Filling In Forms For Cbt

[Roses]

So I have to fill in a form every time I sh for when I have CBT. There are 3 columns - triggers, self-injury behaviours, afterwards. For each column there are rows - environment, how you were feeling physically, thoughts, feelings, what I did. I'm filling them in as soon as I feel able to afterwards but I find the form filling even more upsetting than my guilt about what I have done. I know they are to help them figure out what is motivating me but it seems to be the same thing over and over again and I don't see what the point is. I just want someone to tell me the cure, what can I do? There must be a secret to stopping this. It can't all be snapping elastic bands on your wrist for the rest of my life? Is this like an addiction? Do I need to go to fucking sh anonymous and start chanting!! I am so frustrated and angry and confused and fucking medicated that I can't tell up from down. I took my new meds at 6pm again and by 6.40 I was conked out and slept for an hour. I can't do this every night, I just can't. I feel like I am screaming at the top of my lungs and no-one can hear me. Why can't they just rip this out of me so I can get some god damn peace.

[walker]

Rose - do you have a therapist

You should be talking to someone

that is the only way to get this out of you

I had rows with my cbt therapist, when he expected me to rate my moods

[hummm_mabbe]

So I have to fill in a form every time I sh for when I have CBT. There are 3 columns - triggers, self-injury behaviours, afterwards. For each column there are rows - environment, how you were feeling physically, thoughts, feelings, what I did. I'm filling them in as soon as I feel able to afterwards but I find the form filling even more upsetting than my guilt about what I have done. I know they are to help them figure out what is motivating me but it seems to be the same thing over and over again and I don't see what the point is. I just want someone to tell me the cure, what can I do? There must be a secret to stopping this. It can't all be snapping elastic bands on your wrist for the rest of my life? Is this like an addiction? Do I need to go to fucking sh anonymous and start chanting!! I am so frustrated and angry and confused and fucking medicated that I can't tell up from down. I took my new meds at 6pm again and by 6.40 I was conked out and slept for an hour. I can't do this every night, I just can't. I feel like I am screaming at the top of my lungs and no-one can hear me. Why can't they just rip this out of me so I can get some god damn peace.

Hmmmm CBT for self harm. Ok. I am going to try to imagine what the thinking behind your therapy is, so bear with me as I work through it. I am trying to 'think CBT' and so is not necessarily what I would suggest - I am just trying to understand what they are trying with you.

From my experience of CBT, I think the rationale would be that self harm is a complusive behaviour, done as an attempt to soothe painful emotions, and done compulsively. There is an automatic emotional link for you between stress and self harm, but currently this is out of your own control. You feel the urge, you do it. The aim of CBT diaries is ALWAYS to find patterns - a, b and c. The idea is that when you can clearly see a pattern, you are in a posotion to interrupt the pattern. But whilst you just carry it out on impulse, there can be no understanding. Its just like putting on a tape - click, whirr. You self harm.

The step they want you to insert is to ask "ok, I am feeling stressed. I dont know how to deal with this, I feel overwhelmed and my overwhelming urge is to SH. What can I do instead of SH in order to soothe me and make me feel better?". The aim of CBT is to bring new understanding, insight and rationality to an emotional response. Without the diaries, the actual detail of the why, how and when is not known to you. You DO know that it goes 'stress, cant deal, more stress, need to escape, self harm'. That is the basic outline. But the actual detail will be much finer. Its the detail that is important and which will lead you to a possible 'eureka' moment. Thats the idea - however, this is where CBT breaks down with extreme emotional problems such as PD's.

It assumes that the person is self motivated to actually do it, and that they have some control over the powerful emotions that are attacking them. With PD's this is not often the case. If it were me, I would want to be asking "why do my emotions feel so out of control? What is it that I am missing that makes me feel as though nothing else but self harm will help me? How did I start self harming, and what did it mean to me the first time I did it - what effect did it have that nothing else ever had? What emotional needs are not being fulfilled for me that make these events seem so powerful? Do I feel unprotected? Unheard? Ignred? Judged? Humiliated? Abandoned? What situations from the past felt the same way as this, and so may be driving extremely strong emotions inside of me?" and many others. The thing is, CBT aims to treat the SYMPTOM, eg self harm, as opposed to the CAUSE.

When you are feeling awful all you want is escape, something to take the pain away. All therapy takes a very long time, especially so with PD's. This is a further injustice that we face, but it is there to faced nonetheless. Your self harm is an incredibly complex thing. There are the people involved in the incident that triggered you. There are the similarities to past events. There are the chornically unmet needs that you have yet may be unaware of. There will be expectations you have of yourself and others. There will be assumptions and feelings that come up from nowhere which are only vaguely understood yet extremely powerful for you.

CBT will look only superficially at these deeper issues (except 'beliefs and assumptions' - however in BPD ours go far deeper), it just aims to insert an extra step of "ok I feel bad, I know I need somehow to deal with this - but what can I do instead of self harming?". On paper it seems simple enough, but the web of emotions makes it far harder to tackle than many CBT therapists would like to belive. That is why DBT and schema use Mindfulness meditation, and in the case of schema, "limited reparenting" which aims to identify and fill the chronically unmet needs of your life.

I hope that this does not make you depair - the problem is that CBT, for a long time, has been recognised as lacking when it comes to PD's, especially BPD. Thats why new therapies were made especially for it. The problem is that the NHS wants everyone on financially easier to handle, time limited therapy programmes, which CBT satisfies. Ask if you can get DBT as a first off, as it has an excellent record and evidence base for treating Self Harm - much more than CBT. You may also like to see if you can get schema for BPD - although this is VERY unlikely. What I am trying to say is - not all therapy is therapy. You are coming up against the classic problem seen when CBT is used for personality disorder: Our emotions are much stronger and relevant than CBT theory allows for. We cannot reduce everything to pure rationality, because the part of us that needs attention is emotional, not rational. Knowing this will hopefully mean that, should the CBT fail, you do not presume you are a hopeless case. In fact what will have happened is that they have used the wrong tool for the job and its time to try and find someone with the right tools.

[daisy duck]

im sorry your feeling like this hun....

xxxxxxx

[hummm_mabbe]

Oopsie yes I missed out a cuddle

Huggle ti fluff

Smooooooch

Squish

:bigarmhug[1]:

[bibiddi]

So I have to fill in a form every time I sh for when I have CBT. There are 3 columns - triggers, self-injury behaviours, afterwards. For each column there are rows - environment, how you were feeling physically, thoughts, feelings, what I did. I'm filling them in as soon as I feel able to afterwards but I find the form filling even more upsetting than my guilt about what I have done. I know they are to help them figure out what is motivating me but it seems to be the same thing over and over again and I don't see what the point is. I just want someone to tell me the cure, what can I do? There must be a secret to stopping this. It can't all be snapping elastic bands on your wrist for the rest of my life? Is this like an addiction? Do I need to go to fucking sh anonymous and start chanting!! I am so frustrated and angry and confused and fucking medicated that I can't tell up from down. I took my new meds at 6pm again and by 6.40 I was conked out and slept for an hour. I can't do this every night, I just can't. I feel like I am screaming at the top of my lungs and no-one can hear me. Why can't they just rip this out of me so I can get some god damn peace.

Roses, feeling like this is horrible.

You know when you say that 'it seems to be the same thing over and over again'. Do you mean what motivates you to SH?

So, if there is a set of thought patterns or behaviours that you have that lead you into crisis and then onto self harm, this form will highlight it.

For example, if someone says something about you, you take it as a negative comment, then you believe yourself to be worthless and emotionally beat yourself up, then you start drinking, and then end up self harming.

Thats probably not your routine, but its a typical one.

One bit automatically leads onto the other without much awareness, but by writing it down, you can see the steps that led to the SH.

So, by being more aware, its possible to go. 'Oh heck, I can see my negative thinking, (the black and white, either all good or all bad thinking). I'll try and do something different from take the next step of drinking, I'll clean the kitchen cupboards, I'll draw a picture, I'll listen to songs, have a bath, etc.'

Does that make sense,? Rather than wait until you have the urge to SH, its trying to change your thinking before you hit crisis.

It isnt easy, but can be done. And is very useful.

During that time of the introduction of new meds can often be difficult, keep taking them, and it will hopefully settle down.

Please look after yourself.

[Roses]

Thank u all so much for your replies and especially for all the trouble hmmmaybe went to in typing all that out for me. Thanks again and thanks for all the hugs guys. I don't have BPD I have depression with anxiety. They looked into BPD and weren't sure I fitted. I don't think they know what I am really and are just throwing all they have got at me. I know therapy takes time and I guess I have to hang in there for a bit. I do suffer with black and white thinking and although I have made major changes (no longer think hubbie hates me which is good) and am growing up in lots of ways, still, in others I am reacting like a child and am struggling to move on with this. I will ask about DBT and thank u so much for the advice I appreciate it. The NHS only tell u what they think u need to know and I am grateful for all the information you have given me. Bibbidi - u r right there are triggers. This is the problem though there are so many and it can be the slightest little comment to serious rows - just about anything can set me off and I have literally a few seconds from thought to action and it's hard to pin it down and rationalise it. I have actually wanted to sh for 2 days now and have been posting on here and doing distraction with kids/family/music etc... but it's like triggers happen lots every day and I can only take so many and I'm sh every 3/4 days at moment. I am so angry and confused and sad and aaaarrrgggghhhh!! Just not right. Just got fucking freaked out by Johnathan Creek for god's sake. Had to come upstairs as thought man from painting was gonna come and get me. Now am freaked out people under bed are gonna get me again and there are people outside looking in and it's all going wrong. Am scared.

[bibiddi]

Ok, I have to be honest, and say I think you are doing tremendously well.

This time of year is difficult for so many, and you are in the middle of changing meds. Yet you have been able to find distractions to help you.

When you are in a heightened state of anxiety, distress etc. dopeople become more aware of triggers. This form is hopefully helping you become more aware of your pattern of behaviour earlier. You are right, there is so little time between thought and action, thats why its so difficult to change.

But it does sound like you are doing well. (OK, probably doesnt feel like it at the moment - but it does sound it).

Its OK to be freaked out by scary programmes, but now is a good time to go for the distractions, is there a something funny or nice on tv? is it time to have a relaxing bath with lots of bubbles?

Look after yourself.

[Roses]

Thank u. I'm glad u r here. The buzzing has started and the people are coming. I will go downstairs and see hubbie.

[Rael]

hey, sorry you are feeling so bad hun im glad that you have been trying to distract im sorry ive been sitting here with the reply open and my brain is shot. i agree totally with the advice above, they tried cbt techniques for s/h with me but were inconsistent in going through things even though i filled them out so it never had a chance to work. i hope it does for you.

can you let your husband know how you are feeling? and dont forget that if you worried bout people under the bed you have those quilts.

xxx

[Roses]

U r a good friend. I had an awful night but a bit better this morning now is light. Hope you feeling OK. Hugs xxx

[wounded soul]

Hi Roses

sorry youre feeling so Crap,Maybe CBT is not the Answer,as it focuses too much on behaviour and not the real issues that are effecting you so deeply.If you ever want to talk im here,may i also recomend that you try a persson centred therapist,who you can really talk to.I can feel youre pain and wish i could do something to make it go away,depression is like being in a hole you cant get out of but dont give up,You are an important person and you have been giving loads of support on this site,let us give you some.

Take care

Wounded soulxxxx

[Roses]

Thank you Wounded Soul for your kind words. I really appreciate it. I have a plan tonight. Have bought puzzle book and am going to sit downstairs and try to distract myself for as long as I can. I used to do a lot of puzzles in hospital so had a serious aversion to them over last year as it reminded me of all the bad times. Realised though that it is actually a good distraction technique for me so will try it again. Will let u know how I get on. xxxxxxxxxx

[Rael]

hope your puzzles help. what kinds do you like? i have a thing for sudoku, especially the super-duper hard ones and the ones with letters as well as numbers.

xxx

[Roses]

I did some sudoku but took me a long time. I just got arrowwords as no matter how addled your brain is you can always manage them. Used to get Daily Mail every day in hospital and liked their puzzle pages with finding words from letter wheel and stuff. Did n't manage to do it in the end. I stayed downstairs a bit longer than have been but just too upset to concentrate. Had to go to GP this avo to sort out extra week of meds as started top up and new meds mid month and wanted to get it to tally up with repeat. It was a locum and she sat me down and looked at her screen and went 'oh', 'I didn't realise you were on so much medication' and commented on how I looked so 'normal' and wasn't I doing well to be married and have kids and she went - 'oh, 7 overdoses' (in 2007), but non last year - well done!! And I'm like- fuck off you patronising bitch. Do I have to be 10 stone overweight with a mole on my nose and missing teeth to have depression then? She made me feel like a total piece of crap and I just wanted to run away and sh. Plus I didn't know it was 7 times in 2008 - I only remembered about 5 so where were the other 2. Can't add it up in my brain now. Seh asked me loads of other questions and was in there bout 10 minutes. Then when went to get script made up they asked me why I had these tablets given to me and did I know what I was doing with them? Am I just looking stupid or what???? Makes me so angry nd upset.

[wounded soul]

Hi Roses

I hope the puzzles helped,distraction can be the answer sometimes as it takes you away from the hole.

Wounded soulxx

[walker]

sorry about you doc experience -

i always feel so vulnerable and at their mercy when i'm in there

and hated getting meds from chemist - hated the fact that they knew what I was taking, and were thinking crazy inadequate

I love sudoko too, esp locked in the loo, away from the world!!

[Roses]

I have quite an active brain and get bored easily. That's the worst about when I'm ill I puzzle all day to try and pass the time. When I'm not ill I'm renowned for watching 20 minutes of a programme, guessing the ending, getting bored and walking off to do something else more challenging so when I am ill I take serious occupying! Yeah, chemist workers seem to have this knack of questioning you in just the wrong tone and I guess it's a generation thing about doctors and teachers and the such-like. Hopefully our kids will feel differently and the hierarchy won't be so bad.

[wounded soul]

I have quite an active brain and get bored easily. That's the worst about when I'm ill I puzzle all day to try and pass the time. When I'm not ill I'm renowned for watching 20 minutes of a programme, guessing the ending, getting bored and walking off to do something else more challenging so when I am ill I take serious occupying! Yeah, chemist workers seem to have this knack of questioning you in just the wrong tone and I guess it's a generation thing about doctors and teachers and the such-like. Hopefully our kids will feel differently and the hierarchy won't be so bad.

Have you thought of learning something new to occupy yourself.Its good destraction tactics and can help give your confidence a boost.

Wounded soulxxx

[bibiddi]

I did some sudoku but took me a long time. I just got arrowwords as no matter how addled your brain is you can always manage them. Used to get Daily Mail every day in hospital and liked their puzzle pages with finding words from letter wheel and stuff. Did n't manage to do it in the end. I stayed downstairs a bit longer than have been but just too upset to concentrate. Had to go to GP this avo to sort out extra week of meds as started top up and new meds mid month and wanted to get it to tally up with repeat. It was a locum and she sat me down and looked at her screen and went 'oh', 'I didn't realise you were on so much medication' and commented on how I looked so 'normal' and wasn't I doing well to be married and have kids and she went - 'oh, 7 overdoses' (in 2007), but non last year - well done!! And I'm like- fuck off you patronising bitch. Do I have to be 10 stone overweight with a mole on my nose and missing teeth to have depression then? She made me feel like a total piece of crap and I just wanted to run away and sh. Plus I didn't know it was 7 times in 2008 - I only remembered about 5 so where were the other 2. Can't add it up in my brain now. Seh asked me loads of other questions and was in there bout 10 minutes. Then when went to get script made up they asked me why I had these tablets given to me and did I know what I was doing with them? Am I just looking stupid or what???? Makes me so angry nd upset.

I know how 'professionals' can make us feel rubbish.

However, it could be viewed that she was showing interest in you. The fact you were there for ten minutes could show she was spending time with you, and actually cared.

Many locums, may just do the bare minimum. You only went to tally up your meds, she could have done that barely acknowledging you.

She may not have got it right, as you felt she was patronising, but she did try.

I'm glad you have some good distraction techniques. I have to be in the right mood to do Sudoko. but it is good to complete a difficult one.

[Roses]

You know what, you are totally right Bibbiddi. Me being doom sayer again. Will have to get Monty Python's "Always Look On The Bright Side Of Life" and play it repeatedly.