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

When CBT Fails

warning!!

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.

Circle chart colour

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?

T is for Talk Therapy

I started off at the mental health services at my university in 2006. There, I met with a clinical psychology student. I think it’s great that universities run these programs to give mental health sufferers free services and give the students some clinical experience, but I wouldn’t recommend it for your first talk session. It was so awkward! She had to record the session to go over later with her supervisor. She was really nice, but I didn’t know what to say and she didn’t know how to get me talking. There was a lot of awkward silence.

The next one I saw was a psychologist. She was a bubbly dose of sunshine, which was nice most of the time, but hard to take on some days. She knew how to get me talking. I appreciated having those 50 minutes with her each week to talk about what was on my mind. I didn’t want to burden friends with my dark thoughts, so having that time to talk about myself was great. I didn’t feel guilty unloading on her, I was paying her to listen after all. I saw Ms. Sunshine for several years. Eventually I stopped seeing her because I turned 25 and was no longer covered by my father’s insurance. Ms. Sunshine was expensive!

Ms. Sunshine was very focused. Since it appears that I’ve had depression since childhood, she was convinced the answer was in my venn diagrampast. We went over and over it, but nothing. So Ms. Sunshine moved on to my relationships. She made it clear she didn’t think my current relationship was good for me. I was dating my husband back then. She thought we had too much in common, that he didn’t bring me out of my comfort zone enough (socially). She often compared us to a Venn Diagram. You know, each circle is a person in the relationship and they should only overlap so much. She thought we overlapped too much. I didn’t see my relationship as a problem. I was fine with having things in common and he didn’t need to be really outgoing, he brought me out of my comfort zone in different ways; hiking and travel for example. In the end, as much as I liked her, it was probably good that I stopped seeing her. Her fixation on my relationship wasn’t really getting me anywhere.

The next person I started talking to was a social worker. I was on a waiting list for over a year before I was able to see him. He was convinced that it was my Ph.D. that was making me depressed. He actually told me he didn’t think it was the right thing for me and that I should try something different. That was a big blow, I was heart broken, but I knew it was what I wanted to be doing. These people are smart and they are here to listen and to help us learn to live with our depression, but it doesn’t mean they have all the answers. Had I seen him when I was diagnosed back in 2006, he probably would have succeeded in changing my career path, but not now. I didn’t let him talk me out of the Ph.D. I asked to be transferred to someone else.

The next psychologist was great. We worked on my anxiety, perfectionist tendencies and self-esteem. She didn’t once tell me that my relationship or my career were wrong for me. She listened to me and what I wanted for myself and helped me figure out how to work with what I had to get where I wanted to go. I learned a lot from her and I am still practising what I learned from her today. Unfortunately, the health care system here only allows you a limited number of sessions, so I had to stop seeing her.

Currently I see a psychiatrist, Dr. Dreamy I call him, whom I have mixed feelings about. I’ve only seen him a few times and there has been long wait times between appointments. There might be some potential there, we’ll see.

I’ve had ups and downs with talk therapy. I think it is important to have time to talk about yourself. Saying things out loud and having a neutral party ask questions can make you see perspectives that maybe you weren’t able to acknowledge on your own. These people are caring and intelligent and trying to be objective, but they are only human too. They don’t have all the answers and they may sometimes express their personal opinions which can be right, or wrong. Listen to what they say, learn from them, but in the end, you are in control of your own path and you can choose to incorporate what they recommend or not.

zentangle sunrise

Emotional Regulation

“E” is today’s letter. “E” is for Emotional Regulation.

Emotional regulation was something I learned from a therapy session. The theory behind it is that feelings, behaviour and thoughts all influence each other. Feelings and thoughts come more automatically compared to behaviour. Essentially you are trying to modify your negative thoughts and feelings by behaving contrary to them.

Seriously!? Act opposite? It sounded like fromage (cheese) to me! I was told I don’t need to mask the emotion, that I should accept it and feel it, but my actions should reflect the opposite. This immediately came to mind…..

So this was my task, acting opposite….and because I’m a good little girl who does her homework, I gave it a try. I used my usual scenario, getting out of bed in the morning. When I wake up in the morning, I don’t want to get out of bed. Bed is cozy and warm and I’m safe from people and their opinions. If I get out of bed, I have to eat, get dressed, go to work. This, of course, requires energy that I do not have. Then, the thought of work starts to give me anxiety as I think about all the things that could go wrong and all the mistakes I could make and how that’s going to make me look. That gets me thinking about what other people think of me, then I just start hating myself. This cycle is what goes through my head every morning.

What would happen if I stayed in bed? I’d get to stay warm and cozy, my anxiety over work would lift and I wouldn’t have to spend any energy. So far, sounds good. That only lasts for a moment though. My anxiety is replaced by guilt for not getting up and doing what the average person does every day. This must mean I am lazy. I don’t want to be considered lazy, so I start hating myself and worrying about what people think again. On top of this, since I’ve elected to stay in bed, I’m alone with my self-loathing thoughts all day.

What if I got out of bed? I wake up, I feel like hell. Yes, I am depressed and have no energy, but instead of dwelling on that, I’m going to get up. Getting up is followed by the routine of getting ready to leave the house…breakfast, brush teeth, get dressed, hair, make-up, pack a bag….before you know it, I am out the door without having started my cycle of dread. Huh. It worked!

By getting out of bed right away and starting my routine, I distracted myself from my negative thoughts and prevented that self-loathing feeling. I was still depressed, but I was functioning and I got to skip that whole part about dreading the day and hating myself. There are positives to this technique.

 

C is for Cognitive

Cognition is a huge part of mental health. That’s why I have dedicated the letter “C” from the A to Z blogging challenge to cognitive aspects of depression. I have already talked about the cognitive dysfunction experienced by some depression sufferers and how to combat those symptoms. Today I want to talk about a popular topic in cognitive behaviour therapy (CBT), cognitive distortions.

What is CBT? CBT assumes a relationship between thoughts, mood and behaviour and by changing maladaptive thinking, you can change your mood and your behaviour. The idea is to challenge your negative way of thinking. These automatic negative thoughts are called cognitive distortions. There are methods to counteract these cognitive distortions but first, you must learn to catch yourself in a negative thought. To do this I kept a Thought Record. I recorded the situation, what I was thinking and the cognitive distortion. Here is a list of the most common cognitive distortions.

how i feel

Negative Thoughts – Emotional Reasoning

  • All-or-Nothing Thinking. This is when you look at things in absolute categories; black or white. You forget about the continuum, the shades of grey. If you make a mistake, you see yourself as a total failure.
  • Over-generalization. This is when you look at a negative event as a never-ending pattern of defeat. If it happened once, it will always happen.
  • Discounting the Positives. This was one of my first posts. You ignore your accomplishments and good qualities. It’s like they don’t count for anything.
  • Mind-Reading. You assume you know what other people are thinking, failing to consider more likely possibilities. For example, when someone laughs, you think they are laughing at you, but really they are probably having a conversation or remembering something cute their kid did that morning.
  • Labeling. You identify yourself with your short-comings instead of considering a more complex reality. Instead of shrugging off a mistake, you conclude you are a loser because of it.
  • Magnification/minimization. You blow a negative situation out of proportion or shrink a good situation inappropriately.
  • “Shoulds”. You motivate and criticize yourself with “shoulds”, “ought to’s”, “have to’s” and “musts”.
  • Emotional Reasoning. You feel it therefore you are. I feel fat therefore, I must BE fat.
  • Personalization. You blame yourself for something that wasn’t entirely under your control. I blame myself for not getting a lot of research data. In reality, there are a lot of factors that contribute to this. For example, people don’t want to participate!
  • Filtering. You dwell on the negative and ignore the rest of the situation.
  • Catastrophizing. You automatically assume the situation will turn out badly without considering other outcomes. You fear one negative event will be part of a chain of negative events without end.
  • Selective abstraction. You jump to conclusions without having all the facts.

Once you are able to identify these cognitive distortions it is time to come up with a strategy to challenge them. Being a scientist, I find it easiest to look at the facts of the situation. What are the facts? What information do I have to support my thoughts? What is the proof? You can use previous experiences too. What has happened in similar situation? How did I cope? What have I learned that will help me this time? This line of thinking does not come naturally. You have to literally stop what you are doing and think about it, ask yourself these questions. The good news? It does get easier and more natural over time. It has helped me to manage my anxiety. I hope it helps you too.

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