Thursday, 6 June 2019

The CBT Diaries Week Six

It was a very summery day for my CBT session & my therapist commented on how summery I looked so I figured let's go for a nice summery photograph to go with it. I was really looking forward to this weeks session... I think the stability CBT sessions have offered me has made a huge difference to my mood and ways I cope.  We started as always with the questionnaire ... 

Questionnaire scores were as follows:
Anxiety - 9
Depression - 9 
Improving scores, yet creeping back to closely similar between anxiety and depression.

Danielle*, my counsellor then asked me how I was. I responded a lot better than the week before (thank goodness!) I explained how I'd had a care team coming to the house, side effects of my new medicine which included dizziness, random tearfulness and irritability and also how I'd been taking each day at a time and just taking small steps to ensure I didn't push myself too hard. 

I then set the entire agenda for today. I came prepped with my homework of three things I'd done each day to show self care for myself, and on the back were agenda ideas.

1. Diet and anxiety. 
2. Finding a sensible routine.  
3. How to cope with big changes. 

I'd addressed point three as what was 'adjustment disorder'  as this was something which had been written on a care plan and for once in my life I didn't use Doctor Google and thought I'd ask the professionals their opinions first. 

Danielle suggested we switch the agenda to the most important first, incase we ran out of time.

So the revised agenda was as follows: 
1.   How to cope with big changes.
2.  Diet and anxiety. 
3.  Finding a sensible routine.

How to cope with big changes: I chose this, as currently I felt a bit in limbo with a few areas of my life, but I'd recognised as part of discussions with my care team, that there would be times I'd be more susceptible to increased anxiety and had pinpointed certain dates this could happen. When I'm in a calm state of mind, I can apply CBT techniques and not spiral downwards; a good example is that earlier in the week I'd been watching TV and all of a sudden burst into tears for no reason. This outburst made me feel down all afternoon. A few days later, I began feeling tearful again - I thought of the CBT session with the flowcharts and temporarily took myself out of the situation and hoovered. When I'd finished, I sat and tried to think of why I felt tearful however the moment had passed - I carried on my day as normal. This is an example of how CBT has helped me so far, so I was wondering if when I felt in crisis mode like the week previous, how could I react differently? Danielle said to me, what would you do if a mouse entered the room? I responded saying I'm scared of mice so probably would be on edge, but would feel the mouse would need to find a way to find it's normal home so would need to find a way to act. Danielle asked me if I'd be aware of what she thought of me - I said to an extent I would. She then asked how would I feel if it was a butterfly - I said I'd find it nice if a butterfly came in, yet it would also need to find a way home. I wouldn't be aware of how I was acting with Danielle around though as it's only a butterfly. So next, what if a tiger came in? I responded saying I'd jump out of the window, be scared and not care what she thought of me. By comparing different scenarios, and judging outcomes it can show how you react to change. Change is different to everyone, and everyone will react different, it's just making the choice on how that change will affect you. 

Currently a lot of people surrounding me have felt I need to rest, and take time out to recover. I discussed this, explaining how hard it was having a lot of conflicting advice and changes are still happening around me all the time. Danielle asked me when I would be ready to deal with changes and I responded after some thought saying when I was confident enough and stronger. She then challenged this with, the more you don't do something, you can't be confident and that by going through situations when you are weak, are what gives you the confidence afterwards; if you go through a situation feeling strong and confident in the first place, you don't have the same sense of achievement. 
I then discussed a situation I had observed a few years back, which had made me realise how strong someone I knew was, how they always seemed confident - Danielle picked out the key word 'seemed' and then it jogged my memory of a time in the same situation this person had been in a state, and it made me realise how she turned a horrific situation around, so maybe I could too. 

We moved onto diet and anxiety, and this was set as second on the agenda as it linked to the third point too of a daily routine. I'm not eating properly at the moment. By properly I mean, there is no routine to eating habits. I have no breakfast lunch or dinner. I eat dinner. I snack a lot in-between some days and other days eat nothing. 

Danielle explained the basics of digestion. Three meals a day is generally the acceptable way of eating, two small meals and one large meal which can be in any order. When your are up, you need to digest something - even as small as an apple, your stomach needs to digest something or your stomach will try to digest itself. When you feel anxious, your stomach goes into fight or flight mode, and thus leads to further disruptions to the body's natural digestion. This quite simply explained why my eating habits were up the creek! We looked back into my eating routines before, and I identified I think all along I've been in survival mode when it comes to eating and anxiety. I can't actually remember a time other than maybe when I was a teenager, that I ate properly. I've been on diets, been to Slimming World but there's always been movement in that routine - I can't say I'm a big breakfast or dinner eater, and three meals a day has never been followed properly. It was nice to discuss food, and it not be focused on diet tips or losing weight either! It was simply, you need to eat for digestion. If you want to eat more - maybe think of a way to move more  to counteract that. 

This then led us into the final piece on the agenda - the daily routine. I love a plan and I love a to do list. Over the past few months I've struggled with a routine. Over the past week, I've managed to enjoy doing things for myself, yet the routine hasn't fallen into place. Then I learnt the most important fact which has actually blown my mind, and made me realise the error of my ways since forever when trying to find a routine that works ... 

a habit takes 66 days to become routine. sixty six days! 

I've never given something sixty six days to become routine. Ever. 

One of my biggest concerns was whilst feeling quite fragile, how can I start implementing a routine that isn't overwhelming. I find this with exercise and diet routines of my past where  I set such a high standard, when I don't meet it on one day,  I forget about it altogether. This led to my homework for this week: a diary. I have a sheet of A4 with a table on - each day is a column and in the rows are each hour from 6am through till 12pm. I have to fill in what I do on each day. No pressure to have every single cell filled, but as much as I can fill in the better. Danielle even suggested colour coding it if it took my fancy. I asked whether I should be finding things to do for myself - Danielle said no, this week it is just a diary of my week - so if I sleep for copious hours, or watch TV or just sit doing nothing that's okay. She said it might make a good prompt for reminding me to eat breakfast and lunch, and that's okay if it gives me a boost to make the most of the hours in the day. Next week we'll look at it, then try to start a routine to implement. This sat well with me as it felt like I've been given so many techniques to deal with anxiety and depression, now it's time to start to think of how to move forward whilst coping alongside it. 

This was my fifth session, and Danielle asked if she felt I'd need any more sessions as next week should have been my last - I said yes I would love more sessions, and she agreed. It was nice she actually asked my opinion first. She said she'd ask her line manager to approve more sessions - when I left it had me thinking that I'd like to have monthly CBT or counselling sessions when my sessions were up, which is something I'll be asking her next week - how life moves forward after therapy too. 

I hope the posts have been enjoyable to read so far. If you have any comments, questions or want to chat just drop me a line and I'll get back to you as soon as I can! 

Further resources: 
Making Sense of CBT by Mind (I wish I'd read this pre-writing this post!) 
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