🧠 How CBT Made My Vasculitis More Bearable 🧠
Disclaimer: This was written a while ago.
I don’t know if anyone else is with me on this one, but it feels like the start of 2020 has been a rough one for a lot of people. But as January turns into February and the days gain more sunlight, there’s always something that we can try and feel positive about. Personally, I’ve really treasured the start of my new job, downtimes with my boyfriend, and the weekly CBT course I was lucky enough to be placed on.
In 2019, I referred myself for some counselling. It was a really challenging year for me (in a whole variety of aspects!) and I knew that counselling would help me get back on track. When I self-referred to the Talking Change team, I had a primary assessment to talk through the problems of which I was struggling most. They told me about a CBT course they ran, specifically catered to people with long term health conditions such as vasculitis. I’d been waiting years for this kind of counselling, so I jumped at the chance and gained so much from it.
Before I get into it, it’s important to say that this is only my experience. These are all things that have helped me, and me alone. I won’t talk about anyone else’s experience, and I don’t want to speak on anyone’s behalf. Counselling helps different people in different ways and in varying levels.
The sessions took place in a group setting. I won’t discuss any identifying details, but it was liberating to hear the experiences of others; it made me feel less isolated. As it wasn’t group therapy, there was absolutely no pressure to talk or contribute to these sessions, but I always felt comfortable enough to speak about my own experience.
One big thing I really appreciated about the introductory session, was that I got to see CBT for what it was – a proactive approach to improving mental health. We were told that the more work we put into it, the better it would work for us; we were essentially training ourselves to become our own counsellors. As someone who likes to do everything in their power to overcome patches of poor mental health, it’s been life-changing to learn skills that enable me to steer the course of my own ship once again.
Throughout the weeks, we were encouraged to fill in an activity diary. 7 days a week were split into 2-hour sections, and we had to write what we did and rate our mood out of 10. It was overwhelming, initially. I don’t have the discipline to write a normal diary, let alone track my activities and mood every 2 hours. Unsurprisingly, I didn’t manage to do it the first week, but when I remembered that “you only get what you put in”, I cracked down and managed to complete it. In hindsight this may sound obvious, but it helped me to identify what I was doing when my moods dipped, which helped me to think about whether these activities were the cause or the result of the problem. I’ve now installed Daylio, a really cool CBT app, which allows me to do the same thing but on a daily rather than a 2-hour basis. I’ll be posting a blog I’ve written about it soon, so you can find out more about it if you fancy!
In this course, I learned about processes such as deconditioning, graded exposure, and pacing (via the boom and bust model). Here are some quick definitions of each (to prevent me from reinventing the wheel):
Deconditioning (Disclaimer: this is aimed for the elderly but is frequently seen in those with chronic illness).
'Deconditioning Syndrome' occurs when older people lose their abilities to do everyday activities over a period of time, and is often caused by inactivity. This can lead to reduced mobility, falls, functional incontinence, low self-esteem and functional abilities, and can result in longer term functional and psychological dependence. Regaining the lost abilities (re-conditioning) can often take twice as long as deconditioning. Deconditioning can affect older people in a very short time frame and in any environment especially in acute hospitals and care homes.
It can be prevented by helping, encouraging and assisting people (where required) in performing activities of daily living. One does not need to go to a gym to do exercises. Performing routine day to day activities can be as good as exercises for many frail older people and helps them remain less dependent for longer.
Graded Exposure is a way of treating a range of anxiety problems. It works best with simple phobias or other anxiety problems where you can identify what it is that you are anxious about. The basic idea is to gradually expose yourself to the feared situation in a way that allows you to control your fear at each step. If you get the steps right – in terms of how difficult each one is – you should be able to master your anxiety at each stage and conquer your fear.
Chronic pain can make it difficult to remain active. Many people with chronic pain do as much as they can on good days. This can cause an increase in pain, so that they need to reduce their activity for a few days. This is sometimes called a ‘boom and bust’ pattern. It can lead to reduced activity over time.
Pacing is a key skill in pain management. It involves taking a break before you need to so you have a consistent pattern of activity and rest. Over time, this is associated with being able to do more.
Often people tell us they are surprised how much they can get done by sticking to this approach.
By clicking on the hyperlinks, you can find out more about each technique in further detail. I’ll probably touch on each one in more depth in separate blogs, but for now, I’ll say that learning about each condition exposed me to a new way of living.
I’m so grateful to have been invited to learn more about my chronic ‘life blocks’ through this CBT course, and I sincerely appreciate the NHS for having run it for people like me who often feel unseen due to their invisible conditions. Now that I have tried and tested methods to challenge my anxiety, maintain my energy levels and build up my ability to exercise, I’m feeling empowered to take control of my debilitating conditions.