Yes, I am still here. Still living, breathing and blogging. Just fell victim to a couple of very shocking weeks (interspersed with some lovely moments, but very few and far between).
This week I’ve barely been able to tolerate daylight, let alone the computer screen – migraine like I have not had in a long time since my medication includes migraine voodoo concoctions … but … amidst my Barry Crocker of a week the week before and the ensuing weekend I became a bit disoriented and missed a couple of doses of my meds, hence the hole in the firewall (just to mix some more metaphors). Yesterday I went to the GP to get a medical certificate for work and stopped at the shopping centre on the way home. Talk about sensory overload! My world had not yet totally stopped spinning so I had this strange spacey kind of sensation as I was walking, the noises were louder and more jarring, lights and colours still bright, smells still sharp. I couldn’t get out of there fast enough!
Work has been crazy and exhausting trying to manage the politics and dynamics within the office. Don’t get me wrong – I like my job. If only work could just be about going and doing your job and coming home again, what a relief it would be! But there are systems and other people that one has to navigate to do one’s job. Equipment that one and space one has to somehow get adequate access to do it. Preferably in a way that lets you stay well without creating more stress than is necessary – which is where the battle lies at present for me. At present it seems that I am destined to bang my head against a brick wall and progress nowhere and to endure life in the office that gets claimed by miscellaneous team members to serve as their staff room – while my office buddy and I are trying to work in it!!!
But alas! These are not healthy things to dwell upon. The goal is to work out how to attack and push through. I had thought that we had had a strategy for the work one, but it is back to the drawing board on that one next week as it looks like this is rapidly fading into embers.
At present I am struggling not to dwell on the difficulties of the last few weeks. I grew frustrated that my usual seasonal dip in mood was dragging on longer than usual, but didn’t really look beyond it for other triggers until much too late. Sitting down with a friend a couple of weeks ago to go over what had been happening clarified things a lot more for me. One of the reasons that I am so focussed on work issues over the past couple of weeks has come about because through sitting down and working through my usual triggers and warning signs with my friend revealed that my workplace is simply loaded with triggers. There is little wonder that I have been struggling to emerge from my usual brief decline and regathering of mood.
It’s so easy to forget to go back to the basics when one gets busy. I can sort of see why Mary Ellen Copeland, the woman who designed the WRAP suggested that going over triggers and warning signs should be something that someone should do daily to prevent relapse. I’m not sure that I would ever go to daily, but I do know that I need to be going over my WRAP a lot more frequently than I do. The whole point of knowing one’s triggers and warning signs is so that you can be alert to them. It’s one thing to know them – but so easy to miss them unless you’re really watching.
So – What do you do with the shockers? Do you beat yourself up over them? There’s no point in that. To me, it seems you need to do is stand back and detach a little. Stand in the moment. Not the future. Not the past. Just the moment. Examine – and for me, it helps if I can find someone to help me stay in perspective … at least to get me going – and learn. This helps me to see cause and effect relationships; it helps me to learn and relearn trip hazards; it helps me see things specifically rather than looming ghouls and it leaves room to remember that there were a couple of good moments in the last fortnight too.
From there I can start with a plan. If the plan needs adjusting, then so-be-it, but perhaps – just, perhaps … next week can be a bit better …
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 managersas 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.
Habits. My life is full of them. Good ones. Bad ones. Helpful ones. Ones that I have resolved to end a hundred times over, yet continue with. I have things that I do because I like to. Things that I do because I have to. Things that I do because that’s just what I’ve always done. Some I maintain consciously, some unconsciously; and some are maintained by failing to maintain others. Habits.
I spent yesterday afternoon pottering in the garden. Among my many little chores I spent lifted bulbs from some pots.
Now, I am very new to gardening. My once black thumbs are currently oscillating between a brown and occasionally get a very slight hint of green (until I forget to water the garden for a few days in a row). There is no science going on – it’s all experimentation … almost. I do occasionally look things up on the net. After I write this post I will be looking up what you do with bulbs after you lift them.
Which brings me to the some of the reflections that I had yesterday as I waxed poetical in my head and got very grotty at the same time.
I have never grown plants that were bulbs before. So this year was certainly an experiment. Some grew and some did not. I believe that I probably planted some upside down, but can’t confirm that. I probably over-watered some … they rotted in the soil. Others grew and didn’t bloom. I am not keeping bulbs of plants that did not bloom. Some grew and missed a few days water and got hot wind and died while others did quite well. Some even made it to bouquets for friends.
Yesterday came to the beginning of stage two of my experiment with bulbs. I went to the pots that held the plants that had bloomed that I had liked and decided to lift the bulbs. Not quite sure of the correct procedure I began to burrow. Now the first pot was not so difficult. They were tulips. The second pot I did just to get rid of the bulbs because I still wanted to keep the pot, but needed to get the bulbs out. They too, were easy to find. The daffodils gave me no trouble. And then I came to these other plants – whose name I do not recall – but the bulbs were in little nests that were distributed unevenly around the planter box and while the upper couple of bulbs in the nest were of reasonable size there were also bundles of little balls – I assume new bulbs – that would often fall free and needed fishing for. It took a lot of work to sift through this pot to lift the bulbs.
While I was doing this it struck me that If I were this thorough with everything, much of my life would be a lot simpler. I would not have forgotten to take my medication yesterday morning had I refilled my dosette box when I emptied it. I would not get weary looking at the mess in the kitchen as often if I were in the habit of cleaning up after myself as I went more regularly. I would be exercising regularly by now instead of simply planning to start within the next month. I would not grow weary from lack of sleep. In short, I would be more scrupulous about my habits. Certainly it’s laborious. Yet, there is a purpose to these habits the same as there is a purpose to my clearing the pot. I am seeking to be in the best of health so that I can get on with living and doing other things. Just as I was clearing the pot so that I could plant something new in it that would grow over the summer months. There is a purpose to maintaining habits that are mundane that is anything but.
The second reflection came to me while I was battling one-handed with my bush rose whilst watering it. I was attempting to remove the spent blooms – I’ve been taught to do that, but don’t do it regularly enough so there are lots at present. They’re all over the bush. Some of them were impossible to get to without doing battle with thorns while working one-handed. Others, within reach while able to be grasped and eventually detached, were not easy to remove. I also managed to get spiked by the tree regardless. Ouch. How different the bush rose was from the geraniums which simply slip off the plant with the slightest pull.
I am much more like the bush rose than the geranium when it comes to surrendering my bad habits. How much simpler life would be if when I noticed that I needed to change I were able to simply let go of the old ways like my geraniums. But, no. For me it is work. It requires effort and often shakes up the petals of some of the other flowers during the process. Occasionally, not just the dead rose came off with the pulling, but some of the good ones beside as well. I think my roses are very much like my habits. They grow without effort and bloom. Often they serve a good purpose, but then are no longer needed. Other times they just are. But when they are past their usefulness and deadweight, burdensome – they do need removing. Sometimes it can be done while I’m doing other maintenance like the watering, but I think that I am going to have to go out soon and pull them off myself deliberately. One at a time. Not a job that I see as stimulating, but to encourage the bush to be productive and to keep it looking healthy it needs to be done. Now I just need to take the same path with my troublesome habits and learn to tackle them one at a time and replace them with helpful ones.
Will I be as meticulous in dealing with my dead habits that are no longer blooming as I work at being with my flowers? Will I dig and sift as thoroughly as I looked for my bulbs when it comes to removing them?
Again I set my resolve to commit to tackle my environment and not let it get out of control (The kitchen, living area and study are cluttered again and the floors are past cleaning time). My dosette box should never be left empty – I used to be good with that. There are a number of other things that I need to sit down and map out.
Which plant holds the flowers that are hardest to remove in your garden? Just how carefully are you prepared to dig out your bulbs?
I think I still have black thumbs in the habit garden and it’s time to green up. What colour are your thumbs?
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.
An area that is starting to grow in mental health is an intervention called Sensory Modulation. It is used in a number of different ways and some people use it only in part. Some people may have come across ‘grounding techniques’ and ‘self-soothing techniques’. There is a cross-over between Sensory Modulation and distraction as a technique to deal with difficulties. It is a sub-branch within the world of Mindfulness and involves use of activity and engagement of the senses for therapeutic purposes. It is a big area for Occupational Therapists, Diversional Therapists and is starting to feature in Nursing literature, particularly for use in hospitals to try to find ways to reduce people’s levels of distress without having to resort to extra medication and seclusion. Studies are showing promising results.
The Senses
Despite the way that we usually talk about five senses, we have actually have seven senses. We are used to thinking of our senses in terms of taste, touch, sight, smell and sound. However there are two more that we very rarely talk about.
The first of these is called proprioception. Proprioception is communication between your muscles and your brain. This is how your brain knows what your muscles are doing – when they are stretching, flexing and where your body is in space. It is proprioception that enables you to match the position of one arm to the position of the other with your eyes shut.
The second is a vestibular sensation. This is what gives us our sense of balance and the sense that we are moving in space like when we are in a car. It is also the sensation that gives us the feeling of dizziness and nausea when it is out of kilter.
Some people also differentiate between deep touch and light touch when working with the senses because your body often responds differently to the different types of touch. Think of the difference between being massaged and being tickled.
What is Sensory Modulation & how does it work?
Sensory Modulation involves using different types of activity or stimuli to calm or alert one or more of the seven senses. This in turn can feed into the way that a person is feeling or reacting to a situation, a stressor or the environment. So if feeling anxious and having anxious thoughts churning over through ones head someone might choose to do something that they know will engage the senses in a soothing way for them eg using a rocking chair, listening to music that they like that has a tempo of approx 60 beats per min whilst being mindful of the sensations; or they may choose to ground and/or distract themselves with something that alerts the senses and redirects their attention, perhaps using the tension in their muscles by going for a run or walk, again engaging awareness of the movement of the muscle groups and the engagement of the senses with the environment around.
Essentially, you take control of your senses and use them to serve your advantage.
Mindfulness & the Senses
Some of the ways that you can use your senses with mindfulness include:
Grounding
Grounding techniques are active techniques to help you to orient and focus on the present and to distract or self-soothe when you’re feeling distressed. When you are feeling ‘out of sync’ they can help emotionally, physically, mentally and spiritually. If you know what you respond to best – you can even be prepared for times of crisis or for prevention if you are feeling triggered.
Some activities that people use to help ground themselves include
A hot or cold shower
Eating hot balls or sour balls, chilli, lemon – alerting tastes
Breathing exercises
Yoga
Using a balance ball
Cleaning
Yard work
Wearing weighted item eg back pack, ankle weights
Petting dog or cat
Warm or cold flannel to the face and neck
playing with a stress ball
Aromatherapy
Moving furniture
Holding or chewing ice
Jumping rope or doing star jumps
Stretching
Running or walking
Lifting weights
Push-ups
clenching and unclenching muscles (isometric exercises)
playing drums or other musical instruments
Pottery
Rocking in a rocking chair
Dancing
Listening to music
Waxing
Journaling
Other activities that can be used for self-soothing or for orienting and alerting oneself capitalise on the calming and alerting features of the stimuli. Some examples of these include:
Calming Sensations Alerting Sensations
Hot shower/bath Cold or cool shower/bath
Holding/petting a pet Holding ice in hand or to face
Warmth of fireplace Being in a cool room
Wrapping in a heavy blanket Wrapping in cool bed sheets
Soft materials/textures Rough or prickly materials/fabrics
Rocking in a rocking chair A bumpy car ride
Swinging on a swing Spinning on a swing
Slow rhythmic motions Fast and/or jerky movements
soft/low lighting Bright or flashing lights
Decaf herbal teas Drinking coffee
Chewing gum Biting into an icy-pole
Chewy or crunchy foods/ lollies Sour or hot foods/ lollies
What to do with these activities – A bigger picture
The idea then is to consider the primary areas of difficulty that you encounter. Do you
get overwhelmed
get voices
Get angry
Get anxious
Depressed
Struggle with negative thoughts
Feel disconnected
feel triggered by something …?
Think about a) things that you can use to alert or distract yourself;
b) things that you can use to do to calm or comfort yourself;
c) things that you can do to help improve the moment; (something you enjoy, a treat, something to make you feel better)
Often you may need to do all three in that order – but not always. Regulating your reaction, however, may be more than a single step process.
What senses do you respond to most strongly?
Different people are more responsive to different senses. Some people love touch. Others squirm. Some love movement. Others enjoy scents. We’re all wired differently. How do you think you are ‘wired’? What are your preferred senses for comforting and alerting yourself?
Think about what kind of movement you enjoy (eg exercise, rocking chair, doodling, shopping, cleaning, theme park rides, skating, building, sports activities)
What kind of Touch & Temperature do you like (eg massage, sitting by fire, shower/bath, knitting, sunshine/shade, lotions, playing instruments, art, fiddling with things, doing your hair, heavy blankets/quilts)
What kind of auditory/listening stimuli you like (eg silence, running water, music, rain, relaxation soundtracks, wind chimes, theatre, a purring cat, people talking)?
What kind of visual stimuli you like to look at (eg scenery, photos, lava lamp, movies, window shopping, reading, fish in a tank, art)?
What kind of scents do you like or respond to (eg scented candles and oils, coffee, perfumes and aftershaves, flowers, fruit, herbal tea, fabric after being hung out to dry, chopped wood, forests)?
Think also about what kind of gustatory, tastes and chewing sensations you respond to (eg chewing gum, crunchy food, sour food, sucking a thickshake through a straw, yawning, deep breathing, listerine, blowing bubbles, hot balls, drinking coffee or hot chocolate, fizzy drinks, sucking a lollypop)
Making a Plan
When you have thought about the types of activities that you respond to. Make a note of half a dozen things that you think would be most helpful when you are distressed.
Why not set aside a place or a kit where you have some if not all of those things ready to go and on hand when and if you need them?
Knowing how your senses work can help you tap into them better for relaxation, recreation and for giving yourself a jolt if you need one. I have found ideas from studying this stuff that are great for my recreation, rest as well as helping me when I am worked up or struggling to focus. I hope that it’s useful to you also.
If you are interested in more information, information about making a sensory kit or a questionnaire about your sensory profile, please leave me a message in the comments and I will get something back to you.
(Credit to a lot of the lists goes to a combination of published resources that I have referred to, some of which have no author attached, majority of examples listed resourced from Tina Champaign’s website)
My parents have come to visit – so I didn’t think I’d have time to blog.
But here’s the thing …
I’m too interested in the things I blog about to leave it alone.
I’ve enjoyed sharing some of my early experiences of Mindfulness. I hope that some people have found it valuable and that it has helped some to grasp a little more clearly the concepts behind it.
Being present in the moment, self-aware and able to be aware of your environment or choose to filter what you attend to. Being able to focus your attention, your thoughts and meditate on or observe things. To be deliberate in all of this.
It is a refreshing experience and helpful for many things from distraction to relaxation, to stress management and through to managing early warning signs and symptoms. If you’ve not had the chance to learn it, I would highly recommend it. It is a more concrete skill than it sounds at times.
I have had fun today. I enjoyed having my 5 and 3/4 year-old niece do my hair for me this morning (one must not leave out the three-quarters!). When I got home (after driving for a quite a distance and stopping to get out of the car and fill up with petrol) I believe that I pulled 7 elastics and 2 clips out of my not-so-very-long hair (ie it had bunches sticking out in all directions).
I don’t think that she believed that I was really going to leave it all in until I actually left.
Playing hairdressers with one’s niece is a lot like a dare. She knew I looked silly, and didn’t really think I’d leave her handiwork in – but wanted to see if I would.
What she doesn’t know is the kind of things I did to my own hair for the hell of it when I was in my teens and went out with still in just because I was bored.
My niece is good therapy for me. When I am with her I forget to be anything but open to what she wants to do (except if it involves running too far or something against the rules). I lose most of my inhibitions and allow myself to play like a kid again. She lets me enjoy the moment in her company for just that little while – and while I am with her I feel whole.
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.
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.
The dog rises on his haunches – quietly – all the while waiting for me to stir.
The song changes on the clock radio.
The dog waits.
But I don’t move …
… and slowly, slowly he rises to his legs and creeps out of the room.
The black dog roams free in the house.
And I sleep on.
Eventually, much later I wake.
I look at the clock.
%##@@
And then I see the empty patch on the floor …
and I know that something worse seems to be afoot. I haven’t just slept through an alarm this morning.
The dog is at large in the house.
I fall back on the bed and close my eyes in dread.
What awaits me?
How awful will this become?
Can I face it again?
I pull the covers up over my head and try to snuggle back down to sleep.
It’s not really happening.
But I can’t do that anymore.
I’m not the same person that I was last time I found myself like this.
Bloody Dog!
Now I have to go and clean up this mess.
The mess. Can I face the mess?
Sooner or later I have to. I’m really just putting it off lying here in dread and imagining.
He’s only been loose a little while. How bad can it be?
Bad. It’s been bad quickly before.
Come on. This is getting us nowhere – time to move.
So eventually. Eventually. Eventually – I do.
I was right.
He’s been everywhere.
But unlike before, I can catch him and rein him in reasonably quickly.
Sure, this leaves me tired. But not defeated.
There are muddy prints where the dog has been – but all they are are the traces of his lies upon my consciousness. I can clean those.
Tonight the dog is back on his leash.
Tonight is evidence of what gains I have made with the help of my psychologist in learning to be conscious of my thoughts, emotions, my actions and how my body is responding to situations and to be deliberate in how I respond to this. Tonight I remember how these things used to crush me. How encouragement was drowned out by self-derision.
Today my dog got off the lead. Today I caught him again.
Yes, it made a mess of my morning.
Yes, it upset me.
But today, I could hear encouragement when it was offered by someone supportive.
Today Mindfulness skills allowed me to feel and experience the emotions of the moment and yet use the CBT strategies that I have learned to right my perspective and reorient my day so that I could finish it feeling like I had accomplished something useful.
I live with a black dog. It follows me everywhere. My philosophy now is that I need to plan for its needs when I plan for my own. I also need time out and restful places to enjoy the warmth of the sunshine on my shoulders.
livingwithablackdog 
