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/,
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:
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.