Overview of the 10 day full-time program I'm in.
I want to go into the
social rhythm therapy part of the program today.
If you google SRT, you'll read about it as a treatment for bipolar disorder, involving sleep and circadian rhythms. The term is applied a little more broadly in the program I'm in (4 of 5 of us are unipolar depression).
The initial SRT session (it's one of the "courses" we do every day in this program) gave us a rough overview of the theory. Social Rhythm Therapy follows from the "social zeitgeber hypothesis":
[it's such a great word, I wrote it in calligraphy
(and I'll talk about calligraphy more when I discuss mindfulness)]
Wikipedia:
A zeitgeber is any external or environmental cue that entrains, or synchronizes, an organism's biological rhythms to the earth's 24-hour light/dark cycle and 12 month cycle.
Some examples are
Light
Temperature
Social interactions
Pharmacological manipulation
Exercise
Eating/drinking patterns
The
social zeitgeber hypothesis suggests a link between interpersonal events (loss of a loved one, a breakup, unemployment, etc, which cause changes in social cues and routines (sleep time meal times, the time set aside for productivity, socialization, leisure activities, etc), which then disrupt the biological rhythms governing sleep/wake, energy levels, things like that. The chain goes the other way, too. Those of us with certain biological problems that disrupt things like our sleep have trouble setting our social routines, leading to interpersonal problems.
So, thus far, SRT has been about trying to tune in to biological rhythms, establish routine and structure again, and understand the links between what you did/didn't do and your mood/energy. Then, the larger project is identifying the barriers to holding on to these rhythms, promoting balance in our lives, and filling time with "meaningful activities."
There's quite a bit to it. This is honestly the part of the program that I found most important at the start. I do best when my life has structure and routine. That has completely broken down and made life very difficult.
So the first step is simply to set goals and collect data. I can't just post their forms, so I'll make up my own versions. For now, here's the basic info you'll collect:
So you set target times for waking up, meals, going to bed, work, leisure, taking meds - it's not like you need to specifically account for every minute of every day, but you want things that aren't set times (waking up) in blocks of 30 minutes or an hour (so things like "play video games" or, more generally, "hobbies," "free time," etc.). Meals, waking, going to bed, meds, are all ideally the same even on the weekend, but that's both unrealistic and undesirable for me. So I'll make a sheet with a column for each day of the week, target time columns for the week and weekend, and I'll fill in wake up, bed time, meals, with enough space between them for you to fill in your usual activities. I hope the general outline form I posted makes sense.
So the other things you record are
the presence of other people for these things. It's not about how many people you are with, but more if anyone is there or not, and then their engagement in the activity with you. You either do them alone, in the presence of others,
with others, or REALLY with others (like a party, or making sweet, sweet love (if you rate that a "1"...)).
Mood should be recorded at least twice a day - AM/PM - but three or even more times can be even better (we're encouraged to rate our mood 3 times a day). The scale is a little funny. 0 is a neutral mood. Plus one and minus one are going to represent "normal" variations to a positive or negative mood, respectively. So a -1 is a slightly negative mood, but sort of within what you'd consider your ideal "normal" variability in mood. At the extremes, +5 is frank mania and -5 is the kind of depressed state where you should probably be hospitalized. In my group, we've all kind of settled on -2 or -3 as our usual mood when depressed. Something like a +2 might be an unusually good day on a vacation or something.
So really, someone without depression or bipolar disorder will move between +1 and -1, depending on what's going on. Does that make sense?
Confusingly, energy is rated on the same scale. Many of us find little difference between mood and energy - a -3 mood comes with a -3 energy, but you can be tired but happy (+1/-1) or whatever. It's up to you to kind of say what the neutral, zero state is.
The scales themselves are less important (use 5 stars, 0 to 10, words instead of numbers...) than your consistency in using them. You don't want to say that a mood of zero is a neutral, neither happy nor sad state one day, and then later say that you are usually at a -2, so you're going to switch over and make zero your normal mood from now on. So some zeroes are neutral, and later some zeroes actually represent a pretty bad mood. Right?
So, really, the big idea is just to establish your ideal routine, work at meeting it, record how things make you feel and the energy you have, and look at how you're spending your time in social situations.
So you might establish an ideal schedule and initially fail miserably at meeting it. Later, you might meet it perfectly, but find that your energy is always collapsing in the evening. This may coincide with a lack of social contact (I've become an extrovert in the last few years and especially in the past year, which I'll discuss, because it's so weird for a life-long introvert [no one in this community believes me when I describe myself as "painfully shy." I recognize that the way I think of myself is no longer accurate) or you might look at your evening med dose, etc etc.
At first, it's about finding a routine, especially if you don't have a job or school to define big chunks of time. You want to establish your anchors, particularly social anchors - when are you spending time with others? Next, it's about seeing what is making it hard to keep the routine, if that happens (and it often does). Are negative social interactions making it hard to get to sleep? Stuff like that. You identify the barriers and see how to start working at them.
The last piece is looking at the balance in your life. You can divide it up many ways, but we've looked at a triangle of productive time (including work/school and things like housework), self care (meals, sleep, exercise), and leisure. Something like exercise may be in any of those three, or a bit in each. Again, the key is to identify your needs and see how your activities do or do not meet those needs.
Whew. Again, I'm happy to take questions. I'll have more to say as I continue in the program (7 days left). I'm sorry these entries are so long but a) I always post a lot anyway and b) I'm finding it so incredibly helpful, and having talked to some of you in mumble and IRC last night about it, it sounds like there are some of you who think this therapy would be awesome for you too. Fortunately, there really aren't any magical components to the therapy I'm doing. It doesn't involve any specialized equipment or medications (although having sorted out that piece is the reason I can do this therapy now) or anything.
A few little forms to track things, which I can whip up, or you can make for yourself, some knowledge of the basic ideas, and a desire to do it are all you really need (having a team of professional leading you is pretty damn good, too, but you don't need a therapist to set your schedule and try to keep to it, right?). The other piece, which I hope we can provide here, is a group to work at things with. It's very, very helpful having that input, perspective, accountability, etc.
I'll discuss mindfulness next.