I’ve now written several blogs about my Wellness Recovery Action Plan, or WRAP. And it’s time to finish off this series.
The next two sections of the WRAP plan are entitled “When Things are Breaking Down or Getting Much Worse,” and “Crisis Plan.” I’m lumping these together because both point to severe symptoms, and the potential imminence for a relapse of my depression.
According to Wellness Recovery Action Plan (Advocates for Human Potential, Inc., copyright 2018), “sometimes, even when you’ve been making your best efforts to stay well, things can get a lot worse. Some people call this a breakdown, a setback, or a relapse….often your behavior changes so much that other people can tell something is wrong…Taking immediate action can make a difference in the outcome.” In fact, I might be able to avoid the Crisis part of my plan if I can successfully turn this situation around.
Some of my key indicators that things are getting much worse include that I am staying in bed, isolating. I feel anxiety and a heaviness in my chest, an urge to drive fast and recklessly, a desire to smoke e-cigarettes (I’m a non-smoker). I may have increased trouble concentrating, which was also a red flag in my Early Warning Signs. But in this case, it would be worse. I’d be feeling like a burden to everyone around me. I may have the desire to self-injure or have suicidal thoughts (called suicide ideation – thoughts, but not a plan), and I’d find myself unable to pray. I’d dread the future and ruminate on the past. I’d have flat affect – expressing very little emotion.
So what do I do if things get much worse? First thing – tell someone! My husband, sister, or close friend. Call my therapist and psych doc right away. Reduce caffeine – drink herbal tea instead of coffee – and sit in my glider, which I find very calming. I would try to Face Time my old therapist – he can often “talk me down.” I think I’d call in my second round of support – three other close friends who I know love me and would offer me encouragement and prayer. Perhaps, if these steps work, a relapse would not occur.
The Crisis Plan portion of the WRAP is designed to make it as easy as possible for people to help me, because if I am in a depression crisis, I might not be able to make my own decisions. It outlines who I want to help me – by name – and exactly what I want them to do for me. Things like get me to the hospital emergency room, sit with me, hold my hand. And what I don’t want done, like what medicines I can’t take. It even outlines my daytime and household responsibilities and who will do them, like care for the pets and pay my bills and contact and keep my prayer team updated.
After the crisis has passed, the Post-Crisis Plan is implemented. It’s a brief section of the WRAP where I identify things that worked in my WRAP Plan, and things that need to change. Perhaps there are people I need to thank for their help in my crisis; perhaps there are apologies or amends I need to make as a result of things I said or did during my crisis. This final portion of the WRAP allows me to step back into the responsibilities of my daily life, slowly, as I begin to return to my normal level of wellness. This may take time – crisis recovery is not immediate, and I will need to be patient with myself. But this is a good time to evaluate and make changes to my WRAP, as I can see what worked and what didn’t. Because post-crisis can be very introspective, it’s a good time to modify my WRAP to include stressors or early warning signs that I may have missed before. I can add to the Crisis portion of my plan while it’s still fresh in my memory – what additions do I need to make so that, heaven forbid, things go more smoothly the next time?
Ultimately, the goal of the WRAP is to help me avoid a depression crisis – to identify those markers ahead of time to avert another hospitalization or emotional break down. Because this plan is so thorough, I may be able to stay in remission for the rest of my life.