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Wellness Workshop: Self-Management of Psychiatric Symptoms

Mary Ellen Copeland, MS, MA

The following text presents a model of recovery that will be featured in a new video series with Mary Ellen Copeland and co-produced with The Mental Illness Education Project. The series, tentatively titled " Wellness Workshop: Self-Management of Psychiatric Symptoms", describes attitudes, strategies and tools for relieving psychiatric symptoms including a symptom monitoring and response system. The videos will be based on the on-going research of Mary Ellen Copeland and the recovery model she has developed from her findings.

Wellness Recovery Action Plan
A system for monitoring, reducing and eliminating uncomfortable or dangerous physical symptoms and emotional feelings
By Mary Ellen Copeland, MS, MA (reprinted with permission)
Published by Peach Press 1997
Mary Ellen Copeland is a distinguished teacher, writer, and lecturer from Brattleboro, Vermont. She is the author of numerous books including The Depression Workbook: A Guide to Living with Depression and Manic Depression, The Worry Control Workbook and Winning Against Relapse: A Workbook of Action Plans for Recurring Health and Emotional Problems.

The following reprinted text is from the Introduction to the book Wellness Recovery Action Plan, by Mary Ellen Copeland, MS, MA.

I've been working with people who experience mild to severe psychiatric symptoms, often exacerbated by a wide variety of physical ailments, as well as with people who experience chronic pain, for nine years.

This work is a result of my ongoing personal search for wellness and improvement in the quality of my life in spite of being diagnosed with manic depression, major depression, fibromyalgia and chronic myofascial pain syndrome.

Twelve years ago many years of high achievement and life enjoyment turned into confusion, frustration and pain. I was unhappy with this unanticipated turn of events. I wanted my life back, to work and to play, to enjoy my family and friends.

My attempts to find out how people with these kinds of disorders cope on a day-to-day basis only served to increase my frustration. My psychiatrist first promised me this information, then told me that none existed. My "medical" doctor tried valiantly to convince me that the severe pain and other mysterious symptoms that were physically disabling me were "all in my head."

My persistence in searching for answers and compiling my findings for my own use, and for use by others, has led me on a rich and rewarding journey that has confirmed and affirmed my belief in the richness of the human experience. From publishing houses to major medical centers, from the backwoods of Alaska to the back wards of psychiatric hospitals, I have been privileged to be invited into the lives of people whose courage and persistence continue to impress and inspire me.

Through this process of networking recovery information, I have uncovered ideas and strategies that, while often very simple and very safe, have the capacity to create major life change. I continue to search for these strategies, share them with others, and now I am teaching others to be mental health educators.

A group I was working with in Bradford, Vermont complained that the wellness process was all too confusing. Through their prodding and hard work, and the efforts of a very skilled mental health worker, we have come up with a system that people are finding works for them.

This system has been so enthusiastically received that I decided to publish and distribute it so that it would be widely available. While I specifically developed it to be used by people who experience psychiatric symptoms, people with all kinds of health conditions, and even some who have no significant complaints but want to stay healthy, have found this system to be valuable.

I use it consistently myself. It works very well for me. When things are starting to "go down the drain," my partner says, "Where's the blue book?"

Overall Description
The Wellness Recovery Action Program is a structured system for monitoring uncomfortable and distressing symptoms and, through planned responses, reducing, modifying or eliminating those symptoms. It also includes plans for responses from others when your symptoms have made it impossible for you to continue to make decisions, take care of yourself and keep yourself safe. Anecdotal reporting from people who are using this system indicates that, by helping them to feel prepared, it is working for them by helping them to feel better more often and by improving the overall quality of their life.

This system was developed by people who have been dealing with a variety of psychiatric symptoms for many years and are working hard to feel better and get on with their lives. I have shared it with people with other illnesses and they feel that it can be easily adapted for use with other disorders.

Using a three ring binder, a set of tabs or dividers, and lined three-ring paper, a five-part system is developed by the person who experiences the symptoms. This person may be assisted in this process by the supporters and health care professionals of their choice.

Section 1 is a Daily Maintenance Plan. Part 1 is a description of how you feel when you feel well. Part 2 is a list of everything you need to do every day to maintain your wellness. Part 3 is a list of things you might need to consider doing that day.

Section 2 deals with triggers. Part 1 identifies those events or situations which, if they occur, might cause uncomfortable symptoms to begin. Part 2 is a plan of "what to do" if any of these triggers occur.

Section 3 deals with early warning signs. Part 1 involves identification of those subtle signs that may indicate the situation is beginning to worsen. Part 2 is a plan of "what to do" if any of these early warning signs are noticed.

Section 4 deals with symptoms that occur when the situation has gotten much worse but has not yet reached a crisis, where you can still take action in your own behalf. Part 2 is a plan of "what to do" if any of these symptoms occur.

Section 5 is multifaceted. It identifies those symptoms that indicate you can no longer continue to make decisions, take care of yourself and keep yourself safe. It is for use by supporters and health care professionals on your behalf as the person who developed the plan. Part 1 is information that defines what you are like when you are well. Part 2 identifies those symptoms that indicate others need to take over responsibility for your care. Part 3 names those supporters and identifies their roles. Part 4 identifies those medications which, if necessary, are alright with you, those which are not, and the reasons why. Part 5 gives you the option of developing a home, community care or respite center plan to use in lieu of hospitalization. Part 6 identifies the treatment facilities which, if necessary, are alright with you, those which are not, and the reasons why. Part 7 identifies the treatments which, if necessary, are alright with you, those which are not, and the reasons why. Part 8 is an intensive description of what is wanted from supporters - and what is not wanted - when symptoms become this intense. Part 9 gives information for supporters to use in determining when you no longer need to use you crisis plan.

Through my ongoing work I have discovered particular tools and strategies that are helpful in reducing symptoms. I have included brief descriptions at the end of the book of the ones that are most commonly used. After each description is a list of resources that you can refer to for further information. You can also refer to my books, The Depression Workbook: A Guide to Living With Depression and Manic Depression, and Living Without Depression and Manic Depression: A Guide to Maintaining Mood Stability, and the book I co-authored with Dr. Devin Starlanyl, Fibromayalgia and Chronic Myofascial Pain Syndrome: A Survival Manual.

Who Could Use This Plan?
The answer to the question who could use this "plan" is simple. This plan could be used by anyone who wants to create positive change in the way they feel, or increase their enjoyment of life. It may mean they want to effectively manage certain aspects of their lives to decrease the intensity of physical or psychological pain - anything from depression to arthritis, from panic attacks to diabetes - or increase their level of wellness. It may mean they want to decrease the occurrence rate of acute episodes of an illness such as bipolar disorder, asthma or fibromyalgia. I have described this plan at workshops and conferences and the response is always the same. "This is something I can do for myself, something that will work."

The following example will help you be aware of how this plan can help when trying to avoid, or addressing a condition that seems to be rampant in our fast paced society. It is aptly called "burn-out" and it is caused by working too hard or under too much stress without taking time to take care of yourself. "Burn-out", if not addressed will interfere with day to day functioning, and might even cause a serious illness.

The symptoms of "burn out" often mimic a physical or psychological disorder. They include:
  • irritability
  • disturbed sleep
  • increased anxiety
  • poor memory
  • feeling "spaced out"
  • feeling like a failure at everything
  • feeling overwhelmed
  • feeling emotionally disconnected to things
    that have meaning in life
  • decreased ability to make decisions
  • racing thoughts
  • anger
  • edginess
  • nothing seems worthwhile
  • feeling helpless, hopeless and worthless

As you think about your symptoms, you may realize you are becoming "burned out" or are already "burned out". Then you would develop your book to address "burn out".

Unfortunately, many people respond to "burn out" by trying harder at everything, a strategy that is bound to fail. Your plans of what you need to do for yourself might include:
  • stopping or decreasing the amount of time
    spent dealing with work and other responsibilities
  • rest
  • talking and crying time (see peer counseling in the Appendix)
  • a variety of creative activities (see creative activities in the Appendix)
  • avoidance of activities that increase stress
  • giving yourself permission to say "no".

If you follow your plans, you will notice that the feelings that indicated you are "burned out" will begin to abate. If they don't, you may need to change your plans, work with a section toward the back of your book that includes more direction, or see a health care professional.

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