View Full Version : CBT Advice please
Hi
I've recently been doing CBT in a bid to help my HA and I've had a lot of positives from the first few sessions but there was something I wanted to ask.
During my last session we covered some of my fears and I said that my last really bad bout of HA stemmed from the GP wanting me to have some routine blood tests done that I couldn't bring myself to do.
I explained that I had most of them done but there were a couple I spoke to the GP about and asked if we could not do them, he said it was fine and so that was how it was left.
My therapist then said to me "this week I want you to ring your GP and go and get that blood test done".
I explained to her that firstly I wasn't sure I could do that and secondly as it was a major trigger for my HA that I hadn't been able to do for over a year I couldn't see how I would manage to do it just because she was telling me to.
I was just wondering if this sounds normal for CBT? I can understand that it's all about changing thought patterns and facing up to things but I can't work out how she thinks that just because she's told me to do it I can all of a sudden do it, when my family and friends spent the best part of 9 months telling me to get blood tests done, which I didn't because every time I tried I had a massive panic attack.
So I just really wanted to get some views on this from anyone who has been through the CBT treatment. I could understand it if she'd gone through some coping techniques or maybe ways of managing the anxiety but to just say "go and get the test done" seemed a bit strange to me.
Thanks
It's called exposure therapy. The idea is to face a fear to instil confidence in you that you're blowing the dangers completely out of proportion. It's a useful tactic in CBT, it's used mostly in agoraphobia when the patient is asked to spend small amounts of time in a situation that brings on their symptoms and after the first few times the exposure is gradually increased. In essence, there really isn't much of a coping technique can be given against your fear of blood tests. Perhaps the panic attack that's attached to it can be managed, but not the worry itself. That will only subside when you face it I'm afraid. Go with it, it's amazing what you can achieve when you put your mind to it, and the confidence that will give you will make the rest of your CBT so much more productive.
Very few people do exposure therapy any more since there is a better way. It has a low success rate and a high rate of relapse and only works if you have the right personality. My therapist would teach you how to go for the tests because you want to, not because you have to and that is the difference between cognitive restructuring and exposure therapy. Cognitive restructuring works.
---------- Post added at 12:57 ---------- Previous post was at 12:48 ----------
Sorry but this caveman mentality that you just need a bigger stick just makes me vibrate.
Memory being such as it is if exposure therapy is the best you have I can guarantee you you will be doing it for the rest of your life in every situation that causes you panic. Cognitive restructuring stops the anxiety from happening in the first place, it doesn't just make you tolerant to it. That is like drinking to excess so you get used to the hang over.
MyNameIsTerry
28-04-15, 05:32
It's called exposure therapy. The idea is to face a fear to instil confidence in you that you're blowing the dangers completely out of proportion. It's a useful tactic in CBT, it's used mostly in agoraphobia when the patient is asked to spend small amounts of time in a situation that brings on their symptoms and after the first few times the exposure is gradually increased. In essence, there really isn't much of a coping technique can be given against your fear of blood tests. Perhaps the panic attack that's attached to it can be managed, but not the worry itself. That will only subside when you face it I'm afraid. Go with it, it's amazing what you can achieve when you put your mind to it, and the confidence that will give you will make the rest of your CBT so much more productive.
It does like Exposure Therapy but they don't use this much thesedays as its less efficient than Exposure Relapse Prevention (ERP) which I think you might mean, Gary. ERP is the NICE recommended treatment for OCD, within CBT as well as for phobias.
ET used the principle of "flooding" or facing your worst fears head on. For some it works, for others it just means a load of panic and a reinforcement that they can't do it.
ERP works by using a stepped approach. You rank things from lowest to highest or you write a big feared situation and break it down into smaller steps, just like a ladder (it is commonly show as a ladder in some documentation). The concept is habituation and this means that you need to be exposed long enough to allow for the body to take over and reduce anxiety and you stay like this for a while. Anxiety often rises again towards the end of the exposure. An example would to stay in a supermarket for an hour. Its more complicated when its a quick thing like this blood test but it could easily be broken down into steps leading up to that.
To just go ahead and do it in CBT wouldn't work for ERP as I know it. This sounds more like the older ET or it could be a Behavioural Experiment? If an experiment, it would mean listing certain things about what you would do ot what you expect to happen, etc.
Eitherway, its lovely for someone to say "just don't be anxious anymore" but the reality is it just isn't like that as this website alone proves!!
I would suggest talking to your therapist again because this is a simplified way to deal with this problem and she could easily create a stepped approach to get beyond it.
If you look at my threads (I haven't raised many) you will find a ERP guide for therapists which I think I posted on the Therapy board ages ago. Its a book sized online guide to ERP and how to deal with things that don't work. It might have some pointers in there about this.
Its incorrect that the only way to conquer a fear is to face it. If that were the case, we would all be having ERP and not its greater therapy, CBT. There are various strategies, one of which Davit has mentioned in Cognitive Restructuring. In the context of OCD, ERP isn't always used in this manner either because there are forms where you can't face your fear as the subject is a criminal act, so it is used to prove the compulsion cannot cause the expected outcome.
---------- Post added at 05:32 ---------- Previous post was at 05:28 ----------
Very few people do exposure therapy any more since there is a better way. It has a low success rate and a high rate of relapse and only works if you have the right personality. My therapist would teach you how to go for the tests because you want to, not because you have to and that is the difference between cognitive restructuring and exposure therapy. Cognitive restructuring works.
---------- Post added at 12:57 ---------- Previous post was at 12:48 ----------
Sorry but this caveman mentality that you just need a bigger stick just makes me vibrate.
Memory being such as it is if exposure therapy is the best you have I can guarantee you you will be doing it for the rest of your life in every situation that causes you panic. Cognitive restructuring stops the anxiety from happening in the first place, it doesn't just make you tolerant to it. That is like drinking to excess so you get used to the hang over.
CBT does make use of ERP within it which is the recommended strategy for OCD in the UK. However, this example isn't what I would expect to see in ERP, it looks more like the older version that doesn't seem to be used anymore.
ERP can work, it has worked for some of mine, but its one that doesn't always seem to have an effect. I guess it depends on the issue because anything that doesn't give enough time is going to be hard to expose yourself to to get the reduction so maybe they would use a combination strategy?
Hi
Thank you so much for the replies it was really useful to get other views and opinions.
I will have a look at your posts MyNameIsTerry and Davit the cognitive restructuring certainly sounds like something that would work better for me than exposure therapy.
I know that just someone saying to me "go and get it done" won't work, it hasn't for the last year and as I tried to explain politely to her if I could do that I probably wouldn't be sitting in her office having CBT for HA!
I will go for my session this week and I'm going to see if she can suggest alternative methods as I really don't think exposure therapy is for me.
I have to say I'm not overly confident with this therapist, the first session she spent a big portion of the time discussing her own life and husband which I thought a bit strange as other therapists I've seen don't really tend to tell you too much about their own personal circumstances!
Thanks for the information, as always you've been a great help.
MyNameIsTerry
28-04-15, 07:33
No, they shouldn't be discussing all of that from what I have read about conducting sessions in the past. If its of no value, its just time wasting.
Is this a private therapist?
I think your therapist believes that your underlying fear of what the results of those tests would have been had you had them is getting in the way of you overcoming your HA. You need to get those tests done so that you can stop worrying about what they may or may not show. That's what I think your therapist is thinking anyway. You would know if he or she is right or wrong. Does the knowledge that you never did get all the tests done that the doctor wanted niggle away at you? I'm not saying that you should get the tests done. But if your doctor thinks you should then you are going to continue to worry about it.
MyNameIsTerry
28-04-15, 09:31
I think your therapist believes that your underlying fear of what the results of those tests would have been had you had them is getting in the way of you overcoming your HA. You need to get those tests done so that you can stop worrying about what they may or may not show. That's what I think your therapist is thinking anyway. You would know if he or she is right or wrong. Does the knowledge that you never did get all the tests done that the doctor wanted niggle away at you? I'm not saying that you should get the tests done. But if your doctor thinks you should then you are going to continue to worry about it.
I think thats very likely a part of it. Its either that or fear of the tests or maybe fear that the tests will achieve nothing and what then. You guys on here would no better about all this side.
The therapist just needs to use a strategy to get the OP there as its become a bit like a phobia.
Btw sometimes therapists will take that attitude eg "just go and get it done". My own psychiatrist told me that I should stop worrying about dying because I was already dead. It was very confronting but it did get through to me. Not to the point that it cured me but it at least made me think. He practised CBT.
---------- Post added at 18:11 ---------- Previous post was at 18:06 ----------
Terry I think that is why the therapist is being so blunt. He or she knows that the OP was able to persuade her doctor to not subject her to further tests so softly softly does it isn't going to work.
"want to" works very well for Agoraphobia and fear and is simple to do. The mantra is a distraction which is a coping skill, The difference between it and exposure is cognitive restructuring. It is giving the thought a different reaction which becomes subconscious and the fear then has no reason to be there so it doesn't come up any more because there is no reason too. Combined with short exposure periods which then are actually a check of how well it is working, rather than cure, reinforces the fact you can do it. Mostly it is used for driving or going to the doctor or shopping. It does work for flying and commuting also.
I don't have to do it anymore because the new thought is now the appropriate thought. I don't know of anyone it doesn't work for.
Just do it doesn't work for me, I can but there is always stress and that is not the object of doing anything.
MyNameIsTerry
28-04-15, 10:01
Btw sometimes therapists will take that attitude eg "just go and get it done". My own psychiatrist told me that I should stop worrying about dying because I was already dead. It was very confronting but it did get through to me. Not to the point that it cured me but it at least made me think. He practised CBT.
---------- Post added at 18:11 ---------- Previous post was at 18:06 ----------
Terry I think that is why the therapist is being so blunt. He or she knows that the OP was able to persuade her doctor to not subject her to further tests so softly softly does it isn't going to work.
Very possibly.
The trouble is, it may not work if someone isn't ready. I guess they may mean to try it out and then adopt a new strategy at the next session if it doesn't work? Since the OP's family have already tried it, I can't see what additional impact the words from a therapist have unless they come with a strategy to get you there & get you through it.
I can see how your therapist would have thrown you, I think it would anyone. Its a bit like saying to someone with a fear of needles "think that you already have a needle in your arm".
Well according to my psych my obsession with my health and my fear of dying meant that I wasn't really living life anyway so I was already dead. He was right but it didn't cure me. I'm much better than I used to be. I wonder sometimes if this is as good as I'm going to get. My psych says I don't need to see him anymore after a year and a half because I now have the "tools" to overcome my HA. Ironically I had tools before I ever went to see him. I'm a teacher but I have a degree in psychology up to post grad level. If that's not a tool then I don't know what one is. And yet it has never helped me at all.
I actually found a free CCBT that I like from Wales, Going to read more tomorrow, it is 2 in the morning here. I guess it is tomorrow here now. My tea has been cold for over two hours. I don't know why I bother with it.
Lol at davit. Its 7.20 pm here in Sydney. :)
MyNameIsTerry
28-04-15, 10:30
Well according to my psych my obsession with my health and my fear of dying meant that I wasn't really living life anyway so I was already dead. He was right but it didn't cure me. I'm much better than I used to be. I wonder sometimes if this is as good as I'm going to get. My psych says I don't need to see him anymore after a year and a half because I now have the "tools" to overcome my HA. Ironically I had tools before I ever went to see him. I'm a teacher but I have a degree in psychology up to post grad level. If that's not a tool then I don't know what one is. And yet it has never helped me at all.
I think we all have those thoughts, I know I do. We are all certainly capable of full recovery in my eyes, its just finding the way out of the maze.
The hard part is doing it though isn't it. Its always easy to tell people on here but its extremely hard doing it all. I guess we wouldn't be here otherwise.
I guess experience is important too with these diverse issues but you've got a massive head start in your education. I would imagine you would have adapted based on doing therapy as well to tailor your knowledge.
I don't envy you in teaching though. I hope everything is good there, schools over here can be pretty difficult in the cities & towns and thats just the other teachers :D.
I hope the OP finds the strength to do the test as well.
All the best.
---------- Post added at 10:30 ---------- Previous post was at 10:28 ----------
Lol at davit. Its 7.20 pm here in Sydney. :)
Yeah, well its his own fault for spending over 2 hours playing Bauble Buster and knocking me into second place! :roflmao:
Is dinner in the cat, Davit?
I never practised psych Terry I went into teaching the year after postgrad. When I first got the HA my family said things like " just get your books out and read them".:D Most people just can't understand why you can't just snap out of it and be the way you used to be. Would that we could. :). Love teaching. Have a good night Terry. Enjoy that nice cold tea davit. He he
Hi
My therapist is through the NHS and yes it did feel like her having a chat about her husband, their family and how he hadn't text her that day was a bit of an odd thing for her to be bringing up, felt more like she was offloading on me rather than the other way round.
I definitely don't feel like the "go get it done" would work for me. As for whether it still niggles me about the blood tests, no it doesn't really. I guess like a lot of us with HA there are times when it goes through my mind but I did have a lot of the tests done that were required and they were the doctors main concerns the others were purely just routine not because they were expecting anything so show up. The ones I had done were the ones they were thinking might show some abnormalities but they were all in normal ranges.
This is another reason why I don't feel it would be useful because as I was saying to her my HA jumps from one thing to another and even if I did overcome my anxiety and go have more blood tests done, firstly I think my GP would think I was even more crazy than before and I don't think it would give me any tools to use for future episodes (if that makes sense).
I still know full well that even if I had it done this time as she has asked, I'd be no better placed to deal with it if it came up again in say a year or a few years times.
I think I need to deal with my actual fears of how I would cope if I did have something wrong with me etc. I have said to her my HA mainly stems from a fear of death and I feel like I need to work on dealing with that and then I probably wouldn't be so focused on every ache, pain or twinge etc.
I'm going to try and write some notes to take along to her this time and try and explain to her why I don't feel that getting a blood test will help in my situation and see if she has any other suggestions.
Thanks again :)
Munchlet I feel like I'm in a similar boat, kind of.
I'm really, really struggling with CBT and feel like I am kind of being blamed for my low.moods etc. My therapist is really nice, but I have on multiple occasions came out feeling worse than when I went in.
I too feel like exposure therapy doesn't work for everyone. A big.issue of mine is the school run
I have done it many times before and it simply does not get any easier. I absolutely hate it.
I have done 11 out of 16 sessions and feel like I have gotten nowhere. I dont know what to do anymore.
Therapy, including CBT is individualized to the person taking it. I agree that exposure isn't for everyone but at one point or another, the therapist will incorporate it in some manner, shape or form.
I would have to assume the OP has gone through some testing/assessment and the therapist feels it's time. Otherwise, it would seem irresponsible to force someone who truly isn't ready. IMO, the best course of action is to just ask.
Positive thoughts
MyNameIsTerry
29-04-15, 05:31
Munchlet I feel like I'm in a similar boat, kind of.
I'm really, really struggling with CBT and feel like I am kind of being blamed for my low.moods etc. My therapist is really nice, but I have on multiple occasions came out feeling worse than when I went in.
I too feel like exposure therapy doesn't work for everyone. A big.issue of mine is the school run
I have done it many times before and it simply does not get any easier. I absolutely hate it.
I have done 11 out of 16 sessions and feel like I have gotten nowhere. I dont know what to do anymore.
I would suggest discussing the fact your treatment doesn't seem to be working and put the ball in their court. They need to explain why their approach is required or come up with a new strategy to address this.
Exposure can work, but its not the be all & end all, just like CBT isn't.
Your therapist has to be non judgemental so there should never be an issue of blame. If they do that, they are breaching the codes they accept as a therapist (where with an appropriate body e.g. BABCP or there employement terms should also cover it if they are IAPT). If you just feel this way, then talk to them and they will put your mind at ease about it, frustration at not getting anywhere is normal.
If you have a co morbid condition there could be something else that needs addressing that it keeping you more anxious than you should be and this will have an effect on other anxiety disorders.
---------- Post added at 05:16 ---------- Previous post was at 05:13 ----------
Therapy, including CBT is individualized to the person taking it. I agree that exposure isn't for everyone but at one point or another, the therapist will incorporate it in some manner, shape or form.
I would have to assume the OP has gone through some testing/assessment and the therapist feels it's time. Otherwise, it would seem irresponsible to force someone who truly isn't ready. IMO, the best course of action is to just ask.
Positive thoughts
It will be the monitoring they do. Several forms to check anxiety, depression, social issues, self harm potential, etc. From their its the therapists own notes.
They have to act in the best interests of the patient but they cannot force something on them at any stage. It could just be that they are trying to instill some confidence to see if they do it. If they don't, they will talk about what to try next. I guess sometimes we need a little pointing in the right direction given the nature of fear but if someone is adamant they can't do it, its not going to work.
---------- Post added at 05:31 ---------- Previous post was at 05:16 ----------
Hi
My therapist is through the NHS and yes it did feel like her having a chat about her husband, their family and how he hadn't text her that day was a bit of an odd thing for her to be bringing up, felt more like she was offloading on me rather than the other way round.
I definitely don't feel like the "go get it done" would work for me. As for whether it still niggles me about the blood tests, no it doesn't really. I guess like a lot of us with HA there are times when it goes through my mind but I did have a lot of the tests done that were required and they were the doctors main concerns the others were purely just routine not because they were expecting anything so show up. The ones I had done were the ones they were thinking might show some abnormalities but they were all in normal ranges.
This is another reason why I don't feel it would be useful because as I was saying to her my HA jumps from one thing to another and even if I did overcome my anxiety and go have more blood tests done, firstly I think my GP would think I was even more crazy than before and I don't think it would give me any tools to use for future episodes (if that makes sense).
I still know full well that even if I had it done this time as she has asked, I'd be no better placed to deal with it if it came up again in say a year or a few years times.
I think I need to deal with my actual fears of how I would cope if I did have something wrong with me etc. I have said to her my HA mainly stems from a fear of death and I feel like I need to work on dealing with that and then I probably wouldn't be so focused on every ache, pain or twinge etc.
I'm going to try and write some notes to take along to her this time and try and explain to her why I don't feel that getting a blood test will help in my situation and see if she has any other suggestions.
Thanks again :)
It sounds like a slightly separate issue. In your first post you mentioned about how that test could make you feel and again say there would be anxiety but also say its not really part of the current HA concerns.
So, I could see you needed ways to overcome the issue with blood testing because it causing a previous panic attack but I can't see how that really solves your HA? It feels like both should be done to recovery from anxiety overall but whether that should be a focus is something to discuss with the therapist.
If you did have the test and were fine, what would it achieve? It would prove you can do that test without a panic attack. It would probably have a knock on effect to other medical tests as your confidence would grow. Overall it would give you a boost but it would not directly address the typical issues in HA.
Thats how I feel from reading the 2 posts but I'm not sure that accurate so I suggest you think about this and see if you can make it clearer for discussion with the therapist (sorry :blush:)
In terms of Code of Ethics, all therapy has to be agreed in it states so in their code. NHS CBT therapists (Level 3) would be IAPT (unless you are seeing the Level 4 service which may differ but they are more likely to be members of professional bodies as they hold higher qualifications) so they are expect to be BABCP registered. There is an issue that its not mandatory according to IAPT literature, but they have stipulated they should be. Where they are not, their employment contract will also bind them to a Code of Ethics issues by the local IAPT provider. This can be hard to access.
If they are BABCP registered though, the Code of Ethics is here http://www.babcp.com/files/About/BABCP-Standards-of-Conduct-Performance-and-Ethics.pdf
You will see that there is an "Informed Consent" section to cover your therapy as well as item 2.4. These would cover what you agree to do from your sessions. There is likely a good reason for why she wanted you to try this so discussing this is best but if she is adamant you have to do something you do not want to do, CoE should cover why she can't do that. Therapy is based on agreement, you have full consenting rights where not covered under The Mental Health Act e.g. sectioning.
Yes, she should be professional and discussing why her husband hasn't text her is irrelevant to your therapy. I can understand a bit of small talk, it can break the ice, but if it is interferring or a possible trigger to you, tell her because its unprofessional at that point. Its your therapy.
Hi MyNameisTerry
I can see it does come across as confusing. We got on the blood tests because the therapist asked me what triggered my last bad bout of HA, so I said it was the blood tests and then explained to her how I'd had most of them done now but there were still a couple I hadn't but the GP wasn't concerned etc. She said she wanted to try and trigger my HA again because I said at the moment although I have little niggles I'm not in full blown panic mode.
So she thought by telling me to go and get blood tests it would raise my anxiety etc, but I'm just struggling to work out how she thinks I can get them done because she told me too when it took me nearly a year to get any done at all, despite chats with family members, visits to this board, reassurances from GP etc.
I feel like she's expecting me to say "oh ok because you've told me to I'll do it." I know that's probably not the case at all but it's how it's made me feel and she hasn't given me any suggestions on how I could do something which back last year caused me lots and lots of anxiety.
The only thing we have covered during sessions is working out what keeps my anxiety going, ie the checking/reassurance behaviours etc. She has talked about breaking thoughts down but we haven't actually done that yet. Last week was my third session and it just felt like she was saying "ok get it done then problem solved."
MyNameIsTerry
29-04-15, 08:17
Hi Munchlet,
That makes more sense to me now. Thats not a treatment as in ERP, thats more like a Behavioural Experiment. Basically, trying to test what happens & why.
Here is some information on it:
http://www.cci.health.wa.gov.au/docs/ACF3C8F.pdf
http://psychology.tools/behavioral-experiment.html
Aside from ERP, it could fit into Interoceptive Exposure:
http://en.wikipedia.org/wiki/Interoceptive_exposure
But I suspect its more likely the experiment but badly explained. I think this is made more likely by the current absense of stronger anxiety and the fact you are just starting.
You would have to ask her to be sure though.
I can remember doing some smaller exposure tasks like this. For instance, my therapist had me do short sprints to bring on the feelings I was associating with panic which had caused me to avoid exercise. This was explained as an experiment but she didn't have me using the tools posted above, she merely wanted me to try it and think about how I felt before, during and after. She wanted me to think about how it brought on certain sensations and notice how long they lasted and how I felt afterwards.
So, I didn't have the planning involved in the worksheets but a lot of it was included by making sure I listened to the experience. I didn't do it at first, but I did start before my next session and did it several times. The first time was tricky as the result was issues with sensations but this did subside the more I did it a few more times later that week.
Its tricky though when its a one off event like this. I'm sure your GP would authorise it, regardless of wasted resources, because your therapist wants to use it. So, don't worry about what they would think.
Its early days yet in your CBT. They always want to find out more about our issues, gather info from homework and educate us first and then the various exposures, exercises, planning homework, etc tend to start.
If you don't feel you can do it, throw the ball back in her court and put a direct question to her about how everyone has already tried and you have avoided it so how would another person saying it suddenly make you. Its her job then to explain how she will help you to do that.
I think you need to persevere with your current therapist for a little longer. If you are still unhappy with her after a few more sessions then you may need to look for someone else. I wouldn't view her comments about her husband in a negative way. Not just yet anyway. She was probably just trying to make you feel more comfortable. My psych often shared little tidbits of his life with me and I always saw it as him trying to make me feel more comfortable eg a little less the patient-therapist relationship.
MyNameIsTerry
29-04-15, 10:23
I think you need to persevere with your current therapist for a little longer. If you are still unhappy with her after a few more sessions then you may need to look for someone else. I wouldn't view her comments about her husband in a negative way. Not just yet anyway. She was probably just trying to make you feel more comfortable. My psych often shared little tidbits of his life with me and I always saw it as him trying to make me feel more comfortable eg a little less the patient-therapist relationship.
Yeah, I agree. Mine would say the odd thing and I think thats ok, its only if it gets in the way if they bang on about it or mention something inappropriate or maybe come in moaning about the OH :D
Challenging doctors & therapists can be part of it. They can get it wrong. A therapist has a lot to understand and things can change through therapy.
Its early days with CBT for the OP so they have the chance to raise things now and the therapist should adapt. If not, the CoE's can be used against them to make them change or perhaps switch to another person but I would hope that is not necessary.
Communication is a big part of this but if the therapist just isn't listening, you need to be assertive with them. Don't feel you can't be because its your therapy at the end of the day. If they believe something is truly needed, they will be happy to explain why that is.
Yes as in all professions there are good psychologists and not so good psychologists. The main reason I elected to see a psychiatrist was that some of the people I studied psych with at uni left me with grave concerns about their ability to ever excel in the profession. Still, uni is the kind of place where some of the people who party the hardest during their time there change once they enter their professions.
MyNameIsTerry
29-04-15, 11:22
Very true. I've worked with many graduates, some were excellent, some were very dippy and I wouldn't trust them to boil an egg let alone practice the law they were studying!
Doing it in real life is very different anyway, sink or swim time. Its the making of many though.
Until you access the higher level longer term therapies, have a more serious psychiatric condition or go private, its all CBT therapists over here. There are some other therapies involved though but its mostly CBT and they don't need the multidisciplinary teachings you will have had.
Things are far from perfect in this country but we do seem to have an easier time of it when it comes to accessing mental health services.
Thank you guys :yesyes:
As always your responses have been amazing, thank you for those links MyNameIsTerry I will have a look at those now.
I have written some notes to take with me tomorrow to try and explain my thoughts/feelings to her and hopefully she will be able to come up with some strategies for me to work on.
The thing is I really do want this to work and I'm prepared to work hard at it. I know it isn't a magical cure and I need to be prepared to make changes in order to get results but I just feel that this is a big step for me and unfortunately not something I can just do, because she's told me too
Will keep you posted on how it goes, thanks again x
I just want to add a little tidbit concerning exposure therapy and CBT.
When I was going through some depression and GAD from my illnesses, I sought therapy to help with the feelings and emotions I was dealing with from going through such a traumatic time. I also downloaded the free CBT course here and worked on several of the exercises and techniques. My therapist was all for it as anything I could do above and beyond the face to face time would be beneficial.
One of the issues I developed during my ordeal is called Misophonia. It's an aversion and oft times extreme reaction to certain sounds. I always had a degree of this in retrospect but never to the point of it causing an issue. After treatment, beeping noises totally make me want to lose it. It comes from the chemo treatment room where there were a dozen or more people getting treatment and the machines going off if the drug flow was interrupted. That and the radiation machine with all the freaking beeping that thing did.
So... one of the exposure exercises was to frankly listen to beeping noises. I found a recording online and put it on while I was doing things like reading or practicing music and other things. I would start with a few minutes and began to work my way up. At first I wanted to smash something or punch a wall ~lol~ BUT... as time went on, the anxiety it caused lessened. I still get a twinge of angst when I hear certain noises but all I need to do is use some of the techniques I learned from the CBT course and I'm good.
Definitely speak with your therapist as to her reasons and voice your concerns. Maybe... doing something like visiting a lab where they draw blood would be beneficial in desensitizing your fear.
Hi Fishmanpa
Thanks for your comments, ironically where I go for my CBT is at the local hospital and I sit in the blood test area whilst I'm waiting to be called as my consultation room is next door to the blood tests room.
The strange thing with me is going in the room, having the blood drawn provokes no anxiety at all, it's purely waiting for the results, that dreaded feeling of the phone ringing and being told there's something wrong.
I said to my GP, if I could go get blood drawn and wait for the results I'd be anxious but I could deal with it but for some reason it's that having it done and then just waiting.
I'm the same with any tests, when I've had to go for investigations, obviously I get a bit anxious as most people do but if I know they are going to be able to give me a pretty good idea of what's going on there and then my anxiety isn't too bad.
So I'm not really sure what it is with me, I guess it's a control thing and me not being able to determine when and how I get my results, it's a strange one that's for sure!
Ironically, control, or the lack thereof, is one of the roots of anxiety/HA. Interestingly, with therapy and CBT we're learning to take control of our thoughts and emotional reactions.
Having faced my demise several times in the last 7 years, I've come to live by the words in my signature. The reality is, no matter what we're faced with and regardless of our circumstances or situation, we deal with it. What other choice do we have?
Positive thoughts
Blood test are done by machine and in small towns you can wait for results. most of mine take an hour only for results. The hospital here will even give me a print out.
MyNameIsTerry
30-04-15, 04:46
Hi Munchlet,
In that case your therapist has the option of joining you for the test. CBT therapists are allowed to treat you outside of their premises if it is called for, I can remember mine saying that. So, in the case of an experiment, your therapist could observe you and this would allow for a much greater assessment of how you think & feel as it could be covered during & afterwards.
So, its not like a phobia in this instance and having it done isn't going to cause any anxiety but the waiting for results does. So, whilst it could cost a little bit of cash in the short run but help to resolve your HA in the long run, it could be arranged in such a way that they schedule multiple tests as part of exposure and delay the results longer each time since your GP can control that for you. Thats a possibility worth thinking about.
Lack of control is a possibility and another big route in anxiety is uncertainty. By delaying the results it will create this environment and your therapist could put in place ways to cope with that period with an aim to minimising your anxiety e.g. relaxation techniques, Behavioural Activation to keep you busy with healthy activities, the Cognitive Restructuring stuff, etc.
Maybe they will go that way?
To add onto FMP's example of how he exposed himself (sorry FMP, it always sounds bad like this! ) by using similiar sounds, the same would normally be done if taking blood itself was an issue due to phobias e.g. reading about blood tests, looking at pictures of needles, being nearer and eventually inside a centre as FMP said, etc.
Since your anxiety manifests due to waiting, the therapist could come up with ways to start small and make that harder as I said above in delaying test results. They could also work with exposing you to bad test results so you habituate to those scenarios. This latter exposure is something I have seen a couple of threads about on this board where therapists have actively had people Googling and reading about the subject of their fear.
Exposure Therapy is really an umbrella term for a group of separate or interactive forms of exposure e.g. ERP, Interoceptive, Imagery, etc. Its important to know which we are always dealing with as there are differences just like how CBT has differences to its earlier forms in Cognitive Therapy and Behavioural Therapy.
My CBT therapist said something which opened my eyes and was as scary as it was revealing...
Your safety behaviours are what cause your anxiety!
In short I was told that the more I have safety behaviour, avoidance of things, carrying items for just in case etc...is basically reinforcing to myself that I have reason to worry and that the fears are real.
It's a huge leap of faith and takes a lot of bravery to just abandon our fears but I know on this score that the therapist was right.
I often feel like CBT is causing myself a lot of emotional pain on purpose to get rid of a potential lifetime of pain...I'm not good with making early payments it seems haha.
Good luck to anyone on a therapy course and be strong...it's really not easy but be proud of yourself that you're getting help and moving forward!!
I'm the same as you munchlett when it comes to waiting for test results. It totally destroys me. My doctor would get the blood test results within a couple of days so luckily I didn't have to live in dread for to long. Last year I had to have a colonoscopy which was deemed not urgent but the specialist wanted to be sure that there was nothing wrong. I saw the specialist on a Thursday and when he said he wanted me to have the procedure I asked him "can you do it tomorrow?" I was totally serious. He said he could do it the following Tuesday. I was lucky I only had to wait a few days and he was there to give me the results when I opened my eyes (all good). As someone else said if you get the blood tests done in Emergency they can get the results within an hour. I sometimes read posts on here from people saying they have tp wait until their next doctor's appointment in a couple of weeks to get their results and it sends a shiver through me because I can't imagine how anyone with HA deals with that.
MyNameIsTerry
30-04-15, 09:13
The ironic thing is, if you don't get a call, nothings wrong. For people without HA, this is likely a good sign but I can understand how it just keeps building up for you. Its like the anticipatory anxiety I would feel coming up to an appointment, you just can't seem to shake it when you are struggling.
It gets easier as you recover though and I would hope the same is true of HA.
Also, just because a surgery calls sooner it doesn't have to mean its something bad. They do this sometimes because they have found something and need to follow it up with medication e.g. an infection, or maybe antiinflammatories.
I bet when you get the call though, it sparks off the anxiety response. So, perhaps this is something CBT can address by exposure to similiar triggers? Maybe some rollplay even?
Terry when I have had blood tests done I have told the receptionist "don't ring me I will ring you" and I ring everyday until she says the results are in. Then I head into the doctors straight away to see him. I just can't handle the thought of the receptionist ringing and saying "the doctor wants to see you". I know that the reason may be something minor but getting a call like that would send my anxiety sky high.
MyNameIsTerry
30-04-15, 10:18
I can understand that, swajj. I had similiar issues when receiving messages from my therapist or when I knew work were due to call me. Even thought I knew it would be a neutral call, it caused me great anxiety. I know this stems back to work for me because I started feeling that and avoided using my deskphone so I relied more on email.
Why do you think it happens?
I don't know Terry. I find it impossible to analyse myself. I can read other people's stories and think "hmm that could be because..." But when it comes to applying logic to my own situation I am left dazed and confused.
MyNameIsTerry
30-04-15, 10:46
Tell me about it, I find it pretty easy to do that with other people. My job revolved around being able to analyse. Thats why I found all the CBT homework & tools pretty easy as they were similiar to the ones I used as a BA.
I can drill down on other people but I find it much harder with myself. I can get so far with it and then I hit a wall.
More recently I found it comes to me more intuitively. I can be out walking and then I will have a thought and then use it to complete that analysis.
I can't say I understand my issues with the phone though. The closest I can get is that at some point there must have been panic involved and it has stuck with me. Its much easier now but its still there.
For me the results are not my main focus...I have horrendous thoughts about the actual procedures or the tests themselves.
Example..I have a colo rectal appointment at the start of July and I'll have anticipatory anxiety about it till then and build up to a panic when I go to the appointment fearing what procedures I may need for investigation etc then I'll worry about whatever procedure and how horrible it may be and this goes on...
Blood tests bother me about as much as being tickled and so do most minor surgeries like ingrown toe removal or whatever.
The funniest part is that I have a ridiculous pain threshold...not being a tough guy about pain but I happily have teeth out or cysts removed without anaesthetic and don't mind having a good old fist fight and a wrestle...the fear itself is what cripples me.
Odd but true.
If I have a sparring match doing martial arts I don't worry about the pain but that some damage may be caused that would need me to have hospital treatment or cause a serious injury that would be life threatening...it goes on from there.
When I talk about it I find it laughable but it's really horrendous and anyone with anxiety and panic has my deepest sympathy and respect.
I think these days most tests and procedures are done as painlessly as possible.
MyNameIsTerry
30-04-15, 11:41
Is it more about understanding what will be done then, Daniele? So, if someone talked you through it you would feel more in control and less uncertain?
That would seem to fit with the worry about serious injury as that would be another fear of the unknown.
Indeed it's the fear of the unknown and the habit of scaring myself I think..not the pain involved .
So I had my appt with my therapist. I explained that I couldn't just "go get a blood test" as that was a huge part of my HA and asked her politely why she thought I could do it because she'd asked me to when I'd only just managed to do it a few weeks ago after the best part of a years anxiety building up to it.
Her response was she needs me to do it to stir up my HA as at the moment I'm not particularly worrying about my health and she can't work with me when I'm not struggling with it.
I can understand what she's saying but by the same token because I do feel relatively ok at the moment (which is a rare occurrence) I don't want to stir up my HA for the sake of it.
I tried to explain this to her but she said that "I'm not ready to deal with my HA yet and she would have to discharge me".
I'm not sure how I feel. Part of me understands what she's saying but I find it odd that she couldn't offer me any support just because I'm not having an attack at the moment. Just because I don't want to deliberately make myself sick with worry and put myself in a complete state of panic it doesn't mean that I don't want to deal with my HA.
So basically I can refer myself again if and when it flares up and then I'll probably get a different therapist or can request to see her again.
Bit bemused really, but as I'm sure anyone with HA will understand phases where we aren't feeling anxious and constantly worrying are few and far between and personally I like to make the most of them, obviously not what my therapist wanted to hear.:shrug:
MyNameIsTerry
02-05-15, 04:47
Hi Munchlet,
Ok, some things to think about:
1) If you had a phobia, lets say a fear of clowns, by your therapists logic you would need to be anxious at this time for her to do deal with it. NHS Choices recommends CBT to treat phobias.
Since we don't tend to run into clowns much, how would the patient be anxious at this time? They wouldn't. Unless they frequently run into clowns, they could be as rational & productive as anyone without an anxiety disorder.
2) If you were bipolar and referred for CBT to deal with the depressive episodes by your therapists logic she would have to see them whilst experiencing the episode. CBT is the recommended treatment for depression in bipolar patients according to NHS Choices.
How is that practical? Bipolar requires periods of normality inbetween mania & depression unless you also suffer with "rapid cycling".
3) Panic Disorder. NHS Choices explains that panic attacks may be experienced several times a week or several times a month, dependent on severity of the disorder. So, they are not a constant ongoing condition which can be seen more commonly in anxiety disorders so would this therapist want you to come back once they had started as the timing of therapy wasn't inline with the cycle?
So, in the case of the above examples, your therapist would explain that she cannot help them as they need to be experiencing their fear or episode at the time of treatment. Presumably, this therapist also requires a course of CBT to fit neatly inside an episode.
In the case of our clown phobia, does she expect someone to carry a mobile clown around with them to keep themselves in a state of near constant panic?
Many phobias will mean not experiencing panic or anxiety as much as the trigger is uncommon on regular life. This therapist seems to believe that this means CBT cannot be effective hence CBT cannot be used to treat phobias unless they are constantly triggered.
I wonder how she views agoraphobia? Does she need to get them outside of anything they can do before she can treat them?
What if your issues were environmental e.g. work based, but you are signed off by your GP? Would she require you to go back to work and then come to see her presumably refusing to treat you until you put yourself in the feared situation first?
The NHS disagree with this.
CBT allows for triggering to take place by either using Behavioural Experiments or ERP. It is completely feasible for a therapist to treat you now by ways other than exposure such as Cognitive Restructuring which I believe Davit has mentioned earlier in this thread. The therapist can then incorporate ERP methods to get you to use these methods alongside the habituation principle that will occur from ERP.
I have read a few Codes of Ethics now and I know they talk about how treatment must be agreed with the patient.
I don't like how she is effectively blaming you for this. You have been honest in that you don't know how to approach this situation and another human being telling you to do it doesn't help you beyond the brick wall you have. SHE should be providing you with strategies to get into that situation if she wants it done. Since she is right near the blood testing area she could easily accompany you if this means so much to her because CBT exercises are allowed to be carried out away from their treatment rooms (mine offered it on several occassions)
My personal thoughts on this are that you have a bad therapist here. We had 2 red flags already which could have been explained away but this one is too large and contradicts the NHS.
Did you self refer or did your GP do it? If your GP, go back to them and explain this and they should sort it out for you because this is ludicrous. If you self referred, then you would need to take it higher by way of a complaint to the organisation in question.
I remember you said they were NHS, so if you are in England or Wales, they will be part of IAPT. They will be expected to conform to a national standard with their treatment. If you are in Scotland, its a lot different as NHS Scotland are clearly miles behind E&W in terms of mental health issues (their version of NICE still haven't published any guidance on treatment of anxiety disorders which is about 10 years behind NICE now).
---------- Post added at 04:47 ---------- Previous post was at 04:29 ----------
To add to this, if she is in an IAPT service, they have stated they want their CBT therapists to be members of BABCP. They haven't made this mandatory at this time, its guidance only, but where they are not member of BABCP, they have placed a stipulation on their local employer to cover a Code of Ethics in their employment contracts.
So, if we assume the best case scenario and say she is IAPT and BABCP, then there are some interesting areas of her Code of Ethics to review:
2. You must maintain high standards of assessment and practice
2.1 You must ensure that any intervention procedures adopted will be based upon evaluation and assessment of the service user and the environment. You must also ensure that any as
2.2 You must always be able to justify assessments/treatments by utilising the available evidence in the public domain.
2.3 You must plan and implement assessments/treatments in such a way that effectiveness can be evaluated.
2.4 You must discuss and agree the aims and goals of assessments/treatments with service users at the outset and these may be renegotiated, terminated or a referral made to another worker at the request of either party if the goals are not being met after a reasonable period of time or if they later appear to be inappropriate.
10. You must get informed consent to give treatment (except in an emergency)
10.1 You must explain to the service user the treatment you are planning on carrying out, the aims, rationale, risks involved and any alternative treatments.You must also explain if you see a service user only for evaluative or diagnostic procedures. If the treatment is experimental rather than established and proven, you must also explain this to the service user before consent is sought.You must make sure that you get their informed consent to any treatment you do carry out.You must make a record of the person’s decisions for treatment and pass this on to other members of the health-care or social care team involved in their care
10.3 It is understood that consent to treatment is an ongoing process which places emphasis upon the service user's role in the continual evaluation of the treatment.
10.5 A person who is capable of giving their consent has the right to refuse treatment. You must respect this right. You must also make sure that they are fully aware of the risks of refusing treatment, particularly if you think that there is a significant or immediate risk to their life or the lives of others. You must give full consideration to Standard 1 of this document regarding a service user or other persons who may be in danger and you must ensure that you conform to the requirements of any relevant Mental Health laws and any other relevant guidance.
Hi MyNameIsTerry
Thanks so much for your reply, sorry for not replying sooner but I've been away for the weekend.
It's really helpful to have your view on this. The more I think about it the more I'm confused by her saying she couldn't treat me. As you quite correctly state many types of panic/anxiety/phobias come and go so surely if she takes that approach with all her patients she can't be particularly successful in treating them.
I think I am going to book an appt to talk to my GP and just explain what has happened, my GP was very adamant that he wanted me to have CBT as he said he has found it has helped many of his patients over the years.
She did say I can go back and either ask to see her again or a different therapist so I will see what my GP says. I'm hoping he might be able to contact them directly for me and outline what has happened.
I will keep you posted.
Many Thanks
MyNameIsTerry
05-05-15, 06:51
Hi Munchlet,
I'm glad a few examples like that helped to expose her flawed argument for you.
Another thing to consider is that your GP was adamant you need this. This is a good indicator that he won't be happy about this and really your therapist have put the ball back in his court so he is now expected to take your care forward whereas before he could concentrate on meds and any elements outside of therapy needs.
Since he wanted you to have it, I assume it was his referral in which case he will likely contact them to ask what they think they are doing. I think this works in your favour because a GP is only going to refer people if he/she feels it is needed so he believed it could be done regardless of current anxiety. Besides, it a daft argument by the therapist anyway as a lot of CBT is about changing thinking and you don't need to be anxious at all for that, they use CBT for symptom management in cancer thesedays!
See what he says about choice of therapist although I have to say I am a bit concerned about this therapist's attitude. Do whats right for you and don't feel you have to accept her back if you would prefer someone else. My therapist asked me if I was ok talking to her and if not she would arrange a transfer. She was really nice though and easy to open up to and I found her attitude excellent.
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