Self Harm: Something We Can Change
Self harm is anything we do, too much or too little, that has a negative impact on our well being. Self harm can be mindless, not thought about, automatic, or more deliberate, to achieve a specific goal, like coping or self help.
Self harm behaviors can:
- Ease tension and anxiety
- Escape feelings of depression
- Escape feelings of numbness
- Relieve anger and/or aggression
- Relieve intense emotional pain
- Regain control over one's body
- Maintain a sense of security or feeling of uniqueness
- Maintain previous abusive patterns (what we know)
- Offer a feeling of euphoria
- Express or cope with feelings of alienation
- Be a response to self hatred or guilt
Treatment includes:
- Acknowledgment and awareness of self harm behavior
- Learning about their emotions, then impact on behavior and emotion management
- Learning distress tolerance skills
- Replacing harmful behavior with more effective, helpful behavior
What is Harm Reduction?
Harm reduction is a term for actions aimed at reducing harmful behavior, however you define it. The focus is to reduce the negative effects of your current behavior by learning new skills. You have the ability to change your behavior. You can start to learn where you are now. Any steps in a healthy direction are to be applauded. These approaches are often the first step towards changing your behavior. Change is focused on movement from more to less harm. Change is a personal choice, which allows one to take responsibility and control. It involves setting goals suited for you. The goal may be to stop the behavior and replace it with something more helpful or to reduce the behavior.
Stages of Change
A change process model recognizes that change typically involves people progressing through various stages of motivation or interest in changing. The stages of change identified by this model are as follows:
Stage 1: Pre-Contemplation
A person in this stage is not ready to admit that they have a problem. They often distance themselves from the problem, either by denial or blaming. They are essentially saying that the current situation is acceptable.
Stage 2: Contemplation
The person in this stage might think that there could possibly be a problem, but they tend to minimize it. This is very much a "thinking" stage when they examine the pros and cons of make a change versus continuing with the current situation/behavior. Often a person experiences the most anxiety during this stage.
Stage 3: Decision
This is a very brief stage. A person will either do something or not. If not, they go back to Stage 1 or 2.
Stage 4: Action
Once a person has made the decision they begin to implement the change. They will also evaluate how the change is going.
Stage 5: Maintenance
At this stage, a person looks at how they can maintain the changes they have made. They have to decide what supports they need for this and how to obtain these supports. They also prepare themselves and their significant others for lapses and relapses.
Stage 6: Lapse or Relapse
A lapse is momentarily going back to the old way. Recognizing a lapse quickly and forgiving yourself is the best way to avoid a relapse.
A relapse is reverting entirely to the old way. It is always possible to again make the decision to change after a relapse.
The Stages of Change model also refers to the process of recycling (reverting back to a previous stage) as a normal part of change that should be anticipated and used as a learning opportunity.
Distress Tolerance
Distress tolerance is the ability to tolerate and survive crises without making things worse. The ability to tolerate and accept distress is essential for two reasons. First, pain and distress are a part of life and cannot be entirely avoided or removed. The inability to accept this fact increases pain and suffering. Second, distress tolerance, at least over the short run, is part of any attempt to change yourself. Change is usually uncomfortable. Efforts to escape pain and distress will interfere with your efforts to establish desired changes.
Goals of Distress Tolerance
- Survive crisis situations without making them worse
- Accept reality; replace suffering and being "stuck" with ordinary pain and the possibility of moving forward
- Become free of having to satisfy the demands of your own distress, urges, and intense emotions
Non-Judgment
Judgments can intensify emotions, making it difficult to problem solve, or to access distress tolerance skills.
- See but don't evaluate as good or bad, just see the facts.
- Accept each moment like a blanket spread out on the grass, accepting both rain and sun, and each leaf that falls upon it.
- Acknowledge the difference between helpful and harmful, the safe and dangerous, but don't judge it.
- When you find yourself judging, don't judge your judging.
A non-judgmental approach does not mean moving from negative judgments to positive judgments. The danger of that approach is an extreme view of "good" and "bad". Focusing on the consequences of behavior or events (pain or destruction), allow one to focus on changing the behavior without adding a label of "bad". It is important to start changing where you are now, without judgment.
How to Use Crisis Survival Skills
You are in a Crisis when the situation is:
- Highly Stressful
- Short term (that is, it won't last a long time)
- Creates intense pressure to resolve the crisis now
Use Crisis Survival Skills when:
- You have intense pain that cannot be helped quickly
- You want to act on your emotions, but it will only make things worse
- Emotion mind threatens to overwhelm you, and you need to stay skillful
- You are overwhelmed, yet demands must be met
- Emotional arousal is extreme, but problems can't be solved immediately
Don't use Crisis Survival Skills for:
- Every day problems
- Solving all your life problems
- Making your life worth living
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