My Story: After Outpatient Treatment Part 2

Week 2, Day 1:
I’ve been feeling better for the last couple of days. I need to write more on those days so that everyone understands that depression is up and down. I want to share more of my up days because not everything is down.
I’m scheduled to talk at 2 churches so far this coming month. (May is mental health awareness month.) It’s a little nerve racking, but I’m hoping to speak to another pastor at a local church about speaking to his congregation as well. And I’ve already spoken to a pastor at a larger church and she has all kinds of ideas of where I could speak. She saw me once before when the depression first began and she says she sees a huge improvement.
I’m nervous about my next therapist appointment. I don’t know if it’s going to work out, but I’m thinking I’m doing well enough that I would need to see someone once a week. It’s possible that during winter two times a week would be better because the winter is so hard on me.

Day 2:
The therapist session went really well. I think she’s really going to be able to help me with my issues and help me get to a point when I don’t have to see a therapist weekly. I really felt like there was a connection and that she’s going to be very beneficial for me. She’s going to be the assistant to my mechanic while working on my mind.
I’m really starting to look forward to the future, something I never thought I’d be able to do. I’m still going to have my struggles but for today, things are looking up!!

Day 3:
Today was filled with ups and downs. I went hiking with my BF. Please click here to read about my day.

Day 7:
I’ve been feeling uninspired with my writing lately. It’s not flowing like it used to and I’m frustrated with it. Maybe part of the problem is that I’m writing mostly scientific and informational posts. Posts that are meant to educate but if I’m feeling uninspired writing them, who is going to want to read them?
I think I’m also feeling frustrated that things aren’t moving faster along. I feel like I’m plodding through each today and it’s a struggle. I want to be happy, but at the moment all I can do is find those bits of happy moments that occur day to day and add them together. Will I ever be fully happy? Am I meant to be happy?

Day 8:
I got taken off of all my meds today. I’m not sure how I feel about it. Of course, we weren’t sure if they were working and I was feeling better while only sporadically taking them so perhaps this is for the best. I don’t like having to rely on drugs anyway.
I had a good session in therapy but we really just talked about my week. I think we’re still trying to get the lay of the land. I know that I do want to work on self-validation, so it’s something I’m going to bring up in my next session.

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My Life In Outpatient Treatment: Week 5

This is a continuation, part 5, of my daily journal while in outpatient treatment for depression, anxiety and avoidant personality disorder. Please click for Week 1, Week 2, Week 3 and Week 4.

Week 5, Day 23:
They don’t think I’m ready to change. That I’m holding myself back but I don’t know what is holding me back.
I have a whole list of things I need to work on with my outside therapist. I will be discussing this in more detail in “Reprogramming Myself”.
I’m supposed to focus on myself. Focus on accepting myself, 24/7.
I’m holding onto ideals that I need to let go of. I have to let go of the old relationship with myself.
But I don’t want or like to put effort into something, unless I know the results.

Day 24:
How do you keep your mind occupied and/or disengaged from negative thinking? Especially when you’re doing something that doesn’t require much thought and your mind begins to wander.
Use games, distractions, ask myself what, and why; be logical about it, and breath.
“Rumination is like fire. You feed it fuel and it grows.”

Day 25:
I decided that I would like to write a letter to myself saying goodbye to the negative me and to the expectations that I had for myself before I became depressed. See letter.
How can I forgive myself for not meeting the expectations I set for myself? Or the expectations I feel are coming from other sources, namely my family? Is that what is holding me back from being able to change?
“He who angers you, controls you.”
We also talked about acceptance today. Acceptance is: “It is what it is”; making space; and letting yourself off the hook (from suffering).
Acceptance is not: denial, forgiveness, forgetting, letting it go, being ok, agreeing with it, allowing it or understanding it.

Day 26:
Today is my final day. I thought it would be more difficult than it was.
I discovered that May in mental health month and the ribbon is a dark green. One of my fellow patients is helping me create a logo for ADAPT. I’m so excited about that!!
After talking with my therapist, I realized I need to write down my goals. I need to have short term and long term goals. During session today, I felt very much in control of myself, my thoughts & my emotions. Let’s hope this continues!!!!
“Wake up from your thoughts and experience life!”

This is the end of journaling while during the outpatient treatment program. I’m interested to hear your thoughts and comments on my journey and I hope that my journey will help yours! Believe me, that it isn’t an easy fight. Sometimes you have to slog through mud, blizzards, ice and treacherous terrain, but I know that any fight is worth my chance of becoming a better and healthier person. You can view Week 1, Week 2, Week 3, and Week 4 at each link.

Alternative Medications & Therapies

There are multiple different ways to deal with depression and anxiety. This includes alternative medications and therapies. For mild depression, often herbal supplements are easier and more capable of helping than medication.

There are many different types of herbal supplements and remedies. I am only going to discuss three in this post. These would be St. John’s Wort, Omega-3 fatty acids and SAMe. St. John’s Wort is one of the most popular herbal supplements to treat depression. “In 2000, the FDA issued a Public Health Advisory letter stating that the herb may interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and those used to prevent organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Consult with your doctor before taking any herbal supplement” (NIMH)1. Omega-3 fatty acids are found in nuts, flaxseed and oil as well as cold-water fish. More research is needed to determine if Omega-3 fatty acids can help with depression however, just a note that it may interact with other medications. SAMe is a synthetic form of a chemical occurring naturally in the body. More research is also needed to see how SAMe effects depression, however it should be taken carefully by people with bipolar disorder as it may trigger mania.

There are also different types of alternative therapies. These include expressive or creative arts therapy, dance & movement therapy, music therapy, animal-assisted therapy and light therapies. These alternatives can help those with mild to severe depression and are often used in conjunction with talk therapies.

Expressive or creative arts therapy is when a patient used expressive acts such as writing, art, or music to help themselves emotionally. Art therapy encourages patients to express their feelings through the use of artistic materials like paint, markers or pencils. Expressive therapy allows a person to express themselves emotionally, through a helpful medium and allows them to find coping skills and deal with traumatic events while healing. Dance and movement therapy or DMT follows the same theory as expressive or creative arts therapy. The patient uses dance and movement to express their feelings and thoughts about their life situations. DMT is based on the idea that the body and mind are interconnected and that movement can affect their minds and thoughts.

Music therapy is something people use daily without realizing it. Please click here to read more about music and its affect on a person’s mood. Music is often used to aid in meditation and relaxation. Often patients will either listen to music that they relate to or make music to explore ways of expressing oneself.

Animal-assisted therapy includes working with various animals to help patients cope with their wishes and develop ways to communicate. Companion animals are often used in hospitals, nursing humans and psychiatric wards to bring comfort and joy to those with despair. There are claims that working with animals has a physiological benefit through increased level of activity and the act of caring for another. Interacting with animals is believed to improve confidence and increase acceptance and empathy. I will be discussing the use of Emotional Support Animals in a future post.

Light therapy is most often used to treat seasonal affective disorder or SAD, which is a form of depression that occurs during the winter months. Light therapy is the use of a full spectrum light in either a lamp or a box, that a person uses for periods of time. This can help those who struggle when daylight is at its shortest.

Aromatherapy is also used as a self-sooth or de-stress technique. Incense, candles and essential oils are all used for aromatherapy. Other complementary or alternative treatments for depression are meditation, yoga, spirituality, exercise and acupuncture. I will be discussing meditation in a future post.

These are just some of the alternative and complementary medications and therapies that can be used to treat depression, however these will not replace traditional therapy and medications for moderate to severe mental illnesses. These therapies can be used in conjunction with modern medicine to lessen the affects of your disease.

Anxiety and Depression Association of America
National Institute of Mental Health
National Center for Complementary and Integrative Health
Mayo Clinic

My Life In Outpatient Treatment: Week 2

This is a continuation, Week 2, of my daily journal while in outpatient treatment for depression, anxiety and avoident personality disorder. Click to read Week 1.

Week 2, Day 9:
Today was a continuation of the feelings from day 8. Even with a weekend between the days, I still feel worthless.
My homework for today was to write a journal post as if I was living 10 years in the future. My doctor told me to describe my life as it was happening, exactly 10 years from today.
We also learned about accountability and victimization. That lesson will be posted at a later date.
Parts of today’s journaling also became it’s own post and can be seen here.

Day 10:
I was informed by my group therapist that I’m getting a secondary gain by being in group therapy. Secondary gain can be defined as benefits received by not overcoming a problem. Secondary gains are problematic because while they make you feel better, they aren’t helping you fix the root problem.
I was also told that I need to have ‘Pinterest thinking’. Pinterest is all about uniqueness, and I need to remember that I am like a pinterest board. I am unique. I need to use “I am” statements, but nothing is really going to help me until I decide to ‘flip the switch’ and do the things I’m being taught.
We also had expressive therapy where we had to draw a picture of ourselves as a kite. It was a fun project, and you can view the picture here.

Day 11:
I’m in a good mood today!! 🙂
I’m feeling better; more like my old self. I have energy, some motivation and ideas. I want to do things! I want to make a difference! I’m thinking about starting an outside support group in my area. A group for people who can relate to each other & want or need outside support.
The Problem: When I have energy, I need to remember not to take on too much. I don’t want to become overwhelmed. I don’t want to crash in the middle of a project. For more information, please view the post on Project Immersion, here.

Day 12:
I had my family session today. I was a little nervous about it. I have had family sessions before, but you never know what someone else is going to say. My parents didn’t say much. It often seems like they don’t want to get involved. We talked about how I need to have a value base and a change in priorities. I need to do things for myself and live like I’m driving.
Living like you’re driving is like this: You have to look in the rearview mirror every once and a while and occasionally, you need to look far in front of you to see where you’re going, but for the most part when you’re driving, you have to pay attention to your surroundings and the environment around you so that you don’t crash.

I was in a pretty good mood until I met with my psychiatrist. He informed me that ‘people need people’, ‘I need to make social connections’, and ‘no one will do it for me’. While I agree with these statements, I’m still struggling with them. My doctors are really pushing me to be social and I just don’t do social. I haven’t been to a social outing since college.
I ended the day wondering why people needed people. My psychiatrist was pushing for me to get outside of my comfort zone and I didn’t like that at all.
He did make me a card though and it says, “Life isn’t fair however you, Talia, can be happy! :)”.
But I also learned that Feelings are not facts and thoughts have no power unless you let them.

Day 13:
I don’t really want to be here right now. I don’t feel like it’s helping. I don’t know how these coping skills are going to help. I feel like they’re not helping now. If all of this isn’t helping, what will? I keep trying and trying. What’s the point, if trying isn’t working?
Why do people need people?

Please stay tuned for Weeks 3, 4, and 5. Please view Week 1 as well.

My Life in Outpatient Treatment: Week 1

As I posted here, I was recently admitted into a psychiatric outpatient treatment center for my depression. I kept what could loosely be termed as a diary while in the program and I would like to share with you some of the daily ups and downs that I experienced. What follows are the day to day thoughts of one depressive person while in Intensive Outpatient Therapy.

The first few days were tough.

Week 1, Day 1:
I’m afraid that group therapy isn’t going to help. There’s such a large gap in ages. I’m worried that some of the programs won’t be helpful. I know quite a bit about depression, medication and treatment all ready, so I’m not sure what else there is to learn.
I also learned about Avoidant and Passive-Aggressive Personality Disorders. I have homework from my psychiatrist. I am to research these personality disorders as well as a couple of the medications that he intends to ‘inflict’ on me.

Day 2:
I still feel like I don’t fit in with the group. I can’t relate to what they’re talking about it. My therapist for the day says that I should talk about it in the next group session and that I need to have more awareness. I’m starting a chart to see when I fit in and when I don’t. Maybe keeping track will make me be more aware.
We also talked about change today. I’m not very big on change.

Day 3:
Today we learned a little about self-soothe kits. I’m going to have to make one. I also figured out that I have to take my medication AFTER I eat, unless I want to toss up everything in my stomach again.
My homework for the weekend is to write down examples of avoidant symptoms.

Day 4:
The weekend was not fun. Every time I took my medication, even taking it after I had eaten, I experienced nearly every side effect I could possibly experience. Nausea, drowsiness, weakness, dizziness, etc. We decided to switch the medication immediately.
I also learned that ‘what you resist, persists’ and I have to have awareness of my viewpoint. Mindfulness is being in the moment, and that’s something I’m going to need to work on. I’m not so good at it right now.

Day 5:
Today was fun. We had music therapy group. I played Someone Who Cares by Three Days Grace and I learned about a couple of other really good songs as well.
I learned that relationships can’t be 2 almost fully overlapping circles, or one circle inside another. A healthy relationship is like a venn diagram. I’m beginning to wonder about my relationships/friendships. Am I giving too much of myself to others?

Day 6:
I learned about NAMI and Art Therapy classes in the area today.
I also experienced a quick change of mood from happy to depressed about 15 minutes into therapy today. I don’t know what triggered this quick mood change. I feel like I’m withdrawing. I don’t want to be here today. I don’t know why. I just want to cry.

Day 7:
Today I learned about the Itty Bitty Shitty Committee, or as I’m going to call it from now on, the IBSC (which sounds a lot more official).
My therapist told me I need to focus on me. He told me to ask my best friend what he liked about me, so that I could have “I am” statements to repeat to myself. I’m also supposed to describe my personality and then have a close friend or family member do the same. That could be interesting.
After program today I began to wonder, how are these coping skills that I’m learning, going to help when it’s just me & the IBSC after I discharge from the program?

Day 8:
I feel like crap. I feel worthless, like I’m not worth people’s time and attention. I don’t like myself. I don’t even know how to like myself.
Today’s journaling became it’s own post and can be seen here.

Please stay tuned for parts 2, 3, 4, and 5.

Self-Soothing

One of the biggest coping skills taught in outpatient treatment is self-soothing. Self-soothing falls under DBT or the Dialectical Behavior Therapy. It is used when a person is feeling distressing, and when situations and emotions are overwhelming. Self-soothing is also known as a deterrent to self harm, because instead of doing something to hurt yourself, you’re doing something that gives you comfort and pleasure. These suggestions can help you feel better, calm down, and even feel relaxation or pleasure. Self-soothing most often uses the 5 senses; touch, taste, sight, smell and hearing. Try a variety of these items until you find a combination that works for you.

SIGHT: Be mindful of every sight, but do not linger on any. Allow the sights to calm you.

  • View pictures of family/friends.
  • View pictures of your favorite vacation spot or place you wish to go.
  • Look at art or go to a museum.
  • Go for a nature walk.
  • Walk through a pretty part of town.
  • Buy some flowers for your home.
  • Light a candle and watch the flame.
  • Watch an uplifting movie or video.
  • Be creative.
  • Painting, markers, crayons & a coloring book or sketch pad.
  • Mandalas (Coloring Castle, Free Mandalas, Printable Mandalas).

HEARING: When you are listening, be mindful, letting the sounds come and go. Be mindful of different sounds and let them flow through you.

  • Listen to relaxing music (via youtube, pandora, etc).
  • Listen to sounds of the ocean, forest, rain, or other sounds of nature.
  • Listen to a small animal.
  • Sit by a waterfall.
  • Play a musical instruments if possible.
  • Sing your favorite songs.
  • Do a guided meditation.

SMELL: Notice all the different smells around you and take in all the smells.

  • Smell a meal being cooked either at home or in a restaurant.
  • Walk in a garden or in the woods.
  • Breath the smells of nature.
  • Light a scented candle or incense.
  • Use essential oils.
  • Use hand lotion and/or drawer packets.
  • Use perfume or bath salts (Epsom salts).
  • Bake some bread, cake or cookies.

TASTE: Let the taste run over your tongue and slowly down your throat. Mindfully taste each new thing.

  • Cook a favorite meal.
  • Drink a soothing drink like hot chocolate or tea (especially blends for stress or anxiety).
  • Chew gum.
  • Eat hard candy or chocolate.
  • Go to a potluck and eat a little of each dish.

TOUCH: Take a bubble bath. Pet your dog or cat or cuddle a baby. Put on a silk shirt shirt or blouse, and feel its softness and smoothness. Sink into a really comfortable bed.  Float or swim in a pool, and feel the water caress your body.

  • Play with sand.
  • Use hand lotion.
  • Use a heating pad, back massage pad, or rice pack (hot or cold).
  • Play with modeling clay.
  • Dance.
  • Use a stress ball.
  • Play with silly putty.
  • Pet an animal or cuddle a baby.
  • Take a bubble bath.
  • Float or swim in a pool and feel the water caress your body.
  • Brush your hair.
  • Sink into a really comfortable bed.
  • Nap with a soft and furry blanket.
  • Use a weighted blanket (Bought Blanket; Sew-able Blanket; Tyable BlanketNo-Sew Blanket).

The entire point of self-soothing is to do something that is comforting to you and to continue doing it until you feel better.

DBT Self Help: Self Soothing

Outpatient Treatment Center

To make the next few posts easier to understand, I want to describe to you the treatment center that I was admitted to, the various programs they have and the types of therapies we learned about.

At this center, there are three levels of treatment; Inpatient Hospital Treatment, Partial Hospitalization Program, and Intensive Outpatient Program. There is also a residential facility for patients with eating disorders. In all of these programs, the adults are separated from the adolescents.

With inpatient treatment, there are various units to which a patient could be assigned. This includes the Special Intensity Unit for patients who are experiencing more acute symptoms of their mental illness. While in inpatient care the doctors, therapists and nurses work together to address the patient’s disorder and work towards long-term recovery. After discharge from inpatient treatment, the patient continues care with the Partial Hospitalization Program or PHP.

Partial Hospitalization Program or PHP, is considered the highest level of outpatient treatment. PHP is a full day program that consists of group, individual, family and other various therapies. PHP is the follow up to inpatient treatment but can also be the starting point for another patient. Each patient is placed within different programs where it is deemed that they will receive the most amount of beneficial therapy.

Intensive Outpatient Program or IOP, is a half day program that helps patients transition to life outside of the program. It is often a follow-up to inpatient treatment and PHP. IOP offers group, individual and family therapy along with transitioning to daily routines. It is considered the lowest level of outpatient treatment for the program and transitions patients to life outside of treatment including setting up schedules and appointments with outside therapists and psychologists.

The center also includes an after care program which is a once a week group therapy session. This allows for continued group therapy alongside your individual outside therapist and doctors.

Each day started with our morning check-ins. With these, we described how we felt at the moment, any questions or concerns we had with medications or therapies and how our previous evenings had occurred. After check in, we had our one hour group therapy session which met daily. During these sessions anyone was free to talk about anything and everyone was allowed to talk, discuss and suggest ideas and solutions. After group therapy, we would either have expressive (art) therapy, music therapy, medication education, emotional regulation, or weekend planning depending on the day. The last hour before lunch, which was also the last hour for the IOP patients, was spent learning about different therapies, issues and ideas dealing with mental health or if you were fighting an addiction, learning about co-dependence on drugs and/or alcohol Many of these classes have given me ideas and information to use for posts.

After lunch the PHP program would continue with two more class periods. During the first class period, patients would learn about distress tolerance, cognitive behavioral therapy or CBT, expressive therapy and anger management. During the second class, patients learned about mindfulness skills, healthy alternatives, communication skills, expressive therapy, and interpersonal effectiveness. Expressive therapy is taught often because it allows patients to express how they feel in a safe environment. Please read Alternative Medications & Therapies for more information on expressive therapy. During the day, we are also pulled out by our doctors, therapists and APNs for meetings and check-ups.

At the end of the day, we would fill out our daily wrap up sheets, detailing how we felt and if we felt we could stay safe during the evening. After the program, our doctors, therapists and staff would meet to discuss our continuing treatment and eventual discharge.

The program I attended is an accredited program within the nation. But if you think you need more help than a weekly therapist appointment please check within your area for a program that can teach you to manage your mental illness.