CBT Journal Entry #1

Wednesday, 17th April 2013

My CBT Journey Journal

The time is 3.45pm, and I arrived back from my first Cognitive Behavioural Therapy session about half an hour ago. I hadn't walked into this session blind - I had a somewhat vague idea of what to expect, having researched the therapy online, and spoken to various people I know who have already had the therapy, with varying degrees of success.
I knew that I would be posed a lot of questions, both about my phobia and how it makes me feel, and about how I think when I find myself in a situation where I am confronted by my fears.

Some of these questions I can answer easily; I can tell you that I have a phobia of fish, technically named Ichthyophobia (taken from the greek 'Ichthus', meaning 'fish', and 'phobus', meaning 'fear'), and I can also say that this fear involved confronting the animal group (dead or alive, food or not), an image of the animal (be it printed or on a screen), or even just the idea of confronting the above. Nor can I eat seafood without tremendous mental effort or upset - more often than not, I can't get over the mental hurdle to eat it at all.
I can also tell you that I have suffered from this phobia for as long as I can remember - the first incident where my problem reared its ugly head is not one that I remember for myself, but rather one that has been related to me by my parents. They told me that they'd taken me on holiday abroad, when I was just a toddler - I may have been a little older than that, but I was certainly pre-school - and they took me to this beautiful, warm, sandy beach, where they obviously took me into the ocean, somewhere I hadn't previously been. However, when I saw a fish in the water, I was screaming, and out faster than they'd ever seen me move. That was apparently the beginning (as I remember it being told), but as far as I'm concerned, it has always been this way.

However, there were questions that the therapist asked me, that I was not able to answer with as much clarity, or even at all. She asked me how I feel when confronted with my phobia, but the only answer I could summon was 'extreme discomfort'. Thinking about it a little more, I'd say I feel queasy, like my stomach is knotting, or like a huge rock has been dropped into it, a general discomfort, increased heart rate (linked with the nerves and anxiety, I suppose), and I can sometimes get a headache, like something is applying pressure to my temples, and it can feel like my throat is closing up - this from fighting the tears, as I can often get suddenly tearful or upset when I face my phobia. This, I think, is to be expected. And just to prove that last point to my therapist, my body decided that I would become upset simply by talking about my experiences and how they made me feel. It's so easy for me to become overwhelmed by the upset that my phobia causes me, and the stress that comes hand-in-hand with any attempt to face up to it.

A question that I was unable to answer at all, though, was what goes through my mind when confronted with my phobia, and honestly - apart from the obvious image of a fish - I don't really know. I told the therapist this, and added that I think I must automatically block it out of my mind once the ordeal is over with. It's not something I want to think about, and so I don't remember the details - only that it happened.

My Phobia Diary sheet

It's because of this that she has asked me to keep a phobia diary. Every time I come into contact with fish - be it an image (printed or on screen), walking past the fish counter in the supermarket, or past a tank containing live fish - even being around someone eating fish - I have to write it down, but with certain things in mind.
The picture on the right is the form that she gave me, so that I'd know the kinds of things I would need to be writing down each time I made an entry. The top box is a description of the 'life situation', in other words, the type of confrontation I am dealing with (image, animal or seafood). The box directly below that is 'Altered Thinking', which is the most important box for me, as I need to try and remember what I think about whilst I am in these situations. Here I should write what goes through my mind and what I think about during the ordeal.
The next box, on the right, is 'Altered Physical Symptoms', for example, shaking, or coming out in a cold sweat. To it's left is a box that reads 'Altered Feelings', which would be thinks like nausea, increased heart-rate, faintness etc. And the final box at the bottom of the page is 'Altered Bebaviour', or what I do because of the difficult situation I find myself in, which could be, as I mentioned before, becoming tearful, or running from the object of my fears.
So each time I face my fear, these are the kinds of things I have to think about, and then write down, ready for my next session, so that the therapist can gain a better understanding of how I think, so that this can then be challenged, and the therapy can start to help me.

Writing things down has always been something that I find not only enjoyable, but also therapeutic, so as well as keeping a journal for this, I decided to keep a journal (pictured at the top of this post) of my therapy in general, of which this is the first entry. I will write down what happens in each therapy session, so that I remember what we spoke about, and hopefully I'll gain a better understanding of my own problem this way.
It will also let you all know what goes on during these sessions - and if you have a problem of your own, but you're nervous about the idea of CBT (and trust me when I say that I completely understand those concerns), this might help you to understand a little more about how it works, and remove the mystery that shrouds this type of therapy.

After discussing my phobia for a while, the therapist (who, by the way, works for Birmingham Healthy Minds) spoke a little bit about the therapy, and what it will involve over the next few weeks. She told me that I had already been doing the right thing by trying to not always avoid confrontation with my phobia (in fact, as you know from the 'About Me, My Phobia & My Journey' page, I openly seek confrontation in a bid to overcome my fear), and that the therapy itself will involve a gradual exposure to fish, until my anxiety around them begins to lessen, and eventually I may begin to feel more comfortable with them.

I am feeling hopeful for the results that this therapy may help me achieve, and although I realise that I may never be entirely over my phobia, I hope that I will be able to at least make it more manageable, in a way that I can live with it.
My next appointment is scheduled for the morning of May 1st, in two week's time, and I'm looking forward to seeing what kind of challenges it will throw my way!