How many therapists does it take to change a lightbulb?

Only one, but the lightbulb has to want to change…

Copyright 2012 Rachel Melton

This is the third part in a mini-series I have written about how looking after my mental health has led to improvements in my IBS. Mindfulness and CBT were both crucial in understanding and detecting my anxiety and depression, but in this piece I explore the added benefits of seeking the help of profession therapists and counsellors.

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Over my life, I have used the services of six different counsellors or therapists. This might have been for only one or two sessions, or the best part of a year. Most of the time, though, they didn’t help. Why? Because I didn’t need them. Or didn’t know I needed them.

The title of this post isn’t just to inject a bit of humour into what can otherwise be a fairly terse topic. If the last few years have taught me anything about mental health, it’s that it can take a considerable amount of time and courage to a) realise you have a problem, b) admit it is a problem and c) do something about it.

Tackling my anxiety and depression has resulted in the biggest improvements in my IBS than any of the other interventions and treatments I have tried. However, it was only after many painful months of self-discovery, heartache and dark thoughts that I realised I had an issue and it needed dealing with.

I actually saw two therapists last year: a counsellor at work when I first started experiencing anxiety, and a psychotherapist privately after that. By the end of last year, though, I had realised that my therapist and I weren’t making any progress and decided to change to a third one in January. I have been seeing her weekly ever since.

The therapy has helped in different ways. When I was practising different mindfulness techniques, one therapists was able to give alternative suggestions for parts of my body to focus on: the book I was using recommended focussing on your chest as you breathed normally, but my anxiety centred on my chest. I couldn’t focus on the sensation of breathing in my chest when I had the gremlin of anxiety knotting me up inside.

It is also helpful to have someone other than a friend to talk to. I sometimes felt that I was testing the limits of many friendships by always using every meeting to get worries off my chest. Knowing I had someone I could talk through things with once a week meant I didn’t need to worry about when I was going to have to have someone to speak to about an issue. After a while, I also learned that those feelings pass and you don’t need to bottle them up inside you. The weekly wait instilled a sense of discipline in me that helped me to discover I could cope, and what that felt like.

But it isn’t easy. Therapists themselves need to undergo therapy to make sure they don’t bring any of their own baggage into their sessions with patients/clients. One friend, a therapist, commented that when she had psychotherapy, they broke her down, then built her back up again, before breaking her down a second time. It was a bit like that for me in the early stages: the uncomfortable, terrible realisation that I’d built my life around a falsehood. I remember going home after one session and crying uncontrollably; the very fabric of my universe having been torn from underneath me. This pithy online quote I found today sums it up perfectly: I used to have superpowers but then my therapist took them away from me.

My therapist also spent a lot of time in the early stages trying to pinpoint what I considered superficial things like “where did I feel anxious” and “where did I feel love”. It took me a while to realise what he was talking about and it took me several weeks, if not months, to realise that the knotted, excited feeling I used to get in my chest, that I used to associate with love and the adrenaline buzz of work, was actually one of my critical indicators of anxiety.

It has taken a very long time to reprogram myself to interpret my feelings in new, ‘correct’ ways; to recognise how I actually feel and what the associated physical experiences are. This has partly been achieved through CBT and mindfulness, but a lot of it required the help of the pros.

Typically, I have found my therapist useful for reassuring me that it is okay to feel certain ways: for example, in certain circumstances it is acceptable to feel annoyed, or anxious. But she’s also helped me to look at issues from a different angle. For instance, I used to suffer from a lot of guilt and shame. I’d scold myself for minor misdemeanours or mistakes repeating to myself that I “shouldn’t” have done that. She taught me to rephrase this into something more nurturing: “It would have been better if…”.

Another time, she told me that I was putting myself down. I’d been preparing for an exam and mentioned that I was frequently inventing excuses and reasons in my mind to justify the poor result I felt sure I would get. For me this was rational behaviour. To her, this was a sign that I didn’t have confidence in myself despite the evidence to the contrary. Since then, I have spotted numerous other times I do similar things. This has acted as another trigger to help me explore when I might be anxious, have low self-confidence or when I’m nervous about something.

As I said at the start, understanding and addressing all of this has led to tremendous improvements in my IBS. However, after almost a year of work with my current therapist, the most powerful thing I’ve gained it to learn to have more confidence in myself and what I can achieve. For many of us with IBS, we see our condition as a prison, prohibiting us from living the life we want. We seclude ourselves and don’t want to take risks for fear we won’t cope and our symptoms will get worse. With her help, I’ve learned to overcome this fear.

I realise now that I’ve suffered for anxiety for a long, long time. Symptoms that now seem so obvious – panic attacks as a child, nausea as a teenager, bladder problems at university and IBS in the workplace – were isolated, unexplained problems that I dealt with individually and, until I left the comfort of academia, were things I could by and large cope with. It was the big wide world of work that presented the newest, most uncomfortable challenges.

With my therapist’s help, I learned to spot the daily patterns of anxiety and depression, and construct a narrative that explained what was going on: I felt trapped in a job that I wasn’t enjoying, with a lack of purpose and ambition, but stuck around because I’d persuaded myself that the lifestyle and location were pretty comfortable. However, this meant a daily battle with anxiety as I forced myself to overcome the depression that sank in every day I travelled to work, and weekends and evenings I would fill with activities so I didn’t have to face the then undiagnosed anxiety. I did more and more, worked harder (confusing anxiety with the adrenaline buzz of trying to do too much) and played harder, until I literally couldn’t cope anymore. Doing too much was exacerbating my symptoms, doing nothing led to suicidal thoughts as my IBS got out of control.

It may sound cliche, but therapy has really changed my life. I now realise how I was being controlled by anxiety and depression. My therapist gave me the confidence to break out of this cycle, and to do so sooner than I thought I was ready for: this year I have applied to med school to become a doctor, hoping to specialise in and research gastrointestinal disorders. CBT and mindfulness might have helped teach me about my anxiety, but I don’t think they’d have given me the confidence to make the change I most needed to make. But, to be fair, up until now I wouldn’t have been ready to.

So what have I learned over the last year? In my case, IBS is strongly associated with anxiety and depression, and these are likely to be the root causes of my IBS as well. But I don’t think any of this (mindfulness, CBT or seeing a therapist) would have helped until I’d admitted to myself there was a problem and that I needed to fix it. Dealing with mental health problems is not simple and not quick. It takes persistence and hard work, where you will learn a lot about yourself. You will take small steps forward and then huge steps backwards at times, and you might be forced to face some unpleasant truths.

Sadly, therapy doesn’t come cheap, and is even more expensive in the bigger cities. It is an unavoidable travesty that the NHS can only typically fund short spells of therapy for patients and waiting lists can be huge. This was one reason why I went private. However, I consider it one of the best investments I’ve ever made.

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Tips for finding a therapist:

• make sure they’re registered – http://www.counselling-directory.org.uk/ provides a searchable database of registered counsellors and therapists in the UK
• you may not have to go privately or with the NHS – many large employers and most universities will have a counselling service that will uphold the same levels of confidentiality
• if going privately, try and visit two or three different therapists before choosing who you want to work with
• while experience counts, rapport is better than lots of qualifications – I benefited more from a cheaper therapist
• don’t be afraid to change therapists if things aren’t working, but discuss this with your therapist first (this is equally acceptable if you’re seeing an NHS therapist)
• if you do decide to change, have some alternatives booked in already – therapy can be hard and draining, so it is easy to get out of the habit

How CBT has helped address my anxiety, depression and IBS

Copyright 2007 Flickr user AJC1

 

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.

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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…

What mindfulness taught me about anxiety

When I was first diagnosed with irritable bowel syndrome, I was convinced there must have been some underlying medical cause. Perhaps it was due to the tropical stomach bug I contracted as a child, maybe one of the several bouts of food poisoning/gastroenteritis I suffered during and just after university. Was there a genetic or epigenetic reason, and how much of a role did bacteria play?

However, it took me an awfully long time to realise, and admit, there was a psychological element as well. In fact, addressing this has had the biggest impact on my IBS than any other intervention I’ve tried. In this mini-series of three blog posts I look at mindfulness, CBT and psychodynamic therapy, and how they helped me discover things about myself and improve my IBS.

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I first realised there could be a substantial link between my mood and IBS a couple of years ago when I was going out with my last girlfriend. Throughout this relationship I experienced terrible anxiety, and was terrified I would lose her. Yet, I was comforted to have someone who loved me, and my IBS symptoms all but cleared up. I had more regular bowel movements, and less pain, bloating, wind, diarrhoea and constipation. In many respects, this is typical of a functional disorder: when you are distracted you don’t experience your symptoms.

Following the relationship’s eventual breakdown, I decided to try mindfulness. I had attempted it once or twice while I’d been in the relationship but struggled: I found the initial breathing techniques too subtle. I quickly grew frustrated, thought it was pointless, and gave up.

The second time around was more productive although I still found the breathing exercises too subtle. These involved breathing normally while focussing on the sensation at a certain part of your body. This was too passive for me and my mind easily and frequently wandered. In some respects, this should have been a learning point: my mind was so busy; it took a great deal of effort to learn to ‘mindfully’ focus on a single, short task like brushing my teeth or getting dressed for work.

However, after a few weeks of the recommended yoga exercises and body scan techniques (where you learn to focus on different muscles and parts of your body individually) I had an epiphany. One day in the office I realised that my shoulders were really tense and hunched over and no matter how hard I tried to relax them they kept on tensing up. At the time, I’d been worrying about a broken aerial on the roof of my house and whether it would fall off and injure someone before it could be fixed. The evening it was eventually fixed, I felt a huge weight lifted from my shoulders. I had learned to associate a physical symptom with anxiety.

This was a significant breakthrough but sadly the only major one I had with mindfulness. It was true that after doing some of the meditations I felt a lot calmer and more relaxed, but I didn’t feel like me. Furthermore, as I progressed through the book I was using, the exercises became longer and longer, taking larger and larger chunks out of my day and this was where mindfulness failed for me. I would later discover (through CBT) that I was doing too much, and my reasons for doing so. Mindfulness didn’t address that and, in my mind, the practice was focussed on getting you out of your rat race routine and you’d feel better for it. I needed a change in routine, but I needed to learn why I was struggling to change. So while the major benefit I found from mindfulness (detecting a physical symptom associated with anxiety) was a crucial one, it would take the more active, analytical and introspective techniques of cognitive behavioural therapy (CBT) to really start to change things. I’ll be exploring this next…

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If you’d like to learn more about mindfulness, there are numerous books out there. One of the most popular, and the one that I used, is called Mindfulness: a practical guide to finding peace in a frantic world.