For the last 2 weeks, I've been seeing a private CBT therapist for my anxiety and depression. This therapist uses a mixture of CBT and counselling, and she was recommended to me by a friend. I decided to start this diary to keep track of my progress.

Week 1

As it was my first session, we were mostly discussing my history with anxiety and my background. The therapist is very sympathetic so I felt at ease with her very quickly.

She set me 2 homework tasks - firstly to do more relaxation during the day, such as diaphragmatic breathing and relaxing my shoulders when I'm at work. I need to pay attention to bodily sensations, then try to use relaxation techniques straight away. Relaxing the body by using diaphragmatic breathing should also help reduce the amount of anxious/intrusive thoughts. So I've been doing that when I feel particularly tense. It doesn't seem to have much effect on the intrusive thoughts though, but of course it's still early days and I'll need more practice.

The second task is to have a daily worry period - whenever I get a worry come into my mind during the day, I write it down in a notebook, and then in the evening (usually after tea) I have to spend half an hour thinking about the worries and also coming up with rational challenges to them. When I tried this for the first time, I noticed something interesting - when I was thinking about the negative thoughts and worries, my mind kept wandering off towards neutral/positive things. Yet, during the day, when I'm trying to focus on day-to-day tasks, I find that my mind keeps wandering towards the negative/anxious thoughts.

The therapist said has recovered from anxiety/depression herself – she does still have occasional bouts but can handle them much better than when she was younger, and they pass more quickly.
She also said that most anxious people tend to be in their 20s or 30s, but when people get older it tends to settle down more. This could also be because people are more likely to seek help once they reach middle age.

The therapist also explained that anxiety and depression can be caused by being over-protected as a child, as well as by childhood trauma. You tend to internalise your mother's behaviour more than your father's. That's probably even more true in my case, as my parents got divorced when I was about 5 years old, so while I was growing up I saw a lot more of my mother than my father. It is true that my mother is overprotective, and when I was younger she used to go to great lengths to protect me from being upset. My mother also gets stressed out easily, and although she's never actually suffered from anxiety she tends to be rather pessimistic about things - for example whenever we're stuck in a traffic jam in the morning, she often says "Oh well, we're going to be late for work now!" and when we're watching a football match on TV and the other team is first to score a goal, she will often say "That's it, I can't bear to watch it any more - I can see we're going to lose!" So I probably picked up on this over the years. My father (who I used to see at weekends) was quite the opposite - when I was younger he often used to push me to do things that I used to be too shy to do, such as asking for something in a shop or restaurant. My mother didn't like to push me in that way, presumably because she didn't want to get upset.

The therapist also introduced me to what's called a "hot cross bun diagram", which shows how your thoughts, feelings, body sensations and behaviours are all interlinked.

Week 2

In this session, we discussed my ideals and expectations of the world versus the reality, and how this influences my anxiety. For example, my ideals are fairness, stability, safety, kindness and honesty. My therapist said that many of my expectations are unrealistically high, for example “everything should stay the same/nothing should change” (Due to my Asperger's syndrome I don't like change, especially if a lot of change happens within a short period of time – it makes me feel unsettled and unsafe) and “everyone should be fair and honest, etc”. She said it's good that I live by these ideals, but I need to accept that I have no control over other people's behaviours, in other words I can't expect other people to live by them as well – all I can do is hope that they will.

So, I need to accept that while I may not like the way certain other people behave, I have no control over their behaviour – but it doesn't mean I have to become like them. For example, the therapist explained that it's very hard to change other people's beliefs, particularly their religious/political beliefs – in cases like that, you have to let them come to their own conclusions. My expectations of other people and life in general need to become more realistic, and my therapist said we will work on that in the coming weeks.

I explained that one of the potential triggers for my current anxiety episode could have been recent redundancies and resignations at work, which have made me feel more unsettled, and this could have made me focus more on news stories about the recession and ongoing austerity measures (although I've never liked hearing stories about the recession, it never used to actually worry me as much as it does now). My therapist said I need to accept that there are now very few “jobs for life” like there were in our parents'/grandparents' era. She said that I probably didn't dare think about the possibility of bad things happening (for example, my favourite/most respected colleagues resigning from work or being made redundant), and this made it come as a bigger shock. So I need to accept that the bad things have happened “That's the way it is, and it's outside my control.”

Life is very uncertain and I need to accept this uncertainty, even though I dislike it. The therapist leant me a book about accepting uncertainty. She said the world is the same as it was last year (when I was happy) or even 10 years ago – there were problems and uncertainty then, just like there are today.
Resilience only comes through difficulties – you learn that you can cope with things better than you thought you could. So difficult periods can be a time of personal growth. I said to the therapist “If I'm this anxious now, how ever bad will I be when there's a real disaster or crisis, such as loved ones dying?” She actually used to be a chaplain in a hospital and she said that in many cases, it's the anxious people who are better prepared for these sorts of crises, and they cope with it better than the non-anxious members of the family. Death of relatives is something inevitable that we can't escape from, but she said it's important to remember that I'll be part of a community (such as family and friends) who would rally round to support each other.

When I worry about something inevitable or that's outside my control, I need to think to myself that “when I meet that moment in my life, I'll be ready for it.”
When I get a feeling of dread, I can say to myself “That's just a feeling. It's just my serotonin levels. Accept it, but I don't need to focus on it. It will get better.”
If I have a feeling of foreboding or panic, ask myself “is there a threat to me right now? Is there a tiger in the room or is a bomb about to go off?”

I need to think more about good things during the day and give myself more credit for my achievements – for example I completed a project at work on Tuesday and my therapist said I should give myself praise for that, although my mind is full of gloomy thoughts about other things. This is what non-anxious people do. She said that eventually, the negativity should gradually fade into the background.

My homework from this session is to draw hot cross bun diagrams for my own thoughts, feelings, body sensations and behaviours. Categorise my thoughts using the common thinking errors document, for example waking up early in a panic and dreading the day ahead. I shouldn't jump to the conclusion that it will be a bad day, just because I feel bad first thing in the morning. I said to my therapist that I often jump to this conclusion because I woke up the previous few days in a panic, and they all turned out to be bad days, so why would today be any different? She said that I'm feeding the feelings with evidence from previous days. But this could become a self-fulfilling prophecy. If I wake up early in the mornings and can't get back to sleep (trying to get back to sleep while feeling frustrated is fighting a losing battle), it's much better to get up, go for a walk around the house, get a drink, accept that I'm awake and that there's no point in feeling frustrated about it, read a book or do something relaxing, and most importantly remember to practise my diaphragmatic breathing. For the following 2 nights after that therapy session, I slept a lot better, knowing that I had a plan for what I could do if I woke up extra early.

Use the worry tree – then if a worry pops back into my head again, I can say to myself “I've got a plan to deal with that worry, so I don't need to think about it now”. Distracting yourself can mean doing something physical, eg walking or getting ready for work etc. I said to the therapist that I often feel a bit better when I'm walking around, compared to when I'm sitting down.
When you feel nervous, coach yourself (not out loud!) like you'd talk to a child, eg “everything is OK”.

My therapist also said that I'm coping with this episode better than I think I am. Even though I was tired due to a rough night on Monday night, she said I was still talking to her as if I'd had a full night's sleep, and that it's a positive thing that I don't let the tiredness make me grumpy or snappy towards other people. She said that not many people can remain kind when they feel tired, so that's a positive thing about me. Even though I may feel tired in myself, other people can't see it, so I don't need to worry about what other people might think.

There is evidence that these techniques work – the therapist has seen them work in many other people. So there is plenty of hope for me. I need to have faith that it will work for me, although she said it's inevitable that I'll have some doubts now as it's early days for me.

Typically people have 6-8 sessions, getting more spaced apart as time goes on. Top up sessions are available later if required.

I left the second session feeling more optimistic than I'd felt for quite a few days. I felt more calm that evening and on Wednesday, but yesterday some of my negative anxious thoughts crept back in again, and I woke up too early this morning (I had a day's holiday from work today, so I went to bed last night expecting to have a lie-in this morning, but I woke up before 8am). However, I didn't catastrophise about waking up too early and I still had a good day, even though I felt a bit tired. I sat outside in the sunshine, reading a book and listening to music, and during those couple of hours I felt more like my normal self than I'd ever felt during this anxiety episode. I also enjoyed myself eating a bowl of Ben and Jerry's cookie dough ice cream (my favourite!) Unfortunately I noticed some anxious thoughts creeping back in again just before teatime, but they weren't too bad. I find that I'm not too bad now when I'm doing something to occupy my mind, particularly something I enjoy. I also try to accept the anxiety and intrusive thoughts rather than trying to push them away, and I've found this has reduced my tension as well.

Even though I still get doubts about whether I'll fully recover from this episode, I feel more optimistic overall than I did a couple of weeks ago.