This spring, I completed a full 12 week course of cognitive behaviour therapy, commonly referred to as CBT. CBT is used to help people with various mental health issues, and is often particularly effective with helping to manage anxiety.
This is not sit on a sofa and talk about your feelings therapy, or a chance to offload onto a therapist (although of course you can do that if you want to), this is a course that teaches you to effectively observe, analyse, and rationally choose your thinking process. CBT does not focus on WHAT you think, but rather HOW you think. It is a structured course of therapy that walks you through the process of thinking (cognitive) and acting (behaviour), by exploring your own personal thoughts and habits.
But how and why does it work?
In regards to mental health, you might have heard reference to, or even experienced for yourself, ‘vicious cycles’ of negativity and worry, spirals of thought pulling people down and making them feel trapped, overwhelmed and helpless. Of course I can only talk about this from my own personal experience of anxiety and depression, but I have been told by a fair few other people than it can be a quite common experience for those with other mental health problems too.
For those of us with healthy heads, we can have a negative thought and brush it off with relative ease. Maybe it hangs round for it bit, makes you question and doubt for a minute or two, maybe it even comes back a few times over some weeks or months, but generally speaking we are able to carry on with our lives and even think about something else for a while. When anxiety takes hold however, those same negative thoughts and feelings become completely dominating.
With anxiety, once those negative thoughts are set off, an automatic loop starts to play out; an endless barrage of overwhelming feelings that seem to only grow deeper and darker with each moment and repeating cycle.
From a brain perspective, in very simple terms, it’s to do with creating links, or synapses. When your brain learns to do a new task or activity, a new link is created, and the more you then practise making that link (i.e. through repetition), the better and quicker your brain gets at doing it. For example, when toddlers learn to walk, it takes them a lot of time and energy to start with because the brain is having to manually programme and create these new links. Once they start to work it out and practise, that programming gets imbedded into the brain, and those links get stronger and stronger through the repetition, until it gets to a point where it seems automatic – you can’t imagine not being able to walk. This once difficult activity has become habit – what we often refer to as subconscious– we barely notice ourselves as we do it. From there the brain can create even more new exciting links – we learn to run, to jump, to cartwheel! – links upon links, creating an entire chain network of subconscious synaptic activity that enables us to carry out these vastly complex tasks. And in most cases this is very useful, it saves us energy and makes us much more efficient at our day to day lives – one of the major reasons humans managed to be so successful as a species. Yay for brains!
However, while this whole linking synaptic system is of course absolutely fantastic and ridiculously awesome, it is also totally indiscriminate. Your synapses unfortunately can’t tell the difference between an activity that helps you and one that actually harms you. Once they have learnt a pattern and it has become embedded and automatic, they just do what they do, and they repeat, gradually getting stronger, building habits upon habits.
But this doesn’t mean that all is lost. The brain is of course much more complicated than my simple description gives it credit for. As humans we do have the capacity to choose and discriminate (setting aside any arguments around free will for a minute). Our subconscious, automatic, and habitual thought cycles aren’t written as law.
You can break free from old patterns, rewrite the programming of your synapses, learning new things and adapting your habitual behaviour to effectually remove the damaging links in your head and encourage the creation of new, more helpful and healthy ones.
And CBT is all about teaching you how to actually do this. That doesn’t mean you are being brainwashed or having ideas planted in your head. If anything, a good therapist will never tell you what to think, they simply teach you how to do it for yourself so that you can then make those choices even stronger for yourself.
The bad news is that CBT can only really begin to work when you are able to effectively distance yourself from your thoughts. And I know all too well how difficult that can be when the smallest thought can set off a waterfall of overwhelming and powerful emotions inside you. But a good therapist will hopefully be able to help you get around your thoughts, using techniques that are often based in mindfulness to help you to think about your thoughts without actually becoming your thoughts. I personally find that it helps me enormously to consider my brain as some sort of puzzle, something that is separate to myself that I can fix, rather than a part of who I actually am.
You are not your thoughts – understanding this was possibly the first and therefore most groundbreaking step for me along the long road to recovery from anxiety and depression.
One of my favourite ways of explaining this distancing between yourself and your thoughts, and one that I often use when practising mindfulness techniques with my students or in class situation, is that the brain is like a puppy or child. It is inquisitive, curious, and it wants to play- that is what it does best! But like a puppy or child it can get distracted, and make mistakes as part of its learning process. It is not it’s fault – it is just part of its puppy nature. When this happens (not if, but when!), we can learn ourselves to gently but firmly guide it back to the task at hand. We give it space. We let it learn. And we watch over it as a guardian.
But getting yourself to that point of understanding can be distressing. I’ve heard many stories of people not finishing their courses of CBT, and I can’t say I blame them. 12 weeks is a big commitment, and it is not an easy task to separate your thoughts from your feelings. When battling with the demons in your head, it can sometimes seem impossible to stand back and rationally face those terrible thoughts that cycle through your head. CBT is not a pleasant or a soothing experience, and your therapist is more likely than not, not really going to offer you much in the way of emotional support- they are there to teach you, and train you, not hold your hand and nod along. And this often came across as either confusing, hurtful, or sometimes even downright cruel to me.
But remember your therapist is trained to do what is best for you and for your health, even if sometimes it really doesn’t feel like they’re on your team.
Maybe this is the point at which to remind yourself that you’re not here for comfort, that’s what friends and family for. You’re here to work at something that’s really important, perhaps the most important. You’re here for your future and your health. And when was anything worth having that easy?
In my own personal experience, by the time I got onto the course of CBT (I’ll leave the subject of long therapy waiting lists on the NHS to another time!) I was pretty much past the point of caring about how uncomfortable anything made me feel emotionally anyway. I wasn’t so much determined to stick out the full course, as I just didn’t care and it was something to do that ticked the boxes for my doctor and passed the time. If there was progress, great- and if not, what was there to lose? I was verging suicidal, so I guess there was that, but realistically I knew that the amount of hurt inside couldn’t be touched by anyone external to me anyway anymore. So whatever my therapist said, from my opinion, it wasn’t going to make me any worse.
On reflection, I think it would be strange if CBT wasn’t an uncomfortable experience. As everyone’s minds work in unique ways, your therapist has to ask you directly about your deepest thoughts, and your darkest feelings, and then ask you to discuss openly with them your irrational reactive behaviour. Of course that is going to be distressing, and embarrassing too. They’re asking you to clinically open up and recall, as factually as possible, how you think, feel, and act, when you’re at your most vulnerable. You’re forced to be brutally honest, not only with them, but with yourself. It’s like saying to someone, ‘come on, let’s dig up all of your biggest blackest thoughts, and lay them on the table for us all to see- then we’ll pick them apart until they seem tiny and irrational’. Who isn’t going to feel pressured by that?
Taken like that, it can sometimes feel like your therapist is even judging you, making you feel like you’re being irrational, and making a big deal over nothing. But of course, you must remember that it isn’t nothing, it is a big deal, it is mental illness, not some sort of phase. And that is why their entire profession exists.
These are thoughts and feelings that you’re living with every damn moment of your waking life. And that’s why you are referred a full course of CBT, not just a few sessions, with trained professionals, not just anyone off the street. Accepting, analysing, and then challenging your own thoughts, all the while trying to put your most powerfully and all encompassing emotions aside, is a huge ask of anyone, illness or otherwise. It takes patience. It takes strength. And it takes vast a amount of courage that most people could not even fathom.
For me, CBT worked wonders on my anxiety, and I am back in control of my inner panic alarm. I can go outside, and about my daily life again without that constant choking feeling, like I’m clinging to the edge of a hideously high cliff, with one slip resulting in a breakdown. I do still struggle in loud environments sometimes, at social events, or even if my heart rate gets up too much when running or swimming, and I still have to take a step back when there’s too much emotion (happiness and excitement, and all those positive feelings included -oh man, it is just so cruel). But it’s one hell of an improvement compared to six months ago. I can actually function as a semi-reasonable human being again.
Unfortunately for me, it is not been a cure all, and my depression continues to haunt me. I have been referred on to some further psychodynamic therapy, hopefully starting in the next few months, and I continue to seek balance in all areas of my life. All I can do for now is keep doing what I am doing, practise patience, and just try to give myself and my body the best chance I can to get better.
I hope you’re all well.
Stay breezey 🍃