Signaling: Using Crisis Prevention Plans #AtoZChallenge

Posted on by Astrid

Welcome to my letter S post in the #AtoZChallenge. There are really many S words that are fitting in a self-care routine. After all, “self” starts with an S and self-care is about YOU. I will be writing about creating a crisis prevention plan.

A crisis prevention plan, which is also called a signaling plan in Dutch (hence the letter S), details the signs and symptoms you experience leading up to a crisis. In most mental hospitals, it consists of three phases:


  • Phase 1 or green: I’m doing well.

  • Phase 2 or orange: I’m not doing well.

  • Phase 3 or red: I’m in crisis.

Here in the intellectual disability care facility, a signaling plan is more extensive and can also be used to signal lowalertness. It consists of six phases:


  • Phase -2: sleeping (when not appropriate).

  • Phase -1: low alertness.

  • Phase 0: adequate and alert.

  • Phase 1: low stress, highly alert.

  • Phase 2: high stress, too highly alert.

  • Phase 3: emotional outburst or loss of control (crisis).


I find it pretty hard to translate these into English, so sorry for my quirky word choice.

In each phase, the signaling plan lists signs patients or their staff will notice when the patient is in that phase. For example, one of my phase two behaviors is loud talking. Abilities are also explained. For example, in phase 0 in my case, I am able to make decisions adequately. In phase 1, I can make choices between a few (usually two) different options. In phase 2 and 3, it’s up to the staff to make decisions for me.

Mental hospitals and mental health agencies in general are strongly focused on patient self-reliance, so they include lots of stuff about what you can do yourself in the different phases. In most cases, in fact, the patient is held fully responsible for their self-care unless they enter phase 3. I mean, patients are allowed to ask for help in phase 2, but staff will not reach out and patients are usually required to come up with direct requests for help. IN my opinion, this is rather odd.

I find it extremely comforting yet a bit surprising to see that my current signaling plan, which was created by my care staff and the behavior specialist, details staff responsibilities for each phase.

Like I said yesterday, my signaling plan also includes a recovery phase, which lists signs I’m coming out of a crisis and ways staff can help me then. This is really helpful.

Reading Wrap-Up (April 22, 2020)

Posted on by Astrid

Man, I haven’t done a reading wrap-up in over a month. Of course, I’m still busy with the #AtoZChallenge. However, I’d like to share what I’ve been reading and will be reading next anyway. I’m joining in with WWW Wednesday and also (a little late) with #IMWAYR.

What I’m Currently Reading

Wonder by R.J. Palacio. I bought it on a whim last week and have been loving it so far, though reading August’s sister’s perspective is a bit triggering.

Also still not done with Heroine by Mindy McGinnis. Then again, I’m not really reading that one right now.

I picked up listening to Matilda by Roald Dahl, narrated by Kate Winslet, again. I still can’t seem to get used to a female voice narrating it.

What I Recently Finished Reading

Not much. I mean, I finally finished Left Neglected by Lisa Genova a few weeks ago. After that, I was in a bit of a reading rut until I picked up Wonder. I did download and read some free bedtime stories by Uncle Amon, but that hardly counts.

What I Think I’ll Be Reading Next

I stacked the shelves with a couple middle grade novels that I think are going to be exciting. The one I think I’ll be reading next is Wink by Rob Harrell. That one actually got me to buy Wonder.

In addition, I’ve been looking at some adult romances to read. I would really like to read either Things You Save in a Fire or How to Walk Away by Katherine Center. Still in doubt as to which one to buy first.

What are you up to reading?

Recovery Time After a Crisis #AtoZChallenge

Posted on by Astrid

Welcome to my letter R post in the #AtoZChallenge. There are a lot of R topics related to self-care. I want to write about recovering after you’ve been in a mentally hard space or crisis.

First, let me tell you that recovery time is important in preventing a crisis too. You just can’t go, go, go all the time. No-one can, whether you struggle with mental health issues or not. So take your down time. Whether that be a nap, a nice bath or shower, or listening to your favorite music, is up to you. Or something else entirely, of course. I often need to take a little time to unwind in the afternoon. I do this by lying on my bed with nature sounds or relaxing music playing on Spotify. When we still went to the day center, I’d go to the sensory room for about half an hour to an hour.

When you have just come out of a mental health crisis, it’s especially important to take your time to recover. Your recovery time, according to my DBT handout, may help you come to an insight as to how to prevent this crisis from happpening again. It often does for me. It may not, but then at least you’ll need time to come back to your usual self.

I have a crisis signaling plan here at the care facility. Its different phases normally range from -2 (asleep when you shouldn’t be) to +3 (emotional outburst or loss of control, ie. crisis). My staff put in another phase for me, which they call “recovery”. This is what happens after I calm down from a meltdown. I usually feel sadness and shame then. Staff are in this phase advised to stay near and help me process my thoughts and feelings. This is, for me, often the time when I can be most honest about my needs.

What do you do to recover when you’re climbing out of a mental pit?

Tanka: New Moon

Posted on by Astrid

When moon, earth and sun
Are in perfect alignment
The new moon reveals
Through the darkness of the night
A constellation of stars

With this tanka, I am linking up with Frank J. Tassone’s Haikai Challenge #135, for which the topic is “new moon”. I honestly had forgotten altogether about the astronomical meaning of the new moon until I read Frank’s post.

Quotes, Sayings and Affirmations for Self-Care #AtoZChallenge

Posted on by Astrid

Welcome to my Letter Q post in the #AtoZChallenge. Man, how time flies! We’ve just entered our sixth week in “intelligent” lockdown here in the Netherlands. Tomorrow, prime minister Rutte will hold another press conference to determine whether any restrictions will be lifted on April 28. I doubt it, but oh well.

Today I want to talk about using quotes and inspirational sayings in your self-care routine.

Quotes may seem a little cheesy to some people at first. Then again, maybe you haven’t found the right one yet. If you find a quote that truly speaks to you, it can definitely set you off in the right direction.

I for one love quotes and not just the deep ones. Anna Borges’ first self-care strategy is called “A.A. Milne” after the author of the book Winnie the Pooh. There are lots of funny quotes in that book and in the Disney movies based on it. They may actually make you laugh and inspire you at the same time.

I do also love deep quotes though. My favorites come from Helen Keller, Tori Amos and Madeleine L’Engle. However, I enjoy quotes from a ton of different people.

For those of us who are religious, Bible or other sacred text verses can also certainly speak to you. I am a true cherry picker where it comes to the Bible, picking out random passages to use for motivation. That’s totally okay if you ask me.

When you find a quote or verse that speaks to you, you can use it as a mantra or affirmation. You can also create your own affirmations. The key to getting affirmations to actually do good for you, is believing in them. I mean, I don’t believe in Law of Attraction-like ideas that say anything you set your mind to can come true. Affirmations need to be useful to your life right now. For example, I use the following affirmation: “I love, accept and respect myself exactly as I am right now.”

There are a number of different apps that can be used for focusing on affirmations. I use ThinkUp and Mantra on my iPhone. Both are free but come with ads and an in-app purchase to get premium features and remove advertising.

What are your favorite quotes, sayings or affirmations?

My Life in Books Tag

Posted on by Astrid

Found this tag on Flowers in the Brain and was drawn to considering myself tagged even before I’d read the full post. The first question just appealed to me. Here goes.

Find a book for each of your initials:
A: Attachments by Rainbow Rowell
S: Scars Like Wings by Erin Stewart
T: Throwaway Girl by Kristine Scarrow
R: Rules for 50/50 Chances by Kate McGovern
I: Inside the O’Briens by Lisa Genova
D: Don’t Wake Up by Liz Lawler
Out of these, Throwaway Girl is the only book I haven’t read yet, but I couldn’t think of any others except by going with something that started with “the”.

Count your age along with your bookshelf: which book is it?
This had me a little confused. Do I need to pick the 33rd book on my bookshelf? And since I don’t actually have a bookshelf, which of my three book apps do I use? I’m going with Voice Dream Reader, my Bookshare app, because that one has the most books on it. Hmmm, this is hard. I guess one of the Chicken Soup for the Soul books.

Pick a book set in your city/country.
The Fault in Our Stars by John Green is partly set in Amsterdam. That’s as close as it goes for English-language books set here.

Pick a book that represents a destination you’d love to travel to.
No idea. The only places I really ever want to visit are Ireland and Indiana, USA, because my closest online friends live there. I don’t know any books set there. The closest to Indiana is probably Amina’s Voice by Hena Khan, which is set in Milwaukee. Then again, in college I always wanted to go to Boston, so Left Neglected by Lisa Genova should be mentioned too.

Pick a book that has your favorite color on it?
I have absolutely no idea what my one favorite color even is.

Which book do you have the fondest memories of?
Out of the books I’ve read as an adult, surely Unspeakable by Abbie Rushton. As a child, I loved Astrid Lindgren’s stories.

Which book did you have the most difficulty reading?
That for sure has to be Lucky Jim by Kingsley Amis. It was sooo boring!

Which book in your TBR pile will give you the biggest accomplishment when you finish it?
The Institute by Stephen King. I’ve never read any horror and, though this one sounds intriguing, it’s also pretty thick for me.

I tag all my readers for this. I’d particularly love to see your answer to the first question.

Prescription Meds Can Be Part of Good Self-Care #AtoZChallenge

Posted on by Astrid

Welcome to my rather late letter P post in the #AtoZChallenge. Today I want to talk about the role prescription meds, particularly psych meds, can play in good self-care. Because you know, there is still a lot of stigma attached to taking psychiatric medications or certain medications for physical health, such as opioids. Of course, medication isn’t for everyone and that’s normal. If you do experience serious mental health issues or physical ailments, it’s not weak to ask for meds.

You know, I didn’t take care of myself with respect to my medications until I was 31. Before that, I had subconsciously assumed I wasn’t taking meds for self-care, but rather to please others. That’s how psych meds had been used on me for years in mental health, since irritability (ie. being a pain in other people’s necks) was supposedly my main symptom. Well, it isn’t and even if it were, my irritability is a worse experience for me than it is for others. I mean, I’ve known people, such as those diagnosed with antisocial personality disorder, say they have a problem but don’t suffer. That’s okay, but it is rarer than to suffer in silence.

In early 2018, I finally decided I needed help for my depression. As those who read my blog regularly know, I was already on a low dose of an antidepressant, but had no idea why. I didn’t feel comfortable asking directly for a med increase. Let me tell you, however, suggesting specific med adjustments to your doctor doesn’t make you a drug seeker. They may know meds best, but you know you best.

Also, while meds won’t make you happy, you don’t have to settle for mediocre health if there are still options out there. And if you want to lessen a medication dose or stop it altogether, that’s okay to discuss with your doctor too.

Once you do get on the right meds, it’s your responsibility to make sure you take them as prescribed. Certain meds need to be taken right on time or they’ll not work as effectively. I’ve heard this is the case for antidepressants, so I really need to get back on track with taking my morning dose on time. Other meds cannot be taken together or should or shouldn’t be taken with certain foods. For example, when I took iron supplements, I didn’t know at first that it’s recommended you not consume them with dairy products. You don’t need to read everything that’s in the information on a medication you’ve been prescribed, particularly if you’re hypervigilant about side effects. However, you do need to take your medication as directed.

Organization as a Self-Care Skill #AtoZChallenge

Posted on by Astrid

Welcome to day 15 and my letter O post in the #AtoZChallenge. Today’s topic may seem a bit boring. I’m going to talk about how organizing your life can help you take better care of yourself.

Let me start by saying I’m a terrible organizer. In high school, I had a calendar that I’d typed out myself in Word. I started out keeping it faithfully at the beginning of the first school year. By the time we got to the end of that year though, I forgot to write down my homework about half the time and looked it up even less. I had a great memory, which meant I didn’t usually miss homework deadlines.

I never kept a calendar in college or beyond, but now that I have an iPhone, I do try to use the calendar app to track appointments. Which reminds me, I still need to write next week’s phone appt with my community psychiatric nurse into it. Going to do that now. Be right back.

Okay, done. Where was I? See, I’m pretty disorganized. Still, I try to keep some order in my life. It helps me, for example, to have reminders about taking my medication in my phone. Otherwise I may forget and that’s not good.

I also, like I mentioned before, have an app that reminds me to drink enough water. Habit-tracking apps like this exist for a bunch of habits that will help you have a more meaningful, organized and productive life.

Decluttering is another way of getting more organized. There are lots of specific methods for it, such as FlyLady, the Konmari method, etc. I would love to stick to such a method, but honestly more so that I could talk about it than to actually get cleaning. I guess that’s weird.

Because I am blind, I don’t usually get bothered by clutter unless it’s in my way. However, of course, clutter does make it harder for me to remember where I left my things. That’s why currently I try to keep at least some order in my drawers and my wardrobe. It’s hard, but it pays off.

Are you an organized person? Or have you developed strategies for organizing your life?

Name Your Negative Voice: Dealing with Your Inner Critic #AtoZChallenge

Posted on by Astrid

Welcome to my letter N post in the #AtoZChallenge. Today I want to talk about dealing with negative thoughts coming from your inner critic.

You know what? Just because you think something, doesn’t make it true. Your thoughts and feelings are not fact. See my post on cognitive distortions for some examples of how our thoughts can deceive us.

One way of dealing with negative thoughts, is to engage them in a challenging conversation. It may help, in this case, to name your inner critic. Literally give it a name. Then look at it like you would to a really annoying person you meet, who however has little to no authority over you. It may then be easier to ignore or shut up your inner critic.

For example, let’s assume you call your inner critic Donald. (That’s what Anna Borges suggests and I do wonder whether she bases it on some orange-faced creature currently leading the world’s most powerful nation.) If your inner critic were to say you shouldn’t do something because you presumably can’t, you can then call him out on his bullshit, like this.

Inner critic: You’ll not get the job you want, so don’t bother to apply.
You: Shut up, Donald. You don’t know shit.

In this conversation, you’re purposefully keeping your comebacks to Donald brief. After all, you know he’s ignorant and insensitive and yet he doesn’t have the authority over you that requires you actually listen to him.

Another approach to your inner critic, particularly if it originates in childhood trauma, is to see your inner critic as a punitive parent. Then you can create a nurturing parent in your mind to help you challenge the punitive parent. After all, you most likely do generally feel you need to obey your parents more than you need an annoying acquaintance, even though really as an adult you have no such obligation.

Remember, naming your inner critic still requires you realize it’s part of you. Don’t go about blaming others for your own negative thoughts. Even when your inner critic is a reflection of your parents, it’s still your responsibility to deal with it.

As a side note, having a name for your inner critic can, in my experience, also help you see its function. For example, one of my more critical alters emerged as a named inner critic I thought should just shut up. Later on though, I realized she had a function beyond just being an inner critic or punitive parent. For this reason, I do feel engaging your inner critic can really be more than just telling it to shut up.

Music for Your Mood #AtoZChallenge

Posted on by Astrid

Oh my, I guess I’m growing a bit weary of the #AtoZChallenge. That is, even though a ton of topics were available for the letter M post, I’m still not sure I have any substantial material to share. Today, I want to talk about using music to help your mental health.

Music, both listening to it and playing an instrument or singing yourself, can really help your mental wellbeing. I find, for example, that it gives me something to focus my senses on when I’m overloaded. Like I’ve said before, exposing yourself to a strong sensation can really help you feel more aware of your body. It can also help override other strong internal or external stimuli.

It really depends on you what type of music will help you when you’re in which mood. For example, for me, listening to peaceful piano or guitar music or soundscapes, helps me calm down. My husband says the same music winds him up.

When I need a mood booster, it helps me to listen to faster-paced songs, often with funny lyrics. For example, Tom Lehrer’s music really lifts up my mood.

Song lyrics can also help you describe your mood boost your self-worth. English being my second language means, however, that I don’t often completely comprehend them. I find “powerful” songs in Dutch to be really annoying most times. That being said, I do at times listen to songs with strong lyrics, such as contemporary Christian.

Also, my favorite song of all time is I’m a Survivor by Reba McEntire, which does have strong, relatable lyrics. However, most times even when I don’t fully know what a song is about, its rhythm, beat or melody appeals to me. That’s why I like ABBA, even though their lyrics aren’t all that powerful.

When I’m angry, I like to listen to the likes of Cock Sparrer, Booze and Glory and The Business. I do have an inkling of what their songs are about, but the essential bit is really the beat.

I can’t sing or play an instrument myself. When you can, it can be a true outlet for your feelings. Even when you don’t have any talent, you can still feel better by playing an instrument.

What music helps you right now?