ACCEPTS: Coping with Distress By Using DBT #AtoZChallenge

Posted on by Astrid

I haven’t decided on a theme for this year’s #AtoZChallenge, so I can basically write about whatever comes to mind. Right now, we’re in the midst of the COVID-19 crisis and we’ll most likely be by the end of April still. As such, today’s post is about self-care in times of distress.

Dialectical behavior therapy (DBT) is a commonly-used approach to treating emotion regulation issues such as those found in borderline personality disorder, but its strategies can be useful for anyone having a hard time coping with crisis. DBT’s founder Marsha M. Linehan was probably fond of acronyms, as DBT has many. One such acronym, which is particularly useful for coping with difficult emotions during times of distress, is ACCEPTS. ACCEPTS stands for the following.

Activities: find a hobby or sport to do. Yes, playing video games or watching Netflix counts. For me, reading is my hobby of choice.

Contributing: do some form of volunteer work or help a friend. The book The More or Less Definitive Guide to Self-Care by Anna Borges provides babysitting for a friend as an example. This is not likely possible in these times of lockdown, but helping out online probably also counts.

Comparison: look to a real or fictional situation that could be worse.

Emotions: try to channel the exact opposite of the emotion you’re trying to fight. For example, if you’re sad, watch funny YouTube videos. You can also train yourself to act opposite of the emotion. This doesn’t necessarily mean you need to put on a smile when you’re sad, though that might help. It also means, for example, doing the opposite of your initial response to your emotion. For example, if you’re feeling like sleeping it off, try exercise.

Push away: visualize building a wall between you and the negative emotion or imagine that it is a mass you can push away.

Thoughts: do something that requires your full cognitive attention. The More or Less Definitive Guide to Self-Care clarifies that you don’t need to do any sort of critical thinking. Borges instead provides the example of reading a book, focusing on each sentence intently. I prefer word games.

Sensation: provide yourself with a strong sensation to focus on. For example, hold some cubes of ice. I’ve seen some people even suggest smelling ammonia. That’s crazy to me (I initially thought ammonia was another acronym). Borges, however, says you can actually focus on pleasant sensations such as soft textures too. I love essential oils.

What are your favorite techniques of coping with distress?

What Day Is It Anyway? (March 23, 2020) #WDIIA

Posted on by Astrid

Well, this thing called What Day Is It Anyway? (#WDIIA) is presumably a daily feature during the COVID-19 crisis. However, I won’t promise I’ll make it a daily feature. I’d like to participate when I can though, as I must admit I lose track of the days too.

Today is Monday, March 23. I awoke at 8:29AM according to my Fitbit activity tracker. I got showered, brushed my teeth and got dressed. I then had nice yoghurt with crunchy muesli with nuts for breakfast. I bought it with the staff on Saturday.

Then I went back to my room for a bit, until it was time to have coffee in the living room, which is our day room now that the day center is closed. The day activities staff are still figuring out how to best help all clients in the seven homes that are part of the facility.

I went for two walks during the day, one in the morning and another in the afternoon. Then after dinner I went on the elliptical. Then finally while prime minister Rutte was delivering a press conference on the COVID-19 situation, I took another long walk. I reached nearly 12000 steps today.

As such, I didn’t hear myself what the prime minister had to say. I later heard on the news that people found gathering in even small groups can be fined up to €400 per person. It’s up to each city’s mayor though to take appropriate safety measures. Shops can (and probably should) have strict limitations on the number of people entering at a time. All events and festivals have been canceled until June 1. The prime minister will give out further details about school closures next week. But the good news is… no complete lockdown for now! Though the prime minister did say that people should really go outside alone if they’re outside at all, I doubt I’ll be fined for taking walks outdoors with just one staff. I hope not at least, as walks are true stress-relievers for me in normal times already and this time is definitely more stressful than normal.

Then again, I’m not sure I’m affected more by this situation than most others, or maybe even less. I am constantly on edge, but that’s my normal. That’s what living life with (C-)PTSD and BPD traits is like everyday. My distress level simply is never at a one and this time is no exception. Though obviously the lack of routine is distressing, I must honestly say it’s really more the usual things that cause me overwhelm.

Writer’s Workshop: If I Could Change One Thing About Myself

Posted on by Astrid

Mama Kat in one of her prompts for this week asks us what one thing we would change about ourselves if we could. She also asks us to think on why it can’t be changed.

This is pretty much a no-brainer to me. If there’s one thing I could pick to change about myself, it would be to widen my window of tolerance. The window of tolerance is the window at which point someone is stimulated enough that they aren’t bored too much, but not so much that they are overloaded. Each individual’s window of tolerance is different. Some people thrive on challenging activities and exciting stimuli. Others can barely handle any sensory or cognitive demands. I belong to the latter category.

If I’m correct, the window of tolerance also refers to the ability to tolerate distress or frustration. My distress tolerance is and has always been extremely poor.

So why can’t it be changed? Well, I tried. Ever since I was a little child, psychologists have recommended I work on distress tolerance. Now I must say I really wasn’t aware of the problem at all until I was about eleven, but even when I was, I had no idea how to heighten my distress tolerance.

My tolerance for sensory and cognitive demands was manageable up until I suffered autistic burnout at age 21. I mean, I was in classrooms with 30+ students in them, doing my schoolwork at a high level high school. Ever since my burnout though, I’ve hardly been able to function in group settings without getting overloaded. I also can’t seem to handle any sort of pressure.

In 2017, when I was being kicked out of the psychiatric hospital, it was recommended that I do dialectical behavior therapy (DBT). One of the modules of DBT is distress tolerance. The community psychiatric nurse (CPN) who started DBT with me, even wrote increasing my frustration tolerance as a treatment goal without my having asked her to. I didn’t see how I could work on this. After all, seeing this goal written on my treatment plan already created such immense pressure that I felt overloaded without even trying to work on the goal.

I know I have a bit of an external locus of control. This seems to be tied in with poor distress tolerance. I mean, it isn’t that I genuinely think the world owes me a sensory-friendly, low-demand environment. However, I can’t see how I can work on changing my ability to handle sensory stimuli, demands and distress.

Mama’s Losin’ It