Thursday, 9 May 2019

The CBT Diaries Week Two


Can you tell I'm a little bit in love with my gorge Oliver Bonas calendar? I promise next week's photo, I'll go rogue and be more creative! 

If you didn't catch the first post in this series, have a gander here. If you did, let's jump straight in to week two! 

After last week's appointment which was on a Thursday, myself & Brad spent Friday chilling out then had a Saturday out to our favourite spot where we decided to have a 'no worries' few hours eating our favourite foods and taking a wander. Everything from Sunday was one big panic blur. By the time I made the following Thursday, I was in a bad place. I'd been filling out my mood diary (last week's homework) and part of that homework was to detail negative feelings, score them from 0 to 100 on how intensely you felt that and write down the thoughts and physical symptoms that resulted from that emotion. I felt it all. Literally I didn't realise just how horrendous I could feel in one day. Reflecting on the entire week, I'd spent five days in a permanent state of negativity. The main emotions were restlessness, depressed, frustrated with a surprising sadness coming through by the end of the week (which I hadn't felt in months) and the physical effects included shaking, migraines, dizziness and backaches. 

The session started, and was being recorded on an iPad as I'd previously agreed - I thought it might bother me and I'd been a bit quick to agree; honestly I didn't even notice the camera as it was the other side of the room, I didn't even worry I'd look like a whale (the camera adds ten pounds right?!) which was a miracle in itself.

The questionnaire was my starter for ten. It's no surprise my questionnaire scores went up: Anxiety - 17
Depression - 19 

A 5 and 7 point increase on the week before. Flipping fantastic. It was a proper wake up call that just by going to the appointments doesn't guarantee life getting automatically better and was actually the reason I decided upon writing this series to share my scores weekly to see the highs and lows outside of each session.

Danielle* set an agenda, and in teacher style, wrote a list of what we would cover on the whiteboard on the wall opposite me. The agenda was as follows: 

1. Homework review.
2. Decide whether our sessions will focus on anxiety or depression. 
3. Complete a CBT exercise relating to an area I'm worried about. 
4. Coping mechanisms for the upcoming week (this was part of the agenda I suggested when asked anything to add) 
5. Homework for the following week and feedback on the session. 

The homework review was basically talking through my mood diary, and reviewing the week which as previously mentioned - pretty crap. Danielle  was impressed with how detailed my diary seemed to be (classic perfectionist - go me!). A lot of the mood diary was covered in the third part of the agenda so I'll cover it in more detail there. I did at this point discuss my medication with Danielle. I was on 10ml of Citalopram which then was increased to 20mg. Due to a complete lack of sleep as shown in the mood diary, I was debating going back to the doctor for medication to help sleep or to up my dosage - I found out that during CBT therapy where possible doctor's will try to keep your dosage the same to be able to track  progress so it isn't the medication making the progress. Obviously is a change in medication is necessary a doctor will change it and if I felt it necessary I could request it. I did agree with Danielle though that I should give CBT a good go first to try and manage my symptoms. If in doubt, consult the people you trust most for advice. 

Our second action on the agenda, was to decide whether to focus on anxiety or depression. A lot of techniques and sessions can compliment both anxiety and depression, but having a clear focus can structure the sessions easier. I made the choice to focus on anxiety. Although I feel I experience anxiety and depression, in my personal opinion, I feel my lack of control over my anxiety is the cause of my depression and panic attacks. By tackling anxiety head on, I'm hoping it will be the next step I need. 

For the CBT exercise, I had to pick the most influential emotion of the week I had felt. Choosing took a good few minutes. I'd felt a lot of emotions and which one had the most impact? I think I chose frustrated. This led into the following: 

  • Why are you frustrated? What is the situation? 
  • What thoughts did you have? 
  • How did you feel? 
  • What happened physically to you when you felt this? 
  • What action was you doing?
The exercise was on a worksheet set out like a flow chart similar to this worksheet. We wrote in detail, then Danielle kept pressing me for more information making me think quite deeply about the situation itself. What started as one negative thought actually spiralled into at least five thoughts I'd had on one situation. The situation was a stressful event in my week, which actually led to one of my thoughts thinking 'what ifs' about being able to afford IVF which Danielle pointed out was nothing to do with my original situation. She then stretched out a timeline for me, and put my situation, my past and future worries. The key question she asked me was 'Will the situation kill you?' - I was so taken aback because the answer was obviously not! She then explained that if the situation wasn't in my direct harm, that I should try to stop delving so far forward into the future. Another key factor looked at was my action in the situation. The situation was stressful. How did I respond? I stayed in bed all day. I moped, I barely moved. So a suggestion - try and switch up one aspect of the worksheet. For me the action: instead of staying in bed all day, distract yourself even if only for five minutes. This could be by washing up, reading a book even watching TV. If you can, aim for a walk, start a project or exercise. 

We discussed the origin of anxiety. If I could have magical powers and take your anxiety away would you want me to? I was very quick to say "yes of course!"
"Well then, you'd leave this office, walk down the stairs, out the door and get run over by a car. You'd die", Danielle replied.

Not quite the response I expected. Danielle continued to explain that anxiety is a part of every person. Your body needs anxiety to stop yourself from getting run over by cars. In caveman times, if a tiger went near a cave, a caveman would experience anxiety as fight or flight and in that moment would need to make a choice for what to do next. It's like a voice in your head speculating on what could happen if you make certain choices. The problem with anxiety is if you allow the voice to overtake, it will grow bigger than the other voice in your head making decisions. Danielle said she sees the voice in her head as a lizard called Larry (which instantly reminded me of Impractical Jokers!) - if there is ever anything Larry is saying, she decides when to allow Larry to express his thoughts, and if the time isn't right to discuss now, then you need to tell Larry to leave the thought and come back to it at another more preferable time. At first, I listened and didn't think too much of the strategy yet this week I've put it into practice, and so far, it's worked and especially when I wake up in the middle of the night worrying - I think to myself "this isn't for now, I'll deal with this at X time'. 

We also discussed the physical effects anxiety has on the body, mainly the appearance of adrenaline. When anxiety is present, adrenaline can increase. Without finding an effective way to use this adrenaline, it can stay inside the body, causing restlessness and other physical symptoms. This made me reflect on the past week - I'd barely moved, so I concluded my body was riddled with unused adrenaline. This doesn't mean I'm off to run marathons to use it up, but moving forward, I know I need to use it up to even have a slight chance of a decent nights kip!

We finished by setting homework for the following week which was to keep a daily schedule to make sure every hour I had set tasks to avoid the days being unstructured. I also need to think about what I want on next week's agenda (my mind is blank rn!) 

I hope this has been interesting or helpful in some way. As always, any questions, comments or suggestions feel free to get in touch. 
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