Tag Archives: Co-Occurring Disorders

Dialectical Behavior Therapy (DBT)

Posted on by Gertie

Happy Friday!!! It being Friday, that means it is time for me to do my educational feature. I have decided to do the topic of Dialectical Behavior Therapy (DBT). The reason being is because I did the topic of Borderline Personality Disorder (BPD). I got the following information off of the  Linehan Institute; Behavior Tech at:   http://behavioraltech.org/resources/whatisdbt.cfm

What is DBT?

Overview

Dialectical Behavior Therapy (DBT) is a cognitive behavioral treatment that was originally developed to treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD) and it is now recognized as the gold standard psychological treatment for this population. In addition, research has shown that it is effective in treating a wide range of other disorders such as substance dependence, depression, post-traumatic stress disorder (PTSD), and eating disorders.

What are the components of DBT?

In its standard form, there are four components of DBT: skills training group, individual treatment, DBT phone coaching, and consultation team.

  1. DBT skills training group is focused on enhancing clients’ capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework for clients to practice using the skills in their everyday lives. Groups meet on a weekly basis for approximately 2.5 hours and it takes 24 weeks to get through the full skills curriculum, which is often repeated to create a 1-year program. Briefer schedules that teach only a subset of the skills have also been developed for particular populations and settings.
  2. DBT individual therapy is focused on enhancing client motivation and helping clients to apply the skills to specific challenges and events in their lives. In the standard DBT model, individual therapy takes place once a week for as long as the client is in therapy and runs concurrently with skills groups.
  3. DBT phone coaching is focused on providing clients with in-the-moment coaching on how to use skills to effectively cope with difficult situations that arise in their everyday lives. Clients can call their individual therapist between sessions to receive coaching at the times when they need help the most.
  4. DBT therapist consultation team is intended to be therapy for the therapists and to support DBT providers in their work with people who often have severe, complex, difficult-to-treat disorders. The consultation team is designed to help therapists stay motivated and competent so they can provide the best treatment possible. Teams typically meet weekly and are composed of individual therapists and group leaders who share responsibility for each client’s care.

What skills are taught in DBT?

DBT includes four sets of behavioral skills.

  • Mindfulness: the practice of being fully aware and present in this one moment
  • Distress Tolerance: how to tolerate pain in difficult situations, not change it
  • Interpersonal Effectiveness: how to ask for what you want and say no while maintaining self-respect and relationships with others
  • Emotion Regulation: how to change emotions that you want to change

There is increasing evidence that DBT skills training alone is a promising intervention for a wide variety of both clinical and nonclinical populations and across settings.

What does “dialectical” mean?

The term “dialectical” means a synthesis or integration of opposites. The primary dialectic within DBT is between the seemingly opposite strategies of acceptance and change. For example, DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals. In addition, all of the skills and strategies taught in DBT are balanced in terms of acceptance and change. For example, the four skills modules include two sets of acceptance-oriented skills (mindfulness and distress tolerance) and two sets of change-oriented skills (emotion regulation and interpersonal effectiveness).

How does DBT prioritize treatment targets?

Clients who receive DBT typically have multiple problems that require treatment. DBT uses a hierarchy of treatment targets to help the therapist determine the order in which problems should be addressed. The treatment targets in order of priority are:

  1. Life-threatening behaviors: First and foremost, behaviors that could lead to the client’s death are targeted, including all forms of suicidal and non-suicidal self-injury, suicidal ideation, suicide communications, and other behaviors engaged in for the purpose of causing bodily harm.
  2. Therapy-interfering behaviors: This includes any behavior that interferes with the client receiving effective treatment. These behaviors can be on the part of the client and/or the therapist, such as coming late to sessions, cancelling appointments, and being non-collaborative in working towards treatment goals.
  3. Quality of life behaviors: This category includes any other type of behavior that interferes with clients having a reasonable quality of life, such as mental disorders, relationship problems, and financial or housing crises.
  4. Skills acquisition: This refers to the need for clients to learn new skillful behaviors to replace ineffective behaviors and help them achieve their goals.

Within a session, presenting problems are addressed in the above order. For example, if the client is expressing a wish to commit suicide and reports recurrent binge eating, the therapist will target the suicidal behaviors first. The underlying assumption is that DBT will be ineffective if the client is dead or refuses to attend treatment sessions.

What are the stages of treatment in DBT?

DBT is divided into four stages of treatment. Stages are defined by the severity of the client’s behaviors, and therapists work with their clients to reach the goals of each stage in their progress toward having a life that they experience as worth living.

  1. In Stage 1, the client is miserable and their behavior is out of control: they may be trying to kill themselves, self-harming, using drugs and alcohol, and/or engaging in other types of self-destructive behaviors. When clients first start DBT treatment, they often describe their experience of their mental illness as “being in hell.” The goal of Stage 1 is for the client to move from being out of control to achieving behavioral control.
  2. In Stage 2, they’re living a life of quiet desperation: their behavior is under control but they continue to suffer, often due to past trauma and invalidation. Their emotional experience is inhibited. The goal of Stage 2 is to help the client move from a state of quiet desperation to one of full emotional experiencing. This is the stage in which post-traumatic stress disorder (PTSD) would be treated.
  3. In Stage 3, the challenge is to learn to live: to define life goals, build self-respect, and find peace and happiness. The goal is that the client leads a life of ordinary happiness and unhappiness.
  4. For some people, a fourth stage is needed: finding a deeper meaning through a spiritual existence. Linehan has posited a Stage 4 specifically for those clients for whom a life of ordinary happiness and unhappiness fails to meet a further goal of spiritual fulfillment or a sense of connectedness of a greater whole. In this stage, the goal of treatment is for the client to move from a sense of incompleteness towards a life that involves an ongoing capacity for experiences of joy and freedom.

How effective is DBT?

Research has shown DBT to be effective in reducing suicidal behavior, non-suicidal self-injury, psychiatric hospitalization, treatment dropout, substance use, anger, and depression and improving social and global functioning. For a review of the research on DBT, click here. In this video, DBT Developer and Behavioral Tech founder Dr. Marsha Linehan describes the amazing changes she’s seen in people who have received DBT and gotten out of hell.

Dive Deeper

Philosophy and Principles of DBT

DBT is based on three philosophical positions. Behavioral science underpins the DBT bio-social model of the development of BPD, as well as the DBT behavioral change strategies and protocols. Zen and contemplative practices underpin DBT mindfulness skills and acceptance practices for both therapists and clients. DBT was the first psychotherapy to incorporate mindfulness as a core component, and the Mindfulness skills in DBT are a behavioral translation of Zen practice. The dialectical synthesis of a “technology” of acceptance with a “technology” of change was what distinguished DBT from the behavioral interventions of the 1970s and 1980s. Dialectics furthermore keeps the entire treatment focused on a synthesis of opposites, primarily on acceptance and change, but also on the whole as well as the parts, and maintains an emphasis on flexibility, movement, speed, and flow in the treatment.

True to dialectics, DBT strategies are designed in pairs representing acceptance (validation, reciprocal communication, environmental intervention on behalf of the client) and change (problem solving, irreverence, consultation-to-the-patients about how they can change their own environment). Strategies are further divided into procedures; a set of principles guides the selection of strategies and procedures depending on the needs of the individual client. Clients are also taught a series of behavioral skills designed to promote both acceptance and change. A focus on replacing dysfunctional behaviors with skillful behaviors is woven throughout DBT.

DBT is a principle-based treatment that includes protocols. As a principle-based treatment, DBT is quite flexible due to its modular construction. Not only are strategies and procedures individualized, but various aspects of the treatment, such as disorder-specific protocols, can be included or withdrawn from the treatment as needed. To guide therapists in individualizing priorities for targeting disorders and behavioral problems, DBT incorporates a concept of levels of disorder (based on severity, risk, disability, pervasiveness, and complexity) that in turn guides stages of treatment and provides a hierarchy of what to treat when for a particular patient. In contrast, skills training is protocol based. Once a skills curriculum is determined, what is taught in a session is guided by the curriculum, not by the needs of a single client during that session.

The Development of DBT

In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, and non-suicidal injury. Trained as a behaviorist, she was interested in treating these and other discrete behaviors. Through consultation with colleagues, however, she concluded that she was treating women who met criteria for Borderline Personality Disorder (BPD). In the late 1970s, CBT had gained prominence as an effective psychotherapy for a range of serious problems. Dr. Linehan was keenly interested in investigating whether or not it would prove helpful for individuals whose suicidality was in response to extremely painful problems. As she and her research team applied standard CBT, they encountered numerous problems with its use. Three were particularly troublesome:

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.

In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

They added acceptance-based or validation strategies to the change-based strategies of CBT. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: clients must change if they want to build a life worth living.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play. Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become entrenched in arguments and polarizing or extreme positions.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

In her original treatment manual, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993), Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must:

  1. Enhance and maintain the client’s motivation to change
  2. Enhance the client’s capabilities
  3. Ensure that the client’s new capabilities are generalized to all relevant environments
  4. Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
  5. Structure the environment so that treatment can take place

As already described, the structure of DBT includes four components: skills group, individual treatment, DBT phone coaching, and consultation team. These components meet the five critical functions of a comprehensive psychotherapy in the following ways:

  1. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
  2. Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
  3. Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
  4. Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
  5. The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home

True to dialectics, DBT strategies are designed in pairs representing acceptance (validation, reciprocal communication, environmental intervention on behalf of the client) and change (problem solving, irreverence, consultation-to-the-patients about how they can change their own environment). Strategies are further divided into procedures; a set of principles guides the selection of strategies and procedures depending on the needs of the individual client. Clients are also taught a series of behavioral skills designed to promote both acceptance and change. A focus on replacing dysfunctional behaviors with skillful behaviors is woven throughout DBT.

DBT is a principle-based treatment that includes protocols. As a principle-based treatment, DBT is quite flexible due to its modular construction. Not only are strategies and procedures individualized, but various aspects of the treatment, such as disorder-specific protocols, can be included or withdrawn from the treatment as needed. To guide therapists in individualizing priorities for targeting disorders and behavioral problems, DBT incorporates a concept of levels of disorder (based on severity, risk, disability, pervasiveness, and complexity) that in turn guides stages of treatment and provides a hierarchy of what to treat when for a particular patient. In contrast, skills training is protocol based. Once a skills curriculum is determined, what is taught in a session is guided by the curriculum, not by the needs of a single client during that session.

  1. Clients receiving CBT found the unrelenting focus on change inherent to CBT to be invalidating. Clients responded by withdrawing from treatment, by becoming angry, or by vacillating between the two. This resulted in a high drop-out rate. If clients do not attend treatment, they cannot benefit from treatment.
  2. Clients unintentionally positively reinforced their therapists for ineffective treatment while punishing their therapists for effective therapy. For example, the research team noticed through its review of taped sessions that therapists would “back off” pushing for change of behavior when the client’s response was one of anger, emotional withdrawal, shame, or threats of self-harm. Similarly, clients would reward the therapist with interpersonal warmth or engagement if the therapist allowed them to change the topic of the session from one they did not want to discuss to one they did want to discuss.
  3. The sheer volume and severity of problems presented by clients made it impossible to use the standard CBT format. Individual therapists simply did not have time to both address the problems presented by clients (suicide attempts, self-harm, urges to quit treatment, noncompliance with homework assignments, untreated depression, anxiety disorders, and more) and have session time devoted to helping the client learn and apply more adaptive skills.
  4. In response to these key problems with standard CBT, Linehan and her research team made significant modifications to standard CBT.

They added acceptance-based or validation strategies to the change-based strategies of CBT. Adding these communicated to the clients that they were both acceptable as they were and that their behaviors, including those that were self-harming, made real sense in some way. Further, therapists learned to highlight for clients when their thoughts, feelings, and behaviors were “perfectly normal,” helping clients discover that they had sound judgment and that they were capable of learning how and when to trust themselves. The new emphasis on acceptance did not occur to the exclusion of the emphasis on change: clients must change if they want to build a life worth living.

In the course of weaving in acceptance with change, Linehan noticed that another set of strategies – dialectics – came into play. Dialectical strategies give the therapist a means to balance acceptance and change in each session. They also serve to prevent both therapist and client from becoming stuck in the rigid thoughts, feelings, and behaviors that can occur when emotions run high, as they often do in the treatment of clients diagnosed with BPD. Dialectical strategies and a dialectical world view, with its emphasis on holism and synthesis, enable the therapist to blend acceptance and change in a manner that results in movement, speed, and flow in individual sessions and across the entire treatment. This counters the tendency, found in treatment with clients diagnosed with BPD, to become entrenched in arguments and polarizing or extreme positions.

Significant changes were also made to the structure of treatment in order to solve the problems encountered in the application of standard CBT.

In her original treatment manual, Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993), Linehan hypothesizes that any comprehensive psychotherapy must meet five critical functions. The therapy must:

  1. Enhance and maintain the client’s motivation to change
  2. Enhance the client’s capabilities
  3. Ensure that the client’s new capabilities are generalized to all relevant environments
  4. Enhance the therapist’s motivation to treat clients while also enhancing the therapist’s capabilities
  5. Structure the environment so that treatment can take place

As already described, the structure of DBT includes four components: skills group, individual treatment, DBT phone coaching, and consultation team. These components meet the five critical functions of a comprehensive psychotherapy in the following ways:

  1. It is typically the individual therapist who maintains the client’s motivation for treatment, since the individual therapist is the most prominent individual working with the client.
  2. Skills are acquired and strengthened, and generalized through the combination of skills groups and homework assignments.
  3. Clients capabilities are generalized through phone coaching (clients are instructed to call therapists for coaching prior to engaging in self harm), in vivo coaching, and homework assignments.
  4. Therapists’ capabilities are enhanced and burnout is prevented through weekly consultation team meetings. The consultation team helps the therapist stay balanced in his or her approach to the client, while supporting and cheerleading the therapist in applying effective interventions.
  5. The environment can be structured in a variety of ways. For example, the home environment could be structured by the client and therapist meeting with family members to ensure that the client is not being reinforced for maladaptive behaviors or punished for effective behaviors in the home.

DBT has personally saved my life and am grateful to have had the opportunity to take an intensive outpatient DBT program. DBT is awesome and it is one of the best decisions I have made in my life. Have an awesome Friday and Peace Out!!

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Borderline Personality Disorder (BPD)

Posted on by Gertie

Happy Friday everyone. It is another Friday and that means it is time for my educational blogging feature. Today’s topic is Borderline Personality Disorder (BPD). I got the following information from: https://www.nimh.nih.gov/index.shtml

What is Borderline Personality Disorder?

Borderline personality disorder (BPD) is a serious mental illness marked by unstable moods, behavior, and relationships. In 1980, the Diagnostic and Statistical Manual for Mental Disorders, Third Edition (DSM-III) listed BPD as a diagnosable illness for the first time. Most psychiatrists and other mental health professionals use the DSM to diagnose mental illnesses.

Because some people with severe BPD have brief psychotic episodes, experts originally thought of this illness as atypical, or borderline, versions of other mental disorders. While mental health experts now generally agree that the name “borderline personality disorder” is misleading, a more accurate term does not exist yet.

Most people who have BPD suffer from:

  • Problems with regulating emotions and thoughts
  • Impulsive and reckless behavior
  • Unstable relationships with other people.

People with this disorder also have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides.

Causes

Research on the possible causes and risk factors for BPD is still at a very early stage. However, scientists generally agree that genetic and environmental factors are likely to be involved.

Studies on twins with BPD suggest that the illness is strongly inherited. Another study shows that a person can inherit his or her temperament and specific personality traits, particularly impulsiveness and aggression. Scientists are studying genes that help regulate emotions and impulse control for possible links to the disorder.

Social or cultural factors may increase the risk for BPD. For example, being part of a community or culture in which unstable family relationships are common may increase a person’s risk for the disorder. Impulsiveness, poor judgment in lifestyle choices, and other consequences of BPD may lead individuals to risky situations. Adults with borderline personality disorder are considerably more likely to be the victim of violence, including rape and other crimes.

Signs & Symptoms

According to the DSM, Fourth Edition, Text Revision (DSM-IV-TR), to be diagnosed with borderline personality disorder, a person must show an enduring pattern of behavior that includes at least five of the following symptoms:

  • Extreme reactions—including panic, depression, rage, or frantic actions—to abandonment, whether real or perceived
  • A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love (idealization) to extreme dislike or anger (devaluation)
  • Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
  • Recurring suicidal behaviors or threats or self-harming behavior, such as cutting
  • Intense and highly changeable moods, with each episode lasting from a few hours to a few days
  • Chronic feelings of emptiness and/or boredom
  • Inappropriate, intense anger or problems controlling anger
  • Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

Seemingly mundane events may trigger symptoms. For example, people with BPD may feel angry and distressed over minor separations—such as vacations, business trips, or sudden changes of plans—from people to whom they feel close. Studies show that people with this disorder may see anger in an emotionally neutral face and have a stronger reaction to words with negative meanings than people who do not have the disorder.

Suicide and Self-harm

Self-injurious behavior includes suicide and suicide attempts, as well as self-harming behaviors, described below. As many as 80 percent of people with BPD have suicidal behaviors, and about 4 to 9 percent commit suicide.

Suicide is one of the most tragic outcomes of any mental illness. Some treatments can help reduce suicidal behaviors in people with BPD. For example, one study showed that dialectical behavior therapy (DBT) reduced suicide attempts in women by half compared with other types of psychotherapy, or talk therapy. DBT also reduced use of emergency room and inpatient services and retained more participants in therapy, compared to other approaches to treatment.

Unlike suicide attempts, self-harming behaviors do not stem from a desire to die. However, some self-harming behaviors may be life threatening. Self-harming behaviors linked with BPD include cutting, burning, hitting, head banging, hair pulling, and other harmful acts. People with BPD may self-harm to help regulate their emotions, to punish themselves, or to express their pain. They do not always see these behaviors as harmful.

Who Is At Risk?

According to data from a subsample of participants in a national survey on mental disorders, about 1.6 percent of adults in the United States have BPD in a given year.  BPD usually begins during adolescence or early adulthood. Some studies suggest that early symptoms of the illness may occur during childhood.

Diagnosis

Unfortunately, BPD is often underdiagnosed or misdiagnosed.

A mental health professional experienced in diagnosing and treating mental disorders—such as a psychiatrist, psychologist, clinical social worker, or psychiatric nurse—can detect BPD based on a thorough interview and a discussion about symptoms. A careful and thorough medical exam can help rule out other possible causes of symptoms.

The mental health professional may ask about symptoms and personal and family medical histories, including any history of mental illnesses. This information can help the mental health professional decide on the best treatment. In some cases, co-occurring mental illnesses may have symptoms that overlap with BPD, making it difficult to distinguish borderline personality disorder from other mental illnesses. For example, a person may describe feelings of depression but may not bring other symptoms to the mental health professional’s attention.

Women with BPD are more likely to have co-occurring disorders such as major depression, anxiety disorders, or eating disorders. In men, BPD is more likely to co-occur with disorders such as substance abuse or antisocial personality disorder. According to the NIMH-funded National Comorbidity Survey Replication—the largest national study to date of mental disorders in U.S. adults—about 85 percent of people with BPD also meet the diagnostic criteria for another mental illness. Other illnesses that often occur with BPD include diabetes, high blood pressure, chronic back pain, arthritis, and fibromyalgia. These conditions are associated with obesity, which is a common side effect of the medications prescribed to treat BPD and other mental disorders.

No single test can diagnose BPD. Scientists funded by NIMH are looking for ways to improve diagnosis of this disorder. One study found that adults with BPD showed excessive emotional reactions when looking at words with unpleasant meanings, compared with healthy people. People with more severe BPD showed a more intense emotional response than people who had less severe BPD.

Treatments

BPD is often viewed as difficult to treat. However, recent research shows that BPD can be treated effectively, and that many people with this illness improve over time.

BPD can be treated with psychotherapy, or “talk” therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional’s care, it is essential for the professionals to coordinate with one another on the treatment plan.

The treatments described below are just some of the options that may be available to a person with BPD. However, the research on treatments is still in very early stages. More studies are needed to determine the effectiveness of these treatments, who may benefit the most, and how best to deliver treatments.

Psychotherapy

Psychotherapy is usually the first treatment for people with BPD. Current research suggests psychotherapy can relieve some symptoms, but further studies are needed to better understand how well psychotherapy works.

It is important that people in therapy get along with and trust their therapist. The very nature of BPD can make it difficult for people with this disorder to maintain this type of bond with their therapist.

Types of psychotherapy used to treat BPD include the following: Cognitive behavioral therapy (CBT). CBT can help people with BPD identify and change core beliefs and/or behaviors that underlie inaccurate perceptions of themselves and others and problems interacting with others. CBT may help reduce a range of mood and anxiety symptoms and reduce the number of suicidal or self-harming behaviors.

  1. Dialectical behavior therapy (DBT). This type of therapy focuses on the concept of mindfulness, or being aware of and attentive to the current situation. DBT teaches skills to control intense emotions, reduces self-destructive behaviors, and improves relationships. This therapy differs from CBT in that it seeks a balance between changing and accepting beliefs and behaviors.
  2. Schema-focused therapy. This type of therapy combines elements of CBT with other forms of psychotherapy that focus on reframing schemas, or the ways people view themselves. This approach is based on the idea that BPD stems from a dysfunctional self-image—possibly brought on by negative childhood experiences—that affects how people react to their environment, interact with others, and cope with problems or stress.

Therapy can be provided one-on-one between the therapist and the patient or in a group setting. Therapist-led group sessions may help teach people with BPD how to interact with others and how to express themselves effectively.

One type of group therapy, Systems Training for Emotional Predictability and Problem Solving (STEPPS), is designed as a relatively brief treatment consisting of 20 two-hour sessions led by an experienced social worker. Scientists funded by NIMH reported that STEPPS, when used with other types of treatment (medications or individual psychotherapy), can help reduce symptoms and problem behaviors of BPD, relieve symptoms of depression, and improve quality of life. The effectiveness of this type of therapy has not been extensively studied.

Families of people with BPD may also benefit from therapy. The challenges of dealing with an ill relative on a daily basis can be very stressful, and family members may unknowingly act in ways that worsen their relative’s symptoms.

Some therapies, such as DBT-family skills training (DBT-FST), include family members in treatment sessions. These types of programs help families develop skills to better understand and support a relative with BPD. Other therapies, such as Family Connections, focus on the needs of family members. More research is needed to determine the effectiveness of family therapy in BPD. Studies with other mental disorders suggest that including family members can help in a person’s treatment.

Other types of therapy not listed in this booklet may be helpful for some people with BPD. Therapists often adapt psychotherapy to better meet a person’s needs. Therapists may switch from one type of therapy to another, mix techniques from different therapies, or use a combination therapy. For more information see the NIMH website section on psychotherapy.

Some symptoms of BPD may come and go, but the core symptoms of highly changeable moods, intense anger, and impulsiveness tend to be more persistent. People whose symptoms improve may continue to face issues related to co-occurring disorders, such as depression or post-traumatic stress disorder. However, encouraging research suggests that relapse, or the recurrence of full-blown symptoms after remission, is rare. In one study, 6 percent of people with BPD had a relapse after remission.

Medications

No medications have been approved by the U.S. Food and Drug Administration to treat BPD. Only a few studies show that medications are necessary or effective for people with this illness. However, many people with BPD are treated with medications in addition to psychotherapy. While medications do not cure BPD, some medications may be helpful in managing specific symptoms. For some people, medications can help reduce symptoms such as anxiety, depression, or aggression. Often, people are treated with several medications at the same time, but there is little evidence that this practice is necessary or effective.

Medications can cause different side effects in different people. People who have BPD should talk with their prescribing doctor about what to expect from a particular medication.

Other Treatments

Omega-3 fatty acids. One study done on 30 women with BPD showed that omega-3 fatty acids may help reduce symptoms of aggression and depression. The treatment seemed to be as well tolerated as commonly prescribed mood stabilizers and had few side effects. Fewer women who took omega-3 fatty acids dropped out of the study, compared to women who took a placebo (sugar pill).

With proper treatment, many people experience fewer or less severe symptoms. However, many factors affect the amount of time it takes for symptoms to improve, so it is important for people with BPD to be patient and to receive appropriate support during treatment.

Living With

Some people with BPD experience severe symptoms and require intensive, often inpatient, care. Others may use some outpatient treatments but never need hospitalization or emergency care. Some people who develop this disorder may improve without any treatment.
How can I help a friend or relative who has BPD?
If you know someone who has BPD, it affects you too. The first and most important thing you can do is help your friend or relative get the right diagnosis and treatment. You may need to make an appointment and go with your friend or relative to see the doctor. Encourage him or her to stay in treatment or to seek different treatment if symptoms do not appear to improve with the current treatment.
To help a friend or relative you can:
Offer emotional support, understanding, patience, and encouragement—change can be difficult and frightening to people with BPD, but it is possible for them to get better over time
  • Learn about mental disorders, including BPD, so you can understand what your friend or relative is experiencing
  • With permission from your friend or relative, talk with his or her therapist to learn about therapies that may involve family members, such as DBT-FST.

Never ignore comments about someone’s intent or plan to harm himself or herself or someone else. Report such comments to the person’s therapist or doctor. In urgent or potentially life-threatening situations, you may need to call the police.

How can I help myself if I have BPD?

Taking that first step to help yourself may be hard. It is important to realize that, although it may take some time, you can get better with treatment.

To help yourself:

  • Talk to your doctor about treatment options and stick with treatment
  • Try to maintain a stable schedule of meals and sleep times
  • Engage in mild activity or exercise to help reduce stress
  • Set realistic goals for yourself
  • Break up large tasks into small ones, set some priorities, and do what you can, as you can
  • Try to spend time with other people and confide in a trusted friend or family member
  • Tell others about events or situations that may trigger symptoms
  • Expect your symptoms to improve gradually, not immediately
  • Identify and seek out comforting situations, places, and people
  • Continue to educate yourself about this disorder.

Thank you for reading this long post. Again the above information is from: https://www.nimh.nih.gov/index.shtml Have an awesome weekend. Happy Friday. Peace out!!

Bipolar Disorder

Posted on by Gertie

Happy Friday everyone. It Friday and that means it is time for my blogging feature. Today I’ve decided to give you information on Bipolar Disorder. The information that I am about to share with you I got from The Mayo Clinic at http://www.mayoclinic.org/.

Definition

By Mayo Clinic Staff

Bipolar disorder, formerly called manic depression, causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year or as often as several times a week.

Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).

Symptoms

There are several types of bipolar and related disorders. For each type, the exact symptoms of bipolar disorder can vary from person to person. Bipolar I and bipolar II disorders also have additional specific features that can be added to the diagnosis based on your particular signs and symptoms.

Criteria for bipolar disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing bipolar and related disorders. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Diagnostic criteria for bipolar and related disorders are based on the specific type of disorder:

  • Bipolar I disorder. You’ve had at least one manic episode. The manic episode may be preceded by or followed by hypomanic or major depressive episodes. Mania symptoms cause significant impairment in your life and may require hospitalization or trigger a break from reality (psychosis).
  • Bipolar II disorder. You’ve had at least one major depressive episode lasting at least two weeks and at least one hypomanic episode lasting at least four days, but you’ve never had a manic episode. Major depressive episodes or the unpredictable changes in mood and behavior can cause distress or difficulty in areas of your life.
  • Cyclothymic disorder. You’ve had at least two years — or one year in children and teenagers — of numerous periods of hypomania symptoms (less severe than a hypomanic episode) and periods of depressive symptoms (less severe than a major depressive episode). During that time, symptoms occur at least half the time and never go away for more than two months. Symptoms cause significant distress in important areas of your life.
  • Other types. These include, for example, bipolar and related disorder due to another medical condition, such as Cushing’s disease, multiple sclerosis or stroke. Another type is called substance and medication-induced bipolar and related disorder.

Bipolar II disorder is not a milder form of bipolar I disorder, but a separate diagnosis. While the manic episodes of bipolar I disorder can be severe and dangerous, individuals with bipolar II disorder can be depressed for longer periods, which can cause significant impairment.

Criteria for a manic or hypomanic episode

The DSM-5 has specific criteria for the diagnosis of manic and hypomanic episodes:

  • A manic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). The episode includes persistently increased goal-directed activity or energy.
  • A hypomanic episode is a distinct period of abnormally and persistently elevated, expansive or irritable mood that lasts at least four consecutive days.

For both a manic and a hypomanic episode, during the period of disturbed mood and increased energy, three or more of the following symptoms (four if the mood is only irritable) must be present and represent a noticeable change from your usual behavior:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (for example, you feel rested after only three hours of sleep)
  • Unusual talkativeness
  • Racing thoughts
  • Distractibility
  • Increased goal-directed activity (either socially, at work or school, or sexually) or agitation
  • Doing things that are unusual and that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments

To be considered a manic episode:

  • The mood disturbance must be severe enough to cause noticeable difficulty at work, at school or in social activities or relationships; or to require hospitalization to prevent harm to yourself or others; or to trigger a break from reality (psychosis).
  • Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

To be considered a hypomanic episode:

  • The episode is a distinct change in mood and functioning that is not characteristic of you when the symptoms are not present, and enough of a change that other people notice.
  • The episode isn’t severe enough to cause significant difficulty at work, at school or in social activities or relationships, and it doesn’t require hospitalization or trigger a break from reality.
  • Symptoms are not due to the direct effects of something else, such as alcohol or drug use; a medication; or a medical condition.

Criteria for a major depressive episode

The DSM-5 also lists criteria for diagnosis of a major depressive episode:

  • Five or more of the symptoms below over a two-week period that represent a change from previous mood and functioning. At least one of the symptoms is either depressed mood or loss of interest or pleasure.
  • Symptoms can be based on your own feelings or on the observations of someone else.

Signs and symptoms include:

  • Depressed mood most of the day, nearly every day, such as feeling sad, empty, hopeless or tearful (in children and teens, depressed mood can appear as irritability)
  • Markedly reduced interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in children, failure to gain weight as expected can be a sign of depression)
  • Either insomnia or sleeping excessively nearly every day
  • Either restlessness or slowed behavior that can be observed by others
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt, such as believing things that are not true, nearly every day
  • Decreased ability to think or concentrate, or indecisiveness, nearly every day
  • Recurrent thoughts of death or suicide, or suicide planning or attempt

To be considered a major depressive episode:

  • Symptoms must be severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships
  • Symptoms are not due to the direct effects of something else, such as alcohol or drug use, a medication or a medical condition
  • Symptoms are not caused by grieving, such as after the loss of a loved one

Other signs and symptoms of bipolar disorder

Signs and symptoms of bipolar I and bipolar II disorders may include additional features.

  • Anxious distress — having anxiety, such as feeling keyed up, tense or restless, having trouble concentrating because of worry, fearing something awful may happen, or feeling you may not be able to control yourself
  • Mixed features — meeting the criteria for a manic or hypomanic episode, but also having some or all symptoms of major depressive episode at the same time
  • Melancholic features — having a loss of pleasure in all or most activities and not feeling significantly better, even when something good happens
  • Atypical features — experiencing symptoms that are not typical of a major depressive episode, such as having a significantly improved mood when something good happens
  • Catatonia — not reacting to your environment, holding your body in an unusual position, not speaking, or mimicking another person’s speech or movement
  • Peripartum onset — bipolar disorder symptoms that occur during pregnancy or in the four weeks after delivery
  • Seasonal pattern — a lifetime pattern of manic, hypomanic or major depressive episodes that change with the seasons
  • Rapid cycling — having four or more mood swing episodes within a single year, with full or partial remission of symptoms in between manic, hypomanic or major depressive episodes
  • Psychosis — severe episode of either mania or depression (but not hypomania) that results in a detachment from reality and includes symptoms of false but strongly held beliefs (delusions) and hearing or seeing things that aren’t there (hallucinations)

Symptoms in children and teens

The same DSM-5 criteria used to diagnose bipolar disorder in adults are used to diagnose children and teenagers. Children and teens may have distinct major depressive, manic or hypomanic episodes, between which they return to their usual behavior, but that’s not always the case. And moods can rapidly shift during acute episodes.

Symptoms of bipolar disorder can be difficult to identify in children and teens. It’s often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. And children who have bipolar disorder are frequently also diagnosed with other mental health conditions.

The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings.

When to see a doctor

If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn’t get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.

Many people with bipolar disorder don’t get the treatment they need. Despite the mood extremes, people with bipolar disorder often don’t recognize how much their emotional instability disrupts their lives and the lives of their loved ones.

And if you’re like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.

If you’re reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. He or she may be able to help you take the first steps to successful treatment.

When to get emergency help

Suicidal thoughts and behavior are common among people with bipolar disorder. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options:

  • Reach out to a close friend or loved one.
  • Contact a minister, spiritual leader or someone in your faith community.
  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
  • Make an appointment with your doctor, mental health provider or other health care provider.

If you have a loved one who is in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

Causes

 The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:
  • Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
  • Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
  • Inherited traits. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder

Risk factors

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

  • Having a first-degree relative, such as a parent or sibling, with bipolar disorder
  • Periods of high stress
  • Drug or alcohol abuse
  • Major life changes, such as the death of a loved one or other traumatic experiences

Conditions that commonly occur with bipolar disorder

If you have bipolar disorder, you may also have another health condition that’s diagnosed before or after your diagnosis of bipolar disorder. Such conditions need to be diagnosed and treated because they may worsen existing bipolar disorder or make treatment less successful. They include:

  • Anxiety disorders. Examples include social anxiety disorder and generalized anxiety disorder.
  • Post-traumatic stress disorder (PTSD). Some people with PTSD, a trauma- and stressor-related disorder, also have bipolar disorder.
  • Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms that overlap with bipolar disorder. For this reason, bipolar disorder can be difficult to differentiate from ADHD. Sometimes one is mistaken for the other. In some cases, a person may be diagnosed with both conditions.
  • Addiction or substance abuse. Many people with bipolar disorder also have alcohol, tobacco or drug problems. Drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania.
  • Physical health problems. People diagnosed with bipolar disorder are more likely to have certain other health problems, such as heart disease, thyroid problems or obesity

Complications

Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These may include:

  • Problems related to drug and alcohol use
  • Suicide or suicide attempts
  • Legal problems
  • Financial problems
  • Relationship troubles
  • Isolation and loneliness
  • Poor work or school performance
  • Frequent absences from work or school

Preparing for your appointment

You may start by seeing your primary care doctor or you may choose to see a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).

What you can do

Before your appointment, make a list of:

  • Any symptoms you’ve had, including any that may seem unrelated to the reason for the appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins or other supplements that you’re taking, and their dose
  • Questions to ask your doctor

Take a family member or friend along, if possible. That person may provide more information or remember something that you missed or forgot.

Some basic questions to ask your doctor include:

  • Do I have bipolar disorder?
  • Are there any other possible causes for my symptoms?
  • What kinds of tests will I need?
  • What treatments are available? Which do you recommend for me?
  • What side effects are possible with that treatment?
  • What are the alternatives to the primary approach that you’re suggesting?
  • I have these other health conditions. How can I best manage these conditions together?
  • Should I see a psychiatrist or other mental health provider?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there any brochures or other printed material that I can have? What websites do you recommend?

Don’t hesitate to ask questions at any time during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you or your loved ones first begin noticing your symptoms of depression, mania or hypomania?
  • How frequently do your moods change?
  • Do you ever have suicidal thoughts when you’re feeling down?
  • Do your symptoms interfere with your daily life or relationships?
  • Do you have any blood relatives with bipolar disorder or depression?
  • What other mental or physical health conditions do you have?
  • Do you drink alcohol, smoke cigarettes or use street drugs?
  • How much do you sleep at night? Does it change over time?
  • Do you go through periods when you take risks that you wouldn’t normally take, such as unsafe sex or unwise, spontaneous financial decisions?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Tests and diagnosis

When doctors suspect someone has bipolar disorder, they typically do a number of tests and exams. These can help rule out other problems, pinpoint a diagnosis and also check for any related complications. These may include:

  • Physical exam. A physical exam and lab tests may be done to help identify any medical problems that could be causing your symptoms.
  • Psychological evaluation. Your doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.
  • Mood charting. To identify exactly what’s going on, your doctor may have you keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
  • Signs and symptoms. Your doctor or mental health professional typically will compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders to determine a diagnosis.

Diagnosis in children

Although bipolar disorder can occur in young children, typically it’s diagnosed in the teenage years or early 20s.  It’s often hard to tell whether a child’s emotional ups and downs are normal for his or her age, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder.

Bipolar symptoms in children and teens often have different patterns than they do in adults and may not fit neatly into the categories used for diagnosis. And children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems.

Your child’s doctor can help you learn the symptoms of bipolar disorder and how they differ from behavior related to your child’s developmental age, the situation and appropriate cultural behavior.

Treatments and drugs

Treatment is best guided by a psychiatrist skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.

Depending on your needs, treatment may include:

  • Initial treatment. Often, you’ll need to start taking medications to balance your moods right away. Once your symptoms are under control, you’ll work with your doctor to find the best long-term treatment.
  • Continued treatment. Bipolar disorder requires lifelong treatment, even during periods when you feel better. Maintenance treatment is used to manage bipolar disorder on a long-term basis. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
  • Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
  • Substance abuse treatment. If you have problems with alcohol or drugs, you’ll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
  • Hospitalization. Your doctor may recommend hospitalization if you’re behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you’re having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy), and may include education and support groups.

Medications

A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.

Medications may include:

  • Mood stabilizers. Whether you have bipolar I or II disorder, you’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
  • Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
  • Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.
  • Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the Food and Drug Administration specifically for the treatment of depressive episodes associated with bipolar I disorder.
  • Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep. Benzodiazepines are generally used for relieving anxiety only on a short-term basis.

Side effects

Talk to your doctor or mental health provider about side effects. If side effects seem intolerable, you may be tempted to stop taking your medication or to reduce your dose on your own. Don’t do it. You may experience withdrawal effects or your symptoms may return.

Side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications.

Finding the right medication

Finding the right medication or medications for you will likely take some trial and error. If one doesn’t work well for you, there are several others to try.

This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects. Discuss these issues with your doctor:

  • Birth control options, as birth control medications may lose effectiveness when taken along with certain bipolar disorder medications
  • Treatment options if you plan to become pregnant
  • Breast-feeding, as some bipolar medications can pass through breast milk to your infant

Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:

  • Cognitive behavioral therapy. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
  • Psychoeducation. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what’s going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
  • Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleep, wake and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.
  • Other therapies. Other therapies have been studied with some evidence of success. Ask your doctor if any other options may be appropriate for you.

Other treatment options

Depending on your needs, other treatments may be added to your depression therapy, such as:

  • Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through the brain. This procedure is thought to affect levels of neurotransmitters in your brain and typically offers immediate relief of even severe depression when other treatments don’t work. Physical side effects, such as headache, are tolerable. Some people also have memory loss, which is usually temporary. ECT is usually used for people who don’t get better with medications, can’t take antidepressants for health reasons or are at high risk of suicide. ECT may be an option if you have mania or severe depression when you’re pregnant and cannot take your regular medications.
  • Transcranial magnetic stimulation (TMS). TMS may be an option for those who haven’t responded to antidepressants. During TMS, you sit in a reclining chair with a treatment coil placed against your scalp. The coil sends brief magnetic pulses to stimulate nerve cells in your brain that are involved in mood regulation and depression. Typically, you’ll have five treatments each week for up to six weeks.

Treatment in children and teenagers

Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors.

  • Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There’s less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
  • Psychotherapy. Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy can help children develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems, common in older children with bipolar disorder.
  • Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

Lifestyle and home remedies

You’ll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:

  • Quit drinking or using illegal drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
  • Steer clear of unhealthy relationships. Surround yourself with people who are a positive influence and won’t encourage unhealthy behavior or attitudes that can worsen your bipolar disorder.
  • Get regular physical activity and exercise. Moderate, regular physical activity and exercise can help steady your mood. Working out releases brain chemicals that make you feel good (endorphins), can help you sleep and has a number of other benefits. Check with your doctor before starting any exercise program, especially if you’re taking lithium, to make sure exercise won’t interfere with your medication.
  • Get plenty of sleep. Don’t stay up all night. Instead, get plenty of sleep. Sleeping enough is an important part of managing your mood. If you have trouble sleeping, talk to your doctor or mental health provider about what you can do.
  • Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There’s less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
  • Psychotherapy. Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy can help children develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems, common in older children with bipolar disorder.
  • Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.

Coping and support

Coping with bipolar disorder can be challenging. Here are some strategies that can help:

  • Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan. Help educate your family and friends about what you’re going through.
  • Stay focused on your goals. Recovery from bipolar disorder can take time. Stay motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.
  • Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.
  • Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
  • Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.

Prevention

 There’s no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.

If you’ve been diagnosed with bipolar disorder, some strategies can help prevent minor symptoms from becoming full-blown episodes of mania or depression:

  • Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You and your caregivers may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you’re falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
  • Avoid drugs and alcohol. Using alcohol or street drugs can worsen your symptoms and make them more likely to come back.
  • Take your medications exactly as directed. You may be tempted to stop treatment — but don’t. This can have immediate consequences — you may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.
  • Check first before taking other medications. Call the doctor who’s treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of bipolar disorder or may interfere with medications you’re already taking to treat bipolar disorder.

Thank you for reading. Just remember I am not professional. The above information I got from the Mayo Clinic. I best be going. I will post my Writing 101 assignment later on. Have a good weekend and Peace Out!!!!

Post-Traumatic Stress Disorder

Posted on by Gertie

It’s Friday and that means it is time for my blogging feature. Today, I choose the topic of Post-traumatic Stress Disorder (PTSD) because it is the 14th anniversary of the 9/11 terrorist attacks. I choose this topic in honor of both who perished in the attacks and those who survived it. The information I am about to give you is found at:  http://www.mayoclinic.org/. Please remember that myself and the Mayo Clinic are just giving you the facts. I am not a professional so if you need help please don’t hesitate to call your local crisis line or the national suicide hotline that will be included. Again I got the following info from: http://www.mayoclinic.org/.

Definition

By Mayo Clinic Staff

Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

Many people who go through traumatic events have difficulty adjusting and coping for a while, but they don’t have PTSD — with time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with your functioning, you may have PTSD.

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function.

Symptoms

Post-traumatic stress disorder symptoms may start within three months of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, or changes in emotional reactions.

Intrusive memories

Symptoms of intrusive memories may include:

  • Recurrent, unwanted distressing memories of the traumatic event
  • Reliving the traumatic event as if it were happening again (flashbacks)
  • Upsetting dreams about the traumatic event
  • Severe emotional distress or physical reactions to something that reminds you of the event

Avoidance

Symptoms of avoidance may include:

  • Trying to avoid thinking or talking about the traumatic event
  • Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

  • Negative feelings about yourself or other people
  • Inability to experience positive emotions
  • Feeling emotionally numb
  • Lack of interest in activities you once enjoyed
  • Hopelessness about the future
  • Memory problems, including not remembering important aspects of the traumatic event
  • Difficulty maintaining close relationships

Changes in emotional reactions

Symptoms of changes in emotional reactions (also called arousal symptoms) may include:

  • Irritability, angry outbursts or aggressive behavior
  • Always being on guard for danger
  • Overwhelming guilt or shame
  • Self-destructive behavior, such as drinking too much or driving too fast
  • Trouble concentrating
  • Trouble sleeping
  • Being easily startled or frightened

Intensity of symptoms

PTSD symptoms can vary in intensity over time. You may have more PTSD symptoms when you’re stressed in general, or when you run into reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

When to see a doctor

If you have disturbing thoughts and feelings about a traumatic event for more than a month, if they’re severe, or if you feel you’re having trouble getting your life back under control, talk to your health care professional. Get treatment as soon as possible to help prevent PTSD symptoms from getting worse.

If you have suicidal thoughts

If you or someone you know is having suicidal thoughts, get help right away through one or more of these resources:

  • Reach out to a close friend or loved one.
  • Contact a minister, a spiritual leader or someone in your faith community.
  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor. Use that same number and press 1 to reach the Veterans Crisis Line.
  • Make an appointment with your doctor, mental health provider or other health care professional.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

If you know someone who’s in danger of committing suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

Causes

You can develop post-traumatic stress disorder when you go through, see or learn about an event involving actual or threatened death, serious injury or sexual violation.

Doctors aren’t sure why some people get PTSD. As with most mental health problems, PTSD is probably caused by a complex mix of:

  • Inherited mental health risks, such as an increased risk of anxiety and depression
  • Life experiences, including the amount and severity of trauma you’ve gone through since early childhood
  • Inherited aspects of your personality — often called your temperament
  • The way your brain regulates the chemicals and hormones your body releases in response to stress

Risk factors

People of all ages can have post-traumatic stress disorder. However, some factors may make you more likely to develop PTSD after a traumatic event, such as:

  • Experiencing intense or long-lasting trauma
  • Having experienced other trauma earlier in life, including childhood abuse or neglect
  • Having a job that increases your risk of being exposed to traumatic events, such as military personnel and first responders
  • Having other mental health problems, such as anxiety or depression
  • Lacking a good support system of family and friends
  • Having biological (blood) relatives with mental health problems, including PTSD or depression

Kinds of traumatic events

The most common events leading to the development of PTSD include:

  • Combat exposure
  • Childhood neglect and physical abuse
  • Sexual assault
  • Physical attack
  • Being threatened with a weapon

Many other traumatic events also can lead to PTSD, such as fire, natural disaster, mugging, robbery, car accident, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.

Complications

Post-traumatic stress disorder can disrupt your whole life: your job, your relationships, your health and your enjoyment of everyday activities.

Having PTSD also may increase your risk of other mental health problems, such as:

  • Depression and anxiety
  • Issues with drugs or alcohol use
  • Eating disorders
  • Suicidal thoughts and actions

Preparing for your appointment

If you think you may have post-traumatic stress disorder, make an appointment with your primary care provider or a mental health provider. Here’s some information to help you prepare for your appointment, and what to expect.

What you can do

Before your appointment, make a list of:

  • Any symptoms you’ve been experiencing, and for how long.
  • Key personal information, especially events or experiences — even in your distant past — that have made you feel intense fear, helplessness or horror. It will help your doctor to know if there are memories you can’t directly access without feeling an overwhelming need to push them out of your mind.
  • Your medical information, including other physical or mental health conditions with which you’ve been diagnosed. Also include any medications or supplements you’re taking and the dosages.

Take a trusted family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you.

Make a list of questions to ask so you can make the most of your appointment. For PTSD, some basic questions include:

  • What do you believe is causing my symptoms?
  • Are there any other possible causes?
  • How will you determine my diagnosis?
  • Is my condition likely temporary or long term?
  • What treatments do you recommend for this disorder?
  • I have other health problems. How best can I manage these together with PTSD?
  • How soon do you expect my symptoms to improve?
  • Does PTSD increase my risk of other mental health problems?
  • Do you recommend any changes at home, work or school to encourage recovery?
  • Would it help my recovery to tell my teachers or work colleagues about my diagnosis?
  • Are there any printed materials on PTSD that I can have? What websites do you recommend?

Don’t hesitate to ask questions anytime you don’t understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

  • What are your symptoms?
  • When did you or your loved ones first notice your symptoms?
  • Have you ever experienced or witnessed an event that was life-threatening to you or someone else?
  • Have you ever been physically, sexually or emotionally harmed?
  • Do you have disturbing thoughts, memories or nightmares of the trauma you experienced?
  • Do you ever feel as if you’re reliving the traumatic event, through flashbacks or hallucinations?
  • Do you avoid certain people, places or situations that remind you of the traumatic experience?
  • Have you lost interest in things or felt numb?
  • Do you feel jumpy, on guard or easily startled?
  • Do you frequently feel irritable or angry?
  • Are you having trouble sleeping?
  • Is anything happening in your life right now that’s making you feel unsafe?
  • Have you been having any problems at school, work or in your personal relationships?
  • Have you ever thought about harming yourself or others?
  • Do you drink alcohol or use illegal drugs? How often?
  • Have you been treated for other psychiatric symptoms or mental illness in the past? If yes, what type of therapy was most helpful?

Tests and diagnosis

Post-traumatic stress disorder is diagnosed based on signs and symptoms and a thorough psychological evaluation. Your health care provider will likely ask you to describe your signs and symptoms and the event that led up to them. You may also have a physical exam to check for medical problems.

To be diagnosed with PTSD, you must meet criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

DSM criteria for PTSD

Diagnosis of PTSD requires exposure to an event that involved or held the threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

  • You experienced the traumatic event
  • You witnessed, in person, the traumatic event
  • You learned someone close to you experienced or was threatened by the traumatic event
  • You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You experience one or more of the following signs or symptoms after the traumatic event:

  • You relive experiences of the traumatic event, such as having distressing images and memories.
  • You have upsetting dreams about the traumatic event.
  • You experience flashbacks as if you were experiencing the traumatic event again.
  • You experience ongoing or severe emotional distress or physical symptoms if something reminds you of the traumatic event.

In addition, for more than one month after the traumatic event you may:

  • Try to avoid situations or things that remind you of the traumatic event
  • Not remember important parts of the traumatic event
  • View yourself, others and the world in a negative way
  • Lose interest in activities you used to enjoy and feel detached from family and friends
  • Feel a sense of emotional numbness, feel irritable or have angry or violent outbursts
  • Engage in dangerous or self-destructive behavior
  • Feel as if you’re constantly on guard or alert for signs of danger and startle easily
  • Have trouble sleeping or concentrating

Your symptoms cause significant distress in your life or interfere with your ability to go about your normal daily tasks.

For children younger than 6 years old, signs and symptoms may include:

  • Reenacting the traumatic event or aspects of the traumatic event through play
  • Frightening dreams that may or may not include aspects of the traumatic event

Treatments and drugs

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but often includes medication. Combining these treatments can help improve your symptoms, teach you skills to address your symptoms, help you feel better about yourself and learn ways to cope if any symptoms arise again.

Psychotherapy and medications can also help you if you’ve developed other problems related to your traumatic experience, such as depression, anxiety, or misuse of alcohol or drugs. You don’t have to try to handle the burden of PTSD on your own.

Psychotherapy

Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

  • Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations. For PTSD, cognitive therapy often is used along with exposure therapy.
  • Exposure therapy. This behavioral therapy helps you safely face what you find frightening so that you can learn to cope with it effectively. One approach to exposure therapy uses “virtual reality” programs that allow you to re-enter the setting in which you experienced trauma.
  • Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to traumatic memories.

All these approaches can help you gain control of lasting fear after a traumatic event. You and your health care professional can discuss what type of therapy or combination of therapies may best meet your needs.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.

Medications

Several types of medications can help improve symptoms of PTSD:

  • Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
  • Anti-anxiety medications. These drugs also can improve feelings of anxiety and stress for a short time to relieve severe anxiety and related problems. Because these medications have the potential for abuse, they are not usually taken long term.
  • Prazosin. If symptoms include insomnia or recurrent nightmares, a drug called prazosin (Minipress) may help. Although not specifically FDA-approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.

You and your doctor can work together to figure out the best treatment, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Tell your health care professional about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.

Coping and support

If stress and other problems caused by a traumatic event affect your life, see your health care professional. You also can take these actions as you continue with treatment for post-traumatic stress disorder:

  • Follow your treatment plan. Although it may take a while to feel benefits from therapy or medications, treatment can be effective, and most people do recover. Remind yourself that it takes time. Following your treatment plan will help move you forward.
  • Learn about PTSD. This knowledge can help you understand what you’re feeling, and then you can develop coping strategies to help you respond effectively.
  • Take care of yourself. Get enough rest, eat a healthy diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
  • Don’t self-medicate. Turning to alcohol or drugs to numb your feelings isn’t healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
  • Break the cycle. When you feel anxious, take a brisk walk or jump into a hobby to re-focus.
  • Talk to someone. Stay connected with supportive and caring people — family, friends, faith leaders or others. You don’t have to talk about what happened if you don’t want to. Just sharing time with loved ones can offer healing and comfort.
  • Consider a support group. Ask your health professional for help finding a support group, or contact veterans’ organizations or your community’s social services system. Or look for local support groups in an online directory or in your phone book.

When someone you love has PTSD

The person you love may seem like a different person than you knew before the trauma — angry and irritable, for example, or withdrawn and depressed. PTSD can significantly strain the emotional and mental health of loved ones and friends.

Hearing about the trauma that led to your loved one’s PTSD may be painful for you and even cause you to relive difficult events. You may find yourself avoiding his or her attempts to talk about the trauma or feeling hopeless that your loved one will get better. At the same time, you may feel guilty that you can’t fix your loved one or hurry up the process of healing.

Remember that you can’t change someone. However, you can:

  • Learn about PTSD. This can help you understand what your loved one is going through.
  • Recognize that withdrawal is part of the disorder. If your loved one resists your help, allow space and let your loved one know that you’re available when he or she is ready to accept your help.
  • Offer to attend medical appointments. If your loved one is willing, attending appointments can help you understand and assist with treatment.
  • Be willing to listen. Let your loved one know you’re willing to listen, but you understand if he or she doesn’t want to talk.
  • Encourage participation. Plan opportunities for activities with family and friends. Celebrate good events.
  • Make your own health a priority. Take care of yourself by eating healthy, being physically active and getting enough rest. Take time alone or with friends, doing activities that help you recharge.
  • Seek help if you need it. If you have difficulty coping, talk with your doctor. He or she may refer you to a therapist who can help you work through your emotions.
  • Stay safe. Plan a safe place for yourself and your children if your loved one becomes violent or abusive

Prevention

After surviving a traumatic event, many people have PTSD-like symptoms at first, such as being unable to stop thinking about what’s happened. Fear, anxiety, anger, depression, guilt — all are common reactions to trauma. However, the majority of people exposed to trauma do not develop long-term post-traumatic stress disorder.

Getting support can help you recover. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health provider for a brief course of therapy. Some people may also find it helpful to turn to their faith community.

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. Support from others may also help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs.

Thank you for reading. I realize that this is an extra long post and apologize for its length. I got the above information at the Mayo Clinic at: http://www.mayoclinic.org/. If you need immediate help please call 911. Have a wonderful day. Please don’t forget to take a moment of silence for those who lost their lives in 9/11 as well as for those who survived it.

Mental Illness Basics

Posted on by Gertie

Happy Friday!! I am happy to announce that today is my first blogging feature. It is hope that when I do my blogging feature every Friday, that I not only educate people without a mental illness to lessen the stigma that goes along with having one but hopefully to gain a bigger blog following. My primary goal is to educate people on mental illness. The stigma needs to stop which is why I am doing an “educational” piece every Friday.

Now that I have told you about my blogging feature; lets get going. Today’s blogging feature is about mental illness basics. I got the following information from http://www.webmd.com/. Here is that information:

Mental illness is any disease or condition that abnormally influences the way a person thinks, feels, behaves, or relates to others and to his or her surroundings. Although the symptoms of mental illness can range from mild to severe and are different depending on the type of mental illness, a person with an untreated mental illness often has difficulty coping with life’s daily routines and demands.

What Causes Mental Illness?

The exact cause of most mental illnesses is not known. It is, though, becoming clear through research that many of these conditions are caused by a combination of genetic, biological, psychological, and environmental factors — not personal weakness or a character defect — and recovery from a mental illness is not simply a matter of will and self-discipline.

  • Heredity (genetics): Many mental illnesses run in families, suggesting they may be passed on from parents to children through genes. Genes contain instructions for the function of each cell in the body and are responsible for how we look, act, think, etc. However, just because your mother or father may have or had a mental illness doesn’t mean you will have one. Hereditary just means that you are more likely to get the condition than if you didn’t have an affected family member. Experts believe that many mental conditions are linked to problems in multiple genes — not just one, as with many diseases — which is why a person inherits a susceptibility to a mental disorder but doesn’t always develop the condition. The disorder itself occurs from the interaction of these genes and other factors — such as psychological trauma and environmental stressors — which can influence, or trigger, the illness in a person who has inherited a susceptibility to it.
  • Biology: Some mental illnesses have been linked to an abnormal functioning of brain circuits that connect different brain regions that control thinking, mood, and behavior. Nerve cells within those brain circuits pass information along from one cell to the next through brain chemicals called neurotransmitters. Scientists think that by altering the activity of certain neurotransmitters (through medicines, psychotherapy, brain stimulation, or other treatments), those faulty brain circuits may work more efficiently, thereby controlling symptoms. In addition, defects in or injury to certain areas of the brain also have been linked to some mental conditions. Also, recent studies show inflammation may have a role in the development of mental illness.
  • Psychological trauma: Some mental illnesses may be triggered by psychological trauma suffered as a child or teenager, such as
    • Severe emotional, physical, or sexual abuse
    • A significant early loss, such as the loss of a parent
    • Neglect
  • Environmental stressors: Certain stressors — such as a death or divorce, a dysfunctional family life, changing jobs or schools, and substance abuse — can trigger a disorder in a person who may be at risk for developing a mental illness. This effect is not the same as and goes beyond the grief and other normal emotional responses such events cause.

Can Mental Illness Be Prevented?

Unfortunately, most mental illnesses are caused by a combination of factors and cannot be prevented.

How Common Is Mental Illness?

Mental illnesses are very common. In fact, they are more common than cancer, diabetes, or heart disease. According to the National Institute of Mental Health, about 25% of American adults (those ages 18 and older) and about 13% of American children (those ages 8 to 15) are diagnosed with a mental disorder during a given year.

Major depression, bipolar disorder, and schizophrenia are among the U.S.’s top 10 leading causes of disability.

Mental illness does not discriminate. It can affect people of any age, income or educational level, and cultural background. Although mental illness affects both males and females, certain conditions — such as eating disorders or depression — tend to occur more often in females, and other disorders — such as attention deficit hyperactivity disorder (ADHD) — more commonly occur in male children.

How Is Mental Illness Treated?

A mental illness, like many chronic illnesses, requires ongoing treatment to control symptoms. Fortunately, much progress has been made in the last two decades in treating mental illnesses. As a result, many mental conditions can be effectively treated with one or a combination of the following therapies:

  • Medication
  • Psychotherapy, such as individual or group therapy
  • Day treatment or partial hospital treatment
  • Specific therapies, such as cognitive behavioral therapy and behavior modification

Other treatments available include:

  • Alternative therapies, such as water therapy, massage, and biofeedback
  • Creative therapies, such as art therapy, music therapy, or play therapy
  • Hypnotherapy
  • Electroconvulsive therapy (ECT)
  • Vagus nerve stimulation (VNS)
  • Transcranial magnetic stimulation (TMS)

What Is the Outlook for People With Mental Illness?

When diagnosed early and treated properly, many people fully recover from their mental illness or are able to successfully control their symptoms. Although some people become disabled because of a chronic or severe mental illness, many others are able to live full and productive lives. In fact, as many as eight in 10 people suffering from a mental illness can effectively return to their normal activities if they receive appropriate treatment.

I am grateful for the information I used from http://www.webmd.com/. I hope that the information I shared was hopeful. We need to start educating ourselves as well as others about mental illness. Then that way ignorance and naivety can not play a role in the stigmatizing of people with mental illness. For those of us who struggle with a mental illness will no longer tolerate the stigma with having a mental illness.

Now that I have completed my first blogging feature, I am going to end this post. It is an extremely long post and hope that I have “educated” people some. Have a wonderful Labor Day Weekend!! Peace Out!!!

Daily Prompt: In the Summer Time

Posted on by Gertie

In response to The Daily Post’s writing prompt: “In the Summertime.” If it’s autumn or winter where you live, what are you most looking forward to doing next summer? If it’s spring or summer where you are, what has been the highlight of the season so far for you?

It’s definitely summer in my neck of woods and I am loving it. The weather has been awesome all summer and am grateful for the beautiful weather. Having beautiful weather during vacation always makes it that much more enjoyable.

Junior and myself are currently staying in a hotel in the town where both my brother and mother live. We came to their town because of my brothers birthday and wanted to be here to celebrate it with him. In fact as part of my brothers birthday gift we took him to the fair that always happens around his birthday that is in the area he lives in. Thankfully, we were able to take him on his actual birthday which was on Friday. The cool about coming to see my brother was we were able to stay at his place on Thursday and Friday nights. We could have stayed at my brothers last night and tonight but Junior and I wanted time to ourselves before the next part of our vacation which I will tell you about later in this particular post. About an hour after Junior and I checked into our hotel, we watched the parade. We watched it because my brother was in it. My brother was in the parade because he is a part of the Special Olympics. After the parade, Junior and I came up and had a much need intimate moment that last more than an hour. The best part of our hotel room is it looks over a lake and the state capital building. We can also look down at the local fair that is going on and we will be able to watch the fireworks from our room that end the fair tonight.

Tomorrow, Junior and I take the train to go to see my grandparents. I am looking forward to seeing them. They live right on the Columbia River. Being at their place is very peaceful. One of the things I’m looking forward to when I’m at my grandparents is fishing. Yes, this city girl enjoys to fish. Being able to relax is a great thing and that is what I plan on doing when I am at my grandparents.

In fact Junior and myself not only plan on relaxing at my grandparents, we are relaxing now in the town my brother lives in. We are going to go and do a few more fun things before the fireworks tonight.  So far my highlights for the summer are spending time with my brother and the beautiful weather. Now that you know what my summer highlights are, I am going to get going so I can relax with Junior. Perhaps we might have more intimate moments before we head out for the day. Have a wonderful Sunday, everyone. Enjoy your summer and peace out all!!!

Daily Prompt: Thank You

Posted on by Gertie

In response to The Daily Post’s writing prompt: “Thank You.” The internet is full of rants. Help tip the balance: today, simply be thankful for something (or someone).

As I was searching through the past daily prompts today, I came a crossed this daily prompt. I thought it would be a good one to do just because I have a lot to be thankful for.

First things first I am thankful for my dad. There are so many reasons I am thankful for my dad. Granted he may not have won the father of the year but I’m okay with that. My dad had to take on the role of mom when my own mother abandoned the both of us in the middle of the night. He not only raised me (with the help of my grandparents) in the 80’s and 90’s but showed me what it meant to persevere despite his developmental delays, Traumatic Brain Injury (TPI), mental illness and alcoholism. Most importantly, my dad showed me what recovery looked like. He showed that recovery isn’t an easy process but is well worth it. He also taught me that the road to recovery is uniquely individualized to each person.

Secondly, I am thankful for my grandparents for helping my dad raise me. I was not the easiest of children to raise especially when I was a teenager dealing with an eating disorder, mental illness and self-harm issues. My grandparents weren’t perfect but at least I know they tried to the best of their abilities and most importantly they love me with all their heart.

Another person I am thankful for is my fiancé, Junior. I am thankful for Junior for many different reasons. I am extremely thankful that he not only chose to ask me out and date me but asked me to marry him. The reason being is because he knew what he was getting into when we started dating. He knew how difficult it could and can be with my mental illness and that didn’t scare him. I thankful for Junior’s love for me and his encouragement with my recovery.

I have yet another person I am thankful for. This person has played a significant role in my recovery and am forever grateful to her for it. The person is my own therapist, Diana. (Side Note: Diana is a pseudonym to protect her, her family as well as her past, current and future clients.) Diana has been an incredibly formable person for me in my recovery. She has been in my corner, encouraging me, challenged me (when needed), listening to me and most importantly believing me when I tell her stuff that happened to me as a child. Diana has helped me grow as a person since she is a person who believes that recovery is possible despite how differently it looks to each person.

Last but not least I am thankful for my recovery with my mental illness as well as my eating disorders. I am thankful for my recovery because I am able to enjoy my life despite what difficulties I encounter. If I wasn’t in recovery I wouldn’t haven’t been able to get my certification as a Peer Support Specialist much less have my current job as a Consumer Advocate. I also wouldn’t be able to volunteer at the Warm Line or the young adult homeless shelter I just started volunteering at. Being in recovery means that I am now living a life worth living.

A life worth living also means finding out what you enjoy. That what I am going to do now. I am going to go and enjoy this beautiful summer day. I am going to go and eat at my favorite restaurant on the water front. Yes, that means I am ending this blog post for now. Peace out and enjoy your day.

Daily Prompt: Strike a Chord

Posted on by Gertie

In response to The Daily Post’s writing prompt: “Strike a Chord.” Do you play an instrument? Is there a musical instrument whose sound you find particularly pleasing? Tell us a story about your experience or relationship with an instrument of your choice.

As I was searching through past topics of the Daily Prompts, this particular topic caught my eye instantly. It caught my eye for a multitude of reasons and decided that I would do this daily prompt before heading out to work today.

Yes, I do play an instrument. I play the flute. I’ve been playing the flute since the sixth grade. That was back in September of 1991. Holy shit, that was 24 years ago. The story around why I started playing the flute is quite humorous. I originally started playing the trombone and my arm was to short to slide to the fifth and sixth positions and even with the extension I was still unable to slide to the sixth position. Since I was unable to play the trombone due to short arms, I had to choose another instrument. I was debating between the oboe and the flute and was ultimately persuaded into choosing the flute by my best friend, who was learning to play the flute at the same time as well. I am beyond grateful that I was talked into playing flute but part of still wishes I picked up the oboe. The oboe has a beautiful yet unique sound and is an instrument that catches my ear.

I find many musical instruments quite pleasing to my ear besides the above mentioned instruments. One of the instruments I find particularly pleasing is the bagpipe. Yes, the bagpipe. People tend to laugh at the fact that I not only enjoy the sound of the bagpipes but want to learn how to play them as well. Over the years I’ve come to study the history of the bagpipe. The reason being is because it is a part of my heritage. I am half Irish and identify as Irish. Yes, I do know it’s also a part of Scottish heritage however, I don’t have any Scottish in my blood. A cool side note about bagpipes is my fiancé, Junior can play the bagpipes quite well. In fact he is a part of the pipes and drums with the fire department. He in fact is a firefighter and paramedic. The cool thing that I find about Junior playing the bagpipes is that he is Mexican and isn’t afraid to do so. (Junior is also able to play the trumpet and plays in a Mariachi Band).

Playing the flute has been a life safer to me in many ways. Playing the flute in the high school marching (and concert) band is what helped stay in school and prevented from dropping out. That’s why I am so passionate about keeping both the performing and fine arts in schools. The arts keep people like me in school.

Not only did playing the flute keep me in school, it has helped me enormously in my recovery with mental illness. Playing the flute helps with my mental illness in several ways. It helps keep me distracted at times. It relaxes me. Most importantly it helps me focus on my breath and breathing well. When I am dealing with severe PTSD symptoms I tend to forget to breath and the “normal” breathing techniques and exercises don’t help me much. The “typical” breathing techniques and exercises tend to make my PTSD symptoms worse due to some trauma. That is where the flute comes in to helping me focus on my breath. You need to breathe well to be able to play the flute properly. That means, me being able to breathe well not only helps me with playing the flute helps with the symptoms of my PTSD. You can say that playing the flute has been a type of therapy for me; music therapy. Unforantenly, not many places offer music therapy despite how helpful it is to many different people in this world.

When I chose this particular daily prompt, I had absolutely no idea where it would lead. I honestly didn’t think I would be discussing how the flute helped (and still helps) with my PTSD. I thought I would me discussing more how band kept me in school and how I now have life long friends because of band. In all honesty, I have my best friend since the third grade to not only to join band by picking an instrument but persuading me to choose the flute over the oboe when I was not able to play the trombone. Playing a musical instrument gives one a community that they will always be a part of.

Now that I’ve done this daily prompt, it brings joy to my soul that I was able to share one community I belong to, to you the blogging community in which I to belong to. Thank you for allowing me to share all this. I am going to have to end this blog for now because I have to go to work now. Have a wonderful work week everyone. Happy Monday and peace out everyone!!!!

Pride Parade 2015

Posted on by Gertie

It has been a long, exhausting yet exuberating day. I marched in the pride parade today with my employer. It was awesome and an honor to march along side with my co-workers and clients. Many of the clients were quite surprised that many staff were not getting paid for their time marching in the parade. The cool thing about marching in today parade is that I had an option on who to march with. I could have marched with the Warm Line and Crisis Clinic staff and volunteers since I’m a volunteer with the Warm Line. I also had the opportunity to march with fellow volunteers as well as “guest” of the young adult homeless shelter I recently started volunteering at. In fact a couple of “guest” of the young adult shelter were disappointed I wasn’t marching with them however they understood why I would be marching with my employer.

My fiancé, Junior, even marched the pride parade. In fact he was with his employer. Junior is a firefighter and plays the bagpipes. Yes, that means he was marching in his rainbow colored kilt playing the bagpipe with the fire department pipes and drums. Junior, is quite the talented bagpiper. Unfortunately, I was unable to see Junior march in todays parade because I, too was marching in the parade.

Marching in todays pride parade had me thinking about my junior high and high school years. I was in marching band and loved it. Marching in todays parade had me realize how much I miss being in band.

Enough with my marching band days in junior high and high school and back to Pride Parade and its festivities. Today, was a warm, humid, cloudy day. In fact while marching in the parade, the weather decided to throw a thunder and lightning storm in the mix. In fact the rain felt good. The clients loved it. In fact they broke out into song. Not just any song. They sung “Dancing in the Rain.” Yes, they even started dancing. I wish I was able to get a picture of it however due to HIPPA laws I was unable to do so. In fact even some of my co-workers decided to join in the singing and dancing in the rain. I didn’t because I was enjoying the fact that the clients were enjoying the moment. It was a blast had by all.

After the parade I decided to go and volunteer at the booth my employer had set up. I volunteered for about an hour an half. It was nice to be able to educate the community about mental illness and homeliness and the effects it has on our community. The reason I decided to volunteer at my employers booth was not only to be able to educate the community but because Junior was farther down the parade route than I was and was wanting to do something productive as he was finishing up his portion of the parade.

When Junior was done with his portion of parade he stopped by my employers booth to come and “pick me up.” We then walked around the pride festivities and enjoyed our time together. In fact we discussed our wedding and how we are thrilled that one of his sister is now able to get married to the woman of her dreams anywhere in the United States as soon as she finds her. Isn’t it the most wonderful thing that now anyone can marry the person that they love despite their gender and the gender of their partner?

As we walked around the festivities we noticed some people holding up religious signs. In fact some of those signs were just plain ole hateful. I thought Christianity was a religion of love and compassion and not of hate and ignorance. Not only did the signs say hateful thing, the people holding the signs were saying hateful things. In fact one person told a little girl of 7 or 8 years old that not only are her daddies going to hell but she is as well. A nearby uniformed police officer stepped in and spoke up for that family. I just cant comprehend why people are so hateful especially to children.

Now that Junior and myself are home, we are relaxing. It has been a good day and am grateful that I was able to be alive during a part of a positive event in American History. I hope to blog again soon. Have good rest of your weekend. Peace out!!!

107 Questions With 107 Answers

Posted on by Gertie

I got the idea for this post from another blog, which I of course follow. Thank you Marci over at http://marcimentalhealthmore.com/  It means a great deal to be able to share ideas (and sometimes even still them with permission of course) with other bloggers. Yes, I did add, change not include some questions so I could make it geared more to my blog. .

1. Why did you start blogging?

I started blogging for two reasons: 1) to educate those who don’t have a mental illness in hope to lessen the stigma that goes along with it. 2) to show others who do struggle with mental illness that recovery is possible and there is hope.

2. How did you come up with the title of your blog?

I came up with the title, Gertie’s Journey because Gertie is my nickname and I would be discussing my journey along the way.

3. Why not use your real name in your title?

I originally didn’t use my real name because of the stigma that goes with having a mental illness. I now don’t use my real name because I work in the mental health field and need to protect my privacy.

4. Does that mean you have a mental illness?

Yes!!

5. What are your diagnoses?

As of right now my diagnoses are Major Depressive Disorder (MDD), PTSD, OCD and ADHD. So, I’m an Alphabet Soup.  At one point in time I was diagnosed  with Borderline Personality Disorder (BPD). I no longer meet the criteria of BPD and consider myself a Recovered Borderline.

6. Do you consider yourself in recovery?

Yup, I do!!!

7. What do you do to stay in recovery?

Most importantly, I make sure I see my therapist and psychiatric nurse practitioner (ARNP) on the regular basis. I take my meds as prescribed daily. I make sure I go about my regular routine even if I’m struggling. I exercise on the regular basis.

8. How are you, really?

Overall, I am doing pretty good despite having high anxiety due to PTSD symptoms.

9. How are you feeling right now? What are you thinking about?

Umm….I think I just answered this. If you can’t remember go back to the previous question (as I say sarcastically). I’m thinking about what I’m going to have for dinner. I’m also thinking about working on scrapbooks I’m making for people for their holiday gifts. Yes, I know the holidays are six months away.

10. What is your favorite color?

Purple

11. What is your favorite food?

Mac & Cheese, Strawberries, Mexican Food

12. What is your favorite dessert?

Strawberry short cake and peach cobbler

13. How old are you?

Somewhere between 30 and 39. (Said sarcastically) Honestly, I am in my mid-30’s.

14.  What have you learned today?

I learned about Buddhism and meditation from a book I am reading about Buddhism.

15. What do you do?

I am a Consumer Advocate in a supportive housing program at local mental health agency.

16. What are some of your favorite books?

Enders Game by Orson Scott Card; The Stand by Stephen King and J.A Jance books. I also like many poems by Maya Angelou, Langston Hughes and Emily Dickenson

17. Who are some of your favorite authors?

Orson Scott Card, Stephen King, J.A Jance, Emily Dickenson, Langston Hughes and Maya Angelou

18. What are some of your favorite movies?

BIG, Speed, It’s Kind of a Funny Story, comedies, horror, and many movies Robin Williams is in.

19. Who are some of your favorite actors?

Robin Williams, Winona Ryder, Betty White, and Will Smith

20. What kind of music are you into?

I like 80’s and 90’s music and I also like Punk Rock, Grunge, and alternative.

21. Who are some of your favorite musicians?

Nirvana, Tori Amos, K.D. Lang, Kurt Cobian, Amy Grant, Tears for Fears, Journey, Queen, AC DC, and I can continue on my favorite musicians but wont.

22. If you’re going to write a book, what would it be about?

It would be memoir of my life with a mental illness and my recovery.

23. What’s the scariest thing you have ever done?

I think it would have to be starting my recovery with both the eating disorders and my mental health diagnoses.

24. What accomplishment are you most proud of?

Graduating high school, getting my peer specialist certification and being in recover with my mental illness.

25. How did you meet your fiancé?

I don’t remember meeting my fiancé but will tell you how we met. We first met when I had attempted suicide and one of my housemates found me unresponsive and called 911. He was one of the firefighters on duty who responded to the call.

26. Do you have any children?

Sadly, no

27. Have you thought about fostering or adopting?

Yup, Junior and myself want to do foster care in hope of adopting the foster child/ren.

28. When you were a kid, what did you want to be when you grew up?

I wanted to be a teacher.

29. What profession are you currently in?

I am in the mental health field.

30. How did you get into your profession?

I got into the field because I have my own mental health issues and want to be an example of what recovery looks like. Plus, I have a peer specialist certification.

31. Would you recommend your profession to other people? Why / Why not?

Honestly, it depends who the person would be because not everyone is fit to work in the mental health field.

32. What do you do for fun?

Camp, hike, rollerblade, walk, read, blog, watch movies, do jigsaw puzzles, do Sudoku puzzles, scrapbook, go to sporting events especially baseball games, going to concerts, listening to music, hang out with friends and select family members, and volunteer.

33. Do you like traveling?

I love it.

34. If you could visit any country in the world, where would you go and why?

Its a tie between Ireland, Australia and New Zealand. I would like to go to Ireland because I am half Irish and its part of my heritage. I want to go to Australia and New Zealand because I learned about it summer school between the 3rd and 4th grades and grew fascinated with both countries.

35. Who are some people you’d like to meet someday?

President Obama, Eleanor Roosevelt, Rosa Parks, Martin Luther King, and Sigmund Freud

36. If you could go back in history, who would you like to meet?

Refer to the previous question with the exception of President Obama since he is still alive.

37. If someone asked you to give them a random piece of advice, what would you say?

The future belong to those who believe in the beauty of their dreams. Eleanor Roosevelt

38. What’s one of your favorite habits you have?

Going for a daily walk listening to music.

39. What are some things that make you really happy?

Sunny days, humor, my brother, my fiancé, nature, water, and my job

40. What are some things that make you really sad?

My miscarriages, most of my childhood, and how I have treated people in the height of my mental illness.

41. What are some things that scare you?

My PTSD symptoms I deal with on the daily basis. The mental health symptoms I deal with when I’m in crisis.

42. Do you like to plan things out in detail or be spontaneous?

I like both planning things and out and being spontaneous.

43. Are you a religious person?

No but I do consider myself Spiritual. I am on a Spiritual journey and looking into various faiths at this particular stage in my life.

44. Would you rather live in the country or in the city?

I am a city person. I love living in the city.

45. What was your life like growing up?

It wasn’t the best of childhoods.

46. What were you like in high school?

Depends on who you ask.

47. Do you have any brothers or sisters? How many?

Yes, I do. I have one half brother.

48. What’s your favorite part about today, so far?

The sunny weather, the strawberry shortcake I had and reading about Buddhism.

49. Who in your life has influenced you the most? How did they do it?

I’ve had many people who have influenced my life throughout my life and how those people did it is as unique as they are as people.

50. Have you ever tried sushi? (Did you like it?)

No, I have not tried sushi and never plan on trying it.

51. Do you like spicy food?

The spicier the better!!!!

52. How do you like your steak cooked?

Some pink but not a lot of pink.

53. If you were a type of animal, what would you be and why?

I think I would like to be an Orca because they are beautiful, intelligent animals and they get to be in the water all day.

54. What’s one of the strangest things you’ve ever done?

What are you talking about? Everything I do is strange because I am strange.

55. What kind of vacations do you like?

I love camping and any vacation I can learn something new.

56. What are some of your major goals in life?

To continue on my journey of recovery with mental illness.

57. What are some of your smaller goals in life?

To update my résumé and apply for peer support specialist jobs.

58. What do you like least about yourself?

The scars on my arms, legs and torso due to when I use to self harm.

59. What embarrasses you?

My speech impediment especially the stuttering (Its pretty much under control now but it acts up when I am under stress), being in little kid mode and being in a dissociated state.

60. If you could try out any job for a day, what would you like to try?

Being a psychiatrist.

61. What’s your earliest memory?

When I was three and my mom abandoning me.

62. What’s the best decision you ever made?

Being in recovery and choosing to stay in recovery. Trusting my gut with being in a romantic relationship with my fiancé, Junior.

63. Who’s your best / closest friend?

My fiancé, and three people I grew up with and/or went to high school with.

64. What do you think people think of you?

I don’t want to think what others think of me.

65. What were your grades like in school?

They weren’t the best in the world, mainly because of learning disabilities and/or mental health issues.

66. If you could learn one random skill, what would you learn?

To learn American Sign Language (ASL), Spanish and German.

67. Are you an introvert or an extrovert?

I’m a little of both.

68. Have you ever taken a personality test? (How did the results turn out?)

Honestly, I’m not sure because, I’ve I had so many different test throughout my life that they all kind of run together. I must have if I was diagnosed for Borderline Personality Disorder (BPD). I am really grateful I no longer meet the criteria for Borderline.

69. Do you enjoy the particular sexual pose of what the number of this question is?

Very much so!!!!!

70. What’s the first thing you notice about people?

I notice both a persons eyes and smile.

71. Do you think people can control their own destiny?

To a degree, yes.

72. Do you think all people are equally valuable, or do you think some people in certain situations might be more valuable than others (say, a severely mentally ill patient vs. a doctor who could potentially save hundreds of lives)?

Define value!!

73. Do you think people are basically bad or basically good?

This is a difficult question for me to answer due to the fact that there are many factors to consider.

74. Do you think morals are universal or relative to the beliefs, traditions, and practices of individuals or groups?

I think it I need to know more before I could answer this question.

75. Do you think God exists?

Another complicated question. Yes, I do think that there is a spiritual being out there. I just don’t know who he, she or they are.

76. Do you think any kind of afterlife exists?

Yup, I am positive there is an afterlife.

77. Do you vote? Why / Why not? If you do vote, how do you usually vote?

Yes, I vote and I don’t disclose how I vote.

78. Do you think gay people choose to be gay? Do you think straight people choose to be straight?

I don’t think we choose our sexual orientation.

79. Is torture ever a good option? If no, why not? If yes, when?

Torture is NEVER a good option for any reason.

80. Would you kill an innocent person if you thought it might mean saving a dozen other people?

I would never kill an innocent person.

81. What’s the most money you’ve ever given away?

I rather not disclose. The amount I give away to a charity or person is between me and the charity or person.

82. What’s the biggest personal change you’ve ever made?

Choosing to be in recovery.

83. What’s the stupidest thing you’ve ever done?

I’ve done many stupid things that I cant just name one thing.

84. What do you think would be one of the best steps we could take toward ending poverty around the world?

This is a loaded question and difficult to answer. It is something I will have to ponder about.

85. What do you think we could do to best improve the education system?

Pay teachers more, smaller class sizes and bring back fine and preforming arts.

86. In general, what do you think about art?

I love it.

87. What are some of your favorite websites?

Any website that I am able to learn something on.

88. What’s the biggest lie you’ve ever told?

That my ex-step dad wasn’t abusing me when he actually was.

89. What’s something most people don’t know about you?

I cry myself to sleep because I miss the babies I lost through miscarriages.

90. What’s something you wish everyone knew about you?

I love being able to help others.

91. What are some of the first things you do in the morning?

Go to the bathroom, take a shower, eat and take my meds.

92. What’s the worst thing that’s ever happened to you?

Loosing two sets of twins within 14 months of each other due to miscarriage.

93. Do you cry easily?

No.

94. How do you feel about public speaking?

I hate it.

95. Do you like to talk on the phone?

Its better than texting.

96. How many emails do you get each week, roughly?

Depends what account. I have a work email, a personal email, a professional email and an email for this blog.

97. If someone were to make a movie about your life, who would you hope would play you?

I wouldn’t want my life made into a movie so I hope nobody plays me.

98. What’s one of your favorite questions to ask new friends or to get a conversation going?

It depends on the situation I am in.

99. Would you ever sky dive or bungee jump?

I have always wanted to sky dive. When I was younger I wanted to bungee jump but as I get older it becomes less appealing.

100. Have you ever been in a fist fight?

Yup, in junior high.

101. What’s the best prank you’ve ever pulled?

My senior prank in high school.

102. What did you do on your 16th birthday?

My friends had a surprise party for me.

103. What do you think is one of the most undervalued professions right now?

Teaching and any profession in the mental health field.

104. How would you explain your basic life philosophy?

When I look back on my life I rather regret the things I do than the things I don’t do.

105. Would you rather be hated or forgotten?

Neither

106. If you knew you would die tomorrow, would you feel cheated today?

I don’t want to know when I am going to die.

107. Now, how do you honestly feel after answering all these questions?

Exhausted but overall still doing well.