Mindfulness programme week two

 

In session two we did three exercises

1) We did a body scan again, but this time standing up. I found this harder than sitting down, as less parts of my body were touching something, so it was harder to focus on them. Also standing up without moving for a long time is hard!

2) The second exercise was called 'Walking in the street'. We had to imagine that we were walking along and that we greeted a friend but they didn't acknowledge us. We had to note our emotions, physical sensations and  thoughts in this situation. We discussed the fact that we are all different and react differently to situations, based on our cognitive schemas (patterns of thought or behaviour that help us to understand the world). Our thoughts are a construct: they are subjective and do not necessarily reflect reality. Thoughts also have considerable affects on our body. For example, one person might imagine their friend not greeting them and physically tremble in anger, while another's heart might speed up in anxiety. One might be thinking 'How date (s)he not acknowledge me, the bastard', while the other might be thinking 'Oh no, I must have offended him/her.' Whereas in reality the friend may have been so caught up in their thoughts that they didn't even see or hear the other person.

3) Thirdly we did a breathing exercise. This is one of my favourite ways to be mindful. To help me focus on my breathing I use a technique that wasn't actually taught on my course; I learnt it on Headspace. It involves counting breaths (one to inhale, two to exhale) up to ten, and then starting again.

For our homework we had to keep a calendar of 'pleasant moments' wherein we noted our emotions, physical sensations and thoughts. We also had to continue meditating and doing the five senses exercise like the last time.

Takeaways

It is important to remember that our thoughts don't necessarily reflect reality, and also that we should pay attention to the physical sensations in our body in order to help us know how we are feeling emotionally. I would personally add that deep breathing can help to calm the body and the mind, and thus diminish these physical sensations.

Mindfulness programme week one

 

I was lucky enough to be able to do Mindfulness Based Cognitive Therapy programme following my introduction to the concept in my Therapeutic Patient Education seminars. It took place over 8 weeks starting in January but ending in October because of Covid! I outlined what Mindfulness is in my previous post on it, so instead this and following posts will focuses on the types of mindful meditation I learnt to do and what I took away from the course. 

5 senses exercise 

In this exercise we were told to close our eyes and a small object was placed in our hands. we were then told to explore the object by touching it, tapping it and listening to it, and smelling it. It was hard and gritty and left a residue on my fingers, and smelled cheesy. We were then asked to take the ultimate leap of faith and bite into it. To my surprise I discovered that it was a piece of dried banana! I'd been expecting some kind of cheesy biscuit due to the smell. We the opened our eyes to look at the remaining piece and we observed the small holes in the middle and the slight translucency of it. 

This exercise was meant to introduce us to the idea of being mindful and in the moment. We were told to try it at home and I very much enjoy doing it with a piece of chocolate from time to time; really taking the time to savor it means that I feel the need to eat less! I also enjoy doing a slightly modified version when walking on my commute- I pay attention to everything I can see, hear, feel, smell, and even taste (usually toothpaste!). This exercise can also be enjoyable to do in the shower, espcially when you change to a new scent of shower gel. 

Body scanning exercise

In this exercise we scanned up through our body from our toes to our head, trying to pay attention to how each part of ourselves felt, for example if we were carrying tension in our shoulders. I find doing this exercise slowly hard as I struggle to scan a body part for more than a few seconds, and during the course we would do this for up to 30 minutes at a time. Definitely not my favourite type of mindfulness but interesting to try nonetheless. 

Some takeaways 

It is important to take time to just be present in the here and now and listen to your body and/or pay attention to what is around you. This enables you to take a break from regretting the past or worrying about the future and just to live in the present moment.

What is mental health and why does it matter?

 

We all have mental health,  it's just that some people struggle with it more than others. So what is mental health? It 'includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.' It is just as important as physical health and can be inextricably linked with it. 

Mental illness is more common than you would think. Did you know that in the last week, 1 in 6 people experienced a common mental health problem? And that 1 in 4 people will experience a mental health problem of some kind each year in England? Mental illness is all around us, even if we can't see it.

So what is mental illness? Mental illness covers a 'broad range of problems, with different symptoms. However, [it is] generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others.' Some examples are anxiety, depression, anorexia, bipolar disorder, and schizophrenia. 

So why do some people experience mental illness and not others? There is not one definitive answer, but a range of factors contribute, whether these be biological factors, such as genes and brain chemistry, or life experiences, such as trauma and abuse. 

What are some early warning signs of mental I'll health?

*Eating or sleeping a lot or very little

*Having little to no energy, or having boundless energy despite not sleeping much

*No longer enjoying activities that you usually do or spending time with loved ones 

*Wanting to harm yourself or others

*Feeling helpless or hopeless

*Being unusually aggressive

*Feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared

*Smoking, drinking or using drugs more than usual

*Having unexplained aches and pains

*Experiencing severe mood swings that disrupt your life

*Being unable to perform daily tasks like going to work or looking after your kids

*Hearing voices or believing things that aren't true 

*Having persistent thoughts and memories that you are unable to get out of your head

If you experience a few of these symptoms combined for more than a few days you should consult your GP.

What is mental wellness? Mental wellness is the opposite of mental illness in a way, though someone who has a mental illness can also experience mental wellness (myself being a prime example, as I've been mostly mentally well for a whole year). It is not being happy all the time, as that is unnatural, but it is being able to have an appropriate emotional reaction to life events. When you are mentally well you are able to realise your full potential, cope with stressful life events, work productively, and make meaningful contributions to your community.

So how do you maintain positive mental health, or recover from mental illness? The key things are the same ones that doctors are always going on about: getting enough sleep, eating well and exercising regularly. It is also important to fulfill your need for meaningful relationships by connecting with other people and helping others. For people who are hoping to recover from mental illness, medication and talking therapy are often key, as is developing coping strategies.

The route to good mental health can be difficult and ridden with setbacks, but it's worth the effort. 

Sources:

https://www.mentalhealth.gov/basics/what-is-mental-health

https://www.mentalhealth.org.uk/statistics/mental-health-statistics-uk-and-worldwide

https://www.mind.org.uk/information-support/types-of-mental-health-problems/statistics-and-facts-about-mental-health/how-common-are-mental-health-problems/

https://www.who.int/mental_health/management/en/

Getting help

I am going to talk about getting help both in the UK and in France, as those are the two countries I've lived in.

The first person to turn to if you have (or suspect you have) bipolar is your GP / médecin generaliste. They will be able to refer you to a psychiatrist and a psychologist if necessary. You may also see psychiatric nurses for regular check-ups.

What's the difference between a psychiatrist and a psychologist?

Psychiatrists are  medical doctors who are experts in mental health. They specialise in diagnosing and treating people with mental illness. In the UK a fully trained psychiatrist will have studied for thirteen years and in France ten years. It is your psychiatrist (or sometimes your GP in the UK) who will prescribe and monitor your medication.

Psychologists are therapists who study how we think, feel and behave from a scientific viewpoint and apply this knowledge to help people understand, explain and change their behaviour. In the UK they will have studied for six years and in France five years. It should be noted that while psychologists are a type of therapist, not all therapists are psychologists; the term therapist is often used to encompass social workers, and a variety of counselors, who may not be trained social scientists like psychologists are. 

Paying for health care

In the UK there is the marvellous NHS (long may it live!) that means doctors appointments and hospital stays are paid for by the state. Unfortunately, however, Bipolar is not one of the conditions where prescriptions are covered by the NHS, so unless you are exempt for various reasons you will have to pay £9 per medication if you live in England; prescriptions in Scotland, Wales and Northern Ireland are free. If you take several different types of medication you can save money by paying £29.10 for a three month prescription payment certificate (PPC), or £104 for a twelve month PPC.

In France Bipolar is one of the conditions where social security covers 100% of medical costs, which means that whether you have a Mutuelle (helath insurance) or not, your doctor visits, medication, and hospital stays are all paid for, and you don't have to pay anything upfront (in France you usually have to pay for the doctor upfront, and you then get reimbursed by social security and your hralth insurance). Make sure that your doctor enters you in the system as having bipolar, as otherwise you won't be covered 100% (this happened to me, but luckily I have health isnurance, so they were the ones who were paying). It is worth noting that while hospital stays are 100% covered, you (or your health insurance) still have to pay for your room. This costs about €15 per day.

Financial help

In the UK you may be eligible for benefits if you have bipolar. These may include:

• Attendance Allowance.
• Carer's Allowance.
• Council Tax Benefit.
• Employment and Support Allowance (ESA)
• Housing Benefit.
• Personal Independent Payment (PIP)
• Statutory Sick Pay.

However the benefits structure in the UK is currently being reformed. The charity Disability Rights UK has a website to help you through the benefits maze.

In France the maison départementale des personnes handicapées (MDPH) can help you to obtain financial help. You may also get help from an assistant social through your Centre Médico Psychologique (CMP) if you need assistance filling in forms.

If you are have to temporarily stop work due to your bipolar you need to obtain an arrêt de travail from your doctor in order to get an indemnisation journalière (subsistence allowance). If you are assessed as being unable to work because of your bipolar (and /or other conditions) you may be eligible for a pension d'invalidité (disability benefits), or you may be eligible for Allocation aux Adultes Handicapés (AAH) (a different kind of disability benefits)  if you are unable to work or work part-time. The maximum amount allocated for the latter is €900 per month, and that includes your earnings.

There is a lot of help available in both the UK and France. If you're not sure then some good resources are:

UK:
www.bipolaruk.org
www.mind.org.uk

France:
www.argos2001.fr
www.unafam.org

As mentioned before, if you are feeling suicidal, please call the Samaritans on 116 123 from the UK, or SOS Amitié on 01 42 96 26 26 from France.

References:
https://www.yourhealthinmind.org/psychiatry-explained/whats-a-psychiatrist
https://cpa.ca/public/whatisapsychologist/
https://www.bipolaruk.org/faqs/am-i-eligible-for-benefits
https://www.nhs.uk/conditions/bipolar-disorder/living-with/

Mindfulness

Mindfullness is a type of meditation that involves deliberately directing your attention in the present moment without value judgments. It helps you to focus on the way things are, not the way you want them them to be, or are worried they might become. Mindfullness allows us to anchor ourselves in the present; there is neither past nor future while meditating.

Studies have proven the effectiveness of mindfulness in reducing mental illnesses such as depression, generalised anxiety and bulimia, but also in reducing stress, reinforcing the immune system, lowering blood pressure, reducing pain, and helping  to improve psoriasis!

MRIs show that meditation modifies brain functioning in a positive way. Neuroscience tells us that we all have the potential to be happy if we use our prefrontal brain and mindfull meditation is one way of passing from automatic mode to prefrontal thinking mode. It physically modifies the brain both momentarily and in the long term thanks to neuronal plastisity.  According to a study by Richard Davidson, people who practice mindfullness on a daily basis activate the left prefrontal cortex , which is associated with positive emotions, more than the right prefrontal cortex.

It is important to note that certain types of meditation can provoke mania, so it is best to consult your psychiatrist. It is always best to learn to meditate with a teacher, and if you have bipolar ideally you should go on a course aimed at people with bipolar disorder. 

So how does one meditate in a mindful way? Get into a natural position- for westerners this is sitting in a chair or lying on your back - but whatever the position make sure your back is straight, as this is better both for your breathing and psychologically. You can choose to focus on one of three things: your body, your breathing, or your senses. Additionally you can choose to focus on observing your thoughts without getting carried away by them - like observing clouds going across the sky. You will need to practice, (five minutes a day is better than one hour a week) but with time you will reach a state where you are neither awake nor asleep. In fact you may find yourself actually falling asleep! Better sleep is just one of the many pros of mindfulness.

Later this month I am going to start an eight week mindfullness program, so I'll let you know how it goes!

Managing your emotions

Events in our environment lead to thoughts, which lead to emotions, which lead to behaviour.

The problem with emotions is that they aren't willed into being, they're reflexes. Therefore we can't reproach ourselves for having negative emotions, as they are a normal reaction, and in fact are there to protect us. We should pay attention to what our emotions are telling us. If you're unable to understand what emotion you're feeling you can listen to your body. If your muscles are tense you're probably worried, if you're blushing you're probably embarrassed, if your heart is beating fast and your stomach is in knots you're probably angry or scared, and so on.

Our emotions come from our thoughts, so in order to reduce the intensity of our  (negative) emotions we need to change the way we think. We need to avoid cognitive distortion, which is an exaggerated or irrational thought pattern. We can do this by taking a step back and asking ourselves the following questions:

• What else could I think in this situation?
• What would someone else think if they were in my shoes? (Friend/family member)
• If you were an outside observer of this situation what would you think?

Try not to think in terms of 'always' or 'never', although this is easier said than done when depressed.

One good way of tracking your emotions is through using a mood diary. I personally use the app 'daylio' which lets me use emojis to record how I'm feeling each day and what activities I've done, which allows me to go back and see mood trends and to remember better times when I'm depressed. For example I can look back and see that I'm usually happy on days when I go on a walk and use my exercise bike.

Sometimes it feels like emotions manage us rather than the other way around- think 'Inside Out' (or 'Vice-versa' in French)- but it is possible to mitigate them. One such strategy is Mindfulness, and this will be the topic of my next post.

Sex and pregnancy

As this is quite an intimate topic, I'm not going to talk about my own personal experience, but instead globalities.

Sex

Libido in people with bipolar disorder fluctuates , as it does in the general population, but in a more extreme way. When depressed people with bipolar have an extremely low libido, and when manic an extremely high one.

It is wise to always keep a condom on you, which should have a CE logo on it, to show that it abides by EU regulations. Regularly check the date of condoms, as old ones which have passed their expiration date may split. If a condom does split, and you believe that you have been exposed to HIV, you should go to A&E within 48 hours, but ideally within four hours, as an urgent treatment can be given which reduces the risk of contamination.

Contraception

Avoid contraception that has to be taken regularly like the pill, as it is very easy to forget to take it when manic. There are 13 types of contraception so you should be able to find one that fits your needs, but remember that only condoms protect against STDs.

A link has been found between hormonal contraception and both depression and low libido, so it may be preferable to use a non-hormonal contraception like the copper coil. However it's worth bearing in mind that this form of contracet may cause long periods, heavy bleeding, and increased cramping.

 

Pregnancy

When deciding to start a family a person with bipolar needs to plan ahead, as certain medications are not compatible with pregnancy and you may need to be weaned off and gradually put on new medication  over the course of six to eight months. In the case of an accidental pregnancy, you should talk to your psychiatrist or GP as soon as possible.

Be wary of doctors saying that you should completely come off all medications, as while there is always a small risk of complications, there are medications which are safe for pregnancy, and being unmedicated can be dangerous for the mother, which in turn is dangerous for the baby, particularly if the mother then has a relapse and has to take stronger medication. If you want to find out if your medication is safe for pregnancy and breastfeeding you can look at the French searchable website CRAT, or for anglophones, these websites may be useful
https://www.aboutkidshealth.ca/Article?contentid=341&language=English

https://www.healthline.com/health/pregnancy/teratogens

Bear in mind that being unmedicated in pregnancy may also increase the chances of post natal depression, or indeed post natal psychosis, which can be dangerous for both you and your baby. You may be told that you can't breastfeed if you take certain medications, so it's worth discussing alternatives with your doctor, but you should also bear in mind that bottle feeding may allow for more sleep if you have a partner who can help with night feedings, and as we know a lack of sleep can provoke relapses.