Seven Steps to Stability - Step 2: The Techniques

MHAW 2014

Yesterday's blog focuses on why I decided to get therapy and many from this point forward will look at techniques that came about from these therapy sessions.  Some are "techniques" that therapy may have catalysed that I always knew were there - like being around other people, for example - but today's blog looks at those techniques I hadn't appreciated before, that I learnt specifically as a result of my therapist.

I will emphasise at this point that what you read here should not replace anything you're told from an actual therapist, nor may all of these techniques be suitable for everyone with anxiety.  My aim of this blog is to purely share my experiences with aim of giving hope to anyone considering CBT.

For a start, as I stated yesterday, a critical factor in the success of therapy is how you connect with your therapist and by that I don't mean in terms of the therapy itself, I mean whether you feel comfortable with them and if you don't feel nervous (after a while) about opening up to them.  I was lucky in that I had this and so consequently I was also more inclined to 'believe' what she was telling me was true and to also undertake the various pieces of homework that I was given in between sessions.  I will give a rundown of these now and give each one a mark out of 10 in terms of how difficult it was to implement the technique (0=difficult, 10=easy), length of time it took to implement and a mark out of 10 in terms of how much of a positive impact I deem this technique has had on me (0=no or negative impact, 10=very positive impact).

The main purpose of me doing this is to show that the blindingly obvious is often the best course of action to take when you're suffering.  Things that you may even think you do anyway.  This is all classed as Cognitive Behavioural Therapy (CBT), which is often the therapy that people with anxiety receive. 

Technique 1: CBT as a concept

Implementation: 9
Time: Fairly short
Success: 7

I like to think of CBT as brain 're-wiring,' which in essence, it kind of is... it's about altering thought patterns, many of which are likely to have been embedded for your entire life.  For example, to use a health anxiety scenario:

You feel pain >> you think you're on death's door >> you become anxious which generates more pain >> you think you're on death's door even more >> you become more anxious which generates even more pain >>>>>>>> and so it goes on.

I'm sure anxiety sufferers won't need me to go any further.  CBT is about breaking the cycle at the source, so that when you feel the pain, you DON'T think you're on death's door.  At the very least, if you do, it's about dealing with those thoughts and NOT becoming automatically anxious.  The earlier up the chain you can break this cycle, the more stable you can become. 

I include this as a therapy technique because understanding CBT, or at least forming your own definition, is useful; you know what you want and what you're looking for, and you can create one of the above flow diagrams yourself to fit your situation, so you can track your progress. 

Technique 2: Rationalisation

Implementation: 7
Time: Took a long time to make an impact
Success: 8

This is one of the obvious ones I mentioned.  Rationalisation isn't a simplified name for a complicated technique, it's literally being more rational.  Anxiety sufferers: we're not rational people.  So, it's about realising this and trying to think rationally in a given situation.  So, using the health anxiety example again, when you get a pain in the chest, what could it actually be instead of a heart attack?

Heartburn/indigestion?
A slight muscle strain/pull?
Slight effect of any medication you might be on?

There may be others.  It's about accepting that the likelihood of it being one of the above is a million times higher than it being a heart attack.  Here's another one; because of that horrible advert (you'll know the one if you've seen it; I won't put a link to it), every time I have a minor head pain, I think a stroke is imminent.  Whereas, in fact, it's more likely to be:

Muscle tension/strain/pull
Tiredness
Computer/TV screens
Sinuses

Genius.  Now, accepting these alternatives as an anxiety sufferer - i.e. breaking the cycle - is far easier said than done, and for me took a long time to even begin to get right.  And still sometimes I fail.  It's not just health anxiety either, another example could be thinking that everyone hates me in a social situation.  Is this a rational thought? 

Technique 3a: Mindfulness Practice

Implementation: 4
Time: Not sure it made an impact...
Success: 2

This is being promoted massively amongst various mental health charities and professionals.  I'll let you read an old blog of mine to ascertain what mindfulness is and what it did for me in more detail, but basically it's about being in the present moment and letting all other thoughts of pain, struggle or indeed anything wash away.  Something else becomes a focal point; breathing, your thoughts, sound etc.  I spent months and months religiously practising mindfulness by listening to Jon Kabat Zinn's mindfulness audio books.  It's difficult to establish quite how much effect this had, but I never really got into it.  The period I practised it for was relaxing, but that's not what it was about.  I understood the concept, but against what he reiterated, I just couldn't help but get annoyed with myself when I found my mind wandering.  I'm not also convinced about how much it actually helped me and in the end I stopped the routine as it became and more of a chore. 

Now, this isn't to say I wouldn't recommend giving it a go.  It is a whole new way of thinking and may work for you - as it has for others, I understand. 

Technique 3b: Mindfulness Integration

Implementation: 5
Time: A long time for the penny to drop...
Success: 7

Mindfulness Practice refers to a daily routine of practising the technique.  Integration, which is essence is the aim of mindfulness in the first place, is to do everything mindfully.  That is, focusing on what you're doing and not on anything else.  I don't think I'm very good at this, but I do believe I am better than before I learnt about all of this.  An example would be focusing on other people.  My mind even used to wander when someone else was talking to me; now, I'm much better at bringing my mind back to the present, to them and what they're saying.

The whole point of this, of course, is to stop your mind wandering onto unwanted - or anxious - thoughts and I can certainly see that if it is well implemented it could be an incredibly powerful tool.

Technique 4: Breathing

Implementation: 5
Time: Fairly short
Success: 7

Another award for stating the bleeding obvious.  As you may have noticed, when you're anxious, your breathing often becomes shallow and fast.  The opposite is, of course, meant to help calm you down in an anxious situation and most importantly, in a panic situation.  I have sinus problems which doesn't help me with this one, but generally, when I remember to focus on my breathing (back to mindfulness again) when I need to, it does help.  Breathing slowly in through the nose and out through the mouth. 

It can feel very forced and unnatural at first and in the first few breaths can actually feel like it's making your panic attack worse.  But I've found that if I stick with it, it tends to improve.  It can also help in less severe anxious situations; just when you're feeling 'stressed out' and anxious about something, breathing deeply often helps to calm the situation.

Technique 5: Planning

Implementation: 9
Time: Instant
Success: 7

By planning, I mean events, both in terms of logistics and in terms of organising logistics to minimise stress or panic and in terms of (again) rationalising.  If, like me, going anywhere further than a five mile radius of home was a massive challenge, in doing so I needed a contingency plan, for example:

- I have some mindfulness with me on an mp3 player
- I know what time the train is there and back
- I have a map showing me where to go
- I have food and plenty of water with me
- I have my meds
- I have a list of techniques I can try if needed
- I have a book
- I have my phone
- Someone knows I'm going
- I will take myself away from the situation if the anxiety becomes bad by calmly excusing myself (the hardest one)

The point here is that by organising yourself and by having appropriate items with you, it will help to minimise the likelihood of a panic attack happening in the first place.  This helped me tremendously when I first started catching trains again; knowing that I didn't have to worry about logistics and knowing that, if things did go wrong, I have people to call and I can escape.  I'm lucky in that I'm quite an organised person anyway in this respect, but for someone who isn't, being so could have a big impact.  Again - seems blindingly obvious.

 
So there you go; just some examples of techniques that I learnt as part of my CBT therapy, which individually had mixed but an overall positive impact.  Collectively, I think they helped me massively and I continue to use them over time.  I also continue to monitor them so I can remind myself every so often that I should be doing something more, if necessary.

Not all of these may be appropriate for everyone - I emphasise this again, and this does not replace professional help.  If you're taking help from me Lord help you all.  But hopefully what it does show - and this is my aim - that sometimes it's the really easy and obvious stuff that can really make a difference.

But that, of course, doesn't mean it's easy to begin with.

Tomorrow's blog: medication

Best wishes
Al