Personal rant: on CBT

Cognitive behavioural therapy (CBT) is a talking therapy that can help you manage your problems by changing the way you think and behave. It’s most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems.

This kinda follows on from my rant last week about talking and depression. I was reminded about the different things I’d tried, or been recommended, or been sent to…and CBT’s one that always comes up.

I appreciate that CBT is a really useful thing to have. It’s a set of techniques that can stop panic attacks before they start, make you realise when a depressive episode is warping your thoughts, allow some balance and distance from the emotions that swamp you. It’s theoretically really useful, and a lot of people really benefit from it.

And I hate it.

I was referred to the service back in 2012 when I had my third (I think) major depressive episode – it was just an automatic referral to accompany the medication. So I went.

I managed two sessions. I came back from both in tears.

CBT relies on someone seeing the patterns in their behaviour and thoughts, and acting on those before they spiral down into the destructive cycle. It’s a set of techniques for positive thinking and prevention, but it does rely on an existing pattern of behaviour and a set of identifiable triggers.

I felt completely wrong. I don’t have “proper” panic attacks (I get short of breath rather than having a heart attack feeling), I don’t have a trigger for my depressive episodes, and I don’t get set off by certain things. I already spot my blaming thoughts and generalisations. Bluntly, I don’t do depression correctly.

And being effectively told that I am like this because I can’t manage my own thoughts was piling an extra load of blame onto someone who’s already struggling under a heavy load.

I know the depression is my own fault. I blame myself for it every day. It’s my head, my brain, my thoughts. I actively have to fight the urge to just give up. The worst part of mental illnesses is that it’s your body causing the problem – at least a broken leg is caused by something external!

And so CBT essentially blaming me for the problems was really a kick in the guts.

However, I did spot that I already do some of the techniques. I was taught as a child not to generalise; if you’ve done something wrong, it’s not because you’re crap – you’ve done one thing wrong. If you’re not feeling attractive/clever/human, it’s simply one moment or one thing – don’t extend it. That’s a major part of avoiding the sinking pit of feeling generally awful.

But for everything else…I have ended up working it out for myself. I can usually spot when I’m sinking and when I’m rising, and I know from experience what care I need to give myself and what support I need to ask for. I can definitely spot a panic attack, and I take steps to either remove myself from the situation or get somewhere that I can pass out in peace. I block as many of the self-harming thoughts as I can, while still admitting that they exist and taking steps to neutralise them. In short, I use as many of the CBT techniques as I can, but adapted for my own needs – and I use my own techniques for everything else, because that’s what works for me.

I think CBT is excellent if you do have ‘traditional’ panic attacks, or you can place a trigger that sets off a depressive episode or a panic attack. If you can identify what the event or thought is, you can act before it gets too bad. Being able to be self-aware, particularly when you have a mental illness, helps divide the illness from you and helps you realise that you are not the illness. There’s more information on the NHS website, and there are usually courses running across the country – if you think it might help you, then seriously do check it out.

But if CBT doesn’t work for you – if you already do the techniques, if your mental illness isn’t in a traditional format, if you don’t have specific triggers – then you’re not alone. Work out what works for you, and what’s going to help you. You know what you need, and you can do it.