Friday 11 May 2018

Emotion Regulation Therapy: Session One

Trigger Warning: Mentions of Overdose, Self Harm, and Medication

Since my last post, I've had another appointment with my CPN. This appointment mainly consisted of going over what I'd told her at the assessment, how I've been coping since, and what had been decided at the meeting.

My self harm urges haven't been too strong recently, although they have still been there. I decided I felt safe enough to take control of my medication again and so far have not had any more overdoses. I think this is due to the reassurance that I will get some help. I'm holding out for that, so don't have such a strong urge to do things that could potentially severely harm me. I have self harmed, but only very superficially.

I told her this, and that things have continued to be difficult with my Nan's health (her possible Dementia is definitely worsening). I've made up with the friend who fell out with me over me pulling out of moving house. There's a little less pressure from certain things, but I'm still struggling to cope with the pressure that is still there. I've found recently that my moods have been swinging between feeling numb and feeling very low.

She was pleased that I hadn't self harmed as badly, but she was still concerned at how extremely I tend to react to things. She noticed that I spoke very negatively about myself and put a lot of responsibility on my shoulders when I didn't need to/as much. She told me that she'd had the meeting about me now, and what had been decided was that I will have Emotion Regulation Therapy sessions with my old Support Worker, and that I would have a medication review. I'd already received the psychiatrist appointment for the medication review, but my CPN was concerned that it was too long a wait, so we've decided that my appointment would be rearranged for a much sooner time, with a nurse prescriber instead. I'm quite happy with that. It seems that the Sertraline isn't working anymore, and the Aripriprazole dose is too low.

Emotion Regulation Therapy

Earlier this week, I had my first Emotion Regulation Therapy session with my Support Worker. At the start of the session, she explained that this type of therapy takes skills from Dialectical Behavioural Therapy (DBT) that of course focuses on helping to regulate how someone reacts to certain situations, stressors etc.

My support worker told me the CPN had said that I did want DBT, but unfortunately it isn't offered with my local mental health team. She seemed disappointed that there weren't many therapy options offered (with this team) for people with BPD. She told me that unfortunately, the goalposts kept being moved so it was very hard to get onto things such as pathways that may offer suitable support. I told her that I was just glad to get some support and some parts of DBT that were relevant to me.

We went through how I view and react to things, as well as how I treat myself and others. My Support Worker said that what she could tell from me was that I have strong opinions, but due to fear of backlash, arguments, lack of self confidence etc, I find it hard to voice them. I tend to stand up for others and (in her words) "rescue" others but tend to sacrifice my own wellbeing to do this. I agree to be honest. I wouldn't call myself selfless or anything like that, but I do tend to put others before myself and I'd rather help others than help myself.

We then moved onto the worksheets. The first sheet asked me to think of a situation where I reacted in a quite extreme way. I thought of a recent event, which of course involved my fear of losing friends. This was the time that I was looking to move house with a friend of mine, and due to becoming quite unstable, I had to contact my friend and pull out. He took this badly and (after a few days of silent treatment) sent me a long angry text. Although this has now been resolved, at the time, I was very distressed. I panicked, I cried, I dissociated, and I had very strong urges to self harm/overdose. I felt like I was going to lose my friend of 10 years and I felt very guilty. I knew I'd made the right decision for me, but I'm not used to putting myself first (especially if it meant hurting someone else's feelings) so I felt like a terrible person.

Of course, I had to break this right down into what happened (I put something like "friend fell out with me after I couldn't move house with him). I then had to write down how I reacted (I cried, panicked, asked friends for reassurance, had strong urges to self harm) and then what the consequences were. In this instance, nothing bad happened as a result of my reactions. I got the reassurance I needed from friends, and although I still had urges, my friends talked me out of self harming.

The next skill sheets suggested ways of controlling/delaying acting on my urges, ways of distracting myself, noticing my changes in mood, physical sensations etc, and ways of self soothing. I'll explain each worksheet below:

STOP: This sheet mainly focuses on delaying/stopping acting on your impulse. It reminds you that you are in control. It suggests physically taking yourself away from the situation that is causing these urges, noticing how you feel, how others are reacting, and considering the consequences of acting on urges.

TIPP: This sheet suggests ways to calm physical sensations and emotions (such as using ice to cool yourself down if anxiety or anger raises your temperature).

Distraction Skills: This sheet consists of different types of distraction suggestions, such as activities you can do, helping others, keeping your mind busy or having something physical to concentrate on (different textures etc)

Self Soothing Skills: These involve focusing on stimulating the five senses. This includes stroking a pet, looking at photos, listening to music, smelling perfume or eating a nice treat.

We started on the worksheet that asked me to think of pros and cons of acting on my impulses, and of using the distress tolerance skills. With my Support Worker's help, I filled in the pros and cons of acting on impulses. 

Homework - My homework was to finish the previous sheet, as well as a worksheet where I had to say what skills I wanted to try, what I specifically planned to do, and what the outcome was likely to be. After filling in those sheets, I was to stick up the skills sheets in my room, somewhere I can't ignore them.

Overall, I found this session very useful. I'd already tried some skills, but there were other suggestions I hadn't thought of. I am determined to get my homework done and practise these skills. I'll just have to see how I get on!

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