Group Support Session 5 - Managing Anxiety

This week was my last support session which brings this mini-series of blog posts to a close, so normal service will resume next week with a post that I'm planning on alexithymia. This week's session was about Managing Anxiety, which is something that I'm sure is a useful subject to cover for the majority of autistics.

We started with a warm-up exercise which is designed to show us a distraction technique for when we need to distance ourselves from the world around us and re-focus. It's a very simple exercise that's in the same vein as the classic "Take deep breaths and count to 10" that I'm sure we've all heard a million times, but this one is to stop and take note of 3 things you can smell, 3 things you can see and 3 things you can hear. It's just something to help you take a moment when you need it to escape the cause of anxiety.

After the warm-up exercise we thought about what causes anxiety for us individually. This session was a difficult one for me to really get into because alexithymia means that I often don't recognise how I'm feeling or why, so it can be difficult for me to identify what actually causes me anxiety, although I suspect that deep down I'm more affected by anxiety than I realise. The main causes of anxiety that we came up with as a group were other people (either other people in general, or large crowds of people) and sensory stimulants such as overly strong or artificial smells for example. Then we all put together a diagram to show what physical symptoms anxiety can give you. Mine were feeling sick, sweaty palms and feeling clammy. Other suggestions were things like headaches, tensing up and shortness of breath. Interestingly, when I feel sick from anxiety I feel it in my stomach whereas others apparently feel it further up in their neck/throat area.

We were shown a model of anxiety in the form of a diagram, which just shows that there are 4 factors in anxiety that are all linked to each other. There are Thoughts, Behaviours, Emotions and Bodily Sensations. So if you change one it can affect all of the others and can be used to reduce and relieve anxiety. For example, in terms of thoughts you can change them by trying to be aware of them, choose to let them go if you can, and ask yourself if your thoughts are the only truth. So by changing your thoughts to something else you can then start to feel better in yourself emotionally, reduce any physical symptoms you might be having and also react in a different way to deal with it better. Similarly, you can change any of the other 3 factors to affect the rest of them and cope better. This is the model that Cognitive Behavioural Therapy (CBT) is based on, and I was interested to find out that the success rate of CBT is more hit and miss than I realised. According to the occupational therapist in our session, CBT is something that really works for some people, but really doesn't work for others. And for those like me who struggle with alexithymia or other conditions, a different approach is needed. I was glad to hear that because that would explain why CBT didn't do anything for me a couple of years ago.

One of the last things we covered was a list of daily interventions - small things that you can do each day (or whenever you're able to) to help reduce anxiety:
- Keeping a diary can help you to notice your thoughts and to change how you think and feel about a situation through your increased awareness. Changing your thoughts can then lead onto the next intervention...
- Challenge your beliefs. Beliefs in this sense doesn't mean your religious beliefs or anything like that. It just means your beliefs about your life. For example whether you believe you're liked or disliked by other people, or what kind of job you believe you should be doing. If you change your thoughts it can eventually change your beliefs so that they match and therefore reduce anxiety as you'll be meeting your own expectations.
-Catch assumptions and chase logical conclusions. This one was a bit long-winded in the session, but basically it means think about the event that's causing you anxiety (the example we were given was going to a party) and think about what the consequences and logical outcome are of the specific reasons for your anxiety. So what are the consequences of meeting new people? You might assume they don't like you? Chances are you've been wrong about lots of similar assumptions in the past so you could be wrong about this one and they quite possibly will like you. And even if they don't, chances are you'll never see those people again so in the long-term it won't really matter. The point being you'll be fine after a while, so being aware of this can help reduce your anxiety.
-Chew it over and act normal. This one caused a bit of a discussion in the group because of the wording of it, but by "normal" it means what's normal for you. The point of this one is to train your anxiety by breaking the feedback loop. All that means is that by letting your anxiety influence your behaviours and your decisions you're then re-enforcing it rather than reducing it. So if you've been anxious about going out to a certain place/event that you want to go to, by going and enjoying yourself you're feeding back to your brain that it's ok to go and that you don't need to be anxious so that you find it easier to go next time.

The final thing we did was go over some examples of relaxation techniques with a particular focus on mindfulness. This is the practice of being present in the moment to help you acknowledge what's around you and respond to it accordingly. There are a few different ways and resources to practice mindfulness such as meditation, apps books on the subject etc. Some of the apps they told us about were ones that you pay for, but one that I think they said was free (although don't quote me on that) is called Brain In Hand. There's a few different apps for it available on the app store/Google Play anyway. Other tips for relaxation are things like listening to music, taking a break, and exercising your body and mind, although how you relax is down to your own personal preferences.

At the end of the session we all took a minute to add each other on Facebook, although I don't really use Facebook these days - I deleted everyone off it when I got fed up of it ages ago. So what I'm thinking of doing is starting a Messenger group with the 4 of us and keeping in touch that way.

Group Support Session 4 - Occupation

This week's support session was about occupation, and although I certainly learned some things from it, I don't think I gained as much from this session as I have from the others. One thing I did learn was that occupation doesn't just refer to your job. It means anything that takes up your time and keeps you occupied so it can include your self care routines, your interests and hobbies, as well as your job. The reason I didn't get as much out of this session is because our group has a tendency to run away with the conversation but the adjudicators have always brought us back onto topic to keep the session at least somewhat timely. Whereas this week it was lead by an occupational therapist who hadn't joined us before and he seemed to just let us loose to talk a lot more than the normal adjudicators do, so there were a few bits that we didn't have time to cover.

But still, we discussed how doing meaningful and engaging activities is beneficial to mental health, and we explored some of the barriers that can stop us from doing these and how to overcome them. Some of the barriers mentioned were social skills, environments, sensory issues and more. My personal fix to overcome social issues is to go to/do things on my own. Whenever I go to a gig or to a wrestling show or anything like that I always go on my own because I find it lets me concentrate more on the show that I've gone to see, and therefore I enjoy it more. When I've been to gigs and shows with other people I've always felt a need to concentrate more on them than the thing we've gone to see so I can't enjoy it as much as I would.

Environments refers to anything about the place such as it being an unfamiliar location or it being too busy with people. A strategy that was mentioned for overcoming both of these was to investigate the place in advance so that you can get a feel of where things are, where there might be a quiet area to escape to, or where/how you can access anything else that might help you dependent on your needs. Sensory issues can link into the environment as things like strong smells or bright, flashing lights for example can be distressing for those with sensory processing difficulties. To help with that the best thing to do is to be aware of your own sensory profile (as I mentioned in last week's post) and equip yourself with the best coping strategies for you. This could be sun glasses to protect against bright lights, ear plugs or noise-cancelling headphones to protect against loud noises, or anything else that you find helps you to overcome your difficulties so that you can enjoy what you're doing.

There were 2 things we learned from this week's session that I thought could potentially be really helpful to me in the future, and are definitely worth sharing. The first one is that you can apply for a Safe Place card, which is a scheme that's run across the UK and means that if you need to find somewhere for support or even just to escape from the world for a bit while you're out and about there are certain venues registered to the scheme where you can do this. As I live in York we were given the link for the Safe Places York website, which you can find here, but it's also worth searching online for the scheme in your local area as it is something that's run nationwide. I was surprised at some of the actual venues in York city centre that are signed up to the scheme as I was expecting things like cafes, libraries and so on, which there is but there are also things like the HSBC branch in Parliament Street, the Theatre Royal and DIG, which is an archaeological adventure place for kids.

The other thing I learned is that the government run a scheme called Access To Work, which is there to help disabled people or people with physical or mental health conditions that are affecting them at work. Legally an employer has an obligation to make any reasonable adjustments, but if you're having difficulty with this then Access To Work can help you. They can even offer grants to help towards the cost of things like special equipment, physical adaptations and getting to and from work. The scheme wasn't mentioned in great detail in the session but it may be worth looking at the website here.

This then leads me on to the final section that we covered, which is work and was mainly around disclosing autism to your employer or potential employer. While there's no definitive right or wrong answer to this dilemma we debated whether it's best to tell potential employers during recruitment that you're autistic or not. The plus side of telling them would be that they'll be aware from the start and they'll be able to take you on knowing what adjustments you might need, or that you may need some adjustments to be made as you get to know the job. They can also help with the interview process by providing interview questions in advance or by potentially using a different method of assessment. Autism may also help demonstrate to an employer the skills you have and be a positive reason for why you'd be good in the role.The down side is that the recruiters may show bias if they know you're autistic (whether they intend to or not) and this might lead to your application not being considered. Again, there's no right or wrong answer to this dilemma as it's all down to personal preference and judgment. I would personally prefer to tell an employer during the application process because the positives outweigh the negatives, especially in a world where acceptance of disability as a whole is on the increase. With that said, I see it as a case of when to tell them rather than whether to tell them. I wouldn't necessarily include it in my CV or tell them straight away, but I would certainly tell them after they've had a little while to see how I am and my strengths and weaknesses.

Group Support Session 3 - Sensory Processing & Repetitive Behaviours

First of all, sorry for the late post. I've been mega busy with family life and work so didn't get the chance to write a post yesterday.

This week's support session was on sensory processing and repetitive behaviours and I quite enjoyed the session this week. We started off by having everyone talk a bit about  their favourite sensory experiences. I explained that my new favourite thing was my sequin snap band that I got from eBay after discovering them in the sensory box at the sessions. I also explained that I'm quite a heavy chewer - which is why I've always got my button necklace from Chewigem on me - and I contemplated whether that's related to why I have a habit of over eating, or whether it's to do with the taste, or both.

We covered all the difference senses and how they can be either under active (hyposensitive) or over active (hypersensitive) in autistic people, or even both! I always thought there were only 5 senses, but it turns out there are actually 7 or 8 senses depending how you look at the 8th one. The senses are:
1. Sight
2. Taste
3. Smell
4. Sound
5. Touch
6. Vestibular
7. Proprioception
8. Interoception

The first 5 are self-explanatory, so lets just go over the last 3. Vestibular is the sense of balance and spatial awareness, which helps to coordinate movement with balance. Proprioception is the sense of position of the parts of your own body in relation to the rest of your body, as well as the strength and effort that's put into movement. Interoception is the recognition of the body's signals such as hunger, full bladder etc. One of the coping strategies that we were given to deal with sensory issues is to develop a sensory profile. This is basically just knowing what you're under/over sensitive to in relation to each sense, but they gave us a handy table for us to write it down on, which I'll include at the bottom of this post for you.

There was a brief section about stimming where they explained that it's self-stimulatory behaviour which is used as a coping strategy to help suppress pain, help with calmness, or just simply for sensory stimulation. A stim is defined as a repetitive action or movement. For example, as mentioned before I chew a lot, and I now also play with the sequins on my snap band rubbing them back and forth to change them from black to white and back again. These are among several other things I do. Stimming is something that everyone does in one way or another, but it's usually more obvious, frequent or intense in autistics. We were encouraged to try to be aware of our sensory diet in that we all need a certain level of sensory input on a regular basis, just like we all need to eat food on a regular basis. One particular example of how you can take in sensory input is apparently yoga because it includes the vestibular and proprioceptive senses which can be the most soothing. Everybody is different though, so it's best to find what works for you.

After this we took a short break and then moved on to repetitive and restrictive behaviours, but we were running behind at this point so didn't have the time to go through it in as much detail as we probably should have. We first covered the different types of repetitive behaviours which are:
- Repetitive motor movements (hand flapping, rocking bouncing etc)
- Fixed routines and rituals (insistence on following rules, doing things the same way each time, resistance to environmental change)
- Restricted/fixated interests (for example my interest in wrestling where I can spend hours on end watching/researching/listening to wrestling themes and doing nothing else)
- Sensory seeking/aversion (Seeking out certain senses that you enjoy or find soothing or conversely, avoiding those that you don't)

We went though some pros and cons of each of these 4 types and we established some strategies for finding balance between these behaviours and the rest of everyday life. These can be simple things such as setting a timer, exploring alternatives, asking for help/advice from other people, making plans/scheduling etc. It's also important to be open to and accept other commitments as these are just a part of life and need to be given a time and a place just like your interests and other behaviours. A couple of the examples I gave of routines and rituals are that when I make a cup of tea I make sure I let it brew for exactly 5 minutes (Alexa comes in handy for that!) before I take the tea bag out and add the milk. I also insist on using the document feeder on our printer when I'm trying to scan something in because the idea of it is to make things quicker an easier. But because our printer is a bit crap it doesn't always work, so I end up spending ages trying to fix it to scan my things in through the feeder when by the time I've managed to fix it I actually could have scanned it in manually on the scanner bed in about half the time. These 2 things are the main things that annoy my wife but I insist on doing them because it's how they should be done. I can understand her getting annoyed about the printer because in reality I'm wasting more time by trying to do it the quick way, but I just see letting a cup of tea brew for 5 minutes as doing it properly. I think it does taste better and it also gets more caffeine out of it. And I also think that if you put the milk in first you're a monster!

Here's the table we were given as mentioned above to help profile your sensory preferences and needs:


Group Support Session 2 - Social Communication & Interaction

This week is week 2 of 5 of my group support sessions, and this week's focus was social communication and interaction. Socialising and people skills are the areas I think I struggle with the most in terms of my autism so I was looking forward to this one to see what I could learn. There was 1 more of us in the group this week than there was last week, and we found out that 1 of the remaining absentees has had to drop out due to work commitments. So that just leaves 1 more member of the group who we've not met yet. I think it's interesting that out of the 4 of us that have attended the sessions so far there's only 1 woman. I think that speaks volumes toward the ratio of males to females that have been/are being diagnosed. Autism in women and girls is becoming more recognised and diagnosed more often, but we've got a way to go yet.

This week's session was mostly just things that I already knew, but that's just because I've tried to be as involved as I can be in the online autistic community via the #ActuallyAutistic and #AskingAutistics hashtags so I've learned a lot from that, and I also did a lot of research while I was waiting for my referral.I got the impression that the other 3 members of the group might not be so involved online, in which case it was probably more helpful for them than it was for me. Having said that though, there were a few bits that I learned and will probably find helpful. One part of the session was getting us to think about and write a short list of our social strengths and weaknesses. I literally can't think of any actual strengths but I listed 3 weaknesses. What I put down under the strengths column (just so that I had something to put there) was that I feel more comfortable in places like a work environment where we're there for a reason, so to me that means I don't have to socialise because I've got the excuse of having work to do. In contrast to that, if I'm out in a social or informal situation I feel a lot more pressure because the reason for being there is to be sociable. This is why I don't like going out any more, and when I do go out to a gig or to the wrestling or something like that I usually go on my own.

There was a video about making and maintaining friendships by Robyn Stewart which can be found here, and then some tips for developing friendships. The advice is all good but even long before I knew I was autistic I've always found that this kind of advice is very vague and I've always struggled to translate it into my own personal situations to help me. They gave us this link to a page on Social Isolation from the National Autistic Society's website, which contains a lot of information and resources to help with socialising. The other problem for me personally is that I genuinely don't have time to be sociable. In a typical day I get up on a morning, look after my kids all day, go to work in the evening and then go to bed for a few hours. Maybe when the kids get a bit older and start school full time I might have a bit more time that I can commit to improving my social skills but at the moment I can't fit anything else in.

We were introduced to the concept of social thinking, which is a process to help social development and we were given a link to a company also called Social Thinking. It seems to be an American company offering clinics, conferences, e-learning modules etc, but we were just given the link for information more than anything else I think as there does seem to be a lot on there.

The last part of the session was covering the spoon theory, which I'm familiar with but only recently, and also the social battery, which is basically just another metaphor to help explain the same as the spoon theory but in a different way. There's yet more links that we were given in this bit. Admittedly I haven't had the time to look through them all yet but from what I gather they could potentially be interesting reads if nothing else. This one is an article explaining Christine Miserandino's personal story that lead to the origin of the spoon theory. The other one is a link to a blog by Nell Goddard where she explains the social battery as experienced by introverts such as myself. This one seems particularly interesting and I'm going to make the time to have a read of it before long. Lastly, we covered a brief bit about masking which tied into spoons/social battery by explaining that making an increased effort to appear neurotypical can be very draining and that it's important to take time out to be yourself when you can to prevent burnout.

I hope that by covering my support sessions in the blog I can help people find a bit of understanding of themselves or others, and that I've offered some helpful resources for that.

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