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Do You Tell Your Boss? 13/11/2011

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.

 

Making Sense of It All 04/11/2011

A while ago I spent some time blogging about how we can talk to people about Depression – or about mental health issues in general.  But I left out a very important group of people.  Kids.

How do you talk to kids about mental illness?  How am I going to explain my Depression to the important children in my life?  How do you explain it to those in your own?  While people often worry about upsetting kids or frightening them by talking about mental illness – and I’m talking about the kids in your family or very close to you here; the facts indicate that most of the time children worry less about something if they understand it.  Providing them with opportunities to talk and to find out what they think is happening is important.  So is clearly and simply explaining what is actually happening in a way that they can understand.

But finding the right words to explain what needs to be said in kid language is a tough business.  Plus, adults struggle to share their feelings.  Again, accurate and age appropriate information are the best way to go – and this usually goes down best coming from a parent or another adult family member or close friend of the family.

So – how do you know when and how to do it?

If they ask questions about your or  the other person’s health – this is a good opportunity.  A number of resources suggest strategies like asking the child how they are feeling at the moment, if there has been an incident recently then perhaps ask them how they felt when such-and-such did this-or-that; or even if they thought you or the person were acting differently lately – depending on the age of the child.  But whenever you do – pick a time and place where you’re all most likely to be comfortable and feel safe and where you won’t be interrupted.

It’s suggested that you explore the child’s understanding of what’s going on – not just accept their first reply because they could easily just repeat someone’s words without clearly them.  Plus it’s important to know how they learned what they do know.  Also, make sure that you’ve understood properly what they have told you.

Ask questions that are open – that is, they require the child to do more than say ‘yes’ or ‘no’.  Try to get them to say what they think in their own words.

Be ready to reassure them.  They might feel awkward.  They might feel distressed or disloyal or angry or be afraid of causing worry or getting into trouble.  Make sure they know that this is okay.

Now when you come to the explaining part:

There are lots of good resources take a look through some of them to prepare yourself for the talk or use them with the child.  (Please see links at end of post).

Keep some coloured pencils or pens and paper or some play dough handy.  Something that you can use to illustrate what you are telling them about or that you can ask them to draw something to help illustrate a point or  a feeling.  You may also write down thoughts or questions or plans together later (or draw their understanding of things for you when you are exploring what they know).

Think about examples of illnesses that children are familiar with that could be helpful in your explanation eg asthma, diabetes, broken bones, colds, chicken pox (some will depend on what they or their friends/family have had).  Be specific in the comparison that you make  eg asthma and depression both have triggers and physical signs even though they happen in parts of the body, both can seem to come out of nowhere … ; it is not like a cold because you can’t ‘catch’ it.

Or a common example is to compare the body to a car with different parts – different things work together to make the whole car work, but if something goes wrong then it can make the whole car run badly or not start.  In the case of Depression … (a good example of such an explanation can be found in Talking to Children and Young People )

The big ideas to communicate no matter what are:

  • Mental illness is nobody’s fault
  • It’s not YOUR (the kid’s) fault
  • It doesn’t mean that the person doesn’t love you or care about you anymore
  • It is not your responsibility to make the person better.
  • You can’t “catch” it
  • Just because someone else in your family has it doesn’t mean you’ll get it
  • It happens to lots of people, in lots of families – not just this person
  • The person won’t be like this all the time
  • There are treatments like medicine and people to go to for special conversations and doctors who know about this illness
  • It’s not just about the person thinking or feeling differently.  What is happening to the chemicals in their brain is different.

Here is a summary of an outline that I found about how to explain Depression to a child in an Australian COPMI program booklet.

Children can sometimes understand the impact of your illness more easily than they can its cause.  This means that it may be best to describe what the depression does to you rather than what depression is.

So you might tell them that Depression can cause:

  • no energy (making it harder to play)
  • difficulty sleeping or sleeping too much (making it harder to get out of bed or keeping you up late at night)
  • crying a lot (sometimes when there is no apparent reason)
  • losing or gaining weight (because you don’t feel like eating or you eat too much)
  • not enjoying the things that you used to (means that sport or dancing or cooking or whatever it is doesn’t make you smile anymore)
  • make you tired and cranky (can make you get grumpy at the children for no real reason)

What does your depression make you do?

Depression is an illness.  It’s like having a cold or having asthma except it affects your brain.  Your brain controls the things you feel, think and do.

Everybody feels sad sometimes.

Everybody thinks bad things sometimes.

Everybody has things that they wish they could do, but can’t.

What makes your/this child(ren) sad?

What sort of things do they think about?

What do they wish they could do but can’t?

When someone has the illness called Depression, they can feel sad for a long time and not know how to feel better.

Depression can stop people being able to do things that they used to do and enjoy.

I hope that this gives you some ideas for some starting off points.  Seriously – do take the time to check out some of these links.  The first three have really informative and detailed guidelines in them.  The resource lists include children’s storybooks, links and all kinds of things and the other links have some wonderful things in them too.

I have found some other FANTASTIC resources for parents, siblings, extended family and close friends of children who have parents (or family members) with a mental illness.  Even one about babies for those with bubs or planning pregnancy.  There are more out there just waiting to be discovered.

COPMI stands for Children Of Parents with a Mental Illness.  It’s Australia’s national project over this area.

Piecing the Puzzle Together: Raising a Family When Mental Illness is Part of Your Life

Family Talk

Best for Me & My Baby

Talking to Children and Young People

 

 

Resources for Children aged up to 6yrs

Resources for Children aged 7 – 12 yrs

Resources for young people aged 13-18 yrs

Resources for Parents

Care Planning for a Family

Links for young people

 

Australian programmes offering support for children and young people with a parent or sibling with Mental Illness

Family to Family project booklets

When Things Are Sad And Gloomy : Understanding Mental Illness in your Family

 

Mmmm … Massage 30/10/2011

The Massage Table

I had had it.

I was aching.

It had been a long day at work.

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

My work satchel was dragging down on my shoulder.

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

Then I saw it.

The massage therapy place in the shopping centre.

It was clean.

It was respectable.

It was affordable … with minor adjustments

And it was THERE!

And in only a moment so was I.

“Do you have an opening?”

There was an opening.

What did I want?

“Upper back, shoulders & head please.”

Back, shoulders and head I got.

Forty minutes.

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

I came out uncrimped and able to move.

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

You know where the comments section is 🙂

 

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

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 Breathinghttp://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?

 

Hair Raising Therapy 23/10/2011

I had only two posts for this weekend.

I had finished and scheduled them by Thursday.

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.

She is my favourite anti-depressant.

What’s yours?

 

Watching Wellth 16/10/2011

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

 

 

 

B-B-B-Budget: The Cost of Medication. Is It Worth It? 02/10/2011

Budget.

Now there’s a scary word.

Why is it there?

It goes through my mind on a regular basis.  Like – every time I run out of a few medications at once.  And especially on those really special occasions when they all run out at the same time.  You know the ones?  Or perhaps you don’t.

Me – I have what is known as Treatment Resistant Depression.  It means what it says.  It’s a bastard to treat.  It doesn’t respond to the basics and I go to a psychiatrist who is a specialist.  Yay me!  It also means that what works is an interesting combination of meds.  This is complicated by the fact that my depression is the result of surgery that I had in my early 20’s that also left me with a tendency to partial seizures (now controlled – by medication…).  I also have a history of really nasty and persistent migraine that I resisted medication for until the summer when I had them for 4-5 days a week every week for about 5 months and found myself at risk of losing my job over the number of sick days that I was accumulating.  I also have low levels of vitamin D and a back injury that has resulted in the growth of osteophytes (essentially arthritis).

I figure that I am lucky to live in Australia where a large proportion of the cost of most medications is subsidised by Medicare – the government scheme to ensure that health care is affordable for everyone.  It says something that I generally reach the threshold of what people are expected to pay without further subsidy (Medicare’s safety net) by about October or November each calendar year.

My meds for Depression include Lexapro (also known as escitalopram) an SSRI, Edronax – a SNRI, Lamictal (lamotrigin) which works as a mood stabiliser but is also an anti-seizure medication and Valdoxan – which is only new.  I’m taking Valdoxan at a low dose as an augment to my other anti-depressant medication.  I’ve tried to go without an augment several times, but it just isn’t enough to hold me – I relapse with the slightest of triggers.

Valdoxan is expensive however because it is not PBS listed (ie not on the Medicare Pharmaceutical Benefits Scheme list) but is sooo much better than Lithium which is what was what was used as an augment before.  Valdoxan wouldn’t replace Lithium for someone whose primary medication need was for Lithium – but as an augment it has been great.  It helps me sleep at night, doesn’t leave me drowsy through the day, doesn’t put on weight or make my hair dry and frizzy – just costs a lot of money.  But it allows me to function so much better than the Lithium did that I don’t begrudge a cent.  I also take a very small dose of Abilify which has helped with some other weird symptoms that used to come when I was low on sleep.

Next, I take Topamax to prevent migraine.  Much as I hate to admit it – this has proven very worthwhile.  While I still get an occasional breakthrough migraine a few times a year – they are nowhere near as severe, don’t last more than a day and don’t leave behind the ghost migraines for days afterward.  In short – I can function.  On top of this I take Vitamin D supplements and Glucosamine with Chondriatin (and I notice the difference with my back stiffening if I stop taking it).

Finally, one of the fall out effects of my depression has been the decrease in concentration and attention span that has come with it.  This year to see if we can improve that my doctor has been prescribing me a low dose of dexamphetamine – and I think it’s working.  The catch has been that it gave me tremors in my hands and, in the beginning, headaches – I had finally managed to get rid of all antidepressants that caused this – so it was back to the Propanolol for me to get rid of the tremors.  Propanolol also helps with prevention of migraine too, so it adds a bit of reinforcement to the Topamax (not that I would take it if it wasn’t for the tremor!).

That, ladies and gentlemen, totals at eight prescription medications and two over the counter alternative medications.  Not what I would call ideal – but they all serve a specific purpose and thinning them out would leave me very vulnerable to relapse – trust me, I’ve tried – under the supervision of my doctor whom I’ve told point-blank that I won’t take something or other … several times.  One day I hope to successfully reduce them, but I think that it will take a lot more skill in managing my depression on my part, more research time, planning and preparation.

I buy the Vitamin D and Glucosamine at discount pharmacies.

The rest I go to the same pharmacy for all the time.  This helps if I run into any trouble with any scripts or if I’m physically ill – they’ll run it around to my place for me.  Also if I get prescribed something else or go to buy something over the counter – the pharmacists there know what else I take and can tell me if it will cause me any problems.

Recently I had to get all my scripts filled at once.  It cost a lot of money.  At first I cringed.  But really, I’ve done this before and its nothing new.  It’s about four weeks medication that I’m paying for.  I know how much my medication costs.  In the end I just shrugged my shoulders and paid.  I said to the lady who served me the same as I’ll say to you.

“A day’s wages is not a lot to pay in exchange for the ability to function for a month.”
 

 
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