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Topics - movementforthebetter

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1
Employment / Downsizing Worklife
« on: February 14, 2019, 05:24:28 AM »
I'm going in tomorrow to get a temp job. I don't want to go broke while not working, but in my heart I know I'm not ready to work yet. I just don't have much choice, and my SO is leaning on me hard to return to work.

I'm looking for the unicorn job that won't stress me out and won't have office politics. I don't know if I will ever find that. So I'll temp for minimum for as long as I can stand it.

Nearly everything about work environments trigger me, either with sleep disturbances and anxiety, or all the way to dissociation and crying spells. The whole experience is too much for me to process day-in, day-out. No one on the outside sees it that way, though.

Tomorrow I will have to tell the recruiter that I don't want a job that suits my résumé, without saying why. That scares me. Other people's unending and unjustified expectations scare me.

2
Recovery Journals / Holding Space for Me, Myself, and I
« on: January 21, 2019, 04:26:20 AM »
I am journaling again.

Life was bumpy for the first month and a half after the big move cross-country. But things are mostly settling down now, so it's time to start looking forward again. In hindsight I'll probably hardly remember all but a few key points of the last weeks, so no need to document it all here.

I have been applying for jobs, mainly at the urging of my S. O. He thinks routine will do me well. It's true that I have a tough time with unemployment. But I applied for several jobs in my field and have come to the conclusion I can't handle a serious job currently. He is very supportive but I know he also wants me to have an income and not just live off savings. I don't want to run out of money, either.

I have lingering trauma from my last job. Seeking, applying, and getting 1 interview and 1 short-term offer lead to days of work nightmares, constant anxiety, and some physical symptoms for me. I've realized I need to scale it all back. I'm looking for a very basic part or full-time job close to home. No more commuting over 30 min. No more taking responsibility for things I can't control. My boundary bubble begins and ends with me for the foreseeable future. No taking on extra. No trying to live up to my "potential", which is really the expectations of others.

I look generally healthy at first glance, but I am not. I'm going to appear selfish and confusing to others but I can't help what they think when they barely know me. I still need to find a Dr here, and a therapist. Unexpected circumstances mean that I have been pressured back to work before I am ready, but I will hold firm on how much of my life work can dominate now.

This means I will only make minimum wage most likely, but there will be two incomes now, so life doesn't feel so dire when I look at it objectively.

I am holding space in my life for my own wellness, which is an ongoing journey.

3
Sleep Issues / Who's Getting Better Sleep?
« on: December 30, 2018, 10:07:07 AM »
I'm curious if anyone has found their sleep patterns or quality of restful sleeps have improved over time?

If so, would you say this is due more to processing trauma, or to lifestyle changes?

You are not doctors, but I'd like to hear your experiences on catching more of those elusive Zs.

4
This one could almost be cross-posted to the sleep disturbances section. Sometimes it's nightmares I can identify as a cause, but usually not.

Has anyone else experienced anxiety/Panic Attacks that start during sleep or immediately upon waking? If so, have you successfully reduced their frequency or intensity at all? How? Is this a normal reaction to prolonged stress or part of the healing/processing journey?

It seems like these are coming up when I'm at my most vulnerable, and I have the least conscious control of my thoughts and reactions to them. It makes one of the hardest impacts on my quality of life. They have the power to ruin a day before it even begins. Any tips or insights are appreciated.

5
Sexual Abuse / TW - is this CSA, or something else?
« on: June 11, 2018, 10:10:02 AM »
Trigger warning for CSA in this post.

I still struggle with the fact that I was molested by a babysitter because I was curious at the time it happened. I get consent and that children can't legally give it. But in my heart I still struggle to call it what it is. Cognitive brain and emotional brain aren't on the same page here.

This weekend some things occurred to me. 1. The babysitter took advantage of my curiosity. 2. Something happened earlier that may have sparked this curiosity - or are most children sexually curious at a young age? I don't know.

The thing that happened was finding pornography when I was 5. I wanted to understand what I was seeing, so I asked about it. This sparked a huge fight between my parents, so that scarred me. But then also having it forbidden and never explained was problematic.

I believe that having pornography somewhere a child can find it is negligence. But could it also be a form of CSA because the child (in this case me) that finds it is exposed to graphic sexual content?

Thanks for reading.

6
A long post, but worthwhile for those who wish to access hard data. Moderators, please feel free to contact me if I should edit the post or break it up to better comply with standard forum guidelines. I placed this here as it's not specifically about C-PTSD, but about the treatment of Major Depressive Disorder by many different medications.

A new study, combing through vast amounts of clinical trial data,  published in The Lancet, has confirmed the effectiveness of antidepressants in treating depression.

My own opinion is that antidepressants are most effective in combination with other non-drug therapies. But much better than nothing, if medication is all that the person can access, for whatever reason. C-PTSD is more complex than major depression. I would argue that major depression is one of the symptoms of C-PTSD and other serious conditions. I am not a doctor, just someone who prefers scientific evidence in my treatment journey. I believe this information will be beneficial to many people,which is why I am sharing it here.

Brief excerpt:

"We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine."



Full text:

"Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis.

Background
Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to compare and rank antidepressants for the acute treatment of adults with unipolar major depressive disorder.

Methods
We did a systematic review and network meta-analysis. We searched Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, the websites of regulatory agencies, and international registers for published and unpublished, double-blind, randomised controlled trials from their inception to Jan 8, 2016. We included placebo-controlled and head-to-head trials of 21 antidepressants used for the acute treatment of adults (≥18 years old and of both sexes) with major depressive disorder diagnosed according to standard operationalised criteria. We excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness. We extracted data following a predefined hierarchy. In network meta-analysis, we used group-level data. We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. Primary outcomes were efficacy (response rate) and acceptability (treatment discontinuations due to any cause). We estimated summary odds ratios (ORs) using pairwise and network meta-analysis with random effects. This study is registered with PROSPERO, number CRD42012002291.

Findings
We identified 28 552 citations and of these included 522 trials comprising 116 477 participants. In terms of efficacy, all antidepressants were more effective than placebo, with ORs ranging between 2·13 (95% credible interval [CrI] 1·89–2·41) for amitriptyline and 1·37 (1·16–1·63) for reboxetine. For acceptability, only agomelatine (OR 0·84, 95% CrI 0·72–0·97) and fluoxetine (0·88, 0·80–0·96) were associated with fewer dropouts than placebo, whereas clomipramine was worse than placebo (1·30, 1·01–1·68). When all trials were considered, differences in ORs between antidepressants ranged from 1·15 to 1·55 for efficacy and from 0·64 to 0·83 for acceptability, with wide CrIs on most of the comparative analyses. In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84). For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30–2·32). 46 (9%) of 522 trials were rated as high risk of bias, 380 (73%) trials as moderate, and 96 (18%) as low; and the certainty of evidence was moderate to very low.

Interpretation
All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the analysis, whereas there was more variability in efficacy and acceptability in head-to-head trials. These results should serve evidence-based practice and inform patients, physicians, guideline developers, and policy makers on the relative merits of the different antidepressants.

Funding
National Institute for Health Research Oxford Health Biomedical Research Centre and the Japan Society for the Promotion of Science.

Research in context

Evidence before this study


Antidepressants are routinely used worldwide for the treatment of major depressive disorder, which is one of the most important global health challenges; however, in the scientific literature, there remains considerable debate about both their effectiveness as a group, and the potential differences in effectiveness and tolerability between individual drugs. With the marketing of new antidepressants and increasing numbers of trials published every year, an updated systematic review and network meta-analysis was required to synthesise the evidence in this important clinical area.

Added value of this study

This network meta-analysis represents a major update and extension of our previous study, which addressed 12 antidepressants with data for head-to-head comparisons only, and provides the best currently available evidence base to guide the choice about pharmacological treatment for adults with acute major depressive disorder. We now include a more comprehensive list of 21 antidepressants and placebo, consider three new clinical outcome measures and many potential effect modifiers, and use the most advanced statistical methodology for network meta-analysis to date.

Implications of all the available evidence

Our findings should inform clinical guidelines and assist the shared decision making process between patients, carers, and clinicians in routine practice on selecting the most appropriate antidepressant for adults with acute major depressive disorder. Future research should seek to extend network meta-analysis to combine aggregate and individual-patient data from trials in a so-called individual-patient data network meta-analysis. This analysis will allow the prediction of personalised clinical outcomes, such as early response or specific side-effects, and the estimate of comparative efficacy at multiple timepoints.

Introduction
Psychiatric disorders account for 22·8% of the global burden of diseases.1 The leading cause of this disability is depression, which has substantially increased since 1990, largely driven by population growth and ageing.2 With an estimated 350 million people affected globally, the economic burden of depressive disorders in the USA alone has been estimated to be more than US$210 billion, with approximately 45% attributable to direct costs, 5% to suicide-related costs, and 50% to workplace costs.3 This trend poses a substantial challenge for health systems in both developed and developing countries, with the need to treat patients, optimise resources, and improve overall health care in mental health.

Grouped into various classes of drugs with slightly different mechanisms of action, antidepressants are widely used treatments for major depressive disorder, which are available worldwide. However, there is a long-lasting debate and concern about their efficacy and effectiveness, because short-term benefits are, on average, modest; and because long-term balance of benefits and harms is often understudied.4 Therefore, innovation in psychopharmacology is of crucial importance, but the identification of new molecular targets is difficult, primarily because of the paucity of knowledge about how antidepressants work.5 In routine practice, clinicians have a wide choice of individual drugs and they need good evidence to make the best choice for each individual patient. Network meta-analyses of existing datasets make it possible to estimate comparative efficacy, summarise and interpret the wider picture of the evidence base, and to understand the relative merits of the multiple interventions.6 Therefore, in this study, we aimed to do a systematic review and network meta-analysis to inform clinical practice by comparing different antidepressants for the acute treatment of adults with unipolar major depressive disorder.

Methods
Search strategy and selection criteria
We did a systematic review and network meta-analysis. We searched the Cochrane Central Register of Controlled Trials, CINAHL, Embase, LILACS database, MEDLINE, MEDLINE In-Process, PsycINFO, AMED, the UK National Research Register, and PSYNDEX from the date of their inception to Jan 8, 2016, with no language restrictions. We used the search terms “depress*” OR “dysthymi*” OR “adjustment disorder*” OR “mood disorder*” OR “affective disorder” OR “affective symptoms” combined with a list of all included antidepressants.

We included double-blind, randomised controlled trials (RCTs) comparing antidepressants with placebo or another active antidepressant as oral monotherapy for the acute treatment of adults (≥18 years old and of both sexes) with a primary diagnosis of major depressive disorder according to standard operationalised diagnostic criteria (Feighner criteria, Research Diagnostic Criteria, DSM-III, DSM-III-R, DSM-IV, DSM-5, and ICD-10). We considered only double-blind trials because we included placebo in the network meta-analysis, and because this study design increases methodological rigour by minimising performance and ascertainment biases.7 Additionally, we included all second-generation antidepressants approved by the regulatory agencies in the USA, Europe, or Japan: agomelatine, bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, venlafaxine, vilazodone, and vortioxetine. To inform clinical practice globally, we selected the two tricyclics (amitriptyline and clomipramine) included in the WHO Model List of Essential Medicines). We also included trazodone and nefazodone, because of their distinct effect and tolerability profiles. Additionally, we included trials that allowed rescue medications so long as they were equally provided among the randomised groups. We included data only for drugs within the therapeutic range (appendix pp 133, 134). Finally, we excluded quasi-randomised trials and trials that were incomplete or included 20% or more of participants with bipolar disorder, psychotic depression, or treatment-resistant depression; or patients with a serious concomitant medical illness.

The electronic database searches were supplemented with manual searches for published, unpublished, and ongoing RCTs in international trial registers, websites of drug approval agencies, and key scientific journals in the field.8 For example, we searched ClinicalTrials.gov using the search term “major depressive disorder” combined with a list of all included antidepressants. We contacted all the pharmaceutical companies marketing antidepressants and asked for supplemental unpublished information about both premarketing and post-marketing studies, with a specific focus on second-generation antidepressants. We also contacted study authors and drug manufacturers to supplement incomplete reports of the original papers or provide data for unpublished studies.

Six pairs of investigators (ACi, TAF, LZA, SL, HGR, YO, NT, YH, EHT, HI, KS, and AT) independently selected the studies, reviewed the main reports and supplementary materials, extracted the relevant information from the included trials, and assessed the risk of bias. Any discrepancies were resolved by consensus and arbitration by a panel of investigators within the review team (ACi, TAF, LZA, EHT, and JRG).

The full protocol of this network meta-analysis has been published.8

Outcomes
Our primary outcomes were efficacy (response rate measured by the total number of patients who had a reduction of ≥50% of the total score on a standardised observer-rating scale for depression) and acceptability (treatment discontinuation measured by the proportion of patients who withdrew for any reason).8 All-cause discontinuation was used as a measure for the acceptability of treatments, because it encompasses efficacy and tolerability.9 Secondary outcomes were endpoint depression score, remission rate, and the proportion of patients who dropped out early because of adverse events. When depressive symptoms had been measured with more than one standardised rating scale, we used a predefined hierarchy, based on psychometric properties and consistency of use across included trials.8 In the absence of information or supplemental data from the authors, response rate was calculated according to a validated imputation method.10 We recorded the outcomes as close to 8 weeks as possible for all analyses.9 If information at 8 weeks was not available, we used data ranging between 4 and 12 weeks (we gave preference to the timepoint closest to 8 weeks; if equidistant, we took the longer outcome). We checked trial protocols where available and compared published with unpublished data. We extracted data following a predefined hierarchy described in our protocol and gave priority to unpublished information in case of disagreement.8

Data analysis
For studies published more than once (ie, duplicates), we included only the report with the most informative and complete data. Full details of the applied statistical approaches are provided in the protocol.8 We estimated summary odds ratios (ORs) for dichotomous outcomes and standardised mean differences (SMD, Cohen's d) for continuous outcomes using pairwise and network meta-analysis. In network meta-analysis, we used group-level data; the binomial likelihood was used for dichotomous outcomes and the normal likelihood for continuous outcomes. The study effect sizes were then synthesised using a random-effects network meta-analysis model. We accounted for the correlations induced by multi-group studies by using multivariate distributions. The variance in the random-effects distribution (heterogeneity variance) was considered to measure the extent of across-study and within-comparison variability on treatment effects. Additionally, in network meta-analysis, we assumed that the amount of heterogeneity was the same for all treatment comparisons. To assess the amount of heterogeneity, we compared the posterior distribution of the estimated heterogeneity variance with its predictive distribution.11 To rank the treatments for each outcome, we used the surface under the cumulative ranking curve (SUCRA) and the mean ranks.12 The transitivity assumption underlying network meta-analysis was evaluated by comparing the distribution of clinical and methodological variables that could act as effect modifiers across treatment comparisons.8 We did a statistical evaluation of consistency (ie, the agreement between direct and indirect evidence) using the design-by-treatment test13 and by separating direct evidence from indirect evidence.14

We assessed the studies' risk of bias in accordance to the Cochrane Handbook for Systematic Reviews of Interventions. Additionally, we assessed the certainty of evidence contributing to network estimates of the main outcomes with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.15

We evaluated whether treatment effects for the two primary outcomes were robust in subgroup analyses and network meta-regression using study year, sponsorship, depressive severity at baseline, dosing schedule, study precision (ie, small study effect), and novelty effect.16 The appendix (pp 133–36) summarises the definition of covariates. The sensitivity of our conclusions was evaluated by analysing the dataset with the following restrictions: studies with reported response rate, studies using accepted doses in all groups, studies with unpublished data, multi-centre studies, and head-to-head studies. We used comparison-adjusted funnel plots to investigate whether results in imprecise trials differ from those in more precise trials.17

We fitted all models in OpenBUGS (version 3.2.2)18 using the binomial likelihood for dichotomous outcomes, uninformative prior distributions for the treatment effects, and a minimally informative prior distribution for the common heterogeneity SD. We assumed uninformative priors—ie, N(0,1000)—for all meta-regression coefficients. Convergence of models was ensured by visual inspection of three chains and after considering the Brooks–Gelman–Rubin diagnostic. The codes of analyses, statistical details of the meta-analysis, and meta-regression models are presented in the appendix (pp 182, 183). Statistical evaluation of inconsistency and production of network graphs and result figures were done using the network and network graphs packages in Stata (version 14.2).19 Network meta-analyses of the primary outcomes were duplicated using the netmeta 0.9-6 package in R (version 3.4.0).20 The appendix (p 289) lists the changes to the original protocol. The study was done from March 12, 2012, to June 4, 2016, and data analysis was done from June 5, 2016, to Sept 18, 2017.

This study is registered with PROSPERO, number CRD42012002291.

Data sharing
With the publication of this Article, the full dataset will be freely available online in Mendeley Data, a secure online repository for research data, which allows archiving of any file type and assigns a permanent and unique digital object identifier (DOI) so that the files can be easily referenced (DOI:10.17632/83rthbp8ys.2).

Role of the funding source
The funder of this study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit for publication. ACi, TAF, GS, ACh, LZA, and YO had full access to all the data, and ACi was responsible for the decision to submit for publication.

Results
28 552 citations were identified by the search and 680 potentially eligible articles were retrieved in full text (figure 1). We included 421 trials from the database search, 86 unpublished studies from trial registries and pharmaceutical company websites, and 15 from personal communication or hand-searching other review articles. Overall, 522 double-blind, parallel, RCTs (comprising 116 477 patients) done between 1979 and 2016, and comparing 21 antidepressants or placebo were included in the analysis (appendix pp 6–64). The appendix (pp 65–114) summarises the characteristics of included studies. The mean study sample size was 224 participants (SD 186). In total, 87 052 participants were randomly assigned to an active drug and 29 425 were randomly assigned to placebo. The mean age was 44 years (SD 9) for both men and women; 38 404 (62·3%) of 61 681 of the sample population were women. The median duration of the acute treatment was 8 weeks (IQR 6–8). 243 (47%) of 522 studies randomly assigned participants to three or more groups, and 304 (58%) of 522 were placebo-controlled trials. 391 (83%) of 472 were multi-centre studies and 335 (77%) of 437 studies recruited outpatients only. 252 (48%) of 522 trials recruited patients from North America, 37 (7%) from Asia, and 140 (27%) from Europe (59 [11%] trials were cross-continental and the remaining 34 [7%] were either from other regions or did not specify). The great majority of patients had moderate-to-severe major depressive disorder, with a mean reported baseline severity score on the Hamilton Depression Rating Scale 17-item of 25·7 (SD 3·97) among 464 (89%) of 522 studies. Response rate was imputed in 20 608 (17·7%) of 116 447 cases. Rescue medications (typically benzodiazepines or other sedative hypnotics) were allowed in 187 (36%) of 522 studies. 409 (78%) of 522 studies were funded by pharmaceutical companies. We retrieved unpublished information for 274 (52%) of the included trials. Consistent with the study protocol, the primary analysis was based on the 474 studies (comprising 106 966 patients) that used drugs within the licensed dose range (ie, the dosage approved by the regulatory agencies in the USA and Europe; appendix pp 133, 134)


Figure 1 [viewable at source website]
Study selection process

RCTs=randomised controlled trials. *Industry websites, contact with authors, and trial registries. The total number of unpublished records is the total number of results for each drug and on each unpublished database source. †522 RCTs corresponded to 814 treatment groups."

Source: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/abstract

7
General Discussion / Should I Find A New Therapist?
« on: February 26, 2018, 03:22:03 AM »
(If one is asking, the answer is probably "yes")


I "have" a therapist who's on leave for a year or so. I have been without a therapist for 5 months.

I have a Dr that refills my med scrips and little else.

Thought I'd try and save money while my T was away. I've got issues that I've been pushing aside and that's impacting other areas of my life. I haven't listened to my voicemails since the summer. I haven't done dishes in weeks, since I got back from my work trip. I'm not cleaning my place; am lethargic in general. Not exercising at all.  These things gnaw at my self-worth. I'm not sure what the root is per se, just that I'm going through a long, quiet, self-destructive slow spiral and can't pull up on my own.

My therapist has helped me a lot. I feel like I need a team of therapists if I'm ever going to get "better".

And yet, I have had a number of bad experiences with people, so it's hard for me to trust.  So my relationship with my therapist feels somewhat irreplaceable. I've been holding out for things to get better. I try to tell myself hopeful things to motivate myself, but they're just empty words.

Anyone have any validation/advice?

8
General Discussion / Question RE: Dissociation and EFs
« on: October 12, 2017, 02:46:44 AM »
Can dissociation and an emotional flashback happen concurrently?

I'd been feeling exhausted and disconnected and depressed today. I've only just figured out why. Today it was due to life changes, uncertainty and lack of control while waiting to take my next steps. I think the causes vary but are often around those themes.

How would I know if I'm experiencing a freeze-response EF, or Dissociation, or both? If anyone has any experience I'd like to know.

Thanks.

9
Recovery Journals / Each Day A Blank Page
« on: October 03, 2017, 05:18:19 AM »
This post will contain triggers for violence, and some deep emotional exploration.

I thought I wouldn't write again so soon. But I am too sensitive to the world. And lucky me, my sensitivity is multiplied by a particularly heavy period which has left me feeling sick the last 3 days.

Current events, societal and political, have got me down. There was an attack on innocent people in the pub district of my hometown this weekend, which many are making about race. It's not to say the attack wasn't bad, it was.  But people jump on any chance they can to validate their ignorant redneck views and false assumptions. The attacker had dark skin so he must be a "terrorist". A fire fed to exploding by the police themselves. Disgusting, and one of many, many reasons I Ieft that city.

Then waking up to the Vegas attack this morning. Not since Sandy Hook have I felt such utter futility in the face of the destructive power of insanity. And of course the shooter is a white man, because 99% of them are. But he's a "lone wolf", not a terrorist though almost 60 died by his hand? It makes me nauseous. 

And then the topper is the reporting mess surrounding Tom Petty. I was just reading a news story talking about his music this morning. I got busy at work, took late lunch, checked Facebook and boom, it was everywhere that he had died. Except he hasn't yet, as later corrected. But all night I've been waiting for the news... Looking for something concrete one way or another. Singing his songs in my head.

I had recently decided to give up on a car for now. I can't afford it. I was scraping to make rent, and getting further and further in debt. I think I made an adult decision.

But I had to tell my folks why I wasn't going to be there for thanksgiving. It was a big mistake on my part, saying I would go when I don't have it in me. So I told them, and about what living is like for my generation in general, and for me more specifically. My M said she'd send some money.

I told her multiple times she didn't have to but she insisted. And tonight I got it, and it's a considerable amount. I started sobbing when I saw it. It helps hugely. Yes, I appreciate it and need it. But I do not want it, and feel shame in accepting.

This is how she shows love. I think she means well. She says she loves me. I basically believe that. But I don't feel it in my core. And it was never the love I needed or wanted.

There is a deep emptiness inside me that I am rarely aware of. Tonight, I am. I love, and I am loved. But none of these loves join to form a real connection due to circumstances and biology. It leaves me feeling deeply broken to think that I can't really feel love. That it's something that either I never knew, or worse, could just never process.

And so I am broken down, beaten into submission by life. Accepting gifts from the person for whom the past doesn't exist. The person whose acknowledgement would mean the most. Considering returning to my surface family and redneck city because I have almost nothing left to my name.

Does acceptance of the gift equal condoning the violence of the past? If I am the only one who knows my truth, can that carry me through being closer to my family? These are the questions I will sleep on tonight. 

Edited to add that as I wrote this, Tom Petty did pass away. Rest in peace, Tom, and thank you for the music.

10
Other / Today Would Have Been My Father's Birthday
« on: September 11, 2017, 01:49:03 PM »
I  had been making a habit of celebrating his birthday, rather than commerating the day he died. This year he would have been 68. This year is different - this year I am alone. It doesn't feel like anything to celebrate, just another reminder of all the possibilities I never had. I feel so little and forgotten, even though my friend proves I am not. It was so hard to be vulnerable and say I wasn't coping.

I started getting so anxious about going to work last night. There are compound reasons for that - I am in a demanding time and not at full capacity right now. Haven't had more than 4 days off in almost a year, and only 1 day off last week. I cried a bunch but managed to reach out to a friend to help lend me strength and support to make it through today.

As it is, I am going to be quite late to work because I could not find my keys - they were in the bottom of my purse.  :blink: I am still on the verge of tears and want to turn around and go home.

I would have called in today but my Dr is off and my going to see her to finally say I need more help would have been the only real way I can justify not going. As it is, I still have to make it through the bus ride, then the walk, then the day.

11
Hi all,

Have always known myself to be different from FOO . Was the scapegoat for them for years and years. They still want a normal relationship with me but don't make much effort and the condition is that I will never bring up my abuse or hold it against them because it "didn't happen" .

I struggle with many holidays but have found my own ways to find meaning in them. But a tough one is Thanksgiving, which is coming up. I'm supposed to go home this year and have realized I'd rather not. I haven't been home for a holiday in years. I might be done with them.

I've gone nearly the whole summer without talking to my FOO. Mainly because I needed to focus on myself. My SF texted me the other day, said he misses me. That was it, but it was enough to send me into a major dissociative tailspin. I still feel foggy now.

I've been avoiding this moment for months, I suppose. I have done well at avoiding a lot of family pressure by being an underachiever in their presence. I've done better overall on my own. But standing up to them is something I have avoided with more energy than I should.

I don't know what to do. I don't want to deal with this at all. My catastrophizing has gone crazy, and yet I'm frozen and have been avoiding responding to a simple text. Nothing makes me feel more powerless than dealing with the unpredictability of my FOO.


12
General Discussion / What Do You Do When You First Wake Up Every Day?
« on: August 26, 2017, 03:47:16 PM »
Hi all,

Something I've identified lately is that I wake up and almost immediately I start having intrusive thoughts about work. Does anyone else have this, too?  It starts my day off with anxiety and if the thoughts are particularly bad I will basically freeze and have a lot of trouble getting my day started.  I've never been someone who can leave work at work, precisely for this reason. The thoughts can be of other worries than work, like interactions with people, but work is where I spend the most time so I suppose it makes sense.

I'm curious about how you guys start your days. With stress and busyness I fell out of my good habit of yoga first-thing. I also struggle with meals - particularly breakfast - because I have to be up extremely early.

I'd like to hear how you all get going in the morning and hopefully glean some new ideas to break the rut I'm in. Thanks!

13
Inner Child Work / Amygdala "hijacking" by the inner child
« on: August 23, 2017, 03:33:04 AM »
Hi all, bit of a ramble post here. Not sure if anyone can relate.

Since last night I have been in a pretty anxious state. I can't focus on much visually or mentally beyond what I absolutely need to get done. (that's been the case off and on, more on than off, for months).

Basically my amygdala seems to be hijacked today. My breathing is irregular and shallow if I don't focus on it. My tension in my jaw has sky-rocketed. My tinnitus is really loud due to my jaw. I feel on the verge of a panic attack or tears, depending on what time of day it is. I have a lump in my throat that makes swallowing into awkward gulps. I've been trying to stretch out or massage the tension out but my muscles are hard as rocks and any effort strong enough to break them up is excruciating and only seems to make things worse. Last night I listened to my bedtime music and added binaural beats for relaxation. It seems the "relaxing" unleashed all of my inner child's fears and here I am today, an I explicably frightened,  frozen adult.

I've been feeling that my inner child is a lot closer to the surface lately. I don't know what to do about this because I have to continue doing adult things, and trying to placate or tell my inner child "later", much like a real child, seems to throw me into a real state.

This all seems to be separate from an EF because I feel aware for the most part, unless I fall into some obsessive dissociation, which I have a few times over the last week. At those times it's like I'm in a trance. Right now I know what I'm doing or not doing, what my body is telling me, and what I want.

It occurs to me that psychological healing can only take a person so far. The inner child needs loving touch as much as kind affirmation to feel secure.

I had my happiest moment in what felt like years last week. After a night of nightmares and horrid insomnia, I had the blankets over my head, not wanting to get up in the morning. It was then that my boyfriend, who had stayed over the previous night, sat on the bed beside me, held me, and said something simple to the effect of "good morning, darling". Every part of me responded positively to this and it instantly lifted my mood, just being cuddled. It's very much like how my parents would wake me up In their better moments.

I just now cried at the memory of this. So much mixed pain and happiness contained in an instant. I'm pretty sure my inner child is crying out for loving touch these days, and is taking me over so I can't ignore this. But I am alone most of the time and can't afford massage. Can't really relax with massage either, it's too impersonal. So I need to find ways to improvise.

The little cry did me some good. I think I might have actually identified the reason for the hijacking. A little less tense, breathing  better. Lump still in throat but I've made a little progress through exploring this in writing.

14
Other / Today is the Anniversary of My Father's Death
« on: August 15, 2017, 08:12:41 AM »
So today is the 9th anniversary of my father's death. I've booked the day off work for a change. Decided some self care and gentleness was in order.

He was an alcoholic in my younger years, abandoned us, fought my mother for over a decade, put us in the middle, and eventually tried to "make it right",  but I never fully accepted this and he died suddenly before I ever let him into my life in a meaningful way.

I love him and resent him. I was afraid of him and could never trust him. He was never the father I needed, just the one I had. In the past I excused him because he had tried to make amends. But this year I am more in touch with my anger. He was as toxic and damaging to me as my mother. Because of his choices I have to be my own parents now as an adult.

Despite all that I know he tried, did his best, came from an abusive childhood himself,  etc. He just should never have been with my mother.

The lead up to today was hard. I start being keenly aware the day is coming up about a month in advance. And in a month is his birthday. So the tail end of summer has become pretty melancholy for me.

Not sure yet what I'll do today. Maybe nothing special. Just things that are good for me and honour the memories and feelings I have.

15
General Discussion / ADD or C-PTSD
« on: July 30, 2017, 03:51:32 PM »
I've been thinking about whether or not I may have ADD in addition to C-PTSD. I struggle with time management sometimes. It's all complicated and muddled by the C-PTSD.

I EF and dissociate heavily at work and during tasks as my inner critic really latched on to comments and judgements about me that I have heard over the years.

I am slower than most at tasks and have a tendency to over-think what needs to be done out of fear of negative reprocussions. I think my speed may also just be a limitation... Some are slower by nature. But I live in a fast world and speed causes me great distress, more so when I'm struggling with priorities and estimating how long something will take.

I also suffer from some pretty bad memory problems. Short-term memory is shot, I've become a copious note-taker to cope. But in times of stress my memory worsens significantly now. In the last week I left my keys at work, locking myself out of my home, forgot my phone at a friend's place 2 days in a row, and lost my bus pass.

It's gotten to a point where I can't tell whether my job is a bad fit for me. I am scattered and barely functioning these days. All I know is I am unhappy and trying to stay afloat, but also losing the will to try any longer, which is a high-risk place to be in my head as I need an income to live on.

Has anyone else found they also have ADD or ADHD, and if so, what was your journey to diagnosis like, and how are you now?

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