Posts tagged cbt

I got a private Ask about CBT and how it’s worked for me, and I put so much work into it that this modified version is going up here now.

First: Try some online CBT to see how you like it.  Nothing can answer your question as well as trying it out.  My first exposure to proper CBT happened in the hospital, and that’s not a recommended starting point.

Second: Consider reading Mind Over Mood or Feeling Good.  These are two classic CBT books, and they include a lot of exercises and advice.  Almost any therapist in the world who teaches CBT has read these books (I’ve found them in virtually every mental health office I’ve ever been in, including my career counselor’s office and my psychiatrist’s office.)  They absolutely should be at your local library (seriously, if not, tell your librarian that they need to get it because FOR HEAVEN’S SAKE.)

Now, onto MY answer.

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I’ve got a meeting scheduled tomorrow that I’m nervous/excited about.

Right now I’m writing down all the ideas that are swirling around in my head about the meeting, and classifying them as either unrealistic or realistic.

I’m not allowed to play any computer games until I’ve finished this exercise, and also one about the (totally different, much scarier) meeting I have on Thursday.

This is a continuation of my thoughts on the “standardization” implied by/discussed in that article I linked to earlier.  That study basically said that having patients go through a standardized course of treatment at a mood disorder worked better than discharging the patients directly into care in the community.  It’s important, sort of, to recognize that the study was done in Denmark, BTW: the treatment in the community probably didn’t involve the same issues that it does here in the US.

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I think it’s really important for everyone (not just people with a severe mental illness) to define and defend their personal boundaries everywhere, including (maybe even especially) here on Tumblr.  The more time you spend here, the more important I think it is.

Some of the boundary-defending mechanisms I’ve identified for myself here on Tumblr include:

1. This is a non-specific-to-Tumblr thing: I have several different mechanisms to hide Google search results (from, e.g., exmormon.com, using Personal Blocklist) and profanity (using Simple Profanity Filter.)

2. I use Tumblr Savior to block a very large number of triggering words and phrases -everything from self-harm/cutting to explicit sexual content.

3. I activated the “Browse tag pages in Safe Mode” option on my Dashboard settings (third option down, see picture below.)  This fixed, among other things, the huge problem in the “CBT” tag.

4. I unfollow very liberally. If you have even a very small habit of posting references to things I find disturbing or triggering, that’s it. It generally takes two photos or four or five disturbing-to-me posts for the unfollowing to happen.  I even unfollow people I like and want to support.  If you trigger unwanted thoughts or behaviors for me, that’s it.  If I find myself getting angry or sad or frustrated frequently when I read your posts, that’s it.  There are people I reblog - sometimes very frequently - who I don’t follow because some of their posts are triggering or disturbing or whatever.

Some of the things I block users for, unfollow users for, and/or filter for using Tumblr Savior/Simple Profanity Filter/etc. for:

1. Anything graphic (description or image) of anything relating to abortion, death, serious injury, or severe physical illnesses.  Talking about it is generally fine - it’s the photos and the explicit visual imagery in text that get to me.

2. Pretty much anything sexual at all, including relatively tame images of 1950s pinups and the like.

3. Every swear word and vulgarity I’ve ever run across (I started with the big ones I could remember, and add to the list very, very frequently; you wouldn’t believe how many different ways there apparently are to spell many things.)

4. A ton of the actors in the Book of Mormon musical (mostly so that I can find the actually relevant stuff in that tag.)

5. A lot of anti-Mormon stuff.  Most intolerant posts, really; this is just the one I see a lot of.  People who post anti-Mormon stuff in the various LDS tags are so, so blocked (and reported, if appropriate.)

6. Anything that might exacerbate my OCD and eating disordered behaviors.  Not just pro-ana stuff - most fitness stuff, photos of models, and pretty much all dieting posts.

I want to be very clear: This is not censorship.  I don’t really mind that people are publishing these things - we’re in a free country (yay!), the internet is very much not regulated (yay!), and Tumblr tries reasonably hard to be an open forum for pretty much all of us (yay!)  I only report people to Tumblr if they are breaking the Tumblr Community Guidelines (like posting explicit sexual content while not using the NSFW setting, or spamming LDS tags with naked pictures.)

It’s just that what’s appropriate for the US government and Tumblr and even society writ large to allow to be expressed is not necessarily appropriate for me to allow into my brain.  These materials have, through sad experience, been proven to lead me into very dark, sometimes sinful places.  There are things I wish very, very, very much I had never seen or heard or read.  There are attitudes - towards my body, towards human interaction, towards eating, towards my own self-worth, etc. - that I have adopted without meaning to, and cognitive distortions I saddled myself with unconsciously.  That’s not cool.

There was a period in my life where I didn’t fight that stuff.  Only things that my anxiety forced me to hide from - like interpersonal conflict on TV, or violent images in movies - stayed out of my head.

I’ve realized that this was a lousy strategy.  It made me less like the person I want to be.  It corrupted joyful and pleasant things.  In some cases it has had a severe moral, spiritual, or psychological impact.  And this strategy is totally unnecessary - I’m a grown-up!  I have the freedom and responsibility to choose what goes in my brain!  There are lots of tools available to help me do that!

So now, while it may look to some people (including Teenage Me) like I’m behaving like a total closed-minded prude, I am simply committed to putting my own well-being first.  I suggest you guys do the same.

(I use these rules elsewhere, too.  I have something like fifteen friends whose posts no longer show up on my feed at all, and who I don’t follow on Twitter.)

I made a lot of functional improvements in the partial program (it’s been six weeks since I was discharged, by the way.)  Stuff like taking out the trash, getting places on time, taking a shower right after first waking up in the morning, doing my laundry before I was completely out of clothes - it was all happening.  I wasn’t really trying to make myself do any of those things, they just… happened.  So I knew I was getting better.

And now they’re back to not happening.  It’s not yet as bad as in May to August, but it’s definitely a step back from where I was.  This week at work has been really hard in terms of staying focused on a task, caring about the “boring” part of the job, etc.  I hardly did any filing, in part because I had the excuse of taking care of other things.  It’s hard to explain, but I am very disappointed in myself because of it.

Probably the biggest single factor is the reduced effort in the DBT/CBT area.  I haven’t done an inner critic exercise in weeks, I haven’t filled out worksheets, etc.  Part of that has been NaNoWriMo, part of it has been work taking up a good chunk of my “fill out paperwork and do as you’re told” capacity, and part of it is that no one is sitting there telling me to do it.

So NaNoWriMo ends in five days, and I may soon be starting up with a DBT group where they WILL sit there and tell me to fill stuff out.  Can’t do much about the work thing except continue to change meds around so I have a better shot at doing things when I get home.

And I need to make a concerted effort to take care of my psychological state - I’ve been catching myself in negative self-talk and proactively complimenting myself out loud to avoid becoming mired in the “Demeter stinks” narrative, and that’s good.  I need to do more of that.  And I need to mention this to my therapists and EAP counselor (I believe I have upgraded from “support team” to “army,” by the way.)

I was all “I am completely pathetic in unstructured conversations; I can function just fine giving a speech or answering questions in class or whatever but I can’t handle it when it’s talking without an objective - without a point.”

And my therapist, J, was all “I don’t think it’s a lack of structure, I think it’s whenever anything is personal or emotional.”

And then there was like twenty minutes of totally proving that’s true.

So now I need to figure out why I’m completely uncomfortable with/suppress emotions, why I feel threatened when people say things like “we like you” or “you did a great job on that,” and what role all my negative core beliefs play in this.

Because that’s easily done.  Headdesk moment, times twenty billion.

I’m trying to do some of the worksheets from the program to see if they can help me get through this anxious stuff.  Don’t mind me, just doing some CBT-esque navel-gazing.

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For me, at least right in this moment, symptom management is all about:

• Figuring out what my limitations really are (versus what I think they might be,)
• Doing what I can do within those limitations, and
• Not beating myself up for what I can’t do right now.

Therefore I choose to be really proud of the fact that all my luggage is out of the car and that I went and got food for dinner, and I will not focus on the trash that won’t get taken out today and the laundry that will have to wait till tomorrow.

I’m also going to give this month’s Relief Society book group meeting (this evening) a shot, even though I have not re-read the book in question (Dracula) and even though I will be bringing a fairly lame “spooky snack” to share (ants on a log.)

And yes, the Relief Society book of the month is Dracula.  I love my ward even though I’m too scared and insufficiently functional to go on Sundays.  So far anyway (working on it.)