Email to an old therapist

I’m not sure if I’m going to send this email. I don’t want to bug you. But I started to write it last night as I was going to bed, and it stuck with me until morning. So here it is. 
We move across the country in five days. I’m still excited, and have peace of mind about the decision to move. That’s what we always pray – for God’s sense of peace in our decisions. And we have that. 
I didn’t think I’d feel anything about leaving VA. But I’ve had an impact here – in bringing and starting and leading the Fresh Hope group (support group for those with mental health challenges and those who love someone like that – freshhope.us), and in my volunteering at the Daily Living Center (adult daycare). Both groups gave me farewells this week – they said very affirming and humbling things. I’m really going to miss the friendships and the leadership opportunities that they afforded, as well as the relationship aspects. I’ve said goodbyes to friends at church – did I even know I had friends at church?!
We’re going to a farewell dinner tonight – with people my husband used to work with, and my two other friends here. They’re not long relationships like I had in WI, but friends nonetheless. Which is more than I’ll have when I get to CO. I know some people there, so it won’t be a completely blank slate. But the pressure is on me and me alone to make friends – there’s no job or kids to provide an introduction into a new situation. 
You know me and change – I always find it hard. And I’ve had to move so many times in my adult life. Each move has begun with a mild depression, except the one that started my entire journey with depression – that one was deep and dark and long. That move, which should have been simple since I was moving back to a place I had lived before, was the impetus for years of the battle with depression. Of course, if it hadn’t been for that, I never would have met you. And you counseled me through all those years to a healthier me, for which I am forever thankful.
Seems my thoughts always turn toward you, and the safe place of your office, sitting slouched on your couch, when my mood is down. And despite my excitement for the move, my mood was down last night and this morning. 
I’ve really liked my most recent therapist – she understood me quickly, though we didn’t go through depression together. I’ve said goodbye to her, but she’s offered to counsel me if I need her before I find someone out there. Until her, I feel like I’ve never really had anyone besides you, so this is new. Maybe it means I won’t call you in distress, if I have distress. Will I have distress? I’m trying not to assume so. 
Anyway, I wanted to touch base, as I always do when I’m facing change. So maybe I’ll hit send after all. 

Scary thoughts

“For God has not given us a spirit of fear and timidity, but of power, love, and self-discipline.” ‭‭2 Timothy‬ ‭1:7‬ ‭NLT‬‬

I’ve been having flashes of fear. Sudden bursts in my mind of catastrophic situations. It’s been going on for a month now.

Several weeks ago, I was in town with my daughter; we were in her car running errands, and I had a flash of being broadsided by a black truck. The glass was shattered and flying, the car was crumpled and spinning. Like slow motion from a movie scene. I was shocked by how vivid the picture was – like a daytime dream.

And like a dream, I came back to reason and shook my head. I then quoted the above verse to myself.

Today, I needed to run to a doctor’s appointment, and my husband was on the phone, working from home. It flashed across my mind, as I walked into the garage, that I hadn’t kissed him goodbye, and what a shame that would be if I died while I was out. Again, I shook my head and quoted part of that verse: “we have not been given a spirit of fear…”

Those are the two examples that stand out the most starkly in my mind, but I know there have been more, because I’ve quoted this verse to myself nearly a dozen times in the past month.

I’ve had nightmares lately, too. The kind where I wake up in a cold clammy sweat, afraid to get out of bed, in case the monsters are real, and afraid to close my eyes again, lest I fall back into the scary dream. I reach over to be sure my hubby is there, and I try to focus on his breathing, inhale and exhale. I wake enough to realize I’m safe, then pray my way back to sleep.

What is this? Why the sudden fear?

It started in a joyous time – celebrating family and friends at a wedding. Am I dreading the future of what might befall my loved ones?

I’m in the process of moving across the country. Am I fearing the isolation of being alone?

My mom was very sick this Spring. Am I afraid of the past repeating itself?

The last time I had major catastrophic thoughts, I was badly depressed. I’ve determined that I’m not headed there again!

Actually, it probably doesn’t matter what it is. Or even why it is. Because God’s truth is still truth:

“For God has not given us a spirit of fear and timidity, but of power, love, and self-discipline.” ‭‭2 Timothy‬ ‭1:7‬ ‭NLT‬‬

I need not fear nor be timid. I have the power of the risen Christ in me (Ephesians 1:19-20), I am surrounded by God’s love (Romans 8:39), and I can be self-disciplined to take every thought captive to Christ (2 Corinthians 10:5), even the scary ones.

Wellness Plan – Wrapping It Up

I’ve now written several blogs about my Wellness Recovery Action Plan, or WRAP. And it’s time to finish off this series.

The next two sections of the WRAP plan are entitled “When Things are Breaking Down or Getting Much Worse,” and “Crisis Plan.” I’m lumping these together because both point to severe symptoms, and the potential imminence for a relapse of my depression.

According to Wellness Recovery Action Plan (Advocates for Human Potential, Inc., copyright 2018), “sometimes, even when you’ve been making your best efforts to stay well, things can get a lot worse. Some people call this a breakdown, a setback, or a relapse….often your behavior changes so much that other people can tell something is wrong…Taking immediate action can make a difference in the outcome.” In fact, I might be able to avoid the Crisis part of my plan if I can successfully turn this situation around.

Some of my key indicators that things are getting much worse include that I am staying in bed, isolating. I feel anxiety and a heaviness in my chest, an urge to drive fast and recklessly, a desire to smoke e-cigarettes (I’m a non-smoker). I may have increased trouble concentrating, which was also a red flag in my Early Warning Signs.  But in this case, it would be worse. I’d be feeling like a burden to everyone around me. I may have the desire to self-injure or have suicidal thoughts (called suicide ideation – thoughts, but not a plan), and I’d find myself unable to pray. I’d dread the future and ruminate on the past. I’d have flat affect – expressing very little emotion.

So what do I do if things get much worse? First thing – tell someone! My husband, sister, or close friend. Call my therapist and psych doc right away. Reduce caffeine – drink herbal tea instead of coffee – and sit in my glider, which I find very calming. I would try to Face Time my old therapist – he can often “talk me down.” I think I’d call in my second round of support – three other close friends who I know love me and would offer me encouragement and prayer. Perhaps, if these steps work, a relapse would not occur.

The Crisis Plan portion of the WRAP is designed to make it as easy as possible for people to help me, because if I am in a depression crisis, I might not be able to make my own decisions. It outlines who I want to help me – by name – and exactly what I want them to do for me. Things like get me to the hospital emergency room, sit with me, hold my hand. And what I don’t want done, like what medicines I can’t take. It even outlines my daytime and household responsibilities and who will do them, like care for the pets and pay my bills and contact and keep my prayer team updated.

After the crisis has passed, the Post-Crisis Plan is implemented. It’s a brief section of the WRAP where I identify things that worked in my WRAP Plan, and things that need to change. Perhaps there are people I need to thank for their help in my crisis; perhaps there are apologies or amends I need to make as a result of things I said or did during my crisis.  This final portion of the WRAP allows me to step back into the responsibilities of my daily life, slowly, as I begin to return to my normal level of wellness. This may take time – crisis recovery is not immediate, and I will need to be patient with myself. But this is a good time to evaluate and make changes to my WRAP, as I can see what worked and what didn’t. Because post-crisis can be very introspective, it’s a good time to modify my WRAP to include stressors or early warning signs that I may have missed before. I can add to the Crisis portion of my plan while it’s still fresh in my memory – what additions do I need to make so that, heaven forbid, things go more smoothly the next time?

Ultimately, the goal of the WRAP is to help me avoid a depression crisis – to identify those markers ahead of time to avert another hospitalization or emotional break down. Because this plan is so thorough, I may be able to stay in remission for the rest of my life.

Wellness Plan – Early Warning Signs

The next step in the WRAP Plan is to list the signs that indicate I need to take action before things get worse. They are changes in the way I think, act or feel, so they are observable, either to myself or others.

This section of the Wellness Recovery Action Plan requires that I face my fears about the initial red flags which indicate an episode is possible. It’s more than just Stressors; it’s actual changes in my thinking and behaving. This is a key part to the WRAP – to recognize these signs as serious and do something about them before they get worse!

These are behaviors or attitudes that point to a potential problem – perhaps a descent into a mental illness episode. For me, indicators include things like listening to my music really loud – perhaps to drown out my spiraling negative thoughts. I apologize a lot, and have excessive guilty feelings. I have a strong desire to speak to my old-time long-term therapist, Ted. I find it hard to concentrate, even for a short TV sitcom. I begin to think “What’s the point?” which is an elusive question, as I don’t define “it;” I guess I just feel fatalistic. I desire to be alone with my self-blaming thoughts. I have trouble making decisions, feel easily overwhelmed, and have a lack of energy.

The Wellness Recovery Action Plan book (copyright 2018) suggests that I review this list of early warning signs regularly, perhaps even daily, so that I become familiar with them and can respond before things get worse. A list like this can be an inventory of emotions and behaviors to note. If I am experiencing several of them, I need to ask myself what’s going on, and why I’m feeling out of sorts. And I need to put the next part of my Action Plan into place.

The wellness tools I will use if I see these early warning signs are:

  • Tell my husband, sister, and friend
  • See my therapist
  • See my psych doc
  • Listen to my music playlists that are encouraging and uplifting
  • Have a coffee date with a friend
  • Rock in my glider
  • Try to interrupt the spiraling thoughts with the truth of God’s Word
  • Email, maybe even FaceTime, my old therapist.

Other actions might be to take a walk, or do some stretching exercises.

In the future, I might make this into two lists – one of actions I must take, and one of actions I might take, when I observe these early warning signs. And I can always go back to my Wellness Tool Box and pull activities from there to help me avert a depressive episode.

Wellness Plan – Stressors

If you’ve been reading this blog lately, you know I’ve been working on my Wellness Recovery Action Plan – WRAP. I invested in the guide from Mental Health Recovery – it gives more explanation, details and examples than the WRAP app did. I’m really glad I bought the book – I’ve found it very helpful, and have added to my Wellness Toolbox and the next step in the process, The Daily Plan.

The Daily Plan is an outline of what I look like – my moods and attitudes – and what I “do every day to stay well and stay on track with my goals.” (Reference: WRAP app) It includes an outline of a typical day of wellness. It was fairly easy to write.

The Stressors section was much more difficult. Stressors, sometimes known as triggers, are “things that happen that can cause a reaction. Sometimes they are reminders of specific events, or they may evoke a feeling that takes you back to a time when you felt helpless, scared, or out of control.” (Reference: Wellness Recovery Action Plan – Renewing Your Wellness Your Way, copyright 2018)

The first step was to write down “things that might make me feel unwell or throw me off track if they happened” (Reference: WRAP app) and just the question sparked anxiety in me. I started with a list of five stressors – certain times of year, when my husband travels, when my meds stop working, grief, and major life transitions. But as I worked on this section with help from the book, I came up with seven more. That’s a total of twelve potential stressors! Argh!

Thinking of these stressors was difficult – indeed, it caused a stress reaction in my body. Heart racing, shallow breathing, a lump in my throat. I put the list away several times to take mental breaks from it – had to calm down before I came back to it.

Working on the relief to those stressors brought relief to my physical reactions. Again, originally I had twelve stress relievers, but with the help of the book and deeper consideration, I came up with a total of 22 tools to use when stressors hit my life. Things like walking around the block, savoring a cup of tea or coffee, reading fiction, sitting in my glider, practicing deep breathing techniques, writing in my gratitude journal. These are good wellness tools to add to my mental health toolbox.

I know the process of writing the WRAP will continue to be difficult. The next two sections are When Things Are Breaking Down or Getting Much Worse, and Crisis Plan, which first caused me anxiety when I read about it. And while the point of the plan is steps toward mental health, it’s anxiety-producing in the process of writing it. But I’ll take my time and persevere, because I’m sure the end result – my personalized detailed wellness tool – will be worth it.

Post script – in an effort to be transparent and maybe helpful to someone else writing a WRAP plan – here is a complete list of my stress relievers:

  • See therapist
  • See psych doc
  • Tell husband, sister, and friend that I’m struggling
  • Nap
  • Walk around the block
  • Dance
  • Savor a cup of tea or coffee or mocha
  • Journal
  • Pray
  • Watch Netflix
  • Read fiction
  • Coloring books
  • Knit
  • Listen to playlists (I have several made for my “moods”)
  • Gratitude journal
  • Tell folks at Fresh Hope support group and ask for prayer
  • Coffee date w/friend
  • FaceTime w/my kids
  • Take a break from obligations (work, volunteering)
  • Practice deep breathing, relaxation techniques
  • Rock in my glider
  • Have a date with my husband
  • Take a trip to see the kids