10 sessions and getting murky

[NoPoet]

Hi all,

Well I've had my 10th session of CBT with an exceptionally good therapist provided by Anxiety UK. It's fair to say that I have been almost totally dissected and put back together again with a few improvements, but there is still a long way to go yet. I actually don't know who I am at this moment in time - I have changed that much through CBT.

Some people are cured after 8-9 sessions but since I have GAD and a pantload of other issues, I think I'll be having about 20 sessions in total.

We've got through the surface issues and started digging deep into the murk. Some very painful topics have come to light. When I come out of CBT now I am usually in another blip!

I've found that interestingly, there are 3 layers to my illness. The surface layer is anxiety. The middle layer is depression which occasionally shows itself when I am coping with the anxiety. The bottom layer, which I have only just discovered, is pure, mindless fear.

So, recently I have been more low and mildly depressed than anxious, because the depression realised I was winning so it showed up to kick my arse personally. But as I started scoring victories against the depression, that's when the pure fear was roused, and my therapy has become extremely painful.

Not sure what I want people to say, I guess I will just need to vent here now and then. Some support would be appreciated!

[mashedbanana]

Hi Psychopoet

That's very interesting and it sounds very constructive. They always say things have to get worse before they get better. I often felt that if I was to let go of my anxiety/depression I would just fall to pieces but of course that's exactly what I need to do - let go of this crappy thing that labels and control my life.

Keep pushing on and don't let those three layers win!

[NoPoet]

Thanks mashed, it seems that fear of letting go of the anx/dep is a very common fear for people like us and it reinforces the whole disorder.

one tactic that has been helping is to record my own voice repeatedly giving an honest and extremely positive view of something that bothers me. I'll post some examples soon. it takes a long time for you to notice benefits when you talk about something that is a very big issue and it requires maintenance, so you need to listen regularly.

I have written a script dealing with blips which I will share if it has an effect. It's only been one day so far so let's hope it proves useful.

[rooby]

hi there, am with you on this one, am only starting out with cbt (had 2nd appt today) and was told that it will get worse before it gets better and I came away today in a really strange place. Have to say therapist was very positive tho and made sure to make it clear to me that despite how I feel now, in the weeks following therapy the whole point will be to be more 'me' after it all rather than less.

you said in first post "I actually don't know who I am at this moment in time - I have changed that much through CBT" while you may feel like this now, it shows that cbt is working for you and at the end of it you will be more confident in yourself and your abilities to make decisions .

I will be interested to see how you get on so keep posting.
Out of interest are you on any meds aswell?

[NoPoet]

Hi Rooby. I think most of us can identify with the "in a strange place" feeling, that was a very good way of putting it. Partly it's because we are trying to think in a new way, and we spend all of our lives following the same habits that it can be quite shocking once you start to change the way you see things. I guess this is the part where some people give up, because not knowing who you are or where you're going can be quite difficult to deal with at times.

Did your therapist try to put a limit on the number of sessions? Most will say that they expect around 8-12 sessions, but GAD and long-standing or complex issues may take longer. My therapist says it's not unusual for GAD to take 12-20 sessions. Everyone's situation is different, and someone who has been anxious all their lives may require a lot more therapy than someone who became anxious after a negative event which happened a couple of years ago.

At this stage I simply cannot see myself being "cured" in 10 more sessions. That said, there have been massive changes over the last 10, so I guess we'll need to wait and see. At least I am wanting to tackle the really painful stuff. In fact the more painful the better, because it is obviously better to tackle the really deep-down stuff as soon as possible.

[rooby]

Hi Psychopoet
As I am only after my 2nd session of Cbt, my therapist has told me that I suffer from GAD and has left the exact no of sessions open as he said that there might be other issues that come up as we go along that may mean altering the course to deal with these. I think that shows he is not just going through the motions with me but is actually seeing me as an individual and that has given me hope. He also said that at the end of the course he expects me not to be "cured" but well on the way and armed with tools to help me help myself thereafter and he offers 2 follow up visits in the months that follow. I feel very hopeful that after many years of struggling there may be relief ahead.
It is a big thing for us anxious types that we are willing to face our issues in order to get better and I am encouraged by your attitude.

[LittleMissSleepy]

PP if you knew then what you know now would you tell yourself to have the therapy or avoid it for all the hurt it has put you through ?

[PanchoGoz]

I find it most interesting that you have found these three layers to your illness...the question is, what layer are you treating? Starting at the Fear level and cutting the tree at the roots, or surface level and working your way down?

[kittikat]

Hi PsychoPoet, it sounds like your therapy has been an interesting ride for you. I've been in the past, had about 10 sessions for PA's, which worked really well for me. 6 years on my issues have become more complex but all based around anx/panic/agg and I have just had my first CBT session. This has got me thinking about the 'layers' thing, I believe there is an element of that for me too. My therapist did tell me to expect to feel a bit worse during the first few sessions and says this is perfectly normal and I have to say that did happen to me before. I wish you lots of luck and hope you can tackle the painful issues in a positive and productive way. The limited time does make us feel a little dispondant I guess, but stay positive, things seem to be looking up for you. All the best, Kitti x

[NoPoet]

PP if you knew then what you know now would you tell yourself to have the therapy or avoid it for all the hurt it has put you through ?

If I was back in February 2009 and I had to start again knowing what I know now, I would have signed up for CBT immediately. It could have cut years off my recovery.

While this CBT has had emotional effects that have been very hard to deal with, there is probably no other way for me to recover from GAD after a lifetime of anxiety, avoidance and personal hang-ups. I would recommend CBT as first-line treatment for everyone in the same situation. I have a very analytical brain, and this has given me insights that have cut months off my therapy. I've learned loads of new coping strategies and I have definitely improved in some areas, with more to come.

I find it most interesting that you have found these three layers to your illness...the question is, what layer are you treating? Starting at the Fear level and cutting the tree at the roots, or surface level and working your way down?

Until the last month or so I didn't realise the Fear was a seperate layer. I thought it was mixed into the anxiety, which was the surface layer, and the depression, which I believed was hiding behind the anxiety. I have come so far in 10 sessions of CBT that we cut through the anxiety and the depression to the pain that is really at the heart of my problems. It is big enough and bad enough to qualify as a seperate layer - the ultimate layer, most probably.

EDIT: To actually answer your question, CBT generally starts with minor to moderate problems to get you used to it and build your confidence. Some people find their "real" problems to be so painful or unpleasant that starting with these can scare people off or make them worse. Remember, a lot of people who are just starting CBT won't have many effective coping strategies, and they won't have learned how to "toughen" themselves via exposure therapy.

Kittikat - good luck with your CBT. I'd say CBT is perfect for multi-layered issues but definitely expect a moderate to high number of sessions if you've had problems for many years, or if your problems are really complex or painful.

CBT was actually easy during the first 6 sessions. It was when we started clearing away the "white noise" (anxious and depressive symptoms such as negative thoughts, negative associations, petty fears, things like that) that the depression became a big thing. That happened because A - It was the first time I confronted it instead of avoiding it and B - The anxiety backed down when I cleared away many of the minor fears.

To remind people of something I said in another thread, CBT combined with mindfulness and/or interpersonal therapy (meaning how we relate to other people and deal with the outside world) has dramatically higher success and relapse prevention rates than the "normal" CBT where you intensively treat specific beliefs and problems.