Well, that's pretty much what I had to say about National Mental Health Awareness Week this year. I haven't seen anyone else do anything to celebrate it or even acknowledge it, but oh well. Thank you for reading. I'm glad some of you find it helpful. And if you're mentally ill, hats off to you for fighting a courageous battle against mental illness, and good luck.
Affichage des articles dont le libellé est NMHAW 2009. Afficher tous les articles
Affichage des articles dont le libellé est NMHAW 2009. Afficher tous les articles
samedi 7 février 2009
Limitations of CBT
Like I said before, CBT doesn't cure anything. It doesn't cure any organic damage to the brain, although it can help you manage life with mental illness. But also, it doesn't cure all uncomfortable feelings, because some things cannot be changed by changing your perspective or your behaviour, particularly guilt and grief. If you've lost someone or something, you can't get it back no matter what, and if you've taken someone or something away from someone else, you can't give it back no matter what. Some things can't be made whole, and that's life, so you just learn to live with it somehow.
You can't go around like a Greek tragedy mask all the time, so you learn to be a Greek comedy mask instead, and pretend to be all normal and well, because other people want you to. So, you become two people: the Greek mask that talks to people, and the broken-down you that lives inside. The two operate pretty much independently of each other. The Greek mask has friends and a normal life, and the real you on the inside never talks to anyone again. If you have a crappy therapist like I did, you learn to suppress the real you with cognitive therapy until you're trapped in a vacuum between the Greek mask which isn't you, and the painful cognitions of the real you that you've learned not to listen to.
If you do this long enough, you feel like a ventriloquist with a phantom puppet on your hand. People talk to the puppet and you do the voice of the puppet and give the answers they're looking for, and you're not even sure who they're talking to.
This is life. Not all pain can be taken away. In that way our culture is very dysfunctional, because we pretend that it's a Care Bear world where everybody can learn to get along and no one ever has to be hurt. It's a lie, and it isolates the people who know better. If you live here and you've lost a child to illness, people don't like to think about it. They want you to look gay and merry and normal and not remind them that your child died, because they don't want to believe there is pain so close to their sheltered little world. Whereas if you live in Zimbabwe and you've lost a child, many people around you have also lost a child or a sibling or a spouse, and while it probably doesn't hurt any less, at least the world around you isn't in denial of the fact that pain happens.
So, I've always found it helpful to remind myself that "life is pain", which is the first principle of Buddhism. Because some times, there isn't really anything you can do other than acknowledge your pain. Or someone else's. Pain is real. Cognitive therapy teaches you not to make yourself miserable for no reason, but it can't make real pain go away.
And that's pretty much what I have to say about it.
You can't go around like a Greek tragedy mask all the time, so you learn to be a Greek comedy mask instead, and pretend to be all normal and well, because other people want you to. So, you become two people: the Greek mask that talks to people, and the broken-down you that lives inside. The two operate pretty much independently of each other. The Greek mask has friends and a normal life, and the real you on the inside never talks to anyone again. If you have a crappy therapist like I did, you learn to suppress the real you with cognitive therapy until you're trapped in a vacuum between the Greek mask which isn't you, and the painful cognitions of the real you that you've learned not to listen to.
If you do this long enough, you feel like a ventriloquist with a phantom puppet on your hand. People talk to the puppet and you do the voice of the puppet and give the answers they're looking for, and you're not even sure who they're talking to.
This is life. Not all pain can be taken away. In that way our culture is very dysfunctional, because we pretend that it's a Care Bear world where everybody can learn to get along and no one ever has to be hurt. It's a lie, and it isolates the people who know better. If you live here and you've lost a child to illness, people don't like to think about it. They want you to look gay and merry and normal and not remind them that your child died, because they don't want to believe there is pain so close to their sheltered little world. Whereas if you live in Zimbabwe and you've lost a child, many people around you have also lost a child or a sibling or a spouse, and while it probably doesn't hurt any less, at least the world around you isn't in denial of the fact that pain happens.
So, I've always found it helpful to remind myself that "life is pain", which is the first principle of Buddhism. Because some times, there isn't really anything you can do other than acknowledge your pain. Or someone else's. Pain is real. Cognitive therapy teaches you not to make yourself miserable for no reason, but it can't make real pain go away.
And that's pretty much what I have to say about it.
vendredi 6 février 2009
NMHAW '09 - only one more day
When I started on this mission of blogging about mental health every day of National Mental Health Awareness Week, I wondered what I would be writing about, and I figured I'd probably get bored of it and quit half way through. I also figured all y'all would be bored of it and not read it.
On the contrary, the more I write, the more there is to write, and there is only one more day. And, several of you have been reading along and have left me kind messages, which I really appreciate.
I've already got a topic picked out for tomorrow, but since it's the last day, if any of you have questions or topics you'd like me to address, please leave me a comment and I'll do my best to write something for you.
Thank you for following National Mental Health Awareness Week here on Trucks and the City.
On the contrary, the more I write, the more there is to write, and there is only one more day. And, several of you have been reading along and have left me kind messages, which I really appreciate.
I've already got a topic picked out for tomorrow, but since it's the last day, if any of you have questions or topics you'd like me to address, please leave me a comment and I'll do my best to write something for you.
Thank you for following National Mental Health Awareness Week here on Trucks and the City.
CBT and relationships
If you're successful at CBT, odds are good it will change your relationships, and not always in the direction you wanted.
Consider this. A durable relationship is based on the interaction of two complementary sets of schemas, yes? As a simplistic example, let's look at me and Tinky-Winky. My dog schema is that I want a dog that can walk long distances in cold weather, behave itself around the house, and be MY dog, not everyone else's best friend. Tinky-Winky's human schema is that she wants a human that can walk long distances in cold weather, maintain pack discipline, and be HER human and hers only. I wouldn't enjoy a short-haired dog, or a pug, or a retarded inbred bichon - shih tzu cross that can't be housetrained, or an attention whore like a lab. Tinky-Winky wouldn't enjoy an invalid who keeps four dogs and lets them run all over her. So, our two schemas complement each other, and we're gonna be together for ever.
Likewise in human-to-human relationships. I've had the opportunity to watch them quite a bit when driving taxi, and I've come to the conclusion that being in a durable relationship doesn't in any way depend on being a good person or a good provider or a good cook or a good partner or a good anything. The only thing that matters is that the two sets of schemas agree with each other. I've seen couples who are very verbally abusive to each other but have been together for decades. Couples where one is always cheating and the other is always taking him/her back. Couples where one is a deadbeat and the other does all the work of providing. All kinds of couples where you look at them in light of what TV and Cosmo have taught us about what makes a "strong" relationship, and you're thinking, no way are these two people gonna stay together. But they do, because the reality is, we're not looking for a partner that matches some ideal standard. We're looking for a partner whose schemas mesh with ours.
Family relationships also work along the same lines. As you're growing up, the family teaches you its schemas, and so even though the schemas might be maladaptive, you're tied to your family by the fact that your schemas are shaped around each other.
Of course in all this there is also the biological process of attachment, but I believe that in humans at least, the compatibility of schemas is a stronger motivator than biological attachment, which is why we can separate ourselves from a person to whom we are attached, when we realize that their schemas and ours cannot be reconciled.
So where I'm going with this is, as you make progress in CBT and your schemas change, so will your relationships. Some times a relationship will get better. This is the purpose of family or couples therapy, to understand each other's schemas and each make changes to accept the other. When one person's schema is stronger or more adaptive, the other person would hopefully accept this and adapt to the stronger schema, knowing that in return his or her schemas that are more adaptive will be accepted by the other side, and thus the two will grow together. This is the ideal outcome and hopefully something that we would do naturally as we come together in a relationship.
However, when one side evolves cognitively in one direction and the other doesn't, or goes in a different direction, then there is no possibility of growing together. Or when one side can't accept and yielf to the other side's schemas. In fact, as you evolve cognitively, it's not unlikely that you'll encounter strenuous resistance from some of the people in your life, as your new schemas no longer agree with theirs and they try to hold you back and keep you in the old schemas, where you were complementary with them.
What to do? Well, since you're the one who's evolving cognitively, you might find a way to evolve so that you can continue to make progress and keep those people in your life. That's possible. In fact I think most of us instinctively do this with aging relatives, we yield to their schemas in their presence and keep our own counsel, knowing that they are leaving us anyway and that it's better to keep our attachment with them while they're with us, than to blow them off out of pride and impatience. But if the person resisting your change is not an ailing relative, then you might have to impose drastic changes to the relationship, whether they like it or not.
This is particularly evident with our friends and life partners. As we evolve cognitively, whether in a more adaptive or a less adaptive direction, we often find that the people we've been friends with are no longer congenial to us. They become critical of us, or we of them. We no longer understand each other and share everything. Some times we drift apart, and some times we have a big fight and never speak to each other again. Some times also we have to make a conscious choice to remove someone from our life who is a poisonous influence on our schemas. This happens a lot for people trying to overcome addiction. If all your friends are alcoholics and you're trying to quit drinking, they will pressure you to drink with them, and get mad at you when you decline, and as you stick to your sobriety guns, you find yourself losing touch with your friends and becoming isolated.
So, once again this brings us to the issue of choice, which is the keystone of CBT. We have to realize that changing our schemas will change our relationships, and that some times we will have to make a choice between an adaptive schema and a relationship that is threatened by that schema. Think of it as getting a job offer elsewhere and your boyfriend or girlfriend is not willing to move. Do you pass up the job and keep the partner, take the job and leave the partner, or take the job and continue the relationship long-distance? Likewise with schemas. Do you take the schema and leave the relationship, or leave the schema and keep the relationship, or take the schema and adapt the relationship around the schema?
There is no "right" choice. There is only your choice. The important point to remember is that it's your choice to make and that whatever you decide, you will live with the consequences of that choice.
Consider this. A durable relationship is based on the interaction of two complementary sets of schemas, yes? As a simplistic example, let's look at me and Tinky-Winky. My dog schema is that I want a dog that can walk long distances in cold weather, behave itself around the house, and be MY dog, not everyone else's best friend. Tinky-Winky's human schema is that she wants a human that can walk long distances in cold weather, maintain pack discipline, and be HER human and hers only. I wouldn't enjoy a short-haired dog, or a pug, or a retarded inbred bichon - shih tzu cross that can't be housetrained, or an attention whore like a lab. Tinky-Winky wouldn't enjoy an invalid who keeps four dogs and lets them run all over her. So, our two schemas complement each other, and we're gonna be together for ever.
Likewise in human-to-human relationships. I've had the opportunity to watch them quite a bit when driving taxi, and I've come to the conclusion that being in a durable relationship doesn't in any way depend on being a good person or a good provider or a good cook or a good partner or a good anything. The only thing that matters is that the two sets of schemas agree with each other. I've seen couples who are very verbally abusive to each other but have been together for decades. Couples where one is always cheating and the other is always taking him/her back. Couples where one is a deadbeat and the other does all the work of providing. All kinds of couples where you look at them in light of what TV and Cosmo have taught us about what makes a "strong" relationship, and you're thinking, no way are these two people gonna stay together. But they do, because the reality is, we're not looking for a partner that matches some ideal standard. We're looking for a partner whose schemas mesh with ours.
Family relationships also work along the same lines. As you're growing up, the family teaches you its schemas, and so even though the schemas might be maladaptive, you're tied to your family by the fact that your schemas are shaped around each other.
Of course in all this there is also the biological process of attachment, but I believe that in humans at least, the compatibility of schemas is a stronger motivator than biological attachment, which is why we can separate ourselves from a person to whom we are attached, when we realize that their schemas and ours cannot be reconciled.
So where I'm going with this is, as you make progress in CBT and your schemas change, so will your relationships. Some times a relationship will get better. This is the purpose of family or couples therapy, to understand each other's schemas and each make changes to accept the other. When one person's schema is stronger or more adaptive, the other person would hopefully accept this and adapt to the stronger schema, knowing that in return his or her schemas that are more adaptive will be accepted by the other side, and thus the two will grow together. This is the ideal outcome and hopefully something that we would do naturally as we come together in a relationship.
However, when one side evolves cognitively in one direction and the other doesn't, or goes in a different direction, then there is no possibility of growing together. Or when one side can't accept and yielf to the other side's schemas. In fact, as you evolve cognitively, it's not unlikely that you'll encounter strenuous resistance from some of the people in your life, as your new schemas no longer agree with theirs and they try to hold you back and keep you in the old schemas, where you were complementary with them.
What to do? Well, since you're the one who's evolving cognitively, you might find a way to evolve so that you can continue to make progress and keep those people in your life. That's possible. In fact I think most of us instinctively do this with aging relatives, we yield to their schemas in their presence and keep our own counsel, knowing that they are leaving us anyway and that it's better to keep our attachment with them while they're with us, than to blow them off out of pride and impatience. But if the person resisting your change is not an ailing relative, then you might have to impose drastic changes to the relationship, whether they like it or not.
This is particularly evident with our friends and life partners. As we evolve cognitively, whether in a more adaptive or a less adaptive direction, we often find that the people we've been friends with are no longer congenial to us. They become critical of us, or we of them. We no longer understand each other and share everything. Some times we drift apart, and some times we have a big fight and never speak to each other again. Some times also we have to make a conscious choice to remove someone from our life who is a poisonous influence on our schemas. This happens a lot for people trying to overcome addiction. If all your friends are alcoholics and you're trying to quit drinking, they will pressure you to drink with them, and get mad at you when you decline, and as you stick to your sobriety guns, you find yourself losing touch with your friends and becoming isolated.
So, once again this brings us to the issue of choice, which is the keystone of CBT. We have to realize that changing our schemas will change our relationships, and that some times we will have to make a choice between an adaptive schema and a relationship that is threatened by that schema. Think of it as getting a job offer elsewhere and your boyfriend or girlfriend is not willing to move. Do you pass up the job and keep the partner, take the job and leave the partner, or take the job and continue the relationship long-distance? Likewise with schemas. Do you take the schema and leave the relationship, or leave the schema and keep the relationship, or take the schema and adapt the relationship around the schema?
There is no "right" choice. There is only your choice. The important point to remember is that it's your choice to make and that whatever you decide, you will live with the consequences of that choice.
jeudi 5 février 2009
What, no ads?
I was wrong. The politicians did not take out ads in the paper thanking the mental health "care" professionals. In fact, I haven't seen anything in the papers about National Mental Health Awareness Week, except the annual green insert from the Canadian Mental Health Association - NXT Division. I tried to read it, but I couldn't get into it. Partly, I suppose, because I spend a lot of time reading up on mental health as it is and whatever is in that insert, I already know.
One thing I did find interesting was a little write-up about a program to help people with "serious mental illness" overcome barriers to employment. That's pretty cool, except that, even though I do feel I have barriers to employment due to my mental health, I doubt I qualify for their program. (Note: I initially thought "I'll never qualify for such a program," and immediately amended my thought. This is why you see me doing the "no wait, I choose to" thing. Because I'm so used to doing CT, I'm constantly catching myself. I'm not doing it to be facetious with y'all - that's actually how my inner monologue sounds.)
The other thing I read with interest was the last article, Happiness! Ten tips for mental wellness in 2009. And having read it, I felt really sad. So... Thanks for the green insert, Canadian Mental Health Association.
One thing I did find interesting was a little write-up about a program to help people with "serious mental illness" overcome barriers to employment. That's pretty cool, except that, even though I do feel I have barriers to employment due to my mental health, I doubt I qualify for their program. (Note: I initially thought "I'll never qualify for such a program," and immediately amended my thought. This is why you see me doing the "no wait, I choose to" thing. Because I'm so used to doing CT, I'm constantly catching myself. I'm not doing it to be facetious with y'all - that's actually how my inner monologue sounds.)
The other thing I read with interest was the last article, Happiness! Ten tips for mental wellness in 2009. And having read it, I felt really sad. So... Thanks for the green insert, Canadian Mental Health Association.
Step 2: "behavioural"
Yes. Cognitive-behavioural therapy. So now that we've been over the cognitive part over and over, we come to the behavioural part.
You may have noticed in the post on cognitive techniques that some of them almost lead to the conclusion that action is necessary... but they don't really go there. In fact, I don't have any handouts about behavioural techniques, because all my handouts are uselessly focused on treating depression, which is mostly cognitive. So now I'll just have to write my own stuff entirely.
Consider the following: just because a cognition is uncomfortable, doesn't mean it's distorted. This is one thing my fired therapist would never agree with, but it's true.
Example 1: you're having the cognition "I'm fat." If your BMI is 22, it's a distorted cognition. If your BMI is 32, it's realistic. 32 is fat. Dangerously fat, in fact. If your BMI is 32 and you manage to CT yourself into thinking you're "svelte", you need your reality-testing checked. Some times, if you think you're fat, it's because you are fat. (I'm not picking on fat people, by the way, I'm picking on people who have distorted cognitions about being fat, because it's such an easy example to understand.)
Example 2: you're having the cognition "if I make a mistake at work, something horrible will happen." If you're a cashier in a supermarket, it's a distorted cognition. If you're the guy who filed work permits on Piper Alpha, it's realistic. If you misplace a work permit on Piper Alpha, the whole place might go up in flames and kill 160+ people. If you're filing work permits on Piper Alpha and you're telling yourself it's ok to make mistakes as long as your ego doesn't suffer, you need to get fired. Some times, if you think an error can have catastrophic consequences, it's because it really can.
Just because a cognition is uncomfortable, doesn't mean it's distorted. So, what do you do when you have a realistic uncomfortable cognition?
I have a very good book titled Being Happy by Andrew Matthews. One of the first things it says is "pain is your body's way of telling you something's wrong." If you get a burning sensation when you pee, that's your body's way of telling you something's wrong with your penis. If you get chest pains when you climb stairs, that's your body's way of telling you something's wrong with your heart. And so on. So likewise when your mind hurts, that's your mind's way of telling you there's something wrong. So, when something hurts, you need to change things. That's where the "behavioural" part comes in.
Beyond this, I can't really get specific, because how you change your behaviour depends on what's wrong. Maybe you're fat. Maybe you're incompetent. Maybe you're abusive. What you need to change will depend on what it is you're doing wrong, obviously. But in general, we can go back to the "cognitions" wallet card and ask ourselves 1) does this behaviour help me achieve my goals? and 2) does this behaviour make me feel the way I want to feel? The important difference though, is that with cognitions, you can do the questions after you have the cognition. With behaviours, in the beginning you will review past behaviours and see if they were maladaptive, but ideally you want to question your behaviour before you engage in it. There isn't really much point questioning your choices after you've eaten a gallon of pudding or you've killed somebody while drunk-driving. So to begin your practice, you'll want to spend some time sitting down identifying the behaviours that do not help you reach your goals and feel the way you want to feel, but once you know, the rest will depend on impulse control. Recognizing ahead of time that the behaviour you're about to engage in is on the "don't" list, and choosing not to engage in it. Again, supposing you're trying to lose weight and you see a cheesecake, and you tell yourself "self, eating a whole cheesecake does not help us achieve our goals", and then you eat the cheesecake anyway, well, there isn't much point in giving yourself a pep talk at all.
The good news is, impulse control, like controlling your cognitions, is something that comes with practice. Not so much if you have FASD, but even so, learning is possible. Like I used to say to an abusive guy I knew once, if you can control your bladder, you can control your mouth. And... the rest of you. Most of us know quite well when and where it's appropriate to pee, and we hold our bladder until it's appropriate to pee. Likewise, most of us do know quite well what is appropriate to say to another person, so we can choose to keep our mouths shut until we have something appropriate to say. Why do some people choose to say inappropriate things like name-calling or accusations or triangulation or etc? Who knows. But they're choosing to do it. Not all people are taught appropriate people skills as children, mind you, and if you're one who wasn't taught, then your behavioural therapy would include finding out what's appropriate, and practicing doing it. For example, I had to teach myself to say kind and supportive things to others, because that was not part of how I was raised. Any of you who were reading this blog when Chris was killed, you probably didn't notice, but I did: not one of my relatives offered any condolences. The most basic thing to say to a fellow human being: "I'm sorry for your loss." I had to teach myself that. And, I did. Likewise if your upbringing didn't teach you to listen to others instead of talking all the time, or "if you can't say something nice, don't say anything at all," or to chew with your mouth closed, or to be faithful to your spouse, or to be honest, these are all things you can teach yourself. None of us are slaves to our upbringing and that's one thing that always aggravates me (wait - that I choose to be aggravated by - no wait - by which I choose to be aggravated), is people who say "that's the way I was raised" and won't hear anything else about it.
None of us are constrained by how we were raised, or by our life experiences, or by our job training, or by our religion. We can be conditioned a certain way, but we still have free will. One time I loaded dyed diesel into a tanker and tagged it with regular gasoline tags. Then I got to the customer and looked at my tags and was paralysed. I knew exactly what I had loaded, and the bill of lading confirmed it, but by training, I'm conditioned not to offload if the tags don't match. And I pride myself on my adherence to my safety training. But, knowing rationally that there had been a mistake in tagging, I made a deal with myself that I would pail drain some product from a line, and if it turned out to be diesel, I'd offload it. And of course it was diesel, so I offloaded it. Now this may seem like a small thing, but it's not, because following tag procedures is extremely important and I'm much more conditioned to that than to, say, hold doors open for others. But we can all choose to break out of our conditioning as appropriate. And if our conditioning is maladaptive, then we need to break out of it. That's what the behavioural part of CBT does.
So... I think that's about what I have to say about it just now. I hope some of this made sense and is of some use to y'all. If you can think of any specific questions, I'd be happy to try and answer them.
You may have noticed in the post on cognitive techniques that some of them almost lead to the conclusion that action is necessary... but they don't really go there. In fact, I don't have any handouts about behavioural techniques, because all my handouts are uselessly focused on treating depression, which is mostly cognitive. So now I'll just have to write my own stuff entirely.
Consider the following: just because a cognition is uncomfortable, doesn't mean it's distorted. This is one thing my fired therapist would never agree with, but it's true.
Example 1: you're having the cognition "I'm fat." If your BMI is 22, it's a distorted cognition. If your BMI is 32, it's realistic. 32 is fat. Dangerously fat, in fact. If your BMI is 32 and you manage to CT yourself into thinking you're "svelte", you need your reality-testing checked. Some times, if you think you're fat, it's because you are fat. (I'm not picking on fat people, by the way, I'm picking on people who have distorted cognitions about being fat, because it's such an easy example to understand.)
Example 2: you're having the cognition "if I make a mistake at work, something horrible will happen." If you're a cashier in a supermarket, it's a distorted cognition. If you're the guy who filed work permits on Piper Alpha, it's realistic. If you misplace a work permit on Piper Alpha, the whole place might go up in flames and kill 160+ people. If you're filing work permits on Piper Alpha and you're telling yourself it's ok to make mistakes as long as your ego doesn't suffer, you need to get fired. Some times, if you think an error can have catastrophic consequences, it's because it really can.
Just because a cognition is uncomfortable, doesn't mean it's distorted. So, what do you do when you have a realistic uncomfortable cognition?
I have a very good book titled Being Happy by Andrew Matthews. One of the first things it says is "pain is your body's way of telling you something's wrong." If you get a burning sensation when you pee, that's your body's way of telling you something's wrong with your penis. If you get chest pains when you climb stairs, that's your body's way of telling you something's wrong with your heart. And so on. So likewise when your mind hurts, that's your mind's way of telling you there's something wrong. So, when something hurts, you need to change things. That's where the "behavioural" part comes in.
Beyond this, I can't really get specific, because how you change your behaviour depends on what's wrong. Maybe you're fat. Maybe you're incompetent. Maybe you're abusive. What you need to change will depend on what it is you're doing wrong, obviously. But in general, we can go back to the "cognitions" wallet card and ask ourselves 1) does this behaviour help me achieve my goals? and 2) does this behaviour make me feel the way I want to feel? The important difference though, is that with cognitions, you can do the questions after you have the cognition. With behaviours, in the beginning you will review past behaviours and see if they were maladaptive, but ideally you want to question your behaviour before you engage in it. There isn't really much point questioning your choices after you've eaten a gallon of pudding or you've killed somebody while drunk-driving. So to begin your practice, you'll want to spend some time sitting down identifying the behaviours that do not help you reach your goals and feel the way you want to feel, but once you know, the rest will depend on impulse control. Recognizing ahead of time that the behaviour you're about to engage in is on the "don't" list, and choosing not to engage in it. Again, supposing you're trying to lose weight and you see a cheesecake, and you tell yourself "self, eating a whole cheesecake does not help us achieve our goals", and then you eat the cheesecake anyway, well, there isn't much point in giving yourself a pep talk at all.
The good news is, impulse control, like controlling your cognitions, is something that comes with practice. Not so much if you have FASD, but even so, learning is possible. Like I used to say to an abusive guy I knew once, if you can control your bladder, you can control your mouth. And... the rest of you. Most of us know quite well when and where it's appropriate to pee, and we hold our bladder until it's appropriate to pee. Likewise, most of us do know quite well what is appropriate to say to another person, so we can choose to keep our mouths shut until we have something appropriate to say. Why do some people choose to say inappropriate things like name-calling or accusations or triangulation or etc? Who knows. But they're choosing to do it. Not all people are taught appropriate people skills as children, mind you, and if you're one who wasn't taught, then your behavioural therapy would include finding out what's appropriate, and practicing doing it. For example, I had to teach myself to say kind and supportive things to others, because that was not part of how I was raised. Any of you who were reading this blog when Chris was killed, you probably didn't notice, but I did: not one of my relatives offered any condolences. The most basic thing to say to a fellow human being: "I'm sorry for your loss." I had to teach myself that. And, I did. Likewise if your upbringing didn't teach you to listen to others instead of talking all the time, or "if you can't say something nice, don't say anything at all," or to chew with your mouth closed, or to be faithful to your spouse, or to be honest, these are all things you can teach yourself. None of us are slaves to our upbringing and that's one thing that always aggravates me (wait - that I choose to be aggravated by - no wait - by which I choose to be aggravated), is people who say "that's the way I was raised" and won't hear anything else about it.
None of us are constrained by how we were raised, or by our life experiences, or by our job training, or by our religion. We can be conditioned a certain way, but we still have free will. One time I loaded dyed diesel into a tanker and tagged it with regular gasoline tags. Then I got to the customer and looked at my tags and was paralysed. I knew exactly what I had loaded, and the bill of lading confirmed it, but by training, I'm conditioned not to offload if the tags don't match. And I pride myself on my adherence to my safety training. But, knowing rationally that there had been a mistake in tagging, I made a deal with myself that I would pail drain some product from a line, and if it turned out to be diesel, I'd offload it. And of course it was diesel, so I offloaded it. Now this may seem like a small thing, but it's not, because following tag procedures is extremely important and I'm much more conditioned to that than to, say, hold doors open for others. But we can all choose to break out of our conditioning as appropriate. And if our conditioning is maladaptive, then we need to break out of it. That's what the behavioural part of CBT does.
So... I think that's about what I have to say about it just now. I hope some of this made sense and is of some use to y'all. If you can think of any specific questions, I'd be happy to try and answer them.
mercredi 4 février 2009
What if The Brain is winning?
A reader asks in comments: what if The Brain is stronger than the Dog Training Voice?
Well, it might be just that you need more practice. CBT is like anything else, you get better at it with practice. In the beginning, The Brain is used to having its own way all the time, and the Dog Training Voice has never tried to tame a rogue brain, so it's not a fair fight. But with time and persistence, the Dog Training Voice becomes stronger and more wily. It's on to The Brain's tricks. And it starts to win.
One time last summer, for some reason The Brain got triggered when I picked up a jumbo crochet hook. And I had been having one meltdown after another for weeks and weeks, and I was really tired of them. Tired as in fatigued. So when The Brain started up, one of the other "voices" of me came unglued on him and just screamed that there was NOT going to be a meltdown, period. And The Brain backed down. That marked a turning point in the fight against The Brain. The balance of power changed, if you will. It's changed the form meltdowns take and made them a lot less frequent. So, a CT victory. But it took a long time to get there.
That being said, and I've said it before, CBT does not cure things. If you have a organic issue of some kind, CBT will not make it go away. So, if the Dog Training Voice continues to be unable to control The Brain, or if controlling The Brain doesn't solve everything, then you might want to get professional help. For example, when I got pretty good at CT, I came to a point where I had no cognitions whatsoever. Most of the time I'd just go around either doing my job, or playing circus music in my head. But at the same time, I couldn't stop crying. I would cry for days and days and days. Literally. I didn't have any cognitions, so there was nothing to work on to make me stop crying. So, what's to do? That's when I went back on medication. It worked like magic. Practically overnight, I didn't cry anymore. I didn't have to spend every ounce of mental energy "keeping it together." I still have cognitions and meltdowns, but not the out-of-control emotions. It sure makes my life considerably better.
So, if you can't control The Brain with CBT, or if controlling The Brain doesn't solve the problem, like I said, you might want professional help. And the kind of help you need depends on what's exactly wrong with you, so I can't really say, but here are some generalities.
If The Brain is a danger to yourself or others and won't be controlled, it's a good idea to go to the nearest hospital. If you tell the triage nurse that you're a danger to yourself or others, it's awkward, but it makes you a fairly high triage priority. If you have no hospital or you don't wanna go there, find someone to babysit you until you can see a doctor. It's called a suicide watch, and you need it to live. If you're in a remote community, they should medevac you, because you're a genuine medical emergency, but having not tried it, I have no idea whether they will or not. So if that's your predicament, you might have to fight with them about it. Sucks, but you do need medical help.
If The Brain is not a danger to yourself or others, but you're having a meltdown or that state of things where the cognitions eat at you like a big rat sitting in your skull gnawing on your brain, I find the best policy is to go to sleep, if you can. If you can't, again, I find it useful to find someone to babysit. The best, in my opinion, is to call a good Crisis Line, because the people there will listen to you without judging your cognitions like your friends will (and your friends will judge your cognitions, because they're not trained to deal with the mentally ill). Some times talking about the cognitions out loud helps break the cycle of rumination, or maybe it's just that after an hour crying on the phone you're ready to fall asleep. Doesn't matter, as long as you can go to sleep. When you wake up, hopefully you'll feel better. But then again, maybe not, so you might want to see a doctor. Apparently, they have medication for that.
If you have a genuine organic mental illness, like bipolar or schizophrenia, you will not control it through CBT alone. You will need medication, and probably you will need to be medicated for the rest of your life. Anti-psychotic drugs, from what I've read, have unpleasant side-effects, but mood stabilizers are fairly easy to tolerate. You might have to keep changing drugs until you find one that works and doesn't have side-effects you can't live with.
If your issues come from trauma, you need specific strategies for coping. If you go to a professional and you feel that they're not listening to you or that they're not addressing the right problem, find a different one. A bad therapist is worse than no therapist at all, in my experience.
If your issues come from grief, again, you need specific strategies. With both grief and trauma, they might heal over time, or they might not. As I mentioned before (though I'm not sure if it was on this blog), in my case I feel like a limb has been ripped off, and I can learn to function with the new state of things, but I can't be made whole. Recently I've found other people who express their feelings the same way, which was nice. Makes me feel validated. If you're in a similar position you might not ever get back to "normal". What you have now is the new "normal" and you have to learn to function with it.
So, that's what I have to say about it. Thank you for your question. I hope this helps.
Well, it might be just that you need more practice. CBT is like anything else, you get better at it with practice. In the beginning, The Brain is used to having its own way all the time, and the Dog Training Voice has never tried to tame a rogue brain, so it's not a fair fight. But with time and persistence, the Dog Training Voice becomes stronger and more wily. It's on to The Brain's tricks. And it starts to win.
One time last summer, for some reason The Brain got triggered when I picked up a jumbo crochet hook. And I had been having one meltdown after another for weeks and weeks, and I was really tired of them. Tired as in fatigued. So when The Brain started up, one of the other "voices" of me came unglued on him and just screamed that there was NOT going to be a meltdown, period. And The Brain backed down. That marked a turning point in the fight against The Brain. The balance of power changed, if you will. It's changed the form meltdowns take and made them a lot less frequent. So, a CT victory. But it took a long time to get there.
That being said, and I've said it before, CBT does not cure things. If you have a organic issue of some kind, CBT will not make it go away. So, if the Dog Training Voice continues to be unable to control The Brain, or if controlling The Brain doesn't solve everything, then you might want to get professional help. For example, when I got pretty good at CT, I came to a point where I had no cognitions whatsoever. Most of the time I'd just go around either doing my job, or playing circus music in my head. But at the same time, I couldn't stop crying. I would cry for days and days and days. Literally. I didn't have any cognitions, so there was nothing to work on to make me stop crying. So, what's to do? That's when I went back on medication. It worked like magic. Practically overnight, I didn't cry anymore. I didn't have to spend every ounce of mental energy "keeping it together." I still have cognitions and meltdowns, but not the out-of-control emotions. It sure makes my life considerably better.
So, if you can't control The Brain with CBT, or if controlling The Brain doesn't solve the problem, like I said, you might want professional help. And the kind of help you need depends on what's exactly wrong with you, so I can't really say, but here are some generalities.
If The Brain is a danger to yourself or others and won't be controlled, it's a good idea to go to the nearest hospital. If you tell the triage nurse that you're a danger to yourself or others, it's awkward, but it makes you a fairly high triage priority. If you have no hospital or you don't wanna go there, find someone to babysit you until you can see a doctor. It's called a suicide watch, and you need it to live. If you're in a remote community, they should medevac you, because you're a genuine medical emergency, but having not tried it, I have no idea whether they will or not. So if that's your predicament, you might have to fight with them about it. Sucks, but you do need medical help.
If The Brain is not a danger to yourself or others, but you're having a meltdown or that state of things where the cognitions eat at you like a big rat sitting in your skull gnawing on your brain, I find the best policy is to go to sleep, if you can. If you can't, again, I find it useful to find someone to babysit. The best, in my opinion, is to call a good Crisis Line, because the people there will listen to you without judging your cognitions like your friends will (and your friends will judge your cognitions, because they're not trained to deal with the mentally ill). Some times talking about the cognitions out loud helps break the cycle of rumination, or maybe it's just that after an hour crying on the phone you're ready to fall asleep. Doesn't matter, as long as you can go to sleep. When you wake up, hopefully you'll feel better. But then again, maybe not, so you might want to see a doctor. Apparently, they have medication for that.
If you have a genuine organic mental illness, like bipolar or schizophrenia, you will not control it through CBT alone. You will need medication, and probably you will need to be medicated for the rest of your life. Anti-psychotic drugs, from what I've read, have unpleasant side-effects, but mood stabilizers are fairly easy to tolerate. You might have to keep changing drugs until you find one that works and doesn't have side-effects you can't live with.
If your issues come from trauma, you need specific strategies for coping. If you go to a professional and you feel that they're not listening to you or that they're not addressing the right problem, find a different one. A bad therapist is worse than no therapist at all, in my experience.
If your issues come from grief, again, you need specific strategies. With both grief and trauma, they might heal over time, or they might not. As I mentioned before (though I'm not sure if it was on this blog), in my case I feel like a limb has been ripped off, and I can learn to function with the new state of things, but I can't be made whole. Recently I've found other people who express their feelings the same way, which was nice. Makes me feel validated. If you're in a similar position you might not ever get back to "normal". What you have now is the new "normal" and you have to learn to function with it.
So, that's what I have to say about it. Thank you for your question. I hope this helps.
mardi 3 février 2009
Seventeen cognitive therapy techniques
Again, this is based on an un-attributed handout I got in therapy.
The idea behind most of these techniques is to have a conversation with yourself about the distorted cognition. You might feel critical of this notion, but it does work. I know, because I was very critical of CBT when I was working with the Fired Therapist, but now that I'm on my own and I do it my way, it works. My personal experience of it is that over time it's created a separation in my mind between two (or more) "voices." No, I don't have "voices in my head." I just have various aspects of me who I hold responsible for various kinds of cognitions. For our purposes the important ones are The Brain, which is the voice of mental illness and distorted cognitions, and the Dog Training Voice, which challenges the distorted cognition. It's called the Dog Training Voice because it does sound like my dog training voice. Or horse training voice. Or Girl Guides training voice. The voice that makes it clear to whoever you're talking to that your patience just ran out and now would be a good time to smarten up.
I don't like either The Brain or the Dog Training Voice. They're not friendly people. But that's not the point. The Brain is here to stay, and the Dog Training Voice is here as long as The Brain needs someone to keep it in line. There's nothing that says you have to enjoy Cognitive Therapy when you're doing it, but it's like brushing your teeth. You do it whether you like it or not, or else you live with the consequences of choosing not to do it.
Having said that, on to the CT techniques.
The idea behind most of these techniques is to have a conversation with yourself about the distorted cognition. You might feel critical of this notion, but it does work. I know, because I was very critical of CBT when I was working with the Fired Therapist, but now that I'm on my own and I do it my way, it works. My personal experience of it is that over time it's created a separation in my mind between two (or more) "voices." No, I don't have "voices in my head." I just have various aspects of me who I hold responsible for various kinds of cognitions. For our purposes the important ones are The Brain, which is the voice of mental illness and distorted cognitions, and the Dog Training Voice, which challenges the distorted cognition. It's called the Dog Training Voice because it does sound like my dog training voice. Or horse training voice. Or Girl Guides training voice. The voice that makes it clear to whoever you're talking to that your patience just ran out and now would be a good time to smarten up.
I don't like either The Brain or the Dog Training Voice. They're not friendly people. But that's not the point. The Brain is here to stay, and the Dog Training Voice is here as long as The Brain needs someone to keep it in line. There's nothing that says you have to enjoy Cognitive Therapy when you're doing it, but it's like brushing your teeth. You do it whether you like it or not, or else you live with the consequences of choosing not to do it.
Having said that, on to the CT techniques.
- Questioning what you really mean
This is useful when you're indulging in the "labeling" distorted cognition. Say you're thinking to yourself, "self, I'm a loser." The Dog Training Voice would then ask "Brain, what do you mean by that?" Then you'd think about it and you might say "I don't have any friends." Or whatever it is you're thinking. By itself this exercise doesn't do much, but it then allows you to have something specific to work on with the next technique: - Questioning the evidence
You review the evidence that supports your cognition, and then challenge it. So say you're thinking "I don't have any friends." What's the evidence for that? Say, for example, "I'm never invited to anything." Well, for one, that has "never" in it so we question whether it's an exaggeration. Are you really never invited to anything, if you stop feeling maudlin and really, honestly, review whether you've been invited to anything or not? Just because you didn't go, doesn't mean you weren't invited.
The trick here is that at first you will think all the evidence backs your cognition. But this is a distorted cognition of type "filtering": you're actually (probably) ignoring any evidence that's contrary to your cognition, and choosing to remember only what backs you up. So the challenge is to admit to yourself that indeed there is contrary evidence that you've been discarding. - Reattribution
This is useful when you think a problem is either entirely your fault, or entirely not your fault. Say you're having a conflict with someone and you're thinking "OMFG she is such a skank, this is all her fault." Well, really... Let go of the "it's all her fault," and look at it again. Perhaps using techniques #1 and #2. What do you mean by "it", and does the evidence really support the notion that "it" is all her fault, if you stop discarding the pieces that make you look like you had something to do with it? Did you escalate the situation? Did you react to something based on a distorted cognition? Really? Honestly?
Conversely if you're thinking "this is all my fault," then go through #1 and #2 honestly, stop discarding the parts where someone else contributed to the problem, and look at it in a realistic light. Again, at first you will be convinced that you're right and that the evidence backs you up, so the trick is to be willing to admit that you're not always right, and look for the "other" cognitions, the ones that you're refusing to look at because they disagree with how you choose to think. - Examining options and alternatives
This is fairly self-explanatory. Basically it's just problem-solving. Thinking you have no options is a distorted cognition, because there are always things you can do and choices you can make. One reason you might think otherwise, is because you haven't brainstormed the options, and the other reason is, you refuse to consider some of the options. This is very common among the blogs I read, I find, when someone thinks they "can't" do something, most of the time it's because they're refusing to make the choices that go along with it. For practice, start by looking at previous decisions where you figured you had no choice or no options, and consider honestly, what options were available. Including the ones that are unpalatable or difficult. Just because you didn't like an option, doesn't mean it didn't exist. Once you get the hang of it looking at the past, you can apply it to current situations. - Decatastrophizing
Catastrophizing is when you think something will have catastrophic consequences. The reality is, in most people's lives, nothing you can do has the potential for catastrophic consequences. Clearly this isn't the case if you're, say, the guy who filed work permits on Piper Alpha, but are you? No you're not. In fact, when you look at your own personal life and stop making a big deal out of everything, you start to realize that there is very little you can do that has any consequences at all. Granted, you might have more or less money depending on the choices you make. You might have to move. You might have to change jobs. You might break up with your partner. Is any of this the end of the world? Actually, no. It's a bump in the road, that's all. Nothing horrible will happen along with any of the above, if you're honest with yourself about it.
Now on the other hand, if you discover that there is indeed in all honesty a possibility for catastrophe, then you need to act accordingly. For example, there is a real possibility for catastrophe if you have a baby in a car with no car seat. So don't. But that's something we'll come to later. - Examining expected consequences
This is much the same as decatastrophizing, except looking at all the consequences and not just the catastrophic ones. What consequences, both good and bad, do you expect from something? Now honestly, are these expectations realistic? Really? Seriously? Fine. So if a negative outcome has a high possibility of happening, what can you do to prevent it, or what can you do to deal with it? Example: "if I swear at my boss, I will lose my job." Well, that's a pretty high possibility all right. So... Can you prevent it? Well yes, you could choose not to swear at your boss. Or, can you deal with the consequences? Well yes, you could get a new job. So, should you swear at your boss, or not? Depends. Which sounds more appealing: biting your tongue, or looking for a new job? It's all a matter of choice. - Listing advantages and disadvantages
This is similar to the last three techniques, but again, slightly different. In this one, you ask yourself what are the advantages and disadvantages of engaging in a certain behaviour. For example, you take things personally. What are the advantages? Well, myself I can't think of any, but some people do it, so clearly they find advantages in it. What are the disadvantages? You're constantly being offended. People don't want to talk to you because they can't speak freely around you. You sound like a crazy person. You feel persecuted. In fact, you might even be persecuted, because when people get fed up with you and your schema, they're gonna start doing things on purpose to trigger you. (No, seriously.) So, is it to your advantage to be taking things personally? Realistically, no. However if you do come up with the answer that yes, it is to your advantage to take things personally, that tells me you're abusive and somebody's been enabling you. Because what's happening here is that you take something personally, you get mad, someone caters to your anger with apologies and changing of their behaviour. Ok, yeah, it worked out to your advantage in that you demonstrated control over someone. Bully for you! - Turning adversity to advantage
This is pretty self-explanatory and is another form of problem-solving so I won't go on at length about it. It's really simple: something bad happen, you make the best of it. Or, life gives you lemons, and you make lemonade. - Labeling distortions
We've been over this before. Identify distorted cognitions by comparing them with the categories. "Oh look, a distorted cognition of type 'catastrophizing'!" It becomes a game. How about getting a bunch of coloured stars and sticking one on the calendar every time you spot a certain type of cognition? This is an actual CBT technique that I've seen used with foster kids: you keep track of the number of occurences of a behaviour, and reward decreases in the frequency of occurences. No reason it can't work on you, too. - Guided association and discovery
This is harder to do on your own, given the "guided" part. I've been known to apply it to the douchebags in my life, though. If you remember the argument with Darcy, he had a whole bunch of irrelevant angry cognitions regarding my opinion, and my answer to all of them was "and?" He didn't answer me on that, but that's the idea anyway. Follow up on your distorted cognitions. "You're a bitch": distorted cognition of type "labeling". Possible follow-up questions: a) "and?" b) "what do you mean by that?" c) "what makes you say that?" Answer: "your opinion offends me." Possible follow-up questions: a) "how does my opinion offend you?" b) "why does that make you angry?" Stuff like that. Definitely easier to do with a therapist that you get along with. - Using paradox and exaggeration
Make your distorted cognitions even more distorted. Make them so distorted they sound ridiculous even to you. Then you come to realize, they were distorted even before you blew them out of proportion. Distorted cognition: "I'm fat." Even more distorted cognition: "I'm so fat, I have to back into the stalls in public washrooms." Of course this only works if "I'm fat" was a distorted cognition. Because when I lived in dorms I really did know a woman so large, she had to back into the bathroom stalls, and then she couldn't turn around to flush, either, in which case, "I'm fat" is a pretty realistic cognition. But if you can turn yourself into a "yo mama" joke, it helps point out the distortedness of your distorted cognitions. - Scaling
This is for people who have black-and-white thinking. Distorted cognition: "she's evil." Fine. On a scale of 0 to 100, where 0 is a newborn lamb and 100 is the most evil psychopath you can think of, how evil is she really? Probably she's not 100. If she a 95 on the evil scale? As evil as, say, Dahmer? No? Not that evil? How about 85? As evil as Mussolini? Not even? How about 70? Is she as evil as... Hmmm... Eva Peron? And so on. Maybe she turns out to be only a 21 on the evil scale, which is actually rather on the non-evil side, yes? Or maybe she's like, 54, which is more evil than not, but still only average evil compared to everybody else. - Replacement imagery
Hmmmm... This one is complicated and I don't think I use it. If I think of something later I'll write about it. - Cognitive rehearsal
That's pretty much what the name entails. You rehearse things in your mind. Say you have to be job-tested later in the day... You just rehearse in your mind how it's gonna go and the specific things you need to do to have a successful outcome, like say, remember to wear your safety glasses even though in real life you never do. Practice in your mind until you can visualize yourself doing all the right things and having a successful outcome. It reduces anxiety and depressed feelings. - Self-instruction or coaching
This is where the Dog Training Voice really shines. It's good for learning impulse control. Say you're trying to lose weight and you're about to eat a cookie. You say to yourself in your Dog Training Voice "no!" or in my case "leave it!" (which is what I say to my dog when she's about to eat something off the ground). At first you say these things to yourself out loud. This makes you look crazy, so you quickly learn to do it in your head instead. Conversely, you can cue yourself to do something, rather than not do something. Have you ever had a moment in sports where you suddenly hear your coach's voice in your head telling you... whatever it is he's been telling you in practice all along? And you do it and everything works out? Right. So be your own coach. Cue yourself every time. Personally, I don't like to brush my teeth, so twice a day I have to tell myself "go brush your teeth." Seriously. If I don't order myself to go brush my teeth, I don't do it. Luckily the Dog Training Voice isn't the one who hates brushing teeth, so it has no problem ordering me to go brush my teeth. - Thought stopping
My favourite. Instead of all the above, when a distorted cognition comes up, you just stop it. The self-instruction technique helps here, too. I always tell myself "leave it!" when I'm gnawing at a distorted cognition. The trick here is, you might have to do it thousands of times a day, especially at first. So don't quit because you did it ten times and the distorted cognition didn't go away. The distorted cognition might not ever go away, but if you stop it every time it comes up, it won't get you into a mood cycle. Seriously. - Focusing
That's pretty simple. Focus on doing something other than having distorted cognitions. Your mind can only do so many things at once. If you're focused on something, there won't be room in your mind for the distorted cognitions. This is why I crochet. Because at one time in my life, I needed to be constantly focused on something, and so I started to crochet. Constantly. Every waking moment, except when walking the dog. Now I do because I enjoy it, but it all started as just something to prevent me thinking about distorted cognitions. Like putting a cone on a dog.
lundi 2 février 2009
Cognitive therapy for all!
It seems like in the last year, I've been plagued with people who are supposed to be mentally "healthy" but are total douchebags. Actually, not just in the last year, when I think about it, maybe I've just noticed them more. People who are rude and nasty on purpose, or drama queens, or otherwise a nuisance to have around, but consider themselves to be in the pink of mental health. In fact, they often think of their nuisance behaviour as a sign of superiority. And some of them go a little further and use my being mentally ill and treated for it as an insult. For example, Darcy. Social studies teacher and all, blew a gasket because an opinion contrary to his own was had, and wrote a bunch of insults revolving around the mental health theme. Hmmmm... Well that's cognitively healthy, let alone real professional for a social studies teacher. Likewise Caroline. Got pissed off because an opinion contrary to hers was had, and called me down because I've gone to therapy and she hasn't. Again, not very cognitively healthy. Neither of them have a psychiatric diagnosis. Probably neither of them needs one. They're not mentally ill, they just made the choice to be nasty - and it seems they think that makes them superior to the mentally ill somehow.
Where am I going with this? Well, clearly cognitive therapy, or cognitive-behavioural therapy, is not just for the mentally ill. It's really more of a wellness program for your mind, like yoga. (Replace "yoga" with whatever you choose to do for wellness.) If you're genuinely ill with say, cancer or MS, yoga won't cure you, but it might help manage life with your illness. Likewise if you're genuinely mentally ill with say, bipolar, RAD, FASD, TBI, schizophrenia, or whatever else, CBT will not cure you, but it might help manage life with your illness. But if you're simply not very well or fit, yoga can greatly enhance your wellness, and likewise if you're not very well or fit cognitively without actually suffering from some kind of organic issue, CBT can greatly enhance your wellness.
Having distorted cognitions is a lot like being fat. If you're fat, you got that way through the choices you made. You might have learned those choices from someone else, but they're still choices you made. And you might be blaming it on all sorts of things, like hormones or medication or being "big boned", but the reality is, you got fat because you chose to eat more than you needed. And you might say you "love your body" but that's a misstatement. Maybe you love being fat, but if you loved your body, you wouldn't treat it like that. Being fat is very bad for your body. You might think also that you can't lose weight, because you tried and failed, but the reality is that if you eat less than you need and do so consistently for long enough, you will lose weight. If that hasn't happened, it's because you haven't been doing it. Also, if you're fat, you might meet people who don't want to go out with you, because you're fat. And you might get pissed off because they're so shallow and they should just love you for who you are etc, but no matter what you have to say about it, they will not date you, and that's that. You can either lose weight and try again, or accept the fact they don't want you. Getting mad and arguing that they're wrong is entirely counter-productive.
So, likewise with distorted cognitions. If you have distorted cognitions, you got that way through the choices you made, and even if you learned those choices from someone else, they're still choices YOU made. You might blame your distorted cognitions on all sorts of things like "feeling a lot", but the reality is, you have distorted cognitions, and the feelings that go with distorted cognitions, because you choose to. You might say you love yourself as you are, well, maybe you do. But it's not healthy for your mind to be full of distorted cognitions and unrealistic feelings, and it would be more loving to yourself to get cognitively well. You might think you can't change, because you tried and failed, but you can, because you control your cognitions, your feelings and your actions. Then, you might meet people who don't want to go out with you because of your cognitive and behavioural distortions. And you might get pissed off and argue that they "should" love you as you are, but they made their choices and they have that right. You can change your cognitions and try again, or you can accept the fact that they don't want you, but getting mad about the fact that they don't like your behaviour is entirely counter-productive.
Cognitive-behavioural therapy doesn't cure anything. It's only a method for identifying maladaptive cognitions and behaviours and changing them. Just because you don't have a psychiatric diagnosis, doesn't mean you don't have maladaptive cognitions and behaviours. Just because you're "successful", doesn't mean you don't have maladaptive cognitions and behaviours. Just because you think you're all that and a bag of chips and everyone should love you, doesn't mean you don't have maladaptive cognitions and behaviours. Almost everyone has some amount of maladaptive cognitions and behaviours. CBT allows us to find them and make them go away, like yoga allows us to find areas of tension and make them go away.
Learning and practicing CBT isn't a sign of being an inferior person. Au contraire. It shows that you recognize you're not always right in your thoughts and your actions and you want to become a better person. It's not easy at first, and it's not always easy later on, but neither is yoga. That's the very reason we do it. If we could brush away our distorted cognitions effortlessly, we wouldn't need CBT. The more difficult it seems, probably the more we need it.
CBT is also not about "lying to yourself" as one person who really needs CBT told me. You're lying to yourself now with your distorted cognitions. CBT is about seeing those lies for what they are. It's in fact, all about being honest with yourself.
I could go on and on, but I'm either getting through to you or I'm not. CBT is good for all of us. It doesn't cure the common cold, or anything else, but it improves our cognitive wellness and makes our lives better. I recommend it.
Where am I going with this? Well, clearly cognitive therapy, or cognitive-behavioural therapy, is not just for the mentally ill. It's really more of a wellness program for your mind, like yoga. (Replace "yoga" with whatever you choose to do for wellness.) If you're genuinely ill with say, cancer or MS, yoga won't cure you, but it might help manage life with your illness. Likewise if you're genuinely mentally ill with say, bipolar, RAD, FASD, TBI, schizophrenia, or whatever else, CBT will not cure you, but it might help manage life with your illness. But if you're simply not very well or fit, yoga can greatly enhance your wellness, and likewise if you're not very well or fit cognitively without actually suffering from some kind of organic issue, CBT can greatly enhance your wellness.
Having distorted cognitions is a lot like being fat. If you're fat, you got that way through the choices you made. You might have learned those choices from someone else, but they're still choices you made. And you might be blaming it on all sorts of things, like hormones or medication or being "big boned", but the reality is, you got fat because you chose to eat more than you needed. And you might say you "love your body" but that's a misstatement. Maybe you love being fat, but if you loved your body, you wouldn't treat it like that. Being fat is very bad for your body. You might think also that you can't lose weight, because you tried and failed, but the reality is that if you eat less than you need and do so consistently for long enough, you will lose weight. If that hasn't happened, it's because you haven't been doing it. Also, if you're fat, you might meet people who don't want to go out with you, because you're fat. And you might get pissed off because they're so shallow and they should just love you for who you are etc, but no matter what you have to say about it, they will not date you, and that's that. You can either lose weight and try again, or accept the fact they don't want you. Getting mad and arguing that they're wrong is entirely counter-productive.
So, likewise with distorted cognitions. If you have distorted cognitions, you got that way through the choices you made, and even if you learned those choices from someone else, they're still choices YOU made. You might blame your distorted cognitions on all sorts of things like "feeling a lot", but the reality is, you have distorted cognitions, and the feelings that go with distorted cognitions, because you choose to. You might say you love yourself as you are, well, maybe you do. But it's not healthy for your mind to be full of distorted cognitions and unrealistic feelings, and it would be more loving to yourself to get cognitively well. You might think you can't change, because you tried and failed, but you can, because you control your cognitions, your feelings and your actions. Then, you might meet people who don't want to go out with you because of your cognitive and behavioural distortions. And you might get pissed off and argue that they "should" love you as you are, but they made their choices and they have that right. You can change your cognitions and try again, or you can accept the fact that they don't want you, but getting mad about the fact that they don't like your behaviour is entirely counter-productive.
Cognitive-behavioural therapy doesn't cure anything. It's only a method for identifying maladaptive cognitions and behaviours and changing them. Just because you don't have a psychiatric diagnosis, doesn't mean you don't have maladaptive cognitions and behaviours. Just because you're "successful", doesn't mean you don't have maladaptive cognitions and behaviours. Just because you think you're all that and a bag of chips and everyone should love you, doesn't mean you don't have maladaptive cognitions and behaviours. Almost everyone has some amount of maladaptive cognitions and behaviours. CBT allows us to find them and make them go away, like yoga allows us to find areas of tension and make them go away.
Learning and practicing CBT isn't a sign of being an inferior person. Au contraire. It shows that you recognize you're not always right in your thoughts and your actions and you want to become a better person. It's not easy at first, and it's not always easy later on, but neither is yoga. That's the very reason we do it. If we could brush away our distorted cognitions effortlessly, we wouldn't need CBT. The more difficult it seems, probably the more we need it.
CBT is also not about "lying to yourself" as one person who really needs CBT told me. You're lying to yourself now with your distorted cognitions. CBT is about seeing those lies for what they are. It's in fact, all about being honest with yourself.
I could go on and on, but I'm either getting through to you or I'm not. CBT is good for all of us. It doesn't cure the common cold, or anything else, but it improves our cognitive wellness and makes our lives better. I recommend it.
dimanche 1 février 2009
It's Mental Health Awareness Week!
A whole week dedicated to us! Yay! There will be parades! Fireworks! Banquets! Speeches! Keys to the city!
No?
No.
Poop.
I suppose our various elected representatives will have taken out ads thanking the mental health "care" professionals for whatever it is they allegedly do for us, and that will be it. Nothing about us mentally ill people and our courageous battle against mental illness.
Yeah, that's what I said. People who have cancer always "fight a courageous battle" against cancer, right? Well without taking anything away from the cancer people, we the mentally ill also fight a courageous battle against mental illness, and granted the mortality rate isn't as high, but we still have to do it, and it's rather nice when once in a while somebody takes a second out of their day to say "yo, way to fight a courageous battle against mental illness." Much appreciated. Seriously.
So, in honour of myself and my mentally ill brethren, I'm a' blog about mental health all week. I mean more so than usual. Well, unless I lose interest or something. Hey, it's our week, and y'all supposed to be aware of us. Because The Man says so. Nyah nyah nyah!
I'm even going to include an audience participation component. Because I'm nice like that. So in honour of Mental Health Awareness Week, I challenge all y'all who read this blog to identify a distorted cognition. Preferrably one that you are having. It's pretty easy picking at other people's distorted cognitions, but it's a lot more useful looking at yours. And then if you find one, try to replace it with an adaptive cognition. And then you can even try blogging about it! Yes, it will be the First Annual Mental Health Awareness Week Meme.
But of course you, the mentally "healthy", don't know a distorted cognition when you see one, so I'm a' tell you.
One time just before I fired my therapist, she gave me a little wallet card which said this:
This of course is a general method for finding distorted cognitions, but as some distorted cognitions are particularly common, people have taken to classifying them, and now we have lists of "types of distorted cognitions." That makes life easy, especially when you're first starting out in CT, because you can just look at the list and say "hey, calling people names is on the list, I might as well stop doing it." So to get you started, you might want to refer to the Eleven Types of Distorted Cognitions post or the Twenty Cognitive Distortions post.
The hard part of cognitive therapy is admitting you have a problem. Once you get through that, it all flows from there. So away you go, seeking out new distorted cognitions and boldly thinking where you've never thought before.
Happy Mental Health Awareness Week!
No?
No.
Poop.
I suppose our various elected representatives will have taken out ads thanking the mental health "care" professionals for whatever it is they allegedly do for us, and that will be it. Nothing about us mentally ill people and our courageous battle against mental illness.
Yeah, that's what I said. People who have cancer always "fight a courageous battle" against cancer, right? Well without taking anything away from the cancer people, we the mentally ill also fight a courageous battle against mental illness, and granted the mortality rate isn't as high, but we still have to do it, and it's rather nice when once in a while somebody takes a second out of their day to say "yo, way to fight a courageous battle against mental illness." Much appreciated. Seriously.
So, in honour of myself and my mentally ill brethren, I'm a' blog about mental health all week. I mean more so than usual. Well, unless I lose interest or something. Hey, it's our week, and y'all supposed to be aware of us. Because The Man says so. Nyah nyah nyah!
I'm even going to include an audience participation component. Because I'm nice like that. So in honour of Mental Health Awareness Week, I challenge all y'all who read this blog to identify a distorted cognition. Preferrably one that you are having. It's pretty easy picking at other people's distorted cognitions, but it's a lot more useful looking at yours. And then if you find one, try to replace it with an adaptive cognition. And then you can even try blogging about it! Yes, it will be the First Annual Mental Health Awareness Week Meme.
But of course you, the mentally "healthy", don't know a distorted cognition when you see one, so I'm a' tell you.
One time just before I fired my therapist, she gave me a little wallet card which said this:
- Is this cognition based on fact?
- Does this cognition make me feel the way I want to feel?
- Does this cognition help me achieve my goals?
This of course is a general method for finding distorted cognitions, but as some distorted cognitions are particularly common, people have taken to classifying them, and now we have lists of "types of distorted cognitions." That makes life easy, especially when you're first starting out in CT, because you can just look at the list and say "hey, calling people names is on the list, I might as well stop doing it." So to get you started, you might want to refer to the Eleven Types of Distorted Cognitions post or the Twenty Cognitive Distortions post.
The hard part of cognitive therapy is admitting you have a problem. Once you get through that, it all flows from there. So away you go, seeking out new distorted cognitions and boldly thinking where you've never thought before.
Happy Mental Health Awareness Week!
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