Tag Archives: therapy

My Fight with Anxiety

I have been in a constant state of anxiety for several days now.  My heart and thoughts are racing, I’m grinding my teeth, my sleep has been broken, I’m irritable and I can’t stop catastrophizing every situation I think about.  The most worrisome part of my anxiety is that my hallucinations are working overtime.  Not only am I hearing my ‘people’ (voices) again; I am also dealing with moderate visual hallucinations.  All I want to do is escape and find a quiet place where the world can’t touch me and I can curl up in a ball and be left alone.  I don’t want to deal with anything right now and I don’t want to face any of my fears.

The voices I experience have been with me as far back as I can remember.  The best way I can describe them is that one is a male and one is a female and they sit at the base of my brain just waiting to make life difficult for me.  They don’t have faces or anything like that; the way I see them is as silhouetted heads something like this…

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They are always there facing one another but I never see their lips move when they talk however I can always tell whether it’s the male or female communicating with me.  My voices never tell me to harm myself or others or do things that I normally wouldn’t do; they just like to have an input into my thought pattern when I’m stressed, anxious or overwhelmed.  We do have two-way conversations but no one would ever know this just to look at me.  The dialogue only goes on inside my head and my lips only actually move from time to time.  It sounds funny but that’s how our relationship is.  No, I am not psychotic nor do I suffer from any sort of schizophrenia.  I just experience these voices because of my bipolar disorder and my anxiety.

My visual hallucinations are not as significant as my voices.  Basically I see things move and run across the floor or dart across my field of vision.  I see things with my peripheral vision that aren’t there but I still turn to look as though they are as a knee-jerk reaction.  I have trouble with my visions, too, when I’m stressed and overwhelmed or when I’m overstimulated like I tend to be in the grocery store or large department stores.  All the colors and images and different sounds and smells make it a chore for me and it becomes nearly impossible for me to concentrate in this type of environment.

I can start feeling anxious out of the blue, however I have learned over the course of my mental illnesses to identify certain situations that may make me anxious.  I don’t like to be around a large group of people whether I know them or not.  It’s not so much the people but the barrage of images and movements that make me anxious when I’m around a lot of people.  I can also be anxious in a small group of people if I don’t know the people in the group.  Unlike a large group, I can get to a point where I’m relatively OK in a small group once I get to know the other people though I still experience some anxiety.  New situations or how I perceive a new situation might go are two more times when I will experience a lot of anxiety.  I have to use a lot of self-talk when I’m going into a new situation so that I can get to a point where I can still function.  This is a fairly common situation for me seeing as new experiences are a part of daily life but because of this I’m often preoccupied and inside my own head.  I get anxious when I have to make a phone call I’ve never made before, opening new mail, driving to a destination I’ve never been to, watching the news on television and even praying.  I know right; yes, praying can cause me a great deal of anxiety.

It would seem that it would be easy to combat my anxiety if I know when I might be anxious or I can identify it when it comes but it’s not that easy.  Having anxiety and being aware of it doesn’t make it that easy to deal with.  Life would be so sweet if I could just identify the anxiety, label the source of it and then take the necessary steps to make it go away.  NOT!  It doesn’t work anything like that.  For some years I was on Xanax to help combat my anxiety however that was the worst thing that a not medicated, bipolar alcoholic/addict with borderline personality disorder could possibly do.  When I made the serious decision to get sober and deal with my mental illness I had to make the decision to go at my anxiety from a different direction.  Now I use both CBT (Cognitive Behavioral Therapy) and DBT (Dialectical Behavioral Therapy) tools to combat my bouts of anxiety.

The tools that I have been taught are not foolproof however they do help me to get a better hold on my anxiety when it comes.  I still shy away from many people and situations because of my anxiety but, at least now, I know that I can get passed it when I’m ready to.  I say ready because no matter how hard I may try to combat anxiety in any of its many forms, unless I’m ready to face whatever situation is giving me anxiety that anxiety will still be there.  Anxiety keeps me from experiencing many things in life that I’m positive are probably pretty amazing and I want to be a part of any number of them however my battle with anxiety will be ongoing and on my terms.  I just have to be patient with myself and that’s the best I can do.

 

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Running In Place

My bipolar disorder causes me to experience something called racing thoughts.  Actually, racing doesn’t even begin to define what my brain is doing every waking moment of every day of my life.  Even when I say I’m going to lie down for a bit and rest or take a nap my mind is still racing.  I have racing thoughts while I’m showering, while I’m cleaning, when I’m feeding the dogs even when I’m talking on the phone.  My mind and thoughts are always racing and it gets to be pretty damned exhausting.

My racing thoughts make it hard for me to complete tasks despite how sincere my intentions are to finish them.  I can’t even begin to count the number of projects and personal commitments I have on my plate right now that are only half done because of my racing thoughts.  It doesn’t help that there are some things that I must do every day no matter what; record blood glucose readings, record what I eat, complete DBT diary cards, take my medication, I could go on but that’s enough to get an idea of what my day is like and to see how all of this contributes to my racing thought issues.  Just having to do these things daily is enough to send me into a tailspin of racing thoughts and it would seem that this would be enough for me but it never is.  In addition to the things I do daily I am always taking on more and more tasks to do, sadly many of them go unfinished.   Right now I have a half-finished blanket I’ve crocheted, I have my first novel that I started editing sitting unfinished, without finishing my first novel I’ve already started on my second one, I’ve been working on a book of short stories that consists of two undone novellas, and so on and so on.  I really do want to finish all of these things unfortunately my racing thoughts and mind only let me get to a certain point and then it seems that I just run out of steam.

It’s funny; you would think that a racing mind would be conducive to finishing things but, quite the opposite.  My mind races so much and so often that when I try to do something the myriad of musings that bombard me constantly has me throwing up my hands in frustration rather than crossing the finish line over and over on a regular basis.  Sometimes I just sit looking around in a stupor because I don’t know where to begin trying to tame and satisfy the constant buzzing in my brain.  Now everyone gets a little overwhelmed from time to time having things to do but nothing compares to true racing thoughts.  I have even tried using daily planners, hourly planners and setting alarms on my cell phone to try and make some sense and put some order to my racing thoughts but, often, this tends to have the opposite effect.  I get so worked up trying to stay on task or being on edge knowing that one of my many alarms may be going off at any moment that I find myself abandoning one thing after another out of sheer anxiety.  This just makes my racing thoughts move that much faster.

Racing thoughts are frustrating to me because they make me that much more distracted in general.  Already battling against myself to stay focused, racing thoughts make staying on point a Herculean task.  I have a hard time watching a movie or television program, reading, writing, holding a conversation to name only a few things that my racing thoughts interfere with.  Life is hard enough with all that we are told to like, buy, do, see, acquire, listen to and such but pair this with chronic racing thoughts and the world is a rambling chasm of constant overstimulation.  A lot of the time I wish I could just put my hands over my ears and close my eyes and make it all go away, unfortunately that wouldn’t help to calm my racing mind.  I’ve only found a couple of things to help me with this; medication and working on mindfulness.

Since I take medication for my bipolar disorder I already have a tool available to me to help quell my racing mind.  Another tool that I’ve learned I can have at my disposal, if I work at it, is mindfulness.  Mindfulness includes a lot of different things such as meditation, focusing on the moment, experiencing my feelings without judgement and, most importantly, working with one thought at a time.  This is not something that is a quick fix; I have to constantly work on being mindful so that I can gain some sort of control over my racing thoughts.  Under my breath I’m constantly telling myself to focus, sit still, do one thing at a time, finish this first, stop moving around and the list goes on.  At this moment, I’m trying to write, listen to a program on the National Geographic channel, absorb the smell coming from a fragrant candle, get ready for a visit from a longtime friend, drink a cup of hot chocolate and watch the birds eating bread outside my window; all this going on as a result of my racing thoughts.  Needless to say my focus level is on the negative side right now but I’m pushing on ahead like I do all the time.

It has taken me a matter of hours to write a measly thousand words all because of my racing thoughts and what they do to me.  Popping up and down like a jack-in-the-box and moving from one thing to another several times over these few hours has made getting this done pretty hard.  Though my goal the whole time was to complete this I’ve been unable to just sit in one place and work from start to finish.  Now that I can look back and see the progress I’m capable of it lets me see that even with this handicap I’m still quite a peach!

 

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Grateful for Gratitude

A few weeks ago I decided to start a gratitude journal.  Instead of getting caught up in the highs and lows of my bipolar disorder I figured I’d redirect my focus and look at the good things working for me in life.  There was just one problem; I didn’t count on something getting in the way.  That something is borderline personality disorder.

In addition to my bipolar disorder I have a daily struggle to keep myself balanced because of my BPD.   In short, having borderline personality disorder means that I have a hard time living a life of balance.  It is my disorder inside a disorder and it can make life very complicated for me.  BPD is the reason I often overreact to any given situation and have ongoing unhealthy relationships and thought patterns.  I typically only see life in terms of black and white not realizing that life is full of areas of gray.  I tend to fly off the handle at seemingly benign situations and my interactions with people are often based on pure emotion which, in and of itself, is quite detrimental to living life on an even keel.  Borderline personality disorder can also make it hard for me to balance my emotions and react appropriately to them.  For instance, I can get happy about something good happening to me and instead of just being content with the situation; I may go out and spend money that I really can’t spare as a reaction to it.  If something upsets me I may go into a deep depression and start toying with thoughts of self-harm or even suicide.  Often when a relationship is unhealthy or toxic I may still try to keep the relationship going because; in my thought process, some relationship is better than no relationship.

Earlier I said that this is my disorder inside of a disorder; let me explain.  Bipolar disorder is characterized by intense highs and lows, mania and depression, light and dark.  Well borderline personality makes these instances even more intense. I often suffer from extended periods of anxiety and I have trouble with major bouts of low self-esteem and overall self-loathing.  The mania and depression of my bipolar disorder are made more intense as a result of my BPD.  Already being overly stimulated, borderline personality disorder can make me appear like the Incredible Hulk when it comes to emotions.  One minute I’m fine and the next minute, after seeing a disturbing story on the evening news, I’m a wasted pile of tears and despair.  I know, this may sound extreme but that’s the nature of borderline personality disorder.  BPD is a constant struggle to maintain emotional equilibrium and avoid unhealthy situations and relationships.

I say all of this to make the point that starting a gratitude journal was more of a challenge than I ever thought it would be.  Because my view of reality is often skewed, it’s hard for me to be mindful and find things to be grateful for since I’m always in an extreme emotional state.  This being true, I was even more determined to be able to use mindfulness and find things in life to be grateful for no matter how small or mundane.  Even though mentally I tend to be in a state of flux, I have to realize that if I can compose myself and focus I’ll be able to see that there is just plain good in life.  I’ve decided that I will be grateful despite my diagnosis and I’m going to start that journal no matter what.

 

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It Comes From Inside

I went to see my therapist yesterday and I have to say that, quite frankly, she pissed me off!  I sat in the waiting room with my chest out and my shoulders back and a quiet smile on my face.  For reasons outside of my control it had been quite some time since I’d seen my therapist and I was so excited to tell her that I’d been winning the battle with my bipolar disorder daily, posting to my blog; I’d started it in 2013 but hadn’t done much with it until this year, and I was still celebrating having a year clean and sober.  I was all bubbles and sunshine inside while I waited to see that door open and her pop her head out and call me into her office.  For the first time in forever I was really ready for therapy.  Then it happened.  She did call me back and on the way to her office she asked, “How’s it going?”  I was beside myself with glee waiting to get started on how good life was going for me and how happy I’d been lately and then…she blew it.

I’d decided to downplay the sobriety thing and start with my mood.  I told her that things had been quite good for me where my mood is concerned.  I’d been able to use my CBT and DBT skills to keep me grounded and I’d been more positive than I’d been in a very long time.  She looked at me with a blank stare, shook her head and that was it.  Really?  Maybe she didn’t hear me.  Maybe her mind was someplace else, I don’t know.  This wasn’t what I expected or what I’d planned on.  This was supposed to just floor her and instead she just looked at me.  Fine. Okay. I decided to talk about my blogging.

I went into detail about how I’d been putting my feelings into the blogosphere about my bipolar disorder and treatment and my recovery from drugs and alcohol.  I knew she’d be impressed with me because I’d been in a horrible slump for so long not able to do much of anything and this was monumental for me.  I kept looking at her face waiting for the big smile to open up and let me know she was proud of me.  Nothing.  She just shook her head and turned around to her computer and began making notes.  Are you fucking kidding me!  What the hell is her problem; clearly she did have a problem.  Well, the last thing I had in my arsenal was my sober birthday and I knew this was going to get her.

After no response to my rambling about my good mood and my blog I was jumping up and down inside to tell my therapist I’d finally reached my first year of sobriety.  And I was right, that got a response.  “How did you feel about that?”  That’s what I got; a question.  As far as I was concerned it was a stupid question.  Wasn’t sobriety like this the goal of hours of therapy and training?  Anyway, I decided to bring attention to my blogging again and explain how I’d blogged about the bittersweet feeling of my year being sober.  I went into detail and made a very important point; at least I thought it was, about mourning my addiction like a good friend.  I thought this was really big and I thought that being able to verbalize it in such a way would surely impress her.  Nope.  What did she do?  I’ll tell you what she did.  She took the wind out of my sail like her certification gave her the right to just cut me down at the knees.  How dare she!  “Well, you’ve been mourning this for months, what makes it any different now?”  That was it; I needed to do some quick mental checking because I was on the verge of losing my cool.

In my head this woman was every name in the book but a child of god.  I thought about getting up and just telling her never mind for the session and walking out, she’d touched something in me that I knew wasn’t good.  My inner demon was coming to life and that never ends well.  In an instant I had to jerk myself back to a happy place because I was quickly going down the wrong road.  I could envision her calling security just like the social worker did in the ER when I came to the defense of my partner; I just hoped my eyes hadn’t turned the least bit red.  This just wasn’t going the way I’d envisioned and I was totally thrown off by her nonchalance.  Right then I had to decide whether to take the high road or to just show my ass.  Trust me, it was a hard decision.  All of this took place in a split second.

And then I came to the realization that, as much as I wanted my therapist to be happy for me and give me some sort of accolade, the most important thing is how I feel about what I’ve done and how far I’ve come.  My therapist’s job is to guide me down the road to being able to manage my mental illness and staying sober.  She’s not responsible for giving me my self-worth; that’s my job.

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So after I had this internal dialogue with myself I decided to let my therapist off the hook and go on with our session.  I reminded myself that I was there for therapy not ego stroking and, surprisingly, I was okay with that.

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Mental Illness and Two Types of Therapy

I have been in and out of treatment for my bipolar disorder and substance abuse for nearly fifteen years and I have gained a lot of knowledge about different treatment therapies.  Most recently I have been exposed to two types of therapy that have helped me tremendously. Following is a brief summary of each one of these therapy models.  I encourage further research on both.

The first of these is DBT (Dialectical Behavioral Therapy). DBT was developed by Marsha Linehan to help people suffering severely with BPD (Borderline Personality Disorder). DBT deals with helping to reshape detrimental behaviors that can stand in the way of effectively living with BPD and, over the course of its history; it has been expanded to treat other mental illnesses and recovery from a number of addictions and disorders.

DBT is made up of four specific skill sets being taught that help with the stabilization of extreme moods and addictive behaviors.  These skill sets are mindfulness; being fully present and aware in the moment, distress tolerance; how to tolerate uncomfortable situations without the need to change them, interpersonal effectiveness; how to ask for what you want and learn to say no while maintaining positive relationships and emotion regulation; how to change emotions that need to be changed when you want to change them.

The dialectic module of treatment focuses on self-acceptance but also realizing that some behaviors need to change in order to facilitate mood stabilization and recovery.

The second therapy I have been in is CBT (Cognitive Behavioral Therapy).  This was developed by Dr. Aaron T. Beck and it deals with helping people with depression combat “automatic [negative] thoughts” that can increase this depression.  CBT helps patients to realize that how we see the world will affect how we feel; this, in turn, can increase or decrease depression.  Therapists help patients with anticipated challenging situations that may arise, and they help them to come up with a plan to combat these situations in a positive way.

Of all the different types of therapy and groups I have been a part of I would have to say that these two have been the most beneficial to my current journey towards recovery.  They have also helped me to develop skills that help me to deal with everyday life situations with bipolar disorder.  I highly recommend these therapy models to anyone suffering from mental illness and substance addiction.

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Back To The Drawing Board

Back in IOP (Intensive Outpatient) therapy…oh joy.  This will be my lot three days a week for the next sixteen to twenty weeks.    I walk in the room and come face to face with a motley crew of alcoholics and addicts who have committed to staying sober and working The Steps.  The facilitator is a slight red-head who reminds me of Shirley MacLaine but she is slightly disheveled and majorly unorganized.  I have to correct her about my name and that immediately makes me feel some kind of way.  My initial reaction is that I’m in the wrong place.  I’m a bit anxious and I feel out of place but, ironically, I start using DBT (Dialectical Behavioral Therapy)  exercises; the nature of the group, to calm myself and find my niche in this space.  Twice we are interrupted from getting things going by the late arrival of two people and this aggravates me like nails on a chalkboard.   After everyone has finally settled in Teacher, what I’ll call her, announces that there is a binder of information we are responsible for and she hands me a white binder with a stack of papers that go inside.  She apologizes for the incompleteness of this wealth of information, none of the papers have holes punched in them, telling me that there is no three- hole punch in the building.  Ugh.  Really?  I’m at a loss for words.  This isn’t starting out good at all.  I keep telling myself to give this all a chance because I know the routine all too well; I’ve been in four other groups over the course of nearly a year.

Group begins with a check-in consisting of going around the circle and giving our names, announcing our addiction(s), how much clean time we have and what kind of mood we’re in.  Surprisingly I’m calm with the fact that I will soon give my story to a new group of strangers.  The eye contact that I get from the other group members as we go around the circle puts me more at ease and when it’s my time to introduce myself I’m confident and strong.  Teacher starts things off and my apprehension starts to creep back to the surface.  She’s speaking but it’s as if she really doesn’t know what she’s supposed to be doing.  I feel like I’m balancing on the edge of my seat in anticipation of her next word or instruction because she just seems so hesitant to take control of the meeting.  I want to jump out of my seat and snatch up her papers and her spiral guidebook and just teach the class myself.   Finally the ball gets rolling, albeit slowly, and we dive into the skill for the day.  Not even five minutes into this I discover that my stack of papers is missing the literature for the topic.   This is yet another speed bump to slow our momentum.  Teacher apologizes profusely and excuses herself to go make the necessary copies having to get originals from one of the other attendees.   She returns and we try this once again.

Class seems to creep by so slowly and I feel like I’m in another state of consciousness.  The information is helpful and informative but Teacher just seems a bit off-key to me.  Everyone else seems to be comfortable in a homey kind of way and I envy the way they seem to be able to abandon any judgement of the entire situation, they seem to be completely at ease.  Am I missing something?  We keep it moving and finally one of the other people speaks out of turn and asks Teacher isn’t she ready for a break.  A collective sigh of relief goes around the room and we all start putting down papers and heading for the door even before we hear how long break is going to be.  Maybe my observation was wrong about how the other groupies feel about the whole thing.

We all return from break grateful that there’s only thirty minutes left of this haphazardly conducted meeting.  Though we trudge along and play the game I can tell that I’m not the only one frustrated with how things go here.  I try to keep from watching the clock when one of the gentlemen brings to our attention the time and I perk up and see that time’s up and group is over.  Before Teacher is able to fully give ending instructions we begin packing up our things and preparing for our ending circle to recite the Serenity Prayer.

Wow, it’s over and I made it through and I’m actually glad I came.

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