Overcoming Guilt With CBT

After a few weeks of CBT and homework exercises I’ve figured out a very clear pattern. Many times when I am feeling very down and guilty, my automatic negative thoughts have something to do with my daughter having a problem as a consequence of me being an incompetent mother. With the help of my therapist, I am starting to realize that my current struggles with being a mother and having postpartum depression really originate from my lifelong feelings of inadequacy. The main difference is that being incompetent was never as important as it is now. Whenever my self-esteem was very low in the past I could easily shake it off by calling friends and having fun with them. Getting distracted worked. My problems with self-esteem never had much to do with my looks or with what my friends thought of me. Every time I felt down it was because I thought I was not being successful, capable or smart enough. Now that I have an inescapable responsibility for the care of a baby 24/7, my incompetence could have terrible consequences for her wellbeing.

I’ve learned to identify certain convictions that I’ll have to overcome to stop feeling guilty and get out of this hole. Some of them are: I believe that making mistakes is unacceptable. I see my mistakes and I conclude I am useless. Any average woman is capable of taking care of her children, so my mistakes when taking care of my only baby daughter are not acceptable. Being a terrible mother not only shows that I am inadequate, but it also has dangerous consequences to a defenseless child. Emma goes hungry because of me. She is not gaining enough weight and I am to blame. My sadness is going to have a negative impact in her own mental health. If my husband gets tired of me she’ll grow up in an unstable family.

I realize now that my own assessment of my performance and failures is not completely rational. I can’t just go on feeling guilty. I need to start questioning the judgement I pass on my actions.

The internal negative feedback might have helped me get stuff done before, but now it’s mainly destructive. Telling myself I was an idiot after a bad grade might have helped me study harder for the next test. But telling myself I did something wrong every time my daughter cries is not getting me anywhere.

I’m glad I’ve found a way to overcome the guilt, but it’s not easy. Every time Emma starts crying I need to catch myself when I start thinking I’ve done something wrong. I need to constantly check my automatic negative thoughts and question the ones that are making me feel sad and guilty. I still have these negative thoughts many times a day, but I no longer allow them to dwell in my mind all day and drag me to the deep hole of depression. Now I’m more aware and I feel more empowered to challenge any destructive way of thinking and get my life back.

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Catastrophic Thinking and Postpartum Depression – Thought Challenge

I am so used to thinking the worst, that when my therapist suggested I tried doing a Thought Challenge exercise, to help me have more balanced thinking, I thought I would never be able to do that. Going through the steps of the Thought Challenge exercise made all the difference.
I’ve always had a tendency to think about worst case scenarios, but before giving birth to Emma I could let the catastrophic thinking go. I realize now that before having postpartum depression I was coming up with more balanced thoughts to replace my negative thoughts without even being aware I was doing it. I remember thinking things like “What if my baby is born dead?”, but I was able to push that thought out of my mind immediately. I wouldn’t even start feeling the despair and some healthier part of my mind would come to the rescue saying something like “that is extremely unlikely and I have no need to think about it”.
I am not sure what happened to my hormones or my perception of life and myself, but since Emma was born I am no longer able to keep my catastrophic thinking under control. Now I start thinking that Emma is not gaining weight because she has an undiagnosed congenital defect or because I am a completely incompetent mother, and there’s no stopping me. By the time I realize how negative my thinking is I am already feeling so depressed and in despair that I can’t get out of the hole.
Doing Thought Challenge exercises has helped me practice healthier coping skills. Here’s how I challenged the catastrophic idea that Emma was dying.
I started by describing all the reasons I had to believe she was dying:

  • Maybe she’s not gaining enough weight because she has a serious illness.
  • She looks so fragile.
  • If I am not able to feed her better she will get sick.

Then I wrote down the evidence against my automatic catastrophic thinking:

  • The Dr. said that it is common for newborns to  lose some weight on the first few days of life.
  • The Dr. didn’t seem worried and said she was doing fine otherwise.
  • Even if she was sick, she would most likely be treated successfully.

And then I came up with a more balanced thought:
“Emma’s lack of weight gain is concerning, but she is extremely unlikely to die from it”

Here’s a picture of this CBT activity:

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Worried About My Baby – Is She Sick?

I’m devastated. I took Emma to her first pediatrician appointment yesterday and it didn’t go well.

Even before seeing the doctor I was quite anxious about how the visit would go. I pictured all sorts of negative scenarios in my mind. I caught my self twice several minutes into a catastrophic story going on in my mind. One started with the doctor telling me about Emma’s congenital disease, then I saw my self telling my mother how she was not supposed to make it, both of us crying. I was at the point of seeing myself in the funeral wondering if I would ever have the courage to have another child when I realized the whole thing was only in my and Emma was alive and smiling right beside me. Then I started imagining the doctor accusing me of harming Emma, finding bruises all over her, calling the cops. I was trying to decide how I would spend the time in jail when the nurse called for us.

First the nurse grabbed Emma and put her on a scale, then she tried to measure her length, but Emma kept moving. Then the pediatrician came in. Doctor Marcus. She was a tall woman with long graying her on a pony tail. Not very sweet, I thought. Very matter of fact. She handled Emma with care, but no tenderness, like if she was a delicate specimen in the lab.

“She’s underweight” – Dr. Marcus said. “She’s lost weight since she left the hospital”.

My heart sunk. I never felt such heaviness inside my chest. What have I done? I thought. I thought she was going to start accusing me of being an incompetent mother, of neglecting my child on purpose. I could see her saying she would need to report this to some child protection agency. And poor Emma, so defenseless. What has she done to deserve a clueless mother like me?

I’m able to write about this now that I’m feeling a little calmer. Doing the Stress Log exercise I am attaching as a picture has helped me become aware of all these negative thoughts in my head. If I think I am such an incompetent mother that my child’s life is in danger, then how could I not feel terrible. Knowing that the deep negative emotions I’ve been feeling are not a direct consequence of my current situation, but a product of the way I interpret the situation, gives me some relief. This is just one of the ways how CBT helps depression.

I know I’ll feel even better after challenging these negative thoughts, but we’ll deal with that in my next blog. For now, here’s my latest Stress Log:

Is my baby sick – Stress Log exercise

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Postpartum Depression Negative Thoughts Challenge

All my plans and ambitions are now out of reach.

Having a baby is supposed to be the best thing that ever happened to me. But knowing that my husband, family – and society at large for that matter – expect me to be happy makes me feel even more overwhelmed.

Am I supposed to completely forget about all that I wanted to do in life in order to take care of a baby?

How am I supposed to raise Emma knowing that all her plans will be shattered when she has a baby of her own? Well, I am determined to tell her from the very beginning that she has to do with her life as she pleases and only have babies if she really wants to. But how is she going to take that? Will she think I don’t love her? Here I go again, the worst mother in the world.

It’s good that I now catch myself when I’m thinking so negatively, and that I’m able to stop. Just stop thinking for a while, take a deep breath and try to think about this in a more rational manner

Are all my plans out of reach? This might be a good thought to challenge. It does make a lot of sense that I have no motivation now if all things that motivated me before feel  unattainable.

I’ve learned that extreme words, like “all” can be tricky. So one thing to challenge could be whether it is really “all” my plans that are out of reach, or only “most” of them, or maybe even only “some”.

“Out of reach” is also quite a black or white way to put things. I might be better off thinking how much harder it will be to get there. Maybe I won’t be able to do all of them.

Here’s a picture of the Thought Challenge exercise that helped me cope with this better:

Postpartum Depression Thought Challenge

Postpartum Depression Thought Challenge
I no longer have a life

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I No Longer Have a Life

What a night I had last night! I don’t know if I slept at all. It seems like every time I was starting to doze off Emma woke up crying. Taking care of her is consuming all my energy. I no longer have time for anything else.

I felt very depressed last night. I remembered what my cognitive therapist said about negative thoughts causing negative emotions so I tried to be aware of all my negative thinking. I paid attention not only to the most obvious phrases in the very front of my mind, but I also noticed the running commentary in the back of my mind. I was thinking things like   “What a big mistake”. The additional thinking that came together with these more overt thoughts was something like: “I am an awful person for thinking having a baby was a mistake”, “Thinking this was a mistake is like wishing her dead”, “I am a terrible mother.”

Here’s a picture of my Stress Log Exercise were I rated my emotions and described some more automatic negative thoughts:

Stress Log Postpartum Depression Image

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My First Thought Challenge

With the help of my therapist and after doing my first Stress Log exercise I learnt to distinguish feelings from negative thoughts.
Now I realize that all the negative things I was thinking about had a very deep impact on how depressed I felt right after Emma was born.
My deep feeling of guilt had a lot to do with me thinking “I must be a very bad person not to be happy to have a daughter”. It is quite obvious that feeling guilty doesn’t come out of nowhere. It is not so obvious, though, that feeling guilty is not a direct consequence of the situation. Saying something like “this situation is very upsetting” would have made total sense to me before. Now I understand that there is a very important step between what happens and how I feel: my thinking.
So when Emma was just born I felt very guilty because instead of feeling happy I found myself crying. “I must be a terrible person: I said to myself. If I believe I am a terrible person, well, no wonder I felt really sad and guilty.
My therapist says that any negative thought that causes such negative emotions is worth challenging.
In order to challenge the negative thoughts I identify in my Stress Log exercises, I use another tool called Thought Challenge. Here is a picture of my first Thought Challenge exercise:

Mia Thought Challenge Example 1 Postpartum Depression

 

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CBT exercise dealing with my shocking reaction to Emma’s birth

I’ve written before about how sad and overwhelmed I felt when Emma was born.

Here I am sharing a CBT exercise where I’ve written about this stressful moment.

My therapist told me that the idea is to clearly separate three aspects of the stressful moment: a description of the situation, a reports of what my emotions where with their intensity, and a description of what I was thinking at the time with my level of certainty of what I was thinking.

Here’s a picture of this Stress Log:

When I was holding Emma in the hospital I felt overwhelmed, sad and guilty. I felt like I was  a terrible mother. My therapist has explained to me that it is not very helpful to say “I feel like a terrible mother”. I understand now that being a terrible mother is not really a feeling, but a thought, or an idea that might very well be true. But it also might not be true. And if I am not a terrible mother I better stop thinking I am one because it really makes me feel bad.

You can practice online CBT exercises like this at MindQuire

Baby Blues

I’d heard of baby blues before, but I really didn’t see this coming.

I don’t know how long it lasted, but it felt like eternity. They put Emma in my arms for the first time after the delivery and I immediately felt my arms go numb and a choking tightness in my chest. I felt the deepest sadness I ever remember feeling, like if instead of somebody being born, somebody had just died.

I couldn’t stop crying, sobbing. I guess for the first few minutes my husband and the nurse didn’t think much of it, but it got to the point where the nurse grabbed Emma back and stared at me with a terrible questioning face, like “who is this evil woman?”

The sadness remained, but guilt took over. How could I be such an awful person to be saddened and not delighted by the birth of my first child?

I couldn’t stop thinking about how unprepared I was, how there was no way I would be able to take care of her. I pictured myself running around the house with a sick, starving and dirty baby, not knowing what to do.

I imagined myself older, not having done anything else with my life, but take poor care of a baby.

I finally fell asleep.

The happiest day of my life!

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