Cognitive behavioural therapy- values and depression

It may help to discuss your reservations with your therapist. You will engage better if you are convinced about the process. What's your homework this week?

my homework is to go to the cinema on Saturday with my colleagues from my acting course, and finish the values form. it's hard enough going to the acting course on Saturday for eight hours straight, I'm not going to be able to go to the cinema afterwards.

That's interesting. Do you feel anxious about going to cinema and that's your exposure? Or do you simply aim to socialise more? When you agreed your homework with your therapist did it seem doable? It's important that you mention any concerns about the homework in session as there is no point in agreeing on tasks that you won't be able to complete.

Are you more confident now about your values questioner?

my health anxiety stops me from socialising and doing normal day to day activities. what's just a headache for a normal person is a brain haemorrhage for me. a tummy ache can be appendicitis. etc. I have to go to hospital every day so the doctors can reassure me I'm not dying. I get new symptoms every day. its very difficult to do anything in these circumstances, let alone go to the cinema in a group, possibly somewhere far away from where I live, after eight hours straight of acting lessons.
I didn't actually agree to do it, she just said "this will be your challenge for next week". I told her I'd find it very difficult and she said something to the effect of "your life or A&E, that's what's at stake here" I cant suddenly change a pattern ive had for the last two years, just because I've been told to.

NHS mental health service tried with me from 10-19 years old. The only way I beat my anorexia and get through life without killing myself is by smoking lots of weed.

The problem with CBT is that it assumes that you lack a certain level of self awareness that usually enlightens people to the fat the thought processes and patterns of behavior they engage in are destructive. I already knew exactly how and why I was messed up, and like you just felt like I was wasting their time and money which only added to the guilt complex. The obviously leading questions posed to me just made me either hyper analyse everything or feel patronised. It is painful to be aware.

It may work for you. I don't know how depressed you are but I know my depression is pervasive in how I view just about everyone and everything. There isn't a day that goes by where I don't want to physically harm myself, question whether I deserve to live, have flashbacks or needless apply years of emotional trauma/baggage to completely irrelevant circumstances. You just learn to ignore it after a while.

Um, just answer the questions how you think they want you to answer them right off the bat. The less you over think things the better, less you further ingrain negativity into your psyche.

You are right. You can't make a change just because you have been told to. You are more likely to make a successful change if you really want to. I'm surprised that that's how your homework was devised as idea is to come up with goals in a collaborative fashion. Not spring something like that out of blue. Nevertheless it is a good goal, work trying to work on.

What would you normally do after your acting class? Go home? Would you only go to AE that day if you had symptoms or would you go anyway just in case? Doing something like going to watch a movie can be a very good distraction technique to try and take your mind away from your worries about health. One of the main principles of CBT for health anxiety is trying to shift the focus away from bodily symptoms. The more you pay attention to your body the more symptoms you are going to notice. We all get 'symptoms' everyday. However majority of people don't pay any attention to minor aches and pains. When you ignore them they go away very quickly. However if you focus on them they are magnified by the anxiety. Distraction is a good way of trying to break that cycle.

What are your main concerns about going to cinema? Are you going to be to tired? Are your friends from the acting course planning to go? Does any of them know about your difficulties and could support you in trying to achieve your goal?

I hope you don't mind me asking all those questions. I want to encourage you to stick with it.

i suppose what i meant was that its going to take more to change my thoughts and habits than simply being told "go to the cinema and try to think of something else". My main worry is that ill be feeling unwell and being anxious about it. Normally after class i tend to develop a severe headache and im already predicting ill go to A&E because thats what i always do.
No one in the class knows about my situation. If they did theyd probably want to stay away.

It is a big ask but maybe you could try a behavioral experiment. What if you don't go to AE and go to cinema instead? What would be the worse thing that could happen?

I think your therapist mentioned at some point that you need to face the anxiety. It's true. If you remain anxious for long enough without seeking reassurance or engaging in a safety behavior the anxiety will eventually subside. If you develop a headache and feel anxious about it but stop yourself from going to AE it will get better on its own and you will prove to yourself that you don't need to be seen every time you develop those symptoms. Each time you expose yourself to an anxiety provoking situation it gets easier. A big part of it is breaking habits associated with safety behaviors. So if you normally end up in AE after class you need to try doing something else. If it doesn't work than it doesn't but why not give it a try?

I just know I wont be able to cope. if I could I wouldn't need therapy in the first place. I tried similar stuff in the past and it didn't work.

That's OK. It is a big step to take and you may need some more preparation before you are ready to attempt something like this. As long as you are honest with your therapist as to why you were not able to complete your homework there are always important lessons to be gained from tasks that you can't complete at a given time.

Is there anything that would make it easier for you to cope in that situation?

I cant think of anything that would make it easier. Its just a question of mental strength which i dont have.

Sometimes what help is to break a difficult task into many smaller ones, gradually building up the difficulty. You may want to discuss with your therapist in the next session how this can be done.

It does take a lot of strength to engage with CBT and it can be very hard work. It is worth trying though.

What it it doesnt work? Ill be at my wits end if it doesnt.

There are other types of psychological therapy. Medication is also a potential option. If you haven't already you could be referred to secondary care to be seen by a psychiatrist. There are many different options available.
There is a good chance that you will find CBT helpful. It's early days.

Ive already had counselling and psychotherapy. Im on medication and ive tried several ADs. If cbt doesnt work i will have run out of options.

There are always other options. From various combinations of medication to specialist national services for anxiety disorders. It's really good that you are invested in making CBT work. Try not to think about it as be all and end all though as that creates a lot of pressure.

Theres no other type of therapy that the nhs would offer me and i cant afford to go private.
Im at the hospital now and im not sure that the doctor on duty will examine me.
My life sucks. I didnt ask to be born.

There is a lot that NHS has to offer that may not be very openly advertised. Who manages you care at the moment? GP or are you now under mental health services?

What happened to make you go to the hospital? Do you need the doctor to examine you to feel reassured?

I already had to wait over a year to get cbt, i doubt theres very much else they could offer me. My gp manages my medication, the mental health team are in charge of the talking therapy.
I had chess pain but the doctor couldnt find anything