Mood monitoring

One of the blessings of being in secondary care is that you can pick up some amazing tips in self management. I did a CBT course around self esteem, inner dialogue, unhelpful thinking styles and mood monitoring. In my case when I first came into services I had zero self esteem, my brain never shut up, I didn't understand about skewed thinking and it's impact on mood and I had never thought of actually trying to get a handle on my mood spectrum or understanding it's natural rhythms and explosions. Also, it helped me to identify that these mood patterns had been in my life since I was about 16 and it took another 20 years to get a diagnosis!

In a mood/mental health context, I oscillate on a very different frequency to most normal folk. Mood disorders are generally identified by the list below:

Ongoing sad, anxious, or “empty” mood, Feeling hopeless or helpless Having low self-esteem Feeling inadequate or worthless, Excessive guilt, Recurring thoughts of death or suicide, wishing to die, or attempting suicide, Loss of interest in usual activities or activities that were once enjoyed, including sex Relationship problems, Trouble sleeping or sleeping too much, Changes in appetite and/or weight Decreased energy, Trouble concentrating, A decrease in the ability to make decisions, Frequent physical complaints (for example, headache, stomach ache, or tiredness) that don’t get better with treatment, Running away or threats of running away from home, Very sensitive to failure or rejection Irritability, hostility, or aggression. (www.hopkinsmedicine.org). Add to that the mania mood of elevated joy and excitable thoughts and actions, excessive energy, grandiosity, agitation, racing thoughts, hyper sexuality and the desire to encourage the whole world to be as excessively mental as you are, in a creative speed freak style! Oh yeah and 20 years ago, add into the mixing bowl a large dose of 90's love biscuits and a litre of whisky. I'm such a catch!

Chaos aside, keeping all of this stuff contained is hard going. Also, there is a huge spectrum of day to day thoughts and feelings that knock around alongside the challenging stuff, and also the more difficult thoughts and feeling during periods of genuine distress, joy or sadness that are appropriate and necessary for processing life events. 

So what is the solution? I needed to understand my scale of oscillation and its nuances. I needed to monitor it, get a grip of what happens when, and then figure out how I can handle the situations and the thoughts and feelings that go on when I am in particularly challenging periods. The only way I can describe it is that "you lot" walk through the woods, at a gentle pace, looking at leaves and weaving in and out of the trunks with a direct and purposeful manner. You know where you are going and understand your surroundings. Sometimes a conker lands on you, or you trip over some roots, but you seems to manage that just fine. I however, enter the woods on a mountain bike, cannoning around trunks, vaulting over rocks and whizzing past other folk, then crash unceremoniously in a heap and pace around confused for a bit, then drag my bike around looking for signposts that everyone else apparently already knows but forgot to tell me. Sometimes I just sit in a heap and cry into my helmet until the season changes, or, imagine setting fire to the whole fucking forest just because. Sometimes I actually walk along with you. You think I am matching you for stride and pace, but actually I am just copying you to look normal! I am practising. 

So I did the dreaded mood diary. I took a mood snap shot every half an hour throughout the day, all day, until I went to sleep. I did it for about a month. For every mood snap shot, I also correlated what had been happening, with whom and how I was acting out. So, 7.30, kids screaming and I am tired. Mood snapshot, irritable, angry, self pitying. I am shouting a lot and feeling excessive guilt. Also you can scale the strength of what your mood is doing from 1-10 or 1-100 if that suits better. 1 being manageable and 10/100 being out of control. What it showed me is that depending on where I am in my illness, my mood unpredictability and intensity can vary wildly. I am generally more reactive and sensitive than most on any given day. My spectrum of mood movement is far greater than yours. That doesn't necessarily mean I am suicidal or manic but what I do recognise is that I need to implement strategies and techniques to live in the day to help me manage the fallout of that. Also, if some moods persist much longer than others or start impacting on my day to day functioning, my family and my ability to live normally then I need to get some kind of help, input or review to see what's going on. 

I still employ mood monitoring on a daily basis. I don't stand still every 30 minutes and write it all down. I do however, mindfully check in with myself throughout the day to see where I am at. People who know me really well will pull me if I am "Off" or being a little odd. My mum is great at noticing if I am speedy or fractious. My husband is good at noticing if I am getting easily distracted as I cannot concentrate as my mind is in 80 different directions,  or if I need to ease down on the pathological anger rant about something that isn't even important. I am also much better at knowing when I need to step back as my mood is not helpful and is running rampant and unbridled and I may well act out on it. Also, asking a sensible person if you are feeling the right things in the right situation is also a good practice. I have a few specially selected grown ups who I can ask for emotional accountability. I don't always trust the barometre in extreme circumstances. 

It is hard. Thankfully I am getting to grips with it. Lithium has really helped to reduce the variance of the mood barometre spectrum. I feel more manageable now than I have done for 25 years. Scary I know! Thank God I have great friends and family who are willing to love and accept me as I am. Acceptance is the key. Finding the way through it is up to me, with or without my mountain bike x