Designated Worry Time Part 2

The other part of Designated Worry Time (DWT) is to notice when you are worrying, and delay worry to your next DWT. You can think about the topics of your worry, as long as you are planning or problem-solving and not just worrying. When you are worrying, first validate, and then delay. It might look something like this: "Oh, there is worry [noticing]. I can absolutely worry about this [validate], and I've set aside time to do so. I'll worry about this at 6:15 in the evening [delay]." Or if you've had your DWT already today, you can delay it till tomorrow. You can repeat these steps as often as needed, even if just minutes apart.

DWT was initially designed for people with chronic worry (called generalized anxiety disorder). However, it can also be used if you only tend to worry at one time of day. It usually happens when going to sleep or the middle of the night. Since we often are busy during the day, we tend not to think of our worries until getting into bed when there is less mental activity. This is when the mind often wants to run rampant, but we can remind ourselves that we'll give our mind the opportunity to worry tomorrow.

Although developed specifically for worry, you can use DWT for non-worry mental activity that interferes with our quality of life. For example, if planning, problem solving, or fantasizing become overwhelming, you can set aside time to have "designated planning/problem solving/fantasizing time."

Just a note. There is a difference between worrying and ruminating. Worry is about the future; ruminating is about the past. While DWT leads to satiation/habituation, ruminating begets more ruminating. Do NOT use this strategy to ruminate about the past. It's okay to think about a past event, but then focus on the future consequences, don't replay the past even again and again. If after several days of DWT you feel much worse, there's a good chance your are ruminating.

DWT is most effective when practiced daily over a period of time (weeks, not just days). Some people who benefit from DWT can move on to using it only as needed, but when you start, try to do it daily, even if you aren't particularly worried on a given day.

Source: Alisha L Brosse, PhD LLC (www.bouldercbt.com)

Designated Worry Time

In my last blog, I wrote that I had a mole removed to see it was melanoma. I got a call from my dermatologist that it had atypical cells, but wasn't skin cancer. I was relieved and had been trying to remain calm about the whole thing as best I could. I don't know if this is due to the bipolar disorder, but whenever I get stressed, it immediately effects my sleep. I have trouble falling asleep, and then I wake up several times throughout the night. I usually wake up early and can't go back to sleep. I try my best not to get stressed, but by my nature I'm a worrier.

So, it was interesting when the moderator of our bipolar support group, Alicia Brosse, handed out a sheet about worrying. It's called Designated Worry Time (DWT), and with this process, you set aside time one or two times each day to worry. Here's how it works.

In DWT, you "worry to death" one worry before moving on to the next, rather than jumping from one worry to another. This complete immersion into your worries generally leads to habituation - the anxiety you feel is likely to peak and then decline during your DWT, and after practicing DWT for several days, anxiety may even be replaced with boredom.This helps limit worry to one part of the day so that it doesn't interrupt other times such as at night when you are trying to fall asleep.

Part 1: Designate Worry Time

1. Pick 1-2 times a day and dedicate 10 minute to worrying.
2. Set a timer for 10 minutes. During your DWT, JUST worry. Do not problem-solve, plan or try to reassure yourself.
3. Ask yourself what you are worried about. Really worry about what comes to mind. Stick with it. Ask yourself  "what about this worries me most? What's the worst that can happen?" Imagine the worst possible outcome. Before moving on to the next worry, ask yourself if there are any other concerns related to this worry. If not, you can move on to another worry. Repeat this step until the end of your DWT.
4. If you run out of things about which to worry before the timer goes off, repeat the worries you already worried to death. It's important to keep at it for the entire 10 minute period.
5. At the end of your DWT, you may want to take a few ddep breaths, paying attention to each breath, and then shift your focus to an activity in the present moment (e.g., make dinner, engage in conversation, do some work.

I'll finish the DWT steps next blog, but this can get you started if you want to give Designated Worry Time a try.

Source: Alicia L. Brosse, PhD LLC (www.bouldercbt.com)

Melanoma and Fear

Over the past 30 years, I've had dozens of funky looking moles cut off of my body. Some have been atypical, but none were melanoma. I have so many moles, that I think I have a mole factory in my body that generates the little brown buggers; sometimes new ones show up daily. So, I went to my dermatologist, Dr. Isabell Zhu, this morning for a check-up. I had a mole that looked irregular and wanted her to look at it. It's been a few months since I saw her last, and I decided that going every six months instead of every year would be better for me. She did a full body scan, and the mole I thought was weird she said was fine, but another mole had irregular borders, so she shaved it off so that it could be biopsied.

According to the American Melanoma Foundation, the  ABCD's to look for signs of melanoma are:

A for Asymmetry
One half is different than the other half.

B for Border Irregularity
The edges are notched, uneven, or blurred.

C for Color
The color is uneven. Shades of brown, tan,
and black are present.

D for Diameter
Diameter is greater than 6 millimeters

As per the American Melanoma Foundation, melanoma is the fifth most common cancer in men, and the sixth most common in women. In 2005, at current rates, one in 34 Americans has a lifetime risk of developing melanoma. More than 73% of skin cancer deaths are from melanoma.

With these kinds of statistics, I usually get very uptight when she finds a mole that she thinks is suspicious and begin to engage in catastrophic thinking. I worry that I'll  die from melanoma. Once I start thinking fearful things, the ideas accelerate and like monkeys swinging vine to vine, the scary thoughts connect to one another and lead me in a downward spiral.  Fear rips through all levels of consciousness and my gut hurts so much that I don't want to eat. The antipsychotic meds I'm on don't seem to help keep me emotionally balanced when it comes to fear.

This time though, I'm trying to stay calm about it and not grab the "dread" thread of thinking bad thoughts. Instead, I'm trying to look at this rationally. I get regular check ups, so even if I do have melanoma, hopefully it will be caught early and then it is highly treatable. When melanoma spreads to other organs, that's when it can become deadly. In my bipolar support group, I mentioned yesterday my fears around this, and two of the women in the 8 person group had had melanoma and are fine. So, melanoma isn't a death sentence, and I need to remember that whenever I start down the path of fear.

The Eyes Have It

Went to my opthamologist today, Dr. Kevin May. Haven't seen him in several years. My eyesight had been relatively stable for years, but I noticed my vision getting worse over the past six months...things in the distance were getting more blurry...it was harder to read road signs and such. So, I had to take my mom to see him anyway, and figured I'd have him take a look at my peepers and get me a new prescription. Sure enough, my eyesight did worsen.

We chatted a bit about the health of my eyes. They were a bit dry (he put plugs in for me a few years ago when my eyes were really dry, but they didn't help very much) and the left eye had just the slightest sign of a cataract. I'm only 49, but he said that after 40 years of age, cataracts begin to grow in everyone's eyes. I did not know that. He asked me if I was on any medications, and I told him I was on Depakote, Seroquel, and Zyprexa. He mentioned that Seroquel can cause cataracts, and I said that was a concern of mine. Though Seroquel doesn't cause cataracts in everyone, it's another reason to try to get off of the meds and manage bipolar disorder through natural means (supplements, yoga, breathing techniques etc). One day I'll start the journey towards being med free, but for now, I'm waiting till a slower time in my life to begin tapering Depakote.

Fear of the Future, Dwelling on the Past...Be Here Now!

I'm the kind of person who likes to think about the past or the future...a lot. I find it difficult to live in the moment when there is so much to worry about that might happen, or hope that the past doesn't repeat itself. It's like that for me with going off of my psychiatric meds. I think about the past and how horrible I felt when I tried to taper off of them last time, and then ponder the future and get anxious whenever I contemplate how I'm going to survive getting off the meds in the future. I'm convinced that even though I've done a ton of research on alternative ways to help go off meds with as little side-effects as possible, I'm sure I'll still have problems.

This isn't such an unfounded fear. There just isn't a lot of data out on the internet about how to come off antipsychotic meds without side effects. Psychiatrists and doctors are usually at a loss as well, often saying that their patients don't have problems coming off meds. I've mentioned The Road Back and True Hope's protocol in other posts, but many of the people that used their supplements still have withdrawals or protracted withdrawals. Benzo Buddies is another website geared toward helping people get off benzodiazepenes (common class of drugs such as Klonopin Xanax and Valium), but they don't sell supplements. I keep hoping that there will be a time in my life that I can just rest for months on end to deal with the withdrawals, but that's not realistic. It's never a good time to go off meds for me, so I'll just have to stay as calm as possible and start the process. I'm still not mentally ready yet, but I'll have to face the inevitable at some point.

Some people ask why I want to get off my meds if I am stable, and that's a good question. I am concerned about the long-term side effects of Depakote, Seroquel, and Zyprexa. They can cause liver problems, diabetes, vision problems, and a host of illnesses a mile long. Some people can take these meds for a long time and never have any complications, but many people do have side effects. I figure the longer I'm on the meds, the more likely a problem will manifest. But, if I practice my "what you think about, you bring about" philosophy, then I should focus on feeling well and be grateful for every day that I feel good. Right now, I feel fine, so I'll focus on that and not worry about the future or dwell on the past. At least that's my plan for now.

Sleeping like a Baby for Now

Slept well again last night without my heart racing. Yahoo. Have been listening to my Dr. Shane Sleep Easily CD as I try to relax into sleep. My gut feels better as well, so hopefully if I remain less stressed about going off of my meds, I'll be okay. But the question is, "How do I ever go off of my meds if just thinking about the process causes me to become anxious and loose sleep?"

I'll be seeing Cara Stiles, the hypnotherapist I mentioned in a previous post, in a few weeks, and I want to address this question with her. Perhaps there is a subconscious message I can hear which will help me feel calmer about stopping the Depakote. I don't know why I'm so stressed about it. I think it was the Seroquel which made me have lots of withdrawals last time, so just going off Depakote by itself should be fairly easy. At least that's my hope. The research I've done on the web about tapering off Depakote mostly says to go slowly to avoid convulsions (it's an anti seizure medication). Some people have withdrawal symptoms with Depakote, but they don't seem to be as severe as Seroquel.

I'll continue my sleep routine and supplements (taking Theanine and Seriophos as well as powdered calcium/magnesium) and enjoy the zzzz's while they last.

Sleep and Waking Up in a Panic

Just an update about how I'm doing on the higher dosage of Depakote. I went up to 1500mg ER from 500mg ER for two nights and slept better. Then I went to 1000mg ER for two nights and still slept okay. Then went back down to 500mg ER last night and slept well. I woke up when my daughter came into my room, but quickly went back to sleep, so that was good.

I don't know about anyone else, but my heart races several nights a week, right after I fall asleep, usually within 10 to 15 minutes. I often think that there is something missing from the rings on my fingers. Last night I was convinced my wedding ring was a ring that had a large round disk on it, and the disk was gone from the ring. Other nights I'm just sure a ring is gone, and I frantically feel my fingers worrying what I'll do now that I can't find my precious ring. I have several rings on my fingers in real life, but it doesn't seem to matter. I always panic that a ring is missing or it's not the right ring.

I had an intuitive healer work on this issue several years ago, and things got better for awhile. My heart stopped racing for a few months. But, now it's back and I hope that when I do some regression therapy that I might discover the root of my ring/heart racing. For this kind of wake-up doesn't help my sleep, and right now I'm focusing on self-care and trying to keep my mind and body relaxed so that a good night's sleep is easy to come by. If you have any ideas or suggestions as to my subconscious anxiety, leave or a comment or give me a ring. :)