Cognitive Defusion: How to unhook from negative thoughts and feelings

This entry is a short one. I have been in a depressive episode for the past 7 weeks or so now. At times like this, my mind automatically generates unhelpful thoughts and feelings, that despite knowing that there is validity in them, these thoughts and feelings are unhelpful in my work towards my own recovery. The skill that you’ll read about shortly is one skill that I am still working on, putting it into practice when my mind isn’t too bogged down by the cloud of depression. It is a skill that teach my patients to continue using as it can be a way to get us out of the incessant loop of negative thoughts and feelings that gnaw on us until it feels that there is nothing left of us to salvage.

I hope you find this helpful as it has been helpful for me.

“You cannot stop the waves, but you can learn to sift” – Jon Kabat-Zann

According to Russ Harris in ACT Made Simple (2009), cognitive diffusion is:

– Looking at thoughts rather than from thoughts/emotions.

– Noticing thoughts/emotions rather than becoming caught up in those thoughts/feelings.

– Letting thoughts/feelings come and go rather than holding onto them.

For example, the thought, “I’m useless” is a common thought that most of us can relate to. In cognitive defusion, instead of being caught up in that thought, we notice it instead and say, “I have the thought that I am useless.” The act of noticing and saying that thought/feeling to ourselves aloud or in our head, creates a sense of distance and allows us to be in the hear and now (being present) in order to live the life we want to live.

How Work is Like Currently

The last post I wrote about how I am coping with work was on January 17, 2021. I know that it has not been too long ago for an update about how I am coping at work, so, I thought I share some thoughts on what’s going on.

The past 2 to 3 months, work has been exhausting. I find myself dragging myself out of bed when the alarm goes off and forcing my brain to stop the anxiety thought loop that would start the moment I open my eyes. The level of stress I feel on each work day is all consuming and difficult to describe in words. Recovery is long and difficult and the days when I feel that things might finally start to look up, these days never seem to last long enough for me to sustain some respite from the constant struggle day-in-day-out. At work, it seems that my eyes and mind are focused on the task at hand but my soul was somewhere far away, like a distant observer watching me carry out work tasks, one after the other.

Since the start of last week, I have taken some time off work. I have 4 more days remaining for some respite before I need to go back to work at the start of next week. I am not looking forward to it as I know what it entails. But, life goes on, and I need to continue pushing forwards, even when I feel I’m dragging myself through mud. My relationship with my colleagues have been difficult because I still don’t have the language I need to create boundaries and to be assertive. My opinions and ideas doesn’t get heard or it just gets disregarded during meetings. Decisions have been made on my behalf while I am away from work, assuming that whatever this decision might be, would be ok with me. I don’t have a voice yet. Maybe, one day, this would change. I need to start learning to find the words to create boundaries and to be assertive.

When Your Teeth Tells a Story

Last week I had my visit to the dentist in 2 years. Yes, I know it is waaaay too long to not see a dental hygienist or a dentist. I know that now. Growing up, I remember the first time I learnt how to brush my teeth in school. In Malaysia in the mid-80s, 7 year olds, will sit crossed legged on the concrete ground, one hand brandishing a new toothbrush, while the other a tube of Colgate toothpaste. We were each given a plastic cup, either a blue one of red one. No one had the option of choosing the colour of preferences. Our cups were filled with water. As you remember, I did mention that we sat crossed legged on the concrete floor. So, no bathroom sinks or a mirror on the wall. The whole cohort of 7 year olds, eyes glued to a nurse that showed us how to brush our teeth properly. Whether or not I knew what I was doing was beyond the point. I was just excited to sit with all the other 7 year olds, imitating the movements of the nurse, as my mouth is flooded with tooth paste foam and the taste of mint on my tongue.

You must wonder why I am telling you this story… I am telling this story to immortalise this somewhat mundane occurrence, because I realised something in therapy today. This exact moment was when I learned how to brush my teeth for the first time.

My therapist made me realised that I never had the experience of learning something this mundane from my parents. My mother did not show me how, neither did my father. Somehow, I can understand why my father never took the initiative to teach me, as he only brushes his dentures once a day… in the morning. My father has been wearing dentures for most of his adult life. As for my mother, I have no idea why she never took the time. She would shout from the kitchen or from whichever room she was in around bed time to remind me to brush my teeth. I was never interested in brushing my teeth when I was 4, 5, or 6. There were many nights that I would fall asleep without brushing my teeth.

After that morning in school when I was 7, I remembered that I actually felt ‘excited’ in the mornings and before bedtime, when I needed to brush my teeth. Like a lot of things, it was novel, new, exciting! It takes so little for a child to find the wonder in things. As adults, this magic only happens when we take note of the little things around us.

So… back at the dental clinic… I opted for no anaesthetic before the procedure. I knew it was going to be uncomfortable and of course, it would hurt. But, I just wanted to feel the pain, the physical pain… so, it would numb out the emotional pain. As the dentist drilled and chipped away the decay in my molar, I winced and clenched my fists. This went on for an hour. There was a lot that needed to be done.

The dentist sat me down, in front of large computer screen, with multiple snapshots of my teeth, as well as frames of x-rays…I am not a dentist, but what I saw on the screen, tells me that my teeth is not doing very well. The dentist looked at me, her surgical mask on, that split moment before she spoke, I could see in her eyes that… ‘this does not look good’. She was kind, professional and there was not a single tone of judgement, while she explained what the pictures on the screen are showing. Still, despite her her kindness, I was embarrassed…. I can’t put all the blame to my parents for never showing me how to care of my teeth as a child, but, I know there is truth in what my therapist told me this morning, that my the damage to my teeth, is a bigger reflection of the kind of neglect that I have endured as a child.

A Small Win

For the past two weeks, I wanted to buy something, anything… a new tech… that’s my go to whenever I my mood drops. I’ve written about this in my earlier blog post. I was restless, numb and indifferent. The ‘need’ to buy something expensive was very strong. My impulsive brain was going on overdrive.

Well, I didn’t cave this time around to this impulse. Went out with my partner yesterday afternoon, stopped by a tech shop that I usually get my tech gadgets from, and I was able to resist that gnawing impulse to buy something.

It wasn’t that bad afterall.

Can’t Believe it’s Been A Year

WordPress sent me a notification that my first post was exactly a year ago. My first reaction was, “Has it already been a year?!”

A simple notification such as this can jolt and remind us that time is so fleeting. It is so easy to just live my days, moving through the motion that ‘I am walking through the path of my mental health recovery’. I do realise that my mental health is no longer as bad as how it was exactly a year ago, but this realisation does not discount the fact that the daily struggle is utterly exhausting.

New Zealand is currently in lockdown due to community cases of the Delta variant of COVID 19. Even though I am concerned about COVID, I can’t help but also feel a sense of deep relief that I can stop struggling so hard every day, just so that I can function at work, and be my best for the clients I work with.

I just have to keep reminding myself that “things will get better.”

Exhausted

Everything I am doing is towards mt recovery. Every decision I make on a daily basis is rooted on ‘doing the work’. The constant juggling of emotions, thoughts, exercise, work, studies and self care is exhausting. My therapist reminded me that I have come a long way from where I was at 13 months ago. My rational brain knows that what he said holds true in my recovery journey, but, I haven’t reached a point where I feel totally comfortable in acknowledging that just yet.

Roller Coaster Ride

Last Thursday, I felt the best I have felt in a very long time. Why did I feel good about myself last Thursday? The reason is simple enough: I had enough mental reserve to provide a distressed client the mental and emotional support that she needed at the time. I can’t say more about the encounter due to confidentiality, but, what I can say is that it felt good to be able to support someone else and direct my focus away from my own mental health struggles to give another some reprieve from theirs. This warm, fuzzy feeling lasted for the rest of Thursday evening. It was short lived though…Come Friday, my mental health started to take a dive and at this very moment of writing this, I can feel myself plunging into the depths of darkness, the darkness that pulls you in, deeper and deeper, until there is nothing left to feel, apart from the emptiness and vast open void that you feel inside.

I am getting hooked with so many thoughts and feelings and I know what I need to do to diffuse and unhook myself from these unhelpful thoughts and feelings. Believe me, all I have been doing since Friday morning was that every chance I get an ounce of strength… to ground, re-centre and bring myself back to my present self… damn it! I even have a worksheet that my psychologist have given me to jot down how it went each time I used diffusing and unhooking strategies… it isn’t working. I think the reason why I am writing this post is because I need to try and quiet my thoughts, quiet my feelings … suppressing and numbing is not really working for me anymore. Supressing and numbing was all I used all these years to cope, and it isn’t working anymore. What do I do? What do I do?!

Here We Go Again… An Endless Cycle

For the past month, I have slowly found my mental health deteriorating. I could feel that slow, dread and despair, just lurking around the corner. From my work as a mental health nurse, I know the theory and concepts behind ‘unhooking‘, a term used in ACT (Acceptance Commitment Therapy), where you ‘unhook’ from difficult thoughts and feelings by acknowledging that they are there, but instead of focusing on them, you let them buzz in the background. The idea is to focus on the present moment, and not be dominated by these difficult thoughts and feelings, in order to live the life we want. It does work, when it works. As with many other coping strategies, unhooking is another skill that requires us to repeatedly practice and use and make it so automatic, that our brain automatically uses it as a positive coping mechanism when our thoughts and feelings becomes unhelpful. It’s great when it works, but for me, at this point, it’s a hit and miss at most times. So, what I am trying to say is that I am not quite there yet!

The irony of it all is that I teach my clients these skills. From various grounding strategies, such as physical grounding, object grounding, safe space visualisation and unhooking, to name a few. I understand the concepts behind them and the reasons why they work for some and not others, but, I find it difficult to use and practice them for myself.

My psychologist has given me a task to practice ‘unhooking’ on a daily basis. I have been trying, but, it hasn’t really worked out the way I thought it would. I am quite frustrated with myself. Maybe it’s the stress of work and the stress of an assignment that I am currently racking my brains to try and complete…Maybe my concentration is so bad that I can’t focus on any of the tasks I have in hand at the moment… Maybe it’s just the simple fact that I am slipping into a depressive episode again. The thing is, I have not even surfaced to the light from the episode 8 months ago. It’s just an endless cycle of ‘I’m ok’ and ‘I’m not ok’ and this is just so f***king exhausting!