Step 3: Manage Urges to Self-Harm
Urges are like cravings – the desire to do something. Some people experience strong urges to eat various foods, engage in sexual activities, or to do any of a number of different things. You can think of an urge as a state of desire that can fuel your behaviour. Generally speaking, you’re more likely to do something you feel a strong urge to do.
This brings us to self-harm. It makes a lot of sense that, if you have self-harmed many times in the past, you would get urges to self-harm in certain situations, or if you have gone for a long time without doing it. It can be the same thing with alcohol. If you drink a lot of alcohol regularly or have alcohol problems, and you enter a bar or are around others who are drinking, you’ll probably feel the urge to drink.
For some people, urges to engage in self-harm make it very difficult to avoid self-harming. Some people describe their urges to self-harm as a burning or itching sensation in the area in which they normally self-harm, a feeling of tension or agitation in their body, shakiness or irritability. Generally, people often say that the urges go away during or after self-harm, and in some cases, they stay away for a few hours, a few days, or even for longer.
The problem with urges is that, if you give in to them, you are likely to be stuck with more urges in the future. Urges are a lot like a child having a tantrum in a restaurant or grocery store when you have refused her or his request for dessert; they are your brain’s way of saying, “I want to self-harm; do it now!” What happens, however, if you give the child the dessert when she or he tantrums? Well, the child learns that the tantrum produces results (in psychology, we call this positive reinforcement – you do some kind of behaviour and then get something positive for doing it, and then you’re more likely to continue that behaviour in the future). With urges, if you give in to the urge and self-harm, then the urge/your brain essentially got what it wanted – self-harm – and is more likely to kick up a fuss in the future when you are either in a situation in which you normally self-harm or if you have gone for a while without self-harming. Therefore, if you want to move away from self-harm, it is important to learn how to manage and resist urges to self-harm.
Here are some suggestions for ways to cope with urges:
- Become aware of your urges and the times, days, and situations in which they are most intense and difficult to manage. In order to do this, keep track of your urges each day and at various points in the day. Just write down how strong your urges were at certain times on a scale from 0 (no urges at all) to 5 (strongest urges possible). Then, look and see if you notice any patterns. For instance, some people we have seen have had their strongest urges around mid afternoon, or in the evening. Once they noticed this, they were more able to change their activities at those times of the day to either reduce their urges or reduce the likelihood of their acting on them.
- Use distraction to cope with your urges. Particularly when you are first trying to quit or move away from self-harming, distraction can be a very useful way to make it easier to ride out urges. Do activities that get your mind temporarily off your urges or the emotional distress that you are feeling, do things to get your mind busy (e.g., crossword puzzles, reading, Sudoku), get out of your immediate environment and go somewhere stimulating, talk with other people, and so on. The basic idea is to do activities that grab your attention and take it away from your urges and your problems – at least temporarily.
- Use physical exercise to deal with urges. Do some intense exercise, whether this includes vigorous walking, running jumping jacks, martial arts, cycling, pushups, situps, or other such activities. Many people find vigorous exercise to be a very effective way to manage and reduce urges as well as unpleasant emotions.
- Notice and ride out your urges like waves on the ocean. This strategy is called “Urge Surfing” and was developed by Dr. Alan Marlatt (at the University of Washington) to help people with alcohol problems. The idea is to imagine that your urges are like waves on the ocean, and that you are surfing on those waves. When they become intense, the waves rise and crest, and when the urges weaken, the waves crash to the shore. Just watch your urges as they come and go, and do not act on them. One major benefit of this strategy is that it allows you to see that urges are temporary, that they come and go, and that you have the freedom to choose not to do what they are telling you to do.
