Thursday 18 January 2018

CBT for Anxiety Session 1 - The Assessment

(TW Suicide and Mention of Sexual Assault)

I've decided to try Cognitive Behavioural Therapy again. This time, I want to focus on my anxiety issues with travelling alone. I've had CBT 3 times in the past, but without a specific goal so this is partly why I think it didn't work for me. I didn't know what exactly I wanted to achieve, apart from a lessening in symptoms. Previously, the focus was on my Depression and suicidal ideations. I found CBT unhelpful for this however, as I felt my issues were more complex than this type of therapy allowed for. At the time, I didn't know I had Borderline Personality Disorder however, and this is probably why CBT didn't work for me. Recently, however, I felt trying CBT with a focus on one of my anxiety disorders, with a specific goal/problem would probably be more effective.

After a self referral, a telephone assessment, and a few months on the waiting list, I had my first session earlier this week. As it was session 1, it was more of an assessment however. The therapist initially gave me the standard questionnaires to complete (PHQ-9, GAD-7, phobias and work and social adjustment scale (see page 5)) Once she had looked through my responses, she discussed my suicidal thoughts with me to find out whether I'd attempted in the past or made plans, and if I had plans to end my life right now. I reassured her that although I used to have quite strong suicidal thoughts, they are more passive now and would only be likely to become active if I were to suffer a sudden loss of support or someone from my support network (such as a close friend, parent, or my cat).

She then went through my diagnoses (both physical and mental) and asked how I felt about my BPD diagnosis. I said that the assessment for it was one I'd asked for, and although I did not like how stigmatised this disorder is, I'm relieved to put a name to my problems and to be believed. I mentioned to her that I had not been referred for Dialectical Behavioural Therapy when diagnosed (as this is the standard treatment recommended for BPD). She noted that I had been discharged from Secondary Care soon after my diagnosis, and she was very surprised about this. She told me that Primary Care mainly does CBT and it is Secondary Care that would carry out DBT.

We then went on to my anxiety problems; primarily anxiety with travelling alone. I explained how I felt when trying to travel alone, and problems I've had in the past that I think may have contributed. I used to be bullied and harassed on the coach to school for example. Because it happened for so many years, I expect it to happen on public transport (such as a bus). When I was 17, I was sexually assaulted at my local bus station. Although it has been 11 years, I still can't sit in a bus station by myself. Lastly, I had a panic attack a few years ago when changing trains, because I could not find the correct platform. It was so intense and scary that it put me off taking trains.

I also spoke about how often I have racing thoughts, and that it can get too much to cope with. The therapist asked how I would try to manage this, and I said through distraction (gaming mostly). She said that I was relying too much on distraction and mindfulness may help me to "sit with" my worries. Hopefully this will help me to face my fears and come up with solutions that could calm my anxiety down.

By this time, the session was running to a close. The therapist gave me some links to a worksheet for recording times I'm anxious and why. She also gave me a link to booklets online that described anxiety and panic. I'm to read these, fill in the worksheet and bring it to the next session (in a fortnight).

I hope this blog post has been helpful for anyone considering CBT for anxiety. My next post will be about Session 2.