When Reducing Meds

Messily put-together-tips from personal experience on what to do during a reduction of medication.

When decreasing any amount of psychological medication, it is really important to rememeber you are not going to feel well for a while. It could be several months depending on how much reduction you need. It is important to talk to your loved ones to let them know you may seem “off” for a little while and maybe ask them to keep an eye on you incase widthdrawl symptoms get worse. You may feel more depressed, anxious, fidgety, irritable, impulsive, tired, emotional. You will most likely feel much worse before you feel better.
It is also okay to decide to go back on the medication/increase if you need to.

Practicing a lot of self care and positive self talk is essential. Having patience with yourself and being as self aware as possible when a symptom does arise is also great to help you through it. Name the emotion and where you feel it in your body. ex: “I am feeling very irritable right now. I feel a tightness in my chest, throat, and a dull ache in my forehead.This is most likely due to my medication reduction. I am going to take a nice, hot, relaxating shower to make myself feel better.”

If you end up losing your temper and snapping at someone, try your best to apologize immediately and recognize it is not their fault you are experiencing this. Recognize the emotions and thoughts you are feeling and seperate the feelings from the facts and use i statements. “John didn’t get me a glass of water, he’s a jerk (not fact).”is not helpful to you or him. Try: “John did not get me a glass of water(fact). I feel upset (fact)because it makes me feel like I am not important.”(is that true? That you’re not important just because john didnt get you a glass of water? No, it isnt and you can talk to John about how you’re feeling) Much easier to solve the issues with a partner if youre not just blaming them when you’re angry. Try sticking to “I feel… when you…because.. what i would like is…” instead of “you big jerk, you suck.” Lol

Practice more self care and maybe some mindfulness practices and meditation. Mindful eating, mindful walking, body scan meditation, etc.

Remember it is temporary and you will eventually feel better again.
And if you need to, you can always go back on them if it gets too difficult.

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Grounding Techniques

Grounding Techniques are designed to help you deal with painful, overwhelming feelings. Grounding can be done anytime anyplace, anywhere. You can practice the skills privately and no one has to know or you can ask for support. Do not focus on past or the future stay in the present. Do not judge things as bad or good, stay neutral. Do not journal or think negative thoughts.

Ways to Ground yourself

Find a special place in your home where you have placed safe, soothing objects.

Play a category game with yourself, ie think of types of dogs, bands from the 80s, 90s, types of cars, etc.

Describe an everyday activity in detail to yourself or to someone else.

Say an affirmation.

Read something positive saying each word to yourself.

Think of something funny.

Count to 10 or say the alphabet S l o w l y

Run cool or warm water or your hands.

Hold ice cubes in your hands.

Carry a safety object with you.

Connect your body with the environment, ie I feel my feet making contact with the floor.

Eat, Walk mindfully– noticing the subtleties of the activity.

Focus on your breathing and accompany a positive, pleasant word with each inhalation and exhalation.

Say kind statements to your self.

Think of all your favourites, ie colour, food, animals, season, TV show.

Say a positive coping statement ie, this will pass, I can handle this.

Think of positive things that you are looking forward to in the future, ie social outing with a friend.

Make an index card or upload your most effective grounding techniques.

Think about people and animals you care about. Look at photographs of them.

List 5 things you see

List 4 things that you can touch

List 2 things that you can smell

Take one breath.

 

 

Reference: OTMH, Oakville

Cognitive Distortions

Cognitive Distortions =  Unhealthy Thinking Habits

Do not/Try not to become overwhelmed by the many Cognitive Distortions that exist.

Pick 1 or 2 to work on. That’s IT! Pick easy ones to work on.

These are organized in a way to facilitate memory

 

The Common Ones

All or Nothing

Black and White Thinking

Exaggerating

Mindreading

Fortune Telling

Catastrophe Thinking

Feelings are Facts

 

Twins

Filtering (to ignore)

Magnification

Minimization

 

The Really Harmful ones (To self-esteem- to others)

Discounting the Positives

Labeling

Should Statements

Personalization

Blame

Unfavourable Comparisons

 

 

 

The Common Ones

All or Nothing/ Black-White Thinking

You see things or people in absolute, black or white categories. If a situation falls short of perfect, you see it as a total failure.

You define yourself or others in absolute terms such as good or bad, smart or stupid, introverted or extroverted, fat or thin, attractive or ugly, and so on.

Moreover, you may categorize your behaviour as being either completely acceptable or absolutely unacceptable, without acknowledging the many possibilities that lie between these two extremes.

More often, we exit somewhere in the middle of a spectrum versus on one side only. Much of this comes from perfectionist personality types where we have to be perfect or we’re a failure – there is no middle ground.

Example: I’m a failure. Example: I’m right

 

Exaggerating

To overgeneralize things. You often make a broad conclusion based on a single incident or a single piece of evidence. If something bad happens only once, it is expected to happen over and over again.

For example: You see a single negative event, such as a romantic rejection or a career reversal, as a never-ending pattern of defeat and will conclude that things will always happen that way.

You find yourself using words such as “always” or “never.”

Thus, you generalize one instance in the present to ALL other instances.

Pick out the overgeneralizations in this sentence:

“Everything always goes wrong for me.”

 

Exaggerating Hint Words

Words like:

Always, Never, Everyone, All the time, All woman/men, all “race”

Instead of:

Once in a while, sometimes, that individual, that specific incident, today

 

 

Mindreading

Inferring a person’s possible (usually negative) thoughts from their behaviour and nonverbal communication.

Taking precautions against the worst reasonably suspected case or some other preliminary conclusion, without asking the person.

Making negtive assumptions about what other people are feeling, thinking, and why they act the way they do, in particular, what they are thinking about YOU. Thus, you interpret things negatively when there are no facts to support your conclusion.

Although it is true that people make negative judgements about others; chances are this occurs much less often, and what you’re assuming is far more negative than reality.

Examples:

They probably think I’m incompetent.

They noticed by hand shaking. They know I’m anxious. They think I’m pathetic.

They think I’m a “know-it-all.”

They are looking at me funny. They must think I look weird.

 

Mindreading Hint Words

He/She/They, Them, My boss thinks..

 

Fortune Telling, “Little What If Thinking.”

Also known as: Probability Overstimations

A probability overestimation is a prediction that a person believes is likely to come true, even though the actual likelihood is relatively low. Moreover, the prediction is that things will turn out badly. Said another way, an inaccruately high probability of danger is estimated. Example: A car weaves slightly in the lane next to you and you thnk, “That guy is going to hit me!Trying to kill me!

Hint: Did your self-talk start with “What if..”?

 

Catastrophe Thinking, “Extreme What If Thinking.”

The worst possible outcomes are predicted. Imagining that basic needs (safety, self-esteem, sustenance, etc.) are threatened.

Thinking that a situation is unbearable or impossible when it is really just umcomfortable. Most of the statements will overestimate a particular negative outcome and underestimate your ability to cope.

Example: A first year student began to get extemely anxious once she learned that she could not take all her courses. Her thoughts rose from an undesirable schedule to not being able to graduate and being jobless and homeless.

Furhter, you assume that if a negative event were to occur, it would be absolutely terrible and unmanageable. Below are more general examples:

Example: I won’t be able to handle it. Everyone will think I’m an idiot, I’m going to look stupid in front of the whole class, and no one will talk to me. I’ll be a social outcast.

 

Feelings are Facts:

Refers to the tendency to judge or evaluate something illogically, totally on the basis of your feelings. You believe, “if it feels likely, it IS likely. If it feels dangerous, it IS dangerous.” You assume that your negative emotions reflect the way things really are or will be.

Example: I feel terrified about going on airplanes. It must be very dangerous to fly.

I feel guilty. I must be a rotten person. It was my fault.

I feel angry. This proves I’m being treated unfairly.

I feel so inferior. This means I’m a second-rate person.

I feel hopeless. I must really be hopeless.

I feel anxiety. Something bad is goign to happen.

I feel ugly, so I am ugly.

Because I feel inadequate, I am inadequate.

I will never get well.

 

 

The Twins

Filtering (Selective Attention):

Focusing entirely on negative elements of a situation, to the exclusion of the positive. This is where you pick out a single negative detail and dwell on it exclusively, so that your vision of all of reality becomes darkened.

Example: You receive many positive comments about your presentation to a group of associates at work, but one of them says something mildy critical. You obsess about their reaction for days and ignore all the positive feedback.

Magnification (Minimization/ Mazimization)

Giving proportionally greater weight to a preceived failure, weakness or threat, or lesser weight to a preceieved success or opportunity, so the weight differs from that assigned to the event or thing by others.

Therefore, you blow things way out of proportion or shrink their importance. This is also called the binocular trick. When you look through one end of the binoculars, all your shortcomings seem as huge as Mt. Fuji. When you look through the other end, all your strenghts and positives qualities seem to shrink to nothing.

Hence, you exaggerate the importance of your problems and shortcomings, and/or you minimize the importance of your desirable qualities.

Example: Focusing on a personal flaw

focusing on another’s achievement and ignoring your own contributions

Focusing on someone else’s desirable qualities while comparing your own imperfections.

 

The Really Harmful Ones (To Self-Esteem and to Others)

Discounting The Positive:

You reject positive experiences by insisting they “don’t count.” Discounting the positives takes the joy out of life and makes you feel inadequate and unrewarded.

Example: If you do a good job, you may tell yourself that it wasn’t good enough or that anyone could have done better.

When you disbelieve a compliment or positive appraisal.

When you give away or deny good things that come your way, such as gifts or compliments.

 

Labelling:

Labelling is an extreme form of all-or-nothing thinking. Instead of saying, “I made a mistake,” you attach a negative label to yourself: “I’m a loser,” “a fool,” “a failure.” or “a jerk.” Labelling is irrational simply because you are important as a person. You are not only worthwhile by what you do. Only humans exist, losers, fools, jerks do not. These labels can lead to anger, anxiety, frustration, and low self-esteem.

You may also label others. When someone does something that bothers you, you may lebel that person, “she’s a nag” “He’s a freak”. In that moment, you see them as totally bad. This makes you feel hostile and hopeless about improving things and leaves little room for constructive communication.

 

Should Statements:

We have a list if rules about how we and others should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may believe they are trying to motivate themselves with should and shouldn’ts, and yet the outcome of using “shoulds” is the complete opposite. For example, “I really should exercise. I shouldn’t be so lazy.” “Musts,” “oughts” and “have tos” are similar offenders. Should statements, which are hidden perfectionist expectations, are incorrect or exaggerated assumptions about how things should occur. The emotional consequence is guilt. Lastly, when a person directs should statements to others, they often feel anger, frustration and resentment.

Example: He shouldn’t be so stubborn and argumentative.

Example: After playing a difficult piece on piano, a gifted pianist told herself, ‘I shouldn’t have made so many mistakes.” This made her feel so disgusted that she quit practicing for several days.

Example: I shouldn’t eat that doughnut.

Example: I should visit my family every Sunday.

This usually doesn’t work because all these shoulds and musts make you feel rebellious and you get the urge to do just the opposite.

Should Hint Words

Words like:

Should

Have to

Ought to

Need to

Must

Shouldn’t

 

Replace with:

I choose to

I hope to

I want to

I plan on

I am

(get into action )

 

Personalization

Personalization is the tendency to take things personally and make things about you when they are not about you. You may do this automatically without fact finding first.

To define further,

Personalization occurs when you hold yourself responsible for an event that isn’t entirely under your control. You may take on all the responsibility rather than acknowledge the different factors that may have contributed to the situation.

Personalization also happens when you frequently compare yourself to what you are hearing and seeing, “That happens to me too”, “I have that”, “Wait,I have that”. “I’ve been there.” Essentially, making it about you.

Personalization also occurs when you think or believe what people saying or doing (e.g. laughing down the hallway, have a grumpy look on their face) is in direct reaction or relation to YOU.

If this is a habit for you, you are likely to find yourself overreacting to interpersonal interactions. That is because personalization confuses understanding and boundaries in relationships, especially around dependency and co-dependency issues.

It increases social anxiety.

It’s no wonder that Personalization leads to guilt, shame, and feelings of inadequacy!

Rule: Don’t personalize other people’s inappropriate behaviour.

Example: When a woman received a note that her child was having difficulties at school, she told herself, “This shows what a bad mom I am,” instead of trying to pinpoint the actual cause of the problem.

Example: When another woman’s husband yelled at her, she told herself. “If only I were a better wife, he wouldn’t yell at me.”

Example: My boss is in a bad mood today; he must be angry with me.

 

BLAME

When we hold other people responsible for our own pain, or take the other track and blame ourselves for every problem, we are doing a great injustice to ourselves and to others. instead of pinpointing the cause of a problem, you assign blame. This distortion robs you of appropriate responsibility, and prevents growth. Blame usually doesn’t work very well and will just get tossed back and forth without result or movement.

SELF BLAME: You blame yourself for something you weren’t responsible for or beat up on yourself relentlessly whenever you make a mistake.

OTHER BLAME: Some people do the opposite. They blame other people or their circumstances for their problem, and they overlook ways that they might be contributing to the problem.

Example: The reason my marriage is so lousy is because my spouse is totally unreasonable.

Example: I’m a terrible mother.

Example: I’m a lousy friend.

Example: Stop making me feel bad about myself!

Nobody can “Make” use feel any particular way- only we have control over our own emotions and emotional reactions (Byron Katie does a lot of this sort of talk). Only if we believe a persons negative perception of us do we hurt (ourselves).

 

Unfavourable Comparisons:

Unfavourably comparing yourself is like having a special magnifying glass that magnifies some things (your negatives, other people’s positives) and shrinks others ( your positives, other people’s negatives.) Try recognizing everyone (including yourself) as having unique strengths and weaknesses. If you have to compare, try to compare evenly – include both favourable and unfavourable comparisons.

Example: “She’s thinner, so she’s prettier and smarter; who cares if I have nice hair?”

Example: “He is more interesting and intelligent because he owns his own business; who cares if I make more?”

 

 

 

Reference: This material is from OTMH, Third Line,Oakville ON

 

Active Listening Skills Continued.

Listen to yourself:

Goal: To practice the skill of listening – good communication skills require the art of active listening.

Ask a friend to help participate in this wee little experiment. Allow you or your friend to be the designated listener, and the other is the talker. Later, reverse the roles.

Take for 3-5 minutes about yourself.

Pay attention to your thoughts when talking.

Having trouble? Start off with

Your Family

Your hobbies

Your pets

You’re favourite band (while you were growing up)

Travel

If you had a million (and 1 dollar)

 

LISTEN

L – ook and lean

I -gnore Distractions

S– uspend Judgement

T– ell Them what you’ve heard

E– xperience Their side

N– o interrupting!

 

The Goals of Communication

To better understand what another person is communicating

To relay your understanding to that person.

To improve relationships.

 

Active Listening

Attending Skills

Posture

Appropriate Body Motion

Eye Contact

Non disturbing Environment

Your handshake

Following Skills

Door openers

Minimal Encourages

Infrequent Questions

Paraphrasing and Reflecting Back

Discourages

Door Closers

Minimizing

Criticizing

Judging

 

Active Listening

Active listening is especially useful in two general situations

1) when you are not certain you understand what the other person means.

2) when an important or emotionally charged message is being sent.

Senders will often indicate that they are saying something significant by:

Directly referring it to as Worthing of notice, eg “it is vital for you to understand that..”

Repeating a message several times

Placing a point first or last.

Pausing or waiting for eye contact before speaking.

Speaking more loudly or softly than usual.

Speaking more slowly than usual.

When you are actively listening, you concentrate on reflecting on the feeling that others express, the content or both, depending upon what you think you may have misunderstood and what you consider most important. As yourself:

“What is he feeling?” “What is he trying to say?”

Consider: ” People won’t care what you know, until they know that you care.”

“Seek first to understand, then to be understood.”

 

 

Reference: OTMH, Oakville, ON

 

Listening Skills

This group of skills helps the listener to keep the focus on what the speaker is communicating.

a) Door Openers/ Encourages

 

  • Encouragers are to creative an invitation to talk. Questions that help you show we are genuinely interested: Who, When, Where, Why, How?
  • Are used to encourage someone to begin to talk or to continue talking.

Examples:

i. “Care to talk about it?”

ii. “Please go on.”

iii. “Tell me more.”

iv. “What was that like (for you)?”

v. And my all-time favourite, “How did that make you feel?” <–stereotypical

Remember, it is difficult to offer a door opener, not to be takenn up on it, and subsequently let it go without taking the dismissal personally. Rememeber it takes time to build trust and one must respect the other person’s privacy.

b) Minimal Encourages

1. Brief indications to the speaker that you are listening.

2. Give little direction to the conversation.

3. Examples:

> > “Mm-hmm”, “Go on” “I see”, “Then?” “Yes” “Darn!”

4. You can also encourage the speaker by repeating one or two of his key words.

c) Infrequent Questions

 

  • Ask only 1 question at a time.
  • Be Mindful of the number of questions that help show interest. Try not to do too many who, when, where, what, why, how..

There are two types of questions:

Closed Questions: These direct the speaker to give a specific, short response.

“Did you have a good holiday?”

Open Question

These allow the speaker to chose the direction of the Conversation and explore his thoughts:

“Tell me about your holiday.”

“What was that like for you?”

“Let’s talk about that a little more.”

“How did that happen?”
d) Attentive Silence

 

  • Allows the speaker to think about what he is going to say and to proceed at their own pace.
  • Silence is a reflection of intimacy.
  • If you feel uncomfortable with silence, rather than shatter it with questions, advice, etc. Use the time to:
  • Observe the speaker’s body language.
  • Silently review what the speaker has said,
  • Wonder what the speaker is feeling,
  • And consider possible listening responses.

e) Paraphrasing and Reflecting Back

Restating in your own words what the other person has said, For example:

  • “You’re suggesting that…”
  • “Let me se if I’ve understood. You feel…”
  • ” You think…is that correct?”
  • “So you believe that…”
  • “Do you mean that..?”

 

Discourages (What not to do)

a) Most Discouraging

 

  • Threatening or punishing responses – “Smarten up or else.”
  • Ridiculing/ Belittling, “That’s just plain dumb.”
  • Denying or Contradicting “You’re wrong.”
  • Minimizing “is that what you are worried about? I wish that was all I had on my plate!”
  • Sarcastic Responses “Now that’s a real problem.”
  • Arguing for your Own Point “Well your wrong and I’ll prove it..”

b) Sometimes Discouraging

 

  • Advice – Giving before listening “Here is what you should do..”
  • Persuasion against their will “You can do it if you try.”
  • Interpreting “I know what you are thinking..”
  • Jumping to Conclusions “if you don’t like them you should just leave.”

c) Actions that Discourage

 

  • Interrupting in mid-sentence
  • Looking away, shuffling paper on desk
  • Crossing arms, yawning, shaking your head, rolling your eyes.
  • Continuing on with another task when someone is talking
  • Moodiness/ negative tone/ abruptness etc.

Door Closers (Road Blocks- DON’T Do these)

a) Judgemental Statements:

“What a sourpuss you are today.”

“What did you do, lose your best friend?”

b) Attempts to Reassure

“Cheer up!”

“Things will get better. They always do.”

c) Advice Giving:

“Don’t ruin your day.”

“Forget about it.”

 

 

 

Reference: OTMH, third line, Oakville, ON

Active Listening Skills

 

Goals: To better understand what another person is communicating.

To relay your understanding to that person.

To improve relationships.

Active Listening is especially useful in two general situations:

1. When you are not certain you understand what the other person means.

2. When an important or emotionally charged message is being sent.

Senders will often indicate that they are saying something particularly significant by:

a. Directly reffering to it as worthy or notice eg. “it is vital for you to understand that..”

b. Repeating a message several times.

c. Placing a point first or last,

d. Pausing or waiting for eye contact before speaking.

e. Speaking more loudly or softly than usual.

F. Speaking more slowly than usual.

When you use active listening, concentrate on reflecting on the feeling others express, the content or both depending upon what you think you may have misunderstood and what you consider most important. To arrive at your statement, silently ask yourself:

“What is he feeling?”

“What is he trying to say?”

Remember:

“People won’t care what you know, until they know that you care.”

“Seek first to understand, then to be understood.”

 

Attending Skills

Non verbal communication that indicates you are paying careful attention to the speaker.

a) Posture of Involvement

 

  • Face, and incline your body toward the speaker.
  • Maintain a relaxed, open position.
  • Watch for signs of anxiety and position yourself accordingly.

b) Appropriate Body Motion

 

  • Move your body in response to the speaker.
  • Fidgeting, repeatedly crossing and uncrossing your legs, or continuing with another activity are examples of poor attending skills.

c) Eye Contact

 

  • Focus softly on the speaker and shift your gaze occasionally.
  • This expresses and interest and a desire to listen.
  • You may have to look at the person’s face before you feel comfortable with eye contact.

d) Non Distracting Environment

 

  • Cut environmental distractions to a minimum.
  • Turn off the T.V. or radio, close the door, etc.

 

 

Reference: OTMH, Third line, Oakville, ON.

Good Vs Bad Listening

 

Good Listeners

  • Open, engaging, more verbal- makes a point of it.
  • Really/Very present, nurturing
  • equal time to talk, everyone is heard
  • sincere
  • non judgemental

Bad listeners

  • hidden agenda
  • aggression
  • separate
  • narcissistic
  • lie
  • dishonest
  • waiting for their turn to talk
  • stage hogging
  • too much silence
  • lack of eye contact
  • doing tasks while someone is talking/distracted

Active listening:

 

  • in the moment
  • engage
  • reflecting ‘ hearing you- thinking about what u are saying’
  • pick up what is important
  • digesting the convo
  • empathy
  • asking questions
  • paraphrasing
  • comments, head nods
  • eye contact
  • Door openers – please go on
  • minimal encourages -mmhmm, ohh i see
  • open ended questions
  • attentive, silence, reflecting back

What not to do:

  • don’t discourage
  • deny
  • minimalize
  • argue
  • give advice
  • yawn
  • do a task
  • jump to conclusions
  • don’t door close, ‘what a sore puss’ ‘just get over it’

 

 

Reference: OTMH Outpatients, Oakville ON