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.
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.
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
- 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
- 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.
In my last post, I mentioned writing a book. And I decided that I don’t need initials after my name to be an expert – particularly since it’s my story. Who knows it better than me, besides God? (“You saw me before I was born. Every day of my life was recorded in your book. Every moment was laid out before a single day had passed.” Psalms 139:16 NLT)
Ted first suggested it, many years ago. He said it during several of our therapy sessions. He thinks “I have a book in me.”
While living in Florida, my then-therapist Elizabeth told me that she, too, thinks I should write a book. She said it almost every time she saw me – that I should write it all down. And she’d buy it!
Carol and Anne and Stacy have been encouraging. So has Jane. Even Dad a little. I have support from several friends who think I could do it.
From where will I get my story? I began journaling consistently in March 2008 – right at the beginning of my depression journey. And I wrote lots! Some days I wrote several times throughout the hours, especially when I was in the depths of the darkness. How do I even begin to sort through them? I’ve developed a color-coding system with 3M sticky arrows, to highlight different entries I wrote that might be significant to outlining the book. Now to read through all 17 journals and flag them appropriately!
I also began to write email summaries of my appointments with Ted, often with questions for clarification, and I kept a copy of most of them. I wrote in Docs at work when I didn’t have my journal, so I have those notes. And finally, I joined WordPress to try blogging. Maybe I should print out these things and flag them as well.
I can add to this what I learned when I facilitated the depression support group at my old church. My friend advised when I shared with the attendees, I should simply start with my current situation. “Start with where you are.”
So, is that what I do if I want to write a book? Start with where I am now? Or start with the beginning of the journey? How will it be different from blogging? How do I know to whom I’m writing – who is my audience?
I’d like to write a memoir or devotional of the time of my life when I first experienced depression, up to present-day struggles. To explain to Christian women with depression (there’s my audience) that it’s possible to have hope in Christ in spite of having a mental illness. That I am not my depression – I’m a beloved daughter of the King, and so are they. I want to offer them this hope, as I found it in my journey through the desert of depression.
There are many tools and organizations available to me to help me write this book. A friend of mine just recently published his first book, and he recommended a writing program. Perhaps I’ll use one of those to keep me organized and on-task, and to give me regular feedback in the process. I took a one day writing workshop a few months ago – I need to get the workbook out and finish those exercises. They’ll help me be disciplined, too. Perhaps these tools can give me an idea of the order in which I tell my story.
No matter what, I think I know what my next adventure is. Let the writing begin!