H is for Hopelessness

Ahhhhh, I dropped the ball on this challenge! It’s not that I haven’t had the time to write a post. I have. I just haven’t felt up to it. I guess I am sinking into another depressive episode.

Most people think “sad” when they hear someone is depressed. For me, being depressed has nothing to do with sad. It is hopelessness. Nothing is important, nothing is interesting, you hate yourself and everything is difficult. The worst part is, life is going to stay like this. Everyday, you push yourself to do the things that are required of you. Sometimes you succeed, which gives you no satisfaction and sometimes you fail which makes you hate yourself some more. Everyday is like this regardless of how hard you push yourself. It just goes on and on like this until you start to wonder, what’s the point?

I started to do some reading about hopelessness. I guess I was looking for ways to overcome it. Anyway, I found out there are nine different types of hopelessness. Wow. There are nine different ways I can feel like this. Great. They all stem from one or more basic needs being disrupted. I was going to summarize the nine types for you, but this article is so short, you can read it. The article is heavy on CBT which, if you read my “C” post, you know I am not a fan of personally. CBT does make sense though, there is no arguing that.

In the end, I think learning about the nine different types of hopelessness will be helpful for me. Feelings are abstract and hard to understand, but they are always tied to a thought or set of circumstances. They don’t just occur in a vacuum on their own. Instead of trying to combat the hopeless feeling itself, I can determine what is causing it or which basic needs are being disrupted. At least this way I have something more concrete to work with.

Give the article a read. Tell me what you think.

H.O.P.E. Hold on, pain ends

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.

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?

Loving Yourself

The prompt for Week 2 in the 2015 Art Project was “Loving Yourself”. Just looking at the theme, I knew this week was going to be a tough one. I am awful at self love. I feel guilty nurturing myself. Lately, in order to improve the state of my mental health, I have been taking me-time. It’s definitely not without guilt, but I find if I do something I enjoy, like art, then I get distracted and the guilt of not working or cleaning the house doesn’t get to me so much.

This week’s exercise was one I am familiar with. It’s similar to one of the staple activities of cognitive behaviour therapy. The idea is to re-frame negative thoughts about yourself into positive ones. I find it helpful. It can also be applied to other things. I normally use this activity to deal with my anxiety or perfectionist tendencies. I write down my worries and rationalize the hell out of them. Here is my exercise from this week.

It was recommended to a double page spread this week, so that’s what I have done. We were to interpret the exercise and the loving yourself theme. When I think of love, I think of hearts, pinks and reds, so I’ve incorporated those into my spread. Loving myself is something I am working on and finding difficult, so I doodled a cartoon of myself looking skeptical and pasted that in surrounding it with question marks. You can’t really see it, but I used a stencil full of gears in the background. The gears represent the hard work that has to be put in learning to love yourself when it doesn’t come naturally. I filled the rest of the space with other methods you can use to learn to love yourself.

For the art folk out there, I started with a layer of white gesso, then scribbled all over it with gelatos. The big heart is also gelato. I used white acrylic paint to stencil in the gears. The smaller red hearts are stamped with ink. The writing was done using a Uni-ball Signo gel pen. Letters were coloured in using Sharpie paint markers. The same was used to draw the question marks and the white ruffles around the big heart. The figure was coloured with regular old pencil crayons and outlined in a Sharpie fine liner. I used Modge Podge to glue the figure in.

Does anyone have an opinion on Modge Podge? I got a whole bottle from my sister-in-law, but I’ve heard it’s no good for art journaling and I should be using gel medium. What do you think?

Anyway, on to Week 3! If you’d like to join the fun, you can find more information on Victoria’s blog, or join the Facebook group

When CBT Fails

I like cognitive behaviour therapy (CBT). It makes sense. It helps a lot with my anxiety and perfectionist tendencies. The idea is to change false automatic thoughts (cognitive distortions) and make them more realistic, constructive and positive. My favourite method of combating cognitive distortions is looking at reality. What are the facts? What information sustains my conclusion? What is the proof? For example, during the fall, I had my comprehensive exams for my Ph.D. I had to defend my research proposal among other things. I was being really hard on myself and feeling miserable. I was thinking that I was never going to be able to think of all the angles, the experts would find holes in my proposal and think I’m an idiot. The cognitive distortion here is mind reading. I’m assuming I know what the others are thinking and thus being hard on myself and making myself anxious. In reality, I can’t really know what they are thinking. The purpose of these exams is to solve any major problems in my theory before I get started. No one person can think of everything, that’s why there are four different experts coming to evaluate my idea. They probably wont think I’m an idiot either, I’m a student, my purpose is to learn. Besides, I can’t be the worst Ph.D. candidate there ever was. Here, I relied on logic to talk myself down from a situation that I was making myself sick over.

Sometimes though, logic isn’t enough, I wish it were.. Something can make all the sense in the world, but when you are depressed it doesn’t matter, logic is not enough to change the way you feel. When I try to apply CBT strategies to depression, it feels empty, like I am lying to myself. I know a lot of my problems come from low self-esteem. Is low self-esteem interchangeable with hating yourself? Right now I really hate myself. I hate myself so much I don’t know how to continue existing. I am overwhelmed with anger towards myself. My skin is crawling with hatred. I can’t bare to look in the mirror or hear my own voice. I hate the things I say and the thoughts I have. I’m too ashamed to go out in public and be seen by strangers, never mind people I actually know.

I know this hatred toward myself is irrational. I am not a bad person, most people say I am kind. I’m not on People magazine’s most beautiful people, but no one calls me ugly, except for myself. I’m not too fat or too thin, I wear the clothes that are right for me. I have friends and people who love me. I have the right number of achievements for someone my age. There is no reason for me to despise myself so, yet I do.

I don’t always hate myself. Sometimes I’m fine and I don’t think about how I feel about myself at all. Other times, this wave of loathing washes over me and all I can do is be angry and/or cry. My logical self knows the way I feel is irrational, so I don’t act on it. I know it will pass and I’ll go back to not thinking about it. I try to use CBT to undo my distorted view of myself, but it feels fake and is not changing the way I feel.Why isn’t the logic enough to make me feel differently?

I don’t know what to do with myself when this happens. I usually try to distract myself somehow. Sometimes it works, sometimes it doesn’t. Eventually, the day ends and I climb in to bed and hope that sleep takes me away from myself.

Do you ever feel this way? What do you do?

I is for Insomnia

Insomnia is habitual sleeplessness or the inability to sleep. According to this definition, I don’t have insomnia. I am able to sleep. In fact I love sleep, I always want to sleep…except for those anxiety dreams, but that’s another post. If I don’t have insomnia, then why am I so tired all the time?

Upon further research, I learned there are three different patterns of insomnia. One is sleep onset insomnia, the inability to fall asleep. This I knew. It’s more common in people with anxiety. Your brain just doesn’t want to shut up and thoughts keep cycling in your head. Anxiety is similar to stress in that the hormone cortisol is at higher levels. One of the functions of cortisol is to keep you awake. I don’t have sleep onset insomnia. I have trouble staying awake!

Another pattern of insomnia is early morning awakening with an inability to go back to sleep. Usually you get around 6.5 hours of sleep. This pattern is typical of depression. I’ve been having this kind of trouble lately. I wake up at 3:30am and that’s it, I’m awake. It makes me pretty useless during the day.

The third pattern of insomnia is nocturnal awakenings. I didn’t know this counted as insomnia. I have this all the time. I wake up several times during the night for no apparent reason. Thankfully, I am usually able to get back to sleep, but it still leaves me waking up tired.

How do you treat insomnia? By keeping good sleep hygiene for one thing. This includes going to bed and waking up at regular times, avoiding caffeine and alcohol close to bedtime, giving yourself time to wind down before bed, exercising during the day and keeping the bedroom a comfortable, dark place for sleeping, not TV! This stuff is pretty obvious. I try to follow these rules, but sometimes it just doesn’t work. Then what do you do? Well, I climb out from between hubby and Ewok and head to the couch where I watch the Phantom of the Opera until sleep finds me. Sometimes the movie has to play several times. My psychiatrist has prescribed me sleeping pills for when my insomnia is bad. I’m not comfortable taking them though. I’m sure there are lots of different options, but I am worried about becoming dependent or really wanting to sleep and taking too many. So I was pleased to discover an alternative to sleeping pills, cognitive behaviour therapy for insomnia (CBT-I)!

According the the Globe and Mail (a Canadian newspaper) it’s the first line of treatment for insomnia in Canada, USA and Britain……really? Then why was psych so quick to give me sleeping pills? CBT-I is supposed to teach you how to manage racing thoughts and limit the amount of time you stay in bed to your actual sleep time. This means only going to bed when sleepy, not napping, having a certain rise time and getting out of bed if you can’t sleep for some reason.

It’s hard to believe that this CBT-I stuff is recommended over sleeping pills for chronic insomnia and I’ve never heard of it. With 8 years of mental health treatment under my belt, I would have thought I’d come across it.

Has anyone else heard of this? Has anyone tried it? I’d love to hear from you about CBT-I or about what methods you use to get to sleep.

Sources:

Globe and Mail

Canadian Sleep Society