Life, Therapy

Challenges and benefits of getting better

(Note: brief, vague mentions of self harm, eating struggles, deaths, and violence) 

I am happy and proud to say that I have been feeling much better recently!

My PTSD has almost disappeared! I have nightmares less than once week now, and their content is much less violent and traumatic. I can’t remember the last time I had a flashback! I’ve had many fewer intrusive thoughts, too.

I think the main reason for these improvements in my PTSD is that I’ve been doing Prolonged Exposure and directly confronting traumatic memories. I’m proud of this because I’ve put in the work and done things that scared me and were hard to do. I may write about this more later, but it really is remarkable to me how much it has helped.

I have so much more free time in my day now. Being upset took up so much of my days! I have more time available for going to class, doing homework, and hanging out with my friends, and sometimes I even have free time left over after that!

I got grades that I am proud of this semester; I took on a leadership position in a club I’m part of; I even tried flirting with someone I had a crush on!

Getting better is a change, and change can be scary

However, there are still struggles in getting better. It’s new and very different from how the past few years of my life have been. Change of any type is hard and scary for me, even when it’s positive change. There are new things to get used to.

Experimenting with the possibility of dating someone was a very stressful experience for me, even though I’m glad I tried and have grown from it and made a new good friend (I told him I liked him; he said he didn’t like me back, but we’re still good friends). There are a lot of situations I’m not used to being in. Applying for jobs? Having interviews that aren’t for therapy programs?!

It’s scary, but I’m growing. 🙂

Higher expectations for myself

As my mental health improved, my expectations for myself shot up. Before, I called a day a success if I went to all my classes and ate some meals, and I’d be proud of that and pat myself on the back because I knew it had been hard to do. When those things got easier and more routine, I felt that I needed to do more. I thought that since I was doing better, I had to take school more seriously and actually get better grades (in part to make up for the lower ones I’d gotten when I was struggling more). My mental health had been holding me back before, and it wasn’t now, so I felt that there was no excuse to not do well, to not do everything, to not be like my peers.

I didn’t see it at the time, but those were unrealistic expectations. There is a lot of room in-between managing to make it to most classes and getting straight A’s; it’s not strictly one or the other. I expected myself to be perfect all of a sudden. I wanted to be able to make up for all the things I’d missed out on over the years all at once.

Wanting these things did make me more motivated, and I plan to achieve many of the things that I realized I wanted — someday. I have to radically accept that I can’t do everything all at once, and I can’t do everything so fast. I need to be patient with myself. While it’s great that I am getting better and seeing improvements, I’m not fully better. It’s a slow process and something that I need to keep working on.

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Not everything gets better

Another thing to radically accept is that there are some things in my life that don’t get better as my mental health gets better. I came home from college recently, and it was a bit of a rude awakening to see my parents arguing just as much as they had been when I left. My improvement hadn’t affected them — of course it wouldn’t, but somehow I just assumed that everything in my life would get better as my mental health improved. That’s not the case.

Therapy also can’t make up for the fact that I have two family members missing in my life. Opposite action can’t bring them back from the dead. I think that I am dealing with the losses better than I was a few months ago (I’m not incapacitated by sadness; I don’t spend most of my days lying on my bedroom floor crying; eating isn’t as much of a struggle), but they are still gone. I am still sad. The grief resurfaces every now and then.

Worries about things worsening

Another challenge is that I worry about my mental health worsening again. Now that I’ve experienced how good things can be, I feel a deeper loss when I’m temporarily feeling worse again. I know all the things I’m missing out on and feel sorry for myself.

When something goes wrong, I also worry that it’s the beginning of the end. Will I go back to being depressed and tormented by nightmares? Good things can’t last forever, right? Is this a temporary blip in my life, or a more lasting change?

If I check the facts on these fears, I can see that the gradual changes I’ve made over the past year have lasted so far. I can see that I have been doing the treatment recommended to me by multiple therapists who believed that it would improve my life, and they agree that I have made lots of progress.

Yes, more bad things are bound to happen in my life, but I do have better skills to deal with them now. I haven’t self-harmed in maybe four months? I “graduated” from DBT group, and I use the healthier coping skills that I learned there every day. I can get through things.

Same friends, new relationships?

When I became friends with the people I’m friends with now, I was struggling, and I was looking (consciously or unconsciously) for certain things in friends — sensitive, a good listener, etc. In addition, many of my friends have their own struggles with mental illness. I’ve also stayed in touch with some people I knew from group therapies.

As a result of these things, many of my interactions with my friends were centered around me venting/asking for support, or me providing emotional support to my friends. I was happy and grateful for that, and it enabled me to have deep, intimate friendships, but I’m not struggling as much anymore. What do we talk about now?? What if we can’t relate as much because we’re not in the same dark place anymore? What if my friend liked me because she felt like she was helping me, and now there’s nothing left to be helped? The dynamics have shifted.

I don’t think that any friendships will end over this, but I may end up more distant from certain people, and that makes me sad. I suppose it’s also possible for friendships to evolve as people evolve, and I hope that mine will, because I really do like my friends.

On the other hand, I am also making new friends. Now humor and playfulness are more attractive qualities to me. I want to laugh for a while with a friend more than I want to express to them how badly I’ve been feeling. There is a time and place for both, but I find myself wanting more fun now than I did before. This is another change that is scary for me at times!

My friends enabled my avoidance

Some of my friends also enabled some bad habits that I want to stop doing now. They let me and even encouraged me to avoid things. Part of my exposure therapy is not avoiding things that aren’t objectively dangerous. I don’t want to avoid things anymore, but the message hasn’t sunk in for my friends yet.

Several people know that I hate blood, decapitation, violence, and related things. When there are scenes in movies with those things, they say, “[My Name], don’t look!” They say, “I don’t think you’ll like this movie, it’s not for you.” When I ask, “What are you laughing at on your phone?” they say, “You don’t want to know, you won’t like it, it’s bad, trust me.”

I very much appreciated these warnings at times when I felt like I needed them, but now I feel like I can handle things. I know that avoidance makes my fears stronger. I don’t want to avoid! I am ready to face scary things!

It’s just frustrating that my old habits were so deeply engrained that they spread to my friends, and now I have to change my friends’ habits, too, not just my own.

Overall

Overall, I’m doing so much better now than I was a few months ago. A couple of weeks before final exams, someone asked me how I was doing, and I said “good”! She said, “haha, like the dog in the fire meme?”

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“This is fine” meme — image from https://knowyourmeme.com/photos/1401347-this-is-fine

Meaning, was I saying that things were fine when I was really super stressed out about finals? I wasn’t! I was serious that I was doing well! As I thought back on the conversation afterwards, I realized that I wasn’t just doing well, I was doing the best I had been in the past two years. That seems quite amazing to me.

I wrote this post because I think I had an idea in my head of “getting better” that was all perfect sunshine and butterflies, and I wanted to express the ways in which getting better is still hard. But the positives definitely outweigh the negatives. 🙂

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Affirmations

Affirmation #12 — I can remember AND stay in the present

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I can REMEMBER and stay in the PRESENT.


As part of the prolonged exposure therapy I’ve been doing, I do imaginal exposures, which involve talking through a traumatic memory. I tend to dissociate when talking or thinking about the trauma, so it’s sometimes hard for me to continue thinking about the memory because my mind goes blank with dissociation. However, I need to engage with the memory in order for the memory to make me less scared in the future, so I can’t just block it out. I have to balance not dissociating (by grounding myself in the present moment) and remembering the memory (which brings me a little to the past).

This affirmation is to remind me that it is possible to do this. It is possible to remember without having a flashback or dissociating. I can remember non-traumatic events and still know where I am in the present. With time and hard work in treatment, I am gradually able to do the same with traumatic memories.

Life, Therapy

Finally talking about my trauma in detail

I experienced a traumatic event four years and nine months ago. I decided to do DBT PE (Dialectical Behavior Therapy with Prolonged Exposure) to treat my PTSD eight months ago. And today, I finally talked about the trauma in detail in therapy.

I’ve been building up to this for so long. I’ve gone over the traumatic event in my head so many times in varying levels of flashback-y-ness but always fairly anxious states. This has been a part of my life for so long.

But I had never said it out loud to another human being. I had never said it in order from start to finish. (well, the finish of one part, at least)

This feels like a watershed moment. Something small but fundamental has shifted inside of me, a change that will grow more pronounced as I continue this treatment.

I am still going about my same daily activities and interacting with the same people, but I feel a little different, as if I’m experiencing everything with freer eyes. It feels a little like what getting baptized felt like, or what traveling to another continent for the first time felt like. I knew logically what to expect, but now I’m experiencing it emotionally.

Of course, it was also really hard, and this is also only the beginning. But I finally said it!!!

Positives

Major accomplishments of 2018

I have actually made a lot of progress in 2018.

Mental Health

I’ve gotten more serious about making actual progress in therapy instead of using it as more of a temporary fix to my immediate problems and worries. In the winter/spring, I made a bunch of new lists to follow in different situations. Over the summer, I started DBT, which has really helped me. I learned more about emotions. I was a little clueless before. I can now generally identify what I’m feeling — sadness, anger, shame, fear, love, etc. — and understand where that emotion came from and whether or not it fits the facts of the situation. I didn’t really know that shame was an emotion before this year, and I feel shame a lot!

I also learned what dissociation is, what it feels like for me when it’s happening, and what I can do to stop it. Another thing I didn’t know that was happening to me a lot!

I made the decision to start prolonged exposure therapy for PTSD. I’ve been doing behavioral exposures on my own to things I avoid and things that scare me for the past few months, and already I can see a significant improvement in my PTSD symptoms. There are some reminders that I can fully tolerate now, like pictures of brains, and some reminders that don’t give me as bad flashbacks, like car chase or car crash scenes in movies. I am also doing exposure stuff in therapy and plan to do more.

Relationships

I’ve developed some very close friendships. I have one friend in particular that I’m very close with. I think it may be the most intimate (emotionally intimate) relationship I’ve ever had. I tell her so much. She tells me a lot, too. I love her and am so glad we’re friends.

I’m also much closer with my parents, mainly thanks to the DBT program I did this summer and the family therapy that came with it. They now understand the nightmares, flashbacks, dissociation, and suicidal thoughts I struggle with. Although we still don’t always get along, it’s nice to not have to carry around those secrets anymore. I can also get emotional support from them sometimes, especially my mom. She has made an effort to learn how to validate my feelings, and it makes such a difference. Talking to her does actually make me feel better sometimes. It also feels like they’re on my team now. For example, my dad got me “stress relief essential oils” for Christmas, which I probably won’t use because essential oils have upset me before, but it was a sweet gesture that shows he cares and wants to help.

Because I did the program this summer, many more of my friends know that I have mental health issues and am in therapy. Everyone was asking what I was doing over the summer. I could have lied, but I chose to be vulnerable and tell them the truth. I’ve done a lot of vulnerability exposures in the past few months. They are hard but generally bring me closer to people. I recently also told my friends at college that I am in therapy. I kind of let it slip in front of a fairly large group of people at a Secret Snowflake gift exchange. This was a big deal for me because I’m not close with most of those people. But it was fine, and I feel so much better.

Adulting

I can now file an insurance claim! I can call my insurance company, I can set up my own doctor’s appointments, I can choose to take over-the-counter medicines and buy them on my own, I bought my own razor for the first time. A lot of these accomplishments have to do with me being away from home and being able to do things without my mom’s permission.

I set up some certificates of deposit, which mean I’ll be making some money, or at least not losing any to inflation. Planning for the future!

The place where I live at college has a kitchen (unlike last year), and I also had a portion of a CSA (Community Supported Agriculture) vegetable share this fall. As a result, I can now cook or prepare various vegetables for myself. I can make eggs (scrambled or in an omelette) fairly quickly. I can clean a kitchen and feel okay/confident about its cleanliness. I learned to use a gas stove (my family has an electric stove). I plan on doing more cooking next semester.

School

Well, I’m two semesters closer to getting a degree!

I declared my major, but that may change…

I think I’ve gotten better with procrastinating. I haven’t turned anything in past the deadline this semester!! 🙂 One skill that particularly helps me with this is setting a timer for 20 minutes and saying that I’ll only work on it for that amount of time. It helps me to get started on things and not be overwhelmed by all I have to do.

I’ve learned more about engineering and realized how much I like it. 🙂 Although I’m still not entirely sure about what to major in within engineering, and I sometimes think about becoming a psychologist, writer, dancer, or artist instead, I know that I really do like engineering, too. 🙂

General Health

I’ve consistently been getting 8-9 hours of sleep a night. 7 hours is now low for me. There are weeks where I get less, but for the most part, I really have been getting more sleep. This makes me feel so much better emotionally!

I lost some weight unintentionally over the summer and became more underweight than I normally am, but I’ve been seeing a nutritionist at school, and I’ve gained some of it back! More importantly, I am building better habits of eating, like eating 3 meals a day, every day, and snacks in between. I’m keeping more snacks on hand. I’m eating more calorie-dense foods first. If I skip breakfast, I’ll have two dinners instead of simply having only 2 meals that day. I think these strategies will continue to serve me well.

I haven’t had too many headaches! 🙂

Other

I started this blog!!! 🙂 Having a blog is something I’ve dreamed of doing for years. I’m so glad I finally did it and that I am still at it several months after starting. It feels like it gives me more purpose. What I didn’t expect from blogging was getting to read so many other people’s blogs, which has been really nice.

In the spring, I was baptized into a church, and I later left it. It was a very stressful, confusing experience at the time, but I think it has helped me understand what I actually believe, which makes me more confident and causes me to have fewer existential crises. People in this church group also gave me a lot of hugs. I generally avoided physical touch before then, but now I willingly accept hugs, enjoy hugs, give good hugs back, and am comfortable asking friends for a hug when I feel like I need one.

It’s hard to believe that my first time in group therapy was just last year. I’ve made some good friends through group and learned just how not-alone I am. It’s also been eye-opening to be able to talk with people about mental illnesses and similar struggles. I feel like I understand people better.

Lastly, I’ve been dancing for years, and last spring, I finally learned how to do a pirouette! 🙂 One of my goals over winter break is to be able to spin around twice in a pirouette instead of once.

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Yay! This was uplifting to write. 🙂 I’ve liked reading people’s reflections on the year. Do you have an accomplishment you’re particularly proud of?

Therapy

Exposure Therapy!

Today I made the decision to do exposure therapy for my PTSD!

Prolonged Exposure (PE) is offered as an optional part of the DBT treatment program I’m doing (so it’s DBT-PE if you want to be technical). My prior-to-DBT therapist and my DBT therapist have both been talking to me about doing exposure or processing through my trauma in some way for a while. I’ve been very hesitant to try it because it sounds so scary to expose myself to the things I fear most.

There’s a part of me that really wants to do the exposure therapy so that I can finally get over the trauma and leave it behind me. This part of me, my wise mind, knows it will be good to process it through. It knows that the symptoms are taking a toll on my life.

There’s another part of me, my emotion mind, that has an intense gut reaction of “NO!” to the idea of exposure. Exposure sounds terrifying. It sounds dangerous.

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Wise mind — a DBT concept

My wise mind argues back that a memory isn’t dangerous. I will not be put in any objectively dangerous situations as part of the exposure. And my reluctance to do the exposure is another form of avoidance, part of what exposure is trying to solve (so meta!).

Still, my emotion mind is strong. I have a lot of fear.

My DBT therapist had me do a pros and cons of continuing to avoid the trauma versus doing the exposure for it. Even after doing the pros and cons and seeing how much of my life I could get back by doing this, I wasn’t sure.

After showing my completed pros and cons chart, discussing it, and getting some more info about DBT-PE, I left therapy feeling kind of sad and hopeless. A lot of hope had been riding on this treatment program and especially the PTSD treatment (the prolonged exposure). I was really hoping this would “cure” me, if not fully, then at least a good amount. I started feeling more depressed than I had been before. I didn’t want to do anything. I saw no future for myself.

I kept thinking about it, and a few hours later, I sat down and wrote my decision below my pros and cons list.

Decision: Do exposure stuff.

Because…

  • I’m sick of this!
  • It’s been too long
  • I could feel better
  • It’s worked for other people
  • I could be more of myself
  • If I don’t, I’ll probably keep being like this, and that makes me sad.
  • I can use skills, so it won’t be THAT that bad.
  • My therapist can help me. I won’t be doing this alone.
  • Wise mind me wants to do this!
  • I am doing this because it is safe to do, and I want to feel better, not because I’m being forced into it by anyone. This is my decision.
  • Memories aren’t actually dangerous!
  • I can always decide not to do something later. I am in control of the exposures and the pace, and I can always say no.

Exposure therapy sounds like the obvious choice when I write it out like this. But I’m writing this from wise mind. It was really hard to think about this and to even consider exposure when I was in emotion mind. And I kept getting drawn into emotion mind every time I tried to think about this.

I don’t know exactly what made me switch into wise mind and finally be able to consider this rationally. Maybe the organized pros and cons list helped. Maybe all the handouts and diagrams and evidence helped make it more empirical. Maybe I needed enough time to think about it. Maybe seeing how sad I felt when I thought about deciding to not do it showed me how essential this treatment is for me right now.

This was a really hard decision, but I feel so much more hopeful now that I’ve made it.

(More info on DBT-PE: https://dbtpe.org/treatment-overview/)

What do you think of choosing to avoid something vs. expose yourself to it?