My Depression Management Plan

January 16, 2015

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By Terence T. Gorski
Author

Read Terry Gorski’s Book: Depression and Relapse

Major depression is a serious problem for many people, including people in recovery from alcoholism and other chemical addictions. Many people suffer from depression in recovery and I was no exception. After more than twenty-five years of sobriety, depression nearly took me down.

I figured out a way to manage it. Part of the process of figuring out what to involved researching depression and writing a book about what I learned from the process. The book Depression and Relapse.

I wrote this blog today because I have friend suffering from depression in recovery. I wrote a summary of the things I did to help myself get through the dark times. I thought it might be helpful to others.

Let me know what you think. If you have survived serious depression and used some tools or techniques that helped but aren’t listed here, add them in a comment and be sure to identify yourself and a link to your blog or website so I can properly reference the source. It might help send some traffic your way. So, let’s get on with it.

To manage my severe depression I had to self-monitor it’s severity four times per day (breakfast, lunch, dinner, and before bed).
I used a ten point scale:

0 = No Depression/Normal Mood;

1 – 3 = Mild Depression: It is a nuisance, but I can put it out of my mind and do all of my acts of daily living.

4 -7 = Moderate Depression: It is a nuisance but at times is so severe and drains so much energy that at times I can’t stay focused on my normal daily tasks. At other times I can.

7 -9 = Severe Depression: I get yo and try to function but I usually can’t complete my daily acts of living so I shrink my world by avoiding things.

10 = Disabling: The depression is so bad that I can barely function at all. I can’t get out of bed, I can’t do basic tasks, and no matter what anyone says or does I feel buried by the depression.

I kept a log four times per day and started looking for pattens. I noticed my depression would move through my life in up-and-down cycles. There were times of the day when I was more depressed no matter what was going on. There were other times of the day when the depression wasn’t as bad. I began to see that there were predictable cycles to the severity of my depression symptoms.

I noticed that the depression started to increase and get worse at certain times of the day. Knowing this allowed me to anticipate when I would be the most depressed and avoid scheduling important things during those times. I also learned the times when I tended to be the least depressed and most functional. This allowed to plan my most important activities during those time.

I also noticed weekly cycles. On certain days of the week I would be more depressed than on others. In other words, I could anticipate the really bad days and the better days.

I began doing things to try and manage the depression symptoms. I kept it simple:

– I scheduled alone time for 15 – 30 minutes a day and just distracted myself with pleasant mindless things.

– I took a twenty minute walk each day.

– I started to do brief (3 – 5 minute) sessions of mindfulness meditation.

Here is how I did it: https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-https://terrygorski.com/2013/12/30/mindfulness-made-simple/

I also used a meditation technique called Magic Triangle Relaxation Methof. It is described here: https://terrygorski.com/2014/05/08/magic-triangle-relaxation-method/

It wasn’t easy to manage the depression and most people didn’t understand what I was going through. They would ask me: “Why don’t you just snap out of it?” The answer was easy: “I can’t because I have a depressive illness!”

Many of the people I knew were really angry because I wasn’t able to work as hard or be there for them in the ways I was before I got depressed.

One of the things that kept me going was the research that showed how serious episodes of clinical depression tend to run a course of about nine to eighteen months. Each major depressive episode tends to go through three stages:

Stage 1: Gradual increase in the frequency and severity of depression symptom episodes.

Stage 2: The period of most frequent and intense symptoms. This is the stage where most people seek help because the depression is causing life problems. It’s much better to recognize depression in stage one and make managing the emerging symptoms as a top priority. When I did this I found stage 2 would to be shorter and the depression symptoms less severe and disabling. Yes, I had more than one ride on this roller coaster to dark side of depression. I learned from each ride and used it to make the next ride shorter and more manageable.

Stage 3: A period of gradual Symptom reduction until a normal mood (whatever that is) returns.

What I found is that I had always suffered from a chronic low-grade form of depression called Dysthymia. I also discovered depression ran in my family so I considered low grade depression to be normal.

I also paid attention to my automatic thoughts that made my depression worse. I figured out how to actively challenge my automatic depressive thinking. Both my personal experiences and the research I reviewed on the cognitive therapy of depression were the same:

1. There are automatic thoughts that made my depression worse.

2. When I let these depressive thoughts bounce around in my brain my depression kept getting worse.

The depressive thoughts that make depression worse are:

1. This is awful (Awful means worse than it could ever be).

2. This is terrible (terrible means that there will be serious losses of everything that I value).

3. It’s always been this way, I’ve never had a single moment in my life when I wasn’t depressed.

4. It will always be this way. I won’t ever be able to feel better.

5. I can’t stand the way I feel! (Although it is obvious I could stand it because what else could I do?)

6. I can’t do anything about it. There is nothing I can do to make the symptoms even in a little bit better.

7. I am helpless and hopeless in the face of my depression.

8. There is nothing I can do! I can’t do anything to manage the depression or make myself feel even a little bit better for a few minutes.

9. Being depressed proves that I am no good as a person.

10. My depression has robbed me of everything I value and has made me a helpless, useless, crazy person.

Before I figured all of this out, I became suicidal. I felt the compulsion to end myself. The impulse to commit suicide was so strong and persistent it was difficult to resist.

I had to tell close friends about it. I put all potential suicide tools in the hands of friends with clear instructions not to let me have them back. This included my guns, and anything in the medicine cabinet that could be lethal. There are many over-the-counter medications that can kill you with as few as thirty pills. 

How did I know this? The Internet is a wonderful tool for the suicidal. I put the prescription medications I was taking in the hands of someone else who would give me the daily doses of prescribed medication.

Recognizing and managing my suicidal preoccupations and compulsions is a story for another time.

I also used prayer and meditation. This helped me to transcend or rise above the worst symptoms of depression and to find a meaning in my suffering.

It is important to remember that THIS TO SHALL PASS. Depression is not forever and there are things you can do to reduce the severity and duration of depressive episodes.

Read Terry Gorski’s Book: Depression and Relapse

The exercises in the COGNITIVE RESTRUCTURING FOR ADDICTION WORKBOOK can be easily applied to depression.

The principles of 12-Step Programs can also be helpful. See Understanding the Twelve Steps.


Depression and Suicide – Understanding The Relationship

August 19, 2014

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By Terence T. Gorski, Author
Author of the book DEPRESSION AND RELAPSE

People don’t die from suicide. They die from the untreated fatal symptoms of the illness of depression. The core symptoms of depression are related with the brain chemistry balance which creates hopelessness, despair, and suicidal ideation. In other words, death by suicide is most often the fatal last symptom of chronic depression.

So people don’t die from suicide. Suicide is the immediate cause of death, but the illness of depression is what creates the urge to die. Let’s compare this way of thinking to other terminal illnesses.

When people die from cancer, their cause of death can be various horrible things such things as seizure, stroke, or pneumonia. When someone dies after battling cancer, and people ask “How did they die?” you never hear anyone say “pulmonary embolism”, the answer is always “cancer”. A Pulmonary Embolism can be the final cause of death with some cancers, but when a friend of mine died from cancer, he died from cancer. That was it. And when someone has suicide as the immediate cause of death they die from “Depression”. Depression often coexists with alcoholism and other drug addictions. They die from coexisting disorders with depression as the cause of the terminal symptom of depression.

Suicide is not a choice. People don’t make the decision to kill themselves if they are mentally and physically healthy. The word “suicide” gives many people the impression that “it was his or her own decision,” or “he or she chose to die.” Thus is very different from the way that we think about people who die from cancer, chronic heart disease, or AIDES. We see people with these illnesses as fighting to live and being overcome be the terminal symptoms of a progressive illness.

Depressed people fight for their lives against the disease of depression and die from the progressive symptoms of hopelessness and despair.

The real problem is that depression is a misunderstood condition. People somehow assume people suffering from depression choose to be depressed, choose to be hopeless, choose the chronic unbearable pain of depressive illness and ultimately choose to commit suicide when they believed they had other choices. The stigma associated with both depression and it’s terminal stage symptom of suicide is extreme. It causes people to hide their illness due to the feeling of guilt (I must be doing something wrong that causes my depression) and shame (my depression results from being a worthless person somehow inherently dysfunctional). When the illness is hidden and people feel ashamed of having it they are less likely to seek proper diagnosis and treatment.

Many people have little sympathy for people who are depressed and suicidal. Those who commit suicide are generally blamed for the pain their suicide caused to others rather than being empathized with for the pain they suffered that led to despair. In our current cultural misunderstanding of depression we should be able to pull ourselves out of depression by pulling up on our own shoelaces.

Let’s see if we can get a new and more helpful perspective of suicide as the fatal symptom of a long-term battle with the chronic disease of depression.

Depression is an illness, not a choice of lifestyle. It’s not the same as feeling sad, being down, getting discouraged or having a bad day. Depressed people can’t just “cheer up” and get over their depression by somehow choosing to feel better. Just as we can’t choose not to have cancer or use will power to get rid our tumors, we can’t just choose not to be depressed and use will power to get rid of the pain Nd hopelessness. When someone commits suicide as a result of Depression, they die from Depression – an illness that kills millions each year. Depressed people do not voluntarily become depressed nor do they voluntarily stay depressed. Most people suffering from depression fight back against their depression every day. The shame of being depressed, however, stops people from admitting they have an illness and researching all possible treatment options.

There are lifestyles that promote health and well bring and minimize the risk of developing chronic life-style related illness. These healthy lifestyles can delay the onset of depression and prepare a person with skills for managing the symptoms before the depression becomes debilitating. Depression, however, follows the same patterns of prevention as other illnesses. Healthy living and avoiding risk factors can delay the onset of symptoms. Knowing the early symptoms can result in early identification and being open to seeking a combination of biological, psychological, social and spiritual approaches to managing symptom episodes. Relapse prevention and early intervention strategies can lead to shorter episodes of less severe symptoms and radically extend the length and quality of life. The inherent level genetic predisposition, limited lifestyle options, and lack of access to effective diagnosis, treatment, and community support for recovery will make a big difference in the course of the illness and how well it is managed.

It is hard to know exactly how many people actually die from depression each year because the statistics only seem to show how many people die from “suicide” each year and because of the stigma of death by suicide the cause of death is often misrepresented. Another problem that confuses the issue is that not everyone who commits suicide suffers from depression.

But considering that one person commits suicide every 14 minutes in the US alone, we clearly need to do more to battle this illness, and the stigmas that continue to surround it.

Perhaps depression might lose some its “it was his own fault” stigma, if we start focussing on the illness, rather than the symptom. People don’t die from suicide. They die from Depression. Death by suicide is not usually a choice, although some people do consciously and rationally choose to end their lives. This issue involves people with debilitating terminal or disabling illnesses and involves the moral and political issue of “the right to die.” This is a different issue than suicide as an involuntary result of severe depression. The depression removes the choice by creating biochemical brain balances that create chronic pain, hopelessness and despair.

There is hope. There are disease management strategies that help people to manage the CHRONICALLY RELAPSING DISEASE of depression. The key is a healthy lifestyle that prevents or delays or the onset of symptoms, recognizing the symptoms early and knowing treatment options and resources.

The book DEPRESSION AND RELAPSE discusses the management of depression especially when the depression coexists with addiction.


Adolescent Relapse Prevention

June 13, 2014

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By Terence T. Gorski, Author of
The Adolescent Relapse Prevention Workbook

This article describes the differences between adolescent and adult substance abusers that can lead to relapse and presents practical suggestions for matching the unique needs of adolescent substance abusers to relapse prevention strategies in order to decrease the rate of relapse.

Adolescent chemically dependent patients relapse at a much higher rate than adults. Studies[1] indicate that approximately 42% of adolescents who complete inpatient treatment for chemical dependence maintain total abstinence from alcohol or other drugs during the year following treatment. This is much lower than the 66% abstinence rate reported for adult inpatient programs with similar treatment philosophy and geographic locations.

Seventy-eight per cent of adolescents who relapse (45% of all adolescents treated) do so during the first six months of recovery. The good news is that 77% of those who made it through the first six months of recovery without relapsing maintained their abstinence for the entire year. Of the patients who relapsed during the first six months, 28% were abstinent for the second six months. Of those adolescents who relapse (58% of all adolescents treated), approximately 40% (23% of all adolescents treated) have short-term and low consequence relapses and rapidly return to sobriety. The other 60% (34% of the population) have long-term, high consequence relapses.

Reasons For Adolescent Relapse

There are significant differences between adult and adolescent chemical addictions and the failure to recognize these differences can be an important contributor to adolescent relapse.[2] Most chemically dependent adolescents have three coexisting problems that increase relapse risk:

(1) Chemical Addictions (Adolescent Substance use Disorders)

(2) Normal Problems With Adolescent Development, and

(3) Adolescent Mental Disorders.

Adolescent Substance Disorders

Many chemically dependent adolescents relapse because they fail to recognize that they are chemically dependent and need to abstain from alcohol and drugs. This is especially true for adolescents who are in the early stages of their addiction or lack a long history of alcohol and drug related problems.

Forcing early stage adolescents into harshly confrontational inpatient programs against their will can create high relapse rates after discharge. Many of these adolescents go into compliance and passively resist treatment and, although on the surface many appear to be model patients, after discharge they rapidly return to alcohol and drug use because they have failed to recognize and accept their addiction.

Recovery rates can be improved by using outpatient motivational counseling techniques and substituting intensive outpatient treatment for inpatient treatment.

Some adolescent programs focus exclusively upon the chemical addiction while minimizing or ignoring problems with normal adolescent development or adolescent disorders which can lead to relapse. Many adolescent programs, for example, set behavioral standards that would be appropriate for adults but are inappropriate for adolescents in certain stages of development.

Since the onset of chemical addiction causes many adolescents to stop normal emotional development, treatment centers can overcome this problem by assessing the stage of adolescent development and setting appropriate behavioral expectations and treatment goals.

Normal Problems With Adolescent Development

It can be easy to forget that adolescent substance abusers are children who are not capable of functioning up many adult standards. Normal adolescence is a difficult period of adjustment. Hormones go on-line and start to rage. Social relationships become more complicated. Pressure from peers to conform and pressure from parents and teachers to excel can weigh heavily on many if not most teenagers.

Effective adolescent treatment programs take the stage of adolescent development into account and design treatment plans that are appropriate to the adolescent’s current developmental level. Failure to do so can significantly increase the risk of relapse.

Adding educational approaches to the recovery and relapse prevention process can go a long way to preventing relapse for adolescents in the school environment. [4]

Coexisting Psychosocial Problems

Typical chemically dependent adolescents have three major life problems in addition to their chemical addiction to contend with when they enter treatment.[3] The most common problems include school problems (58%), dysfunctional relationships with one or both parents (38%), parental substance abuse (35%), physical abuse (30%), sexual abuse (37% of females and 5% of males), depression (29%), and suicide attempts (16%). If left untreated, these other problems can create ongoing pain and dysfunction which lead to relapse.

While treating these other problems, however, it is important to keep an addiction focus. To treat these other problems without helping the adolescent to recognize the role that their alcohol and drug dependence has in creating and maintaining these problems can also contribute to relapse.

An effective relapse prevention approach is to provide balanced treatment for adolescents that focuses upon diagnosing and treating their chemical addiction, the normal tasks of adolescent development that they need to cope with in sobriety, and other major life problems that can jeopardize sobriety.

Selecting The Appropriate Treatment Setting

It is important that adolescents be matched to an appropriate treatment setting. There is the mistaken belief that the preferred treatment setting for all adolescents is a long-term inpatient treatment environment.

Many adolescents, especially those in the earlier stage of addiction with less severe coexisting problems and supportive families, do better in outpatient environments where they can maintain their academic and family lives than in long-term inpatient programs that disrupt the normal course of their lives. For adolescents with late stage chemical addiction with numerous severe, coexisting problems and little or no family support, inpatient treatment may be necessary.

The Role Of Outpatient Treatment In Relapse Prevention

Ongoing outpatient treatment is vitally important in preventing adolescent relapse. The majority of adolescents relapse in the first six months with the second highest risk period being the second six months. Adolescents who are not involved in outpatient treatment that includes family involvement for at least one year following discharge from inpatient are at high risk of relapse.

Failure To Teach Warning Sign Identification & Management

The final factor that contributes to an increased relapse rate among adolescents is the failure of many treatment centers to teach the adolescent patients and their families how to identify and manage relapse warning signs.

Relapse is a process that begins long before adolescents begin drinking and drugging again. There are progressive and predictable warning signs that indicate that the adolescent is getting into trouble with his or her recovery.

The typical sequence of warning signs normally begins when a situational problem triggers the adolescent to react with old addictive ways of thinking. The addictive thinking creates painful and unmanageable feelings. In order to cope with these feelings, the adolescents begin reverting to alcohol and drug seeking behaviors which put them back in contact with other adolescents who are drinking or drugging. Once in this environment, return to use is inevitable.

Teaching adolescents and their families to recognize and intervene upon the early warning signs can prevent unnecessary relapse. Helping the adolescent, the family members, and other concerned persons to intervene as soon as addictive use begins can help assure that adolescents will experience short-term and low consequence relapses.

References

[1] Harrison, P.A. and Hoffmann, N. G. (1989), CATOR Report: Adolescent Treatment Completers One Year Later, Ramsey Clinic, St. Paul, MN, pp. 47-48.

[2] Bell, Tammy, Preventing Adolescent Relapse – A Guide For Parents, Teachers And Counselors, Herald House/Independence Press, Independence, Missouri, 1990

Treatment Completers One Year Later, Ramsey Clinic, St. Paul, Minnesota, p. 40.

[3] Harrison, P.A. and Hoffmann, N. G. (1989), CATOR Report: Adolescent

[4] Adding Education to the Relapse Prevention Model: http://www.addictionpro.com/article/adding-education-model 

The Adolescent Relapse Prevention Workbook

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982. CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.

Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster’s College in St. Louis, Missouri. He is a Senior Certified Addiction Counselor In Illinois. He is a prolific author who has published numerous books, pamphlets and articles. Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant. He has presented lectures and conducted workshops in the U.S., Canada, and Europe.

The Adolescent Relapse Prevention Workbook


Managing Grief and Loss In Recovery

June 13, 2014

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By Terence T. Gorski, Author

If you lose someone you love and you don’t miss them there is something seriously wrong. Grief from the loss of a loved one is a normal part of life. People recovering from addiction need to learn how to cope with the loss Ina sober and responsible way. Mismanaging grief and loss lead to depression and activate the relapse process. (see Depression and Relapse).

I find the loss of a loved one is a strange thing. The better the relationship we had with someone we lose, the more it hurts to lose them. The pain never goes away because there remains a hole in our soul — an emptiness that cannot be filled by anyone else.

Anniversaries of a loss are tough. At best they are bitter-sweet. I find, however, that dealing with loss is a skill that can be learned — must be learned — if we want to mature as a human beings.

The stages of mourning and grief are universal and are experienced by people from all walks of life. Learning about the steps and stages of managing grief and loss can help us accept the process as normal and natural and develop skills for managing the different steps of the process. It still hurts, but the pain is more easily managed when we know we are not crazy for experiences.

Each of us must find our own way to cope with grief and loss. Their is no right or wrong way to do it and no universal time-frame for resolving it.

There is, however, a model that helps many people understand and accept the process. A five stage model of normal grief was first proposed by Elisabeth Kübler-Ross in her 1969 book “On Death and Dying.” I’m reality, however, the process is not as orderly or predictable as the five stages of grief make it seem.

I summarize the stages of grief with the acronym DABDA:

D = Denial. This can’t be happening!

A = Anger, usually at life and/or at God. “They can’t take you! You can’t leave me. You have no right to do this to me! What kind of a god would let this happen?”

B = Bargaining. I’ll do anything, pay any price, negotiate any deal to avoid losing this person.

D = Depression. There is a deep sense if traumatic loss that is biopsychosocial. Biologically there are brain chemistry crashes. Psychologically we feel empty and incomplete. Socially there is a big hole in the fabric of our lives.

A = Acceptance. We adapt to the loss, but acceptance does not mean we go back to feeling the way we did before the loss. The loss changes us and we learn to adapt to a new normal as we rebuild our lives.

The stages of grief model suggests people move through grief and get done with the process. In my experience that is not the case. Most people bounce from stage to stage and cues or triggers such as anniversaries and holidays can snap us back into the grief process.

I find that loss is easier to handle if I focus on the good memories and good things and consciously connect with gratitude for having those times with that special person. The only alternative is to stay in anger and forget the gifts this person gave us. This can leave us bitter.

In sobriety we learn to cope with the bitter taste of the loss while savoring the good things that we gained. And we must learn to do it in a sober and responsible way. That means feeling what we feel and developing deeper relationships with other people to help us through the process.

Using alcohol or other drugs to cope with the loss makes things more difficult and painful. It leads to a loss of control of our addiction and hitting a new bottom. When we get back in recovery the unresolved grief is waiting for us. It can complicate our new efforts at recovery and contribute to unnecessary relapse.

The good news is that we can learn to deal with grief and loss in a sober and responsible way. Cognitive Restructuring can help us when the skills are specifically applied to the process of managing grief and loss.

GORSKI BOOKS: www.relapse.org


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