Anguish. She has left, she is gone. “Stop emailing me. Don’t send me any more letters. You are draining, suffocating, and you only ever think about yourself, never what I need.”
Anguish. No more contact? But we are meant to be together, for our love is rare. We will walk the same path in this and every future lifetime. Her words, not mine, spoken after we had met at the Buddhist centre. Years of isolation in the darkness of self makes one want to trust the hand that reaches out, which offers a future of smiles and tenderness.
Anguish. Over the months that followed we spoke about our lives. I told her about BPD, impulsive head punching, and my attempts to overcome my Devil delusion. She promised she had the energy to cope if an episode occurred, and that she would wait if I went away to deal with BPD on my own. Two days before STEPPS therapy began an episode did arise, and I found myself trapped, like a BPD ball inside a pinball machine, emotionally bumped from one event to the other. But she never waited, and the following week, on the morning of STEPPS therapy Week 2, my companion through the aeons dumped me with a text, saying, ‘I haven’t got the energy for you’, and signed off with Kindest Regards. Nice and formal.
Anguish. Anguish? Hold on? What did you say? Head punching? Devil delusion? Some subconscious part of you believed itself to be the Devil? No wonder she left you. Dude, come on, get over it. Just another girl who thought she could fix you with love, who could talk the talk but not walk the walk of compassion. Besides, where was your compassion? You should never have gone out with someone so fragile: she had issues of her own, and a business that was just getting off the ground. Just focus on your STEPPS therapy. Get your emotions back to baseline. After all, it’s been a couple of months since this episode really began, when the sleepless nights head punching returned. Anxiety and depression are not your most attractive qualities.
Anguish. Thoughts focus on a bleak future without her, on my valueless nature that no one can love, and all the things I did wrong. The thoughts become urges, and the knife summoned by imagined throat slicing and wrist cutting burrows into this mind as I sit by the lake where we first meditated. The head punching becomes stone hitting with shooting pains that makes one aware that hair grows from the scalp, and the scalp sits on a skull which encases this despised BPD brain. Pain relieves the emotional tension. My eyes light on larger rocks that smash bone and concuss. . . .
Be mindful. Step back, observe, do not react. Distance yourself. On closing my eyes, I no longer see the rocks, and observe my rapid breaths. In—out, in—out, in-out, in, out, in, out . . . in . . . out . . . in . . . out . . . slow it down, feel each breath as it loosens this constricted chest. Freed a little, sensations within this alien body begin to surface within my consciousness: locked jaw, fists clenched, shoulders hunched, face taught, all mine, mine to control, a part of me. Relax . . . Feel how these tensions, these physical sensations linked to emotions, ease. Emotions?
Next, without judging whether an emotion is good or bad, I explore this volcano heart that spews incinerating magma and suffocating ash into me. Within the searing heat is texture, granularity. I begin to label each emotion, while not getting caught up in them. First, anger. But just anger? No, bitter, bitterness built over the decades of losing careers, lovers and friends to an illness that intermittently turns me into a draining, suffocating, self-centred arsehole, who never does anything well enough for others to recognise. She didn’t tell me about the good things I did, only everything I didn’t do for her. Why did she scarper, when she said she would remain, and love this BPD brain? Why dump by text when she knew I was in an episode, fighting to survive the near-overwhelming compulsion to commit suicide? How could she do this when she knew my wife had left me when I began psychodynamic therapy, ten years ago? How could . . .
Breath. Breath. Like I say, I label emotions without judging them as good or bad, and do not allow myself to get caught up in them: anger, bitter, hate, rage; sadness, dread, misery, grief, remorse; worthless, valueless, useless; anxiety, worry, insecure, vulnerable, helpless, powerless. . . .
Anguish. Anguish? Hold on? What did you say? Head punching? Devil delusion? Some subconscious part of you believed itself to be the Devil? No wonder she left you. Dude, come on, get over it. Just another girl who thought she could fix you with love, who could talk the talk but not walk the walk of compassion. Besides, where was your compassion? You should never have gone out with someone so fragile: she had issues of her own, and a business that was just getting off the ground. Just focus on your STEPPS therapy. Get your emotions back to baseline. After all, it’s been a couple of months since this episode really began, when the sleepless nights head punching returned. Anxiety and depression are not your most attractive qualities.
Anguish. Thoughts focus on a bleak future without her, on my valueless nature that no one can love, and all the things I did wrong. The thoughts become urges, and the knife summoned by imagined throat slicing and wrist cutting burrows into this mind as I sit by the lake where we first meditated. The head punching becomes stone hitting with shooting pains that makes one aware that hair grows from the scalp, and the scalp sits on a skull which encases this despised BPD brain. Pain relieves the emotional tension. My eyes light on larger rocks that smash bone and concuss. . . .
Be mindful. Step back, observe, do not react. Distance yourself. On closing my eyes, I no longer see the rocks, and observe my rapid breaths. In—out, in—out, in-out, in, out, in, out . . . in . . . out . . . in . . . out . . . slow it down, feel each breath as it loosens this constricted chest. Freed a little, sensations within this alien body begin to surface within my consciousness: locked jaw, fists clenched, shoulders hunched, face taught, all mine, mine to control, a part of me. Relax . . . Feel how these tensions, these physical sensations linked to emotions, ease. Emotions?
Next, without judging whether an emotion is good or bad, I explore this volcano heart that spews incinerating magma and suffocating ash into me. Within the searing heat is texture, granularity. I begin to label each emotion, while not getting caught up in them. First, anger. But just anger? No, bitter, bitterness built over the decades of losing careers, lovers and friends to an illness that intermittently turns me into a draining, suffocating, self-centred arsehole, who never does anything well enough for others to recognise. She didn’t tell me about the good things I did, only everything I didn’t do for her. Why did she scarper, when she said she would remain, and love this BPD brain? Why dump by text when she knew I was in an episode, fighting to survive the near-overwhelming compulsion to commit suicide? How could she do this when she knew my wife had left me when I began psychodynamic therapy, ten years ago? How could . . .
Breath. Breath. Like I say, I label emotions without judging them as good or bad, and do not allow myself to get caught up in them: anger, bitter, hate, rage; sadness, dread, misery, grief, remorse; worthless, valueless, useless; anxiety, worry, insecure, vulnerable, helpless, powerless. . . .
The STEPPS Therapy Process
Our culture, society and family condition us to see the world through a filter, a lens, a schema, or put more simply, a belief (see STEPPS 3). Trauma, especially during developmental years (childhood through to adolescence) can entrench in us beliefs about ourselves, others and the world. If people die during one’s youth and we do not receive the correct guidance, or one’s emotions during these difficult times are neglected by caregivers, one may subconsciously come to believe that:
- No one will be there to care for our needs, and no one can be relied upon (Emotional Deprivation Filter).
- Everyone we love or says they love us will eventually leave us (Abandonment Filter).
- People who say they love us, or will be there for us, lie (Mistrust Filter).
When situations are encountered in life, we see them through the lens of our beliefs. Thoughts and emotions arise that make perfect sense when seen through these belief lenses. Such Distorted Thoughts, described in the STEPPS program and listed in the TASK section at the bottom of this blog post, may include:
Blow Things Out of Proportion: she doesn’t want to hold my hand, and therefore doesn’t respect me, or love me.
Catastrophise: my wife left me when psychodynamic therapy was about to begin; this girlfriend is going to leave me too now that STEPPS therapy is beginning.
Believe You are in Control: I’m having an episode, but because I’ve told her about my BPD, and gave instructions about what to do when I enter an episode, she won’t leave me.
These distorted thoughts, born from our beliefs about ourselves, others and the world, are accompanied by intense emotions such as love, anger and sadness. If acted on, such thoughts and feelings compel us to behave in ways others see as irrational and destructive, such as compulsive emailing or bouncing a rock off one’s head.
STEPPS therapy helps by giving us skills to step back and observe our emotions and thoughts before a high-intensity episode, like the one in the above case study, occurs. It asks us to recognise the patterns of distress, namely our thoughts, feelings and physical sensations before the whirlwind thoughts and volcano feelings cause havoc. Aware that we are about to enter an emotional meltdown, we then employ skills to prevent us obeying the urge to lash out, cry out, self-harm, or destroy the relationships that means so much to us. Such skills include Distancing ourselves from the emotions, Labelling our emotions, and and Communicating them to others without blaming or being judgemental. We also learn to Challenge our distorted thoughts, and in doing so, alter our belief, our Filters, overtime, and replace them with helpful ones. Hopefully, this adjusts our unhelpful view of reality, and lowers the psychosis-inducing stresses that some BPD sufferers are so vulnerable to.
To Distance myself from the emotions, I play online chess, listen to music, walk in all weathers, or take a long shower and feel the water on my skin. I cloud watch, and in the ever-shifting sky somehow feel my emotions. Basically, I use either techniques to Distract myself from the emotional firestorm, or, practise some form of mindfulness. Then, the identifying and communicating emotions begins with Labelling. According to psychologists and neuroscientists, the more words you know to describe your emotions, the easier it is to understand the subtleties of your emotions and reduce their intensity. Buddhists use the same technique during meditation. The STEPPS therapy program encourages group members to do the same. To this end, I began learning new emotion words based on work by emotion researchers, Shaver et al. (1987). At the end of each day, when I do my STEPPS homework, I tick off any emotions I have felt using the following table (download).
| label_emotions_sheet.pdf |
Once emotions are labelled, the STEPPS program asks a client to describe their thoughts and physical sensations during or leading up to a high-intensity episode. Once feelings, thoughts and physical sensations can be identified and distracting activities used to prevent a BPD sufferer exploding with high-intensity emotions, they can then regulate their emotions more successfully. If emotions are regulated, maybe those stresses that induce hallucinations, paranoia and other psychotic symptoms in some individuals can also be avoided.
Over the remaining ten weeks, STEPPS builds other skills, including problem management, goal setting, relationship management and abuse avoidance to help group members get their lives back on track, or maybe to put them on the track for the first time. As part of this, the group discusses things that can only help such as regular sleeping, healthy eating, and participating in leisure activities. Until the STEPPS Therapy finally ends, why not try identifying how you feel after good night's sleep, or a good meal, then communicate your thoughts and feelings. . . .
Once emotions are labelled, the STEPPS program asks a client to describe their thoughts and physical sensations during or leading up to a high-intensity episode. Once feelings, thoughts and physical sensations can be identified and distracting activities used to prevent a BPD sufferer exploding with high-intensity emotions, they can then regulate their emotions more successfully. If emotions are regulated, maybe those stresses that induce hallucinations, paranoia and other psychotic symptoms in some individuals can also be avoided.
Over the remaining ten weeks, STEPPS builds other skills, including problem management, goal setting, relationship management and abuse avoidance to help group members get their lives back on track, or maybe to put them on the track for the first time. As part of this, the group discusses things that can only help such as regular sleeping, healthy eating, and participating in leisure activities. Until the STEPPS Therapy finally ends, why not try identifying how you feel after good night's sleep, or a good meal, then communicate your thoughts and feelings. . . .
Go To STEPPS 5
TASK
Below are listed Distorted Thoughts (bold), together with an example of that thought. In STEPPS 3, we learned about unhelpful beliefs (filters). Can you identify which unhelpful beliefs might create the distorted thoughts below? Download the Filter Flash Cards and Distorted Thought Flash Cards to help you. You may be able to do this task as a group activity during a STEPPS session.
Distorted Thoughts
Overgeneralise
(draw a general conclusion)
If it happens once, it could happen again.
Give Biased Explanation
(be too negative or positive)
"He didn't text me. He's leaving me!"
"She text me. We will be best friends."
Focus on Negative
You score 9 out 10 on test.
"But I got 1 wrong!"
Reject the Positive
Someone says, "You look nice in that dress."
You think they have poor taste.
Ignore Information
Girlfriend works late, a lot.
Someone always hangs up when I pick up the phone.
Ignore possibility that girlfriend is having an affair.
Make Illogical Connections
"When I enjoy myself, bad things happen."
"Whoever I love with will get sick and die."
"STEPPS therapy will cure me!"
Magnify
(blow things out of Proportion)
Boyfriend says he's tired and wants a night in by himself.
"He's having an affair and is going to leave!"
Reason with Emotions
(believe what you feel is true)
You feel anxious and nervous about your college lecturer.
"The teacher is a bad person."
Blame Others
"My problems are somebody else's fault."
"Others make me feel angry, and cause me to act the way I do."
"It's not my fault, it's theirs!"
Jump to Conclusion
(about what others think or feel)
I got angry at the doctor before he said anything because I knew he would say there was nothing wrong with me.
Label Others
Label other people and react to that label.
"I shun the homeless because they have brought it on themselves."
Take Things Personally
Think everything relates to you.
"Those people I met were laughing in the corner. They were laughing at me."
Believe Should Statements
You believe things should be a certain way.
"My wife should always want to hold my hand. When she doesn't, it shows she does not care for me."
Believe That You are in Control
"I should be able to look after the kids, have a career, do my therapy, and have time for me. If I can't, then its my fault!"
Create Self-fulfilling Prophecy
You image something bad will happen.
You then believe it will happen.
You then act in a way that makes it happen!
Catastrophise
"The therapist will hate me. Even if I stick it out, the STEPPS therapy will never help. No matter what I do, I cannot get well."
Expect Life Should be Fair
"It's not fair that I got BPD and my friends didn't.
They've got children, wives and careers.
Life isn't fair!"
Expect to be Rewarded
"If I do good, only good things should happen to me!"
"Why do bad people win the lottery and not me?"
| distorted_thoughts_-_flash_cards.pdf |
