C is for Cognitive Behaviour Therapy (CBT)

Cognition is so important in terms of mental health. It is the whole basis of cognitive behaviour therapy (CBT). The belief in CBT is that your life experiences consist of five components; environment (past and present), thoughts, moods, behaviours and physical reactions. These components are all interconnected and a change in one can influence the others. Although adjustments in all five areas are probably needed to improve mental health, CBT puts the emphasis on your thoughts. Thinking patterns are thought to be most important when trying to make lasting positive changes in your life. A change in thought patterns from the usual negative to more positive and constructive can cause similar changes in the other components.

must stay positive

Of course, it isn’t as easy as it sounds. Your negative thoughts are automatic. You have to actively identify them and then use a strategy to combat them. I like to use logic. What are the facts? What information do I have to support my thoughts? What is the proof? I use previous experiences too. What has happened in similar situation? How did I cope? What have I learned that will help me this time? You have to work at it before it becomes natural. CBT has really helped me manage anxiety and perfectionism.

Then, there is depression. My issue is self-loathing. I hate the way I look, I’m not successful, I am inadequate. These are my thoughts. I know they are negative and I know I need to combat them. There is nothing wrong with the way I look. I get compliments, no one calls me ugly. I am successful. I am a Ph.D. candidate, that can’t be a failure. I am adequate. I am a good person, I work hard, I try to lead a balanced life. That is adequate. I have re-framed my negative thoughts into more positive ones. I realize my self-loathing is irrational and there are no flaws in my logic, so why do I feel worse?

The whole thing creates a conflict in my head. I know my thoughts are irrational, but logic is not enough to change the way I feel. It seems like I am lying to myself. Not only that, but I am a failure because I can’t get CBT to work for me. I gave up on therapy for a while because of this. Only after doing my own research and talking to the mental health community online did I figure out there were other forms of therapy I hadn’t tried. I guess CBT is either the front line in terms of talk therapy or it was for my specific case. All the clinicians I worked with wanted to go in that direction.

Here is a list of some of the other options.

  • Psychoanalysis – This was developed by everyone’s favourite psychologist, Freud (note the sarcasm here) and is where the whole lying on the couch thing came from. It is intense, several sessions a week are required. It focuses on bring unconscious thoughts and behaviours to the surface.
  • Interpersonal Therapy (IPT) – This one examines the relationships in your life. There is a focus on communication and may involve role playing with the therapist.
  • Dialectical Behaviour Therapy (DBT) – This is centered around the discussion of opposing views and work on how to balance the two extremes. There are usually individual and group sessions. This form of therapy is often recommended for Borderline Personality Disorder.
  • Mindfulness-based Therapy – It is focused on talking and mediation. Its purpose is to reduce stress and prevent a relapse in depression
  • Eye Movement Desensitization and Reprocessing (EMDR) – This method stimulates the brain through eye movements intending to make distressing memories less intense.
  • Life Coaching – The focus is on hopes and ambitions. It uses empowering and motivational methods to reach goals and make changes in life.
  • Arts-based Therapies – Involves expression through various art forms, visual arts being the most common. The aim is to help you release emotions and understand yourself better.
  • Bibliotherapy – The use of self-help books.
  • Acceptance and Commitment Therapy (ACT) – Uses acceptance and mindfulness strategies to increase psychological flexibility.
  • Hypnotherapy – Uses hypnosis to modify behaviour, emotional content and attitude.
  • Somatic Psychology – Focuses on the link between mind and body. It teaches you to become more aware of the physical body and how the mind interacts with it.
  • Humanistic Therapy – The focus is on the person as a whole. It explores your relationship with different parts of yourself (emotions, behaviours, mind, body, etc.).
  • Existential Therapy – It is a holistic therapy that considers depression the result of how you make sense of yourself and the world around you.
  • Compassion Focused Therapy (CFT) – This is usually recommended for those that have high levels of shame and self-criticism. It has Buddhist and evolutionary elements.

My psychiatrist recommended I try DBT next. I was supposed to start in January. In the mean time I have been art journaling and I have a couple self-help books on ACT and mindfulness.

Did you know there were so many different types of talk therapy? Do you have experience with any of these therapies? What do you think is the best approach? Is medication the more important element?

help quote

A is for Anger

Happy April Fool’s Day! Today kicks off the A to Z Challenge and the first of my posts on mental health. I’m no good with introductions, so let’s just jump right in.

A is for…

2015-01-15 16.13.30

Anger is a basic, healthy human emotion. It is a signal telling you there is a situation that needs your attention. It is meant to motivate you into action. As with any emotion, there is an element of perception, but generally anger is a response to being treated unfairly, hurt or not having our expectations met. Anger exists on a spectrum from irritation all the way to rage. Frustration is probably the most common point people experience on the spectrum. A lot of people deal with their anger by talking about it, writing about it or exercising it out. These are all healthy ways to deal with anger. Other ways to discharge anger that are also common, but more destructive include shouting, fighting, breaking things or dumping on whoever is near by.

How do you express your anger?

When I am angry, I don’t do any of the things I just mentioned. I wouldn’t describe myself as an angry person. “Angry” is probably the last word most would use to describe me. I just recently discovered that I do in fact, have a lot of anger. So how do I express it? I don’t. Most of the time, I don’t even know I am angry. I suppress my anger and I have been doing it for so long that I no longer recognize the emotion.

Depression and anger have a long history together. Studies have shown that the degree of anger correlates with the severity of depression. Those suffering from depression often have trouble experiencing and expressing anger. It creates inner conflict, triggering guilt, self-criticism and fear of disrupting relationships. Freud even described depression as anger towards the self. I agree with Freud, that is definitely part of it.

In retrospect, I have come up with two reasons for why I started repressing my anger in the first place. One being I am a “people pleaser”. I want to be a good person and I want others to see me that way too. “Good” and “anger” aren’t usually thought of together. That leaves little room for getting angry, let alone expressing it. The second reason is my need for control. If I am in control of my emotions, I am safe. No one can hurt me because they don’t know what affects me. This probably had something to do with those stereotypical mean girls while growing up. Being older and wiser, I know this is unhealthy thinking and it was only a means of self-preservation, but the damage is already done. Suppressing my anger has become a reflex that needs to be undone.

If I don’t get angry, what happens when I am being treated unfairly or my expectations are not met? I blame myself. If I am being treated unfairly it is because I must have done something to make people think they can treat me that way. If my expectations are not met, it is because of my own inadequacy. I don’t go through this reasoning like this in my head. It is automatic. This anger towards myself is turned into hatred. I think What is wrong with you? Everyone else can manage that, why can’t you?

When angry with other people, there is a fear of compromising the relationship or guilt of hurting their feelings. This is enough reason for many to hold back. There is nothing to keep my attacks on myself in check. There are no parallel restraints. Anger turned inwards is vicious. Self-loathing can get so intense that it becomes paralyzing. This paralysis makes you more angry at yourself causing more self-loathing, perpetuating depression. It’s a cycle…… Lovely.

The first step towards breaking a cycle is being aware of it. I can check that off my list.

S is for Self

split face

There are so many aspects of self related to mental health. Some of the big ones being self-harm, self-talk, self-growth and self-loathing. One of the big ones I’ve been trying to work on lately is self-esteem. I think it’s a big part of my depression. Self-esteem is a way of thinking/feeling/acting that implies you accept/respect/trust and believe in yourself. Having good self-esteem means accepting and living with your strengths and weaknesses, acknowledging your value as a human being and being confident that you can fulfill your needs, aspirations and goals. Having low self-esteem results in feelings of emptiness that cause you to latch on to something external to provide inner relief. This could be a relationship, food or drugs. I know I definitely rely on cake, but besides that my major vice is work. I rely on my accomplishments at work, or lack there of to dictate my worth. This thinking isn’t healthy.

Psychologists have told me that good self-esteem is accomplished by taking care of yourself, in the form of 1) overcoming deficits from your past by becoming a good parent to your “inner child”and 2) recognizing your basic needs and meeting them. The first part always sounds kind of fluffy to me. What is your “inner child”? One psychologist explained it as being the playful, vulnerable part of yourself. Those who allow expression of their “inner child” will find it easier to be playful, to give and receive affection and to be in touch with their feelings. Those who ignore their “inner child” will find it difficult to have fun, to give/receive affection, will be overly logical and need to keep things under control. To be a good parent you had to identify from your childhood circumstances the cause of you growing up to feel inadequate. Most of these causes were to do with how your parents treated you as a child because apparently you treat your “inner child” the same way your parents treated you. I’m sure this will strike a chord with many, but it made no sense to me. What if your self-esteem issues are not rooted in your childhood? My parents weren’t overcritical or neglectful, I wasn’t spoiled nor was I overprotected, I didn’t suffer any major loss (like a parent’s death or divorce) and I was not abused in any manner. I am much harder on myself and more critical of myself than my parents ever were. Maybe this part of improving self-esteem just didn’t apply to me.

The second part made a world of sense to me. You have physiological needs (food, water, oxygen, etc.) for survival, but it is important to look after your psychological needs to promote well-being. What are psychological needs? I’ll give you some examples.

  • safety/security
  • respect
  • friendship
  • being listened to
  • guidance
  • fun/play
  • creativity
  • loyalty/trust
  • sexual expression
  • nurturing
  • freedom/independence
  • mastery
  • the attention of others
  • physical touch
  • expression of feelings
  • sense of progression toward goals

I don’t know about you, but I never considered these things to be needs. They were wants or wishes, things that I worked for, but didn’t necessarily need for my well-being. Since I have depression and a big part of that is low self-esteem, my perspective is obviously wrong. Are all of these needs being met in your life right now? A lot of them weren’t for me. I started with creativity, I felt that was easiest for me to tackle. I gave myself 15 minutes every evening to doodle. It didn’t have to be anything grand or anything complete, just doing it was the point. This eventually evolved into reestablishing my drawing hobby, which led to fun! Alright, there’s two psychological needs met that I didn’t have before. What’s next? Guidance. I’ve been running the research lab I am part of for the last while. I don’t have the qualifications or the knowledge to do this, it just sort of fell into my lap. So I’ve been stumbling through trying to figure things out in addition to doing my own work. It has given my confidence a good beating. I think I would do better with some direction, but this involves talking to my supervisor about it. Anxiety! Figuring out what I want to say to her and meeting with her is next in my quest for better self-esteem.

While I am working on improving my self-esteem, I have come across a few strategies that reinforce the little belief I do have in myself.

  • Taking care of my body. Yes I wish I were thinner, fitter, prettier, but that’s not what I mean. I mean be healthy. Eating right, resting and exercising. It’s hard to feel good about yourself when you feel weak/tired/ill.
  • Expressing feelings. If you are out of touch with your feelings, it’s like you are detached from yourself. By expressing your feelings you can better understand your needs and desires and are better equipped to meet them.
  • Positive self-talk. Disrupt negative self-talk by distracting your mind or by questioning your thoughts. What is the evidence for this thought? Is this always true? Am I looking at all perspectives here?
  • Having direction. I always feel most confident following the accomplishment of one of my goals. This shouldn’t be the sole basis of my worth, like it has been, but it does affect how I feel. Self-esteem is reinforced by progression towards goals. In looking to the future, it’s important not to lose sight of what you have already accomplished.
  • Personal relationships. It can be intimate relationships, family relationships or friendship. They can’t create self-esteem. It has to come from within. Personal relationships can provide support/acceptance/validation/love that can go a long way toward strengthening your self-esteem.


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