What is CBT, and how will it help me?

So in my absence, I’ve been attending a weekly CBT group therapy session.  The decision to refer me to this group was made when I was discharged from hospital back in January to tackle my anxiety.  I went onto a waiting list then a spot opened for me in April.

So what is CBT?

Cognitive behavioural therapy is a problem based, action focussed form of psychotherapy – it identifies problematic behaviours and thoughts, challenges them and encourages you to form new ones.  It has been proven to be effective in treating many different mental illnesses but in this group was focussed on depression and anxiety.  It can be done individually, or in a group setting.

I’ve done group therapy before but that was DBT, a therapy more oriented at reducing problematic behaviours in people with personality disorders.  I had to do the group something like four times before the therapists decided that they were done with me.  What can I say, old habits die hard.

With that in mind I was apprehensive towards CBT.  I was hoping it wouldn’t attract the kind of drama that comes with a DBT group, where you don’t tend to end up unless your life is well out of control.  My own life was pretty chaotic at the time, and I’m sure there were plenty of people in the group who got sick of hearing about me getting into the same dramas over and over.

My brother in law also tried individual CBT to treat his depression and didn’t like it.  Which is fine, not all therapy styles are appropriate for every individual but he really felt it was too impersonal.  He likened it to treating his brain like a computer that needs rebooting.  Which is interesting because I find that to be an appropriate metaphor for how my anxiety works.  It’s like my brain is programmed to dread unspeakable horrors at all times for no goddamn reason and if reprogramming is what CBT can do for me, then I’m all for it.

So I went along to this group.  It runs for three and a half hours, separated into three sections, sharing, mindfulness and doing worksheets.  When we first arrive we take turns sharing situations where we struggled with our anxiety and/or depression, and where we have done our homework from the last week which generally consists of identifying some problematic thought patterns and connecting them to our behaviours

After sharing – which usually takes twenty minutes or so per person – we have a twenty minute break, then go back to do a mindfulness exercise lead by the therapist.  This is the part I struggled with; I can’t keep my head clear to save my life.  Intrusive thoughts are a big deal for me.  I can do some mindful deep breathing but I’ll guarantee I’m also thinking about my favourite Archer quotes or something.

We then spend the last hour and a half working through the info and exercises on our handouts for the week.  If you follow me on Instagram you’ll notice I’ve been posting them as I get them; they are separated into two seven week modules, one on anxiety and one on depression.  Each week we explore some aspect of thoughts and behaviours that might be shaped by both.

Even though I was put in this group for anxiety, I found the thought challenging exercises in the depression module to be more relevant to me.  I love to catastrophise and obsess over possibilities – and I have a double whammy of autistic spectrum disorder and paranoid delusions from mania facilitating that – and I found the exercises grounding.

So about the people in the group…obviously I can’t share details about them, but was I right in assuming that they would be less dramatic than our mates in DBT?  The answer is yes…mostly.  People with anxiety as opposed to personality disorders tend to be higher functioning I’ve found, but there’s always some individuals who can’t not escalate any drama they get into and don’t want to help themselves by using the therapy tools to challenge their behaviour.  But one of our group rules is accepting that everyone is at a different stage of their recovery journey, so I just have to take it for what it is I guess.

After all, One of the benefits of group therapy that they’re too polite to tell you about is that there’s always something to be learned from other people’s mistakes.

Mac

Jessica Marais’ Bipolar Disorder is Not About You

I’ve always been interested in how the topic of mental health is handled by those in the public eye.  While celebrities might live lives far removed from our own, their take on complicated matters like a bipolar diagnosis tends to be both influential and reflective of the views of society as a whole.  Every now and then you see a story about a celebrity coming out of the ‘mental health closet, and I’m always all over those like a rash.

So when I saw the story about Jessica Marais’ interview with Woman’s Day appear on my news feed, I fell down the rabbit hole exploring every facet of it.

Here’s the news.com.au story, which summarises the Woman’s Day one:

Click here

And here’s one published on Mamamia, which goes a bit more in depth and takes opinions from other people living with bipolar disorder

Click here

If you can’t be bothered clicking, here’s the abridged version:

Jessica Marais, 29 year old mum of one, has struggled with bipolar episodes from age 12

She has a family history of the disease

She chooses not to be medicated and feels that her condition is controlled well

She has done cognitive behavioural therapy and says it was beneficial

she feels her toddler can “pull (her) out of” depression

The author of the Mamamia post reached out to the Black Dog institute for comment.  They supplied an overview of bipolar disorder but refused to comment on the specifics of Marais’ case.

There was an undercurrent of uncertainty in the Mamamia article because the author wasn’t sure how to feel about Marais’ revelation, because some of the things she said do seem to be controversial on the surface.  They ended the article with a selection of comments from bipolar suffering readers, which ranged from congratulating her on her bravery for coming forward to condemning her irresponsibility for (apparently) suggesting that all bipolar can be controlled without meds.

I don’t love the way this story has been approached.  Bipolar disorder is only discussed on an in dividual level, rather than acknowledging sufferers as the diverse population that we are.  All commenters used their own experiences as a measure of how well Marais was managing her condition, and were critical of her when they found that her experiences and management strategies were different to theirs.  Which is wrong.

Because guys?  Jessica Marais’ bipolar is not your bipolar.  It is not my bipolar.  We have a disease that presents on a spectrum that varied widely in presentation.

I suspect that the reason the folks at Black Dog didn’t want to comment on Marais case was because they didn’t want to present her as a single embodiment of all bipolar sufferers.  She isn’t, and I can’t find any point where she claimed to be.

I have bipolar disorder.  Like Marais, it appeared around age twelve and has been a major feature of my life ever since.  My experiences are widely different than what she represents hers as, but I don’t think that’s due to any lies or irresponsibility with management on her part.  Since I was properly diagnosed at age 20, I’ve read up extensively to educate myself on the disease as a whole, not just what it means for me.  So with that in mind, I’ll be offering my perspective on the story.

I find it interesting that she mentions her family history.  It’s been proven that there is a genetic link for the disease.  I know my family has enough problematic mental health genes to supply material for a whole psychiatric conference, but the only person apart from me who has been diagnosed with bipolar is my paternal grandmother.  I remember my dad talking at length with my doctor when she broke the news about my diagnosis to him at my request.  After he was done, he put down the phone, turned to me and said sadly “I supposed I should have expected it in one of you”  I think anyone who has been recently diagnosed should do a little digging in the family closet.

The major issue people have with her interview was where she claimed that she doesn’t need meds because she’s done CBT.  I have to admit, when I first read that I groaned out loud.  I know when I skip meds even for a few days it’s a pretty rapid descent into cray-cray town.  I can understand why it garnered such a negative reaction from the public because remember the last Australian public figure with bipolar who claimed he could handle himself off his meds?

Because I do:

465883-matthew-newton

via http://www.news.com.au

…yeah.  Sure hope he’s changed his mind.

But in the midst of my not-another-Matthew-Newton despair, my wise mind kicked in and I remembered what I’ve learnt about bipolar as a spectrum.  Her bipolar could well be more manageable than mine, I just don’t know.  A lot of bipolar people I was in hospital with were involved in group therapy for CBT, DBT and interpersonal therapy and responded well to it.  Jessica would have learnt about distress tolerance, self talk, diversion tactics amongst other things which once she’d practiced enough to make it second nature, could help take the edge off when she’s having an episode.

She also talks about self awareness which makes me think that she is actually controlling it without meds, or is well on the way to at least.  If you’re experiencing mania or depression, recognising those episodes for what they are will help you be more proactive in overcoming them.

There are bipolar people like me who will likely rely on meds for the rest of their lives but many people with a mental illness diagnosis won’t.  They may need them to be on and off to overcome rough patches but with the right kind of support and therapy they may cope just fine off them.  Once again – bipolar disorder is a spectrum.  For some it’s heavily debilitating, others are towards the lighter end of the scale.  Marais is likely one of those people.

She doesn’t say that meds are unnecessary for all bipolar patients, she was simply stating what works for her.  And quite frankly, there just isn’t enough talk about what a huge fucking difference behavioural therapies can do for people with mood and personality disorders.  Many people who need it don’t get it because they’re suspicious of and there needs to be more people who’ve done it publically talking about how it helped them.  So for singing the much deserved praises of behavioural therapies Jessica, THANK YOU.

The last point which I found interesting was where she says that her kid has been beneficial for her depression.  Now I don’t think she’s saying that to cure depression you should up and start reproducing, but it was a surprise to me because I’d assume that someone with a bipolar diagnosis would be a heavy risk for PND.  Then again, I’ve had more than a few friends who’d struggled with depression tell me that they actually saw improvement when they started a family.

Why is that, I wonder?  If I were to guess, I’d say a kid is a sure fire way to keep you busy.  My hospital psychologist was fond of saying that the best cure for depression was to do the opposite of what you feel – lying in bed doing nothing, not stimulating your brain is perpetuating the imbalance in your brain.  I’d imagine that finding motivation to get out of bed and face life is much easier when you have a little human screaming at you to do so.

If you could take anything away from this article, it’s that I ‘d rather you not look at a mental illness diagnosis as a one size fits all profile.  No treatment plan is going to be perfect for everyone and if someone is happy and healthy we should trust their ability to do right by themselves, even if we don’t agree with their methods.  This is why I love celebrity mental health stories – the more different experiences that we see, the more we will come to understand that the mentally ill community is one of diversity, and different experiences should accepted, not condemned.

Rock on, Jessica Marais.  You’re not obliged to share your personal life, but I’m glad you did.