Saturday, 19 October 2019

Trauma Focused CBT: Session One

(Trigger Warning: PTSD, abortion, self harm, and suicide mentions)

Last Thursday, I had my first session of Trauma Focused CBT. I was nervous and reluctant to go, leading up to this appointment. I was worried that I would be made to talk about things before I was ready. I didn't want to be in floods of tears in a public place, and I didn't want to be badly triggered either.

The therapist I saw, was the same one I saw for general CBT a while back. She is a compassionate, yet matter of fact therapist, which I find is a good balance for me. I don't like people to sugar coat things. I'd rather be told straight out if something needs to be said. Of course, I need the compassion too, especially when talking through some very difficult events.

At the start of the session, I was asked to fill in the usual PHQ etc forms (for Depression, Generalised Anxiety, Phobias etc) as well as a risk assessment for suicide/self harm. I gave similar answers to that of the questionnaires I filled in during my phone assessment. I think it will be very difficult to find a way to improve my scores on these; especially as I am on a low dose of Citalopram now and it's not doing a lot yet.

After this, my therapist asked me to give a brief description of my (main) trauma. This was about my termination 10 years ago. I told her some things, but she realised when I was getting distressed, and didn't push for me to carry on.

She then explained the difference between general CBT and Trauma Focused CBT. That is, that with general CBT, cognitions (thoughts) are challenged. This does not happen with trauma focused. Thoughts themselves are not challenged, but different perceptions are considered. So, in a way, ideas around the traumatic event are broadened, and other perspectives are allowed in.

My therapist then showed me the theory of CBT by drawing on a piece of paper. She wrote "Thoughts" "Emotions" "Behaviours" and "Physical Symptoms" round in a circle shape, with arrows to show how one leads to the other. We went through the main thoughts I had around my termination (she also asked me why I preferred to use the word "termination" rather than "abortion". I told her that "termination" seemed like a softer, more distant term, even though I knew they meant the same thing. She said one aim she wanted me to work towards was to be able to say "abortion" comfortably).

The thoughts, or themes, I felt around my termination were "guilt" "regret" and "loneliness". The emotions I had were low mood, and feeling like this was my only chance to have children (I can't remember what else I wrote). The behaviours included avoiding conversations, and becoming triggered when exposed to conversations, television storylines etc based around termination. She asked me what happens when I am triggered. I told her it was one of two things really. I could become inconsolable; in floods of tears, and panicky, as if I couldn't cope with life. On the other hand, I could dissociate.

She wanted me to explain what happened when I dissociate. I said I felt spaced out, as if I was having an out of body experience. I may go very quiet, and will freeze, as if I can't do anything. I will also stare at walls. It could take hours before I can ground myself. The ways I ground myself include grabbing something near me (a pen, for example) in order to remind myself that I am in my body and I do exist. I could also focus on what I can see, smell, or taste. So it's all based on focusing on what stimulates my senses. It's not easy, but it works eventually.

As for "physical symptoms" I explained that I found it very hard to separate the ones I had due to my mental health problems, and the ones I had due to my physical conditions (i.e. Fibromyalgia and Hypermobility Syndrome/Hypermobile Ehlers Danlos Syndrome). After thinking about it for a while, I found that I felt exhausted, achier, tensed up (especially from clenching my jaw throughout the day) and dizzier.

She also said that we would go through my trauma in little chunks, at my own pace. Sometimes I might want to talk about it all at once, sometimes I might only manage some brief detail. She explained also that some of the topics we will go through include grounding skills, and establishing a "safe place". She asked me if I'd come across the term "safe place" before, and if I knew what it was. I said I'd used the term before and I suppose my safe place would be my home.

My therapist explained that it was a vision/memory of a place that makes me feel calm and safe (a sandy beach for example). I would use this safe place to escape to, in my mind. I would think about what I could see, smell, hear, feel etc and I may do a gesture (such as clenching my fist) to bring me to that place in my mind. I suppose clenching my fist could indicate wanting to hold some sand in my hand, and feel the soft grains running through my fingers.

We talked through what my aims were for therapy. I said that I felt I hadn't processed my trauma properly, and I needed guidance in order to do this. I would also like to be able to talk through my trauma with more balanced emotions. I wanted to not be so triggered, and I would like to ground myself more easily if I dissociate.

Finally, we did a screening questionnaire. These were 22 questions that my therapist would read out to me, and I would answer "not at all", "a bit", "moderately", "quite a bit" and "extremely" depending on how severely I related to the statement. I found that my answers were mainly "quite a bit" and "extremely". To meet the criteria for PTSD, I had to get a score of about 33. It turned out that my score was 65, so showed that I had very significant PTSD. So there's another diagnosis to add to the list!

Although I wish I didn't have so many diagnoses, I am glad that my problems are validated and I have a name to put to them. For about a year, I suspected I had PTSD, but I wasn't sure if I quite fit the criteria. At least now I know that I do, and I hope that Trauma Focused CBT will at least lessen some of my struggles.

After my appointment, I felt very overwhelmed and in my own head. I'm only just starting to come out of this, but I still feel rather overwhelmed. Things from my past are coming to the forefront now, and I'm finding them very hard to face. I know that I need to face these things if I ever want to move on though.


Treatments for PTSD:

PHQ-9 Depression Test Questionnaire:

Dissociation and dissociative disorders:

Grounding exercises:

Finding a Safe Place is Important for PTSD Recovery:

Online PTSD questionnaire:

Tuesday, 8 October 2019

Let's make sure "Every Mind Matters", by funding our Mental Health Services!

It's "Time to Talk", "Ask Twice", "Be in your mate's corner", and currently "Every Mind Matters". These buzz-phrases are easy to remember, and uplifting I suppose, but how helpful can they be for mental illness?

A lot of these mental health awareness campaigns aim to get people reaching out, talking about their mental health; whether they have a diagnosable mental illness, or their mental health isn't as good as it could be (mental health and mental illness are two different things, but that particular thing is for another blog post). They also aim to get people reaching in and checking if their loved ones are really OK.

I took part in the "Every Mind Matters" Mind Plan quiz today (you can take it yourself here ) and was given these 5 pieces of advice:

  1. Relax your muscles and mind - I was given a video to watch, in order to help me with this.
  1. Move more every day - "Why not try getting off the bus or train a stop earlier, or taking the stairs more often?"
  1. Make time to do something you enjoy - It suggested going to the cinema, or listening to music.
  1. Make time to chat - The emphasis was on chatting over the phone or in person
  1. Take time to reflect - This piece of advice wanted me to focus on the good things about my day.

None of these are necessarily bad pieces of advice, but they are extremely simplistic considering the answers I gave. I have severe Clinical Depression, severe Generalised Anxiety Disorder, as well as Obsessive Compulsive Disorder, Borderline Personality Disorder, and possibly Post Traumatic Stress Disorder (not officially diagnosed, mainly because specific treatment isn't available with my local mental health team). My answers included statements that I was often extremely stressed, anxious, low, and struggling to sleep well. This barely touches on the big messy knot that is my (extremely poor) mental health, but even taking this miniscule fraction of it, I'd expect to be getting better advice than moving more, thinking positive, and chatting to a mate.

It's great that there's more awareness of mental health problems, and that people are being encouraged to talk to each other (whether that's reaching out or reaching in) but the appropriate services need to be there when people ask for help.

Just as medication, advice, and possibly seeing specialists is usually what happens when diagnosing and treating physical health problems, so should it be considered when diagnosing and treating mental health problems. Specifically, we need more choice of psychotherapy, better crisis services, more psych beds. We need less of a wait for therapy full stop. Community Mental Health Teams (for people with more serious/complex mental illness) need sorting out too. Too many people fall through the ever widening gaps because their needs are not able to be met.

Do you know how disheartening, even dangerous it can be when you finally muster up the courage to ring for help (whether that be IAPT, CMHT, GP etc) and be told there's either a wait, you need to ring someone else, or even that the help isn't available? I've become suicidal after being knocked back by mental health services. They are supposed to help you get better, not make you worse! Mental Health services in areas such as mine are woefully underfunded, and those with complex/serious mental health problems are given barely any therapy, if any.

If #everymindmatters
then make sure our minds are looked after, by properly funding our NHS mental health services!


Your Mind Plan - Every Mind Matters:

Improving Access to Psychological Therapies:

What is a Community Mental Health Team?: