Sunday 31 January 2016

Resilience to be Cheerful part 3

Resilience to be Cheerful part 3

Except its really just Part 2, but that isn't a play on the Ian Dury song 'Reasons to be Cheerful Part 3', enough, okay I'll move on.

In discussions with my GP, Mental Health Nurse, Talking Therapist I recognised the need for resilience as I begun to see an ever so slight upturn in my depression and anxiety before my failed return to work in October last year before I again returned 12th November.  I was very much afraid that I would relapse again and again and again for the rest of my working life having episodes of Depression, Anxiety in 2010, 2012, 2014 and now 2015 ......... I was afraid that I would be boom and bust mentally for the years upto my retirement.  Right now I'm feeling a tad more optimistic again regards this as I have my first full time working weeks next week and the week after.  I need resilience and robustness because I don't want to be in a cycle of relapse and recovery at close proximity.  I guess I can't promise myself respite from this nor can my health professionals but I know I need to work as hard as I can to avoid that relapse cycle.

Resilience is all about me growing my capacity to handle difficulties, demands, any high pressure situations without becoming overtly stressed or triggered into depression/anxiety/mania.  I don't have a magic wand, I'm aware that I can only do what I can do and hope that it builds resilience and robustness over time.

I think from a headline position its about:-
  • Not wasting energy on unimportant small matters
  • Being flexible to change ( harder to do than say )
  • Ian Holroyd's Bouncebackability ( football manager saying )
  • Making the best of any new situation
  • In all the above, seeing off the negative demon on your shoulder
  • Mindful working
  • Mindful living
  • Seeing and understanding fight or flight respones as they arise
  • Not being hard on self ( avoiding perfectionism )
  • Don't judge own thoughts
  • Don't get cross if you are negative, forgive yourself quickly
  • Plan your day but dont Judge your day against that plan ( flexibility )
  • Allow yourself happiness

There is no magic wand but all the above are going in my little red notebook.  Allowing me to focus on my best chance for resilience and robustness.

We'll see how it all goes.

Saturday 30 January 2016

Resilience is Useful .............

Resilience is Useful, Mindfulness quickie in the workplace

Im not sure how this post will work as I'm unsure that I'm resilient yet at work and home following my illness this last 7/8 months and the condition I'm now navigating.  There was a phrase in Star Trek 'Resistance is Useless' however something I have often discussed with my GP over the last 7/8 months is that I need Resilience once I'm back in the work place, I have relapsed last year far too quickly after my prior episode and I really want to be back at work, robust and resilient against stressors and challenges and my condition.

One of the things I have been trying to do at work is work mindfully, this probably sounds like a load of old tosh but having read around things and continued my dialogue with my Talking Therapist this feels the right thing to try and do and maintain it even when the work day brings a full diary.

Work is, and has always had the potential to be challenging for people.  We find ourselves in the so called 'digital age'  driven by the constant need for efficiencies and cost effectiveness.  I'm sure in some companies you could argue that this might have led to some unhealthy working practices.  There is an idea that we can multi-task but science has poo-pooed this in reality, the belief being that unless a dual task is something you have done time and time again ( sub conciously now ) then you brain is involved in context switching all the while you try to carry out 2/3 different tasks with different focuses.  The advice here is to prioritise and work on one focus at a time to get the best results.

Working mindfully is said to allow us to become more aware of our mental processes, in theory alllowing us to more easily choose the appropriate strategy for any piece of work/task.  I have a little red book that I have on my desk in plain sight in front of me, the idea being that when I am letting my jobs run away with me and I'm falling into context switching that I will remember that I need to be mindful and pull the little red notebook out and carry out a mindfulness exercise.  I'm not very good at this but I hope that I'm getting better week by week.  It also has some learnings I have made from past CBT exercises and other little quotes and notes that hopefully gee me up and help me to survive in the workplace.

One exercise I have written down is a 3 step mindfulness practice and I've been known to have to do this in the work toilets because I cant find somewhere to carry out the practice, it can be really hard to do at your desk unless its first thing in the morning and nobody hardly is in.  I'm hoping that the more I avoid context switching and the more I work mindfully the more resilient I will get and that relapse will be further and further away as I navigate my BiPolar condition.

The 3 step work mindfulness exercise boiled down.  1)  Find a comfortable upright position and avoid slouching.  Although you can do this with your eyes open at work it's probably easier to do this with your eyes shut.  Closing the eyes mean that you are avoiding visual stimulus.  Initially deal with your current thoughts and by recognising them and letting them go.   2)  Focus on your breath coming in and going out, use this as your anchor, make it your focus.   3)  Spend just a minute or two recognising how your body feels in the here and now.  Be aware of any physical sensations and accept them, good or bad, lamenting on bad sensations with not help, just let them pass over you, let them go.  Move to an acceptance that present moment sensations add no fuel to negative thoughts, in the moment you are under no threat.

I hope that makes sense.  A lot of Mindfulness authors make it sound so so simple and it isn't, I find it really hard to get to that moment of 'Now' where you are under no threat but if you can access it then it's a good tool to garner more resilience.

This is a bit more of a lesson of a Blog so apologies but as I continue my phased return to work I'm finding that I have to access things like this to keep going.  One thing I'm struggling with at the moment is that I seem to hit a wall energy wise at about 2:30pm on full days in the office.  I haven't really found a solution to that as yet.


Friday 22 January 2016

Rejecting negative thinking ......... well trying to anyways !

So, one of the things I have been working on, because it trips me up so badly, is rejecting negative thinking.  This is something that I have worked on with my talking therapist but also have targeted with Hypnotherapy as well ( even though I’m still a little sceptical there, I’ve still parted with my money!).

There are techniques that I have been told of or had explained to me.  I have tried them all but I haven’t found them all successful for me.  One of the first I was taught was the ‘throwing away’ technique which was taught through hypnotherapy and I haven’t really got it to work for me.  The idea here is that of visualisation and feeling, so taking the negative or anxietal thought in your head and moving it from your head down your head, shoulders and into your arm and then into your fist from which you throw it away, though I can find this technique relaxing I don’t find that the throwing away works for me.  Secondly I’ve been told of another technique that works better for me, it’s effectively a technique of distraction where when a negative/anxietal thought comes, you then do something else in your head alongside it, not for long, just for perhaps 30 seconds or so and if the thought comes back you do so again, you need to be disciplined.  Things to do are, go shopping in your mind, think of a list of shopping you currently need or list you favourite songs or think through some repetitive actions that do on a regular basis to carry out a practical task, ‘chopping and stacking wood’ maybe.  Thirdly, a practical version of the first above is to write your negative/anxietal thoughts down on post it notes or paper and throw them away or burn them, I haven’t tried this though I have been involved in a thankfulness exercise where post it notes were used and that is a positive distracting process.

Another thing that research has found is that worry and rumination can result from and in that being mirrored in other folks, so there is an idea that you should try and surround yourself with more positive people.  This is tricky for me, as if I think of myself as negative then what right do I have to expect positive people to want me around, but that’s a typical vicious circle with mental health.  I’m lucky that quite a lot of my friends are positive souls, not all of them, but enough that this can be uplifting for myself.

It’s said that if your negative thoughts result in feelings of loneliness often holding a hit liquid in your hands can be helpful, that you can gain comfort from a hot cup of tea/coffee/cocoa held in your hands, this works on substituting physical warmth for emotional warmth and I think even experts see this as just a sticking plaster for folks.  So ‘keep calm’ and ‘have a cup of tea’ I guess J

If you are having negative and anxietal thoughts an expert Winch says ‘ If your urge to ruminate is very strong, distracting yourself isn’t going to be easy.  So before you try, it may be necessary to reframe or reappraise the situation in your head’.   My understanding of this is that if you have a situation that’s playing out such as you are stuck at a bus station because of a cancelled bus or traffic jam for you getting there then don’t focus on what you are missing out on, instead use the time to do something positive like, ring your parents, get a little bit of work done, write a shopping list etc etc.  Once you have reframed the thoughts initially you may then find that you are more easier to distract yourself in the medium term from your ruminations.

I don’t know if any of this will help folks but it’s something that I have been thinking about recently.


Tony

Friday 15 January 2016

twelve symptoms #12 , apols it took rather longer than the 12 days of christmas ...............

##12. Hopelessness / Suicidal Thoughts


For me, I can spot when I’m depressed but I can seem to do very little about it, but I know I’m depressed.  A telling symptom of a depressive episode associated with bipolar is an overwhelming feeling of sadness and hopelessness. We can fall into a state of depression and this then means that the symptoms flip from those associated with manicness/mania  (where sufferers can have heightened happiness and euphoria). You will often quiet quickly become sluggish/fuggish and won’t see much point in trying to hit goals.  Another common symptom is a near-total loss of interest in activities you once enjoyed, music, books, film, children, friends, I’m told this includes sexual activity. This can be seen as juxtaposed to what happens during a manic episode, when sufferers tirelessly pursue their interests and may engage in compulsive, excessive behaviour.
Sufferers with bipolar disorder will often feel sad and depressed, feel hopeless. I have never felt so hopeless as to have plotted anything suicidal however, and I need to be careful regards this as members of my family will read this blog, I have had thoughts about how much better off people would be without me.  I’m worth more dead due to pensions and death in service benefits BUT I’m not!  Because ultimately we are of such great emotional value to our friends and family who love us that we must absolutely fight the devil on our shoulder here.  Suicidal thoughts can be extremely dangerous, since bipolar disorder also commonly includes compulsiveness. A sufferer feeling despondent to the point of suicide may have the compulsion to act on that, it’s really key that we can stay aware such that we don’t find ourselves in this place.

If these symptoms present themselves to you to any degree, please seek medical or professional attention immediately. Sufferers  with suicidal ideas or exhibiting suicidal behavior need quick and keen interventions to tackle these ideas/behaviours.

Thursday 14 January 2016

twelvw symptoms #11

#11. Chronic Pain with No Known Cause
 Sufferers experiencing other symptoms on this list, along with chronic pain with no known cause, may be suffering from bipolar disorder. I haven’t had this symptom personally but I’m informed that pain can present itself throughout many parts of the body, which could be but I guess we would not limit to, severe headaches. Muscle aches and generalised aches, nonspecific pains can also occur.  I don’t think I understand this very well as I can’t imagine this, though I have had headaches but have put them down to medication changes and things that headaches would normally be a symptom of.

There are cases, where the pain felt has a known cause, but for BiPolar sufferers it may be amplified and intensified. An example migh be, a person with a mild thing like a bruised knee may complain of unbearable throbbing pain, intense pain, greater than what would normally be expected from a mild injury. Curiously, it has been established, that rather than painkillers, it seems that antidepressants offer the most effective relief from this type of pain.

Tuesday 12 January 2016

twelve symptoms #10

#10  Fatigue



Perhaps couter-intuitively contrary to manic symptoms/episodes, Sufferers suffering from a depressive episode will often experience extreme tiredness and fatigue. I often feel worn out by my depression and anxiety and even though I haven’t done anything really, feel tired and listless and want to shut myself away from the world and roll up in bed.  An overall lack of motivation throughout the day and the prior are all potential signs of bipolar disorder. Its said that these symptoms are one of the clearest juxtapositions of the night to day to night dichotomy between mania and depression, the two non equal sides of BiPolar disorder.  As well as any felt physical fatigue, sufferers often feel mentally “bogged down” ( I have stated this as feeling muggy and not able interllect wise to do my job ). During depression I and despite maybe getting enough/ample sleep I still feel a Mental sluggishness replaces the manic mania euphoria, I lack, often quite suddenly can lack desire/drive to do the things that interest them.  I also suffer from a failure of decision making, too much choice means I fail to relax. Eg.  I might have 5 films ,  5 Cd’s, 5 work books , 5 comics etc etc to choose from BUT I just can not choose what to utilise !!!

*********ALSO*********

I wrote a short poem regards David Bowie ~ http://sane.org.uk/support_forum/viewtopic.php?f=7&t=28859
He will be missed, more than that he probably inspired a lot of people regards fashion, sexuality and music

twelve symptoms #9

#9 Missed Work and Appointments

Apparently a common symptom of bipolar disorder is the inability to maintain a schedule. This causes many sufferers to miss work or other commitments, luckily I haven’t really had this too much at all.  I do occasionally feel the need to roll up foetally in my bed underneath the duvet and hide away but this is rare when I’m actually at work.  If I’m ill to the factor that my symptom’s affect my day to day life then I’m normally already off work though on returns to work the odd days can be lost.

During a manic period there is an expectation that the sufferer may be busy persuing other activities and miss work, deeming without check that the other activities are more important at the time, again I have not had evidence of much of this.  In fact when I’m manic I’m more likely to over work, overdo my working life amongst the mania.  I have had the issue where I can’t focus on the task at hand so I have seen work disrupted that way during a manic episode.  During depression the lethargy can sometimes kick in and I fail to see the point in working or life in general.

Friday 8 January 2016

twelve symptoms #8

8. Sleep Issues

I have had quite a lot of sleep issues in the last 2/3 years and I’m not sure that I have got to grips with sleep hygiene as yet.  Though I have had a sleep hygiene module with the Great Yarmouth well being service.
As I have maybe previously mentioned, manic episodes often involve large bursts of energy and euphoria. These symptoms can make it incredibly difficult to sleep. This is a reality for me when my mind is buzzing and racing and it’s very hard to calm the mind down, even with CBT, mindfulness, distraction, medication.  Unlike the normal response to this which is allegedly that an individual will not feel tired or exhausted I feel tired and my mind becomes muggy.  I also find that I seem to wake up far to early and then can not get back to sleep, this is disruptive and I now do not fight it but just get up and get on with stuff as I can, even if it’s 3/4am.
The sleep hygiene course did offer me some ideas which I do generally follow.  They were:-  Don’t use screen based tech for a couple of hours before sleep,  Don’t have caffeinated drinks in the evening,  Don’t start a piece of work so late at night that it will drag to bed time, Have a hot bath that you step out of about 45 minutes prior to sleep  ( warm down aides sleep allegedly ).  I have also found that listening to relaxing music helps and also listening to monotone spoken word books can also help  ( the more animated narrators are less helpful ).
An individual experiencing symptoms around sleep may require less sleep, but won’t necessarily feel tired or exhausted. Sometimes these symptoms are often mischaracterized as insomnia.  A person suffering from insomnia experiences persistent difficulty falling asleep or staying asleep  ( I tend to have this during a depressive state ) . This isn’t quite what happens during a manic episode. Patients typically just don’t feel tired to the same degree they normally would, and as such, they choose to stay up and use outlets to expend their energy rather than try to sleep.

twelve symptoms #7

7. Casual use of drugs and alchohol

One symptom of bipolar that Im absolutely unaware that I run risks with is casual use of drugs and alchohol.  I just don’t seem to go down this route at all.  In fact I don’t drink alchohol hardly at all because of possible side effects with my medications and the fact that I have really experienced:-
Sometimes, people suffering from bipolar disorder will turn to drugs and alcohol. Careless use of these substances may be a warning sign of deeper issues. Worse still, illicit drugs and excessive alcohol consumption have both been shown to further destabilize the sufferers mood, which just makes the condition’s symptoms all that much worse.  Drugs and alcohol are also known to increase the sufferers anxiety that can accompany hypomania.  It’s then fairly obvious that most  treatment programs stress to patients that they must limit or eliminate alcohol consumption and avoid street drugs altogether.

Agile Thoughts and Ruminations ( work specific blog )

I was just thinking that I haven’t really blogged anything about my work role
Now I’m not saying that I’m any good, in fact with my condition for a lot of the time I just think I’m mediocre !!

Soooooo, some very simple thoughts on Agile as I’m having to try and re-establish my connection with Agile.
There appear to be three elements that I’m struggling with recognising for myself, I think they are key to me getting my ‘Agile MOJO’ back !!

1.       Being more flexible in my attitude and actions.
2.       Knowing & Believing in the Agile mindset
3.       Understanding where I am on the Agile continuum

Now I know that when I was executing my role well, I was I hope flexible in my attitude and my actions.  I was a Scrum Master and I was there to be inward facing and benefit the team by removing impediments, running a lot of the Agile ceremonies and generally just ‘getting it’, that is Agile.  Getting that we needed to be a team that commited to a feasible set of stories and delivered them in a sprint. No blame just the ability to facilitate velocity as an Agile scrum team.     For Agile to work, all the team need to let go, let go of the command and control philosophy that has driven our IT for so many years.  We need to be able to then trust what we as a team commit to and the actions we take to deliver the backlog for our Product Owners.  We need to be able to look retroactively at our prior Sprint/work and have an open, honest and constructive discussion about what works, what didn’t work and what might work.  Basically remaining flexible in our attitude and our actions.   I hope that makes sense.

Now I think I believed in the Agile mindset, which effectivelty for me was believing in the Agile manifesto.  People over Processes etc.  I’m struggling to get fully back to that position in my head because my last 2 projects before I was off unwell had allowed me to question my own contribution and then allowed me to question the agile  mindset as I was struggling with my teams to deliver the backlogs for the Product Owners.  Not just me, but a whole team, though I was laying the blame primarily at myself.  I have been reading a lot of Agile texts to try and reconnect with the Agile manifesto and the Agile mindset, feels like its alluding me but perhaps its just around the corner as I am feeling a tad more optimistic at work.

I would have said that I was quite advanced on the Agile continuum but as I have questioned everything else about myself I have questioned this as well.  Concerned that I have in the past effectively been lying to myself.  I’m worried that I now might make the same decisions that I used to make in Waterfall though those decisions may now be outdated and not fit with Agile, a sort of resorting to a comfort zone in my old IT world.  I need to rely on my own ingenuity to help facilitate projects and work as well as the Agile mindset and believe that I can recover my place on the Agile continuum.  I need to move away from a reliance on ‘tried and true’ to a position of ’inpsect and adapt’ !  It may also be hard as moving away from ‘tried and true’ might seem counter-intuitive.  So my condition means that I blame myself for most things that go wrong on any project, even if it’s not my actions that have resulted in a specific outcome.

One problem I’m always fighting for some reason is my catastrophic thinking so even though I have never been performance managed I seem to always think it’s just around the corner.


Thursday 7 January 2016

twelve symptoms #6

Increased Physical Activity (manic phase )

Hope people are finding this series of blogs helpful ...............

When I have had my rare manic episodes I have often had extremely high levels of energy and have almost run/walked in the office between meetings.  Some sufferers turn to physical activities but I have tended to keep to my normal activities but proceeded to do them at 100 miles an hour, losing the benefit of my energy by probably losing my friends and work colleagues in my wake.  My energetic mania is interrupted by long periods of lethargy and depression within my type 2 bipolar it seems, it’s a sort of carch & burn scenario it seems.  I don’t tend to see my mania so I need my wife/friends to spot this in me really, in order to arrest that mania in its throws hopefully.
I don’t find though some sufferers do that I engage in compulsive sexual behaviour during a manic episode though it could be said that a few high energy activities I may have randomly taken to could be seen as having risk associated with them.  I need to get to places ASAP and so I cross roads without the normal respect for the traffic on the roads.
Hope that makes some sort of sense.

Wednesday 6 January 2016

twelve symptoms #5

5. Irritation

I'm not aware that I exhibit the symptom of irritation but I am aware that I exhibit agitation as I have sat on the bus into work completely agitated as the anxiety and depression overwhelm me.  
Irritation & Agitation are common when in either the manic or depressive episodes of the mood cycle, the thing is that those with bipolar are irritated by common all garden things that they would not normally be agitated with.
The mood instabilities of the condition are said to be present during both manic and depressive episodes and sufferers can quickly switch from one extreme to another.
Euphoric and Despondent baselines are said to be very different from one sufferer to another.
Treatment, as does mine, primarily focuses on stabilising the mood ( Im on Quetiapine to this end ), preventing hopefully the sudden and longer cycle shifts between happiness and sadness, between euphoria and depression.
The mood swings hold over the sufferer is used by clinicians to understand how ill someone is currently.

Saturday 2 January 2016

twelve symptoms #4

4. Racing Thoughts

With type II I don't have mania/hypomania as often as type I sufferers but racing thoughts are a common manic bipolar symptom.  You have a difficulty in concentrating on one thing at a time and tend to over-analyse your thoughts as well.  You can appear to jump at random from one thing to another and as you are distracted by your own racing mind you are unlikely to keep attention on any goal you might have work or home wise.  

It's true that you can enjoy clarity of mind during hypomania and it may feel productive when your thoughts are racing, flitting from one thing to another.  I tend to talk over people but I do need others to spot this in me as I rarely see it.  If/as you flip into full blown mania from hypomania you will find that you crash & burn and any high productivity is then lost.

Hope that makes sense.