Guide to Developing a WRAP-

[Mel]

Guide to Developing a WRAP-

Wellness Recovery Action Plan
The following handout will serve as a guide to developing Wellness Recovery Action Plans. It can be used by people who are experiencing psychiatric symptoms to develop their own guide, or by health care professionals who are helping others to develop Wellness Recovery Action Plans.

This handout, or any part of this handout, may be copied for use in working with individuals or groups.

Getting Started

The following supplies will be needed to develop a Wellness Recovery Action Plan:

a three ring binder, one inch thick
a set of five dividers or tabs
a package of three ring filler paper, most people preferred lined
a writing instrument of some kind
(optional) a friend or other supporter to give you assistance and feedback
Section 1-Daily Maintenance List

On the first tab write Daily Maintenance List. Insert it in the binder followed by several sheets of filler paper.

On the first page, describe, in list form, yourself when you are feeling all right.

On the next page make a list of things you need to do for yourself every day to keep yourself feeling alright.

On the next page, make a reminder list for things you might need to do. Reading through this list daily helps keep us on track.

Section 2-Triggers

External events or circumstances that, if they happen, may produce serious symptoms that make you feel like you are getting ill. These are normal reactions to events in our lives, but if we don't respond to them and deal with them in some way, they may actually cause a worsening in our symptoms.

On the next tab write "Triggers" and put in several sheets of binder paper.

On the first page, write down those things that, if they happened, might cause an increase in your symptoms. They may have triggered or increased symptoms in the past.

On the next page, write an action plan to use if triggers come up, using the Wellness Toolbox at the end of this handout as a guide.

Section 3-Early Warning Signs

Early warning signs are internal and may be unrelated to reactions to stressful situations. In spite of our best efforts at reducing symptoms, we may begin to experience early warning signs, subtle signs of change that indicate we may need to take some further action.

On the next tab write "Early Warning Signs". On the first page of this section, make a list of early warning signs you have noticed.

On the next page, write an action plan to use if early warning signs come up, using the Wellness Toolbox at the end of this handout as a guide.

[Mel]

Guide to Developing a WRAP-
Wellness Recovery Action Plan
cont.

Section 4-Things are Breaking Down or Getting Worse

In spite of our best efforts, our symptoms may progress to the point where they are very uncomfortable, serious and even dangerous, but we are still able to take some action on our own behalf. This is a very important time. It is necessary to take immediate action to prevent a crisis.

On the next tab write, "When Things are Breaking Down". Then make a list of the symptoms which, for you, mean that things have worsened and are close to the crisis stage.

On the next page, write an action plan to use "When Things are Breaking Down" using the Wellness Toolbox at the end of this handout as a guide.

Section 5-Crisis Planning

In spite of our best planning and assertive action, we may find ourselves in a crisis situation where others will need to take over responsibility for our care. We may feel like we are totally out of control.

Writing a crisis plan when you are well to instruct others about how to care for you when you are not well, keeps you in control even when it seems like things are out of control. Others will know what to do, saving everyone time and frustration, while insuring that your needs will be met. Develop this plan slowly when you are feeling well. The crisis planning form includes space to write:

those symptoms that would indicate to others they need to take action in your behalf
who you would want to take this action
medications you are currently taking, those that might help in a crisis, and those that should be avoided
treatments that you prefer and those that should be avoided
a workable plan for at home care
acceptable and unacceptable treatment facilities
actions that others can take that would be helpful
actions that should be avoided
instructions on when the plan no longer needs to be used

[Mel]

Developing a Wellness Toolbox
By Mary Ellen Copeland, M.S., M.A.
The first step in developing your own Wellness Recovery Action Plan [WRAP] is to develop a Wellness Toolbox. This is a listing of things you have done in the past, or could do, to help yourself stay well, and things you could do to help yourself feel better when you are not doing well. You will use these "tools" to develop your own WRAP.

Insert several sheets of paper in the front of your binder. List on these sheets the tools, strategies and skills you need to use on a daily basis to keep yourself well, along with those you use frequently or occasionally to help yourself feel better and to relieve troubling symptoms. Include things that you have done in the past, things that you have heard of and thought you might like to try, and things that have been recommended to you by health care providers and other supporters. You can get ideas on other tools from self-help books, including those by Mary Ellen Copeland: The Depression Workbook: A Guide to Living With Depression and Manic Depression, Living Without Depression and Manic Depression: A Guide to Maintaining Mood Stability, The Worry Control Book, Winning Against Relapse, Healing the Trauma of Abuse, The Loneliness Workbook. You can get other ideas from the audio- tapes Winning Against Relapse Program and Strategies for Living with Depression and Manic Depression.

The following list includes the tools that are most commonly used to stay well and help relieve symptoms:

Talk to a friend – many people find this to be really helpful
Talk to a health care professional
Peer counseling or exchange listening
Focusing exercises
Relaxation and stress reduction exercises
Guided imagery
Journaling – writing in a notebook
Creative affirming activities
Exercise
Diet considerations
Light through your eyes
Extra rest
Take time off from home or work responsibilities
Hot packs or cold packs
Take medications, vitamins, minerals, herbal supplements
Attend a support group
See your counselor
Do something "normal" like washing your hair, shaving or going to work
Get a medication check
Get a second opinion
Call a warm or hot line
Surround yourself with people who are positive, affirming and loving
Wear something that makes you feel good
Look through old pictures, scrapbooks and photo albums
Make a list of your accomplishments
Spend ten minutes writing down everything good you can think of about yourself
Do something that makes you laugh
Do something special for someone else
Get some little things done
Repeat positive affirmations
Focus on and appreciate what is happening right now
Take a warm bath
Listen to music, make music or sing
Your list of tools could also include things you want to avoid like:

alcohol, sugar and caffeine
going to bars
getting overtired
certain people
Refer to these lists as you develop your Wellness Recovery Action Plan. Keep it in the front of your binder so you can use it whenever you feel you need to revise all or parts of your plan.

[Mel]

Blueprints for Building Self-Esteem

By Mary Ellen Copeland, M.S., M.A.
In my work, I sometimes feel that there is an epidemic of low self-esteem. Even people who seem to be very sure of themselves will admit to having low self-esteem, a feeling that often makes them unhappy and keeps them from doing some of the things they want to do and being the kind of person they want to be. In fact, they may say that low self-esteem causes, or worsens, their bouts with depression and anxiety.

I know this has been a big factor in my life. I feel that I am always working on raising my self-esteem and that I will always need to do that.

There is no single way to build self-esteem. There are many different things you can do to work on this issue, and I, myself, am always on the lookout for new ways to raise self-esteem. This article will describe some of what I have learned to date.

Get Involved

Right now you have an opportunity to do something that will help you to raise your self-esteem. Once every four years, you can vote for the person you would like to be the next President of the United States. You also have the opportunity to vote for other national, state and local officials. Irrespective of the outcome of the election, informing yourself about the candidates and voting for the ones who support issues that are important to you can make you feel good about yourself, raising your self-esteem.

Begin the process by thinking about the issues that are most important to you – education, health care, the environment, taxes, defense spending, etc. If you don't know how you feel about these issues, read some related articles and talk with people who have the information you need. Then, when you know how you feel, find out which candidates support your views. Then vote for those candidates. If you feel strongly about certain candidates and have the time, you may want to volunteer to help them with their campaigns. Activism will give your self-esteem another boost.

Take Good Care of Yourself

Another way you can build your self-esteem is to take very good care of yourself. You may take very good care of others and put your own personal care last. Or your life may be so busy that you don't take the time to do the things you need to do to stay healthy. You may feel so badly about yourself that you don't bother to take good care of yourself.

Some of the things you can do to take good care of yourself include:

Eating three meals a day that are focused on healthy foods – fresh fruit and vegetables, as well as whole grain foods and rich sources of protein like chicken and fish.


Avoiding foods that contain large amounts of sugar, caffeine and food additives. If you can't pronounce the ingredients, you may want to avoid it.


Getting outside and exercising every day.


Spending some time each day doing something you really enjoy.


Spending time each day with people who make you feel good about yourself.


Having regular check-ups with your health care providers.
Change Negative Thoughts About Yourself to Positive Ones

Work on changing negative thoughts about yourself to positive ones. You may give yourself lots of negative self-talk. Many people do. This negative self-talk increases your low self-esteem.

You can decide now not to do this to yourself. That's great if you can do it. However, negative self-talk is often a habit that is hard to break. You may need to work on it more directly by changing negative statements about yourself to positive ones.

Begin this process by making a list of the negative statements you often say to yourself. Some of the most common ones are:

Nobody likes me.


I am ugly.


I never do anything right.


I am a failure.


I am dumb.


Everyone is better than I am.


I'm not worth anything.


I've never accomplished anything worthwhile.
Then develop a positive statement that refutes the negative one. For instance, instead of saying to yourself, "Nobody likes me," you could say, "Many people like me." You could even make a list of the people who like you. Instead of saying, "I am ugly," you could say, "I look fine." Instead of saying, "I never do anything right," you could say "I have done many things right." You could even make a list of things you have done right. It helps to do this work in a special notebook or journal.

When you have developed positive statements that refute your negative statements, read them over and over to yourself. Read them before you go to bed at night and when you first get up in the morning. Read them aloud to your partner, a close friend or your counselor. Make signs that express positive statements about you and post them where you will see them – like on the mirror in your bathroom. Then read them aloud every time you see them. Think about some other ways to reinforce these positive statements about yourself.

Get Something Done

Low self-esteem is often accompanied by lack of motivation. It may feel very hard to do anything. It will help you to feel better about yourself if you do something, even if it is a very small thing. You may want to keep a list of possibilities on hand for those times when you can't think of anything to do. Things like: cleaning out one drawer, washing the outside of your refrigerator, putting a few pictures in a photo album, reading an article you have been wanting to read, taking a picture of a beautiful flower or a person you love, making the bed, doing a load of laundry, cooking yourself something healthy, sending someone a card, hanging a picture or taking a short walk.

Make a List of Your Accomplishments

You may not give yourself credit for all that you have achieved in your life. Making a list of your accomplishments will help you become more aware of these accomplishments. It will also help change the focus of your self-thoughts to positive ones. You can do this exercise again and again, whenever you notice your self-esteem is low.

Get a big sheet of paper and a comfortable pen. Set the timer for 20 minutes (or as long as you'd like). Spend the time writing your accomplishments. You could never have a paper long enough or enough time to write them all. Nothing is too big or too small to go on this list. This list can include things like:

Learning to talk, walk, read, skip, etc.;


Planting some seeds or caring for houseplants;


Raising a child;


Making and keeping a good friend;


Dealing with a major illness or disability;


Buying your groceries;


Driving your car or catching the subway;


Smiling at a person who looks sad;


Taking a difficult course;


Getting a job;


Doing the dishes; or


Making the bed.
Do Something Special for Someone Else

Have you ever noticed the good feeling that washes over you when you do something nice for someone else? If so, take advantage of that good feeling by doing things that are "nice" or helpful to others as often as you can to build your self-esteem. Watch for opportunities that come up every day. Buy your partner some flowers or even one rose. Send a friend a greeting card. If someone you know is having a hard time, send them a note or give them a call. Go out of your way to congratulate people you know on their achievements. Visit a patient at a nursing home or hospital or someone who is "shut-in." Play with a child – read him a book, take her for a walk, push him on the swing. Do a chore for someone that might be hard for her or him like raking the leaves or mowing the grass. You may even want to volunteer for an organization that is helping others, like a heart association or AIDS project. I'm sure you can think of many other ideas.

Other Quick Things You Can Do to Raise Your Self-esteem

Following is a list of other things you can do to raise your self-esteem. Some of them will be right at one time, while others will work at another time. There may be some you choose not to do – ever. You may want to post this list on your refrigerator or in some other convenient place as a reminder.

Surround yourself with people who are positive, affirming and loving.


Wear something that makes you feel good.


Look through old pictures, scrapbooks and photo albums.


Make a collage of your life.


Spend 10 minutes writing down everything good you can think of about yourself.


Do something that makes you laugh.


Pretend you are your own best friend.


Repeat positive statements over and over again.
You can add more ideas to this list as you discover them for yourself.

In Conclusion

Work on raising your self-esteem may go on for the rest of your life. However, this is not a burden. The kinds of things you do to raise your self-esteem will not only help you to feel better about yourself, but will improve the quality of your life while energizing and enriching it.