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Published on Leave a comment on They think it’s all over… CBT

It is now!
After three months, and 12 sessions of CBT, my therapy part of my treatment is over. I have graduated. Completing the course, and learning some new skills along the way. So how was it, what happened, and where am I now. Let's have a look shall we. I will also give a little update on the work situation and the OH/HR saga.

First up, let's take a look at the CBT journey. 
My initial diagnosis and referral to SLAM was for "severe anxiety disorder", that was from the GP, and led to my reintroduction with the system. My conversation with the GP had been very work environment focused, and the issues I felt I faced if asked to return to an office. We touched on my general anxieties too, but from this consultation, and the initial consult with SLAM, it was decided that the main focus of the treatment should be "social anxiety". Indeed this seemed logical given all the immediate issues I faced were people related. 

The first session or two were very awkward for me. A new person, meeting over Teams, and trying to breakdown my automatic barriers with regards to opening up to someone about something so personal. As we got into things, I felt myself relax a little, and just be an open book as much as I could. Open to trying new things, and happy to follow the lead from the therapist. CBT is quite a structured system, so there isn't much room for free-styling the sessions, or too much digression from the path. 

We focused on diagrams, and formulations of how things worked in my mind, how I responded to certain situations, and how my thought processes worked before, during and after encounters with different groups of people. Also taking a look at my beliefs before something occurred, and what my perceptions of myself in that situation were. One example of this was being asked if I was happy to speak to another therapist one on one for five mins, about a random topic. As my previous entry said, this left me terrified.

However, on actually doing the exercise, and looking back at the video of it, things were not as bad as they seemed, in the moment at least. And that reminded me of the complexity of the issues. Put in the situation, with nowhere to run to, my game face went on, my personality went into overdrive, and I faced it head on. Watching myself back I was shining with energy, and came across a lot more confident than I thought I might have. During the debrief I expressed how surprised I was at how comfortable I seemed to be. But an hour or so later, I was reminded of the cost of this display of glitz and confidence, an absolute energy crash.  See it turns out that the shying away from these situations is not just about confidence, it is about self preservation too, and trying to conserve my energy. 

This is something I can look back on and recall clearly time and time again. People will say how chatty I was, or how I looked like I was having a great time, but behind closed doors, for the next day or two I am thoroughly mentally exhausted, and reach a point of not being able to function. Thoughts become clouded, patience is stretched, and ability to focus is gone. THIS is why I refrain from certain environments, to be able to function day to day like a normal human being. 

So looking back at that session and the experiment, it was important to me as it both reminded me, and set in stone my beliefs about my behaviour towards such situations. Possibly not the preferred outcome of the experiment, but to me was invaluable, and something I can say I understand and am happy with the way I have chosen to behave. There is a theme that runs through this whole course which will become apparent over time I am sure. 

As we moved on through the sessions I wavered in my commitment. The build up to the sessions was becoming a source of anxiety itself, and at one point felt like the worst part of my week. Blogging about it, I tried to get some clarity for myself, and see things from an external perspective. I knew in my heart that the sessions were good for me, and as pointed out by a couple of friends, maybe it was the "challenging the norm" that was what I was being defensive about, and they were right. But so was I.
As the weeks progressed, my focused changed a bit, and for a while felt almost incompatible with the direction the course was heading in.  I had shared one of my blog entries with the therapist at one point, so I could give her an insight into my feelings towards the work we were doing. The outcome of this wobbled me a little, when we discussed this the following week. She mentioned that my blog had mentioned her by name, and that she had not consented to this. Reminding me that just like the recordings of the sessions required my consent, mention of her name in my blog also required her consent, and she had NOT given that. 
The name drop had been purely accidental, and in my furious flow of keystrokes, I had written her name rather than "the therapist", however I now felt chastised by the person who was trying to help me overcome my social anxiety, and issues with people I don't know / trust well. Own goal! The rest of the session was awkward, and I spent most of it tuned out, thinking how badly she must now think of me. Counterproductive to say the least.

This was one of a couple of moments in the course that made me feel a bit on edge, and lose faith and focus for a bit, but I am happy to say I stuck with it, and went back for more each session. Except for one. One morning I just could not bring myself to log on to Teams, and sent an email apologising and explaining what I was feeling. Anxious about the sessions, off course with objectives, and a little disillusioned with the process.  As we had passed the half way point with the sessions, I had started to feel that I understood my thought process with regards to social situations. Having challenged myself on a number of occasions for experiments for the course, putting myself in situations I would usually avoid, it was becoming clear to me what I was happy to do, OK with pushing myself to do, and happier just to avoid.

The main take away from these experiments was finding my happy medium, the place I felt I could cope with the anxiety from, whilst maintaining a healthy lifestyle. Not shutting myself away from society, but not pushing myself to become some sort of social butterfly I have no interest in being. This is where the direction we were going in started to seem off. Having discovered these things, the part that affected me the most was the post situation stress and anxiety. The build up to future events is always a little stressful, the thought process goes into overdrive, and panic sets in. The further into the future the event is planned, the longer this panic lasts for. Sometimes weeks of dwelling on things that are yet to happen, and quite frankly insignificant. 

The biggest issue I actually face, and I realised this thanks to the CBT, is after the event. There are three stages of any event, before, during and after (duh!)
Before is variable, the duration can be minutes or weeks, but however long it is, the mind works overtime to create all sorts of terrifying scenarios for me to over think, lose sleep over, and get worked up over. 
During, well obviously that is how ever long the event is, or however long I stay there before fleeing. Game face on, mask on, smile, laugh, make jokes.... Run and die!
After however, now we are talking. Away from the threat, mask off, and back in a safe place, all should be over you would think, but in fact this is where the real damage starts. 

Post event self debrief... Replaying events, and conversations over and over in my head. Rewording exchanges with people, thinking up alternative responses, imagining how I came across, wondering what people thought of me. Had I looked weak, should I have said something different. Hours and hours of reliving an encounter which had lasted 10 mins. Using up more and more mental energy to the point of exhaustion. It is hard to explain the effect of this process on me, other than to say it is exhausting and debilitating. Not to mention the knock on effect for any future situations which bear similarities. 

I am sure there are people out there who will say "over thinking, we all do it". Just like the use of the word depressed or anxious. There are varying degrees of it, and to say "I understand" can sometimes be insulting rather than encouraging and supportive. 

Anyway, I digress a little. Lets get back to CBT in general. 
With the email sent about how I felt the direction was off, I went into the next session a little afraid of how the email had come across. See how this works, I learn to engage, tell a person that is helping me that I need to do something different, then dwell on it, and dread the outcome of the conversation and what they will think of me!
Anyway, I received a reply acknowledging my concerns and saying we would discuss these on the next session. The next week we met on Teams, and I have to say it was a breakthrough moment for me.  The session basically consisted of a one to one chat about the course so far, what I had learned, the direction I felt I needed to go from here on in, and a discussion about general anxiety disorder. It felt liberating to take control for a bit. My first time using that word in this entry, but a word that came up time and time again over the weeks, control. I will come back to that.
The session itself really restored my faith in the process, and renewed my commitment to finishing it til the end of the course. 

A few short weeks later, and this past Tuesday I had my last session, and was officially discharged. Both me and the therapist agree it has been a positive experience, and my achievements are noteworthy. Having had my last session the week before, in the days following I travelled into town on the tube for coffee with a friend in SE1, then walked back to the car afterwards, once on the tube that day was enough. See, learning and knowing my limits.
A few days later I dropped the car for a service, then got a couple of trains home, before heading for a morning hot chocolate with Ann at Costa. Then later in the day getting a train back to collect the car, this time alone. During the train journeys I was able to use my new found skills to distract myself from negative thoughts, prevent a spiral of anxiety, and complete the trips without feeling exhausted or distressed. Quite the achievement for me, and to do this twice in the space of a week, WHO AM I !!

So, back to "control". This came up time and time again in the sessions when explaining what I was feeling in any situation. Loss of control equates to the unknown, which starts the mind going. Conjuring up all sorts of crazy and unrealistic scenarios, which the rational mind identifies and rejects, but the irrational anxious mind takes it and runs with it. Before you know it you are thinking about all sorts of catastrophes, from what was once a simple "as a stranger a question" moment.  My minds ability to go off on a tangent is something quite impressive. A moment of thinking about something simple in the house, can in seconds turn into recollections pf seeing my mum pass away, laying there lifeless. The possibilities are endless. Probably why quite a few of these blog entries go off on wild tangents from time to time. 

Control also manifests when I am in an uncomfortable social situation. If I become loud, and the centre of attention, I can control the direction of the conversation, and exit when I please, so that is where the social butterfly mask comes into play. I can't get away from it, so let's control it. Exhausting as it is, in the moment it helps me maintain control, and prevents my thoughts running away with me. But I can't maintain it for long, and when I over stay, it is like Cinderella at the ball. Midnight is coming, and the world is about to come crashing down.

Anyway, that about sums up CBT for me. A journey I took with a therapist, to get to know myself a little better, challenge the normal, and push my boundaries. To explore my limits, and understand my behaviours. Mission complete, and happy with the outcome. So all is well.......?
GOD NO !!!

I will end this entry here, and do another for the road ahead, and where I am now. You have read enough I am sure.

Thanks for reading, more to follow soon. I mean REALLY soon!

 

 

 

 

 

 

 

 

 

Published on Leave a comment on CBT – Round 2 – FIGHT (or flight)

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.

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Published on 2 Comments on Urrrgh!

Gonna be one of those days I think. Long but crappy nights sleep (thanks Kallik), starting to feel less run down which is nice, but still very unsettled. Body battery (Garmin thing) is quite low for me, and reflects how I feel, but otherwise things are OK. 

Had my first CBT session this morning, and I have to say, after a little pre meeting trepidation, it all went well, and like before, I feel like I have a grip on it and am starting to have a bit of an understanding. That said, I think I have always understood my anxiety, but just not yet learned how to cope with it. She did say in the session that I had made great progress, understood the structure well and was becoming my own coach, so that's good, right?  We did also discover that I am pretty complex and my favourite word is "control". 

As I expected, the scores from my testing this week show a swing back towards depression, and a relaxation of my social anxiety. That is why the therapies route has always been such a pain for me. While they are connected, and dealing with one assists with the other, it's a "pick one" approach, and a more generalised one at that. But for the speed this therapy has come about, I am NOT complaining, and appreciate the help I am getting. But it does support the pendulum effect I have always spoken about, that as one issue lessens, the other gets worse. The goal here is to stop the damn thing swinging and sit happily in the middle, or at the very least, take the energy out of the pendulum and stop it swinging further and further into the abyss. 

Tomorrow I have my meeting with work to discuss my situation moving forwards, so hopefully some progress can be made there. I am hoping we can separate the two situations, and deal with mine individually rather than with the herd. Worst case, herd is first, and I just have to be patient. If that is the case, I still feel in control, so am not too worried about the outcome, just more frustrated by the delays. 

For the rest of the day now I am at a loose end. I really want to do something, but not sure what. Riding seems a bit of an effort and faff for how I feel right now. But sitting on my arse for the whole day seems pretty frickin dull, so maybe a walk is the answer. I don't want to socialise in any way, partially because of how my head feels and partly because of Ann having Covid and me not wanting to spread it. So a walk in the open sounds like the best plan right now I think. Fresh air, pod cast in my ears and get the HR up a bit. 

Mentally today I feel a bit lethargic, disinterested in doing much. Haven't washed the bike after yesterdays ride, a few odd jobs need doing but I haven't been bothered, and beating myself up a bit about forgetting to put the bins out. I wasn't sure if it was a bank holiday weekend for bin collection or not. Meh! Oh well. (edit, I just checked and seems they are being collected tomorrow, phew!) But yeah, head not in a bad place today, just not too motivated. Thought process seems a little more active today. Noticed I was quite engaged during my CBT session, able to think on my feet, and also writing this I feel 8 have some flow. That may of course be because I have only just taken today's dose of meds, so could go downhill from here yet, but all part of the journey. 

It's nice that people are reading these entries and being kind enough to respond to me via messages and other means. Feels good to know it's a shared journey and a path others have trodden before, so thank you to everyone who has been in touch in anyway, your support means a lot to me. And I hope in turn than by writing and sharing this, others somehow get some help and understanding from my journey. It has always been the goal of this blog to share both ways. 

Right, I better get my day in order before I give up on it all together. 

Til tomorrow...