Please note, this post is meant to inform, but is not meant as medical advice, and it shouldn’t take the place of working with your own health care professionals.
I recently posted about receiving TMS treatment for depression. TMS is short for transcranial magnetic stimulation; the treatment involves using the same type of electromagnetism used in MRI imaging, which stimulates neuronal connectivity in the brain. TMS was by far the single most helpful thing I’ve done for my chronic, treatment-resistant depression, and I’d highly recommend it to others.
One of the first steps in this process of getting this treatment was meeting with a psychiatrist. During this appointment, the doctor evaluated whether I would be a good fit for TMS. He was also responsible for officially prescribing the treatment.
By the time I had this initial doctor’s appointment, I had spent some time looking into TMS. I had seen that research has been done on what makes TMS more effective—I found one study, for example, that said taking antidepressants during the course of the treatment augmented TMS’ effects. So during that initial appointment with the TMS doctor, I asked him: What else could I do to help TMS treatment be as effective as possible?
His answer? Therapy. He actually told me that he really wanted to offer talk therapy with a professional during the TMS sessions at his clinic, but that insurance wouldn’t cover two treatments that occurred simultaneously. He explained that TMS is kind of like “re-wiring” the brain—or, more precisely, reinforcing and strengthening the connections for neurotransmitters that, the lack of which, are associated with depression.* He said doing talk therapy during the course of TMS treatment would also help reinforce and “wire in” the positive coping mechanisms that therapy helps teach you.
After that conversation, I decided I would do my very best to simulate therapy during TMS treatments. I started planning how I could do this—activities like reviewing my workbooks from when I did DBT group therapy, meditating, and writing and reviewing positive affirmations. In preparation for this, I bought a deck of colorful notecards and a book on mindfulness.
TMS therapy involves thirty or more sessions that can last 30-60 minutes. Personally, I did thirty-five treatments, and over the course of these visits, I started to refine my cobbled-together DIY therapy method. Though I’ve finished my TMS sessions, this routine continues to be helpful to me.
I’m excited to share it with you. I share this with the hopes that it will give you ideas for how you can build and maintain your own mental wellness. As I mentioned above, I don’t share it as a substitute for working with health care providers like doctors and professional therapists.
My personal DIY therapy plan
My personal “DIY” therapy routine has several components, which I’ve labeled below.
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I’ve purchased a few simple tools to go along with this plan. I really like using multi-colored index cards. I also use some different books and workbooks, since it’s important to keep learning mental wellness tools, techniques, and ideas from outside sources to help improve your mental health.
I don’t go through all the components I’ve listed every time I sit down for a “session” with myself, instead just focusing on two or three that feel like they would be helpful right then. Different sessions seem to have different lengths, too, based on the time I have and what feels helpful. Also, this is a dynamic process. I read different materials, I keep updating my index cards.
Component I: Learning and reviewing positive coping mechanisms and skills (books, workbooks, and orange index cards)
I’m not yet a health care professional, but from my experience and observation, mental health issues—whether depression, anxiety, autism spectrum disorder, obsessive-compulsive disorder, or others—can generally be summed up in this way: Experiencing strong emotions that are unpleasant plus handling those feelings with inappropriate or unhealthy coping mechanisms.
I think people often just don’t know healthy, effective ways to handle strong emotions. We all stumble around in life figuring this out. Sometimes, people figure out healthy skills like talking it out or exercising. But, I think it’s more frequent that we figure out to handle our strong emotions by doing not-so-great things like eating excessively, stonewalling and ignoring people who offended us, yelling or getting angry, spending money, and so on. Those are just the lighter end of the spectrum, a continuum that then gets into things that can be considered symptoms of mental illness—things like self-harm, substance abuse, obsessive cleaning, etc. are just the same thing: unhealthy attempts to deal with strong emotions.
This is why talk therapy is prescribed as a treatment for mental illness. Therapy helps you see the patterns of what causes your strong emotions and how you handle them, then teaches you new, more effective ways to deal with them and prevent them.
I talk about this to illustrate a simple point. If you’re attempting to improve your own mental wellness, you need an outside source to teach you new ways of dealing with things. Part of mental illness is that we’re already using the resources we have, but those resources and techniques aren’t super effective. So, you need new skills and techniques from somewhere else, somewhere outside of yourself and what you already know.
When I was trying to do therapy-type sessions with myself while receiving TMS treatment, I did this a few ways.
First, I reviewed notebooks and handouts from DBT therapy. Dialectical Behavioral Therapy (DBT) focuses on four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, with the goal of “building a life worth living.” It was originally designed for people with borderline personality disorder, but can be very helpful for other mental health struggles, too. I found it to be the first time talk therapy was really helpful in dealing with my chronic depression. I learned DBT skills through one-on-one and group therapy. This is how the therapy was designed, but there are also many publications and workbooks available that teach DBT skills. I've included a link to a book of DBT handouts and worksheets written by Marsha M. Linehan, who invented Dialectical Behavioral Therapy.
I also found reading the book Fear by Thich Nhat Hanh helpful. The author is a Buddhist monk, but his books aren’t particularly religious. They focus on concepts like mindfulness, forgiveness, experiencing peace, and enjoying the present moment. Mindfulness is a key concept of DBT therapy, as I mentioned, and something that has been incredibly helpful to me for handling depression. Thich Nhat Hanh’s words have helped me learn more about that skill. I’ve included links to the books of his I’ve read and found so helpful.
When I read or re-read about a skill or idea that is particularly helpful, I want to remember it, and I want to start putting it into practice. This is where my index cards start to come in. I use orange cards to jot down coping techniques, DBT skills, quotes from my reading, and my own ideas that are particularly helpful for processing difficult emotions. Then, like my other index cards, I try to review these regularly to keep the things written on them in my mind and at the ready when I need them.
A couple of my orange index cards with quick-reference notes on coping techniques
Component II: Meditation
As I mentioned, meditation and mindfulness have been really helpful for me and my mental health. I feel like this is a continual effort. It’s worth learning about meditation, and trying out some different techniques. For me, I don’t really get into long, silent meditation sessions, but I have found some things really work for me.
One is doing short silent meditation. During my DIY “sessions,” I often take a few minutes to close my eyes, breathe deeply, clear my mind, and settle (or simply sit with) my emotions.
Using mala beads and focusing on specific mantras or positive affirmations has also been really helpful for me. (I wrote a post about mala meditation here.) This is also related to my yellow index cards, which I write more about below.
I also like guided meditations, especially to help me fall asleep. These days, there are a lot of apps that help you do this. My favorite is called Smiling Mind—check out a post about it here.
Component III: Mantras/positive affirmations, goals, and life vision (yellow index cards)
For me, when I think of the term “positive affirmations,” I think of dramatic, sky-high, aspirational phrases—like these from a Huffington Post article: “My abilities to conquer my challenges is limitless; my potential to succeed is infinite!” “Many people look up to me and recognize my worth; I am admired!”
I don’t like this brand of positive affirmations.
If something feels completely far-fetched to say, I don’t think it will help you very much. Is my ability to conquer challenges limitless? Mmm…no, I definitely have limits.
I gave up on these sensational and melodramatic positive affirmations a while ago. Instead, I started writing down phrases that are specific to me and my circumstances. There are cheerleading statements to encourage myself, and remind myself of my capabilities. There are cards with the positive qualities I’ve seen in myself. I also write down the life goals that get me excited and motivated. To get included in my stack, the affirmations have to be something that makes sense for me personally to tell myself (that doesn’t feel completely far out there), and they have to fit with my own values and goals.
I use my yellow index cards for these. Here are some that I find especially useful lately.
I am a capable person
I have an awesome future ahead of me
I have control over what I eat
I have things to offer
I can work hard
All things are temporary
My goals matter
I can feel happy
I have people who love me and whom I love
I review these statements, flipping through and reading the cards, stopping and thinking about them. I also use them for mala meditations. They help re-frame my frame of mind, help me think positively, and help me get the energy, excitement, motivation to move forward.
Component IV: My successful moments, happy memories, and the acknowledgment and celebration of things I’ve handled well (pink index cards)
When you’re feeling depressed or down on yourself, it can be hard to remember that you have felt happy in the past. When you feel anxious, it’s hard to remember that you haven’t always felt anxious. It can be difficult to recall the things you have accomplished and handled well, and times where the worst didn’t happen.
That’s why I have my stack of pink cards. On these, I write down happy memories. I also write down, factually, things I’ve done in the past to handle difficult emotions and situations.
I’m a stepmom. I went into becoming one with expectations about what my relationship with my stepdaughters would be like. I thought my stepdaughters would think I was fun and cool like my nieces and nephews do. In the first year or so of my marriage, I suggested my stepdaughter’s summer job should be working at my parents’ vet clinic like I did when I was younger, I invited them to do a makeup class with me, I wanted them to learn the card game my family loves, and I asked to follow them on Instagram.
My stepdaughters don’t think I’m fun and cool. They didn’t want to walk dogs for the summer, turned down my makeup class invitation, gave up on the card game after about one round, and let my mom, but not me, follow them on Instagram.
Every time, it hurt. A lot.
I started to realize I needed to change my outlook. Having specific expectations created the opportunity for those expectations to be disappointed. Instead, I started to try to follow my dad’s philosophy for surviving rollercoasters: “Ride loose.” Instead of hoping for specific things to happen with me and my stepdaughters, I tried to shift my focus to enjoying the moments together that naturally occur. Instead of trying to manufacture bonding moments with them, I’m trying to just be excited when those moments occur, then focusing on and celebrating the ones that do.
Interestingly, that lesson I learned from my stepdaughters was bigger than that one aspect of my life. I started trying to take the same approach with my mood—and it has become really helpful to do that: To try to be more patient, to be present, to remind myself that the bad moments are temporary, and to celebrate and focus on the good and happy moments when they occur.
That’s the philosophy behind this component of my DIY “therapy”: to write down and review happy memories, the times I’ve handled my strong emotions well, and the tough times I’ve survived. Some of my cards talk about…
The time my husband and I had a big fight, but got through it and felt closer than before
That I did well at completing the prerequisites to apply to PA school, including classes like chemistry that I didn’t think I was capable of
That I introduced my stepdaughters to art museums, and that they now enjoy going to them
Component V: Triggers, scary scenarios, and my plan for how I can handle these situations effectively (green index cards)
As you’ve read, the other components of my DIY “therapy” involve learning and reviewing coping mechanisms, focusing on the positive, and building confidence. This is where those things come together. This component is about rehearsing putting all of those things into action so that I’m ready to confront real-life challenges when they happen.
For me, there are some specific things in life that are always challenging. There are situations that I’ve struggled with in the past, and that I anticipate I’ll struggle with again in the future.
Then there’s anxiety about the future. There are things I anticipate happening that scare me to death.
This is what my green cards are for. I went through, and on each card, I wrote down one of my triggering situations or things I’m anxious about. Each one is written as a little scenario, things like…
I have a bunch of stuff to get done and I can’t seem to focus on anything; I’m getting stressed and feeling desperate
There’s something social and new I want to go try, but I’m scared to
It’s Monday morning. I just got to school/work, and I don’t want to get out of the car
I think I’m having a panic attack
My mood has been low for a couple of weeks, and it seems to be getting worse
These things can feel overwhelming and scary, even when they’re just hypothetical (like they are on my green cards). That’s why I don’t work on more than one or two during a session, and I don’t work on them during every session.
When I do work on them, here’s what I do. I choose a situation. I do this after I’ve spent some time on the other components I’ve listed, so things like coping mechanisms are fresh in my mind. I read and think about the situation—how I’d feel, times it has come up, etc. And then I start thinking about all the things I’ve learned and practiced that would help me deal with the situation in a healthy way. On the back of the card, I write down a game plan for how I can approach it.
Here’s what I wrote on the back of my card with the situation “My mood has been low for a couple of weeks, and it seems to be getting worse”:
Do something small to make progress on a goal
Remember times things have gone better. Remember: All things are temporary.
Call a family member, maybe even ask to spend time together
Focus on surviving just the present moment
DBT skill “TIPP”: Temperature change (hold ice cube, etc.), intense exercise, progressive breathing, practice things that work
Visualize things going well, visualize making it through this rough patch
Self-validate that things are difficult right now
Focus on one thing at a time
Remember past times like this, and that things got better
Have patience with self
Mala bead meditation
Cheerleading statements to self
This kind of problem-solving can be really comforting for me. Just like with my other colors of index cards, I try to review regularly my plans for dealing with difficult situations.
I started putting together a DIY therapy plan when I found out therapy could increase the effectiveness of TMS treatments for depression. It was a surprise, then, when I figured out the techniques of reading uplifting material, reviewing coping mechanisms, meditating, creating and focusing on custom-made positive affirmations, and planning for challenging scenarios were useful practices beyond just TMS treatment sessions. These are techniques I've found so helpful for my mental wellness. I hope some of these might be helpful for you, too. I’d love to hear other ideas and things that work for you.
*Note: This is just based on my memory of the appointment. I didn’t find reliable sources to support and fact-check what I remember from the appointment, so please don’t treat me or my blog as a definitive source on TMS! If you’re looking for info about TMS, please talk to a provider. Click here for the clinic I went through--they're a good place to start.