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One of the subjects in my last therapy session was maintaining progress. As with much CBT there was a form is a form to fill in and I thought it would be good to include it here. I’ve written in to myself as ‘you’ for future reference, but as ever, nothing I write here is advice, it’s just thoughts that help me. If you have other things that help you maintain progress do add your thoughts too…
What have you learned?
- You can tolerate uncertainty (really you can!).
- Feelings of sadness and fear can be useful. You can experience these feelings (though may be difficult) and think of them as helping you or alerting you to things you need to know.
- If strong feelings or uncertainty are whizzing round your mind you can choose a good time to think about things. It helps to put a time limit on how long you think about contentious issues, then have a cup of tea and chocolate.
- It is important to notice when you worry, because then you can choose to do something about it. Two major forms of difficult-to-spot worry are: thinking about anything obsessively and doing lots of things at the same time (which is avoidance too).
- Confidence is the opposite to worry, and the more you flex your confidence muscle the more it strengths. This means making decisions yourself and not repeatedly asking for reassurance.
- For most decision there are more than one solution, so most things are just decisions, neither perfect nor imperfect and that’s OK.
- For some worries there is no solution, so there is no point analysing it, or thinking about it.
- There are things called ‘appraisals’ in therapy-language, this means how you assess your situation, or what someone might have said. If I’m feeling stressed about something it’s a good idea to step back and look at how I am appraising, or interpreting the situation. Could it be that I’m jumping to conclusions? Am I being a bit black and white in my thinking?
- Use a three stage wise mind process when feeling c**p. Firstly, write down feelings, then write down rational response (beware of ‘appraisals’. Then think of the wise mind part of you (or ask God) for a kind response to both your feeling and rational self. This is really good for me if I’m being hard on myself.
What was most useful?
- Giving and receiving kindness to and from myself.
- Flexing my confidence muscle.
- Deciding to stop worrying and knowing I can.
What can I continue to do to prevent a setback? [Note language: prevent 'setback' not relapse/meltdown/disaster/collapse/irreversible mistake]
Be conscious that worry is bound to be around sometimes and challenge your behaviour. If you’re starting think in some unhelpful patterns, look after yourself. Flex your confidence muscle and watch out for asking for excessive reassurance, which erodes confidence.
What are my high risk situations for a setback?
Life changing decisions to do with my daughter, my work or my husbands work, like changing jobs, moving and change in schools. If I have a conversation in which I challenge someone, or the challenge me about something I really care about this can also be a trigger.
What are the signs?
The most obvious behaviour, that I find difficult to believe is when doing it is overworking, or doing lots of things at once for a sustained period of time. The feelings that are triggers tend to be fear of being threatened/rejected and intense sadness. The thoughts that are triggers are: ‘You must do x,y,z right now, or else it will never get done.’ ‘See you aren’t really better’,’ You’ll probably always get depression and anxiety’.
What can I do to avoid losing control?
Firstly, to be vigilant for any of the triggers, particularly a feeling of great urgency to do lots of things. Secondly, to be kind to myself when I’m sad. When I do have some difficult feelings or thoughts, then it’s really important to take the time I need to think and to make sure that I don’t avoid the difficulty. A further thing I can do is to make sure I have unstructured time to just do what every I fancy, not at job, or an achievement, because my life sometimes gets overrun by striving for achievement.
If I feel sad then it often helps to talk things through, or spend time writing down how I feel.
What could I do if I did loose control?
Tell my husband and/a close friend. Stop any overwork. Mistrust any ‘rules’ of things that I ‘must’ or ‘ought’ to do. Be outside. Be kind to myself and other people. Remember that I’ve been low before and come through and I will turn the corner again. Go back to the CBT, check appraisals.
If things were really bad I’d go back to the doctor too. I am still taking medication too and want to build up a bit more resilience before I come of it.