DBT Update (or so much for that idea)

group therapySome of you asked for an update about how the Dialectical Behavior Therapy (DBT) class was working out. Well, it’s not. Unfortunately, the facilitator doesn’t seem to understand how a DBT class is supposed to work, and I spent the majority of the two sessions thinking about how much money I had just wasted. She would start the group by saying “Today we’re going to learn XYZ skill,” then the next two hours would be taken up mostly by two participants discussing their problems with their spouses, their kids, their in-laws, their landlords, etc. My insurance is the only one that has the co-pay of $40 each meeting, and I’d prefer to spend that money on the workbooks and my regular therapist. After 12 weeks, I would have spent close to the same amount of money it would cost me to visit my daughter and grandsons. I also happen to know quite a few other things I on which I could be spending the money because that’s what I spent the majority of the time thinking about.

Throughout my adventures in mental illness I have attended several groups, both inpatient and outpatient, and have found them helpful. I’ve learned things such as the difference between voices inside one’s head and voices outside one’s head; and it’s always good to know that many people have the same difficulties. However, it is not helpful to leave a group more agitated than when starting, especially when the group is supposed to be teaching coping skills.

Facebook has a great Do-It-Yourself DBT Group, so in addition to working with my therapist I’ll try to participate there as well. I still feel the learning these skills will be very helpful, just not in this particular environment.

What meds have you NOT taken?

pill headThat’s the question my psychiatrist asked me yesterday, because it’s easier for me to list what I have not taken, than the multitude of meds I’ve tried over the years. He decided to add a low dose of gabapentin, which I have taken in the past but at a higher dose and not for the purpose of a mood stabilizer. Which brings me to another subject…my own surprising ignorance (not to say I know everything) about the purpose of a mood stabilizer. My understanding was that a mood stabilizer makes one “flat.” Instead, he described it as an accordion. People with mood disorders have broad and unreasonable swings of depression and mania; while “normal” people also have mood swings, they’re just not as drastic. The mood stabilizer, when prescribed correctly, will act as an accordion to push those out-of-control moods into a more manageable range.

My feelings of not trying hard enough were discussed as well.  He said he wouldn’t put it that way, but I do need to force myself to do more non-medical/non-traditional self-care (this is why I love my holistic psychiatrist). Starting the DBT class next week will be helpful, but exercise and doing things I used to enjoy (even though I may think I don’t want to do them) will be vital to the prevention of sliding all the way back down the other side of the hill.

So I’ve tucked my new bottle of pills into my arsenal and have begun my trek back up from where I stopped my slide. When the alarm went off this morning, I put on my shorts and my sneakers, grabbed my iPod, and went directly to my elliptical in the basement for 20 minutes. Then I had a healthy breakfast, and while drinking my small amount of coffee I wrote a reasonable to-do list (I usually end up with too much, then get overwhelmed) and ordered some posters (it’s boring to stare at a blank wall even though I listen to an audiobook).

climbing
Perseverence

Adding to my arsenal

not this time

The insidious black fog
begins to roll back in.
She can see it from a distance.
She can feel its presence.

As it moves closer,
she stands taller.
And with a look of determination
etched on her face,
she picks up her weapons
and strides in to battle.

It will not defeat me,
Not this time.


For twelve weeks, starting in September, I’ll be learning how to use Dialectical Behavior Therapy to aid in my battle against mental illness. After a lifetime of fighting for my life, I refuse to give up now.

My arsenal is holistic, with weapons that are both traditional psychiatric treatments as well as alternative modalities. My army is made up of my friends and family. My determination is strong.

Symptom overload

My psychiatrist is a Doctor of Osteopathy, which is basically the same as a Medical Doctor. This type of psychiatrist may also be considered a holistic psychiatrist, as he has often stated that he believes in treating the person not the symptoms.  As the DO website states:

DOs practice a “whole person” approach to medicine. Instead of just treating you for specific symptoms or illnesses, they regard your body as an integrated whole.

Someone who knows me very well was lovingly listening to my frustration with too many diagnoses, and too many drugs. For the most part, I prefer to be proactive in my own treatment. Learning and doing everything I can to help myself is very important to me. I want to be in control, I don’t want to just sit around and wait to feel better. She suggested another diagnosis to look up, which is often misdiagnosed and usually not even considered in adults PDD-NOS.

First, for giggles, I went to the WebMD Symptom Checker and ended up with 37 different diagnoses including Jumping Frenchmen of Maine (really, it’s a thing) and Mad Cow Disease (this is why I’ve never done this before).

OK, back to being serious..The following are excerpts from an article in The Medical Journal of Australia:

Key features are impaired social cognition and communication; obsessive interests, routines or activities; and social or occupational dysfunction.

Pervasive developmental disorders (PDDs) are comprised of the neuropsychiatric developmental disabilities, autistic disorder (autism), Asperger disorder and PDD — “not otherwise specified”. These conditions are also commonly known as autism spectrum disorders. The key features are severe developmental difficulties with social cognition and communication, and non-functional obsessive interests, routines or activities.

PDDs are considered to have been under-diagnosed worldwide, and the variety of presentations and outcomes has only recently been recognised.

… IQ criteria can be used to divide PDDs into “high functioning” (IQ of 70 or greater), and “low functioning” (IQ of under 70).

Taking all this into consideration, along with my other diagnoses of bipolar disorder and borderline personality disorder, then sprinkle in some general depression and anxiety and top with a generous helping of PTSD; I’ve come up with the following simplified chart, and I’ve found that I have a majority of the symptoms in all three groups. Which then explains why I can never find a medication cocktail that works, and perhaps it’s time to stop the med-merry-go-round and concentrate on Dialectical Behavior Therapy.

confusionOverwhelming confusion and frustration shall now commence. I’m feeling very grateful that I’ll be seeing my therapist tomorrow.

PDD-NOS
∙Impaired social/communication skills
∙Impaired development of relationships
∙OCD-type behavior
∙Social dysfunction
∙Impaired perceptions of emotions
∙Impaired expression of emotions
∙Psychiatric comorbities
BPD
∙Impulsive/risky behavior
(with difficulty controlling said behavior)
∙Inability to control self-harm
∙Suicidal behavior
∙Wide mood swings
∙Intense episodes of anxiety/depression
∙Inappropriate anger
∙Inappropriate antagonism
∙Feeling misunderstood, neglected,
alone, empty or hopeless
∙Fear of being alone
∙Feelings of self-hatred
Bipolar Disorder
(a little more difficult to simplify due to several different types)
Mania:
∙Inflated self-esteem
∙Decreased need for sleep
∙Talkativeness
∙Racing thoughts
∙Distractibility
∙Agitation
∙Impulsive/risky behavior
Depression:
(most of these last all day,
every day)
∙Sad, empty, hopeless, tearful
∙Reduced interest or pleasure in
almost all activities
∙Insomnia or sleeping all day
∙Fatigue
∙Worthlessness
∙Inappropriate guilt
∙Suicidal ideations or planning