It was suggested to me I put my check-in sheet I use for myself on my blog in pdf form so DailyCheckIn! More content to come soon, there’s a lot going on including progress with TMS and what it’s like.
To prep myself for discharge I set up my journal with check in sheets similar to those we did daily in outpatient but adjusted to best benefit me. It includes a scale of 1-7 rating of my depression, anxiety and suicidal idiation in both the morning and evening at the bottom and top of the page. It additionally has a space for 3 things I’m thankful for that day. Additionally there’s a space for goals for the day, for daily wins and accomplishments, a space that says “I used [skill] today to:” in which I can write things like “I used radical acceptance today to accept that I am anxious about going to the show tonight and seeing my friends I haven’t seen in 2 months since I left for outpatient. I accept that this is where I am right now and that is okay” or “I used opposite action to go to the show even though I was anxious”. Lastly there’s a spot for exercising my self worth that reads, “The thing I love about myself most today is:”. I feel like this will help keep me mentally structured and build upon everything I’ve worked on at outpatient.
I returned to work as well twice this past week and 6 days a week starting next week. I came back feeling excited, overstimulated and confident. I surely did miss my job. I’m scared the most that I’ll not practice my skills as well as I did while I was in outpatient, but there’s no reason for me not to be able to build upon what I’ve started and exercise the new neural pathways I’ve been creating for myself. I need to remember to look at my affirmations, my vision board, journal and track my wins. These are things I have set up in my favor for success. I feel that transitions are usually hard and this one in particular because of the uncertainty is stressful, but I think I’m sitting with the uncertainty and uncomfortable feelings pretty well and stopping my rumination as fast as I can.
Lastly for this post I wanted to share a letter I wrote to a future patient at the hospital outpatient program I just finished. It was my last assignment before I finished and it was optional.
“Dear Future Patient,
You are a wonderful person. Don’t believe me? I mean we don’t know each other, but I say this with confidence because despite the things you feel like you can’t do right now (which is okay by the way, work from where you are toward who you want to become and accept where you are as a first step to moving forward) and despite the things you may have done that you don’t feel so good about, you are worthwhile of a full life and of help.
Outpatient was my second place I went for help. I was leaving outpatient elsewhere a month before and walking in here I felt like an embarrassment to myself and becoming vulnerable was brutal. However, it was a necessary personal choice I made that helped me grow. It’s a safe environment to be challenged in and supported and the discomfort I felt here made changes in myself.
Because of the paradigm shifts I experienced each week I challenged myself to work a little harder. Your treatment team here will give you tools, teach you and be the tools for processing, guidance and growth. May you open your toolbox here and be willing to use what you’ve been given. There are no comparisons as our struggles are each uniquely our own but for me there has been no better place to be while facing the hard bits of life than at outpatient.
May you grow, even just a little, for little wins add up to benefit the future self you want to be, even if just in this moment you’re not 100% sure you know what that looks like. You will.
My very best wishes for you,
Some of you know I’ve been in outpatient therapy for anxiety and depression for about the past month and a half (I had a major depressive episode – I have bipolar disorder type 1), some of you don’t (a couple months prior to that I was in outpatient for a month but I fell back down deep again), but I wanted to flash my pride that I’m graduating from it tomorrow and I’m a more educated, practiced person creating new neural pathways for myself that I vow to keep active and re-train my brain to think better and be more mindful. I may not be where I want to be but I’m way better off.
The globe below is something I’d add progress to every week on a Wednesday. The leaf was in art therapy that looked like I plant I started growing from a cut to metaphoricalize my roots and growth in outpatient. The actual plant has since been repotted from the water glass it grew in and is pictured with another art therapy project from a book that speaks to sitting with emotions being an uncomfortable and new process.
Last pictures are of my vision board I never thought I’d make one and now I can’t imagine a world had I not made one, I just want to keep adding! Re-reading affirmations REALLY DOES work to make you start to believe them and make them a part of your life energy.
Fighting perfectionism by leaving this post as is is a huge exposure and you’re part of it!
In outpatient I had to pick a DBT skill and present it. I wanted to share what I put together with y’all. I chose this topic because it’s one that I have a hard time with. Unlike mindfulness where you can refer to your breath, this idea is a little more abstract with nothing physical to be able to rely on for grounding acceptance.
- Marsha Linehan the creator of DBT had some things to say on radical acceptance.
- Radical acceptance is – Moment by moment letting go of having to have what you wanted and accepting reality how it is.
- “You need to radically accept that you want something you don’t have and its not a catastrophe” – ML
- “You only have to radically accept the moment you are in, and the past.” – ML
- “In order to change things you have to accept them otherwise what you’re trying to change is something else that you think is reality…and if you want to change it you work on changing it which is perfectly legitimate also.” – ML
Clean Pain vs Dirty Pain
-These are types of pains we have when accepting or not accepting.
-Clean pain example: “I’m sad and I’m human and this is a normal response.”
–Dirty pain example: Fighting against something that gives us clean pain to try to find relief and avoidance/nonacceptance is causing suffering.
–Letting go transforms suffering into more ordinary pain which is part of life.
–When you spend time fighting yourself you aren’t learning how to be a friend to yourself.
Another way to think about letting go is to think of your mind as carrying a backpack. If you need to go from point A to point B and you get tired somewhere in-between you may be carrying too many unnecessary things in your mental backpack. Getting rid of things that no longer serve you or are not useful to carry will lighten the load and you will be able to make it to your destination quicker and easier. What can you let go of to lighten your backpack?
- Another way to practice Radical Acceptance which I have personally used and has worked for me is to write down “I accept (reality)” (ex. “I accept that Ryan and I are no longer in a relationship together”) several times being mindful and taking breaks if I feel myself zoning out so that I am focusing on the meaning of what I am writing, writing it in different ways, (ex. “I accept Ryan is no longer my boyfriend”) and reading these aloud to myself.
- This has benefit me in being engaged in the statements of the reality of the situation. Over three days doing this I noticed myself letting go a little more every time and coming to acceptance of reality as how it is (not to say I like it, but that’s where other DBT skills come in).
How Hard is Radical Acceptance?
It’s a process that requires a lot of energy but it CAN be done.
Some things are easier to accept than others.
As Marsha Linehan said, When we accept reality as it is, we can move forward to change things if we want to, but if we don’t accept reality as it is we’re addressing change to something that’s not real and that’s going to prolong suffering and make no changes moving forward.
Radical acceptance is hard and further you can’t measure acceptance like you can mindfulness and your breath. But trust how your body and mind transform pain as you accept and let go. When we accept we can move forward.
Mindfulness is a DBT skill. In intensive outpatient therapy we’ve learned a LOT about DBT. Mindfulness is the first concept I want to cover not only so I can share my insights and knowledge but so I can say that I’m currently in the process of mastering it. Trust the process. As long as you put in the work, you can create new neural pathways exercising that part of the brain and allowing you to get better at it, and to feel better doing it.
Mindfulness is about paying attention non judgmentally to the present moment. This can go hand in hand with the concept of grounding, and being aware of the environment. In this state we accept what we’re feeling and allow it to come in rather than fighting it. Diffusing feelings and thoughts as they come into our minds and manifest in our bodies by thinking of thoughts as leaves flowing down a river or putting a thought in a mental box and sending it down a conveyor belt and letting it pass by. This allows us to give note to the emotion or thought but also to then let it go and come back to center yourself with your breath.
One thing I like about mindfulness is that there’s a sense of a physical point you can bring yourself back to. You can never be in the past and get a breath back and you can never get a breath from the future ahead of time. Therefore, when you breathe you are totally immersed in the present. There are other DBT skills such as “Radical Acceptance” which we’ll talk about another time and which has some play in mindfulness, but are harder to grasp a grounding point in which to refer back to if you’re having a rough time figuring out if you’re TRULY using the skill or not. However, there are other indicators.
Some people have certain breathing preferences while being mindful. Some people like guided meditations. Headspace is a great app, Calm is pretty good, but not all guided meditations work for everyone. There are tons of ways to be mindful however. To start with guided meditations (easily accessible and they tell you exactly what to do) they may either tell you to inhale a certain amount of seconds, hold and then exhale, they may if it’s an app have a visual for you to follow for inhaling and exhaling. If you’re meditating on your own and want to clear your mind what you want to do is focus on your breathing. Breathe deeply and be sure you’re getting air in your diaphragm. This is a true deep breath feeling your belly rise and fall. If your thoughts wander, don’t get mad or try to suppress them, just let them go and come back to your breath. You may want to start meditating for 3 minutes at a time and build your way up, some people may need to start with 1 or 2. The key really is to come back to the breath.
Another way to practice mindfulness, especially when anxious is to do the 5,4,3,2,1 method. I do this mostly when I feel my anxiety is starting to pick up and run with its energy. You stop yourself and (saying things aloud makes them more real by the way, so if you can, say this out loud) find 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell and 1 thing you can taste.
This may look like:
“I see the door to my room, I see the gold door handle, I see my notebook, I see my weighted blanket (GREAT for anxiety btw), I see a mug.
I feel my weight of the clothes I’m wearing, I feel the hard bar under the table where my feet are resting, I feel my shirt is soft, I feel my dry skin.
I can hear a light buzzing in my ears, I can hear the heater, I can hear someone doing the dishes in the other room.
I can smell eggs cooking, I smell the staleness of the air around me.
I taste my gum.”
Another way is to create a labyrinth. If you glue pipe cleaners, beads, yarn or something physical to the pattern then you can close your eyes, think about the answer to a question non judgmentally or you can just focus solely moving your finger through the labyrinth and getting to the center and then out again. Keep one in your car or in your room or your bag and you can use it when you need something tangible to ground yourself with.
Other ways to practice mindfulness include knitting or crocheting (remember to focus on the task at hand, non judgmentally the way you would your breath, and even during this time you can focus on your breath! Let your thoughts be diffused and BE in the present moment.
There’s also watercolor painting, saying the alphabet backwards or counting backwards by 7’s from 100, spell a word backwards even (things that take your whole mind to do which will help you focus on that and not what thoughts you may be ruminating on etc.). You could go on a 5 minute walk, you could put a cold pack under your eyes and focus on the sensations, you can use affirmations (which it’s best to be able to visually see, flash cards are a great idea for this one), coloring, yoga, journaling and my personal favorite listen to instrumental music with a beat you can follow and breathe in and out with the beat.
I try to practice mindfulness at least 5 minutes a day. I’d like to ramp that up to a half hour a day. Doesn’t have to always be lumped together either, but practicing it has helped me challenge racing thoughts, anxiety and rumination. It feels really weird to just, “be”. But it’s a tremendously important skill to be able to accomplish.
Drop a comment if you’d like to hear more about mindfulness or any other DBT skills in particular! I want to share what I’m learning and experiencing in outpatient a bit at a time. Damn feels good to blog again. Thanks everybody.
Avoidance. It’s a huge anxiety provoking choice we make. I’ve avoided blogging here for over a year now. I also happen to be in an outpatient program for anxiety and depression. I’m using a skill called opposite action right now to blog even though I don’t want to and I’m nervous what people will think especially since this post is less than perfect (challenging my perfectionism here too). So this could be exposure therapy in a way. So next post, that’ll be the one where we get back into the swing of things. This is it. I’m doing it. We’ll touch base on DBT skills next post. I just need to put this up. Stop avoiding. We’re back, ladies and gentlemen.
I want my family, friends, colleagues, strangers on the street who I pass by and say “excuse me” to, doctors, bosses, government officials, indigenous tribes and golden retrievers to know what living with mental illness is like, is because you can’t see it. But I do, it’s like a filter, distorting the picture in a different way than how the next fella may see the world. Go ahead, it looks way better in Valencia than it does #nofilter.
I can’t just, “get over it” Mr. Porter. I’m nearly 30 years old now. It’s a familiar recommendation, but the reality is, I’m likely going to be hard on myself over a mistake the size of a speck of sand on a beach off the coast.
Here are my 13 reasons why my behavior is so shy, and awkward and shaky. Why I’m great at writing and terrible at talking. These are the reasons why I skip showers sometimes and avoid phone calls always. Why I doubt on a daily basis the people that love me really care. These are my 13 reasons why I need your empathy when I’m at my lowest points. Because it’s not something you can take on by yourself.
1 – Just as we discussed, mental illness often takes the form of an invisible disability. I’m not in a wheelchair nor do I have a cast on my skull or stitches on my chest to heal up the everyday heartbreaks. Take note the power of invisibility is real.
2 – My feelings affect my decisions. And in turn, some of my shittiest decisions sparked and reflected my feelings. Guilt hunts me with a sharper eye than death. Oh how there are moments I greatly regret the past. Including today, and likely tomorrow and tomorrow and tomorrow.
3 – I do CBT, I see a therapist, a psychiatrist, I journal and cheer people on in online support groups. And no, it’s not a cure all cocktail. Pay your dues, work with all your heart, proactively adjust your thinking strategies. But it’s still alive inside of me. It never leaves.
4 – Stigma is real. Even self stigma. I spent two years doing empirical research on stigma about mental illness in a university environment. All of us affected think, “change needs to be made” but Paul Revere is out for the season and we’ve run out of tea bags filled with Prozac to toss into the water.
5 – It’s not JUST bipolar disorder, or OCD or ADD. I’ve had Lyme Disease for 13 years, I never went into remission. I don’t take antibiotics anymore. I don’t remember what it feels like to be pain or irritation free, to not have a double dose of brain fog. I don’t talk about it, so no one knows or remembers. I’m no longer a vegetable shipped between hospitals with a PICC line. So who cares? There is no support for me here, about this, anymore. And I swallow the bitter taste of it.
6 – I dropped out of business school and joined the field to help people. Not just people with invisible disabilities, but people with visible ones as well. And strangers. And animals. Not Zombie’s though, I’m on the first responder team for a Zombie outbreak. I get bit and kicked by autistic children on a daily basis. I’ve been spit on by an older woman with an IQ of 6 while changing her diaper. I can tell you how stressful it is to take 4 women with moderate to high degrees of mental retardation to the supermarket to find food for the home I used to run before I became a RBT. I can tell you how great it is to hear a little austistic girl you’ve been working with for a year say, “yay!” as a replacement behavior for a shrill squeal stimm. I’m glad with all my heart I became a therapist.
7 – And as a therapist, who’s been promoted and recognized for my quality direct work, I in particular now than ever take feedback poorly. I’m told to take it and swallow, no speaking up for things I did or didn’t do no matter how minor, just move on, don’t take it personally. We all make mistakes to grow my boss tells me. Make sure you do more yoga with your aggressive client. The fact I didn’t during that overlap cut me with knives made of cursed bones for months. Self hatred flourishes when feedback is given and anticipatory anxiety spins fierce uncuttable webs through my chest and stomach where my anxiety manifests.
8 – I ache missing the people I’ve lost in the storm cloud of knicked and cut up relationships I couldn’t save. I miss a girl I haven’t spoken to now for 10 years, she’s like a sad picture in my mind I can’t manage to set fire to as opposed to store in the attic. I miss a boy who was a breath of fresh air just a few months ago, just to turn around and suck the air from my chest without explanation. I fear a falling out before I’ve finished parking in the top lot.
9 – I am chronically fatigued.
10 – I have difficulty concentrating.
11 – I’m angry I can’t control what you think about me. And how you act toward me. All of you, silent readers, neighbors and best friends alike.
12 – I am a living rock. Every experience good or bad on my daily adventures chips away at the marble. You may be a sculptor and not know it, the way you chip harshly or buff smoothly at my curves. God only knows how deeply I wish the artists who made the boldest dents in the softest parts would look back to see I was not the same hunk of rock they left me as. My carved eyes long to have another chance at those few.
13 – And lastly, I thirst. It’s a deep thirst that wants someone I look up to, to tell me I need to be writing. A woman I admired planted seeds in me 12 years ago. As the Lyme pains became bearable and the manic pre-diagnosed bipolar full fledged obsessive compulsive disorder rose to power I lost track of something that had always been important to me, and that woman and I also parted as life goes between teachers and students. Complications in invisibility have laid bed for a dust storm that has dried the land. I lap up puddles for blog posts. I walk endlessly toward the ocean.
I am more than my faults. It’s just that my faults, are more or less very visible, they’re easy to interact with, and thick enough to mask the marble. Easy enough to walk away from.
Those are my 13 reasons why. What are yours?