Mind and Emotions (24 page)

4. _______________ I have no idea how I am feeling.

5. _______________ I have difficulty making sense out of my feelings.

6. _______________ I am attentive to my feelings.

7. _______________ I know exactly how I am feeling.

8. _______________ I care about what I am feeling.

9. _______________ I am confused about how I feel.

10. _______________ When I’m upset, I acknowledge my emotions.

11. _______________ When I’m upset, I become angry with myself for feeling that way.

12. _______________ When I’m upset, I become embarrassed for feeling that way.

13. _______________ When I’m upset, I have difficulty getting work done.

14. _______________ When I’m upset, I become out of control.

15. _______________ When I’m upset, I believe that I will remain that way for a long time.

16. _______________ When I’m upset, I believe that I will end up feeling very depressed.

17. _______________ When I’m upset, I believe that my feelings are valid and important.

18. _______________ When I’m upset, I have difficulty focusing on other things.

19. _______________ When I’m upset, I feel out of control.

20. _______________ When I’m upset, I can still get things done.

21. _______________ When I’m upset, I feel ashamed at myself for feeling that way.

22. _______________ When I’m upset, I know that I can find a way to eventually feel better.

23. _______________ When I’m upset, I feel like I am weak.

24. _______________ When I’m upset, I feel like I can remain in control of my behaviors.

25. _______________ When I’m upset, I feel guilty for feeling that way.

26. _______________ When I’m upset, I have difficulty concentrating.

27. _______________ When I’m upset, I have difficulty controlling my behaviors.

28. _______________ When I’m upset, I believe there is nothing I can do to make myself feel better.

29. _______________ When I’m upset, I become irritated at myself for feeling that way.

30. _______________ When I’m upset, I start to feel very bad about myself.

31. _______________ When I’m upset, I believe that wallowing in it is all I can do.

32. _______________ When I’m upset, I lose control over my behavior.

33. _______________ When I’m upset, I have difficulty thinking about anything else.

34. _______________ When I’m upset, I take time to figure out what I’m really feeling.

35. _______________ When I’m upset, it takes me a long time to feel better.

36. _______________ When I’m upset, my emotions feel overwhelming.

(Copyright 2004 by Kim L. Gratz, Ph.D., and Lizabeth Roemer, Ph.D. Used with permission.)

Scoring: Put a minus sign in front of your rating numbers for these items: 1, 2, 6, 7, 8, 10, 17, 20, 22, 24, and 34. Then sum up all your ratings, adding the positives and subtracting the negatives, and write the result here: _______________.

Once again, this score represents how much difficulty you’re having with emotion regulation now, today. If this number is lower than your previous scores, congratulations on acquiring some valuable skills that will serve you for the rest of your life.

If this score is the same or higher than either of your previous scores, you still have room for improvement. Most people who are still experiencing significant emotion dysregulation at this point find that they didn’t fully put into practice the techniques in the chapters on emotion exposure. Willingly exposing yourself to whatever frightens, depresses, angers, or shames you is the most difficult task in this book, and it also yields some of the greatest benefits.

If you feel that you need to do more exposure work, go back to chapter 11, Imagery-Based Emotion Exposure, and work through the book from that point forward, taking one small and very deliberate step at a time.

If you feel you gave exposure an honest effort and couldn’t go it alone, consider enlisting the aid of a cognitive therapist or other qualified counselor with experience in helping people with mood disorders.

Regardless of your score on this exercise today, don’t close the book until you read the final chapter and prepare a relapse plan, just in case.

Chapter 14

Relapse Prevention

Occasionally slipping back into your old ways of dealing with painful emotions is inevitable. The skills you’ve learned in this book work well, but they aren’t a “single-dose” solution like the polio vaccine. Rather, you have to monitor yourself on an ongoing basis and apply your skills as needed.

Because you’re bound to experience the occasional relapse from time to time, it makes sense to have a plan for what to do about it. That way you can promptly get back on a more even keel emotionally and spend as little time as possible in distress. This chapter will help you draft such a plan.

The first step is to recognize the signs of relapse. How do you know when you’ve relapsed, anyway? If you’re trying to stop smoking or drinking, relapse is obvious: It happens whenever you smoke or drink again. But relapse in the realm of mind and emotions is more subtle. You have to watch for signs that you’re slipping back into your old habitual ways of thinking and acting.

Learning the Signs of Emotion Dysregulation

As you keep an eye on yourself, here are some signs that can alert you that you’re slipping back into emotion dysregulation. Answer each set of questions as best you can. With time, you may gain more insight into your personal signs of emotion dysregulation. You can always expand on your answers later. If you need a little help getting started, a sample follows the blank version.

Red Flag Emotions

By this point in the book, you should have a pretty good idea of what your red flag emotions are. Still, take a moment to list the feelings that bother you the most and that you have the most trouble dealing with:

_______________

_______________

_______________

_______________

High-Risk Situations

Now consider your high-risk situations. In what circumstances are you most likely to experience your red flag emotions? Where are you? Who are you with? What’s happening? In the space below, make a list of the people, places, and activities that are most likely to trigger problematic feelings:

_______________

_______________

_______________

_______________

Emotion-Driven Behavior

What do you do when your emotions are driving you? Yell and curse? Ramble on? Withdraw? Procrastinate? Apologize? Check things excessively? Stay at home every night? Go out constantly? Take a moment to record the things you typically do when your painful feelings are in charge:

_______________

_______________

_______________

Rumination, Worry, and Negative Appraisals

What are you thinking about when you experience intense, painful feelings? What’s going through your mind and bringing up those feelings over and over or prolonging them for hours or days? What past events do you ruminate about? What future possibilities do you worry about? What negative labels do you habitually apply to your experience? Write your usual topics for rumination, worry, and negative appraisal here:

_______________

_______________

_______________

_______________

Avoidance and Suppression

How do you try to avoid or suppress painful feelings? Do you limit your life by staying away from certain people, places, or activities? Do you try to keep your mind blank or numb? Do you try to keep painful feelings at bay with certain repetitive mental rituals? In the space below, list the ways you most typically try to avoid or suppress your feelings:

_______________

_______________

_______________

_______________

Emily, a recently divorced forty-six-year-old teacher, had two teenage children, and she worried about them a lot. She was behind on her bills and also worried about her mother, who was becoming more and more forgetful and irritable. Here is how Emily listed her signs of emotional dysregulation.

Red Flag Emotions

Anxiety, guilt, depression

High-Risk Situations

Visiting Mom

When my kids are away from home

Paying bills

Emotion-Driven Behavior

Fussing and nagging at Mom

Calling kids’ cell phones too much

Overspending on the credit card

Rumination, Worry, and Negative Appraisals

My wild, reckless youth

Envisioning my kids being assaulted or getting in car wrecks

Bankruptcy, not having a place to live, and thinking “I’m a failure”

Avoidance and Suppression

Keeping the TV on all the time

Postponing visits to Mom

Procrastinating on the bills

What to Do

The most important step in dealing with a relapse is recognizing that you’re having a relapse. Once you realize that you’re in a high-risk situation and starting to experience red flag emotions, you can start applying the skills you’ve learned in this book, using the guidelines below.

Curb Emotion-Driven Behavior

If you’re fighting the urge to engage in emotion-driven behavior—or if you’ve already given in to that urge—review chapter 9, Doing the Opposite. For depression, focus on values-based action (see chapter 4) and stay active instead of withdrawing. For anxiety, use the exposure processes you learned in chapters 11 through 13 to face what scares you instead of avoiding it. With anger, empathize with and validate others instead of venting. For shame and guilt, approach people and situations instead of withdrawing from them.

If your emotion-driven behavior strongly affects your close relationships, also revisit chapter 10, Interpersonal Effectiveness. For healthy alternate behaviors, remember what you learned about building positive, pleasurable activities into your lifestyle in chapter 8, Self-Soothing.

Reduce Rumination, Worry, and Negative Appraisals

If you find yourself falling into rumination, worry, or negative appraisals, review chapter 5, Mindfulness and Emotion Awareness, to accept your feelings and let yourself experience an emotion as it comes. Observe the feeling and let it run its course without trying to avoid or suppress it, and without intensifying it with negative thoughts, judgments, or predictions.

Chapter 6, Defusion, is good for reminding yourself about the nature of your mind and how thoughts come and go. Practice exercises such as MilkMilkMilk, Leaves in a Stream, White Room Meditation, Labeling Thoughts, and “Thank You, Mind.” Also consult chapter 7, Cognitive Flexibility Training, for techniques such as Drafting a Worst-Case Coping Plan, Using Big-Picture Awareness, Finding Alternative Explanations, and Transforming Shoulds into Preferences.

Avoid Avoidance

If you find yourself trying to avoid experiencing painful emotions, return to the skills you learned in chapters 11 through 13, on exposure exercises for emotion avoidance. The key to avoiding avoidance is to expose yourself to your painful feelings, observing them and accepting their natural rhythm as they arise and subside. Finally, chapter 4, Values in Action, will remind you that your life is about more than your fears, losses, or transgressions and increase your motivation to tolerate difficult experiences in the service of living in alignment with your values.

Drafting Your Relapse Plan

Take time right now, before you close this book, to draft your relapse plan in the space below.

WHEN I RECOGNIZE MY DANGER SIGNS

Red flag emotions: _______________

_______________

Emotion-driven behaviors: _______________

_______________

Increased worry, rumination, or negative appraisals about: _______________

_______________

Avoidance of these painful feelings: _______________

_______________

I WILL PRACTICE MY EMOTION REGULATION SKILLS

Instead of this emotion-driven behavior: _______________

_______________

I will do the opposite: _______________

_______________

My daily self-soothing ritual will be: _______________

_______________

I will express my needs or set limits by saying: _______________

_______________

I will set time aside daily for mindful observation of my breath, thoughts, sensations, and emotions.

Time or situation: _______________

I will use this cognitive flexibility skill daily: _______________

Time or situation: _______________

I will use this defusion skill daily: _______________

Time or situation: _______________

I will practice one emotion exposure exercise daily.

Situation: _______________

Time: _______________

Place: _______________

Conclusion

Although occasional relapses are inevitable, they are also transient. By being alert to the signs that you’re slipping back into ineffective ways of reacting to painful emotions, you can quickly get back on track by applying the emotion regulation skills you’ve learned in this book.

References

Allen, L. B., R. K. McHugh, and D. B. Barlow. 2008. Emotional disorders: A unified protocol. In D. H. Barlow, ed.,
Clinical Handbook of Psychological Disorders
, pp. 216-249. New York: Guilford Press.

Beck, A. T., and G. Emery. 1985.
Anxiety Disorders and Phobias: A Cognitive Perspective.
New York: Basic Books.