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?

Alphabet Soup

MDD, GAD, SAD, OCPD, BPD, CBT, DBT…..Argh!! Sometimes when it comes to my mental health, I feel like I’m living in a bowl of alphabet soup. These letters are constantly floating around me and half the time I have no idea what is going on. Health professionals don’t always have the time to explain what these things mean. Sometimes I think they find it easier not to mention them at all and I’ll just get a referral slip with a bunch of letters on it. I know going on the internet to figure things out isn’t always the brightest idea, but I’m glad I starting reading blogs. I’ve learned so much about mental health and these letters are starting to feel less like alphabet soup and more like acronyms that have actual meaning.

When I was 21, I was persuaded to go to a youth clinic for depression. The general practitioner there, diagnosed me as having Major Depressive Disorder (MDD) with some Generalized Anxiety Disorder (GAD). That’s the diagnosis I’ve known for the last 8 years.

Not too long ago, I had an appointment with the local clinic to start up talk therapy again. At the beginning of my treatment, I thought there was just medication or talk therapy, but over the years I’ve learned that there are different types of talk therapy. Cognitive Behaviour Therapy (CBT) was what I was usually referred to. Anyway, this local clinic woman was offering therapy that was new to me (Dialectical Behaviour Therapy or DBT). She was kind, easy to talk to and didn’t seem to be in a hurry so, out of curiosity, I asked her what my formal diagnosis was. She said it was a primary diagnosis of major depressive disorder or MDD (old news) and a secondary diagnosis of Obsessive Compulsive Personality Disorder (OCPD) and Borderline Personality Disorder (BPD).

Wait, what?!

I had never heard of OCPD before. I am familiar with OCD or Obsessive Compulsive Disorder, but OCPD? She explained that OCPD is basically my need for approval and my being a perfectionist, beating myself up over everything. It’s a completely different condition from OCD. Ok, fine. That makes sense but, what about BPD? That doesn’t make sense. I don’t know much about BPD, but I do know they tend to get a bad reputation (clingy, unstable, impulsive, demanding, reactive, difficult relationships, etc..). This sounds like the polar opposite of me. Most of it is probably misunderstood, a stereotype created by so many referring to Glenn Close’s character in Fatal Attraction as an example of BPD. I was pretty sure that the emotionally reactive/unstable mood part was accurate though.

The woman I was with was nice, but she didn’t have the time to answer ALL my questions about this, so I turned to Google.

Here is the DSM IV diagnostic criteria for BPD. A diagnosis of BPD is determined by meeting five of more of these criteria.

• frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. Maybe. I think this is the reason I’m such a perfectionist. I worry people wont like me if I don’t do a good job at things. I always feel guilty that I’m not doing enough.
• a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This doesn’t sound like me at all.
• identity disturbance: markedly and persistently unstable self-image or sense of self. This could be true. I can’t seem to figure out what I want, what is important to me. I just aim for what I think everyone else wants or expects of me or I choose the hardest route so I can’t be accused of being lazy.
  
• impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5. I am guilty of binge-eating, skin picking, isolation, over sleeping, ignoring emotions….
  
• recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. Yea, ok.
• affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). My moods can change relatively quickly. An emotion will come on all of a sudden and I just wont understand it. For example, I’ll be fine in the morning and then, in the depths of despair in the afternoon. This is something I don’t show to people though. No one can tell that I’m dreading something and having a total panic attack on the inside unless I tell them. I think I taught myself to do this because people would feed off my reactions and make things worse for me.
  
• chronic feelings of emptiness. Yes.
• inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). I get very intense feelings of anger, but I am always in control. No displays of temper or fights…I’m more likely to wait until I get home and then just got to sleep for a day or turn on the TV and eat junk until I feel numb.
  
• transient, stress-related paranoid ideation or severe dissociative symptoms. I don’t think so…

Oh….

So, maybe I do fit the criteria…

Google also told me there were different types of BPD (High-functioning, Low-functioning, Extroverted, Introverted and Transparent). You can read more about these different types here. Based on this, an Introverted Borderline with High-functioning tendencies sounded a lot like me. I asked psych about this when I saw him last week and he agreed. Funny that he never shared this with me before. I guess he doesn’t like labels. No one fits perfectly into a cookie-cutter diagnosis when it comes to mental health.

The mystery of why my brain works the way it does is a little less mysterious.

No more alphabet soup….for now.

Share Your World 2015 – Week 1

This post starts off a new year of “Share Your World” hosted by Cee’s Photography. I joined in part way through last year. Let’s see if I can do the whole year this time! Thanks to Cee for her creative questions every week.

How do you get rid of pesky phone calls from telemarketers?

I ignore them. Caller ID is a wonderful thing! They usually come from area codes I don’t recognize or are using some derivative of my own phone number, so they are easy to recognize. I know there is a chance I could be missing a real call, but I figure if it’s important, they’ll leave a message.

What are you a “natural” at doing?

I’m not sure. Creating clutter perhaps. I am never able to finish a project in one sitting. When I get interrupted, I pile what I’m using (ex. scrapbook stuff) off to the side so I can get back to it easily. But then, I have trouble getting back to it. For instance, work stuff will come up and I’ll have to get all my research junk out….but then I’ll need to take a break. So I pile up the research stuff to get out a sketchbook to doodle in. Then, I go back to the research, but leave the drawing supplies in a pile ready for my next break. So you see, it starts to build up. Eventually it becomes distracting and I give up and put it all away.

How often do you get a haircut?

I get a cut about three times a year. I have long hair, so I can get away with that. Split ends are annoying, but I’ve stopped blow drying my hair. Air drying keeps the ends much nicer for a longer period of time. Here is Lego me with Lego Hubby at the Lego Town coffee shop! (Yes, he bought himself another creator set!) My hair is pretty much like that, maybe not so orange, but you get the idea.

What’s the first thing that comes to mind when you hear the word “fun”?

There are two things that come to mind right away and they are polar opposites!

The first is something calming and artsy. I love to sit on the floor at my coffee table with my art supplies surrounding me and just getting lost in it all. Last year, I was usually drawing. So far this year, I’m playing around with mixed media. Here’s an art journal entry to give you an idea.

Art Journal entry – watercolour, watercolour pencil crayons, gel pens, sharpie

 

The second thing is an adventure. For example, caving with Hubby. Inside the caves we climbed up waterfalls and jumped off them. I was scared out of my wits, but it was exhilarating! It was on our honeymoon in Belize. You can read more about caving and other Belize adventures here.

Bonus question:  What are you grateful for from last week, and what are you looking forward to in the week coming up?

Last Week: I am grateful that Hubby and I were both off work and got to spend some time together. We both got the flu, but at least we got time to hang out.

This Week: I am looking forward to hearing from the psyc program I am working with. I’m supposed to be starting group therapy as well as returning to individual therapy.

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?

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 past. 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.