Wednesday, October 13, 2010

Jedi Mind Tricks with Dr. Dave

Yes, of course I'm in therapy.  I'm not ashamed to admit it.  I've done the whole "Oh, I'm so ashamed of my PAMD/PPD" thing before, and it was bad for everyone - my husband, my kids, my extended family, my friends... Not to mention that it was bad for me.  This time I'm charging into it head first, with my face painted blue and a sword aloft, screaming, "FREEDOM!" like some pregnant Mel Gibson...

Baby on Board?
I'll give you a second to let that mental image sink in.

The thing I love about Dr. Dave is that we don't spend a lot of time with the whole "tell me about your childhood" shtick.  Yes, I've told him enough about my background that he has a good sense of who I am and where I come from.  But he doesn't bother with much of it.  His approach to psychology is a lot more practical (not to mention faster!) and, in my experience, it really works.

If you're going through anxiety or depression, whether it's associated with pregnancy or not, I can't recommend Cognitive Behavioral Therapy enough.  Basically, the premise is that your thoughts create your emotions - not the other way around.  A lot of people think that they feel sad, and that's why they're having sad thoughts.  In truth, though, you have the sad thoughts first, and those sad thoughts make you feel sadness. 

Think about it.  You could see a perfectly neutral thing - how about a suitcase?  So you see this suitcase, and it reminds you of the trip you just took to your favorite place, and you have all these happy thoughts of all the fun you had, and consequently you start to feel happy.  Meanwhile, I see the suitcase, and I think about the business trip BJ has coming up, and how lonely I'm going to be, and how much work it's going to be to take care of the kids by myself, and then I start worrying about going into labor while he's gone, or his plane crashing, and suddenly I'm sad and anxious.  The suitcase was neutral in both cases - it was the thoughts that were happy or sad.  Those thoughts caused the emotions we experienced.

The idea of CBT is that you can get in better thought habits - you can train yourself to neutralize the negative thoughts that we all have, and over time they become less and less powerful.  It actually re-wires the neural pathways in the brain, which is pretty amazing when you think about it. 

So how am I re-wiring my brain these days?  Well, last week we decided that whenever I have an anxious thought (and sometimes they're not even fully-formed thoughts, sometimes it's just an "Oh shit!" feeling that hits me out of the blue, especially in the middle of the night, and I have to really think about what thought triggered it - thoughts are sneaky!), I deliberately say to myself, "Reducing my anxiety level is good for the baby, it's good for the labor and delivery, and it will improve my ability to make decisions."  (I actually "hear" it in Dr. Dave's voice, which I find funny.)  That phrase addresses some of the specific concerns that underlie what's been causing my anxiety - that I'll hurt the baby by freaking out all the time, that something bad will happen during labor, and that I won't make good decisions about the delivery (for example, whether or not to induce).  I've been thinking that thought 4 - 6 times a day, sometimes more, and it's really helping.  I'd say that alone reduced my anxiety from an 8 (on a scale of one to ten) to a 6 or 6-1/2. 

I've also been doing some deep breathing.  I have a tendency (especially as I get physically bigger) to breathe very shallowly.  I'm getting a lot better about breathing into my abdomen, which is probably an awful lot better for the baby.  It's also helping me to relax.

Another trick Dr. Dave taught me today was the Fade Technique.  Let's say that BJ is on a business trip.  Before, because I'm a nutjob, I would have a lot of anxiety about his flight.  I would picture, like a horror movie, all the terrible things that could happen in excruciating detail.  Then I'd get on and I'd hold his plane in the air through the sheer force of my own will, only relaxing (a little) when he landed safely (after all, he still has to fly home).  Well, from now on when I have those thoughts, I'm going to deliberately picture BJ on the plane, happy and safe, reading and drinking a Coke, maybe taking a nap, then landing safely, getting his luggage, and arriving at his hotel.  For every one time I go all horror movie in my head, I'm going to imagine the happy outcome twice, in detail.  Research shows that over time the horror movie will fade and it won't bother me anymore. 

The third technique was the first one he taught me, back when MG was a baby and I saw him before.  I had a lot of anxiety that I was going to ruin her, and that if I loved her the best way to protect her was to get as far away from her as possible because I'm such a horrible mother.  Dr. Dave had me write down a list of what constitutes a "good mother."  Big surprise, I was already doing everything on my list.  So, I logic myself out of that, "I'm a bad mom!" thought, now, when it comes.  It was hard at first, but it's gotten really easy now.  Now when that voice says, "You're an awful mother!" it doesn't take any mental effort or energy at all for me to shout it down. 

I do this obsessive anxious magical thinking crazy-making in several different ways, so we talked about some different ways I can apply these three techniques to some specific things I tend to worry about. 

Dr. Dave told me about a longitudinal study (14 years?) that was done on normal, healthy people.  They kept track of all the things they worried about.  Over the course of the study, 98% of the things that they'd worried about never happened at all, and the 2% that did happen weren't as bad as the people had predicted.  He said that people tend to overestimate the likelihood that something bad will happen, and at the same time they'll underestimate their own capacity to deal with it.  "Oh yeah, I totally do that," I said. 

So that's what I'm working on right now.  We don't expect to get me to the point of having no anxiety at all - only sociopaths can claim that distinction, and I don't aspire to be one!  There's a functional level of anxiety around 3 or 4 on a scale of one to ten, that's actually beneficial.  It's an inverted U shape, with anxiety on the x-axis and performance or ability to function on the y-axis (see image below which I borrowed from this website).  I was at an 8 before, as I mentioned.  I'd say I'm down to a 6-1/2 now.  We're aiming for that optimal 3 or 4. 

I'm mainly writing this post for myself, as a record of what I've learned in therapy so that I can go back and re-read it over the coming weeks and months.  There's an off chance that it might help someone else, too.  If you're reading this, though, please know that I'm not a psychiatric professional myself, and this is written based on my own experiences and my own recollections from therapy, and that it is not meant to be advice of any kind, except maybe, "Find yourself a cognitive behavioral therapist!" if you're struggling.  You don't have to suffer. 


morganna said...

Well, keep up whatever is working for you. I'm sending positive thoughts your way!

di said...

Bravo for finding out what works for you. I would be the First to say YES, it's the thoughts that make a huge difference. I found that out also, couple years ago. Takes practice and it works :) So happy for you...You Are a Wonderful individual!