CBT: Challenging core beliefs

We focused this week on challenging core beliefs, primarily by recognizing unhelpful thinking patterns. This is the hardest thing you will ever have to do, the deepest you will have to go.

What can change the nature of a man? CBT? Psychotherapy? Himself? Anything at all? Lets find out.

We challenged one of my deepest core beliefs – that I am weak. This is the dark cousin of ‘I am useless’ and ‘I am undeserving’. Its evil brother is ‘I should be perfect.’ How these things unravel all at once.

My lack of belief in my own strength, this disconnection from my body, makes my own sensations frightening; it makes an enemy of my own corpus. Such a belief has been on in the background, like some annoying programme on Windows running undetected, causing havoc and misery. For years I have looked at the world through these glasses, ignoring evidence to the contrary and focusing, manically, on where it is proven true. To feel weak, to have this as a core belief, is terrible. It makes the world seem much more frightening, it makes doing anything outside of your comfort zone a barrier.

This crisis, which began in early January, was a physical crisis (concussion syndrome), and now at its end it is a physical crisis (bad foot and wrist syndrome). The way my mind fixates and catastrophizes has not changed much – I’m just more used to feeling like shit and being able to wait it out. But the fundamental core belief has not been altered yet. I don’t know or trust myself. My short-term strategies to deal with things are preventing the great update. For instance, being overly cautious about a bad foot, going out full crutches and missing out on things, is anxieties way of being absolutely certain that things are going to be ok. This will then confirm itself by its own methods, however much longer and worse it makes the suffering before recover begins.

But the desire for absolute certainty is a sure means to kill life dead. Life is uncertainty, being out of control is an inevitability, accepting a note of chaos in the symphony of order is healthy. The means by which my anxiety looks after me, trying to ensure an optimum perfect self by its own high standards, sabotages itself and makes its actualization impossible. It is a vicious cycle – the need for perfection creates anxiety about that perfection, preventing any healthy movement toward something better.

I learnt today that the human brain will take an easier route, seeking patterns, making predictions, catastrophizing, trying to protect us. The thinking patterns it develops manifest subconsciously, and operate in the background without our knowing. No wonder if all seems like nothing can change! To displace this toxic thinking with something better is a vast undertaking. The anxious mind sees things in black and white, things must either be perfect and secure or not at all. It catastrophizes, blowing things out of proportion. It mistakes emotions for absolute facts. It filters out what it doesn’t like and leans toward its own subconscious bias.

If I don’t slow down and start changing things now, life is only going to get worse. This crisis has been horrible at times, but it could have been a living hell. In a way it came at a not-so-bad time: better a 70% debilitation when you are healthy than a 90% debilitation later in life when you are jaded and starting to crumble. The question is can I make the changes and eke some success out of life, or be scorched out like a candle burnt at both ends, having never truly achieved anything.

Fucking hell bro, things got very, very real.

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Back to catastrophe!!!

It was all going so well.

Panic disorder was all but gone, and there was no way I was going to get complacent about it. I had a regular routine for my week – two days of garden volunteering, three or four days of adventures and meeting friends, and one day of rest. I finally made it back to see my comrades in West London, and all seemed to be improving in a decidedly linear and inevitable fashion!

Then I kicked a wall three times.

It might sound stupid, viewed out of context, but when you consider that I had insomnia for many nights, and that it was 2am, and that the man next door was singing the same, appalling melody over and over again (interspersed with the occasional wail-like shout and return), I think it was almost justified. If only I had sandals on and hadn’t bruised my heel!

But I didn’t have sandals on, and it looks like I did. So now I can’t walk properly and go around on crutches. Missing work at the garden makes me feel utterly incompetent and useless. Not being able to socialize is making me fear the envelopment of darkness again. Already I have less interest in doing the things I love.

But this is, as they say, the real world bruv.

Anxiety latched onto my heel very quickly. For the first few days after the wall-kick it was fine. After that it started to ache. On that night I slept about an hour and a half. It was my first time with cold sweats (horrible) and a real deep sense of anxiety and danger. What if it’s broken? What if I am trapped here? What if I get the same abject emotions as before and fall back into a void? What if an opportunity comes up and I have to miss it? Will I have to miss volunteering tomorrow? Cyclically these thoughts and similar dooms went round and round. I tried to challenge the significance of them or question them, but this would only make them go away so long.

Horrible.

Naturally the catastrophizing wasn’t an accurate prediction. The next day at A&E went pretty smoothly. I was also greatly helped by family, who I was at first afraid to expose my vulnerability to. The anxiety still fixated on the injury, even after confirmed it was nothing serious, because it could become so. My leg muscles, for instance, feel sore from trying to compensate for heel pain. This kind of thing can make you lame in the long run, which does not bare thinking about. But the anxiety also forced me to work out how to deal with the situation. To accept that I have to rest. To elevate the leg. To change my posture. To ice it twice a day. To get decent insoles and medical tape to protect the heel. Even though anxiety has made me feel like utter shite on a daily basis, it has also driven me to sort this crisis out and stop it from becoming worse.

So its back to catastrophe! It shows how frail a thing ‘progress’ is I suppose. I thought I was doing well, but maybe I was just putting on a band aid. Things have to change for me to be healthy – not just things like posture and medical related, but on a much more fundamental and difficult level. I couldn’t keep going as I was before, and I was in a way imitate that before the heel struck the wall in rage.

Lets see what comes out of this. I should focus on the positives: it has brought me much closer to Professor Tolkien (I have had the Silmarillion lying around for months) and inspired me to finally start my own mythic stories. It has taught me about the foot, and how important one little part on  the lowest bit of the human being really is. I will never take having an unhurt skull for granted again. Now I can add mobility to that list of gratitudes.

Hopefully I end up looking after myself better. I always had a sense that I wouldn’t live much past 40, and that my latter years would be terrible, painful, warped and bent! Acknowledging such anxiety, I have to make sure it isn’t so.

CBT Part III: Sleep Deprivation

This article has been the hardest of all to write. Not because the subject matter is particularly daunting, deep or traumatic. But because it is the first time I have had to overcome fatigue and bodily wariness in a long, long time. Normally I am straight on a computer after a CBT session, full of energy and a desire to share with the world the wonders of cognitive behavioural stuff! Today, I had to overcome a big barrier of fatigue just to be here writing this, and I can’t promise anything special.

My recent episode of sleep deprivations seems to come from two places. Firstly, A gradual build up of anxieties, natural to living in a busy, expensive, polluted city. Secondly a loud idiot next door who shouts and wails at random intervals into the early hours. And I guess there is ultimately my own anxious personality and thinking patterns which can turn problems into serious problems. This I discovered from today’s CBT.

Lets start with the shouting. At random intervals in the night, a man will shout. It won’t be massively loud, but loud enough to jar you, or awaken you. For me it feels like his voice has entered by body, my being is filled with his sound. It is the exact same wail every time, a supposedly songful sound, but in truth, a horrible, mechanical, repetitive, intrusive load of shite. I came to associate any noise he made with the possibility of a wail or shout, and this puts me into a downward spiral of hyper-vigilance, which prevents me from having decent rest and recovering.

I didn’t realize how much this was effecting me. On the first day it was a nuisance. On the second day it hampered my ability to fall asleep. On the third I bashed on the wall at midnight and came close to telling him to shut the fuck up. On the fourth there was no shouting, but my system was in constant vigiliance, and wouldn’t let me fall asleep easily. This causes feelings of frustration, which develop into rage, something highly unconducive to falling asleep. I was, and still am, catastrophizing about the effects of sleeplessness.

Today in therapy we discussed this and revealed I do have unrealistic expectations and standards. I always feel the need to be active, alert and at around 80-90% capacity. I know we can never be at 100%, but I am very wary of being weak and vulnerable, especially having lived in countless environments where appearing unaware can be dangerous. It might seem obvious that this is a vicious cycle – the more you want to make yourself capable, the more you fear incapability, the more prone you are to anxiety and thus incapability. My therapist was very good in challenging this through questioning, making me run through the evidence and realize the vicious cycle. (But I don’t think it is entirely bad to have such high standards. Human beings are hunters by evolution, it makes sense that we will want to be capable of reacting to threat or opportunity at every possible occasion.)

But with me there is an additional problem, and the heart of the problem. The formation of patterns. I have used patterns to some good effect, building up positive days and exploits to get me out of panic disorder. The downside is, one or two shit days and I fear a bad pattern forming. This rigid thinking really is a double-edged sword, and never far from a downward spiral. The challenge is to be more flexible, to accept more sad days as inevitable. This is not easy to do.

My mind is prone to catastrophizing and thinking the worst. This is why the nuisance of an inconsiderate idiot’s shouting can become something frightening and world-shaking. If I stop fearing the predicted outcome of losing sleep, my body should become less hyper-vigilant toward such disturbances. I don’t feel our session quite went into enough detail. How could it? One hour cannot cover a lifetime of being this way. But it has been very helpful, in hindsight. I am less afraid of sleep deprivation, and less prone to it.

There was also the factor of a build up of anxieties. We tend not to realize sometimes how anxiety gets us. It is like a shadowy assassin, slowly poisoning you drop by drop. For the considerate, this causes internal strife and restlessness. For the inconsiderate, this inspires the harming of others to regain a sense of control. I am sadly in the former category of person, and so the day-to-day banalities of life occasionally build up and make it difficult to function, even at 50% or so.

But its not only the cost of living and banal problems like that. The backdrop of an idiot sitting on America’s nuclear arsenal, catastrophic climate change threatening to wipe out everything that breathes, the dissolution of communities and the watered-down experience of Facebook and the like to replace it, new technologies falling into the hands of powerful capitalists; among a host of world events and tragedies, make anxiety quite a normal and relatively sensible state to be in. How we react to that anxiety is another matter entirely – with fear and paranoia, or the will to change things and become more harmonious. Or like myself, a mixture of the two. Nevertheless, I entirely understand why it is there.

These worries are definitely harming natural, harmonious functioning. Not only in me, but in so many citizens of the ‘so-called’ first world. This includes that most natural and essential, but mysterious, phenomena that is sleep. Sadly, I can’t think of a way around this off the top of my head. Maybe to paraphrase Alain De Botton and to see the odd night of insomnia as a creative gift to be cherished. And to realize that normality isn’t quite so normal, and lots of people have trouble sleeping. This doesn’t give me much solace. If I could sleep eight hours a night without disturbance for the rest of my life, I would.

Learning what I have about my own need for patterns and rigid routines, challenging negative thoughts by seeking evidence, practicing breathing exercises and progressive muscle relaxation, I should have a decent night’s kip tonight, and be back up to a decent level of running, without fatigue tomorrow. I at least can write a half-way decent article three days into moderate sleep deprivation! I venture to say then that it isn’t quite as bad as anxiety has made it out to be, (even though it is far from ideal). As with all things in life, the breaking of the pattern has made me realize the pattern. Perhaps this is the key to changing it, and perhaps something better will actually emerge from it. I don’t know, lets see.

 

 

 

 

CBT Part II – Testing a theory

I have just come back from another great session, which ended in a real climax of excitement! Its all happening in the NHS mental health support team!

We covered some exposure exercises, to simulate the feelings associated with a panic attack. It is important to familiarize yourself with these sensations, so as not to fear them. Once in an anxious situation, anxiety tends to peak and then starts to drop. So-called coping strategies prevent the natural decline of anxiety, and prevent the subconscious from ever properly learning that a dreaded situation (such as getting on a bus!), is actually not all that dangerous after all, and there is nothing to be anxious about.

By trying to avoid bodily sensations associated with anxiety, we lend them a power they do not deserve. I call this ‘mythologizing anxious sensations’, something which feeds into the cycle of avoidance and furthers fear. Eventually anxiety becomes a general dread which you will dedicate the whole of your life to avoiding! The short-term cure, avoidance, is worse than the disease. And those who say that time heals all ills have obviously never recovered from a panic disorder before! Time will not heal this.
I must now expose myself to these situations and bodily sensations. This will let the natural course of things play itself out, and the subconscious can learn once and for all that there is nothing to fear. Likewise, I will stop fearing the sensations in my own body, which I have already done much to achieve.

This is all made much easier by going into what I am really anxious about, which my therapist helped me with by proposing a theory. Before we get to the theory, we need to examine my true fears.

Today I boiled down my fears of a panic attack to two things: i) fear of embarassment, not being helped and public humiliation. ii) Fear of bodily weakness after a panic attack, losing my independence, being dependent without a trustful support network.
So we proposed two theories. Lets start with Theory A. This states that if I have a panic attack people will laugh, think I’m weak, and might film it on their phones. The evidence from this comes from seeing lots of humiliating incidents at school and the general shittiness of certain human beings. If theory A is true, then a panic attack would be rather devastating, and the best thing to do is to avoid panic attacks at all costs and restrict my freedom. On recollection, I believe this theory to be about 20% true. In other words, its a load of anxiety-induced shite.

So lets move onto the (infinitely more plausible) Theory B! This states the problem is worry that other people will judge me, be humiliating and unhelpful. But the evidence is against it: I would definitely help others if they needed it. Some people will always want to be helpful, even heroic in such situations. And some people have similar problems with anxiety and depression, so can actually be understanding. If Theory B is true, I need to try to think more realistically and positively about things, and dispel the power of the panic attack. This is as far as I got in working things out. My therapist took the next step.
She gave me an analogy which really helped explain what we had to do to truly see the theory through. Imagine an apprentice on his first day at a building site. The workers on the site put up a wall and tell him to hold it up, or else it will fall down! He spends the whole day standing there, holding up this wall, getting tired and uncomfortable. As night falls, his bosses tell him he has to stay there all night. Well, this just won’t do. So what does the apprentice do, now that he is in doubt about the worth of holding up the wall? He can gradually release his hold on the wall, he can release his support and slowly step away. But will this do? What if there is a gust of wind or something? To truly see if the wall is sturdy, he will have to give it a darn good push!

Ultimately, a theory needs to be tested. ‘If panic attack then people will be helpful, and there will be no harm’ is the crux of the more plausible theory. So lets just say that we might end up doing some field research soon!
I am most excited about the opportunity.
p.s. Get CBT if you can, its great. Just be prepared to look deep inside yourself and realize what needs to change inside you.