bus

I have always printed out versions of all the questionnaires but I don't trust myself to get up so I can get them so I'm doing them here.

Before:

Before You Self-Harm
write down the shadow that's hiding behind the urge. look at it. ask yourself:

• how will this situation or feeling change if I hurt myself?
  
  my want for self-destruction will be at least somewhat fullfilled. if I cut as deep as I want to, I probably need stitches and I might lose control and if I go to the ER/A&E for stitches it might have really sucky consequences.
• what will hurting myself bring to the situation? what will it take away from the situation?
  
  it will bring some calmness and satisfaction. it will take away some good things if things go bad.
• how do I want to feel about this in the long run? is hurting myself likely to get me closer to or farther from feeling that way?
  
  I don't really care that much. I know I need to keep it not really really deep because of possible really horrible consequences but for me personally, I don't really care about stopping or not-going-too-deep or anything like that.
• if hurting myself seems like my best option right now, how long will the relief it brings last? what will I do then?
  
  the relief might last for a couple of days or weeks or just a couple of hours depending on how deep I cut and some other aspects. don't know right now.
• what is something I could do now instead of hurting myself? how will it change the situation I'm in? how long will that change last, and what will I do then?
  
  I'm doing the before questions. I'm reading and replying to threads on bus. I can organize all the new pictures I saved on my hard drive. I could get my small and/or big emergency skills box but I have to get up then and then I just might go to the space where I have my tools and everything. not getting up might be safer for now. I could take some prn. the things I'm doing now might help to express my feelings which is good and they also distract me till I am too tired to self-harm in any way. if I feel I'm getting more urgy, I can still get up and go through my emergency skills box and trying something or everything it has inside, just till something works. taking the prn might be the best thing right now as it makes me more tired and calmer and I have the pills and some water right beside me. while waiting for the effect I will be on my laptop till I am so tired that I can't keep my eyes open. I guess that is the best strategy for now.
• how will I feel tomorrow if I hurt myself? how will I feel tomorrow if I do the other thing I came up with?
  
  i don't know. depending how deep I'd cut and how the staff would treat me if I need stitches. i don't know. depending if the urges start again. maybe angry cause I think I'm a wimp and weak for not cutting (I know that this is messed up thinking).
• what do I really want to do right now? how can I best honor the self-protective instinct that has me wanting to self-injure right now?

I rarely know what to say here (to this question). I don't know what I need and what I want to do. I feel like a failure, maybe I need some reassurement that I'm not? but it's night here and I feel too much shame to tell anyone how lazy and evasive I was and am.


urges aren't necessarily the enemy. they happen for reasons, and they're an expression of a desire to stay alive and stay sane and keep coping. remember that.

More Before Questions To Answer

• why do I feel I need to hurt myself? what has brought me to this point?
  
  it started on monday I think? so little energy and so tired (well that has been going on for longer). didn't go to a regular appointment on tuesday and didn't work on a task I had to do. now I feel lots of shame regarding this because I really underestimated the amount of time and work the task needed so I'd be content with the result. and I don't want a make a half-hearted attempt, I want it to be perfect. and even if I'd make a half-hearted attempt it is too little time for that. I also have SI, OD and some slight SU urges at most nights (or sometimes some evening-hours) for a while now and it is getting harder and harder to deal with this without cutting (with a fair bit of damage).
• have I been here before? what did I do to deal with it? how did I feel then?
  
  I know those moods and being overwhelmed though most times I'm really depressed then which isn't the case right now, so I don't really know if I have been exactly at this point. mostly I cut I think. sometimes I just distract myself for days or weeks and the urges go away at some point.
• what I have done to ease this discomfort so far? what else can I do that won't hurt me?
  
  I'm distracting me and also writing about feeling and filling out the before questions (all on bus). I am listening to music. I'm drinking some water as I didn't have enough liquids today. I can do other stuff on my laptop. I can take some prn which often calms me down and makes me more tired so I'd go to bed before doing anything destructive. if I'd get up, I could get my little and my big skills box or a calendar I'm making for a friend which has to be ready on friday and work on it.
• how do I feel right now?
  
  shame, overwhelmed, lonely, a bit sad, lots of self-hate, a bit disconnected from myself and esp my body.
• how will I feel when I am hurting myself?
  
  more "myself", feeling like I'm in my body again. my mind won't be as much occupied with feelings of self-hate, shame, loneliness and overwhelmed feelings.
• how will I feel after hurting myself? how will I feel tomorrow morning?
  
  don't really know. depending on how deep I cut, if the cuts need medical attention and if yes how the staff is in the ER/A&E... depending on so many things. as well for directly after myself and also tomorrow morning.
• can I avoid this stressor, or deal with it better in the future?
  
  it's something I definitely should work on it but I don't have therapy at the moment (hopefully in 6-8 weeks again). it's something that comes up in this or some other form but my urge for self-destruction is always the same.
• do I need to hurt myself?

I guess, I don't really need to hurt myself. it'a bit like "do I WANT to hurt myself?/do I WANT to work on not hurting myself" but it's a good thing that I actually filled out these questionnaires and thinking of doing other (healthy) stuff than just cut.

As I normally write here about cutting (esp. the after posts) there will be a lot of discussion and writing about self-injury, specifically about cutting. If that could trigger you in any way, please don't read! I prefer having no replies rather than someone triggered by what I wrote.

*SI TRIGGER*



After:

Questions to Answer After A Slip
slips are chances to learn. you figure out what stresses are still too hard for you and you can work on how you'll deal with them next time you run into them. so instead of beating yourself up, take action.

• have you taken care of your physical wounds? if not, go do that now. we'll wait.
  
  I have cleaned, steri-stripped and bandaged them as well as possible. I think they are well taken care of.
• what had happened just before?
  
  It’s a bit hard to say as I cut in several instances over the evening and night.
• what were you thinking and feeling?
  
  I was (and still am) pretty detached from myself physically (later dissociating somewhat) and felt lots of self-hate and the strong urge to destroy myself and my head was (and still somewhat is) a mess with old memories and feelings attached to them.
• why did you end up hurting yourself then instead of some other time? was there an event that was the final straw? what was it?
  
  I’m not sure, I’ve only had very few slip-ups since the last severe episode on October the 1st. I was dealing with more and more self-harm urges lately, normally beating them and stayed self-harm free. I’m starting a new therapy with a new therapist and a kinda new therapy approach for me (I just did some of it in my last IP stay but never outpatient) and there were some delays regarding starting it and tomorrow is the first „real“ session and while I’m happy to start, I’m also very anxious and scared.
  
  As for an event that has been the last straw was watching the last 3 episodes of the 2nd season from „13 Reasons Why“ which triggered a lot of memories of my past.
• how did the situation get to the final straw stage? trace it back through the events that led up to the last event. look for some point at which you could have made a different decision and not arrived at the final straw.
  
  I won’t directly trace it back but there were several points where I could have made a different, healthier decision:
  1st: when deciding to watch the episodes of „13 Reasons Why“. I knew it would trigger me but I still watched it cause I wanted to know how it ends and also because I was in „a mood“ (which is hard to explain). I also could have stopped after the first and the second episode I watched so I wouldn’t have worsened things. Though I really really didn’t expect a certain scene in the last episode which was extremely violent and shocking.
  2nd: after cutting superficially on my stomach. I satisfied the need for self-harm somewhat and for a while things got better again.
  3rd: after cutting deeply twice. It was satisfying the need for self-destruction (which is stronger than „just self-harm“) and I did cut with pauses, with breaks in-between, it was slow. And for a while after doing the first deep cut, it was better then it got worse again and then after the second deep cut, it was better and I though I was finished. I started to dissociate though and in that state I cut deeply the third time. Even while filling this out, I have a hard time to not get another razor and keep on cutting deeply till the point of really needing stitches (I knew I would get stitches if I went to ER with the wounds I had but I managed to steri-strip them to the point of closing the wounds so tight that stitches weren’t absolutely necessary anymore), cutting really deep. Last time I felt like I want to destroy myself that badly (in October 2018), I landed in the ER with wounds that the doc at least considered as a possible suicide attempt. I really really should not repeat that!
• were there outside factors like drugs, alsohol, being off your meds, lack of sleep, etc? can you address those in the future? how?
  
  Eating was kinda bad today. I ate a lot of fruit today at least but my dinner consisted of sweets and chips/crisps. Sleep is off for months now, often having a hard time with appropriate „going to bed“ and „getting up“ times. I really have a hard time changing it though I’m onto it and trying. Food is so-so, sometimes better, sometimes bad. At least I took all my meds at the right times today.
• what other ways of coping did you try besides self-harm? how well did they work?
  
  At first (with the superficial stomach cuts) I didn’t try anything. After cutting more deeply on my arm and realising my thoughts and the extent of my urges I wrote a post in my place here and texted a friend if she was still awake and put some music on that I considered helpful at that point (which it really wasn’t and I DO know that normally). Later after the cutting was done, I took an ativan to avoid even more self harm. I think I needed more than one this time and I have more but if I would have taken the amount I’m needing tonight, I wouldn’t really be able to get up tomorrow. Also later (after the cutting was done) my friend replied (which is a little wonder considering it was about 2am) and we wrote a bit and I was able to unload a bit and get some validation and support and also some distraction which helped with not starting to cut again. But that was all – considering I have a small emergency box for very strong urges and having a big box for all kind of feelings and knowing DBT stuff and having worked on skills a lot that is not much. Sometimes I’m in a state where my head hasn’t this resilience to work against cutting and it is okay or even content and happy with self-harming and self-desctruction and it doesn’t care about trying skills or whatever and I don’t really know how to get out of that mindset. I think today it has even started before deciding to watch the eps of „13 Reasons Why“. I wanted to watch them for quite a while now and always decided against it cause I knew it would trigger me. Today I didn’t decide against it and I don’t know why.
• in retrospect, are there coping methods that you now realize might have helped? what were they?
  
  Not as much a coping method I guess but shut off the tv or switching to something light-hearted or distracting.
  Not getting my tools from the shelve to my bed.
  Getting my emergency boxe and just working my way through the skills till something helped.
• name at least two things you will do to help yourself remember those coping methods if you end up in this situation again.
  I don’t know. I have my emergency boxe quite close to my bed, closer than my tools so it would be easier and cost less effort getting the emergency box.
  
  I don’t know how to change the mindset.
• how do you feel about the situation that led to self-harm now? is it resolved? if not, what are some steps you might take toward resolution?
  
  Well, the season is finished and I definitely won’t watch it again. After therapy tomorrow I hope I feel less scared and anxious about it. Definitely have to work on food, water intake, exercise and sleep but I have a real hard time to make any changes regarding it though I tried several things and apps.
• are you likely to be in that emotional place again? how will you recognize it when you're in that situation?
  
  I am very sure that I’m very likely to be in that emotional place again. It consists memories from my past, lots of self-hate and the want/need to self destruction. I know those feelings very well so I think I can recognise them quite easily. Just not sure how to recognise them early enough so I feel able to do something about them.
• what will you try before you resort to self-harm if you're in that situation again? list three specific things you will commit to trying.

I really don’t know. The only things I can think of:

Switch to another series or movie like Brooklyn 99 or Hawaii 5-0 or something like that… or something romantic stuff depending on what I feel.

Only get up to get the emergency box (and my laptop if I don’t have it close to me).

Write here, in my place, text someone on WhatsApp (but make sure there is a way to deal with the emotions etc without having another person reply to anything you write or text so you won’t be diasppointed when no one replies immediately; rely on yourself so you aren’t dependant on other people).

Definitely relpy to the before-questions (an absolute must as it has helped me lots previously), to that I can committ he best, I think.




Any ideas or suggestions? No need for sugarcoating, I can take it and people being straight with me helps. Even when it might be hard right away, after a day or two at the most, I’m able to take that in and react (appropriately) to it.

something that jumped out to me was not sleeping well, as it's also something i struggle with. i have a chart on my wall which has early warning signs for me and what i will do about them. if i'm not sleeping well it's a sign that i hope to act on, by talking to my t, asking for help from my sister, and setting realistic goals (when things are really bad a realistic goal is just to get out of bed for half an hr. when things are mostly ok, a goal might be to change my alarm settings with multiple alarms and try to bribe myself or encourage myself to get up as soon as i can).

a random thought, but maybe you could have one day a week where you go through your coping/emergency box and add to it or change things around, or just look at what's there? i moved my own coping box to my desk and it's partly open and i find that being more aware of it and more familiar with it makes it easier to remember to use when i am dealing with negative feelings or urges.

i empathise with the feelings of not caring about self-destructive behaviour. i do find the before questions helpful for that because the urge to self-destruct is a coping strategy that is there to help me or protect me, and whatever i'm trying to cope with usually has more effective actions that might help. i also think that when i'm passively or actively thinking about su i find myself spiralling faster towards that goal and it takes outside help to try to convince me to try healthy coping strategies, and to continue living even when i don't want to. if you get to know your new t hopefully they will monitor things like that and learn how to help you.

I know it's been ages but thank you for your reply treasure. I need to re-read your reply before I say something about it. For now just posting the "Before..."-questions. I have already written them out by hand but I also want them here so I'm just transferring them from paper to here. It's also the reason why the time isn't completely up to date, it's been a couple of hours:

urges aren't necessarily the enemy. they happen for reasons, and they're an expression of a desire to stay alive and stay sane and keep coping. remember that.

Before You Self-Harm

write down the shadow that's hiding behind the urge. look at it. ask yourself

date: 26.03.19, time: 7:57pm

• Why do I feel I need to hurt myself? What has brought me to this point?
  
  I don't know. I thought about it and tried to find a reason but I wasn't able to find on. Just no feelings and a really strong desire to cut myself.
• Have I been here before? What did I do to deal with it? How did I feel then?
  
  Sometimes, I guess. Most times I can identify at least on feeling which helps to identify the reason why I want to cut. The times like right now are more diffcult to solve, I think. Though I'm not even sure on this.
• What I have done to ease this discomfort so far? What else can I do that won't hurt me?
  
  Music ("Wise Guys" instead of "The Used"/"Linkin Park"), Chili-gummy-bears, writing in my diary, more Wise Guys-Live Videos on You Tube, Lavender aromatherapy oil and Lavender Body Lotion, Before questions
  
  Answering more Before questions, Ice/Coolpack, tidying my flat, sorting further through my art stuff or photos, being creative
• How do I feel right now?
  
  I don't really know, somewhat dissociated, maybe some self-hate (because of comfort eating) and anxiety
• How will I feel when I am hurting myself?
  
  My bad head space lowers, content, more relaxed, maybe I'm feeling my emotions more and can work with them. Depends on how deep I cut though, I feel like I need pretty bad and deep wounds but I really don't want to go to ER/A&E.
• How will I feel after hurting myself? How will I feel tomorrow morning?
  
  Depends somewhat on depth and seriousness of the wounds.
  
  Directly after hurting myself more relaxed, good, relieved but if ER is needed, not so good, stressed out and not getting a lot of sleep because I have an early pdoc appointment tomorrow.
  
  Tomorrow morning good, more relaxed, content - no matter the depth of the wounds -, except for the possible sleep deficit
• Can I avoid this stressor, or deal with it better in the future?
  
  No idea
• Do I need to hurt myself?
  
  Don't know...

More Before questions

Date: 26.03.19, time: 9:34pm

• how will this situation or feeling change if i hurt myself?
  
  I will be calmer, more relaxed and content.
• what will hurting myself bring to the situation? what will it take away from the situation?
  
  Needing to take care of the wounds, more relaxation, needing to fill out the after questions and discuss the incident in therapy
  
  Healed Arms
• how do i want to feel about this in the long run? is hurting myself likely to get me closer to or farther from feeling that way?
  
  I don't know... . I know I SHOULD want to stop cutting and I'm often trying to take steps in that direction (participating in a DBT group, trying skills, doing therapy...) but my inner core and the inner thoughts aren't really on board on it yet. It's hard and a big thing I'm still struggling with lots. I just don't know...
• if hurting myself seems like my best option right now, how long will the relief it brings last? what will i do then?
  
  Might be quite a while. Though when I'm only cutting superficially, I might cut more deeply in the next days.
• what is something i could do now instead of hurting myself? how will it change the situation i'm in? how long will that change last, and what will i do then?
  
  I already tried quite a lot of skills (see the other Before... questions), continue watching "Wise Guys" on You Tube, sorting through art stuff and try to be creative, write more diary, tidying up my room, write on bus.
• how will i feel tomorrow if i hurt myself? how will i feel tomorrow if i do the other thing i came up with?
  
  Okay, content, relaxed.
  
  Depends on the urges I have tomorrow.
• what do i really want to do right now? how can i best honor the self-protective instinct that has me wanting to self-injure right now?
  
  Idk
• Do I need to hurt myself?
  
  Idk, not really I think.