My Mental Health Journey Through an Intensive Outpatient Program – Part 9

After two days off, I was back to my intensive outpatient program (IOP) this morning. I was about ten minutes early, but I wasn’t the first to arrive. Two people were there ahead of me. I did beat the clinician, though, so the day started on my phone. I keep thinking I should try talking to some of the group members during breaks and stuff, but I’m no good at that kind of thing.

When the clinician arrived, I took my sign in sheet and filled it out. Then we started check-ins. I went second today. It was a short check-in. I talked about not getting a good night’s sleep, mostly because of the Superbowl. It was apparently the seventh longest NFL game in history. I also talked about the family gathering we had on Saturday. I then talked about the suicidal ideations still being there but being less intense. It was a lot like Friday’s check-in.

We had two topics today. The first was Signs of Danger vs. Safety. That started with a list of red flags and green flags. Red flags are the signs of danger and green flags are signs of safety. The worksheet wanted us to check off all the ones that we experience. Instead, we went down the list as a group and talked about each one. The red flags that resonated with me, for which I had something to add to the conversation, were isolation, feeling stuck, passivity, becoming physically sick, absent from work/school, and not enjoying things.

We then talked about which of those red flags indicate mild danger, moderate danger, or serious danger and what we would do to stay safe in each case. I said feeling stuck was mild danger, isolation/low motivation was moderate danger, and intrusive thoughts was serious danger. For the mild danger, I want to try positive self talk. For moderate, being around people and opposite action. And for serious, I will avoid my triggers and talk to my therapist.

The third part of Danger vs. Safety was things to remember about red and green flags. Remember that red flags are messages of distress. Remember that these build. They don’t start at the crisis point. Remember that help from others is essential. Remember to listen to the whispers before they become screams. Remember that as danger increases, we are more likely to act out rather than talk. And remember to notice spiraling.

After danger and safety, we talked about distress tolerance. This was broken into three parts, too. The first was radical acceptance. That’s pretty much what it sounds like, accepting situations and things that cannot be changed. The key thing to remember is that acceptance doesn’t mean liking or condoning. It is just accepting.

Next was self-soothing. This is basically finding pleasurable ways to engage with the world. Going for a walk, listening to music, take a warm bath, have a treat, or smell some flowers. I’m no good at self-soothing. It could be because one of my red flags is failing to find pleasure in pleasurable activities. Who knows?

We ended the day talking about distraction as a strategy. We learned the acronym ACCEPTS: Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts, and Sensations. Activities is just doing things that engage your mind. Contributing is helping others, volunteering, and such. Comparisons is remembering a time where things were worse. Emotions is doing something that will trigger a competing emotion like watching a funny movie or something. Pushing away is a brute force, push the thoughts out of you head strategy. It doesn’t work for me at all. Thoughts is putting thoughts before whatever emotions you’re feeling. And sensations is finding physical sensations that distract you from whatever is distressing.

So, that was today. We covered a lot. It’s supposed to snow tonight and tomorrow. We’ll see what that does to tomorrow’s session.

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