CBT, my personal journey (pun intended).

I would like to talk a bit more about CBT (Cognitive Behavioral Therapy) since it is the main type of therapy recommended for people with anxiety and phobias. If you are considering it or know someone who might, this is how my process took place. I am not sure if it varies but I have been told it is pretty standard. Firstly, if you would like to seek help through NHS the process can be quite long. You have to see you GP, then they will refer you for an external evaluation (you'll be given a 'low mood and anxiety' form to fill up and will undergo a 1h phone interview). It may take a couple of weeks to set this up and I am pretty sure the process depends on severity of your condition and how long you have waited before seeking help. If your assessment is successful you would be offered a treatment (anything from a group session to a one-to-one). At first I was allocated a 50 minute session weekly or fortnightly with a mental health practitioner (guided self help), then a more advanced weekly 50 min-2h CBT sessions with my current therapist.

CBT might not be for everyone, certainly my first experience with it was rather disastrous. I was hoping that just for seeking help I'd get some brownie points and all I would have to do is show up and talk about my problems on a chaise longue. Not quite what happened. I think with any kind of therapy you have to be ready, very determined and committed to it. Your therapist can only guide you, ask you the right questions and suggests suitable solutions but it is up to you to do the work. You need to want this really bad, bad enough to dig deep, face your fears and put yourself in high anxiety provoking situations. It is very scary at first and you will probably find hundreds of perfectly valid excuses not to do it but once you break through that first stage you are half way there. It really is worth it. Even if your issue does not affect your life as much as it did mine not dealing with the fear is like having a dark cloud following you around ready to expand and rain a sh*t storm...

The CBT itself is performed in the following stages. Firstly you need to identify your fear, what you are actually scared of and what might have caused it. Anxiety and panic attacks are simply symptoms, finding the cause is up to you, it may not always be obvious, but it is very important to identify it. There are many ways of uncovering it and your therapist will help you with that (questions, exercises, forms etc.) but you might have to go on a little trip down memory lane. Second thing (which I believe works for every phobia) is to create a hierarchy of feared objects/situations. This will eventually become your practise sheet. You write down the things in order, from the ones you fear the least to the ones that scare you the most and mark your potential anxiety on a scale of 0-100. For example in my case the easiest exercise was taking a bus, so I put down a bus journey, off peek, familiar route with someone I trust first. Then I'd make it a bit more unpleasant by going in rush hour, then move down the least to the most difficult one (in my case it's a packed tube during rush hour). Depending on what you fear and how ready you are you might want to start with something easier. I've been told to begin practising on something between 20-40 on anxiety scale, something that would provoke a bit of anxiety but was manageable at the same time. It can be as simple as looking at pictures of buses or sitting at a bus stop, it is different for everyone. The key with CBT is to expose yourself to anxiety provoking situations but start reprogramming your brain by sitting through the unpleasant situation and wait for the anxiety to go down rather than panic and run away.

As I have previously mentioned I was not on any form of public transport for around 6-7 months before my first exposure. I found it hard to create a clear hierarchy as at that point I felt like I didn't know my body and that anything could happen. I was scared that I would freak out and try to escape, but I was so tired of the situation I was in and decided that trying is better than sitting at home making assumptions. My practice sessions are done with my therapist and are followed by homework to be practised on my own. For my first one we agreed to go on a short overground train journey. The first step was to make a theory of what I think might happen, how anxious do I think I might be etc. then practise and evaluate what actually happen.

I'm not going to lie, the minute I woke up that morning I was anxious, but I knew I had to do it so I convinced myself that this is what I want. I want to put myself through it because I know it will benefit me. When I first got on the train I was paralysed, it felt surreal, like an out of body experience. I wanted to get off but my therapist asked 'how would you feel about staying?' Him given me the choice made me want to stay and see what happens. I sat down and my safety behaviours kicked in, I opened the window and sat down frozen. I rated my anxiety to 60-80 at that stage. Opening the window reinforced the thought that there's a threat so I have been asked to close it. It is actually quite hard to remember everything that happened, we have used all the little coping tricks like shifting the focus etc. and my anxiety eventually went down. It pretty much followed the wave pattern with peek parts getting lower and lower. The whole experience had left me a bit confused, I was afraid that every train journey might be this way. However I soon realised it was like ripping off the bandaid. Yes, it was unpleasant  but everything I have learned about anxiety has been confirmed. It has given me faith that this could actually work and decided I was ready!

TBC.
Much love, Kasia xx

Public Transport & Hyper-Alerted state

So as I have previously mentioned public transport and difficulties I have experience on it taught me the most about anxiety and phobias. I have always enjoyed travelling, a lot of the time it was about getting from point A to B but often it was my favourite part of the day as during some busy times it was the only time I could sit back and relax.
After becoming more aware of my surroundings I have reached the point of constantly looking for escape routes on public transport. I become really hyper-alerted. I was feeling on edge waiting for something to go wrong and looking for potential disasters - I was catastrophizing.

My anxiety started to reach a really high level on the tube at first. Travelling around London during a rush hour obviously isn't anyone's favourite activity, but when you combine it with already underlying anxiety it can become really unpleasant. I started noticing how many people are getting on, is the journey not being interrupted in any way, how could I get off if I needed to, how would people react if I freaked out etc. When the train was in motion it was ok, but the worst feelings and thoughts started coming up when the train stopped on a red light, the thought of being stuck underground made me feel paralysed. By then I would start thinking about what would happen if the train has broken down. I would feel the panic attack coming and adrenalin kicking in. I'd get off at the next stop even though it wasn't my final destination. This is the biggest mistake you could probably commit when you are anxious! By getting off (running away from your fear) you only reinforce that fear and convince your brain that there was really a threat. Yes, you will feel a temporary relief, but if you think of a bigger picture your avoidance has just fed your fear and the next time when you are in the same situation your anxiety will only increase. I know how hard it is to remember that when you feel all of those unpleasant physical symptoms, but avoidance is never a way to recovery! There is many coping mechanisms that I am still learning about and will be writing about them in the future, but if you are reading this post thinking that this may happen to you, talk to someone asap, don't wait until you can't imagine even attempting getting on board of a train, bus or whatever you fear.

I sadly have learnt it the hard way... After justifying to myself that I don't need the tube since there are other ways of getting around I started avoiding it. My fear really quickly started spreading to other means of transport. My brain was looking for more threats, and if something unpleasant happened on a journey once, it would be that experience that I'd obsess about every time I use that specific mean of transport again. I would ignore the rational thoughts that this is just a train or a bus, and that the chances of anything bad happening are incredibly unlikely. The odds didn't matter, just the possibility of something going wrong paralysed me with fear. At that point I wish I could have stepped back from this situation, from my own body and accepted the way I felt but think of a more realistic scenario. Instead I tried to push away the thoughts causing them to come back stronger. I started fearing the fear. It felt like my brain was my worst enemy... I tried to control it rather than accept what I felt and interpret these feelings with a bit more of a flexible and understanding approach. Coping with anxiety isn't about fighting it, it's about managing it as an inconvenience that it is, nothing more!

Pretty soon I started feeling defeated and depressed and began to avoid public transport altogether... Until recently I have not used public transport in any form for around 6-7 months. I know that there are some people who have been in this situation for much longer, but if you really want to, you can find the strength to reverse it. It's scary and painful and it's all about baby steps, but it can be done :) The amount of satisfaction you will get once you face your fears is the best driving and motivating force there is, trust me! I want to continue facing my phobia so keep your fingers crossed. I will talk about my first experiences at a later stage. Next up I will share my thoughts on safety behaviours and why they can be as unhelpful as the avoidance itself.

Remember, adrenaline rush is one of the most amazing things our bodies can produce and can save lives, you don't want to remove it, you want to reprogram your brain to know when to produce it! :)

TBC.

Much love, Kasia :) xx