Jan 15, 2025
In this episode, Helen talks with Lizzie, abeauty content creator and disability advocate, and Bex, a CBTtherapist, about Lizzie’s journey navigating living with long termhealth conditions, trauma and the transformative impact ofCognitive Behavioural Therapy (CBT).
Lizzie shares her experiences living withCrohn's disease, POTS (Postural Orthostatic Tachycardia Syndrome),and hypermobility spectrum disorder, alongside the emotionalchallenges of managing these conditions. She discusses her initialscepticism about therapy and how CBT helped her address anxiety,PTSD, and prioritising her own well-being.
Bex offers insights into the therapeuticprocess, addressing common misconceptions about CBT, and highlightsthe importance of building trust and tailoring therapy toindividual needs. Together, they discuss the interaction betweenphysical and mental health and strategies for balancing drivenlifestyles with well-being.
Useful links:
Explore Lizzie’s content on Instagram andTikTok (@slaywithsparkle).
Listen to our sister podcasts:Let’sTalk About CBT - Practice MattersandLet’s TalkAbout CBT - Research Matters: https://babcp.com/Podcasts
Find us on Instagram: https://www.instagram.com/babcppodcasts/
Learn more about CBT www.babcp.com
Credits:
Music is Autmn Coffee by Bosnow fromUppbeat
Music from #Uppbeat (free forCreators!):https://uppbeat.io/t/bosnow/autumn-coffee
License code: 3F32NRBYH67P5MIF
This episode was edited by Steph Curnow
Transcript:
Helen: Hello, and welcome toLet's Talk About CBT, the podcast where we talk about cognitive andbehavioural psychotherapies, what they are, what they can do, andwhat they can't. I'mHelen Macdonald, your host. I'm the Senior Clinical Advisor for theBritish Association for Behavioural and Cognitive Psychotherapies
What we've got for you today is a conversationwith Lizzie and Bex. Lizzie's going to talk about her experiencesof having CBT and living with a number of conditions that she'lltell us more about in the episode. We're going to talk to Bex, whois a CBT therapist, and she's going to talk with us about workingwith Lizzie as well.
Welcome to you both. Lizzie, would you like tointroduce yourself?
Lizzie: Hello! Thank you so muchfor having me. So as Helen's just said, my name is Lizzie. I amalso a beauty content creator known as @slaywithsparkle onInstagram and TikTok and a little bit of YouTube and I'm also aspeaker that talks about disability awareness. And I try and raiseawareness about the health conditions I've got and general sort ofdisability awareness and activism about that.
Helen: Thank you Lizzie, andwelcome. Thank you for coming to talk to us today. And Bex, wouldyou like to tell our listeners about you?
Bex: Hi. Yes, I'm Bex. I'm a CBTtherapist and worked with Lizzie a little time ago, when I workedin a physical health service for IAPT at the time. And I currentlywork more with trauma in Sheffield both in the NHS andprivately.
Helen Thank you, Bex. And maybe Ishould just say, when you said IAPT, we're now talking about NHSTalking Therapies.
Bex: That's right. Yes. Thank youfor providing the update.
Helen: So Lizzie, can I ask you abit about what was happening for you? What was going on that meantyou ended up having CBT?
Lizzie: So for me, I really hadquite a negative opinion about any sort of talking therapy and hadvery much been brought up with the idea that if you have some sortof mental health problem, you should be able to solve it yourself.And if you just think positively and carry on, then everythingshould be fine.
Because of my health conditions, so I will justmention just briefly so people are aware what my health conditionsare just for context. So I have, Crohn's disease, which I wasdiagnosed with when I was 21 and then later about 9- 10 yearslater, I was diagnosed with hypermobile spectrum disorder and alsoPOTS, which is a condition that affects my blood pressure and heartrate. And when I had a first flare of Crohn's disease. I'dobviously had it a long time without realising, but when I firstflared with Crohn's disease, I really struggled with the concept ofhaving a physical health condition that I couldn't push through. Sowith my Crohn's, I ended up ignoring a lot of the doctor's advicebecause I had this idea that I should be able to cure myself. Ireally pushed myself to look at alternative therapies. And then,because of that, I ended up ignoring what the doctor said andbecoming a lot more ill. Unfortunately, because of a combination ofthe Crohn's having been misdiagnosed for a long time as IBS, andthen because of all of those sorts of ideas about that I should beable to cure myself, my Crohn's did get so bad that I ended uphaving to go to hospital and have emergency surgery on my bowel.Years later, so about two or three years later, I started havingreal panic attacks, which I'd never had before. I was anxious allthe time and I couldn't sleep. I would sometimes wake up in themiddle of the night at like 4am and get the urge to clean theentire house and was sometimes just up in the middle of the nightpacing up and down. And my partner at the time said to me, youknow, this is not normal. Something's going on. You really need tothink about getting some help for this. And I was devastated atthat concept because I obviously had this idea that I should beable to fix myself. And so that was the sort of wakeup call that Ihad to go and get some help and I applied to IAPT at the time andhad my first round of CBT. Since then I've had three rounds of CBTand a course of EMDR as well but yeah, that was the first thingthat sort of led me to CBT.
Helen: Thank you, Lizzie. And itjust strikes me what a difficult combination of things youexperienced that not only were you having a number of quitecomplicated and long-lasting physical symptoms, also theexperiences you'd had when you were younger meant that it wasreally difficult to seek help for the panic attacks and the anxietyand so on. Can I ask you just to say, in case anybody's notfamiliar with the terms, can you just say a little bit about whatthe symptoms of Crohn's disease are?
Lizzie: Yes, absolutely. SoCrohn's disease is different for everybody. For me, I reallystruggled with pain and one of the biggest symptoms that I had waspain. I also struggle with diarrhoea. It's not the most glamorousdisease. It's quite embarrassing sometimes. Some people have a lotof nausea and vomiting. For me, that's not been as much of aproblem. To me, the biggest problem has been pain. And it got sobad that when I was actually in my final year of university, I'dbeen told by the doctors repeatedly that it was IBS, and it wasjust stress related IBS and I just needed to make sure I watch whatI eat, tried to up my fibre, which made me a lot more ill. Andeventually it got to the point where I literally couldn't evendrink water because my oesophagus was closing up. I was in absoluteagony and I finally went back to the doctor and I was like, really,honestly, there's something seriously wrong here and then theyfinally sent me for the right tests and they found the Crohn'sdisease. The other big symptom with Crohn's disease as well isfatigue. So, most people actually say that fatigue is the mostdebilitating symptom of Crohn's disease. And for me, I mean, at themoment I am in a flare and I am sleeping 14 hours. And if I don'tget that 14 hours, I cannot function and I need a full day in bedto recover.
Helen: And again, you've saidabout some of the symptoms being a little bit similar to IBS orIrritable Bowel Syndrome but having a really far reaching impact onevery area of your life, really. You also mentioned that you hadPOTS, which can affect your blood pressure. And if I have thisright, it's Postural Orthostatic Tachycardia Syndrome?
Lizzie: Yeah, so it affects your,for me, it affects my blood pressure. Not everybody has problemswith their blood pressure all the time. But what happens is yourheart isn't getting the right signals. And so you end up having areally high heart rate when you stood up and then that can lead toyou passing out. It also leads to symptoms again, like nausea,fatigue and for me, it just feels horrible. Like, it's just thatfeeling of like sometimes the world's sort of closing in on you andwhen you're about to go you just feel really sick, really likesomething's pulling you to the floor. It's a very frustratingcondition. I think out of all of them, Crohn's is the mostdangerous and that one is the one that when that's flaring, I'malways a little bit nervous because mine is quite severe, but POTSis definitely the one that is the most infuriating. I've had to liedown in the middle of shops. I once had to lie on the floor in themiddle of Poundland because I was passing out and honestly, it'sjust mortifying. It's really embarrassing.
Helen: And I'm noticing there aswell, Lizzie, that you've just said that the Crohn's diseasebecause of the symptoms of diarrhoea and you know that can beembarrassing. We all know that the impact of eating a lot of fibre,which you were advised to do can be, can lead to embarrassingsymptoms and then the POTS as well, that having to lie downsomewhere public, more embarrassment. And in addition to that, youalso said that you have hypermobility syndrome. And again, can youjust say a little bit about what that's like?
Lizzie: Yes, so for me, I have alate diagnosis of hypermobile spectrum disorder. There are a coupleof things that are related, so similar, sorry. So there'shypermobile EDS and then there's also hypermobile spectrum disorderand they're very similar conditions. But the one that I have ishypermobile spectrum disorder and with that, it just basicallymeans that my joints are too floppy. They extend past the naturalpoint where they should extend because my collagen is built in away that means it can stretch further than it should. So it wasokay when I was younger. I used to be able to just do amazing, youknow, bend my back really far back and look very bendy. And then asI got older, as the rest of my connective tissue ended up gettinglooser, as it naturally does when you get older, my joint startedto get worse. I got more and more joint pain. I'd had joint pain mywhole life, but it became a lot more severe. And it's now got tothe point where I am not able to walk any distance with, anysignificant distance without a walking stick. And in order to goaround, say, for example, like a supermarket, I need awheelchair.
Helen: Thank you for explainingall that, Lizzie. Again, I'm listening to you and I'm hearing lotsof things that could make it also really hard to manage your mentalhealth. And I want to come back to you and talk to you a bit moreabout what it was like having the CBT.
Before we do that, can I just ask Bex what it waslike for her when she first met you? Because we've heard a bitabout your background and maybe what you were thinking before youfirst went to see her. So, Bex, what was it like meeting Lizzie forthe first time?
Bex: So, you can't see Lizzie butLizzie is a lovely, warm person. So that was obvious from the startand I guess I was, with any physical health problem, the thingwe're trying to do at the start is to understand what someone'sexperiencing and making space for someone to kind of tell theirstory a little bit about what they've experienced and what they'refinding difficult so that we can kind of map that out and work outhow we could potentially help too by working on this together. Ithink when I first met Lizzie, we fumbled a little bit at thatprocess. I don't know if you want to say a little bit more aboutthat, Lizzie, and I think, you know, I was trying to explain howpain and mental health might interact, and I might've done that abit clumsily.
Lizzie: I think, to be honest, Iwent in with this real prejudice, I guess, against mental health.So when I came to you, I had actually already had one round of CBTto start with, but I was really still coming from this place ofprejudice against talking therapies and fear about whether I wasgoing to be believed about my health conditions. The first round ofCBT that I'd had, it was in a place I used to live down south, andit was very much focusing on the anxiety. And we talked about itbeing to do with the fact that I've been diagnosed with Crohn'sdisease and the fact that I'd had a lot of hospitalisations and thefact that I had emergency surgery, and also the fact that I'd beentold that I might have a shorter life expectancy as well. And so itvery much focused on the anxiety of dealing with those concepts.But underlying it all, I still had this fear of not being believedabout my health conditions. I also, I will just share now, becauseit is relevant as well, that while I was in hospital for theemergency surgery, the night of that emergency surgery, I wasphysically abused by a doctor. He was a locum doctor that thehospital had employed just for, you know, a couple of nights. Andhe insisted on doing a physical investigation on me despite measking him not to and then he purposefully inflicted pain on me andhe enjoyed it, it was a really unpleasant, horrible experience andthankfully a nurse walked in as he was doing this and she got himto stop and he got reported and he no longer works in hospitals andthat has all been dealt with.
But when I first went into CBT, I hadn't eventhought about that as something to talk about because I felt likethat was my fault. And I felt like that was my fault because I wasin pain because I hadn't done a good enough job at curing myconditions. And so that narrative was in my head when I came to seeBex. And I already had this idea of like, I'm not good enough atcuring myself, but I'm now getting to the point where I do need tobelieve that I've got these health conditions because I'm seeingphysical evidence of it more and more. So I was sort of in thishalfway point between trying to accept it, but also thinking,nobody else is going to believe this because I don't really believeit. And that's what I came to Bex with, which must not have beenthe easiest patient. And then at first we did have, I think therewas a very slight miscommunication about the fact that CBT can helppeople with physical health conditions with pain. And I saw thatas, oh she's saying it's all in my head and that if I just talkabout this, then my pain is going to be completely cured, and theydon't believe me that I'm in real pain. But then Bex was brilliantand stopped me and said, no, I really do believe you and youexplained it. So, Bex, I'll go back to you because I think youexplained it really well and it really helped me.
Bex: Well, I think I just said, Ibelieve you and your pain is real. Can we just have that as astarting point and think about how what you've experienced hascontributed to living with it and how some of those beliefs youhave about yourself might make it harder and maybe they're the bitsthat therapy can support you with.
Helen: Thank you for that, Bex.We've just heard Lizzie talk about, not only having those healthconditions and those beliefs, but also about being assaulted whenshe was supposed to be in a safe place. And you started to talkthere about the interaction between the physical conditions andperhaps the emotional beliefs thinking. How did that then help youdecide with Lizzie what to do next?
Bex: So we talked about ittogether to decide what to do next. And I guess part of thatprocess was understanding kind of the emotional impacts of both thephysical health conditions, you know sometimes there'sunderstandable uncertainty, anxiety, maybe grief associated withthose things and the adjustments that are necessary, but also thehuge emotional impact of her trauma experience and how thatcontributed to the stress she was experiencing day by day.
And really it, originally, it's mapping that outand understanding it as much as we can to inform Lizzie making achoice about what she wants to prioritise. And, if I remember, westarted with some work on physical health and understanding that,partly because of you already alluded to that kind of disbelief youhad about your own kind of symptoms and in your own body andlistening to that. So I think we did some work to start with onthat before doing a kind of CBT for trauma approach that Lizzie wasvery much leading that decision.
Lizzie: Yes, I think the otherthing that I remember as well is that I didn't, I don't think Iopened up to you about the thing that happened with the doctorstraight away. I feel like I went knowing that I had still gotanxiety because of things that had happened in hospital and theCrohn's and everything generally and the fact that I was beingdiagnosed with POTS, I think that was what was going on as well. Iwas just about to be diagnosed with POTS, so this new diagnosis hadsort of triggered a lot of anxiety because of what happened when Iwas diagnosed with Crohn's disease. It was sort of like comingback. But I don't think I actually mentioned the doctor to youstraight away. I think that came out naturally when you sort ofasked me to talk about what had happened and what were the thingsthat I sort of was getting in terms of flashbacks because I washaving PTSD flashbacks as well. Sorry, I forgot to mention that,and I think we pulled it out by having those conversations. So itwas really important that you worked with me on it because thatenabled you to be able to pull out this major thing that I probablydidn't even see as a priority because I blamed myself for it. So Ithought that was really useful.
Helen: And I'm hearing from whatyou're saying that combination between very difficult to managephysical symptoms and how those interacted with what you believedand how strong that was. And I think it's really interesting thatsometimes people talk about long term health conditions, as if theywere all in the mind and that being completely wrong. And coming tosomeone like Bex, who's got psychologist or psychotherapist orsomething like that in her title, being particularly difficult atthe same time as for you, believing that it really was somethingthat you had control over by the power of your mind or somethinglike that, that somehow, if you only tried harder, you could changewhat was happening.
Lizzie: Yeah, absolutely. It was,I was terrified. Honestly, I was so confused about what was goingon in my own brain. I felt like I needed to do something because Iwas getting flashbacks at that point. In any sort of moment where Iwasn't actively doing something, I was getting flashbacks every 15seconds, I think. Honestly, it was it was awful. I was gettingcertain colours were triggering things, and it was constant. It wasexhausting and I knew there was something that I needed to do aboutit. I had my first round of CBT which was successful at helping mebring my anxiety down, so I had that sort of stepping stone, but Iwas still coming from this place of fear and doubt. And I thinkpart of that is because I was told by the doctors when I was firstdiagnosed with Crohn's that I should have CBT. And I thought thatwas them saying that it was all in my head, but it was actuallythat they were prescribing it as a way of helping me cope with thepain, but the way it was communicated to me made it sound like theyjust thought, Oh, well, if you have CBT, then you'll be cured ofCrohn's disease, which is not what they meant. And I now know thathaving spoken to people who work in the sector more, I nowunderstand that.
But I think that a lot of people, when they arefirst told, oh, I think you should have CBT. They think, oh, thisis just the doctor trying to fob me off, but it's not, it's themusing their toolkit of things they've got available to them to tryand help. It's just not necessarily communicated that well. And Ithink if it was communicated to me differently, back when I wasfirst diagnosed with Crohn's, maybe I would have had CBT back then,and maybe I might have had a bit more support as I was goingthrough the diagnosis. And some of that fear might have beenmitigated a little bit back then.
Helen: I think that's reallyimportant for you to have explained that actually, that sense of,for people like myself and Bex, perhaps, to understand how toexplain why what we've got to offer might be useful and not to makeassumptions that someone that we're recommending for CBT willautomatically know what we meant. So that's an important message. Ithink.
Once you did go to CBT, can you tell us a bitabout what was actually helpful? What did you actually do or talkabout? What was it that seemed to make a helpful difference?
Lizzie: So the first round of CBTthat I had was very much focused on mindfulness and being able tobe in the moment. I did have PTSD and my PTSD score was very high,my anxiety score was very high. I think my depression score waslower at that point, I'm not sure if I scored for depression atthat point, but the main thing that I found helpful was being ableto stay in the moment because I was constantly worrying about thefuture, worrying about death, worrying about what was going tohappen if my Crohn's flared again, worried about what was going tohappen if I had to stay in hospital again, and I was constantlywriting all these stories for myself that weren't happening, andliving in fear that I didn't need to be thinking about. So thatreally helped me just to be mindful and to focus on the moment. Andwhen I first heard the term mindfulness, I was like, right, okay.Are we just going to be like sit in a circle and go “ohm” orsomething? And it wasn't that at all. It was very much usingstrategies that are very simple to just help my body and my mindrealise that I am safe in this moment. And that for me was reallyhelpful. And as somebody coming from a place of doubt, I thinkagain, if that had been communicated to me before I'd gone into it,I think I probably would have been a lot more open, because I thinkeven back then, my first therapist probably had a lot of resistancefrom me as well.
And then when I came to Bex, the main thing thatI was struggling with then, I think was the PTSD flashbacks, but Ithink I also scored for anxiety and depression at that point. Iwas, again for context, I was a teacher still then, so I now havehad to medically retire, unfortunately. But when I first saw Bex, Iwas still a teacher, and I was really pushing myself past the pointthat I should have been. I was exhausted. I was in pain all thetime. I was determined to have a successful career, which I didhave. Despite all of this, I did have a very successful career as ateacher, but the reason I had that successful career was because Ipushed myself despite all this pain. And it was also a way for meto take my mind off the PTSD, because if I was busy, if I wasconstantly go, go, go, it meant I didn't have to think about it. Sothat was where I was at when I first came to Bex. And I think oneof the things that she did was, like I said, pulled out the keythings that were kind of coming up in flashbacks. And then we did asort of narrative about the trauma, which was horrible. I'm notgoing to say it was really horrible, but it helped. So I thinkthat's another thing to say, like, if you're having CBT and thetherapist suggests something that is horrible, it's probably goingto be good for you because yeah, so we had to basically go throughthe story of the most traumatic time of my life ever. Over and overagain, and I was given homework of going home, reading it throughthis narrative of like everything that happened over and overagain. And it was one of the hardest things I've ever done.Honestly, it was horrible. But by the end of it, I got to the pointwhere I can now, you know, come on a podcast and tell you I wasassaulted by a doctor. When I first saw Bex, I couldn'teven say the words about anything that had happened. And the factthat I can now come on publicly and talk about this is, you know,that just shows how helpful CBT was for me, because I honestly, Iwould have never imagined talking to anybody about it. I didn'teven tell my partner who I'd been with for, I think over 10 yearsat that point, I didn't even tell him until I'd gone through thatprocess of CBT. Most of my friends and family had no idea.
Helen: Thank you, Lizzie. Itstrikes me from everything that you've just been telling me thatbetween working on the post-traumatic stress disorder, the PTSDsymptoms and working with Bex to do something that you reallydidn't want to do and actually deliberately, repeatedly going overit until you could talk about it until, like you say, you can comeand talk publicly about it with us, which we're extremely gratefulfor, but also hearing how hard that is. And in a moment, I'm goingto be asking Bex about what she does both to persuade you and otherpeople to go through something that's that difficult, and how youmake it manageable when clearly it's a horrible thing to gothrough. What I might also want to come back to you about as wellis you really conveyed how driven you were about that wanting thecareer, keeping busy, pushing it. And I want to come back about theimpact of that as well, if I may. But first, can I go to Bex andjust talk about, Lizzie just told us that you've essentially askedher to do the worst thing and do it repeatedly.
Bex: Yes, we did. So yeah, it'sintuitively the last thing you want to do when you've experienced,you know, something so, so awful and life threatening, that thelast thing you want to do is talk about that. So, we do prepare forit, we do some sort of exercises to make sure that we have thetools to calm down if it's distressing, and we explain the theoryfor why we're doing that because these are kind of stuck, emotionalresponses and perspectives from being in a situation that was toomuch for your brain to process at that time. So we're making thespace for it subsequently to understand what happened, connect tothe feelings that were overwhelming at the time and sort of safelyrelease them through this process. And as well as doing that, wealso understand, you know, look at the beliefs that became stuck atthat time. And we challenge those together to see if we can getsome kind of perspective. So, for example, you were talking aboutthe self-blame, that is so, so usual with trauma. And we looked atthat from a different perspective now we had all the information,and I guess the way we encourage people to do that is very muchmaking sure it's their choice, you know, nobody has to do this, butexplaining what the benefits might be if we were to try doing thistogether and try doing it at the pace that you feel like you'reable to tolerate and that you're in control of the process. Andit's also important to have that story heard and understood by bothof us in that process.
Helen: And can I just talk to youboth about that experience of being really driven. And there wassomething about the way you described that, Lizzie, that part ofthat was trying not to be triggered or think about all the badthings that had been happening for you. But also that general styleof pushing for a career, being really busy, being highly motivatedand I just wondered how the two of you managed that aspect, youknow, during your sessions or between them, perhaps moreimportantly.
Lizzie: I think one of the thingsI can remember was in the first session. So I explained that I was,you know, determined to still be a teacher and how I loved my job,which I did, and I still wish I could be a teacher, I'm not goingto lie, I really did genuinely love being a teacher which is partof why I was so driven, because I actually did really enjoy it. Butthere was definitely that element of me trying to kind ignoreeverything. But one of the things that Bex did very early on, Ithink it was the first session, she just said, your homework is todo something fun. And honestly, the concept of doing something funfor myself at that point was unimaginable. And I found it reallyhard. I found it really hard to think about something to do justfor fun for myself. And I think that was just a sign of how much Ineeded that help because I couldn't even think about what to do.And that really helped me to start to come out of this really,like, blinkered existence where I was thinking, go, go, go, go, go.And it just gradually, bit by bit, helped to pull me out of it. AndI think you kept suggesting things like that. And then we talkedabout what was nice in my week and things like that. And it justhelped bring me out of this sort of bubble that I was in.
Helen: And Bex, will you tell usa bit about how you were thinking about that as a CBT therapist?What's going through your mind when you're working with somebodylike Lizzie, who's working really hard, but is almost stuck forfinding something fun or rewarding to do? What's going through yourmind as a therapist?
Bex: I didn't remember thatactually, Lizzie, but I think, well, I guess I'm just noticing howdriven and how exhausting it sounds to be kind of pushing so hard,despite feeling so ill. And I'm encouraging a new pattern ofbehaviour, I guess. I'm encouraging a different way of respondingjust to try it out. You know, with CBT, we're always just testingstuff, see what works, what doesn't, and so I guess I'm encouragingthat early doors to get a bit of a buy into the concept, you know,are you're okay with this approach? And I do remember that we didthroughout, we did do bits and pieces around understanding theconsequences of working that hard or noticing, cause sometimes youmight want to and it might be the right thing for you, butsometimes it might have more impact in ways that are less helpfuland you might want to try out a different pattern. And I think wemight've looked at working pattern and problem solving that ornegotiating with work about trying different approaches anddifferent working weeks to see what was more manageable and moresustainable.
Lizzie: Yeah, I remember doingthat. And also remembering you helping me a lot with being able toactually have time off work before I was forced to by my body. So,I used to get to the point where I was completely exhausted or insuch agony that I couldn't move. And that would be the point whenI'd phone in sick, but I think we did a lot of work looking at whatmy body was doing, thinking about, actually would it be helpful tohave some time off before I get to that point rather than waitinguntil, you know, I need to end up in hospital or something, andgiving myself permission to relax every now and then and prioritisemy body and that really helped me.
Helen: There's something thereabout finding a balance, whether it's a work life balance or a funand effort balance, or a, I don't know, resting and doing thingsbalance, but there's something about finding a way of managing youractivity and energy levels and ending up actually being able to domore rather than pushing it beyond what your body could manage andthen having to take enforced rest at a time, which was already kindof too late in terms of the symptoms. So I'm hearing what you wereworking on together was about managing day to day life as well asother pieces of work that was specifically to do with resolvingincidents or traumas that had happened in the past. So you werefitting a lot into therapy sessions. It sounds quite busy.
Lizzie: Yeah, it was, it wasuseful.
Helen: And I wonder, looking backon it, you've already told us that doing that repeatedly going overthe traumatic event was one of the hardest things that you've hadto do. Was there anything else that you found really challengingthat you and Bex agreed on, but you found it reallychallenging?
Lizzie: I think probably whatI've just been talking about, about having time off work, I think Iwas quite resistant to that. I think I was scared to have time offwork and to prioritise my health. At that point I'd just beendiagnosed with POTS, I'd had a long-term absence from work and wasfeeling really guilty about that. Obviously as a teacher there's anadded level because you've got your students who don't necessarilyunderstand why you're not there. I was a secondary school teacher,so I did actually talk to some of them about my health conditions alittle bit just to give them context, but some of particularly theyounger ones, the year seven students really struggled with whereI'd gone and were worried about me. So I think I had a priority inmy mind to be at work and Bex's priority was my wellbeing overall,as well as making sure I had this fulfilled career. And I think Iwas willing to sacrifice my physical health for my career, butdidn't see the big picture of that actually if I do that constantlyI'm not going to be able to do this job anymore anyway, which didend up being the case naturally because of the way my healthprogressed. But that wasn't because of me pushing it. That was justbecause it got to that point. And when I did have to come to thatpoint where I needed to medically retire, the work we had doneended up setting me up for that. And, I'm not saying as well thatmy, you know, the work we did in CBT was it. I've had more CBT, Ihad another round of CBT in the pandemic. Afterwards, I needed tohave some more support because obviously all of this stuff to dowith the pandemic and I was shielded. So I was actually picked asone of the most vulnerable people in society. And that was scaryand brought up all this confusion about, Oh, I'm really ill. Likethey, they actually believe me, the government messaged me, theytold me I'm ill, you know, it scared me. And then I've also had around of EMDR as well, which was focused on childhood trauma aswell, which actually did weave its way into the physical health andalso why I am so driven in terms of what I want to achieve as welland in terms of accepting my health conditions. But I would saythat CBT helped me get to the point where I'm at now, where I'mmedically retired in one way. I still do my content creation work.I still work as a speaker, so I will work a couple of times a monthdoing talks, and I am able to do that in a way where I'm stilldriven to help people, and I'm still driven to get that out thatmessage out to people, but I spend most of my time in bed andthat's okay and I can do a bit of both and if something needs to gobecause my health needs to take priority, then it does.
Helen: I'm really curious to hearabout that, the things that you still put into practice now fromwhat you've learned from the CBT and giving yourself permission torest so that you can do things that you care about, things that youvalue. Can you tell us more about the key things from what you'velearned from CBT that you still use the most?
Lizzie: It's a combination ofthings really, I use things from all of the rounds of CBT I thinkI've had, from the first round I still use some of the mindfulnesstechniques, I struggled to use those when I was really depressed. Ithink I was most depressed during the pandemic. I think thatreally, you know, everybody struggled, I think, during the pandemicbut my depression got really bad and those techniques didn't workso well. But, for example, if I'm in a hospital waiting room, Iwill use those mindfulness techniques to try and just remind myselfI'm safe. It's not that I'm going to be admitted to hospitalimmediately. Sometimes that's like a genuine fear that I thinkthey're going to kidnap me. But I use those mindfulness techniquesstill there.
I think with the second round of CBT, when we didthe narrative therapy, I think that just genuinely changed meinternally in terms of the way I think about those memories, andI've also learned to give myself permission to be kind to myself.And I think that is just something that it was like a switch that,that turned on when we did the sessions. I don't know when ithappened, but that switch is still on most of the time. Sometimesit turns back off again, and sometimes I have to stop. And actuallyeither talk to a friend and they have to talk to me about somethings and I'll then parrot back to them the things that I learnedin CBT or sometimes it's just me quietly thinking to myself andthinking, no, it is okay for me to have time off. It's important toprioritise my body. And I'm not saying I do that all the time. Idefinitely don't. I still struggle with, you know, anxiety. I stillhave suicidal thoughts sometimes it's horrible, but I'm able tocope with those in a way that allows me to function a lot, lotbetter.
Helen: Thank you, Lizzie. And, ifit's okay, I do want to just pick up on that. You said that youstill get suicidal thoughts sometimes. Can you tell us a little bitabout how you make sure that you stay safe when that happens?
Lizzie: For me, I very much don'tactually want to kill myself and I never have. It's never been thatI have suicidal thoughts in that way. It's that I think it's moreto do with the fact that I'm exhausted with the battle going on inmy mind. I'm exhausted with having to fight the negative side of mythoughts that's telling me, you know, you're useless, you're ill,you might as well give up. Those sorts of thoughts come into mymind. And my friends actually nicknamed that voice, Karen. So Iapologise to anybody called Karen. it's one of those things that'spicked up on the internet, but we've just called her Karen and soit's just helps me sometimes to think, Oh no, that's Karenspeaking. It's not me. And so I'll sometimes have those thoughts,but now I'm at the point where I can just disregard them andthey'll come in and I'll go, that's horrible. And then I'll carryon and it'll go away. And sometimes I have darker moments, but itwould never get to the point where I'd actually hurt myself becauseI've got people I can talk to, I've got the techniques I learned inCBT to draw back on. I also have things in my life that I careabout and I want to live for, and I can remind myself of those. Itis difficult having physical health conditions. When you're livingin pain, you're in bed for days on end, months on end. I, you know,I've had periods where I have been in bed for months on end andpeople listening will have had the same and it's horrible but it'sjust about looking at those little tiny things in a day that makethe day worth living still, even if it's just having a nice cup oftea. And I think for me, those are the things that keep me going,but it's not easy and I think that's the thing with CBT and anysort of talking therapy is I don't think it's about completelyeliminating any, you know, any trace of you having mental healthproblems. It's not that. It's about training you to live with themin a different way. And for me, I feel much more safe in my life. Ifeel like I can cope with those thoughts, and I've accepted that isnot a nice part of me but it's something that is natural for mebecause of the pain I live in and because of the difficult thingsI've gone through and I'm not going to act on them, but they just,it's just there.
Helen: Thank you, Lizzie. And Ijust want to come back to Bex about that as well. And just hearwhat Bex is thinking about what you've just said about carrying onliving with difficult days, difficult weeks, difficult months andreally difficult thoughts.
Bex: Yeah, I think you've sharedthe kind of toll it takes to live with the extreme pain andtiredness that come with your conditions and the uncertainty andthe sort of natural kind of phenomena really of living with thoseexperiences and how you kind of navigate those really well now interms of accepting, in terms of acknowledging what you'reexperiencing, but also putting them in perspective and focusing onstuff that's really important to you. And you know, that might besmall things if you're really unwell, but I know from working withyou from both that time and more recently that you do so well atsharing how you're feeling, at reaching out to people that you havea really positive relationship with, that you're actively managingthose things so well when it is difficult and that's reallyfantastic to see. And it's really helpful how open you are aboutthose things for other people who feel like that it's reallyvaluable, thank you, Lizzie.
I guess the other thing I would say that maybe wehaven't mentioned is that I've observed over time as well is theway you interact with medical professionals now. I don't know ifyou want to say something about that, but there's been a realdifference in terms of, I guess, assertiveness or handling thoserelationships really well. So I don't know if that's something youwanted to reflect on.
Lizzie: Yeah, definitely, I feellike it's important to mention that actually, but I also did wantto just say that you mentioned that I've been really good atreaching out and opening up to friends. And I think that is anotherthing that I got from CBT actually, because like I said, I didn'ttell a lot of people that I was close to about what happened in thehospital and I did used to be a lot more closed off when it came totalking about my health conditions and I think I just thought I wasannoying people when I talked about it, and one of the things Ilearned with CBT was that the people who choose to be in my lifecare about me, and that's why they choose to be in my life. And sothey want to help me. And I was reminded that obviously I want todo that for them. So obviously why wouldn't they do that for me?And so that helped me to reach out to people. And it's notnecessarily that I can always reach out. I think that's animportant thing to say as well. A lot of the time, my friends arethe ones that reach out to me when I'm in a difficult position. Ithink that's really important because sometimes when you're in thedarkest sort of places, you're really not able to even see that youneed that help. But I think the important thing is that if somebodyin your life reaches out to you and asks you how you are, you'rehonest with them. And I think that's the thing that changed for meis that I used to just be like, yeah, yeah, fine, carrying on, youknow, stiff upper lip type attitude. And I think it's reallyimportant to be honest and be authentic with the people in yourlife.
The other thing that you mentioned as well wasabout the health professionals. So not my proudest moment, but Idid actually once punch a nurse. Not like, you know, like a properthump, but it was a reflex reaction because I was so anxious inhospital. So she was, I think she was taking my blood or giving mean injection. And I was so anxious that my reflex was to just thumpher on the arm. I felt so guilty because I've never, I'm not likethat at all. I mean, hopefully you both, you've both interactedwith me and you know, I'm not the sort of person to go aroundbeating people up. So she was very professional and she justcarried on completely like unfazed and I was like, I'm so sorry, Ican't believe I just did that. She was like, don't worry, ithappens all the time. I was like, wow, she really shouldn't have todeal with that. But I used to be so anxious around medicalprofessionals. I didn't trust them. With that nurse it was slightlydifferent, but I genuinely didn't trust medical professionals. Istill don't to a certain degree because I've been misdiagnosed alot. I've had lots of conversations with doctors who don't know asmuch about the condition as I do. I've had conversations withdoctors who haven't read my notes. You know, recently I went intoan investigation, it was important that they knew that I wasimmunocompromised, and he was like, Oh, you're not immune. You'renot on any immunosuppressants are you? And I was like, Oh, only thethree that I'm on. Yeah. And you know, that happens a lot. But Ihave learned to be more assertive in those sorts of situations. Andnow I'm able to communicate in a way where I can get across what Ineed to get across without having a huge panic attack. Because whatused to happen is I used to just get completely overwhelmed andthen I had to leave the room, or I just bursts into tears. And itdoes still happen. Even recently I've had a couple of things thathappen where I get really overwhelmed, but it's nowhere near thelevel that it used to be. And now I've got again, another toolkitwhere I know what to do before an appointment. At the start of theappointment, I explain to the medical professional, you know, theseare the mental health conditions I've got, I'm making you awarebecause this might happen. If this does happen, this is what Iwould like you to do and it's usually just a case of I just wantthem to be quiet and let me just process for a couple of minutesand then I'm usually fine. And then after the appointment as well,I've also got some things that I do afterwards to make sure thatI'm as okay as I can be, but it's again, still difficult. It's notlike it's taken it away and it's still something that I will alwaysfind hard and I need support with. So a lot of the time I'll havesomebody come with me to appointments because I've recognised thatis a need for me. And it's something that I can't do by myself, butthat is part of me dealing with it. That's part of me managing it.And I think that's something that I've learned because of doing CBTand doing therapy in general. And it's changed my life. And it'shelped me to get the diagnosis and also the treatments that I need.So it's been really important for my physical health as well.
Helen: Thank you very much,Lizzie. I’m thinking one of the things I would like is for peoplelistening to hear what are the most important things that you wouldlike them to know. And I'm going to go to Bex first. If there arepeople out there who are having similar experiences, whether it'slong-term health conditions, whether it's having panic attacks,whether they've experienced trauma, struggling to manage what'shappening to them? What are the key things that you would wantpeople to know from what we've been talking about today, Bex?
Bex: I guess the key thing I'dwant someone to know that if you're really struggling with thosethings, that matters and that there is support available where wecan work out, you know, maybe some things can't be changed, maybesome things have to be adjusted or two, but the things that arepossible to make different, maybe some ways of responding that cansupport you with what you're experiencing.
With trauma, I guess I'd want people to know thatthere are treatments that work for trauma that can make a vastdifference in terms of re-experiencing and levels of anxietyassociated with that past event. And I'd want people to know thatthey're entitled to that support and it's available for them ifthey want it and if they're ready for it because it might not bethe right time. And that's entirely their decision. And often, youknow with physical health we see quite a lot of physical healthproblems with people who've had chronic stress for a very long timeas well and that there's an interaction there, and that we'reinterested to understand more.
Helen: Thank you. And Lizzie,what would your kind of key messages be, would you say?
Lizzie: I think the biggestmessage I want to get across is that it's not a replacement for thetreatment that you'd get for your physical health conditions. It'ssomething that can complement it and help to make life easier foryou, but it's not about being something that you do instead ofanother treatment. And I think if you ever are in a conversationwith a doctor where they suggesting that, so they're suggestingthey're going to stop investigating and just send you to talkingtherapy, I would say it's important to advocate for yourself andsay, you know, that's fine, but what's the differential diagnosishere and what else can we do to investigate what else might begoing on? Or, you know, I'm happy to try that, but I would alsolike a plan for if this doesn't help me, what can I do after that?I think that's really important. The other thing that I would sayas well is, I would say to somebody, if you are thinking about thepossibility that doing CBT or some sort of talking therapy mighthelp you, the likelihood is it probably will, because I don't thinkpeople would be considering it unless they're in the position wherethey probably would benefit from it.
And the other thing I would say as well is I gotvery lucky with having Bex as my therapist, and I think if you havestarted some sort of therapy or you're going to start and you don'tfeel like you gel or mesh with the person that you are speakingwith, I think it's important to try and see if you can maybe changeto somebody else, or be open with that therapist. You know, withBex, if I hadn't have been open with the fact that I was anxiousabout her saying, you know, about the connection between physicaland mental health, we might never have gelled, you know, that mighthave really stopped the relationship from progressing. I could havejust never turned up to the next session if I hadn't been openabout it. So I think that's the other thing is if you're feelinglike something's not right, be open, and I think the vast majorityof therapists go into the profession because they are genuinelycaring people. I think it naturally attracts those kind of people.So the likelihood is they probably will want to try and help youand if it doesn't feel right after that, then try and find somebodyelse and see if it can find something that fits.
Helen: Thank you so much. I'djust like to say how much I appreciate you both coming to speakwith me today. Bex and Lizzie, I'm really grateful for your input.Thank you very much indeed.
Bex: And thank you so much forhaving us. It's been really lovely to reflect on that, theexperience together, and it was a joy to work with Lizzie.
Lizzie: Thank you so much. Andyeah, I'm so grateful for honestly, having been able to have theexperience and the experiences that I've had. I'm very lucky tohave had the support that I've had. So thank you Bex for that. Andit's great to be able to talk about it and hopefully this mighthelp some of the people as well. So I really hope that if anybody'slistening, who needs some support out there that this helps alittle bit.
Helen: Thank you. So, ourlisteners will find more information on our show page and, I'm justgoing to say one more thank you to you both. Thank you both.
Thanks for listening to another episode and forbeing part of our Let's Talk About CBT community. There are usefullinks related to every podcast in the show notes. If you have anyquestions or suggestions of what you'd like to hear about in futureLet's Talk About CBT podcasts, we'd love to hear from you. Pleaseemail the Let's Talk About CBT team at podcasts@babcp.com, that's podcasts@babcp.com. You can alsofollow us on X and Instagram at BABCP Podcasts. Please rate,review, and subscribe to the podcast by clicking subscribe whereveryou get your podcasts, so that each new episode is automaticallydelivered to your library and do please share the podcast with yourfriends, colleagues, neighbours, and anyone else who might beinterested.
If you've enjoyed listening to this podcast, youmight find our sister podcasts Let's talk about CBT- PracticeMatters and Let's Talk about CBT- Research Matters well worth alisten.