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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Attachment

 

What is Attachment?

> The capacity to form and maintain healthy emotional relationships which generally begin to develop in early childhood.

> Enduring bond with ‘special’ person

> Security & safety within context of this relationship

> Includes soothing, comfort, and pleasure

> Loss or threat of loss of special person results in distress

What is the Attachment Theory?

> John Bowlby (1907-1990) British Child Psychiatrist/Psychoanalyst

> He was the first attachment theorist, describing attachment as a “lasting psychological connectedness between human beings.”

> Bowlby believed that the earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout life.

> According to Bowlby, attachment also serves to keep the infant close to the mother, thus improving the child’s chances of survival.

> Disturbance/ Disruption of initial attachment bond between child and caregiver renders person insecure as an adult.

> The central theme of attachment theory is that caregivers who are available and responsive to their infant’s needs establish a sense of security in their children.

> The infant knows that the caregiver is dependable, which creates a secure base for the child to then explore the world.

Adult Attachment

> From our childhood experiences we develop schemas that are connected with dependability of others and the worth or ‘lovable-ness’ of self.

> These schemes are easily maintained across time into adulthood as they are reinforced over and over again.

> In the literature these schemas are referred to as attachment styles.


Types of Attachment Styles

(Hazen & Shaver 1994)

> Can I count on this person to be there for me if I need them?

> Are others trustworthy and responsive?

> Am I lovable and able to elicit caring?

ANSWER: NO

Avoidant

fearful- tend to recognize their need for others, but avoid others and frame them as untrustworthy.

Dismissing- Tend to deny their need for attachment and frame others as untrustworthy.

ANSWER: MAYBE

Anxious/Preoccupied

Tend to cling to attachment figures or aggressively demand reassurance, often fearing that they are somehow deficient or unlovable.

ANSWER: YES

Secure

Tend to believe that others are reliable and see themselves as lovable and worthy of care.

***A sense of security provides better

1.better Affect regulation

> less reactivity

> less hyper arousal

> less under arousal

> more acknowledgement of support seeking

A Sense of Security Provides

2.Better information processing

> more flexibility, curiosity, openness

> tolerance of ambiguity and uncertainty

3.Better communication

> more ability to collaborate, to disclose, more assertive and empathetic

A Sense of Security Provides

4.Sense of Self (love)/ is more positive.

How This Applies to Adults

> Seeking and maintaining contact is viewed as the primary motivating principle from childhood into adult relationships

> A secure connection offers a safe haven and a secure base.(needs for connection, comfort and caring are key)

> Accessibility and Responsiveness builds bonds

> Separation Distress – a predictable process.

> Protect

> Cling and Seek

> Depression and Despair

> Dettachment

 

Attachment Styles are working models of self and others

> The way we see ourselves

> The way we see others

> The way we see relationships

> Predict the way we will respond

Role of Emotion

> Emotions will automatically arise when an attachment figure is perceived as inaccessible or unresponsive.

> Attachment Injuries

> An Attachment injury occurs when one partner violates the expectation that the other will offer comfort and caring in times of danger and distress.

> It is characterized by an abandonment or betrayal of trust during a critical moment of need.

> When a partner cries out for help and there is no response, the sense of basic trust that is the foundation upon which the welfare of their bond depends is shattered.

 

Secure Attachment

Believes and trusts that his/her/their needs will be met.

Parent: Quick, Sensitive, Constant

Child: Secure, Exploring, Happy.

 

Avoidant Attachment

Subconsciously believes that his needs probably won’t be met.

Parent: Distant, Disengaged

Child: Not very explorative, Emotional

 

Ambivalent/anxious Attachment

Cannot Rely on his needs to be met.

Parent:Inconsistent, Sometime sensitive, Sometimes neglectful

Child:Anxious, Insecure, Angry

 

Disorganized Attachment

Severely confused with no strategy to have his needs met

ParentExtreme, Frightened, Frightening, Passive

Child: Depressed, Passive, Angry, Non-responsive.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REf: OTMH, 4th Floor., attachfromscratch.com

 

Smart Goal Setting

What are smart goals?

Smart goals are:

Specific
What is your goal?
How will you do it?
What actions are required to achieve my goal?

Measurable
How will I track my goal progress?

Attainable
Pick behaviours you can, or are willing to change first.

Realistic
Can I achieve this goal right now?
Can I fully commit to this goal?
How will I overcome set-backs in my goal?

Time-Bound
Set a time-frame for your goal
Include a specific start, goal and end date.
Set several small goals with shorter timelines within a long-term goal, to increase motivation and confidence.

Example Smart Goal

Specific: Increase my vegetable intake by 2 servings per day, by packing 1 snack baggie with 1/2 cup veggie sticks at lunch, and adding 1/2 cup veggies to my dinner plate.

Measurable: I will check off each day on my calendar that I achieve my goal.

Is this goal Attainable? Yes. I want to improve my meal planning skills, to benefit my nutrition and health.

Is this goal realistic?. Yes. This is a goal I can start immediately.

I will overcome set-backs by focusing on getting back-on-track the next day. I will use my calendar tracking to motivate me.

What is my Time Line?

Start date: March  11, 2017

End Date: None. I plan to make this a daily routine, and will track my progress each month.

Tips to help you reach your goal:

Set 1-3 goals at a time. Setting too many goals at once can make it hard for you to achieve them.

Record and track your progress, to help you stay focused and motivated!

Have a family member or friend work on your goal with you! Or, share your goal progress with others.

Plan a head. Consider, and be prepared for obstacles; and think about how you can overcome any set-backs.

Remember why your goal is important to you. This wil help you stau motivated when obstacles arise!

Celebrate your successes no matter how small. Find ways to reward yourself!

What should I do if I have trouble reaching my goal ?

Stay positive! Take time to reflect on what has worked so far, and think about what you can change going forward. Set-backs are normal, and should be expected. Think about:

Was my goal too big?

Was I working on too much at one time?

Do I need to focus on a different target behaviour?

What got in the way of my success?

What are some solutions?

Was my time frame realistic?

Modify your goal if needed, or start over if you need to.

 

 

smrtgoal.png

 

 

 

 

Reference: Brochure I found. Loblaws.

The Stress Vulnerability Model of Psychiatric Disorders

Psychiatric illness tend to fluctuate over time, with their severity increasing and decreasing at different points in time. An episode of an illness (or a relapse) occurs when symptoms are severe and functioning is impaired. Understanding what factors contribute to relapses can help people learn how to manage their illness more effectively, and to prevent relapses or decrease their severity.

Psychiatric illnesses fluctuate over time in their severity

The stress- vulnerability model of psychiatric disorders provides a useful way of understanding how different factors influence the course of mental illness. According to this model, the course of a psychiatrist illness is influenced by several factors: biological vulnerability, stress, medication, drugs and alcohol, coping skills, and social support. Each of these factors is described below, and illustrated in the accompanying diagram.

 

Biological Vulnerability

Each Person has biological vulnerability to different diseases. This vulnerability is determined by a combination of generic and other biological factors. For example, some people have a biological vulnerability to cardiac disease: some people have a vulnerability to specific types of cancer, and some people have a vulnerability to specific psychiatric disorders. Common psychiatric disorders to which people are biologically vulnerable include schizophrenia, schizoaffective disorder, bipolar disorder, major depression, and anxiety disorders.

Once a person has a biological vulnerability to a mental illness, that mental illness may either develop spontaneously or be triggered by stress. Even among people who have a psychiatric illness, vulnerability may differ from one person to another. On average, people who have a greater biological vulnerability to an illness experience more severe symptoms and difficulties.

Stress

Stress refers to something in the environment that forces the person to adjust in some way. Stress can take the form of specific life events, such as the death of a loved one, a major move, or being a victim of crime. Stress can also be caused by living in difficult conditions, such as living with people who are hostile and critical, living in unpredictable and dangerous environments, or living in poverty.

People who are biologically vulnerable to a psychiatric disorder and who are exposed to stress are more likely to develop that disorder. Once people have a psychiatric disorder, stress can cause relapses and worsen the course of the illness.

Stress can affect biological vulnerability, leading to symptom relapses.

Factors that affect biological vulnerability and Stress.

Although biological vulnerability and stress influence the course of the psychiatric disorder, they can be affected by several factors. Those factors include medication, drugs and alcohol, coping skills, and social support.

Medications

Medications for psychiatric disorders can decrease biological vulnerabiltiy. Medications are effective at both decreasing the severity of symptoms and preventing symptom relapses. People who take medications regularly and do experience relapses tend to have less relapses.

Alcohol and Drugs

Alcohol and Drugs use can increase biological vulnerability. Some substance can directly increase biological vulnerability, while other substances can decrease the beneficial effects of medications on vulnerability. People with psychiatric disorders who use alcohol and drugs regularly are prone to more frequent relapses of their symptoms.

 

Medications decrease biological vulnerability.

Alcohol and drugs increase biological vulnerability.

 

Factors That Affect Stress

Stress can be deceased by coping skills, social support, and engaging in meaningful activity.

Coping Skills

Coping Skills are strategies that people use to minimize the effects of stress. Examples of coping skills include relaxation, positive self-talk, problem solving, talking out one’s feelings with a friend or support person, exercising, journal writing, and artistic expression. People who have several different coping skills are less susceptible to the negative effects of stress.

 

Coping skills decrease the negative effects of stress.

Social Support

Social Support refers to the help and caring that people feel they can count on from other people. Supportive persons can include family members, friends, members of the treatment team, a clergy member, or anyone else with whom a person has a close relationship. Good social support can decrease the effects of stress. Supportive people can sometimes solve problems with a person and decrease stress. For example, if a man feels criticized by his supervisor at work, a supportive person can help him identify strategies for learning more specifically about his supervisor’s concerns. Supportive people can also help a person deal with the negative effects of stress. For example, if a woman has been a victim of crime, she can talk it over with a supportive person, and benefit from that person’s concern and empathy.

Social support and coping skills can interact with one another. People with good coping skills can obtain more social support by reaching out and engaging with other people. Supportive people can also improve others’ coping skills by helping them develop more effective strategies for dealing with stress. People who have more social support tend to experience fewer and less severe relapses.

 

Social Support decreases the negative effects of stress.

 

Meaningful Activities

Meaningful Activities are tasks that provide a strong sense of purpose and gratification to a person. Being invovled in meaningful activities helps people to structure their time and gives them somethign to look forward to every day. Examples of meaningful activities include work, going to school, parenting a child, doing volunteer work, caring for someone else, and being a regular participant at a peer support program. Having meaningful activities to engage in reduces suseptibility to stress, because people are actively pursuing their goals and are less focused on stress.

 

Engaging in meaningful activities decreases the negative effects of stress. V

 

Treatment Implications of The Stress Vulnerability Model

The stress- vulnerability model points to five ways with psychiatric illness (and their families) can improve the course of their illness and reduce relapses and rehospitalisation:

1. Take psychiatric medications as prescribed.

2. Avoid alcohol and drug use.

3. Increase coping skills.

4. Increase social support.

5. Engage in meaningful activities, such as work, school, and parenting.

Taking these steps can help reduce relapses or lessen the severity of relapses, and therefore can help people make progress toward their personal goals.

 

vulmodel

 

Reference: Unknown. Brochure

 

 

Getting Better Sleep

Are you a Lark or an Owl? or maybe you’re both and live on little sleep and caffeine.

Larks: Someone who wakes up early

Owls: Someone who stays up late (Starts projects at 10pm)

To get good sleep, try these:

Get plenty of physical exercise during the day. This helps to lower your stress level and make you sleep better.

Try to make your day meaningful and pleasant by giving yourself a sense of accomplishment, either through doing a task or sharing some time with another person.

Refrain from drinking coffee, colas, or chocolate, all of which contain caffeine which can disturb sleep if ingested within 2 to 6 hours of bedtime, depending on the individual response.

Large snacks or drinking excessively before bed cam cause indigestion and other problems.

Avoid taking naps during the day. This can upset the patterns of associating your bed with nighttime sleep.

Try to relax within two hours of bedtime. Reading a light novel or watching a relaxing television program will provide the body and mind with a “cool down” period before you sleep. Try not to solve your problems or plan your next day’s activities just before bedtime.

The traditional glass of warm milk and cinnamon has been shown to be a sleep inducer.

Smoking before bed can disrupt sleep because nicotine has a stimulating effect.

“Counting Sheep” can sometimes be helpful to lull you into sleep.

Fresh air in your room is important. Shut windows when there is a draft or the weather may be too cold.

If in a new environment, accustom yourself to the new room before it is time to sleep to help you feel more comfortable.

Make sure there are no lights shinning in your eyes.

Add or delete/remove linen for required warmth. Being too hot or too cold can keep you from sleeping.

Indigestion or pain such as a headache can keep you from sleeping.

If taking medication and you are still not sleeping well, inform your doctor.

A positive attitude about sleep is important. If you think you can’t sleep, you will likely have more difficulty in settling. Associate you’re going to bed with the thought that you will sleep well.

Use a comfortable mattress and pillow.

Form a habit of going to the bathroom before bed if you find that you are awakened by the need to empty your bladder.

If you do wake up in the middle of the night, don’t become upset. Often, it may only require a change of position or use of rhe bathroom and then you will settle again to sleep.

Establish a regular but flexible sleep schedule. With habit, sleep becomes more regulated.

If you still can’t sleep after trying to remedy the problem, inform your doctor.

A natural sleep makes you feel refreshed when you wake in the morning.

Below is a list of Sleep Disruptions:

Stress/racing thoughts

Mental psychosis/mania

Nightmares

Anxiety

Animals

Outside noise

Environment (new place, or too hot/cold)

Illness of self or partner (coughing, sneezing, clogged nose, pain, etc )

Caffeine

Sleep apnea

Self-consciousness thoughts with partner (will I snore, be an ugly sleeper, move too much, etc)

Hormones

Sleep attire

Fluid and food intake

Disruptions of routine

Medications

Varying sleep times

Napping during the day

Technology (Light from screen wakes the brain up)

 

Ideas for Better Sleep ZzZzZz

If you nap, try to slowly decrease your nap times. If you normally nap for 1.5 hours, set your alarm and try to sleep for 1 hour, etc.

Research study shows that making your bed helps people sleep better and makes you more productive overall.

Keep the room dark, get light- blocking curtains.

In the morning, open up the curtains to allow the light in

Natural supplement: Melatonin pills (talk to doc first)

Keeping a routine

Calming tea (chamomile)

Aromatherapy (lavender)

Calm music

Fresh air (crack windows a bit)

Turning your clock so you can’t see the time.

Meditation: Triangle/Diamond hands -place hands on your belly in a diamond shape and breathe

Meditation: Beam of Light- trace finger or imagine a beam of light travelling along your face in circles, relaxing each part of your face as you go along. From the nose up and over your eyebrow and around and under your eye, up to your forehead and down to your other eye and around and up to your eyebrow then down and circle around that same cheek then travel down to your chin and up over the other side and circle your other cheek, then over your lip and down around your chin again.

Meditation: Counting Down/Heavy Eye lids- Close your eyes. Say the number 10 to yourself, breath in nice and slow and deep, breath out slowly and open your eyes slowly and softly, then close your eyes and say number 9 to yourself, breath in and take a big breath then while breathing out open your eyes gently, then close your eyes and imagine the number 8, etc.

Count sheep 🙂  1 sheep, 2sheep, 3 sheep, 4. 5 Sheep.6 Sheep. 7 Sheep. Snore! Zz

 

 

 

Reference for this post is from OMTH, Oakville. 4th Floor.

 

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