RAIN Technique to Deal with UrgesNov 11
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I just wrote a blog post about the RAIN technique, simply explaining each step of this self-soothing technique based on mindfulness. RAIN is quite useful for dealing with urges as well, so here, I will explain how to apply to them.
RAIN has four steps, as the acronym suggests:
R stands for recognize.
A stands for accept.
I stands for investigate.
N stands for nurture.
Through an example of a client that I worked with on Tuesday, I will show you how to apply these four steps to the urge to pick or pull. The client in question has trichotillomania, but the same principles apply for every BFRB.
As always, the best thing to do is try it out several times and carefully alter the technique to suit you. If you need more ideas on how to deal with each of the steps, read the main article on www.drmiletic.com that I linked in the beginning of this post.
Step 1 – Recognize
During the session, T. and I talked about a sexual assault that took place when she was 14. As she was telling me her story, she was visibly upset and I could see that her hands reached for her scalp a few times. I asked if she wanted to stop, pause, breathe, change the subject, etc. but she insisted on continuing. “This story has to be told”, she said. And while she was right, I saw her insistence on telling the story while suffering so much to be really hard on her. Pausing for a few minutes or finding another way to approach it would have achieved the same effect, but I have no other choice but to respect my clients’ choices.
I mentioned that I am noticing that her hands are automatically reaching toward her scalp and she then paused and said tearfully: “Yes, I need to pull right now. I need it badly.”
Then she began crying even more, adding: “Great, now I’m going to end up pulling in front of you like a fucking loser!”
I asked her to sit on her hands and then guided her through a short breathing exercise (3x3 breathing) with her eyes closed. At the end, I asked her to describe what she’s feeling in the most concise way that she could. She said: “I feel an intense urge to pull my hair out with both hands at once.”
Because she said it quickly, pro forme, without feeling her words, I asked her to repeat it and she did. I asked her to repeat it slowly and to focus on each word that she was saying.
Step 2 – Accept
The goal of this stage is to stop fighting the urge, although stopping fighting doesn’t mean giving in either. It means accepting that the urge is now a part of your experience, arising from who you are in this moment, not forever.
I asked her how she feels about the urge and she replied with one word: defeated.
VM: Why defeated?
T: Because I’m talking about a huge trauma and now I’m going to end up pulling and making it worse.
VM: Notice how you’re talking about pulling as something inevitable.
T: Well… yeah. I am feeling the urge.
VM: Do you think the urge will last forever?
T: (With reluctance) Well… no but it’s really intense.
VM: Let’s take a moment to acknowledge that: you are feeling a very strong urge now but it will not last forever.
T: How do I do that?
VM: Say it.
T: (Really quickly, almost with an eye roll.) I am feeling a strong urge right now but it will eventually go away.
VM: That’s good. Now let’s do it properly. Take a deep breath in, exhale slowly and say it out loud, word by word listening to yourself: I am feeling a strong urge to pull but it won’t last forever.
She repeats the sentence. I ask her how she feels, and she responds: “A bit easier… I guess.”
Step 3 – Investigate
Investigation introduces clarity in our experience, and it creates a particular effect, what is called defusion in ACT. By investigating your experience, you are both experiencing it and creating a slight distance from it. Creating distance to eliminate the feeling is what we call dissociation, and this is not the effect we’re going for here. Staying with the feelings is crucial because it allows you to develop self-compassion, to understand your experience and to attend to it properly.
I asked T how is she feeling the urge right now. Here’s her description:
“There’s this thought, but not a thought thought, more like a sense of needing to pull. It’s a mood. I don’t know.” Her I don’t know sounded annoyed.
VM: Do you feel annoyed right now?
T: A bit. I can’t describe it.
VM: I think you gave up very quickly. You were on the right track. Let’s consider this further. It feels like a thought but it’s not a word.
T: Yes.
VM: What is your breathing like?
T: Normal. Well… maybe I bit shallow.
VM: See how you jump to answers without first verifying what your actual experience is like?
T: I see. So what do you want me to do?
VM: What do you feel in your chest? Keep sitting on your hands. Close your eyes and feel your chest.
T: (About a minute of silence.) It feels like billions of ants are crawling out of my heart and going into my neck and head and hair.
VM: What do these ants want?
T: Nothing. They’re just ants, they’re just doing their antsy things. Moving around.
VM: So they are not dangerous?
T: No. But they’re annoying.
VM: I understand that. But they are not dangerous.
T: Are you just going to keep saying that over and over again?
VM: No, I promise. But it’s important to know that this experience is unpleasant but not dangerous. Tell me about the source. You said it feels like they’re coming out of your heart. Focus on that area and tell me what you notice.
T: It’s pulsing. It aches a bit. Fuck, I have actual heartache.
VM: That makes sense to me. We talked about a sexual assault. Isn’t that heartbreaking?
T: I guess. Now I feel like crying.
VM: Then cry. It’s OK to cry.
T: (Through tears.) And now when I’m crying there are fewer ants.
Step 4 – Nurture
Nurture is a stage in which we offer ourselves some self-compassion to further reduce our suffering. I asked T. to put her right hand over her heart. She put her hand under her shirt. I instructed her to keep her eyes closed and focus on her hand touching her skin.
We sat in silence while she was focusing on this for about 2 minutes. During this time she said nothing.
I then asked her: What do you need to hear right now?
She stayed silent for at least another minute and then said: I need to hear that I’m safe. I need to hear this will pass. I need to hear that I don’t have to pull my hair because some asshole didn’t have enough self-control.
I encourage her to say it, and she formulates it like this: “You are safe here with Vlad. He’s watching you and you can keep your eyes closed because of that. I am not going to punish myself for something that was done to me. I am going to love myself. I am strong.”
A few moments later, she opened her eyes. I asked her if she’s still feeling the urge to pull and she said no.
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RAIN is a powerful technique, and it can help quite a bit in a short period of time, as you can see from this practical example. If you already have a mindfulness practice, it will be rather simple for you to go through the four steps, but you don’t need to meditate to be able to do them.
RAIN is a healthy way of self-soothing and developing genuine self-compassion, in addition to learning how to tolerate the urge, and when you’re able to tolerate the urge, it already has less power over you. You own it, it doesn’t own you.
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