Showing posts with label cognitive behavioral therapy. Show all posts
Showing posts with label cognitive behavioral therapy. Show all posts

Dr. Burns, I’m Hooked Now

Everyone should know Aqua and their song Doctor Jones.

Or should they?

Dr. Burns, specifically Dr. David Burns, the author of the popular book Feeling Good: The New Mood Therapy would disagree citing multiple reasons.

Things like all-or-none thinking (Everyone should know…)and should statements (should know…) are some of the cognitive distortions that Dr. Burns lists in the book.

I’m making my way slowly through the book and I have to say I’m finding it helpful—helpful to understand what I’m going through with my depression and how severe, and deep-rooted it is.

I scored 74/100 in the Dr. Burns’ checklist. That’s the cusp between Severe (51-75) and Extreme (76-100) (read more here).

I was convinced that my partner J is also suffering from moderate to severe symptoms, but he came in at mild depression scoring 12/100.

I was/am shocked. Happy for him, but shocked that I’m so much further down than I thought I was.

So here’s my little ditty:

Dr. Burns, Dr. Burns
Calling Dr. Burns
Dr. Burns, Dr. Burns
I’m hooked now

Why don’t I invite you to try the book out yourself?

The full list of cognitive distortions is below; read more about it here:

  1. All-or-None Thinking
  2. Over-generalization
  3. Mental filter
  4. Discounting the positive
  5. Jumping to conclusions
    1. Mind-reading
    2. Fortune-telling
  6. Magnification
  7. Emotional reasoning
  8. “Should” statements
  9. Labeling
  10. Personalization and blame

COVID and Severe Depression

I have heard a lot many people talk about their experiences with COVID. Now that I have had it for about 10 days, I find myself in the same boat. I don’t feel like how I feel with my usual flu/viral infection.

I feel drained. My nose isn’t blocked but I still feel like it is. Nothing wrong with my throat, which is very unlike the usual. I’m triple-vaccinated. I have been extremely careful.

I must have contracted it at a gig where I think I was the only individual masking and/or attempting social distancing. Imagine that.

I had a tough evening yesterday. I thought I made my worst meal ever. Partially thanks to the partial impairments of my olfactory and gustatory systems.

The noise from the Ganpati processions (if you are not sure about what this means, read this) was loud well past midnight and I failed to catch my first wave of sleep. I tried to watch boring TV shows (Star Trek: The Original Show and the Big Bang Theory) but I couldn’t. Ended up watching an episode of Mr. Robot.

So I woke up shitty. Felt like calling in sick. Instead, I’m trying to motor on. Don’t have too many sick leaves.

I tried to fix an issue with a door handle by myself. Failed at it as well. Eventually, called a carpenter in.

All of this made me want to read something else with my morning coffee. So I started (maybe restarted) Feeling Good: The New Mood Therapy by Dr. David Burns. Been meaning to read it since my therapist brought it up several years ago.

Took the Burn’s Depression Checklist. And I got 74 (out of 100). That means I have Severe Depression. I’m just 1 point shy of Extreme Depression.

Wow.

But I guess that’s how I have been feeling. Burns talks about a score of 5 or less being normal.

Nudges

Everything nudges you. Sometimes ever so slightly. Things that you see, read, do, and think--all of it does. And I guess these nudges change you.

Technically, everyone you meet and interact with you should too. In my case, it's not so. Probably because I go out of my way to limit my interactions with people. People are one of the most consistently disappointing things that I encounter in my daily life--the reason could be high expectations that I set for them, low returns that I get from them, or a combination of both. I find myself checking out of conversations somewhere between 20 minutes and 45 minutes after meeting someone. Even with people I love and that I care about.

And yet, at least one such interaction has resulted in a nudge.

A few days ago, J told me that he was moved after reading my then last post on the blog. He, I guess, could relate more to me as a person through my post because I'm particularly pitiful in conveying emotions in real life. I appear cold and distant. But it is representative of what I feel like these days.

J also said he was exploring some of the older posts after having conversations with AV. They get along well with each other on Facebook, thanks to their shared interest in photography. In fact, they interact way more with each other than I manage to interact with AV.

When I asked J about what they were talking about, J said that it was not about my depression. AV had brought up some issues that he was having with some posts on my blog with him and that's why he had started reading my blog.

Parallelly, AV and I have also been having conversations about how to get people to not find those posts about him on the blog. He said he gets a lot of shit from antagonists on Facebook photography groups, where he posts his idiosyncratically brilliant photographs and engages with people in fiery comment threads (with questionable political correctness). He now wants me to ensure that such posts don't show up on Google searches.

One of my most popular posts was a photobiography of his life. This was my attempt at showcasing his art to the world. His photography, through which his incredible mind shines, had remained more or less inaccessible to the real world thanks to his social anxiety/phobia. Within a few months of meeting him in 2007, I wanted to help him display his photographs in an art gallery in New York. I thought I could do it. I thought I could help him leave a legacy in the real world.

He had scoffed at my cherubic optimism. I couldn't do it like how I wanted to, but I did manage to push him into opening accounts on Flickr and Facebook. His Flickr stint didn't last too long, but he stuck with Facebook. It is probably what keeps him going these days. He uses Facebook to post photos and get comments and reactions from his friends and, more importantly, from strangers. And some of these strangers look him up when they are upset with something he posts or says, and that leads to my blog posts.

I have been naive and careless about the internet all my life. In 1997, I started warming up to HTML. In 2002, I created a website for my medical school batchmates. I had copied all the content available in a book that was published after we graduated and then started posting updates on their whereabouts. The website was hosted on GeoCities and the content still comes up on Google searches. Some of my classmates are pissed by it, and I'm still trying to find my way out of that mess.

Back to nudges. I guess everyone is figuring out how to find a way out of their labyrinthine miseries. Like how I am trying to get past my current low phase. I have heard a lot of people talk their way out of things with superfluous stuff like, "It's all about the journey and not the destination." Thanks to these nudges, the path that I take (and thus the journey) deviates ever so slightly from what seems like a course of certain doom. Mabye the destination doesn't change and it's just a slight detour. But the journey does. Or it has.

Back to J. So when J brought up my blog, I felt a certain sense of pride. I have always felt that I communicated better in writing than I could ever do in any other mode of communication. Hell, I have met more people by making people laugh and entertaining them on gay social networking chat rooms. So I went back to the blog(s). I hadn't posted in a while. And then I posted All I Want is SolitudeSlide-show, and The Last Best Things.

I felt satisfied. I felt closer to how to I used to feel. I felt like I had done something meaningful. I don't feel that too often.

There were other nudges too. Two weeks ago, during the commute to an outstation gig, I spent most of my time listening to an audiobook. It was the audio version of Judas Unchained by Peter Hamilton--a book I had started three years back. Sometime during the ride, I felt like switching to something else.

I looked for music in my dumber of my two smartphones. It's dumber because it's older and it does not have access to mobile internet. It is a Nexus 5 whose motherboard must feel like a teenager thanks to the number of fixes it needed to keep it going. It does not have a functioning mobile radio antenna and hence does not have a SIM card. It might be dumber, but it is the one that I'm more fond of and feel more safe with. I feel that it is safer because it is not the phone on which I have to interact with people. People tend to bring bad news. Communicating with people make me anxious. That overwhelming sense of expectations and responsibility.

So my dumber phone functions like an iPod. It has everything that I might want to listen to. The vast majority of what I want to listen to is podcasts--on combat sports, science, technology, astronomy, skepticism, conspiracy theories, etc. Audiobooks occupy a much lesser, but significant, chunk of its limited memory. I have a few folders in it with some music. Mostly music that I have to listen to for preparing my sets. But there are also some folders with versions of some of my songs. I keep these folders so that I can remind myself that I can be creative.

I switched to listening to my songs. Mainly because I wanted to check out how they sounded on my new Bluetooth headphones, which have the necklace thing along with the earbuds. As I guess is the case when artists revisit their unfinished pieces after a long time, I was pleasantly surprised. I was enjoying listening to the songs that I had written, recorded, and produced. They were so out of my consciousness that I was intrigued by them initially. I remember smiling and chuckling at the lyrics that I had come up with. If you are wondering, I can't remember my lyrics to save my life.

This whole experience was another little nudge because I had revisited something that I was proud of. I felt like I had done something worthwhile and I was capable of doing something that could also help me leave a legacy. I don't think I much care(d) about leaving a legacy, but I have always wanted to showcase what I could do—at what I think I'm good at doing—to the world. I guess I would also like some recognition, but that's not the most important reason. I would like to think that I want people to feel what I have felt, and I truly hope that I have translated my feelings and thoughts sufficiently adeptly into these songs.

Another nudge happened around that time. Since starting Judas Unchained in 2017, I have just finished about 400 pages. It is the only book I'm officially reading. It's fair to say that I was not reading much. At J's best friend's farewell party, which I reluctantly agreed to go for,  I found myself checking out of people and conversations fast. In the middle of the party, in one of several attempts to separate myself from the raucous conversation, I walked into J's friend's bedroom and found a copy of Narcopolis by Jeet Thayil. I read the the first 30-odd pages. The sheer pleasure of opening a paperback, sifting through pages, enjoying the different angles that one could gaze the pages at, and getting lost in that brilliant chapter are all cliched mediocre aspects of reading a physical book. But for me, it was another nudge. I had suddenly rediscovered the joy of reading a new book, which opened up the possibility of reading many more.

The next night, I found my Kindle Paperwhite and charged it. I logged out of my .com Amazon account and logged in with my .in account so that I can access the books that I have been reading on my other Kindle.

Yes, I have two Kindles. The Paperwhite is mine, and the other (a much older one with a physical keyboard) is a gift from Blummer. It was Blummer's father's and Blummer gave it to me after his passing. In the last three years, I have preferred reading on the older Kindle because it felt more like reading a physical book (because it does not have a backlight) and because I loved its physical page-turn buttons. But it is a problem if I wanted to read in bed with the lights turned off. I either have to use my dumber smartphone (because it has kickback stand in its case) or the Paperwhite.

After the Narcopolis experience, I wanted to get back to being on my Paperwhite because I could read in bed and drift to sleep. Instead of watching something and having to turn that thing off. Since then, apart from continuing Judas Unchained, I started a John le Carre book. Some progress.

Reading goes hand in hand with writing. The more I read, the more I want to write. That meant more posts, of which this, hopefully, will be the fourth.

There have been other nudges too in these past two weeks.

Buying those necklace headphones meant that I could listen to my podcasts with my helmet on while riding my bicycle, which I primarily use for commuting to work and grocery shopping. Listening to podcasts while cycling is liberating!

In another conversation three weeks ago, J had asked me to figure out a way to restart therapy and make it more regular. I had managed to get the first session done two days after I posted my first post in a long time. I don't consider the therapy itself as a nudge, but my efforts for fomdomg a fix to remedy my current situation was one.

My maid has been giving me a fresh set of problems since she started coming a few months back. Despite me requesting her several times to do dusting and other types of cleaning more than sweep/swab and doing the dishes, she was just following her usual routines. This past week, I had a conversation with her explaining what I wanted her to do. The next day was a no-show from her. I was frustrated and I wanted to set an example.

I spent about five hours in cleaning up the apartment so that she could see how things looked if things were done properly. The next day, I did the dishes and cleaned the counter and made the bed before I left for work. She must have been surprised that I had done all of that. Today I met her and explained that things are not working out the way they are being done. I proposed an alternate strategy of focusing way more on dusting and deep cleaning on a fortnightly rotating basis around the apartment. I also said that I'll continue doing the things that I can.

The five-hour cleaning run was a nudge. I felt good after doing it. I had tangible results of something that I had a lot of fun doing. I have always felt a sense of satisfaction and pride after cleaning. This feeling is why I volunteer to do dishes when I go to my friends' place for dinner.

So many nudges. Most will sound inconsequential to many. But they did change the way I was doing things. The way I was thinking about things. Those nudges changed me and my future. There I said it. Every time I come across a sci-fi reference about the lack of free will, I chuckle on the inside. I guess I chuckle(d) a lot when I used to watch Passengers or think about Trafalmadorians.

Last night, I found myself telling J that I might be past my current phase's nadir. Maybe I have. That's where I am now. Feeling better. Thanks to these nudges.




What I'm going through to get better

I'm sure that among my readers, there are at least a few who have battled depression. What it does to you is sometimes devastating. You simply forget how to live they way you used to live and forget how to love what you used to love. It's incapacitating. I still remember that only a few years before, I was interested in going out to a movie and eating out and simply having fun. Two years back, I was absolutely in love with traveling and look forwarded to go to new places and have exotic experiences. The list goes on and on.

After being on a relatively ineffective pharmacotherapy cocktail for approximately two years, I consulted my present shrink, who switched to the present the pharmacotherapy cocktail (below) and guided me to talk/behavioral therapy. During the course of psychological testing, I was diagnosed with major depressive disorder (MDD), anxiety disorder, stress disorder most probably as an effect of post-traumatic stress disorder (PTSD) due to childhood trauma. Yes, it sounds like a lot. Hence, along with the medications, I have started an efficacious, albeit debated, psychotherapy method called eye movement desensitization and reprocessing for PTSD.

As pharmacotherapy for depression, I'm on the following cocktail:
  • low-dose amitryptiline (a classical tricyclic antidepressant)
  • medium-dose bupropion (an atypical antidpressant mood stabilizer)
  • low-dose clonazepam (an antianxiety agent)
  • low-dose haloperidol (an antipsychotic agent)
Apart from that, I'm taking Vitamin B and Vitamin D supplementation.*
As part of pscyhotherapy, I have undergone/am undergoing the following:
Wondering the reason behind why I'm posting all these details? To be honest, I have come across several people suffering from depression who are simply unaware of what they can do to get themselves and their lives back on track. By being open about what I'm going through, I hope to bring more awareness regarding depression and PTSD so that more people can help themselves.

An important point to note is that the bullet about reading and learning about depression, PTSD, and cognition in general need not be limited to who are suffering from depression or PTSD. I would recommend this as a useful exercise to just get accustomed to the concepts and the phenomena underlying these conditions. Especially, those who are close to those who are the sufferers.

In the last few weeks, I have recommended these the first two books to several people and I have gotten very positive responses regarding the same. I hope that I can get my family (my sister and my mother at least) to read these books.
If you are reading this and if you know someone who shows signs of these conditions, please encourage the to seek help and/or read these books.

*I was diagnosed with Vitamin D deficiency a couple of years back.

Merry Christmas

I can't believe that it's been over 6 months since I last posted a note on this blog. I sincerely apologize. Just so you know, I had my last major bout of depression in early April 2012. Life has almost come around a whole circle in the succeeding 8 months or so. I'm at a very happy place in my life at the moment. Knock on wood!

So what happened in that period? The lack of motivation to share thoughts, which comes bundled with the package of depression in the brains of people like me, was the reason in the first three months. I cheated. I mean I lied, or, maybe I should say, I didn't come clean with the truth, in the last few posts. This was when I was really struggling to comprehend what was happening to me.

Supposedly, I was happy. I was in a promising relationship, had ongoing projects with three bands, one one of which looked like it would fulfill my dream of cutting an album, and my work-life was going smoothly. From out of nowhere, it hit me. I fell flat on my face and the people closest to me chose to give up on me. Within no time, I was dumped my my lover, rejected by one band, kicked out of another, and stranded by the third.

I was dazed and confused but I managed to not crack down under adversity, thanks to some excellent friends, who stood by me and saw me through, and of course, to my new shrink. Thank you, Billiards, for spending so much time with me on Skype virtually every night for many months. Thank you, Sujit, for helping me find a new shrink, which made me turn the corner. Thank you, my work colleagues, for providing me with the wonderful environment where I spend most of my awake hours. Finally, thank you Mr. Psychiatrist, without whom, wouldn't have known what it is like to be really happy.

The new shrink, almost magically, brought in a radical transition by switching me to a new medication and guiding me to cognitive therapy. He suggested that I should be weaned off of the previous psychoactive cocktail (low-dose combination therapy with escitalopram, clonazepam, and haloperidol) and started me on bupropion. Along with that, he guided me to http://depressioncenter.net, which gave me the insight about cognitive therapy - I meticulously maintained a mood diary for about a month, which enabled me to find out what were the real triggers, and thereby find the root cause of my negative thought cycles.

Sometime in late July or early August, I started enjoying life like I have never before. I guess I had more time for myself with most of my responsibilities as a musician, apart from my that as a solo performer, having vacated my life, and I started watching, following, and reading stuff that interested me and I started looking forward to spending time by myself. I restarted socializing - dating, drinking out, going for movies, etc. I also was able to get rid of my guilt to spend money for myself for entertainment and leisure. By September, I was dead sure - the period comprising the last three months or so was the happiest that I had ever been.

Then, in October, out of nowhere, I met three interesting men - all three attractive, single (well, technically, at least), and interested in me. All three are so different and yet seemed to offer me something that I had never experienced in Mumbai - dating. Although I'm good friends with all of them, I have spent most of the last two months with one of them - Jay - and it has just been a wonderful experience.

Thus, on the eve of Christmas, I sit by myself, content and happy, albeit missing Jay, hoping to spend the New Year's eve with him.

Merry Christmas.

Stay calm and hug a bear. Trust me, that works.

Getting better all the time

The last week has been really good me. Well, except for the fact that I got kicked out of my main band. Otherwise, with the help of the new medication (I suspect whether it could have such an early effect – maybe placebo effect) and early lessons of cognitive therapy, I am feeling all round better. I have a homework – to track my mood throughout the day and find out what triggers my negative moods. This is helping a lot. The people that trigger my bad moods are those who are close to me who have hurt me previously (e.g., parents, Vinokur, and Joe). I should avoid contacting them when I’m feeling vulnerable, I think.

The new shrink

I finally managed to come out of my depression closet and write something on my blog a few days back. Now, I took it another step forward. I met a new shrink.

The first sitting was rather remarkable. He must have asked me maybe eight or ten questions. I would just go on and about my past. The most that I talked about was my relationship with Vinokur and how it came to an end.

It felt telling a stranger about everything that affected me negatively from the past – from parental physical abuse, incestual sexual abuse, being looked down by my family almost throughout my childhood and adolescence, the hospital changing my perspective of life, why I came to Mumbai, to how I fell in and out of love and was broken into pieces – everything.

My shrink listened to me carefully. At the end of of our session, he offered me a comprehensive plan. New antidepressant (bupropion), slow tapering off of the cocktail, introduction to cognitive therapy, and regular physical exercise.

Although, I have been feeling much better in the last few days and I was even more content with myself that I finally took a measure toward getting out of the rut. Let’s see where this leads me.

Engayging Life has moved to WordPress

Engayging Life has fully moved to WordPress

Yes, I am alive and I'm still blogging. Regularly. But on WordPress because offers an easier workflow for me. Here is a selection of wh...