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!

CBT for Anxiety Session 2 - My Past

(TW: mentions of self harm, suicide, sexual abuse, psychological abuse, and diet)

I'd had a bad couple of weeks between session 1 and session 2 of CBT. I did, however, manage to do the homework my therapist set for me. This was to read and print off a booklet about Panic as well as doing an anxiety based thought record. I filled in quite a few entries for this record, so had a lot to talk about with the therapist. I also wanted to monitor my mood swings in order to help with filling in the questionnaires at the start of session 2 (as well as for my own benefit). One of my best friends suggested this and I found it a very helpful idea.

I used a mood diary template; where I recorded levels (from 1-10) of stress, mood, energy, and how many hours I'd slept. I also commented on my moods and things that had happened that day. I found that I had to add at least 2 or 3 entries for these topics throughout the day (except hours slept of course) as my moods changed. I found my moods changed rapidly and extremely in response to things that happened. I had a couple of days, for instance, where I had read too much into some things and got it into my head that some friends had got fed up of me. This resulted in me feeling very paranoid, angry, upset, and anxious to the point that friends noticed and reassured me. Reassurance helped my mood a bit, but did not completely alleviate those thoughts and feelings.

Moving on to my therapy session, I was a few minutes late but the therapist didn't seem to mind. Once we'd sat down, she gave me the usual questionnaires (see my previous post) as well as a Risk Assessment questionnaire. This yes/no questionnaire asked about suicidal and self harm thoughts, as well as plans and attempts. I did answer yes to some of these, so my therapist wanted to talk about this first. We moved on, once she was sure that I wasn't currently planning to end my life.

We next talked about the thoughts I have about myself, my family, strangers, and going outside. This brought us to various things that had happened in my past, and how they affected my thoughts, feelings, and behaviour nowadays.

Two particular things that were major factors in my mental illnesses were the bullying I experienced at school, and the psychologically and sexually abusive relationship I had when I was at university. These really affected how I saw, and still see myself. I don't see myself as a person of worth, I think of myself as "wrong" no matter what I do or say. I blame myself for everything and punish myself through regular self harm. Long story short,  I don't like myself very much. My therapist commented that I speak about myself very negatively.

The next topic we went onto was lifestyle. What did I do throughout my day? What is stopping me from working? Do I go out much/socially? I mentioned that this past couple of weeks had been difficult and I'd barely been out of the house at all. Partly this was because I felt very demotivated and low, but it was also the Agoraphobia making me avoid situations that make me panicky and anxious. My therapist said that I needed to go out more, and try a short walk at first. I pretty much promised her that I would try to go out more. I also explained why I didn't work, but that I would like to if/when I am ready. I explained that this work would have to be very flexible and accommodating as I have energy "crashes" in the afternoon and need a 2 hour nap when I get too exhausted. Ideally, this job would be a work-from-home one (not easy to find!).

We then went onto general health. Did I exercise much? What is my diet like? Can I cook for myself? I told her that my Fibromyalgia and Hypermobility Syndrome do cause a lot of pain, fatigue etc so cooking is difficult and I need help when cooking from scratch. I spoke about the kinds of things I ate for each meal and that I was doing Slimming World online. Overall, my therapist decided my diet was relatively healthy. She also mentioned how certain inflammatory foods could make my Fibromyalgia flare. I had read up about that when initially diagnosed, but have forgotten now, so will look into it.

The session was coming to a close by this time, as we'd been talking about a lot for a while! My homework for this time is to find 3 things each day that are positive (it could be about my day, myself, something I'm looking forward to or that someone said to me etc). I need to work on being compassionate to myself. She also wants me to carry on with the mood diary and fill in the activities in the Panic booklet.

So far, I'm liking my therapist (apart from her questions about getting back to work soon) and the sessions are at least giving me time and space to vent. I did find this session very emotionally and physically exhausting, however, so had to nap for a while once I'd got home.

My next session is in 3 weeks time, so I hope to write a post on a separate topic before my session 3 post. I hope this post is helpful in the meantime!

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.

RESOURCES

1. PHQ-9 Depression questionnaire https://patient.info/doctor/patient-health-questionnaire-phq-9
2. GAD-7 Generalised Anxiety Disorder questionnaire https://patient.info/doctor/generalised-anxiety-disorder-assessment-gad-7
3. IAPT Phobia Scale https://patient.info/doctor/iapt-phobia-scale
4. Work and Social Adjustment Scale (page 5) http://www.practicalhappiness.co.uk/media/download_gallery/Assessment%20Measures.pdf

My Mental Health Timeline

Childhood: When I think back to my childhood, I believe I had some mild mental health problems back then; which were probably brought on by the bullying I experienced. I have always had a low self-image, and been critical of myself. I've always had anxiety in some form or another as well. I'd feel anxious about eating in front of people, being in busy places, and catching the bus. I still managed to do all of these things, but I constantly worried about embarrassing myself, seeing one of my bullies, or having a panic attack. I self harmed fairly frequently as a way of releasing my emotions, and as a way of punishing myself for not dealing with things as well as I thought I should.

As I moved onto secondary school and the bullying continued, I became very self conscious & blamed myself for anything that went wrong. I started carrying out certain routines (praying 3 times, exactly at midnight) and carrying "lucky charms" in specific pockets. I truly believed that, if I did this, the bullying would lessen or I'd cope with it better. If I didn't carry out the routines, or forgot to bring certain "lucky charms" with me, I believed my day would be awful & that I wouldn't be able to cope with anything. If I did have a bad day, I believed it was because I hadn't done my routine properly or at the right time. I started to have violent intrusive thoughts, that led to violent dreams. I worried that I'd carry out those violent acts and that I was a terrible, evil person.


University: When I finished school, I decided to go to a university where it was unlikely I'd know anyone. I needed a fresh start, and felt I was a bit happier and confident enough to make new friends. I think this was one of the best decisions I made. I was independent, popular, enjoying life! I was also very impulsive and a bit of a risk taker when it came to certain impulses.

In my second year of university, the physical health problems started and I think this is what led to the anxiety relapse and depression. It certainly didn't help that I was in an abusive relationship at the time, and lost friends thanks to my fluctuating physical illness. I blamed myself for everything again and felt I had to explain why I was well enough to go out some days, and not others. I felt very trapped and isolated by my illness, as well as by my partner at the time. We broke up, but I still felt isolated & I struggled with making plans. As well as feeling too physically ill to attend most lectures, I became very anxious with being in busy lecture halls. I spent more time in my room & became fairly paranoid about friends. I wondered what they thought of me, whether they believed me, whether I was losing them.


Work: After university, I had my first full time job. I was in a relationship at the time, and was fairly happy. It was lovely to come home from work to my partner. He made me feel wanted, and encouraged me to be more sociable. Although not as good as university, I became a little more sociable; catching up with old friends. When it came to work, I often felt as if I wasn't good enough. I struggled with phone-calls, as I worried that the customer wouldn't think I was competent. I still had anxiety with busy situations, and found meetings made me panicky. Whenever I could, I would avoid meetings.  Eventually, my physical health had worsened so much that I had to give up working. My anxiety had worsened a lot too.


Breaking Up: The paranoia I had, the anxiety, and the fact that I wasn't well enough to go out much, I think led to my partner breaking up with me. I struggled with being single, and felt completely worthless and broken. Finding out that he'd met someone else just two days later didn't help either. Was I that easily replaceable? I'd moved back to my parents' flat and away from old friends. Most of my social interactions were online, and so I didn't go out much. I lost more friends, and ended up breaking ties with the rest of one friendship group, before they broke ties with me. It hurt a lot, and I still have times where I dwell on it now.



Unemployment: Once I'd moved back home, I had to decide whether to force myself to work again , or to try claiming Employment and Support Allowance. I was really worried that I'd be thought of as "faking it" or just not being ill enough to qualify. After a horrible assessment, I was accepted for ESA. Stories in the tabloids of "fakers", "scroungers" etc made me paranoid that maybe I'd be accused of this if I was seen outside, or walking one step further than I should be. If I saw a strange car or van outside, or if someone looked at me for longer than normal, I instantly thought they worked for the government.


Starting Therapy: I noticed my moods had been so low, and finally decided to open up to my GP about this. (You can find my blog post about this here). I was given the number to self refer for Cognitive Behavioural Therapy. My first lot of CBT was at a low intensity level, and I saw my therapist every fortnight. We talked about my home situation, physical health (and how that had an impact on my mental health) as well as things that'd happened recently and how to re-examine my thoughts. I liked the therapist, but wasn't finding therapy very beneficial. It seemed too simplistic, and I wasn't sure I really fit the boxes that come with mental health questionnaires etc. I didn't know how to explain it so thought that maybe I just wasn't trying hard enough. I started to have very strong suicidal urges, and was soon in crisis. My therapist at the time contacted crisis team, and I had assessments but nothing else could be offered for the diagnoses I had (Generalised Anxiety Disorder, & Depression). I got very panicky at my last low intensity therapy session, and was then referred on to high intensity CBT. I was also prescribed Amitriptyline by my GP, to see if this would help my moods.

I didn't seem to have such a good rapport with my second therapist. I felt she was repeating a lot of what I'd already learnt about CBT, and I wasn't given much opportunity to talk through how I felt. It seemed more about going through worksheets. If my suicidal thoughts were more frequent, my therapist would instantly go to contacting crisis team. In the end, I told her not to, and I began to hide my darkest feelings and just comply with the worksheets. I ended up finishing this lot of CBT early, partly because I couldn't get transport there any more (and was too anxious to use taxis/buses), partly because it just wasn't helping me.

My third lot of CBT (again at high intensity level) was carried out at home. I was far too anxious to travel, and had then been diagnosed with Agoraphobia, which helped a lot with getting a therapist to come to my house. I got on well with this therapist, and was opening up a bit more. I still didn't find much benefit from the worksheets, and found that I was just going through the motions with homework. It seemed I wanted the therapist to think they'd helped me a lot. I felt like I was failing otherwise. Apart from this, I found a bit of benefit from having the odd walk outside, with the therapist. She wanted me to get a bit more confident outside, and I liked how we didn't have to always be indoors for therapy. I knew I needed help for my agoraphobia, and having someone accompany me outside and build up to me being a bit more independent, would be a good idea. Unfortunately the sessions came to an end before I could make any noticeable progress.

As well as going through therapy, my latest crisis also led to some appointments with a psychiatrist. They changed my medication to Sertraline (with Diazepam as a short emergency prescription). They also suggested I have Psychodynamic therapy, as CBT didn't seem to be suiting me. Unfortunately, I was not given that therapy. I'm not sure any available therapists were trained to carry it out. My third CBT therapist did say, however, that due to the trauma I'd experienced in the past, she may be able to offer me EMDR, as she was training in it. She wanted me to have a break from therapy for a few months first though.

Moving: My parents and I moved house quite quickly, a couple of months after the third lot of therapy. Unfortunately the area we moved to was not under the same mental health team, so I was discharged and told to approach my GP and get referred to the team in my new area. I struggled to get up the courage for quite a while, and took longer to phone the self referral number. I wanted to avoid mental health services altogether, and be left alone. I felt that I wouldn't be reliable and would be discharged for cancelling so many appointments; due to (physical) ill health. When I did eventually call the number, and soon after got my telephone assessment, I found myself rambling a lot to the therapist on the phone. I wasn't sure where to start, and was already very nervous. It felt as if they listened though.

Interpersonal Therapy: I was very pleased to be offered a type of therapy that wasn't Cognitive Behavioural Therapy. I needed to talk about things in the past, and how I formed/maintained relationships, so Interpersonal Therapy seemed like a more suitable one for my issues. At my most recent session, however, I lost trust in my therapist after they dismissed my concerns about my self harming getting worse, as well as a diagnosis I thought I might have. This condition is Borderline Personality Disorder. I explained some of the reasons why I thought I had it, but I didn't feel listened to. The therapist just told me that BPD was something that psychiatrists diagnose you with, if they don't know what's wrong with you. This made me really angry, as I know this condition is real. I couldn't listen to what he said for the rest of the session, and spent most of it wondering whether to just walk out. It was a good job I stayed until the end though, as he suggested I get referred to Secondary Care services (CMHT). I went to my GP the next day, who contacted my therapist to confirm this referral was right for me. After a quick phonecall with the therapist, later that day, I was referred. I was contacted the following day by CMHT; who gave me an appointment for 3rd February.

Community Mental Health Team (Secondary Care): On Friday, 3rd February, I went to my appointment. In the room there was a Community Psychiatric Nurse (CPN). and psychology assistant observing. The CPN explained about my referral and gave me a Wellbeing questionnaire to fill in rather than the usual Depression (PHQ9) and Anxiety (GAD) ones. This questionnaire included questions about coping, making decisions, whether I've felt close to people etc. I've found this questionnaire, with similar questions. I was ticking rarely or none of the time for a lot of them; so I'm guessing my "wellbeing" isn't great!

The CPN then went on to asking why I think I've been referred to the Secondary Care Team, what my main struggles are, and what sort of help I think I need. I spoke about mood swings, the intensity of my moods, how I would be full of emotion (to the point where I feel I'll burst) or feeling nothing at all. I told him how I found it hard to cope with how quickly/extremely my moods can change. I mentioned the numerous crises I've had, suicidal thoughts (which became plans at one point) and frequent self harming that's getting worse. I said I was feeling less in control when it came to my moods and self harming. I can get very irritable and angry, but tend to turn this anger on myself. I also mentioned the times where I've been hypomanic, quite impulsive, agitated etc and how I find that strange; given my diagnosis.

I spoke about the many years of psychological bullying I experienced, as well as an abortion I had at 19, and a controlling, abusive relationship I had, not long after.

Finally, I spoke about my last therapy session, where I felt I could now open up about how, for over a year, I've wondered if I have Borderline Personality Disorder.  I can relate to pretty much all the criteria, although some were more prominent when I was a teenager/ very early 20s. The CPN didn't confirm or deny a BPD diagnosis, but did say that (looking over what I'd told him) he believed I had a long-standing trauma related disorder. He wasn't entirely sure if secondary or primary care would be more suitable for me, but he would have a word with my therapist and give me a call next week.

So this is where I'm at now. I'm not entirely sure what to think about the CMHT appointment. It was a shorter appointment than I expected, and not quite as thorough either. The CPN did ask some specific questions, but it was mainly left to me to explain how I'd been feeling. There were things I forgot to mention to him (and he has given me contact numbers to ring if I do need to talk about them) but I think he got a fairly good picture of my problems. I guess I'll just have to wait and see!

Let's try this again: Part two

(TW: Mentions of suicide, self-harm, and abortion)

On Wednesday, I had my phone assessment with the Primary Care Mental Health team. I was really nervous on the day, and was watching the clock. The more I waited, the more nervous I got, and the more shaky I was when the call finally came. In order to prepare for my assessment, I'd gathered together all my paperwork from previous assessments and appointments. I wanted to be as prepared as possible so that I wouldn't miss anything out during the assessment. I completely overwhelmed myself, however.

Although I was extremely anxious when answering the phone, I was very glad to have the opportunity to be assessed again and talk through the things I'd been struggling with. The therapist began the assessment by asking me what sort of problems had brought me to contact mental health services this time. I found it hard to know where to start. I had so much going on in my head that I don't think I made much sense at first. I tried to prioritise the main things that I needed help with; which included how easily overwhelmed I was getting, things from the past that needed addressing, how my anxiety seemed to be worse, and the recent breakdown I had. I told him that I'd been through CBT a few times in the past and found that it didn't help much. I said that it didn't seem to fit my problems, as I wasn't able to talk about certain things in the past that affected how I am now. The therapist said that there were different types of CBT, and some did consider the past when attempting to help with the problems that the person has right now. He told me not to completely shut myself off from the idea of CBT. I reluctantly said that I would keep an open mind, but that other therapies that have been suggested to me by my last therapist and my psychiatrist were EMDR and Psychodynamic therapy. This therapist said to me that there were other therapies we could consider if I found that CBT still wasn't working for me. One therapy he mentioned was a person-centred one. He gave a brief description of what that therapy entailed, and said that this would include going through things in the past and discussing how they affected how I see the world now. I said that this sounded like the type of therapy that may suit me a little more.

He wanted to know how long I'd had symptoms of Anxiety, Depression, and OCD. He also wanted to know the obsessions and compulsions I had now and in the past. Although I was diagnosed as an adult, I'd realised that I'd had symptoms pretty much since the start of primary school. He asked (sensitively of course) what I thought had led to this. Although I struggled a lot, and was in tears for most of it, I just about managed to tell him about the bullying, and the termination I had during my first year of university. He was very patient, understanding, and non-judgmental. He gave me time to talk about what I needed to, and was kind when my mind would go blank & it took me a while to remember what I wanted to say. After this, he gave me a brief analysis of what he thought were my main things that I needed help with.

Next came the necessary, but frustrating part of the assessment; the questionnaires. He admitted that he hated them too. I guess they have to quantify some things, to see how severely a client is affected by their mental health problems. It's just such a restrictive set of questionnaires/ I may meet the criteria for Anxiety and Depression, but if there are any other mental health problems, that could be identified by asking other questions, I don't have that access to those questions.

I may have described these questionnaires before, but the first one I had was the PHQ-9 . This is to test for Depression, and the severity of it. For each question, there is a score between 0 and 3. 0 means "not at all" and 3 means "nearly every day". When responding, you focus on how often you've been experiencing (the things stated in the question) in the last two weeks.

For this questionnaire, you have a score out of 27. My score was 24; which places me in the severe category. The therapist also had to assess my risk of attempting suicide. I told him that although I frequently had thoughts, and sometimes strong urges, I'm unlikely to actively plan or carry them out because of my cat and my parents. I forgot to mention about my regular self-harming, but I guess this is something I can talk about during therapy sessions.

The second questionnaire was the GAD-7 . This tests for Generalised Anxiety Disorder and the severity of it. Similarly to the PHQ-9, there is a score between 0 and 3 for each question. Again, 0 means "not at all" and 3 means "nearly every day", and you are asked to consider how you've felt in the last two weeks.

For this questionnaire, you have a score out of 21. My score was 18; which places me in the severe category.

The third questionnaire focused on phobias. For each types of phobias described, you give a score between 0 and 8 to state to what extent you would avoid various situations because of it. A lot of my fears involve loss of control; for example, losing control of my bladder in a public place, having a panic attack etc. 0 means you wouldn't avoid the situation, 8 means you would always avoid that situation based on the phobias mentioned.

Once these had been completed, the therapist discussed with me what the next steps would be. He said that he believed I should give CBT another go, at least to tackle my symptoms of OCD. He did say that I could have person-centred therapy instead, if I still find the CBT unhelpful. I reluctantly agreed to this. At least I can have access to other therapies, instead of it being CBT or nothing. He said the wait is likely to be around 10 weeks, as the waiting list is long. I knew to expect this anyway. Before we ended the call, he made sure that I knew who to contact if I do become actively suicidal. These were the Out of Hours team, and Samaritans.

 I do feel a little more hopeful about this mental health team, but we'll have to see how therapy goes.