DBT group notes: The two arrows of pain and suffering

MINDFULNESS ACTIVITY

We continued exploring ways of relating to the breath in meditation. For some people, simply watching the breath becomes a struggle with dissociation. One option for meditating that can be helpful is the inhale, exhale count to ten meditation.

With each breath we count:

Inhale 1, Exhale 2

Inhale 3, Exhale 4

Inhale 5, Exhale 6

Inhale 7, Exhale 8

Inhale 9, Exhale 10

As you follow and count the breath, its easy to lose track. That’s ok! You are a human. Humans get distracted. When we did this in group I caught myself counting to 14. Lol. I had completely overshot. If you forget where you are in the count, simply return to one.

Let yourself enjoy the practice.

We all need opportunities to activate our relaxation response. Especially if you have chronic anxiety, your poor sympathetic nervous system is in overdrive. Engaging in trauma informed yoga, massage, meditation, tai chi and chi gong. These all bring your body into the parasympathetic nervous system. Its important to give your body time to be off guard. I am attaching some videos in the homework for you to try.

EXPLORING THE STORY OF THE TWO ARROWS

“The Buddha isn’t a diety or prophet, he is just a guy who WOKE UP….and Nirvana isn’t heaven, it’s the act of living life without craving, and without holding on too much to our own expectations. ” More on the connection between craving and suffering at https://bigthink.com/philip-perry/this-buddhist-parable-can-ease-your-pain-during-a-crisis

I wanted to share this metaphor from Buddhist psychology, because just a few days ago, I was struck by the first arrow. And then eased my suffering when I realized I was stabbing myself repeatedly with that second arrow. Just that realization helped me tame my ranting mind. I saw what I was doing to myself, and I was able to stop and redirect my attention to doing things that make me feel strong and competent.

I pulled the following story from this website: https://www.shamashalidina.com/blog/pain-suffering-story

I want to share a story with you and it’s the story of the two arrows. This is a story originally from Buddhism and it is often used in mindfulness and also in Acceptance and Commitment Therapy as well.

So the story goes like this:

You are walking in the woods and suddenly you get struck by an arrow (someone fires an arrow at you) and it hits your arm and it really really hurts–its very painful and you feel that physical pain in your arm, and it’s bleeding. And then immediately your mind starts to think, “Oh my god! what’s gonna happen? What if I bleed to death? What if this is infected and I can’t walk back home properly? Or I lose energy and I can’t get back to my family? What’s gonna happen to my family? What’s gonna be happening to my husband/wife/my children? What’s gonna happen to me or what’s going to happen to their future, how will they be doing?”

The Buddha described the first arrow as the physical pain and the second arrow is what your mind does–it starts thinking about the worst scenario that can happen (catastrophizing, minimizing, blaming). And the Buddha says, “be warned of the second arrow.”

The first arrow represents the pain–the actual physical pain–and the second arrow represents what you call suffering. So we distinguish between pain and suffering. Pain is something that’s inevitable, we all experience that. But the suffering is something that we actually create. But we don’t realise that.

Samash alidina

PAIN x RESISTANCE=SUFFERING, PAIN x ACCEPTANCE= FREEDOM

I find this metaphor of the two arrows extremely helpful, and I invite you to reflect on it as you move through your week, noting the painful reality of the first arrow, and then being cautious and aware of that second arrow.

The following video by Tara Brach continues this exploration of the difference between pain and suffering. She doesn’t refer to the parable of the two arrows, but I invite you to keep it in mind as she speaks.

One of my favorite distress tolerance activities that I use when I encounter a prolonged period of crisis is listening to Tara Brach’s podcasts. I will pick a topic of interest from the menu and it invariably helps release me from the confines of my struggle into a broader awareness.

REFLECTING ON “THIS BELONGS TOO”

Life, liberty and the pursuit of happiness…as Americans we are plagued with our obsession with happiness. Interestingly, research shows that Americans equate happiness with feelings of elation and excitement, joy! While other cultures equate it with a sense of peace or calm. Chasing endless joy and elation is a certain failure. Other research shows that the pursuit of happiness is not infact what leads to happiness, rather it is the pursuit of meaning–pursuing a meaningful life brings a sense of contentment.

This diagram is a wonderful way to extend the metaphor of flavors as emotions. Consider how we balance and enhance the experience of one emotion with the experience of another.

And….all the other emotions and experiences belong too. At an Acceptance and Commitment Therapy training, one of the instructors used the analogy of flavors to help us understand “this belongs too” for all emotions. The true enjoyment of food is the endless combinations of the five key flavors: sweet, salty, sour, bitter, umami (mushroom, brothy flavor). The reason that Doritos and Oreos are so addictive? They combine all five flavors. Its also why they can be overwhelming.

Imagine a life of only chasing sugar? Even candies are enticing because of their complex flavor combinations with sweet taking the lead, but in a medley of other flavors. Sugar doesn’t make your body feel good if its your only source of nutrition. It doesn’t even taste good after a while.

It’s the same with hoping for a life of elation, excitement and joy. The flavor of a rich life accepts the presence of the spectrum of emotional experiences… All of this belongs too.

Perhaps this idea of “This belongs too” is an avenue for softening around things we don’t want to accept. For softening our resistance. As Resistance itself can be the second arrow.

PAIRING CONCIOUSNESS OF THE TWO ARROWS WITH MUSCLE RELAXATION EXERCISES

Let’s build on the Paired Muscle Relaxation Exercise we practiced last week.

  1. Identify a situation that is stressful and prompts distressing emotions. A situation in which you would like to reduce your emotional reactions.
  2. Ask yourself, “What am I telling myself that brings the second arrow?” When that first arrow strikes (whatever situation arises that causes great stress), where does your mind go? What do you start to tell yourself? This is the second arrow.
  3. Then notice, is there resistance creating the second arrow? Are you resisting letting go of that second arrow? What is the threat?
  4. Now try to rethink the situation—and come up with more effective things to tell yourself.  What words will help you softened around the discomfort? What words can be first aid for that first arrow, instead of striking you with more arrows? “This belongs too.” “I am safe.” “I can get through this.” “I am a safe.” Get creative with sentences and phrases that apply to your specific situation.
  5. Now! Use these phrases during the exhale of your paired muscle relaxation exercise. You will be combining a rehearsal of your effective thoughts with paired relaxation. To do this, as you breath in, imagine the stressful event is happening to you. Be sure to imagine you are in the stressful scene as you tighten your muscles and inhale. Before breathing out, say to yourself (in a convincing tone) the effective self-statements followed by “relax” or “release” as you breath out while intentionally relaxing all your muscles.
Guided Paired muscle relaxation

BRIEF INTRODUCTION TO THE Wise Mind ACCEPTS acronym

Before closing group today, we had a preview of coming attractions! We screened a little video about the Wise Mind Accepts skill. Then I discussed that I think they misunderstood the distracting with intense sensations skill. As you will see, they describe it as a self soothing skill–but we have a whole other skill set for that (self-soothing with the five senses). In the ACCEPTS acronym, that last S is for distract with intense sensations. These are not soothing sensations, things like focus your attention on something other than emotional distress. Holding ice cubes, or peeling a frozen orange, or alternating really hot water and really cold water in the shower. This set of skills is meant to be a hurts-but-doesn’t-harm alternative to self harm. Other ideas for Intense sensations, tasting tabasco sauce, intense sour candies, lemon wedges, listening to loud intense music.

HOMEWORK

  1. Watch for those first and second arrows this week–then examine how to get rid of the second arrow and replace it with some first aid.
  2. Practice practice practice the Paired Muscle relaxation exercise from this group session.
  3. Here are some videos that you can use to trigger the relaxation response with trauma informed yoga or chi gong.
First a little video of Bessel Van Der Kolk discussing trauma informed yoga.
A guided trauma informed yoga session with a certified instructor.
This is wonderful Chi gong practice–just give it 70 % effort.

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Diana is a licensed professional counselor based in Nashville. She has been teaching DBT skills for the last ten years after writing her master's thesis about making DBT skills training interesting and engaging. She loves using story telling to help illustrate how skills can be used.

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