CBT Blog

[Liberty]

Hello everyone. I just started CBT after working briefly with two more traditional therapists with not much to show for it. This guy seems very well qualified. He's got a PhD, specializes in anxieties, fears & phobias, is a CBT therapist, has 15 years experience and is by far the most expensive therapist I've seen. And he claims to have an 80-85% success rate for people with anxiety and that their recovery level is about 80-85%.

So, I was thinking that the information I receive from my time with this therapist may be of some benefit to everyone else suffering from Social Anxiety.

The way I will do this is to list a session and convey as much of the information as I can remember and/or the basic goal or technique for that session.

1st Session

This session was a basic get to know each other introduction. He explained what he does and I gave my history of how long I've had Social Anxiety and what sort of effect it has had on my life.

He explained that most of his patients see him 8-10 times, once a week, before they are improved enough to see him more infrequently.

He described anxiety as sort of a living entity within your brain that seeks to destroy you and control your life. It learns about you and attacks you.

He described the CBT process and how it differs from traditional therapy in that there will be homework assignments after each session which may seem unusual but they are necessary.

That's pretty much all I can remember about this session for now. I may edit later.

 

[Liberty]

2nd Session

This session was more interesting. The aim of the session was to teach me about the history of scientific study of anxiety (disorders) and the different methods by which psychologists/scientists have sought to treat it.

He drew a graph that looked basically like a breaking wave on a seashore. The line underneath the wave was a timeline in minutes. The line going up in front of the wave was the severity level of the anxiety. The timeline starts with the first point on the graph, The Trigger. The Trigger for me, and I assume everyone else reading this, is people. The second point is the height of anxiety, a 10 on the graph, which is reached instantly when the sufferer of anxiety is introduced to the trigger. The third point of interest on the graph is all of the behavior people adopt to deal with the anxiety and to lessen its intensity. For me at least this behavior is almost all automatic and I don't think about it consciously. I will elaborate on this later.

Ok, now on to the different methods that were tried to deal with anxiety. The first method was simply to avoid the trigger. To avoid the cause of the anxiety. This method was prescribed for a while by medical professionals until it was realized that the anxiety (still thinking of it as a living entity/antagonist within your brain) is capable of changing or altering the triggers. At first this did not make sense to me because if the anxiety changed the trigger to watermelon or something like that I wouldn't care at all. But then I remembered that initially for me the only trigger was a single person. Now the trigger is all people. So the formula fits I suppose.

The second method was to treat the anxiety itself. This was done through the use of all sorts of relaxation techniques such as mediation, yoga, breathing exercises and so on. This method was believed in for a while until it was discovered that it was not valid. It does not work because you could be extremely relaxed but when subjected to the trigger your anxiety goes straight to 10 in a few milliseconds. This is not enough time to utilize a relaxation technique. And once you are at a 10 it is too late.

The final treatment method currently in use today and the method that is apparently very useful successful is as follows. The real problem with anxiety disorders are the actions you take to lessen the anxiety. At first this may sound strange but the following analogy should help. Say you have a child and you go to a store where there is candy. The child wants candy but you refuse, this is the trigger for the child. The child throws a temper-tantrum, which is the anxiety. If you endure the temper-tantrum without giving into it or rewarding it with candy you have won. If you give in to the temper-tantrum and allow it to change your behavior (give the child candy) it will increase it's hold on you. The next time the child may decide to use a temper-tantrum to gain something larger.

I hope that analogy makes sense. I feel like I have a good grasp on it so if you have questions please let me know. Anyway, once you are exposed to the trigger and you feel the anxiety if you allow it to alter your behavior in any way you are on the path to ever-increasing anxiety attacks and panic attacks. Any behavior you alter feeds it, or rewards it. Basically, if you allow it to affect you at all it makes it worse. You must act as if it does not even exist and fight it.

Now to elaborate on the different types of behavior you (and I) may exhibit as a result of the anxiety. For me most of my behaviors are entirely automatic and subconscious at this point. I don't really control them at a conscious level and this is what exasperates the problem overall. Some of these behaviors include keep my eyeline very low at all times in order to avoid making eye contact with anyone or inviting conversation. Or using an unusually low-key and meek/timid voice in order to avoid attention from others. Or sitting in a very laid back position with very slumped posture. I wear a hat or sunglasses when going through a drive-thru to hide my face and lessen the chance of making eye contact.

All of these things I do without thinking about it so it was very hard for me to identify them at first without the therapist's help. The other side of this behavior is avoiding things you would not otherwise avoid. And I'm sure we can all relate to this. I avoid eating in public places, going through a cash register with a person at it, avoid all social activities, avoid public gatherings if I can help it and so on.

All of these behaviors reward the anxiety and make it stronger. He also added that when attacked by the anxiety if you avoid giving into it and fight it the severity will always start to lessen after about 7-10 minutes. And go away entirely after about 45 minutes.

Ok, well that's about it for this session.

 

[paydo]

but how to fight it,i try fighting it sometimes and then it becomes even worse

 

[Liberty]

but how to fight it,i try fighting it sometimes and then it becomes even worse

I'm sure that will be revealed in a later session. I've been trying to use the information I've gained so far to my benefit and I've been working on trying to conciously change these behaviors back to a more normal behavior but it has been difficult.

 

[orange_balloon]

This is wonderful! I want to begin CBT soon, and this gives me a good feel of what it is like! I look forward to future updates, and I wish you luck in your therapy!

 

[chained]

please do continue informing us

 

[Liberty]

Thanks for the encouragement. I was wondering if this thread was useful or not.

Session 3

The homework for session 2 was to write down the behaviors you change in order to deal with the anxiety. In session 3 we examined the different behaviors such as avoiding eating in public places and keeping your eye-level very low and assigned each of them a rating from 1-10. Performing the opposite behavior for a 1 was the least anxiety-inducing and for a 10 the most anxiety-inducing. A 1 for me was sitting completely upright in a chair at work or while driving and standing completely upright while walking in front of others. A 10 was eating in a public place.

Once we had assigned each of the behaviors a rating we agreed on three different ones that I was to practice during the week. They were to be the easier ones and I was to do them as much as possible each day. This is supposed to teach the anxiety that you will not be bullied and allow it to change your behavior. This is you fighting back.

So that was the homework for this session. If the three selected behaviors were either too easy or too difficult I was to contact him during the week so we can select different ones. Otherwise the week would be wasted.

Also, the goal of practicing these behaviors is actually to ellicit the anxiety and then to fight it. You will feel anxious but that is ok. That is the goal.

 

[Liberty]

Sessions 4-7

Hello all, I am back. Sessions 4-7 mainly consisted of me talking a lot about many discouraging events I was experiencing with my efforts to perform my homework assignments. My therapists reaction was to offer some encouraging and clever ideas and thoughts to help counteract that discouragement.

Some of the useful ones are as follows and can be used to fight discouragement:

-You must begin at the 0 yard line in your journey to get better and begin making progress toward the 100 yard line. Being 40% better is good, it is the anxiety that will tell you that you are failing for not being at the finish line. This has been a very useful thought

-Tell myself that no one is looking at me or has a reason to be looking at me and try to focus on the purpose of my presence around these people

-People will respond to me in ways that I find unusual or unnatural simply due to my own anxiety. Just feeling anxiety is ok at this point, and just the fact that I feel anxiety alone can make my encounters will people awkward. It does not qualify as evidence that something is wrong with me, aka the source of my anxiety which is the fear of dissaproval which causes a hyper-sensitivity and irrational conclusion that many unrelated behaviors by people I encounter are evidence that they disapprove of me.

Basically CBT so far has consisted of my therapist changing my thought patterns and the way I view things. I say things how I perceive them in my discouraged and hopeless way and he changes it. CBT offers you a quiver of arrows (thoughts) with which to combat the anxiety and to defeat it and make it powerless. Some of them the therapist will give you directly and some of them you will come up with on your own just by continually fighting to keep your thought patterns positive and focused on fighting the anxiety at every turn, even through great discouragement.

And also I am happy to report that I have had some significant success so far. I'd say I'm standing on the 40 or 50 yard line, maybe more, and I'm advancing steadily as I take on tougher and tougher challenges. I've actually had a few non-awkward encounters with strangers at my job recently which has been extremely encouraging and given me a lot of confidence.

One of the worst things is dealing with people who you have trained to treat you a certain way. We all train people how to treat us and the way I trained people I see regularly to treat me when I was on the 0 yard line has been very difficult to deal with and reshape when I am standing on the 40 yard line.

 

[Scrabbl]

Keep up with the updates!

 

[Liberty]

Sessions 8-9

These two sessions were a little different than the rest. Since I've made it to a point where I feel more comfortable in situations where I did not previously we focused on what new homework assignments I should tackle next. And also how to positively look at different discouraging situations or various other things.

In the beginning I was doing things like standing up straight and sitting up straight. Level 1 difficulty. Even still I had some very high anxiety while trying to sit up straight in a meeting or gathering at work. Now these things are boring or unproductive to continue at this point. I've been working on some more advanced ones like eating out for lunch with co-workers and saying, "How's it going" to clerks in Blockbuster or convenience stores. That is my favorite one right now as I can do it every time and with no difficulty or anxiety. According to the therapist, each homework completion is an attack against the anxiety. The more you attack it the faster it falls. So with that in mind I try to say "How's it going" to as many clerks as possible.

At first it was anxiety-inducing and I couldn't even do it out of the nervous anticipation but now I just go there purposefully to complete a homework assignment with the hopes that the more I complete the faster the anxiety will go away.

I have eaten lunch out several times as well and have not experienced much problem either. I have been concerned each time that there is a chance I will slip back into a more anxious state and wish not to have gone at all or worse to regress completely back to the 0 yard line, so to speak, but that has not happened yet. Also, the therapist says that it is the anxiety searching for new ways to attack me and to win the battle. It will also try to say, "Oh, but what if it happens" and drag you back in that way. You must fight this thought as well. So I do.

Another thing the therapist described was that if you win enough battles in the lower-level homework assignments that eventually you will topple the anxiety or deal a severe blow, so to speak. After this you will experience a general relief in all areas even outside of the ones you have been practicing with the homework assignments. I believe I have reached this level, although I fear regressing. I should probably be fighting that thought though.

Even if I do regress and experience a completely paralyzing anxiousness, I have still up until this point fought through every discouraging encounter and incident that has happened so it would just be one more. And I have my army of thoughts ready to be beckoned to fight. I've developed a counter for almost everything so far. So there's no reason I can't fight back through it just with the knowledge and training I've acquired. This is the core of CBT. To teach you to be your own therapist.

There are still things I cannot approach yet although I'm confident I could do much better now than in the past. At the moment I'm just focusing on moving forward toward the finish line and completing as many "clerk greeting" homeworks as I can since that's easy and quick and painless and I think it is really helping. I've been trying to go to lunch as well with some people I am more comfortable around but have not done it as much as I should.

The next homeworks would be:

-More work lunches
-Meetings
-Pure Social situation
-Public speaking

Really that's all that's left I think.

One other good piece of information is the relation between avoidance behaviors, anxiety, and thoughts. As you change your behaviors and confront the anxiety, the anxiety will begin to fall. As the anxiety begins to fall the negative thoughts or the belief about yourself that you are defective or dissaproved of will fade as well. So it goes behaviors, then anxiety, then thoughts as far as recovery.

 

[apollo]

Thanks for your posts, I find it pretty interesting. I might try a few things as well.

 

[emmaandrew]

Dear Liberty,

I really appreciate your efforts to share the information, please continue the same, and let us know the benefits you have got so far.

Thanks
Emma

 

[Liberty]

Final Sessions

Well, I have pretty much completed my therapy. That's not to say that I'm cured by any means but instead I have the tools and knowledge to live with it and control fear and anxiety.

My therapist says that it is up to me if I want to continue or see him less frequently but it seemed he was pretty much encouraging me to end it.

Overall at the end of it I am left with the training to do two primary things:

-Avoid negative thinking patterns
-Suppress fear by constantly doing the opposite of what the anxiety is telling me to do

I have progressed to the point now where any time I sense anxiety pulling me in one direction I immediately proceed in the opposite direction. This is the culmination of my therapy. If I am walking towards my car and I see a group of people instead of indulging the anxiety by avoiding them and moving away from them I move directly towards them. In the past this would have made me self-conscious and nervous but now I rarely, if ever, feel that way. Continual fighting against the anxiety's desires and instead doing the opposite slowly brings confidence and calmness.

If I need to go walk around my building and talk to people instead of avoiding or procrastinating I immediately just do it. This has become a lot easier. I do this in many other ways as well.

I still have progress to make. Things like work lunches, social gatherings, and public speaking are the next step and I haven't quite gotten to this point yet just out of non-anxiety related circumstances. I've been out to lunch with co-workers plenty of times just to grab something to go but not more than a couple sit-down meals. I'm not at the point where I'd walk right into a public speaking engagement just to do the opposite of the anxiety's desires though.

I still feel a bit awkward interacting with strangers but I am hoping this will slowly correct itself over time. My therapist was a specialist in CBT and controlling/conquering fears and phobias. Not necessarily a Social Phobia expert if there is such a thing. So I'm not sure he could address the SP related minutia. It's hard to describe but I feel like my interactions are still a bit unnatural and not completely relaxed. But again I'm hoping this will change over time.

Overall though the final verdict is that I've seen a huge improvement. I haven't used drugs or anything but the exercises and activities in order to progress as well which is what I wanted. SP seems like much less of a big deal and not a huge part of my life anymore. I still have setbacks but with my more positive outlook I've trained myself to have I can get by them more easily.

If anyone has any questions I will be happy to answer.

 

[sevenroses]

I like this thread hehe

 

[fudgy]

liberty this is a fab idea and very kind of you to share your sessions .

 

[chained]

ty Liberyt, I've began avoiding my negative thoughts for about a day and a half (feels like eternity, and even tho it is very hard, I kn ow it's the only way out.. ).

good luck to u