Sarah Lister Psychology https://www.sarahlisterpsychology.com.au Clinical Psychologist Wheelers Hill Thu, 05 Jul 2018 10:20:17 +0000 en-AU hourly 1 https://wordpress.org/?v=4.9.7 https://i2.wp.com/www.sarahlisterpsychology.com.au/wp-content/uploads/cropped-psychologist-melbourne-logo.jpg?fit=32%2C32&ssl=1 Sarah Lister Psychology https://www.sarahlisterpsychology.com.au 32 32 120472101 Relapse Prevention: A Stitch in Time https://www.sarahlisterpsychology.com.au/relapse-prevention-stitch-time/ Tue, 18 Apr 2017 21:45:16 +0000 https://www.sarahlisterpsychology.com.au/?p=296 So, you’ve recovered from an episode of depression, psychosis, or mania, and you never want to be unwell again. The good news is that spending some time and thought on relapse prevention planning can make that a reality. It is possible to set up a personalised plan to help you notice your early warning signs […]

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So, you’ve recovered from an episode of depression, psychosis, or mania, and you never want to be unwell again.

The good news is that spending some time and thought on relapse prevention planning can make that a reality. It is possible to set up a personalised plan to help you notice your early warning signs that an episode may be on it’s way, and any actions you want to take after noticing these signs.

It is important not to live in a constant state of vigilance, wondering if one night of poor sleep means you are about to have a relapse. All that stress can bring down your quality of life and may even trigger a relapse. But, burying your head in the sand and hoping for the best is equally unlikely to help you stay well.

If you have had a significant episode of depression, mania, or psychosis, I would recommend that you take the time to set up a relapse prevention plan. I would also recommend that you commit to attending mental health checkup appointments at set intervals – every three months generally seems manageable and productive. This checkup could be with a mental health nurse, psychologist, psychiatrist, or a GP with a special interest in mental health.

When I see people about relapse prevention planning, I have a process with three stages:

Stage one

We meet for around an hour to identify your early warning signs and work out a personalised plan of actions you can take to stay well and also actions to take if you notice early warning signs. Taking action at the first signs of relapse can prevent a relapse or at least greatly reduce the length and severity of an episode.

I use a card sorting activity to help you identify your early warning signs. This involves sorting cards with statements such as “needing less sleep” or “feeling confused” into piles according to the stage at which they happen for you.

This activity is helpful for identifying early warning signs you hadn’t noticed before. Most people have noticed some of their early warning signs, such as wanting to go back to bed during the day as an early sign of depression. There are likely to be other signs that you’ve never noticed, such as talking less or withdrawing from friends and family.

It is very helpful if you can bring someone who knows you well to this appointment, as they may have noticed some early warning signs that you are unaware of. They can also provide ideas for how you can help yourself, and what support they are prepared to offer.

Stage two

I type up a personalised relapse prevention plan, which includes the early warning signs you’ve identified, plus the actions you plan to take if you notice these signs. The plan includes contact details for any health professionals you see for your mental health, plus crisis numbers. If you have a history of an episode affecting your judgement and refusing to seek support, you may choose to specify that you give permission for a trusted friend or family member to contact treatment services on your behalf. This is reassuring for your loved ones, who often worry about upsetting you or damaging their relationship with you if they “put a foot wrong” when you are becoming unwell.

Stage three

We review the plan and make sure it covers everything you need it to cover. I then give you a printed copy and an electronic (PDF) version for your records. You are welcome to contact me  to review and change the plan whenever you need to in future.

Download a sample relapse prevention plan PDF: SAMPLE Relapse Prevention Plan

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[Book Review] Living With It: A Survivor’s Guide to Panic Attacks https://www.sarahlisterpsychology.com.au/book-review-living-with-it/ Sat, 01 Apr 2017 09:26:52 +0000 https://www.sarahlisterpsychology.com.au/?p=218 If you have Panic Attacks and you haven’t read this book:   I suggest you get a copy right away. Your local library will most likely have at least one copy, and it’s cheap to buy (find the current cheapest online price on Booko). Whenever I make a diagnosis of Panic Disorder, the first thing […]

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If you have Panic Attacks and you haven’t read this book:

 

I suggest you get a copy right away. Your local library will most likely have at least one copy, and it’s cheap to buy (find the current cheapest online price on Booko).

Whenever I make a diagnosis of Panic Disorder, the first thing I do is recommend this book.

What’s so special about Living with It? Not only does it explain what panic attacks are, what causes them, and how to cope with them, but the author had Panic Disorder for many years. This means that most people with panic attacks find it very easy to understand and relate to this book.

Another great thing about Living With It is the format – it’s a short book and much of the information is delivered in cartoon format. Not only does this make it easy to concentrate and absorb the information, it is also often amusing. Concentrating, absorbing information, and laughing are not things that happen all that often when you’re suffering from panic attacks.

Living With It is a crash course in Cognitive Behavior Therapy (CBT) for panic attacks, that you can keep on your shelf and refer back to it whenever you need a refresher. Obviously, a book isn’t a direct substitute for seeing a psychologist for individualised CBT, but it can certainly help the process along.

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Charting a Course Through Mood Disorders https://www.sarahlisterpsychology.com.au/charting-course-mood-disorders/ Mon, 27 Mar 2017 10:14:41 +0000 https://www.sarahlisterpsychology.com.au/?p=202 If you have a mood disorder (such as Dysthymia, Bipolar Affective Disorder, Major Depressive Disorder, or Premenstrual Dysphoric Disorder) there is a brief daily activity that I strongly recommend you try. Keeping a mood chart is a deceptively powerful exercise that can benefit anyone with a mood disorder. You and your treating team can notice […]

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If you have a mood disorder (such as Dysthymia, Bipolar Affective Disorder, Major Depressive Disorder, or Premenstrual Dysphoric Disorder) there is a brief daily activity that I strongly recommend you try. Keeping a mood chart is a deceptively powerful exercise that can benefit anyone with a mood disorder.

You and your treating team can notice patterns

Charts can reveal a relationship between your mood and other variables such as sleep, exercise, alcohol use, medication changes, and menstrual cycle. Taking your mood chart to appointments with doctors and psychologists can help them understand, without you trying to remember and describe how you’ve been going. This is particularly useful because mood disorders commonly cause difficulties with memory and concentration.

Learn how to observe your moods as well as experience them

Ticking boxes and entering numbers into a mood chart helps you take the position of a scientist or journalist observing your mood. Being able to observe your moods as well as experience them helps important areas of your brain start to communicate better with each other. This helps you generate more objective thoughts and even use lateral thinking to help solve your problems. It gets your brain moving towards functioning the way it does when you are well.

Combat mood dependent memory

The human mind is prone to mood dependent memory, which means that our moods dictate which memories we can access most easily. When  you’re happy, it is easy to recall other happy times. When you are depressed, it becomes very difficult to remember the happy times. This can slow down your recovery because you tend to think things like “I’ve been depressed for so long maybe I’ll never feel better.”

If you have been completing a mood chart you can quickly and easily look back and see the evidence that you’ve had happier days. You can then use this to challenge the negative thinking that comes with depression.

Identify early warning signs

Keeping a mood chart can help you notice any early warning signs as soon as they return after a period of wellness. Noticing early warning signs and acting on them can prevent a relapse or at least markedly reduce its severity.

For example, needing less sleep is a common early warning sign for a manic episode. If this is one of your signs, your mood chart makes it very easy to notice changes to your sleep pattern as soon as they occur. You can then use sleep hygiene practices or medication prescribed by your doctor to nip the sleeplessness in the bud and hopefully prevent a manic episode.

Ideally you would spend some time with your doctor or psychologist developing a relapse prevention plan (in writing) that you can follow if you notice early warning signs.

Getting Started

bipolar-mood-chart

If you are interested in doing a mood chart, you can download one I routinely use with my clients here, and start completing it following these steps:

  • Choose a time near the end of each day at which you will be able to consistently complete the chart. You may need to set an alarm, or keep the chart near something you predictably use in the evening (like your toothbrush).
  • Firstly, write the month and year at the top of the page and start entering your ratings for today under the number corresponding to today’s date.
  • Mark the box that represents your average mood for today (ranging from severely elevated to severely depressed).
  • If your mood fluctuated significantly over the course of the day, you can mark two boxes. For example, one day you might mark both “normal” and “moderately elevated”; another day you might mark only “mildly elevated.”
  • Next, rate your average irritability and anxiety for the day using the rating scale provided (0=none, 1=mild, 2=moderate, 3=severe).
  • On day 28 you can record your weight if you choose to. This is because mood disorders can cause weight changes.
  • In the row marked sleep, enter the number of hours you slept LAST night.
  • Under sleep there is a blank row, which you can use for tracking another variable if you like. This can be used for anything that you think cold be related to your mood and can be expressed with a number or a tick/cross. Some examples are naps, meals, binge eating, standard drinks, or arguments with your partner.
  • The final step is to record your current medications and doses. If your dose changes, enter the new dose into a new row and start marking the boxes for that row instead. This makes it easier to track any mood changes after a medication change.
  • On the back page you can use the notes section to add information that can’t be communicated using a number or tick/cross system. For example you might write the details of a significant event that you think could have had an impact on your mood. There is also additional space on the back page for medications.
  • At the end of each month, you might like to create a line graph by drawing a line between your mood ratings. If you have been marking two boxes per day, draw two line graphs.

If you forget to complete the chart at times, do NOT fill it in later as your memory will not be 100% accurate. A mood chart with gaps (even large gaps) is more useful than an inaccurate one.

A quick note for women: I advise women with menstrual cycles to circle the first day of their cycle so that they can track any hormone related mood changes. If you know when you ovulate it can be useful to chart that as well because ovulation can affect moods.

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How Depression Thinks https://www.sarahlisterpsychology.com.au/how-depression-thinks/ Sat, 18 Mar 2017 10:02:48 +0000 https://www.sarahlisterpsychology.com.au/?p=170 As a psychologist, there are a few things I’ve discovered about depression over the years. When I share what I’ve learned with someone who has depression, it generally makes them feel understood and even a little hopeful. I decided to write down what I’ve learned and share it here for anyone who might be experiencing […]

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As a psychologist, there are a few things I’ve discovered about depression over the years.

When I share what I’ve learned with someone who has depression, it generally makes them feel understood and even a little hopeful.

I decided to write down what I’ve learned and share it here for anyone who might be experiencing depression. It might also help you understand depression if you’ve never experienced it yourself.

When depression comes to live inside your mind it starts a process of slow seduction. It starts by pointing out all the things about yourself or your life that you’re not really that happy with, and then it magnifies those things until you start to feel like your life is unfulfilling and you’re not doing a very good job.

It does all of this in a friendly, even charming, way. It suggests to you that it knows you better than anyone else; it knows all your bad parts and still wants to be around you. More than just around you, it wants to be very close to you.

Pretty soon, depression starts to say unkind things to you when you make a mistake. Things like “you always make mistakes” or “you’re a failure.”

Depression is very clever though, and it knows that you would probably reject these ideas coming from someone else, so it says them to you inside your mind and it disguises them as your own thoughts. So, depression sounds like this in your mind – “I always make mistakes, I can’t get anything right” “I’m a failure, I’m a loser, I’m a piece of shit” (excuse the language, but depression often talks like that to get your attention).

Depression gets involved in your relationships too. If someone is unkind, or even just distracted, depression makes you think “they don’t love me anymore”, “they don’t want me around” or “I knew they would eventually realise they didn’t want to be with me” or even “nobody really cares.” Depression also tells you not to talk about how you’re feeling, because it doesn’t want you to get any reality testing.

Reality testing is a very useful process in which you say your thoughts out loud and another human being says “really? wow, that’s pretty negative, why do you think that?” and you say “I don’t know.” After this exchange, you would start to question your thinking and maybe even change it. Reality testing is depression’s worst nightmare, because it would help you to question and then resist it. Depression wants to keep you feeling disconnected from people who love you so that you will rely on its company and keep feeding it your misery.

Aside from isolating you from people that love you, depression also likes to cut you off from activities you used to enjoy or find meaningful. This is so that all the depressive thoughts can really take hold. If you no longer have any sense of enjoyment or meaning in your daily life, you will readily believe thoughts such as “life is pointless, it’s empty and meaningless” and “people are kidding themselves that they enjoy life” and “this is how I’m meant to feel, I was kidding myself when I felt good.”

These kinds of thoughts help depression convince you to isolate yourself even more. You avoid seeing people because the idea of pretending to be happy is exhausting, and the idea of talking about how you really feel is terrifying, because depression tells you that reality testing would go something like this “I’ve been feeling really empty, angry, and hopeless” “What are you talking about? That’s ridiculous, you have a great life” or “come on, shake it off, we all have days like that.”

What’s even worse is that the voice of depression may sound familiar – this might be how people have spoken to you in the past. Our society isn’t well prepared for tackling depression and its dark ways. We may try to wish it away, or try to see a “reason” for it – and if those things don’t work, we might be tempted to tell people they should be able to just use “mind over matter.”

Some people say these things because they are trying to help in a misguided way, and some people say these things because they are scared of depression. It makes them feel small and powerless, so they refuse to accept its existence.

These kinds of reactions from other people can be used by depression to make you feel even more isolated, when it gets you thinking “see, no one understands” or even “they’re right that I have no reason to feel down – so I must be weak or broken.”

After a while, if depression feels really confident that it’s got you listening, it may start telling you the worst thing of all. It may get you thinking “I’m so cut off from everybody they wouldn’t even care if I just disappeared” or “I’m such a burden they would be relieved if I died.” You might start to wonder how you could manage to disappear, because by now you’re listening to everything depression tells you. Actually, you can’t really focus on anything else any more.

Daily life feels at times completely empty and meaningless, and at other times excruciatingly painful and disconnected. Depression says things like “what’s the point?” and “no one would care if I died” and “everyone is better off without me” and even though a tiny little corner of you feels like depression might just be saying this to be cruel, that corner is getting smaller and it can’t talk louder than the depression.

You start either wishing passively that your life would just end somehow, or thinking actively about how you could end your life. You may not realise that thoughts of death or suicide are the depression talking – you think it’s your own idea.

There might be just a tiny, far away corner of your mind screaming that this isn’t like you, but it’s hard to pay attention to it because by now you trust depression’s judgement over your own. When you ignore your own thoughts and choose to listen to the depression, part of you feels relieved and comforted.

There may be another part of you that notices this is an unhealthy choice, but depression will soon use that thought to make you feel ashamed by getting you to think “I shouldn’t be listening to these negative thoughts, I should be stronger than this.” Depression really knows how to get you down and then make you blame and shame yourself for what you’ve become.

When someone with depression comes to see me, my job is to reach in past the depression and talk directly to the person. I help them to see which thoughts are their own, and which thoughts are the depression talking. Then I help them to start talking back to the depression, to say “I see you, depression. I’m not buying those thought any more. I’m going to see what happens if I connect with people again and do the things that used to bring me pleasure. I won’t let you rob me any more.”

Depression is persistent and seductive and it will work hard to maintain its grip on you, but once you’ve learned its secrets you will find out that it’s not as powerful as you think it is.

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Crisis Contacts https://www.sarahlisterpsychology.com.au/crisis-contacts/ Tue, 14 Mar 2017 10:03:12 +0000 https://www.sarahlisterpsychology.com.au/?p=154 Who can I contact if I’m having a crisis? If you need to speak to someone urgently, please contact one of the following agencies: Life Line: 13 11 14 www.lifeline.org.au Suicide Call Back Service: 1300 659 467 www.suicidecallbackservice.org.au Suicide Help Line: 1300 651 251  www.suicidehelpline.org.au Kids Help Line:  1800 551 800 www.kidshelp.com.au Beyond Blue: 1300 224 […]

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Who can I contact if I’m having a crisis?

If you need to speak to someone urgently, please contact one of the following agencies:

 

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