BDA Plans

I’ve had several requests for more information on Before During After (BDA) Plans.  This is a symptom management techniques I learned at Sheppard Pratt last year.

BDA Plans are used to prepare for events that may cause an increase in CPTSD and/or DID symptoms.  You might use them to plan for both positive and negative events.  This includes things like holidays, appointments, or telephone calls.

The plan has three sections, aptly named Before, During and After (the event). In each section, you identify what symptom management skills you can use at each point.

Some things to note:

  • Before starts whenever you need it to start.  This could be anywhere from days to hours before the event.
  • During is helpful to focus on grounding skills or whatever else you need to do to stay present.
  • After is just as important as any part of this plan, to help you in case of any impact after the event is over.  Self-soothing and Internal Communication (if needed) are very important here.
  • Use your Crisis Continuum as a guide to incorporate things that help into the BDA.

To give you an idea of how a BDA looks when all pulled together, here is one that I developed at Sheppard Pratt:

Event: Taking a Shower

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As you can see, Internal Communication is a big part of the entire process.  What helps us is the BDAs not only helps us plan for difficult situations, but helps us have a script/talking points for Internal Communication.  This plan in particular has been very helpful in building trust between parts during a vulnerable moment and in turn giving us power in our recovery.

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Finding Tranquility Amidst Distress

Recovery isn’t perfect.  You can be going along, doing well, and even feel like you’re making awesome progress.  Then, a trigger seemingly hits out of nowhere, or a switch happens with no warning, throwing internal harmony out the window.

Last night, one of my child parts, C., who our therapist, K., has been spending several consecutive sessions working with, was experiencing severe panic as we were trying to fall asleep.  C. often tends to be compelled to focus on the perception of danger, even when there is no danger present.  She is always looking for things to prove we are still in trauma time.

C. also appears to be impacted by RA-related traumas (we’re not yet sure exactly how).  Therefore, our internal communication with each other is inconsistent.  Mina and I try to talk to her often. I can count on one hand how many times we seem to reach C.

As the night wore on, both Mina and I became less and less capable of practicing grounding skills and staying forward.  As C. became more forward, she acted just like someone would in an emergency.  Fear and terror kicked in along with a lot of freeze, flight, and collapse behaviors.  

This continued on into the morning.  It was significant.  We hadn’t been in such an extended, overwhelming crisis since being inpatient.

“Do you need to call K?” [The Fiance] asked this morning.

C., who does not yet trust K., of course shook her head. “No. no. no.” She was crying hysterically, hiccupping, and didn’t want to accept any of his help, even going so far as pushing away tissues he offered.

Fortunately, [The Fiance] remained calm.  He respected her wishes for boundaries, but stayed attentive and listened to her.  Empathy was key here.  There was a moment when he said, “I know you’re upset, but remember that it’s all in your mind. It’s all in the past.”

As you can imagine, that made absolutely no sense to a part stuck in trauma time.  It only made her cry more and insist that this was all real.

Eventually, he started to understand how what he said had been offensive.  He acknowledged, “Ok, I’m sorry.  I didn’t mean for it to come out like that.  Yes, what you are feeling and what happened is real.  But what is equally real is I am not going to hurt you.  I believe you.”

Eventually, his empathy and cooperation allowed for Mina and I to be more forward.  He did exactly what we could not do for C.  We’re all feeling much more secure now, and it has made us stop and reflect tonight.

Internal communication, empathy, and internal cooperation are always the main goals.  But what can we do as a system when internal communication isn’t up to speed yet with new parts, and symptoms are off the scale?

Here is what we learned…

  1. A basic attitude of mutual empathy is #1 in understanding other parts and helping them make effective decisions (e.g. grounding instead of compelled to to focus on danger).  Listen to parts and try to reassure or comfort.  Even a little bit goes a long way.
  2. Once C. felt heard and respected, she was able to calm down.  This allowed us to move in and begin grounding and self-soothing skills to help the whole system move forward from this event safely.
  3. Once grounding is established and parts are in their safe spaces, we can fall back on the skills we learned inpatient like…
  4. Orientation Messages – There are several ways to orient parts to the present.  In therapy, K. often verbalizes to them where they are and the current year. She provides examples, like the name of the President, or shows them around her office.  Orientation Cards are Index Cards we keep with us (taped to the front a of journal, or kept inside our Grounding Kit.  They contain a quick message about the current place and time and explain we are safe.  They explain that the person we live with is safe and share [The Fiance’s] name.  This is all done in bright colors which are appealing to children.  Sometimes, if we know which part is struggling, we re-create the Orientation Card with quotes they like or messages they think are helpful.  All parts are not helped by the same Orientation technique, so it’s important we have them help us.  If we don’t have internal communication yet, we have discovered using imagery with present-day technology (not around during the abuse) helps us bypass programming to get safety messages to subsystems.  For example, we may use a drone which is capable of providing a safe audio message about the place and time and can fly over traps.
  5. Distraction Techniques – Conscious, voluntary distraction can give our parts a “reset” button on feeling overwhelmed.  Today, we took some time to focus on a video game which a lot of the kids enjoy.  This allowed us to take some deep breaths and enjoy the music in the game.
  6. Containment – Tonight, we will be carving out some time in our internal meeting to focus on containment.  Just in case C. is listening, we will remind everyone containment is not ignoring anyone’s feelings, but acknowledging it, putting it in a safe place, and promising to review it tomorrow in therapy with K.

Lastly, we will be enacting a BDA (Before-During-After) Plan.  Tomorrow is Monday, which means we have to report to our Full Time job.  It is likely we will be sensitive to triggers right now, and in order to be grounded and present at work, it is imperative to create a plan ahead of time.  Hopefully, work is smooth sailing tomorrow and nothing happens, but it’s always good to go in with a plan.

Having a BDA not only helps improve internal communication in our system, but it gives us a sense of a “safety measure” and we have control over a situation where C. feels largely powerless.

Note: Part of the “Before” and “After” parts of the plan, I have written elsewhere which I call the “Morning Routine” and “Night Routine.”  As they sound, they are set routines incorporating skills to assist parts have a good morning and fall asleep easily at night.

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