Fourth Appointment – First CBT session

For those of you that have read my previous blogs regarding my initial appointments (1st appointment, 2nd, & 3rd), you’ll know that I’ve found this whole experience difficult. I guess you could say a little overwhelming. The first few appointments were me answering a lot of probing questions, and discussing difficult times in my life. This has allowed me to better understand some of the root causes for why I am the way I am. Before each of these appointments I was so nervous, more so for my initial one. My palms were sweaty, my mouth was dry, my heart was racing, it was horrible. Now though? Now, I appreciate that the hard bit is over. The whole, sitting, feeling vulnerable and exposed to a stranger, was no more. My counsellor is no longer a stranger, and I no longer have to answer probing questions.

Today was the start of my CBT (Cognitive Behavioural Therapy), and I have to be honest and say, I wasn’t nervous. There was no anxious thoughts, fast beating heart, sweaty palms, nothing. I was actually looking forward to today. Today, is officially the start to me making real changes. Check me out eh? Being all positive and optimistic from the offset. This blog will just be like my last; I’ll take you through what was discussed, the information I’ve been given away, and any ‘homework’ I’ve been given to do. I like to think, that if you’re like me, this will help you too.

Firstly, we discussed what anxiety is. A part of me was thinking, ‘yeah yeah here we go. Gonna be sucking eggs for this bit’. I have suffered with anxiety for 10+ years, I know only too well what it is. I know that our body needs it to keep us safe, and I know that I have an unnatural response, of which gives me an anxiety disorder. Well, how wrong was I? Yes I know what anxiety is, and yes I know that it’s there to help us by giving us the ‘Fight or Flight’ response etc, but what I didn’t know was why we get the physiological symptoms. For instance, did you know that you sweat when anxious so as to lubricate your body, and make you too slippery for predators? Yeah! You read right. That made me feel a little bit gross to be honest, but good to know all the same. Here are few more facts:

  • Stomach upset, feeling sick
    • Adrenaline reduces blood flow and relaxes muscles in your stomach/intestines. Causing nausea and/or butterflies. The blood flow is diverted to your limbs, in case you need to fight or flee.
  • Sore muscles
    • I don’t know about you, but my muscles ache for days after a bout of panic. This is because the blood flow that has been diverted to your limbs, has oxygen and glucose energy, which causes your muscles to tense.
  • Relaxed bladder
    • Inner sphincter (don’t care how old you are, that word amuses) muscle relaxes so we might feel the urge to pass urine. I personally have never had this issue, but know of people who have.
  • Hands tingling, legs trembling, dry mouth
    • I get all of these symptoms, a lot in fact. I was so sure it was something more sinister and doctors were lying to me. Today I’ve found out it happens because the blood flow that is diverted to your ‘big muscles’, causes the smaller blood vessels to constrict. This is why we get tingling sensations in our hands, dry mouths, and trembling/twitching legs.

After discussing the physiological side of things, it was suggested that I attempt relaxing techniques daily. Not just when I’m feeling anxious, but every day, in a bid to reduce my stress and tension. My counsellor drew two lines on a board, numbered 0 to 10, 0 was not anxious at all, and 10 was panicked. I was asked to mark on the board, where I would rate myself on an average day, and I said I was an average of a 7 every day. I was then asked to think about what someone with a ‘normal’ level of panic would be like from day to day, and I said about a 1 or 2, and my counsellor agreed that was about right.

It was then explained to me, that, if I’m already up at a 7, I don’t have far left to go until I’m in a panicked state. This means that if something happens, perhaps something stressful, I shoot off the scale. Whereas, someone who rates low on the scale, still has a bit of wiggle room and can cope a little better.

Due to how high I rate myself, we discussed how stressed and tense I always am. For instance, even when I’m sitting ‘relaxing’, I often notice that my shoulder are up to my ears. My shoulders and arms are always aching with how tense I am. I was asked to sit up straight, both feet on the floor, tilt my head down so I was looking at my knees (you can close your eyes), and to bring my shoulders up and tense my arms. Once I was fully tense, I was to tell myself to relax and slowly ease off the tension in my muscles and allow my shoulders to slowly drop. Then I was asked to clench my fists as tight as I could, and repeat the same process of telling myself to relax, and slowly releasing my muscles. Doing this actually felt really good. Like I was genuinely relaxing. My counsellor has said I have to do this every day, with all my muscles, from head to toe. Paying particular attention to the ones I notice I tense the most, like my shoulders/arms. Doing this will help to bring my cross on the bar, down to a more natural level, meaning I’ll have more wiggle room when a stressful situation comes along.

We then recapped on what we had spoken about my in previous appointments, and what my triggers, beliefs, and rules/behaviours that cause me to feel anxious. We spoke about my negative thought process, and I was asked to look at another sheet that displayed a list of unhelpful thinking styles:

  • All or nothing thinking Also known as ‘Black & White thinking’. If I’m not perfect, I have failed. Either I do it right, or not at all.  
  • Over-Generalising Seeing a pattern based upon a single event, or being overly broad in the conclusions we draw. 
  • Mental Filter Only paying attention to certain types of evidence. Noticing our failures but not seeing our successes. 
  • Disqualifying the positive Discounting the good things that have happened or that you have done for some reason or another. That doesn’t count. 
  • Jumping to conclusions (My firm favourite) There are two key types of jumping to conclusions 
    • Mind reading – Imagining we know what others are thinking) 
    • Fortune telling – trying to predict the future. 
  • Magnification (catastrophising) & minimisation
  • Blowing things out of proportion (catastrophising) 
  • Inappropriately shrinking something to make it seem less important 
  • Emotional Reasoning Assuming that because we feel a certain way, what we think must be true. I feel embarrassed, so I must be an idiot.  
  • Should/Must Using critical works like ‘should’, ‘must’, or ‘ought’, can make us feel guilty, or like we have already failed. 
    • If we apply ‘shoulds’ to other people the result is often frustrating. 
  • Labelling Assigning labels to ourselves, or other people. I’m a loser. I’m completely useless. They’re such an idiot.  
  • Personalisation Blaming yourself or taking responsibility for something that wasn’t completely your fault. 
    • Conversely, blaming other people for something that was your fault. 

It was agreed, again, that I tick all of these boxes. I am guilty of all of these, although, some more than others. I would say I’m mostly guilty of ‘All or nothing thinking’, ‘Mental filter’, ‘Disqualifying the positives’, ‘Jumping to Conclusions’, ‘Magnification (catastrophising)’, ‘Emotional Reasoning’,  and ‘Labelling’.

When discussing the above points, my counsellor used my feelings about a recent exam as an example. I was presented with my final sheet, that has a table with 7 colums

Trigger Feelings Unhelpful thoughts/images Facts that support the thoughts/feelings Facts

against the thoughts/feelings

A more realistic perspective Outcome
Driving home after my exam thinking about the questions I got. Convinced myself I didn’t deserve to pass. Anxious, sad, like a fraud. Due to a lot of the questions being related to my day to day job, I didn’t feel it was a fair pass, as not much was based on what I’d actually took the time to study. None I passed, with a really good score. I deserved to pass, as I’d worked really hard. A pass is a pass, and I now know the areas that I can work toward getting better at. I understand that I have every right to be happy with my result, and it was deserved.

Notice how my column for ‘Facts that support the thoughts/feelings’ states none. I honestly have no facts what so ever to back up my feelings, purely my opinions and feelings. Seeing it written out in black and white like that, makes it almost feel too simple. Too easy to be true, but it’s the reality of it. My brain likes to overthink and make a mountain out of a mole hill, and if you couple that in with how I’m feeling, you end up with irrational, unhelpful, self-sabotaging behaviour.

My homework for this week is to do my relaxing exercises, along with filling in this sheet. Although, I am only to fill in the first 3 columns every time I get an anxious or depressed episode, and we’ll then discuss and fill in the remaining 4 columns together.

If you’re like me, I do hope that this has helped you, as much as I feel my appointment today has helped me.

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