Substituting Behavior to Change Behavior

This is a brief note about Parsnip’s training. She has a tendency to lunge at small dogs, larger dogs, sometimes joggers and crowds of kids. I am learning a new way to manage this behavior. Instead of trying to stop the unwanted behavior, I am substituting a behavior that is acceptable for one that is not. When we see a dog on the street, we move to the opposite side of the street and engage in a ritual. I tell her to “leave it” then “come” then “sit.” I then reward her several times until the other dog has passed our field of vision.

I find that substituting this new behavior is largely helpful 75% or more of the time.

I have found out from the dog trainer that this is the preferred approach except for one mistake. I should be pausing the dog with her back toward the stimulus rather than facing it.

This reminds me of my own need to change unwanted behaviors. It is easier to introduce a substitute behavior than it is to stop an unwanted behavior “cold turkey.”

Does Having a Puppy Help Keep You in the Present? (reposted from 12/21)

A week and a day ago, we adopted a puppy whose name is Parsnip. Our old dog had cancer and we had to put him down a little under a year ago . We have had rescue dogs for twenty years so getting a puppy is a new phenomenon in our household.

True confession: I have never been that great at living in the present. I have tended to dwell in the past – would’ve, could’ve, should’ve territory. Or in the future – what on the horizon for next week should I worry about – did I get a holiday card out? What should I worry about next month – will schools go virtual again due to Omicron? What should I worry about about six to eight months from now when my daughter goes to college?

Having a puppy in the house again challenges that past/future orientation. I find myself in the present whether I am comfortable there or not. I am preoccupied with puppy pees and puppy poops and with learning to reward positive puppy behavior and ignore negative puppy behavior. I am also trying to redirect behaviors like nipping with playing with a toy. It is a constant lesson in cognitive behavioral therapy that has taken me by surprise – emphasis on behavioral – for me and the pup. Somewhat LOL and somewhat really true about CBT.

All in all puppies are a joy but a load of work. For me for now, that work keeps me focused on the present day maybe even the present hour. I am extremely exhausted by it but it does seem to keep me in the now.

To all of you who have beloved pups and other beloved pets, do you find the act of taking care of that pet helps keep you in the present? And avoid the terrible would’ve, could’ve, should’ves or that projected anxiety into and onto the future’s horizon?

This is a Brief Introduction to Our Pup Parsnip

I am writing a new blog featuring our pup Parsnip. We adopted her a little over a year ago. Here she is at six months. The idea behind the blog is that owning a pup (or other pet) helps to keep you in the moment and is good for your mental health. In addition, walking the pup multiple times a week is also good for general health and well-being.

I will be posting blogs in the upcoming weeks featuring Parsnip and how she is doing in her training. I would like her to be able to participate in a program where dogs visit patients in the hospital. Some day. But we are a far ways away from that right now. 🙂

Thanks in advance for your interest in our pup and her progress!

Thoughts and Prayers

We have lost a dear friend in the mental health blogging community in the last several months. I have stepped away from blogging for a while to reflect. This has impacted me very much and I have been struggling with the proper response to take. That said — here’s wishing you and yours good health and a heart-felt holiday season. Thank you.

Update – The first time I met this blogger online I had just started blogging and had made some comments about stigma being half or more than half of the battle with mental illness. This blogger invited me to guest blog on her post about debunking the stigma around mental health. I was very happy to be asked to do that. While I am not certain what words to use now to pay respects I would go so far as to suggest to those reading that to do some reflection or some expression of how to limit stigma among those with mental health concerns would mean a great deal. I think she would have liked that.

Sensitive to Light and Shorter or Longer Days? What about the Holidays?

I have never been diagnosed with Seasonal Affective Disorder. But from most of the people I have talked to who have a mental health diagnosis, there is some fluctuation in symptoms (maybe just minor or maybe not) that follows the seasons and/or the time of the year. At least that’s what I think is so.

For me now, the most impacting seasonal symptoms occur during the shorter days of fall and winter. We are coming up on that time. I am a person who likes the daylight. When daylight is scarce, I am more inclined to have bipolar symptoms. My therapist talks about how spring/summer months are another time to experience symptoms seasonally and that this time may be more prone to mania or hypomania or mood sensitivity.

For me in the past when I was first diagnosed with bipolar 35 years ago and getting used to taking meds on a regular basis, I routinely had mini-breaks or break-throughs around the time of the seasonal changes. Once during the fall season and once during the spring season. This pattern lasted about 5 to 6 years.

More recently in the last 15 years, I have not observed the spring/summer highs to the extreme as much as the fall/winter lows oftentimes accompanied by anxiety. This was worse for me when I was in New England for college and 8 years after that. The shorter days did a number on me. I did notice when I moved back South that I did feel better in the longer days even in winter. (As a note – I did experience heightened anxiety this summer with regard to taking my daughter to college but I consider that anxiety as situational and not so much seasonal.)

This dislike for shorter days goes along with not liking the cold much. I am much more prone to keeping with my daily walk-the-dog-for-two-miles-routine if it is not freezing cold out. The regular exercise is really great for my mental health (obviously).

It could also be that winter is more difficult for me in that that’s when the holidays occur. The extra stress of being out of routine and being immersed in family matters may play a large part in my fall/winter moods and anxiety.

Do you feel your moods or behaviors are impacted by the amount of daylight in the day? Are shorter days and longer days something you watch throughout the course of the year? Are your symptoms harder to manage during the holidays and family visits and travel? Does this all feel like a bundle of triggers and symptoms that are sometimes difficult to sort out and manage?

I Have Never Had Much Luck with Self-Talk Until Now

I have a 35 years plus history of bipolar illness and I have never had much luck with self-talk. It used to feel like I was just putting a drop in the proverbial bucket when I would tell myself that my anxiety was destructive and not needed and I could do without.

Then somehow something changed quite recently and I don’t know precisely what that was or is.

Up to a week or so ago, I have decided not to let waking thoughts of anxiety over-influence my day. I have given myself (as a goal) coffee time and coffee time alone as the time when I can feel anxious. After that hour or so, I have told myself and keep telling myself there is no more room for anxiety.

Also during this time I have begun to get a two mile walk in almost every day of the week with my husband and my puppy. The two mile walk is also helping a great deal with the anxiety.

In terms of telling myself there is no room for anxiety in my day I have also had somewhat of a revelation (for me). The more time I feel being anxious the less time I spend enjoying life and the relationships in my life. The more I let anxiety in the less room there is for building relationships and experiencing pleasure and joy in my life. There is only so much I can experience in a day. If I am experiencing anxiety, I am not experiencing love, joy, companionship, well-being or success.

That said, it is easier for me to accept self-talk when I am replacing one behavior or one thought with another. Not sure why? I have never really been able to do away with a negative thought before it occurs (or after it occurs). But I find if I can substitute a new thought for an old thought, my self-talk is that much more effective. Instead of wishing anxiety away, I am trying to replace anxiety with the thought that I am not getting any younger and my days to live in love and joy are limited. If I allow anxiety to be infinite and all-encompassing I am robbing myself of love and of life.

And I am not getting any younger. At fifty-nine I feel like I am coming to terms with my own mortality and am more able to tell myself, this (life full of anxiety) is not how you want to live out the rest of your days. This (life full of anxiety) is not the legacy you wish to leave your child or your family. Even if the change away from anxiety is small, it makes a huge difference in my life and in the lives of others. I don’t need anxiety to rob me of my good days. Not any more.

For whatever reasons, this self-talk appears to be working now and has not really worked that well in the past over the years. I think it does have something to do with confronting my own mortality and realizing the time for feeling anxious is over. It is time to feel love and joy. I also think the two-mile walk most days of the week is helping tremendously. Hoorah for high energy pups needing a walk!

How does self-talk work for you? How does regular exercise work for you? If self-talk hasn’t worked that well in the past, do you feel it might work if you try substituting the old thought or the old behavior with a new one? What might help you to start or keep at an exercise regime?

My Fight with Anxiety (Updated)

Addendum: The only other thought I have to add right now is this notion of getting out in front of my anxiety. Anticipating it in order to limit it instead of succumbing to it because it is there and it is strong. And sometimes feels stronger than me though it is not. I need to put something else in its place. Self-love and the desire for loving relationships with family and friends is a start. Activities that bring satisfaction and joy like donating goods to Goodwill or giving a friend who is a teacher extra art supplies for her classroom. I do not need anxiety to run my life. I am perfectly capable of running my life without it.

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I have bipolar disorder / mixed states which means highs and lows may simultaneously occur. For me this manifests in anxiety.

I have tried to tell my MD that I would like to go on a new med specifically for the purpose of anxiety reduction but he thinks I have been stable on clozapine – no need to bother since that track record is good.

I am thinking about going to another doctor for a second opinion but have not yet decided to do that.

Anyway, the topic for me today is anxiety and how to limit it. I wake up almost 7 days out of 7 with something I am worried about. My therapist says this is normal as when we sleep we are tapping into the collective unconscious and that that transition is difficult to manage in the waking hours.

I am going then to try something new. I am going to try to acknowledge the fact that I start my day with anxiety but that anxiety is just a thought or a manifestation of sleep tapping into the unconscious. I am going to seek to limit the time I allow for my anxiety to disrupt my day for the first hour or two of the day while I am having my morning coffee. That one to two hours of the day is all I seek to allow anxiety to infiltrate my thoughts.

I am getting older in my late fifties and my husband is in his early sixties. There is only so much time to make good memories together and to have a joyous time together. This includes an evolving relationship with joyous memories with my college freshman daughter as well.

Anxiety robs you of making good memories. It robs you from having special moments with family and friends. It gets in the way of new and renewing relationships.

I do not want anxiety to run my life. Quite aptly put I would like my life to run my anxiety.

So far, I don’t have a very sophisticated plan for accomplishing this, but at least I have my resolve and that is half the battle. So far my plan includes self-talk that anxiety may exist for me but it will not dominate me. It also includes affirmations that say I deserve good times and I deserve good memories. No illness can rob me of that. Also, critic talk is to be ignored. I do not need my internal critic saying I don’t deserve happiness since I have not been fully the wife or mother or sister or daughter I would have preferred. No more critic talk! I should be praising myself for being a strong presence in the lives of my loved ones and asking for forgiveness of self in the times I did not or could not do this.

I don’t know if this plan to limit anxiety will work. I welcome any suggestions you may have. I will also plan to update this post several times to talk about the ins and outs of this new relationship with my anxiety as it moves forward. Hopefully, as it progresses.

Can You Learn to Limit the Impact of Your Next Break?

This post was inspired by a recent post at SpeakingBipolar.com.

About 30 years ago I met a psyche doctor who told me the more often you have a break, the greater the likelihood of having a break again. This was directed at the highs and lows, and this doctor requested me to go off alcohol which I have for 30 years and caffeine (which I did for 12 years and then stopped). Knowing this propensity was a great motivator in seeking and obtaining good self care including meds and other forms of care over the years. I tend to call this managing risk. If I manage or minimize the risk of one break, in theory I am (or am I?) managing or minimizing the risk of that or a similar break occurring again in the future.

This seeking good self care and med management and risk management did not start immediately for me but did begin once I was on Clozapine in 2008. This was my bottom out low is as far as it goes time.

Using this logic if it is accurate means that in some respects if I can “learn” from a prior episode, I am more likely to be successful in staving off or managing severe bipolar symptoms the next time. One success begets more success.

So how do you get to the place where you are learning not to break from current or on-going trauma? How can managing a current break help to minimize the risk of a future break? These are steps that I take. They don’t always work 100% of the time but they do help me learn to go around an episode and/or lessen its impacts and/or avoid another one head-on that is so severe that hospitalization is required. This has been the case since 2008 — fourteen years.

I keep a journal of thoughts and self care and regular activities and feelings on a daily basis. A quick sentence or two for each day is all that is needed. I share the journal with my therapist.
I get psyche meds prescribed from a psyche doctor and stay with the regimen. (In the past I have not done this.)
If the regimen is not working I negotiate a change with the doctor.
I keep in regular contact with my therapist. I seek to be as transparent as possible. Secrets tend to create a life of their own.
I read my journal back to myself and see if I am acknowledging and managing triggers or not. This requires knowing what my triggers are like poor sleep, taking too much on in the day, talking down to myself, limiting that internal critic and so forth.
Also I give myself credit for making baby steps in my journal. Perhaps I did not walk 2 miles every day for a week but did walk 2 miles for 4 days last week. Tell myself how much progress this is. Give myself credit for baby steps instead of listening to the critic talk that I am not doing enough.
I get as much exercise as my mental health will allow. I start with small steps like a half mile walk and gradually build up to 2 miles plus. Or practice yoga with a class or on my own.
Tire out my body in order to tire out that mind.
I reach out to my support circle and let them know how I am feeling. Sometimes just acknowledging how I feel tends to diffuse the tension. It helps me to know others are aware I am having an off day.
Eat well if and when I can. Avoiding empty calories. This includes accepting body image impacts of taking meds – ie. weight gain.
Reach out to a friend I haven’t talked to in a while. Arrange a time to meet and walk or just enjoy talking with that person over the phone.
Remind myself that there are always those who are struggling as much if not more than I am. This does require being part of a community. A church community, a mental health community, an on-line mental health community, a neighborhood community? A community hit by hurricane Ida? I seek to reach out and make some sort of contribution to the communit(ies)I am a part of. It helps me to know I can be of help to others even when I am not at the top of my game.
Finally, be kind to myself. It is not my fault I have bipolar disorder. It is not my fault that certain consequences and behaviors trend to follow that diagnosis. I have to learn to forgive myself for sometimes “crazy” or ill-conceived acts. Ill-conceived acts here refers literally to acts I have taken while ill. I seek to forgive myself as readily for those acts as I seek to forgive others.

What do you think? Do you think we have any control over the propensity to have a full-fledged breakdown over time? If we cannot entirely steer clear of it can we at least learn to experience less dramatic highs or lows? Does this argument erroneously assume that the patient has the power to learn a better outcome or is the outcome already set in stone?

Irony or Contradiction – Med Impacts throughout the Day?

For many of us with mental illness, psyche meds are part of the package for movement forward from illness into remission. What I am wondering about today is why my anxiety is the worst when I first wake up for that first hour or two of the day?

The main psyche med I take is Clozapine. The other two are Clonazepam and Oxcarbazepine. I typically take an extended dose of the Clozapine at night before bed around 9:00pm or 9:30pm with a smaller dose of Clonazepam and Oxcarbazepine.

Logically I would think that the time I would feel most vulnerable is the time that is the furthest away from when I last took the Clozapine. In other words, after 24 hours I would expect the medicinal effects of the Clozapine to begin to wear off. What I would expect is that my symptoms would be worse (not better) right before bed at around 9:30pm since that is about 24 hours since my last Clozapine dose.

On the other hand what happens is that my anxiety peaks about 12 hours (not 24 hours) after I take the Clozapine. This peak is at about 9:30am the following day. On the morning after the 9:30pm dose at 9:30am or thereabouts is when I experience the most anxiety.

To complicate matters, the time before bed from 4pm to 9:30pm is usually the least anxiety ridden part of my day. How does that make sense if it is almost 24 hours (not 12hours) since my evening dose of Clozapine? Is it just the routine at that part of the day that calms me?

Overall, these time-frames don’t make sense to me. Again, I would have thought that 24 hours after my last Clozapine dosage would be my most vulnerable time? Not my most anxiety-free time? I also would have expected 12 hours since the last med dose to be a stable time? Not when my morning anxiety peaks?

Does anyone else experience a disconnect between when they take their meds and when symptoms are at their best?

Does Mental Illness Keep You from Enjoying Travel?

My first break was at the site of a small airport, so airport travel is always somewhat of a stressor as I tend to relive that trauma from time to time. (I was handcuffed and taken to the police station at this break because the authorities thought I was trying to bomb the plane….)

Regardless of or in addition to this airport-induced trauma, I still have major issues with traveling today. Here is a quick list of my mental health impacts to travel:

I don’t change time zones easily so travel abroad or to the West Coast is particularly difficult.
I have high anxiety about leaving the house and consistently think I have done something like leave the water running or the refrigerator open. I often will have to ask a friend to “check” on things at the house for me when we are traveling.
I don’t do well when it comes to changes to routines. I am very much a creature of habit. Travel changes that. When traveling I tend to have to wake up earlier than usual and eat dinner later than usual. This change is very stressful for me.
The enhanced contact with family members is enjoyable but also stressful. It is more difficult for me to be in a party of 12 to 15 than a party of 3 to 5 which is usual at my house.
My reflexes and response time are not that great, so when we drive my husband does most if not all the driving. This is very stressful for him.
During airport travel, I tend to get overly anxious with the loudspeaker announcements and lack of windows. The loudspeaker is somehow a trigger for me. Oddly, once I am in the plane I am fine. No worries mid-flight per say. My worries are in the airport itself.
Over the years my hippocampus has been damaged by too much accelerated thoughts. This makes logistics while traveling difficult. I am not always great with a map or a GPS. I can easily get confused while making travel plans and following routes on the map or GPS.
I am a checker. Even if staying with family, I tend to need to check things before leaving the house. My extended family has somewhat gotten used to this but it is still annoying.
Back to the hippocampus: things like finding parking or locating the car when parked are difficult things for me to do. I have to make a mental note or a physical note as to what level in the parking lot we are in and where the parking space is relevant to the elevators.
It takes everything I’ve got to go on a trip and not get really, really anxious. I tend to need more or much more downtime to function. People we are visiting generally do not.
Before going on a trip I need to be sure my meds will cover me for the duration of the trip. Sometimes I have to use GoodRX coupons instead of insurance since my insurance company does not issue vacation overrides.
I also tend to worry that the dog is OK while boarding. She has come back with kennel cough with one boarding.

All of this adds up to loads of stress while traveling. What if anything stresses you out while traveling? Or do you enjoy traveling locally or abroad?