Saturday, 13 March 2021

Interpersonal Therapy (Take Two) - Session 5

(TRIGGER WARNING: Mentions of Suicide, Trauma, Abortion, Domestic Abuse, and TMI Symptoms)

This session was the end of the first section of Interpersonal Therapy. My therapist had written a Formulation of my Depression as a whole, as well as recent depressive episodes, support networks, triggers etc. I will go into this in more detail at the end of this post. 

My PHQ-9 was 20/27, and my GAD score was 14/21, indicating moderate to severe Depression and Generalised Anxiety. My phobia scale stayed constant; between 5 and 6 for each score. My Work and Social Adjustment score was 20, which shows how severely my mental health affects my ability to maintain relationships, function socially, privately, and my ability to take on household chores and work. I am still not working, but this is due to physical as well as mental health problems. 

I picked 5 most powerful symptoms in my Symptom Review this past week. These were:

  • No motivation - I seem to have a sort of "tunnel vision" when something big is on my mind. In this case, it is my most recent physical health problems (See my post, "A Pain in the Arse"). I had been waiting a long time to finally hear about my blood test results and before I got them, I had been worrying a lot that something was very wrong. I had no motivation to do anything else because it seemed I had used it all up with chasing up and worrying about them.
  • Irritable - I felt annoyed that no one had told me about my test results, and that I'd have to wait for a letter from my Gastroenterologist. I didn't want any distractions from this, unless they were important. I had been irritable due to disturbed sleep as well. It seemed any casual conversation annoyed me when I couldn't concentrate on it.
  • No energy - I'd used up so much energy with worrying, and feeling depressed, that I couldn't muster up much more for daily tasks (housework, cooking etc). I also found that my Depression made me feel tired all the time. 
  • Anxiety - For most of the week, I felt very anxious to the point of having physical symptoms. These included dizziness, a tight chest, "butterflies" in my stomach, a lump in my throat, dissociation etc. It turned out that I didn't need to worry too much, as my letter finally came and I had slightly raised Inflammation markers, and low Iron levels. Regardless, my stomach and bowel symptoms were concerning. 
  • Helpless - I've been feeling very out of control, since I had these stomach and bowel problems. I have tried many things to ease the symptoms but I couldn't get the right balance between constipation and diarrhea, finding something to ease the stomach/rectal pain and so on. I'd also been thinking about my mental and physical health in general, my future home, work, studying etc. It has been weighing me down a lot, and it's been hard to just find small amounts of things to think about right now. I can't seem to put other thoughts/worries aside. 

Soon after going through my Symptom Review, my therapist said she would read through my Formulation with me. As mentioned at the top of this post, it involves a recap of my depressive episodes, symptoms, triggers, support network etc.

Symptoms: I find that my Depression manifests in a number of ways, creating certain themes. These involve physical symptoms (such as lack of sleep and appetite), my thoughts and behaviours towards others (by becoming irritable for example), the negative ways I feel about myself (guilt, down on myself, feeling worthless), alongside feelings of anxiety, worry, and sadness.

Recurrent thoughts: I often have passive suicidal thoughts (i.e. thoughts that I am unlikely to act on or plan) but I am likely to ask for help. I often feel "stuck" in situations as well, and when I feel that way, the suicidal thoughts worsen as it seems I have little choice of methods for getting out of those situations.

Medication: I am prescribed 90mg Duloxetine, and 10mg Aripiprazole per day, and find they only slightly help (I do want a review of Duloxetine though). 

Depressive episodes: Although my Depression is usually constant, I am mostly able to split it up into episodes or flare-ups. My most recent one was triggered by my worsening physical health, a few before that involved friendship break ups, trauma from a traumatic abortion, and an abusive relationship, and my earliest (around age 13) was in response to mostly psychological bullying. 

Support network: I have my parents and many close friends to turn to, when needing help for my mental health problems. Each of these loved ones provides support in different ways (practical, social, moral etc)

Types of Interpersonal Relationship Issues: My therapist explained 4 focal areas that occur in Interpersonal Therapy - 

                1. Role Transition - Life changes that trigger depressive episodes

                2. Complicated Grief - Where a person struggles to cope with grief

                3. Relationship Dispute - Conflicts with a loved one that may trigger episodes of Depression  

                4. Interpersonal Sensitivities - Struggling to start and/or maintain relationships, and how that                      relates to or exacerbates Depression.


Although I can think of at least one example where each of these areas have been a factor in previous depressive episodes, the most frequently recurring one most recently has been Interpersonal Sensitivities. Going forward, this is what will be focused on most strongly within therapy. 

The next step is to figure out some goals to help with measuring how successful this type of therapy has been. I also find goals helpful, as I find a sense of achievement does improve my symptoms of Depression. 



Resources

Amy's Mystery Illness: A Pain in the Arse: https://www.amysmysteryillness.co.uk/2021/02/a-pain-in-arse.html

Amy's Mystery Illness: Am I "Triggered?": https://www.amysmysteryillness.co.uk/2014/03/am-i-triggered.html

Amy's Mystery Illness: I'm a Survivor:  https://www.amysmysteryillness.co.uk/2018/07/im-survivor.html

Amy's Mystery Illness: Interpersonal Therapy (Take Two) - Session 4: https://www.amysmysteryillness.co.uk/2021/02/interpersonal-therapy-take-two-session-4.html

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