The Therapy Diaries

The Therapy Diaries 7 | High Intensity CBT

It’s hard to believe I’m on part seven of my Therapy Diaries series. Take from that what you will – I’ve had A LOT of therapy. Anyway, at the present time, this is going to be the last in the series! During my last instalment, we actually rewound a few years and went back to my group therapy sessions which I had as part of my counselling module at university. Today, we’re back into chronological order. We’ve approached my final round of mental health treatment, which was completed in 2017, 21 sessions of high intensity CBT via the Wiltshire IAPT service. It was a wild ass ride. I hope you’ve learned a few bits from the series, or at the very least got an insight into the car crash of a mental health system we have here in the UK.

Disclaimer: I am not a mental health professional in any way, so any recommendations are based on my own personal experiences. If you are concerned about yours or a loved one’s mental health you should seek support from the links below. I will include links to further information at the end of this post should you wish to find out more about each type of therapy, but please bear in mind that this post is based on my own experience so will more likely differ from everyone elses. In addition, I’m looking back over the last 10+ years in some cases, so some procedures mentioned may be different to what they are now.

The Therapy Diaries 7 - High Intensity CBT - Pinterest Graphic

High Intensity Cognitive Behavioural Therapy

So, I gave a bit of an insight into what CBT is and the techniques that it uses in an earlier post in this series, so be sure to have a read for the basics. It generally can be anything between 4 and 12 sessions, and is used to treat different mental health problems, most commonly, anxiety and depression. However, high intensity CBT is often carried out over a longer period – generally 16-20 weeks – and can be used in conjunction with medication.

My Experience

This was probably one of the rare occasions where I actually felt as though my treatment had some sort of structure to it. Additionally, as soon as I met K, I knew she would be a good fit for me. In fact, the overall set up was perfect. It was on a Monday (my day off) and while my sessions were at a health centre a good 40 minutes from my house, it was SPOTLESS. Honestly, it was the cleanest doctors’ surgery I’ve ever been in. As a bonus, I had my own corridor to sit and wait in, that was kept away from all of the other patients. Already a win before I’d even met my therapist.

Mum came with me to my initial session just to make sure that nothing was missed out and so that everything could be covered (I have a tendency to talk stuff down when I’m nervous), but even so, upon meeting K, I felt so at ease. She was nice enough to seem warm and sympathetic, but at the same time, she didn’t pile it on to the point where it seemed like she was patronising me. What stood out for me though, was that she did something I had never experienced with a therapist before. She asked me if there was anything I wouldn’t find helpful during my treatment.

It may seem weird, but I have NEVER EVER been asked that before. I’ve never been asked what I’ve found helpful and what I haven’t before, so in a way I was quite taken aback by it. I explained that more than anything, I REALLY hated being talked down to. That I hated being patronised and spoken to like I was a child (as the lady that did my initial assessment did). That I had a psychology degree with a special interest in counselling (may have made me seem like a dick but by this point I was fed up with being explained things that I’ve known since my first year despite telling them up front I knew about basic psychology) so I knew the basics of what CBT was all about. She was so nice about it all and she spoke to me like more of an equal than a patient. She also gave me the option over what I wanted to focus on – we could focus on the emetophobia, or we could focus on the OCD. While emetophobia had been with me for my entire life, I chose to focus on the OCD because this was what was impacting my life at the most. K agreed this was a good choice, and she seemed to think as we unpicked the OCD, hopefully there would be an improvement in the emetophobia too.

From everything I told K, I felt like she was listening and she genuinely cared. By the end of the session, we’d worked out a treatment plan, and she seemed convinced that she could help me. I left that GP surgery feeling the most optimistic I’d ever felt. For the first time in what felt like forever, I felt like this was actually going to work.

In my earlier sessions with K, she gave me insights into my problems that I had never even considered before. I won’t go into detail because it will keep you here for days, but through creating what was called a “vicious flower,” something I’d never done before, it really got me thinking. We established I have MAJOR control issues which could be related to some earlier life events which more than likely would have influenced my OCD. She told me to create a list of exposure tasks which I would like to complete over my treatment, and these included things like:

  • Having a cup of tea at work no matter the circumstances (if someone was ill at work I would resort to takeaway coffees and foods that didn’t require use of cutlery).
  • To not seek reassurance/ask questions if someone at work was off sick – the assumption being that what I didn’t know wouldn’t hurt me.
  • To only check the front door three times maximum when leaving the house (the ultimate goal being to check it just the once).
  • Using my phone when I was out without Dettol wiping it afterwards (I’d use hand sanitiser anyway but this still would never be enough). 
  • To clean out Tilly’s litter tray without showering or changing my clothes afterwards. 
  • To wash my hands a maximum of three times after using the toilet. 

Yes, these may seem completely irrational, but this is how bad my OCD had gotten. I had a massive list of things like this that I wanted to accomplish, and it was only though putting it together I realised how much OCD had taken from me. K set me regular homework assignments, and on the occasions where I had a bad week and didn’t quite complete them, she was fine with it. She wasn’t disappointed, she wasn’t annoyed, she just wanted to know more about what got me to the point where I felt as though I couldn’t complete my task.

I had 21 sessions with K in total, and as they drew to a close I started to get anxious about what would happen without her support. However, at my last session, we put together a hierarchy of what I would do and whom I would speak to should I find things slipping. We worked together to create a list of the support that I could access – starting with things like telling my husband/Mum if I was feeling bad, all the way up to calling 999 if I was in severe crisis. I left feeling like I had resources for every eventuality.

The Good

  • We all know that it was a bloody long wait to get to this point. However, once things got moving, the structure and the regularity of my sessions was great. 
  • The places where I had the appointments were perfect for someone who had contamination based OCD. Of course I’m not sure this would have been considered generally, but it made things so much easier. 
  • K was fantastic. She properly listened to everything I said, never judged me, and treated me like an adult. She asked me what I found helpful and what I didn’t – something that had never happened in all my time of having therapy.
  • I was given the option of booster sessions when I was discharged
  • The organisation and documentation was great too – I was sent a letter at the start of my treatment and at the end, summarising what we had worked on and what my scores were on the OCI scale now compared to starting treatment. Below are my scores before and after:
My OCD Scores Before & After. Before, my OCD score was 121 (cut off is 40), and after my score was 58.
Apologies, this is a bit blurry on the top. For those who can’t quite read it, my OCI scores were 121, indicating OCD (cut off is 40).

The Bad

  • We all know the general wait to get to this point was ridiculous, but sadly, that’s the case for most people in the same situation as me. 
  • The main issue I had with this form of CBT was the availability and the timings that were available. My Monday morning 10.30 slot was working incredibly well, until K informed me just before Christmas that her hours were changing and she would only be working Wednesday to Friday. Surprise surprise, I worked these days. The options were either 8.30am on a Friday (when I was supposed to start work) or go back on the waiting list for another therapist. It was a no brainer. I put on my big girl pants and spoke to my boss. Thankfully, I had to come clean about my mental health issues when I started taking the medication (thanks side effects), so they were well aware of what was going on when I approached them about this. It was agreed I could start work at 10.30 instead, giving me time to go to the 8.30am Friday appointment – now at the new venue of the psychiatric hospital that was 30 minutes away. From friends of mine I’ve found out that many CBT sessions are Monday-Friday, 9-5. When everyone else works of course! They need to be more accessible.
  • While I am ridiculously grateful I got as many as 21 sessions, I feel the aftercare side of things needs work. It was made clear I could have a maximum of two booster sessions following my last one, and after that I was pretty much on my own. In fact, the words were that I couldn’t have any additional talking therapy for my OCD under the IAPT service. However, should I develop another mental health problem, I would be able to start again from the beginning. The example given being that if I had a baby and developed postnatal depression, I would be entitled to another course of treatment, but for the OCD, I’d had my lot. OH THAT’S GREAT HUN THANKS. As far as I’m aware there was no statute of limitations so to speak, so it felt pretty much like I was on my own for the foreseeable.

Final Thoughts

I wrote a post in March 2019 that celebrated 2 years since my discharge from the Wiltshire IAPT service. I felt it was something worth celebrating given how limited my life had been prior to that point, and it was. I’ll be honest, since Covid-19 hit, I’ve been struggling. I feel this bastard of a pandemic has undone a good ¾ of the hard work I did with K, and I really fucking hate it for that. It’s taken so much from all of us – jobs, opportunities, and in the worst cases, loved ones. For me, it’s taken my recovery. Covid has blurred the lines for me of what is rational and what isn’t. I’m at the point where if I hear someone I know has a cold, I’m writing off seeing them for the next few months. I’m hearing stories of people Dettol wiping their groceries and changing their clothes after attending doctors appointments, things which I worked incredibly hard to NOT do. Now, I’m doing them. I’m washing my hands after touching groceries within the first 48 hours of bringing them home, and I came back from a doctors appointment the other day and immediately changed my clothes – but I didn’t feel “safe” until I had a shower later on.

Anyway, I digress. I didn’t want to make this post all about cuntvid. Sorry, COVID (I promised I wouldn’t use THAT C-word in my blog, but fuck it. I’m done. That word is exactly what this virus is). I’ve had a few gins. Can you tell?

Without a doubt, this form of CBT was my most successful to date. All you have to do is look at my OCI scores to see that it made one hell of a difference. I am eternally grateful to K for that – I left her a thank-you card after my last session telling her she’d given me my life back. And she had. She really had. In hindsight, maybe I should have had those booster sessions following my discharge, but at the time, I felt as though my last session was enough. I felt confident enough that I had enough resources to get me through. I pulled out of the hospital car park singing along to Taylor Swift’s Clean (if you need context, read this post) and as cheesy as it sounds, I felt like I could conquer anything. It was that final session moment I’d always wanted.

We’re now coming up to four years since I was discharged from the IAPT service. Quite frankly, Covid has taken a shit on my recovery, but I know it’s taken so much more from everyone else, so I don’t want to wallow too much. I am still on 100mg of Sertraline, which just about stops me from spiralling I think. I have of course since moved to another catchment area, so I’m not entirely sure what the mental health services in Bath have to offer. I don’t want to put any additional pressure on the NHS at the moment, so I’m holding out for as long as I can, but I’m well aware that I need some more help. As I mentioned in my goals for this year, I’m hoping I can slowly scrape back some of that recovery using the ridiculous collection of self help books I’ve acquired over the years, but I know eventually I could probably use the help of someone who’s done more than a BSc psychology degree that they hated and wish they’d never taken and gotten themselves into a fuckton of debt for. Brains are fun, aren’t they?

Wow, I really didn’t want to be a downer at the end of this, but I fucked that there didn’t I?! Look, global pandemic aside, my recovery was going well, and this particular form of CBT helped. My point being, a combination of the right therapist and the right techniques can work wonders, so please don’t give up hope. Keep on at your mental health service,  and keep on at your GP until you get results. Be honest with your therapist. If something doesn’t work, tell them. Take the medication if you’re offered it, and do the homework tasks you’re given. All of that combined will ensure you get the best results (and fingers crossed that we don’t have another bastard pandemic). x

Additional Support and Information

The following contact details are based within the UK. If you live outside of the UK and need mental health support, CALM has a list of international organisations that you can get in touch with. 

Mind

Mental health support and information. Use this page if you are in need of urgent help.

Samaritans

Free, confidential mental health support available 24 hours a day, 365 days a year. Call from the UK for free on 116 123. 

Childline

Free, confidential support from trained counsellors for anyone under the age of 19. Call from the UK for free on 0800 1111.

CALM (Campaign Against Living Miserably)

Free and confidential crisis support available 7 days a week, from 5pm till midnight. Call from the UK on 0800 58 58 58 or use the free webchat.

References

https://www.healthline.com/health/cbt-techniques

https://www.mind.org.uk/information-support/drugs-and-treatments/cognitive-behavioural-therapy-cbt/about-cbt/

https://patient.info/doctor/cognitive-and-behavioural-therapies

Featured image by Nick Fewings on Unsplash.

15 thoughts on “The Therapy Diaries 7 | High Intensity CBT”

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