Recovery is hard. Recovery is never smooth. Recovery takes effort.
Recovery is filled with pitfalls and roadblocks and deviations. It’s filled with pauses and u-turns and regressions. It’s filled with uncertainties and doubts, lots of doubts.
Recovery is also filled with days of streaming light, when everything has a glow. It’s filled with hope and affirmations and unexpected gifts of joy. It’s filled with reminders of being alive.
Almost immediately after the events of September 2, 2014, I recognized that I wasn’t able to recover on my own. There was the obvious – I needed a place to stay. But there was also the less obvious – I didn’t possess the tools I needed to effect a recovery. So I reached out to my parents to solve the obvious need, and to the Canadian Mental Health Association (Durham) to help me solve the less obvious.
Very early on in my association with the CMHA, we developed a Crisis Plan, a graduated step-by-step protocol that I would use to minimize periods of distress. To reinforce the importance of the Crisis Plan, I wrote the steps in each of my notebooks. Quite simply, I wanted to make sure I was never again in the circumstances that existed on September 2.
Until very recently, I assumed that the creation of a Crisis Plan was a common practice so I’ve never mentioned it in my writing. However, messages on Twitter and via email have caused me to realize that many do not have such a plan and, as a result, they are at risk of falling into the old habits that have already failed them.
In this post, I will explore the Crisis Plan that the CMHA and I developed together. While it’s specific to my needs, I believe that there’s enough generality for anyone to modify it to suit their own needs.
My Crisis Plan begins with a statement of purpose: What to do when I am feeling distressed, depressed, anxious or overwhelmed.
The statement of purpose is deliberately phrased to remove doubt from the equation. The statement tells me that I have a say in how I respond to x,y or z. It says: if you feel x, y or z, do the following things to reduce/remove/end x, y or z. It imparts an element of control into what often seems to be beyond my control, my mental health.
The Crisis Plan then directs me to take progressive action divided into six primary steps.
The first step is to relax. I acknowledge that this isn’t always easy (that’s why there are other steps!) but it’s a necessary beginning. It reminds me that whatever the distress is, I have the tools to deal with it. So I can take a moment, or as many moments as I need, to just gather myself.
Step two is to breathe. It acts in concert with step one. While I gather myself, I take a few deep breaths. There are times when taking these two steps is enough. By pausing, taking a breath or two, gathering myself, what at first seemed imposing, often diminishes to something eminently more manageable.
On other occasions, I move on to step three, which tells me to apply my coping skills/activities. Again, the step is phrased to remove doubt. It’s a reminder that I have acquired new skills for a reason, so now is the time to put them to use (although I try to use them all the time).
Step three has sub-steps only in the sense that I have multiple tools to try. Of these, there is one which is always applied first, namely, to review my lists of successes. Major Depressive Disorder likes to lie about your achievements so I keep lists of my successes, no matter how small they may seem. On some days, simply bathing can be a monumental achievement, while on others it can be writing a blog post. Both are equally as important if they were the best I could manage on that day.
Within step three I have other coping skills/activities: visiting my Wellness Toolbox; going for a walk; colouring; writing; or more passive distractions like reading, listening to music or watching television. Each of these activities will be discussed more fully in subsequent posts.
On most occasions, my distress ends at this step, primarily because I’m in a better emotional place. However, when the Plan was first conceived, I was less secure about my mental health so there are three more steps, each one of which is more difficult than its predecessor.
The primary difference between steps three and four is the intensity of the activity. Step four calls on me to implement my relaxation, or mindfulness, or MBCT and CBT skills. I have a variety of relaxation soundscapes I listen to as well as a variety of relaxation meditations. I also have a number of mindfulness exercises, meditations and books that I can turn to. Finally, I have various MBCT and CBT tools to fall back on. Like the tools within step three, those within step four will be explored in more detail in subsequent posts.
Steps one through four are actions I take on my own. In steps five and six, though, I accept my limitations and reach out for assistance. Keep in mind that by this time I’ve tried my various coping techniques and they’ve failed. I’ve reached a point where I’m uncertain and hopelessness is growing. There’s growing frustration, renewed self-doubt and the possible increased risk of self-harm.
In step five, I reach out to one or more crisis lines (I have the telephone numbers for five different services). Which I call depends on the time of day and the immediacy of my distress.
If I’m fearful of self-harming, I move on to step six, checking in at my local hospital or calling emergency services.
So there you have it, my step-by-step protocol that allows me to face my distress in a safe way. I thank-you for taking the time to read about it. Please, feel free to modify it to suit your own needs and, if you don’t mind, please share your modifications with us.