Wednesday 27 June 2018

Emotion Regulation Therapy: Session Six, Last Session

(TW: Overdose, mentions of self harm, abortion)

Since my previous Emotion Regulation session, my mood had been worsening. Thoughts and feelings were building up rapidly, and there were feelings I found hard to understand. One of them was this heartbroken feeling. I hadn't broken up with anyone recently and I'd not suffered loss for a little while, so I couldn't understand where it came from.

I was also having dangerous urges to self harm and overdose. My thoughts were racing and needed some sort of release. I wanted to shut out my emotions as well. A few days before my last therapy session, I took an overdose. Although small, it was more of an overdose than the last couple of times. Again, I wanted to be unconscious. I didn't want to think or feel, because it was too painful and confusing.

By the time this session came round, I was feeling desperate for more support. I wasn't happy that this was the last session, and I felt I needed more support (although I wasn't sure what support I needed). I also wasn't happy about the fact that my appointment with my CPN (whenever that will be!) will probably result in my being discharged. I felt as bad (if not worse) as I did when I was referred to secondary services, and felt guilty for not improving more through therapy. I had learnt new skills to tune into emotions, self soothing, and how to lessen/delay urges, but I found them very difficult to put into practice.

I spoke about this to my support worker, during my therapy appointment. She was disappointed and worried that I'd taken another overdose. Although she knew that I wasn't exactly suicidal at that time, she did tell me that I could end up killing myself if I keep on like this. She said this unhealthy coping mechanism was in danger of becoming a habit. I admitted it was starting to become that. As for support, she told me that there wasn't a lot the CMHT could do. They could advise me to not overdose, but they didn't have the resources to stop me, especially as I have "insight and capacity".

As for therapy, they could only offer short term sessions. What she did say was that there are some group sessions for Distress Tolerance happening next month possibly. She will have a word with my CPN, to see if I could go to those before being discharged.

We then spoke about the feelings I had noticed recently; primarily the "heartbroken" feeling. I told her I couldn't understand why I felt this way, and what had led to it. What she responded with, really clicked with me though. When we have an unexplained feeling, that we cannot understand in terms of where it came from, it's likely that it is an old feeling resurfacing. She gently suggested that it may be due to the abortion I had nearly 10 years ago. Suddenly, it made a lot of sense. Things such as the Ireland vote had triggered my thoughts and feelings about this. I'd tried to avoid this, but it has been all over the place recently. I knew it affected me a lot, but I guess I didn't expect the feeling to last weeks.

(I'm now dissociating as I write this. It is one of my only ways to cope with speaking about it)

I started to shake and cry as I told her I agreed with her suggestion. I had many complicated feelings about this time in my life, and apart from an amazing friend who was with me throughout, I did not get much support. The man who would've been the father was really upset that I had decided to have the abortion. I know that he'd always wanted children. He never asked me how it went, how I felt, if I was ok etc. He lit a candle to honour the baby that wasn't to be.

My new boyfriend at the time appeared to be sort of supportive, as I had times of constant crying, numbness, and silence, but in arguments afterwards, he told me he was angry that no one had considered how he felt. He also said something disgusting about babies, which really upset me.

When it happened, the nurses treated me as if I was a bad person and an irresponsible child. I was offered no counselling (even though I was clearly distressed) and the only appointment I had afterwards was a nurse's one to put me on the contraceptive pill.

I told my support worker most of this, and also that I worried in case it was my last chance to have children. She said what I needed to do was problem solve. My main worry was about fertility, so a check up with a doctor would be the first step. The next thing would be to get bereavement counselling, so I am able to cope with this and gently expose myself to situations where the topic of abortion arises. She also said it may be helpful to connect with others who have been in similar situations. This type of thing triggers me badly though, so I'm going to need support through it.

We then moved onto the last worksheets. feeling our emotions. It involved staying with uncomfortable feelings, and practise doing this until it becomes easier to cope with. The worksheet spoke about Emotional Mindfulness as a way of feeling emotions without judgment. There were 6 steps to this: acceptance, paying attention, slowing down, giving way, seeing it through, and reflecting.

Acceptance involved understanding that feelings come and go, and we cannot control this. We have to accept them without judgment instead of fighting them.

Paying attention reminded us that feelings are felt in the body. We should pay attention to those bodily feelings and try to link them to certain emotions to see if they fit. We also need to stay in the present, and not try to figure out why we feel this way

Slowing down by focusing on each feeling that arises, and sitting with it as well as observing it closely.

Giving way when the feelings arise. Letting yourself cry or feel angry for instance. You don't have to do anything apart from let go.

Seeing it through by considering the positives that come from feelings. According to the worksheet fear brings wisdom, sadness brings healing, and so on. We should be able to feel our emotions through to completion, and feel lighter once they subside. If we are "stuck" in one feeling, and can't ride it completely, there may be reasons for this. These feelings could be defensive (feeling angry when actually upset etc) and there may be more going on. Another reason, as I explained above, may be that our feelings have roots that go back to a previous time. These feelings are not resolved, so linger and resurface.

Finally reflecting. It is important to reflect on our experience and understand how important it was to feel our emotions through to completion. It is not an easy thing to do, and takes courage.

The session soon came to an end after this. I was still very tearful, but also emotionally exhausted. My support worker told me to look through the worksheets and practise the tasks on them. Also, she said to not put too much pressure on myself. This takes time and isn't easy. I must not blame myself if I can't do this sometimes. She also urged me to not self harm or overdose again. Lastly, she reminded me that she would be suggesting to the CPN that I am not discharged yet, and that I may benefit from the Distress Tolerance group.

Tuesday 26 June 2018

Emotion Regulation Therapy: Session Five

By the time session five had come round, I'd had a lot of different thoughts and feelings. I was supposed to try and tune in to my true feelings, and among feelings of agitation, irritability etc, I'd been very low. Instead of staying with those feelings though, I'd been doing anything I could do distract myself. I also avoided letting myself cry, especially in front of other people. I worried about how I'd react if I really did let myself sit with all these feelings. To me, it was a big risk to take.

I've been reading through the book these sessions have been based around i.e. "Living Like You Mean It" and found that I really do fear my feelings. I'm uncomfortable when I feel happy, I turn away from people when I feel low, I isolate myself and turn my anger on myself and so on. I don't try to "ride the wave" of emotions.

My support worker said that emotions were like waves; they peak, then dissipate. Because I constantly distract myself from my feelings, all I can imagine is the peak, not the dissipation, so it seems as if the feeling won't go away.

My homework from last week was about noticing that I am having feelings, try to tune in to what they were, and to notice how I react to them. There were some suggestions for the kind of ways we avoid showing our emotions e.g. physically turning away from someone when upset, being dismissive of your own feelings etc. I could relate to a lot of things and started to notice when I did them. 

The worksheet called this "Becoming aware of your defences" and categorised ways we avoided/showing feelings into Interpersonal defences, and Intrapersonal defences. 

Prior to this session, I'd found out the decision about my medication review. The nurse prescriber had decided nothing else would help my depressive feelings or mood swings, so I was to stay on the same medications and same doses. I was disappointed about this, and found it hard to accept. I noticed that this had been a main factor in my low, hopeless feelings. It felt as if nothing was going to get better, and that I wasn't trying hard enough in therapy. The nurse had said that therapy would be my best bet, but I honestly thought that I should've progressed more noticeably by now.

I told my support worker this, and together we summarised my thoughts and feelings, as well as deciding which were thoughts and which were feelings. The trick was to see if a sentence I made started with "I feel like" or "I feel that". If that was the case then I would try to replace "feel" with "think". If it still made sense then I was expressing a thought not a feeling. What we then realised was that I thought the situation (no new meds, not much improvement) was hopeless and I thought that my future was bleak. What I actually felt was low, disappointed, and tearful. 

Back to the worksheet. The next part spoke about how feelings themselves can be defensive. e.g. someone could respond to something with anger when they actually feel hurt or sad. We know a feeling is defensive if it does not go away and we ruminate over it. We have to try and find out what else is going on for us. What are our core feelings? Only then can we tune into them, "ride the wave" and eventually feel some kind of relief. 

My homework for my last session was to read through the worksheet again, and use the tools on there to tune into feelings, see which were thoughts instead of feelings, and learn how to deal with coping with what I find. This involved being gentle with myself, not putting too much pressure on myself, and using breathing exercises to slow myself down.

After this session, I recorded a vlog to talk more about the book "Living Like You Mean It". The link is below, if you'd like to hear more.

Thank you for reading (and watching my video, if you did!). My next post will be about my last session of Emotion Regulation and how I've been feeling since.

Tuesday 5 June 2018

Emotion Regulation Therapy: Session Four

(See Session Three to catch up)

At the start of the session, my Support Worker told me about her discussion with the Nurse Prescriber re: my psychiatric medication. Apparently, because I'd said I didn't want to go on the Mirtazapine (because of the weight gain risks), she'd decided I was to stay on Sertraline and she had cancelled the follow up appointment. I was quite shocked about this, especially as the nurse hadn't phoned me to say anything about this. I obviously wasn't happy about her decision, so my Support Worker said she'd have another word, to see if they could put me on something else and rebook the follow up appointment. I'm still waiting to hear back about this.

I was feeling quite numb on the day of my therapy appointment. I struggled a bit with concentrating too. I did ask whether this was my last appointment as well, as I was worried that I hadn't improved enough to be discharged. Thankfully, she said that although this was the last booked session, she and my CPN had a discussion and decided I needed another two sessions before considering discharge. I was really relieved about this. I told her that my moods had been all over the place again, and although I was coping today, I don't know how I'd be the next day and didn't want to be discharged, only to be in need of referral straight after.

She seemed a bit concerned about my mood swings, and wrote some notes down. One thing she did mention, that has been getting my mind going a lot, was that even though I seemed quite low in session three, overall she hasn't noticed Depression in me on the whole. I wasn't sure what to say to that. The first mental health diagnosis I was given was Depression, and that diagnosis has followed me for years. I'm not actively suicidal anymore though, and my low points aren't quite as low as they used to be. I do self harm more than I used to though. I've found a change in the symptoms I have too. After the appointment, I did look into Depression with BPD and an article did talk about how depressive symptoms tend to be different. Of course not everyone with BPD will experience exactly the same, but the article said that the symptoms are more to do with anger, loneliness, guilt/shame, and boredom, whereas with Depression alone, the symptoms are more to do with sadness (understatement I know), feeling like a failure, lack of energy etc. I definitely felt I could relate more to the BPD depression than the standalone Depression diagnosis. It could be that the article is inaccurate but I could relate to what it said.

Anyway, back to the session. The topics we spoke about were more of a follow on from session three. We went through parts of the "Living Like You Mean It" book, and some more worksheets too.

The first worksheet was entitled "Life is Like a Wheel". It explains that life is always changing but eventually goes back round to the first point of the wheel. This is usually because of things happening in your life. For example, you could feel happy or successful at stage 1, a traffic jam could make you very stressed at phase 2, a bad comment from your boss could make you feel worry and suffering at phase 3, a compliment from a colleague could make you feel hopeful at phase 4, then back to happy at phase 1. It says that feelings are temporary and that they can change from hour to hour even.
It also states that certain feelings can take longer to change. For example, grief. A loved one dying can make us feel a huge sense of loss. Sadness and sometimes anger may follow. Anxiety may occur; worrying how to cope without our loved one. Denial may come next; where we may try to hide our feelings and block out memories of the person who has died, eventually allowing the tears and sadness to come, remembering the person in good and bad times, visiting their grave etc will start the healing process, then hope and happiness should follow. This can take years but the grieving process will be completed.

The next worksheet was entitled "The Assertive Option". It gave examples of certain feelings. On the right hand side would be unhelpful things we often feel or do, on the left hand side are better, more assertive behaviours, feelings etc. For example, acceptance rather than denial, and sharing feelings rather than hiding feelings.

The last worksheet (quite a wordy one!) explained acceptance. It defined it in 3 parts. Firstly, to accept something is to acknowledge it exists, secondly to believe there is no reality that should not exist, and thirdly, to see it as bearable.

The worksheet gave examples of accepting certain realities, e.g. that there are no certainties in life, utopia doesn't exist, and we cannot change others. It also explained that accepting something does not mean you have to like or be indifferent to it, and that acceptance is vital for stress management.

I find this very difficult, although I acknowledge it's important to accept things. I have strong views about being compassionate, equal rights etc and I do find it hard to accept when I come across people who believe certain people don't deserve the basic things in life for survival (food, shelter etc) just because they don't work for example. I guess I find it hard to believe someone could be that callous, and I want to have enough courage to debate their opinion and get them to see my point of view. I cannot change anyone and I cannot control the opinions they have. I can educate and maybe even persuade, but I can't completely change them. So I have to try and accept this reality, no matter how much I may dislike it.

In order to accept realities, the worksheet says we need to be mindful of our thoughts and beliefs about other's opinions. These can include believing someone should be different to who they are, the need to make them admit they are wrong, and the feeling of anger at being unable to do anything.

It also includes challenging our demands by asking certain questions of ourselves. "Can I really change this person/situation?", "Why must this situation etc not happen?" for example.

Lastly, the worksheet asks us to practise acceptance in order to improve stress management.

My homework is to do read through the worksheets again and practise acceptance. I think this will be the most difficult task so far, but maybe it'll help my stress levels?