Today saw the second session of CBT for me, and I have to be perfectly honest, my mind was not in the right place for it today. Since the last session I have had a homework assignment to do, as well as a long questionnaire to complete, but quite frankly my mind has really not been up to the task. In fact it has not been up to doing much of late. Putting off and just leaving some tasks all together, choosing instead to slouch in front of the TV and binge watch TV programs. Although it is not all negative, after all, sometimes it's good just to completely let go. Relax a little, break the routine and just do whatever the mind chooses to do. All that before of course, reinstating a strict regime to follow, to keep the mind busy, and a routine ticking over.
So back to todays session. It started with getting up in time to get the homework and questionnaire complete in time to send back before the session. That in itself was a challenge, finding myself getting confused and wound up by some of the questions. Not to mention starting to feel anxious while answering some of them, as they required me to put myself in stressful situations to decide on the answers. By the time the session came around I was already tense and my head was spinning a bit.
At the start of the session I mentioned to the therapist that I was off to a bad start for the day, and we went over the mornings events to try and ease the stress a little. I of course know that had I bothered to get the assignments done before this morning, it would have made for a much easier start to the day. But I have already made my excuses, and I am sticking by them. From there we moved on to the rest of the session, going through the homework, discussing what I had learned about certain aspects of the anxiety structure, and seeing what I could improve on. Then the world turned upside down. The question came, "how would you feel if I asked you to speak to someone you have never spoken to before. Strike up a conversation, and chat for five minutes?". By the time she got to the end of the sentence my heart was already pounding and my mouth had gone dry.
In a flash, running scenarios of what would we talk about, what would they be like etc. Pausing for a second I said "terrified!" The idea of someone else suddenly becoming involved and being expected to make small talk was horrific. Here I am in my safe little bubble, just me and her chatting about things, and suddenly there would be someone else! She replied, "do you think you could manage it though". Instinct said NOOOOOO!!, my happy space is not getting into these situations in the first place, let alone struggling my way through it. But obviously, for the sake of making some progress on the CBT course I know I have to put myself in awkward and uncomfortable situations, so I said I could do it, but didn't feel good about it.
We then went through some pre conversation questions, asking me to gauge how I felt 1-10 about various things like ability to hold a conversation, did I feel safety behaviours would come into play and so on. After this it was explained who the person would be, how we would structure the chat, and what would happen next. Then it was time, the therapist brought the person into the meeting, and made introductions. To my relief it was a lovely softly spoken young lady, so any fear of confrontation or being overwhelmed slipped away. After the introductions we spoke about the chosen subject of exercise and fitness. Throughout I fiddled with a pen on the desk out of shot, and found myself doing what I do best, talking and talking, offering compliments and positive reinforcements to them, while trying to keep the conversation in my control until the time was up. It was not a total monologue, but I was aware of how much I had spoken, and how little I had breathed, based on my heart rate by the end.
She went off, and me and the therapist did a recap, and re-ran the questions again. I had found myself much more confident towards the end of the conversation than I had first thought I would. I am starting to learn things about myself I didn't know. The inital avoidance of the conversation is far more powerful than the anxiety once engaged in the moment. The anxiety then switches to what I can only describe as a sand timer filled with energy inside of me, and I can feel the energy draining away as each moment passes. Almost controlling my fight or flight response, keeping myself in the uncomfortable moment but at great expense to my energy reserves. It is all related, not two separate issues, but it is interesting to see the point at which it switches over from complete avoidance (comfort zone for me) to fight or flight. In my case I choose fight, but thankfully only metaphorically, and fight in this case is to fight my own anxiety, and stay in the situation.
So that was the stranger moment over with.... Or was it. As we finished up the summary of what had just happened, I was asked how I would feel repeating the exercise, this time trying to avoid any physical coping mechanisms. Sit on my hand so to speak, and focus on the conversation and staying engaged. My immediate reaction was almost identical to the first time, became a fidget, and started looking all over the place. But within seconds, I felt myself calming down a bit as this was going to be the same person again, no new introductions, just a new topic, and trying to stay in normal conversation. This time I actually sat on my hands and tried to leave breathing room in the chat for her to speak to. By the end of five mins, despite feeling more comfortable about the conversation, I found myself almost in a tight ball, and hunched up. I had found a different want to use up the excess energy generated by the fight or flight reflex.
Asked by the therapist if I felt that safety behaviours played a positive role in the conversation, I had a mixed response. From the brief exercise I had learned that when my body switches to fight or flight, like anyone else I get a surge of adrenaline which causes my body to feel full of energy. If I can find a way to expel that energy, while remaining in the situation, things start to become more manageable. For example, the first conversation, while more challenging, felt more relaxed due to playing with the pen. Much like my trusty twisty handkerchief I wrote about before. It has clearly played a much more profound role than I had given it credit for.
With regards to other safety behaviours, such as complete avoidance of situations, while it certainly makes aspects of life far more comfortable, it is also sadly impractical to avoid people completely. Besides, contrary to belief, I do actually like some people.. Not many, but a few, and I enjoy their company, so being able to do that more would be lovely, hence here I am in therapy.
So my take away from todays session is that I am stronger than I give myself credit for, more capable than I believe I am, but go into hyperdrive when put in a situation which makes me feel uncomfortable. That part I think I knew all along. Maintain control, wrap it up quickly, and get the hell outta Dodge! Flight plays a part in my responses after all, it's just a little bit delayed for politeness.
Going back to the start for a moment, to address the lateness in getting the assignment done. It all comes back around to the slowing down of my mind at the moment. I am pretty sure it's 90% meds 10% mood, but I just have very little get up and go at the moment. I have recently started having random thoughts just popping up in the middle of other things. For example last night I was thinking about a route I could walk or run, and suddenly roast potatoes and gravy.... What the hell! I mean I love them and all, but what did that have to do with it, But they quite literally dropped straight into the middle of my visualising a route. Just one of many random thoughts. That said, I would take random interruptions to my thought process over the inability to let a thought or worry go for hours on end. Just takes some getting used to. Needless to say, certain tasks which require concentration or focus are rather difficult right now. Next week my med dose increases a little, so it should be interesting to see how that affects things. In the past it has gotten worse before it has got better, so we shall see.
Right, I shall leave it there for now, but to summarise, session 2, shellshocked but feeling positive.
Back for another blog entry soon, got so much more to write, just lacking the focus to be able to get it out.