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It’s been a while since I’ve discussed any mental health topics on the Zebra Pit, so I’m glad Mental Health Awareness Month has come around to help get me motivated. As many of you know, I have a complex PTSD diagnosis and because of this and several of my other diagnoses, I also struggle intermittently with depression and anxiety. I spent a few months in therapy recently to try to get some help to better control these issues and have picked up several new tricks that seem to be working wonders. In this two part series, I wanted to share with you some of the things that have worked well to bring me to a more stable and positive place in my mental health journey.
While I’m sort of a lifer when it comes to therapy and DIY mental health improvement, I found myself struggling when my disability became severe enough to rob me of a life and career outside the home. Between the deep sense of loss I suffered and the onset of dysautonomia and MCAS, my old bag of mental health tricks were failing. As it turns out, I needed some help to get things back in order and the changes I had to make were both related to my physical and mental health.
You don’t have to have complex PTSD to benefit from the techniques I discuss. It probably doesn’t matter how the depression and anxiety got started, either. What’s important to understand is that these conditions are NEVER “all in your head” or “imaginary” and you can’t “just get over it” when you’re suffering from actual clinical depression and anxiety. Can it heal naturally on its own? Sometimes, but healing is much faster and more thorough with active intervention. Generally speaking, these conditions take hold when there’s an imbalance of key hormones in the body such as seratonin, glutamate, and GABA.
My anxiety and depression stem from a combination of genetics and environment. I experienced long-term abuse and neglect as a child and can also experience wild hormonal fluctuations brought on by the central nervous system dysfunction. The most likely culprits are my suspected autism, POTS and MCAS, as these all can have a big impact on the erroneous release of chemical mediators in the body. While the triggers are slightly different, the results are always the same, big fluctuations in mood and even bigger guilt when those fluctuations drive me to behave badly.
What I needed to get my anxiety and depression under control was a way to control my misbehaving mast cells and POTS, some CBT techniques to get me out of negative self-talk cycles and some mindfulness training to help keep me firmly grounded in the present rather than wallowing in the pain of the past.
My Mental Health Journey
If you’ve watched my video on PTSD and Chronic Illness or my post The Toxic Shame of Being Disabled, you know that my mental health took a big hit when I became too disabled to work, after I had done years and years of hard work to improve my mental health. You’ll also know that I already realized my original toxic shame (that heaped on me by my abusers) was somehow connected to my inability to accept my chronic illness and the recurrent PTSD cycles I was entering every time I had to face a doctor or any sort of disbelief when it came to my conditions. I was so close, but I couldn’t quite make everything fit.
It may have been in my first therapy session that my therapist simply handed me the key to the puzzle about why I was still occasionally fighting those rage demons and being so hard on myself. In essence, I was being constantly retriggered because I was being treated by doctors, family and friends the same way I was treated by my mother, my only caregiver. In some cases, even the same words or phrases were used. That’s all it took to unravel hundreds of hours of hard work.
My mother didn’t care enough to pay attention or spend time with me or learn about who I was or even ensure that she was ever home to supervise, prepare meals or anything else. I was largely abandoned at age 4 and left to care for myself the rest of my childhood, as my mother always ensured her jobs were 2nd shift so she didn’t have to be home with us. I wasn’t allowed to use the stove until I was 10 and was left hungry often. When she was there, she struck me constantly with her words and occasionally with her fists. She chose always to believe the worst of me. I was attention seeking when I was ill. I was stupid, worthless and lazy when I did poorly in school (never mind that I had no one to tutor me at home and was moved from one school district to another year after year). And when I had difficulty working under the weight of all the emotional baggage and untreated genetic conditions, I was just plain lazy and slovenly and would never amount to anything.
Having a doctor tell me they didn’t believe me or summarily discharge me or behave condescendingly, immediately transforms me into that helpless 5 year old. Without doctors, I was lost and I knew it. Abandoned, unloved and disbelieved, just as I had been as a child. After a while of dealing with this from doctor after doctor, the anxiety I began to experience before my appointments grew until I was having full blown panic attacks every time I even thought about scheduling an appointment; a very bad place for a person with chronic illness to be.
Techniques for Mental Health Improvement
It has helped a little to finally be diagnosed and connected with doctors with knowledge of my health conditions. Unfortunately, it didn’t help enough. Understanding that my reactions were shame based also helped and let me feel a little less guilty about it. However, it wasn’t until my therapist helped me clearly connect the dots that I could fully accept my behaviors and stop the self-defeating cycle of being triggered, sometimes behaving badly because of it and then beating myself up about it and only fueling that shame more.
I had really begun to feel bad about myself. Even if I could still list the positive attributes about myself, they were all in past tense. I couldn’t feel them or feel like they still existed. I participated in frequent negative self talk that wasn’t even true. In psychological terms, this is known as distorted thinking and many people fall prey to its trap. My therapist helped me with that, too. She assigned me exercises to help me identify when my thinking was distorted and reason out why. This has helped me significantly and I no longer need to pull out the worksheet to do it. If I need to utilize it now, it happens in my head. The true beauty however, is that I find I rarely ever need it anymore. I guess that’s why the workbook it came from is called Ten Days to Self- Esteem! It’s a great cognitive behavioral technique and I’ll probably post about it in more detail going forward, but here are some copies of the worksheets in case you want to try it.
While working with a therapist is probably my number 1 recommendation, there are a variety of ways you can work on these issues alone and buying workbooks like those these exercises came from is a great way to get started. I always learn things from these books. Here are a few that I’ve read or completed and recommend, including the two from above:
- Cognitive Behavior Therapy: Basics and Beyond – 2nd Edition – By Judith Beck
- Cognitive Behavioral Therapy Made Simple: 10 Strategies for Managing Anxiety, Depression, Anger, Panic, and Worry
- 10 Days to Self Esteem by David D. Burns, MD
The other psychological tool that’s been invaluable to me is practicing mindfulness meditation. Meditating can be tricky for people with chronic illness. Most of us utilize mental blocks to help regulate our pain whether we’re conscious of it or not. Because of this, when we open ourselves fully in a meditative state, we get flooded with pain. There is a work around for this, however: practicing ACTIVE meditation of some kind. It sounds complex, but it really isn’t. You just have to choose an easy task—crafts, arts, coloring, a guided meditation, tapping, gentle exercise or simple movements—and discourage any distractions or outside thoughts. Anytime you feel your mind wandering, you just bring it back to the task at hand.
Active meditation isn’t just for spoonies, either. It probably works better overall for people in the current age where we’re always busy and constantly bombarded with information. You can find a wide variety of apps, programs and websites to help you learn how, but I will also write about this in more detail, later. Here are a few great books on mindfulness and active meditation to get you started,now.
- Meditation Interventions to Rewire the Brain: Integrating Neuroscience Strategies for ADHD, Anxiety, Depression & PTSD
- Bliss More: How to Succeed in Meditation Without Really Trying
- Wake Up to the Joy of You: 52 Meditations and Practices for a Calmer, Happier Life
Another technique which sounds really simple, but often isn’t for people with anxiety and/or dysautonomia, is deep breathing. Deep breathing exercises are only helpful if you know how to utilize the technique and your central nervous system and muscles aren’t so locked that it’s physically impossible to take a good, deep breath. The 90/90 balloon exercise below will help you learn how to breathe deeply and will actually help you to build your core and helps to address several musculoskelital concerns:
Once you’ve been practicing the 90/90 for a little while taking a good, slow deep breathing exercises should no longer be a problem. When you begin to feel anxious taking several slow and measured breaths helps to switch the autonomic system and park it in rest mode. Doing this several times a day can be very helpful in maintaining peace. Be sure when practicing breathing exercises that you’re engaging your diaphragm and most importantly, going very slow and steady so you don’t hyperventilate. You can ry the breathing exercise below first to see if you need to practice the 90/90 exercises.
How Exercise Can Help:
Exercise has many powerful attributes which are beneficial to spoonies, when done gently and with healthy consideration given to avoiding post-extertional malaise (PEM) and joint injury. Spoonies should exercise regularly despite pain and other problems unless your doctors tell you otherwise (for example people with NMH need to be evaluated before they take on exercise). It is important that you go slowly, pace yourself and protect your joints. For more information, visit these guides specific to POTS and EDS (the EDS one is probably good practical advice for most connective tissue disorders, but I would consult with your medical team to be sure.
Participating in a regular exercise program can improve overall mood, help balance hormones and raise endorphin levels, providing an overall feeling of wellbeing and happiness. It can improve sleep, something else which is essential for positive mental and physical health. Exercise can also help to loosen tight muscles and help us relax and feel less anxious. It can also help get things off of your mind, especially if you work to stay present and focused on the tasks at hand instead of letting your mind wander to less pleasant ideas.
The activity doesn’t necessarily have to be “exercise” in the traditional sense. Anything physical that gets your heart rate up a little, blood circulating through your body and good deep breaths into your lungs is a great way to combat anxiety and depression. If you prefer to take walks, hike, garden, bowl, canoe or rent paddle boats, go for it! So long as it’s safe for you to perform that activity (see the articles above for some tips).
Spending time doing anything you enjoy is always a great way to turn around poor mental health, at least temporarily. Whether you consider spending time with friends and family, reading a book, taking in the fresh air and flowers at a nature preserve or going shopping to be great fun doesn’t matter, so long as you choose the right activity for you.
There are some great techniques here and I hope you find them helpful, but for most spoonies with some form of dysautonomia and/or mast cell disorder, you’re going to need some help from mother nature’s pharmacy. In part two of this series, I cover a number of over-the-counter natural medications, vitamins and minerals you can take to help with both depression and anxiety. I also discuss how medications can impact mental health and what to do about it when you realize something you’re taking is causing a problem:
References and Further Reading:
- University Health News – Supplements to Treat Anxiety and Depression Yourself
- Health Prep – How Daily Exercises Helps Mental Health
- Consumer Lab: Which Supplements Help with Depression and Anxiety
- Psychology Today – Cognitive Behavioral Techniques Work
- University of Michigan Health – Stress Management: Breathing Exercises for Relaxation
- PubMed: The Role of GABA in Anxiety Disorders
- The Sleep Doctor – Understanding GABA