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Do You Tell Your Boss? 13/11/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Explaining Depression,Function,Managing Depression,Work — jillnottelten @ 11:28 pm
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If you have a mental illness do you tell your boss?

Are you obliged to tell your boss?  Why or why not?

With discrimination rife in society and difficulty getting friends and family to understand what you are going through, what are your greatest fears in the workplace? Or the study environment?  Or wherever it is you spend most of your productive time?

Does your illness affect your ability to do your job at times?  In what ways?

Does your boss know?  Do any of your colleagues? What led to them finding out?

Whether you are studying or working always consider ahead of time whether you are prepared to disclose your illness.  If your current position is non-disclosure, consider carefully any occasions which might arise which might make it more necessary and under what circumstances you may disclose if at all.

Disclosure is always best done in a planned manner.  You should have some idea what you are going to say, how you want to say it and how you are going to explain its relevance to your work.  If you need some adjustments to your work conditions or some time off, it is best for you to come to your boss with some options that you have considered and reasons for your request.  You need your boss to understand that you wish to be healthy and productive as possible and are trusting them so that they are able to best support you to reach a goal that is in both of your best interests.  A large proportion of ‘Western’ countries, including Australia, provide legislation to support your right to this.

When you plan what to disclose think in terms of how you are affected by your mental illness more than your diagnosis.  You may, in fact decide to disclose only the effects of your illness and not your diagnosis, stating that you have “a condition that affects …”.  You may identify symptoms or you may simply describe what it does to you and how that affects your work eg my condition means that I have less energy than I used to have.  This means that I have to be careful how I plan my time and that I have to take holidays at regular intervals throughout the year to maintain stable health.  I need to be careful to use my meal breaks and leave on time so that I don’t become over-tired.  Or my condition means that I need to take medication.  When I change medications, sometimes I am more sleepy than usual and over-sleep or become very drowsy in the afternoons.  Sometimes my speech even gets slurred and I sound a little intoxicated.  So if I’m changing medications I need to take a week off, otherwise I find that I’m coming to work late all week and I sound as though I’m tipsy for half the afternoon and I don’t get much done and am at risk of making faulty decisions or overlooking things because my head is all foggy – especially in the first few days.  After that I will be fine at work again, but might over-sleep a couple of times in the 2-3 weeks afterwards while my body gets used to the new meds.  It doesn’t happen very often.  I’ve only needed to do it 2 or 3 times, but each time I’ve been glad that I did.

You do not need to disclose specify personal or medical information if you tell them about anything at all.

You should also think about when to disclose.  That is – when you are applying for a job, before a job interview, during the interview, after you have been offered the job and before starting, during the time you are employed after you have worked there for a while, if you become unwell and need to or never.  There are pros and cons of disclosing at each point of the way.  Sometimes your circumstances will have presented you with little choice to prevent awkwardness – you may have become unwell at work and have it become obvious that something was wrong or you may have symptoms that you are aware will soon become obvious if arrangements aren’t made to cater for your needs.  Again, despite prejudice and stigma in some places you have legal rights to have your needs and confidentiality met and protected within your workplace in most western countries.  Further, in Australia at least, if you become unwell because the employer failed to attend to your needs having been made aware of them, you are entitled to compensation under work cover.  It is however, worth serious consideration whether or not you are going to disclose because unfortunately discrimination does still happen and there are people who do fail to respect privacy and you never know where they are until you find them.

Some helpful things to consider at each stage of the employment continuum.

Prior to interview

Why you might …

  • You are able to to discuss the organisations policies and support resources when exploring the prospective position
  • You are able to get an idea about your employer’s predisposition to your needs from the word go.
  • If you have restrictions on any key job criteria due to temporary limitations because of recent relapse/graded hours return to work plans.

Examples of Why you might not …

  • Risk of discrimination influencing whether or not you get an interview.
  • No work related needs arising from your mental illness.
  • You don’t believe that they need to know/believe it irrelevant to job.

At the job interview

Why you might …

  • You are able to address people after creating a positive impression of yourself and demonstrating your capability.
  • You can gauge their understanding of your meaning and clarify appropriate questions about your needs.
  • You are able to discuss with the employer positive traits that you bring to the team that you have learned through your journey of recovery.
  • You are able to discuss your needs and what your potential employer would be able to accommodate or explore during the interview process.
  • You can brief them as to whether your referees are aware of your condition and how it affects your work and offer consent to discuss previous workplace arrangements with other employers if they have gone well.

Why you might not …

  • Risk of discrimination in job selection.
  • You don’t feel that you have needs that require accommodating or can manage them without support from your employer.
  • You might worry about where information gathered by panel members will go and whether people are trustworthy to maintain your privacy.
  • Concern that even if you get this job, opportunities for advancement could be limited by poor understanding of your illness.
  • You might be well and consider it unnecessary at this point in time.
  • You might not want to distract the panel from thinking about your abilities by talking about areas of need.

When contacted with an offer of employment

Why you might …

  • You are able to discuss your needs without risk of missing out on the job due to discrimination.
  • You can arrange to enter the work place with a plan in place that accommodates your employment needs and commence as you mean to continue.
  • If required and with your consent, the employer can arrange appropriate mental health sensitivity workshops for managers or staff by organisations such as Beyond Blue or circulate general anti-stigma/population health information among routine organisation circulars, yet not make it obvious that it was for your benefit.
  • Allow development of appropriate support and mentoring systems.

Why you might not …

  • Fear of stigma, gossip and/or discrimination.
  • Currently well and don’t feel that you are affected at work.
  • Work does not need to know.
  • Protection of positive image and opportunity for advancement.

During the course of your employment

Why you might …

  • You decide that your employer is trustworthy.
  • You become unwell.
  • You encounter difficulties or are not performing to standard because of symptoms or medication side effects and need to offer reasonable explanation or require support, alternate work arrangements or time off for medication reviews etc.
  • You are being harassed or bullied.

Why you might not …

  • It might not be necessary.
  • Protection of positive image and opportunities for advancement.
  • It might result in harassment and discrimination.
  • You are able to manage your needs without workplace support.

Never disclosing

Why you might …

  • Protection from gossip and discrimination.
  • Protection of positive image and opportunity
  • Privacy
  • Stable health
  • Lack of necessity

Why you might not …

  • Difficult to prove entitlement to compensation in case of illness, relapse or deterioration due to failure of workplace to meet needs for psychological health if they were not disclosed.
  • Relapse or need for hospitalisation might put your job at risk.
  • Might discover a positive attitude to mental health issues within workplace.
  • Legal obligations under occupational health and safety act where specific work related tasks are affected resulting in serious risk issues.

What did I do about disclosure to my employer with my job?

For me it was simple.  I told mine.  I disclosed at interview.  I felt that this was necessary because I had taken my previous job without learning to manage my mental health well and my references would have reflected that in the answers to some of the standard questions that interviewers ask referees no matter how careful the referees were.  I chose to take control of this situation at the time of my interview because having reached interview I could present myself as a competent individual in person, demonstrate that I was healthy and create a positive impression before and whilst disclosing.  I also needed to disclose because I wanted to work less hours than the position entailed and needed to offer a good explanation.  I told them that I had depression, how it affected me in terms of energy levels, concentration, seasonal patterns, medication changes and how I managed these things to be able to work.  I spoke of arrangements that I had previously made with my former employer that had been helpful and asked if they would be amenable to such strategies.  I also used the opportunity to tell them things that I had learned and accomplished through the experience of working, the determination and dedication that it entailed and the commitment to my job that resulted so that I could achieve personal satisfaction through working.  In my case this had a positive effect and outcome, although it doesn’t always.  I don’t disclose before I have the chance at interview to sit down and talk with the employer so that I can get a gauge on how they are reading what I am telling them and to avoid preconceived assumptions about what I will be like that are difficult to shift.  There are always risks associated with disclosure, but my reasoning is that if they are going to discriminate when I am well, I would rather not have to deal with them if I were to relapse.

When I am in the workplace I lay low for a while and watch what goes on around me.  As long as they are not untrustworthy, I tell someone if they are closely and directly affected by my health so that they are not left in the dark if I have to take leave at short notice.  That’s usually only one or two people.  Often they are among the first to notice that I am off my game,  so it can work in my favour because when someone who I work closely with starts asking if I’m okay and comments that I’m not myself before I notice anything, it gives me a cue to step back and check my early warning signs and triggers.  Over the course of years there have been a couple of people who have learned how to pick my good and bad days at least as well as I do myself and also to support and accommodate me through the bad ones and to lean on me in return when I’m good.  I’m pretty limited in what I disclose to start with, but with proof of worthiness comes more trust.

My current situation in my new workplace is new to me.  I have always had employers who were fiercely protective of my privacy before.  I have little in the way of evidence about my current manager, only the report of one other worker about two specific occasions of breached privacy.  I have, however worked in a place where it has been possible to work with my information kept private and so I am prepared to stand for my rights in both privacy and in workplace accommodation now.  If I expect the respect of others, there may be times that I need to stand up and remind them what it entails.  This is however new to me and the workplace is one with strange dynamics.

I have included in the Fact Sheets menu this week a document called “Choosing Your Path.  Disclosure: It’s a Personal Decision“.  It’s about disclosure of ‘disability’ (or illness) in education and training after High School and employment and the processes of application, entry and engaging in the roles.  The booklet discusses legal issues, reasons why one may or may not disclose at various stages of training or employment, responsibilities and some of the considerations to ponder in making your decision.  Also have a look around the Beyond Blue website as they have a number of resources for work sites and managers as well as fact sheets about telling your employer about your illness and maintaining good mental health for tertiary education students.  Lastly, I have listed a book called “Tackling Depression at Work” in the Books menu.  I’ve not yet read this one, but it was written by reliable people and has been well reviewed so should be worth a read.  I have listed the book at the publisher’s site, you may or may not be able to find it cheaper elsewhere if it interests you greatly.

 

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?

 

How Frail Humanity 26/10/2011

Filed under: Clinical Depression,Depression,Experiencing Depression — jillnottelten @ 4:17 pm
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I have been reading a lot lately that has reminded me how frail humanity is.  How vulnerable we are.  Our bodies, our nervous systems, the balances of the chemicals in various systems that keep us functioning are so finely balanced.  And so, so often is our sense of self.  Our sense of our own competence and worth.  We become vulnerable to so many thoughts and perceptions that we may once have never thought possible – may once have thought weak once this is penetrated.

I have been reading people’s writings – people who are feeling worthless, yet working daily at moving forward – at overcoming illnesses that sap energy and personal reserves like parasites.  For as surely as I breathe Depression and Bipolar Disorder, Seasonal Affective Disorders, Psychosis, Schizophrenia, Personality Disorders and Anxiety are parasites that draw upon the heart and soul, the will and desire, the sense of purpose and confidence in one’s own capacity.

And yet as I read I see evidence that these illnesses and disorders are liars.  I read words written by brave people who are still wrestling, still fighting, still entering the ring round after round.  Sometimes they come out on top.  Sometimes they come out feeling hopeless and defeated.  But I say this.  While people are still willing to step into the ring, they are not losing the war.

The human body, while fragile is also amazingly robust.  We survive enormous things.  Our bodies fight infections.  It is well designed to protect its more fragile organs.  It is our sense of self that is the fragile part.

Each person is unique.

Each person has a different combination of qualities – of strengths and weaknesses to the next.

Each person has something about them that is admirable.  Worthy of respect.

Each person is entitled to dignity.

It is hard to breathe, hard to grow, hard to believe any of these things amid the lies of mental illness when it is out of control and where it has left its scars.  It is hard to believe that friends still care when they are getting on with their lives while you are feeling stagnant and stuck wrestling just to keep your head just above water.  If they haven’t been here they can’t possibly understand that you are feeling left behind.  And so friendships grow fragile too.

Families tell us anything from we “just need to try harder” to telling us “not to push ourselves” because we’re too fragile.  Sometimes they expect the world of us – and sometimes they seem to expect nothing at all.  I’m not sure which is worse.  Those who push too hard make us feel like we are inadequate and seem to think that we are just lazy – and that does wonders for our sense of self.  Those who seem to think that we are too fragile to try don’t inspire hope that anything will ever get better although they mean well.  How hard it is for a family to understand if they have never been here.  They usually mean for the best – which leaves us feeling guilty for being annoyed by at their lack of understanding.  How do we deal with this?  Most of the time when we’re not well we’re not in a state where we feel eloquent enough to express ourselves well and we fear that it will all come out the wrong way.  Sometimes it has before.  And so some of us feel that our family is far from us.

And so we stand; feeling as though we could break at any moment.  Our lives, our friendships, our relationships with our families, our very selves.

Hear me say – I believe that people who make it to this point can still be strong.  Simply deceived.

Yes, your situation may be fragile.  This does not mean that you are weak, undeserving of hope or inadequate.

You don’t have to believe me.  You don’t have to believe it’s true as though you have had some kind of epiphany.

But treat the thoughts with the suspicion they deserve.  Perhaps the same suspicion that you treat my claims.  Keep stepping up for another day.  Keep looking for tools to arm yourself with – mindfulness, sensory strategies, CBT, relaxation (see the link in today’s poll), self-affirming statements, support people, distraction, your medications – whatever is positive and works for you.

You too have strength within you.  Even you – the one who doesn’t believe me yet.

 

A Mindful Journey 21/10/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,Managing Depression,Mindfulness & the Senses,self-management strategies,Therapies — jillnottelten @ 9:00 pm
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One of the therapeutic approaches that I use to help manage my Depression that regular readers will have come across previously when reading my blog is Mindfulness.  Among other things it is helpful for dealing with thoughts, coping with stressors and managing physiological symptoms.  It has been used to help people manage symptoms of a range of mental health issues including Depression, Anxiety, Bipolar Disorder, psychotic illnesses, Personality Disorders and Eating Disorders.

My first experiences were vague explanations by people who I worked with about being present in the moment and awareness.  These are true and make a lot of sense now – but Mindfulness made the most sense to me after my first experiments with it with my Clinical Psychologist when I was, myself, in therapy.  The experience itself made an enormous difference to my understanding and appreciation of the discipline.  For this reason, I thought that I’d share with you some of my experiences with the use of Mindfulness.

The first exercise

My introduction to mindfulness included eating a mandarin.  The exercise involved taking the time to notice all of the sensations that were involved.  The scent of the fruit, the feel of the skin, the firmness of the mandarin before it was peeled, the colour, the weight, the sensation of peeling the mandarin.  I was to notice the texture of the inside outside of the skin and then the feel of the fruit without the skin on, the look of the fruit with its segments and the white stringy bits, the juice.  While eating it I noticed not just the flavour, but the texture in my mouth and the sensation of swallowing.  I paid attention to the sticky juice on my fingers and the sweet smell that it left on my skin before I washed my hands.  The idea was to be fully in the moment and to engage and experience all of the senses.  To be mindfully – deliberately into eating that mandarin.

The breathing exercises

After learning about the need to experience the full extent of whatever I was doing, I did some breathing exercises with my Psychologist.  The idea was not to control the breath, but to observe it – pay attention to the movement of my muscles, the sensation of the air in my body, the sounds of the breath and to concentrate my focus on that.  If I was distracted, I would just think to myself “oh, I’m distracted” – or whatever – and return my attention to the breathing.  It was hard not to start controlling the breathing – but relaxing.  It took focus, but was refreshing and left me alert.

My homework was to practice this and I also had an exercise where I was to start out with the breathing exercises and then imagine the breath that I was inhaling circulating all the way to my toes and paying attention to my toes and then following my breath as I exhaled.  From here attention moved, with my breathing, progressively from the toes to the feet, up the legs, along the other leg and then through my body and my hands, my head and back to just focusing on my lungs.  If you have ever done progressive muscle relaxation, the process is similar – however this was more to do with gradually moving awareness through the body.  Again, the instructions were to allow yourself to just dismiss distraction and go back to the exercise at hand.  I also felt more self-aware and awake after the exercise.  That one lasted about 15 mins.

The Wii game

There is a game on Wii Fit where you have to sit really still.  The graphic on the screen is of a candle and from time to time you get annoying things like a fly or mozzie and footsteps and so forth that come to distract you.  But you need to sit upright and still on the balance board for 2 mins to win the game.

I have found that this is a great exercise for my Mindfulness skills.  I sit in an alert and comfortable posture.  I focus on my breathing and I use my skills that dismiss distractions by acknowledging that they are there and accepting it to deal with the insects and so forth.  I can sit for the whole 2 minutes using my Mindfulness skills!

The fly

A while ago I was staining a piece of furniture.  I needed one hand to hold the tin of wood stain.  I was using an elbow and shoulder to stabilise myself in the most awkward position ever (!!).  The other hand was occupied with cloth working the stain into the grain of the wood.  And there was a fly buzzing in my face throughout.

Now, the same way that you consciously turn all of your senses, you may choose not to do so with some – so I am not focusing upon the fumes.  But again, with the discipline to focus on the here and now and what I want and is important, I can also notice and dismiss what I don’t want.  The fumes.  More particularly in this instance, the fly that just wouldn’t go away.  Rather than let it get me irritated and waste all that energy, the practice allowed me to focus on my work and when the fly was distracting just acknowledge “There’s that fly again.  That buzzing is loud.  I wish it would go away.”  Yes I would blow at it to try to discourage it – but no, I managed to deal with the fly without it driving me mad.  I considered this to be an achievement!

The job interview

I had a job interview at the other end of town.  I had a horrible time getting there.  There was more traffic than I anticipated, I think the tail end of a blockage after there had been a prang.  Plus I had been pushing the clock harder than I had wanted to be to start with.  The end result was that I was late to my job interview.

Bad news.

I was so flustered by the time that I got there that I couldn’t think.  My mind was pumping in circles.  They handed me the interview question for my preparation and all I could do was think,

“How am I going to pull together to do this?”

So I stopped myself.  And before I even looked at the questions I took 2 minutes out of my prep time to do my breathing exercises.  I then gradually brought myself back into awareness of the room around me and focused on the task at hand.  I was alert.  I was focused on the task and I was calm.  I had also put myself into a position that I could acknowledge that the situation was less than ideal and just accept it to focus on what I could do something about.  I could have compassion on myself for finding myself in an embarrassing situation, yet function within it and set myself to do my best in the here and now.  I prepped my questions briefly in what time I had left although I didn’t have time for much depth and then did the interview – again thinking clearly, because I was able to focus on the here and now.

In the end I think the fact that I pulled myself together worked in my favour.  I was offered the job, but turned it down.  Mindfulness got me through the job interview but it would not get me over the travelling time in peak hour traffic any quicker.

The terrible, no good, very bad day

Then there was the day that nothing went right.  Well it seemed like it.  I slept through my alarm.  Right through.  Things went wrong at home after I got up.  The trip in was slow.  I was very, very, very late for work.  Lunch time late.  I missed several appointments and was flustered about what was left of the day.  I had no idea how I was going to finish the day or face anyone.  After freaking out when I finally got to work, I finally stopped and thought, “I know better than this.”

So I paused.  I took a deep breath in and let it out, focused my attention and started observing my breathing.  I then started to pay attention to the feel of the pressure of the chair that I was sitting in and the sounds around me – not listening, just noticing – the clock, various voices, footsteps; I paid attention to the feel of the clothes on my skin and then turned my attention to my muscles and which ones were tense.  I relaxed my shoulders and my jaw and went back to my breathing and did a short version of the breathing exercise where I imagined my breath reaching every part of my body and then just focused on how it felt to breathe for a couple of moments.

After this I allowed myself to think about what I should do next.  I had to accept that I was late and that I’d missed morning appointments and that because of that my afternoon wasn’t going to work as well as I had planned.  But I could now, thinking in the moment accept that just as it was and act in a manner that was compassionate toward myself, rather than sit there blaming myself for things that I might or might not have done.  It was okay that I was a bit frazzled, that was understandable – so I just needed to plan for that too.  From there I was able to return to the moment and begin the rest of my day, planning things out and actually achieved a reasonable amount – something I wouldn’t have done in the state of mind I had been in when I arrived.

The road so far …

It has taken a while to learn some of the basics of Mindfulness and get used to putting them into practice, but the journey has been infinitely worthwhile.  I still have a long way to go.  I’m not good at meditation –  I tend to be more utilitarian in my use of it.  I still need to remind myself to start and could prevent some situations by starting earlier.  However, it helps me to focus and to be able to be where I am, doing what I need to or want to be doing at the moment of time that I’m at.  My next step in the journey is to become better at noticing things about myself in the moment.  I think that this would prevent a lot of difficult situations and to help me to monitor my early warning signs.

 

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

 

 

 

 
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