Category Archives: Mood Disorders

Using Wellness Journals with Teens

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The teenage years are a wonderful and crazy time of life.   As teens we are melodramatic and irrational.   We crave independence while deeply desiring acceptance and approval of others.  As adults teens can be difficult to understand and to relate to.   This unique time of life is caused, in part, by a dramatic growth spurt that occurs in the brain just prior to adolescence.  Although the brain changes throughout our lives there is a burst of “neuronal sprouting” that occurs right before puberty.  During later adolescence and early adulthood this new gray matter is organized and shaped.  It is during this period of adolescence and early adulthood that many of our primary coping strategies to deal with stress, anxiety and depression are learned.

 It is due to this structural reorganization of the brain that begins in adolescence and continues on through the mid 20’s that I encourage parents and therapists to utilize Wellness Journals in teaching strategies to deal with depression, anxiety and stress.  The skills learned in adolescence become “hard wired” or fairly permanent.  If these coping strategies are not learned in adolescence, learning them later in life becomes a difficult and painful process often plagued with failed relationships, chronic depression and anxiety.

 Wellness Journals are a Cognitive Behavioral strategy for teaching coping strategies.   Cognitive Behaviorism is one of the most studied and proven tools for combating depression and anxiety.  Although Wellness Journals can be used by individuals of all ages, they can be a key tool in helping adolescents and young adults who may be suffering from depression or anxiety.

 For more information about Wellness Journals, please contact Gateway Counseling at 242-3771

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What have you overcome?

Journaling Things That You Have Overcome

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Journaling “things I (you) have overcome” can be an effective tool in treating depression and anxiety, and is an important part of a Wellness Journal.  Evaluating things that we have overcome in our lives is not a new idea.  Actually none of the individual sections of the Wellness Journal are unique, but they are all effective and when combined make a formidable tool against depression and anxiety.   Making a list of “things I have overcome” counteracts some of the negative effects of comparing.   I don’t have to tell the reader that comparing ourselves to others can be extremely damaging to ourselves.  Of course comparing ourselves to others is a trap that many of us fall in to.  When we compare our jobs to others we may feel that our career isn’t so great.   When we compare our bodies to the bodies on the covers of magazines we often will start to unfairly criticize our own body size and shape.   When we hear of the great accomplishments of others we may wonder why we are so lazy or untalented.   The flaw in our thinking is that we are not comparing ourselves to reality but are comparing ourselves to a fantasy.  The “people” with whom we compare ourselves to are not real, as we only compare ourselves to their positive traits.   In contrast when we compare ourselves to ourselves, we get to see how far we have grown and what we have accomplished.

Two of the critical parts of a Wellness Journal are “things I have accomplished,” and “things I have overcome.”   When we make a list of what we have overcome, it helps us stop comparing ourselves to others, and start appreciating what we have done.  We stop using a fantasy and start using a real person, someone we know better than anyone else.   We are forced to see ourselves for who we are.

For more information about Wellness Journals, contact Gateway Counseling at (208) 242-3771

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How to Help Your Depressed Son or Daughter

Mood Disorders, Depression, children, Adolescent, risk  The family is the basic fundamental unit of our society, and depression of one family member always affects the rest of the family.   A child struggling with temporary feelings of depression can be difficult to understand and deal with.   He or she may bring feelings of guilt, frustration or helplessness to parents.   It is important that treating depression be a priority. It is also important to recognize whether the feelings of depression are a short term concern or should be treated as a long term condition.

Without intending to, you can make your son or child feel rejected or misunderstood when you are confronted with their depressive behaviors.  All of the family members, including parents, brothers and sisters, and extended family, should have a basic understanding of depression so that the affected child is not shamed or misunderstood.   Your child deserves to have good support and understanding.  Your family deserves to feel safe and happy.

There are a number of steps that you can take to help your son or daughter who has depression.

1)      Understand that depression is very treatable.   Also understand that there may be reasons for the child’s low moods.   Gather information.   Encourage your child to talk to you.  Talk to the school, friends, and family to see if they have noticed a change in mood or behavior.  Take the child to his or her pediatrician to insure that there are no physical causes of the feelings of fatigue, aches and pains, and low moods.

2)      Provide love and understanding.  Learn about depression, so that you can recognize situations which may lead your child to feel rejected or misunderstood.  Make sure you know and they know that you love them unconditionally.  Help your child realize that his or her feelings are normal: “Everyone gets down sometimes.”  Your son or daughter needs to know that depression is not a sign of weakness, nor is seeking treatment.

3)      Don’t pressure your child to talk if they are not ready to.  Just be ready and available when they are.

4)      Keep kids busy.   Insist that they continue to interact with the family, that they get up, make their bed, do the dishes, do their homework.   Don’t let them avoid their responsibilities.  Of course, don’t yell at them, but coach them.  Gently confront their inactivity and isolation.  You don’t want your children to think that because they are depressed that they don’t have to follow the rules.   It is not an excuse.

5)      Encourage your child to exercise daily, or at least 3 times a week.  There is a lot of research to support the idea that exercise increases one’s confidence and positive feelings.  In addition, make sure that your child gets consistent regular sleep and eats regular healthy meals.

6)      Encourage your child to keep a journal.  Encourage him or her to write, draw, or doodle in it.  This often helps children to identify and express their feelings.

7)      Encourage your child to identify a few support people such as peers, teachers, or family members with whom he or she is comfortable sharing his or her feelings with.  Have these people regularly contact your child, and have your child regularly contact them.

8)      If your son or daughter continues to experience feelings of depression or shows any of the following symptoms, seek professional treatment from a Clinical Social Worker or professional counselor: making suicidal statements, is preoccupied with death in conversation, writing or drawing, gives away belongings, withdrawals from family and friends, or has aggressive behavior.

Gateway Counseling

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Using Wellness Journals with Borderline Personality Disorder.

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PREFACE:  Borderline Personality Disorder, or BPD, is one of the most often misunderstood and difficult to treat disorders.  This difficulty may occur because it is so hard to isolate a cause or to nail down a specific definition. It is clear that there are genetic factors behind the presence of the disorder because BPD tends to run in families. 

Professionals also recognize that many individuals diagnosed with BPD struggle with PTSD, and there are movements among some camps to call it Complex Post Traumatic Stress Disorder.  As with other mental and emotional disorders, the presence of BPD is not something that the sufferer chooses. I believe, as do other professionals, that there is a complex set of causes and many factors that lead to the disorder.

TRADITIONAL TREATMENTS:  The most common therapy for treating BPD is Dialectical Behavioral Therapy or DBT.  It is popular due to multiple studies demonstrating its effectiveness in treating Borderline Personality Disorder.  Another similar therapy is Cognitive Behavioral Therapy or CBT.  CBT practitioners often make excellent progress in working with individuals with Borderline Personality Disorder.

Medication has largely been ineffective in treating the disorder, although anti-depressants are used to treat the depressive symptoms associated with the disorder.   Mood stabilizers have also been used, with various levels of effectiveness.  Some individuals subjectively report that medications are helpful in reducing the impulsivity associated with the disorder.

WELLNESS JOURNALS:  Wellness Journals work well both with Cognitive Behavioral Therapy, and  in a Dialectic Behavior Therapy setting.   The Wellness Journal is especially helpful in dealing with increasing one’s “Distress Tolerance” or ability to deal with everyday struggles and challenges and with “Emotional Regulation,” or the ability to minimize the “moodiness” or rapid changes in mood.  

The major focus of Wellness Journals is mood regulation and should not be considered a stand alone approach of therapy.   Consider for a moment that each person has a metaphorical bucket.  In our buckets we keep all our positive beliefs, self confidence, and memories of the good things, and  what we are, and those things which we have accomplished.  If then, we were to compare the buckets of an individual with Borderline Personality Disorder with someone without the disorder, we would find that the individual with BPD had a hole in their bucket.  While the individual without BPD could dip into his or her bucket at times of crisis, the individual with BPD cannot.   Those positive emotions, thinking, and memories keep running out.   Any attempt to fill the bucket with positive statements and reassurances will prove only temporary.  Therefore, the goal is not to fill the bucket but to repair the hole in the bucket.  The wellness journal attempts to  replace a faulty bucket.

During good times, you write in it, obtain letters, remind yourself of the positive things, make plans for the down times, and remind yourself what you are thankful for.  Then during the bad times you utilize it to remind yourself that you believe yourself to be a valuable person – a person with strengths, goals, and accomplishments.

You don’t need to write in the journal every day. Actually, when you are feeling down, you probably shouldn’t write in it.  The one exception to this may be the Gratitude List.  Therefore, there is no need for consistency.  This is the perfect match for the individual struggling with BPD’s inconsistency.  My best results have been to catch an individual with BPD when they are in an up, and then together write in our journals, taking turns writing, and sharing.

I encourage your comments.

What makes a good Counselor?

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By far the single most important indicator of success in counseling is the relationship that you form with your counselor.  You may not know why, and even the counselor may not know why, but if there is not a good fit between individual and the counselor, then significant progress will not occur.   Trust your feelings, if the relationship between you and your counselor is not good, if it doesn’t feel right, terminate the counseling.  A good counselor knows that he or she will not be a good fit for every client.   Excessive resistance to letting go of a client is also a sign that it is not a good fit.  Counseling can be an emotionally difficult time therefore finding someone with whom you can relate is paramount.

Second a good counselor is a good listener.   If your counselor tries to lecture you or does all the talking get another counselor.  The majority of the time should be spent talking to you about your concerns, about what you need to talk about.

Third a good counselor is positive.   They actively look to discover your strengths and use them to help overcome your weakness.   Is your counselor happy to see you, or does it feel like they wished you had of cancelled so they could get caught up on paperwork?  

Fourth a good counselor will challenge you.  They try to gently push you past your comfort zone.  They recognize the pain that you are going through, but still believe that you can make change.  They express belief in you and your ability to make the changes you want in your life.

Fifth a good counselor will work on the things that you want to work on.   They will include you in the treatment planning, let you know how long they expect it to take, and regularly review your progress towards your goal.

7 Habits of Highly Effective PSR Workers

Highly Effective PSR WorkersONE:  Building and Maintaining Interpersonal Attachments

Highly effective PSR workers work to maintain interpersonal attachments.  PSR workers value their relationships with themselves, clients, colleagues, family and friends, and members of the community. Effective PSR workers believed that, to maintain competence and build expertise, they must continually be in relationships with others in the field, whether in supervision or consultation or purely for collegial support and friendship.

Pertaining to performing competently in their work, which is central to ethical practice, effective PSR workers believe that the client-worker relationship is the key to effecting positive change in clients. 

Effective PSR workers attempt to uphold high ethical standards when interacting with others in both their professional and personal life. In most relationships, even those in the community at large, the PSR workers strived for congruence between their values and the way they lived their lives.

TWO:  Client Autonomy

The right of individuals to determine the course of their own lives seemed to be a central value guiding effective PSR workers.  PSR workers respect the phenomenological worldviews of their clients and hold the belief that for change to occur, clients must be allowed to determine the timing and direction of the therapeutic process.  As PSR workers our basic mission is to help them see their choices, and if they want to make bad choices … the PSR worker’s job is to help them see what the consequence will be if they do that.

Competent PSR workers were aware of the ethical dangers of thinking they know what is best for their clients and, therefore, worked to avoid imposing their own beliefs, values, and ideals on clients.  Effective PSR workers often realize this due to this being a central tenant of their own personal development.    The most effective PSR workers believe strongly in the ability of their clients to direct their own lives.

THREE:  Beneficence

PSR workers feel moved to reduce human suffering and to work toward improving the welfare of others. In their unique role PSR workers have the opportunity to demonstrate caring by helping to transform painful experiences into sources of personal strength.   As workers we are like the final fairy godmother in the Disney Movie “Sleeping Beauty.”  We can’t change what was laid down earlier; but we can help a person soften it or make it go in ways that are more interesting.

The best PSR workers express a good deal of satisfaction in helping others. However, rather than acting out of completely altruistic motives, these workers acknowledged that they entered this field to meet their personal need to be useful or to accrue other personal benefits in their professional work.   

FOUR:  Non-maleficence.

Not only do PSR workers value helping others, they also were are of the tremendous potential to do damage in the context of the therapeutic relationship. They seem mindful of the ways they could potentially harm their clients and had developed measures to minimize this risk.

Effective PSR workers are aware that there is the risk that the worker may start to use the client for his or her own emotional sustenance…   Therefore they are on guard against this, knowing that he or she must meet their own needs, that they must be well fed and loved.  Effective PSR workers strongly believe in managing the personal and professional stressors that can lead to harming clients.   Workers who are not aware of their own needs, and become stuck in working with a client can make it about the client, instead of about themselves.  When this happens you are at risk of being abusive to the client.

FIVE:  Building and Maintaining Expertise

The best PSR workers value being exceptionally skilled in their work.  They are highly motivated to move beyond the minimum competency level required by ethical and practice standards toward expertise in their field. These workers, even after years of experience and training, place a high value on maintaining and building their skills set.   

The most effective PSR workers continually seek out formal and informal training to broaden their cognitive and clinical abilities. The drive for competency combined with an awareness of limitations inspire the best workers to be lifelong learners. It is likely that keeping current on the latest developments in their profession and exposing their work to others for feedback minimizes the potential for unethical behavior.   

Effective PSR workers do not, however, limit their search for knowledge and skill to their work.  They expand their study to all aspects of their life.

SIX:  Humility

Clients report that the best workers display humility.  These PSR workers awareness of their limitations seemed to inspire them to keep on growing professionally and personally.  In contrast bad workers don’t know what they don’t know. They think they know everything.  Poor PSR workers have an “I’ve going to fix your problems for you” kind of perspective on everything.

I think if one begins to think of oneself as knowing what their client’s needs, it can lead to grandiosity. It can pave the way to all sorts of misuse of power. The seasoned worker who is so confident in his or her abilities that the rules no longer apply, is a danger both to the client, and to our profession at large.

SEVEN:  Self-awareness

PSR workers expressed a deep commitment to awareness of their own life issues. Their self-awareness seemed to center around two issues: (a) understanding and fulfilling their personal emotional and physical needs; and (b) awareness of their own unfinished business, personal conflicts, defenses, and vulnerabilities. More importantly, the PSR workers were well aware of the potential for these issues to intrude upon the PSR session. It is paramount to effective workers to be aware of personal emotional needs and fulfilling those needs through various activities including travel, exercise, spiritual practice, and contacts with colleagues, friends, and family.   The ability to meet the clients’ needs become compromised when workers do not obtain appropriate resources to meet their own personal needs. 

Letter Requesting a Letter of Love or Support…

Love Letter or Letter of Support from a Wellness JournalIn past posts, I have talked about requesting “love letters” or letters of support from family, friends, and sweethearts.  These letters should be added to a wellness journal, to be reviewed when you are struggling with feelings of depression, anxiety and loneliness.   I have included an example of a letter to give to your support person.   Keep in mind that sometimes you may not get your letter back for quite some time.  If you provide your loved ones with the paper and a stamped envelope, you may have better luck in getting it back.

Dear [sweetheart, family member or friend],

I have been working on creating a “Wellness Journal” to help me in treating my depression.    A Wellness Journal is a compilation of self-affirmations, positive memories, goals, tools, and letters from people who love and care about me.   I would like to ask you to assist me on my path to wellness and happiness.

One of the key components of a wellness journal is letters of love and support from people like you, people who love and care about me.   To this end, I would like to ask if you would be willing to write an honest, truthful letter outlining the positive things that you like and appreciate about me.

I will be reading the letter when I am struggling with feelings of depression and loneliness.  Memories and examples are often a terrific addition to the letter.   The letter does not need to be long, but it does need to be heartfelt.   Also please handwrite the letter, instead of typing it; there is something powerful about a hand written letter.

Once again, thank you for helping me to treat my depression and to navigate my path to wellness.

Love,  [your name]

Hopefully this example will help you in requesting letters of love and support from your family, friends and sweethearts.

Keep in mind that this only one part of the Wellness Journal, and is only one step on the road to mental wellness.

Your comments are appreciated

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The Whole is Greater Than Its Parts

Treating depression using wellness journals

Doodle Page from a Wellness Journal

The phrase, “The whole is greater than its parts,” is especially applicable when talking about a wellness journal for treating depression or other mood disorders.   Depending on the individual, a good wellness journal contains about  twenty or more sections or parts.   Each one of these parts by itself is a too. However, each one of these tools has limited use.

You will begin by adding the small “parts” of the journal to create a greater whole. It is only when you combine the parts together that the journal can help you the most.   Each of the separate parts is simple, and on its own, it is easy to discount its value.   It is only when you combine your positive affirmations, your spiritual affirmations, your loved one’s affirmations, your goals and dreams, and your memories that the journal truly becomes something that can make a difference in your life.

By combining all of these positive affirmations in one place, you may begin to recognize patterns of truth in those affirmations. It becomes harder to discount the words of one friend because you have many friends or family members making similar statements.

The next step is to add the wellness journal “part” of your treatment to the rest of your treatment tools in order to create the greater whole of your treatment plan. Depression, bipolar disorders, and borderline personality disorders are not simple problems.   Therefore, the treatments of mood disorders are not simple fixes. Wellness journals alone cannot fix complicated problems. Once you have created a wellness journal, you can start adding this powerful tool to other powerful tools, including medication, spirituality, counseling, exercise, support of sweethearts, and education, among other tools.

As you create your wellness journal, don’t get over concerned about the level of effectiveness of any one part.   Focus on the understanding that it is only one part of the whole, just as creating a wellness journal is but one part in your path to wellness.

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I love organized religion

Las Lajas Cathedral (Image Credit: Jungle_Boy [Flickr])As a therapist, I love organized religion.  It is my experience that more often than not the local Catholic, Baptist, Jewish, or even Mormon churches, to name just a few, are often very beneficial in increasing the well-being of my clients, especially those of my clients who suffer from mood disorders.  Of course, organized religion is not the same thing as spirituality. There are different benefits to be had from a life of spirituality. In this article, I only intend to address the benefits of participating in organized religion.

I do recognize that there are times when individuals have had bad experiences with organized religion.   However, if they have had positive experiences in the past, and if it has been a source of support in the past, I encourage the people I work with to regularly attend a church of their choice.   I see a number of positive benefits to both membership in a church and regular church attendance.

First, individuals who regularly attend church, including non-Sabbath activities such as a women’s group or scripture study, are regularly fed positive messages of hope.   Most churches that I work with tell their members that there is a God that loves and cares about them, and who wants them to succeed and be happy.   Most ecclesiastical leaders have been taught that depression is not a weakness of character or a result of sin and these leaders are increasingly encouraging their members to seek help from appropriate sources.

Secondly, people who regularly attend church benefit from the social support of individuals with like values and beliefs.  Congregations encourage fellowship; attendance becomes a source of friendship and camaraderie.   Belonging to this supportive group helps people who suffer from mental illness to feel buoyed up and less isolated.

Thirdly, when individuals who regularly attend church stop attending because of personal challenges, people notice.   Ecclesiastical leaders and members reach out to these individuals, asking what is wrong and how they can help.   Members do not have to face loss or depression alone.

I would never push religion on anyone, but when I find that someone has found support in organized religion in the past, or who is currently attending, I encourage it.  In my experience practicing a religion can be a valuable tool towards seeking better mental well-being.

I welcome your comments, but please do not post any disparaging remarks about any specific religion.

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Love Letters…

Wellness Journal Love LettersI know that this might initially sound a little bit odd, but I think that it is important to collect love letters when creating a Wellness Journal.   No, I’m not talking about old ones from your high school sweetheart, but love letters from your current sweetheart, your mom, grandma, father, sister, and best friend.

Let me explain by sharing my own experience.  Years ago, during a particularly grey period in my life, my wife wrote me a love letter.  It told me how much she loved me, listing my admirable qualities and telling me how grateful she was for me.  I kept this letter in my top drawer next to my bed and then, when I was feeling down, I would go back and read it.  This became a valued possession.

As a counselor, many times I have listened to my clients as they have told me how they missed the warmth and support of their grandmother, mother or close friend.   It made me realize how nice it would be if they too had a “love letter” from this special person, something that they could turn to and read even when their loved one was not available.

Since then I have encouraged clients who struggle with emotional dysregulation to ask their loved ones to write them a love letter, and to include it in their wellness journal.   I give my clients a couple of guidelines.

1)      The loved one must be permanent.  (Not your current boyfriend that you have known for a week.)

2)      Explain to your loved ones, the purpose of the letter.  Even if they are “skeptical” of our mental illness, they will generally understand the purpose of the letter, and be willing to write one.

3)      The love letter must be hand-written.   It means so much more if it is hand-written.

4)      Get one from your parents, even if you are currently mad at them! (If possible).

5)      Provide your loved one with paper, and a stamped envelope.  (Usually paper just smaller than your journal, so you can paste it in.)

6)      Remind your loved ones regularly.

I have found that this tool is especially effective with individuals with borderline personality disorder, and bipolar disorder.    I usually suggest that my clients try to get two or three letters.

I welcome your comments.

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What is a Wellness Journal, and why should I create one.

Wellness Journal for treating Depression

Wellness Journal

A Wellness Journal is a simple tool which contains coping strategy used by individuals who suffer from depression, bipolar, or other mood disorders to help keep themselves healthy.   It contains about twenty different sections that are created when you are in a good mood so that you can use it to prevent or get out of depression.   It is a tool that does not replace medication or counseling, but augments existing treatments.

A good Wellness Journal is like creating a savings account.  When you are feeling well you contribute to your journal.  Then when you are down, or are seeing warning signs that you may be entering a down you make a withdrawal from your journal.  However unlike a financial savings account, a withdrawal from this account does not reduce your savings.  One entry can be withdrawn hundreds of times.

A Wellness Journal is powerful and proactive yet it is simple enough that anyone can do it.   Even people without depression can create and benefit from Wellness Journals and most people can see how they are beneficial.    Some of the individual parts of the Journal have been well researched to yield positive results, others I have learned about through speaking to other therapists, or through firsthand experience.   A wellness Journal is a constantly evolving tool, which is unique to the individual, and addresses his or her personal challenges.

I encourage my clients to create wellness journals because I want to encourage self-reliance.    I want people to have the tools necessary to succeed without me.   I don’t want them to need me when they are in a crisis.  I don’t want to be their therapist forever.  I want to give individuals tools that help them move on with their life.

Wellness journals are not time consuming, and can be integrated into your daily life with ease.   If working on it by yourself, you can spend as little as five minutes a day writing in it.   If working with a counselor you can spend part of your session each week working on it, in addition to the time spent on your own.   Poor reading or writing skills, penmanship, concentration, or finances are not barriers to creating an effective and valued wellness journal.

When loved ones see your consistent dedication to working on your wellness journal they often recognize your efforts and become reinvigorated in supporting you in your journey towards wellness.  Therefore I recommend that people don’t keep the journal hidden from their loved ones.  It is not something that needs to be hidden from prying eyes, as it contains only positive things.   If someone were to happen upon it they would find nothing that would embarrass you.  My children regularly read my Wellness Journal and comment when I am not following through with things, such as my Wellness Plan.

It is so simple, but so powerful.  In my journey towards wellness my Journal has been an integral part of keeping myself healthy.

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Having depression is like having a pet Zombie … it eats your brain.

Wellness PlanHaving depression is like having a pet Zombie … it eats your brain.

Of course there are a lot of clinical explanations to what depression is, and its symptoms.  It is hard for people who have not experienced depression to understand how depression steels your ability to think.   Depression is like having a pet Zombie. . .  Sometimes it gets out and eats your brain.

When you are depressed it feels like you are thinking in slow motion.    Doing anything requires effort even things that used to be easy.  Talking to people, deciding what you want to do, anything requiring mental ability is just hard.   Crazy thing is that you can still follow instructions, but it makes you angry when you do.   Your sweetheart can tell you to get out of bed, and you can do it.  You can follow instructions but you just can’t think for yourself and you can’t make any decisions.   All options seem bad.   Performance at work and at school plummets often because you can’t decide what to do next, or can’t concentrate on what you are doing.

Sometimes you even physically feel tired or have pain.   It doesn’t make any sense.  You know that you have slept for 9 hours, but you are still tired.  You know there is no reason for the pain, but it is still there.   Over time you get sick and tired of being sick and tired.   You just want to be happy, to be normal like everyone else.   You secretly hate the bubbly woman in the cubical next; talking about everything she did over the weekend.  You could have done all that stuff if you weren’t so tired and depressed, and dang it does she really have to be so annoying.

This is why you need an artificial brain.   You need to have made decisions for yourself when you still felt normal.  You need a Wellness Plan, or a plan of what you are going to do every day to keep yourself working even when you can’t think.  It is a list of everything that you should do on a daily basis, a weekly basis, and a monthly basis to keep working.   It lists things like taking your meds, going to church, calling your sister, seeing your therapist, exercising, everything that you have committed to do to keep yourself working even when depression has stolen your brain.

When you are depressed you simply forget to do the things that you know you should.  The more things that you forget to do, the more depressed you become and the more the situation starts feeling hopeless.  You begin to feel helpless to do anything to get out of your slump and abandon yourself to be ravaged by depression.   A wellness plan is absolutely critical in keeping yourself whole.  So get that Zombie back in it’s cage, and make yourself a wellness plan.

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Creating a Blue List

Wellness JournalsDepression feels like someone came and shoved out your brains.   You can’t think; instead you sit in a stupor, head in your hands, shoulders slumped forward.  All of the energy has somehow been drained out of your body; your arms are heavy and your chest is heavy.   All you can do is sit there and think about how depressed you are.  Sick and tired of being sick and tired.   Despite being hypomanic the week before last you can’t remember the last time you felt happy.  Worst of all, you recall distinctly telling yourself last time this happened that it would never happen again.  You would take your meds, exercise, eat right, and use your coping strategies.   This wasn’t supposed to happen.

You try to think of your coping strategies, the things that you had discussed with your therapist, but you can’t.  You’re too tired to call anyone.  You’re too tired to get out of bed; instead you sit and criticize yourself for how terrible you are, what a loser you are.

This is one of the problems with depression; it robs us of our ability to think, to make rational decision.  It robs us of our motivation and makes us feel hopeless and helpless.  This is a difficult concept for many people who have never experienced depression to understand.

However, there is a strategy that works for many of us.   This strategy makes up part of what I call a Wellness Journal.  In short, we make decisions ahead of time and write these decisions in a positive journal, so that we can use it as our “brain” when our brain is being sabotaged by the illness called depression.

The strategy that I’m referring to is a Blue List.   A Blue List is a list of things to do when we are feeling blue or depressed.   It’s very simple.   When you aren’t depressed, remember you can’t think well when you are depressed, you make a list of positive activities that you enjoy, and write them in your journal.

My Blue List contains the following:

  • Bake Rolls
  • Walk to the convenience store and buy a soda
  • Play on Pinterest
  • Read a book
  • Tinker in the garage
  • Doodle
  • Read my Patriarchal Blessing
  • Go running

Last time my family was out of town, I started seeing my warning signs of problems.  I found myself slipping into depression.   I pulled out my Wellness Journal, turned to the Blue list, and started doing those things that I had written on my list.   I’ve learned from this and previous occasions that you can’t always do everything on your Blue List, so it needs to be diverse enough to help you in lots of different situations, but I have also learned that it can be a life saver.  Each time I used one of those strategies, I was able to make it through another few hours and eventually days, until the hold of depression loosened its grip.

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Gratitude Journals

Gratitude journaling is an important part of treating mood disorders and treating mental health in general.   I was reading a great blog on the subject by  Finding Your Voice by Kimberly Atwood.  Check out her blog…
Gratitude Journaling:
• Write down at least 5 different things you are grateful or thankful for today.
• Try not to repeat items, but if you have to occasionally it’s okay.
• It is really about noticing all the amazing things that happen on a daily basis that don’t seem to get much attention. It also may create a desire to slow down and take advantage of certain things that you wouldn’t usually take time for in your day.
• Examples:
o I am grateful for the fact that I woke up this morning.
o I am thankful for seeing such a beautiful sunrise and taking the time to enjoy it.
o I am grateful for my morning cup of coffee.
o I am thankful for having healthy legs that carry me places all day long.

Kimberly Atwood is a psychotherapist in private practice in West Chester, Pennsylvania. She specializes in working with women in their late teens, 20’s and 30’s dealing with eating disorders, sexual abuse, anxiety, depression, life transitions and personal growth. Please visit www.Kimberlyatwood.com  for more information.

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Wellness Plan

This is the perfect example of a Wellness Plan (A vital part of a wellness journal)….   You have GOT to check out her blog

Taken from http://justhalfcracked.com/

…My therapist and I decided, about a year ago (the last  time I took myself off my meds), that I needed a plan. She suggested a contract. Part of the plan is, if I get that particular itch, I must discuss it with three people, before I discontinue treatment. My people are:

  1. Michael–Of course, as he an integral part of my treatment plan. Also he tends to notice my mood shifts even before I do. This is helpful. Plus, I feel like I have an obligation to stay healthy not just for myself, but for him, too. It’s not fair for me to create chaos in our life together, if I can help it.
  2. My best friend–She’s known me since we were 14, and we are long past sugar-coating things to spare the others’ feelings. She loves me and will give it to me straight, in order to help me stay healthy.
  3. My stepmom–Dona is a beautiful and supportive second mother to me. She used to be a therapist, and will use her magic therapy skills to reign me back in.

The contract also states that Michael is to have my shrink’s contact info, and my preferred hospital (where my shrink has privileges, basically), so that if I ever find myself swallowed up by depression, or unable to make good decisions for myself, he knows who to reach out to.

There is still a big part of me that feels like I shouldn’t have to have a plan. I should be able to handle things well enough on my own. But that is just not realistic. And I need to learn to accept this.

Maybe one day I will. But for now…I have a contract. And a treatment plan that seems to be working…sure, it has a few kinks here and there, but so far, when I’m looking at the big picture, it’s working.”

Anyway, check out her blog, she’s a great example of someone succeeding in life despite mental illness.   http://justhalfcracked.com/

Are you embarrassed to be mentally ill?

Quit it! Just quit being embarrassed about your mental illness! There was a time when I was embarrassed. Now, I have come to realize that accepting one’s mental illness is one of the first steps in recovery. Mental illness is no different than any other kind of illness; diabetes, arthritis, asthma… The list is endless. All of them are biological conditions which YOU DID NOT CHOOSE. No one ever woke up one morning and thought “I think I would like to have depression.” Yet many of us are embarrassed by our mental illnesses.

Well, of course, part of the reason that we are embarrassed is obvious. In spite of continuing education and progress in diagnosing and treating mental illness, significant social stigma surrounding mental illness still persists. The trick is knowing who to tell and who not to tell about your mental illness. It is important to surround yourself by individuals who understand that mental illness is not a result of a poor character, laziness, or a lack of determination.

The second part is more challenging; convincing yourself that the mental illness isn’t a result of something that you are doing or not doing. Unfortunately, many of us feel that we can fix ourselves if we just had enough fortitude, belief, or determination. We cycle, going off our medications, quitting therapy, telling ourselves that this time we have the determination to stay healthy without the “crutch” of a counselor, medication, or doctor. This is our illness lying to us.

Our embarrassment of our illness sometimes leads to premature termination of services. Yes, there is a time and place for quitting medication or counseling, but it is not because we feel that we are sick of being mentally ill, and we are going to be stronger this time. The decision to reduce medication or counseling should be made in cooperation with our therapist or psychiatrist. Reduction and elimination should only occur when we have developed the coping strategies necessary to handle the vicissitudes of everyday life without high risk of relapse. This cannot be achieved without the approval of your therapist. When we have successfully developed these skills, and only when we have developed them, is it time for measured reduction in our therapy or medication.

Premature termination of treatment of mental illness due to our embarrassment can cause the destruction of families, the loss of jobs, loss of friendships, hospitalization, worsening symptoms, and further embarrassment. This leads to the erroneous confirmation in our mind that we are somehow defective, and that we are ill because of poor character. It becomes a maelstrom sucking us into a life of despair and hopelessness.

Most people I work with know I am mentally ill. They know that I have suffered with the embarrassment of my mental illness. Hopefully they know that I have come to an acceptance that I am mentally ill. I cried the day my psychiatrist told me that I would never be off medication. My wife cries every time I hint at the possibility of quitting them.

I welcome your comments.

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Getting to know our own triggers

Guest Blogger: In reading an earlier post about using Red Lists to help those suffering from self-mutilation it reminded me of a similar tool I use in a different situation.  That being suicidal thoughts.

For those who suffering from Bi-polar, uni-polar, or any type of depression knows, one of the recurring things that happen is  that one continuously suffers from experiencing  times of suicidal ideation. Medication is one of the greatest tools that we have to help from having those suicidal ideations in the first place.  However, it is not a panacea, and the suicidal ideations continue to occur, be it at a less frequent scale, and those suicidal ideations are easier to manage.

However, there are some additional tools that can be used to help one manage from slipping into suicidal thoughts. One of these tools is for one to get to know the triggers that can lead to these feelings.  Creating a list of these triggers can help to remind one of the things that one should try and avoid.  Since we all live in the real world, we know that some triggers cannot be escaped from. One of my triggers that cannot be avoided is when family is fighting.  The negativeness somehow seeps into my essence and starts taking me down a negative path. While one can always try to avoid family squabbles, as long as one is in contact with one’s family, it will continue to exist. When something like this happens, I first attempt to extract myself from the situation.  My family members are very understanding since they know that I suffer from depression. Because they see me extract myself from these situations, they are less likely to involve me in them.

Other triggers I have can be avoided, and by trying to eliminate those situations helps to deal with the negative thoughts.  In creating a list, we then become aware of the situations that can start the downward spiral. My list of triggers include the following.

Family squabbles

Being in large crowds

Eating in public

Socializing in settings where there are numerous people

Thinking about Infinity

My list is quite a bit longer than this, but hopefully this will give you some examples. When I am depressed I avoid these things like the plague.  However when I am not depressed, I try to work through these triggers.  When I am happy, I try to eat in public more often. Of course this does not fix the problem, but by working through these triggers when I am in a good mood, it helps me to not react as strongly to the triggers when I am depressed.

Triggers will be triggered, and this is why we need to have a second list.  This list includes things that will help us keep from getting suicidal ideations when we are close, or to exercise ourselves from suicidal ideations. Not all of the things on the list will work every time, but every item should at least have worked once. These should be positive things, and not self-destructive things. My list of helps include the following.

Drinking a Diet Soda

Eating a bar of chocolate

Drinking coffee

Calling my family

Singing to songs (my voice is terrible, but when you are in your own space, who cares.)

Listening to music

Working on physical, easily finished projects.

Again, there are many other items on my list; these are just a few of them. Some of the time drinking a cup of coffee does not help, but then again sometimes it does. Many people advise you to exercise when you are feeling down, and the endorphins will make you feel better.  I am sure that this is true; however I know that I will never go jogging or exercise. That is why you will never see jogging on my list of things that I can do to help to keep away from getting too depressed.

Having these lists in writing is the ideal.  By having it in writing, you first are thinking through the things that can cause you angst, and you can create plans on how to extricate yourself from these situations.  A personal example may be helpful here. If I contemplate the meaning of eternity it can freak me out, and put me in a terrible place.  So first, If I start thinking about it, I attempt to banish it from my mind.  This works quite well for me.  However the times that I am not able to keep from contemplating it, the second list is a godsend.  In a situation like that, my favorite thing to do is sing along to music.  It takes my mind away from those thoughts. It generally works, however if it does not, I have other things on my list that I can try.

Sometimes all we can do is to get through a situation.  Yet getting through a situation and coming out the other side is a success. I do not always succeed at not becoming suicidal, yet the more I use these lists, the easier it becomes. Those of us that have mental illnesses will always have to deal with suicidal thoughts, however by using lists, and knowing our triggers, it can help us to not follow through on our negative intentions.

Red List: What to do if I feel like self-injuring

When I ask my clients to create a Wellness Journal to help treat their mood disorder, I often ask them to include a “Red List.”  The red list is different dependent upon the client.   For individuals who have anger issues, the red list is things to do when they are angry.  Likewise for anxiety.   However for many of my client’s the red list is what to do when they feel urges for self-inflicted violence, most commonly cutting.

I worked in the Emergency Department of a local hospital for five years during which time I learned that many professionals do not understand the urge for self-injury.   The advice they give is frequently horrendous.   Often well-meaning medical staff treat “cutters” with cruelty.   They can be cold and distant when treating self-inflicted cuts.   I unfortunately have seen physicians staple or stitch up cuts before the numbing shots fully are in effect.  Worse than the physical pain they cause is the emotional pain, making the individual who has inflicted self-violence to feel belittled.  I have also been fortunate to see that with a little education these same professionals can be kind and understanding to “cutters.”

My experience in working with individuals with urges for self-inflicted violence or cutting is that more than anything they need love and understanding.   The first step is to plan in advance.   I encourage the creation of a red list, or a list of what kinds of coping strategies can they implement when they feel overwhelmed and want to self-injure.   I remind them that cutting is a coping strategy…. not one that I encourage, but indeed a coping strategy.   Instead of putting down their coping strategy I want them to find better ones.

Many times the urge for self-inflicted violence is paired with depression and anxiety.   Unfortunately depression seems to cause memory loss and we completely forget our coping strategies.   This is why a red list is so valuable.   In the list we have written down advance instructions for ourselves.   Unfortunately there is no “one size fits all” list.  Each person must create their own list.   Also unfortunately we usually discover what strategies work and what strategies do not work through trial and error.  This is why it is so imperative that when someone we work with, love or care about does self injure, that we do not put them down.   They did not fail, but just found another coping strategy that didn’t work, and now it is time to work on finding some new, better ones.

So…  What is on your red list?

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Gratitude List: an integral part of a Wellness Journal in Treating Mood Disorders.

Wellness JournalsCreating a gratitude list is a key component in Wellness Journals. Creating a gratitude list forces the individual to start looking for and seeing the positive. Journaling gratitude creates a paradigm shift for the individual. When creating a gratitude list, there is only one real rule… it must be positive. I also suggest that people avoid repeat things, but this can be very difficult. On numerous occasions I have read back in my gratitude list, and found repeated entries.

There are impressive benefits to writing down things that you are grateful for including greater physical wellbeing, mental wellbeing, less depression, reduced anxiety, and a more positive relationship with family and loved ones. I recommend to my clients that they come up with at least three unique things each night that they are grateful for.

In my experience it is easier to do this if you add the activity to an already established habit. I have had good results in suggesting that individuals with spiritual beliefs write in their gratitude list each night before saying their evening prayers, including the things that they are grateful for into their prayers. Alternatively I encourage those individuals who regularly mediate to write in their journals before meditating. Look for some activity in which you engage on a daily basis, it will make remembering to write in the journal easier. It does not matter what time of day that you journal what you are grateful for. Whenever is easiest for you.

Remember not to get too picky about spelling, grammar, and how your handwriting looks. It is more important that you do it. Some studies have shown that doing it two or three times a week is as effective as doing it every night, so don’t worry if you forget a night.

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