Everyday Inspiration; Day 12: Critique a Piece of Work

Good Morning, World!!! For today’s assignment for Finding Everyday Inspiration course, is to critique a piece of work. The first thing that came to mind was Picasso because a few years back an exhibit of Picasso came to the local art museum in which I attended. So, for this assignment I decided to  google Picasso and a butt load of images appeared. The above piece of art is not a Picasso piece but it caught my eye. In fact it also caught Junior’s eye. The artist name is Marlina Vera. I don’t know much about the artist however I will look more into this individual after I “critique” this piece of art work.

I was and am intrigued by this piece of art work for many reasons. It reminds me of Picasso but mostly reminds me of the love that Junior and I have for each other. Junior and I discussed the above piece of art as we held hands. We realized that not only looking at the art but discussing it, that this piece of art turned us on sexually.

It turned us on sexually because it shows a couple holding each other with much love. A way Junior and I would do and have done. In fact after looking at this piece of art and discussing it we did have an intimate moment. An intimate moment that was very pleasurable yet cut short due to my PTSD symptoms.

My critique of this piece of art work may not be a typical critique but I don’t care. I love this art piece as it shows the love a couple can have for each other no matter what the other looks like. This piece not only had Junior and I discussing sex and intimacy but that of body image.

Body image can be a big deal when looking at art. This is one piece of art that has not just me thinking about body image but Junior as well. Its amazing on how many topics one piece of art can come up in a discussion about it.

I know this isn’t much of a critique but its my critique and like the feelings the piece of art work brings to me (and Junior). Thank you for reading. I greatly appreciate you reading my blog. I hope everyone has a good Monday. I also hope you all have great week at work. Peace Out, World!!!

A Relaxing Hump Day (Wednesday)

Hello World!!! This morning I woke up with Junior kissing me on the cheek after coming home from work. I couldn’t think of a better way to wake than having my partner wake me up than the way Junior did this morning.

We decided to have a low key day which started off with breakfast. I fixed Junior an omelet with a side of fresh fruit and chocolate milk. Like I suspected Junior was famished due working his regular 24 hour shift that was more challenging than usual.

A shift we ended up discussing. Junior needed to discuss what his shift about for a multitude of reasons. One of which was that he dealt with a child abuse case that included six children. Junior is a firefighter and if you ask any firefighter out there anything that includes a child is one of the most difficult calls they go on especially if it includes child abuse. As we discussed the child abuse call, Junior couldn’t help but tell me that once his crew was done with the call he thought about the “shit” I went through which helped him have that much more compassion and empathy for the children he helped. Junior also went on two separate calls that involved two separate women who were the victims of “brutal sexual assaults.” He and all firefighters have a difficult time dealing with calls that involve both children and/or victims of an assault of any kind especially sexual assault.

As Junior and I discussed the difficult calls he was noon, the topic of sex came up. Junior brought up the fact that he finds it quite difficult to have sex and be intimate after shifts that include child abuse and/or sexual assault. As we discussed the difficulties he had with sex and intimacy after a shift like yesterdays, Junior stated he always seems have better understanding of how I must feel regarding my PTSD symptoms even though he will “never fully understand.” As we finished our discussion Junior realized how exhausted he was from his shift and went to bed to get a few hours of sleep.

As Junior slept, I decided to start reading a book I bought at Emerald City Comic-Con (ECCC) back in March of this year (2017). The book I started reading is Green Rider by Kristen Britain. I, in fact was able to get this book signed by the author after attending a panel she was on at ECCC. A panel I almost didn’t attend but happy I did. I’m in fact looking forward to attending ECCC in 2018 and hope that Kristen Britain is a guest as I will most likely will attend a panel if she speaks on one. The reason being is that when she signed my copy of Green Rider she took fifteen minutes of her time to talk with me even though she did not have to do so.

Looks like I got on the to topic of Emerald City Comic-Con when I was wanting to discuss the book I am reading. So, on that note let get back on back to the topic of Green Rider. So far I am really enjoying the book. I’m only on page 48 and starting the sixth chapter yet I’m finding myself having difficulties putting it down and wanting to get back to reading it. When I find myself having difficulties putting a book down and wanting to pick it back up as soon as possible then it must be a good book.

In fact after Junior woke up from his nap I told him about Green Rider and now he is wanting to read it. After telling Junior about the book we ate a lite lunch and then went rollerblading around a local lake at t local park. As we rollerbladed we discussed a great deal of stuff. Most of it was regarding plans for what we want to do the rest of the day as well as rest of the week before he goes back to work on Sunday for his regular shift as well as an overtime shift on Monday.

After rollerblading at a local park we decided to rent a couple of movies at a local mom and pop video store. Since we were already out and about we decided to pick up my meds from the pharmacy. When we arrived home we ended up watching one of the movies we picked up from the video store. We then fixed and ate dinner. After dinner we decided to go for a walk around the neighborhood. Now we are home watching the nine o’clock news.

As I near the end this post after telling you about my day, it turned out to be a relaxing hump day (Wednesday). Having a relaxing day is extremely helpful for my recovery as well as decreasing the symptoms of my mental health diagnoses. In fact everything I brought up in this post is quite helpful for me and my recovery.  As many of you know my recovery means the world to me and wouldn’t give up the path of recovery for all the money any in the world.

Something else that means the world to me is my time with Junior and with that being said, I want to spend time with him. That means this is the end of this particular blog post. I hope everyone has a good evening as well as good nights sleep. Peace out!!!

A Sunday to Remember

Today has been truly a lazy Sunday. A Sunday, I wouldn’t trade for the world. I wouldn’t trade for the world because it was a truly amazing day. A day that Junior put a great deal of thought in to.

Junior put a great deal of thought into today as he is well aware of how difficult things have been for me the last several months. Junior planned today out to be a relaxing and lazy day as well as to enjoy what he had planned in hopes to have spontaneous events to enjoy. We both enjoyed the planned and the spontaneous events of the day.

This is where I share with you the events of today. Events that have helped me. When Junior got off work this morning he went to my place to gently wake me up to start off the day. He rubbed my back till I woke up. When I woke up, he gave me a kiss and asked if I wanted to spend they day with him at my place or his. I said his place because it has a more homey feeling to it. So, we came over to Junior’s place.

Once we got to Junior’s place, he changed out of his uniform and into his pajamas. In fact the both of us have spent most of the day in our pajama’s with a couple exceptions that I will tell you about later on in this post. After Junior put on his pajamas he made breakfast. Breakfast consisted of French toast, scrambled eggs, bacon, fresh strawberries and chocolate milk. After breakfast, Junior went to bed as he had a long forty-eight hour long shift and I started the dishes. Junior ended up getting up shortly after going to bed to watch me do the dishes. As he watched me do the dishes for about five minutes he turned on some music.

Not just any music but music that represents our love for each other. After turning on the music, he went to were I was, turned of the water and gently grabbed my had asking me to dance. I, of course said yes and we danced in his living room. The dancing led to some passionate intimate moments. Yes, we made love. As we made love, I felt a sense of peace, I haven’t felt in months. A peace that Junior’s love for me is never-ending no matter how tough things get for either of us as individuals or as a couple.

After making love, we talked about things. Things that brought both happy and sad tears to the both of us. It was nice to be able to lay in bed holding each other talking. After a good talk we both fell asleep. We slept for a few hours before waking up to eat lunch and watch a baseball game on television.

We ate left over salad before the Seattle Mariners versus Los Angeles Angels of Anaheim game started. As we watched the Mariners play against the Angels we held hands, cuddled and even did some petting. Petting that led to more intimate moments. Moments that I am beyond grateful for. Yes, we did watch the baseball game. Granted it was only about half the game due to intimate moments but we did watch. I am happy to say that the Angels beat the Mariners once again. In fact they (the Angels) swept the Mariners under the rug. Junior of course was (and is) a little disappointed as he is a Mariners fan. Even though he is a devoted and loyal Mariners fan I still love Junior.

I love Junior because he is devoted and loyal to every aspect of his life. His devotion and loyalty to me amazes me and is something I don’t deserve. Even though I feel like I don’t deserve Juniors love, devotion and loyalty, he continue to give it to me and is extremely patient with me. Patient enough with me to let me cry as he held me. Yes, I cried. I cried due to the pain I was dealing with regarding PTSD symptoms I was experiencing. Junior just sat there holding me as I cried for a good half an hour. After as I was done crying we talked. Talked about the symptoms I was experiencing and then about what we were going to do about dinner.

We decided that we were going to have a simple dinner. A simple dinner of spaghetti, corn on the cob, milk and for dessert we had strawberry short cake. We made enough to have left overs tomorrow. I’m looking forward to left overs tomorrow because they always taste better the next day.

After dinner we did the dishes. Dishes that were left from breakfast and lunch as well the ones we had from dinner. When we were done with the dishes we sat on the couch talking again. Talking about our future. A future together. A future we want together.

As we discussed our future together we decided to do a jigsaw puzzle. Something we both enjoy doing. As we worked the puzzle together we ended up having yet another intimate moment. Another moment I am grateful for. I’m grateful for the moment because Junior and I haven’t had many intimate moments lately due to severe and on going symptoms of my Depression and PTSD. Moments that both Junior and I are grateful for.

Being grateful for what we have is a major reasons why our relationship has lasted so long. Another major factor is good communication. I’m sure you all agree that communication is key a good relationship no matter what type of relationship it is.

Today has been a Sunday to remember because of the time I have spent with Junior and as I end this post remember to thank those people in your lives that make an effort to make your day better. I know I plan on thanking Junior on making my day better. I hope to blog again tomorrow about the continuing education class I will be attending. Have a great rest of your weekend. Peace out!!!

 

Celebrating Three Years

Happy Earth Day!!! Today marks three years since Junior and myself starting dating. Who knew that when Junior and myself met fifteen and a half years ago that we would be engaged to be married.

I of course don’t remember the first time we met. The first time we met was one of the darkest times in my life. I had attempted suicide and a housemate had found me and called 911. Junior happened be one of the first responders that responded to the 911 call of my attempted suicide. As much as I was pissed off that I was saved that particular time and many other times, I am now grateful that my life was saved.

If my life wasn’t saved from the multiple suicide attempts, Junior and I wouldn’t be on a romantic get away to celebrate our three year anniversary. Celebrating my three year anniversary with Junior is another positive sign of me being in recovery with a mental illness.

Being in recovery is awesome and am happy to be celebrating three years with Junior. Junior and I left on our get away when I got off from work. We are celebrating out of town in hotel on the waterfront of a navel town. The first thing we did when we checked into our room we had tested out our jetted tub. We had some very intense and enjoyable adult fun in the tub which continued for another couple hours and ended in our nice king size bed. We then cuddled for another hour before we went out for dinner. After dinner we came back to the hotel and had more pleasure moments.

Now we are watching television as we cuddle and I blog. This getaway is much needed for the both of us and am looking forward to spending some quality time with Junior. I am sure we won’t be leaving the hotel room much due to having multiple and/or continued pleasurable moments.

Speaking of quality time, I think I should be going so I can spend time with Junior. Have a wonderful weekend everyone and Peace Out.

Lazy Sunday

It is a lazy Sunday afternoon. Junior and myself have been taking it easy all day. The day started when Junior got home from work and I had a candle lit breakfast waiting for him. The candle lit breakfast put us in the mood for some serious yet pleasurable intimate moments that exhausted the both of us. We took a nap after pleasurable intimate moments.

When we woke up from our nap we realize it was time for some football. Just not any football but Seahawk football. As I sit here blogging we are watching the game and Seahawks just scored in the third quarter. It is now 17 – 7, Seahawks. It’s been said that ear plugs are nesasary when you go see the Seahawks play at home but earplugs are nesasary when you watch the Seahawks with Junior.

I think I am going to go for now. I want to watch the game with Junior. Have a great Sunday. Go Seahawks!!!

Dialectical Behavior Therapy (DBT)

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!!

Writing 101: Finding Your Inspiration; Day Fourteen: Recreate A Single Day

The day I want to recreate isn’t exactly G or PG rated. In fact it is more X rated. The reason why it is X rated is because the day I have in mind is the first time I had sex willingly. The first person I have ever had sex with willingly was with Junior. The first night, just like every night he was and is extremely gentle with me when we are intimate with each other.

To tell you the truth every time Junior and I intimate with each is like the first time we made love with each other. No need to write about recreating a single day when that recreation happens multiple times a week. Every time I think about making love to Junior, I smile. I smile because he loves me just the way I am. He is always gentle with me when we have intimate moments.

Being with Junior isn’t just about making love, it is about being with someone that I love who loves me back. For Junior and myself its about being with each other and being who we were meant to be with each other. It’s about loving each other without judgment. For me being with Junior everyday is a recreation of a single day and that’s all one can ask for.

As I finish this particular post, I want to encourage you all to be with people who help recreate events and/or moments everyday. Having people who love you to create and recreate days and moment is an awesome experience. Have a great evening. Peace Out!!!

Bipolar Disorder

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/.

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!!!!

Daily Prompt: In the Summer Time

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!!!

Love Wins In The United States; Same-Sex Marriage Now Legal in All 50 States

As many people in the United States (and around the world) are aware of by now, the United States Supreme Court ruled yesterday that same-sex marriage is now legal in all 50 states. Yes, all 50 states. I, like many around the country shed tears of joy when I heard the joyous news.

I shed tears of joy because this means that many people are now able to marry the person of their dreams, just like I am able to do so. I may be madly in love with Junior and engaged to marry him, I consider myself pansexual. For those of you that don’t know what pansexual is, the definition is as follows: not limited in sexual choice with biological sex, gender or gender identity. Yes, Junior knows I’m pansexual and he is fine with it. For me falling in love with the person of my dreams has nothing to do with the persons gender, gender identity or sexual orientation, it has to do with the persons personality. I fell in love with Junior because of who he is on the inside. I am thrilled I am able to marry Junior and just as thrilled same-sex couples are able to marry now.

Unfortunately, many people aren’t exactly thrilled with the Supreme Court ruling. It seems that the people who aren’t thrilled with the ruling happen to be people of faith and not just any faith; Christianity. The reason I say this is because I’ve noticed that on many social media sites (including WordPress) that Christians were being out right hateful. For example, I had posted on my the Facebook account I have for my given name, that I was beyond thrilled that same-sex marriage is now legal. Many people who are Christians on that particular account started messaging, texting, calling and emailing me saying they were offended and that I was “going to hell” because I support “gay marriage.” I even had a handful of people block me. I’m fine with that because if they are going to get offended for something I support then I don’t need them in my life. I just cant comprehend why a particular religion that preaches love and compassion can be so hateful when it comes to people getting married to the person they love even if that person is the same gender as they are. I am trying so hard to not be so judgmental toward that particular faith because I know many kind-hearted Christians out there and some of them even support same-sex marriage.

The ruling of same-sex marriage couldn’t have come at better time. It’s not only came in Gay Pride Month but the biggest weekend for the LGBT community; pride weekend. Yesterday, was a historical moment in United States history. I am beyond happy that this happened in my lifetime. I am sure that there are going to be many people and various types of groups that are going to try to get this ruling overturned. No matter how hard people may try to get the ruling overturned its never going to happen. Too many people will fight just as hard if not harder to keep the ruling in place.

I need to get going. I am heading out to pride festivities before I go and volunteer at the Warm Line. I know that the pride festivities will be more giddy than they have been in previous years because of yesterdays ruling. I love going to pride festivities. I hope to be able to blog after I get home from pride events and volunteering. Have a good day everyone and stay safe. Peace out!!!!