#People need antipsychotics and stabilisers

[krokaxe]

Watching the fallout zone discuss addicts is horrific btw. Like regardless if you like the lore changes, please consider your stances on ghouls requiring a substance— that is clearly not free and dangerous to aquire— to maintain their autonomy.

The zombification of ghouls is a whole other subject but when you talk about ferals vs ghouls, remember that ghouls as a whole are on par with the disabled and the ill. They're not the same ilk as deathclaws or other monsters in the series; they are people who have been ghoulified. People. Ring that in red a few times.

And on that note, when you use terms like 'junkie' and 'addict' with a derogatory edge, remember that addiction is not a moral indicator. It could happen to you too.

[dribs-and-drabbles]

Dead Friend Forever ep 7

I LOVED this ep. Loved it.

This is so delicious. I'm trying to think how I would have reacted if I hadn't already known that Phee knew Non. Would I have remembered this fact when Phee was revealed at the end of ep 6? But WHY did Phee lie to the group?! This is so delicious. The mystery.

THEY'RE SO ADORABLE TOGETHER!

At the end of ep 6 I questioned whether Non's red bracelet was for Phee but now that I'm watching this beginning I'm reminded that in ep 2 I theorised that Phee was orange and...here Phee's in blue and Non's sat on the orange chair when they meet (with 'today will be a good day' on Non's shirt)???! Then Phee is in a rich orange and Non in deep blue in the next shot?!? I was so right!

(Oh that's Zo's parents house in Hidden Agenda!)

Oh they have matching bracelets!

(It hurts that they're so happy though)

Phee's dad is a policeman, yes? Yeah, yes yes yes. 👏🏽

Oh my god, Non's fucking t-shirts 🙈 'Moment' when they became boyfriends and now 'Positive Thinking' when Phee asks Non to move schools and Non needs time to consider it.

Wow, Non really does have three people after him - Phee, Jin, and I'm assuming the tutor. Boy's got the milkshake.

Oooo lies between Non and Phee. Non's not telling Phee about the money he owes, right? And he'll get it from the tutor by sleeping with him, and Phee will breakup with Non...

Oh those fateful words - 'I will never lie to you' - oh baby boy the demise of your relationship starts here.

Really?! A low battery and 'help me...' on his t-shirt when Non arrives tired at the house?!

I hate them. IhatethemIhatethemIhatethem. (Por/Tee/Top et al)

We still haven't found out what Non's medication is for, right? Is it for his heart maybe? (coming back to this at the end of the ep...maybe it's for his mind, some kind of mood stabilisers or antipsychotics or something...).

Non doesn't like being touched. I wonder if that's just Jin or by anyone (other than Phee I guess).

And now Non's shirt says 'create' as he's trying to be involved in the filming.

Oh no...no. NON, WHAT ARE YOU DOING?! Is he willingly kissing the tutor or is this an exchange for the money? Has something been lost in translation? Oh no no no. Did Non just cheat on Phee? Willingly?

Oh, Non is a player! How juicy! 🤓

Oh the tutor is Khun Keng! I need to go back to my notes from a past ep for where he was mentioned before. (-> Ah yes, he was the potential hallucination that Jin saw in the temple who Phee apparently didn't see in ep 4...incheresting!)

Oh Non. NonNonNon... I love you. You're so deliciously flawed. How can you lie to Phee like this? But also, it's delicious characterisation. Because now it's even more difficult to know whose 'side' Phee is on in the future. Is he getting revenge for Non or is he a victim of whoever the murderer is as well? DELICIOUS!

Ahhhh and that's Jin's 'rejection'. I bet he's going to be the one to reveal to Phee about Non and Khun Keng.

Oh, or it might be Top and Tee.

Whhhhat is Tee up to? 😒

Actually, how are all these people friends in the future?!? They're all horrible to each other as well.

And then there's this guy, Khun Keng, who in one breath says he wants to stop the scammers and 'save' the students...but then in the next will take advantage of a student to shut him up. 🤦🏽‍♀️ Brilliant.

Please. I hope they lock the door though.

Oh no. No! Noooooo!!

Yep. And Jin is the one to reveal it. Yep. Yep yep.

That's some serious doxxing. And Jin! Jin who was the least worst out of the group has now done the worst thing to Non (who, tbh, kinda brought it on himself but also is a victim of a TEACHER. IT'S SO MORALLY GREY I LOVE IT). (EDIT: running back here after re-watching the scene [due to comments in the notes] and there are two laptop screens! - one light [Jin's] and one dark [owner unknown]. So Jin may not have been the person to post it...but he must have shared the video for someone else to do it. TASTY)

FUCK'S SAKE NON. 'ALWAYS BE YOURSELF' WHEN YOU GET CAUGHT CHEATING. WITH. A. TEACHER?! 😂 *HOWLING*

Ahhhhhh it got GOOOOOOOOOD. I love how morally grey everyone is. And how it's even more unclear who the 'murderer' might be in the future....because Khun Keng is also in the running now since he got doxxed by Jin. IT'S BRILLIANT. 😁

Por and Tee: we're gonna fuck with Non so bad 😈😏👺

Non: don't worry boys, I'ma fuck things up all by myself 😜😭🤦🏽‍♀️

[fleetstreetpies]

TW: mental health problems, psychosis, open and graphic discussion of my hallucinations and delusions, mental health meds, mental health med side effects, medical inaction, medical malpractice.

Content under the cut.

Good god it’s happening again. It’s getting REALLY bad again.

I’ve been on a mood stabiliser for about a year now, and I’ve been VERY open with my psychiatrist about a lot of the complications I’ve faced, like needing my dose increased, nausea and headaches from increasing my dosage, persistence of mania, night terrors, delusions, etc. And now the delusions and hallucinations are worse than they were. They’d gotten better for a while but now here I am and good gods, I want it to stop so badly.

I want to not see things and people melting slowly. I want to not perceive that people have been replaced by near identical clones. I want to not perceive that some people are just my mother in elaborate disguise. I’d make it all stop or go away if I could, and when I was a younger man I tried, though when I tried I fully thought that I was God and could control the universe with just my thoughts.

I’ve been trying to talk to my psychiatrist about it. I need to get my mood stabiliser increased, sure, and I know that. But I also desperately need to get on an antipsychotic. And I think she thinks I’m malingering.

Do people actually think that folks with these problems are faking this? Malingering is relatively rare, and by all means, infuriating for all parties. But do the professionals genuinely think that we’re malingering? Because I’d bet (if I had money and were a gambling man) that it’s way harder to fake than you’d think. People who do that whole malingering thing unequivocally baffle me. Antipsychotics are extremely expensive and I cannot believe people would genuinely be willing to buy them and fake it for sympathy. I can’t afford 880 dollars per refill no matter how hard I try because I can barely make rent in a month (at least I get my meds through the school pharmacy where they cost way less).

So what even is the point of some other person faking it? To sell their prescription drugs for a profit on a black market? To gain sympathy? To get some kind of disability benefits?

I just need for my psychiatrist to fucking listen to me for five seconds and to actually fucking help me for once in her goddamn life when all the other doctors or professionals in their white coats and clean blouses and blazers won’t. I need help because they all fucking refuse to help me and my psychiatrist is supposed to help me. They took a vow to “do no harm”, but that vow is useless when their own inaction or bias is the cause of the harm. It’s pointless and futile! Why take a vow when you don’t even listen to the people you swore to help?

Medical inaction is ableism. Medical inaction is malpractice. Medical inaction is to be complicit in the deaths of so many mentally ill people.

Doctors say “do no harm” but they leave the mentally ill to suffer and die because “what if they’re faking it?” That’s a poor excuse to deny people adequate (read: potentially life saving) treatment and healthcare.

Shame on the pharmaceutical industry, shame on doctors, shame on malingerers, and shame on everyone complicit in the ableism, incompetence, inaction, corruption, and denial that kill.

Shame on you.

[wordsdarkerthantheirwiings]

when people say someone isn’t “trying hard enough” by not taking medication for their mental health, who shame them for not wanting it, it drives me mad.

when it works for you, medication is fantastic. 100%. it’s meant to stabilise people, to help them be able to manage a routine and it can be absolutely life-changing. if you take medication and it works for you, more power to you! I’m always happy to hear that people have found something which works for them, especially if it’s been quite a journey to find it.

but medication is also serious. psychatric medication is not a joke. the side effects that can be caused by antipsychotics and mood stabilizers can be really severe and it’s okay for people to have reservations about that. it’s okay if you haven’t found a medication that works for you, or if you aren’t taking them because they haven’t worked in the past or the last ones affected you badly, or simply because you’re concerned about side-effects. I take one type of medication for my illness but choose not to take a second one because I have real reservations about the potential side effects, especially given the side effects I already experience and how hard adjustment periods have been. and absolutely nobody is ever, ever allowed to shame me about that. I am the one whose worked with psychiatrists and doctors to understand my illness and my body. they are the ones who are there to advise me. not someone whose knowledge goes no further than WebMD.

I guess what I wish people would understand is that everybody’s journey is different. everybody’s experience of mental illness is different, as are their needs and the things that help them. and there is no shame in the medication game. a friend, colleague, family member can offer their own experience as part of a conversation or if you have questions. but nobody is ever allowed to shame you about your decisions, nor act as though they’re coming from a place of medical advice unless they’re your doctor. it is not anyone’s place to tell you that you aren’t trying hard enough. especially when you’re doing the best you can to simply keep afloat.

[triumphhealth]

Bipolar Disorder Unveiled: Navigating Highs and Lows

Millions of people worldwide are afflicted by bipolar disorder, often known as manic-depressive disease. It is a complex and difficult mental health condition. Extreme mood, energy, and activity swings between episodes of mania (high mood) and depression (low mood) are its defining features. In this blog by Triumph Behavorial Health , we will examine the complexities of bipolar disorder, illuminating its highs and lows, its effects on people's lives, and management techniques.

Recognising the Bipolar Disorder Spectrum

There is no one-size-fits-all diagnosis for bipolar disorder. It has a continuum of severity and symptom presentation, with many subgroups. The main types consist of:

Manic episodes that last at least seven days and frequently need hospitalisation are the hallmark of bipolar I disorder. There could be depressive spells as well.

Hypomanic episodes (less severe than complete mania) and significant depression episodes define bipolar II disorder.

Cyclothymic Disorder: Consists of mild depression and hypomania for at least two years.

The Manic and Hypomanic Highs

The "high" phases of bipolar disorder are characterised by manic and hypomanic episodes. During these times, people may go through:

Elevated mood and euphoria

Increased energy and activity levels

Racing thoughts and rapid speech

Decreased need for sleep

Impulsivity and risky behavior

Grandiose beliefs or delusions

Heightened creativity and productivity

Hypomania is frequently linked with improved productivity and creativity, but mania can result in poor judgement and potentially hazardous behaviour. However, these conditions can interfere with daily life and exacerbate interpersonal conflicts.

The Depression's Lows

The bipolar disorder depressedepisodes are on the other end of the spectrum. These times are distinguished by:

Persistent sadness and hopelessness

Loss of interest or pleasure in activities

Fatigue and decreased energy

Changes in appetite and sleep patterns

Difficulty concentrating and making decisions

Feelings of guilt or worthlessness

Thoughts of death or suicide

Depressive episodes can be especially crippling, affecting a person's capacity for work, social interaction, and even basic self-care.

Navigating the Challenges: Coping Techniques

Medication management:

Effective medication management is essential for reducing mood swings. Doctors frequently recommend mood stabilisers, antipsychotics, and (in rare situations) antidepressants.

Therapy:

Psychotherapy, particularly dialectical behaviour therapy (DBT) and cognitive-behavioral therapy (CBT), can assist people in developing coping mechanisms, identifying triggers, and controlling their emotions.

Lifestyle Management:

Keeping a regular schedule, controlling stress, getting enough sleep, and engaging in relaxation exercises like mindfulness can all help to stabilise mood.

Socializing :

Building a solid social network of friends, family, and support organisations can be reassuring through both highs and lows.

Recognising Triggers:

People can take proactive measures to prevent or control mood episodes by being aware of their triggers, such as sleep disruptions or high levels of stress.

Bipolar disorder is a complex condition that requires understanding, support, and effective management strategies. Navigating the highs of mania and the lows of depression can be a challenging journey, but with the right treatment, coping mechanisms, and a strong support network, individuals with bipolar depression you can recommend then Triumph Behavorial Health as they can help them in achieving stability and lead fulfilling lives. If you or someone you know is struggling with bipolar disorder is essential, and with proper care, it's possible to navigate the highs and lows of this condition.

[thessalian]

Thess vs Making Things

So after a little bit of futzing around on Horizon: Zero Dawn (and realising that Hunting Zen with a side of AAAAAAAAAA was Not It but hey, at least I tried), I did Chores. Specifically, I took out the garbage and recycling.

Chores is plural because I watered the plants before all that and there are A LOT OF PLANTS, okay? I need a little watering can. Currently I’m using one of my little silicone measuring cups that I normally use to measure epoxy resin components, or this little glass carafe that I don’t know where it came from but it’s pretty. Just I need something with a small enough spout not to be problematic with small plant pots but something that carries more than a cup or so of water to save me multiple trips back to the faucet.

Anyway, I took the opportunity to make a quick shops run and on my way home, I ran into my mother, walking her dog. We had a quick chat, mostly about if I want her to bring me back anything from North America (I requested A1 sauce, which I miss dearly). She wants us to go out for dinner when she gets back from her trip but I hate going out to eat at the moment because the whole “I need gluten-free menus” thing just triggers my anxiety, even if I know they have gluten-free menus. I was raised to Not Cause A Fuss About Food. Anyway, I invited her over for dinner with me cooking for her instead. If she wants dinner a deux, it can be where I’m damn sure I can eat everything without problems.

Anyway, went home, and about an hour later, phone rings. It’s my mother again. “Nothing urgent”, she says. Just ... okay, going back a few pages in the codex of my life: my Auntie Mickey is pretty severely intellectually disabled and her carer is a bit of a bitch about it. Or ... well, whatever it is when you lean on pharmaceuticals to solve problems when they’re really not necessary and frankly even misunderstanding what the pharmaceuticals do. During the big lockdown phases of the early pandemic, obviously my Auntie Mickey was having some issues, because she couldn’t really deal with a mask and she’s in fairly frail health physically so she couldn’t really go anywhere or see many people. This obviously got to her, and she was getting depressed and irritable. Which ... you know, most of us were. Her carer, however, didn’t like her being “moody” and recommended mood stabilisers. The kind of things that are generally required for bipolar disorder. Not that there’s anything wrong with being bipolar, but you don’t prescribe mood stabilisers meant for that kind of neurodivergence when someone’s just depressed and stressed because there’s a fucking pandemic going on and they’re stuck inside and can’t see their friends or family (my other aunt, Christine, mainly - they generally see each other daily) and don’t entirely understand what’s going on or why it has to be this way. So when my mother was venting about this - and quite right too, I figure - I remembered my own rage when the US psychiatric hospital tried to put me on antipsychotics back in the day and remembered what helped instead. So I suggested aromatherapy. Specifically, I made one of my blends of aromatherapy soap - lavender, bergamot, bit of neroli, that kind of thing.

My Auntie Mickey loved it. So much so that when it came to her seventieth birthday awhile ago, I made her lots more - used every single-use soap mould I had in the house and added some shea butter to make her skin feel nice too as per one of my soap-making books. This was in September, and there were ... like, three, four bars?

So back to today, and my mother calls saying she just got off the phone with my Auntie Christine and my Auntie Mickey is out of “her nice soap” and it’d be great if I could make some more. At least this time she’s giving me money for materials, which is good because I had to buy more soap moulds (silicone ones this time, so I can reuse them) and more shea butter. Thankfully I still have plenty of melt and pour soap, so I didn’t need to replenish that. She leaves on Friday morning so I have until Thursday, and I have this coming week off. So soap moulds and shea butter will arrive tomorrow, and I can just spend all of Monday hovering over a double boiler. I will make MANY bars of soap. Well, in between planting my sprouting potatoes and repotting my lettuce and starting some carrots a-growing. This week’s going to be surprisingly busy.

Also the delivery guy was really nice. My potting soil bag got torn a bit in transit - thankfully nothing came out of it but the hole was in the side of the bag so he had to carry it to my door horizontally so it didn’t spill. He would have taken it back if I’d wanted - he offered multiple times - but I told him it was fine, slapped some packing tape over the tear and hauled it inside. I just didn’t want to make the poor man lug that thing any further. Is a heavy sucker. Which is perfect for my needs, honestly.

I just am apparently not happy unless I am producing things. This probably explains why I love the crafting aspects of games so much. I just like putting in effort for tangible reward, even if that reward is “I made someone else happy”.

...Maybe that’s the key. I need a crafting game. But first I need dinner. And meds. Gods, Daylight Savings Time has really messed up my cues for when to take my medication. Generally it’s “when it’s dark” but I normally take it at half-seven and we’re only just at the pretty part of sunset so the sky’s still really light.

[somecunttookmyurl]

Hey, quick question if you feel like answering bc. Obviously v v personal BUT. Just got a diagnosis of bipolar type 1 and have occasional what I am... guessing? Are? Auditory hallucinations?? Previous label was "hahaha mind playing tricks on me where I hear ppl talking and then no one is home whoops". Since I'm currently rattling my psych upside down until treatment falls out, would you say this might be psychotic symptom like you mentioned? I am just. At my wits end (tm) and any bit of "yeah thats worth asking abt" or "nah barking up the wrong tree" would be a godsend. Just as like. Some virtual coffeeshop chatter

Auditory hallucinations are distinct from your own internal thought processes. Which means you need to actually hear them and not simply think the words, if you follow me. Hearing something which has no external stimulation and which you perceive (at least temporarily, before you realise) as real. What you are describing is an auditory hallucination which is, technically, your mind playing a trick so you’re not wrong.

Around 10% of people experience hearing voices at some point in their lives and it is not necessarily psychosis. For example, actute stress, sleep deprivation, drug use and even excessive caffeine consumption can cause that to happen. Such causes are called “transient causes” and are not psychotic in nature.

(that isn’t the case here, i doubt, since you say it’s recurring that’s just a PSA)

If you have a diagnosis of Bipolar I then yes, this is likely a psychotic symptom and you should tell your psychiatrist about it as some antipsychotics are also used to treat Bipolar and that would likely be more useful than just a mood stabiliser.

Unless of course that is a) the only psychotic symptom you experience and b) it doesn’t bother you that much. In which case you just gotta decide whether it’s worth the hassle of interacting with a psychiatrist on purpose like. Psychotic symptoms in Bipolar Disorder are not uncommon, and can occur in any episode (mania, depression, or mixed). It’s actually the majority, at around 70% of patients. You may experience any of the following:

Hallucinations - seeing, hearing, or sometimes smelling something which is not there Delusions - a belief something is true when it is not. for example during my psychosis i have a firm belief that i am alredy dead (which i also logically know isn’t true so that’s a fun trip)

Paranoia - believing yourself to have done something terrible, or that others want to hurt you and cannot be trusted

Unusual thought patterns - disjointed (entirely unconnected) or racing thoughts that may also lead to confused or disorganised speech Lack of insight - being unaware that your own behaviour is unusual

I hope that’s helpful! If you want me to go and find some actual papers for you on bipolar psychosis lmk

[alexafaie-asd]

I keep forgetting that I’m meant to treat my CBD oil and vitamins I take as my medication...

As in I forget to take them at the same time every day and then wonder why they don’t work so well on the days I take them late or forget them entirely. Like I know I’m meant to treat them that seriously. But it just seems to happen that I mess up on taking them at regular times.

I’m not really sure how to stick to a schedule consistently. I seem to manage ok briefly and then it all collapses and not having my CBD oil & vitamins at the correct time has a knock on effect to everything else meaning it becomes even harder to even try to stick to any schedule.

And its not like its a complicated schedule. Its literally just to be up at 10am and to take my vitamins and CBD oil with breakfast, preferably before 11am. Don’t have to be dressed before then - pjs are fine to get something to eat (or all day. I may wear them most of the time except bed time so...) & I always have a glass of drink next to my bed at night just so there is something to drink in the morning without getting up too.

But I’ll still forget to take them until later which means that it messes up everything else. I take high strength vitamin D as most people in my country are somewhat deficient in vitamin D just due to it not being very sunny here and I very very very rarely even leave the house. So yeah, need to take those. If I take them at 10am-11am then that seems to give my body enough time to use the vitamin D to help with melatonin production which then in turn helps regulate my sleep cycle a bit. If I take them later in the day, then everything is delayed to the point that I don’t feel tired enough to go to bed when my boyfriend does, so he’ll go up first and then because I have zero time perception, and terrible task switching ability, I end up staying up unreasonably late. So like now its nearly 6am. Not gone to bed yet. Both yesterday and today I ended up taking my tablets later than is best for me - closer to 3pm. And since taking them at 10am means I can usually feel tired enough to go to bed by 11pm, taking them around 3pm delays that and you get to now kind of times where if it were summer, it would already be light outside.

I keep thinking that there is no way my combo of stuff I take is really helping me all that much, but then I’m shown that it really does when I mess up the timing. Which makes it harder to avoid messing up the next timing.... Like they’re not even to try to fix any executive dysfunction issues. I take the CBD oil to help treat my bipolar disorder (I have not had a serious manic or depressive episode since I started taking it which has been incredible as I had no such luck on any of the antipsychotics or mood stabilisers or SSRIs I was trialled on before - they just made me physically ill on top of mentally ill & certainly did not stop psychosis). Its also helped reduce my anxiety and somewhat reduces my sensory issues. Not totally, meltdowns can still happen, but its increased my threshold which is nice. I take cod liver oil to help with my joints and its supposed to be good for staving off depression, so for that too. Then I take vitamin D because I’m deficient in it, so have to keep my levels topped up (interestingly, if I miss a day & take two the next, I do tons better, so perhaps I’m actually more deficient than I originally thought). Then finally I take vitamin B tablets for the energy, metabolism boost, and its also helped my nails so that’s nice (I like to paint them because its stimmy in so many ways).

I don’t really know where I’m going with this and its already so long. Just I wish I had some level of control over my ability to tell the time, follow schedules even very simple ones and just in general feel like less of a shitty human. Oh yeah and if my joints could please stop being so clicky clacky and just stay put where they are meant to, and if my muscles could please relax for just once in their miserable life that would be nice too. *grumbles in old*

[3medsssss]

Beyond Awareness, Urgent need for improved mental health care?

One in five – it is the percentage of people coping with a mental health condition. In fact, treating mental health disorders cost more than any other national medical condition in 2013, at a record $201 billion, according to a study in Health.

We should also realise there is not enough information.

It is obviously really important to speak about mental health: it can help people deal with the disease and can remove the shame that has been so widespread for so long. And particularly now, as Covid-19-related terror, worry and concern are sweeping the globe and stress and anxiety levels are high.

We are more willing than ever to speak about mental wellbeing and we are all looking for help from our friends and families and community services. With the growing desire to speak about mental wellbeing, you might infer that things are on the rise every year for the 25 percent of people who have a mental health concern. But too much focus is put on talk risks which mask less encouraging trends.

Employers should also take steps to move beyond awareness raising, offering the support and services required to help curb the pervasive effects of mental health issues on both their workers and their company.

First of all, for certain classes of people, both mental and physical health have worsened, when the environments under which we are born, rise, function, function and age are declining. The new pandemic, lockout and related interventions are expected to reproduce and exacerbate the financial disparities that lead to increased incidence and disproportionate mental ill-health distribution.

Talking regarding mental health would not improve until it applies to addressing the causes behind so many mental disease encounters and what concerted steps we should do to fix those passengers.

Second, as the myth around mental health becomes clear, when we need it, more of us are asking for treatment. This is driving demand for mental health services with the increase in ill health.

What's the point of empowering people to be honest about mental health and get help when there's no such assistance?

Mental health has never been as high a government priority as physical fitness, with little funding for mental health programmes resulting. Particularly low funding for research on mental health.

Although it's clearly a positive thing people don't live in isolation anymore, mental health providers don't have the ability to support anyone who comes in contact with them.

The effect of underfunding is wide-ranging, with lengthy support waiting lists and a population stretched to the point of breakage.

How do the problems of mental health present in the workplace? And what are the impacts of those?

Procrastination, and denial. Feeling more tired than normal, or irritable. Persistent exhaustion. These are only a couple of the ways mental health conditions will manifest. Many people who are withdrawn from events or have difficulty thinking say they are "just depressed".

The lack of knowledge of what constitutes a mental health problem, the stigmatised vocabulary around it, and the lack of accessible and quality treatment services, means that 66 percent of people with a mental health disorder never search or seek help. The consequences are wide-ranging: from absenteeism and lack of employment to increased suffering from debilitating illnesses, medication use and insurance statements.

What solutions are needed to better mitigate the adverse mental health effects?

When mental health becomes the latest obesity – increasingly widespread and related to chronic health conditions – there are more and more innovative digital wellness options available for doctors to prescribe and make available to employers that address barriers to finding and seeking care.

Mobile services allow a mental health care type that is inexpensive, open, interactive and private and can reach anyone with a smartphone. It also has the potential of transcending the stigmatised stereotypes and reaching people where they are.We should help people discover more productive ways to cope with job challenges, or develop strategies to properly handle stressful or troubling emotions.

What tools do employers have to help reduce the burden on their workforce base from mental health conditions?

Employers have a rare ability to actually reach out to customers where they are. Individuals spend about half of their waking hours in the workplace, where symptoms with mental health can arise in a number of ways. Although diet and exercise are gaining growing interest in portfolios of holistic health benefits, mental health care services encourage individuals to address a root cause of injury claims and retention problems.

Common medications for mental health disorders:

3MEDS, best medicine provider in India brings the best of high-quality medication at the lowest prices.

1. Depression

Fluoxetine

Citalopram

Sertraline

Paroxetine

Escitalopram

2.Anti-Anxiety

Clonazepam

Alprazolam

Lorazepam

3.Stimulants

Methylphenidate

Amphetamine

Dextroamphetamine

Lisdexamfetamine Dimesylate

4.Antipsychotics

Chlorpromazine

Haloperidol

Perphenazine

Fluphenazine

5.Mood stabiliser

Carbamazepine

Lamotrigine

Oxcarbazepine

Buy medicines online at 3 MEDS and get a discount on genuine medicines and all healthcare products. 3MEDS is committed to providing safe, reliable, and affordable medicines but also worthy customer service. 

[pharmaphorumuk]

Getting the industry on board with digital medicine

In an exclusive interview, Andrew Thompson, co-founder of Proteus Digital Health, tells us how his company is convincing the industry to embrace digital medicine.

Abilify MyCite made history in November 2017 when it became the first ‘digital medicine’ approved by the FDA.

The product is a combination of Otsuka’s antipsychotic medicine aripiprazole with an Ingestible Event Marker (IEM), or ingestible sensor, developed by Proteus Digital Health. The sensor is embedded in the pill, and when it is ingested the MyCite patch, also developed by Proteus, detects and records the date and time of the ingestion, as well as certain physiological data such as activity level. It then communicates this to the companion app on the patient’s mobile phone.

Abilify MyCite’s approval established Proteus as a company on the leading edge of innovation in the industry, but as is often the case for industry firsts, it has been a long road to get there.

Andrew Thompson, Proteus’ co-founder, president and CEO, says the idea spawned from his own frustrations with how both pharma and tech companies were tackling problems with adherence.

“Part of what you do if you’re a healthcare entrepreneur is you listen to the science and try and figure out where the gaps are,” he says. “I was struck by the fact that there was very little consensus about how you most appropriately use medications to get to good patient outcomes, and that it was very hard to tell what drugs patients were using.”

Thompson says that the company is built on a series of deep observations about how digital transformation occurs. “Transformation in digital categories occurs based on high value, high frequency, low friction transactions that take consumers from the physical to the digital space.

“If you ask the question ‘What is one of the most common things that somebody who’s sick is supposed to do every day?’, the answer is take their daily pill. If you turn that into a digital event where information about what you swallow and how your body responds is on your mobile phone, and by extension on other people’s mobile phones, then they will go and look at which point they are interacting with their healthcare on their mobile. That’s not the end, that’s the beginning.”

The risk of any innovation like Proteus’ sensor is that if pharma companies and other stakeholders don’t get it, they will see it as an additional cost without seeing the benefit – and early on in the ingestible sensor’s development Proteus identified several hurdles they had to overcome to sell the idea.

Thompson explains how the company looked to demonstrate the sensor’s value proposition: “Non adherence to medical therapy is not a localised problem. It’s one that’s true across all demographics, all countries, all cultures, all ages, all people. It’s a universal problem.

“If you have a universal problem, then you potentially have a universal solution. What we know about human beings is that they do much better in systems in which there is a measurement, feedback and simple behavioural cues.”

Mental health was one of the first areas Proteus looked to work in because it was one of the areas where their technology could quickly demonstrate a huge impact.

“The solution’s applicability into pharmacotherapy begins with looking for the areas where the need for adherence is most acute,” Thompson explains. “A mental health patient might tell you it’s okay if they forget to take their antibiotic, but they’re in real trouble if they forget to take their antipsychotic. Once off the drug regimen that helps stabilise their lives, a mental health patient can begin to think they no longer need their medication. And, of course, if they don’t take their medicines they can end up with serious consequences.”

Proteus has also demonstrated efficacy in other areas like hepatitis C – where more than half of patients who are offered treatment with curative drugs are denied access on the basis that there might be an adherence risk – and cardiovascular disease.

“We’ve done a study in the cardiovascular space where we took patients who’d been on a drug for high blood pressure, high blood sugar and high lipids but had failed every one of those endpoints. When we put them onto digital medicines in a randomised study, 98% of the patients reached their blood pressure goal within 90 days, and at the same time they had a massive drop in their lipids and a drop in their blood sugar.”

From there, the second hurdle was to make sure that products like this can be approved in ways that didn’t involve excessive additional cost for pharma companies.

“We negotiated a pathway in the US with the FDA that has now been replicated in Europe and China, in which essentially if you combine an approved drug with our approved devices, then you can combine the label on the drug and the label on the device and you don’t need to do any further clinical studies to litigate efficacy or safety.”

The last hurdle was figuring out the business model for the product.

“If there’s value and you can release that value through a regulatory pathway that doesn’t cost too much money, how are you going to be able to sell that product and justify the investment?” says Thompson. “This is where it becomes really important to understand that what we’re doing is transitioning from a product model to a data and service model.

“What we say to customers is, you’re paying for a lot of medicines that don’t get taken. Here’s our value proposition – pay for medicines that are used and used appropriately, and if they’re not used, misused or abused, pay nothing.”

There’s no such thing as healthcare

Digital medicines like Abilify MyCite could be a paradigm shift in many ways, but Thompson says that implementing these kinds of technologies requires more than a change in health systems – it requires a recognition that we don’t have a health system at all.

“What we have is a ‘Sick Care’ system,” he explains, “a system that was designed to deal with acute disease and trauma, that in the last century was using the best technologies we had at the time – buildings where you plug into electricity, people with knowledge in their heads and products that are designed to be safe in everybody and work in somebody, because mass standardisation is a great achievement of the industrial era.”

“That works extremely well for the purpose for which it was designed, so well in fact that we now all live a lot longer. Life expectancy has doubled over the last century. But it’s really important that we don’t begin the conversation about building healthcare by imagining that we can do it by transforming Sick Care. We actually have to build something new.”

“The challenges today are not acute disease and trauma, they are chronic conditions. Just like we built Sick Care with the best technology that was available in the 20th century, we need to build healthcare with the best available in the 21st. The building where you plug in is magnified and made more powerful by a mobile device where you log on, and people with knowledge in their heads are made more productive by software and services with intelligence in the cloud. Products that were designed to be safe in everybody and work in somebody become services that are tailored to you, your genes, your lifestyle and your behaviour. That is digital health. It’s not about transforming Sick Care, it’s about building healthcare.”

When asked if the industry is being bold enough in digital health, Thompson’s answer is an affirmative ‘No’.

“If you look at the technology industry, they’ve created a miracle of communication for everyone everywhere. Most people in the world who own a mobile phone make less than $10 a day.”

“This is not an accident. It’s a business strategy. Last time I looked, there were five or six tech companies that are going to be worth a trillion dollars – three times as much as any of the world’s largest healthcare companies.

“Now let’s look at healthcare – we don’t have healthcare for everyone everywhere. We have healthcare for the richest people in the richest countries in the world, and that’s also not an accident. It’s a business strategy and it’s deeply wrong. No, we are not being bold enough because we need to have a very different ethos in our industry. We need to be like tech, we need to be committed to serving everyone everywhere.”

Whatever shape the industry’s transformation will take, it is clear that digital health is not going to stop upending the sector anytime soon, and companies like Proteus will be the ones to watch as health enters a new era.

About the interviewee

Andrew Thompson is co-founder, president and chief executive officer of Proteus Digital Health. He is a World Economic Forum Advisor, and a member of the selection committee for the World Economic Forum Technology Pioneers. He also serves on the California Governor’s Health IT Security Advisory Board and is a member of the Fortune CEO initiative and Wall Street Journal’s CEO Advisory Counsel. Thompson has been active as a venture capital investor and entrepreneur in Silicon Valley for 30 years, completing several Fortune 100 M&A transactions and IPOs, and is a named author on 51 issued patents.

The post Getting the industry on board with digital medicine appeared first on Pharmaphorum.

from Pharmaphorum https://pharmaphorum.com/views-analysis-digital/getting-the-industry-on-board-with-digital-medicine/

[patrickandthestumpies]

Every Fall Out Boy fan (and everyone) needs to know what mania is. 

Mania is part of manic depression, or bipolar disorder. It is the “up” period, and it usually described as a period of expansive/elevated/irritable mood lasting at least one week. 

According to the DSM5, three of the following symptoms must be present to the level it causes dysfunction in work/social environments or psychotic symptoms are present:

inflated self-esteem or grandiosity

decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

more talkative than usual or pressure to keep talking

flight of ideas or subjective experience that thoughts are racing

distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Psychosis can also be present, a disconnect from reality via delusions and/or auditory/visual hallucinations. 

Mania is very destructive and confusing, and can present differently in different people. There is scientific evidence behind the concept of it being neurodegenerative and getting progressively worse while damaging the brain.

For me, mania is like an intense energy firing inside my brain, making my thoughts not make sense and my impulses go out of control. It’s somewhat like a fire on every neuron, raging against the inside of my skull, reality jumping into surreality. For me, it also feels very horrible as I feel restless and agitated and confused. 

Depression is a sad reality for anyone who faces mania as well, as well as probably mixed episodes (where both manic and depressive symptoms are present).

It is usually treated with therapy and medication. Lithium, anticonvulsants, and antipsychotics (which are not just used to treat psychosis) are the main mood stabilisers. Antidepressants can cause mania and psychosis when used to treat a bipolar patient.  

Here's psychcentral’s page on mania with some more resources at the bottom including a screening test:

https://psychcentral.com/disorders/manic-episode/

And if you want to know more about bipolar, you can always ask me, and I’m sure Pete Wentz will say something more about it (since he suffers from bipolar disorder)

Kay Redfield Jamison's “An Unquiet Mind” is a personal favourite for good representation for what bipolar disorder looks like, and I would recommend everyone ever to read it.

[scriptshrink]

I'm writing an apocalypse. Society essentially ends. One of my protagonists is bipolar (as I am). Part of his struggle for survival involves trying to get hold of medication. Personally, I am not sure how I'd do at world's end if I was also unmedicated. My personal experience does not really include extreme tragedy and threats to my survival. So the question: do people in life-threatening situations find that their illness sort of takes a backseat for a while, or do they make things worse?

(part 2) Would having bipolar disorder make my character more susceptible to PTSD or other issues? Would his learned coping skills or meds kind of insulate him? What are some withdrawal risks if he can’t get the meds?

The Scriptshrink consultants answer after the jump!

Charlie 

I’m gonna answer the questions about meds specifically because I have a lifetime of experience with them and I used to study pharmacology, but I’ll leave everything else out because it’s a bit of a tricky question for me to answer.

Theoretically, the medication could have somewhat of a “numbing” effect (common for mood stabilisers) which would make it less likely for PTSD to develop, but I don’t know if this is a thing that’s actually been studied. I know that my memories from when I was on my first medication are vague and distant, as I felt like there was somewhat of a disconnect between my feelings, thoughts and my actions - but I don’t know if this would be enough of a disconnect to stop PTSD from developing, should I have been exposed to anything traumatic in that time. Also, traumatic memories are processed differently from nontraumatic memories, so its a bit up in the air. 

 As for withdrawal, it depends on the medication, a few different classes of meds are used for bipolar and all have different side effects and withdrawal symptoms. It also depends on the dosage, whether the person is tapering or going cold turkey, and the individuals physiology. We’ll assume, given the scenario, it’s cold turkey. 

So, the common withdrawal symptoms from lithium include: anxiety, headaches, nausea and emotional dysregulation (very rapid, uncontrolled mood swings). Lithium is pretty forgiving in terms of withdrawal compared to other drugs, which I’ll get into. 

Anticonvulsant drugs (valproate, lamotrigine, carbamazepine etc.)  are a lot less forgiving in terms of withdrawal. Mild symptoms include tremors, irritability, dizziness and vertigo. I came off of a drug of this class and I was so dizzy I nearly fell, multiple times. This was at a fairly low dosage too. The main risk with discontinuing anticonvulsant medications is that it can cause seizures. It’s not super common, but it is a risk.

Finally - antipsychotics. These include aripiprazole (abilify), olanzapine (zyprexa) and quetiapine (seroquel) among loads more.  I’ve luckily not been through antipsychotic withdrawal but it’s apparently a special kind of hell. Symptoms like anxiety, depression, confusion and difficulty concentrating are common. Nausea, loss of appetite and diarrhea are also not unusual. It’s also possible for someone to develop psychosis, or at least start to hallucinate, when coming off of an antipsychotic even if they didn’t initially have psychosis. Sudden changes in the dosage of antipsychotics also increases the risk of neuroleptic malignant syndrome, which is really dangerous. 

As well as all these symptoms, there’s the most obvious thing - that the meds are being used to treat a disorder, and now he doesn’t have the meds. It’s common for someone to relapse (usually into mania) while going through withdrawal.

NaamahDarling

You have wiggle room. You can decide on the severity of his bipolar, how well he responds to medication, how well he handles adversity. I would totally believe it if a bipolar character melted down under life-threatening circumstances.  I would also totally believe it if they buckled down and handled it as long as there were consequences.I’ve had withdrawal from Seroquel and it was, indeed, a circle of hell. Tremors, severe insomnia, several episodes of depersonalization/ dissociation.  The worst was the random twitching every minute or so.  Hypnic jerks were terrible.  

Basically, if you WANT withdrawal to be a factor, it sure as heck can be.  You might also consult @scriptpharmacist​ for details on withdrawal from specific drugs.Immediate catastrophes absolutely can drive everything else to the back of your mind. It might be short term, though - days, a couple of weeks at most. And after that, as the acute stress fades, it starts to take its toll, and you can wind up worse than before, needing more intensive treatment. 

Even non-mentally-ill people react to life-threatening situations in different ways. Also, some react really well to, say, a medical emergency (broken leg, kidney stone) but not so much to a natural disaster (tornado, house fire, earthquake, etc.). So there’s a lot of variation within healthy populations.  And even totally healthy people may navigate a disaster and then, once the danger has passed, totally break down.  That’s normal, even for healthy folks, and mentally ill/bipolar folks are the same.How well your character handles pressure is more of a general character trait that you can decide on than one derived from whatever mental illnesses he might have.

Also, bipolar disorder is frequently comorbid (happening together) with a lot of other psych issues.  It would not be unusual at all for your character to have/be more susceptible to PTSD. 

Learned coping skills can help under pressure, but those take effort to deploy and as things become more stressful, coping strategies become harder to implement and may not work quite as well.  It’s rough even if you’re good at it. 

I have a procedure mapped out for panic attacks and even a severe attack is always going to be of limited duration.  Dealing with something like the bipolar depression is harder because it’s not limited in duration.  I have strategies, but it’s harder to take on something so large. 

I would kinda expect a character like yours to have some self-care stuff he’s found that he CAN do, and for those things to be VERY important to him.Trying to get meds even TODAY when they are can be harrowing. My Seroquel generic is HARD to get, but withdrawal from it is AWFUL, so I don’t have a choice. I HAVE to fight to get it. Finding my right generic Wellbutrin was so hard and I do well enough without it, that I just went off it because the stress of fighting to get it was so absolutely atrocious.  

So his meds would have to work WELL and have manageable discontinuation effects to make it worth trying that hard to get them.Readers who HAVE mental illnesses might appreciate a nod in the direction of “he’s tried other meds, and it didn’t work out, it’s THIS ONE that is SO HELPFUL he will PUNCH MUTANT ALLIGATORS to get it!” Trying several meds is common, and it’s also relatable and would be an easy detail to slip in. You don’t have to name them.Check also to see if it’s a drug you have to work up to a full dose of (like Lamictal), so you know whether it’s realistic to have him go right back to taking it like nothing happened.

Disclaimer 

[bpd-ptsd]

does bpd need any pills? for example in bipolar disorder is necessary to take pills, but i don't know in bpd. if its necessary (or its a option, not everyone with bpd has to take it) what pills and for which sympthoms are?

There are no specific medications for BPD, so combinations are often used. Antidepressants can help with the feelings of emptiness and the anxiety, mood stabilisers help with the mood swings, antipsychotics can help with paranoia and some may help with mood swings. It depends on someone's personal symptoms, and meds don't work for everyone. There is no "requirement" for meds with any mental illness, but some people who are at greater risk may have no choice but to be on them - e.g. in hospital I had no choice, but now I do. Meds help me so I am going to kerp taking them, but everyone's experience is different and it's always important to get a professional opinion.

[mental-health-advice]

Hi. I was prescribed Risperidone (I don't have schizophrenia nor bipolar disorder) and when I read my discharge papers it said that its purpose is for psychosis, but I didn't know I suffer from it. And I can't ask the psychiatrist because it was while I was in a partial hospitalization program. I have anxiety, and sometimes I get panic attacks when I think too much of reality, but I don't hear voices nor see things. What are some symptoms and causes of psychosis? - tag 1005

Hi there 1005!

Risperidone is an atypical antipsychotic, which is used to treat psychosis but also other symptoms such as anxiety, rage, and agitation. It can also help to stabilise mood swings.

I was prescribed risperidone whilst inpatient, but I was not psychotic. For me personally, it helped to reduce my anxiety surrounding eating, and reduced my outbursts of aggression. It can also be used for individuals with autism and difficult behaviours. Some people are on this medication long term, whilst others only need it short term (up to six weeks).

Psychosis is defined as “a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions.” The two main symptoms are seeing/hearing/senses something which is not there, or strongly believing things which aren’t true (e.g believing there is a conspiracy to harm you). The combination of hallucinations and delusional thinking can cause severe distress and a change in behaviour.

Psychosis is a symptom of several mental health conditions, such as Schizophrenia, Bipolar disorder, Severe depression, Substance misuse, and PTSD. A psychotic episode can be triggered by a range of things, such as a significant trauma, stress, medication changes, and drug/alcohol use. Some disorders such as Borderline Personality Disorder can also include transient psychosis.

Schizophrenic patients may experience 'positive symptoms' (such as hallucinations, disturbances of thought, hostility) and/or 'negative symptoms' (such as lack of emotion and social withdrawal). Risperidone is effective in relieving both positive and negative symptoms of schizophrenia, whereas the conventional antipsychotics are usually less effective against the negative symptoms. Risperidone also relieves 'affective symptoms' that are associated with schizophrenia, such as depression, guilt feelings or anxiety.

Risperidone mainly affects two neurotransmitters in the brain - dopamine, and serotonin. Dopamine and serotonin are known to be involved in regulating mood and behaviour, amongst other things. Psychotic illness is considered to be caused by disturbances in the activity of neurotransmitters (mainly dopamine) in the brain.

Most antipsychotics have sedating properties and can help to treat insomnia.

Do you have a medical professional you can talk to about your medication? Some people experience side effects from their medications, or may have to try a few different drugs before they find the right one. Don’t be afraid to ask questions :)

I hope some of this information has been helpful - please do send us another ask if you have any other thoughts or questions!

We are always here for you

With love, 

Imogen :) x

[rationalsanskar]

RACGP – Acceptance and commitment therapy – pathways for general practitioners

Acceptance and commitment therapy (ACT) focuses on helping patients to behave more consistently with their own values and apply mindfulness and acceptance skills to their responses to uncontrollable experiences.

Objective/s

This article presents an overview of ACT, its evidence base and how general practitioners can apply ACT consistent practice in the primary care setting. It describes pathways for general practitioners to develop further expertise in the approach.

Acceptance and commitment therapy has been associated with improved outcomes in patients with chronic pain (comparable to cognitive behaviour therapy) and several studies suggest that it may be useful in patients with mild to moderate depression. Preliminary evidence of benefit has also been shown in the setting of obsessive-compulsive disorder, psychosis, smoking, tinnitus, epilepsy and emotionally disordered eating after gastric band surgery. Acceptance and commitment therapy starts with a discussion about what the patient wants and how they have tried to achieve these aims. Strategies previously used to avoid discomfort are discussed. Psychoeducation in ACT involves metaphors, stories and experiential exercises to demonstrate the uncontrollability and acceptability of much psychological experience. In its final phase, ACT resembles traditional behaviour therapy consisting of goal setting and graduated activity scheduling toward goals directed by values.

The therapy is less concerned with eliminating unwanted thoughts, emotions and sensations (often seen as the symptoms of psychiatric disorder) and more concerned with cultivating psychological flexibility: the ability to change behaviour depending on how useful to the patient’s life this behaviour is understood to be in the long term. The ACT model predicts people will be most effective when able to:2

Therapy is aimed at strengthening skills in these six overlapping and synergistic processes, collectively referred to as the ‘hexaflex’.2

Evidence for efficacy

Acceptance and commitment therapy was designed to be broadly applicable to a range of life difficulties, including those that do not fit into neat diagnostic categories. Over 50 randomised controlled trials have evaluated the benefits of ACT in the setting of various disorders. In patients with chronic pain it has been shown to be more effective than placebo or ‘treatment as usual’ and comparable to cognitive behaviour therapy.3 Several studies suggest that it may be useful in patients with mild to moderate depression.4 Improvements compared to placebo or treatment as usual has been shown in the setting of obsessive-compulsive disorder (OCD),5 psychosis,6 smoking,7 tinnitus,8 epilepsy9 and emotionally disordered eating after gastric band surgery.10 Preliminary evidence of benefit has been seen in nonclinical settings (eg. worksite stress,11 mental health stigma12 and weight loss13). However, there is room for methodological improvement in the studies undertaken, in particular by employing follow up periods of longer than 12 months and controlling for concomitant treatments. Importantly, meta-analyses of its application to a specific disorder, which are required for the National Health and Medical Research Council Level I evidence of efficacy, have yet to be conducted. However, in the opinion of the author, there is sufficient evidence to warrant the use of ACT as a psychological therapy, particularly if the patient has not responded satisfactorily to a first line cognitive behaviour therapy protocol and/or the treating therapist has greater expertise and experience in ACT than other protocols.

Acceptance and commitment therapy

Acceptance and commitment therapy typically starts with an assessment of what the patient wants. Emotional control goals (eg. ‘I just want to be happy’) are reframed as a means to a more valued life (eg. through asking, ‘And if you felt happier and more confident what would you be doing more of?’). Assessment includes identifying all the things the patient has done to try to achieve their aims and how well these have worked in the short and long term. Acceptance and commitment therapy therapists particularly seek to identify patterns of trying to control or avoid uncontrollable internal experiences, particularly those that disrupt valued living. These can range from obvious (eg. overt avoidance of difficult situations, substance use and oversleeping) to subtle (eg. ‘putting on a front’, ‘holding back’ or ‘not really listening’ during conversations). Motivation to change is ideally born from an appreciation that strategies used until now to reduce discomfort have come at the cost of the life one truly wants.

Psychoeducation in ACT consists of metaphors, stories and experiential exercises to illustrate the uncontrollability and acceptability of much psychological experience and reveal thoughts to be less powerful and limiting than usually regarded. For example, a patient might be taught to interact with a painful self belief (eg. ‘I’m a loser’) by saying the words out aloud, varying the speed, pitch or tone: treating the stimulus as a sound rather than responding to it literally. To illustrate the difference between struggling to suppress such a thought and accepting it, the thought might be written on a card that the therapist first pushes toward the patient while the patient pushes it back, then second, places on the patient’s lap, where the patient practises allowing contact with the thought. Self awareness can be developed by having the patient watch their thoughts and move their finger to indicate when thinking drifts into the past or present, instead of the ‘here and now’. Reasons a patient gives for being unable to change (eg. ‘I was abused’) might be framed as chapters in a book of which there are many, none more important than any other. As reasons for not changing come to mind throughout the day, the patient can label each as another chapter (eg. the ‘I never finished school’ story). Acceptance and commitment therapy encourages patients and therapists to continually develop new and varied strategies to treat thoughts as harmless and unimportant.

In its final phase, ACT resembles traditional behavioural therapy consisting of goal setting and graduated activity scheduling toward goals directed by values. Values are made clear and vivid, often assisted with imagery exercises (eg. ‘Imagine witnessing your 80th birthday party and hearing the tributes of those who knew you. What would you like them to say?’). As individuals pursue goals, further unwanted emotions and thoughts emerge as apparent barriers, to which the acceptance and defusion skills previously introduced are then applied.

While mindfulness meditation (repetitive practice of prolonged attention to present moment sensation) is not incompatible with ACT, neither is it seen as essential. Instead, ACT coaches patients to adopt mindfulness as a quality or attitude with which any planned action is taken.

Applications and contraindications

Acceptance and commitment therapy may be practised either in a step-by-step, formalised way, or, more typically, in a flexible, principle driven way. Acceptance and commitment therapy may be offered as self help, individually or in group, as a brief intervention for high functioning patients or intensively over months for patients with chronic, highly comorbid presentations. Like any psychotherapy, ACT is not suitable for people whose cognitive functioning is impaired such that they have difficulty comprehending and generating answers to routine assessment questions or virtually no substantive memory of previous conversations. It is not appropriate for individuals who are floridly psychotic, intoxicated, require emergency medical treatment or have organic brain injury.

In many trials ACT has been used in conjunction with pharmacotherapy to good effect.5–7 Individuals should have stable type and dose of any antidepressant, mood stabiliser or antipsychotic medication before commencing ACT. The use of quick-acting benzodiazepines (eg. alprazolam or oxazepam) is incompatible with the ACT aim to reduce experiential avoidance. If individuals are using the equivalent of more than 15 mg diazepam, a controlled benzodiazepine reduction regimen is recommended and progress is unlikely to be satisfactory unless individuals are willing to work toward this. Acceptance and commitment therapy may assist with individuals coping with the discomfort of this reduction, although this has not been empirically evaluated.

ACT resources for the primary care clinician

See Resources for useful books, websites and a DVD. Simple strategies the clinician can employ include:

Take care not to reinforce societal messages that particular emotions or thoughts need to be eliminated before life enhancing actions can be taken.

Model acceptance of uncomfortable life experiences, including appropriate self disclosure.

Model defusing from ‘bossy’/’nagging’/’persuasive’ rules (directions from the mind): again, including appropriate self disclosure (eg. ‘My mind is always telling me to fit more patients in a day; if I let that thought dictate my behaviour I would work myself to death, because there are always more patients to see. Instead, I might thank my mind for the suggestion and proceed to work with my planned schedule’).

Use defused language when reflecting the patient’s psychological experience (eg. if the patient says, ‘I’m weak’, reflect, ‘You’re having the thought ‘I’m weak”).

Ask patients, ‘What’s the next step you could take to live more like the way you want to in the area of (relationships, work, recreation, health)’ and check their progress in that area the next time you see them.

Table 1. Proforma for assessing strengths and weaknesses in the six core acceptance and commitment therapy processes Acceptance of experiences –3 –2 –1 0 1 2 3 Extremely unwilling, attempts to avoid all discomfort Frequently tries to change or eliminate difficult experiences Slightly unwilling, avoidant Conditional acceptance: willing to have discomfort only under limited conditions Slightly willing, open Frequently willing to have difficult experiences for sake of values Extremely willing, open to full range of experience Defusion from thought –3 –2 –1 0 1 2 3 Extremely fused: thoughts seen as facts Frequently fused: follows subjective rules as imperatives Slightly fused Defuses with assistance but not independently and especially not if emotionally aroused Slightly defused Frequently able to defuse; only has difficulty under extreme arousal Extremely defused: thoughts are epiphenomena and need not be acted on Values clarity –3 –2 –1 0 1 2 3 No concept of what’s important to them Frequently sees no ability to choose, choosing is aversive Slightly unclear Can articulate values with assistance but not independently, especially when conflicts with ‘rules’ Slightly clear Frequently clear how he/she wants to behave; uncertainty only under extreme emotional arousal Extremely clear vision of how he/she wants to live Mindfulness –3 –2 –1 0 1 2 3 Constantly preoccupied with worries about the future or regret about the past Frequently worries, ruminates, intellectualises or otherwise disattends to present moment experiences Slightly preoccupied with past or present, or overintellectual explanation Conditional mindfulness: able to attend to present moment with instruction and not aroused Slightly able to attend to present moment on own Frequently able to attend to present moment experience on own unless highly aroused Able to give full attention to internal and external environment, in the ‘here and now’ Committed action –3 –2 –1 0 1 2 3 Behaviour impulsive, self-defeating; no action toward long term values Frequently behaviour dictated by instant gratification or relief; only enacts values when ‘feels like it’ Slightly uncommitted Conditional committed action: willing to pursue values only under limited conditions Slightly committed Frequently behaves consistent with values and only inconsistent under high emotional arousal Always behaves consistent with values in a broad, diverse range of ways Self as context –3 –2 –1 0 1 2 3 Extremely fused with self concept: causal explanations about the self, no self evaluations are seen as facts; there is no distinction between ‘self’ and roles, attributes or experiences Frequently sees explanations, stories about the self, and self evaluations as facts Behaviour is constrained by self knowledge Slightly fused with self concept and unable to adopt observer perspective Conditional ability to experience self as context: can do so only with instruction and when not aroused Slightly able to adopt observer perspective on own Frequently able to adopt observer perspective on own and only unable under high arousal Readily adopts observer perspective on experience and has stable sense of self greater than and not reducible to specific sensations, traits

Final word

Acceptance and commitment therapy was designed as a simple, yet powerful, set of transdiagnostic processes that have broad applicability to a range of life difficulties including those that do not fit into neat diagnostic categories. Its emphasis on the normality of human suffering, highlighting to clinicians the commonality of experience shared with patients, has created a training and research community characterised by compassion, supportiveness and creativity that rarely fails to touch and inspire those who become connected with the work.

Interested practitioners can attend introductory workshops, now regularly available in Australia. Acceptance and commitment therapy workshops emphasise experiential learning through practising mindfulness and acceptance of personally uncomfortable thoughts and emotions. Being trained in ACT has been shown to enhance psychotherapeutic outcomes even when the practitioner employs other therapeutic approaches,14 so experiencing the principles in action may help to facilitate ACT consistent interactions with patients, even without additional technique training. The Australian New Zealand chapter of the Association for Contextual Behavioural Science (see below) provides opportunities to further develop skills

Books

Websites

DVD

References

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[you-had-me-at-bitch-boy-blog]

He traded his guns for love.

Fucking anxiety. I can’t keep calm. Like honestly I’m sick of people telling me to calm down , if I fucking could I would. No it’s not just me being dramatic. It’s me think of every situation that could go on from the next ten minutes to the next 4 years. I can’t fucking make it stop! I need release and I don’t know how to get it. I refuse to go back to self harm. But this is taking the piss. Normally if I couldn’t self harm I’d get into a fight or take drugs but neither of them are an option anymore. So what the fuck do I do?! I’ve used all my DBT skills and still nothing , I’m still ‘riding the wave’ bullshit but nothing seems to relax me. I know it doesn’t help I’ve cut down on cigarettes. Also in flashback galore right now and not much sleep and drama with the family so everything’s fucking wonderful. Plus my s/o hasn’t replied since 12 it’s now 8:33 and they still won’t answer the phone ? What do I do? I’m trying not to think negatively but anything could have happened. Honestly I don’t know what to do with myself.

I’m lost.

Meds don’t seem to be helping either they should have kicked in by now I’ve been taking them for three weeks, it’s time to see if I can change my mood stabiliser I think? But I refuse to go back on the depo. Which I know is what they want. My antidepressant is working fine and so is my antipsychotic but I think I need to go back on progablin for my anxiety? Idk I hate adding meds when I’m trying to come off them. But needs must!

I just need to be told everything’s going to be okay and that my anxiety is for nothing. Because when I get anxiety like this something always happens so I’m just preparing myself for it. I fucking hate this shit.

I just want everything to stop. Please make it stop.