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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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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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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Cognitive and Dialectical Behavior Therapy

Over the years, my posts have tended to be about:

(a) incidents of my life that have been analysed beyond all reason
(b) subjects that I have researched and/or lived through so I feel I have some understanding of them
or
(c) random insanity.

Rarely (if ever) do I sit down to write about something I know little about, mostly because doing so fills me with embarrassment over my ignorance and naivity, both of which play into my social anxiety quite severely.

However, for today’s entry in the Mental Health Month Challenge, I must battle through this anxiety to admit my lack of knowledge over two rather well known areas of psychotherapy as the prompt is: I don’t know much about this, but I’d like to.

So please forgive my lack of knowledge on these subjects :)

Cognitive behavioral therapy (CBT)

CBT-Triangle1

“Cognitive behavioral therapy (CBT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to behavior therapy, cognitive therapy, and to therapy based upon a combination of basic behavioral and cognitive principles and research.” [from Wikipedia]

For several years, virtually every psychiatrist, therapist or counselor I saw raised the CBT acronym within a matter of minutes.

Of all the therapies available I’ve always believed that this could have the greatest impact in changing my thought patterns and emotional responses toward my anxiety, mood swings and self-hate, but given my nomadic homeless life, I’ve never been in a position to undertake the treatment nor fully research what this psychotherapeutic approach entails.

Now that I’m in a better position to push forward with my life, this is certainly something I’m planning to look into further, even if it means going it alone via books and/or the internet because of my distrust of psychiatrists and the mental health system.

Dialectical behavior therapy (DBT)

DBT Model Of The Mind

“Dialectical behavior therapy (DBT) is a system of therapy originally developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat people with borderline personality disorder (BPD).DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT may be the first therapy that has been experimentally demonstrated to be generally effective in treating BPD.A meta-analysis found that DBT reached moderate effects. Research indicates that DBT is also effective in treating patients who present varied symptoms and behaviors associated with spectrum mood disorders, including self-injury.Recent work suggests its effectiveness with sexual abuse survivorsand chemical dependency.” [from Wikipedia]

Although I know even less about DBT than CBT, over the last few years I’ve been hearing more and more about this psychotherapy and the possible gains it can bring to someone’s life.

Unlike CBT this has never been raised by any of the MH professionals I’ve seen, which leads me to question just how beneficial it would be in helping me deal with the issues I face? Thus, I would need a lot more information about this subject (and talk to a professional about it’s possible benefits) before I put any thought into whether this could be helpful or not, but it’s certainly something I’m interested in pursuing in my quest to become a better version of myself.

So if anyone wiser than I has any links or book recommendations for someone wishing to research CBT or DBT, please let me know in the comments section, Twitter or email as your help would be greatly appreciated. Thank you kindly :)