It reminded me that I tried to quit smoking all through my 20s with only limited success. One day I saw a woman, in her 50s or so, with awful deep wrinkles all around her mouth and face, puffing on a cigarette and making them look so much worse. (It was obvious where the wrinkles came from.) My vanity caused me to quit on the spot!

I think now I’ll try to apply this same method to my problems with procrastination.

Thanks again,

Linda: Glad you found it helpful.

Alex

My reason for becoming involved in this type of “therapy” is for the treatment of bipolar disorder & other psychological issues that have been causing me much emotional pain & I have very unhelpful coping skills. All of the people in the group have serious mental health issues & have had suicide attempts, cutting behaviors, drug & alcohol problems, anorexia—just the whole gamut of dysfunctional behaviors.

I also take medication but have been able to discontinue some & am decreasing the dosages of others in the hopes of getting off them completely as I am learning new thinking skills that lead to healthier behaviors. The “retraining” of the brain can change the pathways in your brain & you can reduce & eliminate paranoia & other symptoms associated w/serious mental illnesses. I’m proof of it. Regular therapy did not help me change my thoughts & behaviors; it helped me understand why I was depressed, had low self-esteem, was fearful & paranoid, etc., but it didn’t have any impact on my ability to change. But I probably am a stubborn case. (I say “complicated”; my husband says “interesting.”)

In this group, “relapse” is a common occurrence, especially in the first few months when all the skills we are studying are new & the techniques are just being introduced. A major component of DBT is to be non-judgmental & compassionate towards yourself if you take the proverbial 2 steps back (relapse) from the 3 steps forward in progress you have been making.

For me that was a very hard concept—to not think of myself as a failure & feed the failure self-concept w/thoughts like: I’ll never improve. I’ve been this way so long it is too late for me (I’m 56 & had my 1st suicide attempt at 15; my mother also had a serious mental illness & did commit suicide so I know “giving up” on getting well leads to hopelessness & to inevitably contemplating ending it all).

I have so many problems & “issues” that I get overwhelmed sometimes. But in DBT part of the non-judgmental thinking is also looking at “Vulnerability Factors” (V.F.) that led to the relapse. If I can step back & analyze my relapse (for me it is rash harmful behaviors to try to get rid of my emotional pain as quickly as possible; others might be cutting or abusing alcohol or drugs, binge eating or anorexic restricting of food, etc.), I often see V.F.’s that preceded the relapse.

For example, I may have been having a period of insomnia; a flare-up of a chronic pain issue I have; my eating may not have been balanced; an “anniversary reaction” to traumatic events in my past occurred; not exercising; not taking time out for pleasurable activities; hanging around w/people who are negative, mean or hurtful towards me, etc.

Then it is easier for me to give myself some compassion for my relapse. I was in a vulnerable state (sort of like if you have a weakened immune system it is easier to catch a cold) & I can use this analyzing of my relapse to learn & plan how to avoid those V.F.’s in the future as much as possible.

Every year I have a depression come on on the “anniversary” of my mother’s suicide when I was a teenager. Now I plan for it in advance by not adding any extra responsibilities to my life, taking extra time to rest & rejuvenate & alleviate stress, making sure my diet & exercise “programs” don’t get thrown to the wayside, & ask for help when I need someone to listen to me or just hug me & allow me to grieve. But I don’t go into full-blown depressions where I drop out of life like I used to.

Also, another helpful thing DBT teaches is to look back & see how much progress you have made.

So if you have had a relapse, look back & see the line of progress & not focus on this “blip.” Also, I use anger constructively. When I was trying to quit smoking (& have not smoked for over 10 years now), one day at work a customer was really rude to me & obnoxious. I became very upset & had to leave work, but on the way home I bought some cigarettes (had only quit for about 2 weeks at that time).

After smoking a couple cigarettes (relapse), I thought to myself: “I’m not going to let that guy have this kind of power over me. He’d be happy that he caused me to start smoking again.” And I got angry at the cigarettes for having “control over me.” So I learned something w/that relapse—I don’t want to allow other people to “push my buttons” & have me do something to hurt myself because of it. I also strengthened my resolve to not let that flimsy paper full of tobacco have such power over me.

If you are still trying to overcome your areas of difficulty, you are a success! If a relapse happens, learn from it, don’t attach too much power or emotion to it, be done w/it as quickly as possible & see it as an isolated incident—not as a sign of failure or a beginning of a trend.

My long-winded 2 cents worth!!

Sara: Wonderfully wise words. Thank you for sharing.

Alex

While I agree that it is important to forgive yourself and get back up on the horse, it is far more important to resolve, once and for all, that there is no turning back. To quote Jesus the Christ, “Remember Lot’s wife.”

USCLawyer: You do raise a good point. I didn’t mean to imply, in saying that relapse is a part of the process of change, that it is an inevitable part of the process of change and that it should, therefore, be so readily accepted that it becomes an expected part of the process of change. I wanted to make the point not just to encourage people to forgive themselves for its own value but because not recognizing that relapse is often a normal part of the process of change often decreases the likelihood that one will be able to make the change they desire permanent. How often I hear patients say that after binging just once they figured they’d blown their attempt at weight loss and abandoned any further efforts. It wasn’t the initial relapse that caused them to fail. It was the relapses that followed because they allowed themselves to be discouraged by the first one.

Alex

Through school I have been anticipating a medical career, but eventually got cold feet as I was putting my application together. One fear has been a general decline in support for the thinking, listening generalist. Your blog, among several in the online community, indicate to me that role models who enjoy their primary care work still exist, even if their numbers are waning.

One of the big questions that I have wrestled with is the degree to which I could help patients achieve behavior change as a physician. I am more passionate about healthy living and wellness than science. Is it naive to think that taking my training to the highest level (MD) will allow me the most liberty with my patients? Currently I think the opportunities to develop relationships and foster behavior change would be greater with a lower level credential like an RD or even a personal trainer.

I’m not trying to put you on the spot to make any decisions for me, but I think your experience could help answer a couple of my questions. As a physician, do you feel like you are in a good position to encourage behavior change? Or do you feel limited by the time-intensive nature of lifestyle coaching, that efficiency prompts you to spend time diagnosing and treating disease?

Thanks for sharing your thoughts in this blog,

Drew

Drew: Excellent question. Not being either an RD or personal trainer, it’s hard for me to know to what degree they’re able to influence behavior change. As a physician, however, I’ve been astounded by my ability to influence the decision-making processes of my patients (note I didn’t say behavior change—that’s harder, and I’m not certain any one profession really has an advantage in it over any other). What influences people, I think, isn’t so much what you say but who you are to the person to whom you’re saying it. The real power I have as a physician to influence patients comes from the the trust I’ve been able to build with them over the years with regard to one of their most precious possessions: their health. Patients of mine have submitted themselves to dangerously invasive surgeries that required months to recover from at the hands of doctors they barely knew because I advised them to. The influence a doctor has (especially a primary care doctor) represents an awesome power that demands constant accountability. I’ve also found that after a number of years in the medicine game you get efficient enough to be able to attend to the psychospiritual aspects of health care as well as the diagnosis and treatment of disease if you care enough to do so.

Hope that helps bring some clarity to your deliberations. The world needs more doctors who care about not just the health of their patients but their happiness as well!

Alex

I will take your suggestion and leave the url to my site here: http://holisticdivorcecounseling.com. As I mentioned, it’s not just for divorce, but for all life’s challenges and transitions.

Wishing you every goodness,
Nicole