Have you tried grounding techniques to cope with feeling overwhelmed and anxious when too many intrusive thoughts and trauma triggers occur among you and your alters?

Have you also tried internal family systems therapy and coping (aka "IFS")? This is where you learn to communicate with your alters inside and hold meetings with them so that you are cooperating and working together - especially when dealing with triggers and making major life decisions. How we started out was in a trauma treatment facility, where our assigned therapist (who happened to be the director of the program) asked us to write in a journal and have the alters respond back. It was amazing how the alters began responding back! Soon, I became more familiar with their voices and what they looked like in the "inside world." I learned to use art therapy to illustrate parts of my inside world and parts of my alters. I became more and more familiar with who I was and who my alters were. It was scary at first, but we got used to one another. We still have a lot of internal chaos from time to time, but we generally get along now. We're more co-conscious, which means that we don't lose as much time. The trauma treatment facility we attended in the past considered this "managed dissociation," because our dissociation never really goes away. It's a unique disorder where we are pretty much managing our dissociation instead of trying to eradicate it. For some, integration is a goal, but for others, co-consciousness is the ultimate goal. We chose to stick with co-consciousness as an ultimate goal, since there are too many dangers in the world that keep our dissociation and internal identities intact.

What helps is if you have a good therapist who can see you once a week or more, and if the therapist validates all of your parts and gives all of your parts room to speak in session. It also helps for the host/main person to be able to be co-conscious with those conversations, but it is also part of therapy if your system doesn't allow for that yet. Your T should be able to help you work on that - one small, manageable, and measurable therapeutic task at a time.

When there are other comorbidities involved, such as self-injury (SI) or suicidal ideation and attempts (SUI), then a safety plan with your T will help. The safety plan may include a combination of IFS coping and grounding techniques to deal with the dissociation and panic/overwhelm, respectively. However, a safety plan includes the following:

1. When you feel like harming yourself or considering suicide, call a crisis line or, when in distress, call the ER to see if they have room to take you and/or call your local emergency number (in the U.S., it is 9-1-1).

2. Let your T know via voice mail or email (if email is allowed) that you are in crisis and that you would like to schedule a session if possible, in addition to perhaps explaining whether you will call the crisis line and/or go to your nearest ER.

3. If you are able to manage your crisis, you can still do so with the help of a crisis hotline at any time - esp. as you are waiting for your T to arrive.

4. Use any of the coping skills your T has taught you, whether it be to distract, to use some CBT skills, to use some DBT skills, to use art as an expression (art through painting, drawings, sculptures, poetry writing, creative writing, blog writing, and/or music), to find supportive friends or family to speak with, to rest, to self-care like take a shower and/or give yourself a mani-pedi, etc.

5. Write a "reasons to live list" that you and your T have on file. This will be part of your safety plan, in addition to utilizing the coping skills your T has taught you. This is the list you will read whenever you are considering self-harm or suicide. My reasons to live list comprises my T (whom is my favorite person in the whole wide world right now), my daughter (whom I adopted and still have yet to form a relationship, now that she's an adult), my future goals (even though they seem quite unattainable at the moment, due to this ongoing pandemic), my desire to leave behind a good legacy, my desire to be happy about the things I can explore while on earth and living, etc. You can be creative with your reasons to live.

6. Form a safety contract with your T and yourself and your alters - this combines IFS coping along with making a pact with your T, as you are also in relationship with your T, and your T cares about you. The safety contract could include the safety plan, the reasons to live list perhaps positive affirmations, perhaps pacing-and-containing techniques, etc. You are important in this world - and even to us online here. Writing such affirmations down, even if you don't immediately believe them, can help you remain emotionally connected to those who do actually care about you, and to remember that which we sometimes forget when we have tons of pain we're dealing with. You could say that your T encouraged you to live when your T said ____, for instance. The contract is another way for you and your alters to be accountable to one another and with your T.

7. Make an emergency contact list that you can call during certain occasions, such as when you're in need to distract, you can call certain people. When you need to vent or talk about deep stuff, you can call certain safe, validating people only. Having a list with names and numbers for special crises will help you visualize what to do when your emotions are all over the place. You will have your safety contract, your safety plan, your reasons to live list, your affirmations, and your emergency contact lists in one place - perhaps a decorative notebook or framed artwork of some kind - so that you can easily read those things. That routine of reading those things while also using other coping skills that work from CBT or DBT or this tapping thing I hear others using, etc.., might help.

8. Continue processing with your T and with us online here. We're here to help, too, so utilize us here. Share what you feel, but also be proactive by trying to figure out what works best and what doesn't. Sometimes none of the coping skills work, and sometimes the coping skills will only work with certain things. Make a journal about that, too, so that you get to know what works with what circumstances and perhaps with certain alters.

9. Broaden your social network and increase your social capital. Many studies have shown that validating emotional social support in particular helps to protect against traumatic symptoms worsening and/or traumatic sequelae. Social capital also helps us to prevent both self-harm and future victimization from others. We have to choose our social support wisely, but emotional support is more than instrumental (it's more than seeing your T or getting financial or practical help from, say, a caregiver or a family member). Emotional support entails opening up and having a good balance of give-and-take in relationships. Interpersonal effectiveness, assertiveness training, and more will help in these areas of social skills. Increasing your social network will help build on your go-to list for crisis or emergency contacts. You might have a short list now, but you can journal and figure out ways to increase your list in the future. Don't give up on this. It's great that you're online here which is one form of social support. But we're all anonymous (for the most part), and we aren't in real time (we only show up online when we are able or have time, so you might not get an immediate response). You would get more of an immediate response from local friends or those you can call nationally by phone or through Zoom. Video conversations through Zoom or other platforms will help because then you can see at least another human instead of just hearing their voice or reading the words on a computer screen or via text. But it may take you time to get used to using all these tools. Just don't give up on making more friends and building closer relationships. It takes time.

Hope these suggestions help. Hang in there. Tell us how your T is working out.