Introducing Cognitive Behavioural Therapy (Introducing...) (20 page)

When you feel ready, write down all you can remember about the flashback and focus on how you got through it. This will help you to remember information for your healing and to remind you that you did get through it (and so can again).

Remember you are not crazy – flashbacks are normal and part of healing.

This section has been used with the kind permission of Carol Vivyan
.

Plan some activities

After a trauma, especially one involving loss, everything can feel both overwhelming and yet at the same time pointless. It’s tempting to do very little. But the catch is, the less you do, the worse you feel and the more everything mounts up. So you feel still worse, do even less, watch the backlog grow and just don’t know where to start – and anyway, you think, what’s the point?

A way out of this hole is to start with a rough plan for each day – one thing to do in the morning, one in the afternoon and something for the evening. Try to plan one week ahead, carry out what your plan tells you to do and then plan the next whole week. Congratulate yourself for having done the things you achieve, but work on not beating yourself up for what you didn’t do. Instead, break that activity down into smaller steps and put them onto next week’s schedule.

Move from audience to film director

Flashbacks can be horribly unpleasant and even terrifying. One way to deal with them, as we’ve mentioned above, is the technique of separating
then
from
now
. Another solution is to discover that you have a level of control that maybe you thought was impossible. While you are unlikely to prevent flashbacks, when they do start, you can experiment with treating the scene as a film you are watching. Instead of being a passive member of the audience, take over the role of film director. Start modifying the flashback, treating it as if it were a film, rather than the real event. Tell yourself that though the event did happen, what is now going through your head is something your mind is picturing. Give yourself the option that you really don’t have to watch that particular picture again, and let yourself instead work on developing a different ending. Some people change the distance from the event, so it becomes small and far away, others might take the aggressor and make them look ridiculous, for instance by imagining them in a clown-suit, wearing clown’s make up, and walking along on their hands. Still others bring someone or something comforting into the event, so they feel they are receiving warmth and support. The important thing with this technique, called
imagery rescripting
, is that
in no way are you denying that the actual event took place
. What you are doing is being creative with your imagination. There is no reason why you have to keep reliving it
as it was
. You discover that, surprisingly, you do have a choice of what you watch inside your mind, and you
can
choose something that feels better in some way.

The silver lining

Finally, it is worth remembering that many people who have recovered from a traumatic or stressful life event have said that with hindsight, they now see it as an important wake up call. They then start making many changes to their world which they otherwise would not have done. In fact, as one author put it ‘the individual is able to see him or herself as stronger, wiser and with a new value to his or her life’. Some researchers call this
post-traumatic growth
and think that to achieve the optimum level of growth and learning in life a certain amount of adversity may be important or even essential. It can be very hard to believe or recognize this when in the midst of a crisis, and even reading this may make you think we’re being insensitive or patronizing. However, it’s worth remembering that this idea has been around in the writings of philosophers for a very long time. Nietzsche is quoted as saying, ‘What does not destroy me, makes me strong’.

Above all, remember – and heed – the words of Winston Churchill:

If you’re going through Hell, keep going
.

8. Maintaining progress and reducing recurrences

If you can find a path with no obstacles, it probably

doesn’t lead anywhere
.

Frank A. Clark

You’ve reached the penultimate chapter. Hopefully there is quite a difference between how you view and feel about things now compared with when you started this book. However, it’s an unfortunate fact that many of the perceptions and feelings we have discussed can return – at least for a short while. Difficult times will always happen. Research has found, for example, that if you’ve had more than one episode of depression then you are quite likely to experience depression again. So, the million dollar question is …

What can you do about it?

Case study – Agata

Agata is in her early 30s, with two children under the age of five. She experiences depression after the birth of her youngest child, and successfully works through this using many of the strategies we’ve discussed. Agata recognizes her thinking is very negative and that she’s constantly berating herself for not being a sufficiently good mother. She realizes that much of this stems from her longstanding fear of failure. Agata identifies her negative thoughts, weighing up the evidence for them, instead of just assuming they’re true. So, instead of assuming she
knows
how things are in other families, she tests out some negative thoughts by observing what other new mothers do and asking some of them about their own experiences. Agata also practices challenging the self-critical voice in her head, treating herself the way she’d treat a friend who was feeling down. She shares her feelings with her partner, asking him to help her more, which gives her some time for herself. Noticing that she’s stopped doing things she previously enjoyed, like seeing her friends and exercising, Agata starts making time to see her closest friends and also joins an exercise class for mothers, which she can fit in around the children. Agata begins to feel better, and life returns to how it was before the birth of her second child.

However, Agata is still bothered by thoughts that she’s not good enough, and isn’t measuring up to others. Arguing with her thoughts is hard work, so she resorts to saying to herself ‘just stop being silly’ and ‘pull yourself together’. Then Agata’s husband is unexpectedly made redundant and things become stressful at home. Agata feels powerless to help him, and goes back to seriously berating herself for not being good enough. Feeling unable to ask her husband to continue helping her whilst he’s stressed, she once again cuts down on things she’s doing for herself, like seeing friends and going to her exercise classes. Her husband finds a new job, but his salary’s lower, and the hours longer. Agata continues limiting her activity to just caring for him and the children. She notices she’s starting to feel tired and unhappy and – you guessed it – now begins beating herself up about that – ‘here I go again … I’m so useless, being depressed and pathetic when I should be grateful I have healthy children and we have money coming in again – I’m such a loser!’

Research shows that relapse or recurrence of depression, and indeed other psychological problems, can happen because even though we’re feeling better, frequently we still keep some of our old, unhelpful ways of thinking and behaving. This means we’re quite vulnerable when life becomes hard or stressful. The old patterns kick in and down we spiral … again. While many of us look after our physical health, knowing all about diet, exercise, check-ups and screenings, we’re not so aware of our mental health. It’s equally important to work on our mental health when we’re well as when we’re not. Prioritizing our mental wellbeing and learning to keep ourselves mentally ‘fit’, means we’re less likely to spiral down into depression or develop anxiety-related problems when life gets stressful. Think of it as a little like losing weight. If you really want to lose weight and stay trim, crash dieting and then going back to eating exactly the same way as before is useless. You’ll very quickly regain your former size. If you really want to lose weight and stay in shape you have to permanently change the way in which you eat. The same is true of maintaining your improved mood and mental health. To help you do this, we’ve summarized a number of ideas which can increase your resilience and reduce your vulnerability to ongoing mental health problems.

It is as important to pay attention to maintaining your mental health as your physical health!

Keep up good habits

We hope this book helps you develop many useful strategies to manage your mood, mental health and indeed your whole life. All the ideas you find helpful can be applied to everyday life, even when you are not feeing particularly down or anxious. The strategies discussed in
Chapter 4
and
Chapter 6
can be used to develop habits to keep you feeling well rather than just being used when you are struggling.

Take activity scheduling, for example. It’s important that we all ensure that our weekly schedule includes pleasurable activities or those which provide a sense of achievement. If you build this into your normal week, you’ll be less vulnerable to problems when things are stressful or challenging. Equally, watching out for distortions or unhelpful thought patterns and being aware of the ways we interpret the world, even when we are well, can increase our future resilience.

As you begin to feel better it can be really easy to drop new good habits because you don’t need them as much – try to maintain them in order to keep your mental health in good condition.

When everyday blues become toxic – what is normal?

Everyone has down days. It’s perfectly normal to feel sad, lonely or blue at times in our lives. Sometimes we know exactly why we feel that way, sometimes we don’t. Unfortunately, if you have experienced depression, you can sometimes feel very frightened by even ‘normal’ low mood. You find yourself feeling a bit low or flat, and start panicking that this means you are becoming depressed again. This in itself can trigger a cycle of negative thinking which actually worsens your mood. Thoughts like ‘here I go again, I’m never going to get over this’ and ‘nothing I do makes any difference – I’ll always be depressed’ lead to unhelpful behaviours like avoidance or withdrawal, as we’ve described in
Chapter 6
. This then triggers further negative thoughts and unhelpful behaviours, and before you know it, the downward spiral has begun again. It is really important to allow yourself to have low times without panicking or immediately labeling them as depression.

Remember these key points:

• It wouldn’t be normal to never be sad
  
• This is just a difficult time
  
• Get active – even if you don’t feel like it – do anything that might lift your mood
  
• Don’t give in to the urge to shut yourself away and brood – do the opposite
  
• Talk to someone
  
• Curl up on the sofa and escape into a good book or a film
  
• Do anything which takes you away from ruminating on negative thoughts
  
• Remind yourself that going over your worries or negative thoughts right now won’t be helpful – you don’t come up with your best solutions while you are feeling down
  
• If you need to take some time out and have a ‘duvet day’, that’s okay now and then, but don’t let it become a habit
  
• Don’t beat yourself up for anything you think is lazy or frivolous
  
• Recognize and try to meet your needs
  
• Be kind to yourself.
  

Sometimes when someone has been depressed the people around them can also assume they are becoming depressed again if they have a low day. Talk to your loved ones about this – they need to allow you the normal ups and downs of life without panicking that you are once again depressed.

Spot your early warning signs

When we have recovered from a period of depression it’s often very tempting to want to move on as quickly as possible and not think about what happened. However, learning from what’s happened can decrease the likelihood of recurrence. Think back to when you first became depressed. The chances are that it built up gradually over a period of time. Ask yourself the following:

• What happened around that time?
  
• What sorts of things were going through your mind?
  
• What did you stop doing?
  
• What did you do more of?
  
• What did other people around you notice?
  

Really think this through. Talk to those close to you – they may well have noticed things you overlooked. Now write yourself a plan. What is it that you have to watch out for? What should you do if you notice early signs that all is not well with your mood? Doing this can enable you to head off future problems. Tackle problems early, before they get out of your control. Notice your urges to do things you now know are unhelpful to you, like avoiding social events or dwelling on sad memories from the past. Help yourself not to act on those urges – remember that the thing you feel like doing (like staying in bed or cancelling all engagements) might not be the right or most helpful thing for you to do. Let someone else in on your plan – ask for help in detecting problems and in heading them off before they seriously interfere with your quality of life.

Expect setbacks and learn from them

Recovering from any psychological problem is never a smooth process. There will always be setbacks and days where you feel as if you are back to square 1. Remind yourself that it isn’t really so. However bad you feel right at that moment, it cannot undo what you have learned from the progress you’ve already made. If you did it once, you can do it again, even though it may seem really difficult at the time. Try seeing setbacks as an opportunity to learn more about staying well. Don’t jump to conclusions that this means nothing is working and all is lost – imagining catastrophes before they have happened is just counterproductive. Instead, try identifying what tripped you up this time. How could you avoid this kind of thing in the future? What will you need to do differently?