I'm giving Cognitive Behaviour Therapy (CBT) another go - albeit again I'm becoming disheartened by the process. These so-called professionals really aren't geared to deal with an autistic perspective at all.
The Practitioner specialises in 'anxiety issues', and readily admits he has no idea about autism - saying I'm the 'expert' (god help me). He seems intently focussed on the issue of 'panic attacks', even though I say to him I don't consider myself as ever had one. Yet he focuses on anxiety issues with the attention worthy of an autistic! Okay, I do suffer anxiety with the best of Autistics, but for me (cognitive/sensory) overload is far more of a problem. If anything, as a defense mechanism (or attempt to redistribute internal resources) I tend to go into a catatonic state when suffering from overload (unless persistently exposed, whereby I can reach 'meltdown' and lash out), rather than the hyper-aroused state I would assume is a panic attack.
Part of the problem is that I'm having trouble explaining to him the difference between 'panic attacks' and '(cognitive/sensory) overload'. Indeed, I'm seemingly just not getting across to him just how complex and deafening the autistic mind can be, and how exhaustion results from trying to process the sheer volume of thought, rather than a build up to a panic attack.
Does anyone have a clear-cut and concise way for me to explain the difference between a 'panic attack' and '(cognitive/sensory) overload'?
I just wrote this as a first draft. Does it sound right to anyone?...
Difference between a Panic Attack and Overload
"... Both involve activation of the sympathetic division of the autonomic nervous system – the classic ‘flight or fight’ response – and associated physical manifestations.
However, the cause of the activation of the body’s hyperactivity is notably different.
With ‘panic attacks’ there is a perceived fear (either real or supposed), often with an intense impending sense of doom or dread. These can be accompanied by physical manifestations such as a tight chest or even a feeling of dying. With panic attacks there remains a certain degree of lucidity with regard to thought-strands.
With ‘overload’ the body is not in a state of hyperarousal due to fear, but stress. This is due to either too much sensory input, too strong an emotion or external stressors (bearing in-mind how autistic individuals have a different perceptual and neurointerpretive relationship with the world). For me, this is almost experienced as feeling 'suffocated' by an 'tsunami of stimuli', even to the point of feeling 'burned' by sensory compression. Here, thought processes increasingly become less clear and rational - and even less prominent - whereby for those with autism, continued (sensory-cognitive) ‘overload’ can result in either ‘shutdown’ (akin to a catatonic state), or ‘meltdown’(whereby the usual rational thought processes may be bypassed, and the individual lashes out in a rage or anger) – until neurological homeostasis is regained..."
Don't get me wrong, I know you are going through great stress at the moment, however, I think CBT can be of value because if you look at people who are sufferers (many famous ones indeed) yet have achieved a great deal in life, then there must be a way to use thoughts to take some focus off your difficulties. So, maybe just trying to take a positive and up-beat approach to CBT might allow the therapy to take some effect. Fact is, Evan, no therapy can work if there is no belief in it on the part of the sufferer because it is the sufferer who does the real work in trying to improve the situation. Perhaps you are too depressed and lacking energy to really get the most out of CBT but I do think persistence is important here since, sooner or later, you might get into the swing of it and get some real benefit. It might be, also, that you don't really have the right therapist for you, I don't know, in which case trying to get someone who you 'click' with more could be helpful.
I get your point. Indeed, I'm determined to stick with it as a) I do need intervention, and b) I find CBT much better than the 'touchy feely' counselling previously offered.
That's why I came here. My Therapist is a a nice enough chap, but has extremely little understanding of autism - and is relying on me to guide him in that area. Unfortunately, there are no other Therapists to try, so we're kinda stuck with each other muddling through.
It's why I came here - simply with the intention of trying to get help in communicating how panic attacks aren't overload. He's determined to get me to do stuff around panic attacks (though I've never mentioned them or ever suffered with them), and when I did inarticulately try to explain overload (which affects me far more), he just reworded what I said to bring us back around, saying "so really, it's just another way of saying the same thing as a panic attack."
That just doesn't feel right to me. Or have I got this wrong all this time, and panic attacks are in fact the same thing as sensory-cognitive overload?!?!
My being here isn't about me giving up, but about trying to aid communication and make CBT work.
I think CBT can help part of the issue: becoming aware of the thought processes that put a lot of extra strain on us (because I didn't realise that before - but autistics can get sensory overload not only from external overload, but also from our own thought processes).
Also, I believe that our negative thinking also compromises our energy/resilience. So dealing with the thinking is really important. Learning how to relax our bodies too :-) (mindfulness based-CBT = double whammy).
However in dealing with sensory overload, it is also important to do the detective work, on what it is that causes overload. We need to become more and more in tune with our own responses and work out strategies to avoid total overload (and learn what to do before and when it happens).
I think that is the big difference with regular anxiety treatment in the NT population is that (I might be wrong) NT's learn just to change their thoughts and then the idea is to go out and face the things that make them anxious.
Whereas for autistics it might actually be a good strategy to limit certain things, avoid certain situations and to build in recuperation time - and to build resilience via planning, structure and predictability which can cut stress a lot.
I was curious and was browsing a bit, found some stuff on the topic - don't know how relevant it is. Didn't watch any of them completely ;-) but just posting it in case.
https://www.youtube.com/watch?v=TqCwqaZz9DM (applicability of CBT for ASD -talks about how CBT needs to be adapted for autistics)
https://www.youtube.com/watch?v=JIsw-aLQwgY (youtube film Attwood on CBT for Aspergers -with Italian subtitles) https://www.jkp.com/uk/exploring-depression-and-beating-the-blues-34244.html : I already mentioned this book on another thread, think it is excellent.
And here a really cool series of videos for kids with ASD, explaining CBT. It is a bit slow because it is for kids, but I really think it is good :-) https://www.youtube.com/watch?v=af04iwPN6vI
https://www.youtube.com/watch?v=eHTLoU-7R4E (autism, anxiety & CBT) a therapist talks about CBT with autistics (aimed at kids) Also talks about body awareness and mindfulness -
I think we could talk and talk until we’re blue in the face and some people will never hear us.
My psychiatrist is excellent. He’s really good at spotting autism in order to diagnose but I can tell (which is a wonder for me!) but I can just tell that sometimes, he hasn’t got a clue what it’s sctually like. Which made me realise, how could he? I’m just grateful he’s so good at spotting it. He does help me though regardless of his inability to really stand in our shoes.
For example. I have pathological demand avoidance and he made me realise that I’m not really avoiding things. It’s actually, self preservation. Since he made me realise that, there has been a huge shift in how I treat myself at times when I used to think I was avoiding stuff. Now I know I’m actually looking after myself.
I have a support worker now who told me she knows little about autism, but she’s researched it and because she’s open to learning more and she sees me as a person, not just an autistic person, she has been able to help me.
However, my work coach at the job centre has worked with adults with severe autism and she has a step daughter who’s autistic so the help that she gives me is something else.
I realised, after having a meltdown in front of her, that I have never before been around somebody who actually understands a meltdown and knows how to deal with it. She was amazing and she taught me how to deal with the aftermath.
So although I get help from all 3, there’s a definite difference in the help I get from my work coach who has actual hands on experience of working with people with autism.
The mental health team just kept trying to tell me it was anxiety and depression when I knew it was none of those but I could never get them to see that. Mental health nurses are very prescriptive in their approach. It’s the way they’re trained and I could not get them to see it wasn’t anxiety and yes, they gave that subject the level of attention worthy of any autistic person!
There’s a gap in the market for workers with experience of autism and certainly the mental health teams are not trained in autism. I think we all have a lot to learn.
The only thing I could sugggest would be to contact somebody who works specifically with autism and if funding is an issue, you could get it paid via social services in the form of a direct payment or through a health budget which you don’t contribute to.
There’s an organisation in the uk who charge only a nominal fee and I’m sure there are others but that’s the one I found when I was looking for support specifically for adults with autism.
I see it as part of my job now to inform and educate others about autism. I tell everyone I meet, shop keepers the lot, I can’t not tell everyone I come into contact with but in terms of support, when we need support, we don’t want to be the experts, that doesn’t make sense. Yes of course we know ourselves better than anybody else but we wouldn’t be at the therapists room if we didn’t need some support and guidance.
I think it comes down to the level of freedom you have in the relationship as to how much help the other person can be, regardless if they understand autism or not but the mental health teams don’t offer that level of freedom that’s needed to allow the support to be the right support.
My support worker is from the local authority social services wellbeing team and I’m so grateful to her. I wouldn’t be where I am today without her support and the support from my work coach at the job centre.
When I get back to work, I’ll be specialising in working with people with autism, there’s a real need for it.
Well, it seems to me that Evan isn't getting the level of help he deserves, which is pretty commonplace nowadays, what with the terrible underfunding of the mental health sector in the NHS. Going private would be extremely expensive, of course, and perhaps there would be travelling issues involved too. Having said all that, at least Evan is receiving some form of therapy, which I suppose is better than nothing and I think he needs to persevere in trying to 'get through' to his dodgy therapist because it might be a case of developing a deeper understanding and communication relationship with him (her?). Maybe it's best to look upon the whole thing as a learning experience for both parties involved and, hopefully, things will improve. I think this approach is more positive than focussing too much on the shortcomings of the situation.
The point here, I think, is that CBT is an ongoing process that aims to change one's habitual pattern of negative thoughts that has proved to be unhelpful in the past and, gradually, replace them with more constructive patterns of thinking. This takes time and effort but through determination can be achieved. We have to work with what we have and never give up trying.
What level of support does Evan deserve? Is the support he deserves different from the support he needs? Sorry, that’s a bit confusing to me.
What makes you say ‘going private’ is extremely expensive? Are you talking about private therapists who work with people specifically with autism to support them in their day to day life? I guess as well you would need to specify what ‘extremely expensive’ means as that will be different for everybody as well.
Some form of therapy, however much it may be lacking, may be better than none for some people and you sound very confident that that is the case for Evan. I can only assume you two have been discussing this elsewhere to have known that, which would explain how you know that his therapist is also dodgy. I’m not sure what you mean by that, it’s not clear from what you said but it makes sense if you two have been discussing this in more depth. But out of curiosity, what is a ‘dodgy therapist’? It doesn’t sound very safe to me but I’m not sure what it means so it may not be as scary as what it sounds to me.
I think most traditional therapies are an ongoing process which for me, didn’t result in much understanding or in any solutions, other than short term improvements. CBT sounds like an awful lot of effort though, becoming aware of our negative thought patterns and swapping them out for more constructive patterns of thinking. I’m curious to know how CBT helps a person to the swap the thoughts? Are you saying it teaches what thoughts to think and how to think them? Determination sounds like hard work as well, I can’t quite describe how that words feels to me but it’s kind of like a tight fist, so tight that the fist won’t let go. Does CBT teach you how to get the determination first and then it helps you swap the thoughts?
As well as the other very helpful responses in this thread, I wondered if you might want to show your therapist the page from the NAS 'Too Much Information' programme about sensory overload, since it might help distinguish between overload and a panic/anxiety attack if they are unfamiliar with ASD (since they are indeed very different!). The page is here - http://www.autism.org.uk/get-involved/tmi/stories/sensory.aspx - and is made up of four people with ASD telling their stories of dealing with sensory overload and how it affects them.
Ross - mod
Fabulous Ross, thank you. That will be helpful for me as well. I don’t know why but I never seem to think for myself to go to the information on your site yet by following a link that you or another moderator gave the other day to someone regarding eating, I finally (after 50 years) understand my problems with eating and I’m now trying a new solution. I’ll check out the links. Thank you.
lostmyway said:Having said all that, at least Evan is receiving some form of therapy, which I suppose is better than nothing
That's my thinking, insomuch that this CBT doesn't seem to be what I really need, but it's gotta be better than nothing right?
The Therapist is a nice enough chap, and seems well-intentioned. I just find he (quite naturally) has no idea as to what living with autism is like, and he's got this existing neurotypical CBT model that he's desperately trying to fit me in to, as he has no other template to offer.
He told me to "keep it simple" when he asked me to identify the little marks on the top of the kidneys, and I went off about the adrenal medulla and adrenal cortex, and the sympathetic division of the autonomic nervous system etc. I now wonder whose benefit that was for. Likewise, I had to bit my tongue when he was talking about the 'fight or flight' response and said, "of course we can't fly, but we have to use that word as nothing else rhymes with fight." Bless him.
Ultimately, I just can't afford to pay for private therapy, period. So, I have little choice than to try and educate my existing Therapist, and hopefully try to communicate my perception of the world.
Ross-Mod: thanks for the link, as it may be useful. It's a shame, as my Therapist has given me 'homework' to do on panic attacks, despite my insistence that I don't suffer panic attacks. Rather, a major problem is actually sensory overload and shutdowns. Unfortunately, I suspect the poor ol' Therapist may just be to busy to do any homework I assign to him!
Which leads me back to topic - can anyone think of the clearest and most concise way to explain the difference between a 'panic attack' and 'sensory overload'? I don't think handing him a load of links or reading material is going to be a realistic option...