A question about CBT therapy

[Jess123]

Hi, I am seventeen and am suffering from extreme social phobia and selective mutism. Although I am really loud and talkative at home I am basically silent everywhere else, except with really close friends. After spending some time in hospital I am going to see a therapist every Tuesday. The problem is that she always asks me to tell her what I am thinking in those social situations when I am really silent and fearful but the thing is I don't actually know what I am thinking. It is a subconscious thing where I just feel paralysed with fear but I am not actually thinking any specific negative thoughts in that moment. I try to tell her I am thinking negative thoughts about myself but I feel as though I am just making stuff up to please her. I understand that CBT is about changing the thoughts in your head so that the anxiety goes away but what happens if you don't actually know what the thoughts are? Has anyone else experienced this problem and do you have any advice. Are there any other methods of treating SA besides CBT? I would really appreciate your help.

 

[kihira]

"It is a subconscious thing where I just feel paralysed with fear..."

I'm thinking that some relaxation techniques and mindfulness exercises would be good to help you to move away from feeling paralysed with fear in social situations. It may be more useful for the therapist to ask what you're thinking about before you are going to social situations, do you have certain worrying thoughts then?

 

[Earthcircle]

One thing I don't like about CBT is the requirement that one monitor one's thoughts in various situations, or even throughout the day. It seems very unnatural. Thoughts just happen, you shouldn't have to monitor them. Frankly, I'm not aware of any real treatment for social anxiety, although some people might be furious at me for saying this to a seventeen year old. But I've been through a lot of this, having had over a decade of therapy, and really nothing seems to work. Recently, I've been dabbling with acceptance and commitment therapy (ACT), but if I'm ever required to monitor thoughts and feelings throughout the day, then I really can't do that. It's too unnatural. Hopefully, ACT doesn't require that. Actually, I'm getting this from a book: The Mindfulness and Acceptance Workbook for Anxiety. My inclination is just to focus on the parts of the book that are helpful, and ignore anything resembling "Keep a notebook in which you monitor the degree, category, and time of every negative thought or feeling you have." Some things in the book do seem helpful, so maybe it's enough just to focus on that. As I was saying, nothing seems to have worked, but there are some things in ACT which intrigue me and seem promising. The basic idea seems to be that one doesn't fight anxiety, but just lets it happen while making up one's mind to act according to one's values.

 

[Panthagon]

Well first off, don't lie to your therapist! Tell her the truth. If she doesn't believe you, then she's not a good therapist. Personally, I didn't have much success with therapy as, for starters, there were things I had to hide as they are required to tell your parents certain things (at least where I live) as well as they specialized in children, and my CBT therapist pretty much just had little worksheets for 5 year olds. To her credit, she tried to adapt to a teenager, but it just didn't work.
The thing that has honestly helped me the most actually had nothing to do with the mental side of the issue. I went through training in biofeedback to try and relax to relieve pain, which what I learned has sort of helped with, but more than anything it's helped me to be aware of what's going on in my body at different points, and how to change how my body is reacting.
For example, when I am relaxed, my heartbeat and breathing are slow, and certain muscles are relaxed. When I'm anxious, I tense up, and my heartbeat and breathing increase, and depending on what it is, different muscles will tense as well. It sounds kind of simple, typing it out, but if you can learn to make your body replicate how it is when you're relaxed while you're anxious, your mind will (at least a little) follow suit.
One thing a lot of people don't know is that your breathing and your heartbeat are directly related, if you concentrate on slowing your breathing, your heartbeat will slow too.
I'd honestly recommend to everyone, even "normal, healthy" people to go through biofeedback o-o