livingwithablackdog

sit. stay. good boy.

What do you do with the Shockers? 25/11/2011

Filed under: Depression,Experiencing Depression,Function,Goals & Purpose,Managing Depression,Medication,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks — jillnottelten @ 12:34 pm
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Yes, I am still here.  Still living, breathing and blogging.  Just fell victim to a couple of very shocking weeks (interspersed with some lovely moments, but very few and far between).

This week I’ve barely been able to tolerate daylight, let alone the computer screen – migraine like I have not had in a long time since my medication includes migraine voodoo concoctions … but … amidst my Barry Crocker of a week the week before and the ensuing weekend I became a bit disoriented and missed a couple of doses of my meds, hence the hole in the firewall (just to mix some more metaphors).  Yesterday I went to the GP to get a medical certificate for work and stopped at the shopping centre on the way home.  Talk about sensory overload!  My world had not yet totally stopped spinning so I had this strange spacey kind of sensation as I was walking, the noises were louder and more jarring, lights and colours still bright, smells still sharp.  I couldn’t get out of there fast enough!

Work has been crazy and exhausting trying to manage the politics and dynamics within the office.  Don’t get me wrong – I like my job.  If only work could just be about going and doing your job and coming home again, what a relief it would be!  But there are systems and other people that one has to navigate to do one’s job.  Equipment that one and space one has to somehow get adequate access to do it.  Preferably in a way that lets you stay well without creating more stress than is necessary – which is where the battle lies at present for me.  At present it seems that I am destined to bang my head against a brick wall and progress nowhere and to endure life in the office that gets claimed by miscellaneous team members to serve as their staff room – while my office buddy and I are trying to work in it!!!

But alas!  These are not healthy things to dwell upon.  The goal is to work out how to attack and push through.  I had thought that we had had a strategy for the work one, but it is back to the drawing board on that one next week as it looks like this is rapidly fading into embers.

At present I am struggling not to dwell on the difficulties of the last few weeks.  I grew frustrated that my usual seasonal dip in mood was dragging on longer than usual, but didn’t really look beyond it for other triggers until much too late.  Sitting down with a friend a couple of weeks ago to go over what had been happening clarified things a lot more for me.  One of the reasons that I am so focussed on work issues over the past couple of weeks has come about because through sitting down and working through my usual triggers and warning signs with my friend revealed that my workplace is simply loaded with triggers.  There is little wonder that I have been struggling to emerge from my usual brief decline and regathering of mood.

It’s so easy to forget to go back to the basics when one gets busy.  I can sort of see why Mary Ellen Copeland, the woman who designed the WRAP suggested that going over triggers and warning signs should be something that someone should do daily to prevent relapse.  I’m not sure that I would ever go to daily, but I do know that I need to be going over my WRAP a lot more frequently than I do.  The whole point of knowing one’s triggers and warning signs is so that you can be alert to them.  It’s one thing to know them – but so easy to miss them unless you’re really watching.

So – What do you do with the shockers?  Do you beat yourself up over them?  There’s no point in that.  To me, it seems you need to do is stand back and detach a little.  Stand in the moment.  Not the future.  Not the past.  Just the moment.  Examine – and for me, it helps if I can find someone to help me stay in perspective … at least to get me going – and learn.  This helps me to see cause and effect relationships; it helps me to learn and relearn trip hazards; it helps me see things specifically rather than looming ghouls and it leaves room to remember that there were a couple of good moments in the last fortnight too.

From there I can start with a plan.  If the plan needs adjusting, then so-be-it, but perhaps – just, perhaps … next week can be a bit better …

Please.

 

Arch-Enemies 02/11/2011

Filed under: Depression,Experiencing Depression,Function,Managing Depression,Mindfulness & the Senses,Monitoring early warning signs, triggers & Wellness action Planning,Routine,self-management strategies,Therapies,Work — jillnottelten @ 4:33 pm
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Do you have arch-enemies?

I do.  Mine haunts me.  I can never seem to beat it.

There are the odd occasions when I do really well against it and I win.  It feels great.  I could walk on air.

Sometimes they last for a short stretch of time – a few days, a week – two if I’m lucky.  I could fly.

And then

it all comes

crashing

down

in

a

great

big

thud.

OUCH!

And it’s not just me who is affected.

It’s not a small thing with small consequences.

What happens, you ask?

Okay I’ll ‘fess up.

I don’t wake up.  Or if I do – I drop right off back to sleep before I can haul by backside out of bed.

Then I am late for anything that I have on for the day – visits, appointments, ….work.

And we’re talking regularly 30 – 40 mins late during the mid spring and autumn – and every now and then it’s a couple of hours.  It affects other people when that happens – workers, patients … if I don’t get my work done it slows down the process of referrals going through, information getting to people in hospital and their treating teams for planning, people going home.  It means groups can’t run or other people have to cover me.  I nearly lost my last job over it.  Even when well I’m often 10 – 20 mins behind my start time.  I survive because I start before my boss and I always work back – but I can’t keep it up.

And it doesn’t seem to matter what time I ‘m supposed to start – I’ve adjusted starting times.  It’s simply the process of getting out of bed and waking up in the morning.

Once I’m up, my sensory routines are helpful.  I’ve started to experiment with some mindfulness exercises when I get time – which help a lot.  But actually waking up and getting out of bed is jolly hard work.

The other thing that happens to me is that I lose time in the mornings.  I do.  Even when I’ve gotten up on time and have been running on time something happens – I space out in the shower or getting myself a drink and meds and time just vanishes.

I started a new experiment earlier this week that I think holds promise for the latter issue – I’ve started using a mindfulness breathing meditation exercise as soon as I get up that goes for about 10 mins to raise my level of alertness.  If it keeps working at keeping me focused, I’ll be writing about that in a couple of weeks.  But for it to work – I need to get up in time to have time to do it.  It doesn’t need to be earlier – because I’ve worked out that I do everything else more efficiently when I do it.  But I need to get up.

Sleepy-head

At present I use two alarm clocks set 5 mins apart – one to arouse my attention if I am in deep sleep so that by the time the second goes off I won’t sleep through it even if I sleep through the first.  Part of me wonders whether it’s worth investing in a bed vibrating alarm clock – they make them for deaf people.  It might be uncomfortable enough to help me move out of bed more easily.  Has anybody ever used one?

I know the rules – go to bed early and get up and the same time every day.  I’m awfully undisciplined at doing that.

Take your meds at the same time every day.  I tend to get lazy and just take them on the way to bed – which admittedly is probably half of the problem.  There are some very sleepy meds among my cocktail.

Every day is a new day with no mistakes in it – yet.  Thank you, Anne Shirley – but other people remember and I need to work out the best way to deal with their memories and keep myself focused on the present so that I don’t drown in fright.

So here it is.  My arch-enemy.  The alarm clock.  That moment in time that I’m supposed to get up.  To get moving.  To get started with the day.

Please – anybody with your own ghouls – what helps you haul yourself out of bed every morning?

 

Mindfulness of the October Factor 22/10/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Managing Depression,Mindfulness & the Senses,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies,Therapies — jillnottelten @ 2:49 pm
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One of the factors that I have spoken of recently that has affected my mental state is the change of season.  I become more vulnerable to symptoms of Depression and need to be careful not to be taken captive by them and dragged back under the control of the black dog as he strains upon the lead.  October this year has been fraught with tension as the dog hauls away at the lead while I wrestle endlessly to bring him to heel and keep him there.  While each time he strains, I have brought him back – it takes a lot out of me and he knows it as he waits impatiently at heel for the next opportunity to pull away.  I have had a tiring month.

How do I know when things are starting to get too much?

One of the things that I have decided to work on is paying closer attention to the cues that my body gives.  It’s very easy not to be aware of these until I have a nasty headache, my shoulders ache, my muscles are all sore, I have a noticeably palpitating heart rate that makes my chest feel hollow and heavy or I feel exhausted.

I commented in my last post in closing about Mindfulness that one of the areas that I need to work on is that of noticing what is happening in the moment.  This is what I am working on at the moment.  To start with – to notice the cues that my body is giving me.  For instance, when is there a change in the level of tension at key points in my body like my neck, shoulders and jaw?  Am I breathing deep, medium or shallow breaths, what kind of rate am I breathing at?  Am I aching anywhere?  What is my heart rate like?

Now I don’t do this as a checklist and step through it or try to determine these things in a specific way.  What I am learning to do is to try to do what is called – in Mindfulness language – a ‘body scan’ at regular intervals.

What does a body scan involve?

Essentially all I do is start out by observing my breathing until I am into the mindset of observe – not control.  I then move my attention to my heart and notice and feel the rhythm of my heart beating inside me and the sensations that arise from that and enjoy that for a little bit.  From there, I start by noticing the feel of the clothes on my skin, the shoes on my feet if I’m wearing any and then move my attention to my muscles.  To scan my muscle I start by placing my attention on my toes of one foot and paying attention to them, noticing any tension or pain or other sensation, acknowledging it and – if it is tension, consciously releasing it from the muscles by either picturing it draining away or stretching and/or wiggling them.  I then do the same for the other foot and move on to the next section of my leg and do the same thing. And doing this throughout I might move through the body in a pattern something like:

  • Toes
  • Feet
  • Lower legs
  • Thighs
  • Butt
  • Abdomen
  • Lower back
  • Upper back
  • Shoulders
  • Chest
  • Upper arms
  • Lower arms and wrists
  • Hands
  • Fingers
  • Head
  • Forehead
  • Eyes
  • Nose
  • Cheeks
  • Mouth
  • Jaw
  • Tongue
  • Neck
  • Shoulders

I figure that since the shoulders bunch up so easily, it doesn’t hurt to check them again.  It doesn’t really matter what order you do it in though, nor how big or small the groups you break them up into are to a certain extent.

After scanning and relaxing all of the muscle groups, I then observe my breathing again for a moment or three before drawing my attention back to what is in front of me to do.  It doesn’t take very long, and with practice it should take perhaps a minute – maybe less.  If I try to do it when the little ‘beep’ goes on my watch on the hour (when I hear it), I should get lots of practice and stay well on top of these cues.

The goal is to be able to notice the tension before it becomes problematic and to be able to question whether I am becoming stressed before I get there.  A lot of people who do this regularly swear by it.  I guess it’s a bit like paying attention to when there is tension growing on the dog’s lead when walking a dog.  As it grows, it cues us in to the idea that the dog is growing more likely to want to get away from us.  Thus it is living with my black dog.  I must be wary of tension.

So – here’s to my next excursion into the world of mindfulness.  Noticing physiological changes and discomfort and either accepting them or letting them go without blame for their getting there.

Here’s to the next step into managing my Depression.  Noticing the cues that early warning signs are present so that I can act.  Perhaps October will improve from here on in.

Heel, Dog.  Heel.  I’m onto you.

 

Watching Wellth 16/10/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,Managing Depression,Medication,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks,Therapies — jillnottelten @ 10:30 am
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The journey’s oft’ rough as one travels the road

with one’s mood apt to upset the cart;

And if climbing back on aft’ one spill weren’t enough –

Alas – staying on top is an art!

For most of us who have passed though one episode of depression – or other forms of mental illness and come out the other side, a common concern draws us.  We don’t want to go back there.

Some have a harder battle ahead of them than others.  Some have different forms of depression; different forms of anxiety; different forms of mental illness that are more or less responsive to the things that we do to treat them.  Some are more vigilant than others – often this makes a big difference … and sometimes life’s not fair.  Some do all the ‘wrong’ things and yet never have another episode – but that’s unusual.

What’s usual is hard work with a need to use a range of strategies to stay well.  Things like good sleep, exercise, a nutritious diet, keeping up social support networks and getting out of the house, exposure to sunlight and fresh air, use of medications and talking therapies are just some examples of these.

But how do we know that we’re winning?  What can we do at the times when we’re worried about how our mood is going to try to prevent it from tipping over the edge into something we can’t manage?  How do we know if that new medication is doing anything to change anything at all?

One of the things that is helpful to do at times is to track your mood.  How do you do this?  You use a mood diary.  Ever done it?

The purpose of a mood diary is essentially to get a profile of what pattern your mood is following on a day-to-day basis.  At their most basic level, a mood diary will ask you to rate your mood on a numerical or incremental scale every day while you keep it.  Some will additionally ask you to record other information such as your anxiety levels, your irritability levels, how much sleep you had the night before, significant events and triggers throughout the day and/or the medication that you took.  The good thing about doing some of these other things is that they provide a much fuller picture of what is going on.

If you don’t already know what they are – this process can help you to work out what your early warning signs are as well as your triggers.  If you know your triggers and early warning signs, this can help you to monitor them. For that reason, I recommend choosing a mood diary that records significant events in the day.  I would also recommend one that includes the amount of sleep that you had the night before as this tends to be pretty universal and fairly influential.

Talk to someone close and ask for their help if you have trouble working out if you were irritable or if they noticed anything in particular that seemed to set you off if you are having trouble identifying these kinds of things – but the object of the exercise is to make observations about yourself – so do what you can on your own as well.

However, asking someone close to you whom you trust to help monitor your mood and to help you get to know your warning signs and triggers is a good strategy.  They sometimes see things that you are not in the right place to see or notice when you’re not well because your self-awareness can get a bit skewed.  They also see the ways that you differ from the way that you would normally be – so they can measure you against you and not somebody else.  Yes, it might be their perception – but it will still be your behaviour and actions and the things that you say and the responses and facial expressions that they are used to that are part of you.  Choose someone who you trust and talk with them and let them tell you about what they noticed changing last time and as you have been working through your recovery.

Do I use a mood diary and self monitoring systems all of the time?

Not on a daily basis.  When I am well I keep regular tabs on how I am going by talking about it with a good friend and checking over my early warning signs and triggers list regularly to ensure that my awareness of them is good and that I am alert to high risk periods.  I use what is called a WRAP – a Wellness Recovery Action Plan where I have identified what I am like when well, what my triggers are, what things are hints that I’m not as good as I could be, my early warning signs and so on …. I go through this regularly.  Some people do monitor their mood daily and find that it works well for them.  People with things like rapid cycling Bipolar disorder often find that they need to until it slows down and is brought under control.  At first I needed to chart my mood a lot more than I do now.

When I am in a high risk period I watch things more closely and have recently resolved to keep a mood diary through high risk periods because I still find myself at sea sometimes and feeling like I’m losing my grip.  I am particularly vigilant about my warning signs and triggers as well as their corresponding action plans during periods of high risk.  I have to be.  Recently I let things go at home and let the dishes and the housework pile up around me – a sign that things are getting away from me and didn’t act and it triggered me (it becomes a cycle).  I couldn’t face getting up to look at the house.  I didn’t want to go into the kitchen to prepare a decent meal because it was a mess and I didn’t feel up to cleaning it up – so of course my nutrition level went down, my budget blew out and thus the cycle continued.  In the end it took a cleaning weekend to put me back on track, followed by a week of very early nights and a lot  of discipline.  It’s too easy.  So I have decided that I need to do something to catch myself more quickly before it gets away from me.  Not simply cleaning, just lots of little things.  This time of year I need to be very careful about relapse prevention.  It sounds minor when I talk about dishes – but when it snowballs, I just keep sleeping and if I sleep through work or go in late consistently and am still going around in circles while I’m at work and don’t have energy or concentration to work – I could lose my job.

I’ve attached today some links to some self monitoring resources and different mood diary sites.  I know there’s a lot, but different things suit different people and I think these are important tools.  Most mood diaries have room for the full spectrum of mood disorders – both mania and depression.

Warning signs and triggers are important.  Monitoring your mood is tedious sometimes – but there are times when it is necessary.

General

http://breeze.blackdoginstitute.org.au/keepingwell/

Mood Diaries

http://www.bipolar.com.au/common/pdf/mood-diary.pdf

http://www.blackdoginstitute.org.au/docs/MoodChartforDepressionandhowtomonitoryourprogress.pdf

http://www.blackdoginstitute.org.au/docs/DailyRatingScale.pdf
http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=mooddiary

http://www.moodscope.com/ for those who like online resources

https://www.moodtracker.com/ another online resource

http://itunes.apple.com/au/app/moody-me-mood-diary-tracker/id411567371?mt=8 for those who like apps

Mood Monitoring & Relapse Prevention Programmes

http://www.cci.health.wa.gov.au/docs/KYB-3-Self%20Monitoring.pdf

http://www.idamaecampbell.org/files/40263519.pdf (WRAP personal workbook)

Early Warning Signs

http://www.health.qld.gov.au/rbwh/docs/early_warming_signs.pdf

http://www.blackdoginstitute.org.au/docs/20.WellbeingPlanforBipolarDisorder.pdf (can be used for depression too)

Healthy Lifestyle

https://www.mindbodylife.com.au/Downloads/index.cfm

 

 

 

The Wall with a Hole in it … 30/09/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,Routine,self-management strategies,Work — jillnottelten @ 5:23 pm
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And I’m not talking ATM.
Have you ever felt yourself to be up against that dragon that you were never destined to slay?  That worm you’ll never be early enough to get? The one that leaves you feeling like the Emperor in all his glory when he set out in grand style to show off his ‘new clothes’ just when you think you’ve gotten a hold on it.

My nemesis is time.  Not just any time – although we have a slippery time keeping pace with each other continually.  No, the ultimate battle is drawn around the time of sleep and waking.  Here I am repeatedly mauled by my dragon, eaten by the worm and left with nothing but the Emperor’s new clothes to show for all the effort that I have made to conquer the struggle.  I feel as though I am beating my head against a brick wall.

What happens you ask?

I set an alarm clock.  Actually I set two alarm clocks ten minutes apart.  I do not trust myself with one.  I have been known to turn one off in my sleep!  I set one to raise my level of consciousness and the other to wake me.  For most of the year this is adequate.  But then comes the changing of the guard – it starts to get light earlier or later in the spring or autumn and for several weeks my dog hides the alarm clocks.  He must.  Some nights anyway – because they sure as hell don’t wake me.  But then I also have trouble in getting to sleep – so maybe it’s not all the dog’s fault.  At times I sleep no more than an hour or two a night.  Others I may get to sleep and then wake up at two in the afternoon – ON A WORK DAY!  This year I thought that I was winning at work until the seasonal sleep monster set in.

Right now I feel like I am beating my head against a brick clock.  In getting to sleep.  In waking up.  In getting to work.  My psychiatrist has given me something to try for the short-term (ie 4-6 weeks) as it’s a regular pattern and struggle and part of a bigger picture of short-term seasonal change in my mood.  It’s not a relapse – just a dip.  But oh so disappointing because its been so stable for so long.  In lots of ways I think I could handle it if the sleep didn’t go out the window.  It’s started to affect my work though, so I’m taking the medical option this time.  Maybe next time I’ll be able to have the personal strategies down strongly enough to manage it without boosting my meds for a few weeks – but I need to prioritise keeping my job over my pride for this time.  I may have to wake up and phone in to work in the Emperor’s new clothes.  I do not have to parade through the streets in them.

Bloody Dog.

Damn Clock.

So for now I get my sleep under control.  I keep my mood stable with a little extra help than usual until the season settles.  At least I will be able to keep the dog in his place.  At least I will stop messing things up so badly in getting to work.  It will only be for a few weeks and then its back to the normal cocktail that I’ve accepted will be a part of everyday.  Back to using my ‘personal medicine’ or lifestyle strategies to manage life and its stressors.  Then I get summer to strengthen my other skills and to be ready for autumn when it comes.  Perhaps I will plan a short increase in meds again.  Perhaps I will plan time off work.  Perhaps I will be enough on top of my sleep to manage it with flying colours.

My Dog loves the twilight of the seasons.  He thinks its play time.  He loves the dawn.  He dances while I wake.

Oh to be able to open one eye and say in my firmest voice.

“Sit. Dog.  Sit!”

And have confidence that he’d obey.

One day.  One day he will.  One day I am determined to slay that dragon.

One day.

 

Seasons Come & Seasons Go 29/09/2011

Filed under: Depression,Experiencing Depression,Function,Leisure,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies,Treatment Resistant Depression,Work — jillnottelten @ 10:24 pm
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Some people are Summer people.  Some people, spring people.  Some are winter people.  Some love autumn.

No, I’m not talking about people’s colouring or the things that they like to wear (that is something that I, in fact know very little about).  I am simply talking about peoples’ favourite times of year.  Some people like to soak up the sunshine in summery garb out in the garden, down at the beach or over at the local pool.  Others love to curl up by the fire in their favourite jumper under a rug with a good book and a cup of hot chocolate – or put a movie on.  Some love the colours of autumn and the beginnings of that lick of ice in the early evening.  And some the radiant brightness of spring, its scents, the new life, the slow steady warmth, the magpies diving at you from overhead…

I never settled to a favourite time of year.  I really do enjoy almost all of all seasons – and by the time one ends I am ready for the next.  I am not fond of the days that exceed 40 degrees celsius with no cool breeze for long stretches at a time.  Hot winds are their own breed of evil in Australia for reasons far beyond temperature tolerance.  I’m not a great fan of temperatures at the other end of the spectrum either – especially if they come with a wind.  Actually – wind bugs me more than temperature.  But seasons – apart from the odd bits like getting up in the dark to go to work in winter – seasons are a delight.  Full of life.  At least, I always used to think so.

My dog pays attention to the seasons too.

Unlike me, the dog has clear preferences for different times of the year.  It took me a while to work this out, but its consistent.  The dog is stubborn in winter.  He moves slow.  He needs more time.  He takes more time and holds me up whether I plan it or not and he wears me out more easily than he does during the warmer months.  I think he’s arthritic.  He gives me no trouble if I allow for the arthritis though.  A bit more sleep – 1/2 hr or so more than I need in summer and I’m fine.  I just need to be patient.

Summer is usually the dog’s best time of year.  He still needs discipline, but he’s more content to walk at heel and doesn’t drag and tug away at the lead.  Spring and Autumn are strange.  Most of the seasons fall in with the winter and summer behaviour for Dog according to temperature and what the light is doing.  In each of these season there comes a point where the light changes – and over these few weeks the dog goes nuts.  He is unpredictable.  I can not afford to let my guard down for more than a few moments at a time.  My sleep gets poor – this starts the ball rolling.  My energy levels become low, my motivation to maintain routine relapse prevention strategies gets sloppy and I soooo don’t feel like doing anything about it.  It at these times that I have frequently relapsed (almost without exception).  I made it through autumn this year.  So far I have struggled this far through the last few weeks.  Another 3 – 4 should see me through the worst of it.

Until then, its keep on keeping on and stick to the programme.  Watch for warning signs – the very time of year in and of itself is a trigger – even without the presence of other factors.  Light does funny things to my health in other areas too.  It’s like the dog becomes delirious.  Here is a time when I need my friends and family – my supports more than any other time of the year.  I’m struggling to get to work on time at the moment, but so far my boss has let me cover with time in lieu.  Still, I’m determined to conquer that one too.  I get there on time more often than not – just not as often as I should.  Just now – when I least feel like it – discipline becomes oh so important.

I had my last review with my Psychiatrist this week.  We agreed that it would also be possibly a beneficial thing to increase one of my medications for 1-2 months during the peak risk zone while I’m wrestling risk factors and wavering – just for that short-term – and then go back to my current dose afterwards as the weather and season stabilises a bit more.

Hopefully the combination of ‘personal medicine’ or monitoring of triggers and early warning signs with the kind of action plans that are outlined in my post “Better Medicine”  with the temporary medication adjustment will prove to be a good protective measure.  I’ve had a good year.  I’d hate to mess it up now.  I’m hoping to get to at least a whole year without a relapse this year!

So roll on to the latter end of Spring.  Because despite all of this, I really do love spring.  There’s a certain level of hope and promise in the air in Spring that’s unique to this time of year.

Come Dog.  Heel.  Walk.  Heel.  Walk.  Heel …

 

Attishoo! Attishoo! We All Fall Down 31/08/2011

Filed under: Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,Physical health & wellbeing,Routine,self-management strategies,Work — jillnottelten @ 9:42 pm
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What’s going on?

I’ve got a headache that I’ve had on and off for a few days now.  I’m so tired so much of the time.  I’m disorganised.  My house is a mess and getting less clean than I’d like it to be – it’s not grotty, but without action it could get there without a lot of effort … I’ve spent the last couple of days off loafing in my ever comfy PJs and while I’ve gotten up and done stuff, I’m sure I said ages ago that I was going to stop doing that…

Hang on.  These things are all among my early warning signs.  I’m off my game.  Nothing serious yet – but now is the time to act.  I’ve been going really well for ages.  It’s not even my Depression that’s knocked me off my game – it’s the damn cold that I’ve been fighting.  Yet this I do know.  In the past relapse has often followed physical illness.  The dog acts when he knows I’m not at my best.  He takes advantage of weakness.

So what do I do now?  Give in? Panic?  Book an extra doctor’s appointment?  Nope.  Now is the time to reach for my WRAP – my Wellness Recovery Action Plan – something that I should probably be going over more regularly to remind myself of the daily and weekly/regular things that keep me well.  In my WRAP I found that I’ve been neglecting a lot of these over the last couple of weeks and that I have gotten sloppy with a couple of my routine maintenance markers over the past couple of months.  My work WRAP (my own experiment) shows me that I’ve not been sticking to my wellness goals about leaving on time and planning my day either – no wonder I’ve been feeling like I’ve been run over by a truck.

Now is the time to restart the action plans.  I need to tell someone that I’ve noticed that I’m off my game and that I’m acting on it – that way they can ask me how I am going with my action plan in a couple of days to see if I need some help to get things moving again or if I’ve been able to self-start again solo (often harder than I think it’s going to be).  I’ll wait to see how things progress and talk it over with my friend before I rush into moving any appointments forward.  I think I’m okay if I get reorganised at this point.

So its back to setting alarms and keeping them for going to bed and lights out at night.  I’ve been letting the sleep run thin.

I need to plan my meals rather than look in the fridge and hope that there’s something I feel like eating in there.  And I probably need to start putting more attention towards the balance of what I eat because I don’t think I’m eating enough fresh fruit and vegetables (that’s a new strand to the plan for me).

I need to put away the things that are lying around and creating clutter.

I need to clean the house.  When that goes to my list though it will read room by room and the floors will be separate.  That way I can do it in parts and feel like I’m making headway when I cross things off on my list.

I need to set up a routine for maintaining my housework.

I need to set aside time for doing things that I like to do.

I need to work out how I want to prioritise a couple of things that I have going at the moment so that I can put away what I am not going to finish in the immediate future and finish off what I am doing in my ‘projects’ department.

I need to set aside time for some meditation and prayer.

I need to make sure I leave work on time.

I need to make better use of my diary and go back to keeping a list of things that I need to do to mark off and prioritise – this works well for me

I also really need to put some effort into starting to exercise and to spending more time outdoors.

If I need help with anything, I can and will ask.

I’ve been good with most of my other stuff but things involving routine, and doing things that I’m not instinctively motivated by (like exercise and cooking for anything other than guests) are difficult.  It may get easier.  Who knows?  My goal is to find something that I enjoy in the things that I find difficult to do at some point – but not now.  Now the need is to just do it.

We all fall down.  We all need to know the best way to get up again too.  Take the time to be prepared.  I use the WRAP (http://www.mentalhealthrecovery.com/wrap/ .  You can now download an old edition of this from “Recovery X-Change” http://www.recoveryxchange.org/downloads/RxChange%20WRAP%20WorkBook.pdf  if you want to check it out a bit more closely).  There are a number of different systems people have.  The most important thing is to be ready to be ready.

All I have is a cold.  It does not have to become a relapse.

Right now though it’s approaching bed time.  So rather than editing anything else.  I’m going to post this and head for the sack.  Good night.

 

The Best Bucket For Fishing In 27/08/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies — jillnottelten @ 6:13 pm
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I have been cleaning out my study over the last couple of days – no small job – I have been putting it off for a long time.  I unearthed a lot of rubbish, a tonne of reading, receipts, filing, thankfully nothing that should have been included in my tax (which I have done already this year – yay me!) and my bucket list that I did for my Psychologist earlier in the year.

Why a bucket list?

I had been depressed on and off for years.  When I was well I had only just been coping with no room for anything but putting one foot in front of the other.  It had been a long time since I had really allowed myself to cast my eyes very far into the future.  It was hard to do.  My life had become so tied up in looking after the dog and keeping him out of the way so that I could manage walking that it was hard to picture anything else.  This is not a healthy way to live!

Maybe not – but everyone knows that we need to get through each day – so what’s the point of looking any further?

My first response to this would be to give you a reason to stick to the fundamentals that feel so arduous when times are tough.  The healthy lifestyle, the sleep, the medication, the self management strategies that you’ve chosen to compliment your medical treatment (see my post Beyond Medicine) can feel like such a chore at times, and there are days when you question if your daily struggles are all that important.  Things that have some value and potential to motivate you are important.

My second is that a routine is strongly recommended, but often hard to fill out.  An exercise like doing a bucket list may give some clues to your interests or things that you could start even now to use time doing something that you are more likely to consider worthwhile.

Thirdly, if you are getting well and your health is stable, but you’re a bit lost about what you want to do – this is a great way to brainstorm ideas that you can later use to figure out what direction you want to work towards and what sort of goals you want to set for yourself.  You can also look at the different sort of things you have put on your list and use it to try to make sure you keep some balance to your goals so that you can target a balanced lifestyle that reflects you.

Fourthly, if you are struggling to stay well and all that you are focussing on your health or perhaps your health and keeping your job – perhaps you can use it to choose one thing to help with relaxation and/or re-energising.  Often – and I speak from several years of experience here – this is neglected to our detriment when expanding our support network and finding opportunities elsewhere for success would improve our workplace performance and keep the dog in his place much more effectively.

Not sure what you’d put on it?  Try meeting up with a friend and do bucket lists together (I met up with a couple of different people).  This helps stretch your ideas until you start freeing up your mind.  Read past journals if you have some if you used to write about things you’d like to do one day.  Be as vague or specific as you like – it’s your list.

Here are some of the things on my list:

Bushwalking

Make a pretty garden

Redo a house

Teach professional practice skills

Overcome Depression and Anxiety to the point where they no longer require any intervention – even meds

Stay well

To make sure I keep up friendships and make new ones

To grow wise but be humble

To be physically fit and able to run without getting puffed out

To get good at being organised and reliable

To learn lots of interesting things eg Ancient Greek, Ancient & modern History, Latin, Languages, Leadlighting, Aromatherapy, Sciences, making things, gardening, writing and publication industry, professional development and research, theology …

Write a book and publish it

Write a children’s book, get it illustrated and publish it

Go to Scotland, Ireland and Canada and see lots of other places too

Learn Piano

Write a song

Learn to play Cello and/or an alto/tenor woodwind instrument

Research and develop useful intervention strategy for use in Mental Health Recovery – meaningful to and valued by consumers – well weighted by evidence

Learn to tap dance

Build a doll house

Act in a stage performance

There’s a tonne of others that I’m not going to share and I’ve simplified a lot of these.  But they have made way for goals and routine and positive steps.

There are six major themes among the things in my bucket:

Creativity

Learning

Relationships

Social Responsibility/contributing to others

Travel/adventure

Growth (language, fitness etc)

My challenge is to have something – one thing at a time among my goals that touches on each of these areas.  I also try to include something of each – at least most – in my routine.

The steps to some dreams are appealing.  The way to others not so much.  The keys are choice, balance and timing.

Never let the dog stop you from dreaming.  Sure, be careful not to get stuck in them – but be careful not to lose sight of the things that you’d like to do or some day.  These are the things that give you a reason to put your next foot forward.  These are the things that make it matter that the dog stays out of your path.  These are the things that help you choose which direction you walk in.  These are the things that make it matter that it’s you and not the dog that does the choosing.

Look where you are going.  Move deliberately.  Walk one step at a time if you must during the hard times, catching your balance and calling the dog back to heel in between.   Don’t let him draw you down to wrestle with him while you walk.  When you stop looking where you are going, the dog has the upper paw.  Shorten the leash.  Keep him close.  Don’t give him an inch.

Heel, Dog.  Heel!

 

When the Mallee Bull’s Away … 24/08/2011

Filed under: Depression,Experiencing Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,Physical health & wellbeing,self-management strategies — jillnottelten @ 3:23 pm
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In recent years I have developed a fierce respect for my health.  Not only my mental health – but my physical health.  Whereas before I had little patience for the times when I was sick, there are times now when I fear it.  When I am sick I just use more sick days at work – which raises more questions and more suspicion: “what is really going on?”.  I feel disgusting.  I break all of my carefully laid down routines and maintenance plans.  I have to take more tablets. And all too often it drags on for too long thanks to poor immunity and a system that’s already struggling with every day and brings me – if not to relapse, then certainly to the brink.

When I am sick, the dog often thinks he is allowed to play.

It makes sense.  There is less energy to be on top of my game with my thinking, so if I’m not ultra careful I do forget to reality test my thoughts.  I get lazy and don’t practice mindfulness.  My appetite is lacking, so unless there is someone else cooking for me and serving up nutritious food, I’m not eating well.  I’m exhausted and sleeping all the time and not maintaining my routine.  I’m too sick to exercise.  My medication is going in – but that’s about the only maintenance activity that is actually happening – and if I have a gastro bug even that gets out of kilter.

Short term bugs aren’t so bad.  A day or two and I get back on top of my game without too many problems.  No, the one that I hate most of all is surprising to some people.  The thing I dread most is the common cold.  It drags on forever.  It saps my energy.  It robs me of the desire to prepare decent food, to look after the house, to keep much of a routine.  Sound like anything else you know?  I live in fear that the head cold will go to my chest and then I will finish up coughing for weeks on end which leads to fear of aggravation of an old back injury – and so my thoughts become dominated by dismal and negative themes and the black dog leaves his rightful position at heel and begins to circle again.  Thus it is that I find that a cold, if I can’t get rid of it quickly can be a trigger for relapse.

So – what do I do?  I stay rested.  I eat well.  I have my flu shots – which I know some find controversial – and that there are also people who are not convinced that this helps, but as a health worker I find that it has left me less vulnerable and in Australia health workers get them for free.  I wash my hands regularly and use hand disinfectant.  I dress to the climate.  I’ve given up rain walks in cold weather.  Some people use vitamins, but to be honest I couldn’t face taking any more pills and don’t want to spend the money and would rather just eat the vegetables.  I try to avoid spending a lot of time with people who are sick.  If you look back a couple of posts to ‘Beyond Medicine‘, you will find that these are the things that will keep you physically healthy as well as mentally healthy.  If you want to keep the bugs at bay these are the things you go to.  Some I have already mentioned, but lifestyle habits and strategies that reduce stress are also important.  Support is important.  Hope is important.  Sunshine is important.  Recognising the early warning signs and triggers of physical illness is important.  Our mental health and physical health are inextricably linked.

If I get a cold, I do start taking cold and flu tablets early when I get symptoms of a cold – particularly at night, and I use airway clearing aromatherapy oil before I go to sleep so that I can breathe clearly.  I also sleep propped up slightly.  Usually these things stop the cold from getting to my chest.  Usually.

This year has gone well so far.  I’ve stayed mentally well enough while I’ve been sick that I’ve still been able to use my mindfulness and cognitive behavioural techniques to keep the dog in line, so he hasn’t really challenged – even when some of the other important stuff has fallen by the wayside.  It’s still going to involve work to get the rest back in place, but hopefully not as much as usual.  So just for the moment while I get a bit better…

Sit, Dog… Sit.

 

Beyond Medicine 06/08/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Mindfulness & the Senses,Monitoring early warning signs, triggers & Wellness action Planning,Physical health & wellbeing,Routine,self-management strategies,Social Supports & Networks,Talking About Depression — jillnottelten @ 4:01 pm
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Personal Medicine

What's missing from your treatment regime?

Taking a dog to obedience school can be a challenge.  The thing is – it’s you that get’s stuck with the homework.  You that has to reinforce the training and know that the dog understands what you are telling it to do.  You that has to maintain all that new knowledge. (Just who is being trained anyway?)  Tiresome? Yes, while the dog is learning.  Worth it?  When the dog does what it’s told and behaves?  Certainly.

There are “medicines” beyond the pills and potions that I take that serve to keep my black dog in check.  “Personal medicines” if you like.  But to me these are the things that have made the difference between ‘a life half lived’ and the journey of recovery.  Let me share some of these with you now:

Routine:  Keeping up some kind of regular pattern of activity helps to keep the dog at bay.  It’s hard to start with to fill up when there is ‘nothing’ to put in it.  I start by setting meal times and trying to put one thing in the slots of time between meals, perhaps a short walk, washing dishes, putting a load of washing on, having a shower, reading – it doesn’t have to be big.  Then I build up from there as I work on other things on the personal medicine list.

Sleep:  Work out how much sleep you need to have and make sure you get it.  I need to make sure I have at least 8 hrs consistently.  That also means I need to allow time for falling asleep when I go to bed.  Now I have a bed time and a getting up time.  This means that I shouldn’t over-sleep (although sometimes I stay up too late and still do) and that I shouldn’t lie around in bed all day either.  Bed becomes a sleeping place.  I will often allow myself 10 hrs sleep on weekends and 8 hrs through the week.  This suits my work schedule.

Nutritious Diet:  I can’t tell you what a difference it makes to my mood when I am eating a well-balanced, appropriately spaced and portioned diet compared to when I am not.  My energy levels are consistently better.  My concentration is better.  My mood is brighter.  Check out basic dietary guidelines for a balanced, healthy diet and plan your diet around them.  It will take a while to get used to doing – but you will notice the difference in your mood, wellbeing and possibly your weight.

Exercise:  There is research that shows that exercise has an antidepressant effect on the body.  Get into a regular exercise pattern.  It can be as simple as walking most days in a week, or you may choose to do different activities on different days to save yourself from boredom.  My advice – start simple.  Again – start with the recommendation made on general health sites about exercise.  I aim for approx 30 mins about 5 days per week.  At the moment I’m being slack because it’s winter here and I’m just getting over a nasty cold – but I need to get back into it.

Early Warning Signs & Trigger Watch:  Learn to spot the early signs that your mental state is slipping so that you can catch it early!  Make sure you have a plan for what you will do when you notice them – even if it is as simple as call your doctor, counsellor or case worker for help and ask them to teach you some strategies so that you can do it yourself next time.  Also, get to know the things that trigger you, that way you can either plan for them or do something about the effects of the trigger before you become symptomatic (eg relaxation, pleasant events, talk to someone, visit a friend etc).

Pleasant activities:  Plan to include things you enjoy among the things that you do.  Enjoyment is a great way to remind that dog that he’s not wanted.  If you’re not well and not enjoying things – you may find it neutral or relaxing even if it doesn’t give you the same buzz that you usually get.  Sometimes you will also find you like things more than you think you will.  I enjoy reading, getting a massage from a friend – or if I have money I used to go to someone who made me feel comfortable for a back, shoulders and head massage; seeing a movie, going to bookshops and the local wool shop.  I love spending time with my family and playing with my niece.  Doing these things – even when depressed – often leaves me feeling better.

Looking after myself:  Making sure that I shower daily and clean my teeth when I should makes a huge difference to how I feel.  Clean and trimmed nails.  Clean and presentable hair (preferably at a length I like without an inch of grey roots showing), the hair in places that it’s not wanted removed, without wax in my ears … and its nice to use a soap that feels good on my skin and some moisturiser; perhaps a face mask here and there – after all some of those medications do yucky things to my skin.  I also like to make the effort to wear clothes that make me feel nice these days.  I used to be very happy dressing very daggily – and still am often; but it helps me feel better when I’m wearing something that I like.

Social supports:  Having people who care intimidates the dog.  Essentially, he’s a shy creature when the depression’s not at its more aggressive stages or I’m not on a self-pity kick.  Take the time when things are going well – or even just okay – to “screw your courage to the sticking place” (Shakespeare) and build a network of people who will stand by you.  It doesn’t need to be a large one, just people who are friends or family and willing to stand by you.  Even better if they will help you to see when your early warning signs come and to deal with those before you sink right into depression.  Last time I was emerging from a nasty episode of depression, with the encouragement of my psychologist I gritted my teeth and started looking up old friends who I had lost contact with.  I was very surprised to find them pleased to hear from me and have rebuilt a good network from those with some more current contacts who are now more aware of how and why I vanish and are less likely to let me do so again.  They ask questions if they don’t hear from me for a while.  This is helpful.  My family is also great.

Regular Social Contact:  Make sure that you plan regular contact with people.  Coffee with a friend on a regular basis; attend a group, a club or church – something together with others; talk to family or a person who supports you a lot often.  Sometimes you will feel like it, sometimes you won’t.  If you have trouble getting started, ask them to come to you or to pick you up on the way.  Different things work for different people.  I speak to family a couple of times a week and try to make sure I see my brother and his family at least once a fortnight.  I try to cultivate a couple of friendships with people who I have met at work.  There are people who I call once every 2-3 weeks because they are friends that I want to keep close contact with who live a fair way away from me.  I open up my Facebook every day or two to just make a conscious passing by into a handful of people’s screens for the day and join a joke or post some comment about my day.  A couple of people notice if I vanish for  a while and ring me to see where I am.  I try to invite friends around for dinner about once or twice a month and have someone by for a cuppa regularly.  Of course – sometimes I go to their place or we meet elsewhere, but when I make the effort it does help.  Who I spend time with will depends on my mood – people who accept me as they find me and who just don’t see the mess or will help me with it are all I can manage at times; but these are the kind of people I like to cultivate as friends anyway.  If I never spend time with people, I never reach that level of comfort with them.  Remember – the dog does not like competition.  As I’ve pointed out before, he’s a jealous creature when all is said and done.

Mindfulness:  This is a skill that I learned with my Clinical Psychologist.  Its big at the moment and a lot of counsellors are teaching it.  There are also a number of books around and  – I haven’t explored this – you may even be able to find online tutorials (?).  A really useful skill for noticing what is happening in the moment as well as slowing things down so that you can deal with things as they are.    A couple of sites that might be helpful include http://www.bemindful.co.uk/,

http://www.blackdoginstitute.org.au/docs/10.MindfulnessinEverydayLife.pdf,

http://www.mindfulness.org.au/MINDFULNESS%20SOUNDTRACKS.htm,

http://www.dayonepublishing.com/VMC/Exercises/Exercises.html

Reality testing:  This skill is something I picked up through doing Cognitive Behavioural Therapy (CBT) with my Clinical Psychologist.  It’s about checking the evidence for those intrusive negative thoughts.  Don’t just accept them at face value.  Getting into the habit of doing so involves discipline just like everything else – and sure there are days when I don’t do it and the thoughts win out – but over all the effort is worthwhile and gets easier with practice.  If you want to know more about CBT give it a ‘google’.  The research holds up really well.  On the occasions when the reality is tough, then I follow through with a question about whether I am affected by the thought, if it matters and if I need to do anything about it and if so – ‘what?’.  If you can’t afford a therapist, I believe that some places have tried short CBT courses online – there was one in Australia pitched at Uni students a couple of years ago.  Here’s a more recent version of it that seems to have a broader audience in mind along with another I found that seems to have a good reputation:

http://moodgym.anu.edu.au/welcome, http://www.llttf.com/

Mental stimulation:  Keeping my mind active helps me to keep the dog in check.  When there is nothing else happening in a day to stimulate my brain (eg work, other activities, people to talk to) I do puzzles – simple ones when down and more variety most of the time.  I think it just helps to keep my mind busy so that there is less room for it to ruminate on negative thoughts.  It also gets pleasantly tired so that I sleep more soundly and don’t lie awake with my mind churning for hours.

Maintaining the space around me:  I need to keep my home in some kind of order.  I’m often known to say that you can get a good idea of my mental state by looking at the state of my house!  I find that if I stay on top of my housework and the place is orderly and clean it is easier to feel on top of my game.  When the place is looking like a bomb hit it, I need to hunt for things and everything is in the wash I’m more likely to get flustered, stressed and have a blah day.

Goals & Plans:  I hate doing it, but setting goals and making plans helps to keep me on track and walking on days when I don’t feel like making a decision.  It means that I have a sense of direction and a sense of future and that I can tick things off as I achieve them.  Always make sure you have some short-term goals people!  They can be very simple, but it helps to have a map when you have a dog that wants to take over and steer a different course.  You then have a reminder why you might not want to just let it take over and be done with it.  You’re not out to live the dog’s life.  It’s yours.

Bucket list:  I lost all sense of direction during the last few years of depression.  I had long series of bombed goals and really had no idea of what I wanted to do.  My Clinical Psychologist sent me away to write a ‘bucket list’.  Now mine wasn’t a particularly daring one and there’s a lot of room on it for change; but it was permission to start dreaming again.  What we did come up with through that was that there were six main areas that I liked to be doing something in.  The end result was that we sorted the things I would like to do into those categories and I now aim to have something going from each category at a time.  I will probably never do everything on the list and will do things that aren’t there – but it was a good way to find somewhere to start ‘doing’ again.

Projects:  These come off my Bucket list.  I have only a couple on the go at once so that it doesn’t explode on me – but they give me something other than work, eat, sleep to do and be interested in.  I’m quite proud of my projects.  Engaging your interests is an important part of recovery.  Yet another way that you stay in the front seat and the dog must sit at heel while you do your own thing.

Faith:  I am a Christian and turn to God and I pray for him to support me also.  I believe that this makes an enormous difference.  I also believe that there will come a day where heaven and earth will be restored and I will be given a new, whole mind and body with no illness in it because I am one of God’s people.  I am destined for heaven.  There is hope in this.  Although I become fearful when I am depressed about my acceptability to God, I have now learned enough scripture to know that my worth has nothing to do with what qualifies me for salvation.  This helps.

A couple that I don’t use that are also highly recommended include

Relaxation Exercises:  Excellent for managing stress or unwinding enough that you have a chance of getting to sleep.

Sport:  I’ve never been able to connect well with a ball, I’m not overly coördinated and I don’t move quickly and things that you’re not good at are not lots of fun unless they’re back-yard variety with friends – so no I don’t do much sport.  BUT for those who are into it, it’s a great option not only for exercise, but for social activity and networking and hopefully a bit of fun.

And these are not the only ones there are more … all the best as you try some out if you’ve not tried them before.

 

 
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