Tag Archives: DBT

My Fight with Anxiety

I have been in a constant state of anxiety for several days now.  My heart and thoughts are racing, I’m grinding my teeth, my sleep has been broken, I’m irritable and I can’t stop catastrophizing every situation I think about.  The most worrisome part of my anxiety is that my hallucinations are working overtime.  Not only am I hearing my ‘people’ (voices) again; I am also dealing with moderate visual hallucinations.  All I want to do is escape and find a quiet place where the world can’t touch me and I can curl up in a ball and be left alone.  I don’t want to deal with anything right now and I don’t want to face any of my fears.

The voices I experience have been with me as far back as I can remember.  The best way I can describe them is that one is a male and one is a female and they sit at the base of my brain just waiting to make life difficult for me.  They don’t have faces or anything like that; the way I see them is as silhouetted heads something like this…

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They are always there facing one another but I never see their lips move when they talk however I can always tell whether it’s the male or female communicating with me.  My voices never tell me to harm myself or others or do things that I normally wouldn’t do; they just like to have an input into my thought pattern when I’m stressed, anxious or overwhelmed.  We do have two-way conversations but no one would ever know this just to look at me.  The dialogue only goes on inside my head and my lips only actually move from time to time.  It sounds funny but that’s how our relationship is.  No, I am not psychotic nor do I suffer from any sort of schizophrenia.  I just experience these voices because of my bipolar disorder and my anxiety.

My visual hallucinations are not as significant as my voices.  Basically I see things move and run across the floor or dart across my field of vision.  I see things with my peripheral vision that aren’t there but I still turn to look as though they are as a knee-jerk reaction.  I have trouble with my visions, too, when I’m stressed and overwhelmed or when I’m overstimulated like I tend to be in the grocery store or large department stores.  All the colors and images and different sounds and smells make it a chore for me and it becomes nearly impossible for me to concentrate in this type of environment.

I can start feeling anxious out of the blue, however I have learned over the course of my mental illnesses to identify certain situations that may make me anxious.  I don’t like to be around a large group of people whether I know them or not.  It’s not so much the people but the barrage of images and movements that make me anxious when I’m around a lot of people.  I can also be anxious in a small group of people if I don’t know the people in the group.  Unlike a large group, I can get to a point where I’m relatively OK in a small group once I get to know the other people though I still experience some anxiety.  New situations or how I perceive a new situation might go are two more times when I will experience a lot of anxiety.  I have to use a lot of self-talk when I’m going into a new situation so that I can get to a point where I can still function.  This is a fairly common situation for me seeing as new experiences are a part of daily life but because of this I’m often preoccupied and inside my own head.  I get anxious when I have to make a phone call I’ve never made before, opening new mail, driving to a destination I’ve never been to, watching the news on television and even praying.  I know right; yes, praying can cause me a great deal of anxiety.

It would seem that it would be easy to combat my anxiety if I know when I might be anxious or I can identify it when it comes but it’s not that easy.  Having anxiety and being aware of it doesn’t make it that easy to deal with.  Life would be so sweet if I could just identify the anxiety, label the source of it and then take the necessary steps to make it go away.  NOT!  It doesn’t work anything like that.  For some years I was on Xanax to help combat my anxiety however that was the worst thing that a not medicated, bipolar alcoholic/addict with borderline personality disorder could possibly do.  When I made the serious decision to get sober and deal with my mental illness I had to make the decision to go at my anxiety from a different direction.  Now I use both CBT (Cognitive Behavioral Therapy) and DBT (Dialectical Behavioral Therapy) tools to combat my bouts of anxiety.

The tools that I have been taught are not foolproof however they do help me to get a better hold on my anxiety when it comes.  I still shy away from many people and situations because of my anxiety but, at least now, I know that I can get passed it when I’m ready to.  I say ready because no matter how hard I may try to combat anxiety in any of its many forms, unless I’m ready to face whatever situation is giving me anxiety that anxiety will still be there.  Anxiety keeps me from experiencing many things in life that I’m positive are probably pretty amazing and I want to be a part of any number of them however my battle with anxiety will be ongoing and on my terms.  I just have to be patient with myself and that’s the best I can do.


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Mental Illness and Two Types of Therapy

I have been in and out of treatment for my bipolar disorder and substance abuse for nearly fifteen years and I have gained a lot of knowledge about different treatment therapies.  Most recently I have been exposed to two types of therapy that have helped me tremendously. Following is a brief summary of each one of these therapy models.  I encourage further research on both.

The first of these is DBT (Dialectical Behavioral Therapy). DBT was developed by Marsha Linehan to help people suffering severely with BPD (Borderline Personality Disorder). DBT deals with helping to reshape detrimental behaviors that can stand in the way of effectively living with BPD and, over the course of its history; it has been expanded to treat other mental illnesses and recovery from a number of addictions and disorders.

DBT is made up of four specific skill sets being taught that help with the stabilization of extreme moods and addictive behaviors.  These skill sets are mindfulness; being fully present and aware in the moment, distress tolerance; how to tolerate uncomfortable situations without the need to change them, interpersonal effectiveness; how to ask for what you want and learn to say no while maintaining positive relationships and emotion regulation; how to change emotions that need to be changed when you want to change them.

The dialectic module of treatment focuses on self-acceptance but also realizing that some behaviors need to change in order to facilitate mood stabilization and recovery.

The second therapy I have been in is CBT (Cognitive Behavioral Therapy).  This was developed by Dr. Aaron T. Beck and it deals with helping people with depression combat “automatic [negative] thoughts” that can increase this depression.  CBT helps patients to realize that how we see the world will affect how we feel; this, in turn, can increase or decrease depression.  Therapists help patients with anticipated challenging situations that may arise, and they help them to come up with a plan to combat these situations in a positive way.

Of all the different types of therapy and groups I have been a part of I would have to say that these two have been the most beneficial to my current journey towards recovery.  They have also helped me to develop skills that help me to deal with everyday life situations with bipolar disorder.  I highly recommend these therapy models to anyone suffering from mental illness and substance addiction.

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Back To The Drawing Board

Back in IOP (Intensive Outpatient) therapy…oh joy.  This will be my lot three days a week for the next sixteen to twenty weeks.    I walk in the room and come face to face with a motley crew of alcoholics and addicts who have committed to staying sober and working The Steps.  The facilitator is a slight red-head who reminds me of Shirley MacLaine but she is slightly disheveled and majorly unorganized.  I have to correct her about my name and that immediately makes me feel some kind of way.  My initial reaction is that I’m in the wrong place.  I’m a bit anxious and I feel out of place but, ironically, I start using DBT (Dialectical Behavioral Therapy)  exercises; the nature of the group, to calm myself and find my niche in this space.  Twice we are interrupted from getting things going by the late arrival of two people and this aggravates me like nails on a chalkboard.   After everyone has finally settled in Teacher, what I’ll call her, announces that there is a binder of information we are responsible for and she hands me a white binder with a stack of papers that go inside.  She apologizes for the incompleteness of this wealth of information, none of the papers have holes punched in them, telling me that there is no three- hole punch in the building.  Ugh.  Really?  I’m at a loss for words.  This isn’t starting out good at all.  I keep telling myself to give this all a chance because I know the routine all too well; I’ve been in four other groups over the course of nearly a year.

Group begins with a check-in consisting of going around the circle and giving our names, announcing our addiction(s), how much clean time we have and what kind of mood we’re in.  Surprisingly I’m calm with the fact that I will soon give my story to a new group of strangers.  The eye contact that I get from the other group members as we go around the circle puts me more at ease and when it’s my time to introduce myself I’m confident and strong.  Teacher starts things off and my apprehension starts to creep back to the surface.  She’s speaking but it’s as if she really doesn’t know what she’s supposed to be doing.  I feel like I’m balancing on the edge of my seat in anticipation of her next word or instruction because she just seems so hesitant to take control of the meeting.  I want to jump out of my seat and snatch up her papers and her spiral guidebook and just teach the class myself.   Finally the ball gets rolling, albeit slowly, and we dive into the skill for the day.  Not even five minutes into this I discover that my stack of papers is missing the literature for the topic.   This is yet another speed bump to slow our momentum.  Teacher apologizes profusely and excuses herself to go make the necessary copies having to get originals from one of the other attendees.   She returns and we try this once again.

Class seems to creep by so slowly and I feel like I’m in another state of consciousness.  The information is helpful and informative but Teacher just seems a bit off-key to me.  Everyone else seems to be comfortable in a homey kind of way and I envy the way they seem to be able to abandon any judgement of the entire situation, they seem to be completely at ease.  Am I missing something?  We keep it moving and finally one of the other people speaks out of turn and asks Teacher isn’t she ready for a break.  A collective sigh of relief goes around the room and we all start putting down papers and heading for the door even before we hear how long break is going to be.  Maybe my observation was wrong about how the other groupies feel about the whole thing.

We all return from break grateful that there’s only thirty minutes left of this haphazardly conducted meeting.  Though we trudge along and play the game I can tell that I’m not the only one frustrated with how things go here.  I try to keep from watching the clock when one of the gentlemen brings to our attention the time and I perk up and see that time’s up and group is over.  Before Teacher is able to fully give ending instructions we begin packing up our things and preparing for our ending circle to recite the Serenity Prayer.

Wow, it’s over and I made it through and I’m actually glad I came.

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