My steps four and five of the twelve step program used for mental health.

 Here is a step four of mine, 'we took a fearless and moral inventory of ourselves', and step five of 'we admitted our defects of character to ourselves, another person and our higher power'.

Here are my defects:-

Sardonic: bitterly mocking or cynical.

Obstreperous: unruly, turbulent and noisy.

Self-absorbed: absorption in oneself.

Obsequious: servile, fawning, sickeningly polite.

Self-assertive: confident or aggressive.

Opprobrious: very scornful, abusive.

Self-centred: everything has to centre around my needs.

Obtuse: dull-witted.

Self-seeking: primarily concerned with my own journey through life.

Ostentatious: showing off, in my case with physical abilities and education or knowledge.

 

Self-obsessed: primarily concerned with my own role in life and its accompanying insights.

Oculogyric crisis: a dystonic reaction to anti-emetics, in my experience, Maxalon, Stelazine, Olanzapine, and cannabis. Characterised by upward deviation of the eyes.

Side effects / sight: damage to the parietal cortex on the right side of the brain by the use of anti-emetics, in my case, Maxalon, Stelazine, Olanzapine  and cannabis. This can produce a kind of blindsight in the left field of view. Some aspects of the part of space that is ignored are still processed, but there is still blindsight in the form of seeing without seeing by not being able to register the full amount of information. This is called visual neglect.

Ontological: continually rationalising existence, being, becoming or reality. Soul searching that borders on obsessive compulsive disorder. Continually looking for answers or insights relating to my state of mind. Lao Tzu said "Desiring one will only see the manifestations, desireless one will see the mystery" 

 Samizdat: clandestine publication of banned literature, in my case, letters and emails.

An insight that I have developed through this process of listing my own character defects, and liabilities, and then confessing them can be described as follows: I have gone from being opprobrious which means being very scornful and abusive, to obsequious, meaning fawning or servile in conduct. Similarly I have gone from being obtuse, which means dull-witted, to being self-obsessed, and self-seeking, seeking meaning in the experiences that I have. The conclusion that I have drawn from this is that I have gone from one extreme in behaviour to the other extreme at the other end of the pole. To me this dipole means I can have a polarised personality with "mood swings", and like a dipole which is charged at both ends, I can hold a charge which attracts certain situations or scenarios.

Letting go of control.

In the CBT Handbook by Pamela Myles and Roz Shafran the following analogy by Professor Paul Sakovskis of Bath university is mentioned:
A new worker at a building site is given a job to hold up a wall a few bricks high and a few bricks wide. The worker does this but at lunch time he has needs of food and wanting to use the toilet. The boss insists that he stays at his post and the job is important, and that he is doing a good job. At end of the day the worker is tired and has a need for sleep, but again the boss states that he remains at his post and that he is doing an important job.
Using this analogy as an example it illustrates the worker needs to take a risk or a chance of letting go to see that the wall will not collapse. This analogy parallels my situation of having unwanted and intrusive thoughts which resulted from a puncture wood after a night of drinking in a night club. Afterwards I did not feel safe with my anger and experienced an alienation of the expressive. I have been opposing my environment ever since in an attempt to retain control of situations to keep danger away from me and those that are close. I was keeping a projection of danger in abeyance. I have identified the thought or belief that causes the problem to persist, that after the assault I believed that life was unfair and unjust, and I always played the vitim card. A contributory factor was I lost job after job in rapid succession due as a consequence of the fear reaction of PTSD that was later assessed by CBT.
Like the worker I needed to let go to see that the wall would not fall down. I thought by letting go my worst fears would come true so I let go of one aspect of my life space rather than testing my worst thoughts with bigger risks attached.
This behavioural experiment consisted of dropping a safety behaviour and then seeing what happened and possibly disconfirming a belief that something bad would happen after a previous bad experience.
The serenity prayer

God grant me the serenity to accept the things I cannot change
courage to change the the things I can
and the wisdom to know the difference

helps me to let go of some the control.Letting go of control is about step three and letting go and asking for God's will.
'When it comes to control, recovery is a balance between letting it happen and making it happen' (REF: Hazelden step three).
Letting it happen is dropping a safety behaviour, or dropping my gaurd with only a part of my problem to see a chink  of light in the armour of my ego.

Conflict and de escalation

Conflict can arise when there is a clash of interests over a need that has to be met.
The resulting behaviour should be seen in a holistic way without being judgemental, as an attempt to communicate a need.
Conflict can be resolved in a couple of ways:

1. Find a common ground to agree on.
2. Showing empathy and respect to all concerned.
3. Ensure everybody is happy with the resolution before it is acted on.
4. Agreeing to review what has been agreed on at a later date.

It is important that the reason for the behaviour is identified so that appropriate strategies can be developed / implemented to reduce the risk of behaviour escalating.
One can attend to the issue rather than ignoring it and risking behaviour that is aggressive.

Proactive 'Green' strategies

The aim is to support the person / provide affective support to stay in the relaxed and calm phase as much as possible.
Points to look for
1. Feeling well and happy.
2. Interaction styles, how do you communicate with the person.
3. Communication and body language.
4. Preferred activity.
5. Environment.
6. Predictable routine and structure.

'Amber' strategies

Many episodes of challenging behaviour happen when we fail to recognise the warning signs, or fail to change our behaviour once the signs are evident.
At the start of anxiety or distress quick action is need to return to 'Green' proactive phase as quickly as possible.
When there is anxiety there is an affect arousal or drive increase. This can lead to behaviour that reinforces the anxiety and a cycle occurs. Drive reduction is needed which can also reinforce itself, for example, if you are hot, you take off your jumper and the resulting cooler feeling is pleasurable which reinforces that action.
One way to deal with the affect arousal is to allow the person to resolve his / her defences to see that the situation does not present a threat. For this you would need affective support.

To prevent behavioural escalation, things that might help are:
1. Take away the trigger.
2. Ignore the behaviour.
3. Give in, give them what they want.
4. Humour.
5. Distraction / redirection - a guided walk to take them away from the environment.
6. Look at the time of day and where the person is etc.
7. Observable signs - increased pacing, changes in vocalisations, facial expressions or body language.

At the Amber stage behaviours need immediate action.

Reactive 'Red' strategies

How you should react in response to challenging behaviour.
The aim is to manage the behaviour as quickly and safely as possible to keep the person and those around you safe. When challenging behaviour occurs, there is a need to act quickly to achieve safe and rapid control over the situation to prevent any unnecessary distress and injury.
'Red' strategies should be guided by the principle of employing the least intrusive and least restrictive intervention.
'Red' strategies include:
1. Appear calm.
2. Low arousal approaches - calm / monotone voice.
3. No prolonged eye contact.
4. Be aware of your own body language.
5. Do not make demands or keep talking.
6. Distraction / redirection e.g. a guided walk to keep them or others safe.

When behaviour escalates to 'Red', an incident of challenging behaviour is occurring, signs more obvious than 'Amber'.

Post incident support 'Blue' strategies

This will specify behavioural actions that need to be implemented following incidents.
Actions can include
1. Giving the person more space.
2. Engaging in an activity
3. Make no demands.
4. Help the person to recover.
5. Move to a different environment if appropriate.

There should be procedures for ensuring physical and EMOTIONAL safety, e.g. physical checks and supportive counselling. The same support should be available to work mate / carer etc.
In 'Blue' the incident is over and the person is starting to recover and become calm. There is a need to take care as there is a risk of the behaviour escalating again quickly.

Being challenged.

1. When there is a perceived threat, there is an affect arousal.

2. Affective support is needed to help resolve defences with affect arousal.

3. When there is affect arousal there must be drive reduction to deal with an increased want.

4. When anxiety is disproportionate to an actual danger, defences can be resolved to see that a situation does not necessarily present a threat. This is called desensitization.

5. The situation can be relived in a therapeutic context.

6. Acceptance is important, to acknowledge there is a problem , and to go around it, or to say that I am not ready for this and I will deal with it at a later date.

7. Next step there is a need to regain mental composure / poise. To do this one needs to retrieve one's self.


8. Retrieval can be achieved by refocusing or in other words, reframing the    situation.  A way of refocusing is the serenity prayer: God grant me the serenity to accept the things I cannot change - the resistance, the courage to change the things I can - how I choose to respond, and the wisdom to know the difference.
Another way to refocus is to be mindful, and as well as using the serenity prayer, a metaphor can be used, or a combination of both: A camel was once asked which was the most important, going uphill or downhill. The camel replied "neither, it is the load that is the most important" - Idris Shah: The way of the Sufi.

9. Mood regulation, a different frame of mind can be flipped into by remotivating, say by putting on classical music, or softer lighting etc. The use of music, or another preferred activity, is referred to as a distraction technique.

Steps to straight thinking

I have been meditating on producing a General Problem Solver (GPS). I told a doctor in the Montpelier Health Centre in Bristol about twenty years ago that I had plans to produce a GPS.

The following General Problem solver is for reconstructing perception after a trauma or a crisis. I call it 'Rules for Refinement' (refinement as in Step-wise refinement in algorithms for computer programming).

Rules for Refinement
------------------------------------
1. Remember -> incident / trigger - start at an action and work backwards.

2. Regulation -> Affect Arousal Regulation - the affect is inherited from reacting to the environment. With Post-Traumatic Stress Disorder (PTSD) as an example, one is continually oscillating between keeping the deemed threat in abeyance, and reliving the trauma.

3. Rethink -> action required, for example, emotional identication, empathy, self-awareness, acceptance or meditation.

4. Regain -> mental poise / composure -> still the mind whatever you thought caused the scenario. Meditation or Reflection can still the mind.

5. Resistance -> have the grace not to offer resistance -> 'The Serenity prayer' - God grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference. Self-compassion is not resisting part of ourselves and not being self-prejudiced, but embracing even our darkside.

6. Refocus -> Resistance can be seen positively as an opportunity for growth and not distancing one from a source of help. With refocusing more helpful thoughts impact on behaviour (Cognitive Behavioural Therapy).

7. Reframe -> one can reframe / generalise / put the ball into a larger field by reflecting on -

a) You cant calm the storm, so keep calm and wait for it to pass.- Timber Hawkeye

b) Life is not the absence of conflict, it is how you deal with it.

c) Work with the moment, and not against it.- Eckhart Tolle

8. Rationalise -> somebody cannot have an emotion that will produce another emotion in somebody else which will cause them to Respond in a particular way. You only have power over your own mind, not outside events.- Marcus Aurelius.
One can Resolve their defences by seeing that a situation is not as threatening as their model of it believes it to be (R.D. Laing and Existential psychiatry).

The emotion is a response generated from a model in which the client takes no responsibility for experiences he could control (page 52. The structure of magic by Richard Bandler & John Grinder).

9. Responsibility -> Existentialism is a philosophy that emphasises the existence of the individual, who being free and responsible, is held to be what he makes himself by the self-development of his / her essence through acts of the will - The Oxford Popular English Dictionary.

10. Reading (optional) -> examples could include-
                          The outsider by Albert Camus
                          Crime passionnel by Jean-Paul Sartre
                          Knulp by Hermann Hesse
                          The painter in Pictor's metamorphosis by Hermann Hesse


10. Recognise -> recognise needs.

11. Retrieve -> by exercising memory - 'safe in the zone'.


12. Reparitive -> reparitive care - Safety net.

13. Reflexive knowledge -> from experience, psychiatry, counselling, safety net, etc.

14. Restitution -> If you feel guilty about some issue involving someone else, or if you feel you are contaminating people with your issues or difficulties, you can make amends. It may not be a good idea confronting someone with what the wrong is, you may experience rejection or it may be considered as harrassment, or invite indignation or ill will from someone. A preferred method could be to wait until someone is experiencing a difficulty and then provide or offer help.

15. Realignment -> lessen use of alcohol, drugs, food etc as a result of less stress.

16. Relive -> relive in a therapeutic context.

As a foot note, I gained a Red Cross first aid certificate living in Bristol. The Red Cross was set up by a Swiss business man after the battle of Solferino, to protect the wounded.