CBT Tales- session 1 and 2

Hello! I promised to update you on my therapy tales. I had my first session 2 weeks ago and it was so uneventfully boring I didn’t really have much to say about it. It was just going over what we’d be doing. He said a few times, “you fit the model so perfectly”, which I gather was meant to be reassuring but irritated me somewhat. I don’t want to fit any models but of course, we all do in varying ways. Especially us mental health bloggers who literally define ourselves by the set of symptoms we fit that all adds up to a few words on a doctor’s monitor and our entire lives.

There was a lot of diagram drawing on how thoughts and feelings and actions all interact. Talk of safety behaviours, and my biggest is keeping busy all the time, mostly by fucking about online, never letting that thought creep in, having my phone glued to my face until the very second I fall asleep. And it doesn’t work, because in the second afterwards, panic creeps in. And I have an awful tendency to use my phone to look up the things that scare me- cancer, death, cot death, death, death, more death.

Session 2 was yesterday. I wrote this for A Day In the Life, a website which gathers the stories of a day in the life of someone with mental health difficulties. You can submit yours too over at A Day In the Life. The stories are anonymous but I don’t mind outing myself for the purposes of this post.

26 August 2015

Today is Therapy Day. I had about three hours sleep, which isn’t good on Therapy Day. In the days before my baby was born, my medication (Quetiapine) would make me sleep for twelve hours straight. Now, with an internal Mum Radar activated, I wake up when he does (multiple times a night), although I’m pretty uselessly doped up from drugs and it’s up to my husband to feed him. The one time I tried I dropped the bottle and spilled milk all over the floor, mumbling dream talk, his crying from the end of a long, dark tunnel. So it’s pointless lack of sleep, but lack of sleep nonetheless. The baby, now five months old, has decided that 6am is a brilliant time to wake up, so I’m up too.

Despite being up from 6am, I’m still late for therapy. The hours in between are lost in a haze. I eat, too much, to try and muster some energy. A jam bun and some toast. In my sleepiness, I’ve forgotten my homework and worry all the way on the bus that the therapist will be pissed off at me for it. It’s just CBT- I say, “just” because it’s not the kind of therapy that plumbs your heart like a dentists’ drill. It’s functional, rigid, and thus requires concentration I can’t summon on so little sleep.

This is only the second session. The focus is on my anxiety about death. Or, as we find during the session of comparing, “Theory A to Theory B”, the focus is on my anxiety about my anxiety about death. The problem, the therapist says, isn’t that we’re all going to die. That’s true and has always been true. It’s that my anxiety about it is controlling my life. So we go through what happens when I feel anxious. About intrusive thoughts and how we shouldn’t try to control them. The more we try to control them, the more we think them. The aim, he says, is to accept them. To let them intrude.

Towards the end of the session he says we’re going to do something which may make me have a panic attack. It’s to feel where my anxiety is, to hold an image in my head and to focus on it. I try, but all I can focus on is the ticking of the clock coming to the end of our truncated session. I try to hold an image of myself panicking but nothing really happens. He then talks about how the more we look at an image, the more our mind will demonster-fy it. It might become interesting, comical even. I’m not finding this to be true, but I’m left with the instruction that the next time I get an intrusive thought or feel anxious to stay with it, examine it, and not try to suppress it. Good luck, me.

I leave and wander around the shops, thinking of lunch. I’m trying to treat these sessions as little holidays from my life, and take an hour afterwards to drink coffee or eat before I return to the baby, leaving whatever was in therapy scattered along the cafe tables. I get the bus home and exhaustion floors me. I can barely hold my head up and resolve to go to bed when the baby does. We’re all tired today, we forego any attempt at dinner and eat burnt creme brûlée that Robert impulsively bought from Tesco.  I take my medication just after I put the baby to bed, and let it drag me into the blackness of sleep by 8pm. He wakes at 10.30 and I do too, stumbling with my pillow into the spare room while my husband feeds him. And then back to sleep. It’s just like the old days- I slept for 12 hours.

First therapy appointment…

…is flipping tomorrow! That was quick. I was hoping for the traditional 18 month wait. Wish me luck.

Therapy Tales Part 1- So You’re Terrified of Death?

(If you’re wondering where my previous post went, I have made it private as I’ve found this to be true. Thank you for all your comments and encouragement!)

So, I’m starting therapy for death anxiety (my medical diagnosis that led me to it are generalised anxiety disorder and panic disorder but I prefer to think of them as ARGH).  Expect this series of posts to be even more introspective and self obsessed than usual, and for this blog, that’s saying something.

Two years ago (christ), I wrote a post called, “When Fear Becomes Phobia”. It described my ARGH FUCK panic around death and deadness, and how my world was getting smaller and smaller because of it.  Last year, I went to the doctor and asked for help. She was so sympathetic that she made me cry. Saying what an awful thing to carry around with me for 12 years (14, now) and she referred me to therapy. I found out I was pregnant, had an assessment and things didn’t go any further because I was suffering such crippling morning sickness that the 40 minute bus journey to the appointment was 1 hour 30 minutes because I’d have to jump off twice to vomit. Later on in pregnancy, I dispensed with such courtesies and just huffed up all over my lap, or into a friendly plastic bag.  Pregnancy was also pretty distracting- all my anxieties were focused on that, and I didn’t have the mental reserves to panic about death anymore.

My panic has returned, as it does. It’s not constant and strikes at night when I’m trying to sleep (and flip, I need my sleep!) It doesn’t disturb anyone because I sleep in the spare room (Robert does night feeds due to my medication). It means it’s quiet, private, lonely. It comes and goes, ebbs and flows.  It’s probably unsurprising. I had a baby, then I lost my grandmother, and it was my dad’s anniversary.  Catholicism ritualises death in a way that’s both comforting and horrifying. It makes you look at it, it makes an object of it.  She was in a coffin in the sitting room that my dad’s coffin was in, for days, with the same yellow, unnaturally smooth, chillingly cold skin that you have to touch to say goodbye. Their coffins, and every childhood Christmas. These things bring death bubbling back to the surface of your mind. It’s hard to close it out when you’re trudging up a hill behind it. Robert’s grandmother died the month after, and her funeral was like a trip to Argos. Closed, quiet, scripted, burned. I prefer the visceralness of Catholicism, even if it haunts me. It does at least give death, and life, some gravitas.

So, I’ve been referred back to therapy for it. My psychiatrist initially wanted to increase my medication but I refused. This feels existential, albeit obsessive. I’ve often been able to distract myself and try to be less up my own arse, but distraction is tricky and I’m introspective generally. It doesn’t need to be medicated away- that just makes me feel worse.

The assessment happened pretty quickly. A chat over the phone, which gave me a sense of pride that I didn’t have to list a litany of other issues. I haven’t self harmed in six years, my bipolar disorder (if I ever had it) is pretty well controlled. I wasn’t depressed, wasn’t struggling otherwise. I’ve come quite a long way. I knew what they’d recommend- CBT (*spits*) but I’m willing to give it a chance.

The therapist is called Sean, which means the assessment didn’t entail the usual 45 minutes of tuition in how to pronounce my name. It’s high intensity IAPT (Improving Access to Psychological Therapies), so the sessions aren’t at the mental health team (thank bollocks, I used to work at my local one), but in an unassuming house with comfy sofas, pot plants and James Frey books that I had to stop myself openly guffawing at perched proudly on the Ikea shelves.

He asked me what I wanted help with so I explained. I forgot to bring the questionaire they sent me so went through some of it there. My depression score was low, as I knew it would be. People tend to assume I must be suffering from depression if I’m having panic attacks and anxiety.

Au contraire.

Depression is both a mortal enemy and an enemy of mortality. For me, it is ageless, timeless emptiness. It tries to kill me, and it kills the thing inside me that makes me afraid of it doing so. I want to die when I’m depressed.

So when I’m not depressed, I’m scared of that. It’s like being held under water and a peaceful acceptance of what it happening envelopes you, until the final second, and you kick, you convulse in order to be free, to be alive, to throw off the aggressor and then relive over and over at how close you came to drowning.

I do sometimes feel depressed because of the panic. I feel frustrated and angry with myself that I have panic attacks. I feel frightened and distressed by some of the intrusive thoughts I have (like when I’m speaking to someone and suddenly an image of them dead flashes into my brain, with hallucinatory vividness) and sometimes they make me feel like I’m going mad. But depression and this panic don’t come together, and that’s a big massive pain in the hole. The panic tends to be the worst during the happier periods of my life. I’m happy, hurrah, and then my mind goes, “This will end it, all of it, everything, and because it will end, this is meaningless, you won’t be here one day, any day, none of them will” and that’s just BLOODY FUCKING GREAT isn’t it. I don’t want to die, ever, because I enjoy my life. I’m essentially a happy person who wants to see what’s going to happen.  I want to be standing at the end of the universe with Robert and Oisín watching supernovas and planets and the sun.

(Rest your head)

(Close to my heart)

(Never to part).

Maybe it is partly a coping mechanism, the fear. Like pinching yourself.

He asked me if I had other anxiety- I do, social anxiety, but I’m dealing with that in my own way so I didn’t want any help which he accepted (and I think it’s tied up in this anyway).

Two things were said during the assessment that made me willing to continue. One was something stunningly obvious but that I had genuinely never considered. The therapist said that my kind of anxiety is, “idiosyncratic”. It’s not a common reason people come to therapy. That floored me. “Doesn’t EVERYONE feel this way?” I said. No, apparently not. At least, not to the degree they end up in therapy. So, is it that this is such an ordinary fear we live with it and are in denial, or am I the odd one for being periodically consumed by it?

Another was asking me where I think it came from. Nobody has ever asked me that before, and it’s not something I’ve thought about. The worst of my panic began when I was 15. That’s when it started flinging me screaming across the room. “Is that when your friend committed suicide?” Yes, it was- but the panic attacks started before then. Robert (who I first went out with when I was 14), remembers my panic on the phone, but it was more contained, and I was easier to comfort and distract.

It started well before then, when I was about 7 (?). Both my parents had mental maladies. I felt like they were going to die and I was terrified of it. I became aware they wouldn’t be there one day and I feared all the time it was the day. I used to pad into their room at night to check they were still breathing, then pad back and lie awake in the moon (just like I do now with the baby!). I realised I was going to die too, and sometimes would wake up screaming.  Death felt close, ever present, non abstract. I could only perceive it in my childish way, but I never felt safe, and I never have since.

Of course, that’s just a bit of it- I might be wrong, but I had never connected the two things before. I had a massive resurgence after my dad died, too, which is natural. But it wasn’t so much his death as knowing that he feared it. That kills me, still. I hate that he was afraid. If I could do one thing in my life, one magical thing, it would be to take that fear from him before he died.

He asked me what I wanted to get out of therapy. I don’t know really. Not to have panic attacks anymore. To be able to watch/read/listen to anything again. Not to have to ring in late to work because I’ve disintegrated at a funeral procession. To fall asleep. To be able to think about Oisín’s future. At the moment, I’m too scared to talk about it, think beyond tomorrow, in case he’s not here for it, or that I’m not. I’m petrified of something happening to him, and feel superstitious about it. It’s a loss I know I would never, ever recover from, be able to go on living beyond.  Pregnancy should have taught me the futility of this- when it seemed like there was bad news at the 20 week scan, my anxiety didn’t protect me. It didn’t cushion it, it didn’t make anything easier.  I want to be able to talk to Robert about him riding a bike, or going to school, or falling in love. I want to be here and present in the moment without thinking how it’s going to end. That it is. I want to be able to sleep without hours of panic beforehand. I want to be able to not feel regret about not living if I do die tomorrow. When I’m going through anxious periods I always feel mildly dissociated, not here. I don’t want to feel that way anymore. I don’t want horrible flashes in my brain anymore. I don’t want my coping mechanism for the feelings of helplessness and inevitability to be nihilism, as it means I make unhealthy choices (like smoking, which will actively shorten my life, and thus leads to more panic attacks). I want to be present for myself, for my child. Life is so brief. And it is all.

He said that this will involve some unpleasant feelings, but that it usually helps. He says when it doesn’t, “work”, it’s often because people haven’t done the things long enough (bit of, “blame the patient” here, but I understand what he means as my last assessment person gave me a workbook I barely glanced at). I’m pretty frightened of what this is going to entail, and how hard it’s going to be. I’m aware it might mean it gets worse before it gets better, and I’m feeling pretty apprehensive about that. Shit scared, to be honest.

But I’m doing it. So let’s see where this goes. I’ll keep you updated!