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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?

 

Send in the Senses 23/10/2011

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

Massage/Deep pressure touch                                                      Light touch

Isometric(the muscles don’t move) exercises/yoga              Aerobic exercise

Leisure walks                                                                                         Power walks

Dusting powder/powder puff over your body                        Rubber band wrist snapping

Slow/rhythmic music                                                                        Fast paced/upbeat music

Calming sounds of nature eg ocean                                             Alerting sounds of nature eg birds

Humming/singing quietly                                                               Humming/singing loudly

Soothing scents (oils/lotions/candles)                                     Strong scents (oils/lotions/candles)

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 gustatorytastes 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)

 

Mindfulness of the October Factor 22/10/2011

One of the factors that I have spoken of recently that has affected my mental state is the change of season.  I become more vulnerable to symptoms of Depression and need to be careful not to be taken captive by them and dragged back under the control of the black dog as he strains upon the lead.  October this year has been fraught with tension as the dog hauls away at the lead while I wrestle endlessly to bring him to heel and keep him there.  While each time he strains, I have brought him back – it takes a lot out of me and he knows it as he waits impatiently at heel for the next opportunity to pull away.  I have had a tiring month.

How do I know when things are starting to get too much?

One of the things that I have decided to work on is paying closer attention to the cues that my body gives.  It’s very easy not to be aware of these until I have a nasty headache, my shoulders ache, my muscles are all sore, I have a noticeably palpitating heart rate that makes my chest feel hollow and heavy or I feel exhausted.

I commented in my last post in closing about Mindfulness that one of the areas that I need to work on is that of noticing what is happening in the moment.  This is what I am working on at the moment.  To start with – to notice the cues that my body is giving me.  For instance, when is there a change in the level of tension at key points in my body like my neck, shoulders and jaw?  Am I breathing deep, medium or shallow breaths, what kind of rate am I breathing at?  Am I aching anywhere?  What is my heart rate like?

Now I don’t do this as a checklist and step through it or try to determine these things in a specific way.  What I am learning to do is to try to do what is called – in Mindfulness language – a ‘body scan’ at regular intervals.

What does a body scan involve?

Essentially all I do is start out by observing my breathing until I am into the mindset of observe – not control.  I then move my attention to my heart and notice and feel the rhythm of my heart beating inside me and the sensations that arise from that and enjoy that for a little bit.  From there, I start by noticing the feel of the clothes on my skin, the shoes on my feet if I’m wearing any and then move my attention to my muscles.  To scan my muscle I start by placing my attention on my toes of one foot and paying attention to them, noticing any tension or pain or other sensation, acknowledging it and – if it is tension, consciously releasing it from the muscles by either picturing it draining away or stretching and/or wiggling them.  I then do the same for the other foot and move on to the next section of my leg and do the same thing. And doing this throughout I might move through the body in a pattern something like:

  • Toes
  • Feet
  • Lower legs
  • Thighs
  • Butt
  • Abdomen
  • Lower back
  • Upper back
  • Shoulders
  • Chest
  • Upper arms
  • Lower arms and wrists
  • Hands
  • Fingers
  • Head
  • Forehead
  • Eyes
  • Nose
  • Cheeks
  • Mouth
  • Jaw
  • Tongue
  • Neck
  • Shoulders

I figure that since the shoulders bunch up so easily, it doesn’t hurt to check them again.  It doesn’t really matter what order you do it in though, nor how big or small the groups you break them up into are to a certain extent.

After scanning and relaxing all of the muscle groups, I then observe my breathing again for a moment or three before drawing my attention back to what is in front of me to do.  It doesn’t take very long, and with practice it should take perhaps a minute – maybe less.  If I try to do it when the little ‘beep’ goes on my watch on the hour (when I hear it), I should get lots of practice and stay well on top of these cues.

The goal is to be able to notice the tension before it becomes problematic and to be able to question whether I am becoming stressed before I get there.  A lot of people who do this regularly swear by it.  I guess it’s a bit like paying attention to when there is tension growing on the dog’s lead when walking a dog.  As it grows, it cues us in to the idea that the dog is growing more likely to want to get away from us.  Thus it is living with my black dog.  I must be wary of tension.

So – here’s to my next excursion into the world of mindfulness.  Noticing physiological changes and discomfort and either accepting them or letting them go without blame for their getting there.

Here’s to the next step into managing my Depression.  Noticing the cues that early warning signs are present so that I can act.  Perhaps October will improve from here on in.

Heel, Dog.  Heel.  I’m onto you.

 

A Mindful Journey 21/10/2011

One of the therapeutic approaches that I use to help manage my Depression that regular readers will have come across previously when reading my blog is Mindfulness.  Among other things it is helpful for dealing with thoughts, coping with stressors and managing physiological symptoms.  It has been used to help people manage symptoms of a range of mental health issues including Depression, Anxiety, Bipolar Disorder, psychotic illnesses, Personality Disorders and Eating Disorders.

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

The first exercise

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

The breathing exercises

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

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

The Wii game

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

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

The fly

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

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

The job interview

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

Bad news.

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

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

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

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

The terrible, no good, very bad day

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

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

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

The road so far …

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

 

Watching Wellth 16/10/2011

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

 

 

 

Medication: Weight or Baggage? 09/10/2011

Ever want to hear a room full of doctors or mental  health workers stop talking?

Introduce debates that have been raised in recent years questioning the effectiveness or the place of medications in the treatment of mental illness.  Suggest that there might be evidence of options that would be more appropriate starting points for treatment.  Ask them whether they would be ready to choose to live with the side effects that may result from some of the anti-depressants that are out there.

Have I surprised you?

I am not anti-medication by any means.  I use medication.  Unfortunately, at present, a lot of it although I hope in time to be in a position to reduce this.  There are some people who are.  They say that Depression can and should be managed by using strategies such as those that I discuss in “Beyond Medicine” with use of lifestyle strategies with regularity and discipline as well as well evidenced ‘talk therapies’ that build skills and resilience like CBT and Mindfulness.  Some even think that medication makes depression worse.

There are now groups who go over research that comes out about treatments to see what standards people are using to measure ‘success’ of treatments against and how it really measures up with other treatments if judged by the same criteria (eg http://www.power2u.org/medication-optimization.html ).

My depression falls within the ‘major depression’ and severe spheres.  That is within the spectrum of severity where it is clear from research that anti-depressants have a measurable effect.  It can be proven that they make a difference.  Research is finding not much evidence to prove that medication makes a measurable difference as opposed to placebo or other forms of therapy for mild depression and little more so for moderate depression.  Now, that’s not saying that there are no cases where it doesn’t work and all cases where it won’t be worth a shot – or that you won’t underestimate how severe your own depression is.  I certainly did at first.  What it does say is that it is worth asking some serious questions and exploring a range of other treatments either before or instead of medications.

Consider the some of the side effects of antidepressants.

Short term side effects of SSRIs can include nervousness, anxiety, muscle tics, suppression of REM sleep (and then drowsiness), nausea, dizziness, diarrhea, gastrointestinal problems, different types of sexual dysfunction, emotional blunting and apathy.  With long-term use come risks of cognitive changes.  Now most short-term effects will pass as the body gets used to the medication, but still …

Tricyclic antidepressants have potential side effects that include blurred vision, dry mouth, constipation, bladder problems, sexual dysfunction, dizziness, drowsiness and increased heart rate among others – again some settling after a short time and others continuing.  Not everyone gets any or all side effects, but most experience some.

If you take MAOI anti-depressants, then you can’t eat certain types of food.  Potential side effects here include low blood pressure, constipation, vomiting,  headache, altered sleep, dry mouth, drowsiness, fainting, sexual dysfunction, weight gain and lower alcohol tolerance.

And people wonder why people stop taking medications!!?!  Do you want to take them?  How will they help you?  Sometimes trying the non-medication based therapies first does make a lot of sense.  While it seems easier to just take a tablet, how confident can you be that the tablet will make you feel better?  Mine do.  But remember, firstly, my Depression is severe and secondly, I also need to bolster it with management strategies that aren’t medication-based.  I need both.

Here’s the thing though.  What ever you do decide to do – make sure that you are fully informed.  Do your research.  Also – ask your doctor the hard questions like:

“Why this medication?”

“What are the side effects?  How long would I expect them to last?”

“Are there any risks associated with this medication?”

“Will I be able to keep working while I start taking it (if you are working) or will it affect my performance?  Should I take a few days off?”

“How will I know if the medication is starting to work?  How long should it take?”

“Are there any precautions that I should follow over the next few days/weeks?”

“What happens if this medication doesn’t work?”

If you do agree to try a medication, stick with it as advised.  The time frame your doctor gives you for how long it should take to work will be only an estimate.  Also, some medications are dangerous to stop unsupervised.  If you are trying a medication, consider it a joint experiment by yourself and your doctor.  You bring your expertise of your experience and the effect that the medication has upon you.  Your doctor brings medical training and independent observations.  Both are needed to make an informed decision about where to go with your medications.

If you are on long-term medication, you doctor and yourself share a partnership.  Again, you are the expert on yourself, your symptoms, experience and how the medication is (or isn’t) impacting your life.  Your doctor is the expert on the medical facts, observations and assessments as well as the medication itself.  In any partnership for decisions to work to their best advantage both people should be involved in the decision-making event – even if the right of decision is mostly with one person.  This means that both people’s expertise can be used.  Sure, ultimately, it’s your life and your right to agree or disagree with your doctor’s medical opinion – but when there’s medication involved and you want to change it or come off it, at least informing them is a smart thing to do.  They can then tell you if you need to know about any risks and you can ask them what you need to know to make sure that you are safe.  You can also make a judgement call about how much you think you can manage with your own strategies with a lower dose of medication in place and work to negotiate this with your doctor.

Ultimately, I think it comes down to the type of depression that you have.  Some don’t need medication.  For some the decision could go either way.  And there will always be some that need it.  However, the question about whether we do or don’t use medication is weightier than deciding whether we can tolerate side-effects or would rather carry a load of self management strategies that may seem burdensome when we feel so amotivated.

We all need the self-management strategies.  These have been proven to be effective in reduction of depression regardless of the level of severity.  Our decisions about medications need to be weighed carefully.  How much of the work are we expecting them to do?  They are a tool, not a workshop and not a finished project.  They are designed to equip us to work at life.  If they’re working, you’ll be able to take up the management strategies that are more lifestyle driven and see your mental health improve to wellness.  Sometimes with meds still in the background.  Yet for others, in time a mutual farewell to the partnerships with doctors and health workers gives way to a continuing lifestyle-driven means of managing wellness.

 

The Wall with a Hole in it … 30/09/2011

And I’m not talking ATM.
Have you ever felt yourself to be up against that dragon that you were never destined to slay?  That worm you’ll never be early enough to get? The one that leaves you feeling like the Emperor in all his glory when he set out in grand style to show off his ‘new clothes’ just when you think you’ve gotten a hold on it.

My nemesis is time.  Not just any time – although we have a slippery time keeping pace with each other continually.  No, the ultimate battle is drawn around the time of sleep and waking.  Here I am repeatedly mauled by my dragon, eaten by the worm and left with nothing but the Emperor’s new clothes to show for all the effort that I have made to conquer the struggle.  I feel as though I am beating my head against a brick wall.

What happens you ask?

I set an alarm clock.  Actually I set two alarm clocks ten minutes apart.  I do not trust myself with one.  I have been known to turn one off in my sleep!  I set one to raise my level of consciousness and the other to wake me.  For most of the year this is adequate.  But then comes the changing of the guard – it starts to get light earlier or later in the spring or autumn and for several weeks my dog hides the alarm clocks.  He must.  Some nights anyway – because they sure as hell don’t wake me.  But then I also have trouble in getting to sleep – so maybe it’s not all the dog’s fault.  At times I sleep no more than an hour or two a night.  Others I may get to sleep and then wake up at two in the afternoon – ON A WORK DAY!  This year I thought that I was winning at work until the seasonal sleep monster set in.

Right now I feel like I am beating my head against a brick clock.  In getting to sleep.  In waking up.  In getting to work.  My psychiatrist has given me something to try for the short-term (ie 4-6 weeks) as it’s a regular pattern and struggle and part of a bigger picture of short-term seasonal change in my mood.  It’s not a relapse – just a dip.  But oh so disappointing because its been so stable for so long.  In lots of ways I think I could handle it if the sleep didn’t go out the window.  It’s started to affect my work though, so I’m taking the medical option this time.  Maybe next time I’ll be able to have the personal strategies down strongly enough to manage it without boosting my meds for a few weeks – but I need to prioritise keeping my job over my pride for this time.  I may have to wake up and phone in to work in the Emperor’s new clothes.  I do not have to parade through the streets in them.

Bloody Dog.

Damn Clock.

So for now I get my sleep under control.  I keep my mood stable with a little extra help than usual until the season settles.  At least I will be able to keep the dog in his place.  At least I will stop messing things up so badly in getting to work.  It will only be for a few weeks and then its back to the normal cocktail that I’ve accepted will be a part of everyday.  Back to using my ‘personal medicine’ or lifestyle strategies to manage life and its stressors.  Then I get summer to strengthen my other skills and to be ready for autumn when it comes.  Perhaps I will plan a short increase in meds again.  Perhaps I will plan time off work.  Perhaps I will be enough on top of my sleep to manage it with flying colours.

My Dog loves the twilight of the seasons.  He thinks its play time.  He loves the dawn.  He dances while I wake.

Oh to be able to open one eye and say in my firmest voice.

“Sit. Dog.  Sit!”

And have confidence that he’d obey.

One day.  One day he will.  One day I am determined to slay that dragon.

One day.

 

 
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