Autism in girls isn’t what you think

Autism in girls isn’t what you think

No one ever guessed that this socially awkward child had autism. After all, she didn’t fit any of the stereotypes. She was highly intelligent, meeting all developmental milestones ahead of schedule. She was polite and articulate with seemingly good social skills. The clues were very subtle that much of her inner world was regimented, repetitive, and restricted. It would take a highly trained expert to spot these elusive clues.

There was another side of her she kept in check most of the time. She learned early that other people did not like it, so she suppressed it as best she could. She was hypersensitive to stimuli. Lights, sounds, smells, noises — it was all so overwhelming. Sometimes the urge to shut out the world was irresistible, yet she tried to turn off the impulse to curl into a ball, rock back and forth, and scream in protest. In doing so, she only built up emotional tension that inevitably demanded release. The meltdown would come as an angry, unprovoked outburst or buckets of hysterical tears that could not be soothed. The explosion simply had to run its course. Out of steam, she would collapse in a heap, unable to stay awake.

Her parents noticed the pattern, but interpreted the problem incorrectly. They assumed, since she fell asleep at the end of the meltdown, that exhaustion was the cause. So they encouraged her to relax and rest more often. She resisted their attempts to slow her down.

Then there were those unfamiliar social interactions. Whenever she was faced with a new social situation, she behaved out of character. She would withdraw, almost as if she were shy. What no one knew was that she carefully rehearsed her behaviors. Each one was crafted according to the social rules she observed. Social interactions did not come naturally to her. She had to practice them over and over in order to fit in. When new situations caught her by surprise, this normally poised young lady became an immature social pariah. She responded with odd comments, inappropriate emotions, poor physical boundaries, and complete lack of comprehension with sarcasm, innuendo, or humor. In short, sometimes she was really weird.

Everyone saw these lapses and knew there was something unusual about her. But no one ever thought to consider autism. In the late 80s, autism was believed to only affect boys. Even then, only the most severely non-verbal children were diagnosed. It would be almost 30 years before society started to recognize the unique sub-type of autism that affected this little girl.

That little girl grew up undiagnosed, untreated, and misunderstood.

That little girl is me.

I knew I was different. I didn’t want to be. I wanted to fit in. I wanted to stop the stares and eye rolls directed at me. It hurt. I just didn’t always know how to fix it. Sometimes my attempts to correct my behavior only made my problems worse. It was just so much easier to stay locked inside the quiet safety of my own mind. But it got lonely in there. I wanted friends. So I kept trying.

Wanting to understand people, I eventually became a student of human behavior. Those studies led me to a job working with people on the ASD spectrum. I was a natural. I understood these kids in ways I couldn’t explain. Their struggles were familiar and my compassion kicked in. I felt at home. Meltdowns didn’t alarm me. Instinctively, I knew how to calm an overwhelmed child. I didn’t have to rehearse my  lines anymore.

I knew the truth about myself now, but kept it hidden. Even though I learned that symptoms of autism are difficult to hide from the trained eye, I tried to disguise myself. Surrounded by a team of some of the best autism clinicians in the city, I thought I could hide in plain sight. After all, what would it mean for my career if someone outed me?

I eventually accepted the truth and openly acknowledged my autism after a colleague diagnosed my son. The behaviors she described were traits he inherited from me. I confided in her with my suspicions. She confirmed what I had been trying to hide.  Apparently I’d been hiding pretty well, because it took describing my socially awkward childhood before she finally saw the truth. I had been faking neuro-typical (NT) my whole life…and doing a damn good job at it.

But I was tired of faking my way through life. It is exhausting trying to be someone you are not. I can fit in, but sometimes I need a break. I need to retreat inside my quiet bubble, block out the world, and give in to my urges. When stress is high and no one is looking, I stim. Some days I don’t speak a word. It is  sweet relief.

I have high-functioning autism and it doesn’t look anything like you would expect.


Dr. Seuss is to blame

Dr. Seuss is to blame

I love to read.

I managed to develop critical thinking skills, despite the influence of certain conservative-backwoods-redneck elements of my hometown. This is in no small part to the heroic efforts of teachers who introduced me to great literature.

Dr. Seuss is to blame.reading

My earliest introduction was to that lovable renegade, Dr. Seuss. I didn’t realize how influential Seuss had been until I started reading his books to my own children. The moral lessons are disguised by creative wit. As a child I had no idea how subversive and counter-culture Seuss books were from my environment. Looking back, I am grateful for the entertaining indoctrination.

“That’s nice,” you’re thinking, “but what does it have to do with headache disorders?”

Protected from stigma.

Glad you asked! It has everything to do with them. Had I not been gently fed tasty morsels of critical thinking, I might have believed any one of a thousand stigmatizing messages about migraine. They would have been so easy to internalize. Seuss (among others) protected my developing sense of self by helping me to recognize that:

  • Experience and research teach us something valuable
  • No one can know it all.
  • I am unique and special just because I exist.
  • Differences are a good thing.
  • Things can change if you try hard enough.
  • Hard times happen. Hit back.
  • I’m the only one who can change my life.
  • Trying new things, even if you don’t like them, is a good strategy.
  • Everyone (doctors, bosses, in-laws, etc.) is full of it sometimes.

Reading Dr. Seuss books did a lot more than teach me how to read. It laid the foundation that taught me how to think for myself, ignore my detractors, fight through the hard times, and create a life of my own making.

Here’s a dose of Seuss for you.

So if you’re struggling today with the pain of migraine or other headache disorders, I’d like to leave you with some of my favorite Dr. Seuss quotes. I hope they inspire you to keep fighting for better treatments, protect you from stigma, and give you hope that life will get better.

“Today you are you! That is truer than true. There is no one alive that is you-er than you.”

“A person’s a person, no matter how small.”

“You do not like them. So you say. Try them! Try them! And you may. Try them and you may, I say.”

“You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose. You’re on your own. And you know what you know. And you are the one who’ll decide where to go.”

“Think left and think right and think low and think high. Oh, the thinks you can think up, if only you try!

“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.”

“If you keep your eyes open enough, oh, the stuff you will learn!”

“You’ll miss the best things if you keep your eyes shut.”

“In the house, and on the street how many, many feet you meet.”

“I have heard there are troubles of more than one kind. Some come from ahead and some come from behind. But I’ve bought a big bat. I’m all ready you see. Now my troubles are going to have troubles with me!”

“Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”

“We’ve GOT to make noises in greater amounts! So, open your mouth, lad! For every voice counts!” 

Now pick your favorite Seuss quote and guess the book it’s from.


Playing by the rules is effective

Playing by the rules is effective

Don’t cut off your nose to spite your face.

Webster’s Dictionary defines this phrase:
to create a disadvantage to oneself through one’s own spiteful action.”

It happens when we focus on being right or fair despite the negative personal consequences. For migraineurs, there are a lot of  opportunities for this to happen.

  • Insurance companies that limit triptans, deny coverage for needed treatments, or force the use of less effective medicines are the bane of a migraineur’s existence. In order to get what we need, we must file appeals, enlist our doctor’s help and jump through unreasonable hoops.
  • Pharmacies create their own bureaucracy that can drive us crazy. There are long lines, unnecessary consultations, ignorance about our medications, medications out-of-stock, and failure to use our discount cards or insurance benefits.
  • Doctors’ offices have their own bureaucracy, too. The long wait times, bright lights, noises, and paperwork are enough to tempt us to walk out and never return.
  • Emergency rooms are the worst. Some are staffed by nurses and doctors who view migraineurs as drug-seekers. We often endure unreasonable treatment and unnecessary testing just to get a little relief. My own experience with an ER is a perfect example. Forced to endure bright lights, loud noises, and repeated blood pressure checks (lying down, sitting up, and standing), I was told that my request for Toradol to break a migraine was “not medically necessary.”

effectiveDoing what is effective

It is exhausting to play by their rules just to get needed treatment. It can be tempting to just tell them all to “go to hell” and refuse to play. Unfortunately, that means we don’t have a chance of getting the medicines and treatments we need. Many times we have to submit to treatments we know won’t work just to finally get what we need.

My first experience with a headache clinic is a good example.

My goal for making that first appointment was to gain a prescription for Imitrex. It was new to market and there were many concerns about cardiac safety when using it. The doctor insisted I break Medication Overuse Headache first. That took three months. Plus, I was required to keep a headache diary and food log to identify triggers. And finally, my first dose of Imitrex had to be in the office so I could be monitored. Since most of my attacks happened on the weekend (due to stress let-down), it was several weeks before I finally experienced a migraine attack during office hours. At any point in the process I could have walked away. If I had focused on all the barriers to my goal, I might have decided the doctor was being unfair or unreasonable. I would have lost sight of my goal.

That’s what it means to be effective. Right or wrong, fair or unfair, sometimes we have to play by someone else’s rules. It can be difficult to swallow our pride in order to get what we want.

Mindfulness wrap-up

Using Wise Mind, observe the situation. Describe and participate fully in each experience. Focus on the facts with non-judgmental stance, putting aside your own opinions. Stay one mindfully in the moment, doing one thing at a time. Set aside ideas of what should be and just do what is effective.

Next up: Introduction to distress tolerance skills »


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One mindfully in the moment

One mindfully in the moment

The second “how” skill that helps us stay mindful is called “One Mindfully.” I know it sounds strange. Once you understand how to use it, the term will make more sense.

Most people spend their days on “automatic pilot” not really paying attention. We often engage in one activity while our mind is focused on something else. We think we can accomplish more by doing several things at once. This is simply not true. When we bring our whole being into focus on one thing at a time, we are more productive. Sometimes we must quickly switch from one activity to another. The key is to give your full attention to each activity only when you are doing it.

Have you ever washed dishes while cooking?  What about eating a meal, folding clothes, rocking a baby, or some other activity while watching TV? I’ll admit, I write, surf Facebook, and play games on my laptop while watching TV. That’s the complete opposite of mindfulness. When you eat, eat. When you play, play. Do each task as it comes with single-minded focus.

If you have migraine, particularly high-frequency or chronic migraine, you know that time is precious. We rush around, trying to catch up on tasks before the next attack begins. In theory this is not a bad idea IF we can maintain focus on each task rather than letting our minds wander. With so few productive hours available, mindfulness is a way to make the most of them. By focusing all our senses, thoughts, and behaviors on a single task, we will actually accomplish more.

Another way this directly affects migraineurs is our tendency to think about the next attack before it starts. It’s one thing to be prepares for an attack and quite another to keep our focus on the future while missing out on all that migraine-free time in between.

Do one thing at a time

If you must worry about the next attack, then focus all of your attention on that worry. Immerse yourself in the experience, setting aside everything else. You might be surprised to discover that only need to do this for a few minutes before you are able to move on to something else. When faced with a complicated project or long task list, this skill can help get it done. You simply choose the next thing and then do it. When it is finished, start the next thing. Before long that list is much smaller. I found this strategy very effective when looking for a new headache specialist. I went through several doctors before finding the right one. The long list of things to do felt so overwhelming. By taking it one step at a time, I was finally able to find the perfect doctor for me.

Mindful breathing

We breathe all the time. With all that practice, one would think we are pretty good at it. Actually, we’re terrible breathers. We take shallow breaths, rarely filling our lungs to capacity. Several times each day, take a few deep breaths. Focus only on filling your lungs with air and slowly exhaling. Full, deep breaths oxygenate your cells (even the ones in your brain) much more efficiently. Try this for a day or two. Notice how it affects your energy level and ability to focus.

Staying present in the moment

How much time do you spend ruminating about the past or worrying about the future? Rarely do we slow down enough to recognize the moment we are currently experiencing. Even something as simple as thinking about what do eat for dinner while eating lunch is not living in the present moment. It is similar to doing one thing at time except that it adds the mental focus. It is technically possible to do one thing at a time and be completely oblivious to what is occurring because our minds are focused elsewhere. Remember the first lesson on the three states of mind? At the end there is a practice recommendation for achieving Wise Mind. That exercise is helpful for staying in the moment, too.

One mindfully in the moment

Essentially, this skill teaches us to approach observation, describing and participating with one mind (wise mind) in the present moment. DBT therapists and skills trainers refer to this as being “one mindfully in the moment.”


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Source: Rewiring the chronic pain brain

Non-judgmental stance and migraine

Non-judgmental stance and migraine


Mindfulness is the core DBT skill set on which the other three skill groups are based. If you’ve been following along from the beginning, you will remember that there are three states of mind: Emotion Mind, Rational Mind, and Wise Mind. Practicing mindfulness skills will help you achieve that calm inner confidence that comes from Wise Mind.

Our Emotion Mind has the ability to take over when we least expect it. Knowing how to name our emotions and gauge their intensity can help us assess whether or not using Emotion Mind is helpful to a given situation. Our brains are wired with an internal alarm system that signals when danger is present. Most of us need a little help adjusting the sensitivity of our internal alarm as it tends to misfire, taking over when no danger is present. To reduce the chances of an emotional hijacking, the regular practice of mindfulness skills is essential.

Mindfulness involves both behavior (“what” skills) and intention (“how” skills). The behavioral skills are observation, describing, and participation. Now it’s time to introduce the intention skills of non-judgmental stance, one-mindfully, and effectiveness.

Non-judgmental Stance

Like a lot of the skills already covered, this one appears simple. Putting it into practice can be a little more complicated. We all like to think that we are non-judgmental. Yet we place value judgments on ourselves, others, and events all the time.

Judgment is NOT

  • morals or personal values
  • personal preferences
  • emotional responses

Judgment IS

  • evaluating an event, person, thing, emotion, or experience as GOOD or BAD
  • trying to change NEGATIVE into POSITIVE
  • having an opinion that something or someone is RIGHT or WRONG

How to have a non-judgmental stance

  • Focus on just the facts. Don’t try to determine if the facts are good or bad, right or wrong. Just pay attention.
  • Separate your opinion from the facts. Pretend you are a reporter looking for the Who, What, When, Where, and Why. Non-judgmental stance is not for the Editorial pages!
  • Accept each moment as it comes. Acceptance isn’t agreement. It’s an acknowledgment that the moment exists.
  • Acknowledge the helpful or unhelpful without judging either
  • When you catch yourself judging, DON’T JUDGE THE JUDGING!

Applying non-judgmental stance to migraine

So how might this work? Let’s take a look at one way of responding to the onset of a migraine attack.

This day is going to be horrible! My ears are ringing. My neck is stiff and sore. I’m getting a stupid migraine again. Darn it! I do NOT have time to deal with this right now. This project is due by tomorrow. Soccer practice is tonight. Not another night of crappy take-out for dinner! This always happens to me. Just when I need to be 100%, migraine hits. I am getting sick and tired of dealing with this. I am such a failure. My family is going to hate me for this.

Did you catch all that judgment? Now try it this way.

This is going to be a tough day. My ears are ringing. I can feel the stiffness in my neck. A migraine attack is coming. This is going to be a challenge. The project is due tomorrow and soccer practice is tonight. Take-out is on the menu tonight. It’s time to treat this attack so it will be over soon.

Do you see the difference? In non-judgmental stance, only the facts are addressed. The second approach isn’t saying that migraine is a good thing. It’s simple acknowledging the truth about this migraine attack as well as the complicating factors. Admitting that migraine presents a challenge is not the same as labeling those challenges as bad or good.

Now it’s your turn

Describe a situation using non-judgmental stance. Remember to use only the facts and separate your opinion from the facts. Simply state what you observed without labeling it bad or good. If you catch yourself making judgments, don’t judge your judging. Simply notice it and try again.

There are times when judgment is appropriate. DBT skills don’t prohibit you from making value judgments. However, this skill is designed to help you become more mindful. That requires you to set aside judgement for the moment in order to achieve Wise Mind.


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Mindful participation is authentic

Mindful participation is authentic

It’s been awhile since we discussed using DBT skills to help us cope with the challenges of life with migraine. If this is your first visit to the series, please start at the beginning so you have a good foundation for our discussion. 

Participation is the last of the “what” Mindfulness skills. It is the natural extension of Observe and Describe. Anyone can sit on the sidelines observing an experience and describing it. Immersing oneself in the experience invites us to be authentic participants in our own lives.

Enter completely

To participate with mindfulness requires our undivided attention. We do not multitask. We throw ourselves completely into one experience at a time. This is often in conflict with cultural norms. To participate mindfully is an act of modern rebellion. The first time you try it may evoke feelings of boredom or a sense that you should be doing more. Just notice the feeling (observe), acknowledge its presence (describe), and keep on going (participate).

How many times have we felt the early presence of migraine only to ignore it, hoping that it will go away? Who has not pushed down the pain in a race to complete a task before the pain passes that invisible point of no return? That is not mindful participation. That is repression, denial, and avoidance. Mindful participation involves acceptance of the truth and a willingness to experience that truth in action.

Mindful participation is not surrender. You remain an active participant in the experience. There’s nothing about this skill to prevent you from using medication and other measures to ease the pain and shorten the duration of an attack. When using this skill to cope with migraine, you stop trying to finish up that last project. A mindful migraine experience is one in which all other experiences do not exist.

Act intuitively

When we participate with mindfulness, there is an ease to our movements. We don’t have to think about our next move because there is no next move — only here and now. We glide effortlessly through the experience. In terms of migraine, this is played out when we do not resist its arrival. Our response to medicate is instinctive, without doubt or hesitation. We simply enter the treatment process, trusting our instincts to guide us. Acting with intuition is the opposite of anxiety, self-doubt, or hesitation.

We can twist ourselves into mental knots with every migraine attack wondering when to start treating the attack and with what. Even though we’ve been through thousands of attacks, we often withhold even the simplest comfort measures. Instead of reaching for that ice pack and turning off the lights, we hesitate. We waste time trying to stop the inevitable rather than allowing ourselves to do what is best in the moment.

Let go of self-consciousness

Most of the time our minds are filled with self-assessments, particularly when it comes to migraine. By letting go of this internal observer, we can participate in the experience with carefree abandon.  We do what feels right at the time instead of being held back by our self-conscious critic.

I didn’t really understand how this could apply to migraine until I experienced a cluster headache attack. I have described in other posts that the pain of a cluster attack forces me to behave in ways that contradict my personality. Normally stoic in the face of pain, a cluster attack is so intense that I can no longer contain my behavior. I rock, pace, scream, curse, and otherwise make a loud mess in a desperate attempt to manage the pain. Migraine does not require that of me. In fact, the more stoic I behave, the less throbbing and pounding I experience. Migraine is invisible, in part, because silence and stillness ease the pain. None of us start out trying to hide the pain. We learn from experience that the pain of migraine is lessened when we are quiet and still. Migraine becomes its own reinforcer — rewarding us for staying quiet and punishing us for stepping out of line.

There are also cultural pressures that place value on “suffering in silence.” The social stigma of migraine encourages our silence, too. The real question to ask yourself is, “How do I behave with migraine when all alone?” When you think no one can see your pain, far from the critical eyes of society, what do you do? Mindful participation invites us to behave in ways that are consistent with who we really are, not with what we think is expected of us. When in public, do you conceal your medication, try to cope without comfort measures, and pretend that everything is fine even when your head is pounding so badly that you can’t see straight? Would you do this if you were at home alone? Of course you wouldn’t! Mindful participation allows us to be as genuine in public as we are in private.


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Change is healthy

Change is healthy

One moment home was a noisy flurry of activity. The next moment, a surreal silence filled the air. Even the dog sensed it. Change happened in an instant. Three weeks ago I left home for the AHMA Conference. Three days later I returned to an empty house. My three-bedroom home became an empty nest.

Another milestone

I know this change is a normal, healthy transition. It still feels strange because it’s new. There have just been so many changes in the past six months. I need time to reflect, to acknowledge the changes, and incorporate them into my new reality.

Midlife transition

It’s all part of the midlife transition. Everyone’s experience is different. Some people adjust to the change easier than others. A few of the anticipated changes came earlier for me.

A boomerang kid

It’s a common occurrence in today’s world. Adult children leave home only to return during challenging times. My adult daughter returned home about 18 months ago. Raised to believe that you take care of family, I never hesitated to welcome her back. I did reach out to life-long friends for tips on life in a multi-generational home. Their advice helped me avoid a lot common problems. Their love and support helped me get through other unexpected challenges.

Becoming a grandparent

Having my daughter home during her pregnancy was a blessing for both of us. It was such an honor when she invited me to be a part of her labor team. Witnessing my granddaughter’s birth is an experience I will cherish forever. My house was her first home. I was there for the sleepless nights, the colic that seemed to last forever, those first bites of real food, the first tooth, rolling over, crawling, walking, and even those first words. I got to be baby’s caregiver for many months while Mommy was at work. She celebrated her first birthday here, too. Baby Girl and I have definitely bonded.

Youngest child graduates

Our youngest child graduated this spring. In addition to the part time job he’s had for months, he just started a full time job. He loves both jobs as they allow him to use different skill sets.  He purchased his first car in cash rather than get himself stuck with high payments on a brand new one. Within weeks, he’d found an apartment to share with a good friend, too. It all happened so fast.


Earlier this year I became eligible for Medicare. This particular transition has been a welcomed relief, saving me money and offering benefits that were unavailable with my private insurance. I no longer have the stress of waiting in line at the pharmacy only to be told my prescription is not ready or out-of-stock. Once a quarter a package is delivered to my house containing all of my medications. There is a generous allowance for OTC medicines, too. My deductible is minimal and co-pays are affordable.

Age-related health concerns

It’s a good thing that Medicare benefits kicked in. Botox isn’t cheap and they cover most of the cost. Plus,  I recently found out that the terrible pain in my knee is osteoarthritis. I’m only 45 so this is not good news. I’m not keen on going straight to knee replacement surgery so there are a lot of other options we can try. One of those is water exercise. Luckily, I discovered that my new insurance will pay for a membership to the local athletic center which has these classes. The pain is pretty severe at the moment, so I’m hoping for relief soon.

Empty nest

Having all the kids out of the house is an interesting transition. I appreciate the emptiness and quiet. At the same time, I do miss them and hope they come for visits. My husband and I have realized that we do need to set some ground rules though. We’re planning a new house purchase, so the discussions about what we want have changed

Parents retirement

My parents are planning to retire this year. Daddy doesn’t work on cars for family and friends anymore. His hair has changed quickly from “salt-and-pepper” to a thick silver gray. Momma’s hair is visibly thinner. She had back surgery. Daddy needs cataract surgery. The house is paid off. Those are expected changes. What surprised me was their sudden acceptance of technology. They dropped the landline phone, not saying a word to my siblings and me until it was a done deal. We were shocked. They had that same phone number our whole lives. That was home. The idea that someone else might have that phone number after 47 years still drives us crazy. The biggest shocker was when my sister told me that Mom had a tablet and wireless internet. I’m still trying to process the idea of my technophobe mother surfing the internet.

Embracing change

It’s all good. I’m looking forward to discovering what this new life will bring. Getting older does not bother me. I know that it is a natural part of life. This is just the second half of life. The next 40 or 50 years will be an interesting adventure.


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Describe experiences mindfully

Describe experiences mindfully

describeIn the last installment on DBT, we explored the Mindfulness “what” skill of observation. I do hope you’ve had a chance to put this new skill into practice. If you’re not familiar with DBT skills, please start at the beginning by reading Using DBT skills to manage migraine. The focus of this DBT series is to introduce DBT concepts to patients with migraine and other headache disorders. Naturally, each post in the series will offer helpful tips that apply specifically to those dealing with migraine.

Choose an experience

Think about a recent migraine attack. Choose one that was distressing but not terribly traumatic. Think about what happened in terms of what you observed with your five senses. Take all the time you need to review the event using the observation skills already covered.

  • Stay in the moment
  • Have a “Teflon mind”
  • Create a mental guard

Narrating your story

Now tell your story using the observation skills you’ve already learned.  Stick with the things you can describe using your five senses. Leave out any emotions or value judgments.

  • What time was it when you became aware that a migraine attack was starting?
  • What did you feel, hear, see, touch, or smell?
  • What did you do or say in response to these sensations?
  • What did others do or say?
  • Did you take medicine? What was the taste?
  • How did your body respond?
  • How long did the attack last?
  • Were there warning signs that you missed?
  • What do you think triggered this attack?

State your feelings

Now take a moment to state the name of any emotion you experienced during the attack. Describe anything you did, said, or thought in response to those emotions.

Feeling ≠ Fact

Remember that just because you experience an emotion doesn’t make it true. Facts (truth) are the things we can observe and describe using our five senses. Emotions are a result of experience plus our thoughts or beliefs about that experience. They may or may not be true.

Feelings may or may not fit the experience

Sometimes our feelings (emotions) do not fit what we experience. They are out of place. That doesn’t mean they are wrong, bad, or inappropriate. However, the expression of such emotions might create problem for us. So it’s important to recognize when our feelings are out of place. Sometimes just recognizing they don’t fit is enough. At other times we might need to set them aside to be examined later. In urgent situations, we might need some help to process these emotions quickly so they don’t hinder us from achieving our goals.  That’s what DBT therapy is designed to do. Later in this series we will also explore some advanced skills that can be used.

Describe the experience of feeling

As a final step in the process, take the time to describe what’s it’s like to experience these feelings. Examine their effect on your five senses. Emotions can affect how your body feels, too. Remember that this doesn’t necessarily mean there is anything wrong inside your body. It’s just part of the natural alarm system that helps the body prepare for danger. Remember that this alarm system can misfire, setting of warning signals by accident. It’s okay to describe what happens when emotions are part of a false alarm.

Mindfulness: observing what we experience

Mindfulness: observing what we experience

After a brief detour into the world of emotional intelligence, let’s get back to the foundation of all DBT skills, mindfulness. There are two skills that can help you achieve that middle-ground state of Wise Mind. As we discussed earlier, Wise Mind is that midway point between Emotion Mind and Rational Mind. It embraces qualities of both while producing a sense of peaceful calm. It is the ideal state of mind in which to make choices.

Remember also that it is not possible to remain in Wise Mind all the time. Some situations call for the exclusive use of either Rational or Emotion mind. Emergencies often require us to use 100% Rational Mind. Processing emotions in the middle of a house fire is probably not the best use of Emotion Mind. However, Emotion Mind is perfect for showing sympathy when a loved one is sick or has passed away. Can you think of other examples?

Achieving a state of mindfulness involves focusing our attention. It matters HOW we focus our attention and WHAT we focus on. This time we will be discussing on WHAT we focus our attention by learning to Observe our experiences.


Many times we wander through life, only vaguely aware of the world around us. We rarely take the time to focus our attention on anything, even our own experiences. Mindfulness involves paying attention to our own experiences. Observing our experiences without letting our emotions get in the way, especially the ones we don’t like, takes some practice. You’ve already been introduced to this concept in the first Mindfulness article. Now let’s explore some practical tips that will help you observe more mindfully.

Staying in the present

Pay attention your experiences by focusing on the sensations of each experience. Most of the time, we get distracted by the emotions and experience triggers. Those emotions pull us into the past or drag us into the future rather than allowing us to stay in the moment. In order to observe with our five senses, we need to create mental space within which to observe. When we use our mental energy to focus on the physical sensations of an experience, our mind doesn’t have room to distract us.

Teflon Mind

By observing our sensations, we avoid attachment to the experience.  It prevents us from getting overwhelmed by any emotions that appear. So in essence we begin to have a “Teflon mind”. The thoughts and emotions slide right off without becoming attached to us. It’s not that we don’t feel or think. It’s just that these thoughts and emotions have no power over us. We can think and feel about an experience without becoming paralyzed or controlled by them.

Standing guard

When we create this mental space for observing, we are now in control of our attention. This behavior is like setting up a mental guard. We now get to decide which emotions and thoughts we want to incorporate into our self-concept and which we want to toss out. Observing also gives us the ability to stay in the present. Thoughts and feelings can push us into the future with worry or drag us back into the past with regret and pain. Even if they are positive (anticipation, nostalgia, etc.), they still take us away from the here and now.

How does this apply to migraine?

This can really benefit us when we experience anticipation, fear, or anxiety about impending attacks. For those who get frequent attacks, thoughts of the next attack are nearly always present. Those thoughts can easily overwhelm us, especially when exposed to a trigger.

Here’s an example from my own life.

I was walking in to a store when I was exposed to cigarette smoke. An employee was standing next to the door and smoking. Technically, she was outside, so smoking was not prohibited. I was in a hurry and did not take the opportunity to hold my breath. This is a protective measure I normally take when entering or exiting a building. Unfortunately I got a generous whiff of the smoke and instantly began to feel the beginning of a cluster attack, which I knew from experience, would trigger a migraine, too.

Emotions in charge

My initial reaction was anger. I was mad at the employee and also at the company for allowing such behavior. This employee was also the one at the register when I checked out. I saw that her nametag identified her as the Manager. My anger increased and my inhibitions disappeared. That’s when my smart mouth got the better of me.

“You should really think about how smoking right outside the door affects your customers. I get terrible migraines from cigarette smoke. Your insensitivity just cost me at least four hours of pain and a $20 dose of medicine all for a $5 purchase here. I don’t think I will be returning.”

She stood still, shocked by my comment, and mumbled, “I’m sorry.”

I stormed out the door, grumbling, “Sorry isn’t good enough. Change your behavior.”

Attachment to the past

It could have been worse. I’ve said uglier things to people in the past.  It’s still an example of emotions in charge of an experience. Had I been observing the event mindfully, it might have ended differently. I allowed anger to drag me back to all the experiences in which others had been insensitive to my health needs. While I didn’t take all those feelings out on the store manager, they did stick with me for at least a few hours. They robbed me of the opportunity to fully experience anything else for a few hours. Strong emotions also eliminated the option to gently educate the woman and possibly gain an ally who would share that new knowledge with others. Feeling anger wasn’t the problem. Anger in control limited my options.


I could have acknowledged my anger and my fear while still observing everything with my five senses.  Putting my observing skills into practice that day would have given me a chance to decide how to respond. Instead, I allowed anger to make that choice for me. Looking back, I would have preferred to go home satisfied that one more person knew the truth about migraine.

Practice with the easy stuff

This isn’t easy to do when you a caught off guard by an experience, like I was. Despite all my DBT training, this experience surprised me and I got caught in an emotional hijacking. That’s why it’s best to practice these skills on minor annoyances. When you practice using simple challenges, you build your skills through repeated successes. Greater success equals more confidence. Even still, adjust your expectations. Few people can observe mindfully 100% of the time.