Severe anxiety.

[Vi37]

Hi, I have very severe anxiety mostly about health, my health and my 1 and a half year old son. My major MAJOR fear is cancer. My current fear now is that about five years ago I bought some Tefal pans from groupon. They’re scratched and I’ve still been using them for at least a couple of years. Now I’m in a massive panic because I think that chemicals have been leaching into our food and I’ve given my family cancer when I should have thrown them out. I’m so angry with myself for not throwing them away. I’m sat in tears, I’ve had to take diazepam.

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Right. Ok.
It sounds to me like you've had 2 courses of CBT-based guided self help from a Psychological Well-being Practitioner.

The NHS runs a stepped care model. It varies slightly, but in general:

Step 1 - GP
Step 2 - low-intensity talking therapies
Step 3 - high intensity therapy, care from high intensity practitioners/psychologists etc
Step 4 - hospital

Sometimes in the NHS, unfortunately, patients have to advocate quite hard for themselves to get appropriate care. I would very strongly recommend that you go back to your GP, explain that you have completed two Step 2 courses now and you would like to be referred for Step 3 care - you want high intensity CBT from an appropriately-qualified CBT therapist, not a PWP.

Good luck.

I'd definitely give CBT another try OP. I used to have so many irrational fears that would spiral. It definitely helps if you gind a therapist or counselor you can get on with and it took me a few tries. I still use some of the diagrams to sort out my thoughts.
Sounds like you're having a tough time. Hope you feel better soon.

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Thank you everyone, puremagic I’ve never really tried exercise I run round after my son and I’m knackered, I suppose that doesn’t count! Never actually set out to do it for myself. Tableclothing thank you for all that info that’s so helpful, I’ve referred myself online earlier today and it says they'll give me a call back to assess me, could I ask then or would I need to go back to my gp?
Mamasaurus I think that’s partly why it hadn’t worked before, I do understand the concept but I just didn’t get on with the therapists, I don’t know if I could work with a female better,my community mental health nurse was female and she really helped me but she could only help for so long until my son was a certain age, I’m sure it’s not something I could request really, I think with the strain in the NHS I have to get what I’m given.

could I ask then or would I need to go back to my gp?

Exactly how things work tend to vary between NHS trusts and I don't know the Leeds area well, so can't offer much fine-detail advice. I suspect a referral to Step 3 might need to come from your GP, but don't be scared to ask questions of NHS staff. If you speak to IAPT today, find out from them what exactly they can offer you. If it is yet another low-intensity intervention (if you're not sure, ask them) then definitely point out that you have completed 2x LI courses and the problem is persisting, how do they suggest you access high-intensity therapy?

I’m sure it’s not something I could request really, I think with the strain in the NHS I have to get what I’m given.

I don't know where to start I work in MH in the NHS and have recently had to seek MH support myself, although not in the same geographical or expertise area. It's been an eye-opener. I've found myself having to advocate quite hard for myself to get appropriate care. If I didn't have some "insider knowledge" of both the NHS and mental health I wouldn't have been able to access the support I have. At times, it has felt like going for a job interview, with me persuading GPs and consultants why I needed to be referred on. But if I didn't have the background I do, I wouldn't have known what to say or what to ask for. I dread to think how many other people are unable to ask for the care they need, because they either don't know what there is or how to persuade referrers it would be appropriate. Anyway.

Within the stepped-care model, you get referred to the lowest-intensity step that can be considered appropriate (less intrusive care, easier for patient to manage, cheaper). However, you've been on step 2 twice already and it hasn't worked. It sounds like you attended all the sessions and did everything asked of you. It's time to get you up to step 3. The experience you describe having - where you didn't understand what the therapist was on about - is a reflection on the therapist, not on you. It was his responsibility to make sure that you understood and to try a different way if the first one didn't work.

So. When you talk to IAPT, find out as much as possible from them about what other services are available: "So, I've had two courses with you so far of CBT-based guided self help which hasn't been successful - what are the Step 3 services called please?". "It's high-intensity work that I'm interested, does your service offer that or do I need to speak to someone else? Do I get my GP to refer me?" "If you don't know, is there anyone there who could tell me?" Etc. Please please please don't be scared to ask questions. Asking questions is not rude.

Is your diazepam prescribed by your GP, btw?

When you're trying to get referred up, there's 2 main strands of information you need to get across:

1. how the problem is affecting you
2. what you have already tried

Sometimes in GP appointments time is so scarce that GPs will ask the absolute bare minimum they feel they can make a decision on. When this happens, you need to speak up for yourself a bit.

For 1), that would include stuff about, say, physical symptoms of anxiety on you, but also how it affects your daily functioning. Does it affect you as a mother? If taking your DC to soft play is too stressful, mention that. What about your partner, is the stress of your anxiety affecting your relationship? if it makes it difficult for you to work, mention that. If it puts you off socialising, mention that. If you are spending hours each day cleaning and your hands are sore from the chemicals, mention that. If it is affecting your mood and you are starting to feel hopeless, mention that. If you are having trouble sleeping or eating properly, etc etc
2) Also mention the things you have tried already. If you have cut out alcohol and caffeine, got yourself a weighted blanket, tried magnesium/B12/iron/whatever supplements, taken up regular exercise, used mindfulness apps, changed jobs, meditated, attended two full courses from IAPT, etc etc etc, then say so. Otherwise the GP will suggest all this stuff. Don't be scared to ask straight out, "can you refer me to a psychologist or a psychiatrist please? I've tried everything else and this is still ruining my life."

A bit of a side point: research into different psychological therapies has found one thing consistently. The quality of the relationship between client and therapist is the single most important factor in whether the therapy is successful. It's really important you click with your therapist. It is absolutely fine to ask to change therapist, and it is also fine to request a female therapist if you want one. Your therapist should be someone who you can say "Sorry, I just don't get that at all" to, without feeling any stress about it.

To sum up - please don't think you necessarily have to get what you're given. Sometimes you have to ask, or even argue, for what you need.

Oh thank you so so much. This is so incredibly helpful, I am scared of asking for things etc because I am incredibly thankful that we have the NHS and don’t want to demand things but it’s got to a point now where I desperately need help because it’s gone on too long. Every time I’ve been to the docs she just looks at the list of medication I’ve been on and asked when I had counselling and that’s it, the counsellor I spoke to over the phone in April never bothered to phone me back and my dr had to phone and phone him to get a response and then all I got was the letter through the post telling me to self refer. It’s as if they’re saying we can’t be bothered now ‘do it yourself’ I have to await the phone call from the IAPT service but I’m going to write notes from this as to what I need to say. Yes the diazepam was prescribed from my gp a while ago but is still in date so I’ve kept it. I’ve only taken two of the tablets so far this year, knowing I’m not getting any help from anywhere else I felt like I had to keep them in case I was in a state at any point so I could help myself. I honestly can’t thank you enough for this information. Hopefully it will get me sorted. Thank you so so much Tableclothing.

Op it needs to be exercise that gets you breathless to talk. A good walk at a pace or incline to make you a bit breathless if trying to speak is perfect if you are able to. It reduces the cortisol the anxiety is creating.

Thank you, I think I’ll give that a go too, I will throw everything at it this time I need to get rid of this.