Real Tips for Really Decreasing Your Anxiety

Anxiety sucks. Clinical grade anxiety is basically sweaty monkey balls.

Over the course of my time in therapy and various kinds of treatment, one of the things that I have wanted more than anything is to not feel anxious all the time. Unfortunately it isn’t as easy as walking in to therapy and having a therapist tell you what will make your anxiety easier. Typically you have to do some work on the roots issues before you can even get to the real, concrete strategies that you can use to make anxiety less intense or less disruptive.

I want to share some of the strategies that I have learned with you. If you’ve been diagnosed with anxiety, you may already know some of them, but there’s also a possibility that depending on the type of therapist you have, or whether or not you’re seeing a therapist, you may not have heard them before. Some of them might work for you, some might not. That’s ok.

It’s also important to remember that all of these strategies are for dealing with anxiety as it’s happening and for trying to decrease the immediate intensity of the anxiety. If you’re finding that you have intrusive anxiety on a regular basis, you may need to talk to someone or get on medication or do something else to help stabilize your basic emotional state so that these strategies are more effective and so that you don’t need them as often, but these strategies can help as part of a larger treatment plan aimed at decreasing instances of anxiety.

This one will be a little long, but hopefully that’s because there’s a lot of good information in it.

Mindfulness Techniques

The first series of techniques I’m going to talk about all circulate around mindfulness. Don’t get scared off by the name: it’s not spiritual or woo woo, it’s not doing nothing, but it is also not easy. Mindfulness is essentially paying close attention to what is actually happening in this moment. It will take time and practice to get good at, and I strongly recommend practicing it when you’re not anxious so that when you are anxious you can do it without getting frustrated or feeling like it’s pointless.

There are essentially two ways you can do this: you can pay attention to something internal or you can pay attention to something external.

Internal techniques:

1. Breathing

This is a nice one because you can do it anywhere. You always have your breath, and you can always take a minute to stop and pay attention to it. There are a few different things you can do to help yourself focus. One of the easiest is counting. Some people suggest breathing in to a count of four, then out to a count of four. DBT recommends counting your breath, and always breathing out one count longer than you breathe in. You can choose the number that feels good to you. Whatever you choose, pay close attention to the numbers and what it feels like to breathe. If you notice other thoughts, that’s fine. Just let them happen and then refocus on your breath.

Another way to use your breath is to pay very close attention to the actual physical sensations of breathing. What does the air feel like coming in through your nostrils? What part of your body expands as you breath in? Especially focus on trying to breathe from your diaphragm. You should notice your stomach moving rather than your shoulders or chest.

2. Visualization or other sensory imaginings

You can tailor this one to your own preferences: if you’re a visual person, then use imagery. If you rely more strongly on a different sense, you might imagine a song or smell. But the idea is to think of a place or sensation that is very calming to you, and to imagine it as vividly as possible. Put yourself in a place or setting that feels safe. Describe it in great detail in your mind. For me, I imagine a huge library. It smells like old books, and has thick, imposing marble architecture with nooks and crannies everywhere. There’s a huge, overstuffed armchair that looks out a large window onto an empty field. I can read whatever I like for as long as I like, with no impositions or tasks to do. It’s quiet, the special quiet that comes from marble soaking up sound, with the occasional tip tap of a librarian’s shoes across the floor. Take yourself to your safe place, wherever it is and stay there until your body has relaxed.

3. Body scan

I like to use this one at bedtime. It’s fairly simple, but takes some time and patience. Start at the top of your head and spend time focusing on each part of your body in turn. Notice what your scalp feels like, if there’s anything touching it, if it itches, if you’re tense there. Again, your mind might wander, and that’s ok, but simply notice then refocus on what you’re doing. Move down your body and do this with every body part. You can go as small or as big as you want, but the smaller you go the more likely you are to notice where you’re tense and find ways to relax.

4. Progressive relaxation

This is something like a variation on the body scan, with a little more umph to help you relax your muscles and body. This time, as you move down your body, at each muscle you reach, tense as hard as possible for a count of three, then release. That’s it! This is a slightly easier one to start with since it gives you something to do instead of just something to pay attention to.

External techniques

1. Descriptions

I find this one works very well if someone else is with me and they are trying to help. Anxiety is anticipation of a fearful event or situation, so one of the ways to combat it is to remind yourself that you’re safe. This technique works by asking you to describe in as great of detail as possible, the room or space around you. I like it because if another person is with you, they can prompt, or you can talk to them and it doesn’t feel as weird. It doesn’t seem as if it would do much, but if you pay close attention to what you’re describing, it can take your focus off whatever is making you anxious.

2. I Spy

This is a variation on the description game that gets your brain a little more involved so that it’s harder for the mind to drift. Pick a color and find every instance of it you can. If you’re in a small room, find somewhere with more things in it and take a few minutes to play. I was surprised at how into it I got and how quickly the anxiety receded because I wanted to get every green thing.

 

Physical Techniques

Many times when you feel anxious it seems as if it’s your brain that’s making it happen. Your thoughts are spinning or you’re saying nasty things to yourself. In reality, anxiety is an incredibly physical experience, and even if your thoughts are what’s causing the anxiety, your body will react. Helpfully, this means that altering your body can also alter the anxiety in your mind. Here are a few ways to bypass the mental and go straight to calming down your body.

1. Deep pressure

Deep pressure is something that tends to work for people on the autism spectrum, but if you find it comforting, then GO for it. Deep pressure is basically what it sounds like: providing a lot of pressure on your body to help it calm down. This could be a weighted blanket, a strong hug, a weighted vest, or even just burritoing up in your blankets nice and tight and snuggly. Try experimenting and see what works for you!

2. Exercise

No, exercise will not cure your anxiety. Don’t worry, I will not tell you that. What exercise CAN do is a. work as a a helpful preventative measure, and b. help you to regulate yourself when you are feeling anxious. If it’s safe and healthy for you to do so, one method is to exercise as vigorously as possible for 5-10 minutes (full on sprint, or something equivalent), and then calm down to a walk or cooldown. Normal exercise can also help let out some anxiety, but at least according to my therapist, the intense exercise followed by a more relaxed pace does some tricky shit to your body that gets it to calm down quickly (I do not understand this science, nor am I a scientist, so take this with a grain of salt and see what works for you). Sometimes all it takes is a walk to shake up the anxiety.

3. Ice water

Be careful with this one if you have any heart conditions or similar issues. However if you don’t, and you have some time and space, this is one that can REALLY affect you and have immediate results. Fill a bowl with ice water. Now stick your face in it. Yup, that’s the whole thing. The important part is to get the ice water on the place just below your eyes. Again, some physiological magic happens that helps your body calm down. If that’s too involved you can hold ice against your face, or an ice pack, but focus on that area where you get bags under your eyes. I’ve never personally been a fan of this one, but it might work for you!

4. Intense sensations

One good way to distract from anxiety is to do something that you HAVE to pay attention to. Physical sensations are a great example. Hold ice cubes, punch a pillow, take a hot shower or bath, or listen to music that really speaks to you. Pay close attention to what you’re doing instead of on the anxiety.

5. Notice your body

Anxiety often comes with physical manifestations: tensed muscles, an uneasy stomach, or a clenched jaw. Take stock of what your body is doing, and if possible, adjust it. You can unclench any muscles or body parts that are tense. You might use breathing to calm your stomach. You might stretch if some of your body parts are feeling tight.

 

6. Notice your physical needs.

It’s really really easy to forget about your basic needs if you’re very anxious, but sometimes the most basic levels of self care are the most effective. Take stock of your physical needs. Are you hungry? Thirsty? Do you have a headache or other pain? Do you need sleep? Have you moved your body at all today? If any of these needs are not fulfilled, or if you’re dealing with pain, try to manage that first. You’ll often find that your anxiety decreases once you take care of your body.

CBT Techniques

These techniques are more about challenging the thoughts that are leading to anxiety. I don’t tend to find them as useful, but for some people they are the most helpful of all, as they head on address the anxiety. Test them out and see what works for you.

1.Check the facts

Of all the exercises for thinking your way out of jerkbrain territory, check the facts is my favorite. Essentially you sit down and see if your emotions are based in facts or not. Sometimes you might want to check in with other people to see if you’re perceiving a situation correctly. So for example if you feel incredibly anxious about a test, you might ask whether you’re prepared for the test, whether you have a history of doing poorly on tests, or whether the test is likely to have a huge impact on your future. If you have clinical grade anxiety, in many cases your anxiety will not be commensurate with the things that are actually happening.

2. Gratefulness

I personally despise these types of exercises because the good things in my life don’t seem relevant to whatever is making me upset, but for some people they work really well. Essentially you want to make a list of the things you’re grateful for in your life, as a way to combat anxiety about the bad things that are happening. If you’re feeling particularly down on yourself, you might also make a list of qualities about yourself that you like.

3. Work!

As mentioned before, distraction is often a good way to decrease anxiety in the moment. If you know of something that requires your full attention, that can be a great distraction. Maybe it’s working, reading a book, doing a tricky puzzle, or some other form of work that is high concentration. Some people find that the anxiety distracts them too much, but if you can get focused, it’s a great way to distance yourself from the anxiety until you feel more calm.

4. Challenge your thoughts

It’s easy to think that anxiety comes directly from a situation. In reality, anxiety typically comes from thoughts about a situation. For example you might think that you are anxious because you are supposed to go to a party. But in all likelihood you’re having thoughts about the party, for example “I will be awkward,” “No one will like me,” “I won’t know how to behave.” Those thoughts are what leads to the anxiety. If you can identify which thoughts and beliefs are leading to the anxiety, you can ask yourself whether those thoughts are realistic or true. This can be another place to ask for help from someone who might have a less biased opinion about whether no one will like you. If you can start to believe thoughts like “I can find one or two people to talk to at this party” instead, your anxiety will decrease.

5. Probability estimates

If you like facts, this is a great technique for you. Many times we feel anxious about things that are not very likely to actually happen. It can be good to spend some time estimating how likely it is that the event will actually happen. If you’re very anxious about getting on a plane, you might read up on the statistics of how often crashes actually happen (it’s really, really rare). Focusing on those statistics can help remind you that you are most likely going to be completely ok.

Now that this post is over 2000 words long, I think it’s probably time to stop. If you have more ideas or suggestions, feel free to add in the comments. Remember that none of these ideas are a treatment plan that will help you address clinical and chronic anxiety. They’re just things that can help. Good luck!

 

Emotions, Validity, Actions

Providing emotional support to someone else is hard. Most people aren’t quite sure how to do it, and like most other hard things in life it is a concrete skill that requires practice. Most of us learn some of this through emulation. We see other people giving hugs, suggesting solutions, or telling us that things will be ok, and we learn that this is how to provide support when life is hard.

There’s one particular piece of useful knowledge that I learned in DBT that evidence seems to indicate is pretty universally helpful when someone needs support, but that very few people naturally pick up on. Validation. I’m about to say something that for some people sounds utterly ridiculous. It did to me at first. All emotions are valid.

This is a statement that is easy to misinterpret, so let me be specific. What I mean when I say all emotions are valid is not that all emotions make sense, all emotions deserve the exact same kind of consideration, or that we should act on all of our emotions. It simply means that there’s no wrong way to feel. It is telling someone “yes, I see your emotions. They are real and they are acceptable.” You can’t control your emotions, you can’t will your emotions away, which means that you feel what you feel. That’s valid. Being told that your emotions are ok and accepting that your emotions are allowed to happen regardless of what you then choose to do is a really big part of a healthy emotional life.

Validating someone’s emotions lets them know that it’s ok to feel. It lets them know that someone else gets it and can empathize. And it doesn’t diminish the scale of whatever they’re feeling by trying to talk about solutions or the bigger picture. There’s research that invalidation is a quick way to trigger emotional and mental problems in someone. I see it as a very subtle form of gaslighting, saying “no you don’t feel that way” or simply denying that you should feel that way, putting pressure on an individual to control their very thoughts rather than their behaviors.

So practically speaking what does validation look like in comparison with something like problem solving or comforting?

Validation at its core involves recognizing the emotion that someone else is having and then letting them know that it’s ok. Sometimes that can be explicit. “You seem really sad right now.” Sometimes it might be simply by expressing a similar sentiment, like agreeing when someone says they dislike someone, or hearing about their situation and opining “Yeah, that really sucks.” These are extremely little things, but fitting them in before you begin saying things like “what can I do?” or “it will be ok” tells the other person that you’re actually listening.

Sometimes it helps when you need emotional support to let another person know that you don’t want anything but validation. “I just need you to listen to me vent for a while.” Not every form of support needs to come in the form of concrete action. Sometimes it’s simply being with someone while they feel something, a form of reminding them that their emotions won’t drive other people away or make people think they’re crazy or bad.

But wait! Isn’t this just giving people permission to behave irrationally and hold other people hostage to their emotions? Sometimes people do get upset over nothing. Yes young padawans, it is true that not all emotions make sense, nor do they always fit the facts present. Most emotions exist for a few particular purposes, which means that if someone is all balanced and so on, those emotions will show up in pretty predictable circumstances. In a perfect world, people would feel angry when someone violated a boundary, sad when they lost something, and guilty when they did something that violated their own moral code. But that doesn’t always happen. So how can we actually validate emotions that are out of place, like being angry because your friend got sick and had to miss your birthday party?

Here’s the secret: emotions are not the same as behaviors. Even telling someone about an emotion is not the same as acting on that emotion or asking someone else to act on that emotion. It takes a lot of time to learn how to do this without adding in some subtle pressure that the emotion needs to get fixed, but it is absolutely possible to let someone know “Hey, I’m feeling upset in x way. I realize that your action y is related to it, but that it doesn’t really make sense for me to feel this way. I’m going to feel it for a little bit, and at some point when I’m less feely can we talk?”

After you’ve validated someone’s emotions they may then decide that their emotions make sense and they want to act on them, they may decide that their emotions make sense but there’s no good way to act on them, or they may decide that it’s more helpful to try to get past the emotion by distracting themselves, doing something soothing and enjoyable, or through some other emotion regulation technique. But none of that is because the emotion is wrong. It’s because an associated action might be bad or ineffective, and the emotion is causing pain or distress.

In no way is validating someone else going to cure all their problems. But it’s an incredibly small way to take real steps towards better community mental health. And even if it’s as simple as validating yourself and the people you surround yourself with, it helps smooth relationships and strong emotions. Validation: try it!

 

Talking Over

Yesterday I posted about a personal experience that I had. I identified certain things about my identity and mental health, and mentioned some things that were helpful for me in terms of both of those things. The majority of the post was about things that pertained to me and me alone, with the suggestion that perhaps others could try as well because I had found it helpful, so maybe it would be helpful for others as well.

Now overwhelmingly, the response has been positive, but I did get one comment that summed up for me all that is wrong about talking over another person and their experiences.

“Well first off she should stop telling people she is asexual. As she isn’t. She made several references to sexual or romantic relationships she has had in the past. And never once did she say oh I hated the sex part….

Second she right love is awful painful for a borderline and most do get clingy. But this whole if I don’t have sex with you I can love you so hard thing is kinda of not really true. She just removed added simulation to her emotions. Yea borderline emotions are intense and painful.they lead to thinking crazy. But the key part she left out is.you don’t have to act on those feelings. Or thoughts. That once you start learning how to wait them out you learn how to think through them and separate the borderline b.s from what’s actually happening…

All she did was remove an emotional trigger.. and her fb experiment will bite her in the butt when all those friends don’t start giving that love back when she crashes again. But that’s just what I think.”

Normally I don’t take the time to respond to comments like this because they’re awful and just deeply unhelpful, but the problems with this comment are problems that I see over and over and so I wanted to take the time to break down why this isn’t actually constructively engaging with the ideas that I presented. This is a classic example of talking over someone.

So first and foremost, when someone identifies themselves (whether as asexual or bisexual or pansexual or whatever) you don’t get to tell them they don’t identify that way. Identity is complex and personal, and no human being is the Grand High Judge of Sexual Identity. This is one of the most common ways that sexual minorities get fucked with: by others defining what they are and why. It hurts absolutely no one for an individual to identify in the way that they find most compatible with their life experiences, but having your identity undermined or denied is quite painful (and especially for asexual individuals leads to things like corrective rape). As a corollary to this, if you are going to play Sexual Identity Police, at least understand the definitions of the identities you’re policing. Asserting that someone can’t be asexual if they don’t explicitly state they hated all the sex they’ve ever had fundamentally misses what asexuality is, and worse it demands that anyone who is asexual give personal information about their sex lives in order to legitimize their identity to randos on the internet.

Basically, the next time someone tells you how they identify and you feel the need to challenge it, remember that what you’re essentially doing is ignoring someone whose identity puts them in a vulnerable position because you Know More and don’t care about whatever thought they have put into identifying that way.

Now the rest of the comment seems like it’s less harmful because the commenter specifies that it’s just her opinion. The problem comes when she imperiously declares what will happen in my future and what I’m doing with my emotions. This is a nice bit of mind-reading and psychic abilities. I’m impressed.

When someone with a mental illness brings up something that they tried that seemed to help them out, telling them that they’re wrong and that they’ve actually just hurt themselves is incredibly invalidating. While you may have had a different experience from theirs, that doesn’t mean that you get to ignore the words that they have actually said or the experiences that they’ve actually had. If your depression didn’t get better through exercise but someone else says “I tried exercise and I’m really happy with how well it’s working. If you’re interested you could try it too”, the appropriate response is not “You don’t actually feel better! It’s all a lie! Exercise doesn’t work!”

The secret (not so secret) about experiences is that they’re personal. Different things work differently for different people. It’s easy within the mental illness community to get defensive or catty when someone else copes differently from the way you do. It sucks to see someone else doing well if you yourself can’t find good coping mechanisms. But despite how easy it is, it’s a horrible plan. If someone isn’t asking for advice, don’t give advice. If someone did something differently than you would have, you can just move the fuck along. The more we perpetuate the idea that there’s a “right” way to recover, the worse off everyone will be. It’s simply not true that her way of dealing with BPD is the same as my way of dealing with BPD, but that doesn’t have to come with a judgment.

I don’t really care if this person fundamentally misunderstands why I did what I did or how my asexuality is interacting with my BPD or doesn’t get that the point of my experiment wasn’t to just take sex out of love but rather to see what it was like to be open with love and love more people more fully. What I do care about is the implications of her comment that I’m doing something Wrong because I didn’t do what she’d do. I care about the implication that she gets to decide what identities and treatments are better for random people she’s never met. I care that this is considered appropriate dialogue on the internet.

It’s not dialogue. It’s talking over.

 

Staying Functional

It’s been a rough week. Many of my friends, fellow bloggers, and role models are starting to show a bit of wear and tear. The whole internet has been buzzing with news about the shooting, with debates, with misogyny, with threats, with victim blaming. I’m tired. My patience is worn out. I’m getting triggered left and right by the smallest, stupidest things, and my coping skills are slowly running out.

Unfortunately, the rest of the world doesn’t stop when my spoons run out. I still have to work. My dad’s birthday will still happen this weekend and I’ll have to be social and entertain. I still have to write. I still have to clean my kitchen and cook (somehow) and deal with the sudden heat and plan for my move to Ireland next year. I just have to do it all while also feeling like I’m about to snap or break down and start bawling or just run out, stop moving, fall over and not get up.

I’m sure this is the same quandary that all those with mental illness, or those who engage with difficult topics, or those with chronic illness face: how do I remain functional and keep anything from getting worse when my reserves are almost out? I drag myself into the office, but how do I accomplish anything when my brain power is spent just trying to refocus my mind on something other than sexism and shootings and self hatred?

I’ve been trying to use a few tactics, but I would certainly appreciate any suggestions that you all have. Mostly, I’ve been trying to reorganize my priorities so that I can accomplish some things with minimal brain power. This means that my to do list has shifted away from more writing and into some easier tasks at work (as well as I can). At home, instead of trying to tackle some of the bigger project I’ve limited myself to basic, mindless things that will help me feel accomplished: putting away my clean laundry right away, making a big pot of rice and beans so I don’t have to cook for the rest of the week, paying close attention to my schedule so that I don’t miss anything. It’s hard sometimes to feel like I can do these things, but if I get one or two done each day I can head off a lot of the feelings of uselessness and keep myself from hitting a bigger breakdown later.

This also means that at work I am shying away from things that I might really screw up if I’m not all the way present. I’m doing behind the scenes work and trying to save my energy for the times I’m in meetings or have to be front facing for the company. This is the biggest challenge. Part of me is trying to accept that there are certain tasks I simply can’t do right now, but that isn’t something I like to accept and of course it makes me feel like I cannot do my job. In reality, what it means is that right now I need to focus on something slightly different, make my job something a bit different.

And when I don’t have anything that needs to get done, that means complete and utter self indulgence. It means I get to go home and take a nap, or buy myself ice cream every day if I feel like it, or go running twice, or avoid everyone if I want to, or whatever the hell at that moment sounds like it might break through the hazy fear that’s hampering me right now. I hate feeling that desperate. I hate grabbing on to any impulse that seems like it could be remotely positive, but I know that if I simply won’t get through. I hate listening to my needs. I am demanding it of myself though.

Perhaps the hardest part is being responsible for myself and my emotions. I want to fall apart over everyone, bitch people out, yell and scream and swear and cry. I want to tell everyone to piss the fuck off. I want the people who are nonchalantly commenting on blog posts about misogyny to hurt as badly as I do when I see people talk about how mental illness makes you violent. I want to puke.

But it is no one else’s fault that I feel this way. Even the people who are pushing my buttons in all the wrong ways. I still need to be responsible, and when I do lose it, I have to know to apologize and take responsibility for the ways that I can’t cope. I need to be able to set healthy boundaries: I can’t just avoid people, but I need to actively tell them I need space. It is so hard to find the emotional resources to recognize when you’re being out of line when everything feels raw. But as someone who wants to be a positive ambassador for mental illness, I need to be able to function appropriately in my relationships and with my acquaintances even when my mind is not acting appropriately.

And just for fun, I’ve been trying to take mini breaks at work during which I look at goofy GIFs on Tumblr or watch lindy hop on youtube. Little things are all that get me through. Little things are what distract me and keep my mind from spiraling. Little things are what drag me away from that nasty comment.

I will remain functional.

Seeing Progress

Last night I had my final session with my individual therapist for DBT. After almost two years of 5+ hours of therapy a week, I’m starting to get really burnt out, and so after my full year commitment of DBT was up, I decided it was time to be done. I have one more group meeting, then I’ll be leaving. I don’t entirely feel ready to be done with DBT, but I am fairly certain that it’s the right decision at this moment. I need some breathing room and I really need more time to be able to do things that I enjoy. Right now my schedule is a fairly large stress in my life, and I feel like I’m often choosing between committing to therapy and committing to work, something I absolutely hate. So overall, I think that it’s a good choice, although I do wish I could keep learning more about DBT.

Part of moving on when I don’t feel entirely ready is that I feel I haven’t made any progress. It’s easy to do. Since change in mental health often comes slowly, we rarely notice the differences. Often it’s a lack of anxiety or depression that is a big change, and those are also harder to notice than something actually showing up (as an example, I made a phone call yesterday without anxiety, which is a huge change for me, but I didn’t notice it until I brought it up in therapy). Mental health is rarely a straight line upwards, and so there are peaks and valleys. Again, this can make it hard to see an overall upwards trend.

So as I’ve started moving out of DBT, I’ve been feeling a little down on myself. Anxiety’s been high lately, I feel I haven’t excelled at the treatment, and my perfectionism is high. But last night as I was talking to my therapist for the last time, she mentioned repeatedly how far I had come. She pointed out specific skills that I had become much better at. She pointed out my grasp of all the skills and my ability to figure out which skill is the right one to use in a given situation. I was surprised when she first said I had grown, and at first I thought she was simply saying it because that’s what a therapist is supposed to say to a client who is moving on. But the more I thought about the more I realized that I have been more level-headed in the last year, that I’ve made it through some really tough situations with little to no meltdown or target behavior, that I’ve figured out how to think critically about my feelings without invalidating myself.

By no means do I feel recovered or entirely healthy. I absolutely have struggled with a few bad bouts of depression and anxiety in the last month that have interfered with work and relationships. However with the help of someone else pointing it out, I can say that I have grown an amazing amount over the last year and made some serious progress towards healthiness.

I know many people who feel like they can’t find clear landmarks of their progress. Some can, and those things are wonderful, but many people wonder how they’ll ever get better and don’t see how far they’ve come. I think an important element of taking care of your mental health is checking in. Others are far more likely to see how far you’ve come than you are. Of course no one can define how you’re feeling but you, but if you haven’t thought about progress or how you’re doing in the larger scheme of your life for a while, it can be really helpful to have an outside perspective who can reassure you that they’ve seen changes and that they’re proud of you.

When in treatment, you often periodically check up on treatment goals or talk about whether you need to introduce new treatment. It’s great that this kind of check in is often built in to therapy. But I wish that it was just part of our relationships too. I wish that like getting your annual check up, each of us would periodically go through the inventory of our mental health with someone we love and trust to see how we’re doing and if there’s anything we should be worried about. Not only would this make it easier to talk about mental health in general, but it can be incredibly grounding when you’re trying to sort out your mental health by yourself.

I can’t say that I feel I’ve hit any big landmarks in my treatment. I still restrict. It hasn’t been a particular amount of time since I last purged or over exercised or self-harmed. I haven’t weaned off my meds (if I ever will. Still not even sure I’ve found the right ones). But despite all of that muddiness, it can be incredibly validating to see that someone else can point out what it is I’m doing better. What tricks do you use to measure progress and keep yourself motivated?

Why I Need Mindfulness

Recently my mood has been fairly low. I’m still trying to figure out why and how to make it better, but for the moment things are pretty stagnant and I’m really not sure what steps I can take to improve my mood. This is a place of intense frustration, and I know that many people can get to be in this situation: you may not be able to change your work or family situation, you may feel like your external situation is actually fairly positive overall, or you may have no idea what has triggered a depressive episode. There are often times when you can’t take positive actions to improve your depression.

Of course when that happens it tends to snowball on itself. If you don’t know how you’re going to improve your situation, there is an intense hopelessness that it will get better. You think about the future and you don’t know how or if it will ever change, and all you can imagine is the whole size of your whole future feeling the way you do now. That is an intensely icky feeling.

You start to feel bad, you think about feeling bad forever, and how you feel now gets worse. Then you think about feeling even worse forever and it gets even WORSE. Imagine this on loop for days and weeks at a time. This is what it’s like when you don’t know how to fix your depression.

Of course the whole crux of the problem is that you don’t know what to do to make yourself feel better. Here’s the secret though: I know what you have to do. A warning: this will not necessarily make right now feel better, but it will give you some relief from the circling, spiraling pain and might just give you enough time and space to breathe and figure out a good solution. So what is the solution? Mindfulness.

Are you all done giving me dirty looks now? Good. This seems trite. It seems woo woo. It seems ridiculous and not practical. When I was first introduced into mindfulness, I would fart in its general direction too. But that was before I heard this explanation of why mindfulness is useful. Mindfulness cannot make you feel better right now: that’s not its purpose. Mindfulness is about only letting your mind be in the present. While depression can often involve angst and anxiety about the past or the future, mindfulness is just existing and doing what you are doing.

So remember all of that angst about the future that crops up when you cycle in your depression? Those things are not hurting you right now. They’re not even happening right now. If you can stop thinking about them and only exist in this moment, you’ll stop feeling all the crappy feelings of the past and all the potential crappy feelings of the future. That is a lot of crappy feelings that you don’t have to worry about until they actually happen. And the whole point of mindfulness is that if you can train your mind to exist in the present, you don’t have to take on all the suffering that is not really affecting you right now.

If you’re like me, that all sounds lovely except that you have no idea how to do it. Half of your problem is that you’re really bad at being mentally present, you can’t focus, you’re too tired. Never fear. There are concrete steps that you can take to be mindful. They aren’t easy, but they do at least give you a clear path forward.

The most important thing to remember about mindfulness is that it’s about being aware: observing, describing, and being present. That’s what it means to be present-to focus on your surroundings, your emotions, your thoughts, and your senses. Here are some basic steps you can start with. Initially, try one simple, small thing and do it mindfully. Try washing the dishes or driving home from work. While you’re doing it, just notice things: how the water feels, the song playing in your head, the smell of the soap. Once you’ve started to notice it, you can add words: describe it. It might be good to just start with these two steps, and you don’t need to go overboard: 10 minutes might be the most you can handle. Once you’ve started to get the hang of those steps, try participating. If you notice your thoughts or your concentration wandering while you do an activity, just take note and then gently bring your focus back to what you’re doing.

This is probably the hardest part of mindfulness: the idea is not to get annoyed or frustrated with yourself, but just to notice what you’re doing and change it. If you can approach mindfulness with the intent of being gentle with yourself, of recognizing that you’re a little fragile right now, it generally will go better.

If you don’t want to do this while you’re trying to get something done, or if you just want to have some time to seriously practice mindfulness, some good practices are focusing on breathing and body scans. Instead of focusing on a task you can just pay attention to your breathing, or you can start at your toes and focus on each part of your body individually. This is a little more concrete and a good place to start when you’re beginning mindfulness.

Of course throughout your day you can also take time to pull your thoughts back to what you’re doing, to notice your surroundings, to pay attention to your breath, or to stimulate your senses in some way. I particularly find that being aware of my body and being aware of being in my body are good ways to be mindful. As much as 15 minutes of these little things each day can really help to reset that spinning wheel of anxiety and fear that starts going in the midst of depression.

Obviously this needs to be done in conjunction with some problem solving and reflection about what’s really making things bad for you. You might need a change in meds, an adjustment at work, changes in relationships, or a variety of other problem-solving things to improve the situation. But a good way to wait things out when you can’t figure out what to change or to get through your day to day tasks without ruminating is to work on mindfulness.

Tolerating Distress

One of the things that has been very difficult for me in DBT is the idea of “distress tolerance”. For the most part, American society does not promote the idea that there are times that things will suck and you’ll just have to let that be and you can’t do anything to fix it. We’re a society of fixers. There’s always a solution if you try hard enough right?

Unfortunately that’s not the case. There will be times when we simply have to wait out unpleasant feelings. In general those unpleasant feelings will dissipate or be relieved with time, or after some time we will be able to change something to improve our situation. Sometimes we also just have to accept things that are shitty: certain people will not change their behavior, your health may not improve, politics might always suck. These are things that you might just have to let be. And for these things, you have to learn that your feelings may stick around and there’s not a whole lot you can do about it. This is where distress tolerance comes in.

Distress tolerance is hard. It’s not about making yourself feel better, it’s rather about making it to the end of the bad feeling without doing anything to make your situation worse. This is one of the hardest things to remember while trying to tolerate nasty feelings, and it also makes it a lot harder to be successful because it’s hard to feel like it’s working. However it’s not a bad thing to feel like crap for a while. This is hard to understand for many people. It is normal, acceptable, and in fact healthy to feel like crap sometimes.

So what is distress tolerance? There are a number of elements to it and I’m not going to touch on all of them here, but I do want to talk about how many people give tips for distress tolerance and how we can really improve on those tips. I see lots of lists floating around about what to do if you’re tempted to self-harm, or how to resist purging. These lists are GREAT. They include things like holding a piece of ice, drawing on yourself with red marker, ripping something up, all great suggestions. Unfortunately not all of these things work for everyone, and it can be extremely frustrating when you look at the list and can’t find anything that speaks to you.

It seems to me that there might be a better way to approach distress tolerance that is more individualized. Of course sharing ideas and letting others know what’s helped you is great, but not everyone likes or responds to the same things. One of the things that we’ve been discussing in DBT are larger categories that can help you: things like using your senses, imagery, taking a mini-vacation, or relaxation. Each of these categories is then open to all of your personal ideas. Let’s look at a couple of examples:

Senses. I’ve heard a lot of people give examples of this without quite realizing it: finding something soft, holding ice, listening to music. However I’ve often found the examples unhelpful until I heard the larger idea that you should think about your senses and try to pinpoint what sensory experiences really ground you. What makes you feel like you’re really in your body? I’ve heard people suggest scented candles, but those make me sneeze a lot and I don’t much like them, so I basically just discounted nice smelling things. When I heard that scent was something I could think about, I immediately thought about my dad’s spaghetti sauce. It makes me think of home, of youth. It grounds me. I got some from my parents to put in my freezer and now I can pull it out on a bad day and heat it up, letting that smell permeate my whole apartment. This personalization is far more effective for me than the generic suggestions were.

You can do this same sort of thing with any of the skills: what kinds of images calm me down? What would be a “safe place” I could picture? What has calmed me down in the past? What kinds of things do I find relaxing? What places feel “away” for me in my daily life? What’s out of the ordinary that I could use as a small vacation?

It’s a good idea to take some time when you’re NOT distressed to think about these things so that you have a small stockpile. For an explanation of each distress tolerance skill you can go here. I don’t think we spend enough time personalizing our coping skills, but it is important to think about what works for YOU.

Strengths and Mental Illness

Lately, our culture seems to be all about optimizing our strengths. At work, we’ve been taking Strengths Finder and analyzing our strengths up the wazoo. We’re often told how we need to play to what we’re best at. While in the past, we were often told to focus most on what we were worst at to bring it up to speed, we’ve had somewhat of a shift to focusing on how your strengths can help you across the board.

While hearing all of these comments about strengths, and how to optimize myself, I found myself somewhat frustrated. It can be hard to imagine excelling at things when it’s a struggle to get out of bed in the morning. In addition, my strengths in Strengths Finders came up as competition, achievement, input, intellection, and learning. Essentially, all of these things at their root have caused me a great deal of heartache and stress. I can’t imagine I would have the mental illnesses I do without them, particularly without competition and achievement. It was hard for me to see how those could be strengths, how they could help me succeed and flourish in life. I was also frustrated at the idea that we should focus on our strengths and not worry about our weaknesses because we would never excel at them. As someone whose weaknesses are not just a nuisance, but are in fact seriously debilitating, this doesn’t seem far practical to me.

So what can someone with a mental illness learn from these strengths based ideas? Can we use them to our advantage? Can mental health treatment benefit from this movement towards strengths?

The first thing that stuck out to me when contemplating strengths is that I spend a lot of time in the mindset of my strengths. Perhaps too much time. When we were discussing them in my office, we mentioned that one could over rely on one’s strengths: focus too much on one way of doing things, and get lost in that. This can be damaging, and actually turn your strength into a weakness of sorts. As an example, let’s look at competition. This strength is about being able to compare yourself to others, to see where you fit in, to see how others are doing things, and to use that comparison as motivation. When you rely overly hard on it, everything becomes a competition, you start to be extremely hard on yourself if you’re not first at everything, and you can become vicious in your attempts to win at all costs. You don’t focus on the larger picture of how competition is helpful, and instead compete simply for competition’s sake. This happens to me quite often. In this case I’m relying way too hard on one strength to get me through, using it as my sole motivator, and I’m not allowing myself to be balanced.

I am used to looking at my competitive nature as a weakness, as something that needs to be fixed. I’m used to seeing it as the source of many of my problems. I’ve been told not to compare myself to others because it will make me miserable. But truth be told, I feel quite lost when I can’t compare myself to others. If I don’t have a benchmark, I’m not sure where I should be. If I don’t know that I’m getting better, I feel a bit lost about myself and my accomplishments. Having this shift to seeing it not as a weakness, but simply as a strength that I need to be more aware of has been incredibly helpful.

Another way to look at this is to circumvent some of your perceived weaknesses. I’m not so good at a lot of the including, social type skills. Social anxiety and me are best buds. This can make my life harder when it comes to things like making phone calls or doing the customer service portion of my job. I’ve spent a lot of time trying to figure out how to get past this social anxiety. However it might be more helpful for me to put my time and effort into projects that come more naturally to me, or to try to approach social engagements as a way to learn something so as to engage the things I do feel good at. I feel good at explaining things to others, so if I view myself as simply a help desk rather than someone trying to make a deep personal connection, I feel far more comfortable.

However despite how helpful focusing on your strengths can be, there are times when weaknesses require your attention (e.g. when you can’t get out of bed in the morning). This can make focusing on your strengths difficult. This might be a time to think about balance, and to think about how strengths and weaknesses are related to the myths that we carry. In DBT, we like to talk about myths. These are things that you are convinced are true, that were probably helpful coping mechanisms at one point, but are not any longer. They include things like “anger is not acceptable”, or “I can’t ask for help”.

Oftentimes, we internalize myths about what our strengths should be, or about how heavily we should rely on our strengths. To go back to competition, I often tell myself that I need to be the best at everything I do. This is a myth. And it means that I obsess over my competition strength. It may even mean that I force myself into it in situations that I don’t want to use it. Perhaps if I didn’t feel the weight of having to be the best at everything all day long hovering over me from the moment I wake up, I’d have a bit more spring in my step upon waking. Thinking about the values that you assign with your strengths can help illuminate some of those myths and help you understand how pulling back on a few of your strengths may help you with some of your weaknesses.

Perhaps mental health treatment focuses too much on what we can’t do and the ways that our brains hurt us, rather than imagining what we do right and asking us to rely on those things. Perhaps spending some time thinking about what we do well can help us find workarounds for the things we don’t like.

How I got Through My Bad Day: A Chain Analysis

I was planning on writing today about recognizing your achievements when your each a goal (especially for those who are competitive and highly driven), but it’s been a bad day. I woke up to a super triggery comment, read a few articles I should have avoided, and my mood plummeted from there. Add in a lack of sleep, and the soreness from working out for the first time in nearly a year, and you’ve got a recipe for a bad day.

 

So instead of talking about what I was going to talk about, I’d like to talk about chain analyses and applying skills to stop a bad day before it happens. Sometimes it can be hard to notice when you’re on the path to a meltdown. You might know that you’re having a bad day, but you don’t quite know why or you don’t know what you can change. I’m going to try to go through a chain analysis of my own day to give you all a conception of what it might be like to think about what’s making you anxious, unhappy, depressed, or stressed out, and then go through the steps that I could have taken (and may still take) at different points during the day so I don’t engage in any target behaviors (this is DBT speak for doing Bad Things like restricting, purging, drinking, self-harm, suicidal ideation etc.).

 

I’m going to start by talking about emotional vulnerability. I’m surprised this isn’t something that we talk about more often because it’s intensely important when you’re having a bad day or are on the verge of letting your mental illness take over. Emotional vulnerabilities are those factors that make you more prone to feeling extreme emotions. The most basic forms of emotional vulnerability are things like lack of sleep, lack of food, lack of exercise, use of drugs or alcohol, etc. These things make us sensitive and keep us from regulating our emotions well. Right now, I haven’t eaten since last night, I didn’t get enough sleep last night, and I have been working out more than I’m used to, leaving my body tired and sore. I’ve also been dealing with some headaches and bad tension through my shoulders and neck that are really fairly painful. These things are making me far more emotionally vulnerable.

 

However in addition to these very obvious forms of emotional vulnerability there are other things: are you stressed out and busy? What’s going on in the back of your head that’s stressing you out? Are you having relationship troubles? Are you unemployed? What other things are hanging over you that surround the events of the individual day or event that you’re trying to understand? For me, this includes a number of things. I recently changed jobs and I’m not good with transitions. I had some new information about my family that was Big and Important and Scary dropped on me this weekend. A number of my friends have been having relationship troubles recently and I’ve been worried and anxious for them. I also haven’t been keeping up on my blogging so I’ve been feeling overwhelmed and busy. Each of these things adds to that cloud of vulnerability that’s surrounding me today.

 

These are helpful concepts because if you start to notice vulnerabilities you can try to head them off. I’m going to go get something tasty and filling very soon, not let myself work out today, and try to get to bed early. Sometimes you can’t fix the vulnerabilities, or you get triggered or upset before you notice them. When you’re doing a chain analysis, the next step is to figure out what some of the precipitating events were. These can help you notice or avoid these kinds of events in the future, or if you’re in the moment, figure out why they bothered you and how to process/deal with the emotions you’re having right now.

 

So today the precipitating events were a few things. The most noticeable of them was getting a comment on a blog post about veganism that said “having an eating disorder is no justification for forcibly impregnating cows and keeping pigs locked up in tiny pens etc. etc.” The topic of veganism is an intense trigger for me. I was writing about this in the post, and this person chose to ignore that and tell me that I was wrong and bad for trying to take care of my own health needs. I felt disrespected, and I felt as if another person was confirming to me that I am not worth the food that I put in my mouth.

 

In addition to this, I saw another blog post defending “Blurred Lines” that made me throw up a little bit in my mouth. So I could see that the precipitating events to having my mood spiral out of control were that I felt people were challenging my values and my self-worth. So now I have a good understanding of what the problem is. I’ve had this difficulty a number of times before and so I’ve learned some techniques to help with it. One of them is that I try not to click on links that I know will upset me, and so usually I can head it off at the pass, but sometimes one gets by me or my morbid curiosity gets the better of me, and I can’t exactly not get the comments that are emailed directly to my inbox. Whatever your precipitating event is, it’s good to understand what it did to you and why so you can either avoid it in the future or figure out how to best tailor your response.

 

So my response was to reevaluate my values. Check the facts. Remind myself why I do the things that I do. Remind myself why I felt that Blurred Lines was offensive. And then I tried to radically accept that some people have different values from mine. I did some self-soothing, because I felt attacked and raw and afraid (especially when someone said the line in “Blurred Lines” that goes “you know you want it” is not rapey, cause damn is that triggering and not ok at all). This consisted of seeing my boyfriend for lunch and drinking a chocolate shake. I tried some distraction by playing Lumosity and by focusing on work. But I also did some self-care by allowing myself to tackle the simplest tasks at work first so that I wouldn’t get overwhelmed. Because I had figured out all of the ways I was riled up, I could address each of them. Now that I’ve calmed down some I’m willing to look again at these emotions, understand what provoked them, and understand how my use of skills actually worked quite well.

 

If you do engage in a target behavior, your chain analysis might include ideas of what you could have done differently. That’s why I find them incredibly helpful. They give me a framework with which to reflect on my experience without ruminating and becoming overwhelmed. You can even draw it out all nice and pretty like with bubbles and arrows and things. If you want to really break it down you can delineate your reaction into thoughts, emotions, actions, and bodily reactions (so did you clench your hands etc.). This chain analysis method helped me head off the nasties before they got too nasty, but I’d love to hear other suggestions in comments. Tea, hot bath, nap, delicious food, mindfulness, self-soothing…whatever helps you!

Silently Invalidating

The concept of validation and the dangers of an “invalidating environment” are things that pop up in mental health treatment over and over. From what I’ve picked up over about four years of therapy, being invalidated is really bad for your mental health. In fact, in DBT the theory is that a predisposition to mental illness requires an invalidating environment to development into a full-fledged problem. Invalidation in that framework is actually one of the precipitating causes for mental illness.

 

What is so negative about invalidation? Invalidation tells you that your emotions are wrong or fake, and thus undermines your identity and your confidence. It can lead you to distrust your emotions, feel ashamed or guilty, or even begin to think that you’re not in touch with reality. It asks you to ignore the very real messages your emotions send you, and tells you that your emotions are inappropriate. Unfortunately, emotions are always real and valid: the actions they cause may not be. The emotion may not fit the facts appropriately, but it is always real.

 

In my personal life, I have always found this a bit confusing. I haven’t seen my life as something that involves a great deal of invalidation. My parents never told me my feelings were wrong, my teachers have generally been intensely supportive of me, and I’ve had some fairly fantastic friends. There have been a few negative relationships in my life where I was told repeatedly that I had no right to feel the way I did, but overall other people have just let me feel how I feel. So how was it that I had ended up with mental illness without any invalidation at all? How did this apply to me?

 

I have recently come to realize that there are some incredibly insidious ways of invalidating another person that don’t look like invalidation right off the bat.

 

Imagine this: you are having the worst day of your life. Your depression is on high, your anxiety is through the roof, and you’re panicking every other minute. You feel overwhelmed, you feel sad, you feel lonely. You just want someone to give you a hug or listen for a minute, someone to tell you that you aren’t losing it completely. You’re sitting at school, and friends and acquaintances walk past. Some of them glance at you and smile, but keep walking. Some pay you no attention. No one notices that you look like you’re on the verge of tears, or if they do they say nothing. You begin to wonder if you really are crazy, if everything is just fine. Finally, someone stops and says hi, and you bravely smile back at them. You have a pleasant, brief conversation. Nothing of importance is said. They mention that a class is stressful and you agree that you’re really stressed out right now. They brush over what you said and say they have to run to class. Nothing has been said of the dark circles under your eyes or the fact that you can’t quite get your mouth to turn up properly. Now you’re convinced that you’re crazy. Your emotions can’t be right or real if no one else even notices them.

 

This is its own kind of invalidation. When people simply ignore your problems, they by default tell you that what you’re feeling isn’t real: it seems as if you’re hallucinating whatever is wrong because no one else will react to it, or even react to your reaction. It’s confusing. It leaves you less and less certain that you can even mention your problems, more trapped inside your own mind. There’s a reason that giving someone the silent treatment is considered mean.

 

Another example of this is one that happens with kids all the time. One technique that parents use fairly often if their kids are throwing a temper tantrum is to ignore them. When kids throw a tantrum what they’re looking for is attention, so don’t reward the negative behavior, right? Well this method works up to a point. It works to get the child to calm down. What it doesn’t do is then tell the child that their desire for attention is real and important, or that whatever was bothering them deserves attention and care. This kind of method for child-rearing may not seem invalidating, but it tells a child that even if they are bawling, their emotions aren’t worth anyone’s time. It’s important if we don’t want to reward someone’s negative attention seeking behaviors that we find a way to go back and invalidate their feelings, talk it out, or recognize their feelings. This can happen after the fact.

 

Being silent to someone who is in pain or who has strong emotions of any kind is really the fastest way to tell them that what they’re feeling or doing is wrong. Imagine when you’re extremely excited about something and you bounce up to a friend, eager to tell them all about it and they just stare at you. Nothing bursts your bubble faster.

 

It’s a terrifying and horrible feeling when you’re invalidated in that way, but it is understandable why many of us ignore others’ problems. It’s overwhelming and tiring to always be checking in with people, and listening to everyone. Unfortunately, this is part of being a friend or family member: you should be willing to validate the people you care about and you should expect validation in return. We rarely hear about ways to potentially prevent mental illness, but if all of us spends more time listening and validating the emotions of those around us, we could really do some good in the world.