Is Your Anxiety The problem? Why Getting Rid Of Your Anxiety Isn’t The Answer:

When people start to have anxiety problems they usually believe that anxiety itself is a problem. When anxiety becomes the focus of attention people overlook the actual fear or fears that create anxiety in the first place. The problem with this is that it often fails to activate problem solving, because the anxiety creates distractions from addressing the actual situation that is being avoided. People can successfully avoid treatment for panic by focusing on being anxious about being anxious, which ironically tends to generate more panic and amplify the belief that anxiety is indeed the problem. In some circumstances, because people have tried to get rid of their anxiety unsuccessfully, they believe that nothing can be done for their anxiety. Sometimes people get angry when anxiety treatments are presented as options, because they don’t want to be invalidated for their efforts to get rid of anxiety.

People have anxiety about all sorts of things: Losing people they love, sickness or illness, death; threats of losing power, status, money; being in situations that threaten physical integrity or safety, being humiliated or shamed in public, being verbally attacked, being fired, or loss. In a given situation coping well with these situations means incorporating some degree of acceptance, acknowledgement, and sadness. It also might activate problem solving, fixing, or making changes to prevent these things from happening in the future. This is what normal people do in normal situations, and creates understandable, realistic, and adaptive ways of coping. Community supports, problem solving, religious institutions, family, and other means of coming together helps people to naturally solve painful life circumstances and problems.

People that have a lot of problems with anxiety generally tend to have problems identifying and responding to the actual thing that makes them anxious. If you are afraid of having conflict, and then you tend to avoid people when conflict is present, and then you have anxiety because you have conflict, and then you blame your anxiety, and then you try to get treatment for your anxiety, you can create ways to avoid addressing the actual problem. For example, treating anxiety with relaxation techniques without actually looking at what it is about the conflict, exactly, that is making you so anxious evades problem solving. When “the problem” becomes “the anxiety” most people’s solutions are to get rid of how they feel, not to figure out how to deal with conflict. If you could figure out how to respond to conflict adaptively, chances are your anxiety will naturally go down.

You can’t address emotional problems by failing to identify the thing that evokes the emotion in the first place. Here are some brief questions to help you figure out your anxiety:

What is it about this situation that you are actually afraid of? What is the actual threat?

What is the realistic likelihood of this actually happening?

If you had to approach what you are afraid of, what uncomfortable sensations, emotions, or experiences would you have to be willing to tolerate?

If what you are afraid of is actually happening, how would you approach this situation effectively?

What is one adaptive, problem solving step that you could take?

What can you do to validate the pain or difficulty of this situation to yourself?

Tolerating Uncertainty in Uncertain Times: Values, Anxiety, And Willingness In The Era Of The Coronavirus

In this pandemic, many people’s lives have been disrupted in ways they never imagined. People are struggling with losses, lack of structure, difficulty with motivation, changes in schedule, computer fatigue, lack of ability to control things, feeling restricted and limited in what they can do, and being told what to do by governmental authorities. Anxiety prevails when times are uncertain, time frames are not set, and no one knows what it will mean for “things to go back to normal.” People usually cope better when they have a clear answer as to when the stress and restrictions will end; as they can predict and control how long they will have to tolerate what may not feel tolerable. The not knowing is the challenge.

Sitting with uncertainty is often a major part of adaptive coping. Often when people feel out of control they behave in ways that produce an illusion of having more control, including trying to be more controlling themselves. Anxiety behavior tends to be restricting, rigid, and inflexible. Some pick fights with people they love. Some try to micro-manage the people around them. Some yell, lash out, or escalate. Some people withdraw, sleep, or restrict their interactions with others. Some stop reaching out to friends or people they love. Some avoid getting things done or move forward. Some drink alcohol or use marijuana in excess. Others cope by antagonism or rebellion, externalizing blame to authority figures who can’t make this end, either.

In an era of a pandemic, there is no immediate quick fix. No one knows what will happen, who will contract the virus, and who will be taken by the virus. No one can cheat death. Here are some things to keep in mind in the era of uncertainty:

-Anxiety behaviors are not a way to obtain certainty. People often have their own “personal fix” of what they do when they are stressed. Some of this has some sense of normalcy and is not harmful, such as sleeping a bit more or eating more chocolate. However, some anxiety behaviors have hurtful outcomes. What is your anxiety behavior when stressed, and does it actually control the outcome of when the pandemic will “end”?

-Be willing to accept the discomfort of uncertainty. In the face of uncertainty, people have found ways to cope well. Find the ways in which people are coping well and see what you can do to manage stress and anxiety without making it worse. Reach out and ask what other people are doing with boredom, fatigue, work-life changes, and other related stressors. Find the news, heroes, and people who have survived great life challenges well. Once you accept what you can not control, your anxiety may not disappear but it will go down. Trying to control what you can not control makes it worse.

-Keep in mind your values. What is important to and who is important to you and why? What does this tell you about your spiritual values, who/ what to trust, and who you rely on when you are having a hard time? A willingness to yield control often means finding more trust in community. People are rediscovering lost values as limits are being placed on them, and finding new ways and means of connecting to family and loved ones. Keep asking and looking people for the silver lining, the unseen benefit, or the ways that people are enhancing their sense of connection.

-Do your part. If you have something to offer at this time, consider the benefit or value of what you can do for others. Often contributing is a way to distract from our own anxiety and involves universal benefit. Donate to a food drive, reach out to neighbors, do errands for someone who is quarantined, pick up trash in a nearby park or bike path, give blood, make masks, cook or bake for family members, repair something that is broken, join a neighborhood volunteer task force, or start online Zoom socials.

Why Your Psych Meds Aren’t Working- A Bitter Pill To Swallow?

Psychiatric meds actually do work, and they very well may be working. Psychiatric medications have helped numerous people with many different things, including nightmares, anxiety, symptoms of bulimia, public speaking, mood regulation, paranoid thoughts, and depression.

However, there is one thing that medications will never do, and that is get rid of emotions. Emotions are hard wired, biologically adaptive responses to situations that help people survive. They give people important information about threatening situations and painful circumstances. The allow people to know what matters, what to hold close, what to pursue, what risks to take, and what to avoid. Without emotions we would not have important information about ourselves, our circumstances, our environment, and other people.

People have tried numerous and unsuccessful things to get rid of emotions. This might include drinking, drug use, numbing out, hurting oneself, picking fights, avoiding, sleeping, dominating a conversation, being coercive, smoking marijuana, or being violent. The simple truth is, emotions can’t be eliminated. If they are temporarily eliminated, they come back.

Some people don’t like their emotions because their emotions show up when other people tell them what to do, how to think, how to feel, or how to react. Thus they minimize or inhibit their emotions in these situations because they are trying super hard to fit in, avoid conflict, live up to someone’s standards, please a parent, or survive in their environment. However, this can lead to a very unhappy life and can be very painful.

Sometimes people are very sensitive to emotions, thus they tend to have strong reactions to things that may, to others, not seem like that big of a deal. While this can lead to bigger, out-of-control emotional problems, it is also important to learn how to discern when a threat is actually a threat, vs. when a person develops a fear or phobia about something that is not a threat.

Emotions are often related to eccentric, atypical, or problematic behavior. If you have a behavior that you are trying to stop doing, just consider if not doing that behavior brings up any discomfort, anxiety, or restlessness for you. Asking people to stop doing behaviors such as self-harm, drinking, escalating an argument, threatening suicide, doing a behavior excessively or repetitively, or picking a fight is quite hard. The benefits if these behaviors can sometimes include getting a point across, expressing an emotion, getting taken seriously, reducing anxiety, or getting another to be validating or affirming. Sometimes significant others don’t react at all until another person escalates or flips out, which makes the problem behavior even harder to stop. (After all, it worked!).

If you think your psych meds aren’t working it may be worth asking yourself: What feelings do you have that are intolerable? What do you think your feelings might be telling you? What feelings do you try to ignore? What feelings are trying to get your attention? How willing are you to bear with some of the discomfort of what is going on for you? If you honored your feelings and what they were telling you, what sort of action would you take?

Understanding, naming, managing, and controlling moods are a lot of work. Thankfully, there is are services available that are focused on doing just that- and aren’t focused on dosages or prescriptions. While meds do wonders for people- they are not, thank goodness, the only way of helping a person solve emotional problems. In fact, the entire basis of the group services that I provide help people with all of this- managing mood, understanding emotions, listening to one’s wisdom, and taking necessary steps to tolerate feelings better. Getting rid of what you feel is just not an effective long term strategy for solving emotional problems.

Why Teenagers Need Social Groups More Than Anything: The Internet Addiction Is Not Helping Mental Health

This past week I had the privilege of attending a conference on technology and mental health by social worker Ozgur Akbas, LMFT. Ozgur presented some compelling date in terms of technology and mental health. In general, people that have difficulties with technology generally spend a lot of lot of time alone with a phone or computer, are defensive and unaware of the impact of their use of technology, prefer time spent with their devices over time spent with others, lose interest in other activities, become moody, socially isolated, and irritable; and have problems with school or work.

One of the big issues around social media also has to do with its accessible use of pornography, the ability to have phone sex/ send nude photos, and the trend creating unrealistic (online) expectations about body image and relationships. In general, Ozgur presented data that shows us that our youth are having much less sex. In the past, only 2-3% of the population showed problems with erectile dysfunction, while after 2008 that number has increased to 26%. More and more people are relying on “safe” ways of interacting that don’t involve risk, intimacy, putting oneself out there, and developing social and dating skills. In essence, our increased reliance on technology has decreased our competence at being able to relate with authenticity and visibility. The socially anxious person has found more places to hide, and their disappearance makes it almost like they don’t even exist. Imagine that!

Problematic use of technology can fill a short term need and provide short term, temporary relief; yet create long term problems- sleep being one of them. Companies, designers, gamers, marketing agencies, and yes- even neuroscientists are part of a burgeoning market of keeping your kids’ attention for as long as possible. Consistent high arousal increases blood pressure, dilates pupils, induces sweaty palms, increases the flight or flight response, and creates problems in a person’s ability to regulate emotion. Persons who have difficulty “turning it off” or regulating arousal are at risk for being wired all the time and thus having problems with attention, aggressiveness, or moody behavior. Therefore, any number of diagnosis (ADHD, ADD, social anxiety, Bipolar Disorder, Mood Disorders, Anxiety Disorders, and even Psychotic Disorders) may show up when technology use becomes a problem- and can be easily treated with the treatment of problematic technology use!

Group therapy puts teenagers in a social situation where technology can’t be relied on to solve social problems. Groups offered in my practice focus on building group cohesion, which means looking for and finding what members have in common. In some cases it means creating a space for abrupt disclosures, tearfulness, honesty, sharing struggles, and openness. This means staying in the room with all emotions -both easy and hard- and struggling at times with knowing what to say, how to say it, or what (if anything) should be said at all. What social media can’t do for your teens is to help them safely navigate tolerate feeling awkward or uncertain. This great and wonderful developmental task is a significant part of risk and survival. How else do teens build self-respect, find integrity, and “show up” with all of their emotions? If it is easier to ghost someone, what is the value in learning how to end a relationship with grace, to bow out on a situation you don’t want to be in, or to speak up and assert oneself? In my groups the commitment is to do the work, show up regularly, give and and receive feedback (even when it is hard!). Most important, when technology takes away our teens’ ability to grow and develop, they stop growing. Group services can help teens continue to grow in real life situations with real life problems- with real people and with real pain.

Is Technology Affecting Your Mental Health? Top Suggestions For Treating Internet Addiction Use In Your Household (Recent tips from conference by Ozgur Akbas, LMFT)

1) Examine the relationship with social media screen time among the adults. In way what way does your use of technology set a standard or norm at home? Tests for internet addictions include Young’s Internet Addiction Test (IAT) http://huibee.com/wordpress/wp-content/uploads/2013/11/GLOBALADDICTION-Scales-InternetAddictionTest.pdf

2) Ozgur presented three determinants of Self-Development theory to take into consideration when considering the impact of technology use: 1) Autonomy- how much are you (or your teen) in control 2) Relational- how capable are you (or your teen) able to form social bonds in life, and 3) How effective are you (or your teen) at being able to effectively deal with environment/ challenges (ie work, school, stress, life?)

3) Create technology free times and places. Technology free zones might be mealtime, a set period of time before bed, overnight, shower time, homework time, family time, outdoor time, exercise time, or other times of day in which no screen time is permitted. Technology free zones may include certain places in the house such as the bedroom.

4) Turn off push notifications, simplify your home screen, use only what you need, go grayscale, and use settings to decrease accessibility to blue light after sunset (Nightshift on iphone).

5) Other helpful apps to help control screen time include Ublock Origin, InboxWhenReady, Disney’s Circle/ Qustodio (for parental monitors and controls), and Facebook Newsfeed Eradicator.

“There Is No Good Reason To Feel The Way I Feel”

Is this something you find yourself saying? This is something people frequently tell me. Unfortunately a lot of people think this is true. When people think it is true, they often stop trying to figure out the significance of how emotions show up in their life. People will say their emotions come out of the blue, show up for no reason, don’t make any sense, and even create problems in their lives that they wish they didn’t have to deal with.

I actually don’t think that people have no good reasons for feeling they way they feel. In fact, I think reasons are there, but people are often not aware of them. My belief is that emotions show up for a reason, and are important and critical to our existence. However, because emotions can be nebulous, hard to pinpoint, and often elusive; they are sometimes hard to understand and even identify.

All emotions have certain functions. Functions work to serve a purpose or accomplish a task. Functions of emotions include communication, validation, or action. The emotion of sadness, for instance, is an invitation to figure out what is important, grieve losses, search for what is missing, or acknowledge how important something was in our life. Without sadness we would not know what matters, who we love, or what is missing. Sadness gives us important information about all of these things.

Primary emotions are emotions that we have about certain situations, persons, or events in our lives. They are what shows up when stuff happens. They provide valuable information that, if ignored, can create even more problems. Secondary emotions when people have emotions about emotions. For instance, if you feel angry that you are sad, ashamed that you are distressed, or embarrassed that something angers you, you are experiencing a secondary emotion. Secondary emotions generally cause more problems for people because they are ways to judge (or not accept) a primary emotion. When we work really hard to inhibit, hide, minimize, or judge what we feel in the first place, we can create even more problems for ourselves. Sometimes people focus on secondary emotions as a way to avoid focusing on primary emotions. (“If I talk about how angry I am, you won’t really get how much I am hurting.”)

The key point is that people who learn to accept and even value their primary emotions generally have less distress than those who go out of their way to inhibit, hide, or suppress what they feel. If we treat our emotions as useful and valuable means to provide information about ourselves and our environment, the task of addressing emotional pain will be easier. Getting rid of emotional pain because it is uncomfortable doesn’t teach us to be open, present, and accepting of our emotions. While this may seem counter-intuitive, having less shame about how we feel helps us solve the problems of life a bit more easier. (“I am upset because something happened” vs. “Because I am upset I am ashamed, then angry at myself for being ashamed, then guilty for snapping at people because I was angry, then humiliated for how I handled this. Because I have no good reason to be upset.”)

Here are some tips to help you work on your emotions:

  • Treat your emotions as useful
  • Approach how you feel with curiosity, not judgment
  • Assume your emotions are trying to give you important information
  • Be willing to experience the intensity and painfulness of emotions
  • Observe any action urges that come along with emotions
  • Pay attention to how you feel about things more closely
  • Be aware that low levels of distress is still stress, and that minimizing it can sometimes result in a blow up later on

What are Dialectics and Dialectical Behavior Therapy Skills?

What is Dialectics?

Dialectics is based on the idea that two opposing concepts can both be equally true. One truth does not trump or rule out another, which undercuts the dichotomy of a “I am right you are wrong” type of relationship. A common dialectic is that you are perfect as you are (acceptance), and that in order for things to turn out differently in your life, you need to do things differently (change). One is not more true than the other, and one truth does not rule out the other truth. Sometimes people need acceptance, and sometimes people need to be challenged. Both belonging and growth are an inherent part of being in relationship.

Dialectics challenges the idea that one person is always “right”, because when you take into account diversity of perspective, other truths often arise. Being “right” often fails to take into account effective communication and the value of the relationship. Experience and emotions get ignored. A set agenda of being “right” often gets people stuck in a very rigid, dichotomous, black and white, non-dialectical stance. Dialectics are important in that sometimes you can find the one thing you have in common with your enemy instead of focusing in ways you are different. Relationships exist in context of conflicting truths, yet relationships are the glue that carries us through life.

What are the four Dialectical Behavior Therapy Skills?

DBT is a complex treatment that has confusing origins in terms of how it was developed and who it was for, and has been tailored to a wide range of populations and settings. The DBT skills are universally applicable materials that help people with extreme and painful emotions, intolerable life situations, and relationships. The four skills sets are as follows:

Core Mindfulness: Mindfulness is a skill that helps people focus attention, regulate arousal, calm the brain, quiet the mind, and settle in. Being mindful is a way to steady and anchor oneself in order to observe quietly and not “react” to what is going on. It is inherent in all of the other skills in that it requires a steady, quiet, secure stance in the face of demanding life situations. It takes spaciousness to know what is going in with your body, your self-experience, your wants and desires, and your life. If you don’t pause the moment and check in with yourself, it is easier to get “caught up” in the banging and thrashing of what life throws in your direction. Mindfulness can be a spiritual practice of quiet contemplation, a way to press the pause button, and way to regroup. Core mindfulness skills taught from the DBT material include skills of observing and describing without judgement. Other traditions, spiritual practices, health care services, and therapies teach mindfulness, so it is not “new” nor is it confined to just DBT skills; its roots are actually in Zen Buddhism. There are multiple ways of accessing mindfulness including mindfulness based programs, meditation groups, trainings, and apps. DBT groups are known for implementing a mindful practice or exercise in every group, and like many spiritual traditions are simply considered part of a daily practice.

Emotion Regulation: This is a set of skills that helps people to observe and describe what they feel (you can see the overlap with mindfulness) in order to help regulate arousal, understand what they feel, and know the reasons why they feel the way they feel. Skills cover ways to reduce emotional suffering through mindfulness and opposite action, and ways to reduce vulnerability to emotional suffering. Skills are quite complex and take practice, feedback, and validation. Since emotions can be tricky, elusive, (and just plain unbearable at times) the emotion regulation content is not something you could “quick learn” and be done with it. Sometimes people are not always aware of how or what they feel in general, and there is nothing pathological about this. It is a process! Knowing oneself and knowing one’s emotions is a lifelong task not subjected to any particular type of disorder, and does not end just because you have had a first exposure to all of the skill content. That is why working together on ways to regulate arousal given varying life circumstances can best be done over time in small group settings that promote cohesion and intimacy.

Distress Tolerance: In order to regulate emotional arousal, finding ways to endure the “I-can’t-stand-it-itis” of painful and extreme emotions is critical. Surviving painful life circumstances well means doing so in a way where people do not lose self-respect, forget their values, give up what is important to them, or react in such a way that makes things worse. Sitting in the fire and not reacting is often harder than picking a fight, poking the fire, making others suffer in order to prove a point, exacerbating pain to let others know how bad things are, undermining a person where it hurts, forcing the university to prove its point, perseverating on being “right”, asking “why me”, or engaging in self-defeating or relationship destroying behaviors. Being willing to tolerate the unknown, be zen with the universe, stop fighting reality, and do what works is skillful practice. We all want things to do our way or to turn out for the best. In reality, a lot of people are suffering a great deal and need everything they can to survive well. Distress tolerance skills encompass not only change strategies (if you can do one thing make it better, why wouldn’t you?), but acceptance and willingness skills. Anyone who has successfully undergone any type of exposure treatment for anxiety knows that the benefit to tolerating anxiety is a decrease in overall anxiety. There is an inherent truth that reality is easier to face once you stop fighting it, thus freeing you up to do what is needed to effectively solve problems.

Interpersonal effectiveness: True to the concept of the dialectical philosophy of DBT, it is better to be effective than it is to be right. The interpersonal skill content encourages readers to identify objectives in situations (what exactly it is you want or don’t want), how the relationship may be impacted, and if self-respect is at stake. Balancing the three helps people to look at natural barriers and consequences of interacting, and enables readers to problem solve the cost/ benefit of ignoring each. For instance, you can ask for what you want at the expense of the relationship, or you can give into a relationship but sacrifice self-respect. The balancing act of relationships is an ongoing challenge for everyone, and some give and take is part of how people stick together, find intimacy, and keep people close. Interpersonal skills also include ways to get out of or decrease contact with toxic or unwanted relationships, set limits, say no, and to identify barriers to doing so. Direct rehearsal in terms of “what to say and how to say it” benefits group members in that they can try out and receive feedback in both verbal and non-verbal forms.

A book of all the DBT skills is available for purchase via this link: https://tinyurl.com/y2qad6sk

Can You Get Someone To Change Their Behavior Without Sabotaging Your Relationship?

Giving useful, helpful, and adequate feedback is something that is hard for a lot of people. I constantly witness parents, spouses, friends, family members, and even mental health professionals try to change the person they care about by blame, shame, and humiliation. While negative feelings have important functions and can motivate people to change their behavior, lack of useful feedback can have the opposite effect. For sensitive people who struggle with self-destructive behaviors, internalized shame, self-consciousness, and obsessive self-defeating thoughts, the consequences can be devastating. Here is a list of what not to do, and some food for thought about what to do instead: 

Tell them it is their fault: Getting someone to take responsibly for their actions makes sense. However, telling someone they are at fault is generally not followed up on by some plan of action, support, or help to prevent problematic behavior happening in the future. Generally, telling someone they are at fault does nothing more than make them feel bad. It makes more sense to be able to describe what specific behavior they did and the consequences it had in a non-judgmental manner. Is the goal the help prevent them from doing it in the future? If so, what is your role in this interaction? What are your intentions in blaming someone? Often, saying a person is at fault is simply a way to express anger, and expressing anger too intensely can sometimes destroy relationships. 

Tell them they are mentally ill: If you are trying to write someone off for behavior that you don’t understand well, this is an easy way out. Telling someone they are “mentally ill” can sometimes get people off the hook for providing more specific feedback or expressing anxiety more directly. What specific behavior are you talking about? Is there something in particular you want them to change? Do you have trouble describing their behavior? If people are treated with respect, they generally respond proactively. Mental illness can sometimes be a nebulous term for behavior that is not fitting or appropriate to the situation, and can also be a way to say “I am not comfortable with what you are doing.” However, being ganged up on, being misunderstood, and being shamed only ostracizes the recipient. Is calling someone mentally ill a way to express fear of what you can’t understand? Consider what it is about their behavior specifically that makes you uncomfortable, and see if you can use words to describe it without judgment. 

Tell them that they do things for attention: An attentive, listening audience can be a powerful thing. Just ask anyone who has benefitted from a caring partner, a best friend, or a loving family member! I love it when I receive the type of attention I want, and the type of attention I need. It makes me feel closer, more connected, and warmer towards the people I care about. There is no need to pathologize what is completely normal, and to make people feel bad for social inclusion, affection, and control. If there is a behavior that they actually do that burns you out, overwhelms you, or angers you; it may be time to own your frustration and know and communicate your limits. It may also be an opportunity to provide some feedback on what isn’t working in your relationship, or to clarify what it is you actually need for them to do or change. 

Tell them they have a personality disorder: Describing a disorder doesn’t change a behavior. People often think that if they could only describe something, somehow it will change! Telling someone the reason they behavior x way is because they have personality disorder generally just make them feel bad, and in some cases hopeless to do anything about it. If you want to hold someone accountable, you will have to develop better ways of giving feedback. A more thoughtful approach to changing behavior includes a compassionate and realistic plan to address it. 

Tell them they are a bad (parent, teacher, spouse, child, etc.): In essence, bad is a judgment. Trying replacing “bad” with descriptions of impact, consequences, and feelings about what happens when they behave the way they do. What is it about their behavior is “bad”, and why is it so important to bring to their attention? Are you avoiding expressing your own difficult feelings by judging others? 

In general, people are more willing to do what we want them to do when we have a strong relationship with them, when the feedback we provide comes from a place of caring, and when we validate and encourage others. A person is more likely to take feedback into consideration when they feel valued and cared about. Are there ways you can encourage or enhance the relationship? Focusing on behaviors that you want to increase (such as connection, openness, courage, self-awareness) will probably go a lot further than punitive responses coming out of frustration or anger. While constructive feedback is sometimes called for, aversive consequences manage to prevent problem behavior, and limits around what a person can tolerate is reasonable; punitive responses can also damage relationships.  

What Is Mindfulness, What Does It Have To Do With You, And Why Is It So Necessary?

Mindfulness is a particular way of paying attention to 1) expand awareness or 2) focus attention. Below is some brief information on these two applications of mindfulness as it relates to your life and to the practice of psychotherapy.

AWARENESS

What are the benefits of awareness?

  • Increasing awareness increases options (less experiences of feeling or getting “stuck”)
  • Increasing options for how to react to stressors increases a sense of confidence and self control when confronted with life circumstances
  • Increasing awareness helps people understand why they behave the way they do and what controls their behavior
  • Increasing awareness helps people to identify patterns of responding, or repeating themes that may show up again and again, and can be better understood with curiosity and analysis
  • Increasing awareness helps to clarify, understand, and organize behavior in a more meaningful way
  • Increasing awareness (ie, awareness of anger) helps people to be assertive/ proactive, solve problems, and organize action

What problems accompany limited awareness?

  • Repeating patterns of getting stuck
  • Minimizes flexible and adaptive coping
  • Can be likened to zoning out, dissociating, not paying attention, missing out, or failing to show up for one’s life
  • Can increase vulnerability to do, say, or behave in ways that are acquiescent/ compliant; no self-awareness leads to responding/ reacting to environment (reduced autonomy, reduced control, reduced capacity for interpersonal influence/ power)
  • Limited awareness is associated with not knowing oneself, what one likes/ doesn’t like, wants/ doesn’t want
  • If you can’t know yourself (trust experience) how you can you know how to pursue a life that would be fulfilling and rewarding to you

Ways Awareness can bring pain

  • Losses associated with missing out on ones life
  • Grieving times/ time in life when things could have been better (had a person been more aware)
  • Awareness of hope and possibility can feel risky or unfamiliar
  • Familiarity and predictability help people feel consistency/ stability, thus awareness of alternatives can be uncomfortable/ unfamiliar
  • If a past history of problematic responses evoked a particular set of behaviors (escalated conflict results in nurturing/ attentiveness from partner), awareness of alternative ways of behaving may be initially aversive / won’t get immediate desired response

Things to be aware of:

  • Emotions, actions, urges, desires, hurts, want
  • Physical sensations, sensitivities, breath, body awareness, gut feelings, instincts, intuitions
  • Your behavior; how you behave/ change behavior, react in certain situations, which people, in different contexts
  • Your history of behavior; how behavior started, what it means/ meant, how it served a purpose/ had a function or role for you
  • How your behavior impacts others
  • How others’ behavior impacts you

FOCUSED ATTENTION

 Why is obtaining skill to focus one’s attention important?

  • Thoughts, emotions, pain, sensation, restlessness, boredom, etc. can sometimes interfere with a person’s ability to live their life in a valued direction.
  • Thoughts and emotions can create problems, be distracting, and get us derailed
  • Obsessive thoughts, unwanted thoughts, self-defeating thoughts, self-hating thoughts, anxiety thoughts, and non-useful thoughts can threaten to take over attention, control action, and inhibit needed action
  • Staying focused can help a person be less prone to intense, unwanted, or problematic thoughts or beliefs
  • Action urges, emotional reactivity, and other behaviors often happen “automatically”, thus practicing focused attention increases your options for limiting your reactivity (For instance, if you are a person that “flies off the handle” staying focused can help you stay grounded)

Does focusing attention get rid of pain?

No, focusing attention helps a person not get consumed by other things that threaten one’s focus (ie, obsessing, ruminating). Pain is considered a normal part of the human existence; focusing mindfulness activities are not done with the purpose to destroy, get rid of, or inhibit pain.

Focusing on sound exercise. For the next 3 minutes (set a timer if you’d like), try to focus all of your attention on sounds you can hear. Pay all of your attention to the sound, and see if it is possible to do this for 3 minutes. You will likely have multiple other thoughts, sensations, experiences, or distractions that don’t keep you 100% attentive to “just sound.” Likely if you had a painful thought, the thought took you out of the exercise. So, instead of heeding that thought your attention (buying into the thought, thinking the thought, rehashing, problem solving, etc.) you simply be aware of that thought (“oh that thought is showing up again”) and gently return to focusing on sound.

Remember:

  • No one is denying you are in pain
  • You are not denying you are in pain
  • You are not refusing to think about that situation, you are simply redirecting your attention for the time you try mindfulness
  • You are increasing your control of what you pay attention to and when
  • You may need to come back to your pain at some point and solve some problems, but for the three minutes this is not your task
  • Urges, cravings, desires, urges to take action/ do something, urges to eat something, etc. may all come and go
  • You are learning over time to increase control of all of this

Often, if your life is disrupted by intense, extreme, demanding emotions your actions often follow. You may feel as if you are controlled by your emotions and your actions. Focusing attention helps people to be more “aware” of urges, emotions, disruptions, or urgency around fixing or doing something NOW. Learning to control what you pay attention to will help you control yourself; your emotions may DEMAND your attention. Focusing attention exercises can help calm you down, settle you in, and even relax you a bit.

What You Should Know If You Have Been Diagnosed With Borderline Personality Disorder

Here is the truth: BPD, or Borderline Personality Disorder, has a historically bad rap with mental health professionals. I’m going to give you some truths to what you should know to not only think about this clearly, but to consider your options in terms of the person you want to be and the person you want to become.

BPD was historically known for “bordering” on the lines of neurotic vs. psychotic. In the olden days, clinicians who didn’t know if a person was living in the confines of “reality” could put them in a category that didn’t really fit either one. Historically neurosis has to do with issues related to anxiety, mood, and depression. Neurosis can also be related to trauma, vigilance, and paranoia about bad things re-occurring. Psychosis is related to problems hearing and seeing things that others do not see or hear, and is often associated with schizophrenia. “Borderline” has often been referred to as a category that doesn’t really fit any category, and in some cases has been the in- between of no-place.

BPD is also historically written about from an extremely pejorative and hopeless point of view. Words like “manipulative, gamey, cagey” are often used, and mental health professionals often refer to this diagnosis when talking about people that bug them, that they do not like, that get them enraged, and people that can tie up crisis hotlines and emergency rooms. In many cases, labeling someone with BPD has become a substitute for observing and describing behavior, providing useful feedback, and encouraging people to behave in ways that make them competent and more effective.

Here are some truths that you should keep in mind if a mental health professional has “informed” you that you have BPD:

Mental health diagnoses are not valid nor reliable. This means that (in terms of validity), if the same professional assessed a person over time (such as an assessment 20 years ago, 10 years ago, and 5 years ago), the likelihood that that professional would give the same person the same diagnosis is unlikely. It also means that if many different mental health professionals assessed the same person it is highly unlikely the all of them would come to the same conclusion about diagnosis. This is assuming that the only measure of giving a diagnoses is a working familiarity with the DSM-TRV, or the “psychiatric Bible” of diagnostic criteria (which is highly controversial. Be aware that homosexuality was once considered a psychiatric disorder, and now it is not). Mental health diagnosis may be more reliable and valid if the diagnosis is given based on a range of valid and reliable assessment batteries; thus if you have had some comprehensive personality assessment and testing this may be less of the case for your situation. Bear in mind that most people in the counseling profession are doing nothing more than giving you their clinical opinion; hence my point about reliability and validity. Also, there are some counseling programs that don’t cover concepts such as instruments of mental health measurement.

For some mental health professionals, telling someone they have BPD can sometimes be a communication of frustration. In a helpful world, telling someone what diagnoses they have can be useful and even helpful- it can validate if a person really is depressed or help figure out specific treatments. In the case with BPD, the “right treatment” is more complicated and may not be readily available. If your mental health professional is telling you have BPD, you might want to consider: So what? How it is it helpful or useful? Does it help people have the resources or tools for solving painful problems? Is it specific enough to describe what behavior shows up- and how behavior can be changed? Does it provide access to literature that is actually helpful? For some people, being diagnosed with BPD can only serve to increase shame and self-loathing. Literature is not always helpful and mental health professionals don’t always shore up resources for how to move forward to obtain resources and supports. Is the expectation to hide in a corner the rest of your life and not tell people who you “really” are? And do you seriously want to live this way?

There is a lot of confusion for most people around diagnosis being a cause. Diagnoses are actually descriptions of behavior, and mainly identify patterns of responding or behaviors that are typical for a person. Many people, including some mental health professionals, actually believe that they are describing reasons or causes of behaviors when giving someone a diagnoses. For instance, if the way that you behave is because you have a disorder, then someone people think they have adequately not only explained the reasons you behave the way you do, but they think they know why you behave the way you do. In terms of diagnosis, this really is not the case. The failure of the mental health system is that people think they are being helpful (“You have problems because you have a disorder”) rather than addressing causes and potential solutions for behavior change. In this case, many problems of pain are not being solved as the focus of attention is on the “correct” diagnosis, which, in my opinion, is a rather useless pursuit. It can be akin to a parent who has several children; one of them is determined to be “bad.” Instead of figuring out how to prevent problem behavior, solve problems, and tend to the child’s needs; the parent simply attributes all problem behavior to the child being “bad.”

What you can do if you have, or think you have, or someone else thinks you have BPD:

Don’t think you are permanently impaired, hopeless, or beyond help. Fear and shame keeps may people paralyzed from acting with self-respect, doing things that are meaningful, and putting oneself out there in the universe. Universally, fear and shame can prevent anyone from living a decent life. You are not an exception.

Learn to talk about yourself and your behaviors in a descriptive, non-judgmental, and matter-of-fact ways. This will make you competent, understandable, and respectable. This also means that if you go around and tell everyone you are disordered, people may treat you as fragile, incompetent, incapable, or helpless. Create and practice ways to talk about yourself outside of the realm of “mental illness.”

Pay attention to providers, mental health professionals, or family members who attribute your behavior to being “mentally ill” or “bad” or “personality disordered.” Realize that everyone has vulnerabilities and that many, many people struggle with giving accurate, helpful, and specific feedback. Consider how giving and receiving feedback is either helpful or not helpful, and don’t seek out relationships where blame seems to be an acceptable solution for reducing pain or resolving differences. Finding “fault” only works if the consequence is taking responsibility and making changes; not amplifying shame and paralysis of action.

Be aware that if you do delve into literature on BPD, you may encounter a wide range of confusing terminology that attempts to define you; which may not only be disconcerting but also downright confusing. You might encounter terms like object relations, transference, countertransference, self-objects, self-soothing self-objects, object mirroring, intrapsychic processes, or projections. Don’t get bogged down by mental health-ese. Bear in mind that some mental health professionals have a lot of trouble observing and describing behavior and giving useful feedback and sometimes hide behind their own jargon.

Find other things that provide you a sense of identity, that define you, that make you the person you are, and that you value. Consider roles you take on in society; engage in them and be proud of them. What is important to you? Why would you let a diagnoses get in your way with pursuing what is important to you? In what ways do you not “show up” because you have shame around a diagnosis? Life is bigger than the world of “mental health.”

Bear in mind that many mental health professionals are obsessed with political leaders that they believe to be personality disordered. In truth, political leaders are still political leaders, and political leaders have made great gains, influenced many, changed laws, and maintained power. Being diagnosed with something “bad” hasn’t deterred people from being politically active, advocating, having power, or being influential. There is no good reason why you have to be shamed from participating in the universe just like everyone else- people with a lot of problems still manage to be successful and competent in a myriad of different ways.

Finally, feel free to visit the National Education Alliance for Borderline Personality Disorder, a nonprofit that may be more helpful than the general google search. Their website (www.borderlinepersonaltydisorder.com) has some useful non-pejorative literature, trainings, and free services for friends and family members.