To wash or not to wash? Dishes and the fate of the cosmos.

Alright - This is one of the methods have at my disposal to use to cope with an anxiety attack, which is adapted from M. Linehan (Diaclectic Behavioural Therapy), and which my husband used when he talked me through an anxiety attack on the phone last Monday so I could leave the house and go to work.

We learned this technique in my anxiety support group at the Montfort Hospital in Ottawa. Although it's available in many different forms on the web, I've stuck to the form of the worksheet we used, which I've filled in as I go to give you an idea, and because - surprise! - I'm having anxiety, so thought it would be a good idea.  Handy thing is, this can be used in the event of any strong emotion - it was initially developed as a method of coping for those with Borderline Personality Disorder.

The following provides a description of the exercise and its purpose, courtesy of Palo Alto University:

This is to assist the user to develop Cognitive Behavioural Therapy (CBT) skills of identifying thoughts linked to negative mood states (“Catch It”), challenging the accuracy of such thoughts by examining the evidence (“Check It”), and coming up with alternative, helpful thoughts that can improve their mood (“Change it”).
Practiced over time, the process become more automatic and ideally assists in the configuration of more positive mental pathways, thereby reducing assisting with the anxiety (or depression, shame, etc).

Blah blah blah.  Ready? No? Good. Let's do this.

The Exercise: Catch It, Check It, Change It

Step 1. What triggered this emotion?  Be specific: who, why, when, and where.

My Response: After a long day at work, my husband was home sick, son is fussy, and the kitchen is a disaster zone - dirty dishes everywhere.

Note - dishes are a trigger for me.  When I had my breakdown, I happened to be in the kitchen, doing dishes. My husband made an exasperated comment about how I loaded the dishwasher and I.   Lost.    My.    Mind.

Literally - I was hospitalised for a month and off work for over a year.  The timing was coincidental, of course - dishes or no dishes, I had a mental illness and was going down the rabbit-hole.  But spouses everywhere, let this be a lesson to you.  (Also, I've now developed a mild case of PTSD over the goddamn dishwasher.)

Thoughts:

Step 2: Catch It!  Identify: Automatic Thoughts - what I say in my head (words, images, beliefs).  What does this event mean to me, for my life, for my future.  What is it that I predict as a result of my reaction, what is it I have concluded as a result?

My Response: 

My automatic thoughts: I can't handle this.  I'm incapable of dealing with this - it's too much.  I should push through this anxiety - I won't have a breakdown from doing dishes.  Or leaving the dishes there.  But if I'm leaving them there, then I'm not confronting my anxiety, and I'm a failure.  It means I'm not doing what I should, when I should.  (My brain is a big fan of the word "should", and random rules it decides are essential to not just my existence, but the universe as we know it. Me not doing the dishes is like matter meeting anti-matter.  If I don't do it (cuz I should), dire consequences will ensue.)

(Perhaps I should just leave the dishwasher closed - maybe seal it shut.  It could be like Schrodinger's cat - are there dirty dishes, or aren't there?  But I digress.)

I go round and round: If I'm not doing the dishes a.k.a. confronting my anxiety, I'm not doing what I should to be there for my family, and I'm a failure as a wife and mother.  But if I start doing them, and I'm to tired to deal with my anxiety, I won't be able to cope, I'll start to cry, and that will mean I'm sick, and that means I'm going to have another breakdown, and I'll end up in the hospital, and maybe I'll hurt or kill myself, and what kind of person or mother am I that would do that and leave her family?

I could go on.  You see how vital this decision has become - this decision has implications for my worth as a wife, mother, and person.  It could lead to my death.  Either decision dooms me - one to my potential commitment to the mental wing, and potential suicide, the other to my failing my family, which will lead to me being so devastated that - guess what? - I'll have a relapse, end up in the mental wing, and potentially commit suicide.

All roads lead to Rome.

Given these potential consequences (death, hospitalisation, abandonment of my family), and the weight of such a decision, and the fine, fine line I have to travel (i.e. only do what I can when I feel not anxious, or not too anxious, and who decides what that is?), it's no wonder that simply deciding on whether to wash or not to wash has become fraught with fear and peril and doom.

Time for the next step:

Step 3. Ask yourself - is it possible that my thoughts are not entirely realistic right now?  Am I generalising, incorporating all or nothing thinking? Am I accepting my emotions as the absolute truth about the situation?  Do I believe that because I feel it, it must be true?  

My response:  Gee, let's see:  Yes, yes, yes, and yes.  Also more yeses as appropriate.

"Is it possible that my thoughts are not entirely realistic right now?"  It is entirely possible that my thought of imminent suicide as a result of washing dishes is not entirely the most realistic thought I have ever had.  Maybe.

Hmmm.."incorporating all or nothing"- well, "I have to do all the dishes, or I"m a failure as a human being" - does that count?

Next, "Am I accepting my emotions as the absolute truth about the situation?" Hell to the yeah.

Do I believe that "because I feel it, it must be true?"

In the moment, I believe all of it. In the moment, it's more real than gravity.

And what I feel, is that I am failing as I struggle with this simple decision, and I feel I am failing because I am not well "enough", or recovering fast "enough".   I've failed in my pitiful efforts to minimise these intense and agonising emotions I'm experiencing, even though I know how, and  I failedfailed failder faildest.

Step 4. Change It!  Change: Can I replace these automatic thoughts with more realistic, complete, valid, or even simply more neutral thoughts?  If so, what would they be?

 My response: A more realistic thought, and one I can accept, can be as simple as "I am having anxiety over the decision to do the dishes.  I can accept that a decision on whether or not to do dishes might not equate to my worth as a mother."

In this section, any basic truth you can name about the situation that you can accept as logically probable, or at least true from a different perspective.

Facts. Those are good. They can be as simple as "I'm finding this moment challenging"  or "I am having the fear that I'm going to have another breakdown.". Or more simple yet, "It is possible that my fears are not probable.  It is possible that my emotions are affecting my judgement".

These thoughts, these simple facts you remind yourself of, over and over in your crisis moment in response your automatic thoughts.

Having gone through this exercise, you would now reassess your anxiety (or emotion of your choice) level, and determine whether it has increased or decreased.  The goal is to reduce intensity of the emotion, hopefully by the end of the exercise, and over time through repetition..

And repeat as required.

This type of exercise is to train your mind to follow those new neural pathways, and to help you stop fusing with your anxiety; to take that first step back and observe your anxiety and panic instead of blindly reacting to it.

Because you are not your emotions.  You are not your fears.

It's okay.  I didn't believe that either the first 20 times I heard it.

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A final word - strive for improvement, not perfection.  Check your progress now and then ( whatever you're doing to treat your illness), and if you've improved over time, regardless of by how much or how little, if you've improved, it means you can relax, knowing you're on the right track.  Perfect = bad.  Improvement = Awesomeness.

And if you haven't improved, keep going anyway.  You're eventually going to hit on what works for you through sheer stubbornness, if nothing else.

My next post (already mostly written - yay me!), I'll be blathering about how quickly and instantly we can all be happy without any effort whatsoever, and make a million dollars while doing so.  Because really, that's how it SHOULD be.