going to go away on their own, I found a therapist in the yellow pages. And I’ve been in therapy ever since. I turned 60 a couple months ago.

Frequently, throughout those years, counselors instructed me to breathe deeply, slowly, regularly when panic took over me. I always hoped they didn’t see me rolling my eyes at this suggestion. It seemed pointless.

After all, many, many times I’d tried and failed over and over again at “breathing” my way clear of mental storms. If you asked me, there wasn’t enough breathing in the world to blow away turmoil of that magnitude. Eventually, I tried doing this "breathing" thing my own way. I took up smoking as an alternative way to breathe when I was “freaking out.” But even with that, my brain found a way to hyperventilate and still panic—it’s called “chain smoking.”

Eventually, I quit smoking because that also became pointless. What’s more, I’d all but given up on reducing the anxiety.  However, when a more recent therapist recommended DBT, I decided to give it a try. But imagine the skepticism that ran through my mind, when the counselor described a proven-to-be-effective DBT

skill: deep, regular, slow breathing. You’re kidding, I thought. How is this different?

It didn’t take long to answer the question. What’s varied about DBT breathing is that it is practiced mindfully. That is, instead of waiting until I’m in a full blown panic state, I practice mindful breathing intentionally and regularly throughout the day. And as I do with will all “one-mindful” exercises, when I focus on breathing, I only focus on breathing. I don’t drive, make dinner, check emails, or talk with my spouse.

In fact, I’ve made it a habit to set apart several minutes throughout the day to calm myself by myself with intentional, mindful, centering breathing: “in, two, three, four… hold, two, three, four… out, two, three, four…hold, two, three, four.” I count as I breathe because I know this shifts my brain activity out of my frontal lobes and into the part of my brain that does counting. The healing effects of this seemingly simple act have resulted in less tension and more serenity throughout my body, as well as my mind.

There’s a saying that describes how one change can be a catalyst for widespread change: “A rising tide lifts all boats.”  If I think about that metaphor from the perspective of mindful breathing, I can see how this skill has been broadly positive in my life by relieving much stress and anxiety. And I can confidently say deep breathing helps me cope... finally.

The DBT Self-Soothing Kit: Taking a Break from My Frontal Lobes

Several weeks into the group sessions, I learned about the benefits of a “Self-Soothing Kit.” My DBT manual described it as a way “to tolerate painful events and emotions when you can’t make things better right away.” Key word: tolerate.

Components must include something for each of the five senses: tasting, touching, smelling, feeling, seeing, and hearing. Examples from the group members included items like a few pieces of favorite chocolate, scented hand lotion, music downloads, a soft blanket, a beautiful vista on a postcard.

Even without explanation, the kit struck me as a comforting and calming idea. But I also wanted to understand how this worked in my brain neurologically. I already knew that the frontal lobes just behind my forehead were where my brain activity hung out when I was worrying, over-thinking, imagining the worst, doing twenty things at once, and mentally running in circles.

What I’d forgotten from biology class, however, was that the parietal lobes are what’s at work when I am doing arithmetic, reading, sensing temperature changes, being aware of body movements, experiencing smells, or eating. At the back of my brain the occipital lobes process images from my eyes and link them to memories of other images. Under my parietal and frontal lobes are my temporal lobes. They are how my brain responds to music and sounds. The occipital lobes also integrate memories and sensations from the other four senses. 

When I am self-soothing, I can almost picture the shift of electrical activity away from the front of my brain. I see “lights” coming on in other parts of my brain which I deliberately activate by seeing, hearing, smelling, tasting, touching, and feeling something pleasant. 

For example, one of my panic triggers is smelling stale tobacco smoke, strong deodorant, and cooking grease on a man I don’t know. My self-soothing kit includes a bit of peppermint oil to pat under my nose if I can’t walk away from it right away. This avoids the chain reaction that occurs when the first smell hits the occipital lobes, integrates with memories, and lights up my frontal lobes with a firestorm of toxic activity.

Instead, by immediately using a different fragrance from my kit, I shift the area of brain activity to a more pleasant pathway. 

If you don’t have PTSD or panic disorder, you might not fully grasp the impact of this simple act. But for me, the change was a big one. A year and a half ago, I would have been mentally frantic and emotionally caught up in a cycle of revulsion, traumatic memory, helplessness, panic thoughts, more revulsion, and so on. 

I make no scientific claims and have no research that this is why it works for me. I can only say from experience, it does. Eureka!

To learn more about the anatomy of the brain: www.ninds.nih.gov

DBT and Religion

If you’ve already completed the six-month Dialectical Behavioral Therapy group therapy sessions, you’ve most likely encountered a common question many people ask about the program—that is, since Marsha Lenehan, the founder of DBT, practiced Buddhism, are these concepts compatible with my own personal beliefs? I was equally inquisitive when I started the program.

To be more truthful,” inquisitive” isn’t the right word. I was downright spooked.  I’m a Protestant Christian. One of the therapists is Jewish.  A class member casually mentioned one day that she practices Wicca. Another person stated she is a Yoga enthusiast. And the hospital conducting the classes is an agency of a nearby Conference of the Mennonite Church. Philosophies from an ancient Eastern religion? Uh oh, I thought. How is this going to work?

But here’s what I discovered. Some DBT skills and techniques do indeed echo teachings shared by many world religions and philosophies, but not specifically Buddhism. For example, concepts of forgiveness, compassion toward oneself and others, non-judgmentalism, and letting go of what we cannot control are part of many belief systems both religious and secular.  In a year and a half, I've encountered nothing in DBT teachings which involve religious associations. Nor have I come across anything intended to help me grow spiritually.

As a side note, though, I’ve personally found that mindfully focusing and quieting my thoughts in church does enable me to pay closer attention to the teachings, worship, and prayer because I’m not as distracted or judgmental. And from that point of view, I’m guessing people of different faiths and beliefs might be experiencing the same improved focus in their spiritual journeys. I don’t know.

But here is what I do know. I’ve not found that attaining nirvana, heaven, or any other religious destination is the intent of this psychological technique. However, creating a life worth living with greater clarity, less struggling, and a calmer mind is most definitely a desired outcome. For that, I am grateful.

Mindfulness, Right Here, Right Now

"Mindfulness is simply being aware of what is happening right now without wishing it were different, enjoying the pleasant without holding onto it when it changes (which it will), and being with the unpleasant without fearing it will always be this way (which it won't.)" -- James Baraz

DBT emphasizes the importance of mindfulness (as opposed to multi-tasking).  For most of my life, I believed it was better to be able to do many things at once -- such as talk on the phone in one hand, cut up a banana for breakfast with the other, open the screen door with my foot to let the dog go outside, turn off the porch light with my elbow, all the while thinking about paying the electric bill.
 
During my years of working as a public relations and communications specialist, I was richly rewarded for this ability. Steady pay increases and company awards reinforced the notion that it was admirable to spend each moment doing many things at once: ordering catering online for a special event while checking messages on my phone while signaling to another co-worker to hand a file to me while planning the 2:00 PM press conference.
 
A concept called "neuroplasticity"(brains physically change according to experiences) increased my multi-tasking skills as years went on. In other words, doing many things at the same time enabled me to do increasingly more things simultaneously.
 
I now think if someone had done a P.E.T. (positon emissions tomography) scan of my brain at the time, the images of electrical activity inside my head would have looked ablaze. Had I myself seen the picture, I wouldn't have wondered why my fists were always clenched, my thoughts raced all night, my heart pounded, and my anxiety attacks would not quit.

Today, however, I practice being mindful. Throughout my day, I gently and compassionately nudge my state of mind to a greater awareness of myself and my surroundings right here, right now. Whatever I am doing, I try to do it with my full attention and involve all five senses. When I  chop carrots for dinner, I chop carrots. When I wash my face at night, I wash my face. When I play with my grandchildren, I play. You get the idea.

Sometimes I am mindful. Many times I am not. But I continue to practice and remind myself that because of neuroplasticity, my mindful experiences are building new connections in my brain. It will become easier and more natural as time goes on.

Practicing the DBT skill of mindfulness over the past year has produced noticeable changes in me. Friends recently remarked at a dinner I'd cooked and served to them that "I was different." They appreciated that I lingered peacefully between serving courses to give my full attention to our conversation. That dinner was unrushed as I savored each bite. That I did not interrupt but focused on each person as he or she talked.

Right here, right now as I'm writing this, I am pausing occasionally to become aware of my body for a moment. If I am taking shallow breaths, I breathe more deeply, slowly, rhythmically. If my shoulders are tense, I drop them. If my face is tight, I open my jaw. 
I am now aware that I am hungry, so I'll stop writing for now and go eat breakfast. And while I eat breakfast, I will eat breakfast.

 
 
 

DBT Skill Categories

 

In the next few posts, I'll provide examples of my personal understanding and applications of each of the four categories of DBT skills which include:

• Distress Tolerance: feeling intense emotions without acting on them impulsively or using self-injury to diminish the distress.

• Emotional Regulation: recognizing and adjusting emotions.

• Mindfulness: being aware of myself and others and attentive to the present moment

• Interpersonal Effectiveness: navigating conflict and interacting assertively

You Had Me at "Science"

"On bad days, it helps me

to remember that even my most overwhelming and distressing feelings are actually electricity and chemicals. That, and to breathe."

I entered a Dialectical Behavioral Therapy six month group therapy program in January 2013 after 40 years of traditional “talk therapy” and pharmaceutical treatment.  I learned within a few minutes of the first class that the word dialectal implies the concepts of “both” and “balanced.” As someone who’d lived her life in the valley of depression, tried to hike out on her own with all the success of Sisyphus, only to be buried in avalanches of panic attacks, the word “balanced” sounded pretty good to me.

However, the very next concept in the workbook evoked skepticism.  It described the heart of DBT as mastering the art of both accepting and changing thoughts, behaviors, and actions. I was okay with the “changing” part. More than 50 years earlier, I’d been traumatized repeatedly as a little girl. So as far back as I could remember, I’ve been trying to change my life. But “accept?”  

Hold on a minute, I thought. Wouldn't this DBT class be a way to make emotional distress stop once and for all? I sure as heck hoped so. I had deductibles and out-of-pocket expenses at stake here. Not to mention, a smidge of hope still voicing, “I’ll do anything to make this pain go away.”

By that point,  I’d exhausted a wide range of self-help measures, as well as “escapist” behaviors such as compulsive controlling, relentless over-achieving, suicide attempts, impulse spending, and other self-injurious behaviors.

None were effective in keeping emotional and psychological distress at bay for long. Worse, I had exhausted myself, too. I could not even continue working in a job I loved as a communications specialist anymore--even with a big stash of anti-anxiety meds in my top desk drawer.

 

However, when the DBT trainer began to explain the science behind DBT, I perked up. According to her, by consistently practicing a set of skills, DBT seemed to help people create new pathways in their brains. In other words, my thought process could create new mental connections and, essentially, abandon the old ones—even though I’m not sure they ever completely go away. That’s part of the “accepting” aspect, I guess.

However, over time, she suggested I could learn to “turn the mind” through the use of dozens of skills such as practiced relaxation, conscious breathing, and living in the present moment to tolerate whatever came my way instead of constantly struggling with it... or trying to escape it.

 

In my first blog post, I referenced Frost’s “The Road Not Taken.” The poem suggests that once the traveler (in this case, substitute the word “thought”) establishes a route, continuation on that path is virtually inevitable. Frost wrote that “way leads on to way.”

Likewise, brain cells quickly find the most familiar, well-traveled paths on which to race along at lightning speed. In my case, because of repeated early childhood trauma, these pathways include pain, shame, fear, and guilt. One by one, little by little, similar experiences and similar thoughts formed a super highway of grief and fear through my mind.
 

How did it happen? Science. Not a curse upon me from the universe. Not "getting what I deserve" because I MUST be a bad person. Not a consequence of not getting things perfect. Nope. Science.

In a nutshell, it goes like this. Billions of tiny brain cells in my head are called neurons. They each have a main cell body and a set of what I refer to as “catchers” and “pitchers.” Little hair-like tentacles on each neuron, called dendrites, catch a message in the form of electricity and conduct it like a current through the cell body and out the other side to a “pitcher,” called an axon, which tosses it along to the next “dendrite” and on and on forming thoughts, actions, and responses.

There’s a tiny gap, synapse, between each brain cell that the “current” has to jump across. That’s where the brain chemicals, my psychiatrist is always working to manage, come into play. These chemicals help transport the “message.” On bad days, it helps me to remember that everything that feels so big and overwhelming  to me right now  is electricity and chemicals. Breathe.

For a clinical description of
Dialectical Behavioral Therapy, visit the National Alliance of Mental Illness at  www.nami.org

Taking a New Road

I'm pretty sure Robert Frost didn't intend his well-cited poem, "The Road Not Taken,"  as a scientific metaphor for how brains work. But that is exactly how I see it. Each thought in the form of an electrical charge races down well-traveled, well-connected pathways known as neural networks. Now I know for sure I didn't start out life with all these established paths in my head. But, as with all people,  repeated experiences caused brain connections to become well-worn and permanently etched into my brain.  Frost writes about coming to a fork in a wooded road and trying to choose between going down the same road as always--one that is well-tramped-down by those who've gone before him, visibly free of obstacles, and seemingly preferred. Or, taking the first step on another road which appears untraveled and unexplored.

Cognitively speaking, the less familiar roads are the ones I'm choosing to take these days, thanks to a form of psychotherapy called "Dialectical Behavioral Therapy (DBT)." As a matter of fact, I've been standing at a lot of new mental crossroads for the past year. A lot. Sometimes I wonder if I really have the guts to pull up yet another set of stakes in an old neural neighborhood where judgment, negativity, and distress hang out and move a few synapses over to forge new paths leading to more a more joyful, accepting, and peaceful place.  But I take heart in my conclusion that with 100 billion brain cells in my head, surely I have not run out of possibilities to connect thoughts in new ways and, once and for all, turn right instead of left and move on from lifelong thought patterns.

I'm not a therapist. I was an English major in college, as you might have guessed from the opening literary reference. So all the usual and customary disclaimers apply here: I do not give advice nor do I offer professional guidance on this site. I'm simply providing a glimpse of my personal experiences and journey with DBT. I like to journal and report, so you can expect regular updates.