CBT Explanation

I have written a brief explanation on CBT (Cognitive Behavioural Therapy. I have found most of them helpful through the years, and use them regularly at the moment to walk to the bus stop and then catching the bus, going to shopping centres and even keeping in touch with people.
When I first started doing it I found it very hard, but perseverance paid of and a lot of the things I do mentally, others I sit down with pen a paper because I find that reading it back makes it so much clearer than it just running through my head.

CBT

Your thoughts create your feelings
I really like the theory about Cognitive Behaviour Therapy (CBT) thought I better put pen to paper and explain my take on it and how I use it. I’ve compiled this information from various books, groups, people and friends over the past 15 years. This is not a professional view but methods that have worked for me.
I can remember when I first heard about CBT, I had no idea that our thoughts and feelings were so inter linked. I thought I was just a negative person and didn’t realise that I had control over this, as I believed that it was surrounding events and people that made us feel the way we did. To find out that I had a choice and could control this was opening a huge door for me.
CBT is where we change our thinking from negative/irrational thinking and ideas to positive/rational thinking by writing down the events – our thoughts – and the outcome and choosing how we can change for the better.
CBT has changed things immensely in my personal life, and it works really well for me, but as far as a coping strategy for panic attacks/agoraphobia it has not worked that well at all, but I am happy to read a book if I can at least take one great thing away from it and put it into practice, so even though it hasn’t ‘cured’ me, it has made me a much better person.
The first lesson I took on was: People cannot make me feel anything; it’s my interpretation that creates my feelings and emotions.
This was a heard lesson for me, as I had always blamed others for my reactions and my negative emotions. Eg. If someone criticised me in any way I would blame him or her for making me angry and getting low self-esteem and I would also take on board that I was ‘useless’, ‘bad’, ‘nasty’ etc etc.
The method I used was “CBT” to understand and dispute/change my “Cognitive Distortions”. I used the CBT Table to help me challenge my beliefs and thoughts.

Some helpful questions in challenging beliefs/thoughts:

• What other ways are there of viewing the situation?
• How might someone else view the situation?
• If I were not anxious, how might I view the situation differently?
• Realistically, what is the likelihood of that happening?
• What is the worst thing that could happen to me if this thought was true?
• What good things might occur if this thought was true?
• What is the effect of me thinking this way? Is it helpful for me to think this way?
• What is an alternative, more useful way of thinking about the situation?

Some helpful questions in gathering evidence regarding whether a belief/thought is irrational:

• Where is the evidence (or proof) that this thought/belief is true?
• Is there any evidence that disproves my thought/belief?
• Can I identify this thought/belief as one of the Cognitive Distortions?(See below)
• How do I know that my thoughts/beliefs are true?
• Are there facts that I am ignoring or I’ve overlooked?
• What other explanations could there possibly be (ie alternatives to what thought)
• How realistic are my thoughts, beliefs and expectations?

Cognitive Distortions
All or Nothing Thinking
You see everything in black and white there are no shades of grey
“I am always lazy”
No one can “always” be lazy
Generalization
One failure means failure always
One person doesn’t agree with you and you think everyone thinks the same
No one becomes their failure it is just one event
Mental Filter
You pick out one negative detail and focus on that
You look at only one aspect of your personality
You have to look at the whole picture
Disqualifying the Positive
You always find a reason not to see the positive, there is always a ‘but’ or ‘because’.
You need to pat yourself on the back for every positive in your life
Jumping to Conclusions
You make assumptions due to your negative thinking
Look at all the facts in a rational way
Magnification or Minimization
You exaggerate negatives and failures. Shrink abilities and positive outcomes
You may have failed once, that doesn’t mean you are a failure
Be proud of all achievements they are important
Emotional Reasoning
You think that because you feel it, then it must be true
Your feeling can be irrational and may not reflect things as they really are
Once you change your thoughts then your feelings will change too, do not
judge by your feeling, but by the facts
Should Statements
You berate yourself with shoulds and should nots, which only makes you feel guilty
When you expect shoulds and should nots of others you feel resentment
Practice removing the word should out of your vocabulary it is not a healthy word
Labelling and Mislabelling
Using labels to describe yourself or others, like looser, idiot, do-gooder and perfectionist
See every side of ourselves and others, don’t just focus on a negative or positive side
Look at everyone as a whole person
Personalization
You blame yourself for events out of your control
Nothing is totally one person’s fault; do not take responsibility for other’s choices

Shopping Centre for Two Hours

My tasks for this week from the psych was to make myself do things that I don’t want to do and haven’t been able to do for a long time. I was going to go shopping yesterday at the local small supermarket.
So I decided to start my task and go the shopping centre and shop at Coles. I planned to be in and out very quickly as I would cope better that way. I went in to the centre and using my breathing and CBT realised that I was not feeling as bad as I thought I would, so I decided to go into a couple of the smaller shops that I haven’t looked in for over a year. It went so well that I went in and looked at a lot of shops as well as going into a few boutiques and tried clothes on. I must admit it felt really good to shop for clothes again….its been such a long time. I only bought a couple of items but had a good time.
After all this I went and did my food shopping and that went well too. It’s amazing that I could stay in the shopping centre by myself for a few hours without the feeling of having to run out. Desensitisation really works in building up confidence each time a task is done, as well as transference from other tasks achieved.
I took on board that I need to be proud of my achievements and when I picked up Rory, I bragged about my achievements to him and he was happy with what I had done too. It felt weird bragging, but it also made me feel good and confident.
I am going to think of something to do over the weekend that will push the boundaries

Psych Visit - Childhood Beliefs

My visit at the psych this week pretty much carried on from last week. We discussed further how I had gone with becoming aware of my fear thoughts and how I can go about changing them. Basically it is going to be a long term goal, but awareness is the first step.
We also discussed that avoidance behaviour that served me well as a child and teenager, When I need to protect myself from my step father and stay out of the way of people who would tease my because of my home life, and that’s where my avoidance and agoraphobia began. But now they don’t serve a purpose in my life and that I need to use CBT to challenge those thoughts, and replace them with thoughts that serve my life now and we will go into this further next week.
The third thing we discussed was finding the reason I wore a different hat at work, and felt that I was a fraud there. We worked out that it wasn’t that I was a fraud, but that I had such a horrible home life, that when at work I pretended that I was “normal” and when I was in my home environment I thought that was my normal self. Because I was living two different lives with two different personalities I felt like one them was a fraud, but maybe it was my home personality that was a fraud and the work one normal.
Since then I have always felt a fraud in work situations, even though I have always been very competent and confident in my work roles. I now have to change this thought process around and that I can be the same person at home as what I am at work, I do not need to come home and feel insecure and not capable.
I thought I had worked through all my childhood demons….how wrong I was…I am so glad that the psych has worked around to this so I can challenge these thoughts.
I will see her again next week, then we are going to change to fortnightly visits so that I have time to work longer on each task.
Ruby

1. Ruby on July 7th, 2007 10:56 pm
   
   I suppose that one thing with having left work, it hasn’t made me incompetent or blaming myself and it definitely has not carried through to my home life. I am glad that I am so aware of these thoughts now that I can place or leave them where they belong.
   
   
   

Psychologist Visit - Fears & Beliefs

I am a bit behind on writing about the visit, firstly because of working and I haven’t got into a proper routine yet. Secondly because I needed some time to think it through first and decide how to tackle it, I have only come up with a starting solution for #1, and nothing for the rest, as I am so stuck in this thinking and will take a while to challenge to them…not a week task.
I was given a list of things that I had to think about, and how I would put them into action.

1. Consolidating achievements from work to home life
2. Are my fear thoughts realistic and how can I change them (and believe them)
3. How would I put point 2 into practice
4. The impact it would have to have alternative thoughts

This is what I have/n’t come up with so far:

1. Consolidating achievements from work to home life:
I have always separated my two lives, I have a work “hat” and a home “hat” (and never the twain shall meet). I think most people do this but I do it to a fault. At work I never second guess what I need/have to do, I don’t think about what people may think about me as I feel very confident in my work role. At home I second guess everything, think about the panic/anxiety consequences of every task, am always concerned that people will think that I am loop de loop (crazy). I haven’t attempted any changes in thought through the week as I don’t feel I have the time with work. But yesterday I tried to carry the same confidence at home as I did at work through the week, and amazingly I got a lot more chores and tasks done so that proves to some point I suppose that it works. The next step is to try it when I have go on the other side of the front door… Today I want to walk up to the corner IGA (small supermarket), but this depends on the weather as it rained all day yesterday. If the rain holds off I will attempt to do it with my “work confidence” and see if I can consolidate the two life’s to some degree.
2. Are my fear thoughts realistic and how can I challenge them (and believe them):
My main fear thought (besides those that come with a panic attack) is: what will people think? This thought came from my mother who was always saying: what will people think? When we were outdoors, in public and social settings. Firstly - do people even give a think about me? I have some proof that they do, but mostly people are too busy with their own lives to worry or care about mine. I am a people watcher and like to see how people tick and go through their lives, not for gossip purposes, I just find it interesting, so I assume others do the same, but for bad intent. Secondly - does it matter if they do? Yes, it does to me. I don’t want them to have misconstrued ideas about me that I cannot challenge. This is going to be a hard one for me!! Thirdly - does it matter if they pass on their thoughts through the gossip channels? Definitely, that will be even harder to challenge as people take gossip for fact
3. How would I put point 2 into practice
By challenging and changing the thought, which as yet I have no answer to, this thought has been ingrained in me since the beginning of time, it will be a hard one. Firstly I think I need to write down each fear on paper and then try to negate them till I come up with a thought to replace it with.
4. The impact it would have to have alternative thoughts
This one is easy, it would mean that I could do whatever I wanted to without this thought stopping me short….freedom.

I will keep adding comments to this post as I come up with more solutions and changes.
Ruby
Jethro on March 16th, 2008 11:13 pm
Hey Ruby,
I know it’s a bit late but I’ve currently stumbled upon your blog and real glad I did. It’s hard finding people going through the same phases in life as myself who’re willing to talk about it.
What impresses me is the fact that everything in this post pinpoints exactly what I do too/think about. I watch other people pan out their own lives because I find it interesting. One of my past doctors told me it was an attribute associated with chronic boredom which didn’t help me at all.
I’m glad that there are people out there who I can relate too even in times like this. I’ve only started reading your progress now but it is inspiring. By the time I get to the present date I hope everything has worked out for you.

Five More Bus Trips

I have been on the bus five times since my last post. Thursday morning I didn’t feel as nauseous as Wednesday nor did I feel the need to go the toilet, but still didn’t feel comfortable and was very glad when I arrived at work. On the way home I had to stop off at the shops and get a couple of things which is about half way home (the whole trip is 9km), which meant that I then had to get another bus from the shops to home, for the 5km to the shops I tried thinking up lots of different options of getting to the shops, unfortunately there were none and I knew I had to get off. I also had to walk about 700m to get the shopping centre, which was hell, being in the open like that, I kept up the breathing and positive self talk. I quickly grabbed what I had to and returned to the bus stop where I had to wait 15mins for the next bus, but I was happier at the bus stop then having stayed in the shopping centre, the better of two evils. I got home after dark and walked home very quickly as I don’t feel safe walking at night.
Friday morning I felt OK about walking to the bus, but once I got on I felt a huge wave of panic overwhelming me as well as a strong feeling of having diarrhoea, I decided that I would get off at the next stop, once at the next stop I kept telling myself that I had to get to work and I knew that if I got off I would be feeding my anxiety for the next time. Then I decided that I would stay on the bus till I could absolutely not handle it any more, at each stop I had to stop myself getting of the bus and eventually made it to work, it was a terrible trip. Luckily there are never many people on my bus which makes me a bit more comfortable.
During work I tried praising myself for my achievement but the memory of the crappy trip kept overriding. I thought about catching a taxi home as I didn’t want to risk another horrible ride. By the time home time came I had talked myself into taking the bus because I knew if I didn’t then I would be taking a step back in my progress and I really don’t want to do that. When I left it was pouring with rain and I had a 15 minute wait at the stop, but I made it home with medium anxiety.
Thank God its the weekend and I can take a break from the bus and the anxiety and worry about it I really hate agoraphobia and panic attacks!!!!!
Ruby

1. Robert on June 27th, 2007 7:04 am
   
   Hi Ruby!
   I haven’t been online for over a week…and look how far you’ve come on!!!!!
   If your back is not pleasantly throbbing from much patting on it…it should be!!!
   Now you’re going down that road to recovery - at quite a pace - don’t look back :0)
   As always, I send my best wishes to you.
   Robert
   
   
   
2. Ruby on June 27th, 2007 5:56 pm
   
   Hi Robert
   Yes, I have come some way, and I HAVE to start patting myself on the back, I keep saying “its only because…..” my psych told me off for not owning my accomplishments and to start congratulating myself, which I am trying to do now.
   I think I’m scared to make a big deal out of it, in case it all comes crumbling down again. But I need to appreciate what I’ve achieved each day for that day and not thinking of the future.
   Looking forward to a sore back
   
   
   

I Survived The Bus! And Made It Home Too

I did it!!! My anxiety rose very quickly once I got out onto the street, and I started to focus on keeping my breathing at a good rate. I had to wait for 7 mins at the stop, luckily an elderly lady came to the stop who loved to have a chat which kept me distracted.
Once on the bus I started feeling very nauseous straight away I tried very hard not too focus on that feeling, normally I would focus on it until I started a panic attack, it worked on and off and had bouts of the nausea. I had to work on my breathing for the whole trip which at times was really hard and I felt exhausted by the time I got too work. One of my symptoms of my anxiety is the feeling that I am going to “wet” myself and that was constant for the whole trip, I had taken precaution and wore a incontenance pad, I did not need it, but it was a comfort to know I was covered.
On the trip home I felt a lot better, though did not enjoy the trip I had to focus on my breathing rate, and felt like I needed to go to the toilet, but did not feel nauseous . Hopefully that means that each trip is going to get easier every day.
My psychiatrist told me that I don’t appreciate my achievements enough, so for this one I am very proud of myself of completing this task. Now I am about to head off to do it all again…
Ruby

1. Sarah on June 21st, 2007 4:37 pm
   
   Hi..
   I’ve just recently started reading your blog and as an agoraphobic myself (currently in the midst of a pretty poopy relapse) i found this post very inspirational.
   Well done for making that bus ride. Public transport for me right now is a completely no-no, i can barely get in a car
   Anyway…i look forward in reading more of your blog.
   Sarah♥
   
   
   
2. Ruby on June 21st, 2007 7:48 pm
   
   Hi Sarah
   Welcome to my blog, I’m glad you got inspired. Relapses are terrible, I’ve had plenty of them over the years too - I feel for you.
   Its the baby steps that are important, and panic is not bigger than you, that’s just where people who suffer this horrible illness, put it.
   Ruby
   
   
   
3. Leonora on October 29th, 2008 6:00 am
   
   Well said.
   
   
   

GROW Meetings

I haven’t been able to go to GROW for a few weeks now because of working, and I have really missed the group and the support they give as a group and individually to both sufferers with mental health issues and their partners/family, as well as having tasks to do each week that will change me in a positive way.
I found out today that they have had to change their meeting place and luckily the time as well, from the beginning of August they will be meeting on Mondays at 10 am. So in 5 weeks I will get back into ‘growing’ myself, it is such a great program

Bus Trip Tomorrow

Chloe came to pick up the car this evening as she needs it (and not forgetting that it is her car). I have been stressing about tomorrow so much and I spoke to the psych about it this morning at our meeting.
She says that I have to transfer the skills I have used to be able to start work in doing other difficult tasks - like catching the bus - I find this hard to do as I have always worked with my anxiety and agoraphobia to some extent, and I have never transferred the confidence from work to my “home” life. This is something I spend most of the day pondering on, she is right of course, but I have always separated my work and personal persona and now I have to change my view on my home persona and transfer the thoughts I use to complete work tasks.
I have my bus times all worked out, double checked the batteries in my mp3 player and put a book in my bag to make sure that all distractions are in place for the horror half hour trip, not to mention the walk to get to the bus-top (about 3 min) can’t believe that I am having to meet two tasks in one go - AND I CAN’T FAIL!!! - I have to go to an out of office meeting - not just a normal day.
Ruby

1. Ruby on June 19th, 2007 10:41 pm
   
   A friend who had read this post called to say that they would give me a lift to work to save me from facing my fear of buses. I was really thrilled at the offer and was very tempted to take up the offer. But I know that avoiding this task now will make it harder in the future. So I anxiously declined the offer, but said that I would use them as a backstop if needed.
   Even a month ago I would have jumped at the offer, I feel very confident and strong that I was able to say, thank you but no. Somehow I don’t think I will feel that way tomorrow when I am heading up to the corner and taking the first step onto the bus.
   Ruby
   
   
   
2. Robert on June 20th, 2007 7:11 am
   
   Hi Ruby…
   I’m keeping my fingers crossed for you…
   Btw, brave decision!
   Good Luck
   Robert
   
   
   
3. >Ruby on June 20th, 2007 10:17 am
   
   Thanks Robert
   Its great to know people are supporting my efforts, it really spurs me on.
   
   
   

Update on Finding a Purpose

This task is just about impossible for me, my purpose has always been survival and my kids, and I keep justifying to myself that I’m still needed in this role as a mum (and I am only needed now when asked) I will keep persevering on this one. I took up crafts for a short time last year and it was fun at the time, but I don’t really have the creative mind to keep it up and I get bored with it very quickly
I did some decoupage projects that turned out pretty good but now I’ve run out of ideas. though I don’t see this as a purpose, its a hobby.
This task is going to take a lot of pondering.

Still Working

I am still working, I couldn’t bring myself to quit as I really want to stay there, it seems like a great place to work.
I did speak to the boss about the problem I may have with catching a bus to work, he was very empathetic and came up with some helpful suggestions. I am really lucky to have a boss who is so understanding and supportive… I hope I can repay his kindness by turning up on Wednesday afternoon.
I wanted to do a trial run on the bus over the weekend, but that would mean that I would have to make a return trip all in one go and that’s way too scary, it’s way too scary to catch it one way to work, never mind anything else.
I have got batteries for my mp3 player and picked out a good book so I can keep distracted. The plan was to work up slowly to getting on a bus (like walking to the corner first!!) and now I have been thrown in the deep end. If I manage to do this on Wednesday I am definitely going to treat myself to something nice :).