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

Thursday, 11 February 2021

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. 

Wednesday, 10 February 2021

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


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/

Monday, 18 January 2021

Interpersonal Therapy (Take two) Session 2

(TRIGGER WARNING: Mention of past trauma, and an abusive relationship)


Leading up to session 2 of Interpersonal Therapy, I thought I would have to talk about past trauma and previous episodes of Depression. I spent the past week ruminating over this, feeling much worse by the time session 2 came around. I even had a horribly triggering dream; the night before therapy. It involved confronting my abusive ex about everything he'd done, and him denying everything. His friends, and some of my ex friends didn't believe me either. It made me feel so invalidated and unsafe. I woke up paranoid, and unable to do much. It took a while to get out of bed, as I wanted to stay away from everyone. I just felt that no one around me was a safe person (even though the people I live with, my parents and my cat, are extremely safe). 

Even before this dream, I spent the week depressed most days and unable to motivate myself to do much. I tried to do enjoyable things; activities my therapist refer to as "anti-depressant". The one thing I could get myself to do was play casual games. I found this had become more of a habit than something enjoyable though. It distracted me from awful thoughts and feelings, but it didn't do anything to lift my mood as such. 

As it turned out, session 2 of IPT was mostly about my most recent depressive episode. At first, we went through the PHQ, GAD etc questionnaires (to assess and quantify levels of depression, anxiety, and daily functioning/lifestyle), then we went on to the symptom review. I will list below the 5 most prominent symptoms for me:

1. No motivation - I had to go back to past trauma to explain how it linked to my feelings now. I felt stuck in one place. Memories of the past seemed to hold me back. I guess I was triggered by thoughts of past trauma, and they held me in one place when I ruminated on them. I felt like I couldn't move on, especially as I anticipated talking about my past yet again. I know I need to address things, but I'd really rather avoid them.

2. No energy - The energy that constantly worrying about the past takes is exhausting. Thinking about what I need to talk about takes all my energy as well. I think we forget that just thinking can take its toll on our energy levels. Even if all we're doing is sitting and remembering, we are still exerting ourselves. A phrase I used to describe my frame of mind is that I felt the weight of the world on my shoulders.

3. Feel guilty -  I am taking a long time to do things, because of the symptoms of my depression. I am slowed down, and motivation levels are low. Because of this, I may take ages in the shower, planning things, getting dressed, cooking etc. I feel guilty because people may have to wait for me, or wait to use the bathroom. The way I behave has an impact on others, it doesn't happen in a vacuum. I also worry that my problems have an impact on others; such as my frame of mind, my feelings, the way I talk etc. I also assume that my mood has an impact on others. I suppose I'm an empath because of the way a room's atmosphere or a person's mood affects me. I understand other's emotions a lot too. I'm like a sponge to be honest! Not everyone is like that though, and I have to remember that me being sad won't always bring others down. I'm allowed to feel how I feel without guilt!

4. Think other people don't like me - I read into everything! I look for clues that someone doesn't like me, or is drifting away from me. I talk about it on Twitter, because I want that reassurance even though deep down I know it won't help me in the long run. I need to reassure myself and trust others. My lack of trust, my paranoia, and the things I type, I feel are pushing people away. This is a big big part of why I decided to try Interpersonal Therapy. As I said in Session 1 , it involves addressing problems in relationships, role changes, disputes etc. Part of my Borderline Personality Disorder symptoms involves being terrified of rejection and abandonment. I do things to avoid that rejection or maintain that friendship, even if it has turned toxic. In the past, I have begged bullies to stay "friends" with me, so I don't end up alone.

5. Can't make decisions - Due to lack of energy and motivation, I have been finding it do hard to come to a decision about simple things, such as what to eat, what to do to entertain myself etc. It takes me ages to decide, I talk myself out of it, or I spend so long thinking about it, or flicking between activities etc, that there is simply no time left to actually engage in the activity. Alongside this, my concentration levels have been low, so I haven't been able to focus on things, or I worry that I won't be able to focus on or enjoy something. I may have mentioned this before, but the thought of being bored/not enjoying something becomes unbearable rather than slightly disappointing. I think it is part of the extreme mood swings and emotions I get, especially with BPD.  

After going through the symptom review, my therapist noted that I take on so much pressure from assumptions about other people's thoughts about me, how my moods/behaviour impacts others and so on. It's no wonder I have no energy! She then asked about my most recent depressive episode.

I explained to her that I believe it started during lockdown, about 4 months ago when my physical gastro symptoms developed. I have experienced chronic constipation, moderate/severe abdominal pain, appetite changes, bloating, and bloody mucus in my stools. Because of all these symptoms, I started off fed up, then my appetite changed even more, and I noticed something wasn't right when my sleep changed. I would wake up many times in the night (not just because of pain) and I would be deep in thought for a while before I could settle down to sleep again. I would get more tired, much earlier, and therefore would wake up much earlier. I usually take a nap halfway through the day, to try and replenish my energy slightly (it never fully replenishes, due to the nature of my chronic physical conditions such as Fibromyalgia). I found recently that I needed more and more, or longer and longer naps however, and I was desperate to sleep all the time!

My moods were low anyway, but I wasn't sure how low exactly until it affected my sleep first of all. 

As well as having physical gastro symptoms which frustrated and worried me, I had conflicts with some family members I used to be close to. I won't go into details, but it involved some nastiness that I wouldn't tolerate. Trying to make the peace didn't work, and because I saw certain people in a different light, it affected how I expected others to be and therefore affected my moods further. My support circle seemed to be getting smaller and smaller.

Another thing that kept this particular depressive episode going, was my worries about pushing friends away. I wrote some fairly bitter things on social media, that didn't go down well. What I was looking for was support and reassurance, but quite understandably, it was misinterpreted and now I worry that others are drifting away from me, or beginning to see me in the way I see myself (i.e. as some kind of horrible monster who craves attention constantly).

I told my therapist that I do tend to be extremely self critical, and it's something I'm trying to work on, but not getting very far with. She said that I am very critical of myself and conflicts with relationships seem to be a big part of this latest depressive episode, but she would explore other reasons too. Conflicts in relationships need to be addressed first though.

We finally moved on to antidepressant activities. The gaming needed to be put to one side really, as it served no real purpose other than as a slight distraction. She asked me what else I enjoyed doing, and I mentioned my musical side. I play flute, guitar, and keyboard. I also enjoy singing and writing lyrics. Apparently, when I said this to her, my tone of voice became much brighter and happier sounding. She set me "homework" to do more musical things, then tell her how it went in the next session. 

Again, time went on very quickly, and we had been speaking for over an hour, so we had to leave it there. Next session is 1pm on 18th Jan. 


Resources


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 1: https://www.amysmysteryillness.co.uk/2021/01/interpersonal-therapy-take-two-session-1.html


Tuesday, 5 January 2021

Interpersonal Therapy (Take Two) Session 1

(TRIGGER WARNING: Mentions of Self Harm and Suicidal Feelings)

 After a major Depression and mood swings relapse, and encouraging words from loved ones, I decided to ask for help again. Initially, I thought I just needed my medication/dose changing but when calling Access/Crisis team, I was told I would probably benefit from therapy again, and my GP should be able to review my mental health medication. I reluctantly called Primary Care/IAPT to book an assessment and see what therapies were available (thinking they would just put me onto CBT again) but luckily was assessed by a wellbeing practitioner who realised that I had been through CBT many a time; resulting in some help for my anxiety disorders, but no improvement of my depressive episodes. The Primary Care team decided that I would be a good fit for Interpersonal Therapy instead. 

Interpersonal Therapy is intended as a treatment specifically for Depression (whether as a condition in itself or a part of another diagnosis) and focuses on how relationships can have a significant impact on our mental health. It could be things such as role changes (becoming a parent, carer, taking on a new job to name some examples), a loss or bereavement, arguments within relationships of any kind, or a major life event. This type of therapy aims to look at these factors and help the client to build up skills around them in order to improve their symptoms of Depression. There are 16 sessions to this type of therapy. The first 4 aim to get a picture of how Depression manifests for the client specifically, the middle 8 sessions aim to help build up skills to help improve symptoms, and the last 4 aim to conclude the therapy and get the client ready to continue practising those skills once therapy has ended. 

I had a few sessions of Interpersonal Therapy with someone prior to my diagnosis of Borderline Personality Disorder. I was very unwell at the time, however, and due to some things my therapist said as well, the therapeutic relationship broke down and I was unable to continue. I am looking forward to going through the process of this therapy with a different therapist though. 

My initial phone call with the new therapist went very well. I felt she was easy to talk to, and listened well to my problems. We decided that my diagnoses, symptoms, and issues would be a good fit for this type of therapy, and I was happy to go ahead. 

Before the first appointment, I had the PHQ/GAD/Phobia etc questionnaires to fill in, as well as a therapy agreement, consent for my therapist to record our appointments (she is a trainee IPT therapist, so her supervisor needs to monitor the sessions), and a symptom review sheet. 

The Symptom Review worksheet is a grid containing many different possible symptoms of Depression. My task was to tick each symptom I felt had been a problem within the last week, then pick 5 that specifically needed addressing. I did tick a lot of the symptoms, and found it hard to pick just 5. I put a star next to the most pressing symptoms, but through talking to my therapist in our first session, I found that each of those branched out into the other ones, were very similar in the way they manifested, or were linked quite closely together. What looked like a simple task, became a more complex one, the more I tried to explain each of the symptoms!

I felt like I was rambling throughout the conversation, and I worried that the therapist would not be able to organise what I'd said into cohesive notes. I should've had more faith though, she was very helpful and understanding. She would bring me back on topic when needed and would focus on the symptoms that seemed to bother me most. Between us, we decided that I was struggling with the following issues most in the past week:

  • Irritability - I would find conversations and too much noise overwhelming, with led to a type of sensory overload which resulted in irritability. I may not always have made this apparent to the person/people I'm around, but I coped with it by turning on myself and either punishing myself (self harm) or isolating myself (going in my room). Generally, this is something I do if conversations online become too overwhelming or difficult. It's as if I'm suffering an emotional pain and I either want to escape it or turn it into a pain that I find easier to deal with. 
  • Always tired - I experience extreme fatigue, due to my physical health problems, but I know that Depression plays a big part too. I find this symptom links in with lack of motivation and lack of energy (other symptoms on the symptom review sheet). This week especially, I have found I am constantly exhausted and want to stay in bed for longer and longer. I know that this is partly due to the Depression because my moods affect my levels of energy, and the worse I feel, the more sleep I need. Unfortunately, although sleep can have a positive effect on mood, oversleeping can have the opposite effect. I felt as if I hadn't achieved much at all in my week, I saw myself as lazy, and I worried others would see me as lazy too. 
  • Mood swings - These are problems I have experienced a lot recently, which is why I think my mood stabilizers (Aripiprazole) have stopped working. I feel things in the extremes, to a point where I can feel as if I can't cope or I am out of control. The extremes weren't as bad as they could have been this week, but they were bad enough for it to be a problem. I didn't get the hypomanic emotions this time, but I did swing from considerably depressed and down, to irritable/angry, tearful, anxious, and even numb. I explained the numbness further, as my therapist said that it wasn't written down as a particular depressive symptom (which I found interesting, as a lot of people I know with Depression do feel numb quite a lot!). It's something I hadn't realised in myself until I connected with others with similar conditions and symptoms. When numb, my self awareness of how ill I am tends to decrease, and I'm not sure how to respond to the question "How are you?" because I simply don't know. When numb, I can dissociate too, although not always. I explained how I experience dissociation, to my therapist. She found that interesting too. We discussed how some of my symptoms had become coping mechanisms, as my numbness and dissociation can occur after days/events/conversations that I had found overwhelming. Again, it was a matter of extremes. I either felt too much, or not enough. 
  • Feel worthless - I am often very self critical, although this is something I am trying to work on. I try to say more positive things about myself these days, but I do worry about coming across as arrogant, or just being wrong. When I'm not able/don't have the motivation to do much in my day, then I feel worthless and pointless as a person. This can lead to the suicidal feelings, as, in order to feel like I should be on this earth, I want to feel I have some sort of purpose, I am doing something to improve myself, or I'm doing some good for other people. It's a bit of a chicken and egg situation, as if I feel worthless, I lack motivation, but if I lack motivation and therefore don't do much, I feel worthless. I'm never sure which started first, but it seems endless! 
  • Bored - As a symptom, this seems like a very mild one, but boredom can be unbearable for me. When I lack motivation and are not doing much, obviously I get bored. I have things I could do, but the thought of being disappointed if I do not enjoy them, or struggle to progress with them, can be very hard to deal with. Being bored can lead to becoming frustrated, angry at myself, extremely low and self critical, and even lead to suicidal feelings if I feel everything is going wrong. Doing something I enjoy (seeing a friend, not possible at the moment of course! Playing a musical instrument, cross stitch, a TV show etc) can lift my mood, but overthinking the possible result (not enjoying it) can make me talk myself out of even starting. I can usually push past this worry and do the activity anyway, but when very low, any disappointment feels like a big risk. 

As you can imagine, going through the symptom review took up most of the time in the therapy session. I was very apologetic and nervous throughout, but my therapist tried to put me at ease by saying she could understand what I was saying/what I meant, and she felt she had learnt a lot about me that day. She confirmed that, going on the questionnaires and what I had told her, I was still suffering from moderate to severe Depression. Apparently this type of therapy expects a diagnosis to be made and for Depression to be the main problem that needs addressing in order to go ahead. I know labels aren't useful for everyone but I like to have a name to put to the problems I experience, so I know what I am dealing with and what is likely to be helpful for me. 

She then told me what the other sessions would cover (possible past trauma/events, key relationships, arguments, role transitions etc) and asked me to complete the PHQ etc questionnaires and symptom review for next session as well. 

This concluded the session, and after checking there was nothing else I needed to discuss, we booked in for the same time next Monday. 


Resources




Sunday, 22 November 2020

The Connection between Chronic Illness and Self Esteem

 (TRIGGER WARNING: Internalised fatphobia, body image, weight, mental illness, medication)

I've rarely had high self esteem, thanks to years of bullying, but my self esteem has taken such a knock since I've had chronic illnesses.

Throughout my treatment of chronic physical and mental illness, I have been on various medications, some of which have caused considerable weight gain. I try so hard to be body positive but I don't feel like me anymore and I'm desperate to get back some of my old self. I worry that others will think I've given up taking care of myself even though a combination of meds with weight gain side effects, inability to exercise sufficiently, and comfort/stress eating due to depression and anxiety, have led to significant weight gain and body change. I follow body positive people on Instagram in order to help with the disordered thinking I have about weight and diet. I read anti-diet books too. I think any change (not just weight gain) can have a serious effect on a person's self esteem. In my experience, in the past I have been known as the "skinny one", so I suppose, wrongly, I have made it part of my identity. I have liked being called things like "pixie", "petite" etc and when I don't see myself that way anymore, I feel very disappointed, at a loss, as if I've lost part of my identity and need to take on a whole new one which I don't particularly like. I know that this counts as fatphobia and I try so hard to reject those awful thoughts.

My balance problems and chronic pain, that come with Fibromyalgia and Hypermobility Syndrome, have changed the way I walk. I am a bit wobbly, I walk with my feet turned in (as much as I try not to), sometimes I limp. I have been stared at and mocked for this, and so my self esteem has taken a hit. I try not to let it bother me, but if I notice someone is staring, I am extremely aware of my manner of walking.

I often need to go to the toilet, due to Irritable Bowel Syndrome, Overactive Bladder Syndrome, and some bowel/stomach problems that are yet undiagnosed. If I'm particularly bad, I have to cancel plans last minute. Even if my friends are very understanding and compassionate, friends in the past haven't been and this has affected my self esteem too. I feel like a flaky, disappointing inconvenience, rather than a valuable friend. I feel all I do is annoy people and let them down. I know I cannot help this, because I would not do this if it weren't for my physical and mental illnesses, but it does not stop me from feeling this way.

Bladder and bowel issues can be (although they needn't be!) embarrassing and seen as a bit disgusting. I find I refer to them as "TMI problems" and try to describe them as delicately as possible to friends or people in Facebook groups. A lot of people have problems like this though, and a problem with bladder or bowel is nothing to be ashamed of! I do worry about it affecting my dating prospects though, although I would not want to be with a partner who was immature and easily disgusted by my health issues!

Part of mental health is self esteem, but mental health problems in themselves can have a severe impact upon self esteem. (Are you with me?). I'll explain. Anxiety can hold back so many things a person may want to accomplish for example. This could be taking on a dream job, travelling, or maybe even just meeting a friend for coffee. When someone has to cancel plans like these, or when they feel panicky whilst doing them, it can have a real knock-on effect. They can be frustrated with themselves for cancelling or acting in a "not normal" way. They may worry that others will pick up on the anxiety or the fact that they have cancelled multiple plans, and may treat them differently. I've certainly lost friends due to the way I've acted! These were friends I had felt quite close to as well. It does make you feel very low about yourself, as if there is something fundamentally wrong with you. 

Carrying on the mental health conversation, when very depressed we may push people away and isolate, maybe because we don't see a point in talking, maybe because we feel we are not worthy of friendship, maybe because we feel overwhelmed. There are many reasons why someone may isolate. The consequences of this could be losing friends, friends acting differently, friends not reaching in to persuade you to talk. Of course there could be many reasons why a friend might act differently that doesn't necessarily mean they see you as any less of a friend to them. When very depressed though, personally, I will perceive any change in their behaviour as a direct reflection on me and my personality. I may isolate, but I still want friends to reach in and try to contact me. If they don't, I feel that maybe they weren't that close to me after all and "of course" that's my fault for acting the way I do. I feel I can't help how I act though, so I believe I can't do anything about it. And therefore, self esteem = rock bottom. 

I'm constantly told by friends to not care what people think. I'm OK and I don't need to change for anyone. This is easier said than done though, especially when chronic physical and mental illness have ripped away my sense of self and confidence. I have a lot of paperwork from past CBT sessions, to do with negative thinking, all or nothing thinking etc. When very depressed, I don't see the point in looking through them. I also don't feel I deserve to have high self esteem. I think we all deserve to feel good about ourselves if we are good to others though. We beat ourselves up far too often, and usually for very small (although not to us) reasons.

I hope, in time and with practise, we will get that self confidence back.

What knocks your self esteem? Have you found ways of building yourself back up? Comment below!