
                                  Self-Help:
                            Organized and otherwise
                                       
   This section contains a variety of ways that you can stop yourself
   from making that cut or burn or bruise right now.
   
   [1]Am I ready to stop?
   [2]How do I start stopping?
   [3]What to do RIGHT NOW instead of SI
   [4]What if I do all this and I still want to harm?
   [5]"Fake" pain -- Understanding the urge
   [6]DBT skills
   [7]More suggestions
   [8]BCSW
   [9]S.A.F.E.
   [10]First Aid
   [11]Dealing with intrusive thoughts after stopping
   
How do I know if I'm ready to stop?

   Deciding to stop self-injury is a very personal decision. You may have
   to consider it for a long time before you decide that you're ready to
   commit to a life without scars and bruises. Don't be discouraged if
   you conclude the time isn't right for you to stop yet; you can still
   exert more control over your self-injury by choosing when and how much
   you harm yourself, by setting limits for your self-harm, and by taking
   responsibility for it. If you choose to do this, you should take care
   to remain safe when harming yourself: don't share cutting implements
   and know basic [12]first aid for treating your injuries.
   
   Alderman (1997) suggests this useful checklist of things to ask
   yourself before you begin walking away from self-harm. It isn't
   necessary that you be able to answer all of the questions "yes," but
   the more of these things you can set up for yourself, the easier it
   will be to stop hurting yourself.
   
     While it is not necessary that you meet all of these criteria
     before stopping SIV, the more of these statements that are true for
     you before you decide to stop this behavior, the better.
     * I have a solid emotional support system of friends, family, and/or
       professionals that I can use if I feel like hurting myself.
     * There are at least two people in my life that I can call if I want
       to hurt myself.
     * I feel at least somewhat comfortable talking about SIV with three
       different people.
     * I have a list of at least ten things I can do instead of hurting
       myself.
     * I have a place to go if I need to leave my house so as not to hurt
       myself.
     * I feel confident that I could get rid of all the things that I
       might be likely to use to hurt myself.
     * I have told at least two other people that I am going to stop
       hurting myself.
     * I am willing to feel uncomfortable, scared, and frustrated.
     * I feel confident that I can endure thinking about hurting myself
       without having to actually do so.
     * I want to stop hurting myself.
       
     [Alderman (1997) p. 132]
     
How do I stop? And anyway, aren't some of these techniques just as "bad" as SI?

   There are several different flat-out-crisis-in-the-moment strategies
   typically suggested. My favorite is doing anything that isn't SI and
   produces intense sensation: squeezing ice, taking a cold bath or hot
   or cold shower, biting into something strongly flavored (hot peppers,
   ginger root, unpeeled lemon/lime/grapefruit), rubbing Ben-Gay or
   Icy-Hot or Vap-O-Rub under your nose, sex, etc. [13]Matching
   reactions and feelings is extremely useful.
   
   These strategies work because the intense emotions that provoke SI are
   transient; they come and go like waves, and if you can stay upright
   through one, you get some breathing room before the next (and you
   strengthen your muscles). The more waves you tolerate without falling
   over, the stronger you become.
   
   But, the question arises, aren't these things equivalent to punishing
   yourself by cutting or burning or hitting or whatever? The key
   difference is that they don't produce lasting results. If you squeeze
   a handful of ice until it melts or stick a couple of fingers into some
   ice cream for a few minutes, it'll hurt like (to quote someone I
   respect) "a cast-iron bitch" but it won't leave scars. It won't leave
   anything you'll have to explain away later. You most likely won't feel
   guilty after -- a little foolish, maybe, and kinda proud that you
   weathered a crisis without SI, but not guilty.
   
   This kind of distraction isn't intended to cure the roots of your
   self-injury; you can't run a marathon when you're too tired to cross
   the room. These techniques serve, rather, to help you get through an
   intense moment of badness without making things worse for yourself in
   the long run. They're training wheels, and they teach you that you can
   get through a crisis without hurting yourself. You will refine them,
   even devise more productive coping mechanisms, later, as the urge to
   self-injure lessens and loses the hold it has on your life. Use these
   interim methods to demonstrate to yourself that you can cope with
   distress without permanently injuring your body. Every time you do you
   score another point and you make SI that much less likely next time
   you're in crisis.
   
   Your first task when you've decided to stop is to break the cycle, to
   force yourself to try new coping mechanisms. And you do have to force
   yourself to do this; it doesn't just come. You can't theorize about
   new coping techniques until one day they're all in place and your life
   is changed. You have to work, to struggle, to make yourself do
   different things. When you pick up that knife or that lighter or get
   ready to hit that wall, you have to make a conscious decision to do
   something else. At first, the something else will be a gut-level
   primitive, maybe even punishing thing, and that's okay -- the
   important thing is that you made the decision, you chose to do
   something else. Even if you don't make that decision the next time,
   nothing can take away that moment of mastery, of having decided that
   you were not going to do it that time. If you choose to hurt yourself
   in the next crisis time, you will know that it is a choice, which
   implies the existence of alternative choices. It takes the
   helplessness out of the equation.
   
So what do I do instead?

   Many people try substitute activities as described above and report
   that sometimes they work, sometimes not. One way to increase the
   chances of a distraction/substitution helping calm the urge to harm is
   to match what you do to how you are feeling at the moment.
   
   First, take a few moments and look behind the urge. What are you
   feeling? Are you angry? Frustrated? Restless? Sad? Craving the feeling
   of SI? Depersonalized and unreal or numb? Unfocused?
   
   Next, match the activity to the feeling. A few examples:
   
  angry, frustrated, restless
  
          Try something physical and violent, something not directed at a
          living thing:
          Slash an empty plastic soda bottle or a piece of heavy
          cardboard or an old shirt or sock.
          Make a soft cloth doll to represent the things you are angry
          at. Cut and tear it instead of yourself.
          Flatten aluminum cans for recycling, seeing how fast you can
          go.
          Hit a punching bag.
          Use a pillow to hit a wall, pillow-fight style.
          Rip up an old newspaper or phone book.
          On a sketch or photo of yourself, mark in red ink what you want
          to do. Cut and tear the picture.
          Make Play-Doh or Sculpey or other clay models and cut or smash
          them.
          Throw ice into the bathtub or against a brick wall hard enough
          to shatter it.
          Break sticks.
          I've found that these things work even better if I rant at the
          thing I am cutting/tearing/hitting. I start out slowly,
          explaining why I am hurt and angry, but sometimes end up
          swearing and crying and yelling. It helps a lot to vent like
          that.
          Crank up the music and dance.
          Clean your room (or your whole house).
          Go for a walk/jog/run.
          Stomp around in heavy shoes.
          Play handball or tennis.
          
  sad, soft, melancholy, depressed, unhappy
  
          Do something slow and soothing, like taking a hot bath with
          bath oil or bubbles, curling up under a comforter with hot
          cocoa and a good book, babying yourself somehow. Do whatever
          makes you feel taken care of and comforted. Light
          sweet-smelling incense. Listen to soothing music. Smooth nice
          body lotion into the parts or yourself you want to hurt. Call a
          friend and just talk about things that you like. Make a tray of
          special treats and tuck yourself into bed with it and watch TV
          or read. Visit a friend.
          
  craving sensation, feeling depersonalized, dissociating, feeling unreal
  
          Do something that creates a sharp physical sensation:
          Squeeze ice hard (this really hurts). (Note: putting ice on a
          spot you want to burn gives you a strong painful sensation and
          leaves a red mark afterward, kind of like burning would.)
          Put a finger into a frozen food (like ice cream) for a minute.
          Bite into a hot pepper or chew a piece of ginger root.
          Rub liniment under your nose.
          Slap a tabletop hard.
          Snap your wrist with a rubber band.
          Take a cold bath.
          Stomp your feet on the ground.
          Focus on how it feels to breathe. Notice the way your chest and
          stomach move with each breath.
          [NOTE: Some people report that being online while dissociating
          increases their sense of unreality; be cautious about logging
          on in a dissociative state until you know how it affects you.]
          
  wanting focus
  
          Do a task (a computer game like tetris or minesweeper, writing
          a computer program, needlework, etc) that is exacting and
          requires focus and concentration.
          Eat a raisin mindfully. Pick it up, noticing how it feels in
          your hand. Look at it carefully; see the asymmetries and think
          about the changes the grape went through. Roll the raisin in
          your fingers and notice the texture; try to describe it. Bring
          the raisin up to your mouth, paying attention to how it feels
          to move your hand that way. Smell the raisin; what does it
          remind you of? How does a raisin smell? Notice that you're
          beginning to salivate, and see how that feels. Open your mouth
          and put the raisin in, taking time to think about how the
          raisin feels to your tongue. Chew slowly, noticing how the
          texture and even the taste of the raisin change as you chew it.
          Are there little seeds or stems? How is the inside different
          from the outside? Finally, swallow.
          Choose an object in the room. Examine it carefully and then
          write as detailed a description of it as you can. Include
          everything: size, weight, texture, shape, color, possible uses,
          feel, etc.
          Choose a random object, like a paper clip, and try to list 30
          different uses for it.
          Pick a subject and research it on the web.
          Try some of the games and distractions at [14]digibeet's page;
          she's assembled a lot of distractions.
          
  wanting to see blood
  
          Draw on yourself with a red felt-tip pen.
          Take a small bottle of liquid red food coloring and warm it
          slightly by dropping it into a cup of hot water for a few
          minutes. Uncap the bottle and press its tip against the place
          you want to cut. Draw the bottle in a cutting motion while
          squeezing it slightly to let the food color trickle out.
          Draw on the areas you want to cut using ice that you've made by
          dropping six or seven drops of red food color into each of the
          ice-cube tray wells.
          Paint yourself with red tempera paint.
          
  wanting to see scars or pick scabs
  
          Get a henna tattoo kit. You put the henna on as a paste and
          leave it overnight; the next day you can pick it off as you
          would a scab and it leaves an orange-red mark behind.
          
   Another thing that helps sometimes is the fifteen-minute game. Tell
   yourself that if you still want to harm yourself in 15 minutes, you
   can. When the time is up, see if you can go another 15. I've been able
   to get through a whole night that way before.
   
I tried all of that. I still want to hurt myself.

   Sometimes you will make a good-faith effort to keep from harming
   yourself but nothing seems to work. You've slashed a bottle, your hand
   is numb from the ice, and the urge is still twisting you into knots.
   You feel that if you don't harm yourself, you'll explode. What now?
   
   Get out the questions [15]Kharre asks. It's a good idea to have
   several copies of these printed out and ready to use; you can also
   [16]answer them online; your responses will be mailed privately to you
   and no one will see them except you.
   
   Answer these as honestly and in as much detail as you are able to
   right now. No one is going to see the answers except you, and lying to
   yourself is pretty pointless. If, in all honesty, you see no other
   answer to #8 but yes, then give yourself permission, but set definite
   limits. Do not allow the urge to control you; if you choose to give in
   to it, then choose it. Decide beforehand exactly what you will allow
   yourself to do and how much is enough, and stick to those limits. Keep
   yourself as safe as you can while injuring yourself, and take
   responsibility for the injury.
   
   The questions (for more explanation, see [17]kharre's post on the
   subject):
   
    1. Why do I feel I need to hurt myself? What has brought me to this
       point?
    2. Have I been here before? What did I do to deal with it? How did I
       feel then?
    3. What I have done to ease this discomfort so far? What else can I
       do that won't hurt me?
    4. How do I feel right now?
    5. How will I feel when I am hurting myself?
    6. How will I feel after hurting myself? How will I feel tomorrow
       morning?
    7. Can I avoid this stressor, or deal with it better in the future?
    8. Do I need to hurt myself?
       
  Staying safe while hurting yourself
  
   A few things to keep in mind should you decide that you do need to
   hurt yourself:
     * Don't share cutting implements with anyone; you can get the same
       diseases (hepatitis, AIDS, etc) addicts get from sharing needles.
     * Try to keep cuts shallow. Keep first aid supplies on hand and know
       what to do in the case of emergencies.
     * Do only the minimum required to ease your distress. Set limits.
       Decide how much you are going to allow yourself to do (how many
       cuts/burns/bruises, how deep/severe, how long you will allow
       yourself to engage in SI), keep within those boundaries, and clean
       up and bandage yourself later. If you can manage that much, then
       at least you will be exerting some control over your SI.
       
What is "fake pain" and why does it matter?

   The concept of "fake pain" helps to explain why distress-tolerance
   skills are so crucial.
   
   Observation of myself and interviews with others have convinced me
   that one of the reasons people self-injure is to deflect unknown,
   frightening pain into understandable, sort-of-controllable "pseudo" or
   "fake" pain. Calling this phenomenon "fake pain" is in no way intended
   to suggest that it doesn't hurt; it hurts like hell. When memories or
   thoughts or beliefs or events are excessively painful, instead of
   facing them directly and feeling "genuine" pain, we sometimes deflect
   distress into pain that seems understandable and controllable, like
   that of self-injury. The real feelings associated with the event
   you're avoiding get overridden by those of the situation you create to
   distract yourself. It still hurts like hell, but it's a controllable
   familiar hell, whereas the real pain you're avoiding seems scary and
   poised to take over your world like the monster who ate Detroit.
   
   It's easy to revert to "fake" pain. Trying to find the source of your
   distress can be scary as hell, because you often don't know what
   you're going to unleash. Fake pain, although very painful and
   traumatic, is something that you understand and can control and can
   handle. It's familiar, not mysterious and scary like the real pain
   behind it. You might feel that if you ever exposed yourself to the
   real pain you'd lose control: "If I ever start crying, I'll never
   stop" or "If I let myself get mad about that, I'll never stop
   screaming."
   
   Instead, you unconsciously deflect the distress away from the memories
   or feelings that generated it and into self-injury. SI is seductive:
   you control it. You know the boundaries, even when you feel out of
   control. It makes sense and it makes the distress go away, at least
   for a while. It's a clever mechanism -- it takes what seems unbearable
   and transforms it into something you can control. The only problem is
   that when you deflect pain, you never face up directly to what it is
   that has caused this much tumult in your life. So long as you channel
   distress into fake pain, you never deal with the real pain and it
   never lessens in intensity. It keeps coming back and you have to keep
   cutting.
   
   You have to deal with the unbearable if you ever want to make it lose
   its power over you. Every time you can meet the real pain head-on and
   feel it and tolerate the distress, it loses a little of its ability to
   wipe you out and eventually it becomes just a memory. The process is
   like building tolerance to a drug. Narcotics users take a little bit
   more of their drug every day as tolerance builds, until eventually
   they're routinely taking amounts of drug that would kill an ordinary
   person. The poisonous events in your past work in a similar way.
   Exposure (with the help of a trained therapist) over time will build
   your tolerance to these events and enable you to lay them to rest. The
   key is learning to tolerate distress.
   
DBT-related skills

   Marsha Linehan's [18]Skills Training Manual has several helpful
   worksheets for getting through crisis situations. Though they are best
   used as part of a DBT program with a trained therapist, you might find
   some of them helpful.
   
   Accepting Reality
          This concept focuses on learning to accept reality as it is.
          Accepting it doesn't mean you like it or are willing to allow
          it to continue unchanged; it means realizing that the basic
          facts of the situation are even if they aren't what you'd like
          them to be. Without this kind of radical acceptance, change
          isn't possible.
          
   Letting Go of Emotional Suffering
          In this worksheet, you learn ways to observe and describe your
          emotion, separate yourself from it, and let go of it. One of
          Linehan's basic principles is that emotion loves emotion, and
          this worksheet is designed to help you experience your emotions
          with amplifying them or get caught in a feedback loop.
          
   Distraction
          Distraction is simply doing other things to keep yourself from
          self-harming. Most of the techniques mentioned above are
          distraction techniques; you bring something else in to change
          the feeling. Using ice, rubber bands, etc, is substituting
          other intense feelings for the self-injury. Other things
          Linehan suggest substituting include experiences that change
          your current feelings, tasks (like counting the colors you can
          see in your immediate environment) that don't require much
          effort but do take a great deal of concentration, and volunteer
          work.
          
   Improve the Moment
          This worksheet focuses on ways to make the present moment more
          bearable. It differs from distraction in that it's not just a
          diverting of the mind but a complete change of attitude in the
          moment.
          
   Evaluating the Pros and Cons of Tolerating Distress
          As the name implies, this worksheet leads you through an
          evaluation: what are the benefits of doing this self-harming
          thing? What are the benefits of not doing it? What are the bad
          things about doing it? About not doing it? Sometimes writing
          this down can help you make a decision not to harm.
          
   Self-Soothing
          This, like improving the moment and distracting, is a distress
          tolerance technique. It's pretty straightforward: use things
          that are pleasing to your senses to soothe yourself. Some
          people find that active distraction works better for violent
          angry feelings and soothing is more effective for soft, sad
          ones.
          
   Reducing Vulnerability to Negative Emotion
          Prevention of states in which you are likely to self-harm is
          covered in this worksheet, which suggests ways of taking care
          of yourself in order to minimize the times when you feel the
          urge to hurt yourself. If you're balancing eating, sleeping,
          and self-care, you're less likely to be overwhelmed by emotion.
          
   Interpersonal Effectiveness
          Being clear about what you want and about your priorities in an
          interaction are crucial to good communication, and this
          worksheet offers a series of questions and steps to follow to
          help you determine how to approach a difficult interpersonal
          interaction. It is truly amazing how much going through these
          steps can help.
          
   More information about Dialectical Behavioral Therapy can be found at
   [19]DBT-Seattle.
   
Individuals' suggestions for self help

   [20]Kharre, a subscriber to the [21]bodies-under-siege list, compiled
   an excellent list of ways to cope with si. She covers topics such as:
   [22]Questions to ask before you hurt yourself
   [23]Realistic acceptance
   [24]A letter to my SI
   [25]Things to help you through the bad times
   [26]Important tips for those who interact with someone who SI's
   
   Kirsti, who has assembled an incredible page on self-injury,
   dissociation, and abuse, has some very useful [27]coping ideas.
   
   An anonymous poster, an22340@anon.penet.fi, put together a great deal
   of information about self-injury. Included was this useful [28]list of
   things to do. It contains suggestions both for self-injurers and for
   their friends and loved ones. I've added a few of my own, noting them
   with [brackets].
   
   A shorter list of 12 things you can do to try to climb out of a mild
   to moderate depression or urge to cut can be found [29]here.
   
   Another bus member, Tammy Bucklew, adapted these [30]suggestions for
   families and friends of abuse survivors from Kubetin and Mallory
   (1992).
   
   You may at some point want to find [31]professional help for this
   problem. I've collected sources in the USA, UK, Canada, and Australia.
   If you know of people or organizations I've left out, contact me.
   
   There is also a DBT skills discussion list. To subscribe, send mail to
   the listowner (Kieu) at [32]busserv@u.washington.edu explaining your
   background and why you'd like to be on the list. It's intended to be a
   place to share experiences and get support while using DBT skills.
   
Bristol Crisis Service for Women

   [33]Bristol Crisis Service for Women is the leading UK (and as far as
   I know, European) support organization for women who self-harm. They
   offer a confidential help line, publications for self-harmers and for
   professionals, and other services. They're empathetic, dedicated and a
   valuable resource for women in the UK and Europe. Check out their
   [34]Women and Self-Injury leaflet.
   
S.A.F.E.

   In 1984 Karen Conterio (then of Hartgrove) established a support group
   for self-injurers called SAFE (Self-Abuse Finally Ends). SAFE groups
   were not like 12-step groups or most self-help groups; they were
   short-term groups run by a professional facilitator. SAFE no longer
   offers these groups, but they do have a 30-day inpatient program; more
   details are on the [35]resources page. SAFE operates on the belief
   that the underlying emotional conflict is the primary problem, not the
   self-injury. More information about SAFE can be obtained at
   1-800-DONTCUT.
   
First-Aid Basics

   If you've already injured yourself and need to know how to care for
   the wounds, this list of [36]first-aid basics might be helpful.
   
I stopped a few weeks ago, but I keep obsessing about hurting myself. Help?

   It's not uncommon for people to continue thinking obsessively about
   self-injury for a while after they've made the decision to stop.
   Hurting yourself has been a huge part of your life up until recently,
   and you're used to dwelling on it. You might think that you're
   supposed to be "cured" now and that all thoughts of SI should
   magically vanish from your head, so when you catch yourself thinking
   about that blade or lighter or whatever, you get angry and frustrated
   and shove the thought away.
   
   Foa and Wilson (1991) deal with intrusive thoughts by a combination of
   giving yourself permission to think about it and exposure/habituation
   techniques combined with ritual prevention. Exposure refers to
   repeatedly presenting someone with the situation about which they
   obsess, and habituation happens when, after much exposure without
   resulting to usual actions, the person gets used to the situation and
   it no longer distresses them.
   
   To adapt these techniques, first make yourself safe. If you're in a
   mind-set in which self-injury seems very very likely, it might be
   better to use distraction techniques to get past that place. Line up a
   support person whom you can call if you get overwhelmed by this
   technique. Try to tolerate it for as long as you can, even if you're
   uncomfortable.
   
   First, designate two 10- or 15-minute time periods daily. Choose times
   when you will be alone and able to think without being interrupted. To
   begin, set a timer for the designated amount of time. Then obsess
   about hurting yourself. Think about what it would feel like, how you
   would feel afterwards, how much you want to do this -- all those
   thoughts you've been trying to suppress. Get as distressed as you can,
   and stay focused on the topic of injuring yourself. You may find,
   especially after the first few times, that you get really bored toward
   the end of your time period. That's a good sign -- you're becoming
   habituated.
   
   When the time is up, stop thinking about SI. If thoughts of wanting to
   harm come into your mind at other times during the day, acknowledge
   them and remind yourself that you will think about them later, when
   it's time. Then let them go. If they come back, repeat the process.
   Don't shove them away or try to ignore them; just acknowledge, remind
   yourself they have their time soon, and let go.
   
   After a week or so you will notice an improvement (maybe even after
   just a few days). One crucial thing: no matter what, do not act on the
   thoughts of SI. They are just thoughts, and you can use the skills
   that you used to stop harming to get through these times. In order for
   habituation to occur, you have to get through the exposure without
   resorting to the old behavior. Use distraction and substitution for SI
   (ritual) prevention.
   
   [INLINE]
   
  next section: [37]Living with the effects of SI
  return to [38]SI main page

References

   1. file://localhost/usr/home/llama/Web/psych/self.html#ready
   2. file://localhost/usr/home/llama/Web/psych/self.html#why
   3. file://localhost/usr/home/llama/Web/psych/self.html#match
   4. file://localhost/usr/home/llama/Web/psych/self.html#questions
   5. file://localhost/usr/home/llama/Web/psych/self.html#fpain
   6. file://localhost/usr/home/llama/Web/psych/self.html#dbt
   7. file://localhost/usr/home/llama/Web/psych/self.html#more
   8. file://localhost/usr/home/llama/Web/psych/self.html#bcsw
   9. file://localhost/usr/home/llama/Web/psych/self.html#safe
  10. file://localhost/usr/home/llama/Web/psych/self.html#first
  11. file://localhost/usr/home/llama/Web/psych/self.html#expose
  12. file://localhost/usr/home/llama/Web/psych/firstaid.html
  13. file://localhost/usr/home/llama/Web/psych/self.html#match
  14. http://www.geocities.com/HotSprings/Spa/7326/
  15. file://localhost/usr/home/llama/Web/psych/kharre.html
  16. file://localhost/usr/home/llama/Web/psych/questions.html
  17. file://localhost/usr/home/llama/Web/psych/kharre.html
  18. http://www.amazon.com/exec/obidos/ISBN=0898620341/
  19. http://dbt-seattle.com/
  20. http://www.palace.net/~llama/psych/kharre.html
  21. http://www.palace.net/~llama/psych/busfaq.html
  22. http://www.palace.net/~llama/psych/kharre.html/#quest
  23. http://www.palace.net/~llama/psych/kharre.html/#accept
  24. http://www.palace.net/~llama/psych/kharre.html/#letter
  25. http://www.palace.net/~llama/psych/kharre.html/#things
  26. http://www.palace.net/~llama/psych/kharre.html/#fam
  27. http://www.geocities.com/Wellesley/1520/cope.html
  28. http://www.palace.net/~llama/psych/selfinjury.html
  29. http://www.palace.net/~llama/psych/thing.html
  30. file://localhost/usr/home/llama/Web/psych/family.html
  31. file://localhost/usr/home/llama/Web/psych/restherp.html
  32. mailto:busserv@u.washington.edu
  33. http://www.users.zetnet.co.uk/BCSW/
  34. http://www.geocities.com/Wellesley/1520/women.html
  35. file://localhost/usr/home/llama/Web/psych/restherp.html
  36. http://www.palace.net/~llama/psych/firstaid.html
  37. file://localhost/usr/home/llama/Web/psych/living.html
  38. file://localhost/usr/home/llama/Web/psych/injury.html
