Sarah's Health Notes: How online CBT helped one woman through lockdown
Sarah Stacey shares the story of how an online CBT programme helped one woman cope with depression during the first lockdown…
Filmmaker Emma, 55, a mother of two and recent grandmother, gave us this account of her experience with an online CBT programme recommended by her GP to help manage her feelings of anxiety and depression, which came to a head during the first long lockdown. Initially sceptical, she found that it really helped her to understand and manage the underlying problems.
‘To begin with I seemed to be coping well during lockdown. I’d recently changed jobs and moved to a new city. Although I didn't know many people I made friends in my street (albeit at a distance) and settled into a routine. My older son and his partner had a baby and it was wonderful being a grandmother although, of course, I couldn't touch or hold the baby – or even have them in my house to begin with.
‘Then I lost my job because of Covid and, looking back, that was the tipping point when everything started to fall apart. I’m a highly motivated person usually but when I lost that job, my motivation for everything disappeared. I really didn't want to get out of bed in the mornings. When I finally got up, I couldn't sit still but I didn't want to go outside, which was very unusual for me. I either overate or skipped meals. My sleep was very poor all the time. My thoughts began to be extremely bleak. I couldn't concentrate on anything. I felt anxious all the time and a sort of extreme negativity that I’d never experienced before.
‘Finally, I realised I needed help and booked in to see my doctor. On reflection I think I should have asked for help much earlier but I saw needing help as a failure when everyone around me seemed to be coping.
‘My GP recommended an online CBT (cognitive behavioural therapy) programme called Silver Cloud, an eight-week course, which is recommended by the NHS to help people manage stress, anxiety and depression. Patients have to be referred by their doctor and – be warned - there is quite a long waiting list. The website nhs.uk explains that, at your own pace, you work through a series of topics selected by a therapist to address specific needs. A CBT therapist is assigned to you for X weeks and comments regularly (this seems to vary between weekly and fortnightly).
‘I was very sceptical but I knew I needed help so – reluctantly – I signed up. The programme lays out clearly what to work through – understanding feelings, boosting behaviour, spotting thoughts, challenging them, managing worry and core beliefs. In each section there are examples from people who’ve used the programme, which are helpful.
‘A CBT-trained therapist is allocated to you when you sign up on the programme. The therapist suggests the sections you should work though. As you work through the course, there are boxes for you to put comments and questions, which your therapist will then respond to, again online.
‘The first step for me was learning that waiting for the motivation to do something doesn't work. Activation comes before motivation so however bad I felt I got out of bed.
‘Then I learnt that rewarding myself, rather than punishing, is more helpful in overcoming depression. Rather than feeling I should keep up with people who talked about what they were doing and achieving during lockdown, I learnt that for me getting out of bed in the morning and getting through each day – sometimes hour by hour or even minute by minute – was okay.
‘The programme helped me understand how to “catch” and check unhelpful thoughts – the negative and/or hyper over excited ones. It was a shock to find I had a constant stream of negative thoughts; in fact very, very few positive or even okay ones. I realised my thinking had been like this for a long time – years in fact – and the pandemic, isolation and job loss had acted as a catalyst for the pressure to build up and burst.
‘I began to understand how closely physical feelings are connected to thoughts in a two-way cycle. How your stomach knots, your throat tightens and your breathing becomes shallow and rapid when something in your thoughts triggers anxiety. I began to notice the situations that would create a “hot thought” such as “it’s all my fault’ or “I’m going to die” that would lead to a huge sense of guilt or fear. That in turn would lead to a physical stress reaction, such as my body speeding up or feeling dizzy, and a mental reaction such as not being able to focus.
‘When I feel like that, the best thing is to get out of my brain and into my body as soon as I can. So I practise deep belly breathing immediately, then go for a walk or a bike ride. [See Sarah’s Health Notes on ‘Calming the storm’, for tips about what to do when you are anxious, including a breathing exercise.] I also follow Jeff Chand, a practitioner of Traditional Chinese Medicine and qigong instructor, who offers free qigong sessions online; he’s lovely and really helpful. (You can see him on Youtube here.)
‘One section that particularly helped me was understanding the hot thoughts. I learnt to watch out for those thoughts and where they went. To step in wherever I could before the physical and mental reactions took hold. Sometimes recognising I’m having a thought that’s dangerous to me such as “I’m going to die” is enough to stop it or at least not let it escalate into a full-blown panic attack. It takes time to catch and check the hot thought cycle but each time you recognise what’s happening it makes a difference.
‘A light bulb moment was when I learnt that the hot thoughts are based on the core beliefs, often long held, that you hold about yourself. My negative core beliefs included ones like “I’ll never work again”, “I’m useless,” “I can’t do anything”, “I’m selfish”, “I’m a bad person”, and, most destructively, “there’s no point to my life”.
‘Discovering and investigating these core beliefs was a real shock but the knowledge helped me a lot. Silver Cloud asks you to write down and/or consider the evidence and your experience of these core beliefs. Are they completely true 100% of the time? When you’ve seen they are not, the next step is to create an alternative and more balanced version of your core beliefs. That can take time but it gets easier over the weeks and I liked this process a lot. I realised I am not bad and I am not perfect – I’m just human.’
