Its My Birthday and I’ll Cry If I Want To; An Intro to Cognitive Therapy

I guess I let the cat out of the bag, today is my birthday. My anxiety spikes as I type this. The thought that someone is going to read this and wish me a “Happy Birthday” makes my stomach knot. These are not typical feelings associated with birthdays and I am working on changing them, but change doesn’t happen over night.

When I was accepted into the graduate program to become a mental health counselor there were no owls or magic wands, wait who am I kidding there are always owls in my life, but I was not told to buy a book on potions or spells. Counselors do not have the ability to magically dissolve whatever ails you however we do have numerous ways in which we can teach you to make positive changes to your thoughts, feelings, and behaviors that reduce your distress. While you will start to see positive change during the counseling process if you have deep rooted weeds like me, it takes time and continued effort to get them under control. One of the theories that we often use to help people untangle these weeds is Aaron Beck’s Cognitive Therapy.

Cognitive Therapy believes that maladaptive thoughts are the root of distress and by working to modify these thoughts we can reduce the distress. When I try to explain my brain to others I often say that my wiring was wrong and that messages and emotions get twisted, as I am fixing the wiring it happens less often but from time to time I still get a scrambled signal. Cognitive Therapy helps to untangling these twisted wires. In this post we are just going to just skim the surface of how this theory works and look at the main wiring or schema which Aaron Beck defined as “the rule that governs information processing and behavior”. To uncover the schema we start at the surface by looking at automatic thoughts and then deep diver to discover the intermediate beliefs and then core beliefs that we hold that bubble up through those automatic thoughts. Lets look at mine today as an example…

Its my birthday and my distressing automatic thought is I do not deserve to be celebrated.

The intermediate beliefs might cite “rules” about what we except. My intermediate beliefs related to this automatic thought are:
A person worth celebrating has strong social connections with close friends which I lack. I have a few close acquittances and maybe one of two friends.
By 35 I should have a family of my own and an established career.

Which boiled down lead to my core beliefs. Core beliefs are more global and likely are the related to other intermediate beliefs and automatic thoughts as well. Here are mine:
I am unlovable.
I am a failure.

Altogether these build my schema (my faulty wiring).
I am worthless. No matter how hard I try I will always be less then what I should be and therefore am not worthy of praise. Anyone who praises me is doing it out of pity because no one would actually care about a failure like me.

You may have noticed that my thought process and beliefs are riddled with cognitive distortions which we will explore in my next post. In many areas of my life I have already been able to challenge and start to untangle these twisted wires but like I said, change takes time. I started by working on accepting gratitude and am working my way through praise and then someday I will reach a point where I am comfortable being celebrated. As for today I will be practicing mindfulness and challenging these distorted thoughts, but I may still cry not because I want to but because I am struggling to keep my wires from crossing.

If you struggle with depression, anxiety, or other mental health ailments know that you are not alone. These conditions can feel very isolating but do not need to be. My hope is that by being transparent with my story it helps others to feel less alone. There is no shame in seeking support!

The Power of Words- Names

From the time we are born, sometimes even earlier, we are labeled. Labels are applied to us so that society knows how to interact with us. Most of the labels we are given are directly related to some trait we have- genitalia, skin color, ethnic origin, etc. There is one label that is chosen for us, and has great value, our name. Our name is the beginning of our personal brand and our feelings about our name are shaped by how others use it.  

Some names naturally evolve with nicknames, like Elizabeth becomes Beth, while others are shed and new ones adopted. When people make the choice to adopt a new name there is a reason behind it. No longer using a previous name comes with consequences and yet the rewards greater leading to a willingness and continued desire to change.  

Some people chose a new name so that they feel more accepted. This often happens in conjunction with major life changes such as immigrating to a new country to escape poverty and or discrimination. Others select a new name in order to separate from thoughts and feelings associated with their old, birth name. This can be seen with individuals who have decided to live a life more congruent with their true self and or those who have survived abuse. Imagine you spend years hearing your name in combination with demeaning remarks, “NAME you idiot”, “NAME is such a failure”, “NAME you’re worthless”. Over time this combination of name and remarks begins to feel like a definition. By letting go of this name the person can also begin to let go of this maladapted belief that they are those definitions. This is also seen in people whose gender does not align with their birth name. We place so much weight on societal expectations regarding gender that having a name incongruent with our gender can lead to some rather uncomfortable encounters as well. And there are some who choose a name in order to escape from their abusers. These people frequently up root their entire lives and relocate so that they feel safe. 

When you use a name that has been shed you are saying that the experiences related to that name are not valid. You may not, and hopefully do not, use someone’s old name (birth name, deadname, shed name, etc.) with malicious intent. However, using this name can be triggering for some people and bring up maladaptive thoughts and feelings.  

Names are incredibly important to us. Learning how to say other’s names and respecting their name, rather given at birth or chosen as the result of adversity is a simple way to be a better human.  

Measure Effort Not Outcome

This past year, 2020, was trying. No matter how together you had your life, in March our whole world changed. As we reflect on how last year went, I want to share with you one of the most impactful things I learned.  

During my class on addiction counseling this past semester, I was assigned a chapter on counselor self-care. Self-care is incredibly important and I have read a ton on the topic, but in this chapter, something stuck out and stuck with me. It discussed how as counselors there is only so much that WE can do. We can provide our clients with all of the tools in the world, however, we are not in control of their recovery and we cannot take a relapse personally. How then do we measure ourselves as practitioners? The answer is we measure our effort, not our outcome!  

What does it mean to measure our effort, not our outcome? We have to understand that in every situation there are elements in which we lack some level of control. We must look, therefore, at those aspects where we do have control and the amount of work or effort we put in in those areas. We need to measure our performance rather than the product.  

I challenge you, as you reflect on 2020, to think about your performance rather than the outcomes or products as there were a lot of variables that added challenges.  

An example of this from my year would be my grades. I worked really hard to try and maintain all A’s this past year. Last semester, however, I failed got a B. At first, I was incredibly frustrated with myself. I should have worked harder, I should have studied more, etc. But when reflecting on my effort, instead of the outcome, I actually became really proud of myself. I selected this master’s program because of the in-person class style it offered and due to the pandemic we were completely remote now, which is a very challenging learning modality for me. I had also lost my part-time income over the summer, thanks to Covid related business closures. This resulted in me taking on a full-time contract, working overnights while taking four graduate-level courses to recover from the financial loss. I was also volunteering as a wellness counselor for the USF Confirmed Covid Counseling Clinic, and as a director for Owl’s Nest Sanctuary for Wildlife. If you look at the effort I put into growing as an individual and professional I had a very successful year, even though the product was not as I had hoped.  

I encourage you to reflect on your year and praise yourself, not for the outcomes you achieved, but for the effort you put forth. Depending on your circumstances your effort may not look like your usual effort. Majorly modifying your habits and adjusting to the new isolated, remote lifestyle was hard work and few people gave themselves credit for the effort they put into staying safe and healthy this past year. 

What effort are you proud of? Think about an area where you worked hard and deserve to give yourself some credit. Share your effort below so that we can practice praising each other and measuring our success by effort rather than the outcome. 

The Power of Words- Layers of Meaning

“You are overthinking what was said.” If you have heard that line, you are not alone. We’ve all heard “a picture paints a thousand words” and that “actions speak louder then words”. I cringe at how much these sayings discount the power of words.

We often forget that words carry layers of meaning through denotation, or the literal meaning, and connotation, the deeper meaning linked to our thoughts and feelings surrounding the word. Denotation is the meaning that would be found in the dictionary, think of it as the meaning your “brain” interprets. Connotation however, is what your “heart” or “gut” feels and is the key element in “overthinking what was said”. Connotation can elicit positive, negative, and even neutral feelings.

All definitions (denotations) from Merriam-Webster.com

Add to the meanings presented with the words alone the tone in which they are said (by the sender) or read (by the receiver in written messages) and the meaning can become even richer.

Overthinking can occur for a variety of reasons but it tends to be “A NIT”.

*Automatic- seems to just happen unintentionally
*Negative- generally evoke undesirable feelings
*Intrusive- aren’t easily dismissed
*Thoughts- tend to be based on ideas which trigger emotions

Since there thoughts tend to evoke emotions there is a risk that they will influence our behaviors if not kept in check often leading to self-fulfilling or self-sabotaging which reinforces the thought. There are several therapeutic tools and techniques that help address and disrupt this viscous cycle.

In time, I will write individual posts for some of these tools and techniques, however, I strongly recommend working with a licensed professional to learn them.

As we are all senders of messages however, I want you to reflect on they ways in which you say things. If you find that people misread what you say, think about the words you choose and the emotions they may carry with them.

Words are powerful and you have a choice to use them beneficially to have clear communication or haphazardly and risk miscommunications and potentially distress.

PTSD, What is it?

I was recently told, by a journalist, with no credentials related to mental health, that I have PTSD. He had mistakenly and ignorantly diagnosed me based on his lay men knowledge. He assumed that because I have experienced trauma and deal with depression and anxiety that I MUST have PTSD. As I tried to explain to him the differences in diagnoses I realized that too often mental health condition terms get used incorrectly and so casually that some people think they understand, but they don’t.

I could, and will, write an entire post on the how language impacts the stigma related to mental health, but right now I am just going to focus on educating about what PTSD really is.

PTSD, or Post-Traumatic Stress Disorder, is a condition that can be diagnosed at any age and it is listed under Trauma- and Stressor- related disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). While it can be diagnosed in children under 6, I am going to focus on how it manifests in those 6 years and older (including adults). I urge you to seek professional help if you or someone you know is struggling with mental health and want you to understand the purpose of this post is general education and awareness and should NOT be used to make assumptions about diagnosis.

This first criteria that must be met is experiencing a traumatic event that involves death, potential death severe injury, or violence. This can be an event that happens directly to the person, was witnessed by the person, or occurs vicariously.

While I have met this criteria it does not mean that I will automatically develop PTSD.

The next criteria is that the individual has intrusive symptoms related to the event. This means they may repeatedly have undesirable memories of the event, flashbacks (moments in which they feel as if the event is occurring again/still), or distress triggered by a symbolic cue linked to the event (this distress could be mental or physical). There must also be continued attempts to avoid triggers and or intrusive symptoms.

The next criteria is negative changes in the way the person thinks or their feelings. Some of the ways this is seen is through self-blaming for the event, inability to remember details from the event, constant negative feelings, lack of desire to do things or inability or difficulty with relationships.

The final criteria is considerable changes in behavior around the event. This may look like becoming aggressive, self-harming, participating in risky behaviors, hypervigilance, easily startled, difficulty concentrating, and or troubles related to sleep.

Now it is important to understand that this is not a short-term experience. Acute Stress Disorder is a similar, but brief condition (that I have experienced first hand). PTSD is persistent, lasting more than a month, and significantly impacts the persons ability to function in important areas of life such as socially.

The other thing to remember is that each individual with PTSD is an individual and their experiences will vary. It presents differently in my friend with medical trauma then my friend who is a domestic violence survivor and her differently then my friend who survived a sexual assault, and she differs from my first responder friends, and each veteran friend experiences it differently too.

Those with PTSD can benefit from several different sources of support including counseling. I cannot encourage you enough- if you are effected by PTSD, seek support. Help seeking is courageous, not cowardly and no one should be battling alone.

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