My Daily Check-in Sheet

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.

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Graduating Outpatient – Letter to my future self

The prompt: It may be difficult to remember all the things you have learned and are feeling right now as you complete the program especially when you find yourself feeling highly anxious/depressed again. Write a supportive note from your current self to your future self who may need a reminder.

What I wrote: Dear BipolarBarbieQ,
We wrote all our coping skills in the journal Jas gave us and you can look at them often. If we keep practicing our skills we’ll dig new neural pathways. I’ve already laid the ground works for you and planted all the seeds. In fact, you can look back and remember this was the day Ashley led Experiential Therapy we read the story of the butterfly and the caterpillar pillar then shredded our papers and made new paper with seeds in it.

Make sure you look at our affirmations often. Find new ones. Decorate everything. I did some but you can do more! We are the observer from the meditation that had us dig through our memories. Life is context but we, the observer remain a mystical force and a representation of a full person which we always will be no matter the circumstances. Though I have struggled with negative core beliefs about myself and unearthed all the roots attached to them I also started trying to catch and challenge these. Add to the living list of positive attributes of us and don’t be shy to read it to remind our-self that we are enough. Even if we are not where we want to be yet, that is okay. Remember to accept reality wholey as it is.

Opposite action and behavioral activation are our sword and shield against avoidance and isolation. Adjust your goals to where you’re at and don’t take on too much at once. It is okay to cry, healing is not linear. We have the power to make wise choices to change our future with the knowledge we’ve gained and that you will gain for me as my future self. We are enough. We are worthy of good things and have an ability not all have – the ability to ask for help if we need it. It may seem like just a tiny thing but think of how beneficial it has been for us.

We can not change the past nor will any good come of tripping over things that are behind you. Don’t live too far in the future either. Remember we are in the moment and want to be there. Wherever “there” is. Ajham Brahm helped us tie together all the mindfulness we took in every day in so many ways. I’m cheering you on to keep practicing everything we’ve learned.

It’s been a long journey without question but I’m proud of you just as you are proud of you at the moment this was written. Write your wins and remember who you are and who you want to be. Believe in yourself a little more and follow your own example. Taking risks takes practice and your future self will thank you for it.

Love you,

Bipolar BBQ

Mindfulness and How to Use It

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.

First Post in a Long Time

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.

Journey to the Center of the Earth

As a student researcher on mental illness stigma I was impressed to see an article about high functioning depression recently. Unfortunately in my opinion it fell a little flat of the full picture and per usual, unless I’m reading an empirical case study, I’m selfishly irritated with the pop-psych paragraph or two about the strong Suzie Superheroes that go to school and work full time and are still sad inside (but her peers just can’t tell!)

I’d prefer reading an article collaboration by a collection of highly functioning depressed adults that show the individual unique experiences as well as the common struggles. Where is the paragraph of Suzie Superheroes that talks about how the only time she feels relief from the physiological discomfort that rises from her anxiety and depression is when she’s laying in bed and can’t sleep and thinks about how tension relieving it must feel like to pop your teeth out one at a time? Are all Suzie Superheroes having that thought? Likely not, but it’s an accurate example portrayal of how everyone’s depression oppresses them differently, and how brutally gritty it can be.

Today I was ready to quit my job, hitchhike to New Zealand and sleep on a beach for the rest of my life. Like legit, sleeping beauty 100 years of ZzZ’s kind of sleep. That or hop into traffic. Of course I know better, so I went through the motions and have socially self isolated myself to deal with my emotional tetanus privately. THAT way, I don’t have to feel the associated guilt about being a pathetic mope whose no fun to be around. I merely just pine after and resent the lack of an out pour of love and hugs and verbal reassurance that I am special and loved. I know the lows get better eventually, they generally do, but the perpetual sadness even in a baseline state of being is no way to live.

Kleenex must make bank off of folks like me. Shit.

After 2 failed attempts at finding a new psychiatrist (one is booked for the next two months and the other is listed as taking my insurance then e-mailed to say, “just kidding! I don’t take any insurance; though for a small fee of $450 upfront in full I can give you 90 minutes of my time for an intake”.

My mixed bipolar episode of 2-3 weeks and counting (once I caught on that’s what was happening to me I had to go back in time to measure when symptoms started) has destroyed my bank account, led me to making a huge fool of myself, overwhelming numbers of grandiose projects started, absurd thoughts, lost sleep, crying before and after work (and at home, and driving to the grocery store…) and most recently the urge to drop dead (as well as an increase of run on sentences). It’s destroying me!

Today I felt as though I had reached rock bottom, then reminded myself that it’s a simple step to keep digging even if I don’t mean to and fall even further down the jagged path until I reach the center of the earth and burn to a crisp. Worry not though readers, I’m WAY too terrified of the idea of hell to off myself.

Oh yeah, the psychiatrist thing. I threw a metaphysical dart at the pdf file that Blue Cross sent; a list of doctors who take my insurance plan. Looks like I’m seeing some quack Monday morning. I did some snooping for reviews after I made the appointment which either said he was horrible and should take up a job cleaning up vomit or that he’s fabulous.

Regardless, I’m hoping for a medication adjustment and a STRONG anti depressant. CBT, mindfulness, gratitude journals, listing all the things I’m great at and why life is worth living can take you only so far. At the moment it’s all a bunch of ineffective or joke worthy garbage in my state of mind and Obi Wan-Kenobi (obviously a metaphor for expensive Western medicine) is my only hope.

 

Mental Health App Review: Pacifica

The Pacifica app is a new find with a bit of everything to track and treat your mental health on the go. There are some great aspects of this well rounded app and some things I’d like to see improved. If you want the condensed version, Yes. I would recommend this to a friend.

What you’ll see first is the “Mood” screen. You can log your mood between “great” and “awful”. If you’d like, you have the availability to write in details associated with the logged mood. From this page you can also quickly navigate to a journal/thought log which you can do a minimalist version of CBT (cognitive behavioral therapy) which is recorded and can be referred back to.

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This feature allows you to write a distressing thought, highlight the inaccurate or negative parts of the thought/feeling and recognize the cognitive distortions. What I appreciate about this bit of the app is that while it’s on my phone, I can conveniently plug in my negative or obsessive thoughts without having to scribble them down elsewhere and then transfer them to a journal I keep specifically for CBT. Seeing as how it’s usually too much of a hassle to keep my CBT logs together I don’t do them, this allows me to have them in some form. Cool, right? What I don’t like is that if you want to go back to edit the thought later, there is no option to.

There is also a Goals section. You can choose a long term goal (mine is “feel less stress or anxiety in social situations”) and choose daily goals. Write your own or pick from a large selection of pre-made challenges such as ‘sit in the front during class or a meeting’. There’s a tab that logs your completed challenges. Though this is nice in concept,

The Health section allows you to decide what goals you’d like to meet for yourself every day to stay well. Hours of sleep, minutes exercising, etc. If midnight rolls around and you forgot to check in, you can tap back a day and fill out the information (this feature is unavailable on the website). This is great for folks like me who tend to neglect remembering to fill it out until 12:02am and then have to back up.

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Social aspects of the app include Groups (“Groups are private chats centered around peer support”), and Community, which is more of a forum than a chat room. Again these are great concepts. I feel that Groups lacks the depth it could have. With hundreds of members in a 1 section chat room it’s hard to lose focus or let everyone have a turn like you can in a forum setting. However, in Community, which offers some more of that depth, it lacks in the availability of mental health support groups. I love that it has forum space for things like books and general community, but I would prefer to be in a forum about Bipolar Disorder (and OCD) rather than a chat room about it with people that tend to dominate the conversation and a lack of back to back chatter that makes a chat room a great place to communicate (you’ll see people responding every few hours or so instead of seconds).

For $3.99 a month you can unlock all of the meditations (“Relax Now”). There are 15 altogether. You get the first 4 free. I took the bait and gave them my money for a month and was able to review all of the meditations for you guys. I mean the only way to tell if they’re worth it for you personally is to try it, and I believe that they ought to give you a one month free trial option to begin with. I also think that one thing that would make a subscription worth it is if they were to give a different meditation every month or two. Even if they switched it out and gave a different one to replace it, I feel like I’d be on board for that subscription. For all the searching I’ve done for guided meditations, I find these pretty good. They’ve made fitting 5-20 minutes of meditation a day into my routine very easy. 1-5 a day is my goal, but the meditations don’t drag and are to the point which allows for the option of multiple before bedtime.

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Breathing is largely practiced across all meditations. Each meditation also has the opportunity to have either “No Soundscape” or any of these options to accompany the meditation: Ocean Waves, Thunderstorm, Summer Night, Rooftop Rain, Forest Morning, Bach Cello Suite #1, Underwater, White Noise. When the meditation is finished you can “return” or continue sounds. Minor interrupts are noticeable in some soundscapes when sound loop ends. They are most noticeable in the “unguided meditation” which I’ve found soothing to fall asleep to.

  1. Deep Breathing: (FREE) Text tells you when to inhale/exhale. There’s a visual that also widens/becomes smaller as inhaling and exhaling is prompted. You have the option to ‘play breathing sounds’. You can pick your breath length as well in 1 second increments (between 5-25 seconds – holy lord if you can do 25 second inhale/exhales).
  2. Unguided Meditation: (FREE) Just soundscapes here. Length between 5 and 30 minutes, increments of 1 minute. I tend to throw on 15 minutes of Ocean Waves and go to bed without anxiety of having not turned off the sounds. I love the timer option.
  3. Muscle Relaxation: (FREE) Tense up and release all over your body. One of the best ones.
  4. Mindful: Senses: (FREE) Grounding through the five senses. Guided attention from one sense to another. Good meditation.
  5. Mindful: Breathe: Awareness of body sensations while breathing. Attention to the fact your mind may wander and that it’s okay. What I like about THIS meditation in particular is that at the end you get some closure. It says when you’re ready to return to the space around you. They need this in more of them. The lack of ‘closure’ in some of these meditations is a big turn off for me.
  6. Mindful: Observe: Find a small physical object to hold in your hand during meditation. Focus on this item, guided examination of it, an open and closed eyes exercise. This would be a good soothing meditation in a public place with headphones if you were anxious.
  7. Mindful: Body Scan: Grounding through attention to your body in it’s environment. Virtually the same as the sleep meditation.
  8. Anxiety Emergency: Whereas other meditations start with breathing, this jumps first to tell you you’re going to be okay and these are just sensations that are real. “Trust you’re getting all the air you need in this moment.” Grounding using 5 senses. Good meditation. Then affirmations putting logic and control over anxious thoughts/sensations. I’m not a huge fan of all affirmations such as, “I am safe”. I mean I get it, but what if you’re not?! I think something like, “These thoughts can’t hurt me” would be better.
  9. Visualization: Pick your breath length before you start. It’s hard to navigate if you want to record your own mantra with the lack of instructions. They do have ones to choose from though if you’d prefer like, “This too shall pass” and, “I love myself”. Personally, not a fan of this one.
  10. Sleep: Focus on the body. Guided awareness of bodily sensations. I find muscle relaxation a superior meditation to achieve same end to sleep, personally.
  11. Gratitude: Focus on something you’re grateful for. ‘Analyze’ the goodness. Affirmations after. More generalizable than ‘cheesy’ self compassion mantras in later listed meditation. Nice relaxing exercise.
  12. Becoming the Tree: Visualize a tree you’re seen before with some significance. Attention to the environment that has an affect on the tree and how it stands strong regardless of environment. Tree goes through changes, so do you, blah blah blah. It’s decent.
  13. Difficult Experience: Visualize experience that brought up difficult emotions. Examples to help. Allow yourself not to suppress details and physical sensations. Label what you feel. Make it a physical item. I like this one a LOT, but the ending of it doesn’t make me feel super awesome. Perhaps I need more practice.
  14. Self Compassion: Environmental and inner state mindfulness. There’s a prompt to bring to mind something you’re self-critical about and bring attention to sensations in your body triggered by these thoughts then compassionate mantras.
  15. Intense Emotions: Focus’ on bringing attention to thoughts and feeling and to label them as being just that, while stressing that it’s okay to feel what you’re feeling. For someone feeling intense emotions, I’d recommend the anxiety or difficult experience meditations before this one, but it’s still a good listen.

Thanks for reading folks. Go on now, give it a try.

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