My CBT progress diary

[Sparkle1984]

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" (http://2.bp.blogspot.com/-XYPw804ohXM/VWGY_RLE-DI/AAAAAAAABPU/q5mGeYXZjXs/s1600/cross_sectional_formulation.png), 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 (http://www.dynamicyou.org/wp-content/uploads/2015/05/worrytree.png) – 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. :)

[Sparkle1984]

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.

[Justanutter]

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.

[Beckie4567]

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

[Sparkle1984]

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.

[bekw89]

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.

[SarahH]

Great post Sparkle

[swgrl09]

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.

[SarahH]

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

[Dogloverlyn]

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.

[heatherd1986]

Thank you very much for posting this. I am very interested in starting CBT and I am going to ask my dr tomorrow to refer me to start this as this is something that I really want to try. xx

[MavisReilly]

This is very helpful Sparkle, thanks for posting.

[Sparkle1984]

Sorry it's been such a long time since I last updated this thread. I completed my therapy sessions at the end of September, but I haven't had the chance to type up all the notes yet. Here are Sessions 5 and 6 though:

Session 5

I mentioned to my therapist that last week I had 3 and a half really good days – Wednesday, Thursday, Friday and Saturday morning. On Saturday afternoon, the feeling of dread in the back of my mind came back again. That afternoon, I'd gone to the cinema and for a meal at the nearby Chinese restaurant. I think this probably triggered memories of the last time I went (in June) when I felt really anxious. Thankfully though, I didn't feel quite as bad as I did back in June.

I also mentioned my concerns that I feel like time has been going too fast, particularly since this episode began. I had the same feeling the last time I went through an episode in 2013. My therapist said I need to be accepting of this. Practise being in the present moment and practising mindfulness. Practise mindfulness with things like eating a meal. Deliberately slow yourself down. Notice if your mind wanders. When going for a walk, notice things such as the colours of the leaves, birds singing etc.

I discussed my feelings that I have to prove myself, due to being bullied at school and other people having low expectations of me when I was a child. My therapist said I don't need to worry about these things any more, as there is no-one I need to prove myself to nowadays. She said that we need to review our attitudes with an adult mind.

I also asked my therapist about how I can lower my expectations of life and of other people. For example, I find it hard to accept that bad things happen to people. My therapist said that we can work on the way we respond to these events. It's the same for other people. Sometimes we have to put up with a difficult phase, and be resilient in it. It's not a catastrophe – it's OK to go through rough times, and other people have them too.

My therapist also said that we can't be perfectly prepared for every bad thing which could happen – there will be surprises in life. The way you respond to them is important. To have the ability to cope with bad things, it's important to believe in yourself. My past experience shows that I do cope, and that I know when to ask for help (eg with work projects).

When feeling anxious, I can follow 3 steps
1) Do my breathing exercises
2) Get up or do something different
3) Deal with the thoughts – draw my own “hot cross bun” diagram or use my worry tree. Ask myself if I'm catastrophising.

I need to remind myself that I'm an excellent problem-solver – my therapist said I must be, due to the fact that I work as a computer programmer.

Regrets are time wasted – there is nothing that can be done about them now. Learn from them, and then let go of them.

My therapist said I look calmer now.

Practise my meditation in the mornings. I mentioned that when I try to meditate first thing in the morning after waking up, I often just fall back to sleep again. My therapist suggested meditating standing up rather than lying down in bed – I can then look at the trees outside the window. I can also time myself using a stopwatch or app on my phone. The relaxed/calm feeling will then carry on into the rest of the day.

When thinking about things I have no control over: My therapist said I should tell myself that it's OK to let go, and live in the present. Spiritually, there is more to life than just us.


Session 6

I mentioned that I had a blip on Thursday evening – this could have been due to a combination of tiredness and hormones. I also had a blip on Friday evening, but it wasn't quite as bad. I was thinking about people in their late teens and twenties, and feeling sad that I'll never be that young again. I've had those sorts of thoughts throughout my life, when reaching certain ages. For example, even when I was 8 years old, I remember my Dad taking a photo of me sitting on the settee with a box of chocolates, and I recall feeling old!! I was feeling disappointed that I was getting older and that I was no longer 5 or 6! Then when I turned 13, I remember feeling sad that I could no longer do some of the activities that under 12s can do (such as using children's playgrounds in parks and pub gardens) because I was now over the age limit. I mentioned that I think part of the reason why I enjoyed being 5 and under is because all the family were still together (ie it was before my parents had got divorced and before my older sisters had moved out), and I had no real existential anxiety in those days. My therapist suggested that these feelings could be due to a sense of loss as I grew older.

This all ties into the theme of dealing with loss – getting older, loss of childhood hobbies and ultimately the fear of death and dying. My therapist said don't feel negative about dying, and to value your relationships during life, and your contributions to the world. People who have been fulfilled in their life don't feel so resentful or fearful about death. When my therapist worked as a hospital chaplain, a terminally ill man said “I've had such a good life. I've done many things that I wanted to do and I don't have many regrets”. She said you take the thoughts of death in your stride when you get older. Bring your focus back to things you can control. Don't be concerned about matters that are too great for you. There's nothing you can do or know about death and dying so you need to give yourself permission to put that on the shelf. The main purpose in life is to love and be loved.

I also mentioned that when I was 19, I had an anxiety episode where I had intrusive thoughts that I might be the only person in the world, and that everything and everyone else was just a figment of my imagination (solipsism). This seemed to come out of nowhere – it was very scary and I felt so alone as I was too scared to tell anyone in case they thought I was crazy. But a few years later I found out that other anxiety sufferers have had similar fears, it's just that it doesn't get talked about very much. This episode lasted for several months until it gradually fizzled out.

I've also heard that one of my senior colleagues might be leaving soon to do a master's degree, so there might be a chance for me to apply for a promotion. I discussed interview nerves with my therapist. I said that I felt a bit nervous about the prospect of having an interview, as I haven't had one for at least 3 years now. My therapist said that being shortlisted would demonstrate that my employer has a vote of confidence in me, and that I would already know everyone on the interview panel. She said it's important that I don't catastrophise if I don't get the promotion, as the evidence is that I am still progressing well in my career. [Since this therapy session took place, my manager decided not to replace the colleague who left the company, so I haven't had the opportunity to apply for a promotion after all].

Whilst on the subject of jobs, I mentioned a vacancy for a part-time web developer job that had come up while I was in my final year of university (working for the student union) back in 2004 – I applied for the job but I didn't get it, and I was never even invited for an interview. The job had gone to someone who was already involved with the student union. I was disappointed about that for a long time. I dwelled on it and catastrophised about it – I imagined that my dreams of becoming a web developer after graduation would probably be ruined, as I would have no experience and therefore no employer would want me. But less than 5 years after graduation, I still achieved my dream of becoming a web developer. So, missing out on that university web developer job may have been a setback, but it certainly wasn't the catastrophe I once imagined it to be. And I still built up a lot of useful experience in other IT-related jobs in the 5 years between graduation and getting my dream web development job. My therapist said that this was a very good example demonstrating that I'm still able to make progress even when things don't always go my way. She said that dwelling on negatives and speculation doesn't do any good, and that whenever I go down that route I should tell myself to stop, as there are always other opportunities.

Thinking about more immediate concerns, I talked about how I'd spent a lot of time since April working on my social club's new website, and this meant I had less time to relax and partake in my hobbies. I also said that it should be finished soon, and that I'm looking forward to having more free time.

Sometimes I get a feeling in the pit of my stomach – a feeling of dread and I don't always know the cause of it. It's subtle, sometimes imperceptible. My therapist said there are things that I can do about it – ie soothe it, nurture it, then the feeling will happen less frequently. It will gradually help, and I need to believe that it will. I need to be aware of factors such as tiredness and my hormonal cycle which may affect my anxiety levels. Then when I'm doing my caring self-talk, I can say to myself things like “You're probably just a bit tired”. This will help to normalise the negative thoughts and make them feel less frightening.

I also discussed a weird fear about time perception that I'd had earlier in the week – we were having a new patio set delivered, and my stepdad had to wait in for the parcel to be delivered. This triggered a memory of a story I'd once read on the internet about a parcel that had got stuck on the roof because the delivery man had thrown it up in the air for no known reason! I remembered this funny story as being from about 6 or 7 months ago, but according to my Twitter Timehop app, it was actually a whole year ago! In addition to this – I'd remembered the name of the parcel company incorrectly – I thought it was Yodel, but actually it was a company called Hermes. These 2 anomalies in the story (the length of time ago that it had happened, and the name of the parcel company) made me feel like I'd lost touch with reality a bit, and this made me feel unsettled. A similar feeling happened with last year's summer holiday – it happened a year ago, but it feels like it was only a few months ago.

My therapist explained that there are many variables affecting our memories. Chances are, if you interviewed people in the street, they wouldn't correctly remember when things happened either. My therapist said that the reason my Summer 2014 holiday feels more recent than it actually was, could be because my step-niece came with us for the first time and therefore there were a lot of memorable experiences within that holiday. So it seems less far back than it actually was. She also said that when I'm anxious, I probably have a heightened awareness of time perception, and I agreed with this. She said that I need to correct myself by saying it's just another feeling brought about by my anxiety, and that I wouldn't usually worry about this sort of thing so much when I'm not going through an anxiety episode.

My therapist mentioned a research study showing that when you're involved in the present moment, time appears to pass more slowly. Also, time goes slower when you're busy, compared to when you're hardly doing anything. So it's best to put lots of activity in your life to make it seem longer!

This week 6 therapy session took place on the 11th of August, so we checked my scores to see how they had improved since my first session on the 23rd June. My anxiety score had reduced from 15 out of 21 to 8 of 21 (ie it had gone down from severe to mild). My depression score had reduced from 6 out of 21 to 2 out of 21. This means that I'm improving even though there is still some way to go on the anxiety side.

When I asked my therapist why the anxiety is taking longer to go than the depression, she said that for me, the depression is caused by the anxiety. She said that I don't get as depressed as many of the other people she sees, and that I'm very proactive about doing things to help myself, for example I try to keep going out and about, I've still kept up with my job and I use self-help techniques. She said that this will benefit me in the long term.

[uru]

Very useful post -keep it up!

[Sparkle1984]

Here are the notes from my final 3 therapy sessions:

Week 7

I mentioned to my therapist that I had started using the Calm meditation/mindfulness app for around 10 to 15 minutes a day, and that I have been finding it quite helpful so far.

I felt a bit anxious on the morning of the day of this therapy session, probably as I felt tired. My background anxiety is still there. My tiredness is probably because I have a lot going on in my life at the moment, for example working on my social club's website in my spare time, and training a new colleague at work. It took me a long time to get to sleep on the Sunday night before I needed to deliver the training to the new colleague.

My therapist said that I need to ask myself “What's the worst thing that could happen?” and then look into my deeper thoughts about the situation. I explained that I was worried that I would get stuck when delivering the training, and that the new colleague would think I'm not very good at my job. I would feel embarrassed, wondering if they would judge me or talk behind my back. I explained that when I was at primary school, other children would sometimes say nasty things behind my back and I would overhear them. My therapist said I need to tell myself “but that was when I was a child”. Embarrassment is mainly a childhood reaction. Anyone else could get stuck too, when training a new staff member at their workplace, so it's not anything unique to me. I'm no different to anyone else, in that respect. I need to ask myself “Is this an old feeling from childhood?” In the end, the training session went OK. There was one bit I got stuck on, and the manager wasn't around at the time so I couldn't ask for any guidance, so I just told the trainee that we would move onto the next section and come back to it later. The trainee seemed happy with my approach.

My therapist said that my resilience levels may be different from other people, and I need to accept that. So I shouldn't be afraid to say “no” to people if they ask me to do something I don't really want to do.

My therapist said that I mustn't feed the background anxiety by worrying about it. When you know you're doing something about it (such as going to therapy), you don't need to pay attention to it. I explained that it's like I have an urge to keep checking myself to see if the anxiety is still there – it's like a habit of pessimism. My therapist said I need to create a new habit each morning instead, for example when I wake up I can tell myself “This is a new day with new possibilities”. “Morning by morning new mercies I see”. My therapist also suggested that I postpone the urge to keep checking myself for anxious feelings – for example I could postpone it until my worry period in the evening, or until the next therapy session. I don't have to follow every thought, so I can choose a positive thought instead. Every time I choose a positive thought and not a negative one, I can tell myself “this is healing the feeling.” It doesn't matter if I postpone the urge to check my anxiety levels – nothing will happen, no matter how long I postpone it.

My anxiety and depression scores at this session were exactly the same as for my last therapy session 2 weeks earlier. So I have had an August plateau. I said to my therapist that I'm a bit concerned about this – what if I don't get any better than this? She said that after a plateau, it's fairly unlikely that I'll never see any further improvement. I don't need to worry, as this isn't a particularly bad place to plateau at. My therapist said that other people do still improve eventually, even after they reach a plateau.

My therapist explained that anxiety on the surface is always driven by underlying values and beliefs. We have to accept uncertainty in life.

I explained that I'm worried that if anything else bad happens this year, would I be able to cope, seeing as I've already faced so many other stressful situations and disappointments this year? My therapist said it probably wouldn't set me right back, as I've learnt more skills to help myself. If another bad thing happened, I probably could regress a bit, but not fully. I need to trust myself. Tell myself “I'm not that child any more.”

For this week, my homework tasks were to 1) choose positive thoughts and 2) postponing anxiety. Tell myself “I'm doing myself good.”


Week 8

I explained that I'm still continuing with my daily mindfulness practice – I'm now doing it for 15 minutes a day. This week I also discovered the Pacifica app, to track my progress and mood swings. I heard about the Calm and Pacifica apps from the Turn2Me.org group support chat sessions, where people can share ideas about what helps them with their anxiety/depression, and discuss any issues they are facing.
The positive thing is that I've been having more good days lately, so in this session I didn't have very many specific issues to talk about.

I mentioned to my therapist that I'm still concerned about one of my best friends – I hadn't seen her for a long time, and she texted me one day to say that she had been going through such a tough patch that she was emailing the Samaritans every day. Her anxiety and depression seems to have got progressively worse throughout 2015.
I also mentioned that I'm still reading the Beating The Blues book that my therapist had leant me, and that I was finding it very useful, especially the part about dealing with rumination. I said that now I was feeling quite a bit better, I would come back for my next session in 3 weeks' time, instead of 2 weeks' time. I didn't want to risk running out of things to discuss!

I told my therapist how I'd been getting back into my daily exercise routine, completing a daily gratitude diary (where I write down 10 things that I'm grateful for), and my baking hobby. I also said that I have a lot of interesting activities planned for the coming weeks, and this was giving me something to look forward to.

My therapist said it was important to make sure I get enough rest, as I probably tire myself out due to having an overactive mind. This week, my anxiety score had decreased to 7 out of 21 and my depression score was 0. So I was pleased that I'd made some more progress since my August plateau. For my anxiety score, the main contributor was still my worrying thoughts (rather than physical symptoms, which had died down a lot by this point). My therapist said it's normal for progress to get slower as time goes on.

We then talked about how I feel when I'm with others in social situations. I said that I find spontaneous conversation difficult, and that sometimes I'm reluctant to say things in case other people think it's silly. I mentioned that I often hear people make funny comments in conversations and they make me laugh, but I'm usually too scared to make funny comments even if I think of them, in case the other people don't find it funny, and then I would feel embarrassed and silly. This is due to bad experiences when I tried making funny comments when I was a child – other people would sometimes say they were silly, or that I was silly. My therapist said that I need to worry less about what other people think.

My therapist also mentioned a book by Chris Williams which explains a 5 areas approach to dealing with anxiety, but I haven't looked into this yet. I will do if my anxiety gets bad again though.


Week 9

This was my final therapy session, as I'd made a lot of improvement over the preceding 3 weeks. My anxiety score had dropped to 4 out of 21, and it may have been even lower if it wasn't for me being ill with a cold and cough, which meant that I had to have a couple of days work and I spent time in bed alone with my thoughts as I didn't feel like doing much else. This led to some negative rumination, but once I'd recovered from the cold and cough I felt much better.

One of the main issues we discussed this week was about my sister and her husband falling out, and my niece had come to stay with us for a week. My sister also went to stay with our older sister for a week as the atmosphere at home was too bad, and at this point it felt like the marriage was going to end. [Thankfully a week or two after this therapy session, my sister and her husband got back together again].

I also discussed my fear of facing disapproval when disagreeing with people (following on from my discussions in the last session about finding spontaneous conversation difficult). There was a situation in which I'd disagreed with someone and I was worried that I'd hurt their feelings and that they'd think less of me in future. But overall, I've felt a lot better since late August and the start of September, despite these bad things happening.

I mentioned that I'd always had this fear of disapproval. There was an incident when I was about 15 years old when I was at the shop with my sister and one of her friends. My sister's friend offered to buy me a magazine, so I picked out a magazine about my favourite pop group at the time. My sister then said that the magazine I'd picked out was rather expensive, and she also said “That group are a load of pony!” So then I felt really embarrassed, and also worried that I might have offended my sister's friend by choosing an expensive magazine. In the end, I picked a puzzle book instead, which was cheaper. My therapist said that I had been put in an awkward situation, and although it wasn't very nice that my sister had made the negative comment about the pop group, I did the right thing by picking out a different magazine instead. She said that I didn't really have much choice at that point.

My therapist said that I could handle disagreements with other people by saying things like “Yes, I can see what you mean, but I actually like so-and-so better”, or “That's interesting, but...”. This gives respect to the other person's opinion. She said that it's OK to have my own opinions.

If someone starts talking about something and I really don't think I'll ever agree, I can say something like “I don't think we're going to agree on that, but you're entitled to your opinion” or “How interesting that you believe that...”

My therapist summed up the final session by saying that the evidence shows that I recover from anxiety fairly quickly, and I need to re-assure myself about this whenever I feel anxious. She also said that although I can't prevent bad things from happening, and that there will always be unpleasant surprises in life, it's about how you respond to difficulties. It's important to allow myself enough rest, and to get things into perspective – other people would be upset too, if they had faced the same difficulties as me this year.

I mentioned that I'd been continuing with my mindfulness meditation each evening, and that I'd finished reading the Beating The Blues book. We agreed that this would be my last session for the time being, but that I can always get back in touch if or when I need further support.

[uru]

Thanks for posting this :)

[philn]

How have you been since the last session?

[Lucinda07]

Thanks for sharing this.
There are some good strategies which I will try out!

[Sparkle1984]

Since the last session, I've been mostly OK, although I do occasionally still get bad days when I get more worries and physical symptoms, but it's nowhere near as bad as it was last summer. I've found getting back into my hobbies really helpful as a way to take my mind off things.