Only a handful of people know that I suffered from body dysmorphia around 2008. It hit me like a freight train when my life was crumbling before my eyes. I felt like I couldn’t control anything. It was the classic beginning of an unhealthy relationship with myself as I swept away my internal health like it was nothing and fixated on the external. The perspective of seeing my physical self in the mirror was palpable in order to gauge results. You see, to me when you look in a mirror, the reflection doesn’t reflect your mind with your pain, happiness, strength, how lost you are, how far you’ve come. Sure, you can smile in the mirror, but that doesn’t translate the same. At least to me at the time, it was an internal façade.
I began to work out like a maniac, maintained a strict diet, and criticized myself every chance that I could. If I wasn’t happy after hours of working out, I would go up to the local high school and run the track and bleachers until I felt like I was going to pass out. It was my punishment. Let’s say I punished myself a lot. During this time this led to deeper issues, that to this day I’m not comfortable talking about. Perhaps someday, but I want to link this with my stroke for the time being.
Back in the day, the internet didn’t supply a lot of information like it does now. I felt utterly alone and lost and didn’t know what to do. I sought out counseling after counseling and it didn’t work. Sometimes, and not for all, you must take one tool you learned and do the work and fight for yourself. Cognitive behavioral therapy or CBT for short, is a tool that I learned to get me out of the trenches and something that I had to pull out again recently. When I first read about it, it made complete sense and helped merge two different points of thought into one cohesive reality.
All the information below is copied from Cognitive Behavioral Therapy Los Angeles. Their website is http://cogbtherapy.com. After reading some insight on this type of therapy, I explain toward the end how that centers around my stroke.
What is CBT?
“In a nutshell, cognitive behavioral therapy (CBT) helps you learn to change your thoughts, feelings and behaviors so you feel better. By targeting your reactions to situations, CBT can help you react more effectively in challenging situations, and even learn to feel better when you are unable to change situations happening around you.”
Goal Oriented: “cognitive behavioral therapy is a problem-solving therapy aimed at helping you achieve your goals”
Present Focused: “This here-and-now focus allows you to solve current problems more quickly and effectively. Identifying specific challenges and focusing on them in a consistent and structured manner results in achieving greater treatment gains, and achieving them in a shorter period....”
Active:” ….you are able to take an active role in your own treatment, using self-help assignments and CBT tools between sessions to speed up the process of change. Each session is focused on identifying ways of thinking differently, and unlearning unwanted reactions”.
Brief: “CBT is a time-limited therapy, meaning once you feel significant symptom relief and have the skills you need for success, treatment can end”.
Well- Researched: “The most widely researched therapy that exists, over 500 studies have demonstrated the effectiveness of CBT for numerous psychological and medical problems. It is one of the few therapies that is scientifically proven to be effective”.
Supportive: “Relying on the foundation of a supportive relationship, [sic] feel more comfortable stepping outside of their comfort zone to achieve their goals.
Who are the people?
Mind Reading: Assuming you know what other people think. “He thinks I’m unintelligent.”
Personalizing: Thinking you deserve the majority of the blame for something while discounting others’ responsibility. “Because of me we lost the game.”
Fortune Telling: Making predictions that bad things will happen without actually knowing that this is the case. “I’m going to fail the exam.”
All or Nothing Thinking: Thinking of people or situations in black and white terms. “If I don’t do it perfectly, then it’s horrible.”
Catastrophizing: Believing the outcome of a situation will be so terrible that you won’t be able to handle it. “If I lost this job, I’d just fall apart.”
Labeling: Assigning a one word descriptor to the entirety of a person. “He’s a jerk.”
Overgeneralizing: Assuming something based on a limited amount of experience. “I’m late to everything.”
Negative Filtering/Discounting Positives: Focusing on negatives while framing positives as unimportant. “I made an A on the test because it was easy, and besides I failed one of the quizzes, so I maybe I’m not cut out for…”
If you fit this mold, then what does CBT do for you?
“Cognitive restructuring is a treatment designed to help people recognize and significantly alter thought patterns, as a way of shaking up the emotion system and reversing the course of depression and anxiety. Cognitive Restructuring is a useful tool for understanding and reacting differently to the thinking patterns that negatively influence our mood and behavior”.
It’s a multi-system exercise that include:
1. Cognitive Pie Chart Exercise:
Step 1: Identify the automatic thought that comes to your mind when you are being hard on yourself for something going wrong
Step 2: Come up with a list of alternative explanations – as many as you can think of. These need not be mutually exclusive explanations.
Step 3: Assign a percentage to each explanation. The percentage should reflect the degree to which each explanation contributed to the situation.
Sept 4: Finally, use the percentages to draw a pie chart.
“you’ll likely put a little less stock in the original automatic thought. The less you believe the unhelpful appraisal, the more you’ll feel a softening of the negative emotion that goes with it.”
2. Investigating thoughts:
“Cognitive therapy, developed by Aaron Beck in the middle of the last century, identified this problem and developed a very straightforward solution: to look at our thoughts rather than looking from our thoughts. It's a process cognitive scientists term metacognition. It refers to the ability to examine our thinking process rather than assume every thought we have is true. It is the foundation of cognitive therapy.”
Cognitive Techniques to reduce worry
What are you predicting will happen, and what is the likelihood it will actually happen?
What are the best case scenario and most likely scenarios?
How many times have you made this prediction and it came true?
If the worst-case were to happen, what would you do to cope with it?
What are the costs and benefits of worrying about this?
I highly suggest reading more into this article. This 5-step method helped me tremendously.
Treating thoughts as guesses:
“1. When you are feeling an especially strong negative emotion, such as anger, sadness, or anxiety, stop and identify the thoughts that seem most responsible for fueling the emotion.
2. Pick the thought that packs the most punch, and remember that it is just one way of making sense of the available facts, and is not necessarily a fact itself.
3. Brainstorm as many other hypotheses as you can, regardless of whether or not you believe them.
4. Pick a few that seem helpful, and write out how you might feel or act differently if you adopted this new thought
5. Once you decide on the most helpful way of making sense of the current situation, reminder yourself of this new thought as much as you can. It won’t make the other thought disappear, but it will certainly reduce the old thought’s airtime in your mind, making it less dominant over your feelings and behavior”.
Click on the link for details about each item.
There is a solution to your problem
The worry is limited to one situation
Worrying lasts less than 10 minutes
You acknowledge there are factors outside of your control
Anxiety does not dictate your worry
Weigh the pros and cons of accepting uncertainty
Identify areas of your life in which you’re already accepting of uncertainty
Analyze what underlying meaning uncertainty has for you
Imagine what life would look like without uncertainty
None of this can be done on your own at first. I recommend a trained therapist in CBT to start the process so you can come up with a plan that fits the outlined information provided by Cognitive Behavioral Therapy Los Angeles at http://cogbtherapy.com/.
So, how does this tie into my stoke journey?
First, I touched on losing my femininity in another blog, so I won’t go into detail about that. The battle that I’m fighting right now is body appearance which has changed since my stroke. Yes, I was underweight, but that was from my POTS disorder that ravaged my metabolism system. It didn’t matter how much junk I ate; I just couldn’t put on the pounds. From the time that I was diagnosed, within the first three weeks I lost 10lbs. The following few weeks I lost another 10lbs. The weight just kept coming off. I had to replace my entire wardrobe to fit my new unhealthy-looking frame. I did something that I haven’t done since 2009 and looked at the scale daily because I was afraid the weight would keep dropping. A far contrast from where I was in 2008 with the opposite train of thought. So, I decided to stop thinking about it and let it go.
2020 rolls around (great year so far....) and my stroke happens. My body was weak from being underweight, but I had that tenacity to fight anyways. I remember all the nurses or doctors walking in examining me and making a comment about my small frame. “You are so tiny”, “It’s hard to stick the cath, because you are so small”. I hated it! This is something that I’m not proud of nor could help. My mom told me that one of the physicians talked to her in the hallway about my weight stating that I need to eat more. I do! Albeit not healthy things, but I don’t starve myself, nor do I do it on purpose. I have a disorder that’s preventing the weight to come on.
After my second surgery to insert my VP shunt, I noticed something different about myself. My stomach was consistently distended. I figured this would go away, because body is healing. Weeks went by and it stayed the same. So, my twisted mind went back to the 2008 thought process and I began to weigh myself again. I got on the scale and I cried. I had gained weight since I left the hospital. A couple more weeks went by and I weighed myself again. I was starting to go for walks, my eating habits were ok, so something had to give, right? Well the scale showed that I put on more weight. I frantically tortured myself in my head. Where is this weight coming from? I googled with delusion about weight gain + stroke and weight gain + VP shunt. There wasn’t a lot of information, but one story stuck out to me. A young woman walked into her doctor's office because her stomach was severely distended with the appearance that she looked pregnant. She recently had a VP shunt inserted. The physician discovered she had a pseudocyst. Omg! This is what I have! Of course, I had to pull out the CBT tools that I already know so well and talk myself out of that fear. I called my neurosurgeon next and talked to the nurse. I told her that I’m gaining weight and was concerned it was the VP shunt because none of this happened until it was placed. I didn’t know if too much was draining into my stomach, or if there was a malfunction. She talked to my doctor and called me back. “Are you vomiting?” she asked. ” No, I actually feel fine other than the stomach distention”, I replied. The nurse told me the neurosurgeon was down in the ER and would be happy to look at me, however she wanted me to know that there is nothing wrong with me. I’ve been through a lot in the past couple of months and my body is adjusting and I need to give myself time to heal.
When I heard those last words, I tucked my tail between my legs and thought, “I’m an idiot”. I can’t believe that I went through hell with two surgeries, and I’m complaining about weight gain! My theory is that we all have layers of worry. Once you peel back a layer, another worry presents itself. I peeled back two massive layers that I didn’t have to focus on anymore, so I was looking at the new layer- weight.
So, I went to my CBT training
What are you predicting will happen, and what is the likelihood it will actually happen? I predict that I will not stop gaining weight and become obese and I have a shunt malfunction. The likelihood of this happening is very small.
What are the best case scenario and most likely scenarios? The best-case scenario is that I’m finally gaining the weight back that I tried hard to gain last year due to my POTs syndrome. The most likely scenario is that my body will even out as time goes on.
How many times have you made this prediction and it came true? I predicted that I would lose more weight and that didn’t come true. I predicted that my weight gain would prevent me from fitting in my clothes. This is not true- I still fit in all my clothes.
If the worst-case were to happen, what would you do to cope with it? I will tell myself that I’m happy to be alive. Being above ground and enjoying everything on earth far outweighs the other alternative that could’ve happened.
What are the costs and benefits of worrying about this? I’m not focused on other aspects of my recovery or enjoying my new life.
So, there you have it, me being raw once again with my recovery. This stroke has done a number on my mind in more ways than I can explain. I have a lot of emotional trauma to work through, then this stupid weight gain. Yet, I’m fixated on it because for years, I was trained that it was something I could control. So, I’ve worked out my negative feelings about it and looked at the reality. Will this creep up from time to time- yes. Will I fixate on it anymore- no. I have a lot more CBT work with heavier things in life like the chance of another stroke occurrence, and will I get back to normal life. These are imperative for my emotional health.
The bottom line for anyone, stroke victim, or just an average person reading this, is that we allow negative thoughts to take up space in our head. It might not be for the long haul. It could be simple as” Did I prepare myself enough for this meeting”. Life shouldn’t be this heavy, and CBT assists you with looking at the negatives and rolling it into a positive reality that you must live with by sweeping away thoughts that shouldn’t be there.
We are valuable, unique and viable human beings, and intrusive thoughts should not stand in the way. No matter what afflicts you, we were given the gift of thought and problem solving. Use it and you will find a better way to live your life.
Remember- I’m not a trained physician. This is my personal journal and should replace any mental healthcare. Please contact a professional that can guide you through CBT so you can eventually do it on your own.