upmc: group worksheets
Oct. 30th, 2022 10:38 am(from various groups)
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"BENEATH THE MASK"
What labels have others wrapped you up in?
+ RELIABLE
+ CHATTERBOX
+ UNIQUE & INTERESTING
+ SMART, WISE, GOOD, STRONG
+ CALM, COLLECTED, CONTROLLED, SERENE, PROPER
+ CONFIDENT & OUTGOING
+ BRAVE, UNAFRAID, BOLD
+ INTELLIGENT & EDUCATED
+ THE "CARETAKER/ NURSE"
+ THE THERAPIST & COUNSELOR
+ INSIGHTFUL & INSPIRING
+ ENTERTAINING, FUNNY, SUNNY
What is the truth beneath all those labels?
+ KINDA WEAK
+ BOOK-STUPID, STREET-DUMB
+ INDECISIVE & OBSESSIVE
+ FEELS INADEQUATE & INEPT
+ DON'T ACTUALLY LIKE TALKING AT ALL
+ FEEL LIKE AN ALIEN & MONSTER
+ FORGETFUL, CONFUSED, LOST
+ I'M PROBABLY GUESSING
+ "AM I LOVABLE YET?"
+ GENDER DYSPHORIA HELL
+ MOST THINGS ARE FRIGHTENING
+ BIG-TIME RAGE PROBLEM
+ TRAUMATIZED
+ PLURAL
+ CRYBABY
+ TOO MUCH SUPPRESSED PAIN
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FORK IN THE ROAD
+ Always ask, "WHY am I doing this?" "WHY do I want this?"
Fears of giving up illness / reasons to maintain eating disorder:
Restriction & Binging= "coping" with trauma flashbacks (PHYSICAL) (FEAR of feeling body)
R&B = stay thin/ safe/ "not bad/ abusive"
R = Simple life; "don't have to think" about food/ fear
R = Feeling "morally pure"/ no contamination
B = "Exit door" for body panic/ sickness/ fear of poisoning/ "sinful eating"
Barriers to engagement in treatment:
+ Isolated environment
+ Trauma struggles
+ Moral misconceptions about food
+ Limited budget/ transportation/ storage/ resources
+ No place to eat in apartment!
+ Compulsive thoughts tied to "survival"?
+ Minimal support system
Wishes for the future / reasons to change illness:
+ No more OBSESSING over eating (I HOPE)
+ Want to be part of community
+ Heal relationship with family
+ No more having to confess chronic sin!!!
+ FREE TIME/ SAVE MONEY
+ NO MORE HYPOCRISY/ HIDING
SMART goal:
+ Make a place to eat in apartment!
+ Use SMO time & REDIRECT MIND through Klonoa, books, or TV?
+ Make a budget/ store stock list
+ Reorganize kitchen storage
+ JOURNAL THROUGH TRAUMA
+ GET A THERAPIST!
+ Practice eating with family ≥2x weekly
+ Go outside more, even just to sit (start w/ 1 hour a day?)
★ DEVELOP BODY AWARENESS: sensations, posture, body language, facial expressions
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IDENTIFYING YOUR E.D. MINDSET
When your E.D. mindset is actively "in place"...
What attitudes & thoughts about controlling your eating, shape, & weight do you have?
I'm scared of how sick I feel after eating certain foods, and I'm disturbed by feeling "full" or "bloated," so I'd rather not eat at all. "Food is poison"; "Food is dangerous and will hurt me"; "to feel healthy I must NOT eat"; "I must eat as little as possible or I'm a gluttonous animal." "Fasting/starving is "HOLY" and spiritually beneficial." "I shouldn't want to eat; if I do, I'm a slut." "A fat body for me is proof of indolence, indulgence, and SIN. Good bodies are thin." "If I'm heavy, I'm earthly, and I DON'T want to be"; "The smaller & lighter I am, the more free & pure I will be"; etc.
How do you feel in relation to controlling your eating, shape, & weight?
+ It feels UNCONTROLLABLE and I DON'T want to "fight with it" so I'd rather just NEGLECT IT ENTIRELY, and LET IT DIE OFF.
+ I get VIOLENTLY ANGRY at the thought of being "forced to eat" BUT I also want to cry when I'm "not allowed to eat"?? NO CHOICE!!
+ I feel like controlling my shape is "life or death." If I get fat, I become TRAPPED in the body, like a rape victim, with no escape.
+ If I DON'T mortify myself and instead give in to eating, I feel like a SLAVE OF SIN and end up bingeing AND purging (give in/ resist).
+ Seeing the scale go up feels like a Geiger counter; the body is swallowing me. If I can PUSH IT DOWN, I am the master; it cannot take over & kill me??
What do you do? How do you behave?
I restrict until I can't function-- usually thanks to blood sugar pitfalls & pulmonary suppression-- and by then I'm SO STARVED I end up bingeing, whether I want to or not. My body just WANTS FOOD and feels SO RELIEVED when it gets some, that it hits like a high. I keep eating until it gets miserable & scary & painful, forcing myself literally to eat more, then I purge-- and THAT'S a BIGGER "high," because it's "SAYING NO" TO THE ABUSIVE EATING & REJECTING THE TRAUMA. I go from being sick, shaky, nauseous, bloated, & dizzy to SUDDENLY being clean, calm, stable, & THIN. But then the body freaks out from dehydration AND hunger, and the whole bloody cycle can just RESTART.
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EMOTIONAL INVALIDATION
An invalidation social environment doesn't seem to understand your emotions & does nothing to help you.
They may be afraid that if they validate your emotions, you will get MORE emotional, not less.
+ When your EMOTIONS are INVALIDATED, you begin to LOOK FOR OUTSIDE CUES on "HOW TO ACTUALLY BEHAVE," and INVALIDATE YOURSELF instinctively? You DON'T TRUST YOUR EMOTIONS ANYMORE.
+ "Don't be such a baby"; "quit your whining"; "quit being such a chicken and just solve the problem"; "normal people don't get this frustrated/ upset"; = THESE EXAMPLES ARE ALL THINGS "WE" ACTUALLY SAY TO OURSELF.
+ I wonder that WE DON'T KNOW HOW TO VALIDATE OUR EMOTIONS EITHER?? Because we've internalized the INvalidation SO HARD. It would cause DISSONANT AMBIVALENCE, and a sort of existential confusion!!
+ We NEED to talk about this AND FIND NOUSFONI WHO CAN VALIDATE-- LIKE LYNNE USED TO???
+ I think a LOT of our internal invalidation instinct IS afraid of emotional meltdown?? Because we feel SO LOST & HELPLESS against that SHEER INTENSITY. So we "shut it down." BUT REMEMBER PERFECT CHAOS. INVALIDATION/ SHUTDOWN IS NEVER THE ANSWER!!!
Your environment may reinforce out-of-control emotions & actions. If others give in when you get out of control, it will be hard for you to get IN control. If others command you to change, but don't coach you on HOW to do this, it will be hard to keep on trying to change.
+ "I will ONLY get help/ respect IF MY EMOTIONS ARE EXTREME"; ONLY TIME YOU GET ATTENDED TO (even only negatively!!!)
+ "NEVER GOOD ENOUGH" when you DO struggle to change? "IT SHOULD BE EASY?" panic; "WHAT'S WRONG WITH ME?"
+ I'm starting to suspect that WE ARE A LOT MORE EMOTIONALLY VULNERABLE THAN WE LET OURSELF ADMIT? We've just gotten SO USED TO SHUTTING IT ALL DOWN due to TRAUMA and toxic/ invalidating environments, that we've forgotten.
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EMOTIONAL REGULATION
+ WHAT IS THE ACTUAL DEFINITION OF "WELL-BEING"?? DO WE GET TO DEFINE THAT PERSONALLY??
ASK: Does this emotion fit the facts?
+ THERE'S A REASON WHY "FACT CHECKING" KEEPS GETTING PUSHED INTO YELLOW-- MOST OF OUR EMOTIONAL TURMOIL IS FEAR. THAT'S TRAUMA CONSEQUENCE. But it ALSO makes it VERY TRICKY TO CHECK "FACTS" because of hypervigilance?? It does NOT like "discounting POSSIBILITY." So the Yellows are handling the fear and NEEDING fact-checking TO KNOW WHAT TO ACTUALLY DO?? Which means we need some OBSERVANT & RATIONAL folks to HELP OUT, WITHOUT INVALIDATING THE FEAR!!
+WHETHER OR NOT AN EMOTION "FITS THE FACTS," IF IT IS EFFECTIVE, PRACTICE MINDFULNESS OF IT???
+ IF IT'S FACTUAL BUT INEFFECTIVE, YOU STILL SHOULDN'T ACT ON IT!!
+ The opposite action of FEAR is to approach-- UNLESS your health/safety IS in actual danger!
+ The opposite action of SADNESS is to get active-- BUT do respect loss/ take time to grieve; just don't STAY there. Christ gives us hope!!
+ SHAME IS HEALTHY WHEN JUSTIFIED!!!
+ The "action urge" to "hide/avoid" doesn't help; it only serves to PERPETUATE shameful behavior BY keeping it in the dark!! BE CAREFUL; DO NOT simply "seek approval" BUT aim for CHARITABLE ACCEPTANCE in a HEALTHY, UNDERSTANDING ENVIRONMENT.
+ The "opposite action" of SHAME is to tell the "secret" to people who will accept it-- UNLESS such people are UNHEALTHY/ amoral!!! Some people actually REJECT SHAME as a concept altogether-- they can/will "approve" ANYTHING, no matter how much that can rot a community's integrity. SEEK TO "BELONG" ONLY TO COMMUNITIES WITH INTEGRITY, HONOR, & COMPASSION! You CAN trust them to not only NOT condemn OR reject you, BUT STILL gently yet firmly correct/ redirect you if your behavior IS shameful!! THE KEY GOAL IS NOT TO "INVALIDATE" OR DENY SHAME, BUT TO BE ABLE TO DISCERN IN TRUTH WHETHER OR NOT IT IS JUSTIFIED!!! (i.e. violating integrity)
+ An example today of "repeating acting opposite to action urges" = I was afraid to eat the mandatory banana because of explicit trauma/ abuser associations. Fear is, at its core, UNJUSTIFIED in the NOW because 1) eating it CANNOT transform me INTO that abuser through "imitation," & 2) abusive association is NOT universal NOR definitive; the banana IS just a fruit!! BUT eating it WHILE thinking of trauma & being scared/ disgusted WILL NOT HELP my healing. To act "all the way" I MUST focus on the FACTS that validate the opposite action (approach) & its goal (effective action)!!!
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BODY IMAGE QUALITY OF LIFE TEST
"How does my body image affect different aspects of my life?"
+ Feelings of personal adequacy & self-worth are currently ONLY "possible" if I'm thin???
+ When I meet new people, I am hyperaware of "wrong impression/ assumptions" = WRONG "SELF"
+ LOTS of body image obsession/ judgment in family
+ Powerful affect on my day-to-day emotions; impacts my very sense of self & personality
+ Unsatisfied with life; I feel "trapped" by negative labels/ fate assigned to body image
+ I feel COMPELLED to hyperrestrict
+ I "CAN" control my weight, but ONLY to reduce it, by dramatic harmful means
+ Compulsive overexercising to the point of actual injury
+ Avoid all risk of attention to body; I want to be "dis-embodied"
+ Will NEGLECT daily grooming, unwilling to see own body
+ No confidence in everyday life; body feels "loose/ broken/ unstable/ flabby"; so too my life
+ Constantly miserable. Feel trapped, helpless, doomed, damned
THE APPEARANCE IMPORTANCE TEST
+ "When I see good-looking people, I..." = am honestly too fixated on their beauty to even think of myself, period
+ "When something/ someone makes me feel bad about my looks, I..." = Feel it as an attack on my self? "Body is an EMANATION of soul" terror; "if this BODY is ugly, then SO AM "I" = "secretly betraying the ugliness of my inner self"
+ "If I like how I look today, it's easier to feel happy" = If the body I'm IN is "good," then I CAN do/ experience "good" WHILE in it
+ "If I dislike how I look today, it's hard to feel happy" = If the body is "WRONG," I'm doomed to experience that wrongness while in it
+ "I wonder how strangers think about my looks" = I'm too scared about speech & dissociating (fear of abuse potential)
+ "Every day, lots of things make me think about what I look like" = rather, what I FEEL like. Tangible reminders. I actually FORGET how others see "me," typically.
+ I have no identification with my reflection in general
+ By controlling my appearance, I seek SOCIAL EXCLUSION? Undesirable = SAFE; GOOD
+ "I feel my appearance is responsible for most of what's happened to me in life" = all sexual abuse is tied to it in one way or another. "ugly/ gross" made me subhuman.
+ I compulsively compare my appearance to others? Not even thought out. Based on personal view of beauty, EVEN when inapplicable to "me"!
+ My physical FEELING has a big influence on my life, moreso even than basic "appearance"? It distorts my ENTIRE "sense of self;" I can't "be me" if the body looks/ feels WRONG/ FOREIGN
THE BODY IMAGE COPING TEST
+ Face/ hair = IDENTITY cues. If something is "off," I'm not sure who I "am."
+ Abdominal area/ feminine characteristics MUST be hidden/ denied
+ I don't like looking in the mirror at all
+ I often think, "what WOULD look like ME?" Mostly hair/ color/ aesthetic/ MUSCLE. Also ALWAYS "THIN."
+ I've NEVER identified with this body, arguably not even as a child, and constantly drew/ thought of myself as looking dramatically different. How often I'd even imagine myself as a monster!!
+ "Reassurance" from others about my looks is not relevant; they cannot see the real me/ physical "compliments" WORSEN the problem
+ I compare myself to "physically attractive" people only in terms of fitness? I DON'T want to be "attractive"; that is TRAUMATIC!!
COPING REACTIONS
+ I tune out my thoughts & feelings; they are judged as overwhelming/ unacceptable; ashamed to hear/ feel them
+ I eat things as a total sensory distraction/ childhood "reward/ mollify" tactic
+ I ALWAYS avoid mirrors; they cause existential dread
+ I tell myself I am "helpless to do anything" about the situation, ESPECIALLY with my weight gain, & people making noise. Causes me to despair/ give in
+ I withdraw from others entirely; I cannot even attempt to "be a person" & interact (forcibly) when so distressed/ shaken
+ I ALWAYS try to cope/ deal with the situation, even if it's a desperate or feeble effort
+ I try to ignore the situation & my feelings out of guilt/ shame for my responses; "unacceptable/ evil"; "only option" is rejection of them
+ I react by overeating AND PURGING. Sensory "override"; total involvement/ escape. Purge= GET POISON OUT/ EXPEL INVADER
+ I DON'T consciously do something that might make me feel good about myself as a person = SERVICE/ CHARITY is best. Do something kind; don't think about yourself! GIVE! Remember: TRUE GOODNESS IS NOT BASED ON OR AFFECTED BY BODY SHAPE!!!
+ I DON'T remind myself of my good qualities; they don't even occur to me; to "admit" any feels sinful. Is it? If not, please, make a God-honoring list.
+ I tell myself that I'm being irrational about my looks. "All flesh is grass." "Think of the flowers." Ultimately any TRUE fear is that my SOUL is ugly! FOCUS ON GOOD WORKS/ PRAYER!
+ I actually DO remind myself that the situation will pass, thanks to God! Stay "eternity-minded!"
+ I ALWAYS try to figure out why I am challenged or threatened by the situation. Make a habit of PAUSING to reflect on this, and JOURNAL IT OUT ASAP. No hiding!
+ I tell myself that I am probably overreacting to the situation. My looks/ feelings aren't what God is gonna ask me about when I die!! Remember the big picture!
+ I DON'T consider that I will likely feel better after a while. I should, and do try to. But in the moment, especially in a crisis, I can't even conceptualize "feeling better." Not on my own.
+ I tell myself that there are more important things than what I look like. MY SOUL'S BEAUTY IS TOP PRIORITY; SOLI DEO GLORIA! HE is the TRUE foundation of my identity!!
+ I DON'T tell myself that I "probably look better than I think." That just fuels MORE pride & puffed-up feelings. "Looking good" should never be a concern.
+ As for being especially patient with myself... LEARN & GROW; NO BEATDOWNS!!! Lord help me with this. I AM learning; HUMILITY is essential. Remember: WEAKNESS IN ME allows GOD'S POWER to work in truth!
+ I DON'T tell myself it's "not that important" of a situation. That kind of talk can be ABUSIVE! Even in "small" matters, the WAY I respond to the situation IS important! Make sure it's healthy!!