What I've Learned in CBT, And My Own Example

[browneyes]

Sorry, this is going to be long. But I think it will be helpful.

So I've been in CBT for 5 weeks or so now, with someone who's actually had experience with health anxiety (whoo hoo!). Now, for those of you who are thinking about going into therapy, first of all, DO IT. It took me forever to resign myself to the fact that, yes, I have a mental disorder, no it is not my fault, it is the same as if I had gotten the flu, or cancer, or anything else physical. And yes, just as if you needed to go to the doctor for your physical illness to get better, you need to go to the mental doctor to make your brain better. And I also want you to know that you can't get frustrated as you search for the right doctor. It took me 4 therapists and about 6 months of searching, but it is SO WORTH IT. So if you go, and you feel it's not working, do not just give up. Try someone new. You will find them, and then you will get better.

Anyway. Here are the things I've learned over the various weeks, all rolled into one post. And I'm going to use an example of something I'm dealing with right now (so this is helping me too...)

The first things we talked about were not tools, but just about our thinking. Thoughts are not facts. And we have to look at what we think after a symptom as a 'tape'. So after I get a sharp pain in my head, my aneurysm tape starts playing. When I get a palpitation, my heart problem tape starts playing. So when you have a symptom, you have to try to stand back and look objectively and see that when you have a symptom, the same tape starts playing, and you start to recognize the pattern.

Then, he gave me a packet about distorted thinking. It listed the different types of distortions that can occur when we think about things (found here: http://en.wikipedia.org/wiki/Cognitive_distortion). Whenever I had a symptom, I had to look at my thoughts that I had after the symptom and match them up with the distorted thoughts (I'll do this with my example next).

Now onto the fun stuff. Tools!

So the first thing is to create a chart with 5 columns: Symptom, Thought, Emotion, Behavior, Consequence. Let's use my example from right now:

Symptom: 2/24, at night, in the grocery store, bad palpitations, lasting longer than normal
Thought: Why is this lasting so long? This doesn't feel like my normal palpitation. Something must be wrong. This is it, I'm going to pass out or die right here in the grocery store. There's something wrong with my heart.
Emotion: fear
Behavior: walked over to my boyfriend, leaned against the cart, tried to breathe normally, concentrated heavily on how my heart "feels", when i got back to the apartment curled up in my anxiety position, stayed subdued the rest of the night, called out of work the next day (sigh), thought about going to the doctor
Consequence: missing a day of work (not the best reaction...), ruined my mood for two days, afraid to get up and walk around my apartment

Ok, so I do that every time I have a symptom (I just keep it in a spiral notebook). So then I look at the distortions. I would say the above example is:
* All-or-nothing: a palpitation MUST be something serious
* Overgeneralization: one symptom MUST mean I have a serious disease
* Mental filter: this bad symptom is the only thing that matters, never mind there are 324203948 more benign reasons this is no big deal
* Disqualifying the positive: those benign reasons aren't true, it HAS to be this serious thing
* Jumping to conclusions - Mind-reading: I KNOW what's going to happen based on this arbitrary symptom, even though I am not a doctor, and this symptom could mean anything
* Magnification: one symptom means I am DYING, and it is the end of the world, even though there is no other evidence to suggest that
* Emotional reasoning: I FEEL like something serious might be wrong with me, therefore it IS, based on no other concrete evidence

I think that's it for my example. So now I can see that I have SEVEN kinds of distorted thinking associated with my palpitations and how I'm reacting to them. Now this next tool is my favorite. And I actually think someone else posted something very similar if not the same. So sorry for the repeat. But what I do next is associated positive reasons to my symptom, and negative reasons (for simplicity I just call it pro and con).

Pro:
I am 24
I have slightly LOW blood pressure
I am a healthy weight
I have NO history of heart problems in my family
Palpitations are normal, and can happen randomly, the doctor even told me it was normal
I've had THREE normal EKGs in the past year/year and a half
I KNOW I have anxiety, and anxiety causes palpitations, and a lengthening of symptoms (why I'm still feeling crappy this morning)
I had just come from pilates, and I felt fine, even when my heart rate was up...and I always do
I've felt this way before, many....many times, and always been fine
I went to the doctor a few months ago for sinuses, and mentioned palpitations, and she listened to my heart, and said she didn't hear anything, plus my BP was fine, plus my pulse-ox was fine, therefore my heart was fine

Con:
I read a CNN story once about something bad with a woman and her heart
People my age CAN have problems
Palpitations feel scary
I've never had more involved tests, like a stress test, echo, etc; what if the doctor missed something

Hmmm, ok so looking at that list, my 'con' reasons aren't very convincing. Now I pick them apart...

The CNN story was about some random woman and I have no idea what the circumstances were, except that palpitations weren't even involved. People my age can have problems? That's not a reason. Plus, if I had a heart defect I'm sure they would have found it by now, with all the tests I've been given... (EKGs, chest x-ray, blood tests, multiple doctors listening). And just because they feel scary doesn't mean something is wrong. Yes, they feel scary, but they're normal. End of story. And for the last one, I need to trust my doctor(s). I told them I had palpitations, they did what they thought was necessary, and they told me I'm fine. I'm ALWAYS fine. And finally, the most important thing...I am NOT a doctor. I do not have the training to correctly interpret my symptoms and know what they are. I am ASSUMING. And I am assuming the worst case scenario.

There are a few more tools, but I feel like this is getting long, so I'll stop here. If anyone wants more just comment and I'll write another post.

Hope that helps!