Tag Archives: CBT

Online Cognitive Behavioural Therapy: a patient’s view

I finished the online CBT course on Friday. Do I feel any different? No… just relieved it’s over!

A number of people on the forum say it made things better for them.

“It must be nice to be you,” I mused enviously. “Able to say something positive and encouraging about the course, and follow it up with a ‘thank you!’ That’s the desirable reaction.” Some went so far as to say it has turned their lives around. It would be amazing to be able to say that.

One or two, on the other hand, say they didn’t find it helpful. I was disappointed we were in the minority, but maybe only a few of us negative nellies made it to the final session. I read that a lot of people drop out of the course. It shouldn’t have taken me so long, but I had a long hiatus in the middle.

The course is intended for ‘mild to moderate depression or anxiety’, but it seems if it doesn’t work, it’s because of “low adherence and engagement with treatment, rather than lack of efficacy.” See the Guardian article: Questions raised over effectiveness of online CBT for treating depression

I don’t know enough myself to be able to pinpoint why it works for some and not others — can only give my personal experience.

A lot of the time when I was trying to do the CBT exercises, I felt irritated, even angry. If I put it down and did something else for a while, I would eventually be able to complete the exercises, but my heart wasn’t in it… I felt distanced from what I was doing. For instance, I had to list positive self-beliefs, and was jollied along with, “don’t be modest.”

Having got over my spat of grumpiness, I wrote: “I read a lot; I write well; I try to improve my artwork.”

As the online course reminded us, ‘practice makes perfect’. I’m supposed to keep doing these exercises; these tools to improve my mood or how I handle things — but right now I look at those three self-beliefs and feel on the low side of neutral. I’m confused about the kind of beliefs I’m supposed to come up with, and have a sneaking feeling I got it wrong. This exercise is a spin-off from a section about ‘attributional style‘. Healthy beliefs about oneself should be ‘permanent, internal and general’ as opposed to ‘specific, external and temporary’.

So… ‘I read a lot’… is that specific or general? I would have said ‘specific,’ as it’s a specific thing that I do, but the relevance by-passes me at the moment.

It’s internal, I think, because it’s a way of taking credit to myself. I’m not depending on someone else to do all my reading for me! Also, it’s a permanent belief; I read a lot while I can. So what does a temporary belief look like? “I read a leaflet yesterday but probably won’t bother again?”

A lot of people on the CBT forum seem to like that exercise, so they must know what it means and how to correctly label their beliefs. It’s just me who’s the numpty!

Come to think of it, “I was lucky to win that tennis match,” is probably a temporary belief. A more self-believing belief would be, “I won the match because I’m a good tennis player.” No wait, that’s an internal belief, whereas “I was just lucky” is external because the gods smiled on you.

“I read a lot” doesn’t make me feel I can take on the world. People write such contradictory things I find myself believing stuff that cancel each other out, don’t know what to believe, or do daft things because I uncritically internalized the last thing I read. So much for all that reading.

At any rate, perhaps a better self-belief would be “I am kind.” That’s more ‘general’ because it’s something I am, whereas “I read a lot” is a specific belief because it’s something I do… though don’t take my word for it!

It should really be “I am sometimes quite kind.” 😛 Does that make it a more temporary belief? Is that the very thing I’m being warned against by the CBT course? I would probably be told I’m giving away credit for my success.

Well, that brings us to the point of the attributional style. When you have successes or disappointments in life, you use your self-belief in the following way: “I made a new friend today because I’m kind.”

That would be better than saying, “I made a new friend today because the other person is kind,” which would suggest there’s nothing about you the other person thought was remarkable.

“I made a new friend today because I was on my best behaviour and hid my usual surliness”… that’s pretty realistic for many people, especially me, but I think the CBT would frown on it!

I could just switch off the niggles in my head and say, “I made a new friend because I’m kind and witty and clever, and the other person likes me.”

Does that make me feel good? Hmm……..

Just had a lightbulb moment! I noticed the word ‘control’ when reading online about attributional style. People are depressed and anxious if they don’t feel in control, so it makes sense that being able to make more powerful statements should be beneficial. That’s easier for me to grasp than whether or not my beliefs are ‘permanent, internal and general’.

I hate to be curmudgeonly, but you’ll note I didn’t say that I believe telling myself that I believe something that I don’t believe is going to make me step out more confidently! However, since practice makes perfect, I will keep trying the various exercises for a while. I would enjoy setting up a special CBT journal to fill in every day… though perhaps actually filling it in is another story?

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Perfectionism and Plans are not Perfect Partners

If we were having coffee, conversation would stall because we would be too distracted by TV. I’m not watching, but can’t think about anything else while it’s on.

The ads are not much better — perhaps it’s just my mood. When I really want to, I can drown it out and focus on what I’m writing.

What’s annoying is when you get the feeling there was something else you were supposed to be doing, but you can’t pull your thoughts together enough to remember what it was. Instead, you keep staring at the TV, even though the panellists are cracking jokes you mostly don’t think are funny.

Come to think of it, there were lots of things I should have been doing, such as:

1. Painting a tree that the tree outside my window complains looks more like a tiger.
2. Several other pictures I abandoned, and they weren’t looking all that bad.
3. Writing to Apple (something about a bug report).
4. An online CBT session I should have done on Friday.
5. Keeping up with CBT homework, which includes noting my mood every two hours.

Actually, not doing my CBT homework is the main reason I’m avoiding the next session. I got a nagging email that says we will get the best from it if we complete one session a week. I don’t know why waiting another week should ruin the flow of it, especially if I already ruined the flow of it by not doing my homework.

Mood for 22:00…. rattled.

The TV has been turned off, thankfully, but a cat has come in and is sitting at my feet staring at me… as a result, I’m no less distracted than I was previously.

I asked why people keep mocking Piers Morgan, and Mum said, “Nobody likes him.”
“Why… what did he do?”

You can’t really laugh along with them when you know they’re making digs at someone you know nothing about… that’s just one of the things I wasn’t finding amusing. You look at people on TV who have their own in-jokes, and feel alienated from most of them… does that qualify as a ‘mood’ too?

It’s not surprising, I guess; in-jokes are a bonding mechanism. If you don’t know what people are nudging each other about, it makes you realize you’re not one of them. Perhaps most people watching the show understand these attitudes and inferences, and that thought makes me feel even more ‘out of it’. I suppose I could google Piers Morgan but don’t want to. Live and let live.

Nursing your coffee in the other chair, you are nodding politely, but I can tell you are wondering what rock I’ve been living under! Well, I was not too far from Castle Rock once upon a time. I still love the city of Edinburgh. We visited it a little while ago but I wonder if I will ever see it again? I doubt it. The very name ‘Edinburgh’ feels like home, and that’s enough, really.

The nagging feeling of distraction is persisting. Let me just take care of these cats for a moment…

Samson jumped eagerly into his bed… heart-warming. 🙂 Now that we’re all sorted out for the night, I feel more focused… slightly. More coffee?

I’m still not following the little timetable I made. I got tired and stressed on Friday after being unable to sleep. The next day I was a zombie and nearly got run over twice, so the timetable naturally took a back seat. I had a strong feeling I was going to continue to ignore it, and decided I should simplify it a great deal.

I did that this morning and was suitably smug, feeling I might successfully complete my CBT homework this week. Well guess what… I forgot it again. I forgot such a plan even existed. I’ve only missed one planned activity, which was to back up my iPad and sort though my burgeoning Gmail inbox, but even one black mark makes me feel the entire week has gone down the chute.

I paint like that too. Stroke, erase; stroke, erase… I can spend a few minutes on that, and it’s not surprising I never finish anything. The pictures I do finish have usually taken weeks or months. A few times I’ve tried speed painting tutorials but nothing changes! Before you know it, I’m back to teasing away with a tiny brush, determined that not one single pixel will be out of place, even if I have to repaint it a gazillion times.

Then I wonder why I’ve been pushed into doing this CBT thing!

It’s unsettling when you realize that if your life had a reset button, allowing you to return the start and try all over again, you would push it in a flash. This life wasn’t perfect… maybe I’d do it right next time?

No, I realize I wouldn’t. I would feel exactly the same, know exactly what I knew (no more and no less), and think and say the same things. I’d still be me.

I find myself asking questions, though. If my life had a reset button and I could go back to the very beginning… born a younger daughter living under the Rock, forced to go on fishing holidays in damp cottages; fretting over how people managed to do beautiful drawings on Etcha-Sketches… presumably everybody that I’ve even walked past would have to go all the way back to the beginning as well, just so they could accompany me. All of you out there reading this blog… you’d be whooshed back to square one and made to start all over again. If you even realized what had happened, I expect I’d be surrounded by a blogging lynch platoon right now.

Sorry.

More coffee? I’ll try and get it right this time.

PS: I must have caught something in town as I’m running a temperature and my teeth are aching. Definitely no CBT for a week! It would be interesting to know if ‘distraction’ is a symptom of this kind of bug. I should write to Apple, though — Pages is no fun to write in just now.

Throwing a Therapy Wobbly

I’m fizzing.

It’s not anger, exactly, and I’m not annoyed with anyone in particular, but I feel as though my fur has been stroked backward.

I completed Session One of the online cognitive behavioural therapy (CBT) course.

Initial obstacles

First I had to sort out incompatibilities.

(1) Adobe Flash Player — had to use Adobe’s uninstaller before I could install the most recent version of Flash Player, which turned out to have been put in by old software. I hesitated because I couldn’t see why it was necessary, and was suspicious.

(2) Safari (probably because of Flash). Needed a different browser.

I tried to install Chrome, but it kept saying ‘thanks for downloading’ though nothing was happening. So I got Firefox, and found myself registering for an account so I could synchronize bookmarks (why?), then downloading Firefox to the iPad so the process could be completed.

I suspect it wasn’t mandatory to have a Firefox account, but by that time I was past trying to figure these things out — I just wanted to do what I was told so I could get on with life. I even made Firefox my default browser (I was that far gone!) but reverted to Safari a few days later.

The two browsers were playing tug of war. Safari used to be a happy ‘only browser’ on my Mac, but now there was another in the roost.

“Do you want to make me your default browser?”

“Yes.”

You fire up the first one out of habit, as it was your default browser till very recently.

“Do you want to make me your default browser?”

“Er…. oh, go on then!”

You switch back to the other one, as that’s where the online CBT account is lurking.

“Do you want to…?”

“No!”

By the time all issues were fixed, it was almost bedtime, so I left ‘Session One’ for another day.

‘Another day’ arrived…

I could think of fun things I would rather be doing this sunny afternoon, such as uploading photographs from my camera and looking to see if they were any good, but I might as well get this CBT thing over with.

Some time ago I put cheap paper in the printer especially for the CBT course, but Mum used it all on a manual for our new dishwasher, so I put in more… and now we were ready to rumble!

Rumbling

Subtitles were turned on so I didn’t need to listen to the course, and automatically put on some soothing music. The subtitles said something about music playing at the start, and I thought to myself, “Well, thanks, but I’ve got my own.”

I don’t know what they were playing, but mine happened to be Just the Way You Are by the Piano Guys.

Session One

Right now, I lack words to describe what I thought about Session One.

I mentioned in my last post (Shrouded in Scottish Gloom) that I’ve done CBT before and didn’t take to it. On the other hand, I thought once I got into this online course, I might enjoy it. I have a tidy mind… I like creating databases, organizing files and photos, and answering questionnaires and quizzes. Why wouldn’t I enjoy this too?

Nevertheless, I began the session feeling irritated, and it only got worse. I didn’t want to answer the questions.

“Did anything happen during the past week to upset or disturb you?”

“Yes!”

“Oh dear. What was it?”

I couldn’t believe I had to answer this.

“Well, we had to vote in a general election and then there was all the political fallout with everybody blaming everybody else…”

OK, I didn’t type that, but, honestly! I ended up backtracking and saying, “No. Nothing happened.” and the squiggly figure gave me a squinty-eyed look and said, “Hmmmmm…”

I don’t think it believed me.

It shocked and surprised me how reluctant I was to give any information at all. I just wanted to see what it had to say and have done, but if I had to interact to this degree, I had no wish to complete the course.

I realize this isn’t the point… it’s supposed to be a tool that I use to tighten up screws in my head that might happen to be a bit loose, so if it doesn’t know what screws those are, there isn’t a lot it can do. This reflection didn’t comfort me, and my irritation grew so bad I kept stopping and staring unblinkingly at the screen for long moments.

How many times a week do I get anxious? Once a week? Five times a week?

No, it doesn’t work like that!

Hissy fit

I quit the session altogether, absolutely smouldering, then gave myself a good talking-to. I didn’t want to have to explain to people why I didn’t want to do it… it seemed easier to shut my eyes and get it over with. That way you make fewer waves and it defuses the situation. After all, it’s not a big deal… it’s just an amped-up questionnaire.

I went back in and found I had to sit through the entire thing again, homilies and all, answering questions I’d already answered… but changed a few of my responses this time, taking a more measured attitude to it, so it was all to the good.

At the end, I was asked if any of it helped, and I answered honestly… no it didn’t. If I could have given it a minus score, I would have.

The forum did, though! There were people on it who had almost identical thoughts and emotions about the first session, including “I reallyreallyreally don’t want to do this!!” but in the end rationalizing that it’s not a big deal and just to get on with it.

What gets me is that it’s been a few hours now since I did the session, and I still feel like an electrocuted jellyfish.

One thing worth noting… people on the forum said the first session is notoriously awful, but it gets better, and I might gain some benefit in later sessions. So just hang in there…

…just stay clear of my stingers for a while. 😛

Shrouded in Scottish Gloom

The garden looks really good just now. My sister takes care of it every weekend, and I’m amazed at how neat and pretty it is. When I peek out the back door and smell lilac, I understand why gardeners love what they do. There’s something sane, calm and peaceful about the outdoor landscape… it’s an escape for practical, hard-working people.

It makes me yearn to be that kind of person too.

I’m more the kind of person who strolls around with a camera and feels happy at the beauty other people have created. Unfortunately, Scotland doesn’t like us to have heatwaves for very long, and there’s a lot of dreich weather at the moment. Yesterday it couldn’t make up its mind between strong sun, drenching rain, and the occasional bolt of lightning. Today it decided to go ‘all rain’… dark grey clouds parading overhead with shimmering sheets of crystals dangling from their misty earlobes.

When the day was at its darkest, I came across a monster snail clinging to the upstairs window. It reminded me of 20,000 Leagues Under the Sea… water all around and this muscular, glistening creature seeking a way in. Visualizing its fellows squirming all over the house, roof and all, I could understand my mother’s utter abomination of them. She gets the same look on her face that Ripley gets in Alien.

If you were on a spaceship with those things on it, you’d do better with her as a shipmate than me.

I don’t mind the odd snail or group of snails, but we have too many. They slither all over — slugs too — and roll on their backs, drinking in the downpours.

The other night I was trying to move a wheelie bin without stepping on a single invertebrate, and it was impossible. I swear there was either a slug or a snail trekking across each square foot of ground, and because it was dark, I couldn’t even see them all. Despite the best I could do, the bin and I left a trail of devastation in our wake.

Have I complained about this before? I’ve a feeling I have.

Anyhow, with the lowering weather, some sadness, and a general feeling of being under siege, it seemed a good day to activate my online CBT account.

“What’s that?” you say, suddenly looking nervous. “CBT??”

Our GP thinks it might help combat my chronic anxiety, but I ignored the activation request for two weeks. I could always think of something better to do! I don’t have raging agoraphobia any more, but I’ve had a traumatic few years… it’s like a sleeping Leviathan stirring. If it comes up again, it could be bad.

I don’t like cognitive behavioural therapy. I’ve tried it before and it left me bemused. I felt more stressed attending the sessions than at any other time, so I cut them short.

I have to confess, when I read that I would need to have a working printer in order to do the current course, I was irritated. We have ours loaded with 100gsm stuff. I was determined not to start the course till I’d dived out and bought the cheapest paper I could find — 75gsm. I put that in on top.

OK, well, I activated the CBT course today, answered a raft of multiple choice questions, then it suddenly stopped, and I was confused. It just told me I would need an up-to-date Flash Player (which I’ve got) in order to be able to view my sessions, but I couldn’t see any other links, or a home page, or even a bit of text saying “thank you — see you next week!” or something of the kind.

Is this typical NHS behaviour?

I’ve had similar emails when asking for appointments… no ‘hello’ or ‘goodbye’ or individual names… just come straight to the point then drop out of sight. You can imagine the staff rushing around like busy ants, so you don’t really resent it, but it’s still a little… leaves you feeling like one of those cartoon characters who was walking on rock and is now pedalling in mid-air.

Thinking about it, it was just the ‘activation’ I was engaged in… if I went back, the first session would be there waiting.

Brr.

Perhaps it’s all one big cryptic puzzle designed to keep me engaged trying to figure it out so that I don’t have time to stress about anything. There was a multiple choice question I didn’t understand at all, and the only way I could dodge it was to pick the most non-committal response. I felt like turning to someone and saying, “Sorry, what do you mean?” Instead, I said it to the empty room.

I should raise that question with them in case it turns out to be something important… or is that typical catastrophic thinking? What significance could a single, vaguely-worded question have? I gave them a vaguely-worded response… fair dos.

Meanwhile, none of this helped the cats with their own issues. They sat miserably at the back door, looking out at the slurping snails. As far as they’re concerned, this type of day shouldn’t be allowed.

Deafness and Depression

I found this discussion on the BBC Ouch! forum about deafness and depression; I particularly liked the messages from Number 23 onwards. And Message 27 is depressing!! Black comedy, if you like.

Things are said there that I’ve thought a lot myself over the years. Even on the internet it’s so obvious that therapists’ advice is geared towards those without disabilities and communication issues. When I saw a cognitive behavioural therapist years ago, I really felt we were not on the same wavelength. She was trying to persuade me nothing was as black as I was painting it in my mind, and I was wondering how black couldn’t be black, and if she even knew what the picture was.

I asked her once if she thought that maybe my anxiety and ‘panic disorder’ (which she’d diagnosed it as at the time) was caused by my deafness, and she said “oh, I don’t know!” in a tone that seemed to say, “well, perhaps, but you don’t have to be deaf to have issues, and let’s not get into that anyway!”

I found myself thinking of that exchange much later, when I read that cognitive behavioural therapists are trained to guide their clients away from the probable causes… we’re supposed to focus on changing our behaviour and the way we look at things. How it all happened in the first place is apparently irrelevant (and, I grant, often impossible to untangle anyway).

I said to Mum recently that a therapist would advise one to go into a difficult situation with the intention of proving that yes, one can handle it perfectly well… but it’s not so simple when that you are deaf and have poor speech, and have to go through the wringer merely to get fish and chips from the local takeaway. Generally you prove to yourself all over again that any two year old could do it better and faster. I don’t see how the fact that one is deaf can be ignored.

Some of those taking part in the discussion thread say that of course we have these anxiety or depression issues — we’re all of us being shaped to fit in that round hole, whether or not we’re round.