The great demon

I promised to post two informational posts today, so here goes with the first.

Due to some comments I and others have made on other blogs (more than one and it was a while back which is why I am not linking), I got to thinking about different therapy models and how they work or don’t work on an individual basis.  I want to talk about one today that seems to be treated as though it is either a demon or a savior, but not a lot of in-between opinions.  Cognitive Behavioral Therapy (CBT)  is one type of therapy that can be used in the treatment of mood disorders and anxiety.

First things first, I am in no way advocating that this therapy will work for any single individual.  I am going to link you to some websites that talk about it, both positively and negatively, and then I will tell my personal experience with this therapy.

Here’s the Wikipedia page on it.  It is well-cited and very detailed.

Here’s the National Alliance on Mental Illness (NAMI) summary.

And this is the Mayo Clinic’s definition of CBT.

So there is the technical and scientific information I found on it that I can share easily.

Everything below this point is personal experience and in no way is meant to presume that the situations, feelings, or reactions are the same or even similar to your own.

I was hospitalized in October because I was off meds due to insurance and financial issues.  I had spiraled into an extremely deep depression as a result.  Since I had recurring thoughts of driving myself into the concrete barriers on freeways, I finally broke down and had myself admitted to the hospital.  The hospitals here are mostly short-stay just to get you back on meds and set up with appointments.  The also have intensive outpatient programs (IOP) to assist in transitioning from what put me in the hospital to functioning.

I knew that the medication wasn’t going to start working immediately, so I decided to take IOP.  For the particular hospital I was in, their IOP included CBT.  Don’t get me wrong, this was not the only thing we did in therapy.  This program met 3x per week for 3 hours each time.  In that 9 hours per week, only one single hour was devoted to CBT.  I don’t really want to get into all of the other stuff we did as I might just need informational posts another day.  😉

I took IOP for approximately 8 weeks (Thanksgiving and missed classes messed up the actual dates, but close enough).  In that time period, I mostly watched others go through the CBT process.  I only did it myself one time.  Although I am bipolar 2, I also have ancillary diagnoses of PTSD, anxiety, and social anxiety.  I realize that the information in the links above states that there isn’t enough data or that there is no conclusive proof that CBT works on bipolar.  I am not going to say one way or another as the situation that I went through when I did it had more to do with anxiety and depression than directly with my bipolar (although in my head they all seem to be tangled together).

In CBT, you choose a situation that caused a high amount of emotional response that could be excessive or seem inappropriate for that particular situation.  In my case, the “activating event” was ridiculously minor.  One of my coworkers walked up to me and told me that my boss was looking for me and needed to talk to me.  A minor thing that could happen any day at work.  Most people might be curious, or maybe a little worried.  For me, though, my reaction was nothing like those.  I immediately began sweating with rapid breathing and racing heart, my thoughts began racing in circles and spiraling downward, I was physically frozen in my chair, and I wanted to go home immediately.

I am lucky that I froze.  Instead of getting up and running away, I ended up turning back to my work to get my mind off my fear.  Later the same day, my boss came over to my desk to do something unrelated to me or my work.  When I asked him about what he had needed, he told me it was nothing important.  So I had all of that panic and anxiety over nothing.  Wanting to run away from your job for the simple matter that your boss wants to talk to you is a little more extreme than the occasion warrants.

So the next time we did CBT, I volunteered.  I told them about the activating event and my response to it.  I had to determine all of the emotions I thought that I was feeling at the time and how strong each of those feelings were.  This was not as hard for me as it might be since I have been in treatment for so many years.  Identifying my emotions I can often do…controlling them is a whole different ballpark.

The hard part comes next, though.  I needed (and the group helped me) to identify what I was actually thinking when these emotions hit me with so much adrenaline.  It took a while and some dissection, but we came up with a couple sentences that covered the core beliefs that sent my emotions into the stratosphere in response to such a minor event.  [By the way, the activating event does not have to be this  “minor”, mine just happened to be.  CBT is used when the response to the trigger seems to be “over the top”.]  Those sentences were: I am a failure, and I do not deserve anything.

#1. I am a failure:  Man…this thought goes back as far as I can remember.  Let’s suffice it to say that I have a whole host of childhood memories that showed me either in word or deed that all of the people around me believed this to be true.  Whether they believed it or were just unaware, I don’t know and do not judge.  But it is the way I felt and the way it “imprinted” on my psyche.  As I have said before, this is my “go-to” negative thought.  The reason for that is because I honestly don’t remember a time when I didn’t feel like a failure.  I still have a lot of problems believing I am not and accepting compliments because of this.

#2. I do not deserve anything:  This is sort of a corollary to #1.  Obviously, if I am a failure, I don’t deserve anything, whether that is a job, respect, or love.  This also goes back to my earliest childhood memories.  The story I told previously about standing by my parent’s bed and not making a noise even though I was wet and cold is a good example of a memory that triggers these feelings.  Or maybe, was triggered by these feelings.  I stood there waiting for my father to wake up as I whimpered and cried, but I wouldn’t do anything because I didn’t deserve his caring, love, or time.

So I went from hearing my boss wanted to speak with me to, “I must have done something wrong,” to “I am a failure and I don’t deserve anything.”  The majority of people might think the first thought in the same situation, but few are going to make the Grand Canyon size leap to the second thoughts.  So then the question becomes, what is distorted in those second thoughts?  Anyone thinking those thoughts would be depressed, anxious, and likely to do something drastic.

Logically, I know that statements #1 & #2 are not true.  But how can I show myself how distorted they are and re-frame those thoughts?  First of all, I needed to figure out (again, the group helped throughout all of this, along with the therapist) what about these thoughts was distorted.  There is a list that comes with the whole CBT therapy package, but I will list a few I can remember:  All-or-nothing thinking – I am a failure at everything because I have failed at certain things.  Mental Filter – Any success I have doesn’t count because I have failed before.  Jumping to conclusions – If my boss wants to talk to me, I must have done something wrong and he’s going to fire me; I don’t deserve this job anyway and he knows it.  There are many others, but those are the three I can remember.

So now I know what my negative thoughts are and how distorted they are.  But how does that help me?  The next step was the hardest step for me.  I needed to figure out how to re-frame these thoughts in such a way as to reflect my reality better.  For each individual, this re-framing takes different forms.  In all of them, we need to be more compassionate to ourselves.  I read something the other day (and I am probably misquoting, sorry), “If a friend spoke to you the way you speak to yourself, they wouldn’t be your friend long.”  I find that sentiment to be far too true in my case.

#1.  I am a failure becomes: I am trying my best to succeed at my goals.

#2. I don’t deserve anything becomes: I am learning that I can depend on myself for what I need.

Yes, I know that those are not direct refutations.  But, the fact of the matter is that a direct denial just doesn’t work because I won’t believe it.  But if I am trying, working, or learning, then it is a work in progress.  I don’t have to go from the negative all the way to the positive in order to counter the negative thought.  This way, it sort of creeps up on it from the side.  🙂

I have these re-frames, but what good do they do me on a situation that already happened.  Obviously, not a whole lot.  The next time I am thrown into a situation that triggers the same feelings, though, I have a counter.  Now, I am not saying this is a cure for those negative thoughts.  I am not saying that I am able to use these re-frames every time I get upset and start into this spiral.  For me, though, sometimes, I can grasp these thoughts like a life raft to keep from drowning in public.  I can prevent myself from running away and doing something completely damaging.

My physical symptoms of panic may still be there, but, at least for a little while, I can still function.  I can get through that conversation with my boss, coworker, bill collector (talk about triggering…), or whoever it is that has triggered these thoughts.  I might need to go find a bathroom or other private place five minutes later to have a minor freak out of cry, but in that moment…I can get through.  And when it is all said and done…I don’t spiral into a depression as quickly as I might.

For me, this was and is a positive therapy.  Although I don’t advocate any therapy for another, at least you have information and can speak with your treatment team about trying or not trying CBT.

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~ by theartistryofthebipolarbrain on March 2, 2012.

12 Responses to “The great demon”

  1. It doesn’t seem to be a possibility for me to think clearly enough and rationally during that initial stage of panic and self doubt for me to put those thoughts into action. Your example would not be a minor one for me, I remeber having those times at work. I always assumed the worse.

    • Well, I agree that, to me, this was not “minor”. Other people would have considered and did/do consider it minor, though. And a lot of people with these “thought cascades” as I call them, have a lot of difficulty with thinking through them. Although this last year was the first time I was introduced to CBT as a direct therapy, I am pretty sure that therapists have used it before in my 14 years of treatment. And that may be why I am finally able to use it that little bit.

      Fact of the matter is, though, that any one therapy may or may not work for a person. I just hope you can find one (or a combination) that works for *you*. *hugs*

  2. Are you familiar with DBT? It was created for BPD but I know a few bipolars who have said that they found it really valuable. It seems to be about more than just how you react to situations, but a lot of additional coping skills.

    I haven’t tried either of them, but from what I can gather about the two approaches, CBT looks like something I’d have a harder time benefiting from. I don’t have much “cognitive distortion” going on most of the time and can usually recognize it when I do, but that doesn’t mean that trying to think differently will do much for me at those points. Usually other strategies are more helpful for me. Just my $0.02.

    Thanks for this summary and the links – very helpful for getting a more concrete idea of what CBT involves!

    • Your comment is spectacularly appropriate! The second posting I will do today is going to be about DBT as I have also done that therapy as well. 🙂 And I will say that, since I have been through both, I personally think that my actual use of either approach has been bettered by a combination of the two. And I will say more about DBT later.

  3. Your posts really help me with having a better grasp on what it is to actually live with the disorder. Thank you for sharing, as always.

    • I cannot tell you how much I appreciate you saying this. Although this blog is for me to talk about my life, I also want to be able to reach out to people so they feel less alone. Part of the shame that goes with having a mental illness/mood disorder/different thinking process is feeling like there is something wrong with you because no one is like you. Once you start realizing there are a lot of people out there with similar feelings/experiences/issues…you feel less isolated and less ashamed of being who you are. At least, that is how I see it.

  4. I marvel at your way of explaining this theory in a way that makes more sense to me than my theory and practice class did. Want to teach my classes?

    • *LOL* My guess would be that the person teaching has never actually gone through the therapy. You know that I think just about everyone would benefit from therapy of some sort. The people that give therapy to others, whether therapists, social workers, counselors, or (other job titles), probably need it on multiple levels. Not the least of which is direct experience and understanding.

      • I agree. Since being a CNA is required to become a nurse in CO at least, going through some therapy should be a requirement for being a therapist. But then again, I can’t really require someone to go through something that they aren’t ready to. It would just be nice to know that everyone that graduates isn’t bringing their own baggage and emotional crap and inflicting it onto others in the form of “help”.

  5. […] with IOP.  [If this is the first you have heard about any of this, please see related post here.]  During my previous two trips to the hospital and through IOP, the therapy modal was DBT.  Now, […]

  6. Thank you so much for explaining everything so clearly. I’m going to give you a compliment now – your self insight is amazing.

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