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.

Music

I’ve always loved music. Since I was little, I was involved with music and I was learning how to play the piano by the time I was six. I remember a time, I was about 4 or 5, and I was singing along with the radio. My mom turned around, looked at me and asked how I knew the lyrics to the songs. I couldn’t really give her an answer besides saying that I’d heard the songs before.

Music can be very much a universal language. Musicians can often find the music or lyrics to describe a situation that you couldn’t otherwise find words for. I can’t even count the number of times that I’ve played a song for someone rather than trying to explain exactly how I felt. The music explained it better than I ever could.

I often use music as my inspiration. Music can make you feel a variety of emotion and as a depressive, I use it to motivate myself, to tell myself that I’m not the only one feeling this way and that I can get through it. I have a specific playlist on youtube that I can pull up at anytime when I need that inspiration and motivation. This playlist contains songs from Skillet, Breaking Benjamin, Three Days Grace and P!nk, as well as the specifics songs ‘Dare You To Move’ by Switchfoot and ‘Demons’ by Imagine Dragons.

Find what helps you, whether it’s listening to music or painting; playing video games or watching movies. Find an outlet for what you have inside, because you do have something self-destructive inside of you. And depression’s only goal is to destroy who you are. So don’t let it.

Here is one of my favorite songs to listen to when I feel down:

http://getselfhelp.co.uk/docs/Music.pdf

My Life In Outpatient Treatment: Week 4

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

Week 4, Day 19:
My doctor informed me today that they believe my depression is caused by ingrained personality traits which are linked with my avoidant personality disorder tendencies. Supposedly I can fix this by thinking positive things and making positive situations and decisions. I consider this ‘Reprogramming Talia’.
We also discussed change in group therapy today and the therapist had each person write down their top 5 necessities for change. Here are mine:

  1. You have to want to change (willingness)
  2. You have to have help to make change occur (therapist, doctors, etc)
  3. You have to have a solid support system
  4. You have to have the ability to be flexible
  5. You have to allow the change to happen (don’t fight it)

Everyone came up with different answers and it was interesting to see how other people view change and how much needs to happen for change to occur.
Change wouldn’t be worth it, if it was easy.

Day 20:
After yesterday and the realization about the ingrained personality traits, my thoughts have become increasingly negative about myself.
How did I become like is? Is it my fault that these personality traits evolved? Did I make myself like this (unconsciously, of course)? “I am wrong. I am messed up. I made this.”
I want to know why I’m like this. I want to know why I developed in this way.
I want to blame someone, anyone for me turning out this way. Maybe because then I would be the victim and not the perpetrator. And in a way, aren’t I still a victim? A victim of circumstances, situations and environments? Something had to have happened for me to turn out this way.

Day 21:
I feel like I can’t talk. I just get looked over. My issues aren’t important enough. I asked to see my therapist today, but I doubt he’s going to pull me out.
I feel like I’m not getting any better. I’ve been here for a month. I just don’t matter.

Day 22:
Today I talked about how I felt. The group therapist gave me the suggestion to look at situations in my life that have caused me pain and hurt. I am supposed to pick situations that still bother me; situations I still need to process. I am supposed to journal it and hopefully reprocess the situation. I should look at it as a learning experience rather than allowing it to hurt me.
I have a very ‘all or nothing’ attitude. I don’t want to invest time and energy into something if it isn’t going to work out.
My therapist also discussed my discharge from the program today. We decided that I would discharge in a week. I don’t know how I feel about this.

Please stay tuned for Week 5. Here are the links for Week 1, Week 2 and Week 3.

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 3

This is a continuation, Week 3, of my daily journal while in outpatient treatment for depression, anxiety and avoidant personality disorder. Click here to read Week 1 and Week 2.

Week 3, Day 14:
I don’t know what to do. I supposedly ‘need’ people but I honestly don’t want to need people. People are unreliable and dishonest. People hurt me.
I don’t know how to like myself. I have this craving for validation from others. It’s a need. And I know I have to break this need but I don’t know how.
My birthday is tomorrow and I’m honestly not looking forward to it. I feel like the day is just going to be crap. I don’t feel like I have anything to look forward to tomorrow. It’s just another day. Just another boring day with the same old schedule.
Being at therapy today has made me feel worse. This card project is just reminding me that I don’t have anything in my life. I don’t want to be here.
(Note: The card project was to create a card from someone you would probably never get a card from. Who would it be from? What would it say? This was a very difficult project for the entire group.)

Day 15:
Today was my birthday. It was more fun than I thought it would be. I didn’t have anything planned because I had to work, but one of my fellow patients brought in cupcakes & she gave me an awesome present of candles and scent hand soap. Hopefully I’ll have more fun in 2 days when I celebrate with my best friend and my family.

Day 16:
I need to start practicing my happiness sheet. (Link)
I need to change my perspective on life.
Homework – Go do things and keep an open mind. Don’t judge things, including myself & my opinions. Catch the judgements before I make them.

Day 17:
Get out and volunteer. It’s a good way to meet people with similar interests.
Trust = consistency/time
I need to get approval from myself first. I need to ask myself; Do I approve of this? Am I living by my values?

Day 18:
I had another quick mood change today. I don’t know why I have these mood swings. I was feeling all right. Now, I’m upset. I’m not sure what triggers these changes.
I need to figure out what my triggers are.
Today’s trigger – When I feel like I am being perceived or am accused of being childish or childlike.

Please stay tuned for Weeks 4 and 5. Click here to view Week 1 and Week 2.

Coping Skills

Coping skills are the biggest thing they teach you in therapy. By learning different coping skills, you can help yourself relax, calm down and manage your mental illness. Different skills work better than others in different situations, you just have to find the ones that work for you. Take the time to practice these skills, so that when you need to use them, you have them available for your use. *I will be posting about many of these coping skills more in detail at a later time.

5, 4, 3, 2, 1

  • Observe 5 things you see, notice 4 sounds you hear, 3 things you feel, 2 things you smell & 1 thing you taste.

Assertiveness

  • “I” Statements. Assertive communication of your feelings: “I feel __, when you __, because __. In the future, I’d like you to __.
  • Also use DEAR MAN (described here) to be assertive.

3 C’s (Catch, challenge & Change)/Thought Stopping

  • Catch the negative/unhealthy thought, challenge it, and change it. Notice the impulse or thought. Say or think “STOP” either out loud or to yourself. Replace the troubling thought with a positive alternative thought.

Challenge Distorted Thoughts (CBT Skill)

  • Notice the negative/distorted though. Ask yourself, is there evidence for my thought or am I exaggerating? Think of a few alternative, less negative possibilities.

Distract (DBT: Distress Tolerance Skill)

  • ACCEPTS: A – Activites; C – Contributing; C – Comparisions; E – Emotions; P – Pushing Away;
  • Do a puzzle, go shopping, clean one room in the house. DO SOMETHING!!!!!

Exercise

  • Work out the emotion through physical exercise. Walk, weights, jog, biking, etc.

Gratitude list

  • Write down a list of 10 things you are grateful for every night. Make sure at least 5 of them are not the same as the night before.

Imagery

  • Guided imagery uses your 5 senses and imagination to attempt to manage your emotions. Please visit the Inner Health Studio for more information.

Improve the moment (DBT: Distress Tolerance Skill)

  • I – Imagery; M – Meaning; P – Prayer; R – Relaxation; O – One Thing in the Moment; V – Vacation; E – Encourage

Journal

  • Write about a strong emotion you are experiencing, how you coped with it, and what you can do differently next time.

Lemonade

  • Taking the lemons that life hands you and making lemonade.
  • Dilute the situation (add water).
  • Find or add something positive to the situation (Add sugar).

Make/use a self sooth kit

  • Please view the separate post here on making & using a self sooth kit.

Mirror Work

  • Look at yourself in a mirror and repeat a positive self-statement out loud 3-10 times. Run the water if you don’t want anyone to hear you. “I am _______.”

Non-judgmental (DBT: Mindfulness Skill)

  • Not judging anyone or anything.
  • This includes not judging your own thoughts, actions, etc.
  • Accepts the situation as is, for the moment.

Observe breathing (4 square breathing)

  • Breathe in while counting to 4. Hold it for 4. Exhale while counting to 4. Repeat.

One Mind/Mindfulness (DBT: Mindfulness Skill)

  • Focus on something around you. Notice the details. Describe it to yourself. (Will be discussed in further detail in a future post).

Opposite to Emotion (Emotion Regulation Skill)

  • Identify your problematic emotion, and actively engage in activities that bring the opposite emotion to your awareness as well.
  • To change the emotion, acting contrary to how you feel.

PMR – Progressive Muscle Relaxation

  • Involves tensing and relaxing various muscle groups.
  • Listen to a cd or online PMR relaxation meditation.

Positive Self-Talk

  • Focusing on your positive qualities and repeating them to yourself

Pros & Cons (DBT: Distress Tolerance Skill)

  • Think about the positives and negatives to the situation. Write them down.

Radical Acceptance (DBT: Distress Tolerance Skill)

  • Accepting the situation & continuing on
  • Accept what you can’t change and let it go. Focus your attention and energy on what you can control and change: Yourself
  • Accepting is not the same as approving. Tolerate the moment.

Ride the wave

  • Emotions come and go like the waves in the ocean. When you are experiencing a strong negative emotion, visualize that you are surfing on a wave of your emotions, letting it ride.

Stop. Think. Act

  • A strong impulse or emotion is not the same as acting on it. Think it through. You can choose to engage in the impulse, use a skill to manage it or tolerate it while doing nothing. You have the choice.

Talk to Someone

  • Talk  out the troublesome emotion or situation with someone you trust. Often just getting it out verbally is all we need to improve our mood. Helpful advice can put things into perspective too.

Time Out

  • Separate yourself from the situation allowing yourself time to calm down and restore emotional balance.

Turtling

  • Retreat inside yourself and then reemerge when it is safe. Use hard outer shell to let things roll off your back. When you feel knocked down, turn yourself right side up and back in balance.

Volunteer

  • Volunteering and helping others can take your mind out of itself by focusing on helping someone or something else.

Wise mind (DBT: Distress Tolerance Skill)

  • A combination of reasonable (logical) mind and emotional mind.

DBT Skills Handbook
Relaxation & Guided Imagery
Emergency Bag or Box (Self-soothing)

Expressive Therapy – Kite

In this exercise, we had to draw ourselves as a kite. The line was to be what was holding us back, the ribbon was to show our support system and we were also told to draw the environment in which our kite was in. Expressive Therapy Hopefully you can tell that according to my kite, there are light and dark places within me. My ribbon is bright and colorful because my support system is cheering for me. The line is held by me and symbolizes that I am holding myself back from what I could become. The environment is dark and cloudy and it looks like my kite is heading for a tree but you can also see the sun peeking out in the corner. I was hoping to show the light and the dark that pushes and pulls at me and my life.