DBT 'GROUP' Topic #1- Coping w Suicidal Thoughts

It's going to take me some time to prepare the entire first chapter of the DBT Skills Workbook, but in researching and finding a great wealth of resources to aid us in our self help/group efforts I found some great info on setting up personal support plans, stratagies and super easy (do anywhere) coping ideas to help deal with stress and suicidal crisis situations for those of us who suffer.

In researching BPD treatments of all kinds, suicide prevention and support is usually a step one and precurser to professional treatment plans. We are by no means professionals here, but I think that taking into account our emotional fragility, our lack of face to face support (some of us only having an online 'group' support system), and not knowing each persons back ground/connections to real live support in their friends/family/other places; it would be wise to post these simple PDF worksheets up here so that none of us embark on this journey without an active plan of support for moments of crisis.

Please feel free to download the PDF file, read, review and fill out worksheets provided here:
NEW WORD LINK! http://www.mediafire.com/file/8ok6xy6gv ... OUGHTS.doc
(open or save file to your computer)

I'd love to hear your thoughts on these sheets (which have been compiled from similar worksheets found online) and of course the content and focus of these sheets is totally open for debate and discussion.

"Welcome" to our new 'support group' effort for DBT and I'll try and have chapter one ready by this time next week.

Here's Some Info On Thought Processes & Some Simple Coping Tools to Help With Filling in the Work Sheets:

AUTOMATIC THOUGHTS:
Our thoughts are created by our mind, which is constantly helping us to interpret the world around us, describing what’s happening, and trying to make sense of it by helping us interpret events, sights, sounds, smells, feelings. It’s just what the human mind does.
Without even realising it, we are interpreting and giving our own meanings to everything happening around us. We might decide that something is pleasant or nasty, good or bad, dangerous or safe.

Because of our previous experiences, our upbringing, our culture, religious beliefs and family values, we may well make very different interpretations and evaluations of situations than someone else. These interpretations and meanings we give events and situations, result in physical and emotional feelings.
Something happens or we notice something, which triggers a thought. Particular types of thoughts tend to lead to particular emotions.

Thoughts_________________________________________________________________________Emotion
I’m in danger and I won’t be able to cope with it_______________________________________Anxiety,Fear
I’m being treated unfairly and I won’t stand for it______________________________________Anger, Frustration
Everything is hopeless – I’m totally worthless, no-one likes me, and nothing can change_______Depression

Automatic thoughts…
 Can be words, an image, a memory, a physical sensation, an imagined sound, or based on ‘intuition’ – a sense of just ‘knowing’
 Believable – we tend to automatically believe our thoughts, usually not stopping to question their validity. When another driver cuts me up, I might judge that he’s a selfish thoughtless toad, but in fact, he might be taking his wife to hospital as she’s about to give birth. Thoughts are not necessarily true, accurate or helpful. Often based on emotion (rather than facts), which drives our opinion.
 Are automatic. They just happen, popping into your head and you often won’t even notice them.
 Our thoughts are ours – they can be quite specific to us, perhaps because of our present or past experience, knowledge, values and culture, or just for no good reason at all. Some thoughts are so out of keeping with all those things, and that can make them seem all the more distressing – because we add some meaning about why we had them (I must be a bad person!)
 Habitual and persistent – our thoughts seem to repeat over and over, and the more they repeat, the more believable they seem, then they set off a whole chain of new related thoughts that lead us to feel worse and worse. They can follow themes, for short periods, or very often, throughout years and decades.

How do you deal with the automatic thoughts and emotions?

Stop: Don’t act immediately. Wait.
Take a Breath: Slowly breathe in and out a couple of times.
Observe: What am I thinking about?
What am I focusing on?
What am I reacting to?
What am I feeling in my body?
PULL BACK: Zoom out!
See the bigger picture.
Is this fact or opinion?
Is there another way of looking at this?
What would someone else say about it?
How does this affect others?
What advice would I give a friend in this situation?
How important is this situation right now?
Practise what works: Consider the consequences. What’s the BEST thing to do? Do what will help most!

How do you STOP~ STEP BACK, TAKE A BREATH, OBSERVE & PULL BACK???

STOP before reacting, take a deep breath and use the following thoughts questions to observe the situation and identify what's happening righ now:
 Notice what’s happening – your thoughts, physical sensations, emotions, images, memories. Notice the way you’re interpreting what something mean, and how that’s affecting you.
 Notice the unhelpful thoughts. What am I reacting to? Perhaps say the thoughts very slowly, or very quickly, in a squeaky or comic voice, or write them down.
 Identify the emotion you’re feeling, and label the unhelpful thoughts. Is this
- an evaluation?
- a prediction?
- a feeling or sensation?
- a memory?
- an unhelpful thinking habit like:
mind-reading (believing we know or what others are thinking),
negative filter (only noticing the bad stuff),
emotional reasoning (I feel bad so it must be bad),
catastrophising (imagining the worst),
the internal critic etc?
 Learn more and practice mindfulness so that you can be aware of when you are in the present moment rather than being ‘in your head’
- perhaps you're thinking about the past or future too much in that mindset, maybe you need to pull back from what's happening and check in with yourself, ask yourself:
- where am I right now?
- what's happening right now?
- how do I feel right now?
(not with extra thoughts, worries and concerns of past/future events or possibilities; just with now- today. This moment. How am I feeling about right now?)
- what I can do right now to make myself better?

Practise What Works:

It is important to remember that we are in a process of transition here. Our old behaviours and defence mechanisms are in place as a form of protection, and they DO serve a purpose. They've been with us for a long time and have helped us through many struggles in life. There is no shame in needing our 'old methods' of coping in crisis situations. The focus is on progress- not perfection!

If the situation you are in is too stressful/painful it's totally OK to box up the thoughts and emotions surounding it, and leave them to be dealth with at another time. Do what keeps you SAFE while in the moment!

Here are some distraction stratagies to help take your mind off things while enduring stress:

Distraction helps us feel better by diverting our attention away from the distressing thoughts. It works even better if you choose something that will really grab your attention and keep you absorbed in that activity. Different things work for different people. It‟s worth trying and practising many of those listed, and more that you think of yourself, a few times each before giving up on it.
Home and garden
 Mow the lawn
 Clean the car
 Do some gardening
 De-clutter a room or part of a room
 Purge your wardrobe (give to charity)
 Clear out the spare room (give to charity)
 Sweep the path
 Cooking or baking something pleasurable
 DIY
 Bath the dog
 Brush the cat
 Clean the hutch/cage
 Re-arrange the furniture in one room
Leisure
 Do a crossword or sudoku
 Try out aromatherapy or reflexology
 Visit the hairdresser – try a new style or colour
 Watch television or a DVD
 Play on the computer
 Surf the internet
 Watch the clouds whilst lying outside
 Read a novel or new newspaper or magazine
 Walk or sit on the beach or park
Getting out
 Join a leisure centre or health suite
 Go for a walk or jog
 Get the old cycle out!
 Visit a new church
 Go to the library
 Visit a museum
 Check out what movies are on
 Go to a concert
 Browse an antiques or charity shop
 Find out what free classes are on offer
 Potter around window shopping
 Go out for lunch
 Go to the beach – whatever the weather!
 Learn to drive, or take a trial lesson
 Visit a nursery, garden centre or park
 Visit a tourist attraction
 Walk alongside the sea, river, reservoir or lake
 Take a bus ride somewhere new
 Visit an aquarium or zoo
 Visit a car boot sale
 Visit a nature reserve
 Visit a historical or natural site
 Visit an art exhibition
 Go for a drive
Being creative
 Take up a new hobby
 Learn another language
 Start an evening class
 Write a letter or article for a magazine
 Learn to meditate, do yoga or tai chi
 Start a diary or journal
 Write a short story or poem
 Take up a musical instrument
 Decorate a room, or a piece of furniture
 Paint, draw, sculpt
 Join a dance class
 Surf the internet
 Create a weblog or site
 Sew or knit
 Bake
 Make an „emergency‟ box for distressing times – put in any small reminder of what helps
 Take photographs
 Make a scrapbook
 Sort out your photos
Self Soothing
 Have an early night
 Eat something you haven‟t tried before
 Listen to some favourite (calming or uplifting) music
 Try a new newspaper or magazine
 Have a bath or shower
 Use aromatherapy oils
 Massage your hands or feet
 Write a list of things you have achieved, great and small
 Soak your feet
 Make a list of things that you can be thankful for
 Paint your nails
 Meditate, relax, yoga, tai chi, reiki
 Cuddle a soft toy
 Write a letter to yourself
 Read a letter you‟ve written to yourself to read at these times
Making contact with others
 Telephone someone you haven't spoken to for a while
 Join a self-help group
 Join a civil rights group
 Do some voluntary work
 Write a letter to someone you haven‟t written to for a while
 Talk to a friend or family member
 Phone the Samaritans or another helpline
 Join an online support group or discussion forum
 Email a friend
Express yourself physically
 Bang a drum!
 Scream, shout or sing loudly!
 Rip up a phone book or newspaper
 Dance energetically to loud music
 Write – prose, poem, story, music, journal, diary, weblog, whatever comes into your head
 Write a letter to someone, but don‟t send it – shred or burn it outside
 Run, walk, cycle, swim, go to the gym
 Paint
 Vacuum enthusiastically
 Kick a ball against a wall
 Punch or kick a cushion or pillow
 Cry
Positive Self-Talk
 I can get through this, I‟ve managed before and I can now
 I don‟t need to do this, it‟ll only make it worse afterwards
 I‟ll regret it and feel awful later
 It helps for a few minutes, but then it just makes it worse in the long run
 I don‟t want to end up at the hospital again
 I can cope for another hour – I can take one hour at a time

Here's a bit of info on
Dealing with Negative Emotions: http://www.getselfhelp.co.uk/docs/Deali ... otions.pdf
Anger: http://www.getselfhelp.co.uk/docs/anger.pdf
Anxiety: http://www.getselfhelp.co.uk/docs/AnxietySelfHelp.pdf
Depression: http://www.getselfhelp.co.uk/docs/Depre ... lfHelp.pdf
Dealing with Destress (42pg Guide) http://www.getselfhelp.co.uk/docs/Deali ... stress.pdf
Tying it all together with Self Help Cards: http://www.getselfhelp.co.uk/docs/cards.pdf

This is a long post, but a helpful one (I hope).
I'll be working on my own suicide prevention plan and coping stratagies myself today, and I'd love to hear what some of the others here who ahve done DBT previously have found works best for them in these new techniques, as well as others thoughts on these ideas

Have you found this info helpful?
Your thoughts???

Unfortunately, I couldn't get into the PDFs to see what was there? Don't know if other people have had the same difficulty?

This is going to be quite tricky to work out as there is such a huge amount of information to prepare and to try and present in a logical and helpful way. I've just spent about an hour trying to pull together the first set of basic distress tolerance skills from my own group notes. I'll put them here as it backs up some of the stuff already talked about, but maybe gives a little more detail on some of the skills you can use to keep yourself distracted and safe in a crisis situation. Try to leave your scepticism at the door. These techniques might sound too simple to work, but you've got to give them a try if you want to change your life.

Introduction to DBT

Overwhelming Emotions: people with BPD struggle with overwhelming emotions and tend to deal with their pain in unhealthy, unsuccessful ways because they don’t know what else to do. When a person is in emotional pain, it’s hard to be rational and think of a good solution.
Which of these unhelpful (but common) coping strategies do you resort to when faced with a stressful situation?
1. You spend a lot of time thinking about past pains, mistakes and problems
2. You get anxious worrying about possible future pains, mistakes and problems
3. You isolate yourself further from other people to avoid distressing situations
4. You make yourself feel numb with alcohol or drugs
5. You take your feelings out on other people by getting excessively angry at them or trying to control them
6. You engage in unsafe sexual activities such as having sex with strangers or having frequent unprotected sex
7. You avoid dealing with the causes of your problems such as an abusive or dysfunctional relationship
8. You use food to punish or control yourself by eating too much, not eating at all, or by throwing up what you do eat
9. You attempt suicide or engage in high-risk activities, like reckless driving or taking dangerous amounts of drugs or alcohol
10. You avoid pleasant activities such as social events and exercise, maybe because you don’t think that you deserve to feel better
11. You surrender to your pain and resign yourself to living a miserable and unfulfilling life.

All these strategies are paths to even deeper emotional pain because they can only offer temporary relief at best. Each of the above behaviours has a cost: e.g if you spend a lot of time thinking about past mistakes, the cost is that you miss good things that might be happening now and then regret missing those things too, you will also tend to feel more depressed about the past. If you avoid pleasant activities or exercise then the cost is that you lack enjoyment, lack exercise, feel depressed, ashamed and isolated.

Think about the strategies you use every day and think about what they are costing you – it’s not pleasant, but if you are committed to changing those strategies then you can immediately see how your life will improve.

Exercise: Write down 3 ways you currently react to your emotions that you want to change. In other words, what 3 things do you do when upset or overwhelmed that are damaging and that you are committed to replacing with better ways to cope? E.g. catastrophic thinking, self-harm, suicidal thoughts, binge eating, avoiding going out.
1.
2.
3.

If you are prepared to work to learn to implement the DBT skills then you will notice that how you react to your feelings will change and you will no longer resort to the 3 behaviours you have listed.

Basic Distress Tolerance Skills (how to survive a crisis without making it worse)

Distraction skills are important because they can temporarily stop you from thinking about your pain and, as a result, they give you time to find an appropriate coping response. Try not to confuse distraction with avoidance. When you avoid a distressing situation, you are choosing not to deal with it. But when you use distraction you still intend to deal with it in the future, when your emotions have calmed to a more tolerable level.
You will also learn self-soothing skills. Self-soothing can help you regain your strength and bring you some relief from your pain so that you can figure out what you’re going to do next. They also help you learn how to treat yourself with compassion.

Reframing
The first distraction skill is reframing. This means that you try to see the situation in a different way or in a different context.
e.g. if you’re feeling depressed about your life, think about wars and famines that are going on in the world right at this moment. A lot of people are having to deal with worse problems.
By acknowledging your own problem and acknowledging that other people have even more severe problems (e.g. they might get killed by a suicide bomber), you can possibly make yourself feel a bit better about your own situation. Try not to be down on yourself for feeling bad but simply allow that other people are dealing with issues that are objectively more difficult than yours and take comfort in the perspective you gain. Don’t think “people are having to put up with much worse than me so I’m a terrible person for feeling this bad about something so insignificant”. If you do find yourself thinking that way, move on to a different distraction technique. You can also reframe by comparing yourself now to a time when you felt much worse and say to yourself “well, I feel bad now, but I’m doing much better than I was 6 months ago”. Again, if this doesn’t work for you, try something else. Not every technique is going to help – it’s a case of finding the tools that work for you.

Engaging in a task mindfully
Mindfully engaging in an activity means reminding yourself to focus on just this one moment instead of experiencing the current crisis at the same time as remembering past crises and worrying about future crises.
e.g. going for a walk and really noticing the scenery around you, describing it to yourself in great detail; reading a book, taking care to read each word; organising your cupboards; visiting a friend. The goal of the activity is to distract you from the urge to react in an unhelpful manner and to distract you from the emotions and resulting thoughts that trigger the urge. If you were feeling the urge to fly into a rage, you could mindfully watch a funny TV programme; if you were feeling overwhelmingly sad, you could mindfully listen to some upbeat music.

Do something for someone else
Sometimes doing something for someone else can distract you from your emotions and thoughts. E.g. if you are feeling lonely, bake a cake for a friend and take it over. If you’re feeling sad, offer to babysit a friends children which could cheer you up and prevent you from feeling suicidal.

Intense sensations
Physical sensations can provide a good distraction from intense emotions and urges (which is why self-harm is a common unhelpful coping mechanism). So a more helpful distraction technique would be to use an intense sensation that didn’t cause long-term damage
e.g. taking a hot or cold shower/bath; lying in the hot sun; going for a walk in cold/windy/rainy weather; snapping a rubber band on your wrist; chewing on ice or frozen fruit; waxing your legs or other body hair.

Shutting out the situation
If you are feeling emotionally overwhelmed, it can be helpful to leave the situation physically. Sometimes, however, although you have physically left the situation, your mind continues to go over and over the problem. This is where the skill of pushing away can help. Ask yourself if this is a problem that can be solved right now, e.g. do I have the skills to work on this? Is there a solution to this problem that I can begin work on putting into action? Is now a good time for me to work on this problem? If you answered yes to any of the questions, then get to work on solving the problem. If you answered no, however, then worrying over the problem is needless and likely to cause you emotional upset and lead to unhelpful behaviours. So you need to visualise the problem somehow (words, pictures) and then visualise a box and put the problem in the box. Put a lid on the box, tie it up with string, glue it down, wrap it up in paper. Now put the box up on a high shelf in a cupboard and shut the cupboard door, padlock the door. Now the problem is off limits until you CAN deal with it.

Neutral thoughts
The idea is that by focusing on something neutral that has nothing to do with your urge or the crisis at hand, you can decrease the intensity of your emotions and the urge connected to them. E.g. counting, singing the alphabet song, trying to say the alphabet backwards, saying the names of objects out loud as you look around the room, reciting poetry or saying nursery rhymes.

Take a break
Often, taking a break when emotions are high can help you get through the crisis without making things worse. It might be mentally taking a break, by meditation or using mindfulness skill, or you can physically take a break by taking an extended lunch hour, taking the day off, having a takeaway instead of cooking tea, not doing the housework for a day.

This is a lot of helpful information. You both provided a lot of good ideas.

I seem to have a lot of passing thoughts when it comes to suicide. I’m not quite sure whether I’d count them as suicidal ideation because they’re more like intrusive/obsessive thoughts rather than actual contemplation. I only really count it as suicidal ideation when I’m dwelling in the thoughts or thinking about the details.

Exercise: Write down 3 ways you currently react to your emotions that you want to change. In other words, what 3 things do you do when upset or overwhelmed that are damaging and that you are committed to replacing with better ways to cope? E.g. catastrophic thinking, self-harm, suicidal thoughts, binge eating, avoiding going out.

1. I self harm by either binge eating or hurting myself physically; hitting or cutting myself.
2. I dwell on negative thoughts which lead to catastrophic thinking and then suicidal thoughts.
3. I isolate myself; shirking my responsibilities or lashing out.

Thank you, Thank you, thank you! I graduated BDT early Dec 2010. There has been so much happening in my life, I find it hard to practice, practice, practice like I did when in class. I still refer back to my book with my training information and notes. It helps. I have been looking for someplace online to assist in helping me to practice, to share questions etc... Once I can afford it, I will go back for a refresher... right now, this seems to be just exactly what I need. I want you to know, your hard work and time IS helping at least 1 person out here.

angelmoss wrote:Thank you, Thank you, thank you! I graduated BDT early Dec 2010. There has been so much happening in my life, I find it hard to practice, practice, practice like I did when in class. I still refer back to my book with my training information and notes. It helps. I have been looking for someplace online to assist in helping me to practice, to share questions etc... Once I can afford it, I will go back for a refresher... right now, this seems to be just exactly what I need. I want you to know, your hard work and time IS helping at least 1 person out here.

I'm so glad that people are finding this stuff helpful.
I'll admit I haven't yet done the paperwork end of this yet, but I did do the reading and I put a few of those skills to the test yesterday during an emotional crisis.

They didn't take the pain away; but they did help it not to be so overwhelming and hysterical while I was suffering.
Where I would have been psychotic in the past, my head rushing with a furey of thoughts, plotting, emotions and devolving/ destructive reactions, I was instead at a lower level of insanity- an even insanity, just pain, without the madness of it all...

So yes, "it works if you work it (and we're worth it) so work it!"

Weird. For some reason I wasn't able to find this thread the other day. It just vanished. I'm glad to see that it has returned as I found it very helpful.

agirlbyanyothername wrote:Weird. For some reason I wasn't able to find this thread the other day. It just vanished. I'm glad to see that it has returned as I found it very helpful.

If the thread vanishes, it's because I've updated the original 'topic portion' of it. All of my posts are under mod preveiew (along with a few other posters) because of some of the issues we'd been having in the HPD forum. So sorry about that. I just needed to change the link to the PDF file because it wasn't working, so I re did the file as a word doc and it now opens and is usable for working sheet read, printing, etc...

I don't think I'll need to fix it again, but if it goes missing- it's because I had to change/add something to the post- k?

The new docs can be downloaded here http://www.mediafire.com/file/8ok6xy6gv ... OUGHTS.doc

Take care all and again, my appologies for the missing threrad
~Alice

Thanks a lot for making this thread! I'm really going to try as hard as I can! A lot of this information was very helpful. I'll start by saying the 3 emotional reactions that I want to change:

1. Digging my nails into my arms while having thoughts of cutting or kicking and punching myself.
2. Obsessively thinking about a situation that's already done with. This usually leads to me making myself physically sick.
3. Taking my anger and frustration out on others.

I'm going to try to work on these starting right now!

Once again, I'm blown away by the effort you put into your threads. I haven't gotten deep into yet but I'm already grateful for the help you've supplied. Thank you!!