Tuesday 5 June 2018

Emotion Regulation Therapy: Session Four

(See Session Three to catch up)

At the start of the session, my Support Worker told me about her discussion with the Nurse Prescriber re: my psychiatric medication. Apparently, because I'd said I didn't want to go on the Mirtazapine (because of the weight gain risks), she'd decided I was to stay on Sertraline and she had cancelled the follow up appointment. I was quite shocked about this, especially as the nurse hadn't phoned me to say anything about this. I obviously wasn't happy about her decision, so my Support Worker said she'd have another word, to see if they could put me on something else and rebook the follow up appointment. I'm still waiting to hear back about this.

I was feeling quite numb on the day of my therapy appointment. I struggled a bit with concentrating too. I did ask whether this was my last appointment as well, as I was worried that I hadn't improved enough to be discharged. Thankfully, she said that although this was the last booked session, she and my CPN had a discussion and decided I needed another two sessions before considering discharge. I was really relieved about this. I told her that my moods had been all over the place again, and although I was coping today, I don't know how I'd be the next day and didn't want to be discharged, only to be in need of referral straight after.

She seemed a bit concerned about my mood swings, and wrote some notes down. One thing she did mention, that has been getting my mind going a lot, was that even though I seemed quite low in session three, overall she hasn't noticed Depression in me on the whole. I wasn't sure what to say to that. The first mental health diagnosis I was given was Depression, and that diagnosis has followed me for years. I'm not actively suicidal anymore though, and my low points aren't quite as low as they used to be. I do self harm more than I used to though. I've found a change in the symptoms I have too. After the appointment, I did look into Depression with BPD and an article did talk about how depressive symptoms tend to be different. Of course not everyone with BPD will experience exactly the same, but the article said that the symptoms are more to do with anger, loneliness, guilt/shame, and boredom, whereas with Depression alone, the symptoms are more to do with sadness (understatement I know), feeling like a failure, lack of energy etc. I definitely felt I could relate more to the BPD depression than the standalone Depression diagnosis. It could be that the article is inaccurate but I could relate to what it said.

Anyway, back to the session. The topics we spoke about were more of a follow on from session three. We went through parts of the "Living Like You Mean It" book, and some more worksheets too.

The first worksheet was entitled "Life is Like a Wheel". It explains that life is always changing but eventually goes back round to the first point of the wheel. This is usually because of things happening in your life. For example, you could feel happy or successful at stage 1, a traffic jam could make you very stressed at phase 2, a bad comment from your boss could make you feel worry and suffering at phase 3, a compliment from a colleague could make you feel hopeful at phase 4, then back to happy at phase 1. It says that feelings are temporary and that they can change from hour to hour even.
It also states that certain feelings can take longer to change. For example, grief. A loved one dying can make us feel a huge sense of loss. Sadness and sometimes anger may follow. Anxiety may occur; worrying how to cope without our loved one. Denial may come next; where we may try to hide our feelings and block out memories of the person who has died, eventually allowing the tears and sadness to come, remembering the person in good and bad times, visiting their grave etc will start the healing process, then hope and happiness should follow. This can take years but the grieving process will be completed.

The next worksheet was entitled "The Assertive Option". It gave examples of certain feelings. On the right hand side would be unhelpful things we often feel or do, on the left hand side are better, more assertive behaviours, feelings etc. For example, acceptance rather than denial, and sharing feelings rather than hiding feelings.

The last worksheet (quite a wordy one!) explained acceptance. It defined it in 3 parts. Firstly, to accept something is to acknowledge it exists, secondly to believe there is no reality that should not exist, and thirdly, to see it as bearable.

The worksheet gave examples of accepting certain realities, e.g. that there are no certainties in life, utopia doesn't exist, and we cannot change others. It also explained that accepting something does not mean you have to like or be indifferent to it, and that acceptance is vital for stress management.

I find this very difficult, although I acknowledge it's important to accept things. I have strong views about being compassionate, equal rights etc and I do find it hard to accept when I come across people who believe certain people don't deserve the basic things in life for survival (food, shelter etc) just because they don't work for example. I guess I find it hard to believe someone could be that callous, and I want to have enough courage to debate their opinion and get them to see my point of view. I cannot change anyone and I cannot control the opinions they have. I can educate and maybe even persuade, but I can't completely change them. So I have to try and accept this reality, no matter how much I may dislike it.

In order to accept realities, the worksheet says we need to be mindful of our thoughts and beliefs about other's opinions. These can include believing someone should be different to who they are, the need to make them admit they are wrong, and the feeling of anger at being unable to do anything.

It also includes challenging our demands by asking certain questions of ourselves. "Can I really change this person/situation?", "Why must this situation etc not happen?" for example.

Lastly, the worksheet asks us to practise acceptance in order to improve stress management.

My homework is to do read through the worksheets again and practise acceptance. I think this will be the most difficult task so far, but maybe it'll help my stress levels?

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