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

Being Assertive

Being assertive is important for self-esteem. I met with my psychiatrist (Dr. Dreamy) last Friday. He suggested that I work on being more assertive in order to boost my self-esteem. He thinks in order to do this, I would benefit from regular talk therapy. Regular means once a week. I was doing this and it was covered by provincial health care, but you get a limited number of sessions, then you have to wait six months before you can go back. I’m on the six month waiting period now. I could go private and pay to see a psychologist once a week, but that’s not in the budget right now. The last time I did that, it was $130.00 per hour! That was a few years ago now, so I can only imagine what it must cost now. I explained all of this to Dr. Dreamy and we worked out a solution. I will see him every one to two months to talk things out, otherwise, I will read what he recommends and sort it out myself. It’s not ideal, but seeing as I’m an academic, reading and sorting it out myself is supposed to be my forte. So until I see Dr. Dreamy again in June, I am reading about self-esteem and how to be more assertive.

Being assertive is a way of acting that strikes a balance between being aggressive and submissive. I think aggressive is probably one of the last words someone would use to describe me, so I must be more on the submissive side. If you are submissive you end up doing a lot of things you don’t want to do which can create resentment, then tension and then open conflict. That sounds like me…except for the open conflict part. I guess I keep it bottled up, which only hurts me in the end. Here are some characteristics of submissive behaviour…

  • Discounting your own rights and/or needs
  • Not expressing your feelings
  • Feeling guilty or like you are imposing when asking for a favour
  • Overly invested in being nice and pleasing people

And the characteristics of assertive behaviour…

  • Simple and direct communication without attacking or manipulating
  • Standing up for yourself and your rights without feeling guilty
  • Communication of feelings honestly while maintaining respect for others

The list of submissive behaviours totally sounds like me in a lot of situations, especially at work and with authority figures. By not expressing my feelings, people (like my supervisor) are ignorant of my wants and needs. How can I expect my supervisor to recognize how overwhelmed I am if I don’t tell her?

So how can I be more assertive? I need to work on those three points I listed above. I think I’m alright at the first one. I stay calm when speaking to people, I maintain eye contact and an open posture. I know that it is important to use “I” statements rather than “you” statements. “You” statements come off as threatening or like you are setting blame. If I were to talk to my supervisor it would be better to say “I am feeling overwhelmed”, rather than “you are giving me an impossible amount of work to keep up with”.

I do have to work on communicating how I feel and not feeling guilty about it though. I often feel ambivalent about my wants and needs. I think that is part of the problem. I need to sit down and really think about what they are instead of just going with the flow. Maybe that’ll be another post.

zen lace circle colour

 

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

Misadventures with Dr. Dreamy the Psychiatrist

I’m seeing my psychiatrist today. I’m not looking forward to it. The first time I met him was years ago. My doctor sent me to him to get another opinion on anti-depressant medication. I had never been to a psychiatrist before. I was anxious, but keeping an open mind. So I went to my first appointment and it was awkward. First of all, Dr. Dreamy is very attractive and he’s not much older than me. I guess I was expecting someone older and wiser, someone who wasn’t a peer. The fact the he was cute and making me blush just made it that much more uncomfortable.

I had waited months and months for the appointment, so I wasn’t going to bail now. I was okay talking to him about my anxiety issues. It was harder to talk to him about depression and my body image issues, but I did because I thought it was important. I had two appointments with him before I went back to my regular doctor.

It took Dr. Dreamy about two months to get back to my regular doctor about his opinion on my meds. He said the best thing for me would be Remeron. Remeron?! Are you kidding me?! Had he been listening to anything I was saying? I had basically told him I was obsessed with my weight and miserable because I was fatter than I wanted to be. I told him I was addicted to cake. Remeron is notorious for increasing appetite, especially for junk food and is one of the worst drugs for weight gain. I’m lucky I did my research ahead of time. Otherwise, I would have assumed doctor knows best and just taken what he recommended. Needless to say, I didn’t go back to him.

Fast forward a few years. I passed the 25 years old marker which was disastrous. I had to stop seeing my regular doctor because I was no longer considered a youth. 25 is also the cut off for being on your parents’ medical insurance, so no more private therapy. Therapy is a little expensive for a grad student. I tried the counseling services at the university, but that didn’t go well. A story for another time.

So now what? I started going to a walk-in clinic to get my refills. They refused to give me more than a month’s worth. So once a month I’d spend a few hours waiting at the walk-in. Yuck. I was put on a waiting list to see psychiatry (hope!). Then I found out they refer to the same practice that Dr. Dreamy was from. I made sure I requested a woman this time. Not only to avoid Dr. Dreamy, but I was hoping a women would take my body image issues more seriously. It took over 8 months to get an appointment with psych.

So I go to my appointment, feeling hopeful that I’d be able to get some real help again. I’m waiting in the waiting room and I hear my name called. I look up…..and it’s Dr. Dreamy again. Doh! Apparently since I started my file with him, I have to stay with him. Unfortunately, the past few years have been good to Dr. Dreamy and he’s still as cute as ever.

Since I didn’t really have a choice, I gave Dr. Dreamy another chance. He seemed better this time, although talking to him is still awkward. I feel like he is actually listening now. I’ve gone back to him many times, with long wait times in between. Instead of telling me what medication would be best for me, he has been asking what I think would be best for me. I’m managing my own meds? Does anyone else’s psychiatrist do this? At least this way I wont go on anything that causes weight gain, but I’m not a doctor, I don’t really know what I’m talking about…..

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