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Mmmm … Massage 30/10/2011

Filed under: Depression,Managing Depression,Mindfulness & the Senses,Physical health & wellbeing,self-management strategies — jillnottelten @ 8:30 pm
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The Massage Table

I had had it.

I was aching.

It had been a long day at work.

The black dog had been pulling at the lead all week.

My work satchel was dragging down on my shoulder.

I was walking towards Woollies to buy the makings for dinner.

Then I saw it.

The massage therapy place in the shopping centre.

It was clean.

It was respectable.

It was affordable … with minor adjustments

And it was THERE!

And in only a moment so was I.

“Do you have an opening?”

There was an opening.

What did I want?

“Upper back, shoulders & head please.”

Back, shoulders and head I got.

Forty minutes.

I went in with my muscles aching, my shoulders set like concrete and my neck so tight that I’d not been able to comfortably look over my shoulder in days.

I came out uncrimped and able to move.

I happened to be lucky last week.  I had a little money that I’d not budgeted on having.  I couldn’t always just do that.  Besides, I’m not usually the type to let someone I don’t know give me a massage. (Seriously, if you’d heard me coming on Thursday you’d have gotten out the DW40 ready to get rid of the creaky noises when I arrived)

The problem is, however – I have trouble getting a massage at all.  Most of the time it doesn’t bother me – but when I say “massage” around my family and friends, they all turn around and say, “yes please!”

Yep, you’ve got it.  I’m the one who grew up with the sooky Dad.  The one that played sport too hard too far into his 40’s and 50’s and then moaned about the aches and pains all week.  I was trained to massage my father’s legs when I was six or seven … and I am not exaggerating.  There is no need.

My brother, who had once helped, grew callous and demanded payment at some stage, but I was still too gullible to get out of it – or figured it was easier to put in 5-10 mins of back or head massage than to listen to him grovel until he gave up.  In the end I got to be not too bad at it and when I hit Uni and somebody taught me anatomy, I actually became quite good.  Now, this was all fine and dandy for the family and the friends – but it did bugger all for me.

I’ve tried to interest some of them in learning, but do you think I’ve had any success?

The thing is – it’s not that hard to give a passable shoulder massage that will make someone very happy that you took a few moments out of your day to share it.  There are only a few basic principles that you need to follow – and these are consistent pretty much anywhere you massage.

  • Apply pressure in long, slow, firm strokes.
  • Start light and increase pressure slowly over time.
  • If you’re worried about whether you’re working your strokes to quickly – slow them down, just keep your pressure even.
  • Except with specific muscle groups, plan to work the muscle along the grain of the muscle fibres ie the direction that the muscle goes.
  • Work from the surface muscles toward the deeper ones.
  • Always stay away from the spine, throat and other sensitive areas.
  • If it causes pain – stop.

Here is a rough picture of some of the muscles of the back:


If I were looking to spend five or ten minutes just helping someone to unwind, I might start by finding the bony landmarks on the person’s back and think about where the muscles are in relation to those bones.  The spine is usually visible down the centre of a person’s neck and back.  The easiest way to locate the shoulder-blade is to start at the tip of the shoulder and to trace it around with your fingers.  Notice that the shoulder-blade has two bony borders along the top.  This is because it’s not shaped only like the 2 dimensional triangle that you see in drawings, it has another edge – a bit like a fin (but not quite).

So, say a person is sitting in front of me – here I start by running my hands straight up the back to the neck one after the other, avoiding the spine and moving from the centre to the edge – first on one side, then the other.

I then follow this by focusing on the muscles coloured red and green on the left hand side of the illustration – initially the red Trapezius muscle which is large and often carries a lot of tension.  I would massage predominantly in the direction of the arrows – in upward strokes along the muscle fibres.

After these muscles have been freed up a bit and feel less tense, then I might move my attention to the deeper muscles.  If the muscles are not freeing, I would turn my attention to the blue muscle – Latissimus Dorsi.  A person’s lat’s are large and often carry a lot of tension also, so you may need to break up some of this to get anywhere with the Trapezius.  When working the Lats, I use a wide surface of my hand or forearm with long firm, upward and oblique strokes and then smooth them down and go back to the Traps again.

By now the person’s muscles are warmed up, so they are also tolerating firmer pressure as I target deeper muscles and the upper muscles are relaxed enough so that the pressure reaches them.   The principles for the muscles of the deeper layer muscles are pretty much the same as the ones I use for the upper layer ones.  The only exception is that I will often spend some time after warming up the Rhomboids (pink) working them across the grain of the muscle (ie across the muscle fibres, not along them because the Rhomboids get really, really stiff sometimes and need help to free up).

The other muscle to have a good look at that people love having worked is the Levator Scapulae.  Again, just work it up the grain of the muscle fibres.  It’s also helpful to just press on it at about the base of the neck for a few seconds or so.  Also working the muscle inside the triangle at the top of the scapula is easier once the muscles are warmed up.

But if the deeper muscles look too confusing, don’t worry – even if all you do is loosen up the upper layer of the person’s back – most people will thank you.

What part of your hand you use is up to you – I often knead with the flat edge of my thumb while I rest the heel of my hand on the person’s back.  I might sometimes use the heel of my hand to massage.  Depending on the person and how long I have been massaging for I may gently use my knuckle.  You can also use your forearm.

None of the stuff I’ve shared today is particularly scientific or text-book.  Simply hands-on learning.  But I think that people being able to help each other break up muscle tension is worthwhile.  So is nurturing.

When it comes to massage, all I can say is that lots of people like a treat.  See if anything that I have learned adds anything to what you know – and please … you’re welcome to share your tips with me.

You know where the comments section is 🙂

 

calm blue ocean … Calm Blue Ocean … CALM BLUE OCEAN!!! 28/10/2011

Filed under: Depression,Function,Managing Depression,Mindfulness & the Senses,Physical health & wellbeing,self-management strategies — jillnottelten @ 8:16 pm
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Now this is exercise

Now this is exercise

I don’t know about you, but I was very sceptical about relaxation exercises for a long time.  I would always think back to school days when guidance counsellors would take us through guided imagery sequences featuring a calm blue ocean or some such scenic place and tell us how we relaxed we were while the class clown made farting noises, his followers giggled, the teachers reacted and everyone else just rolled their eyes and waited for the session to finish.  At other times, attempting to relax has been more stressful than relaxing because the facilitator just wasn’t on the same wavelength as me.  I find it annoying when that happens.

It took a long time to realise that relaxation was a skill that required practice.  It has taken longer still to discover that there are many different types of relaxation exercises that you can do.  Recently while looking for a site for someone, I found one that had a variety of sound tracks for relaxation exercises ( http://www.allaboutdepression.com/relax/index.html ).  I decided that I would sample all of the relaxation exercises on this site to see what I thought of each of them – to give each a chance.  Today, I’d like to share with you a little about the exercises that I did and my thoughts on each.

Basic Breathing Exercises

Breathing exercises have been proven to be great for managing anxiety.  If you suffer from anxiety and have not already worked on some form of breathing exercises, may I recommend that you start here.  It is simple.  It is easy to follow.  It’s long enough to get a feel for what you’re supposed to be doing without being so long that you feel like you are going to be chained to the computer forever.  Furthermore the first three exercises are all breathing exercises that build upon each other.  You start with Diaphragmatic Breathing ( http://www.allaboutdepression.com/relax/diaphragmatic/diaphragm1QT.html), move on to Deep Breathing 1 (http://www.allaboutdepression.com/relax/deep1/deep11QT.html ) and then Deep Breathing 2 (http://www.allaboutdepression.com/relax/deep2/deep21QT.html ).  You don’t need to be able to do all three, but I would recommend doing the diaphragmatic breathing before any of the other exercises because it does help.

I thought that these were very useful.  Each of them was effective, and they were particularly effective when used in series.  The educators recommended that for those with anxiety disorders, your levels of anxiety will reduce by doing breathing exercises regularly as maintenance – and I can believe this given the difference that it made in the amount of tension in my body.

For those who do not have anxiety – like me … I did my mood diary scoring after I did relaxation exercises and my scores were significantly higher than they had been on any of the recent days leading up to these times.  I have been experimenting recently with http://www.moodscope.com which is a computer based system – so I was not simply giving myself a better score out of 10.

Progressive Muscle Relaxation

Progressive Muscle Relaxation is a favourite of mine.  It essentially involves tightening a group of muscles, holding them tight and noticing the tightness, then releasing the tension entirely and noticing the absence of muscle tension.  You then systematically work through to the next group of muscles and do the same thing.

I will usually start with my toes, progress to the soles of my feet and calves, the upper foot and shins, my thighs, my butt, then my hands, wrists and arms, elbows and biceps then shoulders; then I go back to my trunk and tighten and release my abdomen, then lower back, upper back, chest, shoulders (again), front of neck, back of neck, tilt neck left then right, then I work through my face so my forehead, nose, cheeks, mouth, jaw and tongue (pressed against the roof of my mouth).  Then I finish by either breathing exercises for a while or by standing and shaking out my arms and legs and stretching.  But that’s me and that takes anything from 10 to 20 mins depending on how many repetitions you do of  each muscle group.  Sometimes for really tight groups, I’ll repeat the actions a couple of times eg shoulders.

The progressive muscle relaxation sequence on the All About Depression site goes for 8mins40sec and is nice and efficient while still covering what needs to be covered (http://www.allaboutdepression.com/relax/pmr/pmr1QT.html ).  I found it satisfying and was pleased with the result at the end of the session.

Guided Imagery

I need to be frank here and admit that I am not someone who is a great fan of guided imagery sequences.  I find someone else’s descriptions of a place that they think should be relaxing for me to be kind of distracting.  I’d much rather be left to breathe or if there needs to be an image, then I’ve done sequences where the person guiding the sequence has left room for the person relaxing to select a place they like and guided by asking questions like “what can you see?”, “What can you smell?”, “Look around you and explore the colours.”  I found that kind of guided imagery more engaging.

There are two different sequences on the All About Depression site, one set on a beach and another in a forest clearing.  I think that I liked the second best in this case.  (http://www.allaboutdepression.com/relax/beach/beach1QT.html ,  http://www.allaboutdepression.com/relax/forest/forest1QT.html )

Relaxing Phrases

I came to this exercise expecting it to be grossly annoying and to loathe it.  It was actually one of my favourites.  I’m not sure whether it was because of the sequencing of the exercise, or the conscious repetition of phrases (I repeated most of them in my head because I found that doing it out loud made it difficult to breathe deeply and evenly), but this exercise really worked for me.  I want to go back and learn the phrases and the sequence to use at any time.  http://www.allaboutdepression.com/relax/phrases/phrases1QT.html

Mindfulness Oriented Relaxation Exercises

Mindfulness is about being ‘just in the moment’.  In this context, the relaxation exercise is about focusing oneself on relaxing just into the moment.  A lot of the rationale for this is that a lot of distress occurs surrounding things that have already happened or have not happened yet and that sometimes the sadness, anxiety, pain or negative feelings are easier to bear in the immediate moment if we are not contemplating past or future at that point in time.

Just this Breath

This exercise focuses upon observing your breathing.  Not changing it, simply observing it in the instant that it is happening.  It is difficult to get the hang of, but very rewarding and worth the effort.  Definitely worth a shot.  http://www.allaboutdepression.com/relax/mindfulness/mm11QT.html

Increasing Awareness

This is one of my favourite relaxation exercises.  It starts out with breathing, then gradually asks you to notice things with your other senses, in particular where your body has contact with other surfaces, the feel of your clothes and the sense of the weight of your arms and legs as you’re supported by your chair (in my case) or where ever you are resting.  I loved the sensation of my clothes on my skin as I was breathing – I was wearing a particularly soft shirt the day that I did the exercise for review.  A definite must in my books  (http://www.allaboutdepression.com/relax/mindfulness/mm21QT.html ) although regulars will know that I’m a fan of mindfulness as a strategy in general.

Mindfulness with Guided Imagery

Remember what I wrote earlier about guided imagery?  Well it’s no less true where the imagery is attached to mindfulness strategies.  That said – in the first exercise Sending Thoughts Away on Clouds   (http://www.allaboutdepression.com/relax/mindfulness/mm31QT.html ) I found the clouds a great way to dismiss unwanted or intrusive thoughts – the idea being that where a thought that was a distraction from the scene or your breathing came into your consciousness, you were to send it away on a cloud.  I could picture this as though just blowing the thought away.  Sending Thoughts Away on Leaves  (http://www.allaboutdepression.com/relax/mindfulness/mm41QT.html ) didn’t feel as natural, although it kind of worked.  In this guided image I was taken to a clear forest stream to enjoy it.

The final image was quite different in what it did with distracting thoughts.  In this the idea was to be Sorting Into Boxes (http://www.allaboutdepression.com/relax/mindfulness/mm51QT.html ) thoughts that intruded, the boxes being one for thoughts, one for emotions and one for sensations eg aches and itches.  This was more bizarre to start with and I found myself distracted by the boxes – but after a while I settled down and just focused on my breathing again and that helped.  For a while however, I think I was almost inventing itches and filing the thought ‘this is stupid’ over and over again.  Once I went back to breathing and visualisation the boxes became background scenery – a bit like a picnic basket when you’re not actually eating.  I can imagine this being helpful though if you were being flooded by intruding thoughts and feelings – you could just label them without processing them and put them to the side by the rules of the exercise without it being an intrusion on what you’re supposed to be doing – which is staying in the moment, just breathing and picturing a scene.

MY TOP 3

My favourite three out of these audio tracks in no particular order would have to be:

Increasing Awareness

Relaxing Phrases

Progressive Muscle Relaxation

Why not take the time to try a few?  What were your favourites?

 

Food Glorious Food 25/09/2011

Filed under: Clinical Depression,Depression,Managing Depression,Physical health & wellbeing,self-management strategies — jillnottelten @ 5:54 pm
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Fruit.  Vegetables.  Meat.  Protein.  Dairy. Iron.  Carbohydrates.  Breads.  Cereals. Rice. Pasta.  Vitamin E.  Vitamin C.  Vitamin D. Vitamin B.  Fats.  Sugar.  Cholesterol.
Hormones.  Blood Sugar levels.  Chocolate.  Shortbread…

How we eat makes a big difference to how we feel.  It affects how much energy we have.  It affects how efficiently our system processes what we do eat and how easily it will break down and prevent or minimise constipation.  For some it can affect them at a more vital level – for those with diabetes it is even more important to monitor food intake, as for those with particular allergies.

Recent studies indicated that people with depression have a high (anything up to a one in two) risk of developing diabetes.  That is an enormously scarily high statistic.  You might ask, “Why?  Why this on top of everything else?”

A large part of the answer is thought to be tied up in lifestyle issues.  They actually think that for most people this is preventable!  Risk factors for development of type 2 diabetes include lack of exercise and sedentary lifestyle (ie sitting around a lot and inactive), obesity especially if your weight distribution is more around your stomach than your hips and thighs, eating unhealthily is a major cause of type 2 diabetes – too much fat, too many simple carbohydrates and not enough fibre in particular; also high blood pressure, high cholesterol levels, high cortisol (stress hormone) levels,  smoking, family history, gestational diabetes and aging (over age 45 becomes higher risk).

A lot of these risk factors overlap with issues that occur regularly in people with depression.  It is common for people with depression to have little physical exercise and very sedentary lifestyles, poor diet and become overweight due to a combination of this and at times side effects of medications – and the lovely little belly that the medication leaves is usually a tummy rather than hips and thighs.  Stress level hormone levels may be high due to anxiety levels; depression, like diabetes often has genetic links, many of the high levels can be secondary to diet and lack of exercise and statistics indicate that a high proportion of people with depression also smoke.  Oh – and yes, we might say that we’re 39 for a while, but everybody ages.

The good news is that the majority of the factors identified as risks are preventable.  They are also helpful ways to improve the prognosis of the course of our mental health.

Look for ways to become more active.  Start small and build up a little at a time.  Sooner or later you will feel like you are exercising.  In the meantime, you will be stretching out those muscles and getting them ready for a challenge.  One of the biggest weight loss programmes in the world was started by a woman who started out by walking around her clothesline.

Research what needs to go into a balanced diet.  Plan what you will eat ahead of time and stick to it.  I find this really hard, but it really is worth it.  I have more energy when I do and it helps keep a lot of other things more balanced.  Try cutting up your veggies when you get them and storing them ready to use – that way you don’t have as much to do to prepare food when you have to cook.  Same with your meat and everything else.  It takes longer to store – but half the time (at least for me) a large part of the battle in getting the energy together to get something healthy and wholesome to eat is in overcoming that ‘I don’t feel like all the preparation’ feeling.  At worst keep a couple of pre-cooked healthy meals stored in the freezer for when you don’t feel like cooking.

Talk to your doctor about a Quit smoking programme.  It is possible.  People do it all the time.

See someone about some anxiety management strategies.  If you already see a case worker, therapist or doctor ask them for advice about what to do or where to go.  Look around for local programmes through community health resources.  If you get stuck and are not sure where to start, check out the mindfulness and CBT pages on this site or post me a comment and let me know.  If you’re in Australia, ask your GP to write you a referral under “Better Health” to see a psychologist or clinical psychologist.

Just to start off, this week I had a really simple meal of a piece of steak about the size of the palm of my hand.  I had a couple of mushrooms that I chopped up and cooked with it in the pan.  I then steamed in the microwave generous serves of broccoli, cauliflower, both green beans and yellow ones and some snow peas that I grew in my garden.  It was filling, plain and simple.

Why not share something healthy that you cook/prepare or plan to cook/prepare after reading this in the comments.  Maybe we can collect some recipes and ideas?

 

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.

 

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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