In January I talked about the connection between mental and physical health after needing tendon surgery at the Royal Victoria Infirmary (RVI); part of the Newcastle Hospitals Trust. For those who missed that post, on Boxing Day 2019 I was attempting to open a bottle of Prosecco by wiggling the cork out with my thumbs when all of a sudden, I couldn’t move my right thumb anymore! I thought it was dislocated and went to my local Minor Injuries where – after an x-ray – I was told that it was ‘fine’ and to ‘put it in warm water and slowly start moving it.’ 

After a few days that feeling that something was really wrong became intolerable and I took myself to the RVI. When I was being triaged by a Nurse I actually said to him “I feel like such an idiot for coming to A&E because of my thumb” because I honestly thought I’d just be laughed away and told to follow the advice of the Nurse in Minor Injuries but in fact, the exact opposite happened! The Nurse sent me to the RVI’s Minor Injuries and literally as soon as the Nurse there called my name and I stood to follow him to an exam room, he looked at my thumb and said “well, there’s definitely something wrong with that, isn’t there?!” I honestly couldn’t have been more grateful and comforted – which sounds strange that I was comforted by the thought of something being wrong but it was more about the fact that I’d been right the entire time and that I was especially right in coming to A&E. It was actually such a relief.

The Nurse did another x-ray before calling the Plastic Surgery team down to examine the thumb more closely. The on-call Surgeon said that I had either snapped the ligaments; which would take a long time to heal or had snapped the tendon; which would need surgery. Either way, I was given an appointment to come back in a few days for the RVI Plastic Surgery Trauma Clinic, where I met a Surgeon who, after quite a simple examination, concluded that I needed emergency surgery that same day to repair my ruptured EPL (Extensor Pollicis Longus) tendon.

The surgery was a very painful success, but after a couple of weeks I heard a funny noise and was once again unable to lift my thumb into a ‘thumbs up’ position. Back at the Trauma Clinic they did an ultrasound on my hand (who knew they could do that?! I thought it was just for pregnant people!) and it confirmed their – and my – worst fears; I had torn the repair and the tendon had ruptured again. I saw my Consultant and she determined that because of the inflammation that the ultrasound had found, she wouldn’t be able to operate on it until that had all settled, and I had to begin Physiotherapy until the surgery (which she predicted would occur in around April).

Since then, I’ve had so many painful days – like, entire days(!), where if feels as though I’ve done nothing but take painkillers and sleep. Whenever the pain has gotten too much though, I’ve always worried that I’d end up self-harming or having suicidal thoughts so I’ve used a few Dialectical Behaviour Therapy (DBT) skills to cope with the pain and the feelings that the pain brings to the surface. I won’t lie; sometimes it’s really difficult and on the worst days, I’ve found it difficult to take the pain-relieving medication because I’ve begun to believe that maybe I deserved the pain. Maybe I’d earnt it. I’m a great believer in karma and whilst this is my belief on a dark day, when the pain isn’t so bad or it’s bearable, I can see that maybe I go through the painful days for a reason; like, maybe it’s to make me stronger. Or to teach me something. To test my mental health recovery. Something like that. On those days, I can more than cope without using – or at least without knowingly using – my DBT skills; on a bad day, here’s what I use…

When I’m telling the Doctors and Nurses about the pain: the Mindfulness ‘what’ skill: A popular misconception of Mindfulness – and it’s one that I held until I began attending DBT groups – is that it’s all about meditation and kind of zoning out, tuning out the whole world. Some of it can be, but it’s also about learning to practice mindful awareness of the world around you and to do this, DBT teaches the what skill which comprises of three basic elements: observe, describe, and participate.  Observe starts with encouraging you to notice your surroundings, and then you can move on to observing thoughts and feelings. To do this, you must observe the emotion or thought without judging it or trying to change it and allow your thoughts and feelings to come and go by controlling your attention and not the thing that has caught your attention. Then, in describing the thought or feeling, you need to be simple and yet descriptive in avoiding belittling things and ‘playing them down.’ Finally, participate is about engaging in everything that is happening without obsessing over details and becoming self-conscious. 

Initially, this was really hard to practice when it came to pain because of course I didn’t want to participate in feeling it, but I had to remind myself that if I didn’t do this then no one could help me to get rid of the pain. If the Doctors and Nurses didn’t know what kind of pain it was and exactly where I felt it then how could they provide medication or even the physiotherapy exercises to help stop it?

When I’m in pain and alone: the Distress Tolerance ‘ACCEPTS’ skill: Each of these letters stands for a number of different methods that are designed to help you to tolerate a distressing situation by finding at least one method that works for you. The ‘A’ stands for activities and is about doing something else to distract yourself from what is bothering you. The first ‘C’ is for contributing and it’s about doing something for someone else, supporting someone, offering them help or advice… something that might help you to feel better about yourself as a person. The second ‘C’ is for comparisons and means making comparisons to someone who might be struggling more than you or a time when you have felt worse – to put how you’re feeling now into perspective. The ‘E’ stands for emotions and is about distracting yourself with an activity or something that causes you to experience an opposite emotion to the one you’re struggling with. The ‘P’ is for pushing away the situation bothering you by mentally leaving it to one side so that you can concentrate on something else and strengthen your mental health so that you can come back to what was bothering you and cope with it a lot better. The ‘T’ is for thoughts and is about using something like counting to ten or seeing how many tiles are on the ceiling – anything to distract you from the other thoughts. Finally, the ‘S’ is for sensations and means using your different senses to try and detract your attention from the upsetting things, it could be something like holding a cube of ice in your hand or splashing your face with cold water.

I won’t lie, I actually don’t agree with all of these methods to this skill; namely the comparisons part because I’m a firm believer that you should resist belittling your own thoughts and feelings by thinking – or being told to think – ‘there’s kids out there who are starving.’  Yes, yes there is but that doesn’t mean your feeling suicidal is any less significant and important or deserving of help and support. Another part to this skill that’s worth mentioning is to be careful on the pushing-things-away part because it’s important to be aware of the difference between distracting to maintain your safety and coming back to the issue when you’ve regained some strength, and avoiding and blocking things out for good because you just don’t want to deal with them.

When I’m in pain and with company: the Distress Tolerance ‘Radical Acceptance’ skill: Probably my second favourite skill in DBT is to radically accept the situation, and any thoughts and feelings around it. I guess there’s not a whole lot more you can say on this one except that the ‘radical’ part is to imply that you accept it totally and completely. This one might end up being a bit controversial in some people thinking that ‘if you’re in genuine pain how can you not accept that?’ 

I used to really struggle with this one because I was constantly worried that accepting my reality and owning what has happened to me would make me unsafe and suicidal. With the pain, though, it’s not about accepting that the pain is present; it’s about radically accepting what I can do about it. It’s more around the painkillers and accepting that sometimes all I can do is take them, and all I can do after that is wait for them to kick in! 

When I’m in pain and feeling sorry for myself: the Distress Tolerance ‘self-soothe’ skill: This is my absolute favourite skill in DBT even though I found it incredibly hard to practice at the beginning! Self-soothing is all about doing something nice for at least one of your five senses (hearing, seeing, tasting, smelling, and touching) and it can literally be anything that makes you happy… it could be a bath, or playing with a pet, or doing your makeup, or knitting! Anything that will help to cheer you up when you’re struggling.

Initially, I thought that I didn’t deserve to have be happier or to do something nice for myself, but in time, I learnt that after all I’d put my body through – all of the cuts and the tablets – it deserved something positive and actually beneficial! For taste, I like to eat something savory like cereal or crisps. For seeing I like to watch my favourite shows on TV; Grey’s Anatomy and Pretty Little Liars. For smelling I like to put a candle on. For hearing, I’ll play some feel-good tunes from the movie: Greatest Showman. And for touch, I get cosy in my pjs and a blanket on the settee and cuddle with my pets!

And to avoid the bad days: the Emotion Regulation ‘PLEASE’ skill: This is probably the most basic and obvious DBT skill for coping with pain because it’s all about maintaining your physical health as a means to strengthen your mental health. This skill does this by advising you manage physical illness, eat a healthy diet, avoid mood-altering drugs, get plenty of sleep, and do some form of exercising.

Sometimes, even with these skills I struggle and cry – like today (24.02.2020) for example; I saw my surgeon in the hope she’d do my surgery sooner because I feel as though I can’t live life fully while I have this injury to my thumb. I’m trying though; I’m using the skills and I’m definitely safe!

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