PTSD and me part 4: post therapy

Editorial comment: this blog bring us up to date on a story we have covered over the last few years here on the blog. Rusty covers the eighteen months post therapy and presents a personal account of that journey.  The aim of these blogs continues to be to inform the wider healthcare community about PTSD, the objective to help reduce the stigma associated with the diagnosis.  As Rusty says ‘If just one person seeks help as a result of reading these words, then my goal is fulfilled’.

The post therapy journey

In previous blogs I have discussed my personal journey with PTSD and how you might recognise it in yourself or others.  Most latterly, the psycho-therapy that I undertook was discussed: EMDR.  That was eighteen months ago, so what has happened since therapy completed and I was no longer in active therapy?  It was certainly not the end of the road to improved wellbeing1.

Editor: If you’ve not read Rusty’s previous pieces then now may be a good time to do so.

Let’s have the backstory’s précis: it is a journey from the suicidal, clinically depressed, dysfunctional ball of rage to being back in clinical practice, successful completion of a triathlon and a new approach to balancing the meaning gained from professional life. 

I believe these differences came about through an untold number of small choices, all empowered by the psychotherapy and framed through a single main goal: increasing wellbeing.  From this point, all choices were framed as: “will doing this increase my wellbeing or not?”.  If the answer was yes, then I could do it.  Sounds simple, living it has required discipline as well as the acceptance of the inevitably mixed results.  Another way to frame this question might be to ask: “will doing this service my needs as described by Maslow?” 2, 3.  Wellbeing may not fit well into the hierarchy for some, it is necessary to identify the things that have a positive impact on your energy and joy, and those that drain you.

What sort of decisions are we talking about here?  All of them.  Nutrition, sleep hygiene, exercise scheduling, prioritisation (should have put that one first), use of smart devices as well as social media and even what pen to use.  One of the key steps was to accept that returning to the same clinical environment and full time hours might not be the best initial approach.  That had both ego and financial implications.

It’s action time

Post psychotherapy, the main priority at home and at work became improving physical health.  The comfort eating, fatigue and inactivity whilst ill had compromised my physical health.  Starting slowly, applying the principle of eat less, move more, first nutrition was improved in quality and reduced in quantity, then exercise endurance and strength was gradually built up.  Looking back, the key seems to have been maintaining the consistency of undertaking the two pronged strategy of impacting both eating and exercise.   

Having enough of a pattern and structure to do the exercise regularly, but not getting into a rut and risking over-use injuries was a tip picked up earlier on in life that I was happy to put into practice now.  Varying the exercise workouts as much as possible in order to maintain interest and also continue to challenge the body to adapt.  So, not just the same run, not just running, and some weeks no running at all.  There were, of course, exceptions to this “constantly varied” approach.  There was only one time in the week that a yoga class was available, and the Friday morning squad swimming session acted as an anchor for much of the rest of the week to revolve around.  That swim session was just too good, too hard and too much fun to miss.  Don’t get dogmatic about this stuff.  Well, about anything really.

More than exercise

Once eating better and exercising more became ingrained into daily life, the next step was to address my relationship with work.  There is, perhaps, no better indication of how this was previously out of balance by looking at my Twitter handle: @paramedrusty.  The profession reference coming before the (work based nick-) name.  Looking back now, it seems blindingly obvious, but one of the reasons those failed resuscitations put me into acute and then chronic stress reactions was that I was too wrapped up, too invested in professional successes and failures.  I viewed myself to fully through the prism of professional performance and thus, too much of me was invested in outcomes.  When the inevitable failures occurred, I was shaken to the very core.

The work to develop the optimal relationship with my work and professional identity remains a work in progress.  Invest too little and the caring, compassionate clinician working diligently for the best patient outcomes is at risk of disappearing.  Invest too much and risk the inevitable rollercoaster impact on wellbeing.  This is my new definition of work-life balance: not measured in minutes and hours but in level of personal investment.

We all have to find our own balance here.  I have chosen to do it in an environment where I am supported, have senior advice on hand and can find a new future in clinical practice.  To enter that environment has cost me in some ways, but is paying dividends.

What was that about a pen?

Earlier in this blog there was mention of choice of pen.  I few months ago I came across an old fountain pen and even some cartridges of ink.  I looked at the pen and asked the one question: will using this pen increase my wellbeing?  Will using this pen require me to slow down a little, pay more attention to what I am doing, to focus upon the task at hand?  Oh yes, it will.  Not focussing whilst using an old fountain pen can get messy.  So, I use it.  Not all the time, but often enough that I increase the habit of focussing on one thing at a time.  The pen is a tangible, regular reminder of the need to continue to make good choices.

The pen is just an example of one of the myriad of daily choices that is made with this frame that each contribute to increasing wellbeing.  It is the exact opposite of the insidious decline caused by repeated exposure to psychological trauma and ineffectively managing the subsequent stress response.  Whether you feel well or, not, I commend this approach to you.  Your journey to increased wellbeing starts with your next choice.

Eighteen months post therapy, I continue to grow in wellbeing.  I regularly make choices based solely on their impact on wellbeing.  That is where I am today.  My exploration of wellbeing on a personal level will continue as will my objective of increasing my understanding of what science sits underneath any of this.  I hope you will continue to join me on that journey.

Yours

R

@paramedrusty

Rusty Carroll PgC, DipIMC (RCS Ed), MCoP is a paramedic working in primary care in Manchester and a trainee Advanced Clinical Practitioner. He is on twitter as @paramedrusty.

References

1. NHS. Five steps to mental wellbeing.https://www.nhs.uk/conditions/stress-anxiety-depression/improve-mental-wellbeing/. Published 2016. Accessed 11 October 2018.

2. Maslow, A. H. (1970). Religions, values, and peak experiences. New York: Penguin.

3. Simply Psychology. Maslow’s Hierarchy of Needs. https://www.simplypsychology.org/maslow.html. Published 2018. Accessed 11 October 2018

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Posted by Rusty Carroll

Rusty Carroll PgC, DipIMC (RCS Ed), MCoP is a paramedic working in primary care in Manchester and a trainee Advanced Clinical Practitioner. You can find him on twitter as @paramedrusty.

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