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Articles Cognitive Behavioural Therapy


By Sally

    Using techniques of Cognitive Behavioural Therapy, the following are some exercises I did with a psychologist, Karen.

    The idea was to first identify an activating event or thought which caused distress, then specify the consequences of this event or thought emotional, physiological and behavioural reactions. Then you list your beliefs about this event or thought, or in other words, your self-talk.

    For each belief which you can identify as irrational, you dispute the belief, then write a rational response instead.

    Finally you describe any changes in the way you feel or behave as a result of going through this process.

The first thoughts we worked on was suicide, which only a couple of weeks ago were all pervasive.
Several times over a few months, mental health workers had to come racing over to visit me and stop me acting on the ways I was thinking and feeling.
I just wanted to give up because to go on seemed far too difficult.

The kind of thoughts I was thinking were that I found it hard to get up in the morning. What is the reason to live? I don't want to know about the future. Wouldn't everyone be better off without me? I want to die.

The feelings I had were of extreme distress. I felt abandoned, despite the support of my carer and ex-partner, Paul. Nothing seemed to make any difference. I was unmotivated and dreaded each day beginning.

Physically, I often had shallow breathing and feelings of anxiety, like an uncomfortable knot in my stomach and agitation.

In my behaviour, I procrastinated, and had a persistent image of jumping off a nearby lookout at Point Glorious, to the point where I even drove up there one afternoon. Despite the forestry warning that the road was forbidden, I drove to the northern end of the mountain where the hang gliders jump off. The rocks weren't as high here and there was a wooden platform used for launching. I then drove around to the lookout where a sign warns of the danger of death or injury for anyone venturing outside the fence. I climbed over the fence and spent a miserable hour wandering around the edges of the rocks. Of course, I couldn't jump, I don't think I would ever be able to jump, or in fact to do any harm to myself. Even the soft option of pills and alcohol is beyond me.

The beliefs of suicide, or my self talk, is that quite often I want to die, because I need the suffering to end. So, how much suffering is too much? How do I decide when I have suffered too long. If I've tolerated the suffering until now, what means I can't tolerate it another day, week or month? Logically, if I have managed to tolerate the discomfort for the past six or seven months and at times it has been unbearably difficult, I can realistically expect to tolerate these same feelings in the future.
I have stood it in the past, so I can stand it in the future.
If I have strong suicidal thoughts it is best to confide in someone as the process of speaking about it reduces its power.

Feeling Worthless
I have the thought that I am not a worthwhile person at the moment because I am not contributing enough. How do I determine that I am not worthwhile? I tend to compare myself with how I was before when I definitely was achieving more. All this means is that, yes, in the past, I have been able to achieve more with my life.
However, the fact that I am not achieving as much right now does not make me worthless.
The worth of a person does not rest in what they can or can't achieve. Every person has an inherent worth, regardless of their achievement level.
I am achieving as much as I am able to at the moment, in my current state of mental functioning. I must be careful not to see memory lapses as signs of being worthless.

I can't get very much done and I find I extremely difficult to accomplish any tasks.
What do I achieve in a day? If I take the time to write down all the things I do, I actually do quite a lot, sometimes more on some days than on others, but I don't just sit around all the time.
I volunteer at the Salvation Army and even though I am a bit slow, I still manage to sort through, price and hang clothes.
I go to water aerobics and belly dancing, I visit friends and ring them on the phone.
I cook meals, do washing, cleaning and other domestic chores.
It's not that I just lie around in bed all day, every day as some people do who are depressed.
I should feel encouraged at the amount I manage to achieve, and it does seem to be gradually increasing. I do find it difficult to accomplish some tasks, sometimes I feel afraid, but if I do it anyway, it always turns out alright in the end.

Control of my thoughts
There is also the belief that I am not in control of my mind, that it runs on its own negative tracks, like suicidal thoughts and I can't manage to stop these negative thoughts.
Although, if I am not in control of my mind, who or what is?
There is no one else who can possibly be in control of my mind except me alone.
It is fine. I am more absent-minded, distracted and preoccupied than I usually am, but I am in control. I have to be because no one else is.
NOTE: However, sometimes when we are very ill, we are not in control of our minds, the illness assumes control, particularly if we are paranoid, delusional or psychotic.

It would be better for Paul and Amy, my six year old daughter, if I was out of the way.
Is this true?
No. In fact, Amy could be learning some very important life lessons from me right now like persistence, perseverance and seeing things, like my recovery, through to completion.
Recovery is taking place. I need to be patient. As I know I am recovering, I also know that I will recover fully. It is just a matter of time.

What is the reason to live? I've lost hope. Everyone would be better off without me. I want to die.
Do I really want to die and is it true that everyone would be better off without me? How can I reestablish hope for the future?
I know I don't want to die, I would much prefer to live as before I became ill in May last year I was really enjoying my life.
Since I have been told I will recover and many people have noticed great progress in my recovery so far, for example, Paul, my friends and the mental health team, I should be encouraged by this and press on to full recovery as many people believe that I am more than half way there.
Everyone would not be better off without me. Even in my current state, I can be a friend to people, I can look after Amy.
I can write and hopefully my words will encourage others in the future.
I can do household chores and so on.
I am not as bad as I think I am.
This is borne out by the fact that many people don't even notice there is anything wrong with me. My illness is not that obvious. I do tend to be a bit quiet, but many people like a good listener.

I have a pattern of behaviour which means that I avoid doing things and try to spend as much time as possible sitting and talking to people. I usually want to talk about my illness and get support and encouragement from whoever I am with.

The only time I feel "normal" and comfortable is when I am talking to other people, or listening in as part of conversation. I am often tense and continually moving around.
I find it difficult to talk to people. I get stuck after saying "hello, how are you going?"

I am really stuck in my life at the moment. What do I mean by stuck?
Am I stuck or does it just feel that way?
I need to get out of feeling stuck by doing things. To a point living one day at a time is OK, but planning ahead is better. Then I can look forward to things in the future.
This is not at all like me. I am usually highly motivated.

Why am I different at the moment?
I have had a very severe bout of mental illness and I have been told many times that recovery from this will be very slow up to a year. I need to find ways to enjoy life while I am waiting for recovery to take place.

I am losing my friends. Why do I think I am losing my friends?
If I am is it because of my illness? Is there any evidence for this?
It is true that people don't ring me much any more. I always have to ring them, although I think that this situation probably wasn't much different when I was well. I maintain many of my friendships by me making the effort to ring and organise activities or visits.
I need to remember that people will still be there for me when I become well. I am becoming more well gradually. For example, I had a birthday party last night with nine adults and six children. This was a very happy time and everyone seemed to enjoy themselves.

I am a total mess. What is a total mess like? Is this accurate?
No, this is not accurate as I am still functioning to a degree in normal life. Even though I am not working at the moment, I am doing some things, even though my capabilities are reduced.

People will not want to have me around because I am too depressed. Is this accurate?
In fact, many people, including friends and people on the mental health team say that I seem quite bright at the moment. It is just my perception of how I am that suggests I am too depressed. It is true that there are some people who still enjoy my company.

My mind is continually disturbed. I have no peace of mind.
Is this disturbed state of mind really continuous?
No, in fact, there are times when I am at peace and quite happy, for example, when I am in social situations or sometimes when I am with Paul. This positive mental state does not often happen when I am alone and I do need to work on some peace of mind for myself when I am alone.
How will I do this?
I need to continually watch my mind and challenge any negative thoughts. I need to be disciplined and not always distract myself with activities like seeking out other people to be with so that I don't have to be alone with myself.
Practicing meditation is necessary to help me be comfortable in my own space. This would suggest a return to a discipline of daily meditation as well as continuously watching my mind.

I really just need the support of other people at the moment.
What areas other than just support do friends satisfy?
Friends can be helped by me so that the relationship isn't too one way. I need to concentrate more on the needs of other people and not just focus on my own needs. Depression makes you very self centred, selfish and self obsessed. I can lean on friends and make sure I am available to be leaned on as well.
Friends can provide company and interesting conversation. They can be fun to do things and go places with, particularly if I organise things like this ahead of time, on weekends and so forth.

I am sick of my life. It is so boring because I don't have the support of my mind. My routine will just go on and on unless I do something to break it. I feel depressed, sad, desperately lonely and isolated most of the time. My stomach churns and I don't feel relaxed, but instead feel very uncomfortable. I tend to repeat the same negative patterns of behaviour, for example lying in bed until Amy wakes up, even though I might wake at 5.30am and be wide awake and being scared of going out, even dropping Amy at school.

I am not capable of much more than what I am doing now. I am sick of being tense, depressed and scared. These are actually rational beliefs.

I hate myself the way I am at the moment.
While I may hate it, is it more a reflection of frustration?
Am I a hateful person? Does hating or being frustrated by this illness help me in any way?
In fact, hating doesn't help, it makes things much worse. Loving myself makes me a more likeable person.
Frustration can also be a source of motivation. Use it.

I have become like a prisoner in my home.
Is there anything I can do to change the feeling of being like a prisoner in my own home?
Is there a lock? Am I being too emotive in my language?
I am actually not a prisoner. If I stay home it is by choice. If I keep going out as I am doing, I will be fine. I need to be more careful of the language I use.

I have lost confidence.
This is a rational belief but is there anything I can do to boost my confidence?
I need to take small steps and keep doing what I'm doing to get better and gradually regain my confidence.

My brain isn't functioning properly at the moment.
This is also a rational belief but is there anything I can do to assist my brain functioning?
Make lists of things which I need to do and slowly build up by doing the things I can do. Plan ahead, keep schedules and work on achieving balance between physical, mental and social activities.

I give in to Amy's demands too easily. She is smarter than I am at the moment. I notice her disrespect. She is throwing a lot of tantrums, crying and being upset. She disobeys me often. I feel unable to cope with being a mother, I feel frustrated and "stuck". I get tense and feel uncomfortable around Amy. I tend to resort to smacking and raising my voice as I feel I don't have the power and confidence to discipline her correctly.

I am not able to be a good mother right now. What is a good mother?
Being firm, consistent and positive.
What is a good enough mother? Even "good" mothers are inconsistent and can be negative. The changes in Amy's behaviour may have happened anyway.
I need to focus on doing the best I can and always remember that it is better for Amy to have a mother (who has a mental illness) than not to have a mother at all.

I need to recover more quickly. It is taking too long for Amy's sake.
Is there anything I can to speed the process of recovery up?
Not much more than what I am doing at the moment. I could do with some more contact from others who have recovered or are recovering well and making a conscious effort to move forward.

I will commit suicide rather than continue to be a burden on others, especially Paul.
I am not sure whether I am a burden or not, but really I don't think so.
Paul is quite enjoying being the strong one for a change and he sees supporting me as his job, as he is being paid to be my carer by the government. I need to focus on being positive around others. I know I don't want to commit suicide.

I can't see that I'm getting better. I am stuck.
Is the word "stuck" too emotive? It would be better to use the word plateaued.

I have lost so much confidence as a mother. I don't know how to get it back.
One way might be to practice more at making short conversation with people.
I find telephone conversations much easier, but I need to practice more face to face interaction.
I can try to be more positive, more consistent. Talk more to Amy, be interested in what she has to say. At the moment, I tend to wander mentally and she has to ask me again and again for a response.
Break the task of being a mother into manageable bits.

Your feedback and input will be greatly appreciated.

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