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By Billie Rae
How are you feeling today?
This can be a pretty loaded question at the best of times, and during a global pandemic it’s often downright scary, as if someone just asked you for the meaning of life.
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How are you feeling today? Yeah, not too bad, just trying to get on with my schoolwork, which I can’t concentrate on because I’m worried about what’s been happening in the news, so I guess that’s been stressing me out...well, I’m sad because I don’t know when I’ll be able to see my girlfriend again, and it makes me so angry when my mum hogs the TV, and oh gosh, when will all this end? So, to answer your question, um...I don’t really know.’
It’s very hard to describe how COVID-19 can make us feel. Sometimes we feel good, normal even. Sometimes we feel one emotion, like sadness or anger, really intensely, so much that we can’t focus on anything else.
Sometimes we feel lots of emotions that keep happening all at once, often to the point that sometimes it can be hard to tell them apart and they turn into a big tangled mess of ‘bad’ in our brains that seems to keep growing and growing. Other times we don’t seem to feel anything at all, and we go about your days feeling just, well, ‘fine’: not sad, but not happy either. We might have trouble sleeping, or feel more tired than usual, or struggle to enjoy activities we normally love. If we haven’t already experienced mental illness we might be suddenly forced to seek help, and if we have, our conditions might appear to be coming back with a vengeance.
What if I told you that this is how I live my life, every day?
I suffer from a condition called Borderline Personality Disorder, sometimes known as Emotionally Unstable Personality Disorder (EUPD). I won’t go into detail on the symptoms of it here, but I will provide links to various resources that can help you educate yourselves. What I will say is that this condition causes me to experience intense, unpredictable emotions that last a long time, sometimes seem to come out of nowhere and very often can be so overwhelming that it makes it difficult for me to function in society, which is the main reason why I consider it and my multiple other mental illnesses a disability.
I’ve dealt with this condition for as long as I can remember and consider myself far from being recovered, so as you can imagine I have a lot of experience dealing with difficult emotions, managing anxiety and staying as functional as I can when it feels like the world is crumbling around me. One of the best ways I’ve learned to overcome this along the way is something called Dialectical Behavioural Therapy (DBT), a modified form of the more widely known Cognitive Behavioural Therapy that was developed by Marsha Linehan in the 1980s as a brand-new way of approaching long-term mental illnesses. It’s directed towards people with EUPD like myself, but over the years it’s proven very helpful for all kinds of conditions that are often seen as difficult or impossible to treat, including major depression, PTSD, addiction and traumatic brain injuries. I’ve written this article to share some aspects of DBT that I think will be extremely helpful to many of us during the pandemic and beyond: they have been life-saving for me, and I don’t understand why they’re so obscure at the moment. The skills I’ll be covering- radical acceptance, mindfulness and emotional regulation (dealing with intense emotions) are discussed in detail in the DBT Skills Workbook by Matthew McKay, Jeffrey Wood and Jeffrey Brantley, and I’ll be demonstrating how we might want to use these skills in various pandemic-related situations.
Radical Acceptance, or Staying Sane When Nothing Makes Sense Anymore
When I first heard about the growing threat of COVID-19, I didn’t want to believe it could be happening. It seemed like a bad dream. The truth only started to hit me when term had ended early and I’d arrived home from uni with my bags hastily packed. It hit me like a ton of bricks, and it made me sad and angry and frightened all at once: sad that I’d been separated from my best friends and forced to live at home with my unsupportive parents, angry that my university was doing a terrible job of helping students cope and afraid of what the world might look like in a few months’ time, or of what would happen if I caught the virus. I wanted to shout, scream, lash out, blame someone and do every self-destructive thing I could think of, not necessarily in that order. If some version of this feeling sounds familiar to you, however small it may seem, you are not alone and I hear you.
Yet this served as a painful reminder of how I normally feel when faced with virtually any form of change, uncertainty or rejection in life: the classic EUPD experience, where your intense emotions make you desperate to take them out on your loved ones, to find something or someone to blame, to do something, anything, to make it stop. The only thing that helped me here was the skill discussed in chapter one of the DBT Skills Workbook: radical acceptance.
This sounds like a piece of New Age mumbo-jumbo, as many DBT skills do, but it’s actually a very useful tool for coping with intense emotions without hurting ourselves or anyone else. The word ‘radical’ comes from the Latin word radix meaning ‘root’: we have to accept our emotions by getting to their roots and being properly OK with them as a whole.
Sometimes we engage in unhealthy coping strategies to help us mask or tolerate our emotions rather than accepting them radically, and during a pandemic these behaviours can be normalised. Drinking too much because we miss our friends, binge-eating or restricting food intake to cope with the anxiety and loss of control, yelling at the people we live with when they haven’t done anything wrong: these are so common that people are making memes about them. These are all forms of distress tolerance, which is a fancy way of describing how we cope when things are making us so upset or overwhelmed that we can’t cope. Whilst they can be fine or even healthy in moderation, they don’t address the root of the emotions they are trying to soothe. They often come from destructive or negative thought patterns, like “It’s selfish for me to be sad that I can’t see my friends- there are people dying!”, or “I wish I’d moved in with my girlfriend before this happened! Then I’d be happy like Sarah who got married last month,” or “Watching the news and seeing how world leaders are behaving makes me so anxious and upset that I can’t possibly get through a day without three G&Ts…”
If we catch ourselves going down a path similar to this, we can use radical acceptance to help steer ourselves onto a healthier path, without resorting to unhealthy coping mechanisms like this as quickly as we might otherwise.
The DBT Skills Workbook lists several ‘coping statements’ we can use to practice radical acceptance. They all focus on accepting the present moment, and your state of mind, as they are now, instead of trying to fight or deny them.
“The present is the only moment I have control over.”
“The present moment is perfect, even if I don’t like what’s happening.”
“This moment is exactly as it should be, given what’s happened before it.”
“This moment is the result of over a million other decisions.”
The important thing about all of these statements is that they focus on accepting things as they are now, regardless of how bad the situation is, without minimising how you might feel about it. One thing that we see a lot in how people cope in crisis is phrases like ‘think positive’, ‘count your blessings’ and ‘look forward to when this is all over’. It’s in the rainbow pictures in people’s windows, in images shared on social media: while this kind of thing can brighten your day for a few moments, in the long term it can be much better for your mental health to accept the present as it is now, rather than waiting for things to get better or forcing yourself to be happier than you really are.
Next time you find yourself spiralling into thought patterns like this, it may be a good idea to try to follow this process instead:
Repeat one of these statements in your mind. Try to think really hard about the meaning of the words you are saying. Tell yourself that you can’t change what’s happening in this moment, and that’s OK.
Find a pleasurable, safe activity to help distract you, preferably something easy, low-effort and really enjoyable, and try to ‘ride the wave’ until you are feeling more able to cope. I like to play video games, watch funny videos on YouTube or start a Netflix party or online game with a friend (this can help you find some company without making things worse by fixating or ruminating on what’s bothering you by endlessly venting to your friends).
Remember: try to accept things as they are now, even if you can’t bring yourself to be OK with them just yet. Radical acceptance in the face of distress is a skill that you have to build up over time, and distress tolerance doesn’t improve overnight.
Dealing with Difficult Emotions
Radical acceptance leads us straight into our next DBT skill: managing intense or challenging emotions. These could take any form, from being so angry that we want to slam doors or throw things to feeling so sad we can’t see ourselves ever being happy again. They might have physical effects: heart palpitations, feeling sick, struggling to breathe and loss of appetite to name a few: many people with EUPD say their emotions can feel like intense physical pain. For us EUPD sufferers, intense emotions are something that we have to live with all the time, and sadly there’s often no explanation or reason for this, but in a pandemic it’s totally understandable if you notice negative emotions like sadness, fear, anger etc becoming stronger, longer-lasting and more unpredictable than usual, even if they don’t seem to be directly related to what’s happening around you. Yet during these times it’s just as easy for us to ignore them. We might try and ‘keep a stiff upper lip, as the Brits are known for, or surround ourselves with statements like this: ‘Good vibes only!’; ‘Stay positive! Get rid of negativity in your life!’ ‘Being angry solves nothing!’ Sound familiar? This is toxic positivity back at it again, trying to assign moral value to feelings we often can’t control.
Now, please bear with me because I did not study Biology past GCSE level. Emotions are electrical and chemical responses to our environments, and they are extremely important: they allow us to avoid danger, remember things, cope with traumatic events and communicate with others. This is why we have to apply radical acceptance to them: they are not inherently good or bad, and we shouldn’t see ourselves as inherently good or bad for feeling a certain way.
Let’s look at an example of this I experienced back in March, when I found out I wouldn’t be able to see my long-distance girlfriend until late May at the earliest. Two months didn’t seem like a long time to wait, but we had already been apart for a while and had been planning to see each other at the beginning of April. Of course, when I found this out I felt angry, devastated and sad. I had accepted the situation for what it was, and I knew there was nothing I could do to change it, but the worst thing about it was that I felt angry with myself for feeling angry and sad. This created a snowball effect where I kept feeling angrier and sadder until I could hardly sleep, eat or breathe.
Then, at some point, I realised why I couldn’t seem to stop feeling this way. I was treating my feelings of intense sadness like a monster under the bed: something huge, scary and evil that wouldn’t go away. When emotions are very powerful they can feel just like the gospel truth. But they aren’t really like that.
Emotions aren’t good or bad, right or wrong. They just are, and they don’t last forever. They are not shameful, bad or unnecessary. And they aren’t facts: they can’t be ‘real’ or ‘fake’.
There is a difference between having an emotion and doing something or acting on the emotion. When I felt that deep pit of sadness forming in my stomach back in March, I could have done a number of things. I could have taken it out on my girlfriend, screaming at her over FaceTime even though none of this was her fault. I could have reverted back to my old coping mechanism of self-harm, despite having been clean for several months. But when I thought about it for a little longer, something clicked.
I didn’t have to do any of these things. I didn’t have to act on my emotions at all. Because my feelings were morally neutral and weren’t inherently good or bad, there was no real need for me to rush in and try and ‘fix’ them with self-destructive behaviours. All I needed to do was recognise them for what they were, and let myself feel them. So I did, and gradually I was able to calm down and focus on the things that I knew mattered, like my degree, my hobbies and the parts of my relationship I could still access.
We can try and keep this in mind whenever we experience strong emotions that feel difficult or impossible to cope with. One thing that helps me is this: whenever I get an urge to act destructively on a strong emotion, I wait one minute. I wait for exactly 60 seconds, during which I remind myself that I get to choose how I respond to how I am feeling, and that I am not a bad person for feeling this way. When the minute is up, I am usually able to deal with the situation more calmly, or talk about how I am feeling to a loved one.
After emotionally intense situations I also like to reflect on how I dealt with it, in a neutral and non-judgemental manner. Chapter 6 of the DBT Skills Workbook gives you a series of questions you can ask yourself about how you reacted to a particular emotion:
When did the situation happen?
What happened?
Why do you think that situation happened?
How did that situation make you feel, both emotionally and
physically?
What did you want to do as a result of how you felt?
What did you do and say?
How did your emotions and actions affect you later?
Some people find it helpful to write these down in a journal, but this isn’t mandatory. The most important thing when you feel an overwhelming emotion is to accept the emotion as it is, wait and reflect on how you responded.
Another thing that’s important to remember is that you can have two emotions at once. This may sound a bit too obvious, but in stressful situations it can be easy to think of things in black-or-white terms e.g. ‘I can either be totally OK with the way things are at the moment, OR I can be completely devastated, OR I can be completely apathetic and not care at all.
This isn’t true. You CAN have two thoughts at the same time, even if they appear to contradict each other.
To help get out of the habit of thinking in black and white, instead of saying, ‘I feel X, but I feel Y’ try saying ‘I feel X, and I feel Y.’ You can feel grateful for what you have, and be disappointed about plans being cancelled. You can enjoy extra time with loved ones and feel overwhelmed by their presence. You can feel hopeful and scared for the future. Putting our feelings into boxes does not make things any easier.
Some Tips On Mindfulness
If you’ve read this article and feel like this is a lot of information to take in, that’s OK. DBT and learning to be in tune with our emotions are hard, hard work. It took me months to get to this level of understanding and I am learning new things every day, so the best thing you can do is take what appears most doable for you and go from there. But the one thing I’d encourage you to take from this is that the best way to feel in control of your state of mind is to be aware and mindful of the present moment.
You’ve likely heard the term ‘mindfulness’ come up loads of times in your life before and during the pandemic: in advice brochures, self-help articles, in the news, around your workplace. To be perfectly honest I don’t think it’s as well understood as it should be (I won’t pretend to be an experienced scholar of Eastern philosophy), but the DBT Skills Workbook gives what I think is a pretty good definition:
“...the ability to be aware of your thoughts, emotions, physical
sensations, and actions—in the present moment—without judging or criticizing yourself or your
Experience.” [64]
So it’s not all about 10-minute meditations and spa music (as awesome as those things are); it’s really about being in tune and aware of your thoughts and actions in the moment, the core of DBT. All of the points I’ve discussed above focus on mindfulness, but as a skill it can be difficult to put into practice at first. To give you a head-start I’ve included a couple of simple exercises which helped me in the early stages of my DBT journey. They may work for you or they may not, but they sure have been tried and tested. They’re meant to be practised over time and will feel difficult at first, but if you try at least one every day for a week or so you may start to feel more in tune with how you’re feeling.
Focus on a Single Object (from Skills Workbook pg68)
This one is really good for when you are stressed or ‘dysregulated’ as my therapist would say.
Pick a small object to focus on. Choose something that can rest on a table, is safe to touch, and is emotionally neutral. It can be anything, such as a pen, a ring or something similar.
Find a comfortable place to sit in a room where you won’t be disturbed for a few minutes, and
put the object on a table in front of you. Turn off any distracting sounds. Set a timer for five minutes.
Sit comfortably and take a few slow, deep breaths. Then, without touching the object, begin looking at it and exploring its different surfaces with your eyes. Take your time exploring what it looks like. Then try to imagine the different qualities that the object possesses.
What does the surface of the object look like?
Is it shiny or dull?
Does it look smooth or rough?
Does it look soft or hard?
Does it have multiple colors or just one color?
What else is unique about the way the object looks?
If your mind wanders, don’t worry, just notice and refocus on the object.
Take your time observing the object. Now hold the object in your hand or reach out and touch the object. Begin noticing the different ways it feels.
Is it smooth or is it rough?
Does it have ridges or is it flat?
Is it soft or is it hard?
Is it bendable or is it rigid?
Does the object have areas that feel different from each other?
What does the temperature of the object feel like?
If you can hold it in your hand, notice how much it weighs.
What else do you notice about the way it feels?
Continue exploring the object with both your sight and your sense of touch. Continue to breathe
comfortably. When your attention begins to wander, return your focus to the object. Keep on exploring
the object until your timer goes off or until you have fully explored all the qualities of the object.
Band of Light- from Skills Workbook pg69
This exercise will help you become aware of how you are feeling physically: whether you are tense from anger, or your stomach is hurting from anxiety.
To begin, find a comfortable place to sit in a room where you won’t be disturbed for ten minutes.
Turn off any distracting sounds. Take a few slow, long breaths and then close your eyes. Using your imagination, envision a narrow band of white light circling the top of your head like a halo. As this exercise progresses, the band of light will slowly move down your body, and as it does, you will become aware of the different physical sensations you’re feeling beneath the band of light.
As you continue to breathe with your eyes closed, continue to see the band of white light encircling the top of your head and notice any physical sensations you feel on that part of your body. Perhaps you will notice your scalp tingling or itching. Whatever sensations you notice are OK.
Slowly the band of light begins to descend around your head, passing over the tops of your ears, your eyes, and the top of your nose. As it does, become aware of any sensations you feel there, even small sensations.
Notice any muscle tension you may be feeling on the top of your head.
As the band of light slowly descends over your nose, mouth, and chin, continue to focus on any physical sensations you might be feeling there.
Pay attention to the back of your head where you may be having sensations.
Notice any sensations you may be feeling in your mouth, on your tongue, or on your teeth.
Continue to watch the band of light in your imagination descend around your neck, and
notice any feelings in your throat or any muscle tension on the back of your neck.
Now the band widens and begins to move down your torso, across the width of your
shoulders.
As the band of light continues to descend down around your arms, notice any feelings
you’re aware of in your upper arms, elbows, forearms, wrists, hands, and fingers. Become aware of any tingling, itching, or tension you might be holding in those places.
Notice any sensations, muscle tension, or tingling you might be feeling in your shoulders, upper back, upper arms, and upper chest area.
Now become aware of your chest, the middle of your back, the side of your torso, your lower back, and stomach. Again, notice any tension or sensations, no matter how small they might be.
As the band continues to move down your lower body, become aware of any sensations in your pelvic region, buttocks, and upper legs.
Be sure to pay attention to the backs of your legs and notice any feelings there.
Continue to watch the band of light descend around your lower legs, around your calves, shins, feet, and toes. Notice any feelings or tension you’re experiencing.
Then as the band of light disappears after completing its descent, take a few more slow, long breaths, and when you feel comfortable, slowly open your eyes and return your focus to the room.
DBT isn’t easy. Most of the time it feels strange, artificial, even uncomfortable, but it’s about creating long-term habits that will help you in the long term. And with social distancing and quarantine measures set to last for a while longer yet, a lot of us have both plenty of time and an ever greater need to stay in tune with how we are feeling. The bottom line is that yes, it’s hard, and we can be hopeful, but that doesn’t make it any less hard- and we are not bad or weak for finding it hard. We are going through a collective trauma. We can’t expect to react to it perfectly. So don’t be afraid to reach out to loved ones, friends or anyone you trust. We’re not exactly ‘in the same boat’, but we will get through this together.
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