Friday, 29 January 2021

Interpersonal Therapy (Take Two) Session 3

(TRIGGER WARNING: Mentions of Suicide, Self Harm, and Childhood Bullying)


 This session, we were to speak about previous depressive episodes, in order to create a "timeline" of events and declines in my mental health. We were also going to start to draw up a diagram of my key relationships (family, friends, any romantic partners etc).

In the week leading up to this session, I had a lot of times where I felt quite on edge and irritable. I do tend to have a hatred of sound sometimes, usually when I'm overwhelmed. It tends to be more sounds of people's voices rather than inanimate objects (the washing machine, music etc). The technical term for this is Misophonia, although I am not actually diagnosed with this. I find sounds of voices can instil anxiety in me, or even rage. I go into a fight or flight mode, where I want to either escape the sounds or yell at them in order to hopefully make them stop.

We did the usual PHQ9, GAD etc questionnaires in which I scored more severely for Depression than Generalised Anxiety (which makes me a good fit for this type of therapy, as it is specifically for Depression). We also went through my Symptom Review; where I picked out 5 most prominent symptoms for me in that past week.

As explained above, irritability was one of the main symptoms of my Depression in that week. I explained examples of conversations that had set me off, and how I reacted. I told my therapist about how I find it hard to process information when there is more than one voice speaking at the same time as well. It does either make me very anxious, or very angry, and people don't tend to understand that.

As well as irritability, I found the following symptoms had been either very strong or very frequent recently:

  • Always tired: I believe this could be a mixture of fatigue due to mental health problems, as well as the fatigue I experience with my Fibromyalgia. The weather tends to make my Fibro flare up too. Either way, I struggled with my energy levels and felt relieved on any occasion I could get into bed and nap. I found it hard to do much else really.
  • Think other people don't like me: I think I've mentioned this before, but I find it difficult to reassure myself that my friends still like me. I look for clues that they are drifting away from me, or simply don't like me anymore. It could range from someone cutting off contact online (unfriending on Facebook for instance) to something as silly as not being one of the friends tagged in a post I can relate to. I keep having recurring dreams about a friend who cut contact with me around 8 years ago. In the dream, I am asking her why but never getting a clear answer. I believe some of this paranoia around friends stems from the times I was bullied. Part of the tactics they used were to pretend to be my friend, then leave me out of things. It made it hard to trust who was my real friend, and whether they actually liked me
  • Down on myself: My homework for this session was to play some music on one of my instruments, or to sing. It was supposed to be an "antidepressant activity" that I could enjoy and feel a sense of achievement from. When I struggled to do this more than once or twice in a week, I felt very down on myself. I enjoyed it when I did do it, even though I was quite rusty, but I was very self critical afterwards. When I didn't do it, I felt guilty, as if I was letting myself and my therapist down by not trying hard enough to ease my Depression.
  • Worrying: Although my Generalised Anxiety score on the GAD questionnaire was lower than my Depression score on the PHQ, I still found I worried a lot about things in that week. Various things got to me, and I was apprehensive about when I would get my Gastroenterology appointment through, when I would get my PIP decision, would my therapist be annoyed at me for not doing my homework "enough" etc.
I explained all these things to my therapist; trying not to go off topic too much, and having her guide me back on topic when I did. She also reassured me that she was glad I'd at least tried to do my music practice, and that my struggle to get going with it was something that needed addressing. 

We then went onto the topic of a Depression timeline. This is a recollection of past depressive episodes, what caused/triggered them, how you felt at the time, how you noticed you were depressed, and what happened. I find it hard to split my Depression into clear cut episodes, as it mostly feels quite constant, but I tried my best to recall times it had flared up and the symptoms I noticed first.

My most recent episode started about 4 or 5 months ago and coincided with my stomach and bowel issues. (I will do a separate post about my Gastroenterology journey soon). I had been experiencing pains and severe constipation that was making me miserable. Alongside this, family disputes had come to light, and I finally decided to get help when I had a sort of public breakdown on social media. The symptoms I noticed that made me think my Depression was flaring up, were lack of appetite and sleep problems. I usually sleep fairly well (for a chronically ill person!) and my appetite is usually moderate-large. Waking up in the night many more times, and not feeling like eating had become disturbing symptoms for me. 

The episode before this, I don't remember very clearly. It may have been about a year ago; involving losing a few friends. My Depressive episodes are very interpersonal (hence why I feel optimistic about this type of therapy!) and disputes, anxieties, lack of contact etc can set them off quite badly. I deeply fear rejection, and I constantly seek reassurance. My emotions can feel very unstable too, especially when it feels like things around me are falling apart. I suppose I noticed the start of this episode, when I began to feel out of control with my emotions, and I started tweeting a lot about losing friends. 

I struggled to recall details about previous episodes, and tried to explain how I mostly remember episodes from years ago, when I was suicidal. My therapist then asked if I remembered my first ever Depressive episode.

I was about 13, in my most hated year of Secondary School; year 8. I remember I had strong suicidal feelings, due to the constant bullying I experienced. I confided in a friend, who broke my trust and told the bullies about my urge to attempt suicide and why. They ganged up on me, and I could not trust anyone with my deepest darkest secrets for a while after that. It also helped shape my ideas about people; whether I could trust them, how I expect them to react, how I always felt inferior to them etc. I never sought help for my mental health at that age, partly because I didn't know it was available. There was a school nurse, but you had to be physically unwell to see her. I just didn't feel I had anyone to talk to and my only outlet was to self harm. This is when I started, and it carried on for many years, whilst I was being bullied. I didn't know a lot about Depression at the time, but I knew it wasn't "normal" to feel suicidal or to want to harm myself. I also knew I felt desperately low, and motivation went out of the window. I strongly believe it was music that saved me. I engaged in extra curricular activities, such as junior, then senior band and choir. None of my bullies were in those groups, and I enjoyed music so much that it became my saviour. 

After we had gone through all this, there was only a bit of time left in the session. We were yet to go onto my key relationships. My therapist briefly explained this task, and how it would be presented on paper. I was to use my time before session 4 to have a go at starting the task, and we would go through it properly in this next session.

So far, I think my therapy sessions are going well. I have wanted to explain about various traumas in my life (as they still need addressing) but my therapist hesitates to let me, as this type of therapy doesn't deal with that. I will have to stay on topic and hope that what I can talk about, and address, helps my Depression in the long run. 


Resources

What Is Misophonia?: https://www.webmd.com/mental-health/what-is-misophonia#1

Fight or Flight Response: https://www.psychologytools.com/resource/fight-or-flight-response/

Patient Health Questionnaire 9: https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

GAD 7 Anxiety Test Questionnaire: https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7

Fibromyalgia - NHS: https://www.nhs.uk/conditions/fibromyalgia/

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