Dick O'Brien's Workshop Personal Resiliency in Challenging Times

Workshop funded by the Department of Justice Canada and arranged by Victim Issues Coordinating Committee of Leeds and Grenville and Victims and Survivors of Crime Week 2016

I attended this workshop on June 1st and felt that there was a lot of relevant content for me to share with caregivers of people with mental illnesses. Personal Resiliency is a very important trait for caregivers to nurture within themselves.

I came away with a lot of quotes that resonated with me and I hope they inspire and resonate with you.

Events VS Thoughts

It is important to know that the events in your life are your problems. It is your thoughts about those events that create your problems. As an example, say your child has schizophrenia and decides to go off their medication. You know that this is likely going to result in some drama and crisis for your child as well as yourself. One parent may deal with this situation by saying "Here we go again" or  their self talk may be constantly saying things are going to get scary and their anxiety begins to escalate. A parent who has more control over their self talk and has greater personal relisiency may be more inclined to say "I have been though similar situations and I have the skills and knowledge I need to help manage this challenge." An even more resilient statement could be "I've been through this before and I now have many more tools and more knowledge to handle this effectively than I did when this just started. I am better off and better prepared to handle this situation that I was before."

Life Anchors

We need to do a better job catching our mind in its default mode. The default mode of our brain is to be REACTIVE, JUDGEMENTAL and it FEEDS ON THOUGHTS. We have a cave dweller brain with a victim oriented mind in an office dweller environment. We end up where our thoughts take us. Dick uses the term LIFE ANCHOR to describe something we can say to ourselves in difficult moments that holds you strong. It must be big and powerful and comes from a time of personal struggle. It is an actual phrase, word or sentence. It must replace the reactive "This isn't fair" thought which so many of us go to when faced with a challenge. It can be things such as: This too shall pass. I will find a way. I've survived before. I am strong enough. Temporary.

Bothered

North Americans have become "EASILY BOTHERED" It is crucial to your resiliency to work on becoming less easily bothered. The focus must move from the event to our response to the event. This will help you in becoming less easily bothered. Think about this for a moment. Think about something that usually bothers you. Should it hold the weight in your life and mind that you give it? Would you feel better if you could change your response to the event? Your thoughts drive your feelings. If we can be better at managing our thoughts before they hijack our feelings, we will be able to change how events impact our wellbeing.

Greet Meet Complete

Dick spoke about how his early years as a monk have shaped how he structures his day. He has taken the structure of Lauds/Vespers/Compline and moved it into a more secular GREET/MEET/COMPLETE ritual and structure. 

GREET: Perform a ritual of greeting the day. This can be a quiet coffee or tea and breakfast without the usual distractions of emails and news that North Americans often begin as soon as they wake.

MEET: Meet the day. Mindfully meeting the challenges of each day. Using your ANCHORS and rituals to help you consider your responses to the events that occur.

COMPLETE: Rituals for bedtime. This should not include distractions and screen time. It should include meditative preparation for sleep.

Sacred Spaces

There are very powerful sacred spaces on this planet, some of which are ancient religious places and some are more natural sacred spaces. Places such as Stonehenge, Jerusalem, Mahabohdi, etc. are ancient sacred places where millions of people throughout the ages have gone and prayed, meditated and/or completed rituals. These places hold the original power of the place as well as the energy of those people. There are smaller sacred places locally where you find yourself going to visit, relax and reflect. Your mind already knows this place and why you are there. Allow yourself to seek out these places on a regular basis. There are smaller sanctuaries within our homes. These can be a room or even a corner of a room where you go when you need a place for your mind to know it is safe.

Dick O'Brien's Care Giver Credo

1 I know that before I can take good care of anyone or anything, I must first take good care of myself.

2 I must cultivate daily renewal of the four basic environments--physical, mental, social, spiritual.

3 I need to reflect on how I meet, greet, and complete each day.

4 I must overcome the adversity of life through the cultivation of life anchors.

5 I need to constantly know what is truly important in life and live by it.

6 I must create the time to pursue regular personal renewal.

7 I must never lose sight of my true purpose in life.

8 I need to monitor the balance between work, home and health and daily refocus my attention where needed.

Increase your Personal Wellbeing

You can influence, manage and mitigate but you cannot control life

1 Notice your thoughts - Mindfulness

2 Create healthy space in your life - Visit sacred places

3 Laugh often - The spiritual glue of sanity

4 Counsel yourself - Develop life anchors

5 Become less easily bothered - Dial it down

6 Create quiet time in your life - Stillness

7 Gain strength from being in healthy relationships

To contact Dick O'Brien 

Theresilientjourney.com

Mental Health Week Event

Mental Health Week Event -- Arranged by Lanark County Community Education Committee

Caregiver CBT for Psychosis

We had 22 people attend the event on Wednesday May 4th at Lanark Community Programs in Carleton Place. There was an even split of caregivers and clinicians and other professionals. Dr. Nicola Wright and Tyrone Gamble joined us to share their expertise and experiences with CBT (Cognitive Behaviour Therapy) in Psychosis with the service providers and caregivers in Lanark County.

Below is a summary from the notes gathered from the presentation.

CBT is an important part of recovery. Medication only therapy can often treat the "positive" (added in) symptoms, i.e. hallucinations, paranoia and delusions, however it does not deal with the underlying causes which can be a combination of issues including psychological trauma.

Changing the words we use can have a positive impact on someone suffering with psychosis. When we ask about distressing thoughts or experiences, people are more likely to share their experiences because the language expresses compassion and a non-judgemental attitude. If we ask about or say someone is having delusions, the language implies that their reality is the wrong one and that it is not real. This leads to a person shutting down and being less likely to be willing to engage with you.

Giving a name to an emotion that someone is experiencing helps to calm the body, which in turn calms the emotion rather than escalate it. I.E.) "Wow, you seem to be really afraid."

All people can experience a paranoid thought. If we fuel the thought, the natural feedback loop that occurs is a stress response, which in turn, causes more paranoid thoughts, which creates more stress. Some people worry they are sick because of a distressing thought or hearing a voice. Repetitively checking to see if the thought is still there makes it more likely to get worse. --> BUT trying to suppress the voice or thought can also make it worse.

Some people will have thoughts about being vigilant about getting caught while doing illegal drugs. That leads to always feeling vigilant when doing drugs. This can easily lead to paranoia around "the cops" as a result of selectively attending to certain beliefs.

Refugees commonly experience fear of harm--fear of government. Because they spend a lot of time attending and focusing on these thoughts, they can become hyper vigilant about safety, even after the need for these thoughts has past.

Humans have a negativity bias. Saying "Tell me something you feel good about over the week" helps to plant the focus on the positive and breaks the habit of negativity bias. If the person is attending a group or meeting regularly, they will begin to pay attention to the positive things to share at that group/meeting.

CBT helps move toward living a life out of your gifts and strengths rather than out of deficiencies. When a person is suffering from schizophrenia/psychosis the world shrinks to living the illness.

Nicola's 3 C's

Catch it
Check it
Change it

Looking at distressing thoughts or behaviours.
First--Catch it--Notice that you are having the thought or doing a behaviour. I.E. end up in the bathroom without purpose to be there.
Second--Check it--Check out why we have the thought or why we are doing a behaviour.
Third--Change it--If it's a thought, help move through the thought to consciously thinking about other thoughts, or moving to a different behaviour.

Tyrone expressed that he has stumbled on the last C. He experienced trouble moving directly to the Change. He has added a 4th C

Tyrone's 4 C's

Catch it
Check it
**Cope with it**
Then Change it

Tyrone shared that sometimes before moving to the change, he had to sit with the thought/behaviour for a while before he was able to push through that place.

CAREGIVERS need to use "I" statements in order to express what they see, in a non-judgemental way. "I notice this......., have you noticed that?" Focus on "We" instead of "You" I.E. We all can have distressing thoughts. Sharing your experience of what you notice can help the person living the experience to start to "catch it".

We need to recognize that Recovery does not necessarily mean a return to pre-illness state and functioning. Some people have referred to a psychotic episode as having a brain attack and there needs to be time and compassion to move toward recovery. It helps to be curious, but in a way that is caring. Ask how they cope with all the thoughts/voices. What works best for them.

A very important job of the caregiver is to hold onto the hope and see the beauty of the person until they can regain their own hope and recognize their value.

The Road to Recovery is a Road of Rediscovery.

It is important know a variety of things that helps to keep a person well. If a person counts on only one thing (a medication) and it stops being effective, then a person will be significantly worse off than if they have a toolbox of wellness tools.

If someone is unable to make sense of what they are going through, they will have a much harder time. Going through WRAP (Wellness Recovery Action Plan) program and other tools will help a person to recognize, name and understand what they are going through.

Anyone interested in becoming a member of our Community Education Committee and helping to plan next year's event is encouraged to contact me at mentalhealthfamilies@gmail.com

Caregivers at the event expressed frustration accessing help from the mental health systems and frustration with waitlists. Tyrone encouraged people to access services and groups at the PSO (Psychiatric Survivors of Ottawa) which was created because of the lack of services offered by the medical system.
http://www.pso-ottawa.ca


For more information see resources listed on
www.treatingpsychosis.com

Hope, Humanity and Empowerment

CBT and Coping with Psychosis/Schizophrenia for Family, Caregivers and Individuals with lived experience of Psychosis/Schizophrenia

Wednesday May 4 2016 7-9pm

Learning Objectives:

1) Understand psychosis/schizophrenia using an empowered Cognitive Behavioral Therapy model.
2) Learn treatment strategies used for psychosis/schizophrenia.
3) Help individuals and families develop strategies to cope with psychosis/schizophrenia.
4) Develop self-care strategies when helping others with psychosis/schizophrenia.
Presenters:

NICOLA WRIGHT
Nicola Wright, PhD C.Psych of the Beck Institute of Cognitive Behavioral Therapy, and a clinical psychologist on The Schizophrenia Program of the Royal Ottawa.
She is also the principle investigator of two research trials for group CBT for Psychosis and for Voices. Nicola conducts supervision for the Beck Institute and presents training workshops on CBT for Psychosis locally, nationally and internationally. Co-Author of the book "Treating Psychosis" (Wright et al., 2014)

TYRONE GAMBLE
Tyrone is a hospital Peer Support Worker at the Queensway Carleton Hospital and The Royal Ottawa. He co-leads a CBT for Voices and CBT for Psychosis group at the Royal Ottawa. Tyrone is on his own journey of recovery and has personal experience living with psychosis. Tyrone uses this experience and insights he has gained to support, engage and connect with people experienceing and living with psychosis in these groups.

This talk will focus on recovery, peer support and the use of cognitive behavioural and other therapies in caring for those with lived experience of psychosis/schizophrenia. The talk will initially emphasize the understanding and conceptualization of symptoms/experiences, treatment and recovery. The cognitive-behavioural model and recovery approach in understanding and coping with psychosis/schizophrenia will be discussed. This includes supportive coping strategies, self-care, problem solving and care for the caregiver.  Specific cognitive behavioural strategies will be reviewed. The focus will be on hope, strengths, potential, and meaningful life goals in the recovery process. Ways of reducing self and other stigma will be discussed. A detailed list of self-help, clinical and other important research supported reading material, websites and apps will be provided as well as information on community and hospital-based resources.

EVERYONE WELCOME
LOCATION:
Lanark Community Programs
30 Bennett Street
Carleton Place, Ontario

PRESENTED BY:
Community Education Committee of Lanark County Mental Health including Open Doors and Schizophrenia Society of Ontario


Email for more information:
mentalhealthfamilies@gmail.com

Plans for Mental Health Week/Peer Support

Community Education Committee

I am starting to gather the members of our Community Education Committee to plan a family focused event for Mental Health Week. The inspiration for this year's event came from attending Douglas Turkington's workshop on CBT (Cognitive Behaviour Therapy) for caregivers last year. We are looking at having an evening event during Mental Health Week (May 2-8). Anyone who may be interested in working on this committee is encouraged to contact me. We will be planning a venue and promotion will be a key to the success of this event. We have a presenter in mind and are just waiting to receive their commitment.

Peer Support

I recently participated in OPDI's (Ontario Peer Development Initiative) training for peer support. It was an intensive course which was quite focused on self care. It was a wonderful opportunity that was funded by Bell Let's Talk Campaign. There were 18 participants and there is great excitement that we will be able to make a significant impact on the mental health and wellbeing of people needing services in Lanark County. We are now exploring our internship phase of the training. Here is the text on the Bell Let's Talk Website:

Lanark County Mental Health, Perth and Smiths Falls District Hospital - Smiths Falls, ON

The funded program answers increasing demand from clients who want ongoing support after their primary group programs have wound up. Specifically, it would enable the agency to train 14 people as peer group facilitators with the Ontario Peer Development Initiative. These peer support workers would then be able to serve the needs of about 150 group clients a year for up to a year, to ensure they continue to get support for mental health concerns such as suicidal thoughts, trauma, anxiety, depression or symptoms of psychosis. 

Radio Promotion!

Lake 88

Here is a link to Lake 88 and my interview for InFocus.

http://lake88.ca/media/150924.mp3

I am trying to publicize the Strengthening Families Together course, as it is so important for people who are struggling to understand and help their family members. If you know of anyone, or you think some of your contacts may benefit please pass along this information. I've created a Facebook public event and sharing this event on your page may help reach someone in desperate need.

https://www.facebook.com/events/826018157519342/?ref_dashboard_filter=hosting&action_history=null

Election

There is an upcoming federal election. While healthcare is primarily a provincial matter, there has been discussion of a federal pharmacare program, lack of a strategy for senior care, home care and mental health care in this election. Ask your candidates what they will do about these important issues and vote, vote, vote!
My opinion is that pharmacare could be a big benefit for those with mental illnesses. People who are not on ODSP or other income support do not necessarily have access to the medications which keep them well.

Back in the Swing of Things

Strengthening Families Together (SFT)

I have decided on dates for our upcoming fall session of SFT. We (Margaret and I) will co facilitate the 4 sessions of SFT on Tuesday evenings from 7-9pm at The Link in Smiths Falls (88 Cornelia St W Unit A4, side of the building) starting October 27th.
Pre Registration is appreciated as space is limited and time can be better spent addressing the topics of the course and the needs of the family members attending. Please email me at mentalhealthfamilies@gmail.com for more information or call Purple Yip at 1-800-449-6367 ext 244 to register. Purple will be handling all the intake/registration process.
I will be interviewed on Lake 88 promoting SFT!

SFT covers a broad range of topics including:

Psychosis
Recovery
Treatment
Medication Therapy and Side Effects
Non-Adherance
Health and Wellness Maintenance
Impact on Family
Grief and Loss
Self Care
Effective Communication
Mental Health System
Crisis Prevention and Intervention
Justice and Mental Health
Advocacy

Our Monthly Support/Education Meetings

Our meetings continue to be held on the Second Tuesday of the Month at The Link from 7-9pm. If you or someone you know thinks they may be interested in coming and sharing an area of expertise and answering questions about a topic of interest to our group, please contact me at mentalhealthfamilies@gmail.com.

Community Education Committee

We are looking for anyone who may be interested in serving on our Community Education Committee. Anyone who works or serves in the mental health/education/community services field and feel they can contribute would be welcome. We are beginning to plan for an event to be held during Mental Health Week 2016. We do not have many meetings to attend, so it is not a burdensome commitment.

CBT workshop for Carers by Douglas Turkington

CBT workshop for Carers by Douglas Turkington on May 23/24

I've written the report below based on my notes from attending the CBT workshop. If you have any questions about the material or about the workshop, please contact me at mentalhealthfamilies@gmail.com

Our monthly meeting will be on June 9th at 7pm at The Link in Smiths Falls, 88 Cornelia Street. We will discuss the workshop and any other topics you would like to cover.

Cognitive Behaviour Therapy for Psychosis by Douglas Turkington—Report/Notes

Rumination is thinking about the past and it fuels paranoia.

Worrying is thinking about the future and it doesn’t keep you safe.

When you catch yourself doing either, it is best to set a time to worry or ruminate. Postpone all worry and rumination till the time you’ve decided to do it. Usually less likely to feel important to do it at that time.

Hallucination is fairly common in people who are grieving, sleep deprived, etc. Does not mean you are psychotic.

Make sense of the psychosis—ask about the voices, work with the beliefs to help the voices settle, list possibilities of what the voices/delusions are saying and work at why they might be saying this.

Do Reality Testing—Work with person to help develop an experiment to help test their delusion or voices. Set up an agreement on what certain outcomes would mean in advance of doing the experiment. 

Peripheral questions (shows interest without challenging)

Personal Disclosure-share your own experience

OCD/Psychosis— belief that they caused things to happen due to their thoughts/actions.

Befriending vs CBT

Both worked very well. Befriending had best effect on delusions/paranoia rather than voices and negative symptoms. Once befriending ended, all delusions came back. Medical community starting to think that befriending for 20 sessions before beginning CBT is best outcome.

80% of people with schizophrenia respond to CBT. People with hallucinations are particularly responsive to CBT.  CBT is helpful in getting patient to take the medication and then become able to come off the meds. Kapur believes that antipsychotics encapsulate the delusion and pushes it below the surface and when antipsychotics are stopped the delusion will return. Need therapy to deal with the delusion either with or without meds.

Voices are often triggered by certain noises, particularly white noise. Noises like: birdsong, vacuum, traffic, air conditioner. Isolating when the voices start can help to narrow the possible triggers. Earplugs can often help with voices.

Helping the person with voices and unusual beliefs: write down the voices, ask others if they can hear them, localize the voices (where do they come from?), audiotape the voices, test out explanations (with the person, not in a challenging way, but by working with the person to help them), take a baseline voice diary (this will help identify patters so you can help find a trigger), help the person establish how they feel on and off the meds. Help change the balance of power: person vs voices, writing down the voices and shredding if they are too shameful or painful to share.

Teaching of specific coping skills is not happening!!! Telling a person to do something is not the same as demonstrating how to do it well and checking how well they are doing the coping technique once they have started. Very important to improve the coping skills.

Patients who cope well: believed they are stronger, experienced more positive voices, had less command voices, set limits on their voices, listened selectively, talked to others about their voices.

Patients who do not cope well: saw themselves as weaker, experience more negative voices, had more command voices, did not dare to set limits on them, tried to escape from the voices by using more distraction techniques.

Command (Imperative) voices: Voices that tell someone to go DO something. If someone walked straight up to you and hit their fist into their hand, they may have had a command voice tell them to go punch you and they were able to disobey the command at the last second.

Coping strategies for hallucinations and delusions:

Distraction: listening to music, playing the guitar, attention shifting, art, walk, pets, writing, dvd

Focussing: sub-vocalization, deep breathing, rational responding, schema work (attention shifting—Adrian Wells MCT—metacognitive therapy)

CBT is very helpful in non-compliance issues. Average person on antipsychotics takes their meds 2 out of 7 days. CBT can help the person understand why they are and aren’t taking their meds. “what is the first thought that occurs to you when you first look at the pill bottle?” helps gain insight into their beliefs and feelings about their pills.

Medication Non Compliance

#1 reason to comply with taking meds is that the prescriber is liked by the patient!!!

If the person has selected their own meds based on side effect information provided by prescriber, they are more likely to be med compliant.

All people have a tendency to focus on the side effect rather than the benefits. Need to review benefits regularly to ensure at least equal focus on benefit and side effect.

Greater healthcare provider turnover promotes relapse. Teams need to look at having a limited number or one main person who connects with the patient.

Placebo level results should NOT be a reason to use a med—especially one with lots of side effects.

Negative symptoms: Affective flattening (difficultly in communicating or expressing emotion), Alogia (slowness to respond, and not much to say), Avolition (Get up and go has gone, little motivation/social withdrawal), Anhedonia (Unable to get pleasure), Attention deficits (poor concentration/memory)

CBT is most effective at treating the positive symptoms of psychosis, IE) the hallucinations and delusions.

There are different types of psychosis.

Drug induced basis

Traumatic basis-CBT can help with the hallucinations/delusions and medication compliance, meds are not usually needed long terms if trauma is treated.

Biological basis-more likely to need to remain on meds long term, primary negative symptoms, most likely to be medication responders where CBT can be helpful in medication compliance.

Emotional neutrality in the home is crucial for recovery. Don’t push too hard/no nagging. Demonstrate that they are accomplishing something as long as they are enjoying it, even if it is lying on the bed. Emphasis is always on the attempt of the activity rather than on the completion. Start small (go to bed rather than sleep on couch) Work to re-establish social contacts daily chores. Start with attempting, then move to completion, then to mastery. Have the person make a list of their daily activities, and begin filling in daily logs of their activities.

Resources

Provider resources

High-Yield Cognitive-Behavior Therapy for Brief Sessions: An Illustrated Guide by: 

Jesse H. Wright, M.D., Ph.D.

Donna M. Sudak, M.D.

Douglas Turkington, M.D.

Michael E. Thase, M.D.

Cognitive-Behavior Therapy for Severe Mental Illness: An Illustrated Guide by:

Jesse H. Wright, M.D.

Douglas Turkington, M.D.

David G. Kingdon, M.D.

Monica Ramirez Basco, Ph.D.

Family caregiver resources

Back to Life, Back to Normality: Cognitive Therapy, Recovery and Psychosis by:

Douglas Turkington (Author), David Kingdon (Author), Shanaya Rathod (Author), Sarah K. J. Wilcock (Author), Alison Brabban (Author), Paul Cromarty (Author), Robert Dudley (Author), Richard Gray (Author), Jeremy Pelton (Author), Ron Siddle (Author), Peter Weiden (Author)

Treating psychosis website has numerous links and resources. 

http://treatingpsychosis.com