(TW: Overdose, mentions of self harm, abortion)
Since my previous Emotion Regulation session, my mood had been worsening. Thoughts and feelings were building up rapidly, and there were feelings I found hard to understand. One of them was this heartbroken feeling. I hadn't broken up with anyone recently and I'd not suffered loss for a little while, so I couldn't understand where it came from.
I was also having dangerous urges to self harm and overdose. My thoughts were racing and needed some sort of release. I wanted to shut out my emotions as well. A few days before my last therapy session, I took an overdose. Although small, it was more of an overdose than the last couple of times. Again, I wanted to be unconscious. I didn't want to think or feel, because it was too painful and confusing.
By the time this session came round, I was feeling desperate for more support. I wasn't happy that this was the last session, and I felt I needed more support (although I wasn't sure what support I needed). I also wasn't happy about the fact that my appointment with my CPN (whenever that will be!) will probably result in my being discharged. I felt as bad (if not worse) as I did when I was referred to secondary services, and felt guilty for not improving more through therapy. I had learnt new skills to tune into emotions, self soothing, and how to lessen/delay urges, but I found them very difficult to put into practice.
I spoke about this to my support worker, during my therapy appointment. She was disappointed and worried that I'd taken another overdose. Although she knew that I wasn't exactly suicidal at that time, she did tell me that I could end up killing myself if I keep on like this. She said this unhealthy coping mechanism was in danger of becoming a habit. I admitted it was starting to become that. As for support, she told me that there wasn't a lot the CMHT could do. They could advise me to not overdose, but they didn't have the resources to stop me, especially as I have "insight and capacity".
As for therapy, they could only offer short term sessions. What she did say was that there are some group sessions for Distress Tolerance happening next month possibly. She will have a word with my CPN, to see if I could go to those before being discharged.
We then spoke about the feelings I had noticed recently; primarily the "heartbroken" feeling. I told her I couldn't understand why I felt this way, and what had led to it. What she responded with, really clicked with me though. When we have an unexplained feeling, that we cannot understand in terms of where it came from, it's likely that it is an old feeling resurfacing. She gently suggested that it may be due to the abortion I had nearly 10 years ago. Suddenly, it made a lot of sense. Things such as the Ireland vote had triggered my thoughts and feelings about this. I'd tried to avoid this, but it has been all over the place recently. I knew it affected me a lot, but I guess I didn't expect the feeling to last weeks.
(I'm now dissociating as I write this. It is one of my only ways to cope with speaking about it)
I started to shake and cry as I told her I agreed with her suggestion. I had many complicated feelings about this time in my life, and apart from an amazing friend who was with me throughout, I did not get much support. The man who would've been the father was really upset that I had decided to have the abortion. I know that he'd always wanted children. He never asked me how it went, how I felt, if I was ok etc. He lit a candle to honour the baby that wasn't to be.
My new boyfriend at the time appeared to be sort of supportive, as I had times of constant crying, numbness, and silence, but in arguments afterwards, he told me he was angry that no one had considered how he felt. He also said something disgusting about babies, which really upset me.
When it happened, the nurses treated me as if I was a bad person and an irresponsible child. I was offered no counselling (even though I was clearly distressed) and the only appointment I had afterwards was a nurse's one to put me on the contraceptive pill.
I told my support worker most of this, and also that I worried in case it was my last chance to have children. She said what I needed to do was problem solve. My main worry was about fertility, so a check up with a doctor would be the first step. The next thing would be to get bereavement counselling, so I am able to cope with this and gently expose myself to situations where the topic of abortion arises. She also said it may be helpful to connect with others who have been in similar situations. This type of thing triggers me badly though, so I'm going to need support through it.
We then moved onto the last worksheets. feeling our emotions. It involved staying with uncomfortable feelings, and practise doing this until it becomes easier to cope with. The worksheet spoke about Emotional Mindfulness as a way of feeling emotions without judgment. There were 6 steps to this: acceptance, paying attention, slowing down, giving way, seeing it through, and reflecting.
Acceptance involved understanding that feelings come and go, and we cannot control this. We have to accept them without judgment instead of fighting them.
Paying attention reminded us that feelings are felt in the body. We should pay attention to those bodily feelings and try to link them to certain emotions to see if they fit. We also need to stay in the present, and not try to figure out why we feel this way
Slowing down by focusing on each feeling that arises, and sitting with it as well as observing it closely.
Giving way when the feelings arise. Letting yourself cry or feel angry for instance. You don't have to do anything apart from let go.
Seeing it through by considering the positives that come from feelings. According to the worksheet fear brings wisdom, sadness brings healing, and so on. We should be able to feel our emotions through to completion, and feel lighter once they subside. If we are "stuck" in one feeling, and can't ride it completely, there may be reasons for this. These feelings could be defensive (feeling angry when actually upset etc) and there may be more going on. Another reason, as I explained above, may be that our feelings have roots that go back to a previous time. These feelings are not resolved, so linger and resurface.
Finally reflecting. It is important to reflect on our experience and understand how important it was to feel our emotions through to completion. It is not an easy thing to do, and takes courage.
The session soon came to an end after this. I was still very tearful, but also emotionally exhausted. My support worker told me to look through the worksheets and practise the tasks on them. Also, she said to not put too much pressure on myself. This takes time and isn't easy. I must not blame myself if I can't do this sometimes. She also urged me to not self harm or overdose again. Lastly, she reminded me that she would be suggesting to the CPN that I am not discharged yet, and that I may benefit from the Distress Tolerance group.
Wednesday, 27 June 2018
Tuesday, 26 June 2018
Emotion Regulation Therapy: Session Five
By the time session five had come round, I'd had a lot of different thoughts and feelings. I was supposed to try and tune in to my true feelings, and among feelings of agitation, irritability etc, I'd been very low. Instead of staying with those feelings though, I'd been doing anything I could do distract myself. I also avoided letting myself cry, especially in front of other people. I worried about how I'd react if I really did let myself sit with all these feelings. To me, it was a big risk to take.
I've been reading through the book these sessions have been based around i.e. "Living Like You Mean It" and found that I really do fear my feelings. I'm uncomfortable when I feel happy, I turn away from people when I feel low, I isolate myself and turn my anger on myself and so on. I don't try to "ride the wave" of emotions.
My support worker said that emotions were like waves; they peak, then dissipate. Because I constantly distract myself from my feelings, all I can imagine is the peak, not the dissipation, so it seems as if the feeling won't go away.
My homework from last week was about noticing that I am having feelings, try to tune in to what they were, and to notice how I react to them. There were some suggestions for the kind of ways we avoid showing our emotions e.g. physically turning away from someone when upset, being dismissive of your own feelings etc. I could relate to a lot of things and started to notice when I did them.
The worksheet called this "Becoming aware of your defences" and categorised ways we avoided/showing feelings into Interpersonal defences, and Intrapersonal defences.
Prior to this session, I'd found out the decision about my medication review. The nurse prescriber had decided nothing else would help my depressive feelings or mood swings, so I was to stay on the same medications and same doses. I was disappointed about this, and found it hard to accept. I noticed that this had been a main factor in my low, hopeless feelings. It felt as if nothing was going to get better, and that I wasn't trying hard enough in therapy. The nurse had said that therapy would be my best bet, but I honestly thought that I should've progressed more noticeably by now.
I told my support worker this, and together we summarised my thoughts and feelings, as well as deciding which were thoughts and which were feelings. The trick was to see if a sentence I made started with "I feel like" or "I feel that". If that was the case then I would try to replace "feel" with "think". If it still made sense then I was expressing a thought not a feeling. What we then realised was that I thought the situation (no new meds, not much improvement) was hopeless and I thought that my future was bleak. What I actually felt was low, disappointed, and tearful.
Back to the worksheet. The next part spoke about how feelings themselves can be defensive. e.g. someone could respond to something with anger when they actually feel hurt or sad. We know a feeling is defensive if it does not go away and we ruminate over it. We have to try and find out what else is going on for us. What are our core feelings? Only then can we tune into them, "ride the wave" and eventually feel some kind of relief.
My homework for my last session was to read through the worksheet again, and use the tools on there to tune into feelings, see which were thoughts instead of feelings, and learn how to deal with coping with what I find. This involved being gentle with myself, not putting too much pressure on myself, and using breathing exercises to slow myself down.
After this session, I recorded a vlog to talk more about the book "Living Like You Mean It". The link is below, if you'd like to hear more.
https://www.youtube.com/watch?v=7IjuBWkzI1I&t=8s&list=PLLVKOK6LyfuspXXsZ0xdiKCW_Z6SYjTzO&index=21
Thank you for reading (and watching my video, if you did!). My next post will be about my last session of Emotion Regulation and how I've been feeling since.
I've been reading through the book these sessions have been based around i.e. "Living Like You Mean It" and found that I really do fear my feelings. I'm uncomfortable when I feel happy, I turn away from people when I feel low, I isolate myself and turn my anger on myself and so on. I don't try to "ride the wave" of emotions.
My support worker said that emotions were like waves; they peak, then dissipate. Because I constantly distract myself from my feelings, all I can imagine is the peak, not the dissipation, so it seems as if the feeling won't go away.
My homework from last week was about noticing that I am having feelings, try to tune in to what they were, and to notice how I react to them. There were some suggestions for the kind of ways we avoid showing our emotions e.g. physically turning away from someone when upset, being dismissive of your own feelings etc. I could relate to a lot of things and started to notice when I did them.
The worksheet called this "Becoming aware of your defences" and categorised ways we avoided/showing feelings into Interpersonal defences, and Intrapersonal defences.
Prior to this session, I'd found out the decision about my medication review. The nurse prescriber had decided nothing else would help my depressive feelings or mood swings, so I was to stay on the same medications and same doses. I was disappointed about this, and found it hard to accept. I noticed that this had been a main factor in my low, hopeless feelings. It felt as if nothing was going to get better, and that I wasn't trying hard enough in therapy. The nurse had said that therapy would be my best bet, but I honestly thought that I should've progressed more noticeably by now.
I told my support worker this, and together we summarised my thoughts and feelings, as well as deciding which were thoughts and which were feelings. The trick was to see if a sentence I made started with "I feel like" or "I feel that". If that was the case then I would try to replace "feel" with "think". If it still made sense then I was expressing a thought not a feeling. What we then realised was that I thought the situation (no new meds, not much improvement) was hopeless and I thought that my future was bleak. What I actually felt was low, disappointed, and tearful.
Back to the worksheet. The next part spoke about how feelings themselves can be defensive. e.g. someone could respond to something with anger when they actually feel hurt or sad. We know a feeling is defensive if it does not go away and we ruminate over it. We have to try and find out what else is going on for us. What are our core feelings? Only then can we tune into them, "ride the wave" and eventually feel some kind of relief.
My homework for my last session was to read through the worksheet again, and use the tools on there to tune into feelings, see which were thoughts instead of feelings, and learn how to deal with coping with what I find. This involved being gentle with myself, not putting too much pressure on myself, and using breathing exercises to slow myself down.
After this session, I recorded a vlog to talk more about the book "Living Like You Mean It". The link is below, if you'd like to hear more.
https://www.youtube.com/watch?v=7IjuBWkzI1I&t=8s&list=PLLVKOK6LyfuspXXsZ0xdiKCW_Z6SYjTzO&index=21
Thank you for reading (and watching my video, if you did!). My next post will be about my last session of Emotion Regulation and how I've been feeling since.
Tuesday, 5 June 2018
Emotion Regulation Therapy: Session Four
(See Session Three to catch up)
At the start of the session, my Support Worker told me about her discussion with the Nurse Prescriber re: my psychiatric medication. Apparently, because I'd said I didn't want to go on the Mirtazapine (because of the weight gain risks), she'd decided I was to stay on Sertraline and she had cancelled the follow up appointment. I was quite shocked about this, especially as the nurse hadn't phoned me to say anything about this. I obviously wasn't happy about her decision, so my Support Worker said she'd have another word, to see if they could put me on something else and rebook the follow up appointment. I'm still waiting to hear back about this.
I was feeling quite numb on the day of my therapy appointment. I struggled a bit with concentrating too. I did ask whether this was my last appointment as well, as I was worried that I hadn't improved enough to be discharged. Thankfully, she said that although this was the last booked session, she and my CPN had a discussion and decided I needed another two sessions before considering discharge. I was really relieved about this. I told her that my moods had been all over the place again, and although I was coping today, I don't know how I'd be the next day and didn't want to be discharged, only to be in need of referral straight after.
She seemed a bit concerned about my mood swings, and wrote some notes down. One thing she did mention, that has been getting my mind going a lot, was that even though I seemed quite low in session three, overall she hasn't noticed Depression in me on the whole. I wasn't sure what to say to that. The first mental health diagnosis I was given was Depression, and that diagnosis has followed me for years. I'm not actively suicidal anymore though, and my low points aren't quite as low as they used to be. I do self harm more than I used to though. I've found a change in the symptoms I have too. After the appointment, I did look into Depression with BPD and an article did talk about how depressive symptoms tend to be different. Of course not everyone with BPD will experience exactly the same, but the article said that the symptoms are more to do with anger, loneliness, guilt/shame, and boredom, whereas with Depression alone, the symptoms are more to do with sadness (understatement I know), feeling like a failure, lack of energy etc. I definitely felt I could relate more to the BPD depression than the standalone Depression diagnosis. It could be that the article is inaccurate but I could relate to what it said.
Anyway, back to the session. The topics we spoke about were more of a follow on from session three. We went through parts of the "Living Like You Mean It" book, and some more worksheets too.
The first worksheet was entitled "Life is Like a Wheel". It explains that life is always changing but eventually goes back round to the first point of the wheel. This is usually because of things happening in your life. For example, you could feel happy or successful at stage 1, a traffic jam could make you very stressed at phase 2, a bad comment from your boss could make you feel worry and suffering at phase 3, a compliment from a colleague could make you feel hopeful at phase 4, then back to happy at phase 1. It says that feelings are temporary and that they can change from hour to hour even.
It also states that certain feelings can take longer to change. For example, grief. A loved one dying can make us feel a huge sense of loss. Sadness and sometimes anger may follow. Anxiety may occur; worrying how to cope without our loved one. Denial may come next; where we may try to hide our feelings and block out memories of the person who has died, eventually allowing the tears and sadness to come, remembering the person in good and bad times, visiting their grave etc will start the healing process, then hope and happiness should follow. This can take years but the grieving process will be completed.
The next worksheet was entitled "The Assertive Option". It gave examples of certain feelings. On the right hand side would be unhelpful things we often feel or do, on the left hand side are better, more assertive behaviours, feelings etc. For example, acceptance rather than denial, and sharing feelings rather than hiding feelings.
The last worksheet (quite a wordy one!) explained acceptance. It defined it in 3 parts. Firstly, to accept something is to acknowledge it exists, secondly to believe there is no reality that should not exist, and thirdly, to see it as bearable.
The worksheet gave examples of accepting certain realities, e.g. that there are no certainties in life, utopia doesn't exist, and we cannot change others. It also explained that accepting something does not mean you have to like or be indifferent to it, and that acceptance is vital for stress management.
I find this very difficult, although I acknowledge it's important to accept things. I have strong views about being compassionate, equal rights etc and I do find it hard to accept when I come across people who believe certain people don't deserve the basic things in life for survival (food, shelter etc) just because they don't work for example. I guess I find it hard to believe someone could be that callous, and I want to have enough courage to debate their opinion and get them to see my point of view. I cannot change anyone and I cannot control the opinions they have. I can educate and maybe even persuade, but I can't completely change them. So I have to try and accept this reality, no matter how much I may dislike it.
In order to accept realities, the worksheet says we need to be mindful of our thoughts and beliefs about other's opinions. These can include believing someone should be different to who they are, the need to make them admit they are wrong, and the feeling of anger at being unable to do anything.
It also includes challenging our demands by asking certain questions of ourselves. "Can I really change this person/situation?", "Why must this situation etc not happen?" for example.
Lastly, the worksheet asks us to practise acceptance in order to improve stress management.
My homework is to do read through the worksheets again and practise acceptance. I think this will be the most difficult task so far, but maybe it'll help my stress levels?
At the start of the session, my Support Worker told me about her discussion with the Nurse Prescriber re: my psychiatric medication. Apparently, because I'd said I didn't want to go on the Mirtazapine (because of the weight gain risks), she'd decided I was to stay on Sertraline and she had cancelled the follow up appointment. I was quite shocked about this, especially as the nurse hadn't phoned me to say anything about this. I obviously wasn't happy about her decision, so my Support Worker said she'd have another word, to see if they could put me on something else and rebook the follow up appointment. I'm still waiting to hear back about this.
I was feeling quite numb on the day of my therapy appointment. I struggled a bit with concentrating too. I did ask whether this was my last appointment as well, as I was worried that I hadn't improved enough to be discharged. Thankfully, she said that although this was the last booked session, she and my CPN had a discussion and decided I needed another two sessions before considering discharge. I was really relieved about this. I told her that my moods had been all over the place again, and although I was coping today, I don't know how I'd be the next day and didn't want to be discharged, only to be in need of referral straight after.
She seemed a bit concerned about my mood swings, and wrote some notes down. One thing she did mention, that has been getting my mind going a lot, was that even though I seemed quite low in session three, overall she hasn't noticed Depression in me on the whole. I wasn't sure what to say to that. The first mental health diagnosis I was given was Depression, and that diagnosis has followed me for years. I'm not actively suicidal anymore though, and my low points aren't quite as low as they used to be. I do self harm more than I used to though. I've found a change in the symptoms I have too. After the appointment, I did look into Depression with BPD and an article did talk about how depressive symptoms tend to be different. Of course not everyone with BPD will experience exactly the same, but the article said that the symptoms are more to do with anger, loneliness, guilt/shame, and boredom, whereas with Depression alone, the symptoms are more to do with sadness (understatement I know), feeling like a failure, lack of energy etc. I definitely felt I could relate more to the BPD depression than the standalone Depression diagnosis. It could be that the article is inaccurate but I could relate to what it said.
Anyway, back to the session. The topics we spoke about were more of a follow on from session three. We went through parts of the "Living Like You Mean It" book, and some more worksheets too.
The first worksheet was entitled "Life is Like a Wheel". It explains that life is always changing but eventually goes back round to the first point of the wheel. This is usually because of things happening in your life. For example, you could feel happy or successful at stage 1, a traffic jam could make you very stressed at phase 2, a bad comment from your boss could make you feel worry and suffering at phase 3, a compliment from a colleague could make you feel hopeful at phase 4, then back to happy at phase 1. It says that feelings are temporary and that they can change from hour to hour even.
It also states that certain feelings can take longer to change. For example, grief. A loved one dying can make us feel a huge sense of loss. Sadness and sometimes anger may follow. Anxiety may occur; worrying how to cope without our loved one. Denial may come next; where we may try to hide our feelings and block out memories of the person who has died, eventually allowing the tears and sadness to come, remembering the person in good and bad times, visiting their grave etc will start the healing process, then hope and happiness should follow. This can take years but the grieving process will be completed.
The next worksheet was entitled "The Assertive Option". It gave examples of certain feelings. On the right hand side would be unhelpful things we often feel or do, on the left hand side are better, more assertive behaviours, feelings etc. For example, acceptance rather than denial, and sharing feelings rather than hiding feelings.
The last worksheet (quite a wordy one!) explained acceptance. It defined it in 3 parts. Firstly, to accept something is to acknowledge it exists, secondly to believe there is no reality that should not exist, and thirdly, to see it as bearable.
The worksheet gave examples of accepting certain realities, e.g. that there are no certainties in life, utopia doesn't exist, and we cannot change others. It also explained that accepting something does not mean you have to like or be indifferent to it, and that acceptance is vital for stress management.
I find this very difficult, although I acknowledge it's important to accept things. I have strong views about being compassionate, equal rights etc and I do find it hard to accept when I come across people who believe certain people don't deserve the basic things in life for survival (food, shelter etc) just because they don't work for example. I guess I find it hard to believe someone could be that callous, and I want to have enough courage to debate their opinion and get them to see my point of view. I cannot change anyone and I cannot control the opinions they have. I can educate and maybe even persuade, but I can't completely change them. So I have to try and accept this reality, no matter how much I may dislike it.
In order to accept realities, the worksheet says we need to be mindful of our thoughts and beliefs about other's opinions. These can include believing someone should be different to who they are, the need to make them admit they are wrong, and the feeling of anger at being unable to do anything.
It also includes challenging our demands by asking certain questions of ourselves. "Can I really change this person/situation?", "Why must this situation etc not happen?" for example.
Lastly, the worksheet asks us to practise acceptance in order to improve stress management.
My homework is to do read through the worksheets again and practise acceptance. I think this will be the most difficult task so far, but maybe it'll help my stress levels?
Tuesday, 29 May 2018
Emotion Regulation Therapy: Session Three
(TW: Discussion of weight, medication, self harm, and suicidal ideations)
My third Emotion Regulation Therapy session was the day after my medication review. Because of this, a lot of how I was feeling related to it. I was also feeling very low, and therefore was putting a very negative spin on things.
We started off by discussing my medication review. My Support Worker wanted to know how it had gone, how I felt about the Nurse Prescriber's decisions etc. I wasn't sure what to think of it really. I think it went well, in that I was listened to, my antidepressant would be changed, and I would be seen again in 6 weeks. The antidepressant I may be put on though, is Mirtazapine. I was ok with that at first. A few of my friends take it and find it very helpful. Unfortunately, one of the most common side effects is weight gain. I'm trying very hard to lose weight at the moment, I struggle with comfort eating, and I'm honestly terrified of putting more weight on. I don't feel any benefits of Mirtazapine would be worth it, as the potential weight gain would worsen my depressive symptoms enough to cancel that out. I told my Support Worker this, and she said that when she'd been told by the nurse about the medication, alarm bells rung for her because she knows I'm trying to lose weight. She then told me that she would get the Nurse Prescriber to talk to the Consultant Psychiatrist (who is in charge of deciding the psychiatric medication I should be on) to see if he will consider prescribing something else. I've no idea what exactly will be considered, but I'm a bit more reassured that it'll be something that won't/is less likely to cause weight gain.
We then moved onto how I'd been feeling, besides the medication changes. I said that I'd been numb the day before, and was worried I came across as if nothing was wrong with me. I told my Support Worker that I'd overexplained this to the Nurse Prescriber and was worried about how I'd come across. Apparently, I'd explained myself well though, phew! I'd gone from numb to very depressed this day though. I felt like a failure, like nothing would work out ok, and honestly I felt lonely. It's been a while since I've been in a real loving relationship, and I missed it so much. I didn't feel very lovable anyway, and was nervous about trying to meet anyone new. I started crying a lot when I spoke about this. I just felt so worthless, as if no one could ever feel I'm worth staying with for the long run. I know I tend to take things personally, and the last person I met couldn't make his mind up about whether he wanted a relationship or not. One minute he'd be talking about meeting me, the next he would decide he'd rather stay in and smoke weed. I didn't know where I was with him, and although I understood he was addicted, I had to put myself first and stop seeing him. This made me feel very worthless as well. To me, it felt like smoking meant more to him than continuing to see me, as if I was worth less than a joint. I know with addictions it's complicated though, and it's not right for me to take it personally. I just hope he is able to get help at some point.
Next, we went onto the worksheet for that session. This was about becoming aware of emotions. It named eight main emotions as anger, sadness, happiness, love, fear, guilt/shame, surprise, and disgust.
The first task was to think about six of these emotions and, for each, try to remember a time I was in a situation where I felt this emotion. These were what I put:
Anger: When a PIP assessor lied on their report; saying I could walk much further than I could
Sadness: Losing a close friend to suicide
Happiness: Getting a good result on my research project at university
Love: When an ex told me he wanted to marry me
Fear: When a huge wasp flew into the classroom at school (I have a phobia of wasps)
Guilt/Shame: When I had to pull out of moving house with a friend, and they took it badly
The next section of the worksheet described each of those six emotions, in terms of their physical manifestations. It also reminded me that "feelings are felt in the body", "thinking distances you from your feelings", and "how you experience your feelings is neither right nor wrong, it just is"
The last task was to be mindful of my feelings; using the worksheet's descriptions to help me identify how I am feeling in that moment. I found this difficult, but one thing I noticed was how often I tend to feel anxious, without a particular cause. I'd always been unsure of my Generalised Anxiety Disorder diagnosis, but maybe it's right?
Just before the end of the session, my Support Worker recommended a book to me, that might help with identifying and managing my emotions. "Living Like You Mean It" by Ronald Frederick. It's a very cheesy title, but apparently it's a useful book. I've ordered it and if I manage to concentrate enough to finish reading it, maybe I'll write a review! (I'm not making any promises though).
For now though, I will be writing about Session 4 of Emotion Regulation Therapy. This is my last session, and I'm not sure if I will have another CPN appointment, so I'm not sure what will happen next. I'll keep you posted though!
My third Emotion Regulation Therapy session was the day after my medication review. Because of this, a lot of how I was feeling related to it. I was also feeling very low, and therefore was putting a very negative spin on things.
We started off by discussing my medication review. My Support Worker wanted to know how it had gone, how I felt about the Nurse Prescriber's decisions etc. I wasn't sure what to think of it really. I think it went well, in that I was listened to, my antidepressant would be changed, and I would be seen again in 6 weeks. The antidepressant I may be put on though, is Mirtazapine. I was ok with that at first. A few of my friends take it and find it very helpful. Unfortunately, one of the most common side effects is weight gain. I'm trying very hard to lose weight at the moment, I struggle with comfort eating, and I'm honestly terrified of putting more weight on. I don't feel any benefits of Mirtazapine would be worth it, as the potential weight gain would worsen my depressive symptoms enough to cancel that out. I told my Support Worker this, and she said that when she'd been told by the nurse about the medication, alarm bells rung for her because she knows I'm trying to lose weight. She then told me that she would get the Nurse Prescriber to talk to the Consultant Psychiatrist (who is in charge of deciding the psychiatric medication I should be on) to see if he will consider prescribing something else. I've no idea what exactly will be considered, but I'm a bit more reassured that it'll be something that won't/is less likely to cause weight gain.
We then moved onto how I'd been feeling, besides the medication changes. I said that I'd been numb the day before, and was worried I came across as if nothing was wrong with me. I told my Support Worker that I'd overexplained this to the Nurse Prescriber and was worried about how I'd come across. Apparently, I'd explained myself well though, phew! I'd gone from numb to very depressed this day though. I felt like a failure, like nothing would work out ok, and honestly I felt lonely. It's been a while since I've been in a real loving relationship, and I missed it so much. I didn't feel very lovable anyway, and was nervous about trying to meet anyone new. I started crying a lot when I spoke about this. I just felt so worthless, as if no one could ever feel I'm worth staying with for the long run. I know I tend to take things personally, and the last person I met couldn't make his mind up about whether he wanted a relationship or not. One minute he'd be talking about meeting me, the next he would decide he'd rather stay in and smoke weed. I didn't know where I was with him, and although I understood he was addicted, I had to put myself first and stop seeing him. This made me feel very worthless as well. To me, it felt like smoking meant more to him than continuing to see me, as if I was worth less than a joint. I know with addictions it's complicated though, and it's not right for me to take it personally. I just hope he is able to get help at some point.
Next, we went onto the worksheet for that session. This was about becoming aware of emotions. It named eight main emotions as anger, sadness, happiness, love, fear, guilt/shame, surprise, and disgust.
The first task was to think about six of these emotions and, for each, try to remember a time I was in a situation where I felt this emotion. These were what I put:
Anger: When a PIP assessor lied on their report; saying I could walk much further than I could
Sadness: Losing a close friend to suicide
Happiness: Getting a good result on my research project at university
Love: When an ex told me he wanted to marry me
Fear: When a huge wasp flew into the classroom at school (I have a phobia of wasps)
Guilt/Shame: When I had to pull out of moving house with a friend, and they took it badly
The next section of the worksheet described each of those six emotions, in terms of their physical manifestations. It also reminded me that "feelings are felt in the body", "thinking distances you from your feelings", and "how you experience your feelings is neither right nor wrong, it just is"
The last task was to be mindful of my feelings; using the worksheet's descriptions to help me identify how I am feeling in that moment. I found this difficult, but one thing I noticed was how often I tend to feel anxious, without a particular cause. I'd always been unsure of my Generalised Anxiety Disorder diagnosis, but maybe it's right?
Just before the end of the session, my Support Worker recommended a book to me, that might help with identifying and managing my emotions. "Living Like You Mean It" by Ronald Frederick. It's a very cheesy title, but apparently it's a useful book. I've ordered it and if I manage to concentrate enough to finish reading it, maybe I'll write a review! (I'm not making any promises though).
For now though, I will be writing about Session 4 of Emotion Regulation Therapy. This is my last session, and I'm not sure if I will have another CPN appointment, so I'm not sure what will happen next. I'll keep you posted though!
Saturday, 26 May 2018
Medication Review
(TW: Discussion of Medication doses and weight gain)
Last Monday, I had my medication review with the CMHT Nurse Prescriber. I was worried about how I'd come across during the appointment, as I was feeling numb and tend to look absolutely fine when I'm like that.
I was quite calm during the appointment, and explained how I'd been feeling, the kinds of mood swings I have, as well as the times when I'm numb. I sort of over-explained how I was feeling too, and told the nurse that I worried I was coming across as if there was nothing wrong with me. She took that into consideration thankfully, and understood the problems that I had.
She asked me what I hoped would come of this appointment, and I said that I wanted the Sertraline to be changed to a different antidepressant (as it doesn't work for me anymore) and my Aripriprazole dose to be raised (as I felt I needed a stronger dose to control my mood swings).
She said that, because I have BPD (Borderline Personality Disorder), my symptoms were mainly linked to the relationships I have, and medication wouldn't help as much as therapy. I worried that she would stop my mental health medication altogether, but luckily she didn't.
The Nurse Prescriber told me that what she thought would be best was to put me on a different antidepressant than Sertraline, in a different category (SSRIs, Tricyclic, SNRIs etc) as a similar one probably wouldn't work. She didn't want to put me on a higher dose of Aripriprazole however, as 10mg was the appropriate maintenance dose for my needs. It is technically an antipsychotic, and as I don't really experience Psychosis, it wouldn't be suitable to raise the dose.
She asked me if there were any antidepressants I wanted to try. I wasn't sure, but she did suggest Mirtazapine. At the time, I knew nothing about it apart from that a few of my friends found it helpful, so I agreed.*
She said she would have a word with the Consultant Psychiatrist and then would write a letter to my GP (CCing me in) with the medication I was to be put on. She also wanted me to see her in 6 weeks, to see if the new medication was helping. After asking if I had any other questions or concerns (I didn't at the time) she ended the session.
*The session went well, but the next day, I looked up Mirtazapine and was shocked to find it was one of the worst antidepressants for weight gain. I am desperately trying to lose weight and putting on weight makes me very depressed, so I was worried about this! I've since had a word with my Support Worker**, who will talk to the Consultant Psychiatrist to see if I can be put on something that doesn't cause (as much) weight gain.
** I will talk about my latest session with the Support Worker in the next blog post.
Last Monday, I had my medication review with the CMHT Nurse Prescriber. I was worried about how I'd come across during the appointment, as I was feeling numb and tend to look absolutely fine when I'm like that.
I was quite calm during the appointment, and explained how I'd been feeling, the kinds of mood swings I have, as well as the times when I'm numb. I sort of over-explained how I was feeling too, and told the nurse that I worried I was coming across as if there was nothing wrong with me. She took that into consideration thankfully, and understood the problems that I had.
She asked me what I hoped would come of this appointment, and I said that I wanted the Sertraline to be changed to a different antidepressant (as it doesn't work for me anymore) and my Aripriprazole dose to be raised (as I felt I needed a stronger dose to control my mood swings).
She said that, because I have BPD (Borderline Personality Disorder), my symptoms were mainly linked to the relationships I have, and medication wouldn't help as much as therapy. I worried that she would stop my mental health medication altogether, but luckily she didn't.
The Nurse Prescriber told me that what she thought would be best was to put me on a different antidepressant than Sertraline, in a different category (SSRIs, Tricyclic, SNRIs etc) as a similar one probably wouldn't work. She didn't want to put me on a higher dose of Aripriprazole however, as 10mg was the appropriate maintenance dose for my needs. It is technically an antipsychotic, and as I don't really experience Psychosis, it wouldn't be suitable to raise the dose.
She asked me if there were any antidepressants I wanted to try. I wasn't sure, but she did suggest Mirtazapine. At the time, I knew nothing about it apart from that a few of my friends found it helpful, so I agreed.*
She said she would have a word with the Consultant Psychiatrist and then would write a letter to my GP (CCing me in) with the medication I was to be put on. She also wanted me to see her in 6 weeks, to see if the new medication was helping. After asking if I had any other questions or concerns (I didn't at the time) she ended the session.
*The session went well, but the next day, I looked up Mirtazapine and was shocked to find it was one of the worst antidepressants for weight gain. I am desperately trying to lose weight and putting on weight makes me very depressed, so I was worried about this! I've since had a word with my Support Worker**, who will talk to the Consultant Psychiatrist to see if I can be put on something that doesn't cause (as much) weight gain.
** I will talk about my latest session with the Support Worker in the next blog post.
Wednesday, 23 May 2018
Emotion Regulation Therapy: Session Two
Emotion Regulation Therapy
(See session one to catch up)
I don't think I was very sure how I felt during this session. I found it hard to connect to any emotions, which I sometimes find quite disturbing. Sometimes being numb is a relief (especially after days of really intense mood swings) but other times, I want to feel *something*.
We went through the homework I'd been set; which was to finish the worksheet about pros and cons of acting on impulses, and using distress tolerance skills. In the next sheet, I had to go through the STOP, TIPP etc skills and see which ones I wanted to try, what I'd do specifically, and what I expected the result to be.
I also stuck up the different skills sheets in my room, so I can see them clearly and be reminded whenever I see them. It's still early days, but I did manage to use some of the skills and I hadn't self harmed too much/badly that week.
The next thing we went through was things we do/think when we are avoiding emotions. I don't always realise I avoid emotions (especially negative ones) but I could relate to almost everything on the list on the worksheet. I ticked things such as:
(See session one to catch up)
I don't think I was very sure how I felt during this session. I found it hard to connect to any emotions, which I sometimes find quite disturbing. Sometimes being numb is a relief (especially after days of really intense mood swings) but other times, I want to feel *something*.
We went through the homework I'd been set; which was to finish the worksheet about pros and cons of acting on impulses, and using distress tolerance skills. In the next sheet, I had to go through the STOP, TIPP etc skills and see which ones I wanted to try, what I'd do specifically, and what I expected the result to be.
I also stuck up the different skills sheets in my room, so I can see them clearly and be reminded whenever I see them. It's still early days, but I did manage to use some of the skills and I hadn't self harmed too much/badly that week.
The next thing we went through was things we do/think when we are avoiding emotions. I don't always realise I avoid emotions (especially negative ones) but I could relate to almost everything on the list on the worksheet. I ticked things such as:
- Avoiding situations that might be emotional - (I hate crying, so avoid watching sad programmes or listening to sad music)
- Feeling discomfort or nervousness with sharing a silent moment with someone - (I always feel the need to fill silences, as I find them very awkward. I also feel it's my responsibility to talk)
- Feeling afraid of being or seeming vulnerable - (I find it very hard to "let go" especially with people I don't know or trust. It takes a while for me to fully open up and then I worry about oversharing)
- Never allowing yourself to get angry - (I worry so much about hurting people, even if they've hurt me emotionally. I have had some times where I have lashed out at people I love, and it has made me feel like I'm a bad person)
- Feeling uncomfortable accepting compliments from others - (I never feel like I deserve the compliments, so tend to dismiss them, or say thank you then quickly change the subject)
The second worksheet spoke about emotional and physical things that may happen when feelings are suppressed. These included things such as anxiety, irritability, teeth grinding, angry outbursts, and depression. I could relate to some, including teeth grinding (which I'm aware I'm doing while I type this!)
The next step was to take action. This involved becoming aware of our feelings, finding ways to manage them before they become overwhelming, feeling the emotions through (including physical sensations) and accepting those feelings as they are. The last step was to choose whether to open up or not. Some situations of course aren't suitable for opening up, but other situations call for being open and assertive. This is a difficult thing for me.
Homework - My homework was to read through the steps for accepting and dealing with emotions, and to try to open up.
Friday, 11 May 2018
Emotion Regulation Therapy: Session One
Trigger Warning: Mentions of Overdose, Self Harm, and Medication
Since my last post, I've had another appointment with my CPN. This appointment mainly consisted of going over what I'd told her at the assessment, how I've been coping since, and what had been decided at the meeting.
My self harm urges haven't been too strong recently, although they have still been there. I decided I felt safe enough to take control of my medication again and so far have not had any more overdoses. I think this is due to the reassurance that I will get some help. I'm holding out for that, so don't have such a strong urge to do things that could potentially severely harm me. I have self harmed, but only very superficially.
I told her this, and that things have continued to be difficult with my Nan's health (her possible Dementia is definitely worsening). I've made up with the friend who fell out with me over me pulling out of moving house. There's a little less pressure from certain things, but I'm still struggling to cope with the pressure that is still there. I've found recently that my moods have been swinging between feeling numb and feeling very low.
She was pleased that I hadn't self harmed as badly, but she was still concerned at how extremely I tend to react to things. She noticed that I spoke very negatively about myself and put a lot of responsibility on my shoulders when I didn't need to/as much. She told me that she'd had the meeting about me now, and what had been decided was that I will have Emotion Regulation Therapy sessions with my old Support Worker, and that I would have a medication review. I'd already received the psychiatrist appointment for the medication review, but my CPN was concerned that it was too long a wait, so we've decided that my appointment would be rearranged for a much sooner time, with a nurse prescriber instead. I'm quite happy with that. It seems that the Sertraline isn't working anymore, and the Aripriprazole dose is too low.
Emotion Regulation Therapy
Earlier this week, I had my first Emotion Regulation Therapy session with my Support Worker. At the start of the session, she explained that this type of therapy takes skills from Dialectical Behavioural Therapy (DBT) that of course focuses on helping to regulate how someone reacts to certain situations, stressors etc.
My support worker told me the CPN had said that I did want DBT, but unfortunately it isn't offered with my local mental health team. She seemed disappointed that there weren't many therapy options offered (with this team) for people with BPD. She told me that unfortunately, the goalposts kept being moved so it was very hard to get onto things such as pathways that may offer suitable support. I told her that I was just glad to get some support and some parts of DBT that were relevant to me.
We went through how I view and react to things, as well as how I treat myself and others. My Support Worker said that what she could tell from me was that I have strong opinions, but due to fear of backlash, arguments, lack of self confidence etc, I find it hard to voice them. I tend to stand up for others and (in her words) "rescue" others but tend to sacrifice my own wellbeing to do this. I agree to be honest. I wouldn't call myself selfless or anything like that, but I do tend to put others before myself and I'd rather help others than help myself.
We then moved onto the worksheets. The first sheet asked me to think of a situation where I reacted in a quite extreme way. I thought of a recent event, which of course involved my fear of losing friends. This was the time that I was looking to move house with a friend of mine, and due to becoming quite unstable, I had to contact my friend and pull out. He took this badly and (after a few days of silent treatment) sent me a long angry text. Although this has now been resolved, at the time, I was very distressed. I panicked, I cried, I dissociated, and I had very strong urges to self harm/overdose. I felt like I was going to lose my friend of 10 years and I felt very guilty. I knew I'd made the right decision for me, but I'm not used to putting myself first (especially if it meant hurting someone else's feelings) so I felt like a terrible person.
Of course, I had to break this right down into what happened (I put something like "friend fell out with me after I couldn't move house with him). I then had to write down how I reacted (I cried, panicked, asked friends for reassurance, had strong urges to self harm) and then what the consequences were. In this instance, nothing bad happened as a result of my reactions. I got the reassurance I needed from friends, and although I still had urges, my friends talked me out of self harming.
The next skill sheets suggested ways of controlling/delaying acting on my urges, ways of distracting myself, noticing my changes in mood, physical sensations etc, and ways of self soothing. I'll explain each worksheet below:
STOP: This sheet mainly focuses on delaying/stopping acting on your impulse. It reminds you that you are in control. It suggests physically taking yourself away from the situation that is causing these urges, noticing how you feel, how others are reacting, and considering the consequences of acting on urges.
TIPP: This sheet suggests ways to calm physical sensations and emotions (such as using ice to cool yourself down if anxiety or anger raises your temperature).
Distraction Skills: This sheet consists of different types of distraction suggestions, such as activities you can do, helping others, keeping your mind busy or having something physical to concentrate on (different textures etc)
Self Soothing Skills: These involve focusing on stimulating the five senses. This includes stroking a pet, looking at photos, listening to music, smelling perfume or eating a nice treat.
We started on the worksheet that asked me to think of pros and cons of acting on my impulses, and of using the distress tolerance skills. With my Support Worker's help, I filled in the pros and cons of acting on impulses.
Homework - My homework was to finish the previous sheet, as well as a worksheet where I had to say what skills I wanted to try, what I specifically planned to do, and what the outcome was likely to be. After filling in those sheets, I was to stick up the skills sheets in my room, somewhere I can't ignore them.
Overall, I found this session very useful. I'd already tried some skills, but there were other suggestions I hadn't thought of. I am determined to get my homework done and practise these skills. I'll just have to see how I get on!
Since my last post, I've had another appointment with my CPN. This appointment mainly consisted of going over what I'd told her at the assessment, how I've been coping since, and what had been decided at the meeting.
My self harm urges haven't been too strong recently, although they have still been there. I decided I felt safe enough to take control of my medication again and so far have not had any more overdoses. I think this is due to the reassurance that I will get some help. I'm holding out for that, so don't have such a strong urge to do things that could potentially severely harm me. I have self harmed, but only very superficially.
I told her this, and that things have continued to be difficult with my Nan's health (her possible Dementia is definitely worsening). I've made up with the friend who fell out with me over me pulling out of moving house. There's a little less pressure from certain things, but I'm still struggling to cope with the pressure that is still there. I've found recently that my moods have been swinging between feeling numb and feeling very low.
She was pleased that I hadn't self harmed as badly, but she was still concerned at how extremely I tend to react to things. She noticed that I spoke very negatively about myself and put a lot of responsibility on my shoulders when I didn't need to/as much. She told me that she'd had the meeting about me now, and what had been decided was that I will have Emotion Regulation Therapy sessions with my old Support Worker, and that I would have a medication review. I'd already received the psychiatrist appointment for the medication review, but my CPN was concerned that it was too long a wait, so we've decided that my appointment would be rearranged for a much sooner time, with a nurse prescriber instead. I'm quite happy with that. It seems that the Sertraline isn't working anymore, and the Aripriprazole dose is too low.
Emotion Regulation Therapy
Earlier this week, I had my first Emotion Regulation Therapy session with my Support Worker. At the start of the session, she explained that this type of therapy takes skills from Dialectical Behavioural Therapy (DBT) that of course focuses on helping to regulate how someone reacts to certain situations, stressors etc.
My support worker told me the CPN had said that I did want DBT, but unfortunately it isn't offered with my local mental health team. She seemed disappointed that there weren't many therapy options offered (with this team) for people with BPD. She told me that unfortunately, the goalposts kept being moved so it was very hard to get onto things such as pathways that may offer suitable support. I told her that I was just glad to get some support and some parts of DBT that were relevant to me.
We went through how I view and react to things, as well as how I treat myself and others. My Support Worker said that what she could tell from me was that I have strong opinions, but due to fear of backlash, arguments, lack of self confidence etc, I find it hard to voice them. I tend to stand up for others and (in her words) "rescue" others but tend to sacrifice my own wellbeing to do this. I agree to be honest. I wouldn't call myself selfless or anything like that, but I do tend to put others before myself and I'd rather help others than help myself.
We then moved onto the worksheets. The first sheet asked me to think of a situation where I reacted in a quite extreme way. I thought of a recent event, which of course involved my fear of losing friends. This was the time that I was looking to move house with a friend of mine, and due to becoming quite unstable, I had to contact my friend and pull out. He took this badly and (after a few days of silent treatment) sent me a long angry text. Although this has now been resolved, at the time, I was very distressed. I panicked, I cried, I dissociated, and I had very strong urges to self harm/overdose. I felt like I was going to lose my friend of 10 years and I felt very guilty. I knew I'd made the right decision for me, but I'm not used to putting myself first (especially if it meant hurting someone else's feelings) so I felt like a terrible person.
Of course, I had to break this right down into what happened (I put something like "friend fell out with me after I couldn't move house with him). I then had to write down how I reacted (I cried, panicked, asked friends for reassurance, had strong urges to self harm) and then what the consequences were. In this instance, nothing bad happened as a result of my reactions. I got the reassurance I needed from friends, and although I still had urges, my friends talked me out of self harming.
The next skill sheets suggested ways of controlling/delaying acting on my urges, ways of distracting myself, noticing my changes in mood, physical sensations etc, and ways of self soothing. I'll explain each worksheet below:
STOP: This sheet mainly focuses on delaying/stopping acting on your impulse. It reminds you that you are in control. It suggests physically taking yourself away from the situation that is causing these urges, noticing how you feel, how others are reacting, and considering the consequences of acting on urges.
TIPP: This sheet suggests ways to calm physical sensations and emotions (such as using ice to cool yourself down if anxiety or anger raises your temperature).
Distraction Skills: This sheet consists of different types of distraction suggestions, such as activities you can do, helping others, keeping your mind busy or having something physical to concentrate on (different textures etc)
Self Soothing Skills: These involve focusing on stimulating the five senses. This includes stroking a pet, looking at photos, listening to music, smelling perfume or eating a nice treat.
We started on the worksheet that asked me to think of pros and cons of acting on my impulses, and of using the distress tolerance skills. With my Support Worker's help, I filled in the pros and cons of acting on impulses.
Homework - My homework was to finish the previous sheet, as well as a worksheet where I had to say what skills I wanted to try, what I specifically planned to do, and what the outcome was likely to be. After filling in those sheets, I was to stick up the skills sheets in my room, somewhere I can't ignore them.
Overall, I found this session very useful. I'd already tried some skills, but there were other suggestions I hadn't thought of. I am determined to get my homework done and practise these skills. I'll just have to see how I get on!
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