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Thread: My CBT progress diary

  1. #11

    Re: My CBT progress diary

    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

  2. #12
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    Re: My CBT progress diary

    This is very helpful Sparkle, thanks for posting.

  3. #13
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    Re: My CBT progress diary

    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.
    __________________

  4. #14
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    Re: My CBT progress diary

    Very useful post -keep it up!

  5. #15
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    Smile Re: My CBT progress diary

    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.
    __________________

  6. #16
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    Re: My CBT progress diary

    Thanks for posting this

  7. #17

    Re: My CBT progress diary

    How have you been since the last session?

  8. #18
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    Re: My CBT progress diary

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

  9. #19
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    Re: My CBT progress diary

    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.
    __________________

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