All that I am, all that I ever was…

I am more than my mental health. I am more than my homelessness. I am more than any one aspect of me. I am Addy. And this is…


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31 Days of Bipolar: Day 05. Six of the best treatments for bipolar

Day 05: What treatment, therapy etc do you do?

Lucy-Therapist

Most people who I’ve spoken to that are afflicted with bipolar have a psychiatrist monitoring their progress, medication and moods. In fact, I would go so far as to say that having a psychiatrist is pretty much a prerequisite for someone suffering from an illness as serious as bipolar. However, as the last appointment I had with a psychiatrist went so badly, I no longer have any trust for people in this particular profession. Thus, I am left to navigate the ups and downs of bipolar all on my lonesome.

But that doesn’t mean I don’t undertake treatment, I do, and here are six examples to prove it:

Medication

First and foremost, there is medication, something that pretty much everyone who is diagnosed with bipolar has to contend with. I say contend with because some of the side effects of psychiatric medication can be pretty brutal, as I discovered this year, but regardless of these side effects, medication is quintessential for dealing with bipolar.

At this point in my life my medication regime is: an antidepressant (Fluoxetine, 40mg/daily), an anti-psychotic (Solian, 100mg/daily) and a second anti-psychotic (Abilify, 10mg/daily).  For those who have some knowledge of bipolar, or medication in general, you will notice something pretty obvious is missing from this chemical cocktail…and that is a mood stabiliser.

I had been taking Sodium Valproate (aka Epilim) at 1000mg/daily, but this was immediately cessated in January 2015 after it caused a particularly nasty bout of acute pancreatitis that saw me hospitalised for two and a half weeks. Since then, I have had numerous conversations with my GP about starting an alternative mood stabiliser, as my mood as been rather unstable over the last three months. He ruminated over starting me on Lithium, a drug that works exceptionally well for me, but because it negatively interacts with the Fluoxetine he decided against it. Whether or not I will ever be back on a mood stabiliser is beyond my control. Personally, I would be happy to stop the Fluoxetine in favour of Lithium, but my opinion is neither here nor there. All I do know is that without a mood stabiliser, my moods will continue to fluctuate wildly, and it’s doubtful I will be able to stabilise myself, regardless of how many anti-psychotics I’m taking.

Support Worker

My only form of real-world contact comes from the weekly appointments I have with my support worker. In all honesty we don’t do all that much, mainly because my anxiety prevents me from opening up to her. So our appointments are basically her battling to get me to say anything whilst occasionally recommending a particular course of action for me to take.

This is yet another example of how my anxiety impacts on my life. It would be wonderful to have an open and honest relationship with my support worker, but no matter how much effort I put in toward achieving this, anxiety rears its ugly head and prevents me from saying anything. It’s frustrating. It’s annoying. It’s all manner of badness. In fact, more than anything, it’s gloriously ironic. Here’s a person who could potentially help me manage my anxiety, but I can’t talk to them because of my anxiety. Grrrr!

Talking Therapy

Okay, I’m being a little cheeky here. As I write this I’m not technically undertaking any form of talking therapy. I don’t have a counselor. I don’t have a therapist. I certainly don’t have a psychiatrist. But I am hoping that I will soon have a psychologist with whom to examine the intricacies of my life.

During my last visit to my GP I informed him of how difficult it is to deal with my anxiety, to deal with my PTSD and to deal with the fluctuations of mood that bipolar causes. He suggested I see a psychologist (it’s been several years since I last saw one) and dutifully referred me to someone.

I’m still waiting to hear from them about my first appointment (if I haven’t heard by tomorrow, I’ll be calling them next week) so will keep you abreast of developments in this area of treatment.

CBT and DBT

Without someone to help me with these forms of therapy, I am left to navigate them all on my lonesome. This may sound difficult, and it is, but I have a number of books on both subjects that have helped me understand the basics of each form of therapy and allowed me to partake in them as and when I’ve been focused enough to do so.

I have to be honest, I am hoping that the psychologist I’ve been referred to will be a practitioner of DBT, as I believe it would be of tremendous value to have someone assist me in working through this particular form of treatment. Fingers crossed!

Acceptance and Commitment Therapy

This is something I’ve been practicing since I first learned of its existence in 2013. Back in that heady year of mayhem, busyness and fun I undertook an ACT based psychosocial rehabilitation group and learnt  many of the exercises and metaphors that populate this method of treatment.

Some posts I’ve written on Acceptance and Commitment Therapy (in case you were interested!):

Writing Therapy

Although my blogging isn’t as prolific as it was in 2012-2013, it is still one of the primary methods of therapy that I undertake. There is something gloriously cathartic about writing about your life, feelings, emotions, moods and thoughts before sharing them with the world. Even if no-one reads, likes or comments on a post, I am still proud of myself for having the courage to put it out there in the first place, especially as my anxiety often interferes with my blogging and works to prevent me from posting anything at all.


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Day 23: Four therapies that have worked for me

Day twenty-three of the 30 Days of Mental Illness Awareness Challenge asks:
What is your opinion on therapy?Lucy Therapist

Over the last twenty years I’ve undertaken a variety of different therapies, to varying degrees of success. So, to prevent this post becoming epic in scope, I’ve decided to focus on four therapies that I’ve found most successful, beginning with…

ACT

I have only recently begun practicing Acceptance and Commitment Therapy. It was introduced to me by my support worker before I began attending a support group that focused on this currently in-vogue practice. For those not in the know, Acceptance and Commitment Therapy is not about ridding ourselves of our demons, but learning to accept them so we can live side-by-side with them, and I have written previously of my love of ACT here.

Exposure Therapy

The one aspect of my mental health that I neglect the most is the PTSD. Although it’s true that few psychiatrists have bothered to treat this aspect of me, it’s also equally true that I’ve been too scared to venture into this potentially devastating minefield, so rarely speak up outside of this blog about how much damage trauma has inflicted on my life.

On the rare occasions that I have dared to stand up to my PTSD, exposure therapy has been my choice of weapon. For example, earlier this year you may recall that I was confronted with a new and (potentially) dangerous trigger. This person, the twin of someone I used to know, was wreaking havoc in my mind; resurfacing all manner of emotions and memories that served to drag me further into the abyss.

Given this person works for the MH organisation I frequent, I knew my usual acts of avoidance wouldn’t work, so all I could do was expose myself (for want of a better term) to my trigger in the hope it would differentiate her from the person she reminded me of.

Months later, I can safely say that this trigger no longer poses the threat it once did. Although she does still remind me of the person I once knew, I am able to be in her company without fear of panic or anxiety attacks; all because of exposure therapy.

Currently, my support worker and I are working on tackling my car anxiety through exposure therapy, and this form of therapy will also become crucial during my return to Melbourne (and the negative memories it will resurface) in a few weeks time.

Talk Therapy

This form of therapy is entirely dependent on the level of trust I have with the person I am talking to. If, for example, I despise their very existence (such as the psychiatrist I saw at the end of 2011) no amount of time spent talking to them will do any good whatsoever.

Whereas, if I trust the person (such as with my current support worker) I find talking through my various problems, histories and traumas an entirely beneficial exercise that helps me no end.

Writing Therapy

This form of therapy is, without question, the one I use the most. Over the last six years of writing this blog I have delved into almost every facet of my personality, not just to share my story in the hope of inspiring others, but to work through the issues that have plagued me.


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Teaser Tuesday (September 24)

Teaser Tuesdays is a weekly bookish meme, hosted by MizB of Should Be Reading.

Anyone can play along with Teaser Tuesdays! Just do the following:

• Grab your current read
• Open to a random page
• Share two (2) “teaser” sentences from somewhere on that page
• Be careful not to include spoilers!
• Share the title & author, too, so that other TT participants can add the book to their TBR Lists if they like your teasers!

◊~~~◊~~~◊

The Confidence Gap
by Dr Russ Harris

The Confidence Gap

◊~~~◊~~~◊

So, what’s everyone else reading at the moment? Go on, give us a tease…


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Creative Therapy: The Hero Dies in this One

stairway

Every Monday afternoon for the last eleven weeks I’ve been co-facilitating a group at GT House, the organisation I’ve been a participant of since late last year. The group – Creative Therapy – was created to give participants the opportunity to explore and share their life’s journey in a safe, supportive and (hopefully) fun environment via a number of creative activities, writing prompts and lively discussions.

In today’s group we undertook a writing prompt that is inspired by Acceptance and Commitment Therapy; we imagined ourselves listening to a friend/relative deliver our eulogy (or eightieth birthday address, depending on how morbid we felt) and then shared with the group what we would like that person to say about us.

This was my eulogy (which was freewritten between 2:25pm and 2:55pm):

Many people seem to say that ‘all men are simple’, but in my experience, Andrew was anything but. Throughout the time he and I were friends, I saw him face many challenges and road-blocks, yet in spite of a few stumbles along the way, he dealt with each and every one of them with genuine courage and aplomb. He as a man who – despite all the odds – refused to bow down and give up; a quality that I have long admired.

Andrew summed it up best in his book ‘The (Occasionally) Manic Adventures of a Lonely Heart’ when he wrote:

No matter how I’ve approached my life, no-one has been able to better phrase my
philosophy than my dear friend Samantha. Little did she know when she typed those
words, that she’d be giving someone their mantra for life: “It you always worry about
what other people think, you will always be their prisoner,”

For as long as I’ve known him, he has lived true to these words. From the dark days of suicide and depression, from the even darker days of homelessness and hopelessness, Andrew fought against his oppressors to be his own, self-made man. He wouldn’t let anyone hold him back, label him or define him. His actions, not his words, revealed to the world who he was, and that man was an inspiration not just to me, but to many others.

In his passing, Andrew leaves behind a wife and four beautiful children, all of whom he loved beyond measure. He leaves behind a body or writing that has thrilled and inspired millions of readers. He leaves behind a hole in this world that may never be filled.

His passion for life, for humanity, for giving those society deemed as ‘voiceless’ a chance to hold their held up and have their say is a testament to us all.

He is a man who I miss, for I don’t think there will ever again be anyone quite like Andrew.

The exercise is designed for us to look at our values, hopes and aspirations. It is about taking a moment away from negative self talk and being kind to past, present and future selves.

During the discussion after the activity, it was comprehensively concluded that being kind to ourselves felt “wrong”, “un-natural” and “very strange”. There was also much apprehension (from myself included) about not talking ourselves up, with our minds editing our writing so we didn’t come across as too “arrogant” or “full of ourselves”.

The line I picked from my eulogy as an example of this was ‘He leaves behind a hole in this world that may never be filled‘; for however much I’d like to think my passing would leave a hole in someone’s world, to say it out loud to a group did make me feel like I was thinking too highly of myself.

But this is the whole point of the exercise; there is nothing wrong with thinking so highly of ourselves.

In fact, many of us would benefit from doing it much more often than we do.

Myself included.


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ACT: Identifying your values

compass

To phrase it in the simplest terminology, ‘values’ are what we want to be doing with our life. They are not the goals we aspire to (such as the items on a things to do before I die list) but the things we stand for and how we want to behave as we move through life.

A simple way to differentiate goals from values is by using the ‘compass metaphor’:

“Values are like a compass. A compass gives you direction and keeps you on track when you’re traveling. And our values do the same for the journey of life. We use them to choose the direction in which we want to move and to keep us on track as we go. So when you act on a value, it’s like heading west. No matter how far west you travel, you never get there, there’s always further to go. But goals are like the things you try to achieve on your journey, they’re like the sights you want to see or the mountains you want to climb while you keep on traveling west.”

~ from Act Made Simple, Dr Russ Harris

Once the differentiation has been made, it is up to us to know what our values are if we are to live according to them.

Identifying your values

The only person who can tell you what your values are is yourself. Sometimes it’s something that is known by instinct (for example, I have long known that one of my core values is determination) whereas other times, values reveal themselves only by happenstance or our own hard work.

One exercise that can be beneficial in revealing our values is The Bull’s Eye, available on Russ Harris’ website, and explained below. Of all the exercises I’ve so far completed, this was the most enlightening for me in identifying my values.

The Bull’s Eye

The Bull’s Eye exercise is quite simple. You begin with a set of concentric circles (an archery target) and then split these circles along the lines of a compass. Each of the quarters represent a part of your life, in this case: work/education, leisure, personal growth/health and relationships.

The Bull's Eye

You begin by listing your values for each of these parts of your life. In doing so, think about what really matters to you, deep in your heart? What do you want to do with your time on the planet? What sort of person do you want to be? What personal strengths and/or qualities do you want to be remembered for?

These lists can be as long or short as you like, but in identifying these values, bear in mind these five key points:

1. Values are here and now, goals are the future.
2. Values never need to be justified.
3. Values often need to be prioritised.
4. Values are best held tightly.
5. Values are freely chosen.

Values

Although not exhaustive, this list may assist you in identifying some of your values (Click to enlarge)

Once you have your values in mind, write them on your Bull’s Eye beside each of the areas. In doing so, you may wish to choose (i.e. prioritise) your top three values (or however many suits you) and mark them with a star or highlighter.

After you’ve identified your values in each of the areas, mark on the Bull’s Eye where you stand today. If you live fully by your values, all power to you ’cause you’ve hit the Bull’s Eye, but if not, don’t see it as a failure, but a new direction for you to take in the future.

My Bull’s Eye

So far this year I’ve completed two Bull’s Eyes. Firstly, back in May when I began the ACT for Anxiety support group, and secondly today, so I could provide an example for you, my dear readers.

I began by identifying my values for the four key areas:

~ Work/Education ~

| Discipline | Hard-Working | Dedicated | Committed | Safe | Courtesy | Creativity |
| Open-ness | Inspiring | Connection | Security | Non-Conformity | Fun | Passion |

~ Leisure ~

| Creative | Non-Conformity | Loving | Fun | Be-Yourself |
| Take Risks | Enjoyable | Pleasurable | Mischievous | Passion |

~ Personal Growth/Health ~

| Individuality | Creative | Non-Conformity | Be Yourself | Generosity | Resilience | Discipline |
| Knowledge | Hopeful | Trustworthy | Asking for Help | Self-Esteem | Dedicated| Passion |

~ Relationships ~

| Monogamy | Trust | Respect | Creative | Understanding | Honesty | Co-operative |
| Non-Abusive | Loving | Security | Committed | Harmonious | Compassionate | Passion |

And then prioritised my six primary values for each field (I have a thing about things coming in sixes!) These primary values have been bolded in the text above. In doing this, I was able to identify that ‘passion’ is one of my core values.

Following this I marked on the diagram where I currently believe I’m sitting. Because this is the second time I’ve undertaken this exercise, I’ve been able to chart any progress/regression since the first time I completed a Bull’s Eye.

My Bulls Eye (2)

Xs in yellow are from May 2013
Xs in red are from September 2013

By doing this, I can clearly see that I have taken a backwards step in personal growth/health (because of my recent relapse) but have made a gain in the work/education front (because of a current ‘plan’ to return to tertiary education next year). Obviously, because of my isolated nature I’m ‘off the chart’ when it comes to relationships and leisure has remained relatively stable since May 2013.

To my eyes, I’ve a long way to go to be fully living within my values, but at least I now know what my values are.

Hopefully, by completing this exercise, you’ll have a better understanding of your values as well. :)

~ Previous installments in this series ~
What is Acceptance and Commitment Therapy?


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What is Acceptance and Commitment Therapy?

Acceptance and Commitment Therapy (ACT) is a behavioral therapy all about creating a rich, full and meaningful life whilst accepting the pain that inevitably goes with it. Officially, when written as ACT, the ACT is said as the word “act” and not as the initials A-C-T.

I knew nothing of ACT until earlier this year, when I began attending a support group called ‘ACT for Anxiety’. It sought to apply the core principles of ACT to those of us afflicted with an anxiety disorder. Since then, I’ve found ways to apply some of the mindfulness techniques I’ve learned into various aspects of my life, sometimes subconsciously, to make coping with life’s challenges a much simpler beast.

act-therapy

ACT in a Nutshell…

The core principle of ACT can be described by using a simple (and unsurprising) acronym:

A = Accept your thoughts and feelings, and be present

C = Choose a valued direction

T = Take action

Or through an exercise known as The ACT in a Nutshell Metaphor, which I have adapted below:

ME: Okay, so this week we’re going to be taking a journey through Acceptance and Commitment Therapy (ACT)…but for us to do this, I’m going to need to explain what ACT is, and the easiest way to do that is with a bit of role-play. So, I want you to scamper off and find yourself a sheet of A4 paper.

YOU: Lined, coloured or just any old piece?

ME: Any old piece would be fine, whatever you can get your hands on.

(You scamper away and find yourself sheet of paper before returning eagerly to the computer.)

ME: Excellent. Alright, now I want you to imagine that the piece of paper you’re holding represents all of your difficult, unpleasant, uncomfortable, painful and downright horrible thoughts, feelings and memories. Everything that you’ve been struggling with for so long – be it depression, anxiety, whatever – are all represented by the piece of paper you are holding. Now I want you to take that piece of paper and hold it tight up against your face. Touch it to the tip of your cute little nose so that you can’t see me anymore.

(You hold the piece of paper against your cute little nose and realize that you can’t see anything, let alone me.)

ME: Now, what’s it like having a conversation with me whilst you’re caught up in all those horrible thoughts, feelings and unpleasant memories?

YOU: Very difficult.

ME: Do you feel connected with me in any way? Are you able to read the expressions on my face or interpret my body language? If I was doing the Hokey-Pokey or making faces at you right now, would you be able to see me?

YOU: No.

ME: And what about what’s going on in the rest of the room?

YOU: I can’t see anything apart from the sheet of paper.

ME: Nothing?

YOU: Nothing.

ME: So you’re missing out on an awful lot. You’re missing the sunset that’s blazing out the window as well as the dancing bear behind me. You’re disconnected from me, from the world, from everything. Now, whilst you’re holding onto that piece of paper, I want you to imagine me asking you to hug your children, or cook a healthy meal, or type a blog post on a key board, or give your loved one a surreptitious bum squeeze. Would you be able to do those things whilst holding on so tightly?

YOU: I don’t think so. No.

ME: So when you’re caught up in all your difficult, unpleasant, uncomfortable, painful and downright horrible thoughts, you lose contact with the world around you, including your relationships? You’re also incapable of doing the things you need to do, the things that make your heart sing?

YOU: Yes.

ME: Okay. Now let’s try something else. I want you to take that piece of paper and place it on your lap.

YOU: Alrighty.

(You take the piece of paper and place it on your lap.)

ME: Now, how’s that? Can you see me?

YOU: You’re not doing the hokey-pokey any more.

ME: I’m not. But you can see me. You can see my facial expressions, interact with me.

YOU: And the sunset’s really pretty.

ME: So you can interact with the world as well?

YOU: Yes.

ME: So if I were to ask you to hug your children, cook a healthy meal, type a blog post or give your loved one a surreptitious bum squeeze, could you do any of those things now?

YOU: I could. But they’re still here; all my horrible thoughts and emotions. I don’t want them here.

ME: I know. Absolutely. It’s all still there, and of course you don’t want it, who would? But it’s not having so much of an impact on you now, is it? I’m sure you’ve tried so many things over the years to get rid of all those painful thoughts, haven’t you? Drugs…alcohol…

YOU: …self-help books, therapy, isolating myself, criticizing the crap out of me…

ME: …exactly. And you’ve clearly put a lot of time and energy into all that, but they’re still showing up. They’re still here, no matter what you’ve tried over the years. They might go away for a short while, but they always come back, yes? And sometimes bigger and heavier and more painful than ever before, yes?

YOU: Yeah.

ME: So even though every atom and instinct in your body is telling you to get rid of these thoughts and feelings completely, it’s not having the effect you wanted, is it?

YOU: No. It just makes everything worse. I want to do something that works.

ME: Okay. This is where ACT comes in. We’re going to learn about a whole range of mindfulness skills that will help you handful painful thoughts and feelings. So instead of living life with them all up in your face…you can learn to live with them sitting comfortably alongside you. They won’t be stopping you from interacting with people or affecting the way you live anymore, but they will still be there, only in ways that are more manageable and more controllable. So you can put more energy into the things you love, like cooking healthy meals…

YOU: …and giving my partner’s bum a squeeze every now and then?

ME: Exactly. How does that sound to you?

YOU: Sounds good.

Alternatively, this video sees Dr Russ Harris (author of The Happiness Trap) explaining  The ACT in a Nutshell Metaphor:

Throughout the rest of this week I will be taking a closer look at some of the strategies involved with Acceptance and Commitment Therapy and sharing with you various activities that can be undertaken to help you live a life more in tune with your strengths and values.


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Teaser Tuesday (7 May 2013)

Teaser Tuesdays is a weekly bookish meme, hosted by MizB of Should Be Reading.

Anyone can play along with Teaser Tuesdays! Just do the following:

• Grab your current read
• Open to a random page
• Share two (2) “teaser” sentences from somewhere on that page
• Be careful not to include spoilers!
• Share the title & author, too, so that other TT participants can add the book to their TBR Lists if they like your teasers!

◊~~~◊~~~◊

The Happiness Trap
by Dr Russ Harris, M.D

The Happiness Trap (May 7)

This empowering book presents the insights and techniques of ACT (Acceptance and Commitment Therapy) a revolutionary new psychotherapy based on cutting-edge research in behavioral psychology. By clarifying your values and developing mindfulness (a technique for living fully in the present moment), ACT helps you escape the happiness trap and find true satisfaction in life.

◊~~~◊~~~◊

So, what’s everyone else reading at the moment? Go on, give us a tease…