An insight into CBT

Hi all

I obtained 50 sessions of Cognitive Behavioural Therapy (CBT) in the years 2012-13 and ultimately this set me on the road to alleviating the worst of anxiety that had frankly crippled for most of my life prior.  Yes, CBT isn't the answer to everything but for me it put my life on track to a point where today I can say that I am able to manage anxiety and do things with my life that I couldn't do previously.  I have blogged numerous times before about how I obtained this therapy and the other less successful therapy attempts I had before this.  It's a minefield, sadly, even today when a lot more is being done to tackle mental health stigma and to try and get mental health on a level playing field with physical.  Of course, we're still miles off.

I never said these images would be interesting

Naturally, the effectiveness of CBT or any other sort of therapy does become maximised by the therapist themselves.  Yes they will (hopefully) say insightful things that strike chords and that help you to get out of whatever pit you're in.  But ultimately it is down to you as the person with anxiety, depression, bipolar or any other mental health condition to do a lot of the work.  I understand that sometimes this can be difficult at best and other interventions are required for people to even begin to work at getting help, but once you're in that position, the best way to help you is to help yourself. If that makes sense.

One of the main things that my therapist advised that I did was create a toolbox of things that I could open in times of need.  This toolbox contains a series of things that I learnt from my mammoth run of CBT sessions that remind me what I need to do and how I need to act to ensure tasks I undertake do not cause anxiety to spiral out of control.  Now I'm in a much better state, it would be tempting to lock the toolbox shut and even get rid of it, but instead I routinely open it every couple of months and remind myself where I was and where and I am now and most importantly, how I got here.  The toolbox contains a series of prompts that help me to get through challenges as they get bigger now I'm nearing 30.  I talked in my last blog about my mum's early-stages of dementia, the blog before about my travels - all new challenges.  I need this toolbox to get me through it.

When I say toolbox, by the way, I mean Excel spreadsheet.  Such is the modern way of things.

The first things on this spreadsheet are things I can do to help me before and/or during an event (a trip, meal out, work conference or whatever) to prevent a major anxiety meltdown. I then 'score' them informally on how often I actively trigger this technique when required and how effective it is in helping me get through and even enjoy a situation.  Examples include:

• Planning my time when I'm alone
• Do some people watching in busy places if things feel overwhelming
• Focus on my breathing if things start to become anxious
• Plan out the logistics of events meticulously; maps, literature, materials etc.

Sound daft? Yes probably, but you have no idea how much, especially when combined, these things all help you to get through a situation. There is also a big focus on people - who can you call if things go pear shaped? Who is the first aider at the place you're visiting? Who looks friendly to you (because you're not always with your own friends!) Using people is, of course, a risk when you don't know them, but it is always better to use someone than to use no-one in times of strife, in my experience. I would put my life against this statement.

Then I have another list that is more general to life than to specific events, such as:

• Make a strong effort with my friends
• Try not compare myself with other people, positively or negatively
• Enjoy and take in the feelings of happiness and compassion
• Take criticism well by using it constructively.

This is all about putting a positive or a neutral spin on things; not always easy and probably impossible to get right all of the time. There is a danger that you strive for perfection, of course, which is not helpful either ("love your imperfections" as a multi-national online dating agency says), but this list is about recognising how to feel better and more confident about yourself and with yourself, which is hugely important when you have a mental health condition. Incidentally, I have a heck of a long way to go before my scores are anywhere near where I'd like them to be, especially in the ones more general in life. My strongest points are probably planning and organising things, focusing on my friends and others and work related goals. My weaknesses usually come from the analysis around not being in a relationship, surprise surprise. 

Talking of which, I also have a list that is called 'valued directions' which sets out where I'd like to take my future, including things like:

• I would like to be more tolerant with other people
• I would like to help young people through the job market
• I would like to travel to certain places
• I would like to help in the local community
• I would like to eat well and healthily 

I'm not into all of this "life enrichment, positive thought, you can find yourself" wishy washy bollocks that a lot of people on Twitter seem to be about.  Some of the above may sound like this, but it is not at all; these lists and techniques were brought together through grit and hard work and I'm by no means achieving them all. They are just ideas and concepts to try and model myself against so that I don't spiral back where I was five or more years ago. Having anxiety for nigh on 20 years has made me unable to do a lot of things and this is more about a list of achievements if I can do them. So to provide some annotation around the above list:

• I would like to be more tolerant with other people - I need people around me so that I feel like I'm wanted and in case I do spiral again I have people there who can help. So I don't want to piss people off.
• I would like to help young people through the job market - I know what it was like trying to get a job and work my way through university with anxiety...
• I would like to travel to certain places - I've never been able to go anywhere due to crippling anxiety!
• I would like to help in the local community - this makes me feel good and I also know how important interaction is to the elderly and lonely.
• I would like to eat well and healthily  - being physically healthy is always a good thing for your mental health.

You get the idea. 

As I said earlier, I revisit this Excel based toolbox every couple of months or so, so that I never forget it, and re-score where I need to improve or where I've done well. Overall the scores are glacially going up as I get older and I strive for this to continue. To think where I am now compared to, say, 2011 is just extraordinary and thanks in no small part to these sort of CBT techniques. 

And of course thanks to the therapist who introduced these sorts of practices to me in the first place. To her, I am forever indebted. 

Best wishes,
Al

PS - I go to Ireland for eight days on 8th May; four nights in Dublin, four in Killarney, on my own. This is possibly the biggest self-inflicted challenge I have ever presented myself with. Edinburgh went well in February, but Ireland is on a much greater scale. This trip could, ultimately, make a break the next several years in terms of what I can achieve and my general mental wellbeing. I will report back, but for now, please wish me luck.

PPS - June 15th will be the fifth anniversary of my blog. More to follow...