How not to cope with a setback

Forget there is a setback plan, try to get back to ‘normal’ as quickly as possible, then have half a bar of chocolate and a third of a bottle of wine because what’s the point in trying to be good if you end up feeling horrible anyway?

Still it’s a new week, so I’m going to attempt a new start. Dig out the set back plan, ease myself back into good routines and habits and remind myself that set backs are always going to be a part of chronic illness, no matter how careful I am.

And it’s not the end of the world if I mess up sometimes.

What is Compassion Focused Therapy?

Compassion Focused Therapy (CFT) is an offshoot of CBT.  It was designed for people with high levels of self-criticism or shame.   It is supposed to be helpful for people who can reason against their fears or beliefs but who find that their feelings don’t change.

The theory behind CFT is that we have evolved a set of mental systems because they helped our ancestors survive.   The relevant ones are the drive and motivation system (search for something, feel rewarded, want to search again), the threat and protect system (recognise danger and activate the fight/flight/freeze response) and the soothing and contentment system.  Due to our genes, our early experiences and our environment some of us have overdeveloped threat systems and undeveloped soothing systems.  CFT teaches us to redress the balance by developing our soothing system.  There are a core set of exercises which include meditations, imagination and imagery and thinking through beliefs and coping mechanisms.

There are self-help resources available and I’ve linked to a few below. CFT exercises can touch on difficult and painful issues and memories so a lot of resources suggest it may be better to work with a therapist.  That was true in my case.

How good is the evidence for CFT?

2014 study says there isn’t enough of the kind of research necessary to consider CFT to be evidence based. Studies have been conducted but they generally have too few people participating in them, or other limitations. This means that we don’t know if CFT is better than existing treatments.

My personal experience with CFT: 

It has been difficult, bringing up some difficult emotions but I feel it is worth it to soften that critical voice in my head and to learn to look after myself better and more kindly.  I started with CFT in one to one high intensity CBT sessions where we talked through some of my early experiences, my beliefs, fears and my feelings about myself.  I’ve found the group therapy sessions I’m currently going to really helpful.  The theory and techniques are introduced gradually and repeated so it’s not too threatening and I’m gradually opening up to a new way of thinking.  I can see there’s an awful lot of work to be done and it’s going to take a lot of time and patience.  But I’m really looking to forward to having a calmer more compassionate way of talking to myself and responding to mistakes and difficulties.

How do I think CFT fits into self-management of chronic illness?

  • A chance to develop new or better coping strategies if our old ones are no longer accessible.  For example, worrying, perfectionism, and over-preparing are not ideal ways of coping but they may have been okay in the past.  But they take up far too much precious time and energy for a chronically ill person.
  • An antidote to criticism and judgement from ourselves, people around us and in the media.
  • Learn to support ourselves in doing what is best for ourselves, even when it is hard.
  • Learn to support ourselves in accepting and coming to terms with the changes to our lives.
  • Learning to alleviate anxiety and fear.
  • Learning to address unhelpful beliefs with understanding and kindness.

Resources

  • Compassionate Mind Foundation
  • Paul Gilbert, Overcoming Depression A long and detailed book that I found really helpful. It’s written clearly, with some memorable turns of phrase and exercises to practise with.  This is my favourite because it strikes the right balance of depth of explanation and practical exercises for me.
  • Mary Welford, A Compassionate Mind Approach to Building Self-Compassion A shorter, easier read than Overcoming Depression with exercises to work through. Some of the exercises on thinking about where my lack of confidence had come from were emotionally challenging. I was glad I had covered some of this with a counsellor before reading the book.
  • Paul Gilbert, The Compassionate Mind (I’m only half way through this book so far) I like reading about the background to how the therapy was developed and where research is going.  However, there may be more detailed theory here than some people will enjoy.  I like that Paul Gilbert acknowledges the role of our culture and social context in producing an environment that isn’t supportive of compassion.
  • Kristen Neff website Meditations and exercises
  • Chris Germer website Meditations and exercises
  • CCI Self-Compassion A series of 7 workbooks (PDF) introducing concepts and exercises for building self-compassion.

Do I have intrinsic value?

The intrinsic value of something is said to be the value that that thing has “in itself,” or “for its own sake,” or “as such,” or “in its own right.” – Stanford Encyclopedia of Philosophy

Being chronically ill has really shaken my self-confidence.  My counsellor introduced the idea that I have intrinsic value.  She suggested that I think of something I loved like a pet that had done nothing yet I loved it anyway.  She explained that my pet rabbit had intrinsic value and so do I.  She suggested that everyone has intrinsic value and deserves to be loved.

I found this idea tricky from the start.  Firstly, I wasn’t convinced that value is intrinsic to objects, animals or people.  Secondly, and most significantly the idea that I have intrinsic value was so alien to me it was hard to get a handle on it.

My next issue came with the idea that people or animals deserve love because of their intrinsic value.  If the value is intrinsic it shouldn’t be because they deserve it, they should have value just because they exist.

I then thought about how intrinsic value could be related to uniqueness.  Each person, animal landscape only exists once.  There is no one else in the world exactly like me.  Maybe my uniqueness is my intrinsic value.

I still struggled to really get to grips with and absorb this.  I am struggling to ‘get’ the concept itself.  And I’m having trouble with the idea that this particular self (me) has worth beyond what I can do.  I read a few articles  one given to me by my counsellor, and a couple I found on the internet.  It took a week or two of mulling over the ideas before I could begin to pull together a few thoughts.

I think I do have an issue with the intrinsic part of intrinsic worth.  I think value is something that is ascribed to things by others.  There are all kinds of ways of valuing things.  It seems to me that things have intrinsic properties and those properties may have value, but whether or not those properties are valued will depend on whoever is doing the valuing.  There is also a cultural element.  The reasons puppies are considered to deserve love and care isn’t to do with their intrinsic puppyness but because the culture of this society values dogs as companions and pets.  Or because of the value given to innocence and cuteness.

Then I thought about approaching the problem from another direction, by thinking about my own values.  I value sentience, consciousness and recognise that love and care will allow a person to flourish, neglect or cruelty will cause suffering.  Therefore, I believe it’s right that humans should be given that care and love.  It also makes sense from a practical point of view.  Children that are nurtured are more likely grow up resilient and kind, those that are neglected and mistreated are more likely to have physical and mental health problems.

I also see the potential in human beings to grow and change.  Almost everyone has this capacity to some extent.  A person has future potential even if their behaviour to date suggests they don’t deserve care and affection.

Even if I am sceptical of the philosophical concept of intrinsic worth I still think that sentience, consciousness, uniqueness and the potential to grow and change give human value.  I am against unkindness and cruelty for ethical and pragmatic reasons.  And as I am sentient, conscious, have the potential to grow, respond to kindness, and am unique I should value myself in the same way.

I also believe in valuing people for who they are not what they do.  That is the character they show over time. And I believe in overlooking and forgiving people’s flaws (within reason).  I should apply those values to myself too.

The articles I read:

The importance of self-worth – PsychAlive.org

What is the value of a human being? – Leon Pomeroy Psychology Today

Intrinsic vs Extrinsic Value–  Stanford Encyclopedia of Philosophy

 

 

 

Everyday Heroics

Everyday heroics is not pushing yourself to go further and faster.  It’s not about battling against your circumstances, whatever the cost.  It’s not about insisting on living life as you did before.

It’s getting up and starting another day, even though yesterday sucked, and so did the day before it.  It’s finding the courage to face the reality ahead of you, and deal with it one small step at a time.  It’s recognising that some days it’s an achievement to have got up and gone out the door.  And other days it’s a struggle just to get your socks on your feet.

Everyday heroics is about celebrating victories no matter how small.  It’s about developing the acceptance, resilience and compassion to face those everyday difficulties and challenges with realism and determination.

 

Getting adjustments in place at college or university

I was one year into my PhD when my chronic illness surfaced.  It has been and continues to be a huge adjustment.  I’ve had to learn new ways of organising my work, of doing the basics like writing, reading and researching for my degree.  All this alongside managing my symptoms, looking after myself generally and having time off sick.  It’s been a huge learning curve.  I’ve had support provided through my university and funded by the Disabled Students Allowance that has helped with some of these adjustments.  Not everything I have been offered has turned out to be helpful.  There’s also a cost in time and energy of pursuing support, getting assessment done and learning new software that needs to be weighed against the benefits you might gain from getting extra support.  I feel that it has been worth it in my case.  The support I have in place helps me to get more out of a good day, and to keep going a little longer on a moderately bad day.

Funding for adjustments:

If you are in Higher Education in England you may be able to apply for the Disabled Students Allowance to help pay for adaptations.

If you are in Further Education your college is able to claim back funding for support it provides.

Under the Equality Act 2010, they must make reasonable adjustments to avoid disabled students being placed at a ‘substantial disadvantage’. They receive money from the EFA and/or SFA to meet the costs of reasonable adjustments. In colleges this is usually called Learning Support and it is provided in a way to enable them to be flexible in the way they support all their students.

Disability Rights UK

There may also be adaptations your college or university can make that don’t require funding, such as accommodations to your schedule, deadlines, providing PowerPoint notes in advance or help using the library.

 Some of the adjustments I have in place:

Adjustments provided by my university:

  • Library books will be found and kept at the desk for me
  • Adaptive software:
  • Lectures will be in lower floor rooms
  • Study coaching
  • Voice recorder
  • Chair adapted to my needs
  • Longer loans on some library books
  • A budget for taxis

Other places to look for ideas or find assistance:

Disabled students helpline Disability Rights UK

Factsheet ‘Adjustments for disabled students’ Disability Rights UK