I mentioned in the chat that I was starting therapy, and while its not specifically related to MD right now, I thought I would make a thread where I can share some strategies or whatever that my therapist talks to me about.
I had my first appointment with her this afternoon and I did get myself to mention MD to her. She didn't already know about it, but she seemed interested in learning more so I directed her to the ICMDR and Dr. Somer's research. One of the things that we talked about that I thought would be potentially useful is using a cognitive model to examine your thoughts.
You start off by identifying a thought (or fact), then examine your first interpretation of that thought, the emotion(s) that interpretation creates, and then the behavior caused by the emotion. Once you do that, think of a more positive interpretation of the thought and examine your emotion(s) and behavior caused by that new emotion. For example:
Fact: I'm taking a class in July (Intro to Linguistics) and I know nothing about the subject material.
Interpretation: I'm afraid of taking the class because I don't know anything about linguistics.
Emotion: Anxious and fearful of failure.
Behavior: Avoidance through compulsive behaviors that allow me to escape from the feeling, could potentially get bad enough that I drop the class so that I don't have to deal with the anxiety and fear.
Better interpretation: I'm excited about taking the class because it will give me the opportunity to learn something new and I enjoy learning new things.
New emotion: Happiness, excitement, confidence in my ability.
New behavior: Meeting the challenge head on, allowing my fears to exist without letting them take over, control me, and override the other more positive emotions that I feel when thinking about taking the class.
I thought that this exercise would be potentially beneficial to MDers because a lot of us get stuck in daydreams based on our negative interpretations of thoughts and situations, so being able to interpret things differently would lessen the need to daydream to escape from them.
Don't give up what you want most for what you want now.
I haven't had much new come up in therapy, other than my continuous need to work on identifying and sitting with my emotions and experiences, but I did get some good info from a webinar I attended that was hosted by skinpick.com. It's specifically related to skin picking, but since there is so much similarity, it's still relevant.
This month's webinar was on picking trances, which are pretty similar to the trances we enter when daydreaming for an extended period of time with little awareness of anything else going on. In essence, these trances are a form of experiential avoidance. We enter them to avoid whatever's going on in our real lives, and because they bring us so much relief and pleasure, they are incredibly difficult to break out of.
The trances are soothing because you stop feeling whatever emotions you were originally feeling without actually having to process them or the experiences that lead to them. While they may seem to come on suddenly, they actually build up over time. What the host talked about here reminded me of the 'emotional bucket' metaphor that my therapist has mentioned a couple of times. Basically, everyone has a bucket that our emotions and experiences get put into. If you have proper self care and healthy coping mechanisms, your bucket gets emptied more frequently so that the water level doesn't reach the top as often. If you don't, the emotions and experiences build up until your bucket overflows. In the context of anxiety, this overflowing of the bucket usually appears in the form of a panic attack. It could also appear in the form of explosive anger, a mental breakdown, or a depressive episode. But with people who pick at their skin, or daydream maladaptively, when our bucket overflows, instead of having a panic attack or some other unpleasant mental experience, we shift into a trance state to avoid whatever it is that we have in our bucket.
This knowledge that our episodes don't happen instantaneously can be difficult to understand, especially if your bucket is constantly very full so certain triggers seem to always push you over the edge, even though they aren't the only things that contribute. I'll use myself as an example: it appears like when I get triggered by watching an emotional scene in a movie, I immediately start getting into that trance state. But there are times when I could watch an emotional scene, even that same emotional scene, and not get triggered (or at least not enough to follow through with the urge). This is because watching that scene might sometimes be the thing that overflows my bucket, but sometimes my bucket isn't already on the verge of overflowing. This explains why when my anxiety or level of overwhelm is high, I'm much more reactive and likely to get triggered enough to start daydreaming.
Understanding that your episodes happen because of experiences and emotions building up over time is very helpful. First, you'll be more aware of when those experiences start stacking up, and you'll know to avoid certain things or places that might either overflow your bucket or make it easier to start daydreaming. In the context of picking, if I got stressed out because I don't understand my schoolwork, and then I got into an argument with my mom, those experiences that fill my bucket have started to stack up, so I know to avoid the bathroom as much as I can because I pick most frequently in the bathroom and being in the place where I frequently pick when my bucket is already high will make me more likely to enter a trance state and start picking to avoid my emotions. Second, awareness that your bucket is being filled allows you to employ strategies that act as a pressure release valve to lower that level. If, using the example above, I get stressed out because I don't understand my schoolwork, and instead of ignoring it I employ techniques like mindfulness, exercise, or journalling (or the ever important sitting with and processing my feelings), the level of my bucket is going to lower before I get into an argument with my mom, making it less likely that the argument is going to overflow my bucket.
Because of the nature of the trance states, prophylaxis (using healthy coping skills before you enter a trance state) is much, much more effective than attempting to use your healthy coping skills or competing responses after you've already entered the state. You do, however, have a very small window of opportunity right after the trance begins where you're more likely to be able to pull yourself out. One thing that the host mentioned was to narrate, slowly and out loud, your emotional and physical experiences at that moment. This distances you from the intensity of the urge and the trance and it connects you to your emotional responses, which is super important for MDers.
A final point that he mentioned that I also want to talk about is the experiential avoidance of pleasant things. It can feel baffling that we get the urge to daydream even in response to pleasant things that we actually want to experience. But when you're used to avoiding unpleasant things, it becomes much easier to avoid pleasant ones as well. Another explanation comes from the concept of physiological arousal (side note: its important to note that I'm not talking about sexual arousal, I'm talking about the psychological definition of arousal). Physiologically-speaking, the happiness and excitement that I feel when I accomplish something creates a similar response in the body to what happens when I get anxious about a doctors appointment. For me, the main physical feeling of arousal is whole body tension, especially in my upper body. This state of arousal, whether from something pleasant or unpleasant, triggers me to want to remove the source of the arousal and get back to equilibrium. So even though I enjoy the happiness and excitement from accomplishing something, my body doesn't, and I fall back on my experiential avoidance to get rid of the arousal.
I have no idea if any of this made even the slightest amount of sense. You're welcome to ask questions if you have them and I'll answer them as best I can :)
Don't give up what you want most for what you want now.