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Thread: My CBT progress diary

  1. #1
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    Smile My CBT progress diary

    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.
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  2. #2
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    Re: My CBT progress diary

    My 3rd session this week was good. I feel like I'm gradually improving, and like I'm slowly gaining more control over my worries and negative thoughts. Here are some notes of what I learnt from this week's session:

    What to do when I notice anxiety
    : Start with the bodily symptoms, then relax the body as soon as the thought comes. Stand above yourself and say “Isn't that interesting, I'm having an anxious thought”, or “Here I go again, I'm thinking about that problem again.” Then practise my deep diaphragmatic breathing.

    Accept you're in a trap, rather than fighting it. It is like a Chinese finger trap – in order to escape you have to push your finger further in, rather than trying to pull it out.

    Remember the “don't think of a yellow minibus” paradox. The more you try not to think about something, the more you will think of it.

    When you have a worry, look at the list of common thinking errors and see where it fits. Some worries may fit in more than one category.

    I mentioned to my therapist that I feel regret and guilt that I didn't take more time out to relax earlier this year, instead of taking on too much responsibility for things. I sometimes think that if I didn't overexert myself at the beginning of the year, maybe this episode wouldn't have happened, or it would've been less severe. She said that instead of feeling regret or guilt about the past, I can let it go and say to myself “I've learnt something from this experience – I will take more care of myself in the future”.

    I explained that I don't like saying “no” to people, in case they think less of me or they don't want to be friendly with me any more. My therapist then suggested that if someone asks me to do something and I don't really want to, I can give myself some breathing space by delaying my response, saying “Let me have a think about that, and I'll get back to you.”

    I then mentioned that my holiday in Derbyshire is coming up at the end of this week, and that I'm looking forward to it, but I'm also worried I might feel anxious or have intrusive negative thoughts and not be able to enjoy myself fully. When I'm on holiday, I feel under pressure to enjoy myself, as you only get so many days off work per year. When I was at school, the holidays were a lot longer so I didn't feel this pressure so much. My therapist commented that I'm very strict on myself in this respect, that I'm like a taskmaster or strict headmistress of myself! “I have only 2 weeks so I must enjoy myself!” She said a rational challenge to this kind of thought is to accept that I can't guarantee that I'll have no anxious thoughts while on holiday, but I can say to myself “I now know new ways of tackling this. I'm actually doing something about this. I now have more tools in my armoury to deal with this”.

    Transactional analysis:

    Adult, parent, child transactional analysis. The parent is critical and encouraging, eg “You must do that – go on!” The child is argumentative, eg “You always ask me to do that! I don't want to!” Think about an adult role model in your life – someone who is calm, rational and sensible. Ask yourself, “What would be my adult role model's way of dealing with this? What advice would they give to me?”

    How to stand above yourself when you have an anxious thought:

    Visualise a river flowing by. Put the thought on a boat, and let it drift away. Recognise that your thoughts aren't you – they're separate from you. You are not your thoughts. Tell yourself “I am not my thoughts. They are separate from me. I can choose if I want to follow that thought or act on it.”

    If the anxious thought keeps coming back after it has drifted away on the boat:
    Look at the thought, visualise it going away, and go back to your breathing. Positive self-talk.

    My therapist said I do have a sense of humour about my illness, and that's a positive thing. It would also be good to give the negative thoughts some lightness in the moments while I'm thinking about them.
    I mentioned that I'm worried about one of my friends who has severe depression and anxiety, as she seems to have become extra withdrawn over the last few weeks. She has said no to coming out for a meal with my group of friends, whereas she always used to enjoy this in the past. Also, she doesn't always reply to my texts when I ask how she is – it's as if she doesn't like to admit that she's not feeling well. My therapist said it's fine to show concern (which means caring about the person or situation), but worrying means I'm taking on too much responsibility.

    Lack of enjoyment/less enjoyment of my hobbies:

    I mentioned to my therapist that sometimes I find it harder to enjoy the things that I used to enjoy, or that I feel too lethargic to do them. For example, I enjoy baking cakes but I've hardly done any baking over the last few weeks/months. I then feel worse as I feel disappointed that I'm not doing some of the things I used to enjoy. My therapist said I need to accept that this is how it is at the moment, and not put too many demands on myself. By being more accepting, you can shorten the duration of the episode, as you're not piling worry on top of worry, or gloom on top of gloom. She said that anxiety and depression get better quicker if you look after yourself and don't put too many demands on yourself.
    Imagine you have a sore throat – you wouldn't catastrophise about it so much, you would be more accepting of the symptoms and you wouldn't focus on them so much. I replied to My therapist that with a sore throat or cold, at least you know it will be better in a few days, whereas with anxiety you don't know how long it will last, and this uncertainty makes it seem worse. My therapist said that the evidence is that you do get better. Other clients she's seen have made a full recovery, she has spoken to doctors about this, and it has a shelf life. The body is naturally designed to heal itself. Furthermore, I have recovered every time in the past, even though at the time it always seemed like I might never get better.

    My therapist said I need to keep chipping away at it. Every time I challenge the thoughts, it chips away at the anxiety.

    Reducing the risk of relapses in the future:

    I can make a list of things that keep me well, and a list of things to avoid or watch out for, so then I can be more aware of warning signs of any potential future relapse.

    Meditation – it is better to do this in the mornings, when your mind is more clear, and before everyone else is up. I can do this for longer when I'm on holiday – this will be a good chance to practice. It can take the air (power) out of the thoughts. My therapist leant me a book about mindful photography.

    I can still do my worry periods in the evenings while on holiday, even though I may not have so many worries to think about.

    Towards the end of the session, I mentioned that my episodes have become more intense since I've been in my 20s and 30s. When I was a child or teenager, the physical symptoms weren't as severe, and I used to be able to let go of the intrusive thoughts, even if only for a couple of hours or so while doing something I enjoyed. My therapist said this is very common, as you have more responsibilities and pressure when you're older compared to when you're a child, and also because you tend to analyse things more deeply as you are more knowledgeable/educated. She said this pattern is common in other clients she's seen – people tend to get worse in their 20s/30s before they get better.

    My therapist said to think of times when I've worried about something and it hasn't happened after all, and of times when I haven't worried about something, but something bad still happened. The example I gave was from when I was at high school – in Years 7 and 8, we had to do indoor rock climbing in the spring term, and this made me feel very nervous. So in the spring term of Year 9, I became anxious that the PE teachers might make us do rock climbing again – I spent several weeks worried about this, but it turned out we didn't have to do it after all.
    Last edited by Sparkle1984; 29-12-15 at 00:49.
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  3. #3
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    Re: My CBT progress diary

    Sparkle, you sound as though you are doing really great so keep up the good work. I am in the middle of CBT at the moment and hope to get to where you are at least. That would be one huge step in the right direction. Keep posting please as it is interesting for me to compare our sessions. I am struggling at the moment to make sense of it. Have a good day and thanks for sharing.

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    Re: My CBT progress diary

    Hey sounds like u are doing great im just starting my cbt and have also been reffrered for therapist to so I'm hoping it all works out ok I'll let u no how j get on keep us updated also x

  5. #5
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    Re: My CBT progress diary

    Thanks for your replies - I'm glad you're finding my posts helpful.

    I was on holiday for a couple of weeks in the middle of July. I still felt quite a bit of anxiety, but at least I was amongst pretty scenery (I stayed in the Peak District)! I had my 4th CBT session on Tuesday. I felt quite a bit better afterwards, and for the following 3 days I felt almost like my usual self. I actually felt better than I did during my holiday! Things seem to have dipped a bit since yesterday evening, but I'm still feeling better than I did a few weeks ago.

    Session 4

    I mentioned to my therapist that although my physical symptoms have improved in the last 3 weeks, I still get quite a lot of intrusive thoughts and I still have the almost-constant feeling of negativity and dread in the back of my mind, as if something's gnawing away at me and I just can't let go. My therapist said to think of this negative feeling as if it were a frightened child within me, and that it's a primitive fear.
    She said I need to find ways of pricking my different bubbles of fear. Tell myself that it's just a primitive old fear and that it has no relevance at the moment.
    I need to remember that my expectations are unrealistically high (expectations vs reality).

    When I get a worry about something bad which might happen in the future (such as the time I felt worried after reading an article in a newspaper saying that sick pay may potentially be abolished in the future, and that people would have to take out insurance in case they ever become too ill to work – I said I was worried that the premiums would probably be high as I have a history of anxiety episodes and therefore would probably be classed as higher risk than someone who has never suffered a recurrent health condition), my therapist said I need to ask myself: “So if that did actually happen, what would I do?” I replied that if it did happen (or something similar), and I was too ill to work and couldn't afford insurance, my family would support me – they wouldn't leave me to live on the streets! We both laughed and My therapist agreed “No, I don't think they would!” My therapist said that it's OK to accept help from others, and that I need to learn how to be dependent on others. Being able to accept help from others is part of your personal growth. I need to remind myself that someone will always be there for me – even after my parents die, I will still have my sisters, nieces, friends and other relatives.

    When I mentioned the magazine article about a man who never recovered from a nervous breakdown that began after his wife became disabled in a car crash, my therapist said “If you seek out something to back up your fears, you will always find it.” Remember that you are unique. This man was just one person – many other people do make a full recovery from anxiety. My therapist said that maybe he never asked for help, because he didn't think it would work for him, or he didn't get the right sort of help. Men especially are sometimes reluctant to seek help for depression/anxiety. Maybe he was the sort of person who tried to cope by drinking heavily because he was too ashamed to seek help.

    I then said to my therapist that during the first half of the holiday, I was often fixated on my heartbeat, because it seemed faster than usual, especially after eating a large meal. She said that I don't need to worry about my heart-rate. It's been fast before and I've never come to any harm. She said it's common for people to have a fast heartbeat in various situations (eg jogging) and for people who have physical health conditions, but these people don't come to any harm. She said that it's best if I distract myself from it, as focussing on it and frequently checking my pulse will only feed the fear further. I mentioned that during my holiday I would often play games on my tablet computer, and this would distract me from my heartbeat and my intrusive thoughts, as I needed to concentrate intently on the games. My therapist said that this is a good idea, although I should take care not to take it to extremes, as I could tire myself out or make myself feel wound-up when playing these games for a long time, especially before bed time and that could make it harder for me to get off to sleep.

    When I get worried, accept where I'm at now. Remember that I've made many improvements over the course of the last few weeks. Notice my improvements and give myself credit for them. Then whenever I get a thought like “I'll never get better” (which is a common intrusive thought for me), I can remind myself of how far I've come so far, and that this is evidence that things will continue to improve, as they have during previous anxiety episodes.

    My therapist said to concentrate on my deep breathing, and doing soothing self-talk (eg “It's OK Sparkle, there will always be someone to look out for you. You don't need to worry about things like this.”) When I have that negative feeling in the back of my mind, I can try “hugging” the feeling instead of trying to push it away. I can say to myself “There's that feeling again”. Show interest in it, accept it and accept that I must be tired or weary in order to feel that way. It will get easier as I practise. Remember the times when I've responded well to the negative feeling – such as the second Sunday on holiday. Consider that there could be sub-conscious triggers for the feelings, even if I don't know what the triggers are (think about how certain smells and songs can evoke particular emotions within you – this is the same theory). However, don't overthink it.

    Dealing with morbid thoughts:

    When you get these sorts of thoughts (fears of death and what happens afterwards), go into a different part of yourself. Think about love between people – it can't always be explained or rationalised, so this also applies to the afterlife. Try not to overthink it. It's a relationship. We can only have faith. No one knows absolutely for sure what happens after death, even if they're dogmatic. So we have to tolerate the uncertainty. But remember we're all in this together – all of us will die one day. Love is stronger than death or anything else. Hang onto the simplicity of this thought.

    I then mentioned to my therapist that I sometimes think that if I'm this worried about death in my 20s and 30s, however bad will it be when I'm in my 70s or 80s – will I be constantly worried about dying and be unable to function? She replied that as you get older, you come to terms with death more – my therapist talked about her mother: her mother often talks about the elderly people in her village who have died recently, so my therapist asked if it makes her worried about her own death. Her mother replied no, she's not worried about death at all. Also, we discussed how elderly people usually seem happy and relaxed about the world, as they've come to terms with the worries and stresses of life. In some ways, they seem more contented than younger people. My therapist said that when she was young, she sometimes worried about dying, but now that she's older it's not such an issue. She also said that people are often peaceful just before they die (having previously worked as a hospital chaplain and witnessing many people passing away). We laughed when I said that I've never seen elderly people on the bus (for example) looking miserable and saying things like “I'm scared I might die tomorrow!”

    With regards to my worries about other people dying, my therapist said to remember that there is a community inside us – people remain in our hearts and minds, even after they've passed away. For example, the advice they've given you will remain internalised within you – you will remember how they lived and how they dealt with certain situations, etc. When your parents and elderly relatives die, you cope better than you think you will. My therapist said it's common for people to think they won't be able to bear it when their parents die, but they do cope better than they thought they would.

    I then talked about my fear about running out of time and “What if I don't get to do everything I'd like to do in life?” My therapist said that I need to let go of some of my expectations – I can't expect to be able to achieve everything I want to do in my life. When thinking about my excessive expectations, I can visualise myself holding a bunch of balloons – let go of the ones that are excessive, and visualise them floating away. Then I can treasure the balloons (hopes and dreams) that I have remaining. It's important not to push yourself too hard.

    Whenever an intrusive thought tries to come back a second time after I dismiss it, with an “Ah, but” type of thought, my therapist said I should tell myself I'll tackle it during my worry period in the evening.

    Whenever I get irrational thoughts that I'm being ungrateful, I can picture a strict female teacher from primary school telling me off. Let it make me laugh. My therapist said that she also had more strict female teachers than male ones, and that it is funny to imagine them. You don't need to heed the negative thought – turn it into something you can laugh at. Tell yourself “I'm loved and I'm doing my best”. Treat yourself with love and grace, not strictness and sternness.

    I then mentioned more about the bad things that happened in my childhood, such as being badly bullied at primary school, my parents splitting up, my Dad being bad tempered when he was drunk, and a scary incident from when I was 3 years old. My therapist said that these incidents are probably where my old primitive fear has come from. She said that children absorb more negative than positive from their environment whilst growing up. I need to remind myself that there is nothing to be afraid of now. There is no need to be perfect!

    Towards the end of the session I mentioned that I occasionally feel guilty about having anxiety, for example when I read an article in a women's magazine about cancer survivors and I thought that they must have been through worse in their lives than I have done. But my therapist said I don't need to feel guilty about having anxiety – it involves real suffering, just like physical illnesses like cancer do. We all have our crosses to bear.

    My therapist said that she's noticed my mood is lighter than it was when I first saw her a few weeks ago. So I am definitely improving, even if it seems like very slow progress to me. Also, she said I have a good sense of humour, which is helping me get through it easier. My main task this week is to work on my soothing self-talk, and to develop a re-assuring voice within me which I can use to comfort me whenever I have a worry about something.
    Last edited by Sparkle1984; 29-12-15 at 00:49.
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    Re: My CBT progress diary

    Hi Sparkle, thanks for sharing this is really insightful and useful. Glad you are making progress. I find it amazing how councillors can seem to get to the bottom of everything so quickly it is very reassuring.

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    Re: My CBT progress diary

    Great post Sparkle

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    Re: My CBT progress diary

    Sparkle, good for you for really taking the bull by the horns in your CBT sessions. These are great posts everybody can benefit from!! I know I took something away from reading your notes.

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    Re: My CBT progress diary

    A great quote I heard when I was 17 and lost three best friends in a car crash...

    "Love is not changed by death, nothing is lost... all in the end is harvest"
    Dame Edith Sitwell

  10. #10

    Re: My CBT progress diary

    Another excellent post Sparkle. I so relate with the fear of death and thereafter, the guilt - its only anxiety and panic we have - think of those with "real" illnesses, like cancer, life threatening diseases. The worry for other people, and forthcoming events, when other people often don't care themselves, or the event does't take place. I have learnt that my anxiety is definitely heightened prior to something then the actual event is no where near as bad. I worry I may need the toilet, or have an accident, but I don't. My tummy may rumble loudly and everyone look as me, when I often hear theirs go and nothing is said. The worry of how will I cope, but as you say, I do cope better then a lot of others when put in a situation. Thank you again, you put a lot of time and energy into helping others. Inspirational.

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