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 Toolbox

The first step in writing my wellness plan is determining the helpful steps I already have in my daily life. When I am healthy, what is it I’m doing to make me that way? What are my day-to-day activities that signify health and wellness for me? “What things do I already do to help myself be well, stay well, and live in the way I want to live?” (reference: WRAP Plan app)

This toolbox of activities is critical to my Wellness Plan, as I’ll draw from this list at different stages along my path from wellness to illness and back again. When I feel stressors, or triggers, that might signify a depressive episode is coming, what can I do to alleviate it? Are there any tools in my toolbox that I can pull out and implement to avert an episode?

If I’m further down the path toward depression, and an episode is imminent, which activities can I use to lessen the severity of the episode?

If I’m on my way out of a depression, which tools will I use first to help me post-crisis?

My initial list was 14 wellness tools:

  • time alone with God in Bible reading and prayer (TAWG)
  • taking my meds
  • journaling
  • eating well
  • good sleep hygiene
  • spending time with friends
  • sufficient down-time
  • seeing my therapist regularly
  • keeping my psych doc appointments
  • blogging or writing
  • taking naps
  • reading
  • watching movies
  • Fresh Hope Support Group

But as I thought about steps I can implement in a pre-crisis, I realized I have several more tools, even though I’m not currently using them. Things like savoring a cup of tea, or coloring, or taking a walk in nature. I certainly need to tell my support team that I’m struggling, so they can help me watch for warning signs.

One thing I’ve learned about depression is that it clouds my thinking. I can have this wellness toolbox, but in the midst of a crisis, I’m paralyzed and don’t know how to get out of it. That’s the reason for writing a wellness plan when I’m mentally healthy: so when I’m not thinking straight, I can look back and see what I recommend to myself.

I intend to share my wellness plan with my support folks (husband, sister, therapist, friend) so that they can help me remember to reach into my toolbox when I need to. As soon as I’m done writing the whole thing, I’ll pass it on to my care team.

On the mend

I met with my psych doc this morning – a follow-up to last month’s med increase. I scored a 4 on the PHQ-9, which is still mild depression, but better than last time I saw him.

I told him that I could tell I was on the up-swing. I’m not feeling hopelessness anymore. My husband and I are dealing with a major life event, and it didn’t send me plummeting; I’m handling this stressful situation without succumbing to great distress.

I’m able to track a whole Netflix show – that’s improvement. I’m reaching out to relationships again instead of wanting to isolate – I joined a women’s Bible Study. I haven’t gone back to volunteering, but I hope to soon. I’m sleeping through the night again, instead of the 2-hour-middle-of-the-night insomnia.

I’m still struggling to concentrate when reading. I’m trying to follow Noom, but can’t seem to stay in my calorie allowance, so I’m a bit discouraged at my lack of self-discipline. That’s an improvement, though; before, I didn’t care.

I’ve mentioned my new therapist and our difficulties in timeliness. But I’ve decided that I really like talking to her, so I’m just going to build in some extra time around our appointments, knowing there will probably be some delays. It feels good to have that decided.

My husband and I have some major changes coming up in our near future, and I need to manage those with gentleness. I’ve asked friends to pray, and we’re following God’s direction for our next steps. I know that if I’m seeking His will, He will direct our path. Today’s blog post from Fresh Hope was very timely – about managing a mental health diagnosis in the midst of change. Just what I needed to hear. Thank You, Lord, for those reminders.

Wishful thinking.

“Just pray harder.”

“Why don’t you take a walk in the sunshine?”

“Count your blessings!”

“There are so many who are worse off than you.”

And my mantra: “This, too, shall pass.”

All of these are perhaps well-intentioned, but unhelpful pieces of advice for a depressed person.

I can’t think myself out of depression. Though this time I really tried.

Each day, I answer a mood question, “On a scale of 1-9, how’s your mood?” And when I’m in a healthy mental state, my mood runs at 7 or 8. (9 and 10 are reserved for “extremely good” and “exceptional,” which usually happens when my husband and I are on an adventure or my whole family is together.)

Shortly after Christmas, my mood started running at 7 and 6. Then it dropped down to 6 and 5. Then it was solid days of 5.

I felt like I was handling 5. I didn’t see it as concerning. I was still going to my job, my volunteering. I came home and was tired, but that’s not unusual – it’s the middle of winter, so of course my mood is down a bit.

I started having trouble sleeping – waking at 2am or 3am for a couple of hours, night after night. I wrote it off to being in my mid-50s, that time in my life, etc.

I stopped reading my books, including ones I had been excited to devour. I couldn’t concentrate. And some of the Netflix shows we watched didn’t hold my attention for the entire hour. I’d get up and get a snack: “No, don’t pause it; it’s ok; I’ll be right back.”

I told my friends that I was fighting depression. And I thought I was. But in reality, I wasn’t doing anything but letting it take me further down the tunnel.

I thought it would go away. I thought I would bounce back. For six weeks I let it push me deeper and deeper, but I kept denying it. Or at least minimizing it.

The thing about depression is – my brain is broken during an episode. I don’t think clearly. So I couldn’t see that depression wasn’t going to go away by itself. Even though I know better, I somehow thought that I could will myself out of depression.

I told my husband that if my mood dipped to 3, I would see the psych doc for a med adjustment. And my mood dipped to 4, for several days in a row.

At the same time, I caught a bad head cold, so I continued to “write off” my mood – this time because I wasn’t feeling well.

And then, I tanked. My mood hit 3. I left a message for the doc that I needed to see him.

On our way out of church Sunday, my husband encouraged me to not beat myself up for taking so long to see my psych doc. He reminded me that I gave myself parameters, and I abided by those guidelines: mood = 3 means call for a med check.

I admitted that I am beating myself up a bit. I know better! I know depression doesn’t go away by itself. But he’s right – I did what I said I would do.

I met with the psych doc this morning. He doesn’t want me to plummet (too late), so we’re boosting two of my meds. And because I took my fine sweet time getting in to see him, I’m going to be on these adjusted meds for several months. Hopefully, it won’t take that whole time to begin to feel better.

It is true: “This, too, shall pass.” But not without a helpful push from the doctor.

The role of therapists in my life.

from my therapist’s office

My first therapist was Bill, and I saw him a few times when I was in college. I distinctly remember visiting him before I graduated from school. I was moving back home for some surgery, and wanted his help in learning how to navigate old communication patterns. The tools he gave me were very useful as I adjusted from independence to needing help. I was grateful for the techniques I learned, and I think it made my stay at home a smooth one in an otherwise difficult time.

Ted was my next therapist, about 20 years later. I first started with Ted in April 2008. His practice was recommended to me by someone at the church office. I dialed three times and hung up before I finally let the call go through and scheduled the intake appointment.

I remember “clicking” with him almost immediately. Good thing, because I was in desperate need of someone to help me with my jumbled emotions. I was in my mid-40s, we had just moved back to town, and I had expected to pick right up with old friendships and circumstances. But instead, I was feeling incredibly sad and couldn’t shake it. I tried, but was unable to explain to my husband what was wrong. I could only cry. We both agreed that I needed to talk to someone.

So Ted has been with me from the beginning of my depression, which started that summer, and for all the years since. He was with me through the very worst. When I was at my lowest. When I didn’t think I could go on living. Through my hospitalization. He helped me through the trauma and drama of deep depression, during the days when it was overwhelming and suffocating. He helped me navigate through the darkness and slowly back into the light. And he did this several times as I repeated my depression over seven years.

Ted knows me so.well. Maybe even better than I know myself. He can take the words I say and make them make sense. He finds the thread between my random thoughts, puts order to them and gives them back to me. And he’s done this for me for years.

Ted has served as my coach, as my educator, as my mentor, and as my confidant. I didn’t share with him in place of sharing with my husband, but he helped me to formulate my thoughts in a way that my husband could receive them. So that I could say what I wanted my husband to hear, instead of getting lost in my emotions or randomness. He always pointed me back to my husband.

Ted’s a Christian, and he prays for me at our appointments. He helped me sift through the spiritual battle versus the mental illness, and reminded me regularly that Christ is with me in my depression. He was the first one to really help me see Jesus standing alongside me as I struggled to fight for my mental health.

Ted helped me navigate some difficult memories. He worked with me on abandonment fears. He let me sound off about things that made me angry and helped me learn to express anger in a healthy way, instead of squelching it like I used to. He pointed out my faulty thinking, and gave me a different story than the one I was telling myself. He challenged my all-or-nothing thinking. He showed me that I speak to myself in questions, and I “should” on myself a lot.

I remember one time in particular when he really pissed me off. It’s when he pretended to be me. He told me everything I was thinking, including the things I hadn’t said out loud. I was so angry! Or maybe I was just afraid, because I had been vulnerable enough for him to see through me, to know the way I think and how I form my opinions and thoughts, and he nailed it!

I don’t worship him, nor would he ever let me. But I do have a really hard time finding a therapist, because everyone gets held up to the measuring stick of Ted. And they often fall short. It’s not a fair comparison, I know, because they don’t have the years with me like he does. So of course they don’t know me like he knows me, which puts them at a huge disadvantage when I start comparing.

I found a Christian therapist when we moved to Florida, and she was kind and gentle and accepting. I drove 40 miles one way to see her, and it was worth it. She helped me through the grieving process of relocating, and together we navigated a depressive episode with faith in Christ as my healer.

I’ve tried three therapists here – one was a hit for a little over a year. We just “broke up,” as she is moving to her private practice and I’m looking for a Christian counselor.

But I know that I’ll always have Ted. He’s promised me many times that he’ll always “be there” for me, and he always has been. I haven’t needed him as much as I used to – I’ve found these other therapists over the years who have been helpful. But I suspect I will always reach out to Ted in my depressed moments, for just a word of understanding from him to ease me through the darkness again. And he’ll point me back to my husband, and remind me that Christ is with me.

Now that’s a good therapist!