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!