November 4 – 10, 2018
Wednesday began by having a session with my therapist’s practicum student, Leila, after breakfast. I thought I would try to get a tiny bit of sleep in the break between breakfast and the session, so I went upstairs and lay down on one of the couches. I loved this couch because a huge vent projected cold air straight onto it. When I get anxious or upset, I start getting really warm. The fact that I always wore a sweatshirt or sweater even if it was 90 degrees outside didn’t quite help that either. It helped sitting up there during breaks sometimes. Just to breathe and feel the cold air. I was missing my fall and winter weather in Arkansas.
I opened my eyes just as Leila was walking up the stairs, probably awoken by the sound of her saying “good morning sleepy head!!!” Leila was like this positive beam of light. She was the kind of person who could make me smile or laugh or feel good even as I’m on the verge of a panic attack.
In our session last week, we were sitting on a bench outside, near the huge, vine-covered banyan tree. It was warm, muggy, and I was wearing my sweater and sweatpants. I was hot and exhausted. Some refer to this state as being a “hot mess,” which I would say accurately described me 90% of my time in treatment. Leila asked me how my week had been and I told her about the struggle of sleeping and meds. And how I felt useless during groups because I couldn’t focus on anything but panic.
So we addressed the panic, the shallow breathing and increased heart rate, both during group and at night. She asked me what goes on at night? I tell her that my brain won’t shut off and I can’t stop thinking about everything. Like my thoughts are just racing and won’t stop. Memories play in my mind on repeat if I shut my eyes. I tell her this while trying to hold back the exhaustion tears. I am a very talented person – I can cry not only when I’m sad but also when I’m overwhelmed, tired, confused, happy, angry, or excited. It’s fantastic.
She pulls out a piece of paper and begins to draw a three component model. This includes assessing a situation by bringing awareness to three components — thoughts, physical sensations, and behaviors. We started with what thoughts go through my head at night. I started to really cry. And gasp for air. I couldn’t talk about it. I didn’t even want to think about it.
Leila put the paper beside her and she sat up straight against the back of the bench. She told me to follow suit. I did the same and mimicked her as she put her right hand on her chest and her left hand on her stomach. She told me to take a slow, deep breath. She said that I should not feel my chest rising because that meant I wasn’t taking a deep breath. She then instructed for me to close my eyes, if I was comfortable. I should feel the hand on my stomach move, as my diaphragm extends out. We sat like this for probably a full minute, eyes closed, slowing and deepening my breathing. And when we both opened our eyes I did feel better. And I could breathe a little easier.
She asked me if I’ve ever heard of systematic desensitization. After telling her no, she explained it to me. It is basically like gradual classical conditioning. You expose yourself to memories, situations, or phobias that cause fear, panic, or anxiety. It is gradual because it doesn’t start by marching up and looking your biggest fear in the face. Systematic desensitization starts small and works its way up, gradually desensitizing one’s self to small fears, then those a little larger, and then the bigger fears. A huge component of Renfrew’s model is exposure therapy, or desensitizing yourself and overcoming difficult situations by facing them head on and not avoiding them. It becomes easier and easier with time. It won’t always bring this intense of an emotion.
She said that we’d start out with me telling her about a situation that brings my anxiety, fear, and panic to a 0/10. I told her that my feelings of fear, panic, and anxiety were at a 0 when I’m laying at home in bed, cuddled up to Beau, watching Netflix. She had me close my eyes and think about being in this scenario, breathing deeply and being at a 0/10 with anxiety, fear, and panic. It was very calming.
Then she asked me about a 1/10. I told Leila about the common scenario of sitting at the kitchen table talking to my roommates after everyone got home from work. Usually they were eating and I wasn’t. Usually they were talking about work or school, both of which stress me out. I love them so much but I had only known them a few months at this point so there was still issue with complete trust and comfort. I kept a lot of secrets from them about my issues because I didn’t want them to think I was crazy. Again, Leila had me close my eyes and read my scenario back to me while I took myself there. I could physically feel my anxiety level gradually rise to a 1. After sitting with this scenario for a few more seconds, Leila told me to bring myself back down to a 0 by picturing myself back in bed, watching Netflix with Beau. This, along with the deep, slow breathing worked. I truly could feel my anxiety and fear moving from a 0 to a 1 and back down to 0.
I began to think about how exercises like this genuinely work for me because I have such a strong imagination and vivid, powerful thoughts. I live in my head. I truly could put myself in the scenarios and feel the feelings and think the thoughts that would be going through my head. But it occurred to me that this was only a 1/10. How am I supposed to do this with a 10/10? I started getting worked up again. My breathing quickened and tears returned. I will never be able to do a 10/10. There’s absolutely no way.
Leila reminded me to do the deep breathing, back down to a 0/10. Calmed, after a few minutes, she asked me what happened. She said I seemed calm but then extremely distressed. I told her I began to think about what would happen if I did the 10/10 scenario.
“That is a perfect example of anxiety! We aren’t even close to the 10/10, but you are already anticipating it. This is why it is a slow, gradual process. It takes time to work up to the higher anxiety- and panic-provoking scenarios. Next week we will try to work up to a 2/10 and then eventually a 3/10 and so on.”
As our session was nearing it’s end and we were walking back to the residence building, we talked about my dog and what I watch on Netflix so I was leaving her feeling a little calmer and more relaxed.
After rejoining the girls in the community room, I immediately grabbed my journal and numbered two pages from 0-10 to make a hierarchy. I started to write out each scenario so I’d be prepared for the next session. I made it up to a 7/10 before I had to put it down. I was so shaky, thinking about telling Leila all of these scenarios and re-living them. As the week went on into the weekend, I slowly but surely finished writing a few lines about each of my 7-10 scenarios.
So when Leila came upstairs to find me for our session this week, I was excited to see her. As I woke up more, we chatted a bit about the week and how I was doing. I felt immediately at ease talking to her. She asked me if I wanted to continue doing the scenarios and I said sure, pulling out my journal. “I wrote them all down 0-10.”
She was beaming. She looked at me like I had just shared the secret to happiness with her. “You wrote them all down? Olivia, that is AMAZING. I can’t believe you wrote them down. Do you realize how amazing that is?”
I looked at her in confusion. She could not stop smiling, so neither could I. She asked me, “What was it like to write those down?” I told her that it was hard thinking about them all.
Just the act of sitting down and writing about these situations and scenarios helped with desensitization. The fact that I put pen to paper and faced them, going at my own pace throughout the week was a big step in the right direction. When I started getting anxious I would put the journal away and do something else. Or talk to Sarah or Kelsey. Or watch a movie or play banangrams. Even though I wasn’t thinking about my 0/10 scenario to calm myself, I was unconsciously doing it with the resources I had. Ones that aren’t maladaptive or harmful. So maybe it was kind of amazing.
I decided I didn’t want to work on them during this session, but she challenged me to continue to desensitize those situations and others by writing about them and facing them.
She asked me if there’s anything else I have been struggling with or want to talk about. I told her that Liz, my therapist, gave me homework a few days ago to write down some of my automatic thoughts and then reappraise them, or make them more objective or positive. Leila asked me what one of my automatic thoughts are while pulling out a blank sheet of paper. After some hesitation, I replied quietly, “Um one I think a lot is ‘I hate myself.'” I say it to myself so often inside my head, you’d think it would be easier to say it out loud.
I started to shake my foot and cover up with my blanket. She wrote “I hate myself” down on the top of the paper. She stopped and looked down at the short sentence for a few moments. Then she looked up at me. “Why do you hate yourself?” I said, “I don’t know. I feel gross and disgusting and..” I started to tear up.
She said, “Come over here,” as she walked to the huge floor to ceiling window, where we looked out on most of the campus. She pointed to a huge tree outside the dining hall, “That huge tree right there represents that thought of hating yourself. You have been nurturing it, making it grow tall and strong for years. You have told it all of these messages that enforce the negative beliefs about yourself. It has thick roots and long limbs and it probably looks indestructible.”
“Now do you see that tiny tree right next to it?” It looked like it could be blown over in a strong wind. “That tree represents you loving yourself. You’ve just started to really try and make it grow. You have to give it the time, energy, and attention that you’ve given to that huge tree of self-hatred. Give it more love and attention. Make it grow bigger. That big tree next to it will still be there, but choose which tree you nurture and it’ll grow stronger.”
I was smiling reluctantly through my wet eyes. She looked at me and said, “Does that make sense?” and I said “Yes. It’s just going to be hard.”