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Thank you to Mark Walmsley of the Arts and Culture Network, which is really a cool and fun organization.  I’ve met some super nice people through ACN. Mark interviewed me a while back about mental health and art, etc.

I have to warn you that this interview is definitely one of my most obnoxious, if not the most obnoxious.. But it’s just me who is obnoxious, not Mark. Mark is lovely and wonderful. I am just talking way too much and most of it is idiotic babble about nothing in my life that matters in any which way.  But in my defense, I had no idea we were recording that day and it was right after TMS and I was not good yet at thinking straight or talking without confusion and rambling. So don’t hate me based on this video. There are other reasons to hate me. Get to know me and find out for yourself.

The really important point I want to make by talking out loud about my experience is that Transcranial Magnetic Stimulation (TMS) changed my life entirely. I no longer have suicidal thoughts running freely through my head at all hours of the night and day as if they run my life.  TMS really helped me. I still need medication and good old CBT, but everyone needs good old CBT IMO. And most people need medication for one thing or another. Having to take a few pills a day to keep my mind out of the graveyard is okay by me. Because for the first time ever, I honestly believe I have enough of the right weapons in my arsenal to fight my worst and honestly, my only true enemy. None of my other enemies in life come anywhere close to suicidal thoughts. When you want to die more than you want to live, and when you feel that way chronically, it’s just really impossible to enjoy life and be grateful to wake up every day.  Some days, waking up is the exact thing you are trying not to do.  Even when life is good and you are rewarded for your hard work, your good deeds and your dedication to trying anything and everything, it’s hard to live when all you want to do is die.

But now, because of TMS, those thoughts are off in the background somewhere, just hanging out, but not bothering me.  If I didn’t have something helpful to share, I would shut up. I would shut up and just paint and write all day long. And hike. And bike. And snuggle with Bella. And love the people I love. And go to work. I guess we should mention work. But seriously, there are so many things that would be much more fun than talking about my bullshit brain and how hard it has worked to ruin my life. And how successful it has been.

But for decades, I sought out anything – any book, interview, article, anything to read by anyone who lived with a bad brain. Or some chronic condition that ruled their life. I needed to hear how other people  kept going and going and I have to say thank you to their voices because they helped me to stick around long enough to discover TMS.

So listen to the fun parts of the interview where we are joking around. And listen to the part where I say you need to talk to other doctors and other families.  Seriously, you’ll have to fast forward through some grating sections where I just ramble on about my work history and Capital Hill. Ho-hum-yada-yada. But definitely listen to the part about how you need to try anything new and different. And talk to anyone new and different. Because new people in your life will suggest new and different things. And you need new and different things if you are  feeling the same, decade after decade.  Day after day. Week after week. Month after month after year after five years, ten years, decades. You need something new if it has been too long.

I hope your Sunday is wonderful. I heard that Trevor and Jason are off today. Apparently today it’s Taylor’s turn to rule the world. I have to find something good to eat for that event. My approach to the Grammy’s is to get a really good snack, turn on the channel that shows the dresses, turn off the volume and write.

Because at the end of the day, I’m a writer. But now I’m a writer who makes plans for the future. Send me links to your writing retreats! I never thought I would say that and mean it. But I do. I am planning writing retreats!

Off to walk Bella. She likes TMS too.

xoxoxo, d (and Bella)

P.S. An important point I fail to articulate well is that your doctors and family – though wonderful and there for you and all the good things – are limited in their knowledge and experience. Their view of your situation, your resources, your capabilities and your options is limited in so many ways by their love for you, their limitations, their lack of knowledge, their own conditions, and their fear of losing you. For years, even trying to change a dosage would trigger “But I thought you were doing so well.” Family wanted to support me. But family also wanted for me to be great and stay great and not do anything to mess that up.  They wanted so much for me to just be better and not scare anybody anymore or take a chance that we might get scared again.

So ask other families what they have done and ask other doctors what they would do.  Honestly, I did not start to get the help that really made the significant difference in my ability to think, speak, work and live until I spoke with other families and other doctors. I am absolutely grateful to my doctors and my family for all of their support over the years. But they could only do what they knew to do. Me too. I only knew what I knew. You reach the limit on the breadth of knowledge there is in your circle of support.  So widen your circle.  Start with your virtual circle. It’s the easiest. Start there. 🤎

 

Treating agoraphobia with CBT and ERP

 

How would CBT and ERP treat agoraphobia?
What is agoraphobia?
ChatGPT

Agoraphobia is a type of anxiety disorder characterized by an intense fear and avoidance of situations or places where escape might be difficult, embarrassing, or help might not be readily available in the event of a panic attack or other incapacitating symptoms. People with agoraphobia often experience significant anxiety about being in places or situations from which escape might be challenging or where help might be unavailable.<

Common situations that may trigger agoraphobia include:

  1. Crowded places: Such as shopping malls, public transportation, or theaters.
  2. Open spaces: Like parking lots or bridges.
  3. Enclosed spaces: Such as elevators or small rooms.
  4. Using public transportation: Like buses, trains, or airplanes.
  5. Being outside of the home alone: Without a trusted companion.

Agoraphobia often develops as a complication of panic disorder, where individuals experience recurrent and unexpected panic attacks. The fear of having a panic attack in public or in a situation where escape is difficult becomes a central feature of agoraphobia.

Key features of agoraphobia include:

  1. Avoidance Behavior: Individuals with agoraphobia often go to great lengths to avoid situations they fear may trigger anxiety or panic attacks. This can significantly limit their daily activities and impact their quality of life.
  2. Anxiety or Panic Attacks: The fear of having a panic attack is a central component of agoraphobia. Individuals may worry about the physical sensations associated with anxiety and panic, such as rapid heartbeat, shortness of breath, dizziness, or a sense of losing control.
  3. Dependency on Others: Some individuals with agoraphobia may become dependent on others for support and reassurance. They may avoid going out alone and prefer to be accompanied by a trusted person.
  4. Physical Symptoms: Anxiety and avoidance behaviors may be accompanied by various physical symptoms, including muscle tension, sweating, trembling, nausea, and a sense of impending doom.

It’s important to note that agoraphobia can vary in severity, and the impact on an individual’s life can range from mild to severe. The condition can be debilitating and significantly affect a person’s ability to engage in normal daily activities.

Treatment for agoraphobia often involves psychotherapy, such as cognitive-behavioral therapy (CBT) and exposure therapy (specifically, Exposure and Response Prevention or ERP). Medications, particularly selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines, may also be considered in some cases. Seeking professional help from a mental health provider is crucial for accurate diagnosis and effective treatment planning

Per ChatGPT

Cognitive-Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) are two therapeutic approaches commonly used in the treatment of agoraphobia. These approaches can be used separately or in combination, depending on the individual’s needs and preferences. Here’s how CBT and ERP may be applied to treat agoraphobia:

Cognitive-Behavioral Therapy (CBT):

  1. Cognitive Restructuring:
    • Goal: Identify and challenge negative thought patterns related to agoraphobia.
    • Process: The individual works with the therapist to recognize and reframe irrational or distorted thoughts that contribute to anxiety. This may involve challenging catastrophic thinking or addressing unrealistic fears.
  2. Education and Psychoeducation:
    • Goal: Provide information about agoraphobia and anxiety.
    • Process: The therapist educates the individual about the nature of agoraphobia, its triggers, and the role of anxiety. Psychoeducation helps the individual understand the connection between thoughts, emotions, and behaviors.
  3. Skills Training:
    • Goal: Develop coping skills and strategies.
    • Process: The individual learns and practices coping skills, such as relaxation techniques, mindfulness, and stress management. Problem-solving skills are also taught to address challenges related to agoraphobia.
  4. Behavioral Activation:
    • Goal: Encourage increased engagement in positive activities.
    • Process: The therapist collaborates with the individual to identify and schedule enjoyable and meaningful activities. This helps counteract avoidance behaviors and promotes a more fulfilling life.
  5. Gradual Exposure:
    • Goal: Systematically confront feared situations.
    • Process: While ERP is a distinct technique, elements of exposure may be incorporated into CBT. The individual works with the therapist to create a hierarchy of feared situations and gradually confronts them, building tolerance over time.

Exposure and Response Prevention (ERP):

  1. Systematic Desensitization:
    • Goal: Reduce anxiety through graded exposure.
    • Process: The therapist and individual collaboratively create a hierarchy of feared situations, starting with less anxiety-provoking scenarios and progressing to more challenging ones. Exposure is conducted without engaging in the usual avoidance or safety behaviors.
  2. In Vivo Exposure:
    • Goal: Expose the individual to real-life situations.
    • Process: The individual is guided to confront feared situations in the real world. This may include going to public places, using public transportation, or engaging in activities that trigger anxiety. The therapist helps the individual resist the urge to escape or engage in rituals.
  3. Response Prevention:
    • Goal: Break the cycle of avoidance and rituals.
    • Process: The therapist works with the individual to prevent the typical responses to anxiety, such as leaving a situation prematurely or seeking reassurance. This helps disrupt the connection between anxiety and avoidance.
  4. Interoceptive Exposure:
    • Goal: Address fear of internal sensations.
    • Process: In addition to external exposures, individuals may engage in exercises that intentionally induce physical sensations associated with anxiety (e.g., increased heart rate). This helps them confront and tolerate bodily sensations without avoidance.
  5. Homework Assignments:
    • Goal: Reinforce learning and practice outside of therapy.
    • Process: Individuals are often given exposure exercises to practice between sessions. This helps generalize the skills learned in therapy to real-life situations.

In the treatment of agoraphobia, CBT and ERP are often integrated to provide a comprehensive and tailored approach. While CBT addresses cognitive aspects, such as negative thinking patterns, ERP focuses on direct exposure to feared situations to reduce avoidance behaviors. The combination of these approaches helps individuals develop coping skills, change maladaptive thought patterns, and confront feared situations with increased resilience. It’s important to note that therapy is typically individualized, and the specific techniques used may vary based on the person’s unique needs and progress.

 

CBT, DBT, all the T’s

 

I asked ChatGPT How do CBT and DBT differ?

Here is what ChatGPT said:

Cognitive-Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) are both forms of psychotherapy, but they have distinct differences in their approaches, goals, and techniques. Here’s a brief overview of the main differences between CBT and DBT:

  1. Founding Principles:
    • CBT: Developed by Aaron T. Beck, CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to emotional distress. It’s goal-oriented and aims to help individuals develop more adaptive ways of thinking and behaving.
    • DBT: Developed by Marsha M. Linehan, DBT was initially designed to treat individuals with borderline personality disorder (BPD). It combines cognitive-behavioral techniques with mindfulness and acceptance strategies. DBT is particularly effective in addressing emotional dysregulation and self-destructive behaviors.
  2. Targeted Issues:
    • CBT: Widely used for a variety of mental health conditions, including anxiety disorders, depression, phobias, and more. It addresses dysfunctional thought patterns and behaviors associated with specific symptoms.
    • DBT: Initially developed for individuals with borderline personality disorder, DBT has been adapted to treat a range of conditions involving emotional dysregulation, impulsivity, and difficulties in interpersonal relationships.
  3. Mindfulness and Acceptance:
    • CBT: While CBT may incorporate mindfulness techniques, it primarily focuses on changing thoughts and behaviors. Mindfulness is not as central to CBT as it is to DBT.
    • DBT: Mindfulness is a core component of DBT. It involves cultivating awareness of the present moment without judgment. Mindfulness skills are integrated to help individuals tolerate distress and regulate emotions.
  4. Dialectics:
    • CBT: Generally does not emphasize dialectical thinking, which involves holding and integrating opposing viewpoints. CBT tends to work on identifying and changing distorted thoughts in a more straightforward manner.
    • DBT: Dialectics play a crucial role in DBT. It encourages individuals to reconcile and accept conflicting thoughts and emotions. This is particularly relevant in addressing the inherent tension between accepting oneself while striving for change.
  5. Treatment Structure:
    • CBT: Typically follows a structured, time-limited format. Sessions are focused on specific goals, and the therapist works collaboratively with the individual to identify and change negative patterns.
    • DBT: Often involves a more comprehensive and longer-term approach. In addition to individual therapy, DBT commonly includes group therapy sessions and coaching to address crises and maintain progress.

While CBT and DBT have different emphases, it’s essential to note that therapeutic approaches are often tailored to an individual’s needs. Some therapists may integrate elements of both CBT and DBT based on the client’s specific challenges and goals. It’s crucial to discuss your preferences and treatment expectations with a mental health professional to determine the most suitable approach for your unique situation.

Ketamine, TMS, Gel Polish and Pineapple

How much longer are you going to go on and on about depressing things?

It ends now.

What’s your point anyway?

Ketamine got me through the final few years just before I began TMS treatment. And honestly, I did not think I would make it through those years. But Ketamine kept me going. But that was hard.

But I do not need Ketamine anymore. I have TMS now.

I still need medication. But the combination of TMS and medication has almost completely stopped intrusive thoughts of violence and death. Almost. And almost is Heaven.

How long will it last?

It’s lasting for a period that gets longer every day.  I guess we’ll find out how long is lasts with tweaking and boosters. I am hopeful. I have never been hopeful. And it’s real.

Do you have anything more to say?

I’m not saying anything about intrusive thoughts anymore.

Well, that’s probably not true. Because if you have any questions, I will answer those.

But I’m switching subjects. I am putting TMS, CBT, CBD, ECT, OCD, MDD, GAD, MOT, ETC on the shelf.

What will you write about now?

I will write about my dog. Because Bella is funny every minute of the day.

Anything else? 

Look into Ketamine and TMS if you are in certain types of pain.

Because who knows.

🤎🤎🤎

xoxoxo, d and bella

 

P.S. My boyfriend’s in Time Magazine this month CLICK THE HEART . 🤎

If this works, I’ll die.

Ha!

No. It didn’t work. But I will figure out how to make a clickable link heart.

In the meantime. My boyfriend is HERE AT THIS HERE LINK RIGHT HERE.

There’s a paragraph that begins with “I had a certain expectation of……….

I have the EXACT OPPOSITE response as the author.

I’m wondering what you thought.

🤎

Pop Up Coffee Hang Out Thing

 

I need a Pop Up Coffee Hang Out Thing.

Not a hug, cry, or bitch-and-moan sesh, nothing like that.

Just a quick get together at a coffee shop where I can just say what’s going on and get it out.

Just a quick vent.

But it’s midday and midweek. It’s not exactly hang out and have coffee time in Washington, DC where we keep our heads down a lot of the time.

And I represent DC. well. I have deadlines upon deadlines. And projects. So many projects.

But for now, I just need to vent. So you guys are my Pop Up Coffee.

Read more

Come Back To Reality

 

CBT stands for Cognitive Behaviorial Therapy. But those three words are not very inspiring to me.

I need words that literally tell me what to do.  Because sometimes my mind is so messed up, especially IN THE MOMENT, when I MOST NEED HELP, that I need CBT to stand for something that instructs me precisely as to what my actions should be.

I need a WORKING acronym.

So the way I remember CBT is Come Back To…

I can almost always be snapped back into the present moment by Come Back To…

COME BACK TO R.E.A.L.I.T.Y.

CBTReality

OR Come Back To Reasonable Thinking – CBTReasonableThinking – or whatever works for you. Come Back To The Moment. Come Back To Now. Come Back To Your Breath. Come Back to Your Sane Place.

Come Back To whatever is closest to reality at the moment. Because, as you know, the mind goes to other places so easily. And, for some of us, the mind can go to places that are not helpful. Not helpful at all.

Read more

100 Great Comebacks.

 

When I think of a great book title, it means I’m straying from task.

And I think of great book titles all day long.

Then I type them into my daily journal. Then I debate whether to add them to my list of possible book titles or possible chapters for my book, which will never be finished if I keep adding titles and chapters.

Then I consider using the new book title on the website for ‘Current Project.’  I change my ‘Current Project’ every few days to see if any project in particular grabs anybody’s eye. When I get some readers besides my three loyals (hi, guys!), I’ll let you know how that works out.

So today’s great book title is “100 Great Comebacks.

Since I have scenes in my head when I’m on deadline, instead of working on my deadline, I play all the roles in those scenes to their hilt, to their highly dramatic ends. To their beautiful, logical, perfect comebacks.

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Just Another Manic Monday.

Like most normal people who live for the weekend, I’ve never been the biggest fan of Mondays. But tomorrow is different because I get to return to treatment.

It’s Transcranial Magnetic Stimulation (TMS) and unfortunately Covid forced me to lose a few days last week.

But I am recovered from Covid and ready to go again! Dying actually (pun intended) to get back to the best treatment I’ve ever had.

If you’re new here, I’ve written about how TMS has pretty much completely changed my life.

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Nine and a Half Lives

How many lives have you lived in this lifetime so far?

Or chapters. How many chapters does your book have so far?

Do you come in around the suggested 10 chapters for a memoir? Or are you drowning in chapters?

I’m hoping you have a high number of chapters so I can feel better about my high number of chapters.

I think one of my less-than-helpful, sometimes irrational,  core beliefs or automatic thoughts is that other people live a low number of chapters where not too many chapters would mess up a straight-ish line if mapped out.

But I’m smart. I know that’s not true. I do.

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Why does it matter?

So why do I keep talking about my diagnosis?

Because it could change someone else’s experience.

And here is how it could do that.

For decades, I had horrible intrusive thoughts of death and suicide.

But once I mentioned suicide, I was ONLY treated for depression. And treatment for depression wasn’t enough.

But finally, a doctor connected my intrusive thoughts of death and suicide with OCD. And I was able to get effective treatment,

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ABC 123 CBT

You should try Cognitive Behavioral Therapy (CBT).

Many of us have been doing it for years. Or we’ve kind of been doing it.

Maybe we’ve been inspired by CBT, but not really enforcing the changes we dream up for our would-be-better selves.

But now CBT is really OUT THERE. As it should be!  Because CBT is AMAZING.

And it’s free.  And it’s not really that hard.

But it’s also not really that easy since you have to move around that big old roadblock formerly known as yourself.

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The Best OCD Listen Ever.

 

220,334 views Jun 27, 2022

In this episode, I explain the biology and psychology of obsessive-compulsive disorder (OCD)—a prevalent and debilitating condition. I also discuss the efficacy and mechanisms behind OCD treatments—both behavioral and pharmacologic as well as holistic and combination treatments and new emerging treatments, including directed brain stimulation. I explain the neural circuitry underlying repetitive “thought-action loops” and why in OCD, the compulsive actions merely make the obsessions even stronger.

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Not everything is depression.

It never occurred to me that I might not be depressed.

I mean, really.

If all you think about is death, that equals depression, right?

Well, actually, as it turns out, no.

I think about death all the time because my OCD brain is obsessed with death.

As it happens, it’s also obsessed with some other things.

Actually, if you tell my brain that it absolutely cannot obsess about death, it will just find something else more horrible than death to obsess about.

Like torture, for instance. Or war. Or terrorism.

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