Happiness is…

…snuggling up in front of the fire, guinea pigs splashing around in a bubble bath, hot steamy showers, the wave of pain relief washing over me, making plans and chasing dreams, wrapping up in a toasty blanket, rain running down the window pane, sleepy smiles, cloudy winter mornings 

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Disappointments, Direction and Decisions: Visiting the Musculoskeletal Clinic

Yesterday felt like a big, anxiety-inducing, sad-making day.

I woke up early knowing I had to attend my MSK Clinic appointment with butterflies in my tummy and a raspy dry throat. Perhaps it seems a little over dramatic to feel this way, but I’d be lying if I said I wasn’t anxious.

Truth is, I had been waiting for this appointment for months, having had to be re-referred to a different service in a different part of the country since moving back after my university studies. This appointment would determine what kind of support I’d be entitled to back in my hometown, and having got used to the routine and effectiveness of treatment back in my university town, I was extremely anxious at the prospect of having no support at all, which seems like an exaggeration, I know.

You see, it is very much a postcode lottery when accessing healthcare.

As much as I love the NHS, I must say there really is a huge difference with regards to provisions and accessibility depending on where you are in the country. It’s all a bit touch and go with certain services, as each have different approaches. Back in East Yorkshire I’d been lucky enough to receive frequent acupuncture treatment, excellent mental health treatment through several talking therapies, and access to a neuro consultant, occupational therapy and physio. Though I’d seen a physio and neurologist a long time ago back home, I hadn’t ever seen an occupational therapist despite having cerebral palsy. I also hadn’t had frequent acupuncture, or had monitoring of my curvature since the age of sixteen. It made me anxious to think all the fantastic progress I had made in Hull could possibly be stripped away just because the services and provisions aren’t available here.

All of this explained the butterflies and raspy throat, I guess.

As I suspected, things have changed. Much to my disappointment, they don’t offer acupuncture here. This was a little hard to swallow (and accounts for my exclamation of ‘oh no!’ in the consulting room) and though I was offered facet joint injections back in East Yorkshire, I was told I probably won’t be able to have them over here for a few years owing to my age. I might also have to consider a spinal fusion in the future (eek!) so they’d want to reduce steroid exposure to a minimum.

Again, fairly disappointing.

It’s not all bad, though. I will be discussed at their monthly review -‘they’ being made up of doctors, spinal consultants, neurologists, nurses and pain management specialists – and it is likely I’ll be able to access support to help with the mental struggles of the cerebral palsy and scheuermann’s, which is really quite exciting considering this aspect has never been discussed. I’ll also have specialist physio, with therapists who know the condition, and will be able to advise me accordingly, a change from the ‘I’ve never actually seen scheuermann’s in a person before!’ physio I’ve had previously. So, I’m feeling a bit mixed-up about this one. I am seriously gutted I can’t have acupuncture, and will be looking into private treatment options.

However, I am feeling a glimmer of hope, and really feel that the mental health focus will help. It is also lovely to know I am not alone, so a big thank you to Ben for coming with me to my appointment. This is a start, and I have at least some direction, and I’ll just have to hang tight and see what’s in store.

I’ll get there, I’m sure.

Sending warm bear hugs on this chilly day…

Heather x

Therapy: Letting Go

It’s been a while since I started CBT, and I recently had my final session. CBT, though essentially great, brings up some conflicted feelings. I suppose that’s inevitably the case with  any talking therapy, but as my CBT went on for almost three months, I feel like I really invested a lot into each session.

Therapy for mental health conditions can be really helpful, but – and as with any treatment – you can’t expect a quick fix. Admittedly, though I’ve had counselling before, when I first started CBT I didn’t account for just how hard I’d have to work and how emotionally draining I’d find it. Walking out of the first session I felt simultaneously overwhelmed and absolutely empty, and I remember walking around the nearest supermarket aimlessly and directionless, with what felt like a flick-book of every emotion I’ve ever felt whirring through my head. It did, of course, get easier over time, but I always found it difficult to snap back after each session. 

Each of my sessions were tailored to me each week, depending on the situations I found difficult, and the topics I really needed to address. I loved this part of the session, as we’d draw up an agenda and tackle the issues most important to me. Essentially, though, what each of my sessions boiled down to was working through my low self esteem and trying to recognise and acknowledge the good things I have done. Thing is, I get so blinded by feelings of anxiety, hopelessness and inadequacy that I completely ignore the good and positive things I have achieved throughout my life.

I also spent a considerable proportion of my sessions working through hypothetical situations that I often worried about, with the aim of learning to accept  that I cannot control everything in my life, and I cannot solve everyone else’s issues. This was a particularly challenging topic to address, but I feel like I made some really positive progress in learning to accept and work through these issues.

CBT also addressed what felt like a dirty little secret for far too long. Thing is, I always suspected i had OCD-esque traits, but I’d never actually been diagnosed. Along with the assessor prior to my CBT, we agree that I do have OCD that fluctuates from day to day. I have always been a stickler for routine, but I knew things were a bit unusual when I found myself checking clothes, and jewellery, and other things that really didn’t require constant checking, like whether my alarm was set or that my door was locked, even though I could see that the latch was on. It’s frustrating, because no matter how much I know that these things don’t need checking, I cannot resist. And if I try to resist, I feel an unstoppable anxiety bubbling up which can only be ‘quelled’ by checking. Of course this only reinforces the behaviour, which makes it a really hard cycle to break. I have worked on techniques to help, and I am noticing that I’m getting better, even if this progress is only slow. 

CBT provided some great coping mechanisms to work towards in order to reduce the symptoms of anxiety and depression. These include keeping logs of activities that I’m particularly apprehensive about, or recalling situations that I found difficult and then examining mine – and other people’s – responses. Crucially this made me acknowledge that situations aren’t as bad as I expect them to be, and that working on evidence – and not speculation – is key to working towards a happier, less anxious life. 

Now that my CBT has come to an end, I’m facing the everyday struggles with a mixture of apprehension and pride. I’m proud because I’ve really improved, but apprehensive because I suddenly feel all alone. The relationship with your therapist becomes a really important one; they’re there on a professional level, to help you through what can sometimes be the most challenging times of your life, but they somehow become more than just a confidant as you build up a relationship with them. You open yourself up completely to them, and they are privy to some of your greatest fears, deepest emotions and darkest secrets. They become integral to working through your mental health issues, and  invest a great deal of time and effort in helping you. I feel a little bit lost facing the big, bad world on my own, but I am so grateful that my therapist has equipped me with the skills to tackle this on my own. 

I suppose I’m finding it difficult to let go. I know that I’ve only just embarked on my ‘journey’ (and no, I’m not keen on that explanation, but it’ll have to do) but I know it’s going to be a long, hard slog. My mental health does fluctuate, and dealing with my physical disabilities brings another layer of complexity to proceedings, but I’m positive that I’ll get there; whenever ‘there’ may be. 

I am letting go, and I am learning that I can do this on my own. I just need to prove it to myself. 

CBT, OCD and Coming Clean

It’s been a good few weeks since I started CBT, and thought now would be the right time to share my experiences with you so far.
Since my mental health conditions are ongoing, I’ve had multiple assessments and this isn’t the first time I’ve had ‘talking therapy’ in order to help alleviate the symptoms of my anxiety and depression. When I initially presented with mental health problems, we decided counselling would be the best thing. Counselling is more about talking through the issues that are bothering you; CBT is working out how to change your behaviours and learning how to better rationalise your thoughts by searching for ‘evidence’, rather than clinging onto assumptions. Though I actually really benefited from counselling, it was the right thing for the time. I hadn’t explained my deepest, darkest fears before; I hadn’t confided in someone and told them all about my secrets and how I felt about myself and so on. And for that time, counselling was great. It gave me a voice, and provided that undivided attention I needed to address these issues and tackle my mental health head-on. Now I’m at a different stage in my life, and I didn’t feel talking about everything again would be beneficial right now.
This is where CBT comes in. The NHS defines CBT – or cognitive behavioural therapy – as ‘a talking therapy that can help you manage your problems by changing the way you think and behave’, and is particularly useful for ‘anxiety and depression, but can be useful for other mental and physical health problems,’ (NHS, 2014). Rather than just discussing your thoughts, emotions and resulting behaviours, you are actively developing coping strategies and methods to manage your behaviours, which are often unhelpful and perhaps increase feelings of anxiety/depression.
It’s quite a long-winded explanation, so I’ll try and illustrate with an example from my sessions:
Situation : Seeing deadline date in diary
creates
Thoughts and Images: of a bad mark, disappointing others, feeling unworthy and useless
These thoughts and images then produce
Emotions and Physical Sensations: ‘nervous tummy’, palpitations, impending sense of doom and anxiety.
as a result of these emotional and physical sensations, my behaviour changes:
Behaviours/What I did: withdraw, ruminate, ask for reassurance, plan rather than do, hide away from impending situation.
These behaviours then reinforce my Thoughts and images, and so the cycle perpetuates and continues. The idea here is to address the behaviour; it is very difficult to stop the thoughts, but I can stop behaving in an unnecessary and unhelpful way. So, rather than withdraw, perhaps I should focus on what I have done. Changing this focus involves taking into account my good marks, keeping an activity diary to show myself what I have achieved despite how I’m feeling. I know this sounds so simple, but I often get too blinded by my anxiety and depression that I forget what I have done. It helps me immensely to keep track of this.
If you’ve had dealings with anxiety, depression or similar conditions, you’ll know how troublesome assumptions can be. And when I’m at my worst, when the irrational thoughts pop into my mind, it’s so hard to get rid of them. My therapist is keen on getting me to realise that my assumptions – eg ‘people think I’m stupid – are just that; assumed, with no real evidence. Assumptions are largely negative, and don’t help anything, so I’m working on undoing that negative thought process and replacing it with something useful, instead.
Another thing we’ve identified during my sessions is the fact I have OCD -obsessive, compulsive disorder – and have been engaging in classic ‘OCD’ behaviours, including repeatedly checking. This was a bit of a revelation for me. Admittedly, I did wonder whether the checking I’ve been doing was normal, but I didn’t realise it was OCD. I tend to become fixated with checking various things, including checking locks on doors, both in my own place and when using bathrooms on campus, and sometimes this checking can go on for minutes. On a particularly bad day, I’ll go to check multiple times an hour, or wake up and check because I’m so anxious about whatever it is I’m checking. I also like to have certain items arranged in a certain way; the hangers on my clothes rails are often rearranged every night for fear of ‘ruined’ clothes. I am always worried about things breaking because I didn’t put them away properly, so jewellery is often checked and put back, and my alarms set, reset, checked, set, reset, checked…you get the idea. It’s strange. Thing is, I know these things aren’t actually useful, but at the time, checking things is the only way to rid myself of the anxiety. It’s complex, because the more you check, the more you find it difficult to not check. My therapist described these behaviours as coping strategies, as they help me to feel like I’ve regained control, even if it’s just momentarily. And even though I know my door locks as soon as you close it, it just isn’t enough. It’s like my irrational thoughts, and my unhelpful assumptions; I know it isn’t really helpful, but in that moment, and at that time, that’s all I can do to alleviate my worry.
Undoing these things will take time, and will have to be done step-by-step, but for now I’m feeling positive, and I’m hoping to get the most out of my sessions. I have another on Tuesday, and hopefully my progress will continue.
It feels good to be sharing my progress with you. This is a good way for me to see how far I’ve come, and hopefully I’ll be able to look back at these posts and feel proud. I haven’t always been upfront about things, particularly the OCD, and it’s time to just accept it and learn how to deal with it. Mostly I’m sorry that I hadn’t told Drew, or at least not enough. Hopefully I’ve rectified that.
It’s fairly stressful over this way, but as always, I’ll find a way.
Hope you’re doing well and look after yourself.
Heather x
ps: here is the link to the NHS page regarding CBT if it’s of any use:nhs.uk/Conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx