Back to therapy

I realise I still haven’t posted much about my CBT, and I do still plan to. Somehow everything seems to be busy all the time at the moment and I haven’t been making time to write, which is a shame because I enjoy writing!

Yesterday I went back to see my therapist, who I haven’t seen since before Christmas (because I started CBT in January and you can’t have two types of therapy at once!) It was really nice to see her and to talk things through. She said I seem to be in a different place and that’s true!

We talked about how things have been and how I have had lots of realisations about myself and the relationship with S in the last 6 months. She said I seem more like an adult, that I am taking responsibility for myself and I’m not waiting for someone else to fix things for me anymore. That was really nice to hear, and I actually agree. I think I’ve grown up more in the last 6 months than the last 6 years!

I’ve learned that I can deal with stuff myself. I’ve learned that sometimes I will feel really low and it will be awful, but I can still get through it. I’ve learned some level of distress tolerance, whereas before I had none – I always ran to S to make me feel better.

I feel much stronger and I’m owning my life now. Nothing changes by itself, no one is going to sweep in and save me. I don’t need saving actually anymore – I can save myself. And I’m building up my confidence bit by bit. Yes, I still have my lows, and I probably always will, but that’s ok because I know it will pass. And I know I have a hell of a lot of great people in my life to support me, but not to save me. I have better coping mechanisms now and I’m actually quite proud of myself. (Wow I never thought I’d feel proud of myself!)

Feeling pretty positive today, especially thinking back on yesterday’s session.

Lots of love,

Ellie xx

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Those bloody forms

As with any NHS funded CBT, I had to fill in my favourite forms ever* on the first, middle and last sessions. The PHQ9 and GAD7 (AKA those bloody forms) are measures for depression and anxiety respectively.

The scores are used to determine the severity of the condition, the cut offs appear to be up for dispute, but these are the scores they went off:

PHQ9 (depression)

0-4 none

5-9 mild

10-14 moderate

15-19 moderately severe

20-27 severe

GAD7 (anxiety)

0-4 none

5-9 mild

10-14 moderate

15+ severe

When I started, my scores were 18 (PHQ-9) and 13 (GAD-7), on the middle session 17 and 13, but by the last one they were 10 and 9. I know they are just numbers but I don’t think I’ve ever scored so low on them! And, even better, I think the scores decreasing actually matches how I really feel – a lot better!

I think my baseline is probably higher than the average person. So most people (without anxiety or depression) would score 0-5 on both as their baseline, but I actually think that even if things were amazing, I would never score below about 6-7 in either test. I am an anxious person and probably always will be, part of that is my personality. Likewise with depression, I tend to be a bit pessimistic and I am hard on myself and always have been, that’s part of who I am. I’m ok with that though, as long as my depression and anxiety are at manageable levels, it really doesn’t matter that I’m never going to score 0 on those bloody forms!

So I’m pretty pleased that according to my scores on that day, my depression has gone from the high end of moderately severe to the low end of moderate, and my anxiety has gone from the high end of moderate to mild.

Progress is good. I know the numbers aren’t reliable, for example when I completed the questionnaire the first time, I wasn’t entirely honest on the PHQ-9 and my actual score would probably have been 20+, but as an indicator, they are useful.

Love,

Ellie xx

*in case tone can’t be inferred here, this is definitely sarcasm!

Reflecting on CBT

I had my last session of CBT for fatigue this week. We were only allowed 8 sessions, but they have been quite spread out.

I found it really useful in some ways, but in others I am still dubious about using CBT to manage fatigue.

I am definitely more aware of how my fatigue, pain and mood are linked together. I have known for a long time that pain and fatigue cause my mood to be lower, but I came to the realisation that also my mood affects my pain and fatigue.

We looked at the “boom and bust” cycle, which is evident from my activity diaries. This is how it goes: I feel ok, so I make lots of plans and make myself busy (boom) but then it becomes too much, and I feel like I can’t cope, so I stop everything (bust). Then when I start to feel better, I start over committing to things to make up for my (perceived) failure, and so on and so forth…

Being aware of that cycle actually really helps. Even though that’s simple and anyone could see it, now I really understand it. It helps me understand my fatigue and also understand my needs. So now, when I’m feeling good and like I want to make LOADS of plans, I try to be more balanced. So, if I know I have a busy week, I try to leave the weekend relatively empty, or if I have a busy weekend, I make sure I have some weekends without plans. The ideal seems to be having plans on one day at the weekend and not the other, but that’s not always possible.

I think I feel more in control of my life than I did before. Now I am more aware of how certain things will affect me, I can sometimes control some of those things. I know that I will still make the same mistakes sometimes (hard to unlearn a life of constant busy-ness!) but I feel more in control and that makes me feel more positive about things.

The CBT helped me to change the way I think about things, and reminded me of the skills I learned before when I had CBT. I still find the thought traps really useful, I’m a big offender where they are concerned. It’s funny (in a weird way) that I have all these issues with anxiety and depression, because I spend a hell of a lot of time giving my clients advice and support for the very same issues I have myself.

Has anyone else had CBT for fatigue? (Or anything else actually?) How did you find it?

I’m planning to write several more posts on more specific things we covered in my sessions. I am feeling in a writing mood at the moment so I have lots of ideas for posts, just need to write them!

Love,

Ellie xx

Review: Jan-March

It’s the end of March which means we are already a quarter of the way through 2018. Where has the time gone?

I have been determined to make 2018 a better year, and I’ve been doing a little review each month in my bullet journal which is helping me notice changes, track goals etc.

I have noticed a lot of change in myself in these last few months. Even though I am definitely still having (quite a lot of) bad days, there are also the good days.

I wanted to do a quarterly review and look back at what I have done so far this year. So far in 2018 these are some key changes –

  • I am walking (at least) 10,000 steps pretty much every day now. This is huge for me as I was only doing about 3000 a day before I started working with the physio in November.
  • I am walking with my head up instead of looking at the floor all the time. I think this in itself helps with confidence, and is probably much better for my neck!
  • I am still keeping up with my mindfulness meditation. It has become part of my daily routine and I have done over 180 days in a row on my app. It is about more than maintaining my streak on the app now and I feel like I am able to take mindful moments in every day life.

I do a monthly review page in my bullet journal each month and I find that really useful to help me see my progress. I make a note of best moments, worst moments, favourite things and achievements from that month. This is definitely something I would recommend doing, as reviewing and reflecting is a good way to move forward and it reminds you of the positives rather than just focusing on the negatives.

I wondered about blogging my monthly favourites, so let me know if that is something you would be interested in reading!

Love,

Ellie xx

Progress

Progress is in the small things;

It’s getting through a whole CBT session without crying,

Going through a day without thoughts of self harm,

It’s feeling happy, even for a short while,

Remembering what it is like to feel proud of myself,

When the smile is real and there is hope for the future,

Making plans which I genuinely look forward to,

Little by little, step by step:

That’s progress.

Love,

Ellie xx

Progress 

I did a talk for another organisation this afternoon. I got really anxious even though it was informal and I know my own service.. I panicked and I don’t think they were impressed. 

Feeling pretty embarrassed as I know I didn’t seem very professional and they probably judged me. I am not a good public speaker at the best of times but today was not my best day. I hope they don’t judge my service by my talk. There was a snooty woman that made me nervous and that didn’t help! 

BUT and it’s a big but…

The world has not ended. I have not spontaneously combusted. Life goes on and so does my day. This is a revelation. My fear of failure would have had me in tears, full on panic attack mode. But although I feel a bit disappointed that I didn’t perform at my best, I feel ok. And that’s good. 

Progress!!

Love 

Ellie xx

Progress

So I finally realised that even though S makes me happy, it’s ok and good to be happy without him. Like an epiphany. Other people have probably known this for a long time, but it’s one of those things you need to realise yourself. I need to be happy myself because I can’t always rely on him to be there. This year (year abroad) I have so many opportunities and I really need to take them, and just enjoy the year. I can still be me without him.

I think I never really got that because when I was with the ex he made it so he was all I had. And it was suffocating and controlling but I didn’t know it wasn’t normal. I don’t want to be “S’s girlfriend” I want to be Ellie, who is also S’s girlfriend, and a friend, and a student, and a climber and and and…. And now I’m allowed, and I’m going to allow myself to be me.

Don’t want to jinx it but…

Things are going well. Really well at the moment.

I’ve moved to the town where my school is where there is a bit more civilisation and I’m starting to settle in. I really like my new flat, and I’m enjoying my job in the school too. Everyone has been so friendly towards me and it really does make a difference, without that I would be very lonely here.

I would say at the moment I am not depressed. I still have my down days (doesn’t everyone?) and I know there are still lots of issues, but I’m working on it. I am starting to catch my thoughts and challenge them. For example, Sheep cancelled our Skype meeting because she was going out (last minute decision), my initial thought was “she doesn’t want to talk to me because I don’t matter to her. She doesn’t like me.”, but I recognised that and challenged it: Why wouldn’t she want to talk when she is one of my closest friends? I know she cares about me because she is always there for me, and she made me a lovely cake and leaving card when I left England.

That’s a shallow example, but just shows how one tiny thing sets my mind off on it’s negative thought train, and how my self-doubt puts a lense over how I see things.

The only negative I have to report at the moment is the screaming/nightmares. I was on a school trip last week and shared a room with another teacher. Apparently one night I screamed once, cried multiple times, and talked to her (although I have no recollection of this – I was asleep!) It’s really strange, and in that case it was quite embarrassing – I’ve only been here a few weeks, and they don’t know about any of my “issues”. Luckily the teacher was ok about it and didn’t really question me. But this makes me wonder how often it does happen, as nearly every time I’ve shared a room with someone over the last few months I have screamed or something similar. Except with S… I’ve only screamed once in the night with him, and sometimes mumbled the odd scared whimper, but in general I don’t tend to have these nightmares when I’m with him. Maybe it’s because I feel safe? Who knows.

I want to go to the doctors about this when I go home (to England) but I don’t know if there’s anything they can actually do about it, and if there isn’t then I don’t want to waste their time. Does anyone know of anything that helps stop these night terrors (or whatever they are!?) or even what can cause them? Then maybe there are things I could change to prevent them!

But despite that, things are really falling into place at the moment – and hopefully they will stay this way. I am starting to feel like there is a way through my “issues”, and it will take more time, but I can do it. Recently I have caught myself having positive thoughts, and tonight on Skype I even told S “I’m happy here.” I mean I miss him – a lot, and my friends and family too, but I am still in touch with them all so it’s not too bad, and I know I’m going home for a visit in a couple of weeks, but everything is going well. When I first found out I was coming here, to this small remote town, I was really upset, really worried, but now I’m glad I’m here. And the small place has given me the opportunity to get to know people more easily, and also the opportunity to speak lots of German, as in a small place like this people don’t speak much English (compared to in a big city where a lot of English would be spoken!)

I hope I’m not jinxing things by writing this post. I have held off writing this positive post for a while – just in case it turned things bad! But here it is – a positive post from Ellie!

Now I’m off to bed, and tomorrow I get a lie in as it’s a national holiday tomorrow so there’s no school!

Lots of love,

Ellie xxx

The end

It’s done, finished, over.
Today was the end of CBT for me.
It wasn’t a proper session, just a concluding one – questionnaires about the service, reassurance that if I need to come back after my year abroad I can.
Looking at a scale from 0 to 100, where 0 was the worst I felt, where am I now? And where is recovery?
No one feels good all the time so 100 is not recovery, It’s perfection (which doesn’t exist). We settled on 75 as acceptable – as recovery.
And where am I now? It’s hard to say because my mood varies a lot. I think I’m somewhere around 50ish, maybe up to 60 at times. But when I feel low it goes down a lot, not to 0 though, so its still not as bad as it was.
So take 55, and 75 is “recovered”… It’s not that far away.

I know I still have a long way to go and a lot of things to deal with along the way, but I’ve certainly made progress.
The fact that I’ve started some mindfulness shows improvement – mindfulness is not generally used for people who are severely depressed because it involves thinking about the negative thoughts, and would not be easy when someone is that low.
I still have my downs (and ups) but It’s better than a constant down.

Now I feel strange. CBT is done, over. It’s just me fighting my battles now, A has done her bit. I guess I was hoping by the end I would be magically better (100) but it didn’t happen because it doesn’t exist.

I feel kind of empty. Scared, and alone. Now what do I do? What if…

I can’t believe this was the last session, now it’s time to cope on my own.