Self-Soothing with Smells

And so we have reached "smell", the last of our five senses for self-soothing!  Since smells can be powerfully linked to memories, it is important to think carefully about which fragrances and aromas are soothing for you as an individual, and which can be triggering and remind you of sad or difficult times.  You may choose to use smells that remind you of happy times, good people, or lovely places, or just fragrances you find pleasing.

Here are some more ideas.

Now you have self-soothing ideas for all of the senses you can pick and choose which work best in which situations or for specific moods for you.  You may find the most effective self-soothing activities combine senses, for example, taking a scented bubble bath, or lying on the grass in the park where you can watch the clouds, feel the sun on your skin, and listen to the birds.

What works best for you?

I hope to see you again soon.

The Bear 

xXx

Self-Soothing with Vision

One of the many ways we can make ourselves feel better when things are tough is by looking at or watching something which is either soothing or enjoyable.  For some people, this might be watching the clouds drift by, and for others it might be watching a dance performance or a favourite television show.  There are many ways to self-soothe using vision.

Here are some more ideas.

You can also self-soothe with touch, sounds, taste, and smell.

Why not make a list of the most effective techniques for you?

I hope to see you again soon.

The Bear 

xXx

Self-soothing with Touch

Today's post continues the topic of self-soothing with the senses, and focuses on touch.  How much we like to be touched by other people can be variable, with some people being very tactile and affectionate, and others quite reserved with a need for a lot of personal space.  We might also enjoy physical contact when we are in some moods but not others.

Fortunately, self-soothing with touch does not necessarily involve physical contact with others.  It may be more about sensations on our skin from nature (e.g. the sun or rain) or from caring for ourselves (e.g. by applying moisturiser or having a shower).

Here are some other ways to self-soothe with touch.

Why not check out how to self-soothe with taste or sound?

Check back for more posts on self-soothing with the senses.

The Bear 

xXx

Self-Soothing with Sound

Self-soothing involves applying techniques we have learned to help us feel better when we are distressed, depressed, anxious, or angry.  Some of us are already very good at self-soothing, but others have not yet found helpful ways to feel better or struggle to give themselves permission to do so.

Self-soothing using our senses can be very effective.  Check here for ways to self-soothe with taste and check back for future posts to find ways to self-soothe with other senses.

Today's brief post focuses on sound.

Here is a brief list of ways you can self-soothe with sound.

Make a list of your own ideas and favourites and put it somewhere you'll notice it when you're having a hard time so you can give self-soothing with sound a try.

I hope this has been helpful.

Check back for self-soothing with vision.

The Bear 

xXx

Self-Soothing with Taste

Self-soothing is all about comforting, nurturing, and being kind to yourself when you are distressed, anxious, overwhelmed, or feeling vulnerable.  It is about telling yourself it's okay to have your feelings, but also helping you to survive them and feel better.  For me, self-soothing is a lot about comfort.  It is the equivalent of someone looking after you when you are ill, bringing chicken soup, tucking you up in bed, and being generally kind and caring towards you.

Self-soothing can include any or all of the five senses.  This short post focuses on taste.  Good food and drink can be a great way to self-soothe, but please remember it may be less useful if you have an eating disorder or use food to avoid your feelings.

Some ways to self-soothe with taste include:

- Drinking your favourite hot drink.

- Treating yourself to a dessert.

- Sampling flavours at an ice cream shop.

- Enjoying some seasonal fruit.

- Chewing gum or sucking boiled sweets.

- Having your favourite meal.

- Eating your food mindfully, focusing on taste.

- Treating yourself to a freshly squeezed juice or smoothie.

- Having a soothing peppermint tea.

- Combining touch and taste by having something cold, like an ice lolly.

- Having something hearty and comforting to eat, like a stew.

Do you have any other ideas for self-soothing with taste?

Check back for my next post on self-soothing with sound.  

Thanks for popping by.

The Bear xXx

Self-Care & How to Survive Stress with the PLEASE Skill (DBT)

Last week was Mental Health Awareness week and the theme was Stress.  I chose to share the PLEASE skill as a way of surviving stress, but it is so much more than that!  The PLEASE skill is a DBT skill which focuses on self-care, and this is incredibly important, because we so often forget or overlook the importance of this.  In many ways, we often mistake self-care for indulgence and start to feel like our needs are unimportant as long as everyone else is okay.  This is where the masks on an aeroplane analogy comes in; putting your mask on first keeps you fit to help everyone else, if this is what matters to you.

So here is the PLEASE skill, which focuses on ways of keeping yourself physically and emotionally well.  If you or someone you care about is having a really bad time or is in crisis, these are the basics.

PL - Treat Physical Illness

We are all guilty of ignoring illness or letting ourselves get run down.  Maybe we think we've had too many sick days recently.  Maybe we think it's just a sniffle and it'll pass.  Maybe we have too much to do to be ill, or just can't face the faff of a long wait at the doctor's, if we can even get an appointment to begin with.  Being physically unwell has an influence on our mental health, leaving us feeling tired, run-down, and more vulnerable to emotions.  Moreover, if we ignore our body's protests we can end up more ill or injured.  It is important that we take time to let ourselves recover, seek medical attention if it is needed, and finish that course of antibiotics as prescribed to give ourselves the best shot.

E - Exercise

Some of us love exercise, and can't beat the high we get from achieving a personal best when running, learning a new yoga position, or scoring the winning goal in a football match.  Others can think of nothing worse.  Exercise might not be one of your hobbies, but it is important, so start small if need be.  Get off of the bus a few stops early and walk the rest of the way.  Climb the stairs instead of getting in the lift.  Ride your bike at the weekend.  Follow a Youtube video in the privacy of your own living room, or head to the gym with a friend to try a class.  Try to do around 20 minutes of exercise per day, and over time, see if you can increase to 30 minutes of exercise that increases your heart rate, five times per week. Feeling stronger and fitter can also boost your confidence which can do wonders for your mental health.  

***As always, this might be one to avoid if exercise is associated with an Eating Disorder or unhealthy coping behaviour for you.***

A - Avoid Mood-Altering Drugs

This might not be the most popular form of self-care, but alcohol and illicit substances are unlikely to be helpful when you are not feeling your best.  Alcohol is a depressant, and is unlikely to improve your mood in the long-term, whilst regulating your mood is more difficult when intoxicated.  We can also easily become dependent on substances to help us avoid our feelings, which will ultimately prevent us from changing our circumstances and overcoming our difficulties.  Self-care might involve facing our emotions and difficulties face on rather than numbing ourselves to them.



S - Balance Sleep

Sleep is incredibly important to our emotional and physical health.  Adequate rest will allow our bodies to recover from physical injuries and illness, and optimise our ability to think and focus.  Being tired can severely impact our motivation and leave us feeling overwhelmed or unable to cope.  Try to set yourself a regular bedtime and develop a routine.  Don't watch television in bed, avoid using your phone, and aim for 7-8 hours of sleep per night.

E - Balance Eating

Last, but by no means least, eat adequately.  Avoid under-eating, as under-fuelled bodies and brains are far from effective.  Try to eat a balanced diet with plenty of fruit and vegetables, but also fats and carbohydrates.  Everything in moderation.  Notice whether you are using food as a way of coping with your emotions, and if so, which feelings you are trying to suppress or escape from.  Try eating mindfully, focusing on tastes, smells, and textures as you eat, looking at what is on your plate, and noticing any sounds (if you can bear to!).

The PLEASE skill is the foundation on which you can build other things.  It is putting your mask on first and ensuring you are fit to care for others, as well as acknowledging that you deserve care and nurturing (YOU DO.).

Take good care of yourself.

The Bear xXx

How to Calm Down Fast.

When I was little I would sometimes get myself into a big state about something, crying and crying and unable to calm down.  After this had gone on for quite some while, my dad would generally try to resolve it by bringing me a hot flannel to put on my face and neck, at least partly to calm me down (though probably also to reduce the attractive post-cry puffiness).  I suppose in doing so he was using some variant of the TIP skill.

The TIP skill is a good choice for people who become intolerably overwhelmed, have found themselves in a state whereby they cannot think clearly or even conceive of calming down, or have the urge to harm themselves in some way.  It is another Distress Tolerance Skill from DBT (Dialectical Behavior Therapy) and is designed to quicky reduce emotional arousal by changing our physiological state.

This skill has four parts:

Temperature
Intense Exercise
Paced Breathing and Paired Muscle Relaxation

The two Ps count as one in the acronym but are two distinct skills.  Don't ask why; I'm not sure beyond it ruining the acronym otherwise!

T is for Temperature.
This skill is not recommended for people with a history of heart difficulties or an allergy to the cold (e.g. cold urticaria).  Otherwise, it can be a really very effective way of calming down quickly!

To use this skill, hold your breath, and place your face in cold water.  Your eyes, nose, and mouth should all be submerged.  Keep your face in the water for between 30 and 60 seconds, depending on your lung capacity and how uncomfortable this is for you.

Doing this tricks your brain into thinking you have dived into cold water.  For this reason, this skill is often called the "Dive Skill" or "Dive Reflex Skill".  The dive reflex is a mammalian reflex in which the body responds to being immersed in cold water without oxygen by slowing the heart right down to below the normal resting rate.  The parasympathetic nervous system kicks in to decrease arousal, which is handy as it was under-active whilst you were distressed!

The easiest way to use this skill is to fill the sink or a bowl and to dunk your face, but you can also use a cold compress or an ice-pack (wrapped in a towel to avoid freezer burn!).  The water in a bowl or sink shouldn't really be below 10C (50F) as this is likely to cause pain, and that really isn't the point here, so don't add ice to this.  If submerging your face is not an option, splashing it with cold water whilst holding your breath is an alternative, though this is unlikely to be as effective.

The Dive Skill is probably most useful when you are feeling completely overwhelmed and finding it hard to calm down; however, it can also be helpful to ground you if you are dissociating.

This skill is generally very effective in decreasing arousal; however, if you return to the stressful situation immediately afterwards, the agitation may quickly return, so it is important to consider combining this with another skill.


I is for Intense Exercise.
This skill involves doing at least 20 minutes of aerobic/cardio exercise.  This might include spinning, running, walking, swimming, dancing, kickboxing, or hiking.  The aim is to decrease negative mood and increase positive affect.  Research has shown significant increases in positive emotions for those who manage to get their heart rate up to 70% of the maximum heart rate for their age. 

Part of the rationale for using intense exercise comes from what we know about the body's reaction to intense emotions.  As animals, our emotions tend to evoke actions in a bid to help us survive.  Anger prepares us to fight whilst fear prepares us to run.  Completing a burst of action might therefore re-regulate our emotions by releasing the physical energy and tension.

Exercise is a good choice when you are feeling angry or so anxious that you feel sick or have an upset stomach.  It should probably be avoided if your relationship with exercise is potentially harmful, for example,  if it is involved in an eating disorder.


P is for Paced Breathing.
Paced breathing involves slowing your breathing right down to five or six breaths per minute, and ensuring those breaths are coming from your belly (low abdomen).  If you are breathing in for four seconds, you should generally be aiming to breathe out for about eight.

The heart is generally slower during out-breaths than in-breaths, so breathing in this way can help reduce your heart rate when you are agitated.  This can have a similar effect to the Dive Reflex.


P is also for Paired Muscle Relaxation
Paired Muscle Relaxation combines paced breathing with progressive muscle relaxation.  The general idea is that when you are feeling stressed, overwhelmed, angry, or anxious, you are probably very tense, and there is a good chance you are not even aware of where you are holding the tension.  By deliberately tensing and relaxing your muscles, a zone at a time, you will release any tension you were inadvertently holding before.  This will increase awareness of the tension you had as well as heightening the sense of relaxation.  Noticing this can be quite mindful, and as mindfulness is also a very useful skill for people struggling with emotional intensity, this is a bonus.  If you fancy it, you can also say "relax" to yourself in your mind as you exhale and release the tension.

To try progressive muscle relaxation do the following:

Find a quiet place with minimal distractions.  Sit or lie down.  As you tighten each set of muscles, breathe in.  As you release, breathe out, and try thinking "relax".  Hold the tension for 5-10 seconds each time.  Being tense should be very still and tight, whilst the relaxed state should feel more like being a ragdoll.  It may take practice to achieve this.

Try each group, one at a time.

1) Make fists with both hands and pull fists up on your wrists, towards your body.
2) Make fists and bend your arms so your fists touch your shoulders.
3) Pull your shoulders up to touch your ears in a shrug.
4) Try to pull your eyebrows together, wrinkling your forehead.
5) Shut your eyes tightly.
6) Scrunch up your nose and bring your lips and cheeks up towards your eyes.
7) Press your lips together and stretch the edges of your lips back towards your ears in a closed smile.
8) Press your teeth together and push your tongue against the roof of your mouth.
9) Push your head back against your back, or forward so your chin is on your chest.
10) Take a deep breath and hold it.
11) Hold your stomach in tightly.
12) Squeeze your buttocks together.
13) Put your legs out and tense your thighs.
14) Put your legs out and point your toes down.
15) Put your legs out, point your toes together with your heels out, and curl your toes under.


Next time you are feeling overwhelmed and need to calm down fast, give these a try and let me know how you get on.  I hope to see you again soon.

The Bear xXx

Coping with Overwhelming Emotions

So it's been a while, but I'm back!  In my absence I have been working on my doodles and thinking about how best to create useful content.

This week I have been immensely frustrated by a courier returning a parcel I desperately needed to the sender after just one attempt to deliver.  Since my special interest is working with people who struggle to manage their emotions when such things happen, I decided to take inspiration from my anger and write a brief post about a Dialectical Behavior Therapy (DBT) skill which might help in such circumstances.

DBT aims to equip people with a range of skills to help them manage emotions and relationships.  This skill is a Distress Tolerance skill, and is therefore used to help survive potential crisis situations without making them worse or getting stuck on the injustice or painful feelings in a way that adds more suffering to the natural angst generated by the situation.

THE "STOP" SKILL

Marsha Linehan, the creator of DBT is rather fond of an acronym (even if they are sometimes a bit of  stretch).  In this case, STOP stands for Stop, Take a step back, Observe, and Proceed Mindfully.  Here's how.

Let's break it down a bit.

First up, we STOP.  Freeze.  Do not move a muscle.  When you are in a highly emotional state (e.g. furious!) you may be driven to act on your emotions.  It may be extremely difficult to think clearly, and as a result, the action you take may not be in your best interests.  Stop to enable yourself to regain control.

Next up, we Take a step back.  Take a break.  Step away from the situation and take deep breaths.  Try to let go of the thoughts and feelings and get yourself back towards that calm baseline as best you can.  Do not let your feelings make you behave impulsively; you may regret it later.

Now we Observe what is going on inside and outside of us.  What is the situation?  What are you thinking and feeling?  What are other people saying or doing?  What are the facts of the situation?

 

The final stage of this skill is to Proceed Mindfully.  Your job now is to act with awareness of the facts, your thoughts and feelings, and other people's thoughts, feelings, and actions.  Keep in mind what your goals are (longer-term).  Will the action you take get you closer to or further away from your goals?  If it will make things harder, is there a better option? 

It really is important at this point to remember that you may need to repeat these stages.  If you have taken a step back and the other person or situation has wound you back up immediately, start again from the beginning.  You cannot proceed mindfully until you are able to think again, and you cannot think when you are too distressed and in "survival" or "fight/flight/freeze" mode.

I hope this brief post has been helpful!

Thanks for reading =)

The Bear xXx

What is a Personality Disorder?

***Please be warned that some of this post might be triggering.***

This is Steve.

Steve has decided to seek help with his mental health.  He really struggles with some things everyone else seems to find easy and it's making his life really hard.  He often feels very distressed and people around him get hurt or angry.  Steve isn't really sure what's going on; he just feels like something is wrong, and has been wrong for most of his life.  He doesn't remember things ever being different but is desperate for them to change.

People often comment on the way Steve thinks about things.  They tell him he is getting it wrong.  He is really hard on himself, and seems to jump to extreme conclusions very quickly.  He often thinks people are doing things deliberately to upset him or the world is against him.  Steve experiences his emotions as loud and tidal.  His mood changes often and he isn't really sure why.  He quickly becomes overwhelmed and other people tell him he's being dramatic or seeking attention.  Sometimes he manages his distress by being impulsive; hurting himself, drinking a lot, gambling, or sleeping with someone he doesn't even fancy.

Steve really struggles to maintain relationships.  His family have washed their hands of him because they say he is "too much" and "too needy".  He gets into arguments with his friends and they don't ever seem to make up.  He lost his last job after he got into an argument with the manager.

When Steve just stops and tries to relax, he becomes aware of how empty he feels.  It's a horrible feeling and one he tries to avoid wherever possible.  

Steve often feels intensely distressed, and his difficulties upset, worry, and anger people around him.  His mental health and behaviour have a significant impact on his ability to function day-to-day and prevent him from achieving the things he would like to achieve in his life. 

Steve is showing symptoms of Personality Disorder.

What is a Personality Disorder?

A Personality Disorder is an enduring mental health problem, the onset of which is usually in at least early adulthood if not adolescence, and which is stable, pervasive, and present across a wide range of situations (DSM-5, American Psychiatric Association, 2013).  Symptoms include an enduring tendency to think and behave in a way which is markedly different than other people of the same culture and age group; intense, changeable, and sometimes inappropriate emotional responses; difficulties in relationships; and impulse control problems.  These symptoms cause distress and affect the person's ability to function.

"Personality Disorder" is an umbrella term covering ten types of Personality Disorder.  It is not unusual for people to have a mixed diagnosis, meeting criteria for more than one disorder, or presenting with bits of several but not meeting the full criteria for any one in particular.  Sometimes, people have some milder qualities of Personality Disorder, but function well for the most part.  In these situations they might be said to have some "traits" of Personality Disorder which they may wish to seek help for, but they will not be given a full diagnosis.

As with all mental health problems, Personality Disorders can vary in terms of severity.  At one end, people might have quite mild difficulties and function well with structure and supportive people around them, only ever coming to the attention of mental health services if something very stressful has happened; for example, the end of a long-term relationship, or redundancy.  At the other end of the spectrum, people with severe Personality Disorder might be very disabled by their problems and require a high level of support from mental health services as well as supported housing.

This diagnosis is not uncommon, with an estimated 1 in 20 people in England having a Personality Disorder.


Why do people develop Personality Disorders?

This is a good question, and as with any mental health problem, there is not a definitive answer.  However, our best theory at present is that there is an interplay between nature and nurture.

Think back to that earlier post about attachment.  Attachments are likely to play a major role in the development of Personality Disorder.  Adults with this diagnosis present with insecure attachment types.  For Borderline Personality Disorder, this is most often a disorganised attachment style.  (Here's a quick reminder of what that looks like in an infant.)




They really struggle in relationships with others, and those around them notice a push/pull phenomenon whereby the person wants to be close but then seems unable to tolerate it and pushes the other away.  The other person might respect this and give them space, but the person with Personality Disorder then feels abandoned, neglected, or rejected, and responds with anger and distress.  This pattern can be very difficult for others to manage, and difficult for the person with Personality Disorder to recognise and understand.  It is a major contributor to their difficult relationships and is most likely to have originated from a difficult early attachment which taught them that caregivers are unpredictable and sometimes harmful, scary, or unresponsive or neglectful.  Relationships activate the attachment system and the adult finds themselves playing out something very difficult from their early life.

We all have different temperaments when we are born.

Some babies sleep easily whilst others keep their parents awake all night.  Some babies are placid and content whilst others are anxious or grizzly.  It is likely that people who go on to develop Personality Disorders were more sensitive than the average bear to begin with.  They were attuned to the emotions of others and might feel sad or worried more quickly than their peers.  If life had been plain-sailing for them, they might have been the sort of adults who cried at films and preferred not to watch the news.  However, it wasn't all plain-sailing after that, unfortunately.  Somehow or another, their experiences got invalidated and they learned that their emotions were wrong, bad, attention-seeking, or harmful.  They learned that their needs would not be easily met, and this made the world a confusing, scary place, in which they experienced extreme distress and there seemed to be no resolution.

This invalidation could have happened in a number of ways.  On the less sinister end of it, it might have been that the child was just poorly matched with their parent/s in terms of temperament.  Whilst the child was sensitive and felt things deeply, mum was a "stiff upper lip" type and the sort to just shrug things off.  When presented with a child who cried easily she told them they couldn't possibly be as upset as they thought, because she couldn't conceive of this herself.  It was alien to her.  So every time her child became distressed by something she thought was ridiculous she assumed they were being dramatic or attention seeking, and told them so.  And she didn't respond to that need, because as far as she was concerned, it wasn't real.  She didn't mean any harm, but the child learned that their emotions weren't valid, and their need wouldn't be met.  They were left with not only the initial distress, but now the additional emotion/s arising from knowing they were in the wrong - perhaps shame, anger, hurt, or fear that the distress would last forever.

On the nastier end of the scale, a child's feelings and experiences might be intentionally invalidated.  In the case of child abuse, an abuser might tell the child they like something they do not, or that their distress is not real. Tragically, they might also be disbelieved when making disclosures about their experiences.

Somewhere in the middle of the two are parents whose own mental health or extreme social stressors limit their ability to be available to their children, resulting in emotional neglect, whether intentional or not.  People with Personality Disorders often report early experiences of abuse or neglect, or parents with mental health or substance use problems which were poorly managed.

If the parenting a child receives does not involve them being taught to label their emotions or learning how to manage them, e.g. by a parent noticing they are sad and comforting them, they will struggle to understand their own emotions or know how to manage them in later life.  Adults with Personality Disorder frequently feel like their emotions change without any real cause, have difficulty labelling their feelings, and feel unable to soothe themselves when distressed.

Keeping in mind the kinds of difficulties people with Personality Disorder have and just how understandable this is given their early experiences is helpful in ensuring a compassionate, thoughtful response to people whose behaviour and distress can be challenging and upsetting to those around them.

Check back for posts about specific Personality Disorders!

The Bear xXx