Sidestepping sand traps
Along the path to better mental health, you're sure to encounter obstacles. The following are popular reasons for abandoning your goals or not getting started with pursuing goals in the first place:
Fearing change. Despite feeling really miserable, you may be afraid of what'll happen if you take steps to change. You may have been depressed or anxious for so long that you can't really imagine doing anything else. Perhaps some of the people in your life are helping you to live with your problems, and you fear that by getting better you may lose those people. However, getting yourself well gives you a chance to build more fulfilling relationships and to develop your independence.
Having low-frustration tolerance. When the going gets tough, the tough go home to bed, right? No! You may be tempted to go to bed, but you just wake up every morning with the same old problems. The only way to increase your tolerance to frustration in all its forms is to grit your teeth and stick with it. However uncomfortable you may be while working on changing yourself, the effort is almost certainly a lot less painful than staying unwell for the rest of your life.
Being passive. Maybe if you wait long enough someone else will get better for you! Perhaps a miracle will happen to change your life, or a magic button will appear for you to push! Hey presto! - and you're fixed. Maybe, but don't hold your breath waiting. Take responsibility for doing the work needed to get you feeling better.
Having a fear of being bossed around. Some people have a very strong sense of autonomy and they can be sensitive to other people trying to influence or coerce them. If you're one of these people, you may think that your therapist, or somebody close to you, is trying to take over when they suggest you try new strategies. Try to be open-minded to what professionals and people who care about you suggest. Deciding to give someone else's ideas a try is up to you. No one else can really control you or your decisions.
Being fatalistic. Perhaps your motto is: ‘This is the way I am and how I'm destined to be for all time.' Being convinced that your moods are governed by forces beyond your control, such as chemicals, hormones, biology, the past, fate or God, means that you're prone to surrender yourself to your symptoms. Why not put your theories to the test by making a real effort to rewrite your supposed destiny? You never know: Your original assumptions may be wrong!
Love is the drug that I'm thinking of . . . You may be convinced that love is the only true path to happiness. You may be unable to imagine that you can have a satisfying life by learning to cope with your problems on your own. You may think that you will remain unhappy and emotionally disturbed until your special someone rides in on a steed to rescue you from this crazy mixed-up world. Love is a real bonus to human existence, make no mistake. However, the healthiest relationships are those where both parties are self-sufficient and enjoy the companionship of one another without being overly dependant.
Waiting to feel motivated. A lot of people make the mistake of waiting to feel like doing something before they get started. The problem with waiting for inspiration, or motivation, is that you may hang about for far too long. Often, action precedes motivation. When overcoming emotional disturbance, you often need to do an experiment (check out Chapter 4) or you can stick to an activity schedule (in Chapter 12), even when doing so is the last thing that you feel like doing. Positive action is the best remedy for overcoming the feelings of lethargy and hopelessness.
Chapter 20: Psychological Gardening: Maintaining Your CBT Gains
In This Chapter
Taking care of the fruits of your hard work
Avoiding potential relapse and overcoming actual relapse
Sowing the seeds of love (and compassion)
Looking after the positive changes you've made is a major part of helping you stay emotionally healthy. You can nurture your belief and behaviour changes every day. The process is a bit like watering a plant to keep it thriving. The more care you take of yourself both generally and specifically - for example, by practising your new ways of thinking and acting - the more you reduce the chances of returning to your old problematic ways.
This chapter provides tips and advice that can help you avoid relapses and manage setbacks if they do occur.
Knowing Your Weeds from Your Flowers
Think of your life as a garden. Unhealthy, rigid ways of thinking and corresponding behaviours like avoidance, rituals, safety strategies, perfectionism and trying too hard to please (to name but a few) are the weeds in your garden. The flowers consist of your healthy, flexible thinking, such as accepting yourself and others, accepting uncertainty and allowing yourself to be fallible, and your healthy behaviours, such as assertion, communication, problem-solving and exposure (see Chapters 4 and 13 for more about exposure and response prevention).
No garden's ever weed-free. Planting desirable plants isn't enough. You need to continuously water and feed the flowers, and uproot the weeds to keep your garden healthy. If you tend your garden regularly, the weeds don't get a chance to take hold because there you are with your trowel, digging 'em out at the first sign of sprouting. Depending on the virulence of your weeds, you may need to use some weedkiller from time to time in the form of appropriately prescribed medication. So, know thy garden.
After you've identified your unhealthy behaviours and thinking tendencies, and bedded down some healthy alternatives, you can keep a better look out for emerging weeds and keep an eye on the health of your flowers.
To differentiate your weeds from your flowers, ask yourself the following questions:
What areas do I most need to keep working at in order to maintain my CBT gains? The areas you identify are those where weeds are most likely to first take root.
What CBT strategies aid me most in overcoming my emotional problems? Think about the new attitudes you've adopted towards yourself, the world and other people. These areas are your tender, new flowers - their delicate shoots need your attention.
What are the most useful techniques that I've applied to overcoming my emotional problems? Think about the new ways of behaving that you've adopted (daffodils) and the old ways of behaving that you've dropped (thistles). Stick to your new, healthy behaviours and be vigilant against slipping back into your former unhealthy patterns of behaviour. Use an activity schedule to help you carry out beneficial routines and behaviours (jump to Chapter 12 for more about activity scheduling).
Write down the answers to the preceding questions so that you can look at them often to remind yourself of where to put in the hoe.
Working on Weeds
This section deals with weed-related topics and offers you some suggestions on how to stop them from taking over your garden, anticipating where they're likely to grow, and how to manage those that keep coming back.
Nipping weeds in the bud
Out of the corner of your eye, you see a weed sticking up its insidious little head. You may be tempted to ignore it. Maybe it'll go away or whither and die on its own. Unfortunately, weeds seldom eliminate themselves. Rather, they tend to spread and smother your burgeoning bluebells. Assume that any weed you identify needs savage and prompt killing.
A common reason for ignoring resurging problems is shame (which we talk about in Chapter 19). If you feel ashamed that your problems are recurring, you may try to deny it, and avoid seeking help from professionals or support from friends or family. You may be less likely to make a personal effort to whack down the problems in the way you did the first time.
Setbacks are a normal part of development. Human beings have emotional and psychological problems just as readily as physical problems. You don't have to be ashamed of your psychological problems, any more than you should be ashamed of an allergy or a heart condition.
Another common reason for people ignoring the reappearance of psychological problems is catastrophising or assuming the worst (head to Chapter 2 for more info on thinking errors). Many people jump to the conclusion that a setback equals a return to square one - but this certainly doesn't
have to be the case. You can take the view that a problem you conquered once is at a fundamental disadvantage when it tries to take hold again. This is because you know your enemy. Use what you already know about recognising and arresting your old thinking and behaviour to help you pluck that weed before it gets too far above the ground.
Some emotional and psychological problems are more tenacious than others, for example bipolar disorder, obsessive-compulsive disorder (OCD) and eating disorders. Just because a problem's tenacious, it doesn't mean that it has to take over your life, or even cause you too much interference in it. However, you can expect to meet tenacious problems again. Keep up with treatment strategies even when your original problems are no longer in evidence; doing so will help prevent a relapse.
For example, if you have a history of depression, you may notice that weeds are popping up when you do some of the following:
Begin to think in a pessimistic way about your future and your ability to cope with daily hassles.
Ruminate on past failures and on how poor your mood is.
Lose interest in seeing your family and friends.
Have difficulty getting out of bed in the morning, and want to sleep more during the day instead of doing chores or taking exercise.
If you spot these stinging nettles making their way into your otherwise floral existence, try some of these techniques:
Challenge your pessimistic thinking bias, and remind yourself that your thoughts are not accurate descriptions of reality but symptoms of your depression. (See Chapter 2 for more on thinking errors.)
Interrupt the rumination process by using task-concentration and mindfulness techniques. (We explain these in Chapter 5.)
Continue to meet with family and friends, despite your decreased interest, on the basis that doing so makes you feel better rather than worse.
Force yourself out of bed in the morning and keep an activity schedule. (Have a read of Chapter 12 for more on activity schedules.)
Whatever your specific problems, follow the preceding example: write down your descriptions of anticipated weeds and some specific weed-killing solutions to have at hand.
Don't ignore signs that your problems are trying to get their roots down. Be vigilant. But also be confident in your ability to use the strategies that worked before and in your ability to use them time and again, whenever you need to.
Spotting where weeds may grow
To prevent relapse, become aware of where your weeds are most likely to take root.
Most people, regardless of their specific psychological problems, find themselves most vulnerable to setbacks when they're run down or under stress. If you're overtired and under a lot of environmental stress, such as dealing with work deadlines, financial worries, bereavement or family/relationship difficulties, you tend to be more prone to physical maladies, such as colds, flu and episodes of eczema. Psychological problems are no different from physical ones in this regard: they get you when you're depleted and at a low ebb.
You may notice that some problems, like OCD, anxiety and depression, are more evident when you're recovering from a physical illness. Recognising this common human experience can help you to combat any shame that you may feel, and to de-catastrophise a return of your symptoms.
Compile a list of situations and environmental factors that are likely to give your weeds scope to take on triffid-like power. For example, you may be able to pinpoint environment triggers for your depression, such as the following:
Seasonal change, especially during autumn, when the days get shorter and the weather becomes colder.
Sleep deprivation, due to work commitments, young children, illness or any other reason.
Lack of exercise and physical activity.
Day-to-day hassles piling up at once, such as the boiler breaking down in the same week that the washing machine explodes and a few extra bills arrive.
Reduced opportunity for positive social interaction with friends and family.
You can also identify interpersonal triggers for your depression, such as the following:
Tired and tetchy partner.
Disagreements with your partner, children, parents or extended family.
Critical or demanding boss.
Disagreeable work colleagues.
Compile a list of high-risk situations for yourself, including situations that are most likely to fire up your unhealthy core beliefs (we explain core beliefs in Chapter 16), and situations that put you under strain. Creating such a list helps you to have a clear idea of when you're most vulnerable to relapse and identify which psychological soil is the most fertile for weed growth.
Dealing with recurrent weeds
Some weeds just seem to keep coming back. You may think you're rid of them, only to open your garden door to a scene from Little Shop of Horrors (‘Feed me, Seymour!').
Some unhealthy beliefs are harder to erode than others. Core beliefs (refer to Chapter 16) are those that typically you've held to be true for a very long time - most of your life even. These beliefs will keep trying to take root and may be particularly resistant to your attempts to kill them off. Certain unhealthy behaviours, such as addictions and rituals associated with eating disorders or OCD, for example, can be very stubborn.
The best way to deal with these recurrent weeds is to not become complacent. Keep reinforcing your alternative beliefs. Keep up with activities that fill the gaps left by your addictions or preoccupation with food. Keep doing exposure and response-prevention activities (refer to Chapter 13) to combat your OCD. Trust that over time and with persistence, your new ways of thinking and acting will get stronger.
Are you unwittingly feeding your weeds? Avoidance is a major weed fertiliser. You may have developed a healthy belief, such as ‘I want to be liked by people, but I don't have to be. Not being liked by some people doesn't mean that I'm unlikeable.' And yet, if you still avoid social situations, self-expression and confrontation, you're giving your old belief that ‘I must be liked by everyone or it means that I am an unlikeable person!', the opportunity to germinate.
Check out your reasons for avoiding certain situations and experiences. Are you not going to a party because you don't want to, or because you want to avoid the possibility of others judging you negatively in some way? Are you not visiting a farm because it doesn't interest you, or because you want to avoid contamination from pesticides?
When you spot a recurrent, mulish weed in your garden, dig it out from the root. You can kill off weeds entirely by getting the roots, and the shoots, out of the soil. Try not to make half-hearted efforts at challenging your faulty thinking. Dispute your thinking errors (Chapter 2) and push yourself back into challenging situations using your healthy coping strategies (we cover thinking errors in Chapter 2, and we talk about coping strategies in Chapters 4, 13 and 16.)
Tending Your Flowers
Knowing when you're most prone to the symptoms of your original problems re-sprouting is one thing. But knowing how to troubleshoot problems and prevent weeds from growing back is another thing altogether.
The techniques, behavioural exercises and experiments that helped you to overcome your problems in the first place will probably work again. So, go back to basics. Keep challenging your negative thinking and thinking errors. Keep exposing yourself to your feared situations. If your life is in turmoil due to inevitable things like moving house, work difficulties or ill health, try to keep to your normal routine as much as possible.
Above all, even when things are going well, water your pansies! Psychological watering involves keeping up with your new ways of thinking and behaving, by giving yourself plenty of opportunity to consistently practise and test your new ways of living. As we mention in Chapter 16, healthy, alternative beliefs take time to become habitual. Be patient with yourself and keep doing healthy things, even when you're symptom-free.
Developing a plan for times of crisis is another good idea. Here are some examples of what you may wish to include in your plan to overcom
e a possible relapse:
Consider seeing your GP or psychiatrist to determine whether you need to go on medication for a while.
Talk about your feelings to someone you trust. Pick a person who you can rely on to be supportive. Seek the help of a professional if talking to a friend or family member isn't enough.
Review your efforts from previous CBT work and re-use the exercises that were most effective.
Keep your lifestyle healthy and active.
Planting new varieties
Cognitive Behavioural Therapy For Dummies Page 35