I’ve been doing pyschotherapy since last December. It’s not something I talk about often, because it’s deeply personal and because of the stigma associated with mental health. But there’s things I’ve learned that have changed things for me significantly, so I want to try and share.
I need to begin with a couple of disclaimers. I’ve been doing this work with a clinical psychotherapist every week for the past ten months. I have homework assignments. It’s intensive and it requires commitment.
It’s not really possible to share the knowledge I now have in a thousand words, but I want to try and cover some of the key things I’ve learned.
Obviously, I’m not a medical professional, and I’m talking strictly about things that work for me. But they could be useful for others.
When I first started psychotherapy, I had very little faith it would help me. I’d tried numerous counselling services before, and I was convinced none of it worked. My anxiety was who I was. There was no way out of that.
(Note – counselors and clinical psychotherapists are, obviously, different things. Counselling did little for me. I was lucky to be able to see a psychotherapist. I know that it’s a privilege and that’s why I work so hard).
Of course, the idea that you can’t change is the illness talking. It’s got a lovely little voice that convinces you that not only can you not get well – you don’t even want to. It tells you that you’re made this way.
When I read Ruby Wax’s Sane New World, I learned all about neural plasticity. Turns out those thought patterns you believed were hardwired into your brain can be totally overwritten. That was a revelation for me.
Today I want to talk in particular about distress tolerance. I have never been good at coping with high anxiety situations. – I was ‘distress intolerant.’ I didn’t have any skills for dealing with intense emotions.
Distress is linked to personal triggers so it’s different for everyone. I recognise when it’s happening for me because the voice in my head says things like “I can’t cope with this,” “I must make it stop right now,” and I start desperately looking for ways to fix the situation and stop feeling the distress.
Key learning: Figure out what your distress warning signs are. Recognising that this is what’s happening is the first thing to helping you step outside the situation and deal with it.
Distress tolerance – ‘dealing with it’ – is not necessarily about immediately improving things or making the emotions going away. (though of course it is different if you are in immediate danger).
My first step to recognising what was happening was to confront my beliefs about distress – ie that strong emotions are inherently bad and that I can’t cope with them.
To do this, I started doing these Overcoming Distress Intolerance workshops with my psychotherapist. They are a bit patronising at times, but they are extremely helpful, and all available online at the Centre for Clinical Interventions. (They also have a whole bunch on worrying and anxiety, which I might do a separate post about).
The first module (Understanding Distress Intolerance) has stuff about personal beliefs around distress. Interestingly, I have conflicting beliefs. A part of me can’t tolerate it at all, and will do anything to not feel that way. Another part of me has romanticised that intensity of feeling and will sometimes use ‘coping’ mechanisms that actually make it worse.
I had a real problem with ‘reassurance seeking.’ This is when you try to soothe the intense emotion by getting other people to join in, and to tell you everything is ok. I got myself intro trouble with this a few times by discussing personal arguments on Twitter, in order to try and get reassurance I was right or behaving well. Inevitably, the other people involved find out and you’ve made everything worse before you know it – because you gave into the urge to try and get rid of the distress in the quickest way possible.
Key learning: our brains literally do not work the same when we are distressed. Therefore, we can make decisions we would not normally make. Don’t beat yourself up if you do something you later regret. Just try to remember to “do the opposite of the urge.”
Reassurance seeking can be a good skill, but it is best to try to give this to yourself first. Getting others to do it is often like trying to put a bandaid over an open wound. They can say nice things til they are blue in the face, but if you don’t believe in them inside yourself, it won’t change a thing.
If you can’t do that, the next best option is to speak one-to-one with a close friend or support person.
Key learning: distress tolerance is not about making the feelings go away. It’s about getting through without using coping mechanisms that actually make things worse.
I ask myself the question: How do I be effective right now? What action will be effective for me in getting through this?
(For me, it’s much more effective to reassure myself that I’m doing the best I can, or to receive those words from a close friend, than to have a whole bunch of people online who don’t really know me say the same.)
If you’re going to have a look through the modules (do!), please be aware I spent at least a month on each one, under the supervision of a professional, and I did them in the recommended order.
The first skill is understanding the distress, your beliefs around it, and why you might find it difficult to deal with. The second is learning to accept that it’s an inevitable and even useful part of life. The third is how to improve the distress, often by doing the exact opposite of what your usual coping urge is. And the final module on tolerating distress brings everything together and guides you through creating your own personal Distress Tolerance Kit.
I scoffed at this idea when I first heard it, not going to lie. But it has been incredibly useful. I haven’t even had to use it yet, but knowing that, if something happens, I have a whole bunch of things right at my fingertips to help me get through it gives me a lot of confidence. It’s my own Little Book of Calm. (snap if you get that reference!)
My Kit is in a clear leaf folder. I feel a bit embarrassed talking about what’s in it, but I guess I should give an indication. It’s got:
- A list of songs I know make me feel better
- Names of people who I can chat with
- Chamomile tea bags
- Ideas for soothing or distracting activities – going for a walk, having a shower, reading poetry etc.
- Some useful things I can say to myself, like “I’ve got through this before, and will again.” “These are just emotions and they will pass.”
As I said, I haven’t had to access it directly yet – but I know what’s in it, so sometimes I can put those things in action as soon as I hear the voice telling me I can’t cope with something.
I got asked recently why I wasn’t comfortable talking about my mental health in the newspaper, when I do it here anyway. I guess the thing is, here I get to write it exactly how I want it. I get to edit it a million times. I get to make absolutely sure I can cope with any response I might get before I hit publish – and I have control over the comments.
The reason for all that worry is stigma. I take my career seriously. I take my role as a columnist seriously. I know very well that there are people who would love to say that, because I have depression and anxiety, my work carries less weight or integrity, or is less trustworthy. That’s pretty much my worst nightmare.
So, I will hesitate now, before publishing. I know I’ll go ahead with it, because I want to be able to share what I have learned. I am really hoping it might make a difference. It’s all too easy to write off “talk therapy” – I certainly had. I was privileged enough to then end up with someone who approached everything in a scientific, structured way that worked for me.
If you think any of this might be helpful, ask your GP. Ask your PHO. Look up the modules. It could do for you what it’s done for me.
One other thing I do really regularly: Mindfulness meditations and guided body meditations. I am shit at relaxing, so this stuff is magic. I used to think meditation was BS, so don’t worry if you cringe at the word – but I’ve found a few good ones I use over and over for dealing with anxiety.
Meditations to download
These total body relaxation ones (last page) are really good for insomnia.
Also – rain or white noise on Spotify.
If you’ve got other sites, tips or ideas, feel free to add them in the comments.