Consistency - blech.

Last post I discussed a worksheet I've used with some success during anxiety attacks - the 3 C's: Catch It! Check It! Change It!

Apparently I have much more to say on the subject.

Tip: A good way to practice using any therapeutic tool so that it becomes more second nature, is to use it for more minor causes of anxiety in your life, or smaller emotions, minor crises, or even mild discomfort, as this allows you to the explore how you use the tool in a less fraught situation. This is an excellent way to practice so you are ready when the fraughted-ness arrives.

Consistent Use and the Lack of a Magic Pill - Reality Bites
The worksheet I discussed in my last post, (and the version I've linked to above), or any similar type of exercise or tool,  will not instantly eliminate your "negative" emotions completely or stop you from having anxiety ever again.  Or even right now.

There is no magic pill or magic wand or hocus-pocus that will fix me, or cure my mental illness. (I know.  I've checked.)  But used regularly and consistently, these type of exercises have been shown to assist in decreasing anxiety levels over time, as you practice objectively viewing your thoughts and emotions and consistently replacing them with more neutral, realistic thinking (notice I don't say "happy" thinking. More on that another time.)

And I know it works in the long haul, cuz hey, here I am!  I'm not perfect, but I've sure as hell come a long way. When your worst day now is equivalent to your best day a year ago, you know you've come a long way, baby.

It's hard.  Coming back from a breakdown, surviving this illness, is the hardest thing I've ever done.

Practice is required for any type of therapy to assist over the long term (sorry!).  Long term use of this type of tool has been shown to lower anxiety levels if used consistently and regularly.  This means for me that I do it 2 to 3 times a week, or more often if I need it.  and I promise you, it gets quicker and easier over time (except for those times when it doesn't), and ideally you'll start to do it automatically, and internally, when your experiencing intense emotions.

In this way, it will assist in the cognitive restructuring of those affected neural pathways, so over time you're less and less likely to go down the rabbit hole.

The frustrating suckage that is Consistency.
You may be frustrated while using this tool.  Because this type of therapy (or any therapy, really) requires consistency over weeks and months to work.  You've had a lifetime to develop this illness - it's not going to go away in a few weeks.  (If it does, you are extremely lucky.  And I hate you.).

Consistency, like a diet or a new workout, gets difficult when you reach the point where the initial excitement and motivation of doing something new has worn off, but the "behavior becoming a habit" part of things hasn't kicked in yet  It sucks when that happens.   Because all of a sudden, hey, wait a minute, this is WORK.

And that's not even getting into how much motivation you don't have with a mental illness.

The other part that sucks is that the tools I discuss in this blog are to be used as needed for the rest of my life.  I have a lifelong medical history of mental illness.  I will not be cured.   But I can get better at managing the anxiety that is there and the meltdowns that happen, so that the crazy highs and lows start to even out a little, and I bounce back a little quicker, and everything is slightly  less catastrophic. And maybe I can breathe.

For example, I can now sometimes stand in front of my dishwasher with only a very mild sense of impending doom.  At least until I open it.

The other frustrating suckage is the actual doing of the exercise. It does not come easily at first, seeing thoughts and feelings with some level of objectivity.  And it's a lot of writing. And I do not magically feel better afterwards.

Wait, why were we doing this again?

Oh yeah - as I said in my last post, recovery is WORK.

What matters is that you keep going.  Not how well you do, not how many times you didn't use the worksheet, or that your anxiety or mental illness won that day.  You pick yourself up, or stay on the ground if you need to, but keep going.  The nice thing about moments is that they pass.  No matter how awful and horrible those moments are, they pass. No matter what your head tells you about you being the exception to the space-time continuum and this is going to last FOREVER.

Buying in and fusion - Or why my brain is a big fat liar.
It's when you believe your brain telling you that you're stuck, that this feeling will never end - that's what  gets us into trouble.  When you fuse with the fear, when you buy into it, when you believe those thoughts, then it's all bad. But here's the thing - you can believe all the thoughts you have (and we have something ridiculous like 64,000 a day), but that doesn't make them true.

I can truly, desperately believe I am a banana, but (and I find this a little sad) it doesn't make me a banana.  So, I can believe I am a failure (or a banana), that I am useless, that I will always feel this way.  Doesn't mean any of it's true, or real.  The trick is getting through those times you're in fusion with all the thoughts and emotions, and you really do believe how you feel in that moment is how you will always feel, and there is no hope, and you have no power.  Getting through, living through it, is success.

If you stayed in bed all day and cried, and thought about dying, and you're still here at the end of the day, that means you got through it.  Moments pass.  And they will eventually get less horrible.  You will even one day enjoy yourself again.  (Just not today. But today will pass, and you will come out the other side. Promise.)


So.

Be well.  You will get through this.  You've got this.

And how you're feeling? Me too.

To wash or not to wash? Dishes and the fate of the cosmos.

Alright - This is one of the methods have at my disposal to use to cope with an anxiety attack, which is adapted from M. Linehan (Diaclectic Behavioural Therapy), and which my husband used when he talked me through an anxiety attack on the phone last Monday so I could leave the house and go to work.

We learned this technique in my anxiety support group at the Montfort Hospital in Ottawa. Although it's available in many different forms on the web, I've stuck to the form of the worksheet we used, which I've filled in as I go to give you an idea, and because - surprise! - I'm having anxiety, so thought it would be a good idea.  Handy thing is, this can be used in the event of any strong emotion - it was initially developed as a method of coping for those with Borderline Personality Disorder.

The following provides a description of the exercise and its purpose, courtesy of Palo Alto University:

This is to assist the user to develop Cognitive Behavioural Therapy (CBT) skills of identifying thoughts linked to negative mood states (“Catch It”), challenging the accuracy of such thoughts by examining the evidence (“Check It”), and coming up with alternative, helpful thoughts that can improve their mood (“Change it”).
Practiced over time, the process become more automatic and ideally assists in the configuration of more positive mental pathways, thereby reducing assisting with the anxiety (or depression, shame, etc).

Blah blah blah.  Ready? No? Good. Let's do this.

The Exercise: Catch It, Check It, Change It

Step 1. What triggered this emotion?  Be specific: who, why, when, and where.

My Response: After a long day at work, my husband was home sick, son is fussy, and the kitchen is a disaster zone - dirty dishes everywhere.

Note - dishes are a trigger for me.  When I had my breakdown, I happened to be in the kitchen, doing dishes. My husband made an exasperated comment about how I loaded the dishwasher and I.   Lost.    My.    Mind.

Literally - I was hospitalised for a month and off work for over a year.  The timing was coincidental, of course - dishes or no dishes, I had a mental illness and was going down the rabbit-hole.  But spouses everywhere, let this be a lesson to you.  (Also, I've now developed a mild case of PTSD over the goddamn dishwasher.)

Thoughts:

Step 2: Catch It!  Identify: Automatic Thoughts - what I say in my head (words, images, beliefs).  What does this event mean to me, for my life, for my future.  What is it that I predict as a result of my reaction, what is it I have concluded as a result?

My Response: 

My automatic thoughts: I can't handle this.  I'm incapable of dealing with this - it's too much.  I should push through this anxiety - I won't have a breakdown from doing dishes.  Or leaving the dishes there.  But if I'm leaving them there, then I'm not confronting my anxiety, and I'm a failure.  It means I'm not doing what I should, when I should.  (My brain is a big fan of the word "should", and random rules it decides are essential to not just my existence, but the universe as we know it. Me not doing the dishes is like matter meeting anti-matter.  If I don't do it (cuz I should), dire consequences will ensue.)

(Perhaps I should just leave the dishwasher closed - maybe seal it shut.  It could be like Schrodinger's cat - are there dirty dishes, or aren't there?  But I digress.)

I go round and round: If I'm not doing the dishes a.k.a. confronting my anxiety, I'm not doing what I should to be there for my family, and I'm a failure as a wife and mother.  But if I start doing them, and I'm to tired to deal with my anxiety, I won't be able to cope, I'll start to cry, and that will mean I'm sick, and that means I'm going to have another breakdown, and I'll end up in the hospital, and maybe I'll hurt or kill myself, and what kind of person or mother am I that would do that and leave her family?

I could go on.  You see how vital this decision has become - this decision has implications for my worth as a wife, mother, and person.  It could lead to my death.  Either decision dooms me - one to my potential commitment to the mental wing, and potential suicide, the other to my failing my family, which will lead to me being so devastated that - guess what? - I'll have a relapse, end up in the mental wing, and potentially commit suicide.

All roads lead to Rome.

Given these potential consequences (death, hospitalisation, abandonment of my family), and the weight of such a decision, and the fine, fine line I have to travel (i.e. only do what I can when I feel not anxious, or not too anxious, and who decides what that is?), it's no wonder that simply deciding on whether to wash or not to wash has become fraught with fear and peril and doom.

Time for the next step:

Step 3. Ask yourself - is it possible that my thoughts are not entirely realistic right now?  Am I generalising, incorporating all or nothing thinking? Am I accepting my emotions as the absolute truth about the situation?  Do I believe that because I feel it, it must be true?  

My response:  Gee, let's see:  Yes, yes, yes, and yes.  Also more yeses as appropriate.

"Is it possible that my thoughts are not entirely realistic right now?"  It is entirely possible that my thought of imminent suicide as a result of washing dishes is not entirely the most realistic thought I have ever had.  Maybe.

Hmmm.."incorporating all or nothing"- well, "I have to do all the dishes, or I"m a failure as a human being" - does that count?

Next, "Am I accepting my emotions as the absolute truth about the situation?" Hell to the yeah.

Do I believe that "because I feel it, it must be true?"

In the moment, I believe all of it. In the moment, it's more real than gravity.

And what I feel, is that I am failing as I struggle with this simple decision, and I feel I am failing because I am not well "enough", or recovering fast "enough".   I've failed in my pitiful efforts to minimise these intense and agonising emotions I'm experiencing, even though I know how, and  I failedfailed failder faildest.

Step 4. Change It!  Change: Can I replace these automatic thoughts with more realistic, complete, valid, or even simply more neutral thoughts?  If so, what would they be?

 My response: A more realistic thought, and one I can accept, can be as simple as "I am having anxiety over the decision to do the dishes.  I can accept that a decision on whether or not to do dishes might not equate to my worth as a mother."

In this section, any basic truth you can name about the situation that you can accept as logically probable, or at least true from a different perspective.

Facts. Those are good. They can be as simple as "I'm finding this moment challenging"  or "I am having the fear that I'm going to have another breakdown.". Or more simple yet, "It is possible that my fears are not probable.  It is possible that my emotions are affecting my judgement".

These thoughts, these simple facts you remind yourself of, over and over in your crisis moment in response your automatic thoughts.

Having gone through this exercise, you would now reassess your anxiety (or emotion of your choice) level, and determine whether it has increased or decreased.  The goal is to reduce intensity of the emotion, hopefully by the end of the exercise, and over time through repetition..

And repeat as required.

This type of exercise is to train your mind to follow those new neural pathways, and to help you stop fusing with your anxiety; to take that first step back and observe your anxiety and panic instead of blindly reacting to it.

Because you are not your emotions.  You are not your fears.

It's okay.  I didn't believe that either the first 20 times I heard it.

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A final word - strive for improvement, not perfection.  Check your progress now and then ( whatever you're doing to treat your illness), and if you've improved over time, regardless of by how much or how little, if you've improved, it means you can relax, knowing you're on the right track.  Perfect = bad.  Improvement = Awesomeness.

And if you haven't improved, keep going anyway.  You're eventually going to hit on what works for you through sheer stubbornness, if nothing else.

My next post (already mostly written - yay me!), I'll be blathering about how quickly and instantly we can all be happy without any effort whatsoever, and make a million dollars while doing so.  Because really, that's how it SHOULD be.

Down the rabbit hole.

Today I almost didn't make it into work.

I couldn't convince myself to leave the house.  I have been working from home the passed two weeks (due to a tailbone injury, of all things), and while absence may make the heart grow fonder for some, in my case absence makes the anxiety grow bigger.  And bigger.  Colossal, really.  My anxiety was the Empire State Building.  Or possibly Godzilla (ANGRY anxiety).

But I couldn't make myself get dressed.  Got my husband and my son fed, got them ready for the day, and I somehow couldn't bear to leave with them as I normally would.  So I sent them off, saying I would take the bus later.

And then I sat there, and sat there.  And when my husband called an hour later (checking on me, because he knows), I was still sitting there.  In my pajamas, spiralling into a more and more helpless and panicked state.

I don't know about other mental illnesses, but helplessness is something that anxiety and depression both have in common.  That sense of utter disconnect, that you have no control over your own mind, are powerless over your own actions (which, as it turns out, we are not), and that you are at the mercy of your fucked-up mind.

With all the psychotherapy I've received, I now know that thoughts aren't necessarily (and in fact rarely) a reflection of the facts, or even reality based.  Nor, especially, are emotions.  But knowing that is not always enough to keep me from going down the rabbit hole.  Sometimes you just end up fusing with the badness, the belief in your own helplessness, the belief that somehow you are in fact responsible for all of it (regardless of what "it" is), and that you are the failure you fear.  If you were just stronger, better, more capable, less lazy, you would be able to get your ass off the couch and get dressed and leave the goddamn house like a semi-normal individual.

But there I sat.  I feared having a break down at work.  That I would be ostracized, that I would be seen as someone who was identified as their illness, the one you had to watch out for, the one you couldn't assign any "real" work to, because, hey, she might just crack under the strain and go cuckoo for cocoa puffs.  I feared that being seen this way would lead to a greater sense of failure, and that would lead to further depression and anxiety, and ultimately I would end up so sick again I'd be back in the hospital and maybe kill myself.

Therefore if I went to work I could get sicker and I could die.

Never mind that all the counselling I've received has clearly indicated that I NEED to work, to have that type of productive activity, to have the intellectual stimulation (I work as a policy analyst in an agency of the federal government, work that I love when I'm feeling some kind of normal); studies have shown that productive activity is essential in recovery from mental illnesses. So really, not going, particularly on an ongoing basis, is like shooting myself in the foot.  Or, more accurately, the head.

Believing that you might die if you leave your house, or even get dressed to leave the house to go to your office job, is clearly not the most reasonable, reality based or even probable thought.  In a healthy state of mind, I'd know this and simply ignore the thought, or judge it as ridiculous.

But I believed it. I believed it with everything in me, and sat there.

But here's the crazy thing about anxiety.  You can bring it with you.  It's mobile, take-out, and will go with you wherever you want to go.  So I took it with me.  It was like carrying a forty pound, screaming, flailing toddler in your arms who's slapping you in the face so you can barely see, and sometimes you almost fall over, and doubt that you can go another step without the whole thing going to hell in a hand basket, but I took that fucker with me.  And I went to work.

I had a rough, kind of horrible day.  All the horribleness was in my head - people were actually extremely supportive, and in some cases, shared their own experiences.  I didn't get much done, but I got there.  I showed up, and stayed until the bitter end.  And although it was a close thing a couple of times, I didn't melt down in front of anyone.  But if I had, shockingly enough, the world would not have ended.

I hate to leave you hanging on how I managed, but it is getting late, and my cup full of medication awaits me. My next post, I'll be discussing some of the techniques to use in a situation like this, to navigate through the tidal waves going on in your brain.  In this particular instance, my husband assisted by using some of the cognitive behavioral techniques we've learned in the past year.

I'll leave you with this - recovery is a bitch.  Don't let anyone tell you different.  It's not a straight line - you will go backwards, on not just one, but many occasions, before you go forwards again.  But it is possible. And it is worth it.

But it's still a bitch.