Why It Is Important To Be Aware Of Your Mental Health Triggers

During every moment of every day, everyone’s experiences in the outside world trigger an inward, mental response to that event in that person’s head. Seeing a penguin could cause someone to feel happy for example, or seeing someone kicking a penguin could cause someone to feel a rage more powerful than can be possibly imagined. Either way, what happens on the outside will flip some kind of switch on the inside, and, if a person has a mental illness, that switch may be the one that controls their disorder/sets it off on a rampage. Daily life with a mental health problem is a struggle in general, but pretty much everyone will have things that trigger their disorders more than usual, and for this reason people will avoid thinking about these things.
In terms of OCD I know there are certain words or smells that make me particularly likely to engage in compulsive behaviours, and I know that hearing people talk about weight loss, exercise or calories pushes the buttons of my eating disorder. Consequently, I do my best to stick my head in the sand when it comes to things like that and I avoid thinking about those topics as much as possible. On the surface it seems like a good idea, surely if I avoid thinking about things that make my disorder worse, I will avoid the distress they cause and I won’t have to deal with it. However this head in the sand method tends to fall to pieces if I ever find myself in a situation where I cannot avoid my triggers, because by never thinking about them, I have not prepared a way to manage my response. It is all well and good to turn off TV programs about topics in which my OCD trigger words are likely to arise, or avoid people following the latest diet trend and pretend that they are not a problem for me, but say for instance I was ever kidnapped by my local troop of Weight Watchers (not that I am suggesting that people who belong to the aforementioned diet club are at high risk of kidnapping people), I would be screwed.
For this reason I would say that thinking about your triggers and planning ways to cope when confronted with them is actually vital in terms of living with a mental disorder, and if for some reason you do not believe me when I say this (which I would understand; it is after all asking a lot for you to trust the words of a stranger on the internet without explanation), then allow me to illustrate my point with a story about my good friend Bert…

Bert is a very famous athlete, his sport being the javelin throw. He is 28 years old and has been training since the age of five after he found his first ever Javelin waiting for him in a stocking one Christmas morning (this was back in the day when Santa was not very good at picking out gifts for the under tens and Health and Safety were less on the ball than they are nowadays). Due to many years of training and a natural talent for throwing long pointy objects, Bert excelled at his sport and was thus invited to attend the Olympics in Rio this year. Bert was thrilled. He immediately packed his bags, stepped on a plane and set off to Rio (I don’t know how exactly he got through airport security with a massive javelin when most people aren’t allowed more than 100ml of shampoo but just go with it).
Upon arrival, he went to the stadium in which his sport was to be held, but prior to reaching the changing rooms, a strange man in a top hat came up to him with news that shocked Bert to his very core. For some unknown and mysterious reason it was confirmed that Bert was indeed to compete in the Olympics…BUT NOT IN THE JAVELIN. No, because of some kind of spelling mistake on behalf of an overworked secretary, Bert had been entered into the dressage, an understandable error as we all know how often one will accidentally find oneself writing “dressage” when meaning Javelin. Whoever wrote the dictionary really should have made those words less similar to save us all the stress we face in daily life… ANYWAY. Bert cried out and pleaded with the top hatted man for the error to be changed but there was no way, and thus it happened that Bert found himself as a competitor in the dressage event Rio 2016 despite having no knowledge of dressage whatsoever. With two hours to go before the competition started, Bert rushed off in a panic to try and find someone with any knowledge of dressage, but alas though he looked in every nook (he forgot to check the crannies), he found nothing, and had to turn up to the event as clueless as the moment he had stepped off the plane. Only when it was his turn to perform did he realise the problem even bigger than having no knowledge of dressage. He had no horse. Therefore poor Bert had to compete without a noble steed, resorting to galloping and prancing around the paddock tossing his imaginary mane all alone. It was a catastrophe.
Now, let’s just imagine that story again, but with one very important detail changed. In this second version, instead of finding out about the unfortunate spelling error in the stadium, he found out in a phone call from the man with the top hat before he packed to get on the plane. This way the situation awaiting Bert was to be exactly as it was the first time, but in this version Bert had time to prepare. By knowing about the mix up beforehand, he was able to run to the fields prior to his flight and purchase a horse from an old farmer called Frank, to accompany him on his journey (again I have no idea how he got a horse through airport security but to be honest if the unrealistic portrayal of airport security is the only thing you are finding hard to believe in this story then I feel I am doing rather well.) When it came to the dressage event Bert still had little knowledge of dressage, but having read a pamphlet on the plane and with his horse, he was able to compete considerably better than he had in the alternate universe where he had been forced to gallop around the paddock himself. Did Bert still come last in the event? Yes. Did he score the lowest mark in the history of dressage at the Olympics? Of course he did, but by anticipating the sudden event change before getting on the plane, Bert was able to prepare the best he could for the inevitable difficulty in his future and thus able to manage the situation far better.
Now, if we read this story and interpret participating in a sudden dressage competition as being forced to suddenly face one of your triggers without ever having thought about how to deal with it first, I think we can all agree that it was better for Bert to be aware of the upcoming problem so that he could prepare, and therefore better for people to anticipate and think about ways to manage their triggers before they are sprung upon them unexpectedly.
Did Bert having a horse stop all of the distress and anxiety when performing? No, but he was at least better prepared than in the first story and was able to do all he could to make the best of that situation/gather a horse together.

Knowing your triggers will not cure you of your illness, but there are times in which it can help manage the surprise bouts of anxiety when these triggers come up in situations you hadn’t expected them to (say for example a sudden kidnapping from a band of rogue members of your local Weight Watchers).
Obviously by simply being aware of what situations or things trigger you, you are not going to change the affect those triggers may have or lessen any distress they may cause. Even when you are aware of what makes life difficult those difficulties will still affect you, but when you are aware of what sets your disorder off, you are at least able to anticipate ways of dealing with it.
Thinking about triggers is always going to be hard, yet I can assure each and every one of you out there that doing so is a lot easier than encountering them unawares, just as it is much easier to perform in Olympic dressage when you have a horse…

Take care everyone



The Great Eating Disorder Bake Off

If you live in England it is likely you are a viewer of, (or are at least aware of), The Great British bake off, a show otherwise known as “The Greatest Program on Television ever”. Seriously, if you don’t watch it you really should give it a go…That is unless you have an allergic reaction to the phrase “soggy bottom” or deep seated hatred of collections of people baking in tents and having their creations critiqued by a bearded man who likes to squash bread into balls and then complain about the consistency of the bread he has just mashed back into a dough…If that is the case maybe give the bake off a miss…
Luckily, none of those things bother me, so I am able to enjoy the bake off in all of its pun filled, icing topped glory. However, every time the annual bake off rolls around, it always reminds me of a certain symptom common to many people with food related mental health problems. The symptom? Many people with eating disorders are obsessed with baking.

Obviously not everyone who has an eating disorder bakes and not everyone who bakes has an eating disorder (if they did Mary Berry would be in need of some treatment immediately). On the whole though, it is a very common problem that many people are unaware of, and that rarely comes up or gets talked about other than by the people whom it affects. To some of you out there, it may sound a bit ridiculous to write a post about the issue that is eating disorder patients finding any excuse to whip out a spatula. After all what is the problem with a bunch of anorexics liking to bake a few sponges now and again? Why worry when someone with bulimia gets out a wooden spoon and starts sieving flour with eyes squinted in concentration? Why complain about someone bringing fresh homemade cookies into work purely because the baker has been diagnosed with EDNOS? Well, the problem is that often people with eating disorders who are obsessed with baking, are obsessed in a very unhealthy way that can be detrimental in recovery and serve the eating disorder rather than the baker.
Seriously, it is such a common and big issue that many of my disordered friends and indeed I myself, have been placed on multiple “baking bans” by mental health services during treatment for anorexia, an experience much like being a smoker on a smoking ban, only I was rocking back and forth cradling a wooden spoon rather than a packet of tobacco.

Like I said, not everyone who bakes has this problem and the problem isn’t within baking itself. Baking is awesome, and there is nothing like the satisfaction you get from people admiring your perfectly risen soufflé, but the issues arise and things get disordered when the baker dedicates an unusual amount of time to their pursuit, yet refuses to try even a lick of icing from the bakes they produce themselves.

For people who haven’t experienced an eating disorder, this probably doesn’t make much sense. Why would someone with a difficult relationship with food surround themselves and actively go about creating the culinary masterpieces that they themselves fear to sample?
Well, as always I can’t speak for everyone suffering from a mental health problem. Though similar on the surface, we are still all so varied inside (much like how chocolate chip cookies and raisin cookies look alike but are actually completely different). Nevertheless, I thought I would at least try to explain here why I personally love to bake, in the hopes that maybe I will provide an explanation and speak for a few others out there.

When I bake, it isn’t just about taking part in a little hobby to pass the time, it is about serving a purpose in terms of my anorexia.
Don’t get me wrong, by involving food it is still a scary activity (for example I often worry about touching fatty ingredients for fear the fat will sink into my skin or I worry that the smell of a cake has calories in it), but overall baking is an outlet, a thing I can do with food that other people can do, and most importantly, a way I can take part in the cultural aspect of food.

Normally in my life with anorexia, when it comes to food/events related to food, I see myself on the outside of things. Whenever someone has a birthday cake, a dinner party or hands round a box of chocolates at Christmas, I watch it all play out like an observer. In the room but not really involved, almost like I am in a theatre watching a scene being played out on stage whilst I am firmly seated in the audience. For over a decade I haven’t been able to join in with many food related things. I haven’t shared a pizza or bucket of popcorn with a friend, I haven’t accepted a bourbon offered over a cup of tea or indeed eaten something at a meal table that was the same as other people eating around me.
Baking then, serves as a way I can get a bit more involved in all of those things, only without the terror I would associate with joining in like a “normal” person.

When I bake a cake it is as if I can stand on the stage with everyone else rather than having to stay firmly seated in the audience, watching from afar through my little pair of binoculars (this may be an analogy but I am unable to afford good theatre seats.)
Instead, I can bring out the cake for the characters to start eating in the next scene, I have a role, a part to play in the action, I am not merely an observer but up there in the spotlight as “The bringer of cake”.
If people talk about food I haven’t tried or made I cannot join in. When people comment on something I have made however, I am involved. They can ask questions about what is in the bake and I will know the answers. Okay I may not have eaten the food myself, but in creating it, I can relate to it in a way that sounds as educated and informed as if I had. If people comment “oooh is there vanilla in this?”, I don’t have to just stand there staring at the confection trying to spot a pod of vanilla, or turning to other people to see if they can taste vanilla too, I can answer for myself that there is indeed vanilla in the cake, and for one second I can actually feel like a human being, part of something “normal”, joining in.
That is why I love baking despite having an eating disorder that prevents me from tasting any of my creations myself, and perhaps that is why a lot of other people with eating disorders like baking too.

In writing this my aims are not to encourage any disordered bakers out there to pack up the pastry or to tell carers of the mentally ill to confiscate their whisks.
If you enjoy baking and it makes you happy, do it more often, but still I have written this because I think it is important to question yourself if you are one of those bakers who would never consider having a nibble on their own Battenberg, and important for people to be aware of the fact that in some cases, a baking obsession can be a symptom of an eating disorder. If you as a reader ever feel compelled to get busy in the kitchen, my only hope is that you bake your cake and eat it too. Sure it may be nice just to partake in the creative process, to play the role of “the bringer of cake” in scenes you would otherwise watch from the wings, but the experience is a hell of a lot sweeter when you are actually able to fully join in with the eating part and share a Victoria sponge with friends. It is scary, but as a Bake Off challenge I would encourage you all to give it a go, and, if ever in doubt, just ask yourself: What would Mary Berry do?
(Answer: she would eat it, and as a British national treasure you should really follow her example).


How To Fight Fear With Fear In Recovery From Mental Health Problems

When you are in treatment for a mental health problem, one of the questions that comes up a lot is the query of “What do you want?”. Many people find this helpful, and in thinking about what they want from life, they find motivation and strength to recover. For example, I know a lot of people with eating disorders who want to have children, are helped to eat by the thought that they need to be healthy to have a nice comfy womb (that is the scientific term for “be fertile” I believe).
When you know what you want from life, it doesn’t make recovery easy, but it gives you a purpose, something to fight that nagging voice in your head with, an argument as to why you are forcing yourself to do things like challenging pieces of therapy that make you feel uncomfortable. With an end goal, the stress and pain of recovery make sense, like running a race and focusing on the finish line with a giant gold trophy at the end of it, whether that trophy represents kids, a passion to travel the world or a desire to pursue a difficult career that wouldn’t be possible with insanity by your side.

To be fair I think “What do you want?” is a really important question for anyone to ask themselves in life, or indeed an important question for waiters to ask customers prior to bringing them food. Imagine if every time you went to a restaurant the chef just always assumed you wanted oranges and served everyone who ever sat at a table a bowl crammed with citrus wedges without finding out if the person liked such a thing first. WHAT A MAD WORLD THAT WOULD BE!
Clearly then, the aforementioned question is vital for sanity in the mental health world and the restaurant trade, but the problem with it is how you answer such an inquisition when you are unsure of exactly what you want, what your goal in life is, and it is an issue that can leave you feeling a bit stuck. That is how I feel, like I am running in a race where I can’t see a finish line or big shiny trophy to aim for, and considering that a loss of interest in things is a symptom of depression, I imagine it is a feeling that many are familiar with.

The only thing that I can hand on heart say that I actually have a desire to do, or a want to achieve, is to be a published author one day. That idea is the thing that gets me out of bed in the morning, but I am tentative to make that my overall focus for recovery. Becoming a professional author is a notoriously difficult thing to achieve and I am fearful of basing my entire recovery on such a risky goal that is really quite out of my control. Of course I realise no career or dream is straight forward and nothing anyone would ever really want is easy to reach. After all, if dreams weren’t a little fantastical and difficult, where would the appeal be? The point of dreams is that they have that element of the unattainable surrounding them to make them special. That said, wanting to be a writer is probably up there in the top ten dreams that are seldom realised.
When you want to be a writer, there are no directions, no post code to put into google maps and no yellow brick road giving you a little route to follow to your desired destination. You want to be published and can write all you want, but getting anywhere with it is a little out of your control and a lot of it is based on luck. It really is a case of writing and then keeping your fingers crossed, a particularly difficult combination of actions to do together as when one’s fingers are crossed, it makes it infinitely more difficult to hold a pen to write anything with.

In terms of concrete and definitely attainable things I want then, my pocket of ideas is empty. I suppose I should count myself lucky that I have the want to be a writer at all, as like I said, when you are depressed or caught up in a mental illness, you are so wrapped up in your mind that you can’t want anything other than for the pain to stop.
Coincidentally, when psychology professionals and therapists ask me what I want, that is pretty much my answer. I don’t know what I want, so personally I find focusing on what I don’t want is easier, as I know I don’t want to feel the way I do. I don’t want to feel the weight of sadness on my shoulders when there is nothing rational to be sad about, I don’t want to be anxious about touching doorhandles, I don’t want to shower for ages and I don’t want to care about what food I will be eating in the next few weeks. At the same time though, it has been such a long time since I lived in any other way that I don’t know what the alternatives to those things are. When you have been out of the real world for so long, how can you remember what it is like there, let alone what things you would want to get out of it?

It sounds pretty negative to focus on things you don’t want rather than the things you do, but recently I have to say that actually thinking that way has been a bigger help and more of a motivation than any potential desires on the horizon.
When in hospital and indeed now I am back home, at every meal time I am scared and I do not want to eat. It isn’t a case of not wanting whatever food has been place in front of me (please let it be known that my mother is a fabulous cook and all of her concoctions are a delicious treat for all the senses…if you don’t have an eating disorder screaming at every mouthful). No, rather than a case of unappetising culinary creations, when I do not want to eat, it is a case of feeling so sick with terror that I fear consuming the food as I know it will only make that anxiety worse which, clearly, I do not want. If anyone was placed in front of a plate of something that scares them, who on earth would dive in with joyous anticipation of the spine tingling sensations they knew would ensue?
Say someone was scared of spiders and they were presented with a plate of little arachnids performing a traditional waltz around a dinner plate (fun fact, 8 legged insects are fantastic at and passionate about ballroom dancing. You won’t find any evidence of it online or any book so you will have to trust me on that. Seriously though, they LOVE it.)
When presented with these graceful creatures using crockery as their own professional dance floor, who with a fear of spiders would offer a hand to one of the many limbs scurrying before them in the interests of dancing a jive or having a cheeky go at a tango? More importantly, who would want to? Probably no-one. The only way I can think of getting someone to want to do such a thing would be to make an alternative which they wanted less. For example, if it was a a case of dance with a spider for ten minutes or marry a spider for life, I imagine a lot of arachnophobes would want to give the insect tango a try.

That is in essence how I manage to eat at home and how I motivate myself to do a lot of challenging things treatment requires of me in terms of anorexia, OCD or indeed depression. I do not want to eat, I know that I will feel anxious and an agonising guilt just from picking up the fork, but I know that if I don’t there will be consequences I want even less and fear even more, such as my CTO having me hauled back into hospital before I can say “why are there nurses banging at the door?”.
I guess what I am trying to do is play fear at its own game. I know that I am going to be scared every day and I don’t have a positive idea of what I want in life to override that. Therefore instead of being cornered by the fear, I come back at it and use fear to make me do the things I am scared of by creating a far more horrifying alternative, by making whatever action scares me in recovery the “lesser of two evils” as it were. I am scared to eat dinner this evening, but I am more scared of being taken back into hospital and made to gain more weight, so I know I will get on and chow down no matter what.

I would love to write a Disneyfied post instead of this, one that reassures any readers out there that dreams can come true, can conquer any mental torment and that focusing on the positives like answering the question as to “what you want” in life is the key to recovery. I want to tell people who are struggling that all you have to do is find your passion as the way to overpower your demons once and for all, but answering that question as to what you want is a challenge in itself. Of course it would be infinitely better if I were able to eat a steaming bowl of spaghetti without any anxiety because I had goals and passions in life stronger than the fear flowing through my veins, but it is I suppose better to use fear to manage the scary things than to not do the scary things at all.

If you have a mental illness that is taking over your life and you don’t feel a burning desire to dance like Billy Elliot or paint like Van Gogh pushing you forward, don’t let that lack of knowing what you want hold you back and don’t let the fear of making changes bind you in chains. Play fear and lack of interest at their own game, take advantage of them. Rather than being dominated by an OCD or anorexic fear of touching a door handle/eating pasta, think of the alternative to challenging that behaviour and find a fear of living your whole life being controlled by your neuroses that inspires a greater terror than any door handle/Italian carbohydrate ever could. I can’t promise it will work and I can’t even be sure whether or not this will make sense to anyone out there, however this post is at least an attempt to explain how I am dealing with the fear and apathy involved in the struggle for sanity.
Nobody ever wants to feel fear, but often when it comes to mental illness, fear is all you have, so I for one am going to use what I have got until I can find something better.


Six Tips For Going Home After A Hospital Admission For Mental Health Problems

You know that feeling when you go to the cinema, watch a film, then leave the pitch black room of the movie theatre and step out into the light? Usually, if you have been seeing a film in the day time, the sunlight outside will be such a contrast to the dimmer environment you inhabited previously, that you end up blindly staggering around in a daze wondering where you are, how to deal with the situation, and why on earth that small bucket of popcorn you purchased cost £50.
That overwhelming sudden change in environment and resulting confusion is pretty much what it is like when you leave inpatient treatment in a mental health hospital for the real world after several months (though I admit, in that situation, you are a little less concerned about the price of popcorn in cinemas than the analogical version suggests), and this is one of the reasons so many people relapse the moment they leave 24 hour care.
In hospital, you are helped to manage your mental health problem in a very specific environment which, once changed, can make someone feel like they are mentally back at square one, home in the house with the same ghosts that haunted them prior to admission. Everyone knows that going into hospital is hard, but at the same time, there are moments when leaving and going back home doesn’t feel any easier. There is a lot of support out there for people who are due to be admitted, but not a lot of help for those on the brink of freedom, and when on the brink of anything (e.g a cliff or freedom), it is vital to have a parachute, a safety net, a plan, and that is what I hope to help you lovely people with in this post. So as someone who left hospital a mere six days ago themselves (it is a very long story that I won’t bore you with here, but in summary I kicked up a right fuss about being in hospital and have been allowed home on a Community Treatment Order, a full explanation of which can be found via this link to my post about the Mental Health Act…https://bornwithoutmarbles.com/2016/07/11/demystifying-the-mental-health-act-with-penguins/) here are a few nuggets of advice for how to deal with leaving inpatient treatment after a lengthly admission:

1. Make a plan and stick to it: When you are in hospital, there are usually a lot of rules and staff who enforce them. Your days are structured, and going from this very regulated, controlled environment to total freedom where you can do as you please, can be a frightening shift in responsibility. Therefore it is vital to make a plan and rules to stick to at home so that the change is less dramatic and you still have boundaries, rather than the secure bars of safety falling down around you and allowing your mental illness to run wild. Create a basic timetable to follow (not religiously, just to give you a sense of how to structure the days you are suddenly free to spend as you choose), and implement any non-negotiable rules from the ward at home. Follow the plan of recovery that you have been working on in hospital and don’t let your days be filled up by the to-do lists scribbled on the walls of your mind by your anxieties.

2. Take it one day at a time: Before going home it is important to acknowledge that making the transition is never going to be perfect. There are new challenges to face, and with that it is likely there will be little slip ups along the way (If you watched hurdles at the Olympics this year you will know exactly what I mean. Seriously those people were professional hurdlers and they still kept falling over and sending hurdles flying all over the place). The key however is to not see every set back as permission to revert to relapse or give up the race. If you mess up one day, start afresh the next morning and don’t let a bad hour spiral into another bad year. Treat mistakes like sand castles, make them, acknowledge them, whack a shell on top, and then watch the tides of time wash them away.

3. Keep Moving forward: Whenever I leave hospital I often find myself feeling that the geographical move signals a mental move in terms of recovery. When inpatient you are constantly being pushed to move forward, but when you go home it is easy to halt all progress and remain static because your head tells you that you are “not in treatment anymore”. The truth is, wherever you are, you are in treatment and progress in recovery is possible, so to avoid getting stuck, make a list of goals or challenges for each month to keep progress going.

4. Ask for help: Bottling up thoughts and keeping how you feel a secret is a lot harder in hospital than at home because in hospital there are people constantly following you around and shining a torch in your face at night to check if you are sleeping, which, funnily enough you were until someone rudely shone a torch in your face (if you have someone doing that at home then you should probably bring it up with your landlord). Asking for help when inpatient then is not really necessary, because help is often following you around even when you don’t want it. At home however, it is easy to isolate yourself, pretend you are ok to please others, and fall down a slippery slope greased with eels and vaseline because you fear letting others know that you need a little assistance in scrambling back up aforementioned eel ridden slope. Admitting you are struggling is tough, but it is tougher to fight your battles alone. If you can call the hospital to speak to staff from the unit you were in, do that. If not, call a friend. Either way, reach out, be honest and don’t be ashamed of needing people to hold onto.

5. Use your imagination: Whenever I have been in hospital, then go home and struggle, I often find it helpful to imagine I am back in hospital. It doesn’t sound like particularly great advice to help someone in their journey to mental stability by telling them to imagine they are in a psychiatric unit (in terms of signs of insanity that one sounds pretty high up the list), but I like to remind myself of the fact that though things feel so different and so much harder at home, really the only difference is location. If you have managed to eat your meal plan/not self harm/resist compulsive behaviours within hospital walls then going home and doing the same is, in practical terms, no different. The hurdles as it were have not got higher, they are on a different track, so if you can leap them in one place you can leap them in another. Don’t let your head spiral out of control and make you believe that doing what you have been doing for months is as drastic as it feels.

6. Acknowledge that you are still unwell: One of the biggest mistakes when leaving inpatient treatment is to see yourself as “better” and able to thrust yourself back into hard core “normal life”. Just being at home will take a lot of energy and mental effort, so don’t force or pressure yourself to going straight back to a stressful job full time when you have been out of action for a while. Allow yourself to still see the journey to recovery as your full time occupation and ease yourself back into things gradually. If you have a job, maybe go back part time at first so that you still have time to look after yourself, and find your feet back home. Then when you have found your feet (and we all know how much easier life is when one is aware as to the location of all body parts), you can try full time again, but take it steady and prioritise mental health.

So there you have it! Six delightful tips to help keep you on track when making the difficult transition from hospital to home. Maybe calling them delightful is a bit of a stretch, but they are at least what I am trying to use to help me as I find myself suddenly back in reality after several months of being locked away behind a very high and unscalable green fence.
On a more personal and honest note, I know that discharging myself from inpatient treatment six days ago was probably not the best idea, and I know I did it for the wrong reasons, but hopefully it will work out OK in the end. Whether or not these tips are any good of course will be determined by how things go over the next few months of me carrying them out myself back at home.

I guess that is something we will find out together…

Leaving inpatient tips