I didn’t wake up in a bad place, but it wasn’t a particularly good place either. Do you ever feel like that? I always thought that was just part of being a person—but it occurred to me some time ago that not everyone feels everything I do.
I woke up feeling… out of sorts. I had a hard time getting out of bed. Getting dressed seemed insurmountable. My thoughts were racing. My head spinning. I wanted to go to the local bakery, but the thought of driving felt really, really hard. It’s only like 7 blocks away but I would have to go up a hill and through a round-about and then across a busy street doesn’t have a stop sign so you have to just gun it and hope there isn’t a car hiding behind all the cars parked on the street.
So, I guess you could say I was feeling anxious. Everything just felt so hard—like trying to walk through waist deep mud.
I haven’t had an appetite but I know eating is an important thing to do, so I cut up an apple. Refilled my coffee. Then I sat down at the kitchen table, still covered with a table cloth and set with flowers & candles from last night’s valentine dinner. Then opened my journal.
I write today’s date and Before: 50 (more on that later).
You see, I’ve been going through outpatient treatment for PTSD and severe anxiety/depression for the last few months.
It’s hard to write that, but I guess if you’re reading this, you probably aren’t going to judge me. And even if you were going to judge me or think less of me (personally or professionally) for being open about my struggles with mental illness, you can close this window at any time.
This is my first time writing about this. I’ve talked about it on my Instagram Stories but never in detail anywhere. So here I am.
Part of my treatment involves in-session treatments with the pain psychologist I’ve been seeing to do a combination of “Prolonged Exposure treatment” and “cognitive processing”.
Prolonged Exposure (PE) is a trauma-focused cognitive behavioral psychotherapy that gradually approaches trauma-related memories, feelings and situations. This type of therapy will teach me to approach trauma-related memories, feelings, and situations that I’ve have been sweeping under my psychological rug. By dealing with the stuff I’ve kept bottled up for years and facing my fears, I can decrease my PTSD symptoms and (hopefully) regain control of my life and chronic pain.
There are a lot of steps in this treatment, so I thought it may be interesting to share because I had no idea about any of this. Hell, I didn’t even know I had PTSD until December. ¯\_(ツ)_/¯
Prolonged Exposure treatment, as directed by my psychologist, involves facing trauma head on. The only way out is through. It involves writing and talking in detail about trauma, and keeping track of my anxiety level as I work my way through.
Step one: my doctor and I agree to the treatment. He wanted me to think long and hard about whether I’m ready for it mentally and emotionally.
Step two: make a list of “self-care” routines for after therapy. More on this later.
Step three: I make a list of “traumas” that I have experienced (that part alone was hard, guys). The ones that really, really haunt me. Nightmares, flashbacks, circular thoughts about all the horrible things happening everywhere and potentially to me… and then dissociation. The whole nine yards.
The first trauma that destroyed me happened when I was 13.
Step four: journaling. But it’s not just Dear Diary, stream-of-thought journaling, it’s going back to that night in the present tense, with just facts. I set a timer for 20 minutes and start writing. From start the finish. With exactly what happened, with no language about feeling.
For example, “I’m standing against the bathroom sink with my back to the mirror.”
After several entries and nearly 30 pages like that, I start adding emotion, opinions, and thoughts. That’s the step I’m in. And it’s HARD. Part of journaling like this is not holding anything back. The result is a lot of subconscious feelings and thoughts and beliefs that we don’t usually dig up
I hesitate, but I let my hand guide my pen, “Is this my fault? Why didn’t I scream?”
My doctor made an eloquent analogy that really articulated how I’m hoping this goes for me: it’s like clearing a riverbed. At first, when you start, it’s going to be really muddy and gross. Lots of gunk everywhere. It’s going to get dirty. But after all that stuff is cleared away, the water will be even more beautiful.
Step five: one-on-one therapy with my psychologist where I speak about traumatic events in first person, present tense, as guided by my psychologist. Periodically, he asks me what my anxiety/physical response level is, which he refers to as SUDS.
Subjective Units of Distress Scale aka How Much Are You Freaking Out Right Now?
Today, I journaled for 35 minutes before I started coughing and feeling like my throat was going to close up. My chest hurt… a sharp pain right in the middle. It felt like the wind got knocked out of me. My mind started go blank. I felt like I was looking out in the world and everything felt far away. It felt like my mind is somewhere else. My arms and hands started to HURT. There’s a sharp pain shooting up my back.
I physically couldn’t write anymore.
“After: 90,” I scribble.
That numbers is called SUDS, which stands for Subjective Units of Distress Scale, a system developed by doctors as a way to measure the subjective intensity of disturbance or distress currently experienced by an individual. Basically, “How are you feeling on a scale from 1-100?”. The purpose is to identify differences in anxiety over a period of time.
I started at a 40 (already kinda anxious), and just by writing, I felt that I increased to a 90 (extremely anxious).
There is no optimal range because it’s a subjective scale, but generally staying between 30-70 is a level of adrenaline-induced arousal you can handle while still being mindful and address what’s going on around you (or inside you).
I put my pen down and sit, staring at nothing. After some amount of time that felt like forever (but is actually more like 15 minutes), my pug sees me and saunters over to my chair. He sits down next to my chair and looks up at me with his bulging pug eyes.
After any treatment, self care is extremely important.
I need to calm myself down from a 90, which causes actual physical distress. When you go beyond 70 or 80, your brain starts to become overwhelmed and you can slip into habitual ways of coping. At this point, I need to take care of myself until my feelings (and adrenaline) come down. That brings me to the next step.
When I first started treatment, my first assignment was writing a list of self-care techniques I use.
Having an easily accessible list can help when you’re feeling your worst—cuz hello, who wants to think about what makes you feel better when all you want to do is cry in a dark room?
Self-care is kind of a buzzwords in the beauty and wellness industry, but it’s a lot more than just taking a bath. Self-care helps you rest and recharge, blah blah blah.
We all have needs, but in our technology-driven life, it’s go-go-go until you can’t go anymore and your body starts shutting down because you haven’t stopped to take care of yourself. Resting and recharging is essential to being a human, but it also feels really good, and feeling good is essential to living. Stress is horrible on our bodies.
The goal of self-care isn’t just putting on a face mask and staring at your phone for 10 minutes while it dries.
Step one: put your fucking phone down.
Take 10 minutes to yourself to relax and just be. Focus on activities that make you feel really good—whether it’s a walk in the park or a bowl of ice cream.
How to take care of yourself: a self-care guide
- Take an epsom salt bath
- Apply a face mask or hair mask
- Go on a walk
- Meditate. Download the Calm app. It’s amazing.
- Snuggle with your pet
- Eat your favorite snacks
- Set up a mini photoshoot (or do something creative that you love)
- Give yourself a manicure/pedicure
- Turn on your favorite band or a song you like
- Bake cookies
- Pour yourself a glass of wine
- Make tea (chamomile is especially relaxing)
- Sit by the water
- Write or journal
- Watch a comedy. Laughing is one of the best things for you.
- Watch a nature show (I like Planet Earth)
- Shop online!
- Say nice things to yourself like, “I am awesome. I am successful. I am smart.”
- Smile. Check your posture.
Life isn’t easy, but taking care of yourself is one of the most important things you can do. Right now, I’m trying not to feel guilty as I battle this illness and get to the root of the cause instead of just addressing its symptoms.
I’m attempting to be hopeful that when I finish this treatment, I’ll feel a little better. For now, I’m going to hope that tomorrow is a little better than today was. That’s all I can really ask for, right?
Have you been through this? Do you have any tips for me? Any other self-care techniques? I’m feeling a little desperate.
Note: I am NOT a doctor and I don’t advise you do any of this without the care of a professional healthcare provider. The information in this article is strictly from my personal experiences, research and a little Google.