Group Therapy

About 10 months ago I ended a 9 month course of 1-1 psychotherapy. Whilst it was useful to have a weekly meeting with my therapist where I could talk through any issues or struggles that I was going through, the course ended whilst I was still in a bad place, and therefore I didn’t have the chance to determine whether psychotherapy would ultimately prove a helpful tool for me. I fully appreciate that the NHS is oversubscribed, and that there are people on long waiting lists anticipating help, and so it’s only fair that they should have a similar opportunity as me to receive therapeutic support. However, I don’t believe it was conducive to improving my state of mind to cease the therapy when I did, as I lost the only outlet where I felt able to open up about almost anything (other than this blog of course). Continuing the therapy for another year may not have made any significant difference to my wellbeing, but it would have been desirable to persevere until I felt mentally ready to end the treatment. Within a few weeks of finishing the course I asked my doctor to re-refer me as I was still failing to cope with my mental health. It took about 10 months to get a review appointment, and whilst I have become accustomed to long periods of waiting, it doesn’t ever get any easier or less frustrating.

The psychotherapist I met with for a review recommended that I try group therapy as my next step, as this is something I have not attempted before, and he hypothesised that engaging with other people with mental health issues could prove rewarding, as well as potentially addressing some of the social difficulties that I find myself with. Group therapy has always been something I have steered clear of, and I have repeatedly pushed for 1-1 treatments. I have always reasoned that opening up about the most personal of inner thoughts and feelings to one person is hard enough, but to do so to 7 or 8 strangers is a prospect that causes my pulse to race at the mere thought. Of course my rational mind realises the advantages of striving towards this group undertaking, and how it is absolutely the right course of action to pursue. Nevertheless, even though the first session is still 4 days away, I’m already getting the familiar sickening feelings of unease creeping through by body, and find myself questioning whether it is worth putting myself through this extra anxiety. But of course it is, and that is the knowledge that will ultimately drive me to turn up to the first session on Thursday.

The first few weeks will inevitably be the most challenging, and I expect that after a month or so has gone by I will have fallen into a routine and feel slightly more comfortable. It’s potentially a 2 year course, and so I’m in it for the long haul. What has helped greatly is the support I’ve had from work once again, and being given permission to work from home on the days I’m at therapy ensures that I can fully focus on the sessions, and go into them with a clear mind. It’s surprising how tiring talking for 90 minutes can be, and how the mind can be in overdrive for hours afterwards, ruminating on what was said and how I feel the session went.

Despite my unavoidable negative mindset leading me to view therapy as a defeat and failure of myself and my life up to now, I must also keep in mind the fact that I have waited almost a year to be in this position and to have this opportunity, and consequently I need to try to discourage that unfavourable thought process. A trademark attribute of depression is a need to focus upon the defeats, and ignore the victories. Winning a race would not elicit the response ‘yes I won!’, but instead ‘thank God I didn’t lose’. I’m sure this therapy course will have lots of defeats, and days where I feel that I cannot face it, but I’ve got to believe that along the way there will be some victories as well. I have so much admiration for everyone who competed in the London Marathon today, and this includes all of the runners taking part on behalf of mental health charities. The achievements of human beings are remarkable, and I will try to take inspiration from their triumphs and endeavours going forward. It may be a cliché, and an overused soundbite, but there is so much truth in the old adage that “a journey of a thousand miles starts with a single step”.

 

 

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Anxiety: the thoughts, the feelings and the physical sensations

The particular void that I presently find myself in is persisting much longer than usual, and I’m not exactly sure of the reason for this. I’ve become accustomed to an acceptance that depression works to its own timetable, and I can never second guess or question its process. The ‘black dog’ does what it wants to, and no leash can ever contain its inevitable wanderings. “Take one day at a time” is the old mantra, but by following that logic I get stuck in a persistent cycle where each day blends into the next, and it’s as though I’ve taken on the role of a robot, where autopilot is a constant state of affairs. I am trying to drag myself free, but do not know how to.

I thought it may be helpful to myself, and to others, to list the thoughts, feelings and physical sensations that I experience. As difficult as it is to confine them to print, it’s the only way of facing them as opposed to ignoring or trying to forget them:

Thoughts

  • “I shouldn’t be feeling like this”
  • “I’m weak and not what a man should be”
  • I don’t want to be me any more”
  • “I’ve done something to upset someone. Should I say sorry even though I don’t know what I’ve done. If they don’t like me anymore then I am even more alone”
  • “I will always be alone. No one will love me.”
  • “I must be highly unattractive both inside and out. Why would anyone ever want to be with me?”
  • “I could have done things so differently, but now it’s too late”
  • “I will die before I experience happiness”
  • “I want people to ask me if I’m ok”
  • “I don’t want people to ask if I’m ok. I will only have to lie.”
  • “It’s too late for me to change”
  • “I want to stop feeling like this.”

Feelings

  • Frustration
  • Resentfulness
  • Deep sadness
  • Embarrassment
  • Heartache
  • Nervousness
  • Tension
  • Loneliness
  • Isolation
  • Abandonment
  • Hopelessness
  • Constant uncontrollable negative worries running through the mind
  • Combination of wanting others to reach out to me, but also to be invisible and go unnoticed

Physical

  • Heart pounding extremely fast, as though having a heart attack
  • Constant perspiration – leading to more self consciousness
  • Extreme fatigue
  • Feeling jumpy and constantly on edge
  • Stomach aches/cramps
  • Inability to relax/concentrate
  • OCD elements – constantly checking things…need constant reassurance
  • Habits, nervous subconscious ticks
  • Crying

These are merely the sensations that are in my mind at the moment, and are by no means an exhaustive list. I believe this demonstrates the 3 pillars that are at work (thoughts/feelings/physical sensations), and that all of them feed into each other, again highlighting the cyclical nature of anxiety and depression. Negative thoughts may trigger a unhelpful emotion, which in turn precipitates an unfavourable physical reaction. That physical reaction can then lead to more negative thoughts, which starts the cycle again.

I must emphasise that many of these thoughts and feelings are irrational, in the sense that I realise I shouldn’t be having them, or that they have no foundation in truth. But the part of the brain that can rationalise my thought processes is sadly overpowered by the part that is consumed with these uncontrollable irrational thoughts. Which is why it’s so difficult to have people say “you’re worrying about things that don’t matter”. Unfortunately that is not my choice, whether I like it or not. An oft unmentioned part of the illness is an OCD like tendency to constantly check things over and over again, whether it be a message, or the state of my appearance, or whether the heating has been turned off. I have to keep rechecking them in order to quiet the roaring animal inside of me that is forcing these negative thoughts into my brain.

The one time of the day I am temporarily in a semi-peaceful state is on the train to work in the morning, when I plug in my music, close my eyes and imagine I’m somewhere else, and someone else. My nervous energy prevents me from concentrating on reading, and so I try to relax my mind by switching my visual senses off, and focusing on the aural. The music and the gentle movement of the train almost sends me to sleep, but the arrival at the station soon brings me back to stark reality. This is not going to help me climb out of the pit, but at least provides a temporary respite where I can imagine that all is well, and that I am a different person in a different place. As Lewis Caroll said in Alice in Wonderland, “Imagination is the only weapon in the war against reality”.

Note

In light on the awful attacks of yesterday, my struggles are incomparable to the friends and families who lost loved ones, and those that are severely injured. In my writings I can only talk about my own feelings, and it is never intended to be compared to other people who are suffering much worse than I am. I just wanted to make that clear.

The Cycle of Thoughts and Feelings

Thoughts and feelings are at the very heart of Depression. The simple fact is that the thoughts we have can influence the feelings we experience, and vice versa. It’s a viscous cycle, and the cyclical nature of the illness ensures that once you are in the cycle, it is very difficult to break free. Thoughts can often pop into your head from seemingly out of nowhere, and of their own volition. Frequently however, these introspections are provoked by associations arising from what we see or hear around us. Photos, friends, people in the street, a piece of music, or a particular building can all conjure up thoughts, and consequently feelings, which are both unwanted and damaging. This can happen to all of us, although I would suggest that those with a depressive disorder will experience them in a far greater frequency.

Memories can be very significant stimuli in depression, and can be triggered by a wide variety of occurrences. For example, the other day I walked past a previous flat I had lived in, for the first time in about 3 years. This induced painful memories of the difficulties I was going through when I resided there, and the dark place that I found myself in. For the brief time the building was in my eye line it reignited the anxiety I had all those years ago, and the effect this had upon me took some time to wear off. Just as they say a smell of cooking can take you back to your family kitchen when you were a kid, this visual reminder conjured up all kinds on unwanted sensations and anxieties. On another occasion, I walked past someone in the street who looked remarkably like a person from a few years ago who I had a bad experience with, and this generated the same feelings of anger, sadness and frustration that I had felt at the time. It acted as a kind of portal, which transported me back to 3 years ago and bestowed upon me the exact emotions I had experienced during that period.

It can work the other way too. A certain image or stimulus may conjure up memories of a happy event, and illicit a smile and feeling of warmth, as though you are living through that event once again. The problem stems from the fact that the effects of positive memories wear off extremely quickly, whereas the effects of negative ones can linger for many hours or even days.

When a particular issue or source of anxiety is at it’s height, I often focus upon those things that will justify and confirm my beliefs about it, rather than seeking out those truths that may offer a counter argument. For example, if I get self conscious or low about my appearance I will ‘notice’ people who in my mind are ‘more attractive’, ‘normal looking’, and consequently to my prejudiced perception ‘happy’. This will then feed my exiting beliefs and anxieties, and prolong the cycle of mental unrest. It becomes impossible to see the things that would offer a counter to these beliefs, as you cannot help becoming blind to them. Depression could be described as like a special pair of glasses that allow you to see the negative things, but blinds you to all of the positives.

It seems to me that a need for support from other people is inevitable, and paramount as a facilitation to help you try and overcome this. Not so much for reassurance, as that can have detrimental consequences and potentially lead to a heavy reliance on reassurance before you can even function at all (another cyclical process). But just having other people who are not wearing the ‘depression glasses’ can encourage you to open your eyes and see things for what they really are. My illness (among other factors) has prevented me from ever having a girlfriend, and that has always been a huge roadblock to getting to where I want to be, and consequently has promoted deep levels sadness and frustration, as well as an inevitable elevation of that part of my ‘desired life’ to a near mythic unobtainable feat. This is not merely because ‘you want what you don’t have’, but because of the knowledge that whilst it wouldn’t necessarily solve everything, it would mean that I would no longer have to do things alone, and would enable me to express my emotions in a positive way towards another person (love, happiness) rather than a negative one (anxiety, fear, stress, resentment). Plus it’s its just too damn appealing to be with someone who loves you for who you are, and for which you can reciprocate.

Obviously thoughts and feelings aren’t going to go away, and nor should they, as they are what makes us who we are. The goal however, is to be in a position where you are in control of your thoughts and feelings, rather than them being in control of you. It feels as though mine do not only control me, but in fact own me, and dictate every step of my life. If there is a way to take back this ownership, then that must be what I, and indeed everyone, should aspire to.

Swamped

All around me are familiar faces
Worn out places, worn out faces
Bright and early for their daily races
Going nowhere, going nowhere
Their tears are filling up their glasses
No expression, no expression
Hide my head I want to drown my sorrow
No tomorrow, no tomorrow

Mad World – Michael Andrews & Gary Jules

—————-

How do you feel?

Lie: A little down to be honest, but I’ll be ok. Probably just the time of year.

Truth: I feel like my insides are tearing themselves to pieces. I feel like I’m standing on a stage facing a thousand people and my heart is going to burst right out of my chest. I feel like things aren’t, have never been, or never will be OK. I feel like I want to bawl my eyes out until there are no more tears left to shed. I feel like no one understands, none more so than myself. I feel like I am destined to die alone. I feel like I want to get into bed under the covers and never have to get out again. I feel like I want to throw the towel in. I feel like the light from the centre of the sun could not vanquish the darkness I feel inside.

It goes without saying that I’m not in a great place right now. I’ve been down this road enough times to know that eventually it will subside. But I’ve also been down this road enough times to know that it will happen again…and again. The resolve breaks with this knowledge. How can you expect to drag yourself out of a swamp, when you know that you will be back down in it’s muddy depths within a matter of weeks or months. It becomes too easy to give in and stop trying to pull yourself free.

Time has become a large focus. It’s a thought process of contradictions, on the one hand wanting the day to rush by and be over with, whilst on the other hand being scared witless at how fast the years are rolling by. Being 30 terrifies me, not because of the age itself, but because the milestone reminds me of how much of my life I have wasted, or rather my illness has wasted. I want to go back, and have another shot at things. I find myself not having experienced, or having dealt with certain things that I should have in my teens. I can’t help feeling out of place, and not belonging, and terrified of the past, present and future. On the one hand I want to run away and hide from the world, and on the other hand I want to shout from the rooftops ‘please like me’. I simply don’t know what to do. All I can do is get back up again in the morning and carry on. The Garden of Eden must be out there somewhere. I’m just too tangled up in the undergrowth to see it.

Katelyn

At the weekend a news story went viral about a 12 year old American girl taking her own life and live streaming the whole event on social media. Katelyn Nicole Davis from Georgia recorded a 42 minute video in her backyard on 30th December, featuring a heartbreaking explanation to camera as to why she was deciding to end her life, followed by her apparently hanging herself from a tree in the fading daylight. The news story focused upon the fact that the tragic event unfolded live on the internet, with the potential ramifications of this, and the inevitable difficulties in attempting to take the video down, as there is no legal obligation to do so (although the moral obligation is undisputed). Whilst the manner of her suicide being carried out for the world to see is clearly a significant concern, it was not what stuck with me when reading the multitude of articles that sprang up on Saturday. Clearly issues of social media and the ways that people live out their lives on the web is a big feature of society in the 21st century, and one that cannot go unanalysed. However, what concerned me more was that a 12 year old girl felt that her only option was to cut short her life, with all of it’s undeniable potential, because she believed she had nowhere else to turn to. In an age where we can put a man on the moon, travel to the other side of the world in less than 24 hours, and discover cures for natures most deadly of diseases, how can we find ourselves reading about a little girl in so much pain and anguish that her only option was to cease living?

I haven’t watched the video myself (why anyone would want to I can’t imagine), but some of the articles showed pictures and featured transcripts of her final words. Apparently she was abused mentally and physically by her step father, as well as having suffered with depression and a tendency to self harm for many years. And all that by the age of 12. It’s impossible to know exactly what was going on within her mind, and what support (if any) she was receiving from her family and friends. But what is clear is that her final words are both chilling and devastating:

“I’m sorry – I’m sorry that I’m not pretty enough…I’m sorry I came into your lives just to get out of it this quickly. I’m sorry for everything. I’m really and truly sorry for everything. But I can’t do this. I’m sorry…I’m sorry everyone. I’m sorry I let this depression get to me.”

See how many times she apologises. She has been the victim of abuse, and of a terrible illness, and yet she is the one saying sorry. Society should be apologising to Katelyn for letting her down. Depression really is such an irrational illness, which causes you to despise and blame yourself for everything. She has allowed the dark thoughts and feelings of hopelessness to infest and take over her mind, and this is something I can relate to as it is a daily challenge that is faced by many people. But what is impossible to grasp is how for a 12 year old girl these thoughts and feelings prevented her from seeing any other way out.

We live in an incredibly connected world, in which communication with people in the far reaches of the planet is possible at the touch of a button. However, this network of connectivity can further highlight the feelings of loneliness or isolation that the mentally vulnerable feel, rather than providing an outlet for compassionate consideration. The loneliest of moments are often not during times of being on ones own, but rather when one is surrounded by others, both physically or virtually, as you are privy to the kinds of human relationships or successes that you fiercely yearn for. Rather than a casual sense of longing that you may feel when alone, this becomes a source of desperate painful longing when you see these relationships existing in the real world, but just out reach.

Depression is without doubt this centuries biggest health crisis. It’s not good enough that someone may have to wait 12 or 18 months before getting therapy that may save their life. It’s not good enough that systematic child abuse goes unchallenged and unpunished. And it’s not good enough that depression plays a part in at least 50% of all suicides, and that the statistics are going in the wrong direction. I know that every time I feel that the darkness is enveloping me, or that I am not strong enough to go on coping, I will think of Katelyn. We cannot let this illness keep on killing, and we have to ask ourselves some very stark questions. Is enough being done? No. Is there a quick and obvious fix. Not really. Do we need to do something at all costs? Without question. The tragedy is that for Katelyn it is already too late.

Walking The Tightrope

Have you ever played one of those 2p coin pusher arcade games? All it takes is one little coin being pushed through a slot to cause everything else to fall apart. That sums up how I feel. Now more than ever it seems as though every day I’m walking a tightrope, and I’m one little nudge away from falling. The constantly changing mood is in many ways worse than a persistent period of feeling down, as the ability to predict what my state of mind will be from one day to the next becomes impossible.

It’s amazing how tiny things can cause the already unstable equilibrium to become seriously unbalanced: a throwaway remark from a friend, an image on facebook, a memory or thought coming to mind. It’s not these things themselves that cause the spiral downwards, as often they are meaningless, insubstantial or wrongly interpreted, but rather they act as the final little push needed to facilitate the nose dive into turmoil. When a particularly strong sea wave causes a rock face to crumble and fall into the sea, it’s not that single wave that did the damage, but rather it was the years of constant battering that caused the rock face to weaken. The last 7 days have featured the highs of laughing with friends at Christmas parties or in the office, to the lows of shutting myself in the toilets and failing to hold back the tears.

A significant cause of anxiety is a perception or concern with how others view you, and generally these preconceptions are either false, or hugely exaggerated. However, there is one person I know that truly despises me, and that is myself. I find that the loathing I have for myself is only matched by the desire I have to make others happy. It may be a cliche, but how can you expect anyone else to love you when you don’t even like yourself? More than the contempt I have for myself is the constant fear I have of it alienating friends, and all I want to do is constantly apologise for how I am to be around at times. It’s too important that I don’t lose these people…the consequences could be devastating.

As previously mentioned in other blogs this time of year is a particularly difficult one, and whilst I got through my birthday without the immediate difficulties I had anticipated (due in part to the kindness of certain friends in making the day feel special), I certainly feel the affects as a delayed reaction. As 2016 comes to a close it should present everyone with a sense of optimism for what 2017 will bring. For me if merely fills me with dread of another year of my life ticking by, and being nowhere nearer to feeling any semblance of happiness or peace. Is it really worth another year of pain? On 1st January I will have been writing this blog for 1 year, comprising almost 50 posts. The fact that from blog 1 to blog 50 I am still writing the same sorts of things is a testament to how frustrating this illness is, and epitomises how difficult it is to remain hopeful. Whilst it’s true that “to be alive is to have hope”, the longer time goes on the less alive you feel and therefore it’s not just the hope that you crave, but the feeling of being alive.

 

Trigger (Un)Happy

When finding myself in the midst of particular difficult period I often get asked ‘what triggered it this time?’ This is a perfectly legitimate question, and one that a non-sufferer would be completely justified in asking. Of course there are some obvious triggers, such as big life events like bereavements or breakups, that are bound to cause a whirlwind of emotions and a downward spiral into depression. However, for the majority of the time there are no rational or tangible triggers that precipitate the relapse; instead it appears out of the blue, like a bullet train rocketing out of a tunnel. In some instances it builds up gradually before it reaching its painful crescendo, but on other occasions it hits you full pelt in the stomach, with no warning or let up.

According to this the article Top Relapse Triggers for Depression & How to Prevent Them “the risk of recurrence — ‘relapse after full remission’ — for a person who’s had one episode of depression is 50 percent. For a person with two episodes, the risk is about 70 percent. For someone with three episodes or more, the risk rises to around 90 percent”. That statistic doesn’t provide much comfort, as clearly the chances of relapse increase with each depressive episode that occurs. Putting it bluntly, things will only get worse.

The article proceeds to suggest 3 potential trigger categories, and how they can manifest into a period of depression:

Not Following Treatment

The article proposes that “The biggest issue regarding relapse has to do with children and adults not following through on their treatment plan… this includes anything from skipping therapy sessions to missing doses of your medication to ending therapy too soon”. I can certainly relate to the negative effects of ending therapy too soon, although through no fault of my own, but rather the underfunded and oversubscribed NHS. If these support structures are not strong enough, or are fragmented and disturbed, then it undeniably ensures that a relapse is increasingly likely. The article also suggests that “while your life may involve psychotherapy, medication and the need for a protective structure that keeps your illness at bay, also realize that you have passions, desires, gifts and talents that require just as much attention.” It is all to easy for these facets of life to fall by the wayside, which consequently prolongs the negative cycle.

Ruminations

“Negative self-referential ruminations play a key role in recurrence… for example, individuals with depression tend to dwell on their (supposed) flaws and failures. They also may view neutral events with a negative lens.” Ruminations are a big deal for me, allowing my mind to dwell on my insecurities, and conjure up thoughts of sadness, hopelessness and a misguided longing for a perceived better life. This trigger is particularly problematic to tackle, as the thoughts come out of the blue, and linger sometimes for days or weeks. Unfortunately the mind cannot be switched off, and the more time you spend alone, the more the thoughts penetrate deep into the brain, eating away at you, with little or no regards to the consequences. Despite being a cliché, it’s like being trapped inside a prison, with only your thoughts as the ruthless prison guards for company.

Knowing Your Personal Vulnerabilities

“Triggers may be very specific to each individual’s situation, since all of our emotional responses are unique to some extent…learn how to recognize the who, what, whys and whens of your emotional and physical life.” For example particular dates or times of the year can prove to be difficult and act as triggers for a depressive state of mind. For me personally my birthday and Christmas are particularly troublesome as they can provoke the ruminations mentioned previously, and cause them to take hold, whilst also proliferating ideas of another year having passed by and another year when I still feel trapped in a deep well of unhappiness. Regret, frustration and sadness are emotions that become second nature. The article also notes that “If you find yourself excessively fatigued, irritable, having trouble eating or sleeping, you might be in the midst of a trigger event.”

Identifying certain triggers doesn’t really provide much assistance or solace. I sometimes have anticipated an event 8 months in advance as a potential cause of anxiety or depression, and despite this warning, it plays out exactly as I had envisioned. Plus the fact that there are so many invisible and intangible triggers at play ensures that any attempt to fight the process becomes virtually impossible. The article concludes that you “don’t measure your success living with depression on whether relapse happens or not. Instead, realize that if relapse occurs, true success comes from rising after the fall…Fall down seven times, get up eight.” The difficulty comes in the fact that falling down is so easy, but getting back up again requires reserves of energy and determination that are in very short supply.