Last week I discussed my experiences of mindfulness. I noted how it helped me to recognise physical signs of anxiety but how I failed to move forward and overcome the surrounding issues. This week, in the second of a three-part mini-series into mental health and my IBS, I look at how cognitive behavioural therapy (CBT) helped me to spot some of the destructive patterns leading to anxiety, depression, shame and anger.
Cognitive behavioural therapy (CBT) is a very common treatment for a number of mental health conditions and is offered for free on the NHS (although waiting lists can be long). Mine was started with the help of a psychotherapist (more about those next week) but breakthroughs really came when I started to use the book Mind Over Mood by Greenberger and Padesky.
There seems to be a bit of blurry line about what specifically constitutes CBT, and different practitioners may introduce different concepts and techniques depending on their training. My therapist introduced me to diaphragmatic breathing, a technique where you actively slow down your rate of breathing, taking slower, deeper breaths, hold them, and then exhale slowly. This was to be practised when I wasn’t feeling anxious, so I would know how to do the exercise properly when I was. Because it was more active, I found it more useful (distracting) than the more passive breathing exercises favoured in mindfulness.
I was also given a short list of sayings to copy and keep in my wallet or pocket so that when I was getting anxious, I could repeat these to myself. These were simple reminders such as “I’ve had this feeling before and nothing bad happened” and “This is nothing more than an over-reaction of the body’s natural responses: the feeling will grow, peak, fade and vanish”. I think it’s a testament to how much I used them, and how well they worked, that I could type those out from memory, even though I couldn’t tell you the last time I used them or looked at the slip of paper.
Those techniques were undoubtedly useful for learning to cope with the feelings of anxiety I was learning to recognise but I needed further help to unpick the underlying problems. That was when a friend (a doctor who also suffers from anxiety) recommended Mind Over Mood to me.
The first thing that struck me about the book was its design. Unlike all the other self help books I’ve tried to use at one point or another (which were nice, easy-to-hold books that were too easy to read in bed), Mind Over Mood was an A4-sized thick workbook. This book demanded sitting down at a table and working through properly.
Another great advantage came from the anxiety and depression inventories towards the back of the book. You were encouraged to score the frequency of different anxiety and depression symptoms weekly or fortnightly as you worked through the book. This instantly gave you a way to record your progress and see that you were making a difference.
And very early on I started making progress and learning things about myself. In one of the first exercises you are encouraged to think about specific situations that make you feel anxious/depressed/angry etc. and then note down your thoughts, behaviours, moods/feelings and physical responses. The idea is that all of these are inter-related and that by addressing one of the responses you can break the ‘cycle’ and start to overcome the issue.
I had spent some time at the recommendation of my therapist also noting down my moods in different situations, and this allowed me to identify thoughts I fixated on and situations that made me anxious. Similar exercises are found later in the book, but this just helped me make some of the connections sooner. Notably, on researching this post, I discovered that the mindfulness book I used also referred to the same cycle I mentioned above (thoughts, moods, behaviours and physical responses) but merely as an explanation of what was involved in an emotion, not as a method for unpicking these emotions.
Anyway, I did this for a few weeks, and I still repeat this exercise now, whenever I encounter a new situation that has shaken me. This has been a really powerful tool and I’ve now got a whole host of physical responses I am more acutely aware of that serve as early warning signs that I could be experiencing anxiety or depression:
- Stiff jaw
- Teeth grinding/gnashing
- Forcing tongue against teeth
- Tripping over words/stuttering
- Hunched shoulders
- Tense/stiff shoulders
- Tenser arms (most noticeable when I’m leading dance moves)
- Heart burn
- Knotted feeling in chest (I used to associate this feeling with love and excitement – how wrong was I!)
- Sudden shiver/the someone-walking-over-your-grave sensation
- More sensitive to cold temperatures (because body is more tense)
- Pain (often around bowel but sometimes higher up in chest)
- Other IBS symptoms
- Feelings of incontinence/bladder leakage
- Urge to urinate
- Restlessness
As I’ve continued to work through the book, it has provided lots of bits of advice and useful techniques and training materials to overcome depression, anxiety, anger, shame and guilt, all of which I’ve experienced at one time or another over the last few years. Some of the techniques are shared, but others are specific to your emotional state. For instance, you are encouraged to find (with help) activities that are pleasurable and purposeful and do a mixture of these to overcome depression. But the same solutions would not work for anxiety and could be seen as avoidance. The book helps you to learn to cope with and manage feelings of anxiety, which is the only way we’ll deal with them in the long term.
The hardest part about CBT, apart from the perseverance required, is being forced to be honest with yourself. And this is where I’ve found my therapist to be of most use: spotting the connections you haven’t made, and reassuring you that what you’ve spotted is perfectly normal when you’ve come to some uncomfortable conclusion. And I’ll be talking more about therapists next week.
But most importantly, the patterns I have been able to detect using the techniques in the book, and my discussions with my therapist, have really helped to reduce my IBS symptoms. True, I still get flare-ups, but they are rarer and shorter-lived. Equally, I don’t fixate or worry about my IBS as much, because I’ve learned to recognise these are just another symptom of anxiety and depression and will pass soon enough. More excitingly, after months and months of avoiding wheat on the low FODMAP diet, I have finally found myself in a position when I can manage wheat on a far more routine basis. Oh pizza, how much I’ve missed you…
Patient J 