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It's been over 2 years??!!

 It seems I have taken a MUCH longer break from blogging than I intended to! My previous post was back in September 2021!

I apologise for forgetting to write part 2 of the previous post. As it has been so long, I will update you on life in general, instead of following up on that post specifically.

I'm still doing my Psychology Masters! I had to take two 6 month leave of absences, as well as deferring or retaking some modules. The main reasons for this were my own health relapses (and a surprise Pulmonary Embolism in 2022!) and health decline in my family. It has been overwhelming, to say the least, but I am pleased that I persevered with my MSc and made it to the dissertation stage! The university has been amazing. They were so understanding of my situation and encouraged me not to give up (something I had considered on multiple occasions!). Maybe I will make Clinical Psychologist some day? I have no idea how I will physically manage it or how my health conditions will be in the future, but I'm doing what I can to at least get the qualifications and knowledge to give myself a bit of a chance.

There are various things I want to explain/update on, which I will do in separate posts as and when possible. I won't make any promises as to the timescale, as clearly I can't commit to regular posting at the moment. There will possibly be links below, to posts on each topic; as I write them. 

This is just a quick post, to assure you that my blog is still active, and I will get back to writing again when things are a little less...chaotic (?)... 

Going Round in Circles... (Part One)

(TW: mentions of Trauma, Domestic Abuse, Suicidal Feelings, and Overdose)

(Due to the length of the blog post, I have split this into two posts. This is part one, where I talk about my studies and my mental health.)

First of all, I want to apologise for not blogging in about 6 months (has it really been that long?!). I have had a lot going on this year; new beginnings, endings, new stresses, changes, relapses. A lot. I guess this will be another big update post, so I will try to organise it as best I can!

MSc Psychology

I can't remember if I mentioned this before (possibly not, as I was a little paranoid about DWP finding out before I told them) but I have now been studying for my Masters in Psychology since April. It is a distance learning course, which is technically part-time but the work load (and my stamina issues) make it feel very much full-time! Nevertheless, I am enjoying my studying and although my physical health and mental health have really taken a downturn recently, I am just about keeping up and coping with my lessons and assignments. 

I still have my dream of becoming a Clinical Psychologist. I was hoping I would be in some sort of psychology/mental health based job by my 30s (I'm nearly 32), but life has not turned out the way I expected and I guess it doesn't come with deadlines either! The main thing is, I am trying to achieve that dream despite all the hurdles in my way. 

I started this course at a time when I had just finished my course of Interpersonal Therapy, and I was feeling quite stable. I know I did not write about the last few sessions of this therapy, and I probably won't because it was a while back and I have far too much to talk about now. The main thing is, the therapy helped for a while and I felt I was on track. I was in a good place, I'd even started a new relationship! There were a lot of changes and I was coping with them, thanks to the work I'd put in. Unfortunately, I have relapsed since, and the relationship has ended very abruptly. I will speak more about my mental health in the next section. 

Mental Health

As I mentioned previously, my Interpersonal Therapy sessions were very helpful and put me in a good place, for a little while. I felt ready to take on a new degree and a new relationship. Unfortunately, something happened (I'm not sure what), and I became stressed, overwhelmed, insecure, panicky, and very depressed. I had mood swings too. 

I got in touch with Access Team as I felt I needed input from Community Mental Health Team/Secondary Care and I also needed a medication review with the Psychiatrist. All seemed well at first. I had a thorough assessment soon after contacting the Access/Crisis Team and I was given the impression that I would finally be given a decent amount of help. I was told of two types of therapy, with CMHT that would focus on stabilising my emotions and teaching me better life/coping skills. They would involve some group sessions and some one-to-one sessions. A multidisciplinary team would meet to discuss my case, and someone would be in touch soon. 

Eventually, I received a letter to summarise that assessment. It was pretty accurate in reiterating what I had told them, but I was disappointed to find out they had now decided I would just be having one appointment with my support worker to update my care plan. I would also be having my medication review with the psychiatrist soon-ish, but that was it as far as support went. So, I had my care plan appointment soon after the letter came. I was given time to explain how I'd been feeling, but it really was more focused on completing an updated care plan for myself. I didn't even receive the care plan until very recently, after chasing CMHT up. 

I had another downturn not long after this appointment; where I took a small overdose and was in contact with Access Team a couple of times to let them know this, and ask for more support from CMHT. They assessed me again and said they would try to get more support for me. I had to chase up CMHT again, and eventually got in touch with my Community Psychiatric Nurse (CPN). This was the only time I was able to speak with her. Even though I'd been allocated this CPN, there was no appointment booked to meet her (phone, video, face to face etc) or even a follow up to see how I was getting on! She seemed in a rush to get off the phone, as she explained that, despite the overdose, no more support was available and I was to wait for my Psychiatrist appointment. 

I felt so let down by mental health services. After just two 4 session courses of therapy with CMHT about four years ago, they had decided that I didn't qualify for any other psychological help. I felt demoralised, disheartened, distressed. I couldn't understand why the help just wasn't available and how I was expected to exist not being mentally well enough to function enough to even consider working. I had already had suicidal thoughts and feelings when I had this downturn, but they were getting stronger and more frequent. The only things keeping me going were friends, my parents, and my cat Billie. I had to stay alive for them, as much as I didn't want to exist in a future where I wouldn't get any better or have any more support. 

Soon after this, my partner broke up with me via social media. It came very abruptly. Part of the day he seemed loving and caring, the next, he was cold. I have seen him in a very different light since, but this set me back too. The small amount of moral support I got from him was gone, and I would have to deal with that. 

I think it was a day or two after this that I had my phone appointment with my Psychiatrist. I was very depressed, anxious, lonely and desperate. The appointment itself didn't start off brilliantly. She (the psychiatrist) told me that with my Borderline Personality Disorder diagnosis, there simply weren't any tablets that would alleviate the mood swings. I was to taper off my antipsychotic, Aripiprazole. I asked about my antidepressant Duloxetine and eventually in the conversation, we decided the dosage was to be doubled from 60mg to 120mg per day. If that still didn't help the depressive mood, I would be prescribed Paroxetine. (I'm waiting to speak to the GP about the dosage change). We then spoke about my struggles, my current diagnoses, current events and what psychological help I needed. After I'd spoken (rambled) about how I'd been feeling, what had been going on etc, the psychiatrist asked me some questions about sensory overload, past relationship issues (not in depth, just whether there was a pattern of suddenly being dumped without noticing things going wrong beforehand, unstable relationships etc), eye contact and confusion with social cues. She also asked me if I'd had any past trauma. I spoke about the traumatic abortion at 19, the psychologically and sexually abusive relationship soon after, and the fact I'd been bullied for 10 years at school. I felt they all had a long-lasting impact on the way I see the world, how I feel, the trust issues I have and my self-hatred. 

She then told me that she was going to ask me 10 questions that would screen for Autism. Now I've mentioned in passing about thinking I might be neurodivergent, but I never thought I really fit the criteria for being on the Autism Spectrum. I was surprised she mentioned it, but I answered the questions and it turned out I'd scored 8/10. She explained to me how a lot of people with the clusters of symptoms I have turn out to have Autism/Aspergers rather than the Borderline Personality Disorder diagnosis they were previously given. Apparently it is common for a person with Fibromyalgia and Hypermobility diagnoses to be Autistic also*! 

(*N.B: I'm purely passing on what she said here. I need to do my own research to verify this)

As I'd scored highly on the short screening questionnaire, she told me to complete the AQ50 and email CMHT with my score. (I did this soon after the phonecall and scored 41/50, which is significant!). As I read up more about Autism, especially in females (I am non-binary but as I am assigned female at birth, I have to gender myself as female for the sake of psychological/social factors). My psychiatrist told me that CMHT don't do diagnostic assessments for Autism formally, but there is an NHS assessment centre in Dudley that my GP can refer me to. I agreed, I would like this to happen as long as it meant more support in the long run. 

As for psychological help for my other mental health problems, my psychiatrist told me there is a short workshop (6 sessions) for Emotional Grounding that she will recommend to my CPN. If I do become more suicidal and my functioning gets worse, I will need reassessment and possible referral for Life Skills group sessions (I'm not holding my breath). 

(Please see next blog post for Part Two)

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

A Pain in the Arse

(TRIGGER WARNING: Mention of Cancer, Laxatives, Appetite Changes, and TMI symptoms)

 I've mentioned a bit about my stomach and bowel problems in recent posts, where it has affected my mental health. Up until now, I haven't told you the whole story though. 

I've had Irritable Bowel Syndrome for over 10 years; it being suggested by a GP well before my Fibromyalgia diagnosis, and then finally finding its way on to my ever-growing list of medical conditions. I've found it affecting me in a pretty mild way, with constipation being the main problem, and diarrhea only occurring when very stressed out.

The past 5 or 6 months have been very different though. Tell a lie, I notice a lump in my backside just over a year ago, but it didn't really give me any problems until about 5 or 6 months ago, when it grew quite big. I assumed it might be an internal hemorrhoid, or a small prolapse that would need sorting at some point. Over the past few months, I have been experiencing severe constipation, only relieved with 3 kinds of laxatives (Senokot/Dulcolax, Lactulose, and Dulcoease), as well as appetite changes, fluctuating abdominal pain, a lot of noise coming from my stomach, bleeding when wiping with toilet paper, nausea, bloating, mucus with streaks of fresh blood when trying to poo, constant pressure, anal spasms that make me feel the need to poo constantly, and shooting pains up my backside. All in all, not very nice and quite embarrassing to have to talk about. 

After about a month, I decided I needed to talk to the GP about it. It was them who got me on the 3 kinds of laxatives and eventually I was prescribed Laxido to replace Dulcoease (Dulcoease is tolerated very easily so the effects can wear off quickly). I had some initial blood tests to check my thyroid, which all came back negative/normal. I still had problems a couple of months later, however, so I was referred to a Gastroenterologist who sent me for more blood tests and an Ultrasound of my stomach (which I will have at the start of March). These blood tests showed low iron levels (almost to the point of full blown Anaemia) as well as raised CRP and ESR levels (inflammation markers). I was only told about the iron levels at first; being advised to take iron tablets and wait for my ultrasound, and the Gastroenterologist will be in touch in the near future. 

I thought "near future" would mean months away, so I took my laxatives, ordered my iron tablets, upped my fluid and fibre, and accepted I would have to wait. 

Some of the symptoms worsened, however, and the pressure, pain, and constant urges to poo were getting increasingly hard to deal with. After some unsuccessful 111 calls, with uninterested out of hours GPs, I decided an urgent GP appointment was needed. 

I explained all my symptoms, including the fact I thought I had a prolapse that maybe was exacerbating my stomach and bowel problems. I thought I'd need surgery to sort it out. The GP on the phone got me to see a female GP in person later that day. I was hoping I would get something to calm the urges, rather than simply more laxatives. It was a more interesting (and nerve wracking!) appointment than I expected, however.

The GP was a lovely one, I had seen before for other issues (including my now sort-of-diagnosed Raynauds). I told her everything, and really pressed the fact that the pressure, urges, and pain were horrendous, and the "prolapse" needed sorting. She wrote down a lot of what I said, and decided a rectal exam was needed. I had one with another GP initially but nothing "worrying" was found. This time, I was asked to relax, and then push though. Although no bleeding was present at the time of the examination, a very large lump was found inside me. What I thought was a prolapse could be something very different. At best, a hemorrhoid, but it could be more serious. 

Because of this, and my worsening symptoms, the GP decided to refer me to the "2 week wait" Lower GI Clinic for an urgent Colonoscopy. I remember making a face and saying "urgent?!". My GP reassured me it probably wasn't Cancer, but because of my symptoms and presence of a very large lump, it was necessary to get me seen ASAP. If it was a Hemorrhoid, I would need a small procedure called Rubber Banding, to cut off the circulation to it and it would eventually fall off. Until then, I was to take my laxatives (including Laxido this time), take my iron tablets, wait for my referral, and try not to worry too much. 

I had my referral review letter come through yesterday, and made the mistake of Googling what it said. Good ole' Google managed to convince me that it was most probably Colorectal Cancer, as I strongly fit the criteria. Good friends managed to bring me back to Earth however (as my Anxiety had hit the roof at this point!) and I am less distressed today, although still worried that the Big C is a possibility at all. I should get my appointment letter through very soon as they are Triaging my case. (The letter was dated the 8th, and said to call on the 10th if nothing else had come through). 

I also had a letter come from my Gastroenterologist, with a surprisingly quick approaching telephone appointment on 25th February. 

I can only imagine it is very soon because of my GP finding the lump and doing the urgent referral. Again, it made me worry that it was so quick. I usually wait ages for appointments, and initially the Gastroenterologist didn't even think I needed to speak to him. 

So this is where I am, at the moment. I am in a lot of pain, I feel constantly drained and bloated. The laxatives are helping to ease some of the pressure, my appetite is better, and at least I am able to go however. I guess all I can do is what the GP advised and try not to worry (and stay well away from Googling anything to do with my symptoms, test results, or referrals!).

I feel extremely grateful for the support my friends have shown me so far. They have kept me grounded, been realistic with me, but also have been sympathetic, caring, and loving. Whatever the results are, bad news or good, I know they are there when I need them. 

Interpersonal Therapy (Take Two) - Session 4

As with other sessions, I had to fill in my PHQ9 etc and my Symptom Review. I scored quite highly on the Depression and Anxiety questionnaires particularly, but this was mainly for reasons related to my physical health. For about 5 months now, I have been having some awful stomach and bowel problems. I am already diagnosed with Irritable Bowel Syndrome (IBS), but what I have been experiencing is out of the ordinary for me. Waiting for test results had me worrying about all sorts of possible diagnoses, including Bowel Cancer. (I will talk about this in full in the next blog post). 

My 5 most powerful symptoms this week are as below:

• Anxiety: This was mainly about some blood test results that had just come through to my Gastroenterologist. The secretary would not tell me the results, and said I would get a letter and a phone appointment to discuss them. This set off my Anxiety, as I worried there might be very bad news. I spent the week waiting for the results and hearing nothing back, which only made me worry more.

• Wake early in the morning: I have had disturbed sleep through worrying about various things. I'm scared of missing calls or post, in case it is some news about my physical health problems. I have been extremely fatigued, but I have been forcing myself to get up if I haven't naturally woken early anyway. 

• Can't concentrate: I was hoping to do more "antidepressant activities" such as playing musical instruments and singing. I have not been able to focus on doing that, or watching full television programmes. This is because worrying and fixating on my test results has given me a sort of mental "tunnel vision" where I can't see anything aside from the problem at hand, in front of me. 

• Sadness: I feel extremely negative about my results. I am sure that I will be given bad, worrying news and will suddenly have something huge to deal with. The constant anxiety is draining any positivity from me too. I have been trying not to be too negative, as I know that has an impact on others, but I can't seem to help myself out of this hole. 

• Can't get going: I feel far too tired and distracted to do much, and getting started with things such as blogging, housework etc, has become a really difficult task. I have been worried that friends wouldn't understand why I'm so fixated on my current health problems. My To Do list has been getting bigger and bigger. I have been really stressed out, which has exacerbated physical symptoms and made it physically harder to get things started. I particularly notice my Vestibular Migraines have returned with a vengeance, and my Fibromyalgia/Hypermobility pain is worse.

Alongside talking through my Symptom Review, this session was mainly about my support network; i.e. friends, family members etc that I felt close to for various reasons. My homework, leading up to this session, was to draw a social map of people in my life, using increasing circles (with me in the middle) to plot how close I felt each person was to me. I also had to think about why I felt they were so close, how they help me, the roles they play in my life etc. 

I won't say who featured in these circles, as I don't think it is fair to list my favourites in case friends see this. I'm sure the ones who are close to me know they're close anyway. I will use numbers instead of names.

Persons 1-6 are very close to me for different reasons:

Person 1: They have been a support to me all my life; but especially since I turned 18. They provide emotional support, as well as some practical support. I feel I can tell them almost anything and I feel they can tell me almost anything too. There is a lot of trust in this relationship. We both have mental health problems, so have an understanding when one or both of us is depressed. We advise each other and aren't afraid to help out when needed. 

Person 2: This person has also been a support all my life. They do not understand mental health quite as well as Person 1, but they will listen to what I feel comfortable telling them. They are also brilliant with practical help, such as lifts to appointments and sitting with me for assessments/appointments when allowed to. I feel like they are on my side and I try to help them out too.

Person 3: I've known this person since the start of university and I'm not sure if they know this but I see them as my rock. They have been there for me through some of my darkest moments, including the traumatic abortion and the abusive relationship I had. I have had times where I have been afraid of losing them to other people, but they have never given me reason to doubt our friendship. They wouldn't agree, but I feel I owe them everything. This person gives me practical, as well as emotional support, and I can tell them anything that is on my mind without fear of them taking it personally.

Person 4: I became friends with this person from out of the blue. I met them in a club when I was 18. I thought they were part of my friendship group, as they happened to be sitting near us, but years later found they didn't know each other! We hit it off straight away. We have had our differences, and don't talk every day, but I know we have each other's back. This person has seen my disaster of a love life and is not afraid to be honest about it! I respect them for that and I give as good as I get.

Person 5: I met this person online many years ago, and we have met in person a few times. We support each other a lot, especially emotionally. We talk nearly every day and know a lot about each other's mental health, for example. We are very honest with each other and seem to know when the other one needs extra help. They have seen me through some very dark moments too, and I really appreciate their support, honesty, and ability to keep my feet on solid ground.

Person 6: I also met this person at university, while I was with my abusive ex. We have got on well for many years, despite some falling out times. They showed so much support during my abusive relationship especially, and they noticed things that many others didn't. I could confide in them and they would turn up at any time for a good chat, watching a funny TV show, and the best of hugs. We may not be able to meet up much now, but I still feel we are close and have each other's back. 

I talked through most of this with my therapist, and told her I felt I was lucky to have such a large and solid support network. Not everyone has this, and I can't understand why I'm still so paranoid about friends when I feel so supported by the above people especially. Alongside these, I have other close friends, but I worry more that I might lose them. It may not be that I get as much reassurance, although that is neither of our faults. It just shows how different friendships can be. My therapist found this interesting, although she could understand where I was coming from. She sympathised with my worries about my test results too, and said that if anything changed and an appointment clashed with the next therapy session, then to email or phone her as soon as I knew. 

The next session would be about going through all the information I'd given her about my most recent, and some of my past Depressive episodes, as well as my support network, recent events, triggers, interests etc. These would be summarised and she would read them out to me so I could agree with them, amend anything that wasn't quite right etc. We would then move onto the next phase of therapy; where we use skills to improve my symptoms of Depression and my social skills. My homework this time was just to complete the PHQ9 etc questionnaires, and the Symptom Review.  

Resources

Irritable Bowel Syndrome: https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/

Gastroenterology: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/gastroenterology

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

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

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/