Dialectical Behavioral Therapy To Help with SI
*~10 YEARS BABY~*
Thread Starter
Join Date: Nov 2005
Location: Hollywood
Posts: 9,369
Dialectical Behavioral Therapy To Help with SI
DBT-related skills
Marsha Linehan's Skills Training Manual has several helpful worksheets for getting through crisis situations. Though they are best used as part of a DBT program with a trained therapist, you might find some of them helpful.
Accepting Reality
This concept focuses on learning to accept reality as it is. Accepting it doesn't mean you like it or are willing to allow it to continue unchanged; it means realizing that the basic facts of the situation are even if they aren't what you'd like them to be. Without this kind of radical acceptance, change isn't possible.
Letting Go of Emotional Suffering
In this worksheet, you learn ways to observe and describe your emotion, separate yourself from it, and let go of it. One of Linehan's basic principles is that emotion loves emotion, and this worksheet is designed to help you experience your emotions with amplifying them or get caught in a feedback loop.
Distraction
Distraction is simply doing other things to keep yourself from self-harming. Most of the techniques mentioned above are distraction techniques; you bring something else in to change the feeling. Using ice, rubber bands, etc, is substituting other intense feelings for the self-injury. Other things Linehan suggest substituting include experiences that change your current feelings, tasks (like counting the colors you can see in your immediate environment) that don't require much effort but do take a great deal of concentration, and volunteer work.
Improve the Moment
This worksheet focuses on ways to make the present moment more bearable. It differs from distraction in that it's not just a diverting of the mind but a complete change of attitude in the moment.
Evaluating the Pros and Cons of Tolerating Distress
As the name implies, this worksheet leads you through an evaluation: what are the benefits of doing this self-harming thing? What are the benefits of not doing it? What are the bad things about doing it? About not doing it? Sometimes writing this down can help you make a decision not to harm.
Self-Soothing
This, like improving the moment and distracting, is a distress tolerance technique. It's pretty straightforward: use things that are pleasing to your senses to soothe yourself. Some people find that active distraction works better for violent angry feelings and soothing is more effective for soft, sad ones.
Reducing Vulnerability to Negative Emotion
Prevention of states in which you are likely to self-harm is covered in this worksheet, which suggests ways of taking care of yourself in order to minimize the times when you feel the urge to hurt yourself. If you're balancing eating, sleeping, and self-care, you're less likely to be overwhelmed by emotion.
Interpersonal Effectiveness
Being clear about what you want and about your priorities in an interaction are crucial to good communication, and this worksheet offers a series of questions and steps to follow to help you determine how to approach a difficult interpersonal interaction. It is truly amazing how much going through these steps can help.
More information about Dialectical Behavioral Therapy can be found at DBT-Seattle.
Marsha Linehan's Skills Training Manual has several helpful worksheets for getting through crisis situations. Though they are best used as part of a DBT program with a trained therapist, you might find some of them helpful.
Accepting Reality
This concept focuses on learning to accept reality as it is. Accepting it doesn't mean you like it or are willing to allow it to continue unchanged; it means realizing that the basic facts of the situation are even if they aren't what you'd like them to be. Without this kind of radical acceptance, change isn't possible.
Letting Go of Emotional Suffering
In this worksheet, you learn ways to observe and describe your emotion, separate yourself from it, and let go of it. One of Linehan's basic principles is that emotion loves emotion, and this worksheet is designed to help you experience your emotions with amplifying them or get caught in a feedback loop.
Distraction
Distraction is simply doing other things to keep yourself from self-harming. Most of the techniques mentioned above are distraction techniques; you bring something else in to change the feeling. Using ice, rubber bands, etc, is substituting other intense feelings for the self-injury. Other things Linehan suggest substituting include experiences that change your current feelings, tasks (like counting the colors you can see in your immediate environment) that don't require much effort but do take a great deal of concentration, and volunteer work.
Improve the Moment
This worksheet focuses on ways to make the present moment more bearable. It differs from distraction in that it's not just a diverting of the mind but a complete change of attitude in the moment.
Evaluating the Pros and Cons of Tolerating Distress
As the name implies, this worksheet leads you through an evaluation: what are the benefits of doing this self-harming thing? What are the benefits of not doing it? What are the bad things about doing it? About not doing it? Sometimes writing this down can help you make a decision not to harm.
Self-Soothing
This, like improving the moment and distracting, is a distress tolerance technique. It's pretty straightforward: use things that are pleasing to your senses to soothe yourself. Some people find that active distraction works better for violent angry feelings and soothing is more effective for soft, sad ones.
Reducing Vulnerability to Negative Emotion
Prevention of states in which you are likely to self-harm is covered in this worksheet, which suggests ways of taking care of yourself in order to minimize the times when you feel the urge to hurt yourself. If you're balancing eating, sleeping, and self-care, you're less likely to be overwhelmed by emotion.
Interpersonal Effectiveness
Being clear about what you want and about your priorities in an interaction are crucial to good communication, and this worksheet offers a series of questions and steps to follow to help you determine how to approach a difficult interpersonal interaction. It is truly amazing how much going through these steps can help.
More information about Dialectical Behavioral Therapy can be found at DBT-Seattle.
*~10 YEARS BABY~*
Thread Starter
Join Date: Nov 2005
Location: Hollywood
Posts: 9,369
What is "fake pain" and why does it matter?
What is "fake pain" and why does it matter?
The concept of "fake pain" helps to explain why distress-tolerance skills are so crucial.
Observation of myself and interviews with others have convinced me that one of the reasons people self-injure is to deflect unknown, frightening pain into understandable, sort-of-controllable "pseudo" or "fake" pain. Calling this phenomenon "fake pain" is in no way intended to suggest that it doesn't hurt; it hurts like hell. When memories or thoughts or beliefs or events are excessively painful, instead of facing them directly and feeling "genuine" pain, we sometimes deflect distress into pain that seems understandable and controllable, like that of self-injury. The real feelings associated with the event you're avoiding get overridden by those of the situation you create to distract yourself. It still hurts like hell, but it's a controllable familiar hell, whereas the real pain you're avoiding seems scary and poised to take over your world like the monster who ate Detroit.
It's easy to revert to "fake" pain. Trying to find the source of your distress can be scary as hell, because you often don't know what you're going to unleash. Fake pain, although very painful and traumatic, is something that you understand and can control and can handle. It's familiar, not mysterious and scary like the real pain behind it. You might feel that if you ever exposed yourself to the real pain you'd lose control: "If I ever start crying, I'll never stop" or "If I let myself get mad about that, I'll never stop screaming."
Instead, you unconsciously deflect the distress away from the memories or feelings that generated it and into self-injury. SI is seductive: you control it. You know the boundaries, even when you feel out of control. It makes sense and it makes the distress go away, at least for a while. It's a clever mechanism -- it takes what seems unbearable and transforms it into something you can control. The only problem is that when you deflect pain, you never face up directly to what it is that has caused this much tumult in your life. So long as you channel distress into fake pain, you never deal with the real pain and it never lessens in intensity. It keeps coming back and you have to keep cutting.
You have to deal with the unbearable if you ever want to make it lose its power over you. Every time you can meet the real pain head-on and feel it and tolerate the distress, it loses a little of its ability to wipe you out and eventually it becomes just a memory. The process is like building tolerance to a drug. Narcotics users take a little bit more of their drug every day as tolerance builds, until eventually they're routinely taking amounts of drug that would kill an ordinary person. The poisonous events in your past work in a similar way. Exposure (with the help of a trained therapist) over time will build your tolerance to these events and enable you to lay them to rest. The key is learning to tolerate distress.
same planet...different world
Join Date: Sep 2006
Location: Butte, America
Posts: 10,946
hey done -
thanks for posting this -
but ZI've GOT to say this -
I don't think it's anyting to do with being "fake" or "real pain" ...
it's more a matter of controlled.... or not controlled.
inflictor ... or inflict-ed...that makes more sense to me.
thanks for posting this -
but ZI've GOT to say this -
I don't think it's anyting to do with being "fake" or "real pain" ...
it's more a matter of controlled.... or not controlled.
inflictor ... or inflict-ed...that makes more sense to me.
*~10 YEARS BABY~*
Thread Starter
Join Date: Nov 2005
Location: Hollywood
Posts: 9,369
I thought it was funny/ironic, cuz that part jumped out at me, that was part of the reason I posted it. lol, so we are/were definitely thinking along the same lines of each other.. 
bona fido dog-lover
Join Date: Mar 2008
Location: SF Bay area, CA
Posts: 99,759
THe funny thing is, I've never been a cutter, but now, at age 56, with my life in unbearable circumstances, I feel ike hurting myself "for real" since it would seem that my actions in the past year have been hurting me. I'm afraid of pain but would welcome a diversion from the mental pain of being useless.
*~10 YEARS BABY~*
Thread Starter
Join Date: Nov 2005
Location: Hollywood
Posts: 9,369
Originally Posted by least 
THe funny thing is, I've never been a cutter, but now, at age 56, with my life in unbearable circumstances, I feel ike hurting myself "for real" since it would seem that my actions in the past year have been hurting me. I'm afraid of pain but would welcome a diversion from the mental pain of being useless.
For Me, it's a harder thing to give up than something like drinking or drugs.
(Meth was my issue).
Please visit a self harm board, like www.recoveryyourlife.com or some place and read the posts before you decide to hurt yourself.
If you think 'mental pain' is useless, wait till you start to experience self inflicted physical harm that you feel as if you can't stop, and like everything else it is progressive. Today's cut won't work tomorrow, you will have to cut deeper eventually, you have to keep doing more to get the same affect.
And then the numbness goes away and you "Realize" what you've just done to yourself.
You'll need to think up lies before you start, the cat scratch only works for so long, need lots of long sleaved shirts, bracelets or watches, and you only hope they don't hurt too much...
There is nothing okay, or fun, or pleasant about hurting yourself physically.
Please don't consider this an option. And it solves nothing, it makes your life worse. Like I said visit a self harm board and do some reading.
I'm sorry you are in pain enough to want to hurt yourself.
Have you made any posts to talk about what is going on?
:ghug
*~10 YEARS BABY~*
Thread Starter
Join Date: Nov 2005
Location: Hollywood
Posts: 9,369
"warning"
"WARNING"
- Before you make that first cut remember: You will enjoy this. You will find the blood and pain release addictive. Even though you think you can make a few tiny cuts that aren't deep and will heal easily, they will get deeper. They will scar. They will take sometimes months to heal. And years for the scars to fade. If you think you can limit the cutting to one area of your body, think again; it will spread when you run out of skin.
"Be prepared to withdraw from others and live in a constant state of shame. Even if you are the most honest person ever to live, you will find yourself lying to the people you love. You will jerk back from your friends when they touch you as if their hands were dipped in poison. You will be terrified that they will feel something under the cloth of your shirt or because it just plain hurts so much to be touched. Be prepared to get so out of control you fear your next cut because you don't know how bad it will be. Just wait for 10 cuts to turn into 100.
"Be prepared for your entire life to revolve around thinking about cutting, cutting and covering up cutting. And just wait till that first time you cut "too deep." And you freak out because the blood won't stop, and you are gaping, and you feel yourself shaking all over. You are having a panic attack and you are terrified but you can't tell anyone. So you sit there alone, praying it will be ok swearing you'll never let it go this far again. But you will, and further.
"Don't worry, you will learn how to take care of your cuts so that you can go deeper and deeper and avoid the ER. And the better you get at treating your cuts, the deeper they get. You will lie to yourself and justify it when you find yourself spending 20, 30 or 50 dollars every time you go the pharmacy. You will feel the flutter of your heartbeat every time you go to the counter to ring up your order. Butterfly strips, 3 or four different kinds of dressings, Betadine, antibiotic cream, medical tape, scar reducers. You will tap your foot impatiently, hoping the line will just move and no one will stare at you or wonder why you need all these things. And at the same time, secretly hope someone will notice; someone who is standing in line with an armful of the same supplies; someone who understands but of course that never happens.
"Medical supplies won't be the only thing you spend all your money on. Be prepared to buy a new wardrobe; long-sleeve shirts in summer colours, bracelets, wristbands , boots, gloves, the list goes on and on. You will start looking at everyone in a different way, scanning their bodies for any signs of SI just hoping that you might meet someone like you so you don't feel so terribly alone. You won't even think about it as your eyes scan their wrists arms, hoping, just hoping, they will be like you. But they are not. You will see their clean arms and feel terribly ashamed and alone. You will start doing a lot of things alone.
"You will always have to wash your laundry in private so know one sees the blood stains on your clothes and towels. You will always be cleaning up the blood, scrubbing your bathroom floor, wiping the blood off your keyboard. You won't be able to make it through a day without cutting.
"Next thing you know, you are in a public bathroom somewhere breaking open a scab with a sewing needle that you keep in your wallet for emergencies. When you get really desperate anything will be a cutting tool; scissors, a car key, a needle, a paperclip, even a pen. Doesn't matter what it is if you need to cut badly enough, you will find something.
"Say goodbye to things you took for granted. Like wearing shorts or sandals, pedicures, sleeveless tops. A normal summer day at the beach or in a swimming pool will become a far off memory for you. Get ready to itch. Because you will itch and itch, "so much you will look like you have fleas or a skin disease." You will become an expert on your body as you destroy it carefully. You will dream about cutting, you will dream about being exposed. It will haunt you day and night and take over your life. You will wish you never made that first cut because while you absolutely HATE cutting at the same time you love it and can not live with out it..."
- Anonymous
- Before you make that first cut remember: You will enjoy this. You will find the blood and pain release addictive. Even though you think you can make a few tiny cuts that aren't deep and will heal easily, they will get deeper. They will scar. They will take sometimes months to heal. And years for the scars to fade. If you think you can limit the cutting to one area of your body, think again; it will spread when you run out of skin.
"Be prepared to withdraw from others and live in a constant state of shame. Even if you are the most honest person ever to live, you will find yourself lying to the people you love. You will jerk back from your friends when they touch you as if their hands were dipped in poison. You will be terrified that they will feel something under the cloth of your shirt or because it just plain hurts so much to be touched. Be prepared to get so out of control you fear your next cut because you don't know how bad it will be. Just wait for 10 cuts to turn into 100.
"Be prepared for your entire life to revolve around thinking about cutting, cutting and covering up cutting. And just wait till that first time you cut "too deep." And you freak out because the blood won't stop, and you are gaping, and you feel yourself shaking all over. You are having a panic attack and you are terrified but you can't tell anyone. So you sit there alone, praying it will be ok swearing you'll never let it go this far again. But you will, and further.
"Don't worry, you will learn how to take care of your cuts so that you can go deeper and deeper and avoid the ER. And the better you get at treating your cuts, the deeper they get. You will lie to yourself and justify it when you find yourself spending 20, 30 or 50 dollars every time you go the pharmacy. You will feel the flutter of your heartbeat every time you go to the counter to ring up your order. Butterfly strips, 3 or four different kinds of dressings, Betadine, antibiotic cream, medical tape, scar reducers. You will tap your foot impatiently, hoping the line will just move and no one will stare at you or wonder why you need all these things. And at the same time, secretly hope someone will notice; someone who is standing in line with an armful of the same supplies; someone who understands but of course that never happens.
"Medical supplies won't be the only thing you spend all your money on. Be prepared to buy a new wardrobe; long-sleeve shirts in summer colours, bracelets, wristbands , boots, gloves, the list goes on and on. You will start looking at everyone in a different way, scanning their bodies for any signs of SI just hoping that you might meet someone like you so you don't feel so terribly alone. You won't even think about it as your eyes scan their wrists arms, hoping, just hoping, they will be like you. But they are not. You will see their clean arms and feel terribly ashamed and alone. You will start doing a lot of things alone.
"You will always have to wash your laundry in private so know one sees the blood stains on your clothes and towels. You will always be cleaning up the blood, scrubbing your bathroom floor, wiping the blood off your keyboard. You won't be able to make it through a day without cutting.
"Next thing you know, you are in a public bathroom somewhere breaking open a scab with a sewing needle that you keep in your wallet for emergencies. When you get really desperate anything will be a cutting tool; scissors, a car key, a needle, a paperclip, even a pen. Doesn't matter what it is if you need to cut badly enough, you will find something.
"Say goodbye to things you took for granted. Like wearing shorts or sandals, pedicures, sleeveless tops. A normal summer day at the beach or in a swimming pool will become a far off memory for you. Get ready to itch. Because you will itch and itch, "so much you will look like you have fleas or a skin disease." You will become an expert on your body as you destroy it carefully. You will dream about cutting, you will dream about being exposed. It will haunt you day and night and take over your life. You will wish you never made that first cut because while you absolutely HATE cutting at the same time you love it and can not live with out it..."
- Anonymous
same planet...different world
Join Date: Sep 2006
Location: Butte, America
Posts: 10,946
Least -
I'm 49, and recently had a 'recurrence;' of 'old' behaviours
I thought were LONNNG put away and handled.
Although I didn't engage ... the temptation ... was alarmingly powerful.
I've been tearing the internet up - I read an article one night online in the 'back pages at some site to do with the topic of preimenopause. and it discussed the hormonal fluxuations causing the recurrence of these self - destruct patterns...
but I can't find it !!!!!!
I tend to stick to John's Hopkins, UC Davis ... those kinds of sites.
It only back up my signature, though -
and all the mis-reads I've been doing shows
I'm not COMPLETELY back from the Topamax debacle,
but I"m way better....
I'm 49, and recently had a 'recurrence;' of 'old' behaviours
I thought were LONNNG put away and handled.
Although I didn't engage ... the temptation ... was alarmingly powerful.
I've been tearing the internet up - I read an article one night online in the 'back pages at some site to do with the topic of preimenopause. and it discussed the hormonal fluxuations causing the recurrence of these self - destruct patterns...
but I can't find it !!!!!!
I tend to stick to John's Hopkins, UC Davis ... those kinds of sites.
It only back up my signature, though -
and all the mis-reads I've been doing shows
I'm not COMPLETELY back from the Topamax debacle,
but I"m way better....
Currently Active Users Viewing this Thread: 1 (0 members and 1 guests)
