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Online therapy – what's it like?

With more and more of our daily activities becoming online based, here is a personal account of how therapy for depression and anxiety can still be beneficial online.

It was several months into the pandemic, I felt on edge, I was tearful, I was catastrophizing. I was struggling for motivation and feeling tired. I couldn’t concentrate at work or in my free time. I didn’t feel like myself.  I would sleep all the time if I could.  

Things were going well from an outside perspective. I was at the beginning of a new and supportive relationship and doing well in my job, a job I love. I have wonderfully supportive family, colleagues and friends.  

The weather wasn’t helping, days getting shorter, colder and restrictions tightening. Living alone and seeing fewer and fewer people wasn’t suiting my personality. I was pretty unhappy and tearful, not enjoying very much, finding it hard to concentrate on a film.  

I try to have a proactive approach to my own mental health, one day when I was sharing a post about symptoms of depression to help others on Facebook, I thought ‘wait, I can relate to many of these.’ I’ve known about having anxiety for some time now but low mood wasn't something I’d been diagnosed with officially. 

But what to do next? How do I know it’s something serious enough to get help for – and if I do get support, will it even make a difference? So many thoughts swirling around.  

I referred myself online – I didn’t need to speak to a soul or navigate a GP appointment. I had a phone call within a week and they spent half an hour asking me questions and reviewing a mood questionnaire. They then quickly contacted me with the next steps they recommended. 

Online group Cognitive Behavioural Therapy

A group setting wouldn’t have been my first choice, it feels like a very private thing – my innermost thoughts and worries. In ‘normal’ times it would take place in person but now it’s been adapted to two hours a week on Zoom for 12 weeks. And despite some hiccups it seems to be working well.   

I didn’t put my camera on until the second week and used the chat at first rather than speaking out loud. 

What is CBT?   

CBT is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that unhelpful thoughts and feelings can trap you in a cycle. It is most commonly used to treat anxiety and depression.  

CBT aims to help you deal with ‘overwhelming’ problems by breaking them down into smaller parts. 

You're shown how to change these negative patterns to improve the way you feel. 

Unlike some other talking treatments, CBT deals with your current problems, rather than focusing on issues from your past. It looks for practical ways to improve your state of mind on a daily basis. 

More info here: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/ 

What have I learnt through CBT?  

The group element I have found helpful - to be able to hear what other people have said has been helpful and I found that I can empathise with them and they with me. I have also used some practical techniques, listed below.  

Behaviour Activation  

My goals are small – whereas once I wanted to run three times a week, now my goal is to leave the house once a day, to make sure my washing up is done before going to bed. 

We look at behaviours that we want to introduce including what they call ‘natural antidepressants’ (e.g. better sleep, exercise, seeing others) and look at how we are actually spending our time. Then we put a plan together for the next week to show the sort of week we would like to have.  

Worry Tree 

The worry tree approach aims to help you get in control of your worrying.  

The idea is you notice the Worry. “What am I worrying about?” then think about “is this worry about a current problem or a hypothetical situation?” If it is hypothetical you need to move on (or save it for worry time, another technique) or a problem needs an action plan.  

‘Overdoing it’ and boom bust cycles  

When I feel more well, I throw myself into things, with a period of very low energy following this peak. Now I’ve recognised this, I try to keep some energy back – rationing it more sustainably.  

Credit: @trainee_psych_scribbles 

Low mood and activity cycle💜🌀 
 
When we feel low, we feel less motivated and have less energy. So naturally, we end up doing less. We do less of the things that give us a sense of enjoyment, achievement and closeness to others. 
 
But if we do less... we also tend to get less joy out of life. We might have a sense that life has less value... and we can easily fall into a vicious cycle of lower and lower mood🌀 
 
I thought this might be a helpful post right now because there are lots of potential triggers for low mood and low activity right now (e.g. lockdown, cold weather, short days etc.). Just like a hibernating bear, we might be tempted to curl up and do less and less 🐻🐾. 
 
How do we break out of this cycle? By scheduling activities and doing them, even when we don't feel like doing them. It's tough, but even if it's starting small with a short walk or a quick call to a friend, it could make a difference to our mood💫 
 
As always, please see my how to seek help and self help highlights if you would like help with low mood or depression 💜 
 
This is illustration is based on the behavioural activation approach to depression (Lewinsohn, 1974).🎨 

Scores 

The GAD-7 is a measurement for Anxiety Disorders and the PHQ-9 is a measurement for Depression. They are designed to facilitate the recognition of depressive and anxiety disorders respectively and are the national standard measures routinely used by GP’s, therapists and psychiatrists as screening tool. The scoring for both measures helps to ascertain how severe the ‘issue’ is, which can range from none to severe. I complete these every week online, using special codes so that they can monitor how I’m doing by selecting how many days in the past week I felt a particular way.  

If you want to see what they are like, you can see a version here:  

https://www.nhs.uk/conditions/stress-anxiety-depression/mood-self-assessment/ 

I was first quite upset when I was given a ‘moderate’ score for anxiety and low mood. It is a strange feeling to be ‘rated’ on your mental health. But I did eventually realise that this did reflect how I was feeling and that this meant I could get the help I needed.  

I still have mixed feelings, sometimes I feel like I’m not ‘ill’ enough to need help – that I’m taking someone more needy’s place. I have felt myself reacting better to situations but it was never going to be an instant fix and is something I need to work on, hopefully giving me the skills I need in the long term.  

I just wanted to share my experiences in case anyone was wondering what it was like and who to get referred for this sort of support. There is obviously no one size fits all approach to mental health but CBT has lots of apps and resources in development and is something many people have found helpful. Please don’t hesitate to talk to someone about how you are feeling, whether it’s a friend, a professional or a neutral person.


Resources    

These are some Instagram accounts I find helpful (should not replace talking to a medical professional!)  

How to find a service (UK) 

Low Mood 

Anxiety 

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