Saturday 31 March 2018

CBT for Anxiety Session 4 - Overwhelmed, But Less Anxious

At the time of this assessment, I was feeling quite low, but my anxiety levels weren't too high. We went through the usual PHQ etc paperwork and then the therapist asked how things had been recently.

I started off by talking about the fact that I was moving house with a friend of mine. At the time, we did have a house lined up and had paid the agency fees (Unfortunately we lost the house, but this was a day or so after the therapy appointment). I said I was looking forward to moving, but felt very overwhelmed by everything that needed doing e.g. boxing up what I needed to move, chucking out what I didn't need anymore, booking a removal company for the day etc. One other thing that worried me was whether DWP would make assumptions about us living together. I worried that they would think he was my partner and that, because he worked full time, I would lose my benefits. The therapist reassured me that they would be very unlikely to assume this as the house has more than one bedroom, if they went so far as to check my bank statements, they would also find no money from my friend going into my account. If I was still worried though, she advised I see Citizens Advice Bureau.

The next thing we spoke about was my nan. She's out of the hospital finally, and under the care of the Enablement Team (they basically give care for things she can't do and encourage her to do the things she can do). She reluctantly agreed to have this team help her for up to 6 weeks, but she's already cutting down how many times they can visit (from 4 to 2 per day). They note down the things she can and can't do, as well as observations (such as her cognitive struggles). More people involved in Nan's care are starting to notice how poor her mental health and capacity have become. She seems quite depressed and forgets things easily. She'll get confused and won't be able to fully process conversation; especially if more than one person is speaking. She can be quite inappropriate and rude too.

I explained to my therapist how I was finding it stressful and difficult to cope with Nan, and making decisions for her felt like a role reversal. I found it hard to decipher which of her views and behaviour were parts of her personality, and which behaviours were warning signs for Alzheimers. She is having a cognitive assessment soon though, which should clear things up (hopefully!)

My therapist reminded me that Nan is not solely my responsibility, and that it is also up to other members of family to help out.

The next overwhelming thing was a message I received from a friend I'd blocked a while back. This friend had been my "Favourite Person" for many years. (I have included a link to the article I wrote for The Mighty). He had read The Mighty article and wanted to apologise for everything he'd put me through. I have recently replied, but at the time I didn't know what to think! It was very unexpected and I found myself missing him a lot. He has not yet replied to my message, so again, I'm not sure what to think.

Lastly, we came on to the topic of anxiety with travelling alone. I'd filled in a worksheet of distressing situations, how I would rate them, and the order from most distressing to least. I'd managed one of the least distressing situations (walk to the shop alone) but was due to try one of the more distressing tasks (taking a taxi by myself). Although he gave me a lift to therapy, my dad couldn't give me a lift back home. I told the therapist that, although it felt like a daunting task, I felt ready to give it a try.

For homework, she wanted me to keep trying these distressing situations, but also to fill in a thought record to monitor how I felt, what thoughts I had, what alternative views I could have, and what happened/how I felt afterwards.

Once therapy had ended, I geared myself up for phoning a taxi, and then taking the taxi back home. I had to have a break first, to slow my breathing down, then I phoned. Luckily, I didn't have to wait long for the taxi to arrive, and I didn't panic when I got in! I feel like I could do this again, although not regularly.

I feel like CBT is really helping with my anxiety. I feel more ready to do some things that I wouldn't have even thought of before. I feel like I'm getting closer to seeing friends on a more regular basis, I just need to try tackling my anxiety with busy places now!

Tuesday 20 March 2018

The Big Meeting

A couple of weeks ago, a meeting was set up to discuss concerns about my nan, and the needs that she has. Nan insisted on being present at that meeting.

Myself, my parents, and some of my uncles were also present. Luckily, we had time to cover one topic out of earshot of my nan. This topic was her mental health and capacity.

Over the past year or so, some family members and I have started to notice some changes in Nan's personality, memory, mood, and ability to process things. She seems very depressed as well as argumentative and verbally aggressive at times. She is finding it hard to follow conversations and often forgets things or mixes things up. She has trouble organising her medication. She does not cope well with bright lights or any kind of noise, and often complains of her head thumping. She doesn't seem to realise how much help she needs either. There's probably more that I can't think of right now, but these signs and symptoms are definitely worsening.

I explained all of this to the staff present (namely a doctor, an occupational therapist, a social worker, and a discharge nurse) and the doctor said he would arrange for Nan to have a cognitive assessment. I think the nurses involved in her care had noticed certain things themselves.

Straight after this, my nan came into the room. She basically lectured us on speaking about her behind her back. I wasn't sure what to say to this as I feel conflicted about it. I don't like to speak about people behind their back, but there are important things to be said that might not have been put across properly if Nan had been there. She tends to speak over people and doesn't allow them to finish what they say, especially if she disagrees with it. We needed to be able to voice some of our concerns in a way that would allow the hospital staff to understand.

Once Nan had (finally) sat down, other concerns were voiced by the present members of family. These included her struggles with sleeping in bed (she sleeps in her recliner chair as she cannot lift her legs to get into bed), as well as struggles organising medication, needing night visits from carers (but these not being available), problems with incontinence, problems controlling her type 2 diabetes, the help she needs to shower, and other help she may need since having a major operation (a full hip replacement).

Naturally, my nan disputed a lot of things and we had to explain to her why we had these concerns. The discharge nurse, occupational therapist, and social worker tried their best to explain too. The occupational therapist had a list of equipment she could order to make Nan's life a little easier. This included a shower chair with a back, a commode in her bedroom, a grabber (as she is not allowed to bend from the hip more than 90 degrees), a perching stool, a key safe, and equipment to help her lift her legs. Nan rejected a lot of this equipment, saying she didn't need it, but she did agree to the shower chair, perching stool for the kitchen, and key safe.

The next topic was help with care. The occupational therapist explained that Nan would have visits 4 times a day, for up to 6 weeks, from the Enablement Team. This is a team of carers who would observe and encourage Nan to do what she can for herself, and help her with things she cannot do. This help is free, and is designed to rehabilitate Nan so that she is able (with the help of carers) to look after herself in the community. Nan didn't see the point in this, as she believed the carers at her care home would do everything whenever she asked. This is not the case however, as the care home she lives in is vastly understaffed, and does not provide night visits. The Enablement Team unfortunately do not offer night care either, so would see my nan first in the morning.

Once everything had been agreed and clarified, the meeting came to an end. The family were left for a few minutes, to discuss things amongst ourselves, and this included explaining things to Nan again. She seemed to accept what was going to happen, if reluctantly.


Yesterday, Nan was discharged from hospital, and brought home by hospital transport. We were told the transport would arrive at 12, and it'd be around 12.30 that she would be home. What actually happened was the transport arrived at 1, and dropped Nan home around 3! My dad was left waiting 3 hours to let the transport staff (and my nan) in the flat. Luckily, she'd had lunch before being discharged, so didn't complain about that. The Enablement Team arrived a couple of hours after that. I am waiting to hear how she is getting on with this team, so I will keep you posted!

Wednesday 14 March 2018

CBT for Anxiety Session 3 - Facing my Fears

I had my latest CBT session on Monday, last week. On that day, as well as the stress and worry about my Nan, I'd had a shock after finding out a close friend of mine was transphobic. This seemed very out of character for him, but the post he had supported was so obviously abusive that I had no option but to block him.

Losing friends in any way is very distressing for me. I may dissociate or panic, my mood will plummet and the whole thing will play on my mind for at least a few days afterwards. Needless to say, I was on the verge of a panic attack whilst on my way to therapy. I was looking forward to therapy, however, as I really needed to vent how I was feeling.

Therapy itself went very well. Surprisingly, I didn't cry (although I was pretty close!). We talked about losing friends, as well as my Nan and her declining health. I found my therapist quite validating. She understood why I felt the way I did, and was reassuring as well

After all that, we moved onto the main reason I wanted CBT; to get out of the house more. We talked through the topic of Panic, and discussed the booklet she had asked me to print off. I'd filled in the activities I was asked to complete. I'd mentioned my symptoms of OCD as well. She wanted to know more, and whether it was still a problem for me.

I'm sure I've written about my OCD before, but cannot find the post right now. I may edit and add the link if/when I find it, but for now I will describe the obsessions and compulsions I have.

The first time I started having symptoms of OCD, I was about 13. I was being verbally/psychologically bullied badly and was looking for something/someone to help. I didn't talk to friends about it, as one had spoken to the bullies (in a well meaning but misguided way) and this had made it worse. Teachers didn't help either; arranging a meeting where I'd have to speak out in front of the bullies which of course meant I didn't have the courage to say much.

At the time, I and a few friends had started to dabble in Paganism. It was on a very superficial level, so I couldn't explain what it is to you in detail. We learnt blessings and prayers though, and I thought that saying these blessings/prayers may help to protect me from the bullies. It eventually got to a point where I "had" to start them at exactly midnight, and had to repeat them three times every night. If I had a bad day the next day, rather than blaming the bullies, I blamed myself for not saying the prayers/blessings in the "correct" way. I also carried things (which I saw as lucky charms) in certain pockets of my blazers. I would panic if I could not find these things straight away and I would hold them throughout the day for reassurance.

Once I left school and the bullying stopped, these compulsions stopped. Later on, I started to get an overactive bladder and this really heightened my anxiety and need for control. I would "go" at least 4 times and each time, I had to wipe 10 times. I would count to 10 each time. This would lessen my anxiety slightly but for the rest of the day, needing the toilet would be at the forefront of my mind.

My compulsions are much less, since I've been on Sertraline and since I've taken Vesicare for my overactive bladder. I don't spend as much time in the toilet, so I don't see these symptoms as a real problem now. Other than this, I do some things in three's but I don't think they are done strictly enough to be called compulsions.

I explained all of this to the therapist and she was reassured that I don't really fit the criteria for OCD any more. I can't tell you how relieved I am that these obsessions and compulsions don't have so much control over me anymore!

Anyway, onto my other anxiety problems, e.g. getting out of the house. At the moment, my limit is to occasionally walk from my house to the local shop, and do a small shop by myself. I have gone from being on the verge of/having a panic attack to just feeling moderately anxious. I'd say this is progress! I do want to be able to travel further by myself though. My therapist gave me a worksheet with a table to fill with distressing situations. For my homework, I had to list the distressing situations I wanted to work on. I'd have to rank them from most to least distressing, as well as rating them from 0-10 (0 being "no distress" and 10 being "extremely distressing"). I have listed as many situations as I can for now, and I will write them below:

  1. Do some volunteer work (10/10)
  2. Go to a Slimming World group with mum (9/10)
  3. Take a train somewhere, alone (9/10)
  4. Take a bus into town, alone (9/10)
  5. Take a taxi into town, alone (8/10)
  6. Take a bus, with mum (8/10)
  7. Take a taxi to therapy, alone (7/10)
  8. Take a taxi with mum (4/10)
  9. Walk to the shop, alone (3/10)
There are various reasons why each of these is very distressing or not so distressing. It depends on factors such as, how familiar the destination is, how busy the destination is, how busy the mode of transport is, how long the journey is likely to be, how easy it is to get out of the situation etc. For example, walking to the shop alone doesn't cause too much anxiety now as I know the journey and the destination well, I tend to know how busy the shop is at certain times, I know how busy the journey there is likely to be, and I know I can escape the situation whenever I like, without anyone noticing. On the other hand, going to a Slimming World group means going to a destination I don't know well, with a big group of people I don't know, I may be required to speak up, I'm expected to last the duration of the session, and getting out of the situation early wouldn't go unnoticed. 

I am so fed up of being controlled by my mental health however. I want to be able to face my fears and get to a point where I realise nothing terrible is likely to happen. With the help and encouragement from my therapist, I hope to at least tackle some of these distressing tasks.

Wish me luck!

Thursday 1 March 2018

Family, Social Services, and a Whole Load of Stress

I'm sorry for my silence recently! I've had a lot going on, mainly with family and illness. I will try to explain this in a somewhat coherent manner.

A couple of months ago, my Nan went into hospital for a total hip replacement operation. She has other issues, such as Arthritis all over (we're not sure which type), a worn out total replacement on her other hip, Type 2 Diabetes, double incontinence, memory problems and could potentially have the onset of Dementia. The nurse at the hospital originally said Nan would be in for 7 days, but this was before all the other issues were noted.

The operation went as planned, but due to these other issues, she is still in hospital. As well as all of this, she contracted Norovirus, so has had to stay in another 2 weeks regardless. Despite extra infection control measures, visiting members of the family (including myself and my parents) caught Norovirus too! Because of this, we've not been able to visit Nan for over a week, which is a worry as she does not cope well by herself. She doesn't mix well with other patients and will only "socialise" (to use the word very loosely) with family members.

Another issue is the care home she lives in. It does not have an adjustable bed, so Nan spends 24 hours a day in her adjustable chair (bought by herself years ago). She sleeps in that chair, badly, and due to such poor mobility, is almost completely sedentary.

She has carers in, but she has cut their hours down to the bone, as she thinks struggling on her own (even with her risk of falls) is acceptable. The care she does get is not adequate in the slightest. Before she went into hospital, she was getting care for 15-30 minutes in the morning; which mainly consisted of a very quick wash from her chair. She did have carers come to take her laundry now and again, but clothes etc often came back still dirty. It appears she is also paying for more care than she is actually receiving.

The care home itself is vastly understaffed. At night, you are lucky to get two care assistants and in the daytime there are often only two carers covering the whole home (which has quite a few flats as well as bungalows attached to the home). Nan needs two carers to help her to shower, but the home is unable to provide this, so Nan's hygiene is unfortunately quite poor.

Onto Social Services! Well, they have been involved to assess Nan's needs and whether the care home is suitable for her anymore. My family have agreed that it is now a nursing home that Nan needs because of the amount of personal help she requires. Dad has been speaking to a social worker, but despite all of our concerns, the social worker is under the impression that the care home will be able to provide the levels of care required. This is something we struggle to believe but it looks as if we'll have to trust the care home to do this, and if it is not done then we are going to have to find a nursing home for Nan.

In the meantime, next week there will be a meeting with the care home manager and an occupational therapist (as far as we're aware?) at Nan's flat, to see what other equipment she needs before being discharged. There will also be a bigger meeting with whichever relatives are available, at the hospital, to come to an agreement as to what Nan needs and whether she will be ready to be discharged soon.
One of my uncles does have the legal right to invoke Power of Attorney, so we need to discuss whether this is something that needs to be done yet.

We want her to be happy, but we also want her to be safe. It is very difficult and has caused arguments as Nan is not good with change and is very home sick. I will do another post once everything is finalised.